Review Set 7
What does each part of TMN mean?
T- primary tumor M - distant metastasis N - Regional lymph nodes
The right recurrent laryngeal nerve branches from the right vagus at what level?
T1 (subclavian artery)
Where are the sympathetic nerves that supply the 3 plexuses from?
T1-T5
At what vertebral level does the esophagus pass through the diaphragm?
T10 along with the vagus nerve
What vertebral levels are the lesser splanchnic nerves found at?
T10-11
What vertebral levels are the least splanchnic nerves found at?
T12
The left recurrent laryngeal nerve branches from the left vagus at what level?
T4-T5 (The ductus arteriosus or 6th aortic arch)
What vertebral levels are the greater splanchnic nerves found at?***
T5-9
What are the 4 chemotherapy regimens for breast cancer?
TC AC AC+T AT
Are bilateral THAs or TKAs more common?
TKA
Around 20 % of post-op ______ infections are associated with methicillin-resistant bacteria
TKA
If a person has a bilateral TKA done, what will their WB precautions be afterwards?
WBAT (hopefully)
What are the results of scalping?
You can bleed to death due to extensive blood supply, but if bleeding is controlled then often the scalp can be reattached
What motions of the hip does the pubofemoral ligament resist?
abduction and extension (small amt of external rotation)
What does efficacy mean in terms of drugs?
ability of drug to initiate a response after binding to its target
AKA stands for:
above the knee amputation
How are gliomas classified?
according to cell origin (astrocytoma) and location of the tumor
How do you determine the dosage of exercises for a pt after a JA?
according to physiological principles and the pt's individual deficits (not 3 sets of 10 reps)
What does it mean for a cancer to be sporatic?
accumulation of mutations in somatic cells over a lifetime (develops at an older age)
The pain associated with shingles can be significantly reduced if anti-________ drugs are started within what time frame?
anti-viral 48 hours of onset
Contact precautions are used for:
antibiotic resistant bacteria such as VRE, MRSA, c diff, RSV, lice, scabies, etc.
Lung infections such as TB can be treated with either _________ or _________ depending on the offending organism
antibiotics or antiviral drugs
Decongestants are often given together with what other drug?
antihistamines
How do you treat neuroborreliosis?
antimicrobial therapy
Pancytopenia is associated with which type of anemia?
aplastic anemia
Which type of anemia is due to impairment or failure of bone marrow?
aplastic anemia
Failure to identify and treat which type of anemia promptly can be life-threatening? How should you treat it?
aplastic anemia -treat by removal of any bone marrow suppressants and perform a bone marrow transplant and/or stem cell infusion in blood
What is the most common injury seen in Little Leaguer's elbow?
apophysitis or fx of ME
Standard precautions apply to:
body fluids of all patients
What is a down side of parasympathetic blockers?
body will develop tolerance over time
In MES (LIS) for (bone/wound) healing, the electrode can be implanted or external
bone
_______is the most likely site for metastases of any type of cancer
bone
A biopsy of what substance can confirm a diagnosis of leukemia?
bone marrow
In aplastic anemia, what would you expect the results of a bone marrow biopsy to be?
bone marrow cells are replaced by fat
Why are the levels of other hemopoietic (blood) cells reduced in leukemia?
bone marrow is too busy making WBC's (immature cells)
What part of the body is responsible for the uncontrollable production of WBC's seen in leukemia?
bone marrow or lymph nodes
What is considered "the only potential treatment" for sickle cell anemia?
bone marrow transplant
With pernicious anemia, what would you expect to see with a bone marrow exam?
bone marrow will be hyperactive (inc number of megaloblasts)
IF a patient presents with hip and groin pain unilaterally, continuous pelvic pain and inability to bear weight, what might you be concerned about with a diagnosis?
bone pathology (screen for cancer)
What is an infarction (necrosis) of brain tissue due to a lack of blood called?
cerebrovascular accident (CVA) also known as a stroke
What is the "best" example of proteins that act both as the receptor and the endpoint of a signalling cascade?
channel receptors (ion channels)
What are treatments that may fit into the category of neoadjuvant therapy?
chemo, radiation and hormone therapy
What are treatments that may qualify as adjuvant therapy?
chemo, radiation, hormone therapy, targeted therapy or biological therapy
The virus that causes herpes zoster is the same virus that causes ___________________ in kids
chicken pox
People who have had ________________ are at a greater risk for shingles. Why is this?
chicken pox the virus can reactivate
Does acute or chronic leukemia have mild signs and a better prognosis?
chronic
Does acute or chronic leukemia occur primarily in older people?
chronic
Does acute or chronic leukemia usually have an insidious (gradual) onset?
chronic
Does acute or chronic leukemia have a higher proportion of mature cells? Are these cells functional?
chronic, however they still have reduced function
Decongestants are specifically given to relieve __________. Do they treat the problem?
congestion no, they treat symptoms
Which type of LE orthoses provide individualized fit for maximal function? -pre-fabricated -custom fit -custom fabricated
custom fabricated
Which type of LE orthosis does Brittany rarely use? -pre-fabricated -custom fit -custom fabricated
custom-fit they're difficult to fit bc everyone's bony anatomy is very different
High chloride sweat test, inc sputum production, malnourishment and pneumonia are all symptoms of what condition? -case study-
cystic fibrosis
How does cystic fibrosis lead to malnutrition? -case study-
cystic fibrosis causes thick mucus that blocks pancreatic ducts from producing enzymes for nutrient absorption which causes malnutrition
Epoetin alfa is an artificial form of what substance?
erythropoietin, which stimulates erythropoiesis
What motions may be restricted at the ulnohumeral joint with a CPR?
flexion extension
What motions may be restricted at the radiohumeral joint with a CPR?
flexion extension supination pronation
What is Dupuytren's contracture?
flexion contracture of the palmar aponeurosis
Which type of TKA allows for correction of valgus, varus or flexion deformities?
geometric knee
The chances of developing scoliosis drop dramatically after age _____ in girls and age ____ in boys
girls: 15 boys: 17
A TSA consists of a humeral component and an optional ______________ component
glenoid
Astroglia, oligodendroglia, microglia and Schwann cells are all types of ________________ cells
glial cells (SAMO)
When abducting the hip in an open chain movement, the femoral head will glide ___________(superiorly/inferiorly) and roll ___________ (superiorly/inferiorly)
glide: inferiorly roll: superiorly
What is the largest category of primary malignant brain tumors?
gliomas (classified according to cell origin & location of tumor)
If you are going to touch the pt or anything that has touched the pt, what PPE should you wear?
gloves
PPE for contact precautions:
gloves and gown when entering the room
What is the preferred category of drug for controling mild to moderate asthma long term?
glucocorticoids
In Addison's disease, a deficiency of what substance decreases the person's ability to withstand emotional or physical stress?
glucocorticoids (Ex: cortisol- manages stress response)
Glia- means:
glue
What is the prognosis of: -Panner's disease -osteochondritis dissecans
good depends- age & type of lesion
If you are performing a task where you might get splashed with body fluids, what PPE should you wear?
gown
Inc ICP spreads gradually or rapidly through the CNS? What does this result in?
gradually wide spread loss of function
RROM is the addition of a resistive force other than _____________
gravity
If a pt says they're knees feel like they are going to buckle or give way, which type of ground reaction AFO would be most helpful to them?
ground reaction with anterior shell this would reduce the flexion moment they are experiencing and give them more of a knee extension moment
_________ (listed as an expecorant) also has cough supressing abilities and is sold under the name Robitussin for either purpose
guaifenesin
What are the two generic names for expecorants?
guaifenesin guaifenesin and pseudoephedrine
What are some common side effects of chemo?
hair loss due to break down of follicles chemobrain chronic exhaustion/fatigue weakened immune system chemotherapy induced peripheral neuropathy sensitivity to UV rays
How severe is hemophilia A?
has varying degrees of severity
cervical rotation grading/procedure
have pt start looking to R and tell them to bring their head straight forward to test L SCM then have pt start looking forward & apply pressure to R side of head to test L SCM performing R cervical rotation
Why is hip strength so important for someone who uses a KAFO?
have to be able to compensate for lack of knee motion during gait with a hip hike to clear the foot
Which AFO is best to treat quad weakness?
have to find a happy medium based on the way they walk by working w/ an orthotist Example: -ground reaction w/ anterior shell: give them an extension moment, but they may not be able to control the extension eccentrically -ground reaction w/ posterior shell: give them a flexion moment, but they may not be able to prevent their knee from buckling concentrically
HAIs stands for:
healthcare-associated infections (also called nosocomial infections)
Expectorants help to treat obstructive lung diseases how?
help to move the mucous so that it can be removed from the lungs (by lubricating the lining of the airway)
Does the heme or globin portion of hemoglobin get converted to bilirubin during breakdown of RBC's?
heme
In general, all anemias are due to a deficit of what substance?
hemoglobin (and therefore RBC's)
Sickle cell anemia, incompatible blood transfusions and malaria can all cause what type of anemia?
hemolytic anemia
Which type of anemia results from excessive destruction of RBC's?
hemolytic anemia
Spontaneous bleeding into joints and possible hematuria or blood in feces are signs of what condition?
hemophilia A
What is the most common inherited clotting disorder?
hemophilia A
Which type of hemophilia is considered "classic hemophilia"?
hemophilia A
All drugs/substances in the body are toxic at __________ enough doses
high
Which procedure can delay a TKA for roughly 9 years?
high tibial osteotomy (esp helpful if they develop problems early on ~30s or 40s)
What is HVPC also known as?
high voltage *galvanic stimulator*
What does HVPC stand for?
high voltage pulsed current
Earlier, ___________ intensity physical activity is encouraged after a JA
higher intensity (includes strength training)
How contagious is poliomyelitis?
highly contagious via direct contact or oral droplet
What motion of the hip joint does the iliofemoral ligament resist?
hip extension
When you lock out the knee in a locked knee KAFO, what gait compensation will you see?
hip hike during swing phase
What *education* should you include in your early post-op interventions after a *THA*?
hip precautions!
If someone has a metal on metal hip, usually this means they had what procedure done instead of a THA?
hip re-surfacing
Breast cancer that is ER+ and PR+ may benefit from what type of cancer treatment?
hormonal therapy
Disinfectant contact time (definition):
how long the disinfectant must stay wet in order to kill germs (usually 2-5 min, can be found on the container)
What is *frequency* in terms of biofeedback?
how often activity is measured
Which part of an AFO determines how much talocrural motion the user will have?
how thick/thin the orthotic is right above the heel thinner = more motion
Kyphosis is also known as:
hunchback
With external radiation treatment in breast cancer, what are the 3 types of therapy that are an option?
hyperfractionated (smaller doses 2x/ day) hypofractionated (larger doses shorter course) intraoperative radiation therapy (single large dose)
What are some changes in the skin that when presented with other symptoms might be a reason to screen for cancer?
hyperpigmentation jaundice erythema pruritis excessive hair growth
Cerebral aneurysms are often aggravated by ______________
hypertension a sudden inc in BP (exertion) may cause it to rupture
Is Grave's disease a hyperthyroid or hypothyroid condition?
hyperthyroid
Neuromuscular irritability, such as muscle twitching in the face and hands (tetany), is a symptom of what endocrine disorder?
hypoparathyroidism (hypocalcemia)
Is Hashimoto's thyroiditis a hyperthyroid or hypothyroid condition?
hypothyroid
What is an endemic goiter?
hypothyroid condition that affects large groups of people in a specific geographical region (endemic) with low iodine levels in the soil or food
What modalities could you use for the treatment of lateral epicondylitis?
ice US ionto
What modalities might you utilize for treatment of medial epicondylitis?
ice US ionto (same as LE)
What modalities might be utilized in the treatment of Panner's or OD?
ice e-stim
What modalities might you use in the treatment of a fx of the ME?
ice & hot pack
Describe the ideal *patient* for a unicompartmental knee arthroplasty:
ideal for "ends of spectrum" 1. older, lower demand patients 2. younger populations
When would a calcaneal fracture be treated surgically?
ideal for intra articular fracrture (via ORIF) however, there is no gold standard for surgical approach for this
How often should you clean equipment?
ideally just as often as you wash your hands
How do you treat DIC (disseminated intravascular coagulation)?
identify underlying cause and treat it, but in the meantime: -add more clotting factors (plasma transfusion) -add blood thinners (heparin)
Can PT make any difference in a patient with avascular necrosis before surgical intervention?
if caught early enough, PT could help reduce pain and prevent further damage BUT what's already happened cannot be reversed so PT can manage AVN, but not treat it
What determines if a brain tumor is life-threatening or not?
if it is accessible and removable or not
Why might olecranon bursitis be treated non-surgically?
if it is suspected that the bursitis is due to infection they may try aspiration with a needle first to remove fluid.
What is an indication that someone is not correctly using their inhaler?
if mist is coming back out of their nose or mouth
When might surgery be used to treat olecranon bursitis?
if non-surgical treatments do not work
When is the glenoid component of a conventional TSA omitted?
if one of the following is true: 1. cartilage is intact 2. bone quality is poor 3. RTC tendons are irreparably torn
When might non-surgical treatment for a distal biceps tendon be used?
if pt is older or less active. Treatment is focused on pain relief and maintaining function (rest, anti-inflammatory meds, PT to strengthen other mm)
If you are treating someone with a posterior offset KAFO for significant hyper-extension, at what degree of knee motion should you stop them with knee extension?
if the pt has been hyper-extending their whole life you can't all of a sudden put them into neutral can position them to allow enough hyper-extension for them to feel stable and gradually progress from there
What conditions indicate the need of a conventional TSA?
if you have OA and your RTC is still intact
lumbar, thoracic & combined extension muscles
iliocostalis longissimus spinalis
What ligament of the hip is shaped like a "Y" and connects the AIIS to the intertrochanteric line of the femur?
iliofemoral ligament
Beta-agonists can alleviate the ________ symptoms of asthma
immediate
How quickly to you begin rehab. after someone experiences a stroke?
immediately team approach to rehab. with OT, PT and SLP
The loss of myelin that takes place in MS interferes with conduction of ____________ in affected neurons
impulses
How is a tumor "graded" in terms of severity? (not numbers)
in terms of differentiation (well, moderate, poor)
What is trismus?
inability to open mouth (usually after surgery on head/neck region to remove cancer/lymph tissue)
Many of the receptors that make their way to the nucleus are originally found in their ________________ form in the cytosol.
inactivated
After a neuron has been stimulated by an AP and it has released neurotransmitters into the synaptic cleft to stimulate the next neuron, how is the neuron inactivated?
inactivated by: -enzymes destroy the neurotransmitter -reuptake of neurotransmitter into the presynaptic axon
Expansion of fluids or tissues in the brain have what effects? What causes the fluid/tissue to expand?
inc ICP (intracranial pressure) -inc in fluid: blood, inflamm -additional mass: tumor
What is a common side effect of brain tumors?
inc ICP due to occupying space (explains why benign brain tumors can be life-threatening)
What augments the effects of the sympathetic NS?
inc adrenal medulla secretions (epinephrine & norepinephrine)
Does hematocrit increase or decrease with dehydration?
increase
Would you increase or decrease the sampling frequency in biofeedback with a kid who has low tone?
increase the frequency to catch any twitches that occur
Increasing the recording area in biofeedback means (inc/dec) number of muscle units being monitored
increased
Interferential current is ________ modulated, whereas russian is ________ modulated
interferential - amplitude modulated russian - time modulated
What motions does the ischiofemoral ligament resist?
internal rotation and extension (superficial fibers) adduction (superior fibers)
What are the two different classifications for calcaneal fractures? Which is more difficult to recover from?
intra-articular (more difficult to recover) extra-articular
What type of receptor requires the drug itself to enter the cell in order to have an effect?
intracellular receptors
Is a larger area of the brain damaged due to ischemia or intracerebral hemorrhage? (2 causes of stroke)
intracerebral hemorrhage this is complicated by secondary effects of bleeding in the brain
Which coagulation pathway is more reliable, but takes more time, the intrinsic or extrinsic pathway?
intrinsic pathway
What is plantar fasciitis?
involves inflammation of the plantar fascia (a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes) -tears in the tissue result in pain and inflammation
Which type of anemia is caused by insufficient iron?
iron deficiency anemia
What is the most common type of anemia? What population is most likely to be affected?
iron deficiency anemia -estimated that 1 in 5 women of childbearing age is affected by this -proportion increases for pregnant women
In time, with several recurrences of MS, neural degeneration becomes ____________________
irreversible, function is lost permanently
What can result from prolonged use of the nasal spray or eye drop form of decongestants?
irritation of the eye or nasal passageway (exacerbate symptoms)
What is an abnormally rounded upper back called?
kyphosis
AIDS dementia involves a gradual loss of what 2 things? It also impairs _____________ function
memory and cognitive ability motor
Are men or women at a higher risk of getting ALS?
men
What population is typically affected by gout?
men, 40+ yo
What is a tumor in the meninges called?
meningioma
If a pt has high risk feet or fluctuating edema, which AFO would be indicated?
metal upright
Caffeine and theophylline are two drugs that fall under the category of _________?
methylxanthines
What does MES stand for?
microcurrent electrical stimulation
Is thalassemia a type of macrocytic or microcytic anemia?
microcytic
Which type of glial cell participates in phagocytic activity?
microglia
What are the two types of achilles tendinopathy?
midsubstance insertional
Are pre-fabricated LE orthoses better for mild, moderate or severe involvement?
mild
Mediator-release inhibitors are most commonly used to treat persistent _____ asthma
mild
Are custom-fit LE orthotics better for mild, moderate or severe involvement?
mild to moderate
What are side effects of expectorants?
minimal and rare... but include: -rash -urinary retention -insomnia -hallucinations (very rare)
What MT may be use to treat Panner's or OD?
mobilization for pain and general mobility
What MT could you use to treat a ME fx?
mobilizations to gain/maintain ROM
Are custom fabricated LE orthoses better for mild, moderate or severe involvement?
moderate to severe
How do antihistamines work?
modulate the neural activity within the CNA and regulate gastric secretions by means of two types of histamine receptors, H1 and H2
Give an example of how biofeedback can be made into a functional treatment for a runner w/ anterior femoral glide syndrome: (read)
monitor the activity of both their glutes & quads to ensure that both are active during the return from a squat
What are the 3 leukotrine blockers by generic name?
montelukast zafirlukast zileuton
Which leukotrine blockers work by competing with the leukotrines at the receptor (competitive agonists)?
montelukast and zafirlukast
Radial head fractures are more frequent in __________ (women/men) and is more likely to occur in people between _____ and ______ years of age
more common in women 30-40
A larger TI of a drug indicated that the drug is more or less safe?
more safe -means it takes a much larger dose to produce a toxic effect than it does to produce a beneficial effect
What are the 2 best signs to rule in achilles tendinopathy?
morning stiffness and tenderness with palpation
What are some symptoms of bone tumors?
most are asymptomatic -local swelling -local pain -other systemic symptoms of cancer
How many people in the U.S. have the Rhesus factor in their blood?
most people are Rh+, about 15% are Rh-
How do you prevent erythroblastosis fetalis?
mother receives shots of RhoGAM to prevent the mother from forming anti-Rh antibodies after her first pregnancy
Does ALS affect motor, sensory or autonomic neurons? ***
motor neurons
AROM definition:
movement of joint or body segment by active, voluntary muscle contraction with unrestricted ROM
Is the rate of revision higher for hip re-surfacing or hip arthroplasty?
much higher in a 5 yr time period for hip re-surfacing
Which type of prosthetic foot is preferred for uneven terrain?
multi-axial foot
MDRO stands for:
multi-drug resistant organism
What are the 3 red flags for hereditary cancer?
multiple cancers young cancers rare cancers
What are the 2 types of cholinergic receptors? Which neurotransmitter are they associated with?
muscarinic and nicotinic they are the 2 forms of acetylcholine receptors
What is a benefit and a drawback of a coxa valga hip alignment?
+: increased functional length of hip abductor muscles -: alignment may favor joint dislocation
What is a benefit and a drawback of a coxa vara hip alignment?
+: may improve joint stability -: decreased functional length of abductor muscles
What are the parameters for HVPC *in general*? -current -voltage -pulse duration
-DC and PC -high voltage/electromotive force -PD: phase duration of both spikes (*short*, usually fixed)
What are some complications after a JA? (lots)
-DVT -infection (ST or LT) -arthrofibrosis -CRPS -component loosening/failure -allergic rxn -hematoma -surgical fracture -mal-alignment of prosthesis -fracture of prosthesis -limb length discrepancy -dislocation -neural injury -thermal damage/laceration -heterotrophic ossification
Obesity is related to an increased risk of:
-DVT -post-surgical infection -post-operative cardiac complications -fall risk
What would be found during an examination of a patient with cuboid syndrome?
-FF valgus and pronated foot -unstable midtarsal joint due to pronated foot -tight fibularis longus -pain reproduced during terminal stance at onset of heel rise -decreased ROM
What is the MOI for a radial head fracture?
-FOOSH (most common - causes radius to hit capitulum) -direct blow
What are some common ways that trauma causes an elbow injury?
-FOOSH (radial head & humeral condyle) -fall on tip of olecranon -ligament overuse
What are some theories for CECS?
-inc blood flow goes to the muscles during exercise (mm size can inc up to 20%) -if the fascia does not simultaneously expand, the inc pressure will cut off the blood supply in the particular compartment -may be because of biomechanical movement, hypertrophied muscles, thick fascia with dec elasticity or high BP
What do you look for to diagnose polycythemia? (3)
-inc RBC count -inc hemoglobin & hematocrit -hypercellular bone marrow
What effects does inc ICP have on the body? (3)
-less blood flow to area -brain tissue is compressed *leads to ischemia and eventual infarction of brain tissue*
Roll Boards are used for:
-transfer a pt from one bed to another -make sure breaks are engaged on both beds -make sure board stays under pt during the transfer
People with infectious (septic) arthritis may have a history of: (4)
-trauma -surgery -nearby infection -Lyme disease
What are the MOI for acute compartment syndrome?
-trauma (fracture, crush injury, burns) -casts and bandages -blood vessel surgery or clot -vigorous eccentric exercise -taking anabolic steroids
What is the MOI for a Volkmann's contracture?
-trauma (most common- fracture, crush injury, supracondylar fracture compromising brachial artery) trauma causes acute compartment syndrome which cuts off O2 supply to wrist flexors and other mm which results in a Volkmann's contracture
If someone has weak plantarflexors, what will their gait pattern look like?
-trouble w/ toe off in pre-swing, may result in toe drag during swing if uncompensated -compensations: hip hike, vaulting, circumduction, etc. to clear the foot
What conditions might a high tibial osteotomy be considered for?
-unicompartmental disease -angular deformity
Progression of mobility training:
-upright tolerance -sitting stability -standing stability -gait training
Define passive stretching:
-use of an external force on a joint within *restricted* ROM in an attempt to gain ROM -therapeutic exercise or positioning designed to lengthen shortened soft tissue structures to inc ROM
Algorithms for safe procedures
-use of decision trees -more flexible & dynamic than standard protocols
Engineering approach for injury reduction
-use of safe systems and technology to promote safe practice -Ex: sharps that can't be recapped
Pituitary adenoma: -malignant or benign -effect of mass -what happens if untreated -affects ages:
-usually benign -mass can cause pressure in skull -effects tumor secretion -if untreated, will eventually destroy all types of cells -people ages 30-50 yo
If a person has a bilateral THA done, do they do both hips in the same surgery?
-usually staged by at least 1 week -often staged by more than 6 weeks
What are some potential causes of dementia? (4)
-vascular disease (arteriosclerosis) -infections -toxins -genetic disorders
What are some symptoms of a Volkmann's Ischemic Contracture? (7)
-vasoconstriction -inc sympathetic stimulation -muscle swelling- compartment syndrome -muscle necrosis -sudden onset of pain -*cyanosis* of fingers -*absent radial pulse*
What are some symptoms of congenital Cushing's syndrome?
-weight gain, esp in face -bruising -excess hair growth -weakness, fatigue -*loss of muscle mass* -*dec fertility* -*high BP* -high blood glucose
Ways to do RROM:
-weighted exercise -band resistance -body weight or loaded activity
What is non-selective binding?
-when a drug binds to something it was not intended to bind to -happens when a drug is at a high enough concentration
Description of airborne transmission of infections
-when pt with a respiratory infection coughs, sneezes or talks *small* droplets are generated that can remain in the air for a long time -transmission occurs when the droplets are inhaled
What is hemophilia? What causes it? What types are there?
-when the ability of the blood to clot is severely reduced -condition is due to lacking one of the coagulation factors -causes the person to bleed severely w/ slight injury -3 types: A, B and C
What 2 disorders do we need to know that are classic G-protein coupled diseases?
-whooping cough -cholera
What are characteristics of a shoe that Brittany likes for someone using a LE orthotic?
-wide -stable -solid on bottom brands: NewBalance & Sketchers recently
Fixed ROM limitation:
-won't respond to stretching or positioning alone -surgical release if contracture causes functional limitations
What is a typical MOI for a repetitive strain injury? (2)
-work-related activity -repetitive activity
Positioning for wounds and burns:
-wound tissue shortens, so position for scar elongation -should be out of a "position of comfort" to avoid a wound contracture during healing
What are some risk factors for THA *revision*?
-younger age -male -comorbidities -avascular necrosis -femoral head size? (higher failure rate even though it dec dislocation rate)
What is the incidence of *dislocation* for primary THA procedures? This percent may increase to what # with THA revision? What percent of these dislocations occur within 6 weeks of surgery?
0.3-10% 28% 60-70%
How many channels are used with MES?
1 or 2
Most of the time, how many times do tyrosine kinase receptors cross the membrane?
1 time
A mini-incision arthroplasty in general is performed through how many smaller incisions?
1-2
What are the 2 types of joints that a locked knee KAFO can have? How does each work?
1. *bail lock*: works based on a cabling system, use depends on if the pt is able to reach down and undo the lock 2. *drop lock*: can push on a little ball to lift the lock up & allow knee motion, and push it back down if you want to lock the knee again
What types of bone injuries can MES (LIS) be used to help heal?
1. *fractures*: clavicle, humerus, radius, ulna, MCs, femur, tibia, fibula, MTs (long bones) 2. *s/p spinal fusion* 3. *wounds*: skin ulcers
What beneficial effects does HVPC have? (6)
1. *inc circulation* 2. *inc wound healing* (inc current at injury, maintain + polarity w/ anode to attract - cells to clean things up, similar to MES) 3. *dec pain* (Gate Control, pain-spasm cycle?) 4. *dec muscle spasm* (little evidence) 5. *dec muscle weakness* (little evidence) 6. *dec edema* (muscle pump due to greater contraction, dec histamine levels w/ cathode over injury site?)
Jason said doctors tend to tell patients that a joint replacement will last around ____ years, but they actually seem to last up to _____ years
15-20 40
What ethnic group has the highest incidence of the thalassemia trait?
15-30% of Italians and Greeks
How many channel stimulators are there with interferential?
2
If someone has weak quads, what will their gait pattern look like?
2 Possibilities: -knee buckles, results in crouch gait in stance, compensated w/ dec step length -excessive knee extension to avoid position of instability (knee flexion)
How long is positioning for pressure relief?
2 hours
Describe the currents and set up for bipolar IFC?
2 med frequency currents (1 channel) oval shaped field
There is roughly a ___ % risk of infection after a TKA in the first 2 years, and a cumulative risk of ___ % over 10 years.
2% 2.5%
What is the ratio of women to men affected by MS?
2-3 women : 1 man
Is Alzheimer's disease more prevalent in men or women?
2/3 women and 1/3 men in U.S.
If a scoliotic curve is less than _____ degrees in an adolescent, it won't be treated
20 check every 6 months
At what age is the typical onset of MS?
20 to 40
If a pt is only partially able to assist, do not lift over ______ lbs
200
Droplets are expelled into the air then fall within a ___ft radius around the patient
3
How many degrees of freedom are available at the hip?
3
How many portions of the hip joint capsule are thickened?
3
How many articulations are there at the elbow?
3 ulnohumeral radiohumeral radioulnar
The Na+/K+ pump transports _____ Na+ ions out of the cell and _____ K+ ions into the cell (#)
3 Na+ ions 2 K+ ions
Which nerves provide sensory innervation of the face?
3 divisions of trigeminal N: Opthalmic V1 Maxillary V2 Mandibular V3
Describe the set up for the stereodynamic method of delivery for IFC
3 pairs of electrodes all crossing at one central point (add additional circuit or output generator to generate 3rd med freq sinusoidal current (3D)
Most orthotics revolve around a ___________ pressure system
3-point orthotic designs are based on this
At what angle is a scoliotic curve braced in an adolescent?
30 deg
What is the loose packed position of the hip?
30 deg hip flexion 30 degrees abduction and slight external rotation
What age population is most commonly affected by avascular necrosis?
30-60 year olds
By 2050, someone in the U.S. will develop Alzheimer's disease every _____ seconds
33
What age population is typically affected by epicondylitis?
35-50 years old & younger athletes
combined lumbar & thoracic extension grading
3: move hands to sides & see if they can lift themselves up 2: can come up a little, but don't clear belly button 1: palpate for contraction pt lifts above parallel to ground
How many stages of lateral epicondylitis are there?
4
In sickle cell anemia, clinical signs do not appear until the child is at least _____ months old
4 months old
When is the typical onset of ALS?
40 to 60
When is the typical onset of Hungtington's disease?
40+
The trinucleotide CAG has to repeat roughly more than _______ times to be considered Huntington's disease
40, the more repeats there are, the more severe the effects of the disease
Avascular necrosis occurs bilaterally about ______% to _____% of the time
40-80
How many people are diagnosed with MS in the U.S.?
400,000
In the U.S., someone has a stroke every _____ seconds
45 seconds
What percent of blood is RBC's?
45%
How many methods of delivery are there for IFC?
5
What is the close packed position of the proximal radioulnar joint?
5 deg supination
How many minutes of ischemia causes irreversible nerve cell damage?
5 min
What is the statistical landmark for being considered "cured" of cancer?
5 years
What % of the population has mutations in hemoglobin alpha or beta chain?
5%
What percent of total cancer cases are hereditary?
5-10%
How many Americans are affected by Alzheimer's disease?
5.2 million (5 million of which are 65+ yo)
Above what age does the statistical probability for cancer increase?
50
What are some risk factors for Parkinson's disease? (3)
50+ yo male exposure to toxins