Midterm Theory

Question 1

A chronic, systemic, autoimmune disorder causing symmetrical, erosive synovitis of the joints. Eyes, lungs and the cardiovascular system may be affected

Answer 1

RA

Question 2

What joints are most often affected in RA?

Answer 2

• Fingers (DIPs)
• Hands
• Wrists
• Knees
• Feet
• Upper cervical (C1/C2)

Viral pathogens, and antibodies launch a full scale attack on these health tissues bilaterally

Question 3

Who is most commonly affected by RA?

Answer 3

• Women are 2.5/3 times more affected than men (3/1)

- 20-40 most frequently

Question 4

What are Ci’s to tx and assessment for RA?

Answer 4

• No testing during flare ups
• AF ROM and PR ROM tested in pain free ranges only
• No PF testing in severe R.A
• AR testing in pain free ranges only
• All relevant treatment precautions in the event of neuropathies, pulmonary and cardiovascular involvement
• Do not work directly on or distal to inflamed joint
• Do not traction C-spine or perform joint play techniques if there is C-spine involvement
• Do not friction ligaments capsules or tendons in severe progressive R.A or of the client is taking anti-inflammatories
• Modify hydrotherapy and techniques in the case of joint replacement or flare up
• Avoid vigorous techniques or overly long treatments as they will fatigue the client make them susceptible to a flare up
• Avoid heavy applications during flare ups. Use cool cloths, arm or foot baths

Question 5

What is the difference between RA and OA?

Answer 5

RA
Autoimmune and bilateral
Could lead to OA
Have Burchard's: PIPs
Swan Neck: DIPs

OA
Degenerative and not bilateral
Bones/cartilage. Wear and tear with age
Hands, hips, knees, L4/L5, C4/C7 - upper thoracic

Both affect the joints

Question 6

What are CI’s to tx and assessment for clients with OA?

Answer 6

1) Do not mobilize hypermobile joints!

2) Do not mobilize joints with osteoformation

Question 7

What is the recommended remedial exercise program for clients with OA? How does it differ from RA?

ADD MORE

Answer 7

OA
Increased ??
Walking/swimming - weight bearing exercise to decreased impact

RA:
Swimming, pain to stop pain?

Question 8

Disorder of carbohydrate, protein and fat metabolism. Resulting from imbalance b/t insulin availability and insulin needed

Answer 8

Diabetes

Question 9

What are different types of Diabetes?

Answer 9

1) Diabetes Mellitus Type 1: Insulin dependent
2) Diabetes Mellitus Type 2: Non insulin dependent
3) Gestational Diabetes: Glucose intolerance during pregnancy

Question 10

What are the 3 P’s of Diabetes?

Answer 10

Polyuria: Excessive urination
Polydipsia: Excessive Thirst
Polyphagia: Excessive hunger

Question 11

Prior to treating a client with insulin dependent diabetes, what is important to know?

Answer 11

Injection sites

Question 12

What are common insulin injection sites?

Answer 12

Tummy, Thigh, Upper Arm

Question 13

Progressive condition of axial skeleton presenting as pain and stiffness of the spine leading to bony ankylosis of the SI joint

Answer 13

Ankylosing Spondylitis

Question 14

What are the 2 types of AS?

ADD ANSWER

Answer 14

1) Marie-Stumpell

2) Bechtrew

Question 15

How can you alter your diet when you suffer from Gout?

Answer 15

No: Red meat, organ meat, anchovies, sardines, seafood, lentils, mushrooms, peads, asparagus, alcohol

Question 16

hat are the extra-articular symptoms of clients with AS?

Answer 16

1) Pain in the SI & Lumbar
2) Muscle stiffness or pain after prolonged rest, interrupted sleep due to pain, fatigue, fever, weight loss
3) Misdiagnosed with muscles strain or spasm, loss of ROM in spine, lordosis, kyphotic spine, osteoporosis of the spine

Question 17

What is Scleroderma?

Answer 17

Autoimmune disease of connective tissue characterized by thickening (fibrous) of the skin, fascia, tendon sheaths of the body

Question 18

What is CREST?

