Exam 2 stuff

Question 1

Capillary (Plasma) hydrostatic pressure

Answer 1

• pressure inside vessel pushing fluid out

Question 2

Interstitial fluid hydrostatic pressure

Answer 2

• pressure outside vessel pushing fluid in

Question 3

Plasma colloid osmotic pressure

Answer 3

• pressure from proteins inside of vessel drawing fluid in

Question 4

Interstitial fluid colloid osmotic pressure

Answer 4

• pressure from proteins outside of vessel drawing fluid out.

Question 5

Primary v secondary lymphedema

Answer 5

primary = developmental abnormality

secondary = acquired disorder of lymphatics

Question 6

What is the most common cause of lymphedema worldwide?

Answer 6

lymphatic filariasis

caused by mosquitos. parasitic infection

Question 7

most common cause of lymphedema in US?

Answer 7

procedures used for dx and treatment of cancer

Question 8

Lymphedema: stage 0

Answer 8

latent lymphedema

- lymph transport impaired. no clinical evidence of swelling

Question 9

Lymphedema: stage 1

Answer 9

• reversible
• has pitting edema
  min to no fibrosis or tissue change

Question 10

Lymphedema: stage 2

Answer 10

• not reversible
• non-pitting edema
• mod to severe fibrosis
• may see skin changes

Question 11

Lymphedema: stage 3

Answer 11

• Elephantiasis
• protein-rich edema
• severe fibrosis
• freq infections

Question 12

prognosis of lymphedema

Answer 12

• life-long, progressive condition. no cure. needs to be managed

Question 13

distinguishing causes of edema: pitting vs non-pitting

Answer 13

• pitting = early lymphedema, DVT, venous insuf.

- non-pitting = advanced lymphedema

Question 14

Stemmer’s sign

Answer 14

pinch skin by toe. if you can lift skin = negative (lipedema is negative sign) if you cannot then positive for lymphedema

• dorm of foot spared in lipedema, but involved in lymphedema

Question 15

Lipedema

Answer 15

• swelling due to deposits of subcutaneous adipose tissue.
• not a disorder of the lymphatic system
• treat swelling, address nutrition and exercise.
• • negative stemmer sign
• ** feet uninvolved

Question 16

Lymphedema risk reduction bolded stuff

Answer 16

• avoid BP on affected side

- avoid overheating (hot packs)

Question 17

What do you do if you think someone has lymphedema?

Answer 17

• notify physician

- need script to treat for lymphedema

Question 18

Very important to ask lymphedema pt about?

Answer 18

medical history. Cancer, surgeries, infections, etc.

Question 19

Lymphedema severity grading. min, mod, severe

Answer 19

• min = 40% inc

Question 20

Complete decongestive therapy (CDT) - for lymphedema

Answer 20

• manual lymph drainage (MLD) - massage
• compression bandaging
• exercise
• skin care
• edu, HEP

Question 21

Low stretch bandages provide?

Answer 21

(for lymphedema)
- resistive force

• high working pressure, low resting pressure

Question 22

High stretch bandages provide?

Answer 22

• compressive force

- high resting pressure, low working pressure.

Question 23

Law of LaPlace

Answer 23

smaller the radius, higher the pressure

Question 24

Levels of compression

Answer 24

Level 1 = 20-30 mmHg
Level 2 = 30-40 mmHg
Level 3 = 40-50 mmHg
Level 4 = >60 mmHg

< 20 mmHg considered a support stocking, not for treatment.

Question 25

Exercises and lymphedema

Answer 25

- inc lymph flow 10X | - *always performed with use of compression bandages or garments

Question 26

Other lymph tissues and organs that provide immune function

Answer 26

- thymus, bone marrow, spleen, tonsils, peyer's patches in small intestine

Question 27

What is the function of the lymph system?

Answer 27

- fluid back to circulation - filters junk from lymph fluid - absorbs fats in small intestines - immunity

Question 28

Circulatory review.

