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Foundations of Disease SCCC PTA program Final

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Question
Answer
Diabetes Mellitus   metabolic syndrome with hyperglycemia and alterations in metabolism of carbs fats and proteins, decondary to absent or reduces production of insulin and or ineffective action of insulin  
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Type 1   beta cells in islets of langerhans damaged and cannot produce insulin, early onset, patient underweight, lack of effective insulin, ketosis prone, need insulin to live  
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glucose   blood sugar  
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glycogen   stored glucose  
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glucogenolysis   breakdown of glycogen  
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gluconeogenesis   breakdown of fasts and proteins into glucose  
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lipolysis   breakdown of fats  
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pancreas   makes insulin  
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liver   controls glucose levels  
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insulin   hormone produced in pancreas to get glucose from blood stream tot he cell  
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glucogon   gets glucose from cell to bloodstream  
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three purposes of glucose   used as energy stored as glycogen, converted into fatty acids  
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type 2   cell membrane resistant to glucose leading to hyperglycemia will not progress to ketosis, patient generally overweight, later onset in life  
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retinopathy   eye problems associated withDM  
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neuropathy   nerve damage caused by DM  
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CVD   complication of DM approximately 50%  
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nephropathy   kidney comlications associated with DM, generally kidney failure  
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Macrovascular disease   TIA, Stroke, Angine, Myocardial infarction, cardian failure, PVD  
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Microvascular Disease   diabetic retinopathy, non proliferative, proliferative, macular edema, microalbuminuria, macroalbuminuria, end stasge renal disease, ED, autonomic neuropathy peripheral neuropathyh, osteomyelitis, amputation  
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risk factors for diabetic ulcers   uncontrolable hyperglycemia, durtation of diabetes, PVD, blindness or visual loss, chronic renal disease, older age, peripheral neuropathy, foot deformity, trauma and poorly fitted shoes, callus, Hx of ulcers prolonged elevated pressure, limited jt mob  
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Gangrene   complication of necrosis caused by infection two major types wet and dry and both can lead to an amputation  
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PT education   teach patients to imspect feet and body daily for open wounds that may become infected  
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symptoms of hyperglycemia   excessive thirst polydipsia, urination polyuria, dry skin, hungry polyphagia, blurry vision, drowsy, slow healing wounds, what to do chekc glucose level, call HCP  
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symptoms of hypoglycemia   shaky, increased HR, diaphorisis, dizzy, anxious, hungry, blurry vision, weakness or fatique, headache, irritable, what to do check glucose treat and check again  
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ketoacidosis   is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat proteins in response to a perceived need for respiratory substrate, is a type of metabolic acidosis which is caused by high concentrations of ketone bodies  
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TBI   Truamatic brain injury  
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brain   uses 1/5 of resting cardiac ourput, 1.6 of O2 consumption  
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Major causes   MVA, falls, suicide  
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direct blow injuries   can be closed or open, opne involves penetrating skull,  
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indirect blow injuries   caused by a blow on another part of the body, fall on buttocks or whiplash  
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types of axonal injuries   stretching of axon, twisting of axon, compression of axon, or a reaction of axon to damage  
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primary damage   damage caused by injury nerves and or blood vesels of brain  
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secodnary damage d   death of unaffected cells from bleeing or edema diaschesis  
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associated trauma to other systems   fractures and organ involvment  
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injury mechanisms   compression, hemorhage, hematoma edema: tenion; intracranial pressures: shearing; herniation  
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concussion   transient state of unconcsiousness, associated post traumatic amnesia, closed injury  
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contusion   bleeding and bruising, coup and contrecoup, closed injury  
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laceration,   tearing of tissue, hemorhage and severe edema, open injury  
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grade 1 concussion   mementary confusion, no loss of consciousness, symptoms clear in 15 minutes  
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grade 2 concussion   symptoms last more than 15 minutes  
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grade 3 concussion   you got knocked out, loss of consciousness  
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subarachnoid hematoma   headnache stiff neck, vomitting, photophobia, iritability usually resolves on own  
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subdural hematoma   involves veins, surgical evac required slow healing  
