hsc4558 exam 1
exacerbation
(MS) symptoms become worse; lasts at least 24 hours; separated from other attacks by 30 days; may last several days to weeks or months; not due to an infection or other cause
relapsing-remitting (RRMS)
85% of MS cases; exacerbations followed by remission; symptoms subside or recovery to baseline; may have disease progressions between attacks
immunodeficiency
HIV impairs the immune system cells leading to _________________
activities
ICF; execution of a task or action by an individual (learning and applying knowledge, general tasks and demands, communication, mobility)
personal factors
ICF; influences on functioning particular to the individual which are not represented elsewhere in ICF (gender, age, race, education)
participation
ICF; involvement in a everyday life situation (self care, domestic life, interpersonal interactions and relationships, major life areas, community social and civic life)
environment
ICF; the physical, social and attitudinal environment in which people live and conduct their lives; these are either barriers to or facilitators of the person's functioning (products and technology, natural environment/ human changes to environment, supports and relationships, attitudes, services, systems and policies
body functions
ICF; the physiological functions of body systems (including psychological functions)
FIM (Functional Independence Measure)
Quantifies the amount of assistance needed with activities of daily living (ADLs); -independence: 7= complete (safety) and 6= modified (devices -modified independence: 5= supervision, 4= minimal assistance, 3= moderate assistance complete dependence: 2= maximal assistance, 1= total assistance
sudden unexpected death in epilepsy (SUDEP)
Sudden and unexpected death in an individual diagnosed with epilepsy who is otherwise healthy; no other cause of death found in autopsy; leading cause of death in people with uncontrolled seizures; prone position (face down) is a major risk factor in people 40 and younger
lung
________ cancer is the leading cause of cancer deaths
prostate; breast
_____________ cancer is the most common in men; ____________ cancer is the most common in women
thrombus
a blood clot formed inside an artery that supplies brain tissue with blood
embolism
a clot that has formed in another part of the body breaks free and travels through the blood vessels to the brain, lodging in one of the cerebral arteries
Multiple Sclerosis (MS)
a neurological condition that involves the deterioration of myelin; an autoimmune disease; the immune system attacks the protective sheath (myelin) that covers/ insulates nerve fibers and causes communication problems between your brain and the rest of your body; eventually can cause permanent damage or deterioration of the nerve
tissue plasminogen activator (tPA)
a strong "clot dissolving" medicine; helps breakdown clots and restore blood flow to the brain; eligible when ischemic stroke patient is seen within 3 hours of having symptoms
aneurysm
a thin walled outpouching protrudes from a blood vessel; may be due to either weakness of the wall of the vessel or a congenital aberration; in many cases, cause no manifestation until they burst
neoplasm
a tumor; a new and irregular growth of cells that serves no useful function and may interfere with healthy tissue function
broca's aphasia
a type of nonfluent (expressive or motor) aphasia; speech output is severely reduced and is limited mainly to short utterances of less than four words; may understand speech relatively well and be able to read, but be limited in writing
dysplasia
abnormal growth or development of cells; may signify a precancerous stage
primary progressive (PPMS)
about 15% of MS cases; may manifest in people in their 30s or 40s; gradual but steady disease progression from symptom onset (may have short periods of disease stability; no clear relapses or remissions
deficiency
according to the medical model, disability is _____________
cure of the underlying difference; surgery, medication, intervention/ education
according to the medical model, how do we change/ address disability?
individual, physical, cognitive/ mental, and sensory ability to perform without added time or assistance
according to the medical model, what is independence?
in the individual body
according to the medical model, where is disability located?
professionals (doctors, rehab professionals, special educators)
according to the medical model, who is the expert who creates change?
difference
according to the social model, disability is ________________
change the interaction between the individual and society; policy changes; disability pride and culture
according to the social model, how do we change/ address disability?
freedom to do what you want to do, when, where, and with whom you want to do it; choice; power over life decisions; control over everyday life and resources to support it
according to the social model, what is independence?
