PCE Studying

Grasping reflex

0-4m: grasp when pressure is put on palm of hand. Relaxes if stroke back of hand.

Asymmetric tonic neck reflex (ATNR)

0-4months: head turn to one side, ext of arm at that side and flex of the contralat side

Subdural hematoma

Tear in a cerebral vein at the site where it enters a sinus - results in bleeding between the dura and arachnoid Usually due to a rotation force, shearing of brain under dura matter

Anterior spinothalamic tract of SC: fxn, path

crude touch and pressure (lateral spinothalamic is pain and temperature) decussates within 1-2 segments in ant commissure of SC, goes to thalamus then parietal lobe 1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury

SCI complication: osteoporosis

d/t rapid increase in calcium excretion within days of SCI. Large incidence of #, especially in L/E.

SCI: level of lesion

Most distal segment with intact sensation and motor fxn bilaterally. Sensory level: most caudal segment with bilateral score of 2 Motor level: most caudal segment with a bilateral grade of 3 or more Only look at sensory scores to get level of injury in T spine.

CN XI

Motor to SCM and traps

Sustained maximal inspiration/incentive spirometry

Same thing, only IS provides visual feedback, perhaps more motivating. Similar indications to diaphragmatic breathing. 10x/hour. Goal is to increase collateral ventilation via Kahn & Lambert channels (equivalent to yawning).

Bronchiectasis

Scarring, destruction, dilation of alveoli/airways as a result of chronic bacterial infection (eg: CF, TB, endobronchial tumor). Heavy mucous production also impedes airflow. "vicious circle": persistent infection/inflammation leads to mucus production, leads to impaired mucociliary clearance, leads to hypersecretion and obstruction, leads to microbial colonization, leads to bronchial dilation and airway drestuction, leads to more inflammation and infection, and so on. Starts with an initial infection

myocardial infarct

See p. 73

Treatment for sensory deficits ( joint position sense, 2 point discrimination, etc.)

educate on limb protection and skin care, use available somatosensation (balance exercises, minimize edema, promote active mvmt, desensitize hypersensitivity, maximize visual and vestibular input via mirrors), adaptive equipment, increase confidence

Moro reflex

when feeling like they are falling the child will open their arms then bring them back to their chest

Medical management of pleural effusion

thoracocentesis (removal of fluid with a needle)

Symptoms of hypertrophic cardiomyopathy

SOB, angina, fainting, sudden death. Can be asymptomatic or have very mild symptoms

Positive expiratory pressure (PEP)

Same principle as PLB. Low pressure PEP: evidence in CF and post-op. Little evidence for high pressure

Capsular pattern: ulnohumeral

flex>ext

Explain pupillary reflex

Afferent is optic nerve, efferent is oculomotor's parasympathetic fibers. Light shined into one eye causes that eye to constrict (the direct response). The other eye also constricts (consensual response).

Heomophilia causes

Caused my a missing factor in the clotting cascade. In Type A, it's factor VIII, in other types, it's another. Inherited genetic disorder. Females usually not affected, but can carry the gene.

Emphysema

Generally caused by smoking, results in hyperinflation of alveoli and floppy airways. Causes merging of alveoli into larger air spaces thus reducing the surface for gas exchange. In pure emphysema, dry cough/no mucus production.

SCI and respiration

Generally need to be at least a C4 to breathe independently. T11 and below, normal vital capacity. Innervations: - diaphragm: C3-C5 - accessory muscles of respiration: C2-C7 - intercostals: T1-T6 - abs: T7-T12

Burns: zones

Zone of coagulation: zone of maximum damage, irreversible tissue loss Zone of stasis: decreased tissue perfusion, potentially salvageable Zone of hyperemia: increased perfusion, will recover unless sepsis occurs

Back pain. What indicates that may be inflammatory arthritis?

-young people ( under 45) with persistent back pain that does not get better -morning stiffness for longer than 30-60 minutes -pain wakes them up at night, gets better when they move around

Anterior cerebral artery (ACA)

Lines floor of longitudinal fissure, on top of corpus callosum. Supplies medial aspect of both lobes. Stems from int carotid artery. Lesion: - contralat paralysis in L/E - contralat loss of somatic sensation in L/E

Aneurism

Localized abnormal dilation of blood vessel wall. May rupture. Most common location is abdominal aortic aneurism, and can turn into an aortic dissection. Other bad places to get one is circle of willis and thoracic aorta

Broca's area

Located in left premotor cortex, responsible for directing motor language output. Lesion (Broca's aphasia) - difficulty initiating speech - difficulty with articulation (dysarthria) - difficulty with writing - comprehension of speech intact

Salter Harris #

# in children, growth plate involvemnt. Immob usually btwn 3 and 6 weeks

Greenstick fracture

# in young kids, have malleable bones, # is only on 1 side

Clinical symptoms LMN syndrome

(1) Weakness/paresis of denervated muscle, hyporeflexia and hypotonia, (rapid) atrophy, fatigue. (2) Sensory loss; proprioceptive losses may yield sensory ataxia; insensitivity may yield limb trauma. (3) Autonomic dysfunction: vasodilation and loss of vasomotor tone (dryness, warm skin, edema, orthostatic hypotension). (4) Hyperexcitability of remaining nerve fibers. (a) Sensory dysesthesias: ie. hyperalgesia. (b) Motor: fasciculations, spasms. (5) Muscle pain (myalgia) with inflammatory myopathies (e.g., post polio syndrome).

IRDS

(Infant respiratory distress syndrome) Babies who do not have fully developed respiratory systems, and lacking surfactant Risk factors: -premature -multiple births -C-section -turning blue -stops breathing and grunts Treatment: deliver artificial surfactant

Airway clearance techniques

(This is from the bronchiectasis lecture) -postural drainage -manual techniques -active cycle of breathing -oscilatory PEP -PEP therapy -autogenic drainage -high frequency chest wall oscillation

Concussion, dx

- sudden acceleration to the head - manifestation of 1 or more symptoms: --> cog (memory, brain fog, concentration) --> sensory (visual disturbances or sensitivity, sensitivity to sound) --> somatic (headache, balance impairment, nausea) --> emotional (anxiety, depression) --> other (fatigue, drowsiness, sleep disturbance) Fatigue, headache, and balance disturbance are the 3 most common ones

Rheumatoid arthritis: common deformities

- MTP subluxation - hallux valgus - claw toe - hammer toe - mallet toe - MCP ulnar drift - boutonniere - swan neck - claw finger - BD thumb or swan neck - wrist DRUJ instability (ulnar head subluxes distally)

Kolaczowski techniques

- Rib springing - Lift on inspiration - Intercostal stretch - Percussion on SMI

SCI - causes

- traumatic (35-40%): falls most common cause. Also MVAs, sports, etc. - non-traumatic (60-65%): congenital, vascular, tumour, infection/inflammation, motor neuron disease

Skin graft: 2 types

- split thickness skin graft: stitched, glued, or sutured in place. immobile for 5 days - full thickness skin graft: skin transplant. Rx: scar massage, sun protection, ROM, pressure garments. Strengthening in 3-4wks.

Hypoglycemia, S&S

- weak - shaky - dizzy - nervousness, anxiety, irritability - nausea or hunger - sweating, chills, pale skin - fainting -confusion

Juvenile rheumatoid arthritis PT management

(same as juvenile idiopathic arthritis) -Encourage child to keep participating in social, sports activities an other activities with their peers. -Sports and physical activities while in remission -rest and symptom reducing therapies during flare ups -Maintain strength, ROM, function

SARS definition and S&S

(severe acute respiratory syndrome) Viral respiratory illness, caused by SARS coronavirus S&S: flu like symptoms (myalgia, cough, sore throat, lethargy Can lead to pneumonia

GBS: presentation

- Ascending motor weakness (begins in legs, goes to arms, and sometimes involves facial/ocular/oropharyngeal muscles). May require mech ventilation - Bilateral weakness, although some asymmetry is common - Reduced or absent DTRs (LMN lesions) - Some sensory disturbances in stocking/glove distribution - disautonomia, eg: cardiac issues - cranial nerve involvement

Ankylosing spondylitis ax

- C/o of AM stiffness (>30min) - LBP (>3months) - decreased spine ROM - signs of enthesitis (TOP) - scan of surrounding joints - decreased CW expansion - altered posture/muscle imbalances - fatigue

Contraindications to doing manual lymph draimage

- Cardiac edema/ CHF -acute renal failure - acute untreated infection -Thrombosis/ DVT - Lymphedema caused by suspected active cancer/tumor, that has not yet been diagnosed.

Key aspects of PT treatment for Parkinson's

- External cues: visual, rhythmic, multisensory - helps activate different brain regions to increase attention req'd and decrease BG involvement - Amplitude-based Behavioural Intervention: "training big" program, repetitive, high-amplitude, whole body mvmts - Other: relaxation exercises, flexibility, resistance training, functional training, balance training, aerobic exercise, breathing exercises, client/family/caregiver education

TBI outcome measures/predictors of prognosis

- Glasgow Coma Scale (GCS), scale out of 15, higher number the better. 3 categories: eye opening, verbal response, motor response. Used acutely - Rancho Los Amigos scale, out of 10, higher number the better. 1 is unconscious, 8 is fxning well but lacking abstract reasoning. Predictor of fxnal outcome post injury - Length of LOC and length of post-traumatic amnesia used to determine if TBI is mild, mod or severe

2 types of airway-lung reflexes

- Irritant (mechanical or chemical --> cough, sneeze, deep breath in) - Stretch (Info about lung volume sent to medullary neurons --> Participate in H-B inflation reflex (e.g. inflation inhibits insp and promotes exp))

OA: symptoms

-AM stiffness <30min -localized joint pain/tenderness -worsens c activity, relieved by rest -may have locking/giving way -may see malalignment, alterations in gait pattern

SCI: ASIA classification system

- Sensation: 28 dermatomes tested bilaterally for light touch and pin pinck. Graded as: 0 - absent, 1 - impaired, 2 - intact. 2 is considered normal Includes sacral sensory: deep anal pressure. if present, pt has a sensory incomplete injury ASIA B - Motor function: 10 bilateral myotomes. Graded from 0 --> 5 C5: shoulder abd/elbow flex, C6: wrist ext, C7: elbow ext, C8: thumb ext, ulnar deviation, long finger flexion, T1: finger abd. L2: hip flexion, L3: knee ext, L4: ankle DF, L5: big toe ext, S1: ankle PF > or = gr 3 considered normal. + sacral motor: voluntary anal contraction. If present, indicated motor incomplete, ASIA C.

Midline cerebellar lesion

- Truncal ataxia (difficulty sit or standing without falling over, generally towards side of lesion) - Nystagmus when directing gaze ipsilaterally - Wide ataxic gait - Vertigo - Fine motor control of limbs intact

Concussion - rehab principles

- acute phase rest (typically 5-7 d) - gradual symptom free progression of stressors - active rehab - address other issues

Contact dematitis (exogenous eczema)

- allergic contact dermatitis: immune hypersensitivity to an allergen in contact with the skin (eg: nickel, poison ivy) - irritant contact dermatitis: contact of skin c smthg that primarily causes direct local irritation (harsh detergent, chemical) Rx c topical steroid

Rheumatoid arthritis - key features

- bilateral -synovitis is a main feature - pain worse in AM (synovitis) - tends to affect distal joints (eg hands, feet) - may involve deformities as progresses

Radiation side effects

- burns - scar tissues - ROM loss - local bone density loss - fatigue

IPPA - Palpation

- chest wall expansion (upper, middle, lower lobe ant, and lower lobe post) - tracheal position - tactile fremitus - muscle palpation (accessory muscle use) - rhoncal fremitus, subcutaneous emphesyma

IPPA - Percussion

- dull, resonant, hyper-resonant - can be used to measure diaphragmatic excursion - dull: air/tissue ratio lower than normal (Eg: pulm fibrosis, atalectasis, consolidation) - hyper-resonnant: eg: COPD, pneumothorax

Burns: contra-indications to ex

- exposed joint - fresh skin graft - DVT - compartment syndrome -PROM in the acute phase

IPPA: Inspection

- facial expression (distressed?) - nose (flaring) - lips (cyanosis, pursed lips) - neck (signs of accessory muscle use, jugular vein distention) - chest wall (intercostal indrawing, barrel chested, kyphosis, scolosis) - limbs (cyanosis, clubbing) - cough (strong/weak, productive, dry, wet) - sputum (colour, amount, consistency, smell) - speech (interrupted by laboured breathing) - type of breathing (paradoxical, diaphragmatic, increased RR)

Dorsal columns of SC: info it carries

- fine touch/2 point discrimination - vibration - conscious proprioception Fasciculus gracilis: L/E, medial Fasciculus cuneatus: U/E, lateral

Side effects chemo

- hair loss - weight/muscle loss - nail damage - diarrhea/constipation - fatigue - nausea, vomiting - low WBC, RBC, platelets (bone marrow suppression) - peripheral neuropathy - headaches - mouth sores

Types of shock

- hypovolemic (blood loss) - cardiogenic (heart damage) - distributive (hypotension and general tissue hypoxia. like anaphylactic shock) - obstructive (for example, pulmonary embolism, aortic stenosis)

Breathing exercises

- increases ventilation/prevents atelectasis - reduces the work of breathing/O2 demands - strengthens respiratory muscles - helps with relaxation - helps with secretion clearance - increases chest wall mobility - in through nose, out through mouth

Burns: PT management

- keeping wound moist - electrotherapy - debride wound - pain management - first 2-3 wks: AROM and PROM to maintain range - scar management (as early as 1-4 days can get a scar tissue contracture)

Rheumatoid arthritis dx criteria

- morning stiffness >1hr (6wks) - arthritis in >3 joints (6wks) - arthritis of hand joints - rheumatoid nodules - serum rheumatoid factor - radiographic changes - abnormal antibody HLA-DR4 (80% of those w RA)