Answer 18

C: Calcinosis
Formation of tiny calcium deposits

R: Raynaud Phenomenon
Spasms of the small articular, supplying the finger, toes, lungs

E: Esophageal Dysmotility
Poor functioning muscles of the lower ⅔ of the esophagus

S: Sclerodactyly
Localized thickening of the skin over the fingers and toes

T: Telangiectasia
Tiny red blotches, caused by dilated capillaries that appear on the face

Question 19

This hormone produced by the pancreas. It regulates carbohydrate and fat metabolism. It takes up glucose and stores it as glycogen

Answer 19

Insulin

Question 20

What is the most common complication associated with diabetes?

Answer 20

Blindness is most common Chronic Complication of Diabetes

Question 21

What are the complications associated with diabetes?

Answer 21

1) Peripheral Neuropathies:
such as paresthesia in the legs and feet, muscle weakness, foot drop, carpal tunnel syndrome and impotence in men

2) Vasomotor Reflex Defects:
lead to dizziness and syncope (fainting) when moving from supine to standing

3) Impaired Innervation to the Bladder:
can lead to urinary stasis and the development of bladder infections and renal complications

4) Nephropathies:
diabetics have increased susceptibility to pyelonephritis (kidney inflammation) and papillary or glomerulosclerosis (scarring of tiny vessels in kidney)

5) Retinopathies:
Diabetes is the leading cause of acquired blindness. There is an increased risk of cataracts and glaucoma, microaneurysm formation (spots on retina), hemorrhage, scarring and retinal detachment.

6) Vascular Complications:
Increased risk for coronary artery disease, cerebrovascular disease, peripheral vascular disease

7) Diabetic Foot Ulcers:
Poor circulation and tissue health results in ulceration, infections, gangrene and eventually amputation. Common sites for damage are the back of the heel, plantar metatarsal area or great toe. Feet should be inspected daily for blisters, open sores, fungal infections. Feet should be kept warm, clean and dry. Nails should be trimmed carefully to avoid cuts.

8) Periarthritis and Adhesive Capsulitis:
result in limited joint mobility particularly in the hands (Dupuytren’s Contracture)

9) Reflex Sympathetic Dystrophy (RSD):
a condition characterized by pain, hyperesthesia (sensitivity to stimuli/touch), hyperhidrosis, tenderness and swelling of the hands and feet

Question 22

What is the cause and contributing factors of Diabetes? (For both types)

Answer 22

1) Absolute insulin deficiency or impaired insulin production from the pancreas
2) Defective insulin receptors on cells
3) Genetic predisposition which causes an auto-immune response to the pancreatic B-cells which produce insulin
4) Environmental factors in a genetically susceptible person (viruses and chemical toxins)

Question 23

What are the symptoms associated with Diabetes Type 1?

Answer 23

1) Polyuria (increase urine output)
2) Glycosuria/ ketonuria (glucose and ketones in urine)
3) Polydipsia (increase thirst)
4) Polyphagia (increase in hunger)
5) Unusual weight loss with normal eating and activity
6) Extreme fatigue
7) Irritability
8) Sweet smelling breath
9) Nausea and vomiting
10) Blood sugar levels fluctuate often including hyperglycemia and hypoglycemia, either can have potentially serious consequences – ketoacidosis
11) Often difficult to stabilize this type of diabetes mellitus

Question 24

What are the symptoms associated with Diabetes Type 2?

Answer 24

1) Same as IDDM +
2) Frequent infections (esp. Skin, gums, bladder)
3) Slow wound healing, cuts and bruises
4) Tingling and numbness in hands and feet
5) Blurred vision
6) Fairly stable and easy to control

Question 25

What are the contraindications for treatment of Diabetes?

Answer 25

1) Keep juice, fruit on hand for sugar 2) No massage on injection sites 3) When in doubt administer sugar only not insulin 4) Monitor cuts, ulcers. Ensure areas is clean - prone to infection 5) Peripheral Neuropathies cause altered sensation - adjust hydro as they may not feel hot or cold 6) Try to arrange appt just after insulin injection 7) No deep on areas where sensation changes

Question 26

What is gestational diabetes?

Answer 26

Glucose intolerance during pregnancy | -They are also at a higher risk for developing diabetes 5-10 years after delivery

Question 27

What are the risk factors of gestational diabetes?

Answer 27

1) Women with a family history of diabetes 2) History of stillbirth or spontaneous abortion 3) Presence of fetal anomalies in previous birth 4) Previous history of having large babies 5) Obesity of mother 6) Advanced maternal age 7) Five or more pregnancies

Question 28

Understand the rationale on treating on or around injection sites?

