Review Set 4
What is an Acoustic Neuroma?
A benign Schwann cell tumor of cells which myelinate CN VIII, that arises from the vestibular portion of the nerve
Define manual muscle testing
A clinical procedure which manually assess muscle strength & contractility of a muscle
What is treatment for vaginismus like?
A comination of education, counseling & behavioral sciences. Vaginal dilation exercises under the direction of a PT or sex therapist.
What is vaginismus?
A condition involving involuntary spasms of the muscles surrounding the vagina which close the vagina and makes intercourse difficult or even impossible
What is spina bifida occulta?
A fairly common type of spina bifida. It involves a tuft of hair growing along the SP and incomplete closing of the backbone
What is otosclerosis?
A hereditary disorder causing conductive hearing loss, due to overgrowth of bone at the annular stapedial ligament, which prevents the stapes from moving at the oval window and leads to a loss of vibration
What is acute brachial plexus neuritis? What trunk of the brachial plexus does it involve? Is it a superior or inferior BP injury?
A neurological disorder of unknown cause, involves the superior trunk and severe pain around the shoulder. It is a superior brachial plexus injury
What is the carpal tunnel?
A passageway deep to the flexor retinaculum. 9 tendons pass through it and 1 nerve. Passes through tubercles of scaphoid & trapezium and pisiform & hook of hamate
What is functional muscle testing?
A performance-based muscle assessment
What is Myringotomy?
A surgical incision into the ear drum to relieve pressure or drain fluid with pressure equalization tubes
What is the perineal body?
A thick connective tissue mass that serves as the site of insertion of many urogenital muscles
What group do efferent axons of large myelinated nerves belong to?
A-alpha
What are the two types of nociceptors?
A-delta C fibers the different types help to distinguish between different types of pain (burning, stabbing, sharp, dull etc.)
Afferent axons of small myelinated nerves belong to which group of fibers?
A-delta (for diameters of 2-5 micrometers)
What group do efferent axons of medium myelinated nerves belong to?
A-gamma
What are some advantages and disadvantages of MRIs?
A: *good sensitivity*, images soft tissue well, no ionizing radiation, little distortion D: *low specificity*, expensive, contraindicated if pt has a ferrous metal implant or exposure
What are the ABCS of radiology?
A: alignment B: bone density C: cartilage S: soft tissue
What are the advantages and disadvantages of rigid removable post-op dressings?
A: allows skin inspection, consistent pressure, easily put on, protects residual limb D: may require *frequent re-fitting* (volume of residual limb changes)
What are some advantages and disadvantages of CT scans?
A: both sensitive & specific for *fractures*, useful for quick assessment of brain or neuro injury D: radiation exposure, discriminates density but limited in precise hist. differences, small volumes of tissue image as a uniform shade of gray
What are the advantages and disadvantages of soft post-op dressings?
A: cheap, lightweight, readily available D: inconsistent, weak compression, frequent re-wrapping & replacement, *doesn't prevent contracture*, difficult for pt to self-apply Jason sees this very often
What are the advantages and disadvantages of semi-rigid post-op dressings?
A: controls edema, adheres to skin, allows some ROM, breathable, cheap, easy to countour D: loses effectiveness as swelling goes down, not as protective, *doesn't prevent contractures* Jason said this is like a very soft cast
What are the advantages and disadvantages of rigid post-op dressings (IPOP)?
A: dec edema & pain, *prevents contracture*, protects limb, allows *early WB*, easier transition to definitive prosthesis D: difficult to apply, requires close supervision, *can't visualize wound* or residual limb Jason said he has never seen anyone use this, not overly common
What are the advantages and disadvantages of a bone scan (radionuclide scintigraphy)?
A: highly *sensitive* for early bone & joint disease, fast, reasonable cost D: easily influenced by osteoblastic activity or blood flow of any etiology, *poor specificity*
What are some advantages and disadvantages of x-rays?
A: time & cost efficient, non-invasive, low risk, good for screening D: may be normal when a pathology actually exists
Which type of amputation requires a waist belt for a limb shrinker?
AKA
If you want to use +/- other than Kendall, or want to precisely test the strength of a muscle through available ROM, which MMT scale should you use?
ART
If you decide to use + and - as a PT, which scale is the most objective?
ART or gravity-eliminating testing
Where does the inguinal ligament attach?
ASIS
Which CN passes through Dorello's canal?
Abducens N
Which is the most common CN palsy?
Abducens N
Which is the only cranial nerve to run through the cavernous sinus?
Abducens N
Where is the location of the primary neurons of the abducens N?
Abducent nucleus
If you test the patient's thumb abduction, adduction, extension, flexion, opposition, and reposition, what nerves are you testing the integrity of with each motion?
Abduction: median & radial Adduction: ulnar Extension: radial Flexion: median Opposition: median Reposition: none
What are the muscles in the hypothenar eminence?
Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi
What are the muscles in the thenar eminence?
Abductor pollicis brevis Flexor pollicis brevis Opponens polllicis
What lymphatics are responsible for the area of the rectum above and below the pectinate line?
Above: internal iliac nodes Below: inguinal nodes
What ligaments are above and below the pubic symphysis?
Above: superior pubic ligament Below: inferior pubic ligament
What is the end product of the 1st major pathway of catabolism of alcohol?
Acetaldehyde
What is the end product of the 2nd major pathway of catabolism of alcohol?
Acetate
How should you adjust a transfemoral prosthesis if the user has a hip flexion contracture? ********
Add socket flexion to the point where there is 5 deg more socket flexion than the flexion contracture, this is essentially giving them back 5 deg of hip extension
What are 3 special tests for TOS?
Adson's cotoclavicular or Halstead's maneuver Roos test
Opening the auditory tube during swallowing allows what?
Air from the nasal pharynx to move into the middle ear, which otherwise would have a pressure negative to atmospheric pressure
What is the lateral boundary of the greater pelvis?
Ala of ilium, iliacus muscle
Why do chronic alcoholics tend to bleed profusely if injured and for longer periods of time?
Alcohol interferes with the blood-clotting process in several ways. -dec platelets (thrombocytopenia) -disabled platelet function -dec fibrinolysis
What diretion of flow/shunting does the foramen ovale allow?
Allows right to left atrial flow
What direction of flow/shunting does the ductus arteriosus allow?
Allows right to left flow. Allows blood to bypass the lungs and enter the systemic system
Cholinesterase inhibitors, memantine and antipsychotic drugs could all be used to treat what disease?
Alzheimer's Disease
What is Klumpke's Palsy?
An injury to the inferior part of the brachial plexus, that results in a "clawhand": you can only flex the 1st and 2nd digit and the rest just partially
What is Backpacker's Palsy and what causes it?
An injury to the superior part of brachial plexus. A micro injury of the superior trunk due to carrying a heavy backpack.
What can cause a sudden CN III palsy?
Aneurysm especially within: post. cerebral A sup. cerebellar A post. communicating A
Which scalene muscles does the brachial plexus travel between?
Anterior and middle
What forms the medial cord?
Anterior division of the inferior trunk
What forms the lateral cord?
Anterior divisions of the superior and middle trunks
What does the median nerve innervate?
Anterior forearm and a little bit of the hand (8 muscles): flexors, pronators, palmaris longus, some thenar and lumbricals
What is the sacral promontory normally covered with?
Anterior longitudinal ligament
Degradation of neurotransmitter: the breakdown of the transmitter may halt neuronal activity. What drugs act on this step? (picture)
Anticholinesterase drugs
What structures does the perineum include in men? (3)
Anus Penis Scrotum
What structures does the perineum include in women? (2)
Anus Vulva (external genitalia)
What are the results of Erb's Palsy? What do you lose function of?
Appearance: "waiter's tip position" injured limb hangs by the side in medial rotation, loss of sensation on lateral aspect of upper limb, also causes muscle paralysis of deltoid, bicep, brachialis, and brachioradialis
Where is the perineum located?
Area between thighs that extends from the coccyx to the pubic symphysis It is the outlet of the pelvis
Where do parasympathetic visceral motor components arise from and terminate?
Arise: 4 brain stem nuclei Terminate: 4 peripheral ganglia
In normal capillary dynamics, which pressure is higher at the arterial end? At the venous end?
Arterial: Hydrostatic pressure (pushing fluid into interstitial space) Venous: Osmotic pressure (pulling fluid back into venous system)
What is the blood supply (artery & vein) to the part of the rectum above the pectinate line provided by?
Artery: IMA Vein: portal venous system
What is the blood supply (artery & vein) to the part of the rectum below the pectinate line provided by?
Artery: internal iliac A Vein: IVC
When doing MMT, where does the PT apply pressure? ***
At the distal end of the bone to which the muscle attaches (know this***)
If you damage the surgical neck of the humerus, what nerve are you also likely to damage?
Axillary Nerve
What vessel do the cords of the brachial plexus wrap around?
Axillary artery
What group do efferent axons of small myelinated nerves belong to?
B fibers (for diameters less than 3 micrometers)
If PROM=AROM, or you want to test the muscles of the cervical spine or small digits or scapula, or you want to do a quick screen for strength, which MMT scale should you use?
BT (break testing)
What conditions can both back sprains and strains lead to?
Back pain which in turn may cause protective reflex tonic muscle contraction (tight back) to guard the back from excessive movement
What is the flexor retinaculum?
Band of connective tissue that bridges between pisiform/hook of hamate and trapezium.
Summary of drugs that can be used to treat Epilepsy: (read)
Barbiturates Benzodiazepines Pregabalin Hydantoins Carbamazepine Vigabatrin Ethosuzimide Valporic acid
How are pelvic fractures treated that do not involve significant displacement?
Bed rest, external stabilization is not needed
Postsynaptic receptor: when the neurotransmitter finally binds to the post synaptic neuron, the signal is transduced to the next neuron. What is a drug that acts at this step? (picture)
Beta blockers
Why should pregnant women not consume alcohol?
Binge drinking of alcohol is thought to inhibit neural crest cell migration and can lead to heart, head, and neck defects
If the blood is pumped into the right ventricle, where does it go next?
Blood pumped out of the right ventricle will go toward the lungs which has a high resistance. The ductus arteriosus allows this blood to join the descending aorta to bypass the lungs.
What is the anterior boundary of the pelvic wall?
Body and ramus of pubic bone, pubic symphysis
Is MMT performed on functional patterns or specific muscles?
Both
Is the trigeminal N sensory or motor?
Both
What innervates the internal anal sphincter muscle?
Both sympathetic and parasympathetic Parasympathetic is from pelvic splanchnic NN
What are the branches off of the aorta from medial to lateral?
Brachiocephalic trunk, left common carotid artery, left subclavian artery
What is the most common type of MMT?
Break testing
Afferent axons of unmyelinated nerves belong to which group of fibers?
C fibers
What group do efferent axons of unmyelinated nerves belong to?
C fibers
What roots have fibers in the phrenic nerve?
C3-5
What roots have fibers in the upper subscapular nerve?
C5-6
What roots have fibers in the lateral cord?
C5-7
What roots have fibers in the lateral pectoral nerve?
C5-7
What roots have fibers in the long thoracic nerve?
C5-7
What roots have fibers in the posterior cord?
C5-T1
What roots give rise to the brachial plexus?
C5-T1 (sometimes C4)
What roots have fibers in the lower subscapular nerve?
C6-7
What roots have fibers in the thoracodorsal nerve?
C6-7
What roots have fibers in the medial cord?
C8-T1
What roots have fibers in the medial cutaneous nerve of the arm?
C8-T1
What roots have fibers in the medial cutaneous nerve of the forearm?
C8-T1
What roots have fibers in the medial pectoral nerve?
C8-T1
Innervation of tensor tympani:
CN V3 (mandibular trigeminal)
Innervation of Stapedius:
CN VII (facial)
Which CN does not exit from the brain?
CN XI, spinal accessory
Frequent attacks of acute asthma may lead to what condition?
COPD
PTs are responsible for monitoring pts following fractures and immobilization for possible development of ___________
CRPS should create a checklist of signs & symptoms to asses it
In what type of imaging does an x-ray tube and film move around a fulcrum?
CT scan
What would clinical presentation look like for a patient who has damaged their median nerve?
CTS: -burning, tingling or itching numbness in the palm of the hand and the fingers, especially the thumb, index and middle fingers Palsy: -ape hand with atrophy in the thenar eminence -no arm pronation, weak grip, no thumb abduction and opposition -sensory loss in thenar region
What is the cause of death of 67% of people with diabetes?
CVDs: -heart diseases such as CAD/MI and diabetic cardiomyopathy -stroke
Who is at the greatest risk for otosclerosis?
Caucasian women (and those who have 2 parents with otosclerosis)
What causes injuries of the brachial plexus and what are the results of an injury?
Cause: disease or injury Result: paraylsis or anesthesia
Which compartment of the hand is the common flexor synovial sheath located in?
Central compartment (sheath of FDS and FDP)
What is neurotmesis? What happens to the nerve? What happens in healing?
Characterized by not only *loss of nerve conduction, but damage to surrounding nerve trunk connective tissue*. In extreme cases of this injury category *complete transection occurs*. Commonly a *neuroma forms over the proximal stump* of the nerve, preventing normal continued regeneration to occur.
Why do chronic alcoholics eventually reverse their tolerance to alcohol?
Chronic alcoholics develop liver damage which reduces the amount of enzymes it can make to metabolize alcohol
Which peripheral ganglia do the parasympathetics of the oculomotor N synapse in?
Ciliary (V1)
What is the peripheral ganglion of the opthalmic branch of the trigeminal?
Ciliary ganglion
Is the Eustachian tube normally open or closed at rest?
Closed
What are the main termination branches of the superficial palmar arch of the ulnar artery?
Common palmar digital arteries which further branches into 2 proper palmar digital arteries
On the Daniels & Worthingham scale, what does a score of 2 mean?
Completes full ROM (not BT)
On the Kendall scale, what does a score of 3 mean?
Completes full ROM against gravity (no pressure)
On the Daniels & Worthingham scale, what does a score of 3 mean?
Completes full ROM against gravity (no pressure) and "breaks" with any resistance applied (BT)
On the Daniels & Worthingham scale, what does a score of 5 mean?
Completes full ROM against maximum resistance OR holds against max resistance (break testing, BT)
What is the palmar aponeurosis?
Continuation of fascia from the forearm and hand. It blends with the palmaris longus and flexor retinaculum.
What does the musculocutaneous nerve innervate?
Coracobrachialis, biceps, brachialis
What ganglion do the cranial nerves come from that also hitch hike along blood vessels such as the carotid AA?
Cranial nerves from the superior cervical ganglion
What would clinical presentation look like in someone who has damaged their ulnar nerve?
Cubital tunnel syndrome: -pain, numbness and/or tingling in the ring and little fingers Palsy: -partial claw with atrophy between the metacarpals and hypothenar region -loss of use of 4th and 5th digits for spherical and cylindrical power grip -thumb for adduction, finger abduction and adduction are lost -sensory loss in hypothenar region
What are the 2 diagonal PNF patterns called? Which body segments can these patterns be applied to?
D1 and D2 UE, LE and trunk
What is a widely used method of measuring bone mineral density?
DEXA (dual energy x-ray absortiometry)
Is diabetic nephropathy more common in people with DM1 or DM2?
DM2
What do straddle injuries result in?
Damage to external genitalia may bleed into the superficial perineal space The area the blood/urine can spread to is limited by the superficial perineal membrane and where it attaches Does not extend into thighs or around anus, does not go above arcuate line in abdomen
What is diabetic retinopathy?
Damage to the eye retina due to damage of retinal blood vessels by high glucose levels (hemorrhage) that can lead to vision loss
What day does the heart start to beat?
Day 22
What day does the intraembryonic circulation begin?
Day 25
What fascia is the perineal membrane a part of?
Deep fascia
What are the 3 parts of the external anal sphincter muscle?
Deep, superficial, and subcutaneous external sphincters
What does the axillary nerve innervate?
Deltoid and teres minor
What is the distance between the inferior* surface of the pubic symphysis and the sacral promontory called?
Diagonal conjugate
What can be estimated by transvaginal palpation? Why is this information helpful?
Diagonal conjugate Used to estimate the true & obstetrical conjugate which is the pathway of the baby
What is the perineum shaped like?
Diamond, can be separated into 2 triangles
Kendall's scale, Daniels & Worthingham, and ART are examples of what?
Different grading systems for MMT other than the normal numerical or quantitative scoring
Sympathetic fibers run in short & long ciliary NN to the back of the eye to innervate dilator or constrictor muscles of the pupil?
Dilator pupuillae muscles
What is the rate-limiting step of the 2 major pathways of catabolism of alcohol?
Dissociation of NADH to NAD+ which accepts H+ ions from each of the 2 major pathways. This reaction can affect other metabolic processes in the liver.
What does a mixed spinal nerve split into?
Dorsal and ventral rami
Which brain stem nuclei does the vagus preganglionic neuron start in?
Dorsal motor N. vagus
Why are people with Kaposi's sarcoma prone to develop other malignant tumorous processes?
Due to decrease in CD4 cells
How does the fossa ovalis close after birth?
Due to the pressure in the left atrium now being greater than the right atrium, the septum primum is pushed against the septum secondum thus closing the atrial shunt.
What is the difference b/w the pathophysiology of emphysema and chronic bronchitis?
E: destruction of alveolar walls, loss of elasticity, impaired expiration, barrel chest, hyperinflation CB: inc mucous gland size, inc secretions, inflamm, infections, obstruction
The oculomotor CN has parasympathetic and motor fibers. Which brain stem nuclei are the (preganglionic) parasympathetic fibers in? Which functions of CN III are due to the parasympathetics?
Edinger-westphall nucleus (this is b/c it is parasympathetic visceral motor) Parasympathetics control sphincter pupillae and ciliary muscles
What can induce right-to-left shunting in patients with a PFO?
Elevation in right atrial pressure, redirection of blood from the Eustachian tube, and straining and release phases of the valsalva maneuver
In MMT, if you are testing a single-joint muscle, you generally want to test near ________________ .
End range
What does the superficial perineal space contain?
Erectile tissue & muscles of the external genitalia
What is another name for the intermediate layer of the deep back muscles?
Erector Spinae group
What is the function of the pelvic diaphragm?
Essential for maintaining the proper positioning of the pelvic organs Essential for maintaining abdominal & thoracic pressure during micturation, defecation, child birth, and heavy lifting
Why is the consumption of methyl alcohol more rapidly toxic than the consumption of ethyl alcohol?
Ethyl: is oxidized quickly into acetate first and then CO2 & water Methyl: is only partially oxidized. It is quickly oxidized into formaldehyde, but slowly oxidized into formic acid which causes methanol poisoning
During cholesteatoma, the tympanic membrane is pulled into the middle ear by negative pressure due to:
Eustachian tube dysfunction
FYI: when viewing an x-ray film, the identification letters may be backward or upside down
Ex: L. AP or R. lateral
What is De Quervain's tenovaginitis stenosans?
Excessive friction of APL and EPB tendons that causes thickening of the synovial sheath. This causes pain that radiates down the forearm and thumb
Where is the lesser/true pelvis located?
Extends from pelvic brim to the pelvic floor/diaphragm
What do the posterior divisions mainly innervate?
Extensors (muscles in posterior region)
Which anal sphincter muscle is under voluntary control?
External anal sphincter
What structures does the urogenital triangle include in both males and females?
External genitalia and urethra of both sexes
What are the functions of the occulomotor N?
Extrinsic Eye Muscles: (motor)* levator palpebrae superior rectus medial rectus inferior rectus inferior oblique Intrinsic Eye Muscles: (para)* ciliary muscle sphincter pupillae muscle
What is the name of the U.S. government agency responsible for ensuring that drugs marketed in the U.S. are safe and effective?
FDA (food & drug administration)
What muscles can be used to test the integrity of the ulnar and median nerves?
FDP and lumbricals
FYI: Glutamate and aspartate strongly excite neuons in the brain
FYI
FYI: Lyrica is helpful in treating not only epilepsy, but also neuropathic pain, neuralgias associated with herpes, and fibromyalgia
FYI
FYI: Treatment of Parkinson's with antioxidants may actually slow the progression of the disease rather than mask symptoms
FYI
FYI: many of the drugs prescribed to treat epilepsy can also be used to treat anxiety and insomnia, but there are drugs also prescribed specifically for anxiety
FYI
Irina cautions you from looking up drugs on any website b/c anyone can put anything on the Internet. She lists lots of websites that she likes as drug references like the FDA
FYI
T/F: PNF session effects will result in lasting changes when used independently
False PNF alone will have ST effects, but if the new ROM is used in a functional way and strengthening is done within the new ROM the effects will last for longer
T/F: there is only one pressure acting on capillary fluids at both the arterial and venous ends.
False at both the arterial and venous ends of capillaries, both the hydrostatic pressure and the osmotic pressure exist, one is just higher at each end controlling fluid flow
What does most of the anal triangle contiain? What is this space called?
Fat to allow expansion of the anus during defecation Ischioanal/Ischiorectal fossa
Is the female or male true pelvis more wide & shallow?
Female
What is the subpubic angle of males and females? ****
Female: 90 degrees Male: 60 degrees
Is the pelvic outlet larger in females or males?
Females
Are patent ductus arteriosus more common in males or females?
Females, the ratio is 3:1
What type of joint is the pubic symphysis?
Fibrocartilaginous joint with an interpubic disc between the pubic bones
Which of the following muscles have a corresponding longus muscle: flexor digiti minimi brevis, flexor pollicis brevis, abductor digiti minimi, abductor pollicis brevis?
Flexor pollicis brevis Abductor pollicis brevis
What forms the roof of the carpal tunnel?
Flexor retinaculum
What do the anterior divisions mainly innervate?
Flexors (muscles in anterior region)
Where is the greater/false pelvis located?
From the iliac crests to the pelvic brim/inlet
What is the function of the abducens N? What does it pass through? Is it sensory, motor or both?
Function: lateral rectus (abd) Passage: superior orbital fissure Motor
What is the function of the puborectal sling and what is it formed by?
Function: maintain fecal continence, relieves pressure on anal sphincters Formed by: puborectalis portion of levator ani muscle
What is the function of the optic N? What does it pass through? Is it sensory, motor or both?
Function: sense of sight Passage: optic canal Sensory
What is the function of the olfactory N? What does it pass through? Is it sensory, motor or both?
Function: sense of smell Passage: cribiform plate Sensory
What is the function of the trochlear N? Where does it pass through? Is it sensory, motor or both?
Function: superior oblique: moves eye down, out, & slight IR Passage: superior orbital fissure Motor
_______ (neurotransmitter) is the most common neurotransmitter of the brain and is produced from glutamate
GABA
What are side effects of serotonin selective reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (same side effects for both)?
GI symptoms (nausea, vomiting, diarrhea, constipation)
NO (nitric oxide) is the transmitter of the __________ (organ system) smooth muscle cells that determines the activity level of those cells (also functions in the CNS)
GI tract
What is the difference between gross and specific testing for MMT?
Gross- common, assesses function of a patient overall Specific- more specific
What are the potential causes of an ulnar nerve injury?
Gunshots, stab wounds, fractures at distal humerus, olecranon, or head of radius
What does the ulnar artery pass through when it comes into the hand?
Guyon's canal along with the ulnar nerve
What are the different classifications of pelvic outlets? (4)
Gynecoid: typical female Android: typical male Anthropoid: elongated pelvis Platypelloid: flat pelvis
What 3 things can infection of the middle ear reduce?
Hearing, salivation, and taste
How do you test for De Quervain's tenovaginitis stenosans?
Hold thumb inside other fingers and ulnar deviate wrist. Should be very painful if positive
In the Kendall and Daniels & Worthingham scales, what scores are in the horizontal and vertical planes?
Horizontal: 0 - 2+ Vertical: 2+ - 5
Afferent axons of large myelinated nerves belong to which group of fibers?
Ia, Ib and II
When is a situation that you should get a patent foramen ovale fixed if you know about it?
If you are wanting to become pregnant
How can a pt with Kaposi's sarcoma be immunodeficient and still be hypergammaglobulinemic?
Ig levels are raised but decreased CD4 cells lead them to not be able to activate T and B cells which then would have activated Ig cells, so she is still immunodeficient
Where do the bulk of middle ear ossicles reside?
In the epitympanic recess above the tympanic membrane
Where are holes in the tympanic membrane usually made for myringotomy?
In the inferior half of the tympanic membrane, often posterior or near to the "cone of light", away from ossicles and chorda tympani N.
What is passive insufficiency in relation to MMT?
Inability of a 2 joint muscle to lengthen over 1 joint when it is already lengthened over the other joint. Ex: rectus femoris
What is active insufficiency in relation to MMT?
Inability of a 2 joint muscle to perform a concentric contraction* over 1 joint when it is shortened over the other joint. Ex: hamstrings
What is the purpose of producing hormones to relax pelvic joints during pregnancy?
Increase the birth canal size, especially the lateral dimension
What can be given to a premature infant to speed the closure of a patent ductus arteriosus?
Indomethican
What is tenosynovitis? (cause, symptoms)
Infection of the synovial sheath caused by an injury such as a puncture of the palm with a rusty nail. Symptoms include: swollen digits and painful movements. Infection can spread based on connection of sheaths.
What innervates the external anal sphincter muscle?
Inferior rectal nerve (branch of pudendal nerve, somatic NS)
What is a brachial plexus block?
Injection of anesthesia between the SCM and clavicle. This is done during an upper limb operation. Have to be careful not to cause a pneumothorax or injecting into the vessels instead of the axillary sheath
What is Erb's Palsy and what causes it?
Injury to superior part of brachial plexus caused by excessive separation of the head & neck such as falling with shoulder on ground or during child birth
Which anal sphincter muscle is tonically contracted but relaxes to release gas and fecal material?
Internal anal sphincter
Where are internal vs external hemorrhoids?
Internal: above pectinate line External: below pectinate line
What should part of a differential diagnosis for back pain include?
Intervertebral disc rupture/herniation, nerve inflammation/compression, degenerative changes in facet joints, metabolic bone disease, abdominal aneurysm, metastic cancer, myofascial disorders, back sprain/strain
What is the difference between intrinsic and extrinsic hand muscles?
Intrinsic muscles originate and insert in the hand. Extrinsic muscles originate from the anterior forearm and insert in the hand.
What bony structure causes the transverse diameter of the pelvic inlet to be smaller?
Ischial spines
What is the lateral border of the perineum?
Ischial tuberosities
What is the superficial branch of the ulnar nerve?
It branches distal to the flexor retinaculum and supplies the medial 1.5 digits on anterior surface (palmar musculature)
What is the deep branch of the ulnar nerve?
It branches just below the flexor retinaculum and supplies the hypothenar muscles, medial lumbricals, adductor pollicis, and all interossei muscles
What is the palmar cutaneous branch of the ulnar nerve?
It branches off before the wrist and passes superior to flexor retinaculum to supply skin of palm There is also a palmar cutaneous branch of the median nerve
What is the dorsal branch of the ulnar nerve?
It branches proximal to the wrist and supplies the medial half of the dorsum of the hand, 5th digit and half of 4th digit
What happens to the brachial plexus if an individual has hypertrophied scalenes?
It can impinge on the brachial plexus
What does the Eustachian tube do?
It equilibrate the pressure of the closed middle ear cavity with the air pressure in the nasal pharynx only during *swallowing and yawning*
What does the palmar aponeurosis form around the digits?
It forms 4 digital bands that attach to the proximal phalanges that each form a ligamentous sheath for the flexor tendons
What is the function of the external ear?
It functions to collect sounds
What is the function of the middle ear?
It functions to transmit vibration in air to fluid in the inner ear
When and why is folic acid important for pregnant women?
It helps form a closed off neural tube, this is formed at about 2 weeks gestation, so folic acid is needed early on in pregnancy and is recommended prior to conception
What is the function of the fibrous digital sheath?
It holds the tendons to the phalanges during flexion
What forms the middle trunk?
It is a continuation of the C7 root
Where is the pelvic brim/inlet located?
It is a plane marked by the: sacral promontory** pubic crest** arcuate line pectineal line
Why is the sacral hiatus clinically important?
It is a site of injection into the caudal epidural space
What motion causes compression of cords of the brachial plexus if done repeatedly?
It is a superior injury caused by hyperabduction of the arm (i.e. painting a ceiling) symptoms include pain running down the arm, numbness, tingling
Is serratus posterior an upper extremity or back muscle?
It is a true back muscle, it is just inferior to the rhomboids so it is important not to get the 2 confused
What population is vaginismus most often seen in?
It is an uncommon condition, but when it is seen it is frequently present in certain religious groups
Why should the sudden loss of smell not be ignored
It is associated with early... Parkinson's Alzheimer's Huntington's
What is the clinical importance of a PFO?
It is associated with paradoxical embolism and stroke
What type of joint is the sacroiliac joint?
It is both fibrous and synovial
What is the innervation of the rectum below the pectinate line like?
It is completely somatic below the line Above the line is somatic and visceral
Why is the puborectalis muscle less likely to be injured during child birth?
It is only attached anteriorly and is used to being stretched (defecation) If it is injured though it may result in fecal incontinence
What is the flexor retinaculum deep to?
It is under the palmar aponeurosis and palmaris longus tendon. It is a part of the palmar fascia
What happens if the ductus arteriosus is still patent after 3 months?
It is unlikely to spontaneously close and generally requires surgery
What happens to the interpubic disc during pregnancy?
It may increase in size and laxity which is a source of pelvic pain in pregnant women. This change may be permanent after pregnancy which causes an increase in lateral pelvic dimension
Is bed rest recommended for back strain?
It used to be, but recent studies show most of the time people get better faster if they go about normal activities (nothing excessive)
What kind of accidents may lead to displacement of the head of the femur through the head of the acetabulum?
Jumping accidents (parachuting)
Where do the cords start in the brachial plexus?
Just below the clavicle
What kind of movement do the lumbricals create?
L or Z movement
Which type of DM is "type 1.5"?
LADA (latent autoimmune diabetes in adults)
Are amputations due to cancer usually in the UEs or LEs?
LEs
How many stages of lymphedema are there? What are each of the stages called?
Latency Stage Stage I (reversible) Stage II (spontaneously irreversible) Stage III (elephantiasis)
What branches off of the lateral cord?
Lateral pectoral nerve
What does the thoracodorsal nerve innervate?
Latissimus dorsi
If a pt had a purple nodule on their shoulder and nodular lesions in their lungs and GI tract, what would you think caused this?