Sternotomy precautions

- no lifting of >10lbs above waist - no pushing or pulling of >5lbs

Summary of symptoms of degenerative joint disease

- pain/stiffness upon getting up, which eases over the morning (4-5 hours) - pain with repetitive bending (flexion of joint) - constant awareness of discomfort when exacerbated - pain described as sore and nagging pg 22 of MSK American textbook

Percussions: contraindications/precautions

- rib fracture - severe osteoporosis - metastatic bone cancer - resectable tumour - burns - asthma - prone to hemorrhage (check platelet count) - subcutaneous emphysema (neck or thorax) - poor/unstable CV status - recent skin graft or flap - pneumothorax - can trigger bronchoconstriction: use carefully if at all in pts with asthma

Auscultation: vocal sounds

- whispered pectoriloquy (pt whispers 1, 2 ,3 as you auscultate. Shouldn't hear anything - if do, consolidation) - bronchophany (pt says 1, 2, 3 as you auscultate. Increased transmission = consolidation, decreased transmission = block of some sort) - egophany (pt says "e" as you auscultate. If sounds like "a", increased density)

Posterior cerebral artery defecits

-vision loss in contralateral visual field of both eyes -Thalamic syndrome (neuropathic pain from damage to posterior thalamus) -difficulty with naming and colors

What are the different elements of combined decongestive therapy? (for lymphedema)

-Exercise -Compression/taping -Manual lymph drainage -Skin care and infection prevention

Percussion precautions/ contraindications

-Flail chest/ fractured ribs - Prone to hemorrhage - metastatic bone cancer, brittle bones - Burns - subcutaneous emphysems - unstable CV status (really unstable not just high BP) - recent skin graft - resectable tumor - pneumothorax (Fat Ponies/Horses Make Bums Say U Rock Rotund Pony)

Ankylosing spondylitis PT management

-Global functional approach -dec pain -increase spine mobility. -spinal extension exercises, 2x daily -try to sleep in prone -breathing exercises (AS causes decreased pulmonary function) -prevent deformity -aerobic

Middle cerebral artery defecits

-contralateral loss of motor and sensory function IN THE UPPER BODY AND FACE (because of upside down homunculus) -Global aphasia (broca's and wernike's area affected) if in left hemisphere, (assuming that is their dominant one, as is the case with most people)

Lymphedema risk factors

-Node removal (the more removed, the higher the risk) - full mastectomy - radiation to axilla, higher number of doses -nodes that were positive (after removal, they test them to see if tumor positive. If they are, increases risk of lymphedema) -radiation that includes upstream nodes and vessels -post op complications -cording -increased BMI -genetic pre-disposition (some people just more likely to get it)

PT management of bronchiectasis

-airway clearance techniques -assess for exercise/ functional capacity - assess O2 requirements -exercise training and adjuncts (IMT) -education on self management -these patients appropriate for pulmonary rehab SPECIAL CONSIDERATIONS FOR EXERCISE: -cut back exercise during acute exacerbations -stay hydrated -infection control

Abducens nerve palsy

-cannot abduct ipsilateral eye (loss of lateral rectus muscle) -diplopia

Oculomotor nerve lesion

-diplopia -ptosis -pupil dilation due to loss of parasympathetic efferents -Eye position "down and out"

Anterior cerebral artery defecits

-emotionally labile -contralateral weakness and loss of sensation in LOWER BODY (because of upside down homunculus) -self care problems

Haemophilia clinical S&S

-excessive or prolonged bleeding post surgery, during surgery -joint and soft tissue bleeding -bleeding in joints is the most common problem (knees, elbows, ankles) -large bruises -serious trauma causes serious internal bleeding signs of bleeding in the joint: -jt tightness without pain, then with pain. Then swollen, hot to the touch, hard to move. Then all ROM lost, and severe pain... if not treated leads to arthritis

Cystic fibrosis S&S

-fatigue -salty tasting skin -frequent respiratory infections -persistent cough with infections -wheezing and shortness of breath -poor growth and weight loss -problems with bowel movements in first 24/48 hours of birth THERE IS A MUCH LONGER LIST OF S&S ON PHYSOPEDIA, DIVIDED BETWEEN INFANT, CHILD, AND OTHER MEDICAL PROBLEMS THAT ARISE. FEEL FREE TO MAKE THIS CARD MORE DETAILED IF YOU LIKE

Medical treatment approach to inflammatory arthritis (rheumatological diseases)

-first, trial anti inflammatory drugs. Try at least two (not at the same time), at their full dose, for several months. If that doesn't work, then biologics (what advanced practice PT said)

red flags for rheumatic diseases

-fracture, septic bursitis, malignancy, cord signs.

PT for RA in the chronic phase

-functional exercises -moderate intensity exercise -aquatic exercise (endurance) -fall prevention -decrease stiffness with gentle ROM -modalities for pain -prevent deformity

Medical management of bronchiectasis

-get flu and pneumonia shots -antibiotic therapy -inhalation therapy (bronchodilators, corticosteriods) - airway clearance techniques -pulmonary rehab -O2 therapy SURGICAL: -surgical resection of focal disease -bronchial artery embolization -lung transplant (but has to be double or infection will spread from bad to good lung)

Causes, contributing factors for thrombophlebitis

-inactivity -cancer (increases clotting factors) -pregnancy -oral contraceptives -stasis of blood -trauma, surgery -dehydration -injury to vessel wall

Peripheral arterial disease S&S

-intermittent claudication -occurs at distant sites from where narrowing is -skin shinny, thin and hairless (often in the feet) -ulceration and gangrene -acute ischemia (palor, pain, no pulse, paralysis) same as peripheral vascular disease, I think

S&S of an inflammatory condition

-morning stiffness that lasts more then 30 minutes -moderate to severe swelling -sometimes present erythema -warmth sometimes present -systemic features sometimes present -frequently increased ESR (erythrocyte sedimentation rate)

Juvenile idiopathic arthritis S&S

-often starts with fatigue and lethargy -Limping -AM pain and stiffness -persistent swelling in the joint -May have flu like symptoms

Asthma treatment

1) prevent triggers (mould, dust, animal dander, cold...) 2) if exercise induced, make sure to do proper warm up (increase SNS activity to cause bronchodilation, before the spasm starts). Also can do pursed lipped breathing. 3) meds. Many kinds. corticosteriods, sympathomimetics, anticholinergics, long acting cortocosteroids. Available in combinations as well, eg, corticosteriod combined with long acting bronchodilator OTHER THINGS TO DO FOR MANAGEMENT IF IT'S EXERCISE OR COLD INDUCED???? (CAN'T FIND LECTURE ON IT)

Types of lymphedema

1) primary lymphedema: rare genetic disorder. Lymphatics don't develop 2) secondary lymphedema. lymphatic system becomes compromised due to injury, trauma, cancer treatment

Physical findings with flail chest

1) shallow breathing 2) splinting due to pain 3) crepitation over the fractured segment during ventilation 4) paradoxical movement of flail segment 5) confirmation with CXR

Causes of pneumonia

1) Bacterial, viral or fungal (usually airborne pathogens) 2) inhallation of toxic chemicals (smoke, dust, gas) 3) aspiration (impaired consciousness: after surgery, neuro disease, alcohol abuse)

Kinds of pulmonary edema

1) Cardiogenic: from increased load on the pulmonary circulation, from left heart failure, aortic valve disease, or mitral valve disease 2) Non cardiogenic: caused by increased permeability of the alveolar capillary membrane. From ARDS, inhalation of toxic fumes, hypervolemia, narcotic overdose

Cranial nerves that carry taste

1) Facial (anterior 2/3 of tongue) 2) Glossopharyngeal (posterior 1/3 of tongue) 3) Vagus (epiglottis)

Types of scoliosis

1) Structural or Functional --> in standing only, ie leg length discrepancy 2) Idiopathic --> most common Congenital --> vertebral deformities Neuromuscular --> secondary to other conditions, like CP, spina bifida, physical injury

Types of pneumonia

1) Typical: sudden onset of symptoms, usually cause is bacterial). Fever, sputum, physical consolidation signs 2) Atypical: No symptoms, little sputum, min chest signs

Types of asthma

1) atopic/ allergic/ extrinsic Usually due to a specific allergen (dust, aminal, mould, pollen, food additives) -onset usually in childhood -most common kind -type 1 hypersensitivity reaction 2) Intrinsic/ non-allergic -develops later in life usually -episodes precipitated by: cold, stress, pulmonary infections, chemical or environmental pollutants Mixed asthma: There is also a kind of asthma that is a combination of both kinds.

Pertinent physical findings with pulmonary edema

1) crackles 2) tachypnea 3) coughing up pink frothy sputum 4) dyspnea 5) hypoxemia 6) CXR: increased vascular markings, hazy opacities in a gravity dependent pattern, causing a butterfly pattern. Atelectasis possible.

Assessment findings for pneumothorax

1) dec breath sounds on affected area 2) hyper-resonant/tympanic on percussion 3) decreased expansion on affected side 4) decreased tactile fremitus (pillow effect) (RIGHT?) 5) decreased whispered pectroliloquy (sp?) (RIGHT?) 6) black on CXR, vascular markings don't extend all the way to the chest wall 7) trachea shifts away (depending on degree of atelectasis) 8) signs of resp distress 9) chest pain

Terrible triad of MI (and what kinds of changes on ECG go along with them, and when the onset is)

1) ischaemia (inverted t waves, poor blood supply and hypoxia. Occurs within seconds on onset. is reversible) 2) injury (A. Elevated ST segment- myocardia injury occurs during MI in 20-40 minutes. reversible. B. depressed ST segment- injury to myocardial tissue. can occur during angina). 3) infarction (abnormal Q waves and QRS complexes. Can also have increased R waves. Not reversible. Occurs 2 hours after onset)

Types of pneumothorax

1) open (like a stab wound). air moves in freely during breathing 2) closed pneumothorax. no movement of air from pleural space (like from a needle) 3) Tension pneumothorax (is a kind of closed pneumothorax): opening becomes open on inspiration, and seals on expiration. Air goes from lung into pleural space and gets trapped in pleural space. Increases the pressure on the heart, and heart can stop beating VERY SERIOUS. 4) traumatic pneumothorax. May be caused by non-penetrating injury to chest wall, like a rib fracture 5) spontaneous: kind of like an air-filled pleural bleb (like a blister) that bursts in pleural space. Common in 30-40 yo men. May be associated with TB or asthma. 6) hemothorax: blood in the pleural space. usually from laceration of parietal pleura - more of a pleural effusion

types of angina pectoris

1) stable (effort angina, or classic angina). Worse with activity, better with rest or nitroglycerin 2) unstable (lasts longer than stable angina, is more severe, or more frequent. Can happen at rest. May not get better with rest or nitroglycerin). 3) prinzmetal (variant angina). Occurs at rest, more rare, caused by a spasm of coronary arteries.

What are the kinds of heart valve disease?

1) stenosis ( failure to open completely). impedes flow. 2) regurgitation/insufficiency. valve fails to close (reverse blood flow)

Kinds of congestive heart failure

1) systolic (has trouble contracting. can fill but can't get enough out when contracting) 2) diastolic (has trouble relaxing. Can't accomodate ventricular blood volume. Can pump the blood out, but enough didn't get into the ventricles in the first place.) Note: CHF can also be classified in other ways, eg right vs left heart failure, or other ways

Categories of pleural effusion

1) transudative (also called non-inflammatory PE). pleural fluid is made up of the same stuff, there is just more of it. Causes include: systemic causes. problem with the lymphatic system, heart failure... 2) Exudative. larger amount of fluid, and also the content is different. Examples: blood from surgery, inflammation/infection OTHER CLASSIFICATIONS OF PE: -inflammatory (inflammation in pleural space. this includes emphyema, which consists of pure pus) -chylous PE. chyle in the space, usually from metastatic disease, or cardiac surgery -Chiliform PE. Looks like chyle but is not -Fibrous PE. accumulation of fibrous tissue

ABGs: steps

1. Check pH: normal, acidotic, alkaline? 2. Check pCO2 and HCO3 for one that matches disturbance - responsible one 3. Check other value to see if any compensation has occurred. --> will be either absent, total or partial compensation to metabolic or respiratory acidosis or alkalosis

Impingement sites for thoracic outlet syndrome

1. Interscalene triangle 2. Costoclavicular triangle (scapula 1st rib and clavicle) 3. Subcoracoid space (between pec minor and thoracic wall)

Rheumatic diseases - Subjective Ax

1. Red Flags - #, septic arthritis, malignancy, central cord S/S, focal/diffuse muscle weakness, burning/numbness/paraesthesia 2. Inflammation - in joint or around joint? if in joint affects multiple ROM, no focal TOP, swelling common 3. Focal (<3 joints) or Widespread (>3 joints) 4. Acute (<6 weeks) or Chronic ( >6 weeks) 5. Inflammatory or Non-inflammatory condition

Types of multiple sclerosis

1. Relapsing-Remitting (80%) - attacks of 1+ symptom but don't return to baseline between 2. Primary Progressive (10%) - gradual worsening with no attacks 3. Secondary Progressive - starts as RR then turns to progressive 4. Progressive Relapsing - most severe

CN3 lesion

1. dipoplia 2. ptosis (droopy eyelid) ipsilat 3. dilated pupil ipsiplat 4. eye down and out

CN 4 lesion

1. dipoplia 2. eye up and out at rest ipsilat 3. difficulty to direct gaze down and in ipsilat Trochlear nerve (aka PATHETIC NERVE because head position)

CN2 lesion

1. optic nerve: loss of vision ipsilat eye 2. optic chiasm: tunnel vision (loss of outer half of vision on both sides) 3. optic tract, 1arey visual cortex: hemianopsia (loss of same half of both eyes)

10 principles of neuroplasticity

1. use it or lose it 2. use it and improve it (motor learning) 3. specificity 4. repetition 5. intensity 6. time matters 7. saliency 8. age matters 9. transference 10. interference

Anterior corticospinal tract

10% that crosses at level of innervation, travels in ventral white column. Innervates trunk muscles. Lesion cannot be clinically detected

How long does it take an adult to heal from a fracture?