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epidural   involves arteries compression of brain herniation surgical evacuation required  
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intracerebral hematoma   hematoma with in the brain generally in the white mater  
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impariments of TBI   level of consciousness, a and O memory, executive functions  
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coma   state of consciousness no arousal or awareness no sleep wake cycle eyes closedm short duration 3-4 weeks  
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vegetative state   sleep wake sycle returns, vegetative functions retunr may be aroused but unaware, reutnr of brainstem reflexes, grimacing, vocalizations to nociceptive stimulus grasp response, tonic reflexes  
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persistant vegetative state   you are not moving out of this state  
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minimally responsive   signs of awareness are present  
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glascow coma scale   measure state of coma  
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ranchos los amigos levels of cognitive function   progess once out of coma  
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decerebrate rigidity   extenor pattern rigidity  
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decorticate rigidity   flexor pattern rigidity in uppers extensor pattern in lowers  
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parkinsons disease   shaking palsy, caused by low levels of dopamine produced by substantia nigra in the basal ganglia, it is idiopathic no known cause  
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parkinsons disease   insidious progressive and degenerative involving the basal ganglia as a result of the substantia nigra which results in a deficiency of the neurotransmitter dopamine  
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Who is PD likely to effect   50-60s, men over women, whites over blacks, 1.5 million people in the US, 1/1000 people, lower prevalence in africa and china,  
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types of PD   postencephalic, pseudoparkinsonian symptoms due to tumors, and boxers brain or head truama, cna be drug induced from synthetic heroin, MPTP, antipsychotic meds  
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etiology of PD   free radicals, external or internal toxins, genetic factors, aging process is accelerated  
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cause of PD   loss of 80 percfent of the dopamine producing cells in th esubstantia nigra  
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neurotransmitter imbalance   imbalance of dopamine and acetylcholine when dopamine to low acetylcholine takes over and movements become shaky the dopamine and ach work together to produce smooth movement  
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early signs of PD   difficulty dressing, alterations in handwrtiting, stiffness slowness, eating difficulty, voice changes, facial masking, blaance issues, tremors  
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parkinson tetrad   tremor, rigidity, bradykinesia, postural instability  
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tremors   pill rolling, common first symptom, resting, distal, can be exacerbated  
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rigidity   cog wheel lead pipe flexores over extensors, not position dependent  
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brady kinesia   slowing of voluntary movement, secondary to delayed initiation, delayed stopping, decreased reaction time, decreased speed and amplitude  
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akinesia   freezing  
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kinesia paradoxia   may be frozen but you can initiate movement  
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poverty of movment   no blinking, facial expression or arm swing in gait  
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postural instability   loss of righting, and equilibrium reactions, festinating gait, loss of anticipatory postural reflex, stooping posture  
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motor planning   feedback mode instead of feedforward, requires cuing, and triggers  
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sensory   PD is a motor disorder but patient may experience abnormal sensations paresthesias, akathisia- restless moving  
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ANS complications of PD   B and B, thermoregulation, flushing of skin, sialorhea(drooling) seborhea- flaky skin, orthostatic hypertension  
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hypomimia   facial masking  
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hypophonia   low voice  
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micrographia   small writing  
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dysarthria   slowed slurred speech  
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dysphagia   trouble swallowing  
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gait characteristics   decreased BOS, decreased stride length, decreased velocity, loss of pivoting, loss of armswing, stooped posture, short shuffling steps, festination, retropulsion(body leaning back as walking) anteropulsion(body leaning forward in gait using momentum)  
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cognitiv eeffects of PD   affected usually secondary to drugs with psycosis effect  
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treatments of PD   surgical pharmaceutical rehabilitation  
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surgical treatment of PD   cryotherapy, pallidotomy, thalamotomy, neural tissue transplants, tremor control therapy, neurostimulation  
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L dopa   synthetic dopamine  
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carbidopa   slows breakdown of l dopa  
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entacapone   extends time period of l-dope in brain  
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drug complications of treating PD   dyskinesias, depression anxiety, psychotic episodes, halucination, wearing off phenomenon, on/off phenom window of drug use small.  