Lesions most likely due to Kaposi's sarcoma
What causes carpal tunnel?
Lesions/damage of the structures within the tunnel such as inflammation, infection, excessive exercise, etc.
Which muscles form the pelvic diaphragm/floor?
Levator ani Coccygeus
What organ is responsible for the catabolism/detoxification of the major portion of alcohol ingestion?
Liver
What is anosmia? What causes it?
Loss of ability to smell Causes: skull fractures that shear CN's at cribiform plate and hypogonadism
What are the 5 terminal branches?
MARMU: musculocutaneous, axillary, radial, median, ulnar
Which type of DM is hereditary?
MODY (maturity onset diabetes of the young)
Which type of imaging uses pulses of radio frequency and a strong external magnet to generate an electromagnetic field?
MRI
What nerve root(s) is the levator ani muscle mostly innervated by?
Mainly S4
What nerve root(s) is the coccygeus muscle innervated by?
Mainly S4, but some S3 and S5
Is the female or male greater pelvis more narrow?
Male
Is a male or female pelvis heavier?
Male pelvis is heavier, female is lighter
What passes through the pelvic diaphragm in males and females?
Male: urethra and anus Female: urethra, vagina, and anus
What is active resistance testing (ART)?
Manual resistance applied during an actively contracting muscle. Requires more skill to accurately test.
What is break testing?
Manual resistance applied to test a limb to "break" a static positional hold. The joint is NOT actively moving through ROM.
What branches off of the medial cord?
Medial pectoral, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm
Is the ulnar nerve lateral or medial to the ulnar artery?
Medial to artery
What are the medial and lateral fibrous septa of the hand?
Medial: separates the hypothenar compartment from the potential midpalmar space Lateral: separates the thenar compartment from the potential thenar space
If you damage the distal end of the humerus, what nerve are you also likely to damage?
Median nerve
What is often injured when the wrist is lacerated either by accident or on purpose?
Median nerve injury that will result in carpal tunnel symptoms
In MMT, if you are testing a two-joint muscle, you generally want to test near _________________ .
Mid-position of the range
Which scalene muscles does the long thoracic nerve travel between?
Middle and posterior
In differential diagnosing from resisted testing, what does "strong and painful" mean?
Minor lesion of the tested muscle or tendon
What will be affected in carpal tunnel syndrome?
Mostly the 3 thenar muscles (esp opponens) and half of the lumbricals
The brain stem contains the nuclei for the cranial nerves. Are the motor or sensory CN's more medial?
Motor nuclei are more medial Sensory nuclei are more lateral
What type of nerve fibers are in the brachial plexus?
Motor, sensory, and autonomic (sympathetic)
On the Kendall scale, what does a score of 2 mean?
Moves through complete ROM in a gravity minimal plane
What does the deep perineal space contain?
Muscle of the urethra and a deep transverse perineal muscle that supports the free edge of the perineal membrane. Nerves and arteries are also in this space
What is an antagonist?
Muscle that acts in opposition to the action of another muscle/agonist
What is fixation substitution?
Muscles that normally fixate a joint compensate for a weak agonist
What is the pelvic diaphragm/floor? What does it attach to?
Muscular funnel that surrounds the anal canal Stretches from pubic symphysis anteriorly to the coccyx posteriorly, and is attached to the obturator internus muscle on each side (laterally)
What roots have fibers in each of the terminal braches of the brachial plexus?
Musculocutaneous: C5-7 Axillary: C5-6 Radial: C5-T1 Median: C5-T1 Ulnar: C8-T1
Serratus Posterior Superior (N & A)
N: first 4 intercostal nerves A: elevates ribs
Serratus Posterior Inferior (N & A)
N: last 3 intercostal nerves A: depresses ribs
Which part of the retina does the temporal visual field strike?
Nasal retina, which then crosses at the optic chiasm
In differential diagnosing from resisted testing, what does "strong and painless" mean?
No lesion or neurological deficit involving the tested muscle or tendon
Does the ulnar nerve pass through the carpal tunnel?
No, it passes through the ulnar/guyon's canal
Does all blood make it through the foramen ovale in utero?
No, the rest will be pumped into the right ventricle
Are patent foramen ovale considered to be an atrial septal defect?
No, there is no septal tissue missing
What branches come off of the 6 divisions of the brachial plexus?
None
What intrinsic muscles of the hand does the radial nerve innervate?
None, it innervates the lateral skin of the dorsum of the hand and thumb
Does the sacroiliac joint permit much movement?
Not normally, but during pregnancy it does due to hormones produced to relax the ligaments to allow the birth canal to be more flexible
Does the transverse diameter of the pelvic inlet limit vaginal delivery?
Not usually because ischial spines are not usually large enough to cause a problem
Does the pelvic outlet limit vaginal delivery?
Not usually because the coccyx is moveable
What are the 2 common grading systems for MMT?
Numerical scores (5-0) Qualitative scores (normal-zero)
If a pt has AIDS and Kaposi's sarcoma, what nutritional and PT interventions might be used and why?
Nutrition: healthy eating, inc calories & protein to counter cachexia & dec immune system PT: inc strength, aerobic exercise, improve balance, pain management
What do oximeters measure?
O2 saturation in blood
Spinalis
O: SP I: SP N: posterior rami of spinal n A: bil extend cerv/thorax, unil lateral flx, rotation Only talking about lumbar and thoracic regions of this muscle for this section
Latissimus Dorsi
O: SP T5-T12, thoracolumbar fascia, iliac crest, ribs I: bicipital groove of humerus N: thoracodorsal nerve A: adducts, extends, & IR arm
Rhomboid Minor
O: SP of C7-T1 I: root of spine of scap N: dorsal scapular nerve, C5 A: adducts scapula
Rhomboid Major
O: SP of T2-T5 I: medial border of scapula N: dorsal scapular nerve, C5 A: adducts scapula
Rotatores
O: TVP I: SP 1-2 segments superiorly N: A: slight rotation of spine
Levator Scapulae
O: TVP of C1-C4 I: medial border of scap N: dorsal scapular nerve, C3, C4 A: elevate scapula
Semispinalis
O: TVP of C4-T12 I: SP of 4-6 segments superiorly N: A: Extend & rotate the neck
Trapezius
O: base of skull, lig nuchae, spines of C7-T12 I: spine of scap, acromian, lat 1/3 of calvicle N: CN 11, C3, C4 A: adduct, elevate, depress, rotate
What is the O, I, N, F of adductor pollicis?
O: capitate, 2 & 3 metacarpals I: medial side of proximal phalanx N: ulnar nerve F: adducts thumb It has a transverse head (MC) and an oblique head (capitate)
What is the O, I, N, F of lumbricals?
O: flexor digitorum profundus tendons I: lateral sides of extensor expansion (dorsal side) N: same as FDP F: flexes MCP joints, extends IP joints of 4 fingers
What is the O, I, N, F of opponens pollicis?
O: flexor retinaculum, scaphoid, & trapezium I: 1st metacarpal N: median nerve F: abduction & IR of 1st CMC joint deep to abductor pollicis brevis, lateral to flexor pollicis brevis
What is the O, I, N, F of abductor pollicis brevis?
O: flexor retinaculum, scaphoid, & trapezium I: base of 1st phalanx N: median nerve F: abducts CMC joint of thumb
What is the O, I, N, F of flexor pollicis brevis?
O: flexor retinaculum, scaphoid, & trapezium I: base of 1st phalanx N: median nerve: superficial head, ulnar nerve: deep head F: flexes CMC joint of thumb
What is the O, I, N, F of flexor digiti minimi brevis?
O: hook of hamate & flexor retinaculum I: base of proximal phalanx of 5th digit N: ulnar nerve F: flexes the 5th digit at MCP joint
What is the O, I, N, F of opponens digiti minimi?
O: hook of hamate & flexor retinaculum I: medial border of 5th metacarpal N: ulnar nerve F: flexes & laterally rotates 5th digit at MCP joint
Serratus Anterior
O: outer surface of ribs 1-8 I: medial border of scap N: long thoracic nerve A: abducts & protracts scap
What is the O, I, N, F of abductor digiti minimi?
O: pisiform I: base of proximal phalanx of 5th digit N: ulnar nerve F: abducts 5th digit
Longissimus
O: posterior lateral surface of sacrum/iliac crest, supraspinous lig, and TVP I: ribs, TVP of thoracic & cervical, and mastoid process N: posterior rami of spinal n A: bil extend cerv/thorax, unil lateral flx, rotation Has a distinct logissimus capitis portion that is important to know
Iliocostalis
O: posterior lateral surface of sacrum/iliac crest, supraspinous lig, and ribs I: ribs at angle, cervical TVP N: posterior rami of spinal n A: bil extend cerv/thorax, unil lateral flx, rotation
Multifidus
O: sacrum/ilium, TVP I: SP 2-4 segments superiorly N: A:
What is the O, I, N, F of the dorsal interossei?
O: shaft of metacarpals I: extensor expansion, base of proximal phalanx N: all ulnar nerve F: abduct digits (DAB)
What is the O, I, N, F of the palmar interossei?
O: shaft of metacarpals I: extensor expansion, base of proximal phalanx N: ulnar nerve F: adduct digits (PAD)
What is the anteroposterior distance between the inner* surface of the pubic symphysis and the sacral promontory?
Obstetrical conjugate
What is the lateral boundary of the true pelvis?
Obturator internus muscle***
Which CN's come from the midbrain? (3)
Oculomotor Trochlear part of Trigeminal
What do pelvic fractures from car accidents usually look like?
Often involve displacement of the pubic symphysis posteriorly, breaking the superior and/or inferior rami The pelvis rarely breaks in one place (like a pretzel) ***
Which CN's are extensions of the CNS? (2)
Olfactory Optic
Where is the location of the primary neurons of the olfactory nerve?
Olfactory epithelium
Why should anosmia be tested bilaterally?
Olfactory loss may be unilateral
What is the main difference between the actions of the opponens pollicis and the opponens digit minimi other than the direction that they rotate their respective phalanges?
Opponens pollicis: does true opposition Oppnens digiti minimi: does not do true opposition
Which bones make up the bony pelvis?
Os coxae (2) Sacrum Coccyx
Which peripheral ganglia do the parasympathetics of the glossopharygneal N synapse in?
Otic (V3)
What is the peripheral ganglion of the mandibular branch of the trigeminal?
Otic ganglion Submandibular ganglion
Is a female pelvic brim oval or heart shaped?
Oval shaped Male is heart shaped
How is the blood flow directed through the foramen ovale in utero?
Oxygenated blood from the placenta passes through the umbilical vein, into the inferior vena cava, and into the right atrium. From here, the Eustachian valve of the inf vena cava jets the blood at the foramen ovale to send it into the left atrium thus bypassing the lungs
What may clinical presentation for radial nerve damage look like?
PINS: -pain and tenderness in proximal forearm, finger extension weakness, *numbness should not be present* Palsy: -wrist drop -high lesions affecting the triceps, cannot push, weak supination -unable to make fist or grip objects unless wrist is stabilized in extension -sensory loss in posterior arm, forearm, and hand on radial side in the case of *radial tunnel syndrome*
When should you initiate transfer training after an amputation?
POD #1 if pt is medically stable
In MMT, if AROM is limited, what should you check next?
PROM If PROM > AROM, score should be less than 3, if it is the same as AROM use BT or ART to score
What creates dimples on the back side near the sacrum?
PSIS
Which branch of the median nerve is not affected with carpal tunnel syndrome?
Palmar branch of median nerve will not be affected because it branches prior to the carpal tunnel
What are the branches of the deep palmar arch of the radial artery?
Palmar metacarpal arteries
What does oculomotor pass through? Is it sensory, motor or both?
Passage: superior orbital fissure Motor
How is a Roos test performed?
Patient sitting with arms in a "touchdown" position, palms facing forward, have them slowly clench fingers in a fist and straighten for 3 mins. Any reports of pain, heaviness, numbness and tingling is positive for TOS
What does the lateral pectoral nerve innervate?
Pectoralis major
What does the medial pectoral nerve innervate?
Pectoralis major and minor
What area of the body is the inferioposterior portion of the abdomen?
Pelvis
What are the external genitalia and urethra built up on for support?
Perineal membrane
What is the cause of vaginismus?
Possible causes include religious upbringing, psychological factors, past sexual trauma, or history of discomfort with sexual intercourse
What does the radial nerve innervate?
Posterior arm (tricep) and forearm (11 muscles: all the extensors, supinator
What covers the sacral hiatus?
Posterior sacrococcygeal ligament
Where do ulnar nerve injuries most often happen?
Posterior to the medial epicondyle of the humerus. They also happen at the cubital fossa, wrist, and hand
Fampridine is a generic name for what class of drug? Which are used to treat what condition?
Potassium channel blocker used to treat MS
What are the midpalmar and thenar spaces?
Potential spaces bound by fibrous septa. You generally don't feel these spaces unless they become fluid filled (due to infection or injury)
What are common variations of the brachial plexus?
Prefixed/postfixed brachial plexuses, formation of trunks, divisions, cords may be different, the median nerve might be formed from 2 branches of the medial cord
Lyrica is the trade name for what drug?
Pregabalin
Lymphedema can be divided into one of two classifications. What are they?
Primary Secondary
What is an agonist?
Prime mover
What can problems with one set of structures lead to?
Problems with a second set of structures
What hormones are produced during pregnancy that are responsible for making the pelvic joints more mobile, especially the pubic symphysis?
Progesterone Relaxin
What does PNF stand for?
Proprioceptive Neuromuscular Facilitation
Which peripheral ganglia do the parasympathetics of the facial N synapse in?
Pterygopalatine (V2) Submandibular (V3)
What is the peripheral ganglion of the maxillary branch of the trigeminal?
Pterygopalatine ganglion
When standing, the ASIS is in the same vertical plane as what other bony landmark?
Pubic symphysis
Which muscle is most likely to be compromised during child birth? What might this result in?
Pubococcygeus Urinary stress incontinence & may contribute to uterine prolapse
Relaxation of what muscle is essential during defecation?
Puborectalis along with external anal sphincter muscles
What are the parts of the levator ani muscle called?
Puborectalis muscle Pubococcygeus muscle Iliococcygeus muscle
What named nerve innervates external genitalia in both males and females?
Pudendal nerve
What is the function of the puborectalis muscle?
Pulls anorectal junction anteirorly creating an anorectal angle which aids in maintaining fecal continence **
Pressure equalization tubes are generally placed in which quadrants of the tympanic membrane?
Quadrats II (or III)
What artery travels in the anatomical snuff box?
Radial artery
If you damage the radial groove, what structures are you also likely to damage?
Radial nerve and deep arm vessels
Which side of the FDP tendons do the lumbricals arise from?
Radial side
What is digital tenovaginitis stenosans?
Repetitive forceful use of fingers that causes thickening of the fibrous digital sheath. FDS and FDP tendons may enlarge. Passive extension of the affected finger results in a snap sound like beads moving through constricted openings
Where is the location of the primary neurons of the optic nerve?
Retinal ganglion cells
What does the brachiocephalic trunk branch into from medial to lateral?
Right common carotid artery, and right subclavian artery
What are the 5 regions of the brachial plexus?
Roots, trunks, divisions, cords, terminal branches (nerves)
What is the only bony articulation that the shoulder has with the axial skeleton?
SC joint
What does SNOUT stand for?
SN: sensitivity OUT: negative test rules out
Stage II CRPS is thought to be caused by an over reactive ______
SNS
Sympathetic pain is a type of nerve pain due to the abnormality of the function of the ________
SNS see peripheral changes in somatic tissues
What does SPIN stand for?
SP: specificity IN: positive test rules in
What is the anterosuperior most portion of the sacrum, just below the junction of the sacrum with L5 vertebra, called?
Sacral promontory
What is the posterior boundary of the pelvic wall?
Sacrum, coccyx, and part of ilium/sacroiliac joint
Which 2 muscles pull on opposite sides of the cartilage of auditory tube to open the aud. tube during swallowing?
Salpingopharyngeus & tensor palatini
What is the superficial fascia called in females? (2 names)
Scarpa's fascia Colles' fascia
What is the superficial fascia called in males? (3 names)
Scarpa's fascia Darto's fascia (penis & scrotum) Colles' fascia (behind scrotum)
Is AIDS a primary or secondary immunodeficiency? Why?
Secondary because it was acquired. Primary would mean it was hereditary
What does cutaneous mean?
Sensation
What are the symptoms of carpal tunnel?
Sensation changes in median nerve area and thenar muscle weakness/atrophy which can result in being incapable of opposing thumb. Sensation change can radiate into forearm
What are the results of Backpacker's Palsy? (Which nerves are affected?)
Sensory deficits in the musculocutaneous and radial nerves. It may also cause muscle spasms
What is the function of the trigeminal N?
Sensory: face, scalp, nose, paranasal sinuses, eye, mouth & teeth Motor: 4 mastication mm, mylohyoid, ant belly of digastric, tensor tympani m, and tensor palati m
What is tic doloureux?
Severe, sudden pain in areas covered by the trigeminal N It can occur in only 1 branch or a combination of branches
The sympathetic postganglionic neurons that innervate the dilator pupuillae muscles run through which nerves?
Short and long ciliary nerves
What does the medial cutaneous nerve of the arm innervate?
Skin on medial side of arm and superior part of forearm
What does the medial cutaneous nerve of the forearm innervate?
Skin on medial side of forearm
What is the palmar brevis?
Small, superficial muscle above the hypothenar eminence. Aids in gripping, but isn't important. Animals use this when they run on the ground.
Why do some prefer ART over Kendall or D & W?
Some think it is more objective
What are potential causes of back pain?
Spinal cord, spinal nerves, vertebral bodies, intervertebral joints, intervertebral ligaments, muscles and their interactions with each other, etc
What is the difference between a back sprain and back strain?
Sprain: involves ligament damage (less common). Strain: involves muscle damage.
When do the bones of the os coxae start to fuse? When do they finish fusing?
Start: around puberty (12 girls, 14 boys) Finish: age 20-25
Name the 4 articulations that occur in the shoulder
Sternoclavicular Acromioclavicular Glenohumeral Scapulothoracic
What is Cholesteatoma?
Stratified squamous epithelial misplaced within the tympanic cavity (accumulation of dead skin that becomes trapped in the middle ear)
On the Kendall scale, what does a score of 5 mean?
Strong pressure
What nerves does the superior trunk give off?
Subclavius and suprascapular nerve
What does the subclavius nerve innervate?
Subclavius muscle
What does the upper subscapular nerve innervate?
Subscapularis
What are common injuries to the inferior part of the brachial plexus? (C8-T1)
Sudden pull of the arm superiorly such as grasping a tree to stop a fall or during child birth resulting in Klumpske's palsy
What anatomical space fills with fluid in a straddle injury?
Superficial perineal space
What 2 spaces are created by the presence of the perineal membrane?
Superficial perineal space Deep perineal space
Which muscle of the eye runs through a pulley?
Superior oblique
Which muscle is the main intorter of the eye? Damage to which CN results in its inability to work?
Superior oblique trochlear N lesion
Which brain stem nucleus does the facial preganglionic neuron start in?
Superior salivatory
What is superior, attached to, and inferior to the ischial spines?
Superior: greater sciatic notch Attached: sacrospinous ligament Inferior: inferior sciatic notch
What does the suprascapular nerve innervate?
Supraspinatus, infraspinatus, and glenoid joint
Name the amputation: ankle disarticulation w/ preservation of heel pad
Syme's
How do you diagnose and treat carpal tunnel?
Symptoms can be reproduced by pressing the wrists for about 30 seconds. Treatment includes surgical release of the carpal tunnel
What is in between the fibrous digital sheath and the flexor tendons of the digits?
Synovial sheath
Contrast MRI imaging increases the signal to a (T1 or T2) weighted image
T1
Do T1 or T2 MRI images have good gray/white matter discrimination?
T1
Which type of MRI image has short repetition and echo times?
T1 image
Are T1 or T2 MRI images useful for imaging CSF and edema?
T2
Which type of MRI image has long repetition and echo times?
T2 image
What happens during the primary stage of TB?
TB Infection -person is exposed/infected -doesn't have the active disease -is asymptomatic -can't transmit the disease
What happens during the secondary stage of TB?
TB disease -person has active infection -occurs when cell-mediated immunity is impaired -can be spread to others -highly infectious when there's personal close contact for a period of time
What is the "white line" of the pelvic floor also known as?
Tendinous arch of the levator ani muscle Epimysium of obturator internus
What does the lower subscapular nerve innervate?
Teres major, and inferior part of subscapularis
What harm comes from Cholesteatoma?
The accumulation of dead stratified squamous cells that become trapped in the middle ear can destroy the middle ear structures by compression, due to inadequate blood flow
Do the suprascapular artery and nerve go above or below the superior transverse scapular ligament?
The artery goes above and the nerve goes below it
Why is there a decrease in pressure in the right atrium after birth?
The blood flow from the umbilical veins is lost
What population commonly fractures the surgical neck of the humerus and how do they do it?
The elderly, caused by fall on to hand
What are MMT grades an expression of?
The examiner's evaluation of the strength/weakness of a muscle
Define pressure/resistance in relation to MMT
The external force applied by PT to determine the strength of the muscle
What is fixation/stabilization?
The firmness/stability of the body or body part Necessary to ensure an accurate test of a muscle, important for MMT Can be applied by table, pt's body or PT
What is a patent foramen ovale?
The foramen ovale is a hole between the right and left atria in a fetal heart. It should close after birth. Patent means failure to close, so a patent foramen ovale is when this hole does not close like it should after birth.
What is a possible explanation for the damage to the retina associated with methanol poisoning?
The formic acid produced from oxidizing methyl alcohol causes specific injury to the retina & optic N by inhibiting mitochondrial energy function
Can a patient move their arm if they fracture the surgical neck of the humerus?
The fracture is stable due to surrounding ligaments, so the patient can still move the injured arm passively with little pain
Where does the superficial membranous fascia (Colle's fascia) attach to?
The free edge of the perineal membrane just anterior to the anus
What is a potential complication of a postfixed brachial plexus?
The inferior trunk may be compressed by the 1st rib producing neurovascular symptoms
What is a possible explanation for how people develop tolerance to alcohol?
The liver adapts to the presence of alcohol in the body's system by increasing the amount of enzymes ADH and ALDH. This way it can clear the same amount of alcohol in less time.
What does the anterior wall of the ear contain?
The opening for the Eustachian tube and a bulge for the internal carotid a.
What are the branches of the deep palmar arch of the ulnar artery?
The palmar metacarpal arteries which anastomose with the common palmar digital arteries of the superficial palmar arch
Where does cholesteatoma usually start?
The pars flaccida, where a fibrous layer is lacking
What is a test position?
The position in which a muscle or muscle group is to be tested Usually start in a position that allows pt to move against gravity and move to anti-gravity if needed
What forms the posterior cord?
The posterior division of all 3 trunks
Why is there a significant increase in pressure in the left atrium just after birth?
The rise in blood flow to the lungs will also cause an increase in blood flow from the lungs which goes into the left atrium
What will never vary about the brachial plexus?
The terminal branches
What are the intermediate layer of the deep back muscles contained within?
The thoracolumbar fascia
What is called the "nerve of fine movements"?
The ulnar nerve because it innervates muscles involved in intricate hand movements
What happens just after birth to the ductus arteriosus?
The vascular resistance of the lungs decreases. Increased oxygen levels cause muscle contractions in the walls of the ductus arteriosus to contract which largely increases blood flow to the lungs.
Do ventral or dorsal rami make up the brachial plexus?
The ventral (anterior) rami of C5-T1 spinal nerves
Why are synovial sheaths important for the extrinsic muscles of the hand
Their muscle bellies are in the forearm and only tendons enter the hand, the sheaths help protect these tendons
Congenital Spinal Cord Defects: what is the range of severity and cause of these defects?
There are a range of defects from mild to debilitating including paralysis and death. The most common congenital spinal cord defect is due to failure of the neural tube to close completely. These defects are thought to be due to folic acid insufficiency
What is a prefixed and postfixed brachial plexus?
These are both variations of what spinal nerves contribute to the brachial plexus. Prefixed: C4-C8 Postfixed: C6-T2
How do most postganglionic sympathetic neurons, that innervate head & neck structures, travel? What are the 2 exceptions**?
They "hitch hike" along blood vessels, especially carotid AA Exceptions: deep petrosal NN and long ciliary NN ***
What are the function of the shunts in utero?
They allow blood flow to bypass the fetal lungs which are non-functional
What are the proper palmar digital arteries and where do they run?
They are branches off of the common palmar digital arteries of the superficial palmar branch of the ulnar artery. They run along the sides of digits 2-4
Why might someone who ingested a small amount of methyl alcohol be treated by giving them ethyl alcohol?
They are competitive substrates for the same enzyme. ADH will oxidize ethyl alcohol first which would reduce the rate of metabolism of methanol significantly
How do the tensor tympani and stapedius act as shock absorbers?
They contract to limit the transfer of energy for the air to the inner ear during loud sounds, which tightens the ossicular chain and thus protects the inner ear from excessive mechanical energy
Why are neural crest cells important?
They contribute to the cells that form the endocardial cushion and a wide variety of head and neck structures
What do kegel exercises involve and why are they used?
They involve isometric contractions of the pubococcygeus muscle and pelvic diaphragm in general Helps prevent urinary stress incontinence during/after pregnancy, also helps prevent injuries during child birth
What is a paradoxical embolism?
This occurs when an embolus arises in the systemic venous system or the right atrium and crosses the PFO during right-to-left shunting and enters the systemic arterial circulation
What is the purpose of the ear drum and middle ear ossicles?
To capture a high % of the energy of the vibrating air and transfer it to create vibrating fluid in the inner ear
What are Parcopa and Sinemet?
Trade names for Carbidopa and Levodopa
What is another name for the deep layer of the back muscles?
Transversospinalis group: multifidus, rotatores, semispinalis
List the superficial back muscles (8)
Trapezius, levator scapulae, rhomboid major and minor, latissimus dorsi, serratus posterior superior and inferior, and serratus anterior
What makes up the triangle of auscultation?
Trapezuis, latissimus dorsi, and medial border of the scap
What may produce an "ape hand"?
Trauma to the median nerve which would limit thumb movement in flexion and abduction (ape monkey bars)
All of the peripheral ganglia are associated with branches of which cranial nerve?
Trigeminal
Which is the largest CN?
Trigeminal
Which CN is in Meckel's/dural cave?
Trigeminal N
Where are the sensory primary neurons of the trigeminal nerve located?
Trigeminal ganglion
Where are the motor primary neurons of the trigeminal nerve located?
Trigeminal motor nucleus
What does TKA stand for and what is it in terms of prosthetics? (Hint: not total knee arthroplasty)
Trochanter Knee Ankle refers to stationary alignment line to identify the relative alignment b/w the center of the socket weight line (trochanter), the rotation point of the knee & the functional rotation point of the foot/ankle
Most cranial nerves exit from the ventral surface of the brain, which cranial nerve exits from the dorsal surface of the brain?
Trochlear N
Where is the location of the primary neurons of the trochlear N?
Trochlear nucleus
How many shunts are there in the heart prior to birth?
Two: foramen ovale and ductus arteriosus
Are UE or LE diagonal PNF patterns used more often?
UE
Is acceptance of a prosthesis often an issue with UE or LE amputees?
UE amputees, especially in pediatric patients
If you damage the medial epicondyle of the humerus, what nerve are you also likely to damage?
Ulnar nerve
Damage to what nerve would result in a loss of Z movement?
Ulnar nerve, it would cause a claw hand
Where is the brachial plexus in relation to the clavicle?
Underneath it
What are early signs of vestibular schwannoma?
Unilateral hearing loss (98% of cases); tinnitus (ringing in the ears); loss of balance; dizziness
What branches off of the posterior cord?
Upper subscapular, thoracodorsal, and lower subscapular nerves
What are the 2 triangles of the diamond shaped perineum called?
Urogenital triangle Anal triangle
Where do the 3 divisions of the trigeminal N pass through the skull?
V1: ophthalmic: superior orbital fissure V2: maxillary: foramen rotundum V3: mandibular: foramen ovale
Compare/contrast vascular system with lymph system based on the following: -closed/open system? -direction of fluid in system -volume
Vascular: -"closed system" -circulating system -fairly set volume Lymph: -open ended -one way flow -capacity can increase by 10X
What is the function of the inner ear?
Vestibulocochlear organs interpret different vibrations as nerve impulses and send them to the brain
What is substitution in terms of MMT?
When a muscle attempts to compensate for the lack of function of another muscle
What is Bruised Ear or "cauliflower ear"?
When the ear is struck hard enough to cause a hematoma between the cartilage and perichondrium. The cartilage dies and reduces in size under the hematoma, resulting in deformed cartilage
Meningomyelocele
When the meninges and spinal cord have "wandered out". This is almost always associated with neural defects, anywhere caudal to this area is usually non-functional.
Meningocele
When the meninges have "wandered out" of the spinal column and into the subarachnoid space due to the posterior arch failing to form
Rachischisis
When the neural tube does not close off and there is just neural tissue instead. This is why folic acid is recommended for pregnant women.
What is Kaposi-stemmer sign? What does it test for and when is it considered positive?
When you pinch the skin on the dorsum of the second toe tests for lymphedema positive when you're unable to pinch skin
What does the pectinate line mark the location of?
Where the columnar mucous membrane transitions to stratified squamous epithelium
When does the ductus arteriosus anatomically close?
Within 3 weeks
In what time period does the ductus arteriosus normally functionally close? Why is this a potential issue?
Within 36 hours. Normally women and newborns leave the hospital within 24 hours, so it is important to go to well baby exams
How can you diagnose the cause of hip misalignment?
X-ray
Do you still need to inspect the skin if a pt is wearing a limb shrinker?
YES
Should MMT be pain free for the pt?
Yes
Is MMT grading subjective?
Yes to an extent (use of gravity/active resistance provides an aid in objectively measuring the strength)
If you do not have a palmaris longus muscle, will you still have a palmar aponeurosis?
Yes, it is important for creating the toughness of your palm
If the ductus arteriosus is needed to remain open until surgery can be performed on a newborn, what can be done?