10-12 weeks (Kids = 4-6, adolescents = 6-8 weeks)

HIV: consequences

Loss of immune syst fxn, decreased CD4+ helper T cells (CD4 count will be 200-500/ml vs normal = 800-1200/mL) Increased vulnerability to: - TB - pneumonia - meningitis - malignancy - encephalitis - dementia - herpes zoster (shingles)

Normal amount of dead space in the lungs

300 ml

Neutropenia

Low levels of WBC, relates to body's ability to fight infection. Should be 4,500-11,000/mcL (per microliter)

Malignant melanoma

Most dangerous form of skin ca. High potential for metastasis - likely to have many lymph nodes removed, Mole will have the following characteristics: ABCD rule: asymmetry, irregular border, irregular colour, diameter (generally >5mm)

Normal tidal volume

500 ml

Psoriatic arthritis

15-25% of people c psoriasis (inflammation of the skin: red, scaly, itchy) dvp psoriatic arthritis. Classic feature: swelling of toes and fingers, look sausage like, damage to nails. Genetics strongly involved. Joints affected can be axial or distal. May have soft-tissue involvement, TOP site of muscle/tendon insertion

normal plateltt count

150-400 bil/L (PMH sheet) 150-400,000/mcl (study guide)

Liver's main fxn

Producing albumin (maintains fluid balance), clotting factors. Ammonia metabolism: break down protein by-product, urea.

Postural drainage: contraindications to bed tilting

I HEAL U + 5Ps - Intracranial pressure (increased) - Hemoptysis - Esophageal anastamosis - Aneurysm - Laminectomy - Unstable CV status - 5Ps: pulmonary edema /CHF, pulmonary embolism, pleural effusion, untreated pneumothorax, pt upset/agitated

Autonomic dysreflexia: causes and Rx

Causes: - bowel or bladder irritation (full bladder, kink in catheter, UTI - tight clothing - noxious stimuli (eg: muscle stretch, ingrown toe nail, pressure ulcer) - sex, pregnancy, and labour Rx: - place pt upright! - look for and remove painful stimuli - might need anti-hypertensive med - loosen clothes

Angina pectoris

Chest discomfort causes by transient ischemia of heart muscles. Due to obstruction or spasm of coronary arteries

Symptoms of joint bleed

Common problem in haemophilia - joint tightness with no pain --> tightness + pain but no bleeding --> swollen + hot to touch + hard to move --> all ROM lost + severe pain --> bleeding slows in few days (jt full of blood)

Rheumatoid arthritis pathophys

Autoimmune disease resulting in synovitis. Pannus formation (dense cellular membrane), that spreads over articular cartilage, destroying it, along with underlying bones, and also spreads to opposite articular cartilate. Eventually bone and cartilage also attacked. Can result in immobility/consolidation of joint. Bones can become osteopenic, ligaments/tendons damaged or ruptured. Surrounding muscles deteriorate, joint instability and prone to deformity.

BMI values

18.5-24.9: normal 25-29.9: overweight 30-39.9: obese 40+: morbidly obese

Stages of healing: remodelling

2 weeks-6months (up to 2 yrs for tendon) Goals: - replace immature randomly oriented collagen matrix c mature collagen - scar tissue to mimic original tissue in terms of biomechanical fxn

Psoriasis: what is it?

Autoimmune disease, affects skin. Growth cycle of skin cells sped up leading to profound cutaneous inflammation and epidermal hyperproliferation.

Systemic Lupus Erythematosus

Autoimmune disorder that can invole skin (butterfly - malar rash), localized erythema, edema, alopecia, photosensitivity, muscosal ulcers, Raynaud's, joint effusion Dx: positive serum antinuclear antibodies (ANA), symmetric arthritis

flail chest

2 or more fractures on two or more adjacent ribs (free moving segment). Usually due to blunt trauma. pradoxical movement of the free moving segment

small cell lung cancer

20-25% -develops in bronchial cell mucosa -spreads rapidly and metastasizes early

SCI - Postural hypotension

Common. Drop in >20 mmHg SBP or >10 mmHg DBP when assuming an upright position. Caused by decreased sympathetic input and decreased muscle pump below LOI. S/S: can be asymptomatic. Dizziness, nausea, fainting, light headedness when assuming upright position Rx: assume upright position slowly, use of abdominal binder, tilt table

Rotator cuff tendinopathy

Commonly long head of biceps + supraspinatus impingement. Primary: older, degen, posture, etc. Secondary: younger (<35) microtrauma --> instability --> subluxation --> impingement. Ant capsule lax, post capsule tight

Heart block that causes a progressively lengthened PR segment, leading to a missed beat. Which degree of block is this?

2d degree (mobitz type 1 or Wenckebach)

Which areas are at a high risk of avascular necrosis with fracture?

Proximal femur, 5th metatarsal, scaphoid, talus neck, proximal humerus

in what kind of heart block is there complete dissociation of atria and ventricles?

3d degree block. Is the most serious. can cause cardiac arrest.

surgery for RA

4 Rs: -remove (MTP resection) -re-align (tendon rupture) -rest (surgically remove a joint by fusing the adjacent bones) -replace (arthroplasty)

Dvpt milestones: 8-9m

4 point kneel, goes from sit-->prone, pull to stand

Chronic venous insufficiency, and causes

Blood pools in the veins, straining at the vessel walls. Venous return is insufficient. Causes: -Damage from DVTs (in this case it is called post thrombotic syndrome) -superficial vein thrombosis -phlebitis (inflammation of the vessel) -May Thurner syndrome (something to do with clots in the iliofemoral vein

Silent unit

Both alveoli and vessel collapsed. Often as a result of a shunt unit: hypoxic pulmonary vasoconstriction

what is the number 2 cause of death from brain conditions

Brain tumor (# 1 is stroke)

Lymphoma

5 % of all ca. Solid tumour type. Cancer in glands/nodes of lymphatic syst, affects white blood cells.

Psoriasis: 5 cardinal signs + sites

5 cardinal signs: 1. plaque (raised lesion) 2. well circumscribed margins 3. bright salmon red colour 4. silvery micaceous scale 5. symmetrical distribution Commonly found on extensor surfaces, over bony prominences (elbows, knees), scalp, retroauricular (mastoid process), ears, palms and soles... but can affect any area

Chances of survival for brain tumor

50% (significant cause of death in children. infratentorial)

Medulloblastoma

Brain tumor in the cerebellum or posterior fossa (they are in the category of infratentorial tumors). High grade, grow rapidly, and often spread through CSF and metastasize to other parts of the brain and spinal cord. Often it's in children.

Heberden's node

Develop in the DIP of the hands. Caused by OA. seems to be a genetic component to getting them. More common in women. (B comes before H. so bouchard's nodes are PIP, and Heberden's are DIP)

Internal carotid artery. Functions and symptoms of defecit

Function: main supply for anterior, middle and posterior cerebral arteries defecits: -contralateral hemiplegia and hemisensory disturbance -partial horner's syndrome -global aphasia (if dominant side) -mentally slow -gaze palsy (eyes to opposite side) -contralateral homonymous hemianopia

Auscultation: breath sounds/adventitia

Breath sounds: - normal or vesicular (louder on I, can be decreased, or absent) - bronchial BS (normal at trachea, loud on I and E, indicates consolidation b/c transmit sound from trachea) Adventitia: - wheezes (low-pitched - upper airway secretions, high-pitched - bronchospasm) - crackles (coarse: secretions, pulm edema, fine: atelectasis or pulm fibrosis) - stridor: upper airway obstruction - pleural rub: fluid in pleural space

Dvpt milestone: 0-3m

Brief head righting, turns head side to side, randomly kicks in supine

Carcinoma

80-90% of all cancers. Cancer of the epithelial cells - lining skin and organs. Eg: breast, colon, bladder, uterus, prostate. Solid type tumour

Causes of dilated cardiomyopathy

Alcohol (long term use), third trimester of pregnancy (due to inc volume), cocaine, genetics, certain infections, chemo. Cause is often unclear

3D degree AV block

Also called complete heart block Block at AV node, bundle of his, or bundle branches. Complete dissociation between atria and ventricles, atria and ventricles beat independently. results in bradycardia, hypotension, and hemodynamic instability. can cause cardiac arrest. bundle branch block: in bundle branches, and QRS is longer.

Neonatal respiratory distress syndrome

<37 weeks gestation due to lack of surfactant. S&S: tachypnea, in-drawing, cyanosis, occurs soon after birth. Rx: corticosteroids

Obesity BMI

> or = 30

Pleural effusion

Additional fluid in pleural space: - transudate: content of pleural fluid isn't changed (clear), just increased amount. Back up of fluid, eg: heart failure or lymphatic syst problem - exudate: content of pleural fluid different ( opaque, eg: pus or blood). Could be from infection, cancer of pleura, or blood from trauma or sx

What kinds of fibers carry info in the dorsal column?

A beta

What kinds of fibers carry sharp pain

A delta (C fibers carry slow/ dull pain)

Cor Pulmonale

Also called pulmonary heart disease. Failure and enlargement of the R ventricle of the heart, caused by problems (increased resistance) in the pulmonary circulation such as pulmonic stenosis or pulmonary hypertension (I THINK THIS TERM IS INTERCHANGEABLE WITH R SIDED FAILURE -MEG) p.72

Vestibular schwannoma

A neuroma of CN 8. Benign, intracranial, of the myelin forming cells. Sometimes also called acoustic neuroma, although it usually affects the vestibular fibers more

Gout

Build up of serum uric acid, leads to crystals and deposits into joints. Most affected joints = knee and great toe (1st MCP most affected according to physiopedia)

Structural vs. fxnal scoliosis

Functional scoliosis = reversible b/c caused by muscle spasm or leg length discrepancy Structural scoliosis = irreversible.

FITT for bronchiectasis

AEROBIC F: 3 days per week I: 80% of 6MWT speed, or 60% of max HR, borg of 3-4 T: 20 minutes T: walking P: increase to 30 mins RESISTANCE: F: 2 days per week I: 50% 1RM T: 1 set of 10 reps T: all major muscle groups P: 80% of 1RM, 3 sets, 10 reps

Gluteal tendinopathy

AKA greater trochanteric pain syndrome. Mix of bursitis and tendinopathy of abductors. Caused by trauma, repetitive movements, increased loading, previous injury, hip instability/biomechanics.

Developmental dysplasia of hip (DDH)

Abnormally shaped HOH or acetabulum at birth = subluxation/dislocation. Can lead to degenerative hip OA (if leads to leg length discrepancy, muscle weakness, or gait impairments). Risk factors: F>M, breech, large weight, tight swaddling Rx: keep hip in Fl+Abd using a Pavlik harness

Contraindications to functional exercise capacity testing

Absolute: acute MI (3-5 days), unstable angina, uncontrolled arrhythmias causing symptoms or haemodynamic compromise, syncope, active endocarditis, acute myocarditis or pericarditis, symptomatic severe aortic stenosis, uncontrolled heart failure, acute pulmonary embolus or pulmonary infarction, thrombosis of lower extremities, sustected dissecting aneurysm, uncontrolled asthma, pulmonary edema, room air SpO2 at rest < 85%, acute resp failure, acute noncardiopulmonary disorder that may affect exercise performance, mental impairment leading to inability to cooperate.

Acidosis vs Alkalosis

Acidosis: pH is lower than normal Alkalosis: pH is higher than normal Respiratory - because of PaCO2 (lungs) Metabolic - because of HCO3 (kidney)

ARDS

Acute resp failure with hypoxemia. (from pulmonary or systemic problem). Characterised by inflammation and increased permeability on alveolar capillary membrane - leakage of blood and fluid into interstitium and alveolar space. Leads to alveolar collapse. Key feature on CXR is white out.

Dermatomyositis

Affects muscle and skin. autoimmune disorder.

Hypoxic respiratory failure

Also called type 1, or hypoxemic. Most common kind of resp failure KEY THING TO KNOW: Resp failure characterized by decreased O2 in the blood (PaO2 < 60 mmHg) , but normal or reduced CO2 Causes: usually caused by some type of ventilation perfusion mismatching (volume of air flowing in and out of the lungs is not matched to volume of blood flowing through the pulmonary circulation). Can be caused by most acute diseases that involve fluid filling the alveoli, or collapse of the alveloi (pneumonia, ARDS... it is a long list) -obstructive lung disease (note, this is also on the list of causes for type 2 resp failure)

Hypercapnic respiratory failure

Also called type 2 KEY THING TO KNOW: characterized by low O2 and elevated CO2 (PaCO2 > 50 mmHg) Causes: anything that causes decreased alveolar ventilation -depressed CNS -neuromuscular disease affecting the resp muscles (ex: myasthenia gravis) -increased mechanical load -excessive dead space -head injuries -muscular dystrophies -COPD (note, COPD is also on the list of causes of type 1 resp failure)

Down Syndrome

Alteration of Chromosome 21 S/S: hypotonia, dec strength and lig laxity, short arms and legs, heart defects, AA instability, scoliosis, pronated feet, hip dislocation, identifiable facial features Rx: discourage compensatory patterns, improve muscular strength (antigravity muscles), monitor ortho issues, sensory and gross motor stimulation, monitor cardiovascular and resp health, try to obtain developmental milestones

Side effects of radiation:

Burns, tissue fibrosis, tightness/ROM loss, local bone density loss, cardiovascular effects, rapidly dividing cell types are affected, bone marrow (esp if pelvis, prox femur, vertebrae), swallowing difficulties, whole body symptoms, fatigue

Dead space

Anatomical: volume of conducting airways - air in these not taking part in gas exchange, about 150mL on average (depends on height and weight) Physiological: additional volume of gas not taking part in gas exchange. Typically about 150mL, will be more in diseased lungs (eg: pneumonia) RV = way of measuring dead space

For all the ascending spinal tracts, what are the kinds of receptors they correspond with?