Answer 28

New injection sites should be avoided during massage as excess insulin may be retained in the tissue and can be released during massage on-site. The tissue may also be tender. Old injection sites need to be located as repeated scarring and tissue breakdown can occur in these areas. Extra caution is needed in massaging these areas as the tissue may be fragile. Common injection sites are the abdomen, thighs and biceps

Question 29

Chronic, degenerative progressive deterioration of a joint characterized by a loss of articulate cartilage and reactive changes at the margins of joints and subchondral bone Wear and tear of cartilage, unilateral

Answer 29

Osteoarthritis

Question 30

Be able to describe the process of degeneration at the joint?

Answer 30

Inflammation of the joint capsule → fibrosis → capsular restriction → facet irritation → gradual degeneration due to altered biomechanics → OA

Question 31

Define primary osteoarthritis?

Answer 31

- Idiopathic | - Aging, Wear and Tear, Genetic Factors

Question 32

Define secondary osteoarthritis?

Answer 32

- Caused by trauma, pathology - Inflammation: Infection in joint - Bone disease - Bleeding Disorders - Neurological Disorders

Question 33

What are the symptoms that are associated with the Early stages of osteoarthritis?

Answer 33

1) Few visible changes, capsule/ligaments thickening 2) Swelling is low grade not visible 3) Slight decrease ROM 4) End-feel normal/springy 5) Surrounding muscle guarding 6) Pain after normal use, relieved by rest 7) Morning stiffness last 30 mins

Question 34

What are the symptoms that are associated with the late stages of osteoarthritis?

Answer 34

1) Visible palpable change in joint and shape, Osteophytes 2) Swelling low grade but chronic 3) Progressive loss ROM (PR ROM) 4) End feel premature and bony 5) Surrounding muscle spasm 6) Pain during rest 7) Morning stiffness last longer than 30 mins

Question 35

What are the common locations of osteoarthritis?

Answer 35

1) Hips, Knees, SI, Facet joint, L5-S1 2) Small joints hands and feet 3) Lumbar, Cervical spine

Question 36

Know the treatment approaches for clients with the various stages of osteoarthritis.

Answer 36

1) Correct predisposing factors Correct muscle imbalance through stretch, eliminate TP 2) Educate client on proper body use Lifting objects, stretching before activity, taking breaks, posture 3) Encourage Activity Move through pain in EARLY OA 4) Rest and cool hydro During FLARE UP 5) Massage GSM, PR ROM, Low grade joint play, tissue health, etc

Question 37

What is the relationship between osteoarthritis and facet irritation

Answer 37

1) OA, FJI and Herination may all be connected or lead to one another 2) If client has FJI due to faulty posture and the FJI becomes chronic, then degenerative changes occur causing OA of FJ leading to instability of the spine which can lead to DDD due to increase mechanical stress on IVD which may result in Disc Herniation

Question 38

Define Disc prolapse?

Answer 38

Tearing of both the inner and outer layers of the annulus fibrosis causing the nucleus pulposus to bulge directly into the intervertebral space.

Question 39

Define Disc Herniation?

Answer 39

- A bulging of the nucleus pulposus against the outer layers of the annulus fibrosis into the intervertebral space. -- - Tearing of the inner annulus fibrosis layers leads to a structural weakening, but the outer layers remain intact.

Question 40

What are the causes of DDD?

Answer 40

1) Postural or occupational deviation leading to excessive rotation 2) Fixation of the spine will lead to degenerative changes especially above and below the sites of fixation. Joints above and below a fixation will make up for the loss of movement and become hypermobile causing excessive wear and tear on the spine. 3) Direct trauma such as a fall or whiplash or lift and twist injuries

Question 41

What are the CI's for DDD? (Same with OA)

Answer 41

1) As disease progresses ROM will diminish due to osteophyte formation, and bone rubs against bone 2) Don’t mobilize hypermobile joints (above and below fixations of spine) 3) Don’t mobilize joints with osteophytes, possible to break of and become loose body 4) No hydro during flare up 5) No temp extremes if joint has been placed with pins, plates, etc 6) No Friction around joint that has been treated with Corticosteroid 7) Don’t remove protective muscle guarding around hypermobile joint 8) Modify hydro if client has altered sensation along nerve root

Question 42

In RA what are all the classes for an RA diagnosis?

