Medical Conditions Midterm Flashcards
(70 cards)
1
Q
most common reason a foot ulcer in a patient with diabetes does not heal
A
lack of pressure relief
2
Q
functions of the skin
A
- Protection: barrier between internal/external environment
- Thermoregulation: dilation/constriction of blood vessels in skin. Sweating/evaporation
- Sensation: containing nerve endings- pain; temperature
- Metabolism- synthesis of Vit D
- Aesthetics/communication- provides looks/nonverbal communication
3
Q
3 layers of skin
A
epidermis, dermis, hypodermis (many times not considered part of “skin”
4
Q
Structure of epidermis
A
- Stratum corneum: dead cells-tough outer layer
- Stratum lucidum: may or may not be present (prominent on heels/palms)- AKA horny layer
- Stratum granulosum: area where keratinocytes are losing many of organelles from within cell transitional area- metabolically active
- Stratum Spinosum: visible spinal processes on cell- form little projections that go into dermis-stability of skin. Desmosomes act as cell-to-cell junction
- Stratum Basale: mitotically active where keratinocytes are born. Cells take 203 weeks to migrate from basal layer. Rete ridges protrude to anchor epidermis to dermis
5
Q
What separates the epidermis from the dermis?
A
basement membrane
6
Q
What are the 4 cell types in the epidermis?
A
- Melanocytes: basal layer- manufacture and secrete pigment
- Merkel Cells: basal layer- attached to sensory nerve endings
- Keratinocytes: arise from basal layer of epidermis to stratum spinosum: produce keratin, antibodies, and enzymes
- Langerhans cells: stratum spinosum- part of immune system
7
Q
Dermis- three functions
A
Thickest layer
Functions: store supply of water, supply nutrients to epidermis, regulate body temperature
8
Q
2 layers of dermis
A
- papillary layers: regulates body temp and supplies nutrients
- reticular layer: provides structure and elasticity
9
Q
Hypodermis
A
Subcutaneous tissue (often not considered part of skin)
- attaches skin to underlying bone and muscle- contains 50% of body fat
- provides shock absorption/insulation
10
Q
Erosion
A
loss of epidermis only
11
Q
Partial thickness skin loss
A
loss of epidermis and part of dermis
12
Q
Full thickness skin loss
A
loss of all of dermis and into subcutaneous tissue
13
Q
4 steps of wounding and hemostasis
A
- vessel injury
- vascular spasm: vasoconstriction- reduce blood flow
- platelet plug: primary hemostasis
- coagulation: secondary hemostasis- form stable thrombus
14
Q
What cells act during the inflammation process to mediate vasodilation and vasoconstriction?
A
Mast cells
15
Q
What cells act during inflammation to kill and degrade pathogens?
A
Neutrophils
16
Q
What cells act during inflammation secrete cells that attract the immune system?
A
Macrophages
17
Q
5 cardinal signs/symptoms of acute inflammation
A
- redness
- edema/swelling
- heat
- pain
- loss of function
18
Q
3 major components of inflammation
A
- alterations that lead to increased blood flow
- plasma proteins and leukocytes leave the circulation
- emigration of leukocytes from the microcirculation to the site of injury combined w/ activation of immense cells
19
Q
destruction >repair
A
chronic inflammation (may be occurring simultaneously w acute inflammation
20
Q
The 5 stages of wound healing
A
- hemostasis: vasoconstriction/platelets
- inflammation: heat/pain/edema
- proliferation/migration: granulation tissue- migration of fibroblasts
- Remodeling/maturation: around 21 days- changes to type 1 collagen
21
Q
Mitotic activity for the epidermis occurs in which of the following layers?
A
stratum basale
22
Q
normal wound healing follows what sequence?
A
- hemostasis
- inflammation
- proliferation
- remodeling
23
Q
Does epidermis have direct blood supply found in the stratum spinosum?
A
no- it is found at the stratum basale
24
Q
classic signs of inflammation include edema, redness and pain- what are they due to?
A
mast cells release histamine which increases vascular permeability
25
What would you use to elevate pressure in a patient that requires 2 persons assist to roll in bed?
-use a hoyer lift to mobilize the patient out of bed several times per day
26
what would you do with a patient that weighs 600 lbs. and frequently has to use the bathroom?
use expanded capacity sling lift and transfer her to a bedside commode
27
Do PT's have the autonomy to apply SPH concepts when most appropriate based on pt presentation?
yes
28
discomfort in the chest or adjacent areas associated with myocardial ischemia leading to myocyte necrosis
myocardial infarction
29
second heart sound associated with
aortic valve closure
30
first heart sound associated with
mitral and tricuspid valve closure
31
elevation of the S-T segment on an electrocardiogram associated with
myocardial ischemia
32
QRS wave of electrocardiogram is produced by
depolarization of the ventricles
33
which of the following will normally increase resistance to blood flow the most
decreasing the diameter of the blood vessel
34
The AHA states that essential hypertension that requires medical management results from:
abnormalities in aretiolar vasomotor tone
35
Bilateral LE edema, dyspnea walking less than 1 block, and an S3 heart sound is consistent with what diagnosis
heart failure
36
shortness of breath and GI discomfort are considered angina equivalents in this population
patients with diabetes mellitus
37
what is a pressure ulcer the consequence of?