Anterior spinothalamic: -free nerve endiings -Merkel's discs (pressure) -Ruffini corpuscules (stretch, sustained pressure, heat...wait what? I give up) Lateral spinothalamic: -free nerve endings Dorsal columns: -merkel's disc (pressure) -Meissner's (light touch) -Pacinian corpuscules (vibration and pressure)

Pneumonia treatment

Antibiotics/antibacterials. Antifungals if that is the cause. Airway clearance. O2 therapy, positioning.

Wha lung volumes/capacities can't be measured by spirometry?

Anything that includes residual volume because you can't measure that (it stays in the lungs no matter what)

APGAR Score

Appearance, pulse, grimace, activity, respiration Each scored 0-2, Want a high score (>7 considered good). Taken 1, 5, and 10 min after birth

Atherosclerosis

Artery wall thickens due to accumulation of atheromas (WBCs + cholesterol + triglycerides) in the lumen. This weakens the underlying artery. Higher risk of stroke, MI, aortic aneurism.

Causes of aneurism

Atherosclerosis, high BP, trauma, congenital defects, infection (syphilis, TB, brain infections).

AMBRI (shoulder dislocation)

Atraumatic, Multidirectional, Bilateral shoulder findings, Rehab appropriate, Inferior capsule shift (if surgery performed)

Myasthenia Gravis

Autoimmune attack of ACh receptors at neuromuscular junction, so signal doesn't reach muscle. In bulbar and proximal limb muscles. Progressive muscle weakness --> decreased cardioresp fxn, atrophy, fatigue. Rx: improve function, prevent complications

Bankart Lesion

Avulsion of ant/inf capsule and ligaments. S/S:clicking, apprehension, deep vague pain

V/Q matching positions

Bilateral lung dis: prone (last resort for ARDS) Unilat lung dis: lie on unaffected side Frequently change positions as V/Q matching will never be perfect!

Causes of atelectasis

Blockage, compression, post-anesthetic (breathing at low volumes)

Consequences of dilated cardiomyopathy

Blood backs up into the pulmonary circulation. Because heart is so full and dilated, valves may fail to close (regurgitation), and this increases the risk of afib. Ejection fraction/stroke volume becomes smaller and smaller and symptoms of heart failure get worse.

Cardiac tamponade

Blood in the pericardial sac causing compression on the heart. Can be caused by puncture wound from a procedure.

SCI and cough fxn

C1-C3: absent C4-T1: non functional T2-T10: weak T11 and below is normal

SCI: C1-C4 LOI

C1-C4: ventilator dependent. Has neck mvt, able to shrug shoulder, slight shoulder retraction. C1-C3: SCM, neck flexors + extensors C2-4: traps C3-5: lev scap, supraspinatus, infraspinatus, diaphragm C4-5: rhomboids Work on strengthening neck, ROM - contracture prevention, chest PT, spasticity management

SCI: C7-8 LOI

C7: elbow extension - allows independent transfers, manual W/C use C8: DIP/PIP flex, MP flex Still have limited hand fxn, grasp and release, lack of intrinsic mm of hand. With C8 injury, will find it difficult to perform fine motor skills.

ischemic heart disease

Caused by myocardial ischemia S/S: Angina, MI, sudden cardiac death 90% due to artherosclerosis

Sever's Disease

Calcaneal apophysitis. Inflammation of calcaneal growth plate. Common in active kids (9-14, 7-15) boys > girls. Spontaneous recovery with maturation. Rx: offload tissues, education, stretch calf muscles and plantar fascia

Femoral acetabular impingement: types

Cam: - more common in younger males - bony growth on neck of femur Pincer: - more common in 30-40yo women - bony growth on acetabulum

Crohn's Disease

Can affect entire GI tract, especially small and large intestine. S/S: Ulcers, fistulas, fissures, alterations in digestion and absorption --> malnutrition Rx: anti-inflamm drugs for bowel (not systemic), prednisone (immunosuppressant), antibiotics, biologic therapies

What type of bone is most affected by osteoporosis? (same thing as trabecular bone)

Cancellous --> inside bones

Sarcoma

Cancer of the connective tissue (eg: muscle, bone, ligament). Solid tumour type. <2% of all cancers

Osteosarcoma

Cancerous tumor in bone, tends to be at the end of long bones. Pain in joint, worse c activity.

Epidural: precautions

Careful w mvt of trunk, hips, L/E - can be very uncomfortable

AIDS (Acquired Immunodeficiency Syndrome)

Cause: HIV - transmission through contact with infected body fluids (NOT sweat, urine, vomit) Result: loss of immune system function, decreased CD4 helper T-cells

Aortic dissection

Caused by aneurism. Inner wall of aorta tears, blood gets in between the layers of the wall and forces them apart. Can quickly lead to death due to not enough blood getting to the heart or rupture of the aorta

Lymphedema

Chronic condition where lymphatic fluid builds up in tissues Stages 0 through 3

Asthma

Chronic disease, but characerized by reversible episodes of -bronchospasm (hyper reactive smooth muscle) -infammation of mucosa, and -hypersecretion of mucus in response to a variety of stimulants

Cushing's Disease

Chronic excess cortisol - adrenal tumor, pituitary tumor, lung tumor that produces cortisol if d/t medication (ie for MS, asthma, RA) = Iatrogenic Cushing's Syndrome S/S: moon face, buffalo hump (central obesity), abdominal striation, muscle wasting, decreased bone density, kyphosis Comorbidities: hyperglycemia, cardiac hypertrophy, osteoporosis, depression, mental changes + memory loss Rx: surgical if caused by tumor

Fibromyalgia

Chronic pain syndrome affecting mm and soft tissue. - headaches - sensitivity to stimuli - fatigue - myalgia (mm pain) - generalized aching - sleep disturbances - anxiety/depression --> widespread 4 quadrant pain above and below waistline for > 3 months. TOP at 11 of 18 points. very common that it co-occurs with the following: chronic fatigue syndrome, depression, anxiety Characterized by central sensitization. Diagnosis involves ruling out other things that could be the cause of those types of symptoms, (like hypothyroid...) (actually they have moved away from the 11/18 tender points thing, no longer a criteria for diagnosis... based on readings they gave me to do at WCH)

Lupus erythematosus

Chronic rheumatic, autoimmune, inflammatory disease of connective tissue. Affects skin, joints, kidneys, heart, lungs, nervous syst, blood, mucous membrane - pts present differently, rarely have all organs involved. Presentation: - skin: may see butterfly (malar) rash - localized erythema - localized edema - alopecia (hair loss) - photosensitivity - mucosal ulcers (eg: mouth, nose, vaginal) - Raynauds - joint effusion - anemia - kidney involvement - CNS involvement (headaches, seizures, peripheral neuropathy, etc.) - fatigue, low grade fever Evidence for aerobic exercise to improve fatigue

Achilles Tendonopathy

Chronic/insidious onset of pain over Achilles tendon d/t microtrauma. No inflammation. Rx: Eccentric loading necessary, heel lifts to offload, stretching/man ther (DTF) DDx - partial tear (doesn't respond well to loading program)

Deadspace unit

Circulation to a alveoli is stopped but the alveoli remains inflated. eg: pulmonary embolism, anemia

Most common hand deformity with burns and how to splint

Claw deformity is most common one: wrist flexion, MCP extension, PIP flexion Splint: in opposite way: wrist extension, MCP flexion (70 degrees), IP joints in extension, thumb abduction

Autonomic dysreflexia: def and S/S

Clinical emergency! Increase of 20 or 30mmHg of SBP above normal. Sometimes associated with bradycardia (more rarely tachycardia). Symptoms: pounding headache, skin flushing and sweating above LOI, increased resp rate, dilated pupils, blurred vision, feeling of anxiety, nausea, penile erection. Skin cool, pale, dry below LOI

Shunt unit

Collapsed alveoli but perfusion is maintained. eg: atelectasis, pneumothorax, consolidation, etc

Intracerebral metastatic brain tumor

Comes from prostate, breast, lung. Body compensates by having less room for brain tissue, CSF, blood flow)

Dvpt milestones: 7m

Commando crawling, reach to grasp

SCI: complete vs. incomplete

Complete: no sensory or motor fxn preserved at S4-5 (no deep anal pressure sensation and no voluntary anal contraction). May be dermatomes below sensory level and myotomes below motor level that remain partially innervated --> zone of partial preservation. The most caudal segment w some sensory fxn defines the extend of the zone of partial preservation: has to be within 3 segments below LOI. Incomplete: either sensory or motor fxn preserved at S4-5 --> applies to both traumatic and non-traumatic SCI

Lung compliance

Compliance determined by: 1.Elastic tissue properties 2.Surface tension - surfactant equalizes large and small alveoli. Without surfactant small alveoli would empty into large (La Place law)

Hill-Sachs Fracture

Compression fracture posterior/lateral humeral head, associated w anterior shoulder dislocation (post/lat HOH impacts c ant glenoid)

Sclerodema

Connective tissue chronic disease, primarily affecting skin, characterized by sclerosis (hardening of skin) --> provokes fibrotic tissue response Can cause joint contractures, pulmonary fibrosis, HTN, renal issues, GI dysmotility (esp esophagus), Raynaud's

Assisted cough: contraindications/precautions

Contraindications: - ruptured diaphragm - inf vena cava filter Precautions: - rib # - abdominal or thoracic sx - pneumothorax - perforated bowel --> clinical judgment, may just need to change hand placement

Stabilization of the acromion (ligaments)

Coracoclavicular ligament (conoid and trapezoid ligaments) Coracoacromial ligament - controls vertical stability Acromioclavicular ligament - controls horizontal stability

Coughing

Coughing easiest in sitting with knees up. Might need to provide assistance with cough. Can use suction catheter or tracheal tickle to stimulate cough. Splinting for pain

Incentive spirometry

Criteria: RR<25 breaths/min, FVC>15ml/kg (ie: not severe restrictive lung dis), not ideal for COPD b/c difficult to do PLB Flow IS: requires a certain flow to make ball go up - could cause bronchospasm Volume IS: not as likely to use accessory muscles

Neurotmesis

Cutting of the nerve with severance of all structures and complete loss of function; reinnervation typically fails without surgical intervention because of aberrant regeneration (failure of regenerating axon to find its terminal end).

Decorticate vs Decerebrate posture

Decorticate: UE flexed, LE ext --> damage above red nucleus, in cerebrum, thalamus, cord, corticospinal tract = no inhibition of red nucleus (= UE flexion). Decerebrate: extension in UE and LE. Indicates brain stem damage (midbrain, below level of red nucleus)

Dorsal columns of SC: path + lesion

Decussates at medulla, finishes in parietal lobe Lesion above medulla: contralat loss of fine touch, proprio, vibration Lesion below medulla: ipsilat loss of fine touch, proprio, vibration

Axonal degeneration (distal)

Degeneration of axon cylinder and myelin. Possibly d/t inability of neuronal body to keep up with metabolic demands. Distal to proximal. Example: peripheral neuropathy.

Trigeminal neuralgia

Degeneration/compression of trigeminal nerve (CNV), most commonly mandibular or maxillary branches. Abrupt onset, mean age of 50. Causes sharp, shooting pain, worse with stress, heat, cold, touch (brushing teeth), movement (chewing/talking), eased with relaxation. Motor fxn remains normal.

Eczema

Dermatitis/inflammation of epidermis ( outer ayer). Itchy, red, scaly disorder.

Symptoms of dilated cardiomyopathy

Develops insidiously, may not have symptoms right away. SOB, fainting, angina (if there is ischemic heart disease).

Chronic fatigue syndrome

Dx by exclusion. Persistent or relapsing fatigue for > or = 6 months. Not resolved c bed rest. Still tired after plenty of sleep. Caffeine doesn't help. Reduces daily activity by > 50% Currenylt the criteria is to have unexplained persistent chronic fatigue + 4 of the following 8 things: -impaired short term memory and concentration -sore throat, tender lymph nodes, muscle pain -joint pain without swelling or redness -headaches of new type, pattern or severity - unrefreshing sleep - post-exertional malaise lasting more than 24 hours (observation from placement: traditionally seems like they have been told not to exercise)

Capsular pattern: GHJ

ER>abd>IR

What do you need to include in pt record (CPO guidelines)

Each piece in record has: Name and date of birth or a unique identifier Date Writer (name and title) Those who provided care Definitions of abbreviations

ACE inhibitors

Effects: blocks conversion of angiotension converting enzyme I to II, prevents vasoconstriction Uses: HTN, CHF, CVD, MI, kidney fxn in diabetics Considerations: decreased BP (postural hypotension), gradual warm up and cool down

Anticholesterol Agents

Effects: decrease mortality in pts with heart disease, decreases cholesterol and triglyceride levels Includes: statins (muscle aches and joint stiffness), niacin (postural hypotension, need gradual warm up and cool down)

Beta blockers

Effects: decrease pulse and contraction force Uses: CAD, angina, hypertension, irregular rhythm Considerations: blunted HR and BP with exercise, postural hypotension, use RPE not age predicted HR

Antiplatelet agents

Effects: decreases platelet aggregation at site of tissue damage Uses: reduced risk of MI, TIA, brain attacks or ischemic strokes Considerations: caution with bruising or increased bleeding, no contraindications for exercise

Nitrate and Nitroglycerin

Effects: relaxes smooth muscle in blood vessels, increase blood flow and O2 supply Uses: angina, CHF, acute MI Considerations: increases resting HR, decreases BP (postural hypotension), ensure proper warm up and cool down

PT for RA in acute phase

Energy conservation, ice splints, gentle ROM. NO STRETCHING, CAN PERMANENTLY DAMAGE JOINTS.