Answer 42

1. Morning Stiffness- in and around ,lasting at least 1 hour before maximal improvement 2. Arthritis of 3 or more joints- Simultaneous soft-tissue swelling or fluid (not bony overgrowth alone) observed in 3 of the following 14 joints: left or right PIP’s, MCP’s, wrists, elbows, knees, ankles, and MTP joints 3. Arthritis of hand joints- at least one area swollen in a wrist, MCP, or PIP joint (DIP’s are rarely involved) 4. Symmetric Arthiritis- simultaneous involvement of the same joint areas on both sides of the body (bilateral involvement of the PIP’s, MCP’s, or MTP’s is acceptable without absolute symmetry). 5. Rheumatoid Nodules- subcutaneous nodules over bony prominences, extensor surfaces, or surrounding joints. 6. Serum rheumatoid factor- abnormal amounts of serum rheumatoid factor. 7. Radiographic changes- hand and wrist radiographs showing erosion and bony decalcification localized in or adjacent to involved joints. (O.A of a joint alone does not qualify)

Question 43

In RA what 4 do you need present for an RA diagnosis?

Answer 43

1) Morning Stiffness 2) Arthritis of 3 or more joints 3) Arthritis of Hand joints 4) Symmetric Arthritis

Question 44

What are the causes and contributors to RA?

Answer 44

1) Idiopathic 2) Autoimmune disease, and occurs bilaterally 3) Most have RF factor in blood 4) 60% found to have genetic marker HLA 5) Emotional trauma/stress exacerbate attacks 6) Ratio 3/1 for women

Question 45

What is swan neck deformity and boutonniere deformity?

Answer 45

1) Swan Neck: Deformity of MCPs | 2) Boutonniere: Deformity of PIPs

Question 46

What medical treatment aims are there for RA?

Answer 46

1) Slow progression to prevent RA: rest, education 2) RA foundation support groups 3) Physical/emotional rest 4) Reduce weight on inflamed knees 5) Limits activities like housework, gardening 6) Swimming, Walking encouraged to reduce joint stress 7) Aspirin, NSAID’s, gold salts, DMARD’s 8) Surgery last resort

Question 47

Who is AS most commonly found in?

Answer 47

Most frequently seen in North American, rarely in Asians and African Americans

Question 48

What is spinal fusion of ossification of ligaments and IVD?

Answer 48

Ankylosing Spondylitis

Question 49

2 Types of AS?

Answer 49

1) Marie-Stumpell | 2) Bechtrew

Question 50

What is the cause of Ankylosing Spondylitis?

Answer 50

- Idiopathic | - Presence of mononuclear cells in acutely affected tissue suggest autoimmune response

Question 51

Describe the progression and presentation of Ankylosing Spondylitis?

Answer 51

1) Insidious onset, mild pain, stiffness in lumbar area 2) Sometimes, present acute onset, severe pain in SI and lumbar spine 3) Pain local in SI and lumbar may radiate to hips, down back and thigh 4) Pain at rest, lying in bed 5) Morning stiffness 6) Interrupted sleep due to pain 7) Fatigue 8) Ease back pain developing forward flexed posture 9) Lost of ROM in all lumbar movement

Question 52

What is the medical treatment for clients with Ankylosing Spondylitis?

Answer 52

1) Controlling pain, maintain mobility, supress inflammation 2) Encouraged do exercise regime, maintain healthy weight 3) AS Support group 4) Education on sleep positions 5) Aspirin, NSAIDs prescribed 6) Surgery

Question 53

Abnormally high amounts of uric acid in the blood (hyperuricemia). Not all people with hyperuricemia develop gouty arthritis

Answer 53

Gout

Question 54

This disease is chemical causing

Answer 54

Gout

Question 55

What is the pathology behind Gout?

Answer 55

Uric acid is a metabolite (a waste product from the normal metabolism of purine). About 2/3 of uric acid is filtered through the kidneys where it is either reabsorbed or excreted. The other third is eliminated through the GI tract

Question 56

What are the risk factors for Gout?