in social structures and practices that oppress as well as in interactions with others
according to the social model, where is disability located?
person with a disability/ disabled person; advocacy groups directed by people with disability
according to the social model, who is the expert who creates change?
autonomic neuropathy
affects nerves which control bladder, intestinal tract, genitals (UTIs, erectile dysfunction, diarrhea/ constipation, gastroparesis- slowing of digestive system)
gestational diabetes
affects pregnant mother late in pregnancy who have never had diabetes; occurs in 5-7% of all pregnancies; screening often conducted during pregnancy; this could cause your baby to be at a higher risk for health problems
epilepsy
an impairment of the brain; underlying neurological condition causing disruption of electrical activity in the brain; recurring seizures
grade IV
anaplasia- undifferentiated, origin of cells difficult to determine
body structures
anatomical parts of the body such as organs, limbs, and their components
66
approximately _______% of MS cases are female
stage 2: chronic HIV infection
at this stage HIV is active but reproduces at low levels; clinical latency- may not have symptoms or feel sick; can transmit disease; at the end of this phase if not taking meds (untreated, could be ~10 years) the viral load increases while CD4 count decreases; taking appropriate meds may keep person from going to next stage
localized
cancer limited to its origin; no evidence of spreading
refractory cancer
cancer not responding to treatment
leukemia
cancer of blood cells or blood precursor cells
melanoma
cancer of pigment-producing cells, usually of the skin
sarcoma
cancer of the bone, muscle, or other connective tissue
carcinoma
cancer of the epithelial cells (skin, organ lining, glandular tissue)
lymphoma
cancer of the lymphatic system
recurrent cancer
cancer returns after treatment
distant
cancer spread to distant organs, tissues, lymph nodes
regional
cancer spread to nearby organs, tissues, lymph nodes
malignant tumor
cancerous; invades normal tissue and may recur after removal
mutation
changes in the DNA by deletion, insertion or rearrangement of genes; may be harmful or beneficial
carcinogen
chemicals or substances that may cause cancer
amyotrophic lateral sclerosis (ALS)
chronic disease affecting voluntary motor pathways of the central nervous system; symptoms usually begin after age 40; clinical course is rapidly progressive
dysarthria
coordination and accuracy of movement of muscles, lips, tongue, or other parts of the speech mechanism may be impaired secondary to weakness or paralysis of muscles needed to speak; occurs when muscles used for speech are weak or you have difficulty controlling them; often causes slurred or slow speech that can be difficult to understand
dysphagia
difficulty swallowing
aphasia
difficulty with the ability to transmit or understand verbal or written language
corticosteroids (can be used for a limited time; have multiple side effects); disease modifying drugs (injection, oral, infusions); mostly used for relapsing forms of MS and should begin ASAP
discuss medications to manage MS
-healthy habits (address sleep/ consider rest breaks -work simplification and energy conservation (activity modification and assistive devices/ technology) -alternative and complementary therapies -identifying and avoiding triggers (stress) -rehabilitation therapies
discuss some general management strategies when dealing with MS
peripheral neuropathy
disorder of the peripheral nerves that carry information to and from the brain and spinal cord; affects hands and feet; 50% of diabetes have some form; more common in long-term disease (tingling, pain, numbness, sensitivity to touch)
receptive aphasia
don't understand what the person with a stroke is saying
secondary
form of ALS due to other disease processes; ALS-like symptoms associated with syphilis, hypoglycemia, plasma cell disorders
familial
form of ALS occurring more than once in a family lineage (genetic dominant inheritance); in these families, 50% chance each offspring will inherit the gene mutation (may develop disease); very small number of cases in the US (5-10% of all cases)
Sporadic
form of ALS that can affect people of any race, ethnicity, or gender; 4-6 per 100,000 people; most common form in the US (90-95% of all cases)
Guamanian
form of ALS with extremely high incidence in Guam, Trust Territories of the Pacific in 1950s (50-100 times greater); one theory: exposure to a toxin from the cycad nut
WHO (World Health Organization)
formed 1948; 194 member states; primary role is to direct and coordinate international health within the United Nations system
hyperglycemia
high blood glucose due to too little insulin or inefficient use of insulin; high levels of sugar in the urine; frequent urination (polyuria)/ at night (nocturia); increased thirst; severe- diabetic coma
prediabetes
higher than normal blood glucose level but doesn't yet meet diabetes diagnosis; known as impaired glucose tolerance; fasting blood sugar (normal)- under 100 mg/dL; more than 1 in 3 people
antigen/ antibody tests; nucleic acid tests; oral mucosal transudate and urine testing
how can HIV be diagnosed?