Answer 28

Filtration = fluid leaves capillary and go to tissue - reabsorption = reentering circulation - 90% thru venous network, 10% the lymphatic

Question 29

What is the "true" cause of lymphedema

Answer 29

- reduce lymph drainage

Question 30

What is cistern chyli?

Answer 30

lymph reservoir in abdomen at the end of the thoracic duct

Question 31

Dynamic insufficiency vs mechanical insufficiency

Answer 31

dynamic = too much fluid. no damage to system Mechanical = true lymphedema. problem with the system. (clogged sewer)

Question 32

Does more lymph drain to right lymphatic or thoracic duct?

Answer 32

- 1/4 to right lymphatic | - rest = thoracic duct

Question 33

Exercise dec BP by what for how long?

Answer 33

10-20 mmHg for up to 9 hours

Question 34

wt reduction to normal BMI dec BP by what?

Answer 34

5-20 mmHg

Question 35

Tunica intima

Answer 35

inner layer. smooth, prevent adherence of platelets, produces vasodilators (NO) and vasoconstrictors, semipermeable

Question 36

Tunica media

Answer 36

- muscle | - SNS innervation

Question 37

Tunica adventitia

Answer 37

-loose connective tissue (support and protection)

Question 38

blood flow =

Answer 38

delta P/ resistance resistance is related to length, viscosity, and 1/radius^4

Question 39

essential vs secondary HTN

Answer 39

-essential = idiopathic (90%) secondary = identifiable cause (10%)

Question 40

what is the single most common characteristic of HTN?

Answer 40

inc TPR due to narrowing of peripheral arterioles

Question 41

what is the most important preventative factor of HTN?

Answer 41

physical activity

Question 42

FITT for HTN

Answer 42

``` F = 4-7 days/wk I = 40-60% HRR, RPE 11-13 T = 30-60 min/session T= large muscles, aerobic activities (walking) ```

Question 43

a drop in what amount is considered orthostatic hypotension

Answer 43

20/10 (one or the other)

Question 44

What is an aneurysm

Answer 44

abnormal stretching or dilation of vessel wall (50% greater than normal)

Question 45

What is peripheral vascular disorders?

Answer 45

disorders or arterial and venous blood vessels. or both

Question 46

important ischemic signs and symptoms

Answer 46

numbness, coldness, pallor ******

Question 47

main risk factors for venous thrombosis

Answer 47

- previous DVT - surgery/trauma - prolonged bed rest

Question 48

Wells clinical predictor rules

Answer 48

- active cancer - immobilization of LE - bedridden > 3 days , major surgery last 4 wks - localized tenderness along distribution - entire LE swelling - unilat calf swelling >3 cm - unilat pitting edema - collateral superficial veins - (-2) alt dx more likely Key: -2 to 0 = low (3%) 1 to 2 = mod (17%) 3+ = severe (75%)

Question 49

What is the goal of INR when thrombosis?

Answer 49

2.0-3.0

Question 50

which is worse? arterial or venous insufficiency

Answer 50

arterial. treat it first

Question 51

What is the gold standard for measuring edema?

Answer 51

volumetric - detectable change is 10 mL

Question 52

Does capillary refill test discriminated btw those with and without PAD?

Answer 52

no

Question 53

Ankle brachial index (ABI)

Answer 53

systolic of leg / systolic of arm *should be about 1 ***post exercise drop >= 25% = PAD dx <1 arterial disease

Question 54

elevation pallor

Answer 54

- lift leg 45-60 degrees for 60 seconds - normal = no change - testing arterial insuf.

Question 55

rumor of dependency

Answer 55

- if pallor with elevation, quickly stand - normal = return in 15 sec - arterial issue = >30 sec and will be dark red (positive)

Question 56

venous fill time

Answer 56

- elevate for 1 min - rapid change in position - record how long it takes to fill veins - too long = arterial issue - too quick = venous issue