You can give the newborn prostaglandin
What is neurapraxia? How severe is this injury? What typically causes it?
a *low severity* injury that typically leads to *complete recovery*. Structure of the nerve remains *intact* but electrical conduction down the axon is interrupted, typically by *ischemia or compression*, additionally secondary injuries can be caused by vascular damage leading to intrafascicular edema
55% of people with PVD that undergo an amputation will eventually undergo what procedure?
a bilateral amputation
What is epilepsy?
a chronic disease that includes seizures in which cerebral neurons fire rapidly and out of synchrony, may be localized or spread throughout the brain
What is pseudoparkinsonism?
a condition brought on commonly by an antipsychotic drug, characterized by resting tremor, bradykinesia and rigidity (due to the blockage of dopamine receptors)
What is lipedema?
a disorder in which an unusual amount of fatty tissue is deposited, usually below the waist, causing progressive enlargement of the legs
What is apomorphine?
a dopamine agonist, can be used for severe cases of dyskinesia
What is GM-1 ganglioside?
a drug used to treat Parkinson's by having the aim of maintaining membrane integrity
Most amputations (85%) in people with diabetes are preceded by:
a foot ulcer
What are functional (K) levels?
a grade from 0-4 that determines if an amputee would be *able to use a prosthesis* and if so, which type(s)
What is a nociceptor?
a nerve fiber that responds to noxious stimuli
What is insulin?
a small protein (polypeptide) / hormone made in the pancrease by beta cells (islets of langerhans)
What is the main side effect of barbiturates?
a strong feeling of sedation, may also cause uncoordinated movement
Define radioopaque:
a substance with high attenuation (it is good at slowing down x-ray beams, less pass through it)
Define radiolucent:
a substance with low attenuation
What device may be helpful to transfer a non-ambulatory patient after an amputation?
a transfer prosthesis (looks like a normal prosthesis, but is only used for transfers and not ambulation)
Many elderly pts face physical, psychological and psychosocial issues that are difficult to cope with and can affect their:
ability and motivation to learn
Ethosuximide is specifically used to treat what type of seizure?
absence
What are the categories of neurotransmitters?
acetylcholine monoamines nitric oxide peptides amino acids
Ultrasonography is a successful imaging technique because different tissues have different _______________ qualities
acoustic
How does the control of the serratus anterior change with increasing shoulder elevation?
activity increases throughout
What does hydrostatic capillary pressure do?
acts as a suction that favors transport out of capillaries and into the interstitial space
Pain that has a recent onset of less than 3 months, close link with the pain generator, not a learned response, objective findings that coincide with pain generator, high anxiety levels and pain that is protective and necessary are all characteristics of what type of pain?
acute
Stage 1 of CRPS is ______ and lasts several weeks to several months
acute
What is an advantage of mitoxantrone in treating MS? What is a disadvantage?
advantage: more effective in treating lesions on nerves disadvantage: has more serious side effects like heart damage (can only be taken for 3 years)
When can an amputee begin to wear a rigid removable post-op dressing?
after suture/staple removal the cast is fit from an impression of the residual limb and is worn over the wound dressing or compression socks
Amputation rates increase with ________
age
What is the least radiodense substance in the body?
air
Rank the following from least dense to most dense: bone, fat, air, contrast media, water, heavy metals
air (black on film) fat water bone contrast media heavy metals (white on film)
What is a closed pneumothorax?
air can enter the pleural cavity from internal airways, no opening in chest wall
COPD involves obstruction of the _________________.
airways
What does it mean to say, "diagnostics are a tool, not the answer"?
all diagnostic findings, including imaging, must be applied in the context of clinical presentation
How do you determine how much resistance to apply when performing PNF pattern?
allow smooth movement and no pain
What structure of the respiratory system is defined as: clusters of alveoli open to communicate with each other?
alveolar sacs
What is the end point for inspired air in the respiratory system?
alveoli
Pulmonary edema involves fluid collection in what respiratory structures?
alveoli & interstitial area
Which race has a higher rate of diagnosed diabetes?
american indians/alaskan natives
There are many signal cascades that happen during the release of neurotransmitters, but what are two drugs that acts on this step? (picture)
amphetamines and botulinum toxin
Is the lifetime cost of an amputation or salvage of a limb higher?
amputation is up to 3x higher
Define density: (photographic quality)
amt of blackening on x-ray
What does activation of A-delta or C fibers result in?
an action potential that travels down the nerve to the dorsal root ganglion and then to the spinal cord
What structure of the respiratory system is the site of gas exchange with capillaries?
an alveolar wall comes in close proximity with a capillary wall
What is indicated by excessive sclerosis on an x-ray?
an arthritic or rheumatic condition
What causes pneumonia?
an infection leads to inflammation of alveolar sacs which leads to: -fluid accumulation, may be pus -dec oxygen exchange -difficulty breathing
Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with hip abduction (open chain)?
anterior
Starting with the hip in neutral, which way does the femoral head glide with external rotation (open chain)?
anterior
Starting with the hip in neutral, which way does the femoral head glide with hip extension (open chain)?
anterior
If someone is lacking hip extension, what would be a good joint glide to facilitate this motion?
anterior glide
With the SC joint, clavicular protraction involves a(n) ________ roll and a(n) _________ glide
anterior roll anterior glide
A barrel chest is an increase in diameter of the thorax in the ant/post or med/lat direction?
anterior-posterior
For many types of anxiety disorders __________ are the drugs of choice
antidepressants
Bipolar disorder may be treated in combination with Li+ and what other types of drugs?
antidepressants, antipsychotics (manic phase) and antiseizure (stabilize mood and manic symptoms)
What does reserpine do? (picture)
antihypertensive that impairs the ability of anrenergic (presynaptic) terminals to store norepinephrine
Selegiline and rasaliline are both types of?
antioxidant drugs
Examples of special x-rays: (read)
anything that is not A/P or lateral: -oblique -open mouth -sunrise/tangential -flexion/extension -upright, WB
When does gestational diabetes develop?
around week 24 of pregnancy
The cardiovascular system is made up of the ______ and ______ systems
arterial and lymphatic
Having excessive anteversion of the femur puts you at a higher risk for what pathologies?
arthritis patellofemoral and subtalar dysfunction
How is mitoxantrone administered?
as an injection, but must be done by a physician about once every 3 months
When should you initiate wrapping or shrinking after an amputation?
as soon as surgeon allows
When should you initiate ROM after an amputation?
as soon as the surgeon allows (usually immediately post-op)
What are the AMPRO and AMPnoPRO tests?
assesses *ambulatory potential* with (AMPRO) and without (AMPnoPRO) a prosthesis -good correlation w/ 6 minute walk test -distinguishes b/w functional (K) levels
What is the CHAMP test? What population is it commonly used for?
assesses progress towards *high level mobility* commonly used for military service members
When is effleurage done throughout a massage?
at the beginning and end
In what condition do alveoli become airless?
atelectasis
What is an open pneumothorax?
atmospheric air enters the pleural cavity through an opening in the chest wall Ex: trauma, surgery
The radio source and magnet used to create an MRI image cause what structures to align?
atomic nuclei align/resonate to this electromagnetic field
aripiprazole, clozapine, olanzapine and ziprasidone are all generic names for what class of drug?
atypical antipsychotics
PNF techniques use which 3 types of stimuli?
auditory visual tactile
How is type 1 diabetes an autoimmune disease?
autoantibodies form against islet cells, insulin, GAD (glutamic acid decarboxylase), IA-2 and 2B (tyrosine phosphatases)
How do symptoms of CRPS manifest in different systems (autonomic, psychological, inflammatory, motor and sensory)?
autonomic (skin color change, sweating, swelling) psychological (fear, anxiety, anger) inflammatory (nail growth, hair growth) motor (weakness, tremor) sensory (allodynia, hyperalgesia)
Why can't you diagnose a soft tissue injury with an x-ray (without contrast media)?
b/c soft tissue looks a lot like water (have similar radiodensities)
Primidone is a derrivative of what drug? What is it converted to in the body?
barbituates converted to phenobarbital
amobarbital, pentobarbital and phenobarbital are generic names for what class of drug?
barbiturates
Pentobarbital and phenobarbital are types of what drug?
barbiturates (used to treat epilepsy)
Why don't we move the knee center on every prosthetic user back 2 inches so that their knees never buckle?
bc they would have a very difficult time initiating swing or knee flexion in late stance
Why can't Parkinson's disease just be treated by a dopamine supplement?
because dopamine will not cross the blood-brain barrier to get to the basal ganglia where it is needed
Why does lung hyperplasia occur in emphysema?
because it is harder to expire, may need to treat this with lung reduction surgery
Why are macrophages needed in alveoli?
because the air you breathe in has foreign particles in it
Why don't blinded studies work well to test personalized medicine?
because the drug has been personalized for each patient so people are on different doses or different alterations of the drug
Adapting appropriate teaching strategies will allow older pts to:
become successful learners and more satisfied partners in care
Where is the film plate located relative to the patient in an AP image?
behind the patient
Where should you guard a patient when going up stairs?
behind them, hang onto the gait belt
What are down sides to benzodiazepines and nonbenzodiazepines?
benzo: addictive and strong sedative effect throughout the day non: small therapeutic index and can be addictive
Clonazepam, diazepam and Iorazepam are all generic name for what class of drug?
benzodiazepines
_______ have replaced barbiturates for anti-anxiety drugs but can cause tolerance and physical dependence
benzodiazepines
estazolam, flurazepam, quazepam, and temazepam are all generic names for what class of drug?
benzodiazepines
Over which ribs does the scapula cover in resting position?
between ribs 2-7
What is CO2 converted to when it diffuses into RBC's?
bicarbonate
How are LE veins able to return blood to the heart against gravity?
bicuspid valves (normally) prevent retroflow of blood
What do barbiturates do?
bind to the GABA receptor opening the chloride channel (reducing the membrane potential and making it less likely that an AP will occur)
What color is air on an x-ray?
black
Most new cases of ___________ are caused by diabetes
blindness among 20-74 year old adults
What do beta blockers do in the nervous system? (picture)
block the binding of norepinephrine to the beta adrenergic receptors of the heart and thus they slow down the heart beat and the force of contraction
What does Istradefylline (Nouriast) do?
blocks the receptor for adenosine in the brain thus reducing the bradykinesia movements seen with Sinemet treatment
PO2 and PCO2 are the partial pressures of oxygen and carbon dioxide in ___________ .
blood
What is an embolus?
blood clot or mass that obstructs an artery or it's branch
A functional MRI is a technique based on the increased ________________ that accompanies neural activity in the brain
blood flow
In a contrast MRI, tissue enhancement is proportional to:
blood flow to the tissue
In addition to measuring bone density, DEXA can also determine:
body composition
What is the modality of choice for detection & follow-up of metastatic bone disease?
bone scan (radionuclide scintigraphy)
What is the modality of choice for detection of stress fractures?
bone scan (radionuclide scintigraphy)
Does atelectasis alter ventilation or perfusion?
both
Are pediatric amputations more common in boys or girls?
boys (3:2 ratio)
What nerve(s) is/are affected by thoracic outlet syndrome?
brachial plexus
What are symptoms of thoracic outlet syndrome?
brachial plexus pain, paresthesia, nubness, weakness. Nerve tension when the plexus is stretched
The clinical features of Parkinson's disease includes:
bradykinesia tremors and rigidity
What are the goals of cross-fiber techniques on soft tissue?
break up/prevent fibrotic tissue (mechanical effect)
In a T1 MRI image, long bones appear: ***
bright/white
In a T2 MRI image, water appears: ***
bright/white
Asthma involves obstruction of _______________ .
bronchi
The ___________ have a similar structure to the trachea
bronchi
Chronic bronchitis is a disease of what respiratory structure?
bronchi (thickening of bronchial walls leads to obstruction)
What structure of the respiratory system is composed of smooth muscle cells but does not have cartilage?
bronchioles
How is an image produced in nuclear medicine?
by detecting the location & concentration of radioactive elements in tissues
How do you maximize the detail of an x-ray?
by positioning the object as close to the film plate as possible
What does ethosuximide act on to treat seizures?
calcium channels and the Na+/K+ ATPase
Does asthma involve a partial or total obstruction of airways?
can be either
Is amputation bc of cancer due to primary cancer (osteosarcoma) or metastatic disease?
can be either
Does acute respiratory failure result from acute or chronic disorders? What are some examples?
can be either Ex: emphysema, neuromuscular diseases
Does pneumonia develop as a *primary* condition or in response to another condition (*secondary*)?
can develop as primary or secondary
With wrist glides for flexion and extension, the midcarpal joint involves what two bones against each other?
capitate moves on lunate
With wrist glides for radial and unlar deviation, the midcarpal joint involves what bones moving against each other?
capitate moves on lunate
Ceruminous (wax) and sebaceous glands are restricted to that portion of the skin of the auditory canal that overlies _______
cartilage (not bone)
The tensor tympani muscle originated from:
cartilage of auditory tube
ARDS (adult or acute respiratory distress syndrome): -what causes it? -what effects does it have?
caused by injury to the alveolar wall & capillary membrane results in the release of chemical mediators that causes: -inc permeability of alveolar capillaries -inc fluid & protein in alveoli and interstitium -damage to surfactant-producing cells
Why do smokers develop emphysema?
causes a deficiency of alph1-antitrypsin -needed to prevent elastase from breaking down elastin which would lead to dec recoil of alveoli = emphysema
Is drug testing completed on isolated cell cultures or animals first?
cell cultures, then they apply for approval for animal testing
Gestational diabetes brings an inc. risk of:
cesarean and chronic HTN
What is happening pathophysiologically during asthma?
changes of bronchi & bronchioles -inflammation of the mucus membranes with edema -bronchoconstriction -inc secretion of thick mucus obstructing airways
donepezil, rivastigmine and galantamine are all generic names for what class of drug?
cholinesterase inhibitors
Pain that has a longer onset of 3+ months, loose link with pain generator, is a learned behavior, has no clinical findings, not broken by force and pain that serves no biological purpose are all characteristics of what type of pain?
chronic
Is diabetes acute or chronic?
chronic (life long condition)
Emphysema, chronic bronchitis and bronchiectasis are all what type of pulmonary disease?
chronic obstructive pulmonary disease (COPD)
Complex regional pain syndrome, fibromyalgia, neuropathic pain, headaches, TMJ, and chronic LBP are all examples of what type of condition?
chronic pain syndromes
What respiratory condition is exercise tolerance testing done for?
chronic pulmonary disease
Geometric qualities of an x-ray refer to the _____________ of the image
clarity
What happens to the clavicle during abduction of the shoulder between 0 and 60 degrees?
clavicle elevates ~30 degrees at the SC joint (rolls superiorly, glides inferiorly)
What are two accessory motions that happen with shoulder abduction? (read)
clavicle rotates and retracts 30 degrees, thoracic spine extends slightly
Structures that are (further/closer) to the film plate are more sharply defined and less distorted
closer
What sensory changes take place with aging?
communication, vision, inner ear and balance difficulties
Reflex sympathetic dystrophy is another name for what condition?
complex regional pain syndrome (CRPS)
What are some MOIs for damage to the common peroneal nerve?
compression from crossing legs, fracture at head/neck of the fibula
What may cause damage to the sciatic nerve?
compression from tight piriformis, hip dislocation or fracture of femur
What is the MOI for a lower brachial plexus injury (C8-T1)?
compression of cervical rib or stretching the arm overhead
Deviations in hip alignment can be __________ in nature or due to ____________
congenital; fracture
What is surfactant made of?
consists of lipoproteins
Once you begin massage, try not to break ______________
contact w/ pt's skin, so they always know where you are
What are 2 "companion" stretching techniques?
contract-relax hold-relax
A ___________ MRI involves intravenous or intra-joint injection
contrast MRI
Using barium-sulfate in a video swallow is an example of a:
contrast media
What is the role of antioxdants in the treatment of parkinson's?
control the synthesis or elimination of free radicals which, in parkinson's, can have elevated production of free radicals, or decrease in natural defense against them
What is the best way to determine the effects of a new drug?
controlled clinical trials
What is the only legal way for the FDA to conclude that a new drug has shown "substantial evidence of effectiveness"?
controlled clinical trials
With stage III CRPS, _____ skin is associated with a poor prognosis
cool
Prednisone and methylprednisolone are generic names for what type of drug?
corticosteroids
How does a coxa valgum hip create a less stable joint?
creates a more superiorly tilted head of the femur, which results in less acetabular coverage superiorly on the head of the femur
What is the most common MOI for all nerve injuries?
crush injury (wound of UE and LE fracture are also fairly common, but not the most common)
Where can ulnar nerve entrapment occur?
cubital tunnel, Guyon's canal
You should provide an amputee a wheelchair with a ____________ if they are at high risk for skin compromise or socket intolerance
cushion consider specialized cushions for LT use
What are the 3 sources of pain in inflammation?
damaged cells secondary plasma leakage and lymphocyte migration nociceptors
In a T2 MRI image, bones appear: ***
dark/black
What color is exposed film on an x-ray?
dark/black
The pharmacological goal in the treatment of epilepsy is to _________ neuronal activity, resulting in severe side effects
decrease
What happens to a person's total lung capacity that has a restrictive lung disorder?
decreases
How does excessive anteversion affect the muscle lever arm?
decreases -- increased joint forces
How does excessive anteversion affect joint stability? Why?
decreases due to more of the joint being exposed anteriorly (femoral head)
How does excessive anteversion affect external rotation? (not compensating)
decreases hip external rotation
How does fluid in alveoli affect gas exchange?
decreases it
Which type of massage technique is considered inhibitory to voluntary muscles?
deep tendon pressure of stretch (helps w/ charlie horse or cramps)
Are kids miniature adults?
def not
What should you always do before getting the patient up to do stair training?
demonstrate first
What are the 2 photographic qualities of an x-ray?
density contrast
What does the time frame until a prosthesis can be tolerated by an amputee depend on?
depends largely on skin tolerance & healing healing depends on circulation
What does metyrosine do? (picture)
depletes the presynaptic terminal of transmitter and blocks transmission of catecholamine neurotransmitters
Which geometric quality of an x-ray is also known as sharpness or resolution?
detail
What are the 2 geometric qualities of an x-ray?
detail distortion
T1 MRI images reveal:
details of anatomy in high resolution
What role do chemoreceptors play in the control of ventilation?
detect changes in levels of -CO2 -O2 -H+ in the blood or CSF
What does transduction mean in reference to first order neurons?
detection of noxious or damaging stimuli
How do you determine the correct size of limb shrinker for an amputee?
determine size by circumferential measurements and length
Prediabetes inc. the risk for:
developing DM2
Peripheral Vascular Disease is often associated with which conditions?
diabetes and smoking
What is the leading cause of ESRD (end stage renal disease)?
diabetic nephropathy
Define contrast: (photographic quality)
differences b/w adjacent tissue densities how easily can you tell one type of tissue from another?
As a PT, we need to learn to differentiate ______ pain from _______ pain, both of which are part of the peripheral nervous system
differentiate between *somatic* pain and *visceral* pain
If the PCO2 is 45 and the PO2 is 40, which way will gas exchange occur? PCO2 norm is 35-45 PO2 norm is 90-100
diffusion of CO2 into alveoli
If the PCO2 is 40 and the PO2 is 105, which way will gas exchange occur? PCO2 norm is 35-45 PO2 norm is 90-100
diffusion of O2 into blood
Name the amputation: disarticulation at MCP joint
digit disarticulation
Parkinson's disease is a disorder of the _________, which is made up of the _____ nuclei of the cerebrum
disorder of the basal ganglia made up of the deep nuclei of the cerebrum
Where on the hand can you test for sensation loss resulting from damage to the medial nerve?
distal tip of 2nd finger
Where on the hand can you test for sensation loss resulting from damage to the ulnar nerve?
distal tip of 5th finger
Describe the pressure gradient of a limb shrinker:
distal to proximal
In what direction should your pressure gradient be when applying an ACE wrap?
distal to proximal
What does the density of an x-ray depend on? (3)
distance time current
-schisis
division
What are side effects of hydantoins?
dizziness, drowsiness, uncoordinated movement, blurred vision, anemia, water retention, cardiac arrhythmias, and CHF
A loss of _______ has been associated with Parkinson's disease
dopamine
Parkinson's involves a deficit of what neurotransmitter?
dopamine
What neurotransmitters fall under the category of monoamines?
dopamine histamine epinephrine norepinephrine serotonin
What neurotransmitters are included in the term catecholamines? Why?
dopamine, norepinephrine and epinephrine because they share a common biosynthetic pathway that starts with the amino acid tyrosine
To assist with MCP extension of joints 2-5, you would perform what kind of glide?
dorsal
To facilitate wrist flexion, would you perform a dorsal or volar glide
dorsal
Since the wrists aren't in the anatomical position when performing glides, what direction are the glides referred to as?
dorsal (towards back of hand) volar (towards palm of hand)
Where on the hand can you test for sensation loss resulting from damage to the radial nerve?
dorsal web spaces
What are signs of toxicity for vigabatrin?
drowsiness, dizziness, weight gain and possibly confusion
The search for a drug to decrease cholesterol levels without significant side effects is a good example of _______________ .
drug design -summary: studied how the body makes/uses cholesterol, identified different steps of making it, isolated an acid & enzyme, used computers to find a drug to inhibit the enzyme, found a fungus that inhibited it, identified which chemical in the fungus did this, further analyzed this chemical & improved its effects, then animal testing was done
In summary for neurological pharmacology (read):
drugs of the CNS work primarily by *blocking the signaling cascade* at the synaptic terminal where two neurons are communicating with each other. The drugs will typically work by *decreasing neuronal activity* as indicated by the fact that the side effects frequently include *confusion and sedation*
What is a Pincer impingement of the hip? What does it limit?
due to the irregular shape of the acetabulum, it is more posterior and deeper, hip abduction pinches the superior labrum
What is a CAM impingement of the hip? What does it limit?
due to the shape of the femoral neck, creates poor level of clearance when flexing and abducting the hip (cannot clear the acetabulum)
What is Dalton's law?
each gas in a mixture moves along its partial pressure gradient *independent* of other gases
The FDA has little to do with early or late stages of drug testing?
early, they become involved when drug testing has been completed in animal models and is ready for human testing
What is an exception to the Basic Swedish Principle of working distal to proximal?
edema, start proximal to clear
_______________ is key for elderly pts to maintain their independence and health
education
What are limb shrinkers?
elastic shrinkers that help decrease swelling & assist in shaping the residual limb
Name the amputation: disarticulation of elbow
elbow diarticulation :)
Who is at the highest risk for dehydration, even above those who don't drink enough or sweat frequently?
elderly
When does a superior roll and inferior glide happen with shoulder motions?
elevation (flexion > 90 degrees, abduction)
What general motions are available at the scapulothoracic joint?
elevation/depression abduction (protraction)/adduction (retraction) upward/downward rotation
Clubbed fingers, barrel chest and "pink puffer" face are symptoms of what respiratory condition?
emphysema
What happens if you don't set the tibia in 5 deg of ER during bench alignment of a transfemoral prosthesis?
end up w/ a lateral whip (ER the tibia to account for pelvis rotation)
The decision to use a wheelchair or not after an amputation is largely based on what?
energy cost of ambulation
What is vigabatrin used to treat? How does it work?
epilepsy, it enhances the natural effects of GABA
What condition is carbamazepine used to treat? How does it work?
epilepsy, it works by affecting the sodium channels and acts on the presynaptic neuron to inhibit synaptic transmission
Carpometacarpal joint - digits 2-5
equal loss of all motions
metacarpophalangeal and interphalangeal joints
equal loss of flexion and extension
Lung or pulmonary compliance is the ability of the lungs to ____________ .
expand
Restrictive lung disorders are a group of disorders with impaired lung _____________ .
expansion
Atelectasis, pleural effusion, pneumothorax, adult/acute respiratory distress syndrome (ARDS), and acute respiratory failure are all examples of what type of disorder?
expansion disorders
Emphysema can lead to progressive difficulty of inspiration or expiration?
expiration
When the pressure in the alveoli is higher than in the atmosphere, what happens?
expiration
How does the thoracic spine react with shoulder abduction between 60 and 180 degrees?
extends slightly
Shoulder abduction is coupled with shoulder ___________ (motion) above 60 degrees to prevent shoulder impingement
external rotation
When does a posterior roll and anterior glide happen with shoulder motions?
external rotation extension horizontal abduction
Venous bulging stiffens the _________ matrix
extracellular
Efferent axons of large myelinated nerves innervate what?
extrafusal muscle fibers
Increased diameter of larger venules and veins bulge into the _____________ compartment, raising tissue pressure, resulting in what?
extravascular compartment venous edema
Every hour, there are 2 deaths and 251 ER visits for ______-related injuries among older adults
fall
T/F: a limb shrinker is the same thing as a limb sock
false
T/F: dementia is a normal condition of aging
false
T/F: effleurage can move deep muscle mass
false
T/F: massage can build muscle
false
T/F: massage can reduce fat
false
T/F: massage can reduce spasticity from CNS damage
false
T/F: older people have a hard time doing things for themselves so its best to take over and do things for them
false
T/F: people with dementia have "lost touch with reality" so they can't understand most of what you are saying to them
false
T/F: sudden weight loss is expected with elderly people
false
T/F: PTs are capable of independently interpreting imaging results
false -their role is managing care, directing imaging & relating imaging studies to clinical presentation, not reading the results
T/F: PTs in primary care, such as the military, increased diagnostic imaging orders
false -they decreased imaging by 50% -MDs are happy w/ this
T/F: a person who wanders should be restrained to protect him/her from injury
false goes for both chemical & physical restraints
T/F: a radiolucent object is more dense than a radioopaque object
false radiolucent objects are less dense than radioopaque objects
T/F: a CT scan provides detailed anatomical imaging of soft tissue
false replace soft tissue with bone
T/F: falling and fear of falling are a part of the normal process of aging
false should NOT be accepted as normal, instead find and address the cause of falls
T/F: Radiation exposure is a concern with DEXA
false the exposure to radiation in DEXA is roughly the same as flying on a plane from NY to LA and back
T/F: elderly people are less sensitive to medications
false they are more sensitive
T/F: it is helpful to reorient an agitated elderly person by making sure they understand what is real and what is not
false they can become even more agitated
T/F: when communicating to a confused senior, speak in a loud, sharp voice
false use an elevated voice, but a calm tone
T/F: a person who has dementia can remember things that happened recently, but have no memory of the distant past
false usually the opposite is true
What is a type 2 error in statistics?
false negative
Do x-rays have a high false positive or false negative rate? Does this mean they are not very sensitive or specific?
false negative not sensitive
What is a type 1 error in statistics?
false positive
Do bone scans get a lot of false positives or false negatives?
false positives (sensitive, not specific)
T/F: never begin a massage with a pt completely draped
false, always do this
T/F: you can only apply resistance in PNF techniques to facilitate concentric muscle contractions
false, can facilitate concentric & eccentric
T/F: phantom limb pain is normal after an amputation
false, phantom limb *pain*, although very common, is not considered normal
T/F: amputation is a relatively new procedure
false, they are among the oldest medical procedures
T/F: use of a walker for stair training is a good solution for long-term use of the walker
false, this is for short-term use of a walker, for recovery from a WB restriction period
T/F: you can attempt to make significant adjustments to a prosthesis to save the pt a trip to the prosthetist
false, you should def not do that
T/F: when applying an ACE wrap to an AKA, you should avoid the adductor tissue
false, you should include it to prevent an adductor roll
T/F: you should educate an amputee as quickly as possible with all the info they need about their new lifestyle
false, you should prioritize the most important info and gradually build on it to help not overwhelm the patient
People with asthma often have a ____________ history of allergic conditions.
family
What is it called when a pt has a lasting concern about falling that can lead to them avoiding certain activities that they remain capable of performing?
fear of falling serious, widespread problem among older adults
CRPS is more common in what gender?
females
What nerve is responsible for muscular innervation of the anterior thigh?
femoral
What causes contraction atelectasis?
fibrotic tissue in lungs or pleura
Which type of ACE wrapping technique should you use to prevent the tourniquet effect?
figure 8 pattern
You should be careful with how you lead with your hands during massage, for example, you should avoid what type of lead in the groin area?
finger tip lead
With the hip, flexion usually is associated with _________ __________, and extension is usually associated with __________ __________
flexion = internal rotation extension = external rotation
What is the only unpaired longus/brevis muscle in the hand?
flexor digiti minimi brevis
How does pulmonary edema reduce the amt of O2 diffusing into blood?
fluid collecting in alveoli reduces gas exchange
Name the amputation: amputation of humerus, scapula & clavicle
forequarter amputation
Dopamine degradation results in the production of a __________
free radical (1-methyl-4-phenylpyridinium)
When assessing alignment, what are the 4 lines you should be able to mentally draw when viewing a lateral x-ray of the cervical spine?
from anterior to posterior: 1. anterior vertebral line 2. posterior vertebral line 3. spinolaminar line 4. posterior spinous line
Where does small cell lung cancer come from?
from bronchi, oat cells, combination
In what plane does a positive trendelenburg happen?
frontal
Fibrosis can lead to loss of ____________ areas of the lungs
functional
What are side effects of ethosuximide?
gastric distress, nausea, vomiting, headaches dizziness, and euphoria
Are generic or trade drugs less expensive?
generic b/c companies that sell these drugs have lower expenses in bringing the drugs to market
Babies born from gestational diabetes have a risk of:
getting DM2 later
What is glycation?
glucose irreversibly sticking to a protein (diff. from glycosylation)
How does insulin act on an insulin receptor?
glucose transporters (Glut-4) move from cytoplasm to membrane (to allow glucose to pass inside the cell)
________ (neurotransmitter) is the simplest amino acid and is an inhibitory neurotransmitter released by interneurons within the spinal cord
glycine
The utricle and saccule are:
gravitation receptors
What color is water on an x-ray?
gray
What color is fat on an x-ray?
gray-black
What color is bone on an x-ray?
gray-white
Side effects of memantine:
hallucinations, confusion, dizziness and headaches
What should you be careful about when tucking the sheet or towel during massage?
hand placement
What do you have to have in order to do stair climbing with a walker, especially if the pt has a WB restriction?
handrail
Name the amputation: amputation of both LEs and pelvis below L4-5
hemicorporectomy
Name the amputation: resection of half of the pelvis
hemipelvectomy
Air always moves from an area of __________ pressure to an area of ___________ pressure
high to low
What muscle group is weak if someone has a positive trendelenburg?
hip abductors (glute med and min)
Name the amputation: amputation through the hip joint w/ intact pelvis
hip disarticulation
If you have muscle imbalance that causes posterior tilt of the pelvis, how will hip and low back be affected?