Acquired Brain Injury - Etiology & Pathogenesis

External forces,blast waves (ie explosion), rapid acceleration/deceleration --> diffuse axonal injury Primary injury = direct trauma Secondary injury = biomechanical, cellular, or molecular events over time (ie inflammatory damage) may be d/t initial injury, hypoxia, edema, or increased ICP

Asthma: intrinsic vs. extrinsic

Extrinsic: triggers = allergens. Mast cells release mediators causing bronchospasm and hypersecretion. kids>adults Intrinsic: non allergic. Hypersensitivity to bacteria, exercise, virus, drugs, cold air, stress. adults>kids

FITT for cardiac rehab patients

F: 3-5 days per week I: (60-80% HRR, RPE 4-6). if pacemakers, 30 bpm under level it starts at T: work up to 45 to 60 mins. in 5-10 min intervals T: whole body dynamic movenent must have warm up and cool down

What FEV assess the small airways?

FEV 3 (sensitive indicator of early small airway dysfunction. Think smokers)

How would you assess the 10 year absolute fracture risk of someone with osteoporosis? (tools)

FRAX - Fracture Risk Assessment Tool CAROC - Canadian Association of Radiologists

Normal glucose levels

Fasting glucose: <5.6 mmol/L Diabetes: >7

Side effects of chemotherapy:

General: nausea, constipation/diarrhea, hair loss, nail damage, sores in mouth/throat, headaches, bone marrow suppression (low WBC, RBC, platelets), pulmonary fibrosis. PT-related: weight loss/muscle loss, peripheral neuropathies, fatigue

Capsular pattern: hip

Flex>abd>IR

What is the on/off phenomenon with Parkinson's?

Fluctuations in motor performance based on meds "On" periods = dystonias (sustained contraction in abnormal position) and dyskinesias (involuntary mvmts) "Off" periods = freezing more common, akathisia (distressing restlessness)

Spondylolysthesis

Fracture at pars interarticularis + ant displacement of superior vertebra. Can be traumatic (younger population, back hyperext) or degenerative (older population). Gr I-IV based on amount of displacement (25% of each grade of slippage). Will see LBP, aggravated by ext eased c flex. Common at L5-S1

Bennetts fracture

Fracture dislocation of CMC thumb joint. MOI: Axial force on a partially flexed thumb: punching things, bike falls (gripping handle bars during crash), car crashes where gripping steering wheel

Spondylolysis

Fracture of pars interarticularis in spine. Seen in young dancers, back hyperextension. Can result in spondylolysthesis if both pars intercularis fractured. Often asymptomatic

horner's syndrome

From damage to sympathetic trunk. Happens on same side as lesion. -constricted pupil (miosis) -no sweating on that side (anhydrosis) -drooping eyelid (ptosis) -inset eyeball

Lateral medullary syndrome

From stroke in the PICA -Nausea, vomiting, and tendency to fall over to the side of the lesion (damage to inferior cerebellar peduncle) -hoarse voice, difficulty with swallowing (damage to vagus nerve roots) -loss of pain and temp to ipsilateral face and contralateral side of body (damage to descending tract of V and to spinal lemniscus) -ipsilateral horner's syndrome (from damage to sympathetics)

Prader-Willi Syndrome

Genetic disorder (not inherited, chromosome 15 from father gets deleted) --> distrubances in hypothalamus Infants: hypotonia, poor feeding, slow development, resp difficulties Older kids: hypotonia, intellectual impairment and behaviour problems, short stature, hyperphagia (constantly hungry) --> extreme obesity Rx: weight management, exercise program to increase activity, orthotics, improve postural control, behaviourist

Osteogenesis Imperfecta

Genetic disorder where not enough collagen is produced, leading to weaker bones (fractures, bowing, and OP). Also known as brittle bone disease. Connective tissue also affected, see joint laxity and muscle weakness. • Type I: most common, least severe • II: lethal in perinatal period (lack ossification) • III: severe, progressive deformity, very short • IV: rare & mild, moderate deformity, ✓ambulate

Causes of hypertrophic cardiomyopathy

Genetics. It is an inherited disease

RA joint count assessment

Go through all the joints and assess for -joint line tenderness -joint swelling -stress pain Rheumatologist or advanced practice PT

Diagnosis of bronchiectasis

Gold standard is high resolution CT scan. Also CXR, PFTs, blood tests (infection, immune factors), ABGs, sputum cultures, autoimmune screening (causes of bronchiectasis include autoimmune disorders like RA, SLE), bronchoscopy a characteristic thing you see on imaging is honeycombing

Breath stacking & huffing

Good techniques to use if breathing and/or coughing is painful.

CN XII

HYPOGLOSSAL N. MOTOR: - muscles of tongue (shape and movement)

CN XII lesion

HYPOGLOSSAL N. all tongue muscles innervated bilaterally except for genioglossus (protrudes tongue): when stick tongue out, will deviate to ipsilat side

Consequences of aortic stenosis

Hear murmur, hypertrophy, angina, syncope, decreased exercise tolerance (often first symptom), heart failure, chest pain.

Dilated cardiomyopathy

Heart is enlarged and can't pump efficiently (smaller ejection fraction. can fill but can't pump it out). weakened.

Charcot Marie Tooth Disease

Hereditary Motor and Sensory Neuropathy (HMSN). Symptoms begin in adolescence or early adulthood. Extensive demyelination of m&s nerves. Begins in foot/lower leg and progresses to hand and forearm. Pes cavus or extremely flat footed, with hammer toes.

Haemophilia

Hereditary bleeding disorder --> body unable to control blood clotting/coagulation. Presentation: joint and soft tissue bleeding, excessive bleeding, operative and post-traumatic hemorrhage, large bruises, prolonged bleeding, trauma can causes serious bleeding internally IF NOT TREATED: disabling arthritis (d/t bleeding into joints) Rx: Treatment of to give them the clotting factor that their body can't make. blood transfusion, I think was what they did in the past. or desmopressin if mild

Which has the higher mortality rate, hospital acquired pneumonia, or community acquired pneumonia?

Hospital acquired

Graves' Disease

Hyperthyroidism of autoimmune cause. Autoantibodies stimulate the thyroid S/S: fever, weight loss, exercise intolerance, goiters, bulging eyes, tachycardia, decreased fertility Rx: betablockers, anti-thyroid drug therapy, radioactive iodine, Sx to remove thyroid F>M

Hashimoto Thyroiditis

Hypothyroidism Autoimmune destruction of thyroid gland S/S: weight gain, cold intolerance, round puffy face, bradycardia, constipation, depression Rx: thyroid replacement therapy

Legg Calve-Perthes Disease

Idiopathic adolescent avascular necrosis of the hip. Can lead to permanent deformity and premature OA. Interrupted blood supply of femoral head (med and lat circumflex femoral arteries) leads to bone death. Eventually bone regrows but it has decreased mass and is weaker.

Burns: effects on different systems

If burn covers >30% body surface area, has systemic effects, body goes into shock CV: - increased capillary permeability --> interstitial edema - peripheral vasoconstriction - hypovolemia - myocardial depression --> hypotension and decreased organ perfusion - decreased cardiac output Resp: - bronchoconstriction - ARDS - carbon monoxide (dec O2 carrying capacity of blood) Metabolism: - increased 3 fold Immune system compromised Renal failure

Primary motor cortex

In frontal lobe, precentral gyrus. Controls voluntary motor mvt Lesion: paralysis on contralat side

Pre-motor cortex and supplementary motor areas

In frontal lobe. Responsible for controlling movts involving gps of muscles, posture, planning of mvt Lesion: - complex skilled mvt are lost without paralysis (eg: grasping, climbing) - postural instability

V/Q matching

In healthy lung, air goes towards bottom of lung in sitting/standing (gravity, alveoli more empty b/c of weight of lung). In diseased lung, air doesn't make it all the way down to bottom of lung in sitting/standing b/c alveoli too collapsed b/c of gravity. To optimize ventilation, place affected lobe on top, where rest of lung is least likely to squish it. Blood will follow gravity in diseased and healthy lungs (ie: bottom of lung in sitting/standing)

Synovial sarcoma

In larger joints (eg: knee or ankle). Fairly rare. Will have swelling and instability

Somatic sensory association area

In superior parietal lobe. Perception of somatic sensory information Lesion: - inability to recognize complex objects by feel (stereognosis) - difficulty reaching for objects

Primary auditory cortex

In temporal lobe. Receives hearing from both ears Lesion: - decreased sound perception from contralateral ear (not deafness)

Bouchard node

In the PIP. Boney outgrowth or cyst. Caused mostly by OA but can also be caused by RA more rarely. (B comes before H. so bouchard's nodes are PIP, and Heberden's are DIP)

Atopic dermatitis (or endogenous eczema)

Intensely itchy (pruitis) inflammtory skin disease associated c atopy (genetic tendency to dvp allergic diseases: eg: asthma, hayfever, allergic conjunctivitis). Will see lichenification (thickening of skin lines) and crusting. 3 phases: 1. infantile (2mo-2yrs): facial and extensor distribution 2. childhood: dry skin, flexural distribution (popliteal, cuboid fossa) 3. adult-atopic dermatitis generally improves c age, less flexural distribution, primarily affects the hands. Rx c moisturizer, antihistamines, topical glucocorticoids, UV if severe

SCI: wounds

Increased risk for wounds: - decreased ability to detect or relieve pressure - decreased blood flow to skin decreasing skin tolerance to pressure --> frequent skin checks and position changes, adaptive equipment. Can use UV or e-stim to treat.

Osteomyelitis

Inflammation of bone secondary to infection. Serious, send to family doc. Can be caused by spreading of infection in another part of body via bloodstream, open fracture or sx can expose bone to infection. Suspect if pt has localized swelling/redness/warmth but no MOI, pain (not always present in early stages), fever, nausea, sausage toes in diabetics. Rx: antibiotics, sx if severe to drain puss/remove necrotic bone

Pneumonia

Inflammation of parenchyma of lungs

Dermatomyositis

Inflammatory connective tissue disorder characterised by proximal limb girdle weakness (often without pain) Dermatomyositis = Skin and muscle affected, associated with photosensative skin rash, purplish erythematous eruption over face and UEs PT: prevent/treat Contractures and weakness Polymyositis = affects muscles only

Dermatomyositosis

Inflammatory connective tissue disorder, both skin and muscle affected. Proximal muscle weakness pattern. Associated c photosensitive skin rash, purplish erythematous eruption over face + U/Es.

Osteoarthritis: pathophys

Initial cause unclear, progressive degradation of cartilage, osteophyte formation. Whole joint affected, including meniscus

Axonotmesis

Injury to nerve interrupting the axon and causing loss of function and Wallerian degeneration distal to the lesion; with no disruption of the endoneurium, regeneration is possible, e.g., crush injury.

Neurapraxia

Injury to nerve that causes a transient loss of function (conduction block ischemia); nerve dysfunction may be rapidly reversed or persist a few weeks, e.g., compression.

SCI: T1-9 LOI

Intact U/E fxn, mainly use W/C. Impaired L/E fxn, paralysis & spasticity. Can have spasticity in trunk, worse the higher the lesion level. Resp fxn compromised above T6

SCI: L2-5

Intact trunk. Sparing of L/E mm may allow for fxal walking. Need gr3 quads to walk w/o KAFO. Cauda equina = flaccid bladder and bowel, and flaccid paralysis. More of a periph n injury, take time but generally recover well

Barton's Fracture

Intra-articular distal radius fracture

Neuroma

Is a broad term that means any growth or swelling of nerve tissue. Could be nerve cells, or myelin sheath. Sometimes it can even mean swelling of nerve tissue without abnormal cell growth. Schwannoma is an example of a neuroma: tumour of the nerve sheath.

Interstitial lung disease

Is a group of diseases that affects the space between the alveoli (including: endothelium of the pulmonary capillaries, basement membrane, alveloar epithelium, perivascular and perilymphatic tissue.) Lung gets stiff, decreased compliance (is a restrictive lung disease) Causes: -autoimmune disorders/ connective tissue disorders -inhalation of harmful substances -infection -drug induced (eg chemo) -idiopathic ILD can lead to pulmonary fibrosis

Symptoms of cardiac tamponade

Jugular vein distension. Decreased cardiac output, leading to hypotension, shock, death. Decrease in systolic BP on inspiration (pulse paradoxus = more than a 10 mmHg decrease). Muffled heart sounds.

Scars

Keloid: thick, extends beyond margins of original wound Hypertrophic: thick, stays within boundary of original wound but has excess tissue

Cerebrocerebellum

Lateral aspects of cerebellar hemispheres. Important for skilled asymmetrical mvts of the limbs (mainly upper) and speech. Lesion: - Difficulty with fine coordination of limb movement: --> intention tremor (during mvt) --> positive heel to knee and finger to nose tests - Minor gait disturbances - Dysarthria (uncoordinated speech) - Muscle strength and sensation are intact

Tennis Elbow

Lateral epicondylalgia - 90% of cases involve ECRB. Worse with gripping, repetitive reach tasks. Tests: Mills, Resisted extension of D3, Cozen's. Rule out: nerve root (C5-7), shoulder referral, bursitis, LCL sprain, prox RU jt

SCI: central cord syndrome

Lesion around central canal of SC. Sensory and motor fxn of U/E more impaired than L/E. MOI: hyperext of neck which causes vascular lesions and ischemic injury.

Horner's syndrome

Lesion to SNS commonly from neck trauma or surgical trauma resulting in loss of ipsilat sympathetic responses in the head: - ptosis (droopy eyelid) - miosis (pupil constriction) - anhydrosis (lack of sweat Think of how it is different from occulomotor n disruption

SCI - anterior cord syndrome

Lesion to about 2/3 of ant cord. Corticospinal and spinothalamic tracts involved, dorsal column spared. Will see paralysis and loss of pain and temperature below level of injury bilaterally. Fine touch, vibration, and proprioception spared. MOI: hyperflexion and compression of C spine. (eg: diving)

Thrombocytopenia

Low platelet count, increased risk of bleeding/bruising. Normal = 150,000-400,000 mcL. - if <50,000mcL: avoid activities c contact/risk of falling, heavy resistance exercise. --> low weights, stationary bike c low resistance, walking, ADLs - LIGHT EXERCISE - if <20,000: increased risk of spontaneous bleed unrelated to trauma. If Dr approves, AROM, walking, ADLs - NO EXERCISE unless approved by doc - if <10,000: no exercise, only essential ADLs. Prevent falls - NO EXERCISE

Cancers that cause the most mortality

Lung, pancreas, colorectal. And prostate for men, breast for women

Clinical manifestations of bronchiectasis

MAJOR ONES: -repeated infections -chronic cough of muco-purulent sputum OTHER -dyspnea -fatigue -exercise limitation -hemoptysis

Syndesmotic ankle sprain (high ankle sprain)

MOI: ER or DF of talus (eg: IR of leg on planted foot). Common in american football and downhill skiing Damage to: (basically a bunch of things with the word tibiofibular in them. the ones that hold the distal tib fib together) -Anterior inferior tibiofibular ligament -superficial posterior inferior tibiofibular ligament -transverse tibiofibular ligament -interosseous membrane -interosseous ligament -inferior transverse ligament Also common to happen along with fracture of either malleolus or spiral fracture of the fibula Dx: - foot ER stress test, squeeze test (proximal tib-fib), fibular post/ant translation - squat test --> DF w pain, malleolus stabilization test decreases pain - heel thump test, one-legged hop test

Colles Fracture

MOI: FOOSH into extension, distal radius + ulna subluxation. Extra-articular dorsal angulation + radial deviation/shortening Dinner fork deformity

Smith's Fracture

MOI: FOOSH with wrist flexed Extra-articular + palmar angulation/ulnar deviation Reverse Colles

CN VII

MOTOR: - facial muscles - blink reflex (efferent limb) SENSORY: - external ear VISCERAL: - lacrimation -salivation (cry & spit) - taste ant 1/3 of tongue

PT for HIV

Maintain functional mobility moderate aerobic avoid exhaustive exercise

Basal Cell Carcinoma

Most common type of skin ca. Low risk of spreading, translucent and red in colour

Ventrical fibrillation

Medical emergency, requires defib. Incompatible w life! Quivering heard, rapid and repetitive firing of multifocal ventricular ectopic foci in an irregular fashion

De Quervain's Tenosynovitis

Microtrauma of APL and EPB btn radius and extensor retinaculum in anatomical snuffbox. Degeneration (+/- inflammation) of tendons. Ax: Finkelstein Test. Rx: offload, PRICE, edu, --> man ther, strengthen

Active cycle of breathing

Mix of diaphragmatic breathing and huffing. Takes about 15-20min/day, not a lot of evidence

Segmental Demyelination

Myelin breakdown for a few segments but axons preserved. Mostly reversible because Schwann cells make new myelin, but some axons may be permanently lost. Example: GBS

A delta fibres

Myelinated fibres that transmit pain. High threshold, sharp prickling, localized, fast adapting. Respond well to meds

In flail chest, which lung gets less ventilated and why?

NOT SURE: DIFFERENCE BETWEEN 2016 AND 2018. BOTH SAY: on inspiration, the flail segment gets sucked in, and the heart, mediastinum, and lung shift towards the unaffected side = less air entry into unaffected side. On expiration, the flail segment is pushed outwards, and lung, heart, mediastinum get pushed back towards flail segment 2018 ALSO SAYS: "Less ventilation on affected side, because chest wall no longer rigid" (american book does not explain)

Aortic stenosis

Narrowing of the aortic valve (between the left ventricle and the aorta, or can be slightly above or below this level). Due to calcification from age or lipid accumulation.

HIV: Rx

No cure, reduce viral load. 1. Multidrug antiviral therapy - multiple meds, adherence can be tough 2. Symptomatic rx: maintain nutrition, maintain fxal mobility, education Moderate aerobic activity, resistance training

Treatment for chronic fatigue syndromw

No cure. These patients are often told to avoid over-exertion, which often gets interpreted as exercise is bad. Evidence supports GRADED exercise (like for fibromyalgia and chronic pain). Also need multidisciplinary approach to address things like diet, and manage stress

PT management for pleural effusion

No manual techniques (won't help). breathing exercises to prevent atelectasis

Osteoid osteoma

Non cancerous tumour in bone. <1.5cm, occurs in young males. May be relieved by NSAIDs, may undergo ablation Sx if not managed via NSAIDs. Pain c exercise.

Anemia

Normal Hb levels: - males: 140-180 g/L - females: 120-160 g/L Exercise is scaled back if <80 g/L

Ranges of bone density

Normal: 0-1 SD of young adult mean Low bone mass (osteopenia): 1-2.5 SD below Osteoporosis: 2.5+ Severe/established osteoporosis: presence of fragility #

Hyperglycemia

Not as obvious as hypo, develops more slowly and often no S&S until quite high EARLY SIGNS: - frequent urination, increased thirst - double vision, blurred vision - thirst - fatigue, headaches LATER SIGNS: -fruity smelling breath -nausea, vomiting -SOB -dry mouth -weakness, confusion -coma

Spondylosis

OA of the back, degeneration of joints Will have decreased joint space, decrease cartilage height, osteophytes, subchondral bone sclerosis

Primary visual cortex

Occipital pole of brain, surrounding calcarine fissue. Receives vision from contralat half of visual field Lesion: - blindess in contralat half of visual field

Pneumoconiosis

Occupational, restrictive lung disease, due to dust inhalation. Depending on the kind of dust, it is given different names coal dust = miner's lung, or coalworker pneumoconiosis Aluminum = aluminosis Asbestos = asbestosis Silica dust = silicosis and several others...

Seborrheic dermatitis (dandruff)

Occurs in areas of higher sebaceous gland activity (oily areas): scalp, face, central chest and back). Probably due to an excessive immune response to a yeast. Seen frequently in PD, neuro disorders (eg: stroke, TBI, HIV).

What is a hip hemiarthroplasty?

Only femoral head is replaced (not acetabulum)

Lateral horn of SC

Only in T and upper L-spine: pre-ganglionic fibers of the autonomic nervous system

Lateral corticospinal tract

Or pyramidal tract. Main voluntary motor pathway. 90% cross in pyramids in medulla, pyramidal decussation. Start in frontal lobe, synapse in ant horn of SC

Treatment for ARDS

PEEP, to keep airways open. Address underlying cause. Prone position.

Capsular pattern: talocrural

PF>DF

Vertebral artery supplies what other arteries?

PICA (largest branch of vertebral artery), AICA, PCA

Flail chest Rx

Pain control, intubation/mechanical ventilation if necessary, O2 and airway clearance

Thrombophlebitis

Partial or total occlusion of a vein by a thrombus. (same thing as venous thrombus). Can be deep or superficial. With secondary inflammation. Usually happens in lower limbs or pelvis

Vestibulocerebellum

Parts of the vermis + flocculonodular lobe. Controls balance, posture, head/eye mvt. Receives input from vestibular apparatus in inner ear.

Spinocerebellum

Parts of the vermis and paravermis. Concerned with muscle tone, mvt of large proximal limb mm. Important for locomotion.

Pathophys and S/S of Asthma

Pathophysiology: •Obstructive bronchospasm •Bronchial wall edema and inflammation •Hypersecretions of mucous glands •Hyperinflation and gas exchange defects •Increased respiratory work Clinical Manifestations: •Dyspnea (discrete episodes) •Cough then remission •Retrosternal chest tightness •Wheezing •Cough present +/- sputum •Signs of respiratory distress

HIV increases risk of

Pneumonia, TB, malignancy, encephalitis, meningitis, dementia, herpes zoster. Immune system suppressed from decreased CD4 cell count and helper T cells

Primary sensory cortex

Post central gyrus in parietal lobe. Receives somatic sensation from contralat side: touch, proprioception, vibration, pain, temperature Lesion: - loss of touch and proprioceptive sensation contralat - inability to localize pain and T - inability to judge shape of obj or textures

Thromboembolism: predisposing factors and factors that facilitate formation

Predisposing factors: -pregnancy -Obesity -Decreased mobility -post-surgery -long periods of sitting -contraceptives -varicose veins Factors that facilitate formation: -retardation of venous circulation -damage to vessels -conditions that favour coagulation

Types of Osteoporosis

Primary Type 1: menopausal women Primary Type 2: 70+ years Secondary: d/t another med condition or treatment, any age

Addison's Disease

Primary adrenal insufficiency --> dec aldosterone & cortisol S/S: weak/fatigue, anorexia, hyponatremia, hypoglycemia, hyperpigmentation Rx: fatal if not treated with replacement aldosterone and cortisol

Quadriplegia vs. paraplegia

Quadriplegia or tetraplegia - U/E, trunk, and L/E affected - injury to C1-T1 Paraplegia: - L/E and sometimes trunk affected - Injury to T, L, or S-spine

SCI complication: post-traumatic syringomyelia

Rare. Formation of a cyst filled w CSF in SC --> leads to compression of cord + vascular supply. Can occur yrs post injury. Look for differences or increased severity in presentation. Rx: decompression or shunt via sx

Guillain Barre: definition, pathophys

Reactive and self-limited autoimmune syndrome, demyelination of LMN, presents as acute generalized weakness. Often a autoimmune response post vaccination, upper respiratory tract infection, viral infection. Destruction of Schwann cells that produce myelin, but axons generally left intact. Causes inflammation, slows/blocks nerve conduction. After 2-3 weeks, inflammation subsides and re-myelination begins.

CN IX

SENSORY: - post 1/3 of tongue - upper pharynx - middle ear MOTOR: - swallowing (one muscle of the pharynx: the stylopharyngeus) VISCERAL: - afferent input to the carotid sinus and body - taste post 1/3 of tongue - salivation (parotid gland)

Enteropathic spondylitis

Related to inflammatory bowel disease (2 types: ulcerative colitis - lower 1/2 of bowels, and Crohn's disease - whole digestive syst). Increase in bowel disease correlated with increased arthritis symptoms. A kind of inflammatory arthritis that is linked to inflammatory bowel disease (seems like it can also be called enteropathic arthritis or enteropathic spondyloarthritis?)

Patellar tendinopathy

Repetitive loading of extensor mechanism of knee (quad, patella, patellar tendon, tibial tuberosity). VS Osgood-Schlatter (tibial tuberosity of children/adolescents) VS Sinding Larsen Johansson Syndrome (apex of patella in adolescents)

Capsular pattern: spine

SF=rotation>ext

Septic shock

SIRS+presence of infection Normal local response to infection but causes widespread vasodilation and vascular permeability --> decreased tissue perfusion --> unmet cellular needs --> cell death Dangerously low BP

Lung volumes

Residual volume cannot be measured via spirometry - everything else can.

SCI: T10-L1 LOI

Resp fxn intact. Community dwelling, indpt. Ambulation may be possible with bracing

Pre-frontal cortex

Responsible for judgment, decision making, awareness, attention Lesion (Phineas Gage): - difficulty solving complex problems - loss of ambition, low attention span - loss of aggressiveness - inappropriate social responses - mood swings

What are the 4 cardinal features of Parkinson's disease?

Rigidity, bradykinesia, tremor (resting), postural instability

Epidural hematoma

Rupture of an artery that nourishes the bone outside the dura. Associated with a skull fracture (eg: sport, MVA). Common in temporal or temproparietal region (middle meningial artery)

S&S of left sided heart failure

S&S divided into left sided and R sided failure, but they often co-occur (L sided heart failure often causes R sided failure) Left sided heart failure (blood backs up into the pulmonary circulation) 1) dyspnea (can happen during exercise, can happen when lying flat, (orthopnia) can happen at night. Can wake patient up at night), increased work of breathing, increased resp rate. 2) s&s of pulmonary edema (causes pulm edema due to back up of blood in pulm circulation). crackles, cough, wheezing 3) s&s of impaired systemic circulation (not pumping enough blood into systemic circulation). confusion, dizziness, cool extremities. decreased kidney perfusion. p.72

Causes of ARDS

Severe trauma. Aspiration, embolism, or indirect (after viral infection or pneumonia)

Neuro testing - papillary light reflex

Shine light in eye. Should see constriction of both pupils (direct and indirect). Test both eyes. CNII (sensory), CNIII (motor)

SCI: C5 LOI

Shoulder and neck movement, elbow flexion+supination. Significant imbalances at shoulder girdle Risk of contractures, unopposed biceps and brachioradialis. Partial innervation: C5-6: deltoid, biceps, brachioradialis, teres minor Hand fxn: wrist splint, universal cuff

SCI: C6 LOI

Shoulder mvt, elbow flex/supination, and wrist ext. Sometimes able to get elbow ext with shoulder ER Tenodesis grip for weak grip. Slide board transfer possible, manual w/c possible. Lats, pecs and serratus allow weight bearing thru U/E (add of shoulder to prevent elbow flex?? NOT SURE) Maximize strength to increase independence, teach tricks and compensation strategies

S&S of pulmonary embolism

Signs: -increased resp rate -cyanotic -hypoxemia -tachycardia -hemoptysis (with infarction) -on auscultation, may be normal, or have crackles and decreased breath sounds -CXR: decreased vascular markings, high diaphragm, infiltrate or pleural effusion (if infarction) -ventilation perfusion scan shows perfusion defecits Symptoms: -dyspnea (sudden onset) -headache -increased work of breathing -Pain (with infarction) THE AMERICAN STUDY GUIDE DIVIDES S&S BETWEEN PE WITHOUT INFARCTION AND WITH INFARCTION. THE ONES WHERE I WROTE "WITH INFARCTION" ARE THE ONES LISTED IN AMERICAN BOOK UNDER "ADDITIONAL FINDINGS CONSISTENT WITH PULMONARY INFARCTION" (Dina's notes don't differentiate)

Talipes equinovarus (club foot)

Tali: ankle, pes: foot, equinus: PF foot (like a horses foot), varus Congenital bone deformity. Presentation: - PF - forefoot adducted - hindfoot varus/inversion - high arch - Often have smaller calf Rx: - serial casting, Sx, splinting

How do you assess nystagmus?

Smooth pursuit (follow side to side/up and down). and eye movement (looking different directions). Record direction of nystagmus.

Squamous Cell Carcinoma

Solid skin tumour, often volcano shaped, high risk for mets

SCI: contractures

Some mm more at risk (eg: biceps when unopposed by triceps). Might do selective shortening of mm to increase fxn (eg: tenodesis grip, back extensors to improve postural control) or selectively lengthen (eg: h/s, important to be able to reach)

Spastic vs. flaccid bowel

Spastic: increased colorectal tone, transit slowed down, retention of stool. Constipation is a common prob. Need suppository &/or digital sim within anus for voiding, can be trained. Flaccid: loss of colorectal tone, don't feel when rectum is full, slow transit, risk of incontinence.

Spastic vs. flaccid bladder

Spastic: seen in lesions above the conus medullaris --> UMN lesions. As bladder stretches, sensory nerves activate reflex at SC to initiate voiding --> no UMN to inhibit reflex. Danger of leakage without warning. Can manage w intermittent catheters, condom/foley drainage Flaccid: seen in lesions at conus medullaris or cauda equina --> LMN lesions. Loss of sensory fibres, no reflex. pt unaware of bladder filling, danger of overfilling. Requires intermittent catheterization for management

Stages of lymphedema

Stage 0: Can't see it, but subjective complaints of fullness, tightness, heaviness, ache. stage 1: "reversible lymphedema". May be pitting. It is reversible/intermittent, can reduce with elevation Stage 2: "Irreversible lymphedema". Feels harder. Elevation doesn't help. develops fibrosis. Stage 3: extensive fibrosis, sclerosis, skin changes, papillomas, hyperkeratosis.

Staging of malignant tumours

Stage 1: <2cm, no nodes involved, no mets 2: 2-5cm, nodes may be involved, no mets 3: >5cm, nodes involved, no mets 4: mets

Consequences of hypertrophic cardiomyopathy

Stiff wall impedes ventricular filling. consequences include heart failure, irregular heartbeat. Especially in young athletes, there is risk of sudden cardiac death.

Arteriosclerosis

Stiffening of artery wall, decreased elasticity, hardening of arteries. Gradually restricts blood flow to organs. This is an umbrella term that includes different kinds of arteriosclerosis, including atherosclerosis but also other kinds.

Platelets < 20,000 mcl

Still at risk for a bleed but can do AROM, walking, ADLs. Crucial that falls be prevented

Medial medullary syndrome

Stroke of ipsilateral anterior spinal artery at it's origin from the vertebral artery -contralateral paralysis below the neck (corticospinal tracts) -ipsilateral paralysis of the tongue (hypoglossal nerve roots) -contralateral loss of fine touch and conscious proprioception (medial lemniscus)

Gout S&S

Sudden onset of pain, redness and swelling. Often at night. Redness and extreme tenderness will develop a few hours after the initial onset of the pain.

SLAP lesion

Superior Labrum Anterior-Posterior - elevated position with sudden (concentric or eccentric) biceps contraction - throwers

Middle cerebral artery (MCA)

Supplies most of lateral side of brain, stems from internal carotid artery. Lesion: - contralat paralysis in U/E and face - contralat loss of sensation in U/E and face - Broca's and Wernicke's aphasia --> global aphasia if large left sided stroke - left neglect if R sided infarct Could get blockage in just 1 branch of MCA

Posterior cerebral artery (PCA)

Supplies underside of brain (temporal and occipital lobes). Stems from vertebral arteries Lesion: - vision loss contralat visual field (hemianopsia) - other visual disturbances - somatic sensory loss (d/t damaging of ventral post nucleus of thalamus) - thalamic syndrome (neuropathic pain) possible

Signs and symptoms of pleural effusion

Symptoms: pain and SOB signs: IPPA -trachea shifts away from affected side if upper lobe -tactile fremitus decreased over affected area, unless atelectasis -decreased breath sounds (or bronchial breath sounds if lots of atelectasis?) -dull percussion

Scleroderma

Systemic sclerosis - chronic disease primarily affecting skin --> hardening of skin via massive fibrotic tissue response Can cause jt contractures, pulmonary fibrosis, HTN, renal, GI dysmotility (esp esophagus), Raynaud's There is a form of it called CREST: calcium deposits, raynaud's, esophageal problems, skin thickening in fingers and toes, areas of small dilated blood vessels.

CN 5

TRIGEMINAL NERVE V1: ophthalmic V2: maxillary V3: mandibular All have sensory branches to face. V2 has sensory supply to inside of nose. V3 provides sensation to ant 2/3 of tongue V3 also has motor supply to mastication mm

Ankylosing spondylitis: features

Tends to affect young men, affects spine and SIJ. "Bamboo back". Starts off c SIJ pain, then progresses to be the whole spine, enthesitis (inflammation of where tendon ligaments and joint capsule attach to bone). Peripheral joints may also by involved (eg: shoulders, hips, knees, ankles). Will see decreased chest wall expansion. Morning stiffness > 30 min Night pain Improves with movement

Neuro testing - visual field testing

Test quadrants with other eye closed. Superior, inferior, lateral, medial

Perfusion and diffusion of gases

The rate of movement of gas across the blood-gas barrier is limited by •Perfusion- related to amount of gas in blood. O2, CO2 and N2O are perfusion limited because bonding to HbG slows it down. •Diffusion- related to diffusion properties (tissue area, gas principles, pressures on either side). CO is diffusion limited because it would attach to all HbG if wasn't slowed by diffusion through the tissues.

Hypertrophic cardiomyopathy

Thickening of the ventricular wall. This increases stiffness of the wall and interferes with filling of the ventricle. Can be ASYMPTOMATIC in many cases.

Wallerian degeneration

Transection (neurotmesis) results in degeneration of the axon and myelin sheath distal to the site of axonal interruption to allow for regeneration.

HIV: means of transmission

Transmission through contact c infected body fluids: - blood - CSF - vaginal/cervical secretions - semen - breast milk - mother to child in pregnancy - saliva Not transmitted through urine, sweat and vomit

Hep C

Transmission: percutaneously (needle stick, drug use), sexually, hemodialysis, mother-->child. Higher risk of it turning chronic from acute then in hep B, but it can take decades for chronic complications to occur. Rx: interferon and anti-viral agents.

TUBS (shoulder dislocation)

Traumatic onset, Unidirectional, Bankart lesion, Surgery - MOI: abd/er

Treatment for haemophilia

Treatment is replacing the missing clotting factor ex: recombinant factor VIII infusion. (factor VIII is a clotting factor that is missing in people with type A) for milder cases, desmopressin

Myofascial pain syndrome

Trigger points caused by sudden overload/stretching/repetitive strain/sustained activities. Can = referred pain, motor dysfunction, autonomic phenomena. Rx: dry needling, stretching, soft tissue massage, modalities, manual therapy if joints affected

Intracerebral primary brain tumor

Tumor cells don't proliferate, glia cells around proliferate

What are the 2 uses of diagnostic percussion?

Two uses: •Locate abnormality (no more than 5 cm deep no less than 2-3 cm in diameter) •Assess the extent of diaphragmatic motion

Reactive arthritis

Type of spondyloarthritis caused by infection in gastrointestinal, genitourinary or resp system. Prognosis usually good (goes away in a few months), but recurrence is a possibility, as well as developing other things like ankylosing spondylitis. Affects many other systems too, not just joints (muscular, eyes, skin)

CN VII lesion

UMN: contralateral lower part of face paralyzed (eg: MCA stroke) LMN: ipsilateral half of face paralyzed (infarct to pontine branches to basilar artery)

Ulcerative Colitis VS Crohn's

Ulcerative colitis affects only the inner lining of the colon, also called the large intestine. But in Crohn's disease, inflammation can appear anywhere in the digestive tract, from the mouth to the anus, and it generally affects all the layers of the bowel walls, not just the inner lining.

Spondyloarthritis

Umbrella term for group of inflammatory arthritis diseases c common features including inflammation of the spine, eyes, skin, and GI. Ankylosing spondylitis = most common. 90% genetic Mostly affects younger patients. They are serum negative, meaning that unlike RA and SLE, you can't fine rheumatoid factor or CRP and other markers in the blood).

Bell's Palsy

Unilateral facial paralysis dt virus causing inflammatory response in facial nerve (CN VII). Can't close eyelid on affected side. Decreased taste, tears, and saliva. Recover in weeks to months.

C fibres

Unmyelinated fibres that transmit pain. Low threshold, dull, aching, diffuse, slow adapting and persistent. Don't always respond well to meds

Autogenic drainage

Unsticking (breathe at very low lung volumes), collecting (low lung volumes), and evacuating (normal to high lung volumes) phases. Takes 30-45 min/day, not a ton of evidence.

Tenodesis grip

Useful for C6 and C7 injuries. Selective shortening of finger flexors to allow a fxnal weak grip (eg: holding a fork) 1. gravity assisted wrist flexion, fingers and thumb passively open 2. volitional wrist ext, fingers passively close

Fat embolism

Usually from a fracture of a long bone. Uncommon in pulmonary circulation

Signs and symptoms of pneumonia

Usually preceded by upper resp tract infection. Productive of sputum (green). Tachypnea, SOB

CN X

VALGUS Nerve MOTOR: (most of soft palate, pharynx and larynx, and one tongue muscle: the palatoglossus) - swallowing - phonation - efferent limb of gag reflex SENSORY: -sensation from the lower pharynx, larynx and external ear VISCERAL: -PNS branches to organs of thorax and abdomen -visceral afferents from the organs -taste from the epiglottis

CNVIII

Vestibulocochlear Nerve Purely sensory. Receives two special sensory afferents - vestibular input - hearing

Collateral Ventilation

Via Channels of Lambert (between bronchioles) and Pores of Khon (between alveoli) Advantage: can help clear secretions/mucous plugs Disadvantages: spread of infections

Lesion in optic nerve

Vision loss in ipsilateral eye (see neuro anatomy notes)

Lesion in optic chiasm

Vision loss of outside halves of visual fields of both eyes.

Lesion of optic tract

Vision loss on contralateral half of both eyes

FEV1

Volume of air that can be expired in 1 sec after max inspiration. Generally measured as part of a pulmonary function test (PFT). Normal: FEV1/FVC=0.8. Restrictive lung disease: Increased FEV1 (esp in early stages of dis --> decreased compliance of lungs) and decreased FVC --> FEV1/FVC > or = 0.8 Obstructive lung disease: much decreased FEV1, decreased FVC (increased RV) --> FEV1/FVC < 0.8 Also interested in FEV1 value, and it's % of predicted value --> used to classify stage of respiratory condition

Sepsis

When body's response to infection causes injury to its own tissues + organs.

Optic nerve lesion: effect on pupillary reflex

When light shined in eye of the side with the optic nerve lesion, neither pupil will constrict. When light shone into eye of the unlesioned side, both pupils will constrict.

Oculomotor nerve lesion: effect on pupillary reflex

When shine light into unlesioned side, that side will constrict. Lesioned side will not constrict, and will be down and out. When shine light into side with the lesion, opposite side will constrict, but lesioned side will not, and will be down and out (same result no matter what eye you shine light into: no response on lesioned side)

non small cell lung cancer

a) squamous cell. spreads slowly. Arises central portion near hilum, metastasizes late. b) adenocarcinoma (30-40%). slow to moderate spread, early mets throughout lungs, brain, organs. Cancer of glandular cells c) large cell. rapid spread, widespread mets (kidney, liver, adrenals) poor prognosis

Systemic inflammatory response syndrome (SIRS)

Whole body inflammatory state Dx: 2 or more of following signs: - HR>90 - temp >38 or <36 - RR>20 or PaCo2<32 - WB count >12000 or <400

Liver disease: S&S

Yellow, itching (pruitis), big belly (ascities), bleeding, esophageal varices Different types of hepatitis caused by different viruses, but similer S&S.

Acute vs chronic rheumatic disease

acute < 6 weeks. chronic is more

Pupillary light reflex

afferent limb: optic nerve efferent limb: oculomotor nerve If R optic nerve lesioned and shine light in R eye, won't see constriction in either of the eyes. If shine light in L eye, will see constriction in both eyes

Air embolism

air in the pulmonary circulation. May result from trauma, neurosurgery, cardiac surgery, IV Small amounts are reabsorbed, no big deal Larger ones may cause death due to frothing in the R ventricle or massive occlusion of the pulmonary circulation

Platlets < 50,000 mcl

avoid activities with risk of falling. Low intensity exercise, minimal or no resistance of 20,000 to 40,000 light resistance if 40,000 to 60,000

Postural drainage

bilateral apical segments: sit upright RUL ant segment: supine LUL ant segment: semi reclined position RUL post segment: prone LUL post segment: semi prone or sitting with chest/arms leaning on table RML/LUL lingula: supine/semi-sidelying (on unaffected side) with bed tilted down 30 degrees LLL and RLL ant segments: supine, bed tilted down 30 degrees LLL and RLL post segments: prone, bed tilted down 30 degrees LLL and RLL lat segments: side lying, bed tilted down 30 degrees LLL and RLL sup segments: prone

What do osteoclasts do?

bone resorption Osteoblasts build/form bone

Neuro testing - accomodation

bring finger slowly to nose and look for convergence and papillary constriction. Tests optic, oculomotor, trochlear, and abducens nerve.

COPD

broad term, encompasses emphesyma and bronchiectasis. Progressive airway obstruction. Hyperinflated airways, lacking elastic recoil. Meg: guys I'm pretty sure it is usually defined as including emphyseme and chronic bronchitis, not necessarily bronchiectasis - KD: correct

CN VI lesion

can't abduct ipsilat eye

1st degree AV block

caused by prolonged conduction at AV node. PR interval is longer (more than 0.2 seconds). P wave is normal

Tendonopathy/tendonosis

chronic microtrauma = loss of collagen organization, no inflammation - collagen disorganisation, glycosaminoglycan, variable tenocyte density, increased vessel/nerve

2 Post horns of SC

contains afferent sensory neurons with cell bodies located in the dorsal root ganglia (fine touch, proprio, vibration)

2 Ant horns of SC

contains cell bodies giving rise to efferent motor neurons: alpha motor neurons (to muscle) and gamma motor neurons (to muscle spindles)

Neuro testing - graphesthesia

draw number or letter on palm. Assesses all systems and higher level planning. Results: intact, absent, impaired

Autism

dvpmtal delay in social/language/motor and or cog dvpt. avg age of onset = 4yo S&S: stereotyped + repetitive play sills, avoids eye contact, dislike change in routine, strong sensory preferences, dyspraxia (needs time to plan mvt and execute goal related fxn), gait (waddling, abnormal weight distribution), cerebellar involvement. Outcome measures: M-ABC, Bayley-3, PDMS-2

SCI complications: heterotrophic ossification

dvpt of bone in soft tissue. Might be painful, will often cause fever, increased spasticity, warmth, low grade fever, erythema, local swelling. Hard to distinguish from cellulitis/osteomyelitis. May see sudden loss of ROM and a abnormal firm/hard end feel.

Treatment for vision deficits (visual field, nystagmus, saccades, etc.)

environment modifications, instruct scanning of environment, balance exercises so other systems can compensate, referral to CNIB

Capsular pattern: 1st CMC

ext=abd > add

Capsular pattern: 1st MTP

ext>flex

Capsular pattern: carpometacarpal

flex=ext

Capsular pattern: radiocarpal

flex=ext

Capsular pattern: CMCs (D2-D5)

flex>ext

Capsular pattern: IPs

flex>ext

Capsular pattern: MCPs

flex>ext

Capsular pattern: radiohumeral

flex>ext

How long should FVC take?

forced vital capacity. should be able to get it all out in 3-4 seconds

spontaneous pneumothorax

happens spontaneously in young healthy males (tall and skinny). due to rupture of a "bleb" (an air filled sac on the visceraL (?) pleura - DOUBLE CHECK THIS- IT'S WHAT I REMEMBER FROM DINA LECTURE)

Neuro testing - saccades

have finger 15deg to one side of nose, have pt look rapidly from your nose to finger (side to side, up and down). Look for overshooting.

Dvpt milestone: 4-5m

head control, able to prop with extended elbows, rolls, supported sitting, weight bears in standing when supported. Grasps small toys, reaches

Congestive heart failure

heart can't pump enough blood to meet metabolic demands of the body, OR able to, but at elevated filling volumes. p.72)

Risk of infection if WBC falls below what

if absolute neutrophils falls below 500 mcL (but also take into account do they have fever, etc...)

Pursed lip breathing

important for COPD patients. provides positive pressure, prevents air trapping.

Flatback posture

in 2018 edition, pg 16 Decreased lumbar lordosis + posterior pelvic tilt • Short and strong: hamstrings and often the abdominals • Long and weak: one-joint hip flexors • Possible causes: poor postural habit, poor ergonomics • Potential sources of dysfunction: short abdominals/hip extensors, long and weak lumbar extensors, loss of normal lumbar curve (reduced capacity for shock absorption), stretched PLL and lumbar erectors, compressed anterior disc, altered respiration

Swayback posture

in 2018 edition, pg 16 Pelvis shifted forward in relation to thorax, increased lumbar lordosis, thoracic kyphosis and hip extension • Short and strong: hamstrings and upper fibers of internal oblique -- Lumbar erector spinae are strong but not short • Long and weak: one-joint hip flexors, external oblique, upper back extensors and neck flexors • Potential sources of dysfunction: stretched iliofemoral ligaments, hip joint dysfunction (ie. anterior femoral head, femoral-acetabular impingement), lumbar lordosis/thoracic kyphosis/HFP

Why load tendons?

increased collagen synthesis, cellular proliferation, alignment

Pulmonary edema

increased fluid in extravascular spaces in the lung (that can mean in the interstitial space, or in the alveoli).

Lung abcess

infection leading to necrosis of lung tissue, leading to cavity filled with necrotic debris Causes includes aspiration (higher risk with alcoholism)

Hep B

infection of liver, can persist and become chronic, long standing can lead to cirrhosis (scarring of liver) and hepatocellular carcinoma. High (Africa) to low risk (north Am) countries. Vaccine available Can be spread: high risk (mother to child) to low risk (sex transmission and injection drug use). Rx: antiviral agents, vaccine. No cure.

Bronchitis

inflammation of trachea and bronchia tree with excess mucus production 1) Acute: self limiting condition, often brought on by bacterial or viral infection, or chemical irritants 2) chronic: longstanding inflammation of mucosa. number one cause is smoking. Also pollution, occupational hazards, urban living. Part of COPD.

Tendonitis

inflammation, dt overloading --> pain, swelling, from tears

Cystic fibrosis

inherited autosomal disorder that affects all mucus and sweat glands (so affects many systems: mostly lungs, intensines, pancreas, liver). Thick mucus blocks airways and ducts.

Capsular pattern: subtalar

inversion>eversion

Accessory nerve lesion

ipsilateral paralysis of SCM and upper traps (depressed shoulder, difficulty elevating shoulder, and difficulty turning head away from the side of the lesion)

Causes of L sided heart failure

ischemic heart disease valve disease HTN myocardial disease

Focal rheumatic diseases

less than 3 joints

Bradycardia

less than 60 BPM

SCI: Brown Sequard syndrome

lesion to half of SC. - Flaccid paralysis (ipsilateral) at level of lesion - Ipsilateral spastic paralysis below level of lesion (corticospinal tract) - Ipsilateral loss of fine touch, conscious proprioception and vibration below the level of the lesion - Contralateral loss of pain and temperature below the level of the lesion MOI: lateral hyperflexion of spine or penetrating trauma. Most common causes is stab or gunshot wound

Wernicke's area

located in the left temporal lobe, multimodal association area. Responsible for language comprehension and expression of thoughts. Lesion (Wernicke's aphasia): - speak gibberish - will have difficulty with language comprehension (oral and written)

Tuberculosis

look it up

CN1 lesion

loss of smell (anosomia)

Causes of R sided heart failure

major causes include: L sided heart failure, chronic severe pulmonary hypertension cystic fibrosis

PT management of lung cancer

manage fatigue

Concussion - second impact syndrome

minor second blow to brain before initial symptoms are resolved. Rare but often fatal d/t uncontrolled swelling of the brain

Tachycardia

more than 100 bpm

Hip precautions for THA (lateral approach) (25% of THA)

no FL past 90 no IR no ADD past midline --> cut through glut med and min

Hip precautions for THA (postero-lateral approach) (75% of THA)

no FL past 90 no IR no ER no ADD past midline --> cut through short external rotators, glut max and post capsule

What is a normal FEV1?

normal is 80% (study guide), or over 70% (Dina) of forced vital capacity. Expressed as FEV1/FVC

s&s of right sided heart failure

note: remember that most common cause of R sided failure is L sided failure, so can occur along with signs and symptoms of L sided failure Causes damming of blood in systemic and portal venous systems. Also decreased flow in periphery 1) pitting edema (increased peripheral venous pressure) 2) nocturia 2)congestion of portal system = liver damage, enlarged spleen 3) kidney and brain issues 4)fatigue

Vibrations

only on expiration, moves secretions to larger airways (vs. percs loosens mucus). Doesn't cause bronchoconstriction PD+percs+vibes: only 4-5min to drain each segment vs. 20min with PD alone

Draw picture that illustrates all the lung volumes and capacities

p. 83

stages of lung disease

p. 84

How does type A haemophilia work in terms if inheriting the condition

p.101

Draw a normal ECG wave

p.71

Signs, symptoms and treatment for atelectasis

p.75 Collapse of normally expanded & aerated lung tissue involving all or part of the lung - CAUSES o blockage of bronchus/bronchiole --> lung is prevented from expanding due to: paralysis, diaphragmatic disorders, mucous or airway obstruction, hypoventilation o compression due to pneumothorax, pleural effusion, space-occupying lesion (tumor) --> prevents alveoli from expanding o postanesthetic --> effects of anaesthesia and prolonged recumbency

Describe TNM cancer grading system

p.96

ABGs: normal values

pH: 7.35-7.45 PaCO2: 35-45 HCO3: 22-28 PaO2: 80-100 SaO2: 95-100%

Lateral spinothalamic tract of SC: fxn, path

pain, hot/cold decussates within 1-2 segments at anterior commissure, goes to thalamus and parietal lobe 1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury

Goals of peds physio

participation, motor abilities, functional mobility, health & prevention, family centered care

Neuro testing - stereognosis

pick 3 objects, test one hand at a time. Results: intact, impaired, absent

Pulmonary embolism

presence of emboli in respiratory circulation (air, fat or thrombus). Emergency Diagnosed by symptoms, imaging (CT, MRI, pulmonary angiography, perfusion scan).

Burns: primary vs. secondary intention healing

primary: closed by sx secondary: wound left to heal on its own

Capsular pattern: prox radial ulnar joint

pronation=supination

Causes of pneumothorax

puncture of the chest (usually lacerated visceral pleura from rib fracture), or can be spontaneous (usually young males)

Neuro testing - smooth pursuit

range 30deg, side to side, up and down - look for nystagmus

Arthrogryposis multiplex congenital (AMC)

rare non progressive neuromusc syndrome. S&S: joint contractures (d/t lack of fetal mvt), muscle weakness, poor muscle dvpt and fibrosis (can lead to scoliosis, heart defects, resp problems).

platelets < 10,000 mcl

risk of spontaneous CNS, GI, or respiratory bleed. No exercise, only essential ADLs. VERY important to prevent falls (<10 bil/litre)

Subarachnoid hemorrhage

rupture of a cerebral artery (ACA, MCA, or PCA) resulting in bleeding in the subarachnoid space along surface of cortex. Would see blood in lumbar puncture!

Pulmonary fibrosis

scarring of the alveoli Can be secondary to ILD, or idiopathic I'm not clear on how this is different from ILD, can someone clear this up?

Normal FEV3?

should be greater than 90% of FVC

Dvpt milestones: 10-11m

sitting bum scoot, standing (stand--> sit), crawling

Dvpt milestones: 6m

sitting independently, uses hands for play, stands c support

cardiothoracic index

size of heart in relation to the thorax

Neuro testing - two point discrimination

start with 5mm apart Normal: finger tips = 2-5mm, palm = 8-12mm, extremity/trunk = 20-30mm

Capsular pattern: DRUJ

supination=pronation

Tendons consist of

tenocytes (tendon-specific fibroblast cells that produce collage molecules, crave mechanical load) ECM (collagen, glycosaminoglycan)

Thrombophlebitis S&S

symptoms are rare with superficial clots (not totally occluded, or have formed collateral circulation). symptoms might include tenderness, pain swelling. In deeper veins may cause: pulmonary embolism, post phlebitis syndrome (develops years later, and causes severe pain, swelling and heaviness in the leg), and damage to valves (swelling, varicose veins, skin discoloration.

Does the pleura have pain fibers?

the parietal pleura does, the visceral pleura does not

2nd degree AV block

two types: Mobitz type 1 and 2 1) Mobitz type 1. block happens at AV node and is tansient. PR lengthens (more lengthened than in 1st degree block) until totally blocked, then no QRS will follow the P wave, causing a missed beat. 2) Mobitz type 2. block happens at bundle branches/bundle of his. Abrupt drop of QRS (failure to conduct to the ventricles), but PR interval normal. 2-3 P waves to 1 QRS

Stages of healing: inflammatory phase

up to 1 week post injury. By end of phase, area should be clean (free of debris), sealed, re-vascularized

Hep A

virus transmitted by fecal oral route, usually self limiting bout. RF: international travel, daycare. Vaccine available. Most people recover fine, children usually asymptomatic. Does not become chronic S/S: jaundice, fatigue, weakness, anorexia, nausea, vomiting, abdominal pain

Physiologic dead space

volume of air left in the lungs that does not participate in gas exchange, not counting volume of conducting airways (is that right?). Usually around 150 ml

Anatomical dead space

volume of conducting airways. Usually around 150 ml

Dvpt milestones: 12-18m

walking independently, squats, walks up stairs

Vestibular treatment

walking program, exercises (habituation, accommodation, adaption), balance, address falls risk, aids pg 65

Signs, symptoms and treatment of vestibular schwannoma

wikipedia

Stages of healing: proliferative/fibroblastic/healing

~4 days-4weeks post injury. Goals: - synthesize collagen - proper alignment of collagen - prevent adhesions - prepare scar for remodelling

Acute hemarthrosis symptoms

• swelling • pain • heat around joint • tenderness • decreased motion • tingling, aura, or prickling sensation • stiffening into the position that is comfortable (usually flexion) --> pts should be aware of these symptoms as steps should be taken to address acute bleeding

Impact of smoking

•Inhibits ciliary motility •increased airway resistance by bronchoconstriction •Affects unfavorably the pulmonary AB activity of alveolar macrophages •CO interferes with RBC O2 transport function by 2 ways: a)CO and O2 compete for the same binding site on Hb molecule b)CO increased affinity of remaining Hb for O2, impeding its release in systemic capillaries

6 minute walk test - Outcomes

•distance walked = Primary outcome - Minimal important difference (MID) of 30 m for the 6MWD •number and duration of rests •modified Borg rating of dyspnea / leg fatigue •heart-rate •nadir oxygen saturation (lowest SpO2 recorded)