Answer 56

1) A diet high in purine containing foods. This includes red meat, organ meat, anchovies, sardines, fowl, lentils, mushrooms, peas, asparagus, spinach, alcohol (especially fortified alcohol such as sherry or port). 2) Obesity and/or sudden weight gain 3) Moderate to high alcohol intake 4) High blood pressure 5) Diabetes 6) Renal pathologies 7) Heredity

Question 57

What are your treatment aims in an attack or between flare ups of Gout.

Answer 57

1) Treatment may proceed as normal with a focus on encouraging circulation and elimination of metabolic waste. Steam baths or saunas may aid in elimination. 2) Encouraged increased fluid intake. 3) Chronic and severe gout may come with other cardiovascular or renal complications as well as severe joint degeneration and tophi deposits. All precautions for these respective complications must be taken into account when treating.

Question 58

What is the medical treatment for clients with Gout?

Answer 58

1) A small amount of synovial fluid is extracted from the joint and tested for the presence of calcium pyrophosphate dihydrate (CPPD) is the main diagnostic test. The diagnosis is often supported by x-rays revealing a linear calcification in fibrocartilage. 2) Treatment for pseudo gout is often the same as gout with the administration of colchicine (both abortively and preemptively prescribed) and in severe cases of acute synovial effusion, drainage and corticosteroid injections are often performed.

Question 59

Disease is unknown, girls more affected than boys, 75% expected to recover

Answer 59

Juvenile RA

Question 60

3 types of Juvenile RA?

Answer 60

1) Pauciarticular Arthritis of 4 or fewer joints Most common in knees 2) Polyarticular More than 4 joints Most common in hands, feet and TMJ 3) Still’s Disease Affects the whole body High fever, pink rash, anemia

Question 61

An autoimmune disease characterized by chronic inflammation affecting any organ of the body

Answer 61

Systemic Lupus Erythematosus (SLE)

Question 62

What is the cause of Systemic Lupus Erythematosus?

Answer 62

1) Idiopathic and Hereditary from Autoimmune disease 2) Connective tissues become inflamed by Lupus 3) Severe head/personality changes due to inflammation of connective tissue in CNS 4) DLE Lupus is the most Mildest form

Question 63

3 types of Systemic Lupus Erythematosus?

Answer 63

1) Discoid Lupus (DLE) Mildest form Limited to skin 2) Subacute Cutaneous Lupus (SCLE) Lesions resembling psoriasis and are found on sun exposed areas Affects face, chest, upper back/skin 3) Systemic Lupus (SLE) Inflammation of almost every organ in body Fever, malaise, joint, muscle, poor circulation (Raynauds)

Question 64

This form of Lupus is the Mildest form

Answer 64

Discoid Lupus (DLE)

Question 65

This Lupus: Lesions resembling psoriasis and are found on sun exposed areas Affects face, chest, upper back/skin

Answer 65

Subacute Cutaneous Lupus (SCLE)

Question 66

This Lupus: Inflammation of almost every organ in body | Fever, malaise, joint, muscle, poor circulation (Raynauds)

Answer 66

Systemic Lupus (SLE)

Question 67

What are the diagnostic criteria of SLE?

Answer 67

1) Non-erosive polyarthralgia (joint pain) in 2 or more joints with join effusion 2) Mala (butterfly rash on face) 3) Discoid (flat) Lesions on sun exposed areas 4) Photosensitivity (symptoms increase with sun exposure) 5) Renal disorders such as Proteinuria, nephritis, glomerulonephritis (inflammation of tiny filters in the kidney known as glomeruli) 6) Chest pain related to pleuritis or pericarditis 7) Blood disorders such as anemia, increased bleeding or thrombosis 8) Neurological disorders such as seizures, psychosis or coma 9) Ulcerations of the lining of the mouth, nose or throat 10) Cellular immune defects such as low red, white or platelet cells 11) Immunologic Disorders (anti-DNA antibodies, false positive for Syphilis)

Question 68

An autoimmune disease of connective tissue characterized by thickening (fibrosing) of the skin, fascia, tendon sheaths and organs of the body Idiopathic and Heredity in autoimmune disease

Answer 68

Scleroderma

Question 69

What are the aims of treatment for Scleroderma? | During Flare up

Answer 69

Massage may not be tolerable, avoid areas of inflammation

Question 70

What are the aims of treatment for Scleroderma? | Between Flare up

Answer 70

MT and underwater massage are recommended by MD’s, physiotherapy

Question 71

Overall Aims for Scleroderma?