bodily fluids, vaginal or anal intercourse, oral sex, sharing needles, passing virus from mother to fetus, accidental contamination with infected blood
how can HIV be transmitted?
can cause glaucoma (increased eye pressure/ damage to optic nerve, loss of vision), cataracts (lens clouds and blocks light), and retinopathy (disorders of the retina, blurred vision, vision loss)
how can diabetes affect the eyes?
high blood sugar feeds bacteria and leads to plaque buildup (can cause cavities, tooth decay, and gum disease)
how can diabetes affect the teeth and gums?
physical and neurological exam, bloodwork, EEG, MRI, CT, PET
how can epilepsy be diagnosed?
MRI (lesions found in 2 separate areas); rule out everything else; take clinical history and neurological exam; evoked potentials (measures electrical activity in brain (visual, auditory, sensory); lumbar puncture (CSF); blood tests
how is MS typically diagnosed?
stage 0
in situ
hyperplasia
increased reproduction rate of cells
ataxia
individuals may experience inability to manage the accuracy of muscle movement or limb position; a lack of muscle control or coordination of voluntary movements such as walking or picking up objects
unknown
insufficient information of cancer to make decision
type 1 diabetes mellitus
insulin dependent diabetes (IDDM)- autoimmune disease, insulin deficiency (need injection), more common in youth; 5-10% of diabetic population; genetic predisposition; symptoms include polyphagia (weight loss), polydipsia, polyuria, fatigue
kidney disease (nephropathy)
kidneys are damaged and can't filter blood the way they should; filter too much blood with high glucose, leaking of protein, waste products build-up, kidneys work hair but fail at the end (fluid build-up, loss of sleep, poor appetite, upset stomach)
stage III
larger cancer, may have spread to surrounding tissue/ lymph nodes
stage II
larger tumors have grown deeper in tissue, may have spread to lymph nodes but probably not
stage 3: AIDS
last and most severe stage of HIV infection; ripe for developing opportunistic infections; may have a high viral load and infectious; no treatment means survival or ~3 years at this particular stage of the disease
AIDS
last stage of HIV, stage 3; extremely low number of CD4 cells; opportunistic infections occur
permission
level of PLISSIT model that allows patients to raise sexual issues by creating a comfortable environment where they are open to sharing; the provider can also ask open ended questions to encourage the patient to open up more; strong emphasis on asking patients if they feel comfortable talking about sexual symptoms before asking direct questions related to this
specific suggestions
level of PLISSIT model that emphasizes the importance of making specific suggestions based on a full evaluation of presenting problems; stage where the problem starts to be addressed; it is important to tell the provider that this is only the first attempt at addressing the issue, but there are also other treatment options, so no one should feel discouraged if the current treatment plan doesn't work
Limited information
level of PLISSIT model that gives patients limited information about sexual side effects of treatments; once the patient expresses that they have a concern, it is the responsibility of the provider to offer information and educate the patient
intensive therapy
level of PLISSIT model where the provider would offer a referral to more specialists and intensive therapies; for example, some individuals may need psychological interventions, sex therapy, and potentially biomedical approaches. these specialists can provide more support and guidance in a field that they know well.