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stroke   sudden onset of neurological symptoms resulting from a disturbance of the blood supply to the brain  
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incidence of stroke   700k ppl/yr, 500k first attacks, 200k recurrent  
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morbidity/mortality of stroke   1/3 recover 1/3 disable, 1/3 die  
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modifiable risk factors of stroke   HTN, smoking, heart disease, diabetes, TIA, high cholesterol, CAD, sleep apnea, birth control pills  
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non modifiable of stroke   age(over 65), gender moremen then women, women die more, ethnicity 2x in AA, family history, prior stroke  
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symptoms of stroke   sudden numbness or weakenss of face, arm or leg, elspecially on one side of the body. trouble speaking, sudden confusion, sudden trouble seeing, in one or both eyes, trouble walking, dizziness LOB, or coordination sudden sever headache with no known cause  
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ischemic attack   embolus blocks area, leading to no blood in area therefore no O2,  
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hemorhaggic attack   blood vessel bursts, secodnary to HTN pin hole in blood vessel  
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aneurysm   weakeing and ballooning of vessel walls  
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symptoms of right CVA   left hemiplegia left hemianopsia, visual sptial skills, motivation, emotional lability, recognition, attention,  
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left CVA   right hemiplegia, right hemianopsia,working memory ,learned skilled movements, brain stem, understaning speech, talking, verbal memory, long term goals,  
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muscle tone   UMN lesion, hypertonia, spasticity, slow disuse atrophy  
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apraxia   association centers inability to do something on command ideational as well as ideomotor  
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synergies   brunstrom, six stages flexors strongers over extensors, six stages moving to normalcy, 6=normal, 5 isolated movement 4 movment in synergy, 3 full synergy, 2 spasticity, 1 flaccidity  
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flexion synergy   shoulder elevators, elbow flaxors, hip flexors  
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extension synergy   , shoulder adductor, and depressors, pronators, hip adductors, hip internal rotators, knee extensors, plantar flexors  
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hemianopsia   half of the visual field is missing, folows plegia of CVA  
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pushers syndrome   pt pushes to affected side  
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neglect   they dont realize there is a side of involvment  
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aphasia   wernickes brocas global depending upon what portion of brain affected wernickes in males, brocas more comon in females  
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pharmacological affects   ticlid reduces risk, selfotel prevents further cell death, tirilazad protects cell from hemorhage, TPA dissolves the clot  
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Best PT timing   early treatment, active treatmenr orient to involved side, bilateral activities, trunk emphasis, proper positioning  
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neurofacilitation techniques   positioning, successive induciton, irradiation, tone inhibition  
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souques phenom   when arm raised over 90 degrees abd or flex fingers fanout  
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successive induction   antagonist facilitates agonist  
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raimistes phenom   overload a strong muscle to get a weak one to fire  
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homolateral limb synkinesis   flex arms legs flex on same side  
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tone inhibition   reciprocal inervation, icing, tapping virbration of opposite muscle, and positioning  
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problems with sling   limit sensory input, place extremetiy into non functional pattern, impairs body image, impairs arm swing in gait can lead to edema of hand  
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assistive devices   encourages asymetry, decreases wlking speed, increase energy expenditure, inhibits WS and WB to weak side, inhibit normal arm swing, may increase hypertonus  
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common gait deviations   slwoer wlking speed, longer cycle, difficulty in singel limb, short stance phase, fast swing phase on stronger side, associated reactions in weak arm, absent trunk rotation, retraction of weak hip during stance phase recurvatum of weak knee,  
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more gait devieation   circumduction hiphiking, extended knee during swing phase, lack of dorsiflexion, +trendelenburg, no push off on weak side  
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diaschesis   flaccid paralysis in muslce bladder and bowel, loss of sensation, areflexia, loss of perspiration, hypotension, bradycardia  
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stretch injury   hyperflexion in c56, hyperextension at c45  
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falls   severe compression vertebra can shatter, axial loading head c45 feet t10 11 12  
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complete TSCI   total loss of motos and sensory in the lowest sacral segment s2-4  
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incompplete TSCI   sacral sparing, partial preservation or complete preservation of motor and sensory function in lowest sacral segment, anal sensation, sphincter function  
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brown sequard   one side of the SC injured common from stab wounds GSW  
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central cord   central part damaged,  
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posterior chord   sensory involvment  
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anterior cord   motor involvment  
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cauda equina   horses tail involvement compression of cauda equina  
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UMN lesion   PMC to AHC, causing spasticity  
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LMN lesion   flaccid areflexia, @ level of lesion  
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motor level of injury   last nerve root that innervates key muscles at F strength  
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sensory level of injury   last nerve root in which sensation is normal, light touch and pin prick  
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zone of partial preservation   neurological levels below injury that may still exhibit some function  
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impairments TSCI   across all body systems, NM, pulmonary, CV ANS, genitourinary, Musculoskeletal, integumentary  
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breathing complications   phrenic nerve c3-5 primary muscle of inspiration, intercostals, t1-12 inspiration and expiration functions, cervical c2-4 acccessory to resp. abd. t6-t12, forced expiration and cough  
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pulmonary impairments of SCI   no independent respiratory function with lesions above c4, respiratory fatique, sleep apnea with high cervical lesions, difficulty clearing secretions, atelectasis(collapsed lung), bronchial obstruction, pneumonia, pneumothorax  
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CV impairments SCI   bradycardia, hypotension, disruption of sympathetic nervous system decreased BP,  
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ANS impairments SCI   thermoreg, orthostatic hypotension, apnea bradyarrythmia, syndrome, autonomic dysreflexia, neurogenic bladded/bowel, sexual dysfunction  
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GI impairments SCI   paralytic iteus, motility stops, stress ulcers-ans not working  
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Musculo skeletal SCI   osteoporosis, heterotropic ossificans, contractures, paraplegia dystonia, spasticity, pain  
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integumentary SCI   decubiti, complications infection abscess, sepsis, osteomelitis, death  
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PT goals of SCI treatment   maintain and improve function  
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c3   face and neck motion none to litlediaphram, portable ventilation, totally dependent in self care, sip n puff wc, able to use environmental contorl unit  
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c4,   diaphragm trap, dependent on personal care, independent pressure relief with poer tilt in space wc  
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c5   delt some biceps low respiratory reserve, light grooming and feeding with hand device,sassistance for bathing dressing and transferes with sleiding board  
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c6   rotator cuff biceps wrist extensors, may acheis ind in perosnal care, assist in transfers, rolling in bed with side rails, manual propulsion in wc, pressure relief, skin inspection, cough with abdominal pressure  
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c7-8   triceps, writs flexors, finger flex and extends, upper limb except hand intrinsics, may totally independent in personal care, can roll over, sit up in bed, mover in sitting positioning, transfers with and without sliding board wheelchair smooth surface  
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t1-5   hand intrinsics, and some intercostals, full inervation of UE at t1, can function independent form WC, lacks trunk, trnasfers between floor and WC  
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t6-12   intercostals and abd, enhanced respiration, may ambulate with bracing and swing thru  
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l1-3   hipflexors some quads may ambulate with short leg bracing  
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l4-s1   hamstrings some ankle and foot, ambulation with minimal aids  
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CV impairments   bradycardia, hypotension, disruption of sympathetic nervous system decreased BP,  
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ANS impairments   thermoreg, orthostatic hypotension, apnea bradyarrythmia, syndrome, autonomic dysreflexia, neurogenic bladded/bowel, sexual dysfunction  
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GI impairments   paralytic iteus, motility stops, stress ulcers-ans not working  
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Musculo skeletal   osteoporosis, heterotropic ossificans, contractures, paraplegia dystonia, spasticity, pain  
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integumentary   decubiti, complications infection abscess, sepsis, osteomelitis, death  
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PT goals   maintain and improve function  
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c3   face and neck motion none to litlediaphram, portable ventilation, totally dependent in self care, sip n puff wc, able to use environmental contorl unit  
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c4,   diaphragm trap, dependent on personal care, independent pressure relief with poer tilt in space wc  
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c5   delt some biceps low respiratory reserve, light grooming and feeding with hand device,sassistance for bathing dressing and transferes with sleiding board  
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c6   rotator cuff biceps wrist extensors, may acheis ind in perosnal care, assist in transfers, rolling in bed with side rails, manual propulsion in wc, pressure relief, skin inspection, cough with abdominal pressure  
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c7-8   triceps, writs flexors, finger flex and extends, upper limb except hand intrinsics, may totally independent in personal care, can roll over, sit up in bed, mover in sitting positioning, transfers with and without sliding board wheelchair smooth surface  
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t1-5   hand intrinsics, and some intercostals, full inervation of UE at t1, can function independent form WC, lacks trunk, trnasfers between floor and WC  
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t6-12   intercostals and abd, enhanced respiration, may ambulate with bracing and swing thru  
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l1-3   hipflexors some quads may ambulate with short leg bracing  
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l4-s1   hamstrings some ankle and foot, ambulation with minimal aids  
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MS   chronis progressive demyelinating inflammatory disease involving the CNA  
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demelinating   myelin erodes from the axon decrease NCV and more energy to conduct impulses  
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etiology MS   viral autoimmune or combination, first sixteen years determines risk  
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autoimmune response   system attacks itself  
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plaques   slcerosis and scarring of CNS, around spinal cord  
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incidence of MS   white temperate climate, young adult women folk  
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diagnosis MS   made upon evidence of lesions in CNS demonstrated onCT or MRI, or two seperate attacks lasting at least 24 hrs at least one month apart, and involving 2 areas of CNS, progression of symptoms for at least 6 month  
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course MS   unpredictable exacerbations remissions classical coursed, subclinical, benign, relapsing remitting, secondary crhonic progressive, primary progrressive which has no remissions  
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common attacks   corticospinal tract, optic nerve pathways, brainstem and cerebellar pathways, posterior column tracts  
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somatosensory impariment   5-70 percent or patients, usually first symptom, one limb, one side, all limbs, parethesias, loss of vibration and proprioception, loss of tactile discrimination, l'hermittes sign  
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l'hermittes sign   neck bends forward electircal shock down back  
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somato motor   first noted in gait, corticospinal tract, fluctuating muscle tone, heaviness of limbs, weakness, spastic paresis, spasms, UMN symptoms, cerebellar symptoms + babinski  
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Visual   early symptom, 8% of patients, optic neruitis, decreased visual acuity, photophobia, nystagmus, ptosis, strabismus, pain, dimmin, oscillopsia  
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ANS complications   neurogenic bladder, detrusor internal sphincter dysynergia, bowl problems, abnormal sweating, intolerance to heat, sexual difficulties  
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cognitive impairments   50% of patients, more prominnetn as disease progresses, mood swings, euphoria, lability, memory problems, reasoning difficulties,  
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related difficulties   central fatigue, paroxsymal symptoms(sudden outburt of symptoms and sudden remisison)  
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charcot triad   is the combination of nystagmus, intention tremor, and scanning or staccato speech  
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best prognosis   acute before 35, monosymtomatis, sensory over motor, complete remission after first attack  
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worst prognosis   early cerebellar signs, early spasticity or trmor  
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pharmacy   ACTH replacement, steroids, immuno suppressant, antiviral mood elevators, antispasmotics(valium baclophen dantrium)  
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disease modifiers   betaseron interferon avonex, copaxone  
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other treatments   dorsal stimulators, snake venom bee venom  
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arthritis   inflamation of joints cna be reumatoid or osteo  
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RA   systemic disease affecting the synovial sac, invovles joints, organ including heart eyes skin vascular, systemic response, malaise, weakness, fatigue, depression ,exacerbations and remissions  
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three major courses of RA   flareups and remissions, long clinical remissions, progressive unremitting  
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RA   affects all structures of join increaes join pressure and joint effusion  
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granulation tissue   in joint pannus, describes the granulation tissues that is formed with the synovium by proliferating fibroblasts and inflammatory cells  
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joint bones   characterized by pitted carilage and bone  
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joints affected   cervical spine, shoulders, finger (ulnar deviation) knees, ankles, toes,wrist general morning stiffness lasting 1-3 hrs, knockkneed, peripheral involvment progressing proximal  
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deformities   hammertoes rhematoid nodule, ulnar drift, vallets of weakend muscles  
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swan neck   hyperextension of PIP, flexion of DIP RA  
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bouteniere   flexion of PIP, extension of DIP, RA  
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Ankylosing Spondylitis   fusing of vertebrae as well as kyphosis  
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Osteoarthritis   Trophis degeneration not inflmmation  
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Etiology of OA   abnormal physical forces, OBesity, orthpedic problems, trauma,, altered biocheimical processes of cartilage, aging hormones and drugs  
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SYmptoms of OA   pain with exercise, gel phenomenon, osteophyte, hypertrophy of bone, squaring off of bone, enlarged bony jt, crepitus, deformity and loss of ROM ,muslce weakness, and dusue atrophy, aching with cold,  
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Joints affected,   spine, hips, fingers, knees big toes bow legged  
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bouchards node   huge PIP  
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heberdens node   huge DIP  
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Arthritic Gait pattern   slow antalgic, decreased stance, asymmetrical step length, less motion in involved jts, decreased forward and alteral smoothness, + trendellenberg  
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PT GOals of OA   releive paint, analgesis and anti inflammatory, maintain mobility, ROM and exercise, reduce disability, protective splinting adaptice devices, prevent progression with surgery and drugs  
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pharmacology of Arthritis   nsaids corticosteroids, disease modifiers  
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surgeries for Arthritis   synovectomy, tenosynovectomy, tendon surgery, athrodesis, athroplasty the last two are for OA  
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athrodeissi and atrhoplasty   relieve pain provide stability correct or reduce deformity improve function  
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total hip contraindications   hip flex past 90, hip add, and IR  
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patient education   remove things that promote ulnar drift jar opening, stirring spoon, lifitn pots  
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Glascow COma Scale   numbered scale that measures the level of consciousness of a person  
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exacerbation   an increase in symptoms when speaking of MS or RA  
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remission   when a symptom disapears  
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euphoria   an emotional and mental state defined as a sense of great (usually exaggerated) elation and well being  
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uthoff symptom   diplopia or blurred vision in people with MS  
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dyskinesia   decreas of voluntary movement  
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dysphagie   difficulty swallowing  
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wearing off phenomenon   drug wears off  
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hypokinesia   slow movements  
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hypomimia   facial masking  
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micrographia   small handwriting  
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on/off phenomenon   drug on and off  
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sialhorrhea   drooling  
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seborhea   flaky skin  
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hypophonia   weak voice  
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akinesia   no voluntary movements  
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akathersia   reslessness  
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brsdykinesia   extreme slowness  
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autonomic dysreflexiA   HYPERREFLEXIA`  
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postural hypotension   othrostatic hypotension  
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DVT   deep vein thrombosis, clot  
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heterotropic ossification   bone formation within soft tissue  
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spinal cord dysethesias   pain or abnormal sensations  
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post traumatic seizures   seizures after the trauma occurs  
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multipodus boot   boot used for wounds lots of padding  
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tilt in space wheelchair   gives the TBI patient ability to move  
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status epilepticus   refers to a life-threatening condition in which the brain is in a state of persistent seizure  
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seizure trigger   stiumulus that forces a seizure  
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ansence seizure   the person may appear to be staring into space with or without jerking or twitching movements of the eye muscles. These periods last for seconds, or even tens of seconds.  
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prodromal sign   first symptoms  
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focal seizure   seizure occurs in one spot  
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jacksonian seizure   grand mall seizure  
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aura   prodromal sign of seizure episode  
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anomia   trouble recalling words  
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paraphasia   is a notable feature of aphasia in which one loses the ability of speaking correctly, substitutes one word for another, and changes words and sentences in an inappropriate way. The patient's speech is fluent but is error-prone  
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abulia   lack of initiative  
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disinhibition   no inhibitions  
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emotional labiltiy   INABILITY TO CONTROL EMOTION  
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PERSEVERATION   is the uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder  
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emotional dysregulation syndrome   uncontrollable lauching crying, pseudobulbar affect  
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learned nonuse   they dont use affected side  
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unilateral neglect   they negelct a side dont realizxe they even have it  
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ideomotor apraxia   inability to perform a task on command and to imitate gestures even though the person understands the concept of the task  
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ideoational apraxia   an inability to perform a purposeful act automatically or upon command an inability to retain the idea of the task and to formulate the necessary motor pattern  
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