Pathologies Flashcards
HIV Etiology and definition
Definition: Destruction of T4 lymphocytes that progresses in various disease states: acute infection > asymptomatic HIV > early symptomatic HIV> advanced HIV (AIDS)
Etiology: virus causes cell death / inactivation of important immune cells that fight infection: macrophages, B cells, dendritic cells, and microglia. Body becomes immuno copmpromised due to lack of T4 cells
HIV Prevalnce/ Incidence, Risk Fxs, Gender and Age preference
Prevalnce/ Incidence: 1.1 million with 14% not knowing dx. In: recent deline in past 2 years, about 40k new cases in 2018
Risk Fxs: IV drud use, intercourse, unprotected male-male contact
Gender and Age Preference: 77% reported in males, but is not gender specific. 1/2 of glabal cases are women.
Hypersensitivity Etiology and definition
Definition: exaggerated or inappropriate immune response to allergen or antigen. Damage comes form immune response itself rather than from the substances that provoke it.
Etiology: complement cascade is activated under diff conditions: genetic (high affinity for IgE) or environmental fxs (allergen expose, diet)
1 IgE, instead of IgG is produced in response to antigen and causes response
2. own body’s tissue is attacked and clumped together 2/2 the activation of the cascade system.
3. antigen-antibody complexes are deposited into tissues and around small blood vessels ls and activate the complement cascade, causing inflammation and local tissue injury.
4. delayed response/ sensitization to an allergen
Hypersensitivity Risk Fxs, Gender and Age Preference
Risk Fxs: exposure to allergens, 2- multiple blood transfusions,
Gender and Age Preference: 58% women. allergic rhinitis was highest in those ages 18-34 and 35-49, decreasing after age 50
Hypersensitivity Medical MGMT
H1 blockers, Mast cell stabilizers, Anti-inflammatory corticosteroids, Immunotherapy, Oral allergy pill, remove allergen, epinephrine.
Emergency attack: clear an airway block, and secure an airway is the highest priority in that situation.
Hypersensitivity Tests and measures
-Tests and measures
prick test, Allergen specific serum IgE tests to see if IgE binds, thorough hx of attacks and related info. Gathering hx and details is more reliable.
Hypersensitivity Physical Therapy Tests and Measures and Implications for Eval and Tx
-Physical TherapyTests and Measures and Implications for eval: NONE
-Best practice for Physical Therapy Treatment
make sure area is clean and allergen, powder and latex free
Scleroderma Definition and etiology
Definition: generalized connective tissue disorder characterized by immune dysregulation (autoantibody production), micro-angiopathy (vasculitis and obstruction of small vessels), andfibrosis of skin and internal organs. May occur in the heart, lungs, GI and kidneys. 3 sub groups:
Limited: less risk of systemic involvement. Pulmonary HTN adn espagus pathoolgy can occur. Skin tightness is limited to the hands and face.
Diffuse: Most debilitating - more frequent renal and pulmonary involvement. Classified on all body + skin
Systemic: Fibrosis of the skin, joints, blood vessels, and internal organs from deposition of excessive amounts of collagen. Can last months- lifetime
Etiology: Possibly triggered by auotimmunte response, otherwise unknown
Scleroderma Clinical Presentation
- Clinical Presentation: Signs/symptoms: not all peeps pass through all stages but Raynaurds is common btwn all exposures.
- *Stage 1:** edematous stage: bilateral, non-pitting edema is present in the fingers, hands, and, less commonly, feet. progresses to other body areas. PItting edema is replaced with thick, hard skin that has less sensation and vasoconstriction.
Stage 2: sclerotic stage tight, waxy, smooth skin. hyper-or hypo-pigmented. Facial skin may also be affected and take on a tight, mask-like appearance with thin lips and a pinched nose
** 3rd stage atrophic stage** tightening and calcification of subcutaneous skin over joints (elbow, knee fingers) which may lead to flexion contractures. Decr GI motility, decr fxn of esophagus andanorectal regions, frequent reflux, heartburn, dysphagia, and bloating, pulmonary heart and kidney issues.
Atrophy can occur 2/2 limited use/ mobility
Scleroderma Medical MGMT
-Medical MGMT: due to systemic involment treatment can consider Pulmonary arterial hypertension and digital ulcers, GI tract, heart, and joints. For tx, stage and involvement must be determined, the earlier tx the better.
Organ involvement: immunosuppressant, paniculonin, and anti-inflammatories)
Renal failure: ACE inhibitors
NSAIDS for pn mmgmt 2/2 active and passive stretching
Scleroderma Tests and measures
-Tests and measures Distinctive serum autoantibodies are found in more than 90% of cases. No single laboratory test for scleroderma. Skin biopsy, urinalysis, blood studies, presence of rheumatoid factor, and presence of antinuclear antibodies are used to determine the extent
Scleroderma Physical Therapy Tests and Measures and Implications for Eval and TX:
- Physical Therapy Tests and Measures and Implications for eval: Vitals (for CP involment), check capillary refill, joint pain, skin integrity, edema girth, facial tightness, 2 point discrimination for neuropathy, vitals, depression, MMT for atrophy, tinnels for carpal tunnel.
- Best practice for Physical Therapy Treatment: menthol and other soothing no itch creams, aquatic therapy, ROM and Ex, precaution of skin which can be V sensitive to pressure, ulcer mgmt- protect and dress it form trauma and pressure, flexibility for joints NSAIDS to help control pain which can be a limiting fx. Exercise should be done for pulmonary/cardiac involvement bu should consider tolerance and premorbid state. Address phsyco-social fxs as needed. Splints, but monitor skin changes.
Scleroderma Risk Fxs and Gender and Age Preference
Risk Fxs: Fetomaternal cell trafficking, emotional shock, chemical exposure
Gender and Age Preference: Fetomaternal cell trafficking, mortality rate higher in men. Affects 35-50 years of age
Sjogrens Definition and etiology
Definition: T-lymphocyte infiltrate or B cell hyperactivity cause autoimmune disease which causes destruction of exocrine glands like the salivary and lacrimal glands.
Etiology: perhaps genetic component - disrupted neurogenic regulation of salivary glands on a genetic level does not allow stemcells to make acinar cells
Sjogrens Risk Fxs, gender and age
Risk Fxs: having RA, as well as other autoimmune diseases or familial connection
Gender and Age Preference: Second most common rheumatic disease, 9 times more likely to affect women > men. more common in postmenopausal women, however, can affect men and women of all ages
Sjogrens Medical MGMT
-Medical MGMT:
local+ systemic stimulators for tear production for eyes, oral hygiene, prevention/treatment of oral infections d utilization of saliva stimulants and mouth lubricants for dry mouth.
Avoidance activities that cause dryness, use moisturize for skin.
NSAIDS, prednisone, or hydroxychloroquine + proper nutrition and exercise can help with joint/muscle stiffness and fatigue.
NSAIDS with proper nutrition for joint pain and gabapetin fro nueropathy
Sjogrens Tests and measures
- Tests and measures: (SSLP )
- Slit lamp test-detects damage to the eyes
- Schirmer Test-measures the dryness of the eyes
- Lip biopsy-detects inflammation of the salivary glands
- Blood test-checks for antibodies present in primary SS
Sjogrens Clinical Presentation
Clinical Presentation: Signs/symptoms: Problems with the integumentary, respiratory, renal, hepatic, neurologic, and vascular systems can lead to DRYNESS throat/ eyes esophagitis, gastritis, cavities in the teeth due to lack of saliva, vaginal and kidney dryness, fatigue, joint and muscle pain/stiffness, swelling, rashes, and peripheral neuropathy. keratoconjunctivitis and xerostomia = Dry eyes and mouth.
Sjogrens PT implications for Eval ,TX, tools and outcomes
- Physical Therapy Tests and Measures and Implications for eval: monofilmanet tests, Vo2 max for aerobic capacity (AC), 6 min walk test, 1 RM
- Best practice for Physical Therapy Treatment: Similar to RA. Fatigue is a huge fx, therefore create a baseline fo where activity tolerance is with tests to progress and track aporp. Moderate-high intensity exercise will increase AC. Use RPE to make sure pt. isnt sore after 1 hour of session and include strength and ROM EX to address stiffness, depression, body mechanics and CV fitness. 1 RM and 60-70 of Vo2 via astrand methood for 1-8 week and 70-80% for 9-12 weeks of training.
Ankylosing Spondylitis definition and etiology
Definition: chronic inflammatory joint disorder in axial skeleton. Can lead to fibrosis, calcification, and ossification of the involved structures: VB and assciated joitn inclding the costovertebral
Etiology: hereditary
Ankylosing Spondylitis gender, age add Risk fxs
Risk Fxs: first-degree relative with the HLA-B27 antigen.
Gender and Age Preference: Men> women 15 and 30 years but Women may be under dx
Ankylosing Spondylitis Medical MGMT, and tests/ measures
- Medical MGMT: NSAIDS, COX-2 inhibitors, anti-rheumatic drugs (DMARDs), Tumor Necrosis Factor Alpha (TNF-α)antagonist for prgression prevention and peripheral symps.
- Tests and measures: MRI, Schober test for patient’s ability to flex their low back(<15cm), and measurement of chest wall expansion(<2.5cm)
Ankylosing Spondylitis Clinical Presentation
-Clinical Presentation: Signs/symptoms: Low back, hip, or buttock pain and stiffness lasting at least 3 months, Dull pain that is hard to locate, occasionally sharp. Morning stiffness > 1 hour, better with activity worse with immobility and pn can go into thigh but never below knee.
Ankylosing Spondylitis PT implications for Eval ,TX, tools and outcomes
-Physical Therapy Tests and Measures and Implications for eval+ TX : Spine P/AROM (Schober test), CHest wall expansion, 6MW. Monitor for S/S of infection 2/2 supressed immune system if on TNF meds.. Avoiding flexion exercises, high impact exercises, contact sports, and other high risk activities due to increased risk of fractures. Gentle mobility exercises, passive physiological joint mobilizations, spine mus stretch and soft tissue, Aquatics program > land for benefits and pilates.