hypoglycemia
low blood sugar (less than 70 mg/dL); shakiness, nervous or anxious, sweating/ clammy, irritability, confusion, fast heartbeat, hunger, headache, feeling weak/ no energy; may exacerbate MI and dysrhythmia, may lead to falls in the elderly, severe: insulin shock
apraxia
manifestation in which individuals lose ability to carry out purposeful, coordinated voluntary motor skill movements, despite having the physical ability to do so
silent stroke
may not know of stroke; may have had momentary confusion or memory problems; minor difficulty with walking/ getting around
amputation
may result from peripheral arterial disease; reduced blood flow to feet, reduced sensation- unable to detect injury such as ulcers and infections, impacted by smoking which decreases blood flow and slows wound healing
hemoglobin A1c test
measures average blood sugar level for past 2-3 months; below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes
urinalysis
measures glycosuria; not definitive in making diabetes diagnosis; may be good screening tool
hospice
medical care for people with an anticipated life expectancy of 6 months or less; when cure isn't an option, and the focus shifts to symptom management and quality of life
stage IV
metastasis, cancer has spread from primary area to other parts of body, worst stage
grade I
mild dysplasia
grade II
moderate dysplasia
20-50
most cases of MS are in people ____-_____ years of age, although it may occur in children and elders as well
diabetes
most common endocrine disease; improper processing of sugar; high blood sugar disorder with defects in insulin secretion, insulin action or both; imbalance of supply and demand for insulin; insidious as it affects every body system
clinically isolated syndrome
newer category of MS; single demyelinating attack; first neurological symptoms experienced (typically 24 hours or longer); may return later or not (delay could be years or months)
apraxia of speech
no significant weakness or incoordination for reflexive action but rather the inability to position and sequence muscle movements properly; individuals may be able to scrape a food particle off their teeth with their tongue, yet be unable to coordinate the muscles that move the tongue so as to produce a phonetic sound; speech disorder in which a child's brain has difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases
type 2 diabetes mellitus
non insulin dependent diabetes (NIDDM)- aka adult onset but also in obese children/ teens; insulin resistance; 90-95% of diabetic population; usually milder form than type 1; main risk factor is obesity; symptoms include polydipsia/ polyuria, unusual weight loss or gain, headaches and fatigue
benign tumor
non-cancerous; non-harmful; localized
ischemic stroke
occlusion or blockage of a blood vessel that diminishes blood flow to brain tissue; most common type of stroke; common cause is blood clot formed inside artery that supplies brain tissue with blood; another cause is embolism
secondary progressive (SPMS)
occurs following relapsing-remitting MS type (delay of years or maybe decades between R-R and secondary progressive); progressive course of disease (disability gradually increases); may or may not have relapses (90% of RRMS)
opportunistic infections
only occur in those with deficient immune systems; can effect all body systems; pathogens run amok and cause severe illness; occur when CD4 count is less than 200 cells per milliliter of blood
primary site
original place where cells mutated
secondary site
other areas that are impacted from the spread of the originally mutated cells
65%; 60%
over ____________ of people with TBI caused by bullet wounds have seizures; over _____________ of people who need 2 or more brain surgeries after a TBI experience seizures
glucagon
produced by pancreas alpha cells; stimulates liver to release glucose when levels are low; may be used to treat medical conditions; opposes the effect of insulin; elevates under stress conditions
insulin
produced by the beta cells of pancreatic islets; regulates carbohydrate metabolism; types include rapid-acting, short-acting, intermediate-acting, and long-acting; methods of entry include syringe, injection pen, and pump
Huntington's Disease (chorea)
progressive, genetic condition of the central nervous system; mutations in HTT gene; neurons in basil ganglia of brain deteriorate; symptoms develop between ages 30-50; leads to total disability and death after 15-20 years
endocrine system: ductless glands
provide regulatory function; maintain homeostasis; secrete specific hormones; communication amongst the systems
ICF (International Classification of Functioning, Disability, and Health)
provides a common language across disciplines; conceptual framework for understanding the complex nature of disability
hemorrhagic stroke