hip extension lumbar flexion
If you have muscle imbalance that causes anterior tilt of the pelvis, how will hip and low back be affected?
hip flexion lumbar extension
If you're standing on your right leg and you have a posterior pelvic tilt, what position will your hips and low back be in to keep you standing upright?
hips will be in extension low back will be in flexion
If you're standing on your right leg and you have an anterior pelvic tilt, what position will your hips and low back be in to keep you standing upright?
hips will be in flexion low back will be in extension
A patient _________ can help in a differential diagnosis to determine if pain is somatic or visceral
history
What does "mellitus" literally mean?
honey (means there is sugar in the urine)
Define permeability
how easily x-ray beams can pass through a substance to reach the film plate
After axillary lymph nodes are dissected, what determines if a patient is at high risk for lymphedema?
how many nodes are removed (11-13 = high risk) lymphedema can occur with as little as 1 axillary node removal
With shoulder abduction above 60 degrees, how does the humerus move?
humeral head glides inferiorly and anteriorly while rolling superiorly and posteriorly
What happens to the humerus during abduction of the shoulder between 0 and 60 degrees?
humeral head glides inferiorly while rolling superiorly
Phenytoin is a generic name for what class of drug?
hydantoins
An increase in PCO2 in the blood is called:
hypercapnia
Is hyperventilation caused by hypercapnia or hypocapnia?
hypercapnia
The normal partial pressure of CO2 is 35-45 mm Hg. A PCO2 of 60 is considered what condition?
hypercapnia (resp. distress)
_____________ develops slowly in type 2 diabetes
hyperglycemia
What causes the increased production of mucous secretions involved in chronic bronchitis?
hypertrophy and hyperplasia of mucous glands
A decrease in PCO2 in the blood is called:
hypocapnia
Is hypercapnia or hypocapnia caused by hyperventilation?
hypocapnia
The normal partial pressure of O2 is 90-100 mm Hg. A PO2 of 80 mm Hg is considered what condition?
hypoxemia
What is an example of a second group, restrictive lung disorder?
idiopathic pulmonary fibrosis
How does the total surface area available for diffusion affect gas exchange?
if part of the alveolar wall is destroyed, SA is reduced, and less gas exchange occurs Ex: emphysema
When is open, provisional or delayed closure of an amputation indicated?
if severe infection is present
When performing a hamstring length test, what is considered a positive reading?
if someone has tight hamstrings, and their PROM will be <80 degrees of hip flexion with them in supine and their leg stright
Why would you elect to use a hold-relax technique over a contract-relax technique?
if tight muscle is painful
Should you have the pt hang onto the handrail if they are using crutches on stairs?
if you do, tell them to put the crutches into one had, but you do not have to use the handrail
Define elongation:
image appears longer than the actual object
Define foreshortening:
image appears shorter/wider than the actual object
What is the main theory for what causes bipolar disorder?
imbalance between GABA (inhibitory) and excitatory neurotransmitters (norepinephrine, dopamine, glutamate and aspartate)
What does IPOP stand for?
immediate post-op prosthesis it is a plaster socket w/ a removable pylon & foot
When should you initiate positioning after an amputation?
immediately prone positioning ASAP, some pts will really not like this, esp dysvascular pts, Jason would push this harder if it is a younger pt
mitoxantrone is a generic name for what class of drug?
immunosuppressors
What do tricyclic antidepressants do? (picture)
impair the reuptake of amine transmitters back into the presynaptic terminal
Prediabetes is referred to as:
impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)
What does botulinum toxin do? (picture)
impairs the release of Ach from the presynaptic neuron
Where is the source of x-ray beams located relative to the patient in an AP image?
in front of the patient
Where should you guard a patient when coming down stairs?
in front of them, hang onto the gait belt
Where is the 1st order neuron located in a pain neuron system?
in the PNS- in the peripheral and visceral tissues
Where is the 2nd order neuron located in a pain neuron system?
in the SC- they then travel to the thalamus
Where is the 3rd order neuron located in a pain neuron system?
in the brain- they travel from the thalamus to various parts of the brain
What does "diabetes" mean?
inability to retain fluid (reflecting the observation that people with diabetes urinate frequently)
What is the #1 cause of "medial whip" or "lateral whip" gait deviations?
incorrectly donning the prosthesis amputees don't have a mark to let them know exactly how to align the prosthesis when they put it on, brand new patients have a hard time getting a sense of the correct amount of rotation they should have
What do amphetamines do? (picture)
increase the presynaptic release of cathecholamines
What causes venous edema?
increased intravascular hydrostatic pressure
How does excessive anteversion affect internal rotation? (not compensating)
increases hip internal rotation
How does retroversion of the hip affect external rotation?
increases it
How does pleural effusion affect the pressure in the pleural cavity?
increases it -separation of pleural membranes, dec cohesion during inspiration
How does hydrostatic pressure change to cause altered fluid flow in capillaries?
increasing with increases in arterial flow or blockage of free return into veins, exercise, pressure on veins and decreased mm pumps
What is a surgical consideration for *cancer-related* amputee patients?
indicated in high grade tumors, proximal lesions, those risking pathologic fractures or neurovascular involvement or recurrent disease
What does high uptake of the methylene injection in a bone scan indicate?
indicates areas of inc bone activity or mineral turnover
Starting with the hip in 90 degrees of flexion, which way does the femoral head glide with further hip flexion (open chain)?
inferior
Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with internal rotation (open chain)?
inferior
Starting with the hip in neutral, which way does the femoral head glide with hip abduction (open chain)?
inferior
If someone is lacking the last few degrees of hip flexion, what would be a good joint glide to facilitate this motion? What if they have knee pain?
inferior glide with hip at ~120 degrees if knee pain - perform the inferior glide at 90 degrees hip flexion instead
With the SC joint, clavicular depression involves a superior ________ (roll/glide) and an inferior ________ (roll/glide)
inferior roll superior glide
Which trunk(s) give off the medial cord?
inferior trunk (lower)
What is pneumonia?
inflammation in lungs due to infection
Once vasodilation of vessels and edema occur in the process of inflammation, what are the next 2 steps?
inflammation reaction rapidly proceeds to remove and repair the damaged tissue and pain develops as a protective mechanism
An exacerbation of MS is when the symptoms get worse for a period of time and includes an ____________ process
inflammatory
GABA is an _______ (inhibitory/excitatory) neurotransmitter that does what?
inhibitory neurotransmitter that opens a chloride channel allowing the negative ion to enter the cell and hyperpolarize the cell membrane
Describe how the control of the trapezius muscle changes with increasing shoulder elevation?
initiation: upper trap predominates at 90 deg: middle trap peaks later phases: lower trap predominates
What is contrast enhancement?
injection or ingestion of a radio-contrast medium prior to a radiographic study Ex: angiography, arthography, myelography, barium swallow, etc.
What are some factors that affect pain from person to person? (7)
injury (previous injury changes pain threshold) fatigue age (older people tolerate more pain) gender (women tolerate pain better) fear and apprehension racial and cultural characteristics emotional status
Where is intracellular fluid located?
inside cells... lol
Sedative-hypnotic drugs are used to treat what condition? What two categories can these drugs be split into?
insomnia benzodiazepines and nonbenzodiazepines
When atmospheric pressure is higher than the pressure in the alveoli, what happens?
inspiration
What does insulin act on?
insulin receptor (on cell surface)
What do you call it if there is a dysfunction lower than the insulin receptor level?
insulin resistance (body is resistant to insulin)
What is the only class of drugs used to treat MS that actually affects the progression of the disease rather than treating the symptoms?
interferon-based drugs
Summary of drugs used to treat MS: (read)
interferon-based drugs immunosupressors corticosteroids potassium channel blocker
interferon beta -1b, interferon beta-1a and glatiramer acetate are all types of what drug? What are they used to treat?
interferon-based drugs used to treat MS
Diabetes alone increases the risk of _________________ (associated w/ PVD) by 4-5 times, even after controlling for HTN, smoking and cholesterol levels
intermittent claudication
When does an anterior roll and posterior glide happen with shoulder motions?
internal rotation flexion < 90 degrees horizontal adduction
AC joint motion may be involved with fine tuning of what shoulder motions?
internal/external rotation anterior/posterior tilting
The lymph system plays a key role in the ________ fluid balance
interstitial
The net fluid exchange at the venous end of the capillaries results in fluid coming into or out of cells?
into capillaries (out of cells)
The fluid in the body is either __________ or _________
intracellular extracellular
Efferent axons of medium myelinated nerves innervate what?
intrafusal muscle fibers
What does capillary osmotic pressure do?
it is a pressure that causes fluids to pass from areas of lower concentration to higher (pulls water into capillaries)
How does memantine work?
it is an antagonist of the receptor (NMDA) that binds glutamate which is an important neurotransmitter in information processing, so it prevents excessive glutamate binding and thus prevents overstimulation from glutamate which leads to cell death (neuroprotective)
How does lithium treat bipolar disorder?
it is not known for sure but theories are... -it may directly decrease the release of amine neurotransmitters and increase their reuptake -may reduce the production of second messengers, cAMP and inositol triphosphate and affect intracellular enzymes
If someone stands with excessive supination in the foot, how does this affect the hip alignment and lower limb?
it would cause the following: -hip external rotation -extension of the hip -lengthening of the limb
If someone stands with excessive pronation in the foot, how does this affect the hip alignment and lower limb?
it would cause the following: -internal rotation of the hip -flexion of the hip -shortening of the limb
If gestational diabetes continues after >6 weeks of pregnancy, it means:
it's no longer gestational DM
What pathology may have an increased risk of occurrence from a coxa varum hip alignment?
joint fracture
What is a life-threatening complication of diabetes?
ketoacidosis
In TKA alignment of a transfemoral prosthesis, which of the 3 points is slightly off-set?
knee center is slightly posterior to the TKA line
Name the amputation: amputation through knee with intact femur
knee disarticulation
What pathology does retroversion of the hip put someone at an increased risk for?
labral tears
Is the angle of torsion in children larger or smaller than adults?
larger (starts at ~40 degrees and decreases towards the adult normal)
The median nerve is made up of what 2 cords?
lateral cord medial cord
Highly radiodense objects result in more or less radiodensity on the film?
less (object appears whiter)
How does coxa valgum affect the forces on the neck of the femur?
less bending and shear forces
Fear of falling can restrict a person's normal activities causing:
less independence
What do arterial blood gas determination tests measure?
levels of the following in the blood: -O2 -CO2 -bicarbonate -serum pH
What molecule (drug) has served a major role in the positive treatment of Parkinson's disease?
levodopa
Summary of drugs that can be used to treat Parkinson's (read)
levodopa (dopamine) Sinemet - levodopa with carbidopa istradefylline and apomorphine etilevodopa and melevodopa anticholinergic (trihexyphenidyl and benztropine) amantadine (bromocriptine and pergolide) antioxidants (selegiline and rasaliline) GM-1 ganglioside
How is the premature conversion of levodopa to dopamine prevented so more dopamine reaches the brain?
levodopa is combined with carbidopa which prevents the conversion to dopamine and therefore smaller doses can be given and a larger amount of dopamine can reach the brain
What is the point of petrissage?
lift subcutaneous tissue up and off of underlying structures
What is used b/w the residual limb and prosthetic socket?
limb sock
How thick are the walls of alveoli?
lined by a single layer of epithelial cells
What is the main treatment for bipolar disorder?
lithium
During an AP, the presynaptic AP travels down the membrane of the cell and depolarizes the presynaptic cell. Examples of drugs that act here are? (picture)
local anesthetics
What are some of the mechanical effects of massage on blood vesssels?
local capillary dilation via splanchnic autonomic fibers: -relaxation of voluntary mm -dec pain stimuli -inc in skin temp (???)
T/F: you don't need to monitor pt swelling and limb volume fluctuation after an amputation
lol, of course you do
What is effleurage?
long stroking, gliding movements following the length of a muscle
Name the amputation: retains more than 50% of femoral length
long transfemoral
Name the amputation: retains more than 50% of tibial length
long transtibial
How do you treat TB?
long-term treatment with a combination of drugs (from 6 mo to 1 yr)
How does coxa varum lead to an increased mechanical advantage for the hip muscles?
longer moment arm for the muscles to work and decreased joint reaction forces
What is the *clinical* presentation of an upper brachial plexus injury (C5-6)?
loss of shoulder abduction, external rotation weakness of the arm, loss of flexion and forearm supination (Waiter's tip - present w/ IR arm, pronated forearm and loss of shoulder flexion)
Do barbiturates have a low or high therapeutic index?
low
Alternative garmets (velcrow) have ______ resting pressure and _____ working pressure
low high
What is a side effect of DM meds?
low energy levels due to low blood sugar
With wrist glides for flexion and extension, the radiocarpal joint involves the movement of what two bones against each other?
lunate moving on the radius
Blood gas levels indicate the level of function of the ___________.
lungs
What organ does TB primarily affect?
lungs
Why is early detection of malnutrition important?
malnutrition is associated with diminished cognitive function, mobility, and a diminished ability to care for one's self
What is the role of Amantadine, bromocriptine and pergolide in the treatment of Parkinson's?
may be used in combination with levodopa to *facilitate release of endogenous dopamine*
The affected limb may have what appearance with stage 1 CRPS?
may be warm and red or dry and cool, pale
What does the treatment outlook for stage 1 CRPS look like?
may resolve spontaneously or should respond rapidly to appropriate treatments
What does it mean to say that x-rays are a *first order* diagnostic modality?
means it is often the first thing that is done
Stretching, elongating or mobilizing techniques are considered a _________________ effect of massage
mechanical
Loss of thumb opposition is a clinical sign of damage to which nerve?
medial nerve
What nerve(s) is/are affected by carpal tunnel syndrome?
median nerve
Where is the primary control center for breathing located in the brain?
medulla & pons
What should you be able to see specifically in long bones?
medullary cavity
What is dementia?
memory impairment causing cognitive, functional and behavior deterioration
Side effects of anticholinergic drugs?
memory impairment, hallucinations, dry mouth, constipation and urinary retention
What is the definition of PNF?
methods of promoting the response of the neuromuscular mechanism through stimulation of the proprioceptor
What are etilevodopa and melevodopa?
methyl and ethyl-esterified modifications of levodopa which should (hopefully) be able to cross the blood-brain barrier
Synthesis of neurotransmitter: presynaptic neuron will synthesize many neurotransmitters used in the synaptic cleft. Examples of drugs that act here are? (picture)
metyrosine
Which trunk(s) give off the lateral cord?
middle and superior (upper)
Parasympathetic innervation to all salivary glands and taste runs through the:
middle ear
The Eustachian tube slants from the:
middle ear to the nasopharynx
Realistically, the PT would expect to write a stair training goal using a walker with ______________ assistance of the caregiver
minimal
CRPS is often _________ and attributed to psychological problems
misdiagnosed
isocarboxazid, phenelzine and tranylcypromine are generic names for what class of drug? They can all be used to treat what conditions?
monoamine oxidase inhibitors (MAO) anxiety or antidepressants
Which races more frequently get peripheral vascular disease?
most common in African Americans and Hispanics
What motion(s) of the hip does an anterior glide of the hip facilitate?
mostly extension, but also some external rotation
What motion(s) of the hip does a posterior glide of the hip facilitate?
mostly flexion, but also some internal rotation
In general, do drugs prescribed for MS treat the symptoms or prevent disease progression?
mostly they treat symptoms of the disease (MS has many symptoms so patients likely to take multiple drugs)
What is akathisia?
motor restlessness, patients will pace the floor and experience insomnia
Geriatric patients commonly present with ____________ comorbidities in addition to their admitting diagnoses
multiple
ARDS is often associated with what other condition?
multiple organ dysfunction or failure
What are side effects of corticosteroids?
muscle wasting, abdominal adipose tissue, decrease in cognitive funtion
Why does a coxa valgum hip alignment affect the mechanical advantage of the hip muscles?
muscles have to generate more force and there is an increased joint reaction force
The lateral cord gives off what 2 major nerves of the UE?
musculocutaneous median
The PT should be able to recognize signs and symptims of non-___________ pain to help with a differential diagnosis
musculoskeletal
Name the muscle stabilization technique post-amputation: transected muscles are re-attached by suturing through drill holes at the distal end of the bone
myodesis
Name the muscle stabilization technique post-amputation: fascial envelope is sutured over the transected muscles
myofascial
Name the muscle stabilization technique post-amputation: suturing of one muscle group to its antagonist
myoplasty
Does prediabetes have clear symptoms?
nah
How are x-rays named?
named for the beam direction relative to the patient and the patient's position
How do you name a lateral/oblique x-ray?
named for the side *closer* to the film plate
The middle ear connects to the __________ with each swallow
nasopharynx
Many neurological drugs minic the action of _______ neurotransmitters or they block the ability of the _______ to bind to receptor and transduce signals
natural neurotransmitter
What are major side effects of Sinemet treatment?
nausea, abnormal muscle tone, tremors, confusion, hallucinations, cardiac arrhythmias and hypotension *dyskinesias* resistance may develop after a few years
What are side effects of valporic acid? What is usually an issue with a lot of seizure medications that is not an issue with this drug?
nausea, vomiting and other GI problems this drug does not cause sedation like many other seizure medications
What can constant, long term stimulation of nociceptors result in? What may cause the constant stimulation of these nociceptors?
nerve damage/changes chronic inflammation causes the constant stimulation of the nociceptors
Stage II CRPS follows what type of injury?
nerve injury
What are the different classifications based on Seddon's classification for nerve injuries?
neurapraxia axonotmesis neurotmesis
Neuropaptides may act as _________ or _________
neurotransmitters or hormones
__________ and their receptors are major targets for pharmacological intervention for the nervous system
neutrotransmitters
Are beta cells autoimmunely destroyed in type 2 diabetes?
no
Do zolpidem, zaleplon, and eszopiclone have many side effects?
no
Does massage done to only one area affect total body blood flow?
no
Do visceral organs have pain receptors? How do we feel visceral pain?
no there are pain receptors present in the walls of the arteries serving these organs allowing us the sensation of visceral pain
Is the damage done by COPD reversible?
no, irreversible lung damage
Can cell-mediated immunity protect you from TB?
no, normal neutrophil response does not occur
Are tricyclics selective reuptake inhibitors?
no, they block reuptake of all 3 types of amine neurotransmitters and are used when people do not respond well to selective reuptake inhibitors
Do you have to perform the full PNF pattern?
no, you can isolate a certain part of the body like the foot
As long as the chemical mediators of inflammation are present, the _________ will be stimulated and you will feel pain
nociceptors
Are zolpidem, zaleplon, and eszopiclone benzodiasepines or nonbenzodiazepines?
nonbenzos
eszopiclone, ramelteon, zaleplon and zolpidem are generic names for benzodiazepines or nonbenzodiazepines?
nonbenzos ... "others"
What is the primary neurotransmitter used by the postganglionic sympathetic neurons?
norepinephrine
PNF movement patterns are designed to mimic _______ movements. Do they do a good job at this?
normal/functional movements not really, that was the intent but when working on strengthening within those patterns, they don't apply that well to functional movement patterns
What is the theory behind using anticholinergic drugs to treat parkinson's?
normally dopamine and acetylcholine are balanced in the brain, since dopamine is reduced with parkinson's, reducing acetylcholine also should decrease the symptoms of parkinson's
What is D3?
not a real thing, practicing PT's often forget the difference b/w D1 and D2, so they make up their own thing and call it D3
Are Ted Hose helpful for edema?
not usually unless pt is non-ambulatory (small compression)
Stage 1 CRPS usually manifests after a ________ event or immobilization
noxious event
People with type 1 diabetes are rarely:
obese
Define magnification:
objects further from the film appear larger than closer objects
Is asthma a type of obstructive or restrictive pulmonary disease?
obstructive
What nerve is responsible for muscular innervation of the medial thigh?
obturator
What is a surgical consideration for *traumatic* amputee patients?
often involve open, comminuted fractures w/ soft tissue loss and vascular/nerve disruption
Personalized medicine has a long way to go, right now only the ______________ field is regularly using this approach.
oncology
A sucking wound is a type of ______________ pneumothorax
open
With SC elevation and depression, roll and glide happen in the _______ (same/opposite) direction
opposite
What would the origin of pain and the quality of pain be for a neurovascular injury?
origin: blood vessels quality: throbbing, pulsing, pounding *can migrate to different locations*
What would the origin of pain and the quality of pain be for a muscular injury?
origin: muscle quality: deep aching, poorly localized, dull or sharp
What would the origin of pain and the quality of pain be for a neuropathic injury?
origin: nerve quality: shooting, sharp, burning pain *electric shock type sensation with acute injury*
What would the origin of pain and the quality of pain be for a cutaneous injury?
origin: skin quality: sharp, superficial
What would the origin of pain and the quality of pain be for a visceral injury?
origin: visceral organs quality: deep aching, pressing, boring, stabbing *very poorly localized*
What is a side effects of anti-hypertensives?
orthostatic hypotension
What are side effects for drugs that induce endogenous dopamine release?
orthostatic hypotension, depression, hallucination, nausea, vomiting, confusion and insomnia
What pathologies could coxa valgum lead to an increased risk of?
osteoarthritis and dislocation
What is indicated by low contrast or "washed out" bone on an x-ray?
osteoporosis
People with type 1 diabetes are prone to:
other autoimmune diseases
The net fluid exchange at the arterial end of the capillaries results in fluid coming into or out of cells?
out of cells into interstitial space
In acute pain, pain ______ is more important whereas in chronic pain, pain ______ is more important
pain quality (intensity, pt description) pain behavior (observation, questionnaires, objective measures)
Afferent axons of small myelinated nerves innervate what?
pain temperature and visceral receptors
Afferent axons of unmyelinated nerves innervate what?
pain temperature and visceral receptors
What is phantom limb pain?
painful sensation in body part that is no longer present -can be constant or intermittent -can be triggered by an external stimulus -characterized as either cramping, squeezing, shooting or burning pain
What is the *clinical* presentation of a lower brachial plexus injury (C8-T1)?
paralysis of the intrinsic muscles of the hand
Which CN's come from the medulla? (5)
part of Trigeminal Glossopharyngeal Vagus Accessory Hypoglossal
Which CN's come from the pons? (4)
part of Trigeminal Abducens Facial Vestibulocochlear tiny bit of Vagus
What type of seizure is vigabatrin used to treat?
partial
Phenytoin is most effective in preventing what types of seizures?
partial and generalized tonic-clonic seizures
Name the amputation: excision of a portion of one or more fingers
partial digit
Name the amputation: resection of 3rd, 4th and/or 5th MT's and digits
partial foot/ray resection
Is air trapping and hyperinflation of lungs a symptom of partial or total obstruction of airways with asthma?
partial obstruction -air is expired partially -RV inc -more difficult to inhale
The ____________________ of a gas reflects the relative concentration of this gas in the mixture of gases.
partial pressure
Name the amputation: excision of a portion of 1 or more toes
partial toe
What does transmission mean in reference to first order neurons?
passage of the resulting sensory input from peripheral terminals to spinal cord
How is glatiramer acetate administered? How often must this be done?
patient can inject themselves, must be done either weekly or monthly this decreases the number and frequency of exacerbations of MS
When performing a piriformis muscle length test, what is considered a positive reading?
patient in prone with knee bent to 90 degrees, internally rotate the hip, less than 45 degrees PROM or sciatic pain present indicates a positive test
What specific traumatic injury has the highest rate of an associated nerve injury within 90 days post trauma?
pelvic fracture
What is tapotement?
percussive strokes w/ alternating hands in a rapid, rhythmic motion (hands should be relaxed)
What are some lower extremity syndromes caused by compression of a peripheral nerve?
piriformis syndrome peroneal nerve compression tarsal tunnel syndrome
The acromioclavicular joint is a _______ joint. Describe the arthrokinematics of this joint.
plane joint no arthrokinematics
What initially may be normal in type 2 diabetes?
plasma insulin levels
What respiratory condition involves the presence of excessive fluid in the pleural cavity?
pleural effusion
What respiratory condition involves air in the pleural cavity?
pneumothorax (leads to atelectasis)
Elevated venous pressure increases the volume of blood within __________ venules
postcapillary
Starting with the hip in 90 degrees hip flexion, which way does the femoral head glide with adduction (open chain)?
posterior
Starting with the hip in neutral, which way does the femoral head glide with hip flexion (open chain)?
posterior
Starting with the hip in neutral, which way does the femoral head glide with internal rotation (open chain)?
posterior
The ______ ramus supply structures in the midline of the body, whereas the ________ ramus supply the lateral and anterior body
posterior = midline anterior = lateral and anterior
If someone is lacking a large amount of hip flexion, what would be a good joint glide to facilitate this motion?
posterior joint glide or inferior joint glide with leg at 90 degrees
With the SC joint, clavicular retraction involves a(n) _______ roll and a(n) ________ glide
posterior roll posterior glide
Efferent axons of unmyelinated nerves innervate what?
postsynaptic autonomic
What is the function of benzodiazepines?
potentiate (enhance) the effects of GABA to hyperpolarize the neuronal membrane
What can happen if gestational diabetes is untreated?
premature death of baby or stillbirth
During therapeutic massage, be sure to gauge ______________ carefully throughout it
pressure
Efferent axons of small myelinated nerves innervate what?
presynaptic autonomic (for diameters less than 3 micrometers)
Why is lithium considered to possibly be neuroprotective?
preventing neuronal degeneration in certain parts of the brain and sustaining neuronal activity
How does inc surface tension of alveoli lead to atelectasis?
prevents expansion of a lung
What is another name for the 1st order neuron in a pain neuron system?
primary afferent neuron
List the 6 divisions of the bronchial tree in order
primary bronchi --> secondary bronchi --> bronchioles --> alveolar ducts --> alveolar sacs --> alceoli
During which stage of TB is the person asymptomatic and can't transmit the disease?
primary stage
When are limb shrinkers used by an amputee?
prior to prosthetic fitting and wearing worn 24 hrs/day
What is the cumulative effect of the interaction between nutrition and changes seen in aging?
progressive undernutrition, often goes undiagnosed
What may cause damage to the musculocutaneous nerve?
projectile wounds (GSW)
Where can medial nerve entrapment occur?
pronator teres, FDS, carpal tunnel
Alpha1-antitrypsin is a _____________ inhibitor.
protease (Ex of a protease: elastase)
What does P.R.I.C.E. stand for?
protection rest ice compression elevation
What are the 5 motions of the clavicle?
protraction retraction elevation depression posterior rotation
For a AKA, in which direction is the "pull" while applying an ACE wrap?
pull into extension and adduction
Which respiratory/vascular condition reduces the amt of O2 diffusing into blood and interferes with lung expansion?
pulmonary edema
What does spirometry measure?
pulmonary volumes airflow times
The posterior cord gives off what major nerve of the UE?
radial
What nerve(s) is/are affected by radial nerve compression?
radial nerve
Wrist drop is a clinical sign of damage to which nerve?
radial nerve
What are radiopharmaceuticals?
radioactive tracers used in nuclear medicine (PET, SPECT, bone scan) that are absorbed according to the metabolic properties of the tissue
The radiodensity of an object is inversely related to the:
radiodensity (amt of black) on the x-ray
An x-ray is simply a reflection of the _____________ of anatomical structures
radiographic densities
What diagnostic test can evaluate tumors and infections (such as pneumonia or TB)?
radiography (helps determine drug approach)
Is air radiolucent or radioopaque?
radiolucent
Is heavy metal radiolucent or radioopaque?
radioopaque
Bronchiectasis arises from _____________ inflammation and infection.
recurrent
Define attenuation
reduction in strength or density of an x-ray beam as it passes through something
What is geriatric syndrome?
refers to multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render an older person vulnerable to situational challenges multiple causations of a unified manifestation
PNF involves the use of the patient's strengths or ________ responses to minimize weakness
reflex responses
Stimulation of sensory receptors in the skin and superficial tissues is considered a _______________ effect of massage
reflexive
Older patients who undergo a unilateral AKA will have difficulty doing what?
regaining upright independence
What type of MS is mitoxantrone approved to treat?
relapsing-remitting that is also getting worse (secondary progressive MS)
What is an advantage of anticholinergic drugs for treatment of parkinson's?
relatively inexpensive
What is a controlled clinical trial?
researchers observe patients receiving a new drug compared to patients receiving a placebo
Storage of neurotransmitter: Neurotransmitters are often stored within the presynaptic terminal before they are used. What drug acts at this stage? (picture)
reserpine
Does hypercapnia result in respiratory acidosis or alkalosis?
respiratory acidosis
Does hyperventilation lead to respiratory acidosis or alkalosis?
respiratory alkalosis (excess amt of CO2 expired)
What are side effects of MAO?
restlessness, irritability, agitation, insomnia and hypertension
What is characterized as tardive dyskinesia?
rhythmic movements of the mouth, tounge and jaw (reversible with cessation of the drug)
If you're standing on your right leg and you have a contralateral (left) pelvic hike, how will your hips and back compensate to keep you standing upright?
right leg abduction lateral flexion to the left
If you're standing on your right leg and you have a contralateral (left) pelvic drop, how will your hips and back compensate to keep you standing upright?
right leg adduction lateral flexion to the right
What are the main *sections* of the brachial plexus?
roots trunks divisions cords nerves
At the SC joint, rotation of the joint occurs with what two shoulder motions? Can this rotation happen independent of other shoulder motions?
rotation occurs with *flexion and abduction* of the shoulder *no* SC rotation cannot occur without another shoulder motion
What is the main muscle group responsible for controling shoulder elevation?
rotator cuff
The thumb CMC and the SC joint are both ________ joints
saddle
For hip and low back muscle imbalances that occur, they cause deviations of the pelvis positioning in what plane?
sagittal
Is amputation or salvage more psychologically acceptable?
salvage
Is the risk of subsequent hospitalization greater after an amputation or salvage?
salvage
With SC retraction and protraction, the roll and glide happen in the ______ (same/opposite) direction
same
With wrist glides for radial and ulnar deviation, the radiocarpal joint involves what bones moving against each other?
scaphoid, lunate and triquetrum move on radius
What happens to the scapula during abduction of the shoulder between 0 and 60 degrees?
scapula is fixed until 30 degrees of shoulder motion at 30 degrees the scapula upwardly rotates at a 2:1 ratio (also causes AC joint rotation)
Motion at the acromioclavicular joint are pertinent with what motion?
scapular motions (upward/downward rotation) require AC joint motion to happen
What is the most common type of psychosis?
schizophrenia
What nerve(s) is/are affected by piriformis syndrome?
sciatic nerve
What syndromes could you use a sciatic nerve mobilization to help treat?
sciatic, tibial, sural and peroneal entrapment or compression
If an area of an x-ray appears "hyper-intense" (very white) what does this suggest?
sclerosis
Bronchiectasis is usually a ________________ condition
secondary
Which stage of TB is caused by invasion of dormant microbes or a new infection?
secondary stage
What are side effects of benzodiazepines?
sedation, ataxia, and behavioral changes
What are side effects of tricyclics?
sedation, confusion, delirium, tachycardia, dry mouth and urinary retention
A test that is ______________ will minimize type II errors
sensitive
If a test is very _________________, then the test will almost always be positive when the condition is present
sensitive
MRIs are _________ but not ___________ (sensitive/specific)
sensitive, not specific
______________ refers to a test's ability to correctly identify people with a condition
sensitivity
Pain and _______ changes are present with stage III CRPS
sensory
Diabetic neuropathy affects:
sensory, motor, or autonomic nerves
________ (neurotransmitter) may be involved in temperature regulation, sensory perception, sleep control and mood changes
serotonin
citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline are all generic names for what class of drug? What condition are these used to treat (specifically)?
serotonin reuptake inhibitors treats anxiety - specifically generalized panic disorder and PTSD
Which class of drug is a mainstay in treating depression and blocks the serotonin reuptake into the pre-synaptic receptor?
serotonin selective reuptake inhibitor
citalopram, fluoxetine, paroxetine and sertraline are all generic names for what class of drug? What conditions can these be used to treat?
serotonin selective reuptake inhibitors anxiety or antidepressants
Desvenlafaxine and duloxetine are generic names for what class of drug? What conditions can these be used to treat?
serotonin-norepinephrine reuptake inhibitors anxiety or antidepressants
If a transfemoral amputee has a 10 deg hip flexion contracture, how should the prosthesis be adjusted?
set to 15 deg of socket flexion
Stage II CRPS generally lasts about how long?
several months (3-6 mo)
Is elongation a type of size/simple or shape distortion?
shape distortion
Is foreshortening a type of size/simple or shape distortion?
shape distortion
Name the amputation: retains less than 50% of femoral length
short transfemoral
Name the amputation: retains less than 50% of tibial length
short transtibial
What is the MOI of an upper brachial plexus injury (C5-6)?
shoulder depression and lateral flexion of the neck
Name the amputation: amputation through shoulder joint
shoulder disarticulation
Small pulmonary emboli might be ____________ unless they involve a large area of lung
silent
Is magnification a type of size/simple or shape distortion?
size/simple distortion
Where are nociceptors located?
skin deep tissues blood vessels (all in peripheral nervous system) (not in visceral organs)
What should you always inspect before you begin massage?
skin condition of the area
During therapeutic massage, try to make transitional movements as ___________ as possible
smooth
How should you position a walker for an amputee who is learning to do a stand-pivot transfer?
so that the pt can put their elbows into full extension
Tricyclic antidepressants are effective at treating what kind of anxiety?
social anxiety disorder
Which type of post-op dressing is an ACE wrap or incision dressed with 4x4's and Kerlix?
soft dressing
What does water have roughly the same radiodensity as?
soft tissue
T2 MRI images show:
soft tissue pathology and are ideal for acute trauma
What color is heavy metal on an x-ray?
solid *white*
What is a simple explanation for why we feel somatic pain for visceral structures?
somatic and visceral pathways run parallel to each other and have intersections in the spinal cord (Dr. Sharma)
Through a subjective and objective exam, you can use differential diagnosis steps to determine if pain is ______ or ______ in nature
somatic or visceral
How is excessive anteversion of the hip defined?
some say >~15 some say >~20 good...
A test that is ______________ will minimize type I errors
specific
If a test is very _________________, then it will almost always be negative when the condition is not present
specific
_______________ refers to a test's ability to correctly identify people who do not have a condition
specificity
What are the three types of power grips?
spherical cylindrical hook
rachi-
spine
During therapeutic massage, you should never apply pressure over which bony prominences?
spinous processes
Which transfer should be worked on with an amputee first? If the pt is unable to stand, what may be indicated instead?
stand-pivot transfer slide board
What are two ways to assess pain behavior?
standard questionnaires objective observation/measures
Where should you guard a patient when turning around at the top of the stairs?
stay a step below them, you always want to be downhill from them
Repetition of PNF patterns promotes the development of _______ and ________
strength and endurance
PNF methods are divided into techniques used for _________ and __________
strengthening and stretching
What are the goals of passive stretch & traction techniques on soft tissue?
stretch/inc flexibility & length (mechanical effect)
The physiological effects of massage depend on:
stroke/technique
Large emboli may cause _______________
sudden death
What happens in diabetes mellitus?
sugar (glucose) in urine and blood
Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with external rotation (open chain)?
superior
Starting with the hip in/near neutral, which way does the femoral head glide with hip adduction (open chain)?
superior
Which trunk(s) give off the posteior cord?
superior (upper) middle inferior (lower)
With the SC joint, clavicular elevation involves a superior ______ (roll/glide) and an inferior ______ (roll/glide)
superior roll inferior glide
What is thought to be the cellular mechanism cause of depression?
supersensitivity of the post-synaptic receptors to their ligands (many antidepressants formed with the thought that there are too many post-synaptic receptors)
Where can radial nerve entrapment occur?
supinator muscle
The inner surface of alveoli is covered by _________________ .
surfactant
What substance is spread as a thin film at the air-liquid interface in the lungs?
surfactant
What is lymphedema?
swelling in a body part due to excess accumulation of protein rich fluid in the interstitial spaces
Which part of the nervous system is responsible for bronchodilation?
sympathetic nervous system
If you think there is a problem with a prosthesis, what should you check before calling a prosthetist?
take the prosthesis off and put it back on again Jason said 80% of the time this will fix the problem and the prosthetist will want to know you've tried this already
What are some side effects of antipsychotic drugs?
tardive dyskinesia pseudoparkinsonism bradykinesia akathisia dyskinesia
What may cause damage to the tibial nerve?
tarsal tunnel syndrome compression site between medial malleolus and flexor retinaculum
What is a simple or spontaneous pneumothorax?
tear on the surface of the lung
Name the muscle stabilization technique post-amputation: intact tendon(s) are re-attached to the bone
tenodesis
What is the most serious type of pneumothorax?
tension pneumothorax
Define true negative
test detects nothing, and nothing is there
Define false negative
test detects nothing, but there is something there
Define false positive
test detects something that is not really there
Define true positive
test detects something that is really there
What is a modified ober test? What is considered a positive reading?
testing IT band length, patient in sidelying, therapist brings leg into hip extension and lowers leg until hip tilts, if the leg doesn't reach 10 degrees below horizontal, it is a positive test
What is Ely's test? What is a positive reading?
testing rectus femoris muscle length, patient in prone and if their heel cannot reach their gluteus (PROM) that is considered a positive reading
What are the Merck Index and the Physician's Desk Reference (PDR) ?
the 2 traditional drug references (used to look up drug info)
What creates the blood-brain barrier and why does it exist?
the CNS capillaries that have very tight junctions and a lack of fenestrations, the capillary basement membrane and astrocytes contribute. This exists to limit what enters the CNS and serves as a protective mechanism
Which traditional drug reference is considered to be for chemists and provides the full chemical name and structure of a drug?
the Merck
Which traditional drug reference is commonly seen in rehabilitation departments?
the PDR (Physician's Desk Reference)
How do zolpidem, zaleplon, and eszopiclone work in treating insomnia?
the affect the GABA receptor action (act on the benzo binding site of the GABA receptor) and only affect one part of the receptor, resulting in a specific action
How is the angle of torsion defined?
the angle between a line that runs through the femoral head and the neck, and a line that runs between the femoral condyles (rotation between the neck and shaft of femur)
Define angle of inclination:
the angle in the frontal plane between the neck of the femur and the medial side of the femoral shaft
You should hold acupressure or trigger pressure points ideally until:
the extinction of any pain pattern elicited, but no longer than 5 minutes or than your fingers can tolerate
Where is the primary location for non-fatal unintentional falls?
the home (inside the home and outside areas immediately surrounding the home)
What are trihexyphenidyl and benztropine?
the most commonly used anticholinergic drugs for treatment of parkinson's
What is pain behavior referring to?
the observed (potentially measurable) consequence of a painful experience that can be considered as a "distress" response
What determines the direction of gas exchange between the alveoli and the blood?
the partial pressures of gases
You should gauge massage pressure by:
the patient's tolerance
What is pain quality referring to?
the perception of nociception that is not directly measurable (self-reporting)
Definition of edema:
the presence of abnormal amounts of fluid in the extracellular tissue spaces of the body
What is phantom limb sensation?
the sensation that an amputated limb is still present
What must be true before drug testing can progress from phase I to phase II of a controlled clinical trial?
the testing did not reveal any major problems such as unacceptable toxicity
What is nuclear medicine?
the use of radiopharmaceuticals for diagnosis, therapy & research
What impact have lobbying groups had lately on the time required for a drug to be approved by the FDA?
their efforts have reduced this time -FDA is making an effort to get more drugs to market with less regulatory burden (more like Europe and Canada)
What do hydantoins do?
these are drugs that interfere with the movement of sodium across the membrane, thus stabilizing the membrane of the neurons. They may decrease K+ and Ca++ movement in higher doses
What are side effects of cholinesterase inhibitors?
these are rare... but: nausea, vomiting, loss of appetite and diarrhea
What do anticholinesterase drugs do? (picture)
these drugs block the break down of acetylcholine and thus are used for treatment of myasthenia gravis
How generally do antipsychotic drugs work?
they act on a subtype of the dopamine receptor, the D2 receptor located in the limbic system (inhibit D2 receptor)
How do Monoamine oxidase inhibitors (MAO) work?
they act on the MAO enzyme that normally degrades the amine neurotransmitter and removes it from the synaptic cleft (blocking enzyme results in more amine neurotransmitter in the synaptic cleft)
How do tricyclic antidepressants work?
they affect the concentration of both serotonin and norepinephrine
Why are interferon-based drugs helpful in treating MS?
they are thought to inhibit the immune system from attacking itself, and MS is considered to be an autoimmune disorder
What role to antipsychotics play in treating Alzheimer's?
they are used to control aggression and agitation (only to restrain patients for a brief period of time)
The newer antipsychotic drugs (atypical antipsychotic) work differently on the receptors how?
they are weak antagonists of the D2 dopamine receptors but strong blockers of the serotonin receptors (5-HT2 receptor)
How do immunosuppressors work?
they block the immune system from being able to attack cells from the person's body, but they also block the immune system from attacking foreign organisms
How do potassium channel blockers work?
they block the potassium channels in the neurons which makes the neuron more likely to fire and thus function better (potassium normally hyperpolarizes the cell, making it less likely to fire, thus blocking potassium will result in a neuron that is more likely to fire)
How generally do serotonin selective reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors and tricyclics work to treat depression?
they block the reuptake of neurotransmitters into the pre-synaptic neuron, which increases the amount of neurotransmitter in the synaptic cleft for a longer period of time, resulting in overstimulation of the post-synaptic neuron and a compensatory down regulation/desensitization of the post-synaptic receptors
How should you work on toe loading in prosthetic gait training?
they don't like to do this bc they feel like they're going to fall, watch them to make sure they load weight across the entire prosthetic foot surface
What is a surgical consideration for *dysvascular* amputee patients?
they often present w/ comorbidities, neuropathy, vascular compromise, infection or osteomyelitis
How do Cholinesterase inhibitors work?
they prevent the breakdown of acetylcholine (important in memory and reasoning)
In MRI imaging, what happens to atomic nuclei when the EM field is removed?
they realign to their resting state and release resonant energy this radio frequency signal is detected & processed into an MRI image
How are corticosteroids helpful in treating symptoms of MS?
they reduce inflammatory signals and thus will decrease the total time of the exacerbation and severity of symptoms
How does the thickness of the respiratory membrane affect gas exchange?
thicker membrane decreases gas exchange
What is the role of levodopa in the treatment of Parkinson's disease?
this molecule can cross the blood-brain barrier and reach the basal ganglia. This drug is then converted to dopamine in the brain where it can take action
What syndromes could you use a median nerve glide to help treat?
thoracic outlet syndrome and CTS
Who is compression contraindicated for (with edema management)?
those with ABI <0.5 -also possibly those with fluid volume overload
Which patients may benefit from compression to treat edema?
those with ABI between 0.8-1.1 (may tolerate moderate to firm compression)
What nerve(s) is/are affected by tarsal tunnel syndrome?
tibial nerve
COPD involves progressive degeneration of _______________.
tissue
What is the function of Pregabalin? What is its chemical structure similar to?
to bind to the calcium channels in the brain, inhibiting the role of calcium in the development of an AP has a chemical structure like GABA, but does not bind to same receptor
Why might a sunrise/tangential x-ray be taken?
to image the patellofemoral joint
Why might an open mouth x-ray be taken?
to image the upper cervical spine
Why must muscle length be preserved in an amputation?
to prevent contracture and atrophy
What is the goal of having a lymph system?
to return excess fluid and protein from interstitial spaces to the blood system
Name the amputation: disarticulation at MTP joint
toe disarticulation
How will a person with excessive anteversion walk when they are NOT compensating?
toe out
How will a person with excessive anteversion compensate with gait?
toeing in (to stabilize joint in acetabulum)
How should you give verbal commands when working on PNF patterns with a patient?
tone of voice should relate to what your goal is for using the PNF pattern. ex. loud & firm tone of voice for strengthening or soft tone for stretching
Valporic acid is a drug used to treat what types of seizures?
tonic-clonic and absence
Is airway obstruction leading to atelectasis or non-aeration of tissue a symptom of partial or total obstruction of airways with asthma?
total obstruction -air diffuses out into tissues -no new air to fill the space -section of lung collapses
What causes obstructive or resorption atelectasis?
total obstruction of airway
What structure of the respiratory system has: elastic tissue, smooth muscle cells, & C-shaped rings of cartilage
trachea
Where is air normally present in the body? (4)
trachea lungs stomach GI tract
chlorpromazine, fluphenazine, haloperidol, loxapine, molindone, thioridazine, thiothixene and trifluperazine are all generic names for what class of drugs?
traditional antipsychotic
Where should you train unstable patients on stairs?
training stairs in a rehab. gym, not on real stairs in a stairwell
Name the amputation: amputation of hand w/ preservation of wrist
transcarpal
What are the two main functions of the first order neurons?
transduction and transmission
Are hip flexion contractures more common in transtibial or transfemoral amputees?
transfemoral **** (almost every amputee)
Name the amputation: amputation through humerus
transhumeral
Name the amputation: resection through long axis of metacarpals
transmetacarpal
Name the amputation: amputation through long axis of all MT's
transmetatarsal
What is vibration in terms of massage techniques?
transmitting trembling motion from PT's hands onto tissue
What is the main purpose of the respiratory system?
transport oxygen into the blood and remove CO2 from blood
Over 70% of UE amputations are caused by:
trauma
Of the pediatric amputations that are acquired, what is the most common cause? Are they usually UE or LE? What % are unilateral?
trauma LE 90% are unilateral
Which types of amputations more commonly experience phantom limb pain or sensation?
traumatic or later in life less common in congenital
In which direction do x-ray beams travel in an AP image?
travel through the pt from anterior to posterior direction
How does stage II CRPS respond to treatment?
treatments can be effective but not as responsive as stage I CRPS
Reuptake of neurotransmitters: neurotransmitters can be taken back up into the presynaptic terminal as a common feature of neuronal signaling. This happens for recycled use of the neurotransmitters later on. What is a drug that acts on this step? (picture)
tricyclic antidepressants
amitriptyline and nortriptyline are generic names for what class of drug? What condition are these used to treat?
tricyclic antidepressants anxiety
amitriptyline, doxepin and imipramine are all generic names for what class of drug? What conditions can these be used to treat?
tricyclics anxiety or antidepressants
Stage 1 CRPS is associated with beginning signs of ______ changes
trophic
T/F: PNF is a technique that preceded the field of PT
true
T/F: PNF patterns have a functional relevance
true
T/F: an elderly person with dementia may resist personal care
true
T/F: conduction speed of large myelinated nerves is much faster than small myelinated nerves, and especially faster than unmyelinated nerves
true
T/F: contrast MRI allows for before and after contrast image comparisons
true
T/F: effleurage can have a physiological effect when moving from the periphery towards the heart
true
T/F: massage can build trust b/w pt and PT
true
T/F: massage can convey concern & respect for another in need
true
T/F: massage can energize or elevate mood
true
T/F: massage can increase pt's body awareness
true
T/F: massage can reduce stress & anxiety
true
T/F: most elderly people prefer to live as independently as possible in their own homes
true
T/F: one of the benefits of PNF is that it can be modified many different ways
true
T/F: phantom limb sensation is normal after an amputation
true
T/F: the PT should stay as relaxed as possible during massage application
true
T/F: the cause of phantom limb pain is unknown
true
T/F: the pt and PT must have understanding of prosthetic components and their functional implications
true
T/F: you can't do stair climbing using a walker with a platform attachment
true
T/F: you should drape patients during massage for modesty and warmth
true
T/F: you should focus on positioning of an amputee both in and out of bed
true
T/F: home modifications, such as stair climbers, offer only a partial solution
true (stair climber: moving chair on stairs like in the movie Up)
T/F: massage has been around for a long time
true -Eastern & Western medicine -Middle Ages -Rebirth in 16th cent. -Swedish Movement System 18-19th cent.
A test that is specific helps determine a:
true negative
A test that is sensitive helps determine a:
true positive
T/F: you should avoid going too low in the pectoral region
true, except with post-mastectomy
T/F: amputations are associated with psychological trauma
true, need for an extended period of adjustment
T/F: many kids who have a congenital amputations chose not to wear a prosthetic
true, they learn how to do everything without the limb, esp. UE amputations
Is it okay to talk with your patient during the massage?
try to keep conversations to a minimum
What disease can survive in dried sputum for weeks?
tuberculosis
What disease occurs more frequently in poverty and crowding?
tuberculosis Ex: prisons, war, malnutrition, alcoholism, chronic disease, immunodeficiency
What causes compression atelectasis?
tumor exerts pressure on part of the lung
When doing stair training with a walker, what should you do to the walker at the top of the stairs?
turn it around
Are amputations more common in men or women?
twice as common in men
Which type of DM is also called the "misfolding disorder"?
type 1
Which type of diabetes is formerly insulin *dependent*?
type 1
Which type of diabetes is usually juvenile?
type 1
What type of hypersensitivity is asthma?
type 1 -occurs in people with hypersensitive or hyperresponsive airways
Which types of diabetes can have a genetic predisposition?
type 1 and 2 (type 2 = multifactorial)
Which type of diabetes is formerly insulin *independent*?
type 2
Which type of diabetes usually has an adult onset?
type 2
The medial cord gives off what 2 major nerves of the UE?
ulnar median
Loss of thumb adduction (Froment's sign) is a clinical sign of damage to which nerve?
ulnar nerve
What nerve(s) is/are affected by compression on Tunnel of Guyon?
ulnar nerve
What nerve(s) is/are affected by cubital tunnel syndrome?
ulnar nerve
Which type of imaging creates anatomic images through sound waves?
ultrasonography
With what hand position is petrissage applied?
uni- or bi- manually with open "C" type position of the hand
Does a bilateral BKA or unilateral AKA increase the energy cost of ambulation more?
unilateral AKA
How long does stage III CRPS last?
unlimited amount of time
How long does scar maturation take?
up to 1 year
You should go up stairs leading with the (good/bad) LE and go down stair leading with the (good/bad) leg
up with the good, down with the bad
What are the names of the trunks of the brachial plexus? What root levels make up each trunk?
upper (superior) -made by C5 and C6 middle -made by C7 lower (inferior) -made by C8 and T1
Notes for acetylcholine
used by all motor axons from the spinal cord, plays important role in autonomic system, important in basal ganglia for controlling movement, implicated in development of Alzheimer's
What is an osteomyoplasty?
used in a *transtibial amputation* -osteoperiosteal flap (bone bridge) is harvested from the amputated tibia -flap is implanted, bridging the distal tibial & fibular ends -incision is closed over bone bridge
What is the point of the friction massage technique?
used to loosen/soften tight mm
What type of endogenous contrast agent is used in a functional MRI?
uses magnetic properties of deoxyhemoglobin
When can an amputee begin to wear a semi-rigid post-op dressing?
usually applied in the OR or PACU
Over 80% of LE amputations are caused by:
vascular disease or neuropathy
Pulmonary edema and pulmonary embolism are what kind of disorders?
vascular disorders
Which gait deviation is very common in transfemoral amputees?
vaulting
Lymphedema risk is increased in chronic ________ insufficiency
venous (creates phlebolymphedema)
The lymph system returns fluid to _______ system from the LE at the ______ venous angle
venous left
How well does stage III CRPS respond to treatment?
very resistant to treatment
When viewing a lateral x-ray film, in which direction will you view the patient?
viewed in the direction the x-ray beam traveled
When viewing an AP or PA x-ray film, in which direction will you view the patient?
viewed with pt facing the viewer in the anatomical position-- hands, feet & digits point upwards
Diffuse, poorly localized pain are characteristics of _______ pain
visceral
What chart is a helpful tool for a PT to determine if pain location may be due to a visceral origin?
visceral referred pain pattern table
Photographic qualities of an x-ray refer to the ________________ of the image
visibility
To assist with MCP flexion of joints 2-5, you would perform what kind of glide?
volar
To facilitate wrist extension, would you perform a dorsal or volar glide?
volar
Cardiac edema can be the result of one of two things?
volume overload (CHF) HTN
In a person with retroversion of the hip, how will their gait look when they are NOT compensating?
walk toe in
In a person with retroversion of the hip, how will they compensate during gait to make the joint more stable?
walk with toe out
Which lubricant for massage is used by most hospitals and clinics?
water-based lubricant
Why is it important to be able to recognize visceral pain as a PT?
we must be able to distinguish this type of main from musculoskeletal pain to know when to refer back to MD or advise patient to seek another treatment route
Once axillary nodes are removed (due to cancer) what further increases one's chance for lymphedema?
when chemo/radiation are added
When does the post-surgical phase after an amputation end?
when pt is provided with a definitive (not temporary) prosthesis
When guarding a patient during stair training, when should you move down a step?
when the pt is transitioning feet, you should stay still when the pt is moving
When is a definitive socket (permanent prosthesis) provided to an amputee?
when the volume of the residual limb has stabilized
What color is unexposed film on an x-ray?
white
Venous edema increases when?
with legs in dependent position
Medical treatment of one condition has the potential to:
worsen another condition
With stage 1 CRPS, movement affects pain how?
worsens it immobility of the limb serves as a protective position
Name the amputation: amputation of hand and carpals
wrist disarticulation
Define radiodensity
x-ray absorption capacity based on a substance's composition, density and thickness
A CT scan uses ________________ to produce cross-sectional images
x-ray attenuation
Can all unilateral BKA amputees be functionally independent?
yes, all of them can
Should you have the pt hang onto the handrail if they are using a cane on stairs?
yes, use whichever rail is available
Should you have the pt hang onto the handrail if they are using a walker on stairs?
yes, use whichever rail is available
How is a transverse CT scan read? (when you look at an image, which way are you looking at the person?)
you are always looking from the person's feet upwards
Traumatic amputations are more common among which population?
younger men
Can all bilateral BKA amputees be functionally independent?
younger patients can be
How do you isolate a muscle in MMT?
"can be done by putting muscles at a mechanical disadvantage, which is often built into the test position when testing a specific muscle"
What does an ulnar nerve injury look like?
"claw hand" Lean to radial side when you flex the wrist
A recent change in pharmacy is from the "one drug for all" concept to ___________________ instead.
"personalized medicine"
Classic Stacia-ism: (read)
"your first touch should be done with respect, you should address the skin, not invade it"
A high _____ is common in type 2 diabetes
% body fat
What happens in phase IV of a controlled clinical trial?
(a.k.a. postmarketing surveillance) -begins once drug is approved to market -monitor any problems that occur
What are the 7 steps for testing/mobilizing the *median* nerve?
(patient in supine) 1. shoulder depression 2. shoulder abduction (slight) 3. elbow extended 4. shoulder ER 5. supinate forearm 6. wrist and finger extension 7. contralateral cervical bending
What are the 7 steps for testing/mobilizing the *radial* nerve?
(patient in supine) 1. shoulder depression 2. slight shoulder abduction 3. elbow extended 4. shoulder IR 5. pronate forearm 6. flex wrist and fingers 7. contralateral cervical bending
What are the 7 steps for testing/mobilizing the *ulnar* nerve?
(patient in supine) 1. wrist and fingers extended 2. forearm supinated 3. elbow flexion 4. shoulder depression 5. shoulder ER 6. shoulder abduction 7. contralateral cervical bending
Fact or Myth: About 80-90% of patients return to work; the other 10% of people are never pain free no matter what is done
*Fact* most patients do want to get better and return to work/normal activities, some people are never pain-free and it is not known why
Fact or Myth: 6 months after an injury, 50% of the people that are still not back to work will never go back to work
*Fact* 6 months is a big landmark for PT goals to get patients back to work
Fact or myth: Within 2 months following an injury, the majority of patients get better regardless of intervention type or no intervention provided
*Fact* body will heal itself with time (to a certain extent), but some conditions can be recurrent in nature without treatment in acute state (LBP can become chronic and recurrent if not treated appropriately in the acute phase)
When is an instance where a PT might have some treatment plan for visceral pain? What is this type of pain called?
*centrally mediated pain* when visceral pain leads to chronic pain, this is something a PT can help treat
For the thumb, flexion and extension of the CMC joint involve the _________ (convex/concave) base of MCP in frontal plane moving on the ________ (concave/convex) surface of the trapezium. This means that the roll and glide happen in the ________ (same/opposite) direction
*concave* MCP *convex* trapezium *same* direction
For the prox and distal IP joints of digits 1-5, the ________ (convex/concave) base of the distal phalanx moves on the ________ (convex/concave) head of the proximal phalanx. This means that the roll and glide happen in the ________ (same/opposite) direction
*concave* base of distal *convex* head of prox *same* direction
For MCP joints 2-5, the ________ (convex/concave) base of the proximal phalanx moves on the _________ (convex/concave) head of the metacarpal. This means that the roll and glide happen in the _______ (same/opposite) direction
*concave* base of phalanx *convex* head of the metacarpal *same* direction
At the SC joint. retraction and protraction involve the __________ (convex/concave) clavicle moving on the __________ (convex/concave) sternum
*concave* clavicle moving on the *convex* sternum (manubrium)
The arthrokinematics of the humeroradial joint involve the _______ (convex/concave) head of the proximal radius moving on the _________ (convex/concave) capitulum of the humerus. This means the roll and glide happen in the __________ (same/opposite) direction
*concave* head of radius *convex* capitulum *same* direction
The arthrokinematics of the humeroulnar joint involve the _______ (convex/concave) ulna moving on the _______ (convex/concave) trochlea of the humerus. This means the roll and glide happen in the _________ (same/opposite) direction
*concave* prox ulna *convex* trochlea *same* direction
For the thumb, abduction and adduction of the CMC joint involve the _________ (convex/concave) base of MCP in sagittal plane moving on the ________ (convex/concave) surface of the trapezium. This means that the roll and glide happen in the ________ (same/opposite) direction
*convex* MCP *concave* trapezium *opposite* direction
At the SC joint, elevation and depression involve the ________ (convex/convace) clavicle moving on the _________ (convex/concave) sternum
*convex* clavicle moving on the *concave* sternum (manubrium)
Since the glenohumeral joint involves the _________ (convex/concave) humeral head moving on the __________ (convex/concave) glenoid fossa, the roll and glide happen in the ____________ (same/opposite direction.
*convex* humeral head moving on *concave* glenoid fossa, roll and glide in *opposite* directions
For the radiocarpal joints, the _______ (convex/concave) proximal carpal bones move on the _________ (convex/concave) distal radius. This means that the roll and glide happen in the __________ (same/opposite) direction
*convex* proximal carpals *concave* distal radius *opposite* direction
Are amputation rates due to cancer currently increasing or decreasing? Why?
*decreasing*, due to earlier diagnoses, improved chemo and limb salvage/ reconstruction techniques
The infraspinatus, teres minor and subscapularis muscles all _______ (elevate/depress) the humeral head
*depress* humeral head (inferior glide)
What is axonotmesis? What happens to the nerve? What typically causes it? What will happen in healing?
*disruption of the neuronal axon* takes place but the *myelin sheath is still intact*. Typically caused by a *crush based injury* and not a laceration. If the neuronal tubules are maintained in place, *regeneration and restoration of sensory or motor ability may return*
The infraspinatus and teres minor _______ (internally/externally) rotate the humerus
*externally* rotate
T/F: ultrasonography imaging is only used in OB/GYN practice
*false* -it is also useful for imaging musculoskeletal tissue -can be used during a physical exam & w/ active, functional activity
T/F: orthopedic hardware is ferromagnetic and cannot undergo MRI imaging
*false* but surgical clips usually are and pacemaker fxn can be compromised in MRI imaging
What is petrissage?
*kneading*-- compress & release movements
What is a T1 MRI image?
*longitudinal magnetization*: -how long it takes protons to "relax" back to a resting state after an RF pulse
The clinical application of PNF techniques focuses on _______ contact and ________ commands
*manual contact* -use of good body mechanics is key -use manual contact over mm that are working *verbal commands* -learn motor sequence -enhance motor output
Venous edema can be classified as what? Describe each breifly
*mild*: when associated with uncomplicated varicose veins *moderate*: edema with perforator involvement *severe*: edema is usually associated with acute deep system blockage
Do most bilateral AKA amputees use a prosthetic?
*no*
Should you get medical imaging done for a patient over the age of 50 with acute low back pain that has no signs of systemic disease?
*no*, symptomatic therapy is appropriate
Barbiturates are best used on what types of seizures?
*partial and generalized tonic-clonic* do not work well on absence and atonic seizures
What is bronchiectasis?
*permanent dilation of the medium-sized bronchi*
Visceral organ pain is often "________" to or felt in another _________ structure distant or near the source of visceral pain
*referred* to or felt in another *somatic* structure
The supraspinatus muscle controls the ______ (superior/inferior) roll of the humerus, seats the head of the humerus in the ______ fossa, and prevents excessive __________ (superior/inferior) translation
*superior* roll of the humerus *glenoid fossa* *superior* translation
Like in any joint, the roll and glide must happen at the same ________ to keep the joint articulated
*time* roll and glide happen simultaneously
What is a T2 MRI image?
*transverse magnetization*: -how long resonating protons remain "in phase" or oriented following a RF pulse
T/F: ultrasonography imaging is included in PT practice
*true* but should only be used to confirm a diagnosis
T/F: ultrasonography is operator dependent
*true* good technique requires practice
Review of symptoms for MS:
*weakness* *tingling* numbness/impaired sensation poor coordination *fatigue* balance problems visual disturbances *blurred vision* involuntary rapid eye movements tremors spasticity muscle stiffness
What color is contrast media on an x-ray?
*white* outline
Should you get medical imaging done for a patient over the age of 50 with acute low back pain and signs of systemic disease?
*yes*, conventional x-ray and simple lab testing can almost completely rule out underlying systemic disease
On the ART scale what do + and - mean after the number score?
+ means less than half ROM with a certain resistance - means more than half ROM with a certain resistance
Effleurage can allow the PT to "listen" to their hands to search for:
-"hot spots" -edema -tightness -other injuries
What would clinical presentation look like if someone has damaged the sciatic nerve?
-"sciatica" pain radiating to posterior thigh and leg; atrophy of posterior thigh, leg/calf and foot -weak knee flexion, loss of ankle and foot control affecting all phases of gait -sensory loss of lateral and posterior leg, lateral and posterior lower leg, and part of the foot
How do you bill for massage?
-*CPT 97124*: effleurage, petrissage, tapotement -*CPT 97140*: CT massage, joint mobilization & manipulation, manual traction
What are some examples of nuclear medicine?
-*SPECT*: single-photon emission computed tomography -*PET*: positron emission tomography -PET/CT and SPECT/CT -*bone scan*: radionuclide scintigraphy
Short Summary of Key Points of Imaging Types: (read)
-*X-rays* are usually the first order modality -*CT* is used to visualize complex anatomy -*MRI* is used to assess soft tissue
Which structures appear dark and which appear bright in a T1 MRI image? (read)
-*bright*: fat (bone), subacute hemorrhage, necrosis -*dark*: high water content (edema, tumor, infarction, infection, chronic hemorrhage)
Which structures appear dark and which appear bright in a T2 MRI image? (read)
-*bright*: high water content -*dark*: bone, fat, calcification, fibrosis, blood -useful for imaging CSF and edema
What are some management guidelines for a peripheral nerve injury in the *chronic* phase of healing? (2)
-*compensatory function* (compensatory function minimized during recovery BUT is emphasized when full neurological recovery does not occur) -*preventative care* (emphasis on lifelong care to involved region) (reinnervation potential peaked w/ minimal or no signs of neurological recovery)
What are some post-op complications of amputations?
-*contracture* -swelling -phantom limb sensation or pain -personal grief and depression surgical complications: pain, infection, respiratory compromise, DVT, etc.
What is the difference between extrinsic and intrinsic asthma?
-*extrinsic*: acute episodes triggered by type 1 hypersensitivity rxn to an allergen -*intrinsic*: hyperresponsive tissue in airway initiates an attack. stimuli include: stress, cold, exercise, drugs, etc.
What are some management guidelines for a peripheral nerve injury in the *acute* phase of healing? (4 - immediately after injury OR surgery)
-*immobilization* (time dictated by surgeon) -*movement* (amount and intensity dictated by type of injury and surgical repair -*splinting or bracing* (to prevent deformities or tension on the injured side) -*patient education* (protection of the injury site)
What are some management guidelines for a peripheral nerve injury in the *subacute* phase of healing? (3)
-*motor retraining* (hold in shortened position, electrical stim / short pulses) -*desensitization* (multiple texture for sensory stimulation and vibration) -*discriminative sensory reeducation* (identification of objects with, then without visual cues) (signal of reinnervation - muscle contraction and increased sensitivity)
Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with hip extension (open chain)?
-------- (does not apply?)
Evidence for massage: slide 5 (read)
-10 trials reviewed for effectiveness of diff types of massage on fibromyalgia -MFR: large, positive effects on pain, medium effect on anxiety/depression--- moderate evidence it's beneficial for FM -Swedish massage: not effective
How successful was the 19__'s method of traveling to South America to find new plants and trying to isolate any active compounds within them?
-1950's -very low success rate -what little success it did have was based on shear luck
Through the 19__'s, most drug discoveries were based on the identification of ___________ with medicinally active compounds.
-1970's -plants
What are the 5 points of the "functional position of the hand"?
-20-30 degrees of extension -slight ulnar deviation -35-45 degrees of MCP flexion -15 to 30 degrees of PIP and DIP flexion -35-45 degrees CMC abduction
What do CV drugs, psychotropic drugs and NSAIDs all have in common?
-3 most commonly involved in drug-related illnesses -3 most commonly prescribed in the elderly
It is estimated that only ______ in 5,000 compounds make it to human testing, and only ______ of them may be safe & effective enough to reach pharmacy shelves.
-5 in 5,000 -only 1 of the 5
What causes bacterial pneumonia? What about viral pneumonia?
-B: resident bacteria spreading along mucosa -V: direct virus
4 risk factors for gestational diabetes:
-BMI > 30 -prior baby > 10 lb -prior gestational DM -family history of DM
2 therapeutic interventions for diabetic nephropathy:
-BP control (ACE inhibitors) -dietary protein restriction
What are treatment options for breast cancer related lymphedema?
-CDT -lymph anastomoses (surgical) -mechanical pneumatic pumps
If PCO2 increases, how does the body realize that its in a state of respiratory acidosis? How does the body then try to compensate?
-CO2 can now easily diffuse into the CSF -this lower the pH and stimulates the respiratory center -results in inc rate & depth of respirations (hyperventilation) which would inc the pH back to normal
Which conditions increase your risk for PVD and amputation?
-DIABETES -obesity -HTN -HLP -nephropathy
What are some PT interventions to treat phantom limb pain?
-E-Stim and US -mechanical stimulation: massage, percussion & vibration -desensitization & reprocessing -exercises -biofeedback: mirror box therapy, immersive virtual reality -(counseling)
What are the 3 main divisions of the ear?
-External -Middle -Inner
Types of plasma glucose tests:
-Fasting -Random during the day if a person has severe symptoms -oral glucose tolerance test -hemoglobin A1C (HbA1C)
Glenohumeral joint
-Greatest loss of lateral rotation -moderate loss of abduction -minimal loss of medial rotation
What are symptoms of AIDS?
-HIV positive -immune deficiency (low CD4) -fatigue -low grade fever -cachexia -weight loss -shortness of breath -occasional colds leading to pneumonia -gynecological infection
What are some structures of the external ear?
-Helix (outer rim) -Lobule (only part without cartilage) -Antihelix -Tragus -Antitragus -Concha (entrance into ear canal) -Incisure terminalis (surgically important because an incision can be made here without damaging the cartilage or perichondrium)
What is the name of a grade I nerve injury? What is the disrupted element? What is the expected return for function if not repaired?
-I: Neuropraxia -Nerve conduction disrupted -Complete return expected within hours to weeks
What is the name of a grade II nerve injury? What is the disrupted element? What is the expected return for function if not repaired?
-II: Axonotmesis -axon disrupted (w/o myelin sheath involvement) -complete return expected at 1 mm/day (takes weeks or years)
What are the different types of post-op dressings after an amputation? (read)
-IPOP (rigid) -rigid removable -semi-rigid -soft
What happens with gestational diabetes?
-Inc. glucose levels leads to reduced insulin sensitivity (bc pregnancy hormones interfere w/ the action of insulin, allowing extra glucose to pass to the fetus) -the pancreas doesn't cope w/ higher demand for insulin
What happens with Type 2 diabetes?
-Insulin is produced but the body doesn't respond to it (relative insulin deficiency)
What conditions can cause pulmonary edema? (4)
-L sided CHF (leads to HBP) -hypoproteinemia (liver or renal disease = dec osmotic pressure) -inflammation in lungs -blocked lymphatic drainage
Evidence for massage: slide 6 (read)
-MFR effectiveness at treating orthopedic conditions -10 studies reviewed -evidence was mixed in quality and results, some studies found little to no effect
What does complete decongestive therapy (CDT) consist of?
-MLD -compression bandaging -remedial exercise -meticulous skin and nail care -instructions in self-care
What are some examples of trauma that often lead to amputation?
-MVA -combat -severe burn -electrocution
What is contained in the middle ear?
-Ossicles (malleus, incus, stapes) -Eustachian tube -Mastoid air cells
What syndromes could you use a radial nerve glide to help treat?
-PINS (post interroseous nerve syndrome) -tennis elbow -deQuervain's syndrome
What does the binding and release of oxygen to Hb depend on? (4)
-PO2 -PCO2 -temperature -plasma pH
What is contained in the external ear?
-Pinna -Ear canal -Tympanic membrane
What are the 3 layers of the ear drum?
-Strat. squamous epithelium (lateral/external surface) -Fibrous layer with circular and radial fibers (pars tensa and pars flaccida) -Mucous (respiratory) epithelium
What's the difference between transudative and exudative pleural effusions?
-T: watery effusion (hydrothorax, inc hydrostatic or dec osmotic pressures) -E: contain proteins & WBC (response to inflammation)
In combination lymphedema, is the following normal, increased or decreased? -transport capacity -lymphatic load How do you treat this type of lymphatic failure?
-TC: decreased -LL: increased Treat with CDT
In mechanical lymphedema, is the following normal, increased or decreased? -transport capacity -lymphatic load How do you treat this type of lymphatic failure?
-TC: decreased -LL: normal Treat with CDT
In dynamic edema, is the following normal, increased, or decreased? -transport capacity -lymphatic load How do you treat this type of lymphatic failure?
-TC: normal -LL: increased (like with acute injury) Treat with RICE
In hemodynamic edema, is the following normal, increased or decreased? -transport capacity -lymphatic load
-TC: normal/decreased -LL: increased due to R ventricular failure
Which 2 muscles of the middle ear function as shock absorbers?
-Tensor tympani -Stapedius
What is capable of destroying mycobacterium tuberculosis?
-UV light, heat, alcohol, glutaraldehyde, formaldehyde
What is the name of a grade V nerve injury? What is the disrupted element? What is the expected return for function if not repaired?
-V: neurotmesis -epineurium disrupted (axon and surrounding myelin/soft tissue) -none or difficult return of function if not repaired
What are 3 theories for the cause of CRPS?
-abnormal activity of the SNS -gate control theory (imbalance between normal receptors and nociceptors) -reflex muscle spasm *all deal with abnormalities in the sympathetic NS*
How is CO2 transported in the blood? (3)
-about 20% bound to Hb -about 7% dissolved in plasma -MOST diffuses into RBC's
The neurological drugs can act where? (7)
-action potential -synthesis of neurotransmitters -storage of neurotransmitters -release of neurotransmitters -reuptake of neurotransmitters -degradation of neurotransmitter -postsynaptic receptor
Evidence for massage: slide 2 (read)
-active release & joint mobs had sig changes in VAS & ROM pre and post intervention -sig difference in pressure pain thresholds for all muscles in active release group vs. all muscles but traps for joint mobs group -only 24 subjects
What may cause damage to the axillary nerve?
-acute dislocation -fractures of the humerus neck
The FDA realizes 15 years is too long to wait for some drugs to reach market. What effort did they make to help alleviate this problem?
-added a new way to categorize drugs as either standard or priority -*standard*: provides minor improvements over an existing drug -*priority*: believed to have advances in health care & move more quickly through the approval process. Still have to go through 3 phases of human testing
What are some trophic skin changes that take place in stage II CRPS?
-affected limb is edematous and cool -hair loss -cracked, brittle nails -motor changes
When is the vibration massage technique used?
-after deep pressure of a trigger point -for joints after deep stroking
How is the type of prosthesis chosen for an amputee?
-age -activity level -job demands -funding -compliance
According to the Ottowa Knee Rule, a conventional x-ray should be ordered if:
-age over 55 OR -tenderness at fibular head OR -isolated tenderness of patella OR -inability to flex knee to 90 deg OR -inability to walk 4 WB steps immediately after injury in the emergency department
According to the Pittsburg Decision Rule for Knee Trauma, a conventional x-ray should be ordered if:
-age under 12 or over 50 AND/OR: -inability to walk 4 WB steps in the emergency deparment
How does dementia affect treatment behaviorally?
-agitation or aggression -depression -lack of motivation -other abnormal behaviors
Airflow during inspiration and expiration depends on __________________ gradient. This is known as _____________ law.
-air pressure gradient -Boyle's law
What should you keep in mind when positioning a patient for a massage?
-allow greatest access to target area -pt comfort
What teaching strategies can you adapt to the pts cognitive level?
-allow inc processing time -take into account for after images -promote the formation of short-term memory
What is the trade name of a drug?
-also called brand name or proprietary name -assigned by pharmaceutical company -identifies drug as exclusive property of the company -usually does not relate to chemical nature of drug, but is catchy & easy to remember
How does emphysema lead to decreased recoil?
-alveolar walls are destroyed due to breakdown of elastin -causes large, permanently inflated alveolar air spaces -leads to decreased recoil
How do you treat a pleural effusion? (4)
-analyze fluid to confirm cause -remove underlying cause -remove fluid & relieve pressure -treat respiratory impairment
How do you prevent a pulmonary embolism? (2)
-assess risk factors -anticoagulants to prevent thrombosis
What is a secondary pneumothorax?
-associated with underlying resp. disease -Ex: rupture of a bleb on lung, erosion by tumor, tubercular cavitation
2 underlying causes of macrovascular complications of diabetes:
-atherosclerosis -HTN
What would clinical presentations look like in a patient who has damaged their musculocutaneous nerve?
-atrophy along the flexor surface of the arm -weakness of elbow flexion with forearm supinated -sensory loss to radial side of forearm
What is some specific info you should give a patient for preventative care if they have loss of sensation in an *upper limb* following a nerve injury?
-avoid handling cold, hot, sharp or abrasive objects -redistribute hand pressure by building up the size of the handles -avoid sustained grasps -wear protective gloves
How do you treat emphysema?
-avoid resp. irritants (smoking) -breathing techniques -immunizations for flu & pneumonia -antibiotics -bronchodilators -O2 therapy -adequate nutrition -lung reduction surgery
Describe some activities you could do to work on balance training after an amputation:
-balance COG over the sound limb in parallel bars to get used to the loss of weight of limb -PT initially provide confidence during stand-pivot transfers and ambulation w/ AD -be able to balance on their own for at least 0.5 seconds
What are some general principles of treatment for a peripheral nerve? (read?)
-be more gentle if pt condition is very irritable -stretch force applied to tissue resistance slower then held for 15-20 sec, released, then repeated 3-5x -neuro symptoms should not last when the stretch is released -positioning the patient at the point of tension (symptoms just begin), passively move one joint at the time to further stretch tissue -move the joint where the nerve is trapped at the end and carefully, respecting the symptoms
When tissues are damaged, the chemicals released into tissues have what effects? -bind to? -activate? -release? -result?
-binding of substance to specific receptor -activation of ion channels for depolarization -activation of other receptors and intracellular messenger systems -release of neuropeptides from neurons -vasodilation of vessels and edema
What are some treatment techniques that can be used in PT for CRPS?
-biofeedback -imagery? -behavioral modification -desensitization -edema control -TENS -soft tissue mobilization -thoracic mobilization (sympathetic input) -exercises for ROM and activity (not for strengthening) -mirror therapy (trick your brain)
What is the background of DM?
-body = unable to use glucose as a fuel molecule to produce ATP -cells can't uptake glucose due to insulin signaling impairement
How can pain be documented subjectively? (3)
-body chart (location and description) -intensity of pain -behavior of pain (over 24 hr period)
What respiratory changes take place with aging?
-breathing takes inc work -easy fatigue w/ effort
What are some causes of amputations other than trauma or vascular disease/neuropathy?
-cancers (esp. bone cancers in kids) -infection -congenital limb defects
What are things that cause disruption to normal fluid exchange at the capillary level?
-capillary permeability change -capillary hydrostatic pressure -injury to the tissue -obstruction to the lymph system
How is pneumonia classified? (4 categories)
-causative agent (viral, bacterial) -infection location(1 lung, 1 lobe) -pathophysiologic changes -epidemiologic data (nosocomial, community)
Where are central and peripheral chemoreceptors located?
-central: medulla -peripheral: carotid bodies, aortic body
Is pneumoconioses an acute or chronic condition? Is its onset rapid or insidious?
-chronic -insidious
What are 2 symptoms of bronchiectasis?
-chronic cough -production of a lot of purulent, foul-smelling sputum (1-2 cups per day) Ew...
What are precautions for therapeutic massage?
-chronic fatigue syndrome -fracture sites -osteoporosis -hypersensitive to touch -DM -complicated pregnancy -HTN -asthma -alcoholism -psychiatric illness -open lesions -kids w/ shunts (must elevate head)
Considerations for the elderly in PT treatment of pain (read):
-chronic pain common in older persons -1/5 of all elderly take analgesics regularly -45% of elderly that take pain meds have been seen by 3+ Drs in past 5 yrs -45-80% of nursing home patients have substantial pain that is undertreated -follow Americal Geriatrics Society Clinical Practice Guidelines for management of chronic pain in elderly
Things to know about compressogrip (read):
-circular knit, tubular stocking -ABI should be *0.8* or greater -moderate compression appropriate for venous insufficiency and edema associated with trauma in patients tolerating exercise rehab -20-30 mmHg
Evidence for massage: slide 1 (read)
-classified as low to very low evidence for effectiveness of massage to treat LBP -improvements in pain & function only existed in ST follow up
What are some challenges with geriatric rehab.? (7)
-comorbidities -dementia -education -multiple meds -dehydration/malnutrition -falls -geriatric syndrome
Evidence for massage: slide 3 (read)
-compared soft tissue mobs & PNF to ultrasound as control to treat shoulder impingement -sig improvement in pain reduction, ER and OH reaching in a single intervention -only 30 subjects
What are the goals of PT in the post-surgical phase after an amputation? (after surgery, before prosthesis)
-compression -ROM -positioning -endurance
What are mechanisms of injury for nerve injuries?
-compression/crush -laceration -stretch -radiation -electricity
What are the most common symptoms of inflammation? (6)
-constant pain -redness -heat -edema -tenderness of the affected area -limitation in function
Whare are some measure to take to treat acute asthma attacks?
-controlled breathing techniques -inhalers (bronchiodilators) -glucocorticoids
What are symptoms of pulmonary edema? (5)
-cough -orthopnea (SOB lying down) -rales -hemoptysis (cough up blood) -frothy, blood-tinged sputum ... Ew
What are some symptoms of asthma?
-cough -shortness of breath -tight feeling in chest -wheezing -rapid & labored breathing -expulsion of thick/sticky mucus -tachycardia
List some symptoms of pneumonia
-cough (may have green, yellow or bloody mucus) -fever -chills -headache -sharp chest pain -excessive sweating -clammy skin -loss of appetite -low energy -fatigue
What are some examples of specific friction massage techniques?
-cross-fiber -rolling -wringing
What may cause damage to the radial nerve?
-crutch palsy or saturday night palsy (compression site being radial sulcus) -posterior interroseous nerve syndrome (PINS) - (compression sites being radial head, ECRB and supinator)
What may cause damage to the ulnar nerve?
-cubital tunnel syndrome or compression in the Guyon's canal (GCS)
What are some benefits of exercise? (read)
-dec fear of falling -inc ROM, strength, endurance -dec depression -dec sleep disorders
What musculoskeletal changes take place with aging?
-dec muscle mass -dec bone density -changes in articular cartilage -variable resistance to manipulation
What changes seen in aging lead to undernutrition?
-dec sense of taste -dec sense of smell -loss of vision/hearing -dental problems -altered energy needs -dec physical activity -muscle loss -psychosocial (isolation) -environmental (financial)
How does having comorbidities affect the following (inc or dec): -rate of functional gains achieved w/ rehab -length of hospital stays -adverse health outcomes -preventative care -treatment for each condition -treatment intensity
-decreased -increased -increased -decreased -decreased -decreased
A deficiency of what substance can lead to emphysema? Why?
-deficiency of alpha1-antitrypsin -inhibits elastase from breaking down elastin
What are some physiological conditions that cause nerve root injury via compression (not trauma)?
-degenerative disc disease -degenerative joint disease -spondylolisthesis -spine deviations (all lead to narrowing of intervertebral foramen)
What are some contraindications for prosthetic use?
-dementia -institutionalization -advanced cardiopulm. or neuro. disease -bilateral transfemoral amputations w/ inability to transfer or stand -unacceptable energy expenditure for ambulation
What does the therapeutic category of a drug tell us?
-describes what effect the drug is expected to have (Ex: diuretics) -includes side effects of a drug
What is drug design?
-designing drugs to alleviate illnesses based on factors that cause certain illnesses -became popular in the 1970-80's
What reflexive effects does massage have on capillaries?
-determined by amt of pressure- 1st: white rxn (blanching) 2nd: red rxn (inc blood flow)
2 most common types of diabetic neuropathy:
-diabetic peripheral neuropathy (DPN) -autonomic neuropathy
What are some examples of medical conditions that can cause dehydration? (read)
-diarrhea -vomiting -heat stroke -high blood sugar -infections -excessive exercise
Comorbidities often result in increased: (3)
-disability -hospitalization -mortality
What is cor pulmonale?
-disease of lungs that causes R sided heart enlargement -can be caused by COPD
What may medical management of edema include?
-diuretics -dialysis -fluid restriction -albumin management
Which 2 classes of medications often have the side effect of dehydration?
-diuretics -laxatives
What are 4 side effects of sedatives and anti-histamines?
-drowsiness -balance problems -risk for falls -delirium
What happens in phase II of a controlled clinical trial?
-drug is given to people w/ condition the drug is intended to treat -but only to a few patients -if this goes well, progress to phase III
What happens in phase I of a controlled clinical trial?
-drug is given to small # of healthy volunteers. -assess most common acute adverse effects and examine doses that patients can take safely w/out high amt of side effects
When can a trade name exist for a drug but not a generic name?
-during the time that the drug is under patent -would happen if the original company decided to use a trade name
What are 4 different types of lymphatic failure? Which is considered edema or lymphedema?
-dynamic (edema) -mechanical (lymphedema) -combination (lymphedema) -hemodynamic (cardiac edema)
List some symptoms of emphysema
-dyspnea -hyperventilation w/ prolonged expiratory phase (barrel chest) -"pink puffers" (pink face color) -clubbed fingers -anorexia, fatigue, weight loss -secondary polycythemia (compensatory inc RBC)
What are symptoms of ARDS?
-dyspnea -restlessness -rapid, shallow breaths -inc HR -dec PO2 -combination of resp. & metabolic acidosis
What cardiac changes take place with aging?
-easy fatigue w/ effort -inc BP response -orthostatic hypotension
What are indications for therapeutic massage? (12)
-edema (localized) -skin tone -pulmonary congestion -adaptive shortening -muscle imbalance -altered ROM -neural tension -hypermobility -loss of tissue extensibility -inc wound healing -dec/*prevent adhesions* -to relax muscles
What are contraindications for therapeutic massage? (8) (not including precautions)
-edema from total system failure -acute inflam edema -site of suspected clot or aneurysm -tumors -over open lesions/conditions that spread -abnormal abdominal mass -non-union fracture -graft sites
A new compound is typically tested on isolated cells in culture. This allows the investigator to identify what aspects about the drug? (2)
-effect of the drug at a cellular level -determine dose at which the drug is toxic to cells
Which type of massage strokes are considered inhibitory or relaxing?
-effleurage -petrissage (slow, long, rotational strokes)
What does lung compliance depend on? (3)
-elastic properties of the tissue -alveolar surface tension (amt of surfactant) -thorax anatomy & flexibility
What can you do regarding positioning to help with edema?
-elevation of affected extremity above heart -prevention of tourniquet effect -avoid prolonged sitting and standing with inactivity -elevating legs in the seated position will not decrease edema but prevent worsening
Which respiratory condition involves the destruction of alveolar walls and septae? This is due to the breakdown of what substance?
-emphysema -elastin (elastase breaks down elastin, have to inhibit this enzyme to stop the breakdown causing emphysema)
How do you treat pneumoconiosis?
-end exposure to irritant -treat infection
Wrist
-equal loss of flexion and extension, slight loss of ulnar and radial deviation
Forearm
-equal loss of supination and pronation, only occurring if elbow has marked restrictions of flexion and extension
What does Starling's Equillibrium state?
-equillibrium between fluid forced out of the capillaries and the fluid absorbed back in -filtration is greater than re-absorption at the arterial end -re-absorption is greater than filtration at the venous end
Signs/symptoms of DM:
-extreme thirst -frequent urinating -feeling v hungry even when eating -extreme fatigue -blurry vision -cuts/bruises that are slow to heal -weight loss even though eating more (type 1) -tingling/pain/numbness in hands/feet (type 2) -hyperglycemia
What are some risk factors for developing a fear of falling?
-fair/poor perceived health -feeling unsteady -having 2+ falls
What things does the lymph system transport?
-fat - (cancer?) cells -protein -water -waste products -other foreign substances (bacteria) -hyaluronan?
How is trigger point massage done?
-find tender area -usually no lubricant -apply pressure w/ finger or thumb -duration: 1-5 min/point
What is the difference between the first and second group of restrictive lung disorders?
-first: abnormality of chest wall, limits or impairs lung expansion -second: diseases affecting the supporting framework of lungs, not alveoli or airways
What are *motor* symptoms of mixed peripheral nerve lesions (axonotmesis or neurotmesis)?
-flaccid paralysis -loss of reflexes -muscle wasting and atrophy -lost synergic action of muscles -fibrosis, contractures and adhesions -joint weakness and instability -dec range of motion and stiffness -disuse osteoporosis of bone -growth affected
Where can extracellular fluid be located?
-fluid in blood vessels (plasma) -interstitial fluid
What would a clinical presentation for damage of the common peroneal nerve possibly look like? (motor and sensory)
-foot drop (deep nerve) -eversion weakness (superficial nerve) -gait impairment during the load response with foot slap, excessive hip flexion to clear toes -sensory loss at anterior-lateral or lower leg and dorsal part of the foot
3 other complications of diabetes:
-foot probs -ketoacidosis -Alzheimer's
Things to know about Unna's boot (read)
-for treatment of dependent edema -mild compression accomplished by adding Coband as top layer -18-24 mmHG
When is a granuloma formed? What is it made of?
-formed if cell-mediated immunity is adequate in the primary stage of TB -bacteria is walled off by CT -has a necrotic center -tubercle forms and calcifies -calcified tubercle microbes can remain viable in a dormant stage for *years*
What is the purpose of a limb sock?
-friction absorption -fill socket volume -absorbs sweat
What are the residual limb requirements to be able to use a prosthetic?
-fully healed incision -no signs of infection -no drainage from incision site -*ability to tolerate WB* -frequent skin inspection
How should you prepare to give a therapeutic massage?
-gather materials -wash hands -remove your rings, watches, etc. -remove patient jewelry -wear loose clothing -pt remove as much clothing as is comfortable, but all clothing should be removed for full body massage
When examining a pt in a differential diagnosis screen, the PT should ask what questions relating to associated signs and symptoms if they suspect visceral referred pain?
-general health questions -questions unique to each organ system (endocrine, pulmonary etc.) to locate the pain
What causes a deficiency of alpha1-antitrypsin? (3)
-genetic mutation -smoking -environmental pollutions
If a patient, even a ___________ pt , has stairs and potential to reach indepedence on stairs, progression to use of _____________ might be more functional than a walker
-geriatric pts -axillary crutches
The neurotransmitter category of amino acids includes what neurotransmitters?
-glycine -GABA -glutamate -aspartate
Things to know about garmets for compression (read):
-gradient pressures -8-50 mmHg -compression based on ABI, severity of edema and patient tolerance -removed at night and cleaned
What are the different ways you can apply resistance during PNF techniques?
-gravity -manual resistance (prox/distal hand placement) -other means of resistance
Hip
-greatest loss of medial rotation and flexion -some loss of abduction -slight loss of extension -little or no loss of adduction and lateral rotation
What types of prosthetics do UE amputees often use?
-harnesses -body-powered cable control systems -myoelectric control systems are becoming more common
More PT treatment considerations for CRPS (read)
-have patient make a plan and write it down -start with low baseline and build up tolerance -do small amounts often rather than all at once -avoid prolonged activity and prolonged rest -motivation; hurt does not equal harm -movement is the key - general exercises, aerobic activity -weight bearing exercises -aquatic therapy -patient must participate
3 macrovascular diabetic complications:
-heart attacks -stroke -PAD (peripheral artery disease)
What is the point of effleurage?
-helps apply lubricant -inc superficial venous return -accustoms pt to touch
How does DEXA work? What does it measure?
-high & low energy *x-rays* are directed at bone from *2 sources* -the difference in *absorption* b/w the beams is used to determine bone density
D1 extension of the LE: -hip -knee -ankle -toes
-hip: extension, abduction, IR -knee: either -ankle: plantarflexion, eversion -toes: plantarflexion exact opposite of LE D1 flexion
D2 extension of the LE: -hip -knee -ankle -toes
-hip: extension, adduction, ER -knee: either -ankle: plantarflexion, inversion -toes: plantarflexion exact opposite of LE D2 flexion
D2 flexion of the LE: -hip -knee -ankle -toes
-hip: flexion, abduction, IR -knee: either -ankle: dorsiflexion, eversion -toes: dorsiflexion
D1 flexion of the LE: -hip -knee -ankle -toes
-hip: flexion, adduction, ER -knee: either -ankle: dorsiflexion, inversion -toes: dorsiflexion
What are some chemicals that are released into tissues after tissue damage that cause pain? (6)
-histamine -serotonin -bradykinin -acetylcholine -prostaglandins -cytokines
What are 2 side effects of diuretics?
-hypotension -incontinence
What 3 pH imbalances can take place due to asthma?
-hypoxia leads to... -initially: respiratory alkalosis due to hyperventilation -then: respiratory acidosis due to dec ventilation -then: metabolic acidosis due to dec in metabolism and inc in lactic acid -finally: respiratory failure
Things to know about Profore (4 layer compression wrapping) (read?)
-ideal for venous insufficiency wounds with heavy drainage -mimics high working pressure and low resting pressure for tolerance at night -*used mostly in presence of ulcerations* -ABI should be *0.8* or greater -30-40 mmHg
Why is animal testing done before releasing a new drug? (3)
-identify the potential of the drug -identify side effects -determine a safe dose
What may cause damage to the median nerve?
-impingement in hypertrophied pronator teres (pronator syndrome) or CTS
Why should PT's study diagnostic imaging? (6)
-improves PT/MD communication -improves PT evaluations -guides PT treatment plans -increases PT autonomy -emerging interest in manual orthopedic techniques -advancing imaging technologies
How does venous edema lead to ulcers?
-inc pressure in veins due to insufficient return causes leakage of fluid into interstitial space -edema and blood products cause inflammation -inflammation leads to skin failure
Summary of how retroversion of the femur affects the structural alignment of the hip joint:
-increased hip external rotation -femoral head sits more posteriorly in the joint *compensate with gait by toeing out
Summary of how excessive anteversion of the femur affects the structural alignment of the hip joint:
-increased hip internal rotation ROM -decreased hip external rotation ROM -decreased joint stability due to more joint exposure anteriorly -decreased mm lever arm - increased joint forces *compensate with gait by toeing in
What causes alteration in capillary permeability?
-increases with vasoactive substance (histamine) release -increase or decrease in tissue temp
How do you diagnose primary stage TB?
-indicated by a positive tuberculin (skin) test results -*type 4* hypersensitivity because it is cell-mediated -could also look for calcification on an x-ray
Things to know about short-stretch bandaging (read):
-inelastic/stretch less than 100% -cotton -Unna boot -ABI of *0.8* or greater -20-50 mmHg
Secondary Lymphedema is caused by damage to the lymph system. What may cause this?
-infection (celluitis) -trauma -radiation therapy -surgery (lymph node dissection) -chemo -tumors -lymphatic filariasis
What are some risks associated with having pneumonia?
-inflammation of lungs -defense mechanisms, such as cilia, are reduced
What do selegiline and rasaliline do?
-inhibit monoamine oxidase, which is an enzyme that breaks down dopamine -directly limit # of free radicals in surrounding area -enhance body's defense against FR
What are the different vessels in the lymph system called?
-initial lymph vessels -lymph capillaries -precollectors -collectors -lymph trunks
When does phantom limb sensation occur?
-initially, right after surgery (90%) -may dec over time, or the pt may have the sensation throughout life -67% have it 6 months post-op
How is desensitization and massage done to treat phantom limb pain?
-initiate gentle touch & textural stimulation after wound is closed -initiate scar & deep friction massage -massage should be used as an adjunct to daily skin inspection & care routine
The decision to use a prosthesis after an amputation should be based on input from whom? and pt performance with what?
-input from patient, prosthetist, PT and MD -pt's performance w/ a temporary prosthesis
What is some general info you should give a patient for preventative care if they have lost or diminished sensitivity after a nerve injury?
-inspect skin regularly -provide prompt treatment to wounds or blisters -compensate dryness w/ massage creams and oils
What develops in type 2 diabetes?
-insulin resistance (bc insulin sensitivity is dec.) -insulin production (initially)
What is surface tension (of water)?
-interactions of water molecules on the surface -each individual force isn't very strong, but the sum of the forces is very strong
What happens with Type 1 diabetes?
-islet beta cells = destroyed -no insulin = produced in the body
Why is TB hard to kill?
-it is a MDRO -it's resistant to drying and many disinfectants
How does having comorbidities affect a pt's rehab potential?
-it is limited -focus on prior level of function and pt goals
When is MMT not appropriate?
-kids -upper motor neuron lesions w/ significant tone
What are some noteworthy differences between adult and pediatric amputations?
-kids have excellent circulation which enhances wound healing -kids have superior tissue tolerance which may allow early post-op prosthetic fitting -surgeons have to be careful not to disrupt growth plates in kids -surgeons must consider both longitudinal and circumferential growth that kids will experience
What are some examples of first group, restrictive lung disorders?
-kyphosis, scoliosis -poliomyelitis -amyotrophic lateral sclerosis -botulism -muscular dystrophy
How does radionuclide scintigraphy (*bone scan*) work?
-labeled methylene is injected -scanning occurs 2-3 hrs after injection -high uptake indicates areas of inc bone activity or mineral turnover
What happens in phase III of a controlled clinical trial?
-large # of participants with disease of interest -effect of drug is not always easy to assess -drugs rarely miraculously reverse fatal illnesses, but instead reduce risk of death, and reduce symptoms
What is a sucking wound?
-large opening in chest wall -air moving in/out makes a sucking sound -type of open pneumothorax
In what ways does a coxa valgum hip alignment change the following: -limb length -femoral shaft alignment -hip stability -mechanical advantage of mm
-lengthens the limb -femoral shaft more aligned with vertical weight bearing forces -decreases stability -decreases mechanical advantage of the hip muscles
Carpometacarpal joint - digit 1
-loss of abduction (more so than extension)
Foot interphalangeal joints
-loss of extension greater than flexion
Metatarsophalangeal joint - digit 1
-loss of extension greater than flexion
Metatarsophalangeal joints - digits 2-5
-loss of flexion greater than extension
Knee (tibiofemoral joint)
-loss of flexion is greater than extension
Elbow complex
-loss of flexion is greater than loss of extension -rotations full and painless except in advanced cases
Midtarsal joint
-loss of inversion (adduction and medial rotation); other motions full
Subtalar joint
-loss of inversion (varus)
How does dementia affect treatment functionally?
-loss of muscle strength -CV deconditioning
What are *sensory* symptoms of mixed peripheral nerve lesions (axonotmesis or neurotmesis)?
-loss of or abnormal sensation -loss of vasomotor tone: warm flushed (early); cold, white (later) -skin may be scaly (early); thin smooth and shiny (later) -shallower skin creases -nail changes (striations, ridges, dry, brittle, abnormal curving, luster lost) -ulceration
Ankle (talocrural joint)
-loss of plantarflexion greater than dorsiflexion
What are sympathetic symptoms of mixed peripheral nerve lesions (axonotmesis or neurotmesis)?
-loss of sweat glands (dryness) -loss of pilomotor response
HIV blood tests are very sensitive which means they have low _____________ rates and high _____________ rates
-low false negative rate -high false positive rate
Home pregnancy tests are very specific which means they have low ___________ rates and high ______________ rates
-low false positive rate -high false negative rate
What syndromes could you use an ulnar nerve glide to help treat?
-lower brachial plexus entrapment -ulnar nerve entrapment
What are the components of massage? (read)
-lubricant -draping -position -behavior of therapist -preparation -application
How do you diagnose a pulmonary embolism? (4)
-lung scan -MRI -pulm. angiography -x-ray
The lymph system includes what anatomical structures?
-lymph nodes -tonsils -thymus -spleen
What are different things that all help with lymph flow?
-lymphangion contraction -A/PROM -Arterial pulsation (deep vessels) -massage -respiration
What are some of the goals of surgeons when performing an amputation?
-maintain adequate circulation for wound & incision healing -remove damaged tissue -preserve as many joints as possible, esp the knee -preserve max bone length -provide residual limb that will accept a prosthesis & tolerate WB
What are some general guidelines for an exercise program for an amputee? (read)
-maintain full ROM -strengthen trunk & extremities -work on balance -work on functional activities (bed mobility & transfers) -*CV endurance*
What are side effects of Li+?
-major danger is accumulation = toxicity -metallic taste in mouth, resting hand tremor, diarrhea, nausea and vomiting, slurred speech, dizziness, vertigo, increased muscle tone and confusion
What does the hemoglobin A1C (HbA1C) test do?
-measures a person's avg. blood glucose level over the past 3 months -measures the level of glycated Hb
When evaluating an amputee acutely after surgery, what information do you need to get from them?
-medical hx -hx of present incident -mental status -precautions -social situation -pain level -sensation -phantom limb sensation or pain -ROM: passive, AA or active -strength -bed mobility -sitting/standing balance -transfers -locomotion: gait or wheelchair -endurance -home & work environment -barriers to care or adjustment -knowledge of limb care & prosthetic use
What are 3 general treatment strategies for pain?
-medication -PRICE -rehabilitation
Describe the structure of a peripheral nerve?
-mesoneurium -external epineurium (hold fascilces together) -internal epineurium (hold fascicles together) -grouped fascicle -perineurium -endoneurium -single fascicle -myelin -axon
During a primary infection of TB, when a microbe first enters the lungs, what happens?
-microbe is engulfed by macrophage & causes inflammation -if cell-mediated immunity is adequate, a granuloma is formed at the site of infection -if it is inadequate, the bacteria reproduce & begin to destroy lung tissue
Peptides are responsible for controlling the following:
-modulate pain perception -regulate temperature -stimulate contraction of the smooth muscle cells of the gut
How is cryotherapy effective in treating edema?
-most effective after acute trauma -constricts blood vessels, temp reducing arterial flow. Rebound effect leads to improved blood flow following treatment with ice. (if you ice long enough the arteries vasoconstrict, then vasodilate leading to improved blood flow when ice is removed)
How is oxygen transported in the blood?
-most is bound to Hb -about 1% of it is dissolved in plasma
How will tissue regeneration affect physical therapy?
-much of our chronic care business will go away -treat pt after transplant initially, but then they will be fixed
What are different aspects of treatment for CRPS? (6)
-multidisciplinary management -patient education -medications -rehabilitation -sympathetic block -peripheral nerve block *early diagnosis is crucial to a good outcome*
What neural systems are included in the periphery? (3)
-muscle spindle receptors -golgi tendon organs -motor endings on the muscles
What are some factors that increase the risk of falls? (lots, info from 3 slides)
-muscle weakness in LE -foot problems -HR and rhythm problems -history of falls -vision & sensation problems -dizziness -multiple meds -difficulty with walking/balance (slow walking speed, small steps) -dec flexibility in LE joints -dec coordination -dec reflexes & longer rxn times -dec activity
What is the etiology of TB?
-mycobacterium tuberculosis -aerobic, slow growing -transmitted by oral droplets from persons with active infection
What are the different ways surgeons can stabilize muscles after an amputation? (read)
-myodesis -tenodesis -myofascial -myoplasty -open (guillotine) closure -provisional closure -delayed closure
What is the chemical name of a drug?
-name reflecting its molecular structure -long & cumbersome name
What tests and measures may be done for lymphedema?
-near infrared imaging -MRI -US
What does it mean when Rucker says "one view is no view" with regards to x-rays?
-need at least 2 views to visualize an object in 3D -ideally at views at 90 deg angle to each other -Ex: A/P and lateral
3 microvascular diabetic complications:
-nephropathy -retinopathy -neuropathy
Foot problems in people w/ diabetes can be caused by:
-nerve damage -impaired wound healing
What are factors involved with weakness?
-nerve involvement -intrinsic muscle damage -neuromuscular inhibition -stretch weakness -atrophy/disuse -fatigue -pain -edema
What is tissue regeneration?
-new field where new organs are grown -sample is taken either from the patient or stem cells to grow the tissue -if it is taken from the patient there is no chance of tissue rejection
Characteristics of latency stage of lymphedema:
-no visible/palpable signs of edema -subjective complaints possible
Is the damage due to chronic bronchitis reversible? What damage does it cause?
-no, damage is irreversible and progressive -inflammation, obstruction, & repeated infections
Characteristics of Stage III lymphedema:
-non pitting edema -fibrosis -skin changes (dry and scaly) -fluid may leak from extremity
What is atelectasis? -what does it cause? -what does it interfere with?
-nonaeration or partial/complete collapse of a lung -alveoli collapse, inflammation & atrophy occurs -causes dec gas exchange & hypoxia -interferes with blood flow through the lung
Who should not use cryotherapy to treat edema?
-not indicated on patients with impaired perfusion/arterial insufficiency
What can be done in risk reduction for lymphedema?
-obesity (weight gain after diagnosis - associated w/ dec lymph function) -minor UE infections (lost freq lymph complication) -injury or trauma to affected limb -overuse of limb
How can pain be documented objectively? (4)
-observation (skin/temp) -edema -ROM -function
Bronchiectasis leads to _______________ of airways and weakening of the ______________ . _______________ accumulates in dilated areas and becomes infected.
-obstruction -muscle & elastic fibers -fluid
Where does primary lymphedema mostly occur? When does primary lymphedema develop? What causes primary lymphedema?
-occurs most often in LE -may be present at birth or may develop later in life -impaired development of lymph system
Some American Geriatrics Society Clinical Practice Guideline points (read):
-on initial presentation, older persons should be assessed for pain -persistent pain should be recognized as significant problem -variety of terms should be used to screen older adults for pain -for those w/ cognitive or language impairments, nonverbal pain behavior and information from a caregiver should be sought -thorough analgesic medication history should be collected -physical exam should include functional tests -pain reassessed frequently -patient education is important part of the intervention -when treating a geriatric patient, the PT should first assume that the pain has a physiological basis until they are sure otherwise
Evidence for massage: slide 4 (read)
-only 4 subjects..... -soft tissue mobs to lateral aspect of knee in athletes w/ patellofemoral pain -3 of 4 subjects improved on LE functional scale
Most drug references include dosing regimes, since PT's do no prescribe, why is this information needed?
-only important when you suspect improper intake of drugs by your patient
After the patent for a drug expires, what happens?
-other companies can start selling the drug as a generic version or they can make their own trade name -original company can also keep selling drug under original trade name
What characteristics must be present for a *definite* CRPS diagnosis? (4)
-pain and tenderness in distal extremity (disproportionate to injury) -signs/symptoms of vasomotor instability -swelling in extremity -dystrophic skin changes usually present
According to the Ottowa Ankle Rule, a conventional x-ray should be ordered if:
-pain in the malleolar area AND -tenderness at posterior aspect or tip of lateral malleolus OR -tenderness at posterior aspect or tip of medial malleolus OR -inability to WB immediately in emergency department
According to the Ottowa Foot Rule, a conventional x-ray should be ordered if:
-pain in the midfoot area AND -tenderness at base of 5th metatarsal OR -tenderness at the navicular bone OR -inability to WB immediately in the emergency department
When a drug is first made by a pharmaceutical company it is protected by a __________ typically for ____ years.
-patent -20
What are some characteristics of a patient's pain in a subjective exam that may indicate chronic pain? (7)
-patient focused on the pain -pain persists beyond healing time frame -pain is poorly localized/referred -vague description of pain -severely limited function -high anxiety and fear -work history (related to job)
How do you test/mobilize the sciatic nerve?
-patient in supine -straight-leg raise -ankle dorsiflexion
What is a blinded study?
-patients receiving the drug don't know if they are getting the placebo or drug & neither does the physician -the effects for the experimental and control groups are compared
How does personalized medicine affect physical therapy?
-patients who are on the same drug might have different side effects from the drug since it has been "personalized" for each patient -PT will have to keep track of a lot more drug information
Which type of massage strokes are considered excitatory or stimulating?
-percussion -friction -vibration -knuckling (quick, short strokes)
How might stage II CRPS affect the following clinical features: -pain -joints -muscle -bone -skin
-persistent pain exacerbated with any stimulus -edema spreads and joints stiffen -muscle wasting begins -osteoporosis begins -cutaneous and trophic (change in soft tissue due to dec nerve supply) present
What can a PT do to help reduce falls? (5)
-physical activity -education -environmental modifications -fall risk assessment -review medications
How does injury to tissue cause altered fluid flow in capillaries?
-physical disruption causing protein escape into interstitium -any condition that increases amount of osmotic substances in interstitium (imbalance of salt - regular hormones)
What conditions are "pink puffers" and "blue bloaters" a part of?
-pink: emphsema -blue: chronic bronchitis
Characteristics of Stage I lymphedema:
-pitting edema -puffy appearance in the hand -reduces with elevation
Characteristics of Stage II lymphedema:
-pitting is less visible -lymphedema does NOT respond to elevation typically -fibrosis may become apparent
Conventional radiographs are also known as:
-plain films -films -x-rays
What are some examples of lower respiratory tract infections?
-pneumonia -tuberculosis
What are categories of edema prevention and intervention?
-positioning -cryotherapy -compression -activity -medical management
What education should be provided to an amputee?
-post-op goals & expectations -positioning -pain relief -residual limb care -*protection of contralateral leg* -prosthetic info & time frame -encourage them to stop smoking if they are
What are indications for MMT?
-postural asymmetry -pain -reported weakness/fatigue -mechanism of injury -difficulty with function -prolonged disuse
What are the three types of prehension?
-precision grip or pinch (when control or delicate action is needed - variations) -power pinch (lateral pinch) -power grip (large forces w/ no need for precision)
What are the goals of acute PT rehab with an amputee?
-prevent complications -allow healing -develop limb strength & ROM for prosthesis -maximize independence in mobility & ADLs -pre-prosthetic training & limb preparation -endurance training & initiation of HEP
What is the purpose of an osteomyoplasty?
-prevents "chopsticking" of distal bone ends of tibia & fibula -improves WB on residual limb
What is the function of surfactant?
-prevents collapse of alveolus during expiration -reduces the effort to expand the lungs during inspiration (by reducing surface tension)
What are the 2 stages of TB?
-primary: 1st exposure -secondary: infection
How does stage III CRPS affect the tissues?
-progressive atrophy of the skin, subcutaneous tissue, muscle and bone -skin is thin and shiny
How do you treat a pulmonary embolism? (6)
-prolonged bed rest -compression stockings -surgically inserted filter into vena cava (sometimes) -heparin or streptokinase -mechanical ventilation -embolectomy
What environmental modifications can a PT make to reduce falls? (7)
-protect stairs w/ hand rails on both sides -de-clutter stairs -use highest safe wattage in light fixtures -nightlights -non-slip mats, install adhesive safety strips in bath/shower -install grab bars in bath/shower -choose latex-backed bath mat to avoid slipping when getting out of bath/shower
Things to know about ACE bandage - long stretch (read)
-provides mild compression -high working, high resting pressure -can decrease dependent edema
What happens in the oral glucose tolerance test (OGTT)?
-pt drinks a high-glucose liquid (75-100g of glucose) -plasma glucose level = measured at 2 hours
How does dementia affect treatment cognitively?
-pt has difficulty following directions -pt can experience hallucinations or delusions
How is Halstead's maneuver performed? What is a positive test?
-pt in sitting, arms down -PT palpate radial pulse -pt protrudes chest while depressing and retracting the shoulders -decreased pulse is positive for TOS
How is Adson's test performed? What is a positive test?
-pt in sitting, arms down -PT palpate radial pulse -pt turns head towards clinician and extends neck -decreased pulse is a positive result for TOS
What is mirror box therapy?
-pt performs a movement w/ the unaffected limb -movement is viewed in a mirror -at the same time, pt attempts to perform the movement with their residual limb pain relief is hypothesized to be due to cortical restructuring
For a BKA, in which direction is the "pull" while applying an ACE wrap?
-pull medial to lateral -pull posterior to anterior
How is connective tissue massage done?
-pull skin in opposite directions, perpendicular to the muscle -pinching technique over the muscle
What conditions involve reduced surfactant levels?
-pulmonary edema -lung injury -genetic diseases that cause mutations controlling surfactant production
What are some activities to work on with an amputee to improve bed mobility?
-push ups w/ arms -sitting forward -move up/down in bed -roll from one side to other -bridging
What 2 rationales support the hold-relax stretching technique?
-reciprocal inhibition via muscle spindle -*psychologic effect*
What are 3 goals of performing neural mobilizations?
-release tension, compression or entrapment due to inflammatory conditions in the surrounding connective tissues or nerves -release adhesive scar tissue -free up the nerve to slide in its sheath
When is alpha1-antitrypsin released?
-released by neutrophils during inflammation -released by some pathogenic bacteria
What are the functions of the lymph system?
-remove waste and excess fluids from body tissues -production of immune cells -absorption of fatty acids -transportation of chyle
How can you treat acute respiratory failure?
-resolve the primary problem -supportive treatment
COPD can lead to what 2 things?
-respiratory failure -development of cor pulmonale
What is a tension pneumothorax?
-results from open or closed pneumothorax -with each breath, air accumulates in the pleural cavity -this inc pleural pressure & atelectasis -BAD
What education should be provided to reduce falls?
-risk factors for falls -fall prevention -fall injury reduction -home safety -physical activity -medical management
With shoulder abduction above 60 degrees, how does the clavicle move?
-rotates posteriorly 30 degrees at SC joint around longitudinal axis -retracts 30 degrees at SC joint (rolls and glides posteriorly)
D2 extension of the UE: -scapula -shoulder -forearm -wrist -fingers
-scap: depression, protraction -shoulder: extension, adduction, IR -forearm: pronation -wrist: flexion -fingers: flexion exact opposite of UE D2 flexion
D1 extension of the UE: -scapula -shoulder -forearm -wrist -fingers
-scap: depression, retraction -shoulder: extension, abduction, IR -Forearm: pronated -wrist: extension -fingers: extension exact opposite of UE D1 flexion
D1 flexion of the UE: -scapula -shoulder -forearm -wrist -fingers
-scap: elevation, protraction -shoulder: flexion, adduction, ER -forearm: supination -wrist: flexion -fingers: flexion
D2 flexion of the UE: -scapula -shoulder -forearm -wrist -fingers
-scap: elevation, retraction -shoulder: flexion, abduction, ER -forearm: supination -wrist: extension -fingers: extension
What is phenotypical drug discovery?
-scientist no longer knows the target molecule -instead, they know what the end effect should be & search for drugs that produce this final effect Ex: diabetes researcher may look for a drug that increases the release of insulin from pancreatic islets
What 4 things are decreased in patients with diabetic peripheral neuropathy?
-sensation -temperature/vibration -proprioception -pain sensation (these all occur in a "stocking-gloves pattern)
In stage III CRPS, how might the following be affected: -trophic changes -mobility -swelling/edema -cutaneous tissues -bones
-severe trophic changes -severe immobility of affected limb -edema often has resolved -cutaneous tissues atrophied and changes in nails -X-rays show osteoporosis
What is the purpose of a temporary prosthesis?
-shapes residual limb -early gait training & independence -*endurance training* -prevents contracture
What is the generic name of a drug?
-shortened version of chemical name -often as a variation of chemical name -also called nonproprietary
In what ways does a coxa vara hip alignment change the following: -limb length -femoral shaft alignment -hip stability -mechanical advantage of mm
-shortens the limb -femoral shaft has increased bending moment at neck of femur (less in line with vertical forces than normal) -increases joint stability (relative to valgum) -increases mechanical advantage of the mm
How do you know which side to use a cane on?
-should be used on contralateral side **greatest reduction in force on the affected hip with use on opposite side, not a significant change in body weight reduction, BUT it does significantly reduce the muscle force required by the hip abductors on the opp side
What are some general measures to treat asthma?
-skin tests for allergic rxns -avoidance of triggers -good ventilation -swimming & walking -maintenance inhalers
How does having comorbidities affect a pt's rate of progress? Why?
-slower progress -due to pain, SOB, fatigue, dec flexibility -document progress & barriers
What is friction in terms of massage techniques?
-small circular strokes w/ deep pressure done w/ thumbs -linear strokes done w/ sides of hand, finger tips, back or heel of hand
What are symptoms of small and large pulmonary embolism?
-small: transient chest pain, cough, dyspnea -large: inc chest pain w/ cough or deep breath, sudden dyspnea -later hemoptysis & fever, hypoxia
Chronic bronchitis is caused by constant irritation due to what substances?
-smoking -air pollutions
When may activity be helpful in edema management? What exercises would be beneficial?
-some edema can be reduced actively with muscle contraction improving fluid return (when edema is secondary to trauma or reduced mobility) -calf pump -bike -walking
Afferent axons of large myelinated nerves innervate what?
-spindles -golgi tendon organs -touch and pressure receptors
Where does non-small cell lung cancer come from?
-squamous cell carcinoma (epithelial cells) -adenocarcinoma (mucus producing cells) -large cell carcinoma (everything else)
What would clinical presentations look like in a patient who has damaged their axillary nerve?
-squared shoulder from deltoid muscle atrophy -shoulder abduction and ER weakness -sensory deficit on lateral deltoid
How do you diagnose an active/secondary TB infection?
-staining sputum for M. tuberculosis -sputum sample & sensitivity of microbes to drugs -chest x-ray (cavitations)
How do you treat chronic bronchitis? (9)
-stop smoking -reduce exposure to irritants -treat infection -vaccination for prophylaxis -expectorants -bronchodilators -chest therapy (percussion) -low-flow O2 -nutritional supplements
What bacteria can cause bronchiectasis?
-streptococci -staphylococci -pneumococci -influenzae
What are some of the mechanical effects of massage on soft tissue?
-stretch/inc flexibility & length -break up/prevent fibrotic tissue -inc muscle health by dec metabolic acids, improving tissue nutrition & enhancing waste exchange (helps rid muscle of fatigue) -dec scar tissue
What neurotransmitters are included in the category of peptides?
-substance P -neurotensin -endorphin -bradykinin -vasopressin -dynorphin
Describe proper residual limb positioning in supine, prone and sitting:
-supine: knee extension, hip adduction -prone: hip & knee extension -sitting: knee extension neutral hip rotation for all 3 of these
What are the 3 functions of the hand?
-support (to brace or stabilize, serve as a platform) -manipulation -prehension (grip and pinch)
What is a concern for babies that are born prematurely that has to do with the development of the respiratory system?
-surfactant is produced late in fetal development -babies born prematurely may have difficulty breathing which can lead to resp. failure
What may cause an obstruction to the lymph system that causes disruption of normal fluid flow in capillaries?
-surgical removal of lymph nodes -systemic conditions
What are signs/symptoms of lymphedema?
-swelling of part or all of your arm or leg, including fingers or toes -feeling of heaviness or tightness -restricted ROM -aching/discomfort -recurring infections -hardening and thickening of the skin (fibrosis)
What is included in diabetic peripheral neuropathy?
-symmetrical distal degeneration of peripheral nerves -impaired nerve regeneration
What is required for diagnosis of lymphedema?
-symptoms as described -2 cm inc in girth or more inc in limb volume or a 5% or greater limb volume change (measured w/ tape measurer or Bioelectrical Impedence Analysis (BIA)
During an objective exam in a differential diagnosis screen, the PT should pay attention to these 3 things:
-symptoms change with testing -selectively stress MSK tissues -recognize common MSK pain patterns
What should the PT keep in mind about body mechanics during massage application?
-table height -hands relaxed-- avoid hyper-extension at fingers -don't lock elbows -move from hips/knees -bend knees -deep breathing
How do you perform a contract-relax stretching technique?
-take muscle to point of limitation -end-range contraction with rotation into opposite direction of stretch (10 sec) -relax and passively move limb to new range -repeat if indicated
How do you perform a hold-relax stretching technique?
-take muscle to point of limitation -end-range isometric contraction into direction of stretch (10 sec) -relax and passively move limb to new range -repeat if indicated
What should you document after you administer therapeutic massage?
-techniques used -duration of each technique -pt position
What is the purpose of taking sputum samples?
-testing for presence of pathogens -determine antimicrobial sensitivity of pathogen
What is targeted drug discovery?
-the researcher knows the target molecule that they want to affect -they find/create a compound that will have the desired effect
Why were pharmaceutical companies hesitant to make anti-HIV drugs more widely available?
-these drugs have to be taken daily, exactly the way they were prescribed -otherwise this could result in a resistant form of HIV which would be devastating to the efforts made to cure the disease
In the secondary stage of TB, what happens when microbes begin to reproduce and infect the lungs?
-they form large areas of necrosis causing erosion into bronchi & blood vessels and cavitations (openings) -cavitation promotes spreading into other parts of the lung -cough, fever, night sweats, weight loss and fatigue
Why are drug-related illnesses more common in the elderly?
-they have inc sensitivity of diseased tissue to drug toxicity -potential for drug interactions -difficulties in pt compliance w/ an increasing number of drugs
What are general characteristics of nociceptors? (4) -what do they require to be activated? -threshold -acute vs chronic pain -adaptation?
-they require tissue damage or painful stimulus to be activated -their threshold is intensity driven and is different from person to person -the relationship of tissue damage and pain intensity changes from acute to chronic pain -there is no adaptation that occurs to a painful stimulus
How successful has targeted drug discovery been?
-they thought it would increase the liklihood of finding new drugs, but it has been quite poor in reality -in 2010, phenotypical drug discovery was developed to replace this
List some symptoms of chronic bronchitis?
-thick, purulent secretions -constant, productive cough -dyspnea -hypoxia -cyanosis (blue bloater) -hypercapnia -fatigue, weight loss
2 major glomerular wall changes assoc. w/ diabetic nephropathy?
-thickened/glycated wall (GFR decreases) -more permeable (microalbuminurea/albuminurea)
What are the most common signs of dehydration in the elderly?
-thirst -dry mouth -headaches -dizziness -weakness -UTI -cramping in arms/legs -dry, warm skin -flushed face -irritability -constipation
Is there truth to the statement that people who eat & drink at the same time, instead of just drink, stave off the problems developed by chronic alcoholism?
-this is based on the premise that alcohol absorption is slowed in the stomach when food is present -this does not carry over to the rate at which one develops blood clotting problems due to alcoholism
What are some upper extremity syndromes that are caused by compression of a peripheral nerve?
-thoracic outlet syndrome -cubital tunnel syndrome -radial nerve compression -carpal tunnel syndrome -compression on tunnel of Guyon
What 4 muscle groups are involved with a muscle imbalance that results in a posterior tilt of the pelvis? Are they lengthened or tightened?
-tight hip extensors -tight rectus abdominus -lengthened hip flexors -lengthened erector spinae
What 4 muscle groups are involved with a muscle imbalance that results in anterior tilt of the pelvis? Are they lengthened or tightened?
-tight hip flexors -tight erector spinae -lengthened hip extensors -lengthened abdominals
What may clinical presenation look like with damage to the tibial nerve?
-tingling, burning or a sensation similar to electric shock, numbness, pain including shooting pain felt on the inside of the ankle and/or bottom of the foot Palsy: -inability to plantar flex ankle or flex the toes -gait impairment during terminal stance = "drop off"
Can a drug have more than one trade name or generic name?
-trade: yes -generic: no
How do you treat pulmonary edema?
-treat causative factors (duh) -supportive care (O2, antibiotics, upper body elevated)
How do you treat bronchiectasis?