Answer 71

1) Decrease pain and edema 2) Maintain circulation 3) Reduce stiffness of affected joints 4) Gently maintain mobility of affected joints 5) Focus on stress reduction 6) Position for comfort and/or systemic complications such as hypertension/congestive heart failure 7) Shorten tx to 30min 8) Full diaphragmatic breathing should be encouraged 9) Decrease pain and edema with drainage techniques such as unidirectional effleurage, running vibrations, stroking towards lymph nodes, 8 soldiers technique, pump and scoop techniques 10) Decrease mm spasms with indirect techniques such as GTO, O&I, mm approximation 11) Swedish techniques should include holdings, light stroking, soothing vibrations, light muscle squeezing and circular kneading 12) Hydrotherapy of the affected joints should be cool (watch cool/cold applications to fingers and toes to avoid Raynauds flare up) 13) Gentle isometric contractions and ROM to affected joints (usually 1-2 times) for affected joints may be performed during the treatment and as self care

Question 72

Causes of OA?

Answer 72

1) When the space between the joint decreases and therefore leads to a rubbing of the joint, this will cause bone to lay down (ossification) and forms osteophytes 2) The joint capsule deteriorates causing an instability in the joint and will most always have a capsular pattern associated with it 3) Disrupted by postural changes, activity related occupations, or autoimmune diseases 4) OA may also be due to an increase in the lordotic curve of the lumbar spine

Question 73

CI's of RA?

Answer 73

* 1) No testing during flare ups * 2) ROM testing in pain free ranges only * 3) All relevant treatment precautions in the event of neuropathies, pulmonary and cardiovascular involvement * 4) Do not work directly on or distal to inflamed joint * 5) Do not traction C-spine or perform joint play techniques if there is C-spine involvement * 6) Do not friction ligaments capsules or tendons in severe progressive R.A or of the client is taking anti-inflammatories * 7) Modify hydrotherapy and techniques in the case of joint replacement or flare up * 8) Avoid vigorous techniques or overly long treatments as they will fatigue the client make them susceptible to a flare up * 9) Avoid heavy applications during flare ups. Use cool cloths, arm or foot baths

Question 74

CI's of AS?

Answer 74

1) If fusion has not taken place: prone position should have NO abdominal pillow supine should have NO knee or neck pillow however a small towel roll may be used to support knees and neck 2) Joint mobilizations to the affected but not fused joints. Mobilizations should be low grade and designed to reduce pain and maintain mobility 3) Fascial work and PNF techniques are appropriate as well as trigger point therapy if the client is not in severe pain from a flare-up 4) • Frictions should not be performed on sites of fibrosis and/or fusion. This fibrosis/ossification process cannot be reversed or diminished by friction therapy and May in fact cause a local flare up. 5) • If fusion has taken place: The client will likely not be able to lie in prone. Position client in sidelying. When in supine the client should now be well supported under the knees and neck.

Question 75

CI's of SLE (Lupus)?

Answer 75

* Do NOT over treat client, limit treatment time and don’t be too aggressive * Modify hydrotherapy if Raynaud’s or other sensory deficits are present * Clients may have to be positioned in right side-lying (left side up) or semi-reclined if they have cardiac complications * Clients may be most comfortable in semi-reclined if pleuritis or pericarditis is present. This reduces the pressure of the viscera pushing up against the lungs and heart. * Segmental massage to limbs may be performed first if client has cardiac complications. * Do NOT encourage Full Deep Breath or coughing if plueritis or percarditis is present, as this will increase pain * Do NOT perform frictions if client is on anti-inflammatories * Do NOT massage a feverish client * Do NOT apply passive forced over pressure to unstable joints

Question 76

CI's to Gout?

Answer 76

1) Acute attack no local treatment 2) Do not use heavy applications of cold hydro such as a cold pack 3) Do not attempt to cover the foot with a blanket, sheet or sock. Allow the foot to remain exposed. DO NOT bump it 4) If treating the back in prone, allow the affected foot drop off the table to avoid pressure on the toe. Do not bump it during treatment.

Question 77

CI's to Scleroderma?

Answer 77

* Excessively long or overly aggressive treatments may trigger a flare-up. Limit treatment times to no more than 45 min in length * Avoid hot hydrotherapy during flare up * Avoid cold hydrotherapy on hands, feet or ears if Raynauds is present * Avoid massage or joint play directly in inflamed joints during flare up * Modify client position for hypertension, congestive cardiac failure or GERD(gastroesophageal reflux disease) (semi reclined) * Modify treatment for hypertension or congestive cardiac failure (start with hands or feet and perform segmental massage)

Question 78

What is also called morphea scleroderma?

Answer 78

Localized Scleroderma

Question 79

Define localized scleroderma?

Answer 79

- Onset primarily in children and young (usually female) adults. - Does not have visceral or serologic manifestations - They may be bordered by a purple areola (circular area of different pigmentation) - Affects limbs and face - Skin, subcutaneous tissue, muscle and sometimes bone is replaced with fibrotic connective tissue that appear as white or pink oval patches, bands or lines - Mauskopf (mouse headed appearance occurs as the lips pucker causing difficulty opening mouth)

Question 80

Define Limited Systemic Sclerosis?

Answer 80

- Onset usually in 30's and 40s - 1st symptom is Raynauds Phenomenon - Subsequent symptoms include skin edema and tightening of the hands, face and feet - Often develop pulmonary hypertension and esophageal disorders causing dysphagia, possible development of trigeminal neuralgia - People with this form may have overlapping autoimmune conditions such as R.A or Lupus

Question 81

What disease is often referred to as CREST?

Answer 81

Limited Systemic Sclerosis (LSS)

Question 82

Who does RA affect more common?

Answer 82

Women ratio 3/1

Question 83

Does OA or RA have more morning stiffness?

Answer 83

RA has more morning stiffness than OA

Question 84

What is Mala rash associated with?

Answer 84

Lupus

Question 85

Is RA unilateral or bilateral

Answer 85

Bilateral

Question 86

What is most affected in Polyarticular JRA? How many joints?

Answer 86

- hands, feet and TMJ are often affected | - 4 or more joints

Question 87

How many joints are affected in Periarticular?

Answer 87

Less than 4

Question 88

What is the wear and tear of OA?

Answer 88

Cartilage

Question 89

How would you accommodated for diabetes in your treatment room?

Answer 89

Have juice packs in case sugar drops

Question 90

What health question is most important for diabetes?

Answer 90

When was last injection and the injection sites

Question 91

Which joint is most effected in JRA: Pauciarticular?

Answer 91

Knee

Question 92

Are RA and OA the only diseases that affect the joint?

Answer 92

Yes

Question 93

CI of Arthritis in CS/Bone spurs?

Answer 93

No traction of CS

Question 94

How long does morning stiffness last in OA?

Answer 94

30 mins

Question 95

How long does morning stiffness last in RA?

Answer 95

1 Hour

Question 96

• Ketones (Glycosuria) in urine:

Answer 96

Type 1 Diabetes

Question 97

What would you modify if client has Neuropathy?

Answer 97

Hydro and pressure

Question 98

Which Type of diabetes is monitored with diet and exercise?

Answer 98

Type 2

Question 99

Would you use hyrdo on acute inflamed joints?

Answer 99

No

Question 100

Remission of any inflammatory disease what is CI'd?

Answer 100

Heat is STILL CI’d : Will cause a flareup

Question 101

Goals of AS in early stage

Answer 101

help maintain mobility in thoracic and lumbar – control pain

Question 102

Main aim of Lupus?

Answer 102

reduce muscle and joint pain and increase ROM

Question 103

AS, Spine fusion is what?

Answer 103

ossification of the ligaments and IVD

Question 104

What tissue is inflamed by Lupus?

Answer 104

Connective tissues

Question 105

What area does Gout occur to most?

Answer 105

Big toe, uinlateral

Question 106

What would cause severe head/personality changes in Lupus

Answer 106

Cause is inflammation of connective tissue in CNS

Question 107

Is there chest expansion in AS?

Answer 107

No, it collapses in because you are bent over

Question 108

Localized Scleroderma affects:

Answer 108

Skin, fascia, muscle. NOT LUNGS

Question 109

1st thing affected with Limited Scleroderma (LSS)

Answer 109

Skin

Question 110

•Onset for Limited Scleroderma

Answer 110

30's-40s

Question 111

Onset for Localized Scleroderma

Answer 111

Children, usually female

Question 112

Cause of Scleroderma

Answer 112

Idiopathic and Heredity from Auto Immune disease