rupture of a blood vessel in the brain
simple focal
seizure with subtle changes in sensations and emotions, twitching
absence seizures (petit mal)
seizures accompanied by rapid blinking, staring into space
generalized tonic-clonic (grand mal)
seizures characterized by loss of consciousness, muscle rigidity, and muscle jerks; may cry out, fall to the ground; may last for minutes; followed by confusion and fatigue
complex focal
seizures with uncharacteristic repetitive movements such as twitching, mouth movement, walking in a circle, actions that may seem purposeful, and other automatisms
heat
sensitivity to _________ is another common symptom of MS
global aphasia
severe difficulty communicating because of both inability to use language and severe difficulty in understanding language
grade III
severe dysplasia
stage I
small cancer, localized to origin
anosognosia
sometimes after a stroke, people are not able to recognize the effect that it has on them. so you may not known that you have lost movement in your arm or leg, for example
palliative care
specialized medical care for people living with a serious illness; focused on providing relief from symptoms and the stress of the illness; goal is to improve quality of life for both patient and family
metastasis
spread of cancer from primary site to other areas
seizure
state of temporary loss of control over specific body functions
relapse
sudden deterioration after a period of improvement; slip back into a former state
in situ
superficial, abnormal cells have no spread beyond where they first formed
remission
symptoms disappear or lessen in intensity; may stay in remission or may come and go over time, but does not mean that MS has disappeared; may return to baseline
transient ischemic attacks (TIAs)
temporary blocking of cerebral arteries causes slight, temporary neurological deficits that lead to these "mini-strokes"
fasting blood glucose
test that measures your blood sugar after an overnight fast; blood sugar level of 99mg/ dL or lower is normal, 100 to 125 mg/ dL indicates you have you have prediabetes, and 126 mg/ dL or higher indicates you have diabetes
tumor size, node involvement, metastasis
the TNM staging of cancer is based on what 3 components?
HIV
the virus; stage 1 or 2; causes the collapse of the immune system; introduction of life-threatening disease; destroys CD4+ ("helper") T cells; may be latent for up to 10 years**; underlying mechanism for AIDS; doesn't last long outside body
2.3 million; 1 million
there are about ___________________ cases of MS globally and about _______________ in the United States (mostly in high altitude regions- canadians have highest rate)
increase
there has been an _______________ in the prevalence of individuals with epilepsy
PLISSIT
this model is used to address sexuality in individuals, potentially those with MS
antiretroviral therapy (ART)
treatment for HIV that involves a combination of 3 or more meds from different drug classes in 1 pill; may take between 3-6 months to be effective; medication to be taken consistently to be effective; may need to be changed (drug efficacy may decrease over time); goals- maximize virus suppression, reduce infection risk, keep immune system strong, reduce disease transmission
true
true or false: individuals with MS have a close to normal lifespan
true (you should work on non fatiguing exercises, with some resistance- light weights or resistance bands; focus on maintaining strength and range of motion)
true or false: overexercising can increase MS symptoms
false
true or false: the ICF is a diagnostic structure
false (you can just manage it)
true or false: there is a cure for MS
wernicke's aphasia
type of fluent aphasia in which there is effortless speech, relatively normal grammatical structure, and increased verbal output, but with reduced information content so that what the individual says makes little sense; auditory and reading comprehension is usually poor; individuals usually unaware of their communication difficulties
oral glucose tolerance test
undergo fasting test and then drink sugary solution; 2 hours post have another blood test
anaplasia
undifferentiated cells; possible malignant transformation
ICD (International Classification of Diseases)
used to promote international comparability making it easier for data collection, processing, classification, and presentation of mortality statistics; it helps to provide a method of reporting the cause of death on the death certificate
unexplained persistent fatigue; fever, chills, night sweats; unexplained weight loss; swollen lymph nodes; pink, red, purple, or brown blotches
what are some common symptoms of HIV
autoimmune, genetic factors, environmental triggers, geographic areas further from equator, and viruses & bacteria
what are some of the causes of MS?