ischemia and anoxia to tissue- commonly due to pressure, or pressure in combination with shear/friction
38
4 stages of wounds
1: discoloration of skin/warmth/swelling/hardness
2. partial thickness skin loss
3. full thickness skin loss involving damage to underlying tissue- extends down to but not through fibrous tissue beneath skin
4. extensive tissue/cell seat, damage to muscle, bone or supporting structures
39
What are the key points of pressure ulcers
1. occur over bony landmarks
| 2. caused by shear, friction, or pressure forces, or moisture
40
what is the most appropriate exercise intensity range for someone who has a HR range of 66-121 bpm?
HR= 80-96 bpm
41
Complaints of left shoulder and jaw pain while exercising at the prescribed intensity during cardiac rehab would indicate...
contraindication to continuing a scheduled exercise session
42
A probably cause of increased myocardial oxygen demand while rushing to the office resulting iin a heart attack includes...
increase in pulse rate
43
Atenolol, a beta blocker is indicated because
beta blockers will decrease resting heart rate reducing myocardial oxygen demand
44
6 cardinal symptoms of cardiovascular disease
- chest pain/discomfort
- dypnea,othopnea, wheezing
- palpitations, dizziness, passing out
- cough, hemoptysis
- fatigue, weakness
- pain in extremities with exertion
45
Origins of chest pain
Cardiac origin: angina/MI/pericarditis/cor pulmonale
Non-cardiac origin: pulmonar-pleurisy, phenmothorax, GI: heartburn/GERD, pancreatitis, MSK: fibromyalgia/rib fx/TOS, Neuropsychiatric: anxiety/panic
46
Definition of angina
demand>supply
| aggravated by: physical exertion, emotional stress, cold/heat/humidity, heavy meal
47
What relieves angina?
rest, NT
48
Angina equivalents
- SOB/DOE
- n/v
- weakness/lethargy
49
Angina pectoris
-discomfort in the chest and/or adjacent area associated w myocardial ischemia, but without necrosis (angina can LEAD to MI but doesn't have to)
50
Myocardial infarction
local arrest of sudden insufficiency of arterial blood supply that produces an area of necrosis in the heart
51
4 components of oxygen demand in the heart
HR, preload, afterload, contractility
52
Examples of demand angina
increased: HR, contractility, preload, afterload
53
Examples of supply angina
vasospasm, fixed stenosis, thrombus
54
Cardiac markers after acute myocardial infarction
Creatine-iinase-MB used to be marker of choice for someone having heart attack- most specific marker now considered Cardiac troponin
55
3 risk factors most closely associated with cardiovascular diseases?
smoking, high BP, elevated cholesterol
56
Difference in stable and unstable angina
-unstable angina is the change in pre-existing patterns that leads to increased morbidity/mortality- DONT TREAT pts w unstable angina
57
What is the common cause of unstable angina and printzmetal's variant angina?
unstable angina: thrombus
printzmetal's: vasospasm
(stable angina= fixed stenosis)
58
3 medical treatments for MI
- risk factor reduction
- cardiac rehabilitation
- pharmacologic therapy
- sugery "revascularization" procedures
59
sternal precautions
- weight restriction (5-10 lbs)
- UE ROM: shoulder elevation <90 degrees, horizontal abduction
- driving (6-8 weeks)
- observe for sternal click/infection
- brace with cough
60
Aortic stenosis
- obstruction to flow from LV into ascending aorta
- systolic abnormality
- impairs forward flow
- leads to ventricular hypertrophy
61
Aortic insufficiency/regurgitation
- retrograde blood flow from the aorta into the LV through an incompetent aortic valve
- diastolic run off- reduces forward flow
62
Mitral stenosis
- obstruction to flow from LA into LV because of a narrowed mitral orifice
- "diastolic" abnormality
- reduces filling, reduces SV/CO
63
Mitral regurgitation
- retrograde flow of blood from LV into LA
- reduces forward flow
- increases next diastolic preload
64
pump failure and filling failure
systolic (larger chamber size/dilated cardiomyopathy) and diastolic (smaller chamber/hypertrophic cardiomyopathy)
65
At what percent of ejection fraction does one have heart failure
50%- as ejection fraction falls, mortality rate increases, but CANNOT judge oxygen consumption or functional abilities by ejection fraction
66
Primary hypertension caused by?
TPR/abnormal vasomotor tone
account for 90% of HTN cases
unknown etiology
67
Secondary HTN
usually a known cause and is 10% of HTN cases
68
Prehypertension and stage 1
120-139/80-89 mmHg
| 140-159/90-99 mmHg
69
Complications of prolonged/uncontrolled HTN
- changes in vessel wall- trauma/arteriosclerosis
| - target organ dysfunction: cardiovascular system, renal system, nervous system, eyes
70
lifestyle modifications that can reduce BP
-weight reduction, adopt DASH eating plan, dietary sodium reduction, physical activity, moderation of alcohol consumption