-treat primary condition -antibiotics -bronchodilators -chest PT
How do you treat ARDS?
-treat underlying cause -supportive resp. therapy
If a pt has AIDS and Kaposi's sarcoma, what would their treatment be like?
-try to boost immune system to treat Kaposi's sarcoma -currently no cure for AIDS
What are the 4 different types of precision grip or pinch? Which is the most precise? Which is also known as 3-jaw chuck?
-two-point tip to tip (most precise) -three-point tip to tips -two-point pad to pad -three-point pad to pads (3-jaw chuck)
5 classifications of DM:
-type 1 -type 2 -gestational diabetes -maturity onset diabetes of the young (MODY) -latent autoimmune diabetes in adults (LADA)
What do you need to document after performing MMT?
-type of grading system -position of pt -actual muscle strength grade -anatomical part & type of movement -comparison of both sides -presence of pain during test
What are pneumoconioses?
-type of restrictive lung disorder -general term given to any lung disease caused by long-term exposure/inhalation of irritating particles such as dust -could lead to fibrosis (stiff lung)
What characteristics indicate a *doubtful* CRPS diagnosis? (2)
-unexplained pain and tenderness in an extremity -diagnostic blocks can indicate sympathetic involvement
What are 3 goals in rehabilitation when the object is to treat pain?
-unload the area/joint -change in posture/position -ROM within pain free range
What are the 2 anatomic areas of the respiratory system?
-upper respiratory tract -lower respiratory tract
What is muscle stripping?
-use one thumb over the other to apply direct pressure along the length of the muscle -separates mm fibers and inc blood flow to promote healing
In MMT, how does a PT apply resistance?
-usually in the line of pull of the muscle -build pressure gradually -apply pressure at the distal end of the body part onto which the muscle inserts
What characteristics must be present for a *possible/probable* CRPS diagnosis? (3)
-vasomotor instability and/or swelling -pain and mild to moderate tenderness -dystrophic skin changes present
What systems may be altered to cause edema/lymphedema?
-venous -lymph -cardiac -renal -hepatic -low albumin ... not a system but ya... -trauma
How does the ventilation-perfusion ratio affect gas exchange?
-ventilation (air flow) -perfusion (blood flow) ventilation & perfusion need to match for max gas exchange
What are some characteristics of *pain behavior* that you can examine on a patient with chronic pain? -verbal -vocal -facial expression -physical actions -function -social actions
-verbal: patient constantly complains of being in pain -vocal but not verbal: screams, sighs -facial expressions -phycical actions: guarding, bracing, rubbing, limping -function: change/limitation in activity, use of medications -social actions: nor going to work or social events
Type 1 diabetes can be triggered by:
-virus -cold weather
What is bronchoscopy used for? (3)
-visualizing the inside of airways -performing a biopsy -checking sites of lesion or bleeding
In the history of pharm lecture, how is thalidomide used as an example of why animal testing is necessary?
-wasn't FDA approved -never legally sold in U.S. but was in Asia -only tested on rats which were immune to the toxic side effects -*if it had been tested on more animal species, toxic effects would have been seen* -consequence: many kids in Asia were born with terrible deformities
What are symptoms of Kaposi's Sarcoma?
-watery diarrhea -purplish nodule -skin lesions -swollen lymph nodes -intestinal & lung lesions -pleural effusion
What is personalized medicine?
-we each have different genetics that affect how drugs work in our bodies -a drug could be altered/developed, based on our DNA, to work best for us
What is some specific info you should give a patient for preventative care if they have loss of sensation in a *lower limb* following a nerve injury?
-wear protective shoes that fit properly -inspect feet regularly for pressure points (reddened areas) -modify shoes or provide protection if they occur -do not walk barefoot -shift weight frequently when standing for long periods
What pt changes indicate the need to refer the pt to their prosthetist?
-weight gain -volume change -ROM or functional changes -anything that consistently affects prosthesis fit
If you still think there is a problem with a prosthesis after checking it, what information should you have ready for the prosthetist?
-which motions cause the pt pain? -is it a musculoskeletal issue or a pressure issue? -what is the condition of the skin of the residual limb? should also try to reproduce the problem with the prosthesis off
How does the relationship of tissue damage to pain intensity change with acute vs. chronic pain?
-with acute pain there is a linear relationship -with chronic pain there is a nonlinear relationship (may not need a lot (or any) injury to feel chronic pain)
How long is the Eustachian tube open for during a typical swallow?
0.1-0.9 seconds
What is the average conduction speed of unmyelinated nerves?
0.2-2.0 m/sec
Ketoacidosis = common complication in type __ diabetes
1
Someone with prediabetes should check for DM2 every:
1-2 years
What TherEx should you focus on with an amputee once they have their prosthesis?
1. *core work*- TA activation, Russian twists, etc. 2. *transfers*- sit-stand progression, wall squats, etc. 3. *balance*- perturbations, weight shifts, etc. 4. *gait*- stool stepping, resisted gait, lunges, etc.
What are the 4 specific tapotement techniques mentioned in lecture?
1. *tapping*: striking w/ fingertips 2. *hacking*: striking w/ ulnar borders of hands 3. *cupping*: striking w/ cupped hands 4. *pinchment*: alternate pinching w/ thumb & index finger
What should you look for in bench alignment in the M/L view of a transfemoral prosthesis? (3)
1. 5-7 deg socket adduction 2. 5 deg ER of tibia 3. heel falls just under the ischial tuberosity in the socket (transtibial socket adduction is only 2-5 deg, it also doesn't have the tibia ER setting)
What are the 4 branches off of the mandibular division of the trigeminal that are sensory?
1. Buccal N 2. Auriculotemporal N 3. Lingual N 4. Mental N
List the 4 peripheral ganglia and which division of the trigeminal its associated with
1. Ciliary (V1) 2. Otic (V3) 3. Submandibular (V3) 4. Pterygopalatine (V2)
In differential diagnosing from resisted testing, what does "weak and painless" mean?
1. Disorder of nervous system or NMJ 3. Complete rupture of tested muscle or tendon 4. Disuse/atrophy
Differences between emphysema and chronic bronchitis: 1. location 2. cough 3. sputum 4. cyanosis
1. E: alveoli. CB: bronchi 2. E: some coughing, marked dyspnea. CB: constant cough 3. E: little. CB: large amt, purulent 4. E: no. CB: yes
Prosthetic causes of "medial whip" gait deviations in a transfemoral amputee: (5)
1. ER of knee 2. tight socket 3. incorrect foot rotation 4. cylindrical socket shape vs. anatomical 5. heel too stiff (1-2 are exact opposite, 3-5 are the same as lateral whip)
Which brain stem nucleus does the oculomotor pregnaglionic neuron start in? in other words, what is the location of the primary neurons of the oculomotor nerve?
1. Edinger-Westphal (parasympathetics) 2. Nucleus of the oculomotor N (motor)
Prosthetic causes of "lateral whip" gait deviations in a transfemoral amputee: (5)
1. IR of knee 2. loose socket 3. incorrect foot rotation 4. cylindrical socket shape vs. anatomical 5. heel too stiff (1-2 are exact opposite, 3-5 are the same as medial whip)
What are the 3 branches off of the ophthalmic division of the trigeminal? (subbranches too)
1. Lacrimal N 2. Frontal N: supratrochlear & supraorbital 3. Nasociliary N: long ciliary, short ciliary, infratrochlear (internal & external nasal NN)
What are the 6 branches off of the mandibular division of the trigeminal that are motor?
1. Medial pterygoid N 2. Masseteric N 3. Deep temporal N 4. Lateral pterygoid N 5. N to mylohyoid 6. N to ant. belly of digastric
In differential diagnosing from resisted testing, what does "weak and painful" mean?
1. Serious pathology 2. Acute inflammatory process that inhibits muscle contraction 3. Partial rupture of muscle/tendon 4. Minor muscle damage + inflamm.
What should you look for in bench alignment in the A/P view of a transfemoral prosthesis? (2)
1. TKA should travel from the trochanter down to the front of the heel 2. initial 5-10 deg of socket flexion (if 0 deg contracture)
What are the 4 branches off of the maxillary division of the trigeminal?
1. Zygomatic N: zygomaticotemporal & zygomaticofacial 2. Infraorbital N 3. Superior alveolar NN 4. Pterygopalatine N
Amputee causes of "abducted gait" deviations in a transfemoral amputee: (2)
1. abduction contracture 2. poor gait habit due to insecurity- widen base to inc stability (same as wide gait)
Amputee causes of "wide gait" deviations in a transfemoral amputee: (2)
1. abduction contracture 2. poor gait habit- pt insecure & widens base to inc stability (same as abducted gait)
Difficulty with expiration that occurs in emphysema can lead to what lung changes? (6) -RV, ribs, chest, diaphragm, etc.
1. air trapping 2. inc in RV 3. overinflation of lungs 4. fixation of ribs in an inspiratory position 5. barrel chest 6. flattened diaphragm
What are the Basic Swedish Principles of massage? (5)
1. all strokes w/ pressure are towards the heart 2. begin & end w/ effleurage 3. work distal to proximal 4. force should be applied in the direction of the muscle fibers 5. the focus is to return the body to a complete, non-encumbered flow of energy
What are the 4 different modifications of a sciatic nerve test? What does each test?
1. ankle DF and eversion (tibial n) 2. ankle DF and inversion (sural n) 3. ankle PF and inversion (c. peroneal n.) 4. hip adduction and IR (general tension)
When do we use MMT?
1. as part of a physical exam 2. assist w/ differential diagnosis, prognosis, & treatment of neurological, neuromuscular & musculoskeletal disorders
What are the types of MMT?
1. break testing 2. active resistance testing 3. functional muscle testing
Describe the pattern of using a cane to go down stairs:
1. cane 2. bad LE 3. good LE
Describe the pattern of using a cane to go up stairs:
1. cane 2. good LE 3. bad LE
What are the 5 different types of pneumothorax?
1. closed 2. simple/spontaneous 3. open 4. secondary 5. tension
What are some things you should assess under the B in ABCS of radiology? (4)
1. cortical margin should be dense, w/ lower density cancellous bone & medullary cavity 2. WB surfaces should have higher density 3. low contrast, "washed out", bone suggests *osteoporosis* 4. excessive sclerosis may suggest an *arthritic* or rheumatic condition
What 4 different petrissage techniques were mentioned in lecture?
1. cross stroke 2. scissoring 3. kneading 4. knuckling (links to videos of these in PP)
Describe the pattern of using crutches to go down stairs:
1. crutches 2. bad LE 3. good LE (1 & 2 almost happen together)
Amputee causes of "uneven pelvic rotation" gait deviations in a transfemoral amputee: (4)
1. dec pelvic rotation 2. fear of falling 3. weak abductors, excessive adductors 4. habit
What are the 13 most common geriatric syndromes?
1. dementia 2. depression 3. delirium 4. falls 5. pressure ulcers 6. inappropriate prescribing of medications 7. incontinence 8. iatrogenic problems 9. failure to thrive 10. sleep disorders 11. osteoporosis 12. sensory alterations 13. immobility & gait disturbances
What are the 3 steps to a trauma survey? (read)
1. diagnose & evaluate any fracture or dislocation 2. match the MOI to the clinical presentation 3. assess treatment & monitor healing
What is distortion of an x-ray usually due to?
1. distance b/w the beam source, patient and image receptor 2. alignment & positioning issues
Therapy goals for "lateral whip" gait deviations in a transfemoral amputee: (3)
1. encourage proper donning 2. strengthen hip ERs 3. stretch hip flexors & adductors
Therapy goals for amputees with "medial whip" gait deviations: (2)
1. encourage proper donning 2. strengthen internal hip rotators & extensors
Prosthetic causes of "knee instability" gait deviations in a transfemoral amputee: (5)
1. excessive dorsiflexion 2. knee aligned in unstable position- need to move it more posterior to fix it 3. insufficient socket flexion- esp. w/ contractures 4. poor foot alignment 5. incorrect knee settings (upon IC, knee flexes the user had to forcefully extend it back which results in a jerky motion in MS)
Amputee causes of "heel rise" gait deviations in a transfemoral amputee: (1)
1. excessive use of hip flexors to initiate swing, overpowering knee unit
What are the 3 types of substitution?
1. fixation substitution 2. substitution from another agonist 3. substitution from an antagonist
Prosthetic causes of "lateral trunk bend" gait deviations in a transfemoral amputee: (3)
1. foot too far outset 2. high medial wall 3. aligned in abduction
Amputee causes of "medial whip" gait deviations in a transfemoral amputee: (3)
1. gait habit 2. *socket not donned properly* 3. ER of hip at toe off/hip flexion (1-2 are same, 3 is exact opposite, compared to lateral whip)
Amputee causes of "lateral whip" gait deviations in a transfemoral amputee: (4)
1. gait habit 2. *socket not donned properly* 3. IR of hip at toe off/hip flexion 4. tight adductors, IRs or flexors (1-2 are same, 3 is exact opposite, 4 is new compared to medial whip)
Amputee causes of "vaulting" gait deviations in a transfemoral amputee: (3)
1. gait habit- fear of catching toe*, hard to break 2. weak hip flexors on residual limb 3. improper initiation of hip flexors on residual limb
Steps to prepare for MMT (4)
1. gather materials 2. pt should be pain-free for duration of test 3. environment should be quiet 4. explain test to pt
Describe the pattern of using crutches to go up stairs:
1. good LE 2. crutches 3. bad LE
What are some things you should assess under the A in ABCS of radiology? (4)
1. gross bone size 2. # of bones 3. shape & contour of cortical outline 4. joint position & alignment
What are some things you should assess under S in ABCS of radiology? (3)
1. gross size of muscles 2. outline of joint capsule 3. periosteum
What should you look for in static alignment of a transfemoral prosthesis? (5)
1. height of prosthesis 2. verify knee center matches sound side 3. pylon is vertical 4. trim lines & comfort of socket 5. knee is stable, foot is flat, & back has a normal lordotic curve
Amputee causes of "external foot rotation" gait deviations in a transfemoral amputee: (1)
1. improperly donning socket
Amputee causes of "internal foot rotation" gait deviations in a transfemoral amputee: (2)
1. improperly donning socket 2. flexed at hip during gait, typically w/ walker or crutches, looking down at the ground
Therapy goals for "lateral trunk bend" gait deviations in a transfemoral amputee: (2)
1. improve balance 2. strengthen core
Amputee causes of "lateral trunk bend" gait deviations in a transfemoral amputee: (3)
1. inadequate balance 2. short residual limb (lack of adductors to prevent the lean) 3. habit
Prosthetic causes of "heel rise" gait deviations in a transfemoral amputee: (3)
1. inadequate extension aid 2. insufficient knee friction 3. improper knee selection
What lung changes occur with chronic bronchitis? (4) -mucosa, glands, etc.
1. inflamed/swollen mucosa 2. hypertrophy of mucous glands--*inc mucous secretions* 3. fibrosis, thickening of bronchial wall -- obstruction 4. low O2 levels-- cyanosis
Prosthetic causes of "uneven pelvic rotation" gait deviations in a transfemoral amputee: (3)
1. instability of prosthesis 2. poor suspension 3. proximal trim line too high or tight
What are some things you should assess under C in ABCS of radiology? (4)
1. joint space width 2. subchondral bone 3. joint margins 4. epiphyses & growth plates
Prosthetic causes of "external foot rotation" gait deviations in a transfemoral amputee: (4)
1. knee ER 2. foot ER 3. socket design issues 4. tight adductor channel in socket -results in a medial whip-
Prosthetic causes of "internal foot rotation" gait deviations in a transfemoral amputee: (4)
1. knee IR 2. foot IR 3. socket design issues 4. excessive quad pressure
Amputee causes of "circumducted gait" deviations in a transfemoral amputee: (4)
1. lack of confidence in flexing knee 2. abduction contracture 3. weak hip flexors 4. habit- using entire hip & pelvis to initiate gait
What does a CN III lesion result in? (review)
1. lateral strabismus- eye rotates down and out 2. Ptosis- lid droop 3. Pupil dilation 4. loss of lens accomodation
Prosthetic causes of "circumducted gait" deviations in a transfemoral amputee: (3)
1. long prosthesis 2. excessive knee friction 3. excessive knee stability (2 & 3: can't flex knee, doesn't allow heel rise)
Prosthetic causes of "toe drag" gait deviations in a transfemoral amputee: (3)
1. long prosthesis 2. excessive plantarflexion 3. excessive knee friction
Prosthetic causes of "wide gait" deviations in a transfemoral amputee: (3)
1. long prosthesis 2. high medial wall 3. insufficient femoral stability (basically the same as abducted gait in function, in this case they prefer the wide gait, in abducted they can't always control it) (same as abducted gait answers)
Prosthetic causes of "abducted gait" deviations in a transfemoral amputee: (3)
1. long prosthesis 2. high medial wall 3. insufficient femoral stability, may cause distal-lateral femoral pressure, not able to keep femur in its natural adduction angle -induces medial whip- (same as wide gait)
Prosthetic causes of "vaulting" gait deviations in a transfemoral amputee: (5)
1. long prosthesis 2. poor suspension 3. excessive plantarflexion (easy to fix) 4. excessive knee resistance/stability* 5. inadequate knee extension assist
The breakdown of alveolar walls in emphysema results in what effects? (4)
1. loss of elastic fibers (affects recoil) 2. loss of surface area for gas exchange 3. loss of pulmonary capillaries (affects ventilation-perfusion ratio) 4. dec support for other structures (small bronchi may collapse)
What are the different mechanisms that cause atelectasis? (5)
1. obstructive or resorption atelectasis 2. compression atelectasis 3. due to inc surface tension in alveoli 4. contraction atelectasis 5. postoperative atelectasis
Describe the pattern of a walker to go down stairs:
1. one side of walker to next step, hold the back side of the walker 2. bad LE 3. good LE
Describe the pattern of using a walker to go up stairs:
1. one side of walker to next step, hold the front side of the walker 2. good LE 3. bad LE
What are two ways of measuring pain quality?
1. pain intensity (numeric scale or quantitative threshold measure) 2. pain description (sharp/dull, constant/intermittent)
What factors affect the diffusion of gases during gas exchange between alveoli and capillaries?
1. partial pressure of gases 2. thickness of respiratory membrane 3. total surface area available for diffusion 4. ventilation-perfusion ratio
What are the 4 factors of gait?
1. patient 2. socket fit 3. prosthetic alignment 4. physical therapy
Advanced medical imaging in patients with acute low back pain should be reserved for:
1. patients who are considering surgery 2. patients whom systemic disease is strongly suspected
Amputee causes of "uneven timing" gait deviations in a transfemoral amputee: (3)
1. pt insecurity 2. weak hip muscles 3. poor balance
Describe the appearance of some of the reflexive effects of massage: (5)
1. red flare or streak from arteriole dilation 2. red wheal from release of histamines & prostaglandins 3. dec in pain 4. inc in lymph flow 5. some studies say it changes chemicals in the blood
PNF is a series of techniques that use what 3 principles of normal movement?
1. rhythmic and reversing motions 2. diagnonal motions 3. synergy of agonists & antagonists
Describe the modern technique for an amputation: (read)
1. skin & muscle are divided to form ant & post flaps 2. primary AA & VV are dissected, clamped & severed 3. major NN are dissected, severed & allowed to retract into soft tissue 4. bone is severed, distal end is filed & beveled to produce a smooth surface 5. muscle & skin flaps are sewn together to form the residual limb
Prosthetic causes of "uneven timing" gait deviations in a transfemoral amputee: (5)
1. socket pain 2. weak extension aid 3. unstable knee 4. leg length discrepancy 5. poor suspension (unsure what this looks like)
What should you look for in bench alignment in the transverse view of a transfemoral prosthesis? (3)
1. socket rotation 2. knee rotation: 3-5 deg ER 3. foot rotation: 5-7 deg ER
What are the 6 key areas of emphasis in prosthetic gait training?
1. step width 2. step length 3. toe loading 4. knee flexion 5. pelvic rotation 6. trunk rotation
Therapy goals for "uneven pelvic rotation" gait deviations in a transfemoral amputee: (3)
1. strengthen aBductors 2. stretch aDductors 3. gait training
Therapy goals for "knee instability" gait deviations in a transfemoral amputee: (2)
1. strengthen hip extensors 2. stretch hip flexors
Therapy goals for "toe drag" gait deviations in a transfemoral amputee: (2)
1. strengthen hip extensors (of sound leg) & abductors 2. encourage pelvic motion to initiate enough knee flexion for swing phase
Therapy goals for "vaulting" gait deviations in a transfemoral amputee: (2)
1. strengthen hip flexors 2. work on timing & symmetrical pelvic rotation
Therapy goals for "uneven timing" gait deviations in a transfemoral amputee: (2)
1. strengthen hip flexors & extensors 2. improve balance
Therapy goals for "wide gait" deviations in a transfemoral amputee: (2)
1. stretch abductors 2. strengthen core, RL & sound limb (same as abducted gait)
Therapy goals for "abducted gait" deviations in a transfemoral amputee: (2)
1. stretch abductors 2. strengthen core, residual limb & sound leg (same as wide gait)
Therapy goals for "circumducted gait" deviations in a transfemoral amputee: (3)
1. stretch abductors 2. strengthen hip flexors 3. gait training
What are some of the mechanical effects of massage on the pulmonary system?
1. vibration w/ postural drainage: loosens mucous plugs 2. percussion/tapping strokes: (didn't say what this does)
Amputee causes of "knee instability" gait deviations in a transfemoral amputee: (2)
1. weak hip extensors 2. hip flexion contracture (things that would make your knee buckle)
Amputee causes of "toe drag" gait deviations in a transfemoral amputee: (4)
1. weak hip extensors on sound side (or residual limb hip flexors) 2. weak hip abductors on sound side (hip drop on residual limb) 3. poor posture 4. poor gait habits
How well are the following lubricants absorbed by the body or when are they used? 1. almond oil 2. baby oil 3. pure lanolin 4. cocoa butter 5. water-based 6. tiger balm
1. well absorbed 2. not well absorbed, wipe down pt after 3. used for scars or when there's a need for a lot of friction 4. pleasant smell, expensive, can clog pores 5. well absorbed 6. expensive, can irritate some people, mostly used in athletic settings
Therapy goals for "heel rise" gait deviations in a transfemoral amputee: (2)
1. work on coordination & encourage symmetrical motion of the femurs 2. work on timing of flexor firing
Therapy goals for "external foot rotation" gait deviations in a transfemoral amputee: (1)
1. work on donning correctly
Therapy goals for "internal foot rotation" gait deviations in a transfemoral amputee: (2)
1. work on donning correctly 2. more upright position during ambulation
What are 2 possible explanations for why the contract-relax stretching technique works?
1.*neurophysiological effect* (autogenic inhibition via GTO - controversial) 2. *psychological effect* -accepted that this may work with the neurophysiological effect or replace it to explain why PNF works
What does the ulnar nerve innervate?
1.5 muscles of forearm: flexor carpi ulnaris, and medial portion of flexor digitorum profundus. Also innervates almost all of the hand except 3.5 muscles
What is the outlook for patients treated with levodopa for parkinson's?
1/3 - respond well for rest of life 1/3 - respond well for 5-7 yrs 1/3 - respond well for 4-5 yrs additional medication will be required after that time
About ___-___%e of the population has insomnia
10-15%
If replantation of a limb is attempted, it must occur within what time frame?
12 hour window
What is the ideal step length in prosthetic gait training? How should you work on this with the pt?
12" they often take short steps, encourage them to step longer with stool stepping, ball rolls, etc.
What is the average conduction speed of small myelinated nerves?
12-30 m/sec for diameters 2-5 micrometers) 3-15 m/sec for diameters less than 3 micrometers
On average, it takes a drug _____ years to go from drug discovery to the market.
15
What is the normal value for hip angle of torsion?
15 degrees of anteversion
Insulin was discovered in year:
1921
Humulin was made in year:
1982
What 2 enzymes are responsible for the 2 major pathways of the catabolism of ingested alcohol?
1st: alcohol dehydrogenase (ADH) 2nd: aldehyde dehydrogenase (ALDH)
In what order do you progress the type of ROM in PNF patterns?
1st: passive 2nd: active assistive 3rd: resisted
Alzheimer's = linked to type __ diabetes
2
What is the ideal step width in prosthetic gait training? How should you work on this with the pt?
2-4" they tend to inc this due to feeling unstable, instruct them not to do this
A unilateral BKA increases energy cost of ambulation by ___ % A unilateral AKA by ___ % A hip disarticulation by ___ % A bilateral AKA by ___ %
20% 49-65% 200% 280%
The error rate in radiological interpretation by radiologists may be as high as ____ to ____ %
20-30%
______% of people with diabetes have diabetic nephropathy
20-40%
What is the average conduction speed of medium myelinated nerves?
20-45 m/sec
1 in _____ Americans will undergo an amputation
200
To date, there are at least ____ different peptides secreted by cells that act as __________
25 that act as neurotransmitters
An estimated ____-____% of breast CA patients will develop lymph during their lifetime. This risk may increase to ____% after radiation therapy.
25-30% 48%
What percent of adults have a patent foramen ovale (PFO)?
27%
With shoulder abduction above 60 degrees, how does the scapula move?
2:1 ratio humerus to scapula AC joint upwardly rotates 30 degrees
A radiograph is a ____-dimensional picture of a ____-dimensional object
2D picture of 3D object
PAD (peripheral artery disease) occurs in 1 in __ people over 50 w/ diabetes
3
You should do at least ____ repetitions of each Swedish stroke
3
How many stages of CRPS are there? Is this condition progressive from one stage to another?
3 no
Traditionally, pain is considered a _____ (#) neuron system
3 1st, 2nd and 3rd order neurons
When should the septum primum anatomically fuse to the septum secondum by?
3 months
After 12 months post-lymph node biopsy/dissection, what percent of women who get a sentinel node biopsy are at risk for lymphedema? Axillary node disection?
3% for sentinel 20% for axillary
The book does not advocate using + or - for scoring MMT except for _____________ .
3+ and 2-
When testing a potential new drug, how many species of animals must it be tested on? Why?
3+ species because the effect may be different
Gestational diabetes occurs in ___% of all pregnancies in the US
3-5%
In MMT, if AROM is full, the score should be at least what?
3/5 use BT or ART from here
What is the ideal amount of knee flexion in prosthetic gait training? How should you work on this with the pt?
30-60 deg exercises for knee flexion such as step overs w/ cones
Over _____% of all elderly residents in nursing facilities are on at least one psychotropic drug such as an atidepressant, antipsychotic, or sedative
35%
Diabetic nephropathy occurs in ___% of dialysis pts
35% (one third are DM1 and two-thirds are DM2)
How many cords are in the brachial plexus?
3: lateral, posterior, and medial
How many trunks are in the brachial plexus?
3: superior, inferior, middle
How many arteries do we have in one finger?
4 arteries, 2 on each side
ACE wraps must be re-wrapped every __ to __ hours
4-6 hours
When does a 4 chamber heart form?
4-6 weeks
Lymphedema occurs in _____% of breast cancer patients
40
What degrees of motion are considered "functional" ROM of the wrist needed to complete ADLs?
40 degrees flexion/extension 10 degrees radial deviation 30 degrees ulnar deviation
The 30 day mortality rate following a major leg amputation is as high as ___ % 5 year mortality rate is as high as ___ %
40% 70% (other lecture said 80%)
After an amputation, skin integrity and pressure tolerance is only ___ % of normal on the residual limb
40% important to keep in mind for massage
______% of people with diabetes have diabetic retinopathy
40-45%
How many terminal branches do you end up with in the brachial plexus?
5
What is the ideal amount of pelvic rotation in prosthetic gait training? How should you work on this with the pt?
5 deg exercises for rhythmic pelvic rotations & figure 8 walking
What is the ideal amount of trunk rotation in prosthetic gait training? How should you work on this with the pt?
5 deg exercises such as trunk perturbations and manually facilitated rotation
What are the 3 aspects of resting position of the scapulothoracic joint? (upward rotation, IR and anterior tilt)
5-10 degrees upward rotation 35 degrees internal rotation 10 degrees anterior tilt
Type 1 DM = __% of all DM
5-10%
An estimated ___ to ___% of patients who underwent a sentinel node biopsy will develop lymphedema
5-14%
Diabetic neuropathy occurs in __% of people w/ 20 years of diabetes
50%
How many compartments of the palmar hand are there and what are they?
5: Thenar: thenar mm Hypothenar: hypothenar mm Central: flexor tendons, lumbricals, superficial arterial arch Adductor: adductor pollicis Interosseous: interossei mm
How many roots make up the brachial plexus?
5: C5, C6, C7, C8, T1 (when he says roots he does not mean spinal roots, they are ventral rami)
What percent of pediatric amputations are congenital? acquired?
60% congenital 40% acquired
How many divisions are in the brachial plexus?
6: each trunk divides into anterior and posterior
With wrist extension, what is the normal ROM? How much of this motion comes from the radiocarpal vs. midcarpal joints?
70 is normal 45 from RC 25 from MC
What is the average conduction speed of large myelinated nerves?
70-130 m/sec
1 in ___ women will develop breast cancer during their lifetime
8
When do heart valves become functional?
8 weeks
With wrist flexion, what is the normal ROM? How much of this motion comes from the radiocarpal vs. midcarpal joints?
80 is normal 30 from RC 50 from MC
What percent of people will suffer from back pain at some point in their life?
80%
What passes through the carpal tunnel?
9 tendons and 1 nerve. Tendons of FDS, FDP, and FPL Median nerve
___ % of Americans have diagnosed/undiagnosed diabetes
9.3%
_____ % of pulmonary emboli originate from DVT in legs are are preventable
90%
The hand is involved in _______% of UE activities. What percent of UE activities are the following structures involved in? -thumb -index finger -long finger -ring finger -little finger
90% thumb = 50% index = 20% long finger = 20% ring finger = 10% little finger = 5%
Type 2 DM = __% of all DM
90-95%
What is a major down fall of levodopa?
99% is converted to dopamine *before* crossing the blood-brain barrier, thus a high dose is required to obtain an effect. This results in many side effects
Normal glucose level:
<100 mg/dl
How is retroversion of the hip defined?
<15 degrees and of course some say <8 degrees because why not...
Diabetes glucose level:
>126 mg/dl (on 2 occasions)
With the OGTT, diabetes glucose level =
>200 mg/dl