unpredictability of symptoms, adjustment to disease and fluctuations, chronic condition
what are some of the challenges of MS?
low levels of vitamin D in utero, low levels of sun exposure in childhood, high cow's milk consumption, high BMI as adolescent, smoking (passive as well)
what are some of the environmental triggers for MS?
slow progression, manage/ reduce symptoms, support lifestyle changes, tailor program to address individual needs (address/ decrease relapses, promote mobility)
what are some of the goals of MS rehab?
kidney failure, liver damage, heart disease, diabetes/ insulin resistance, hyperlipidemia, lipodystrophy, osteoporosis, peripheral neuropathy, depression, suicidal thoughts
what are some of the long term HIV medication side effects?
vision loss, spasticity, pain, fatigue, functional limitations, numbness and tingling, muscle spasms, stiffness, weakness, problems with thinking, learning and planning, and depression and anxiety
what are some of the most common symptoms of MS?
Speech, PT, OT, Neuropsychology, Rehab Nursing and Physiatry
what are some of the rehab therapies involved with managing MS?
fatigue, nausea, vomiting, diarrhea, headache, fever, muscle pain, occasional dizziness, insomnia
what are some of the short term HIVmedication side effects?
weight control, healthy nutrition, exercise, oral medications (potentially insulin)
what are some of the treatment management strategies for diabetes?
ketogenic diet, vagus nerve stimulation, surgical intervention, medications (may have side effects)
what are some of the treatment methods for epilepsy?
check your blood glucose, 15-15 rule (eat 15 grams of carbs and check blood glucose after 15 mins- if below 70 mg/ dL, have another serving), IV glucose, severe case: injectable glucagon (IV, intramuscular, subcutaneous), wear a medical ID, trained service dog
what are some of the treatment options for those with hypoglycemia?
stroke, high fever, concussion, other TBI, low blood sugar, alcohol and drug withdrawal, reaction to medication, and more
what are some related symptoms/ conditions that may present seizures?
insulin injection, correct any dehydration, ID bracelet, trained service dogs
what are some treatment options for people with hyperglycemia?
genetics, immunology, virology, and the biology of glial cells
what are the four areas of research regarding MS?
injury and death
what are the most serious epilepsy related complications?
muscle weakness, fasiculations (involuntary contraction or twitching of muscle fibers); begins with muscle atrophy, loss of strength (fasiculations in extremities and face); progresses to muscle spasticity, severe weakness; gait abnormalities, arm function deficits, impaired speech and swallowing, respiratory muscle weakness
what are the symptoms of ALS?
must be a licensed clinician; involves watching training videos, observing others in practice, and taking an exam
what kind of trining is involved in order to administer FIM?
undetectable
when there is a ________________ viral load, the risk of transmitting HIV is greatly reduced; can be maintained with ART; you are not cured
ART (antiretroviral therapy)
when there is a high viral load detected there is a high degree of HIV in the blood. this is typical in early stages of the disease. _______________ treatment can decrease the viral load
negative
when there is no viral load detected, or no exposure, you are identified as HIV _____________
cognitive
which area of FIM is this? -communication: comprehension, expression -social cognition: social interaction, problem solving, memory
physical
which area of FIM is this? -self-care: eating, grooming, bathing, dressing upper body, dressing lower body, toileting -sphincter control: bowel and bladder management -transfers: bed, chair, wheelchair, toilet, tub or shower -locomotion: walk, wheelchair, stairs
25
with RRMS and PPMS, people can work up to ______ years past onset
Stage 1: acute HIV infection
within 2-4 weeks of becoming infected with HIV; large viral load: INFECTIOUS; flu-like symptoms OR may have no symptoms
glucose; ketones
without insulin, the body cannot use ___________ as a source of energy; to replace the energy normally gained from this source of energy, the body must break down fat instead, causing a buildup of a toxic byproduct known as _____________. eventually, this results in diabetic ketoacidosis- a life-threatening condition in which excess ketones make the blood too acidic
advance directive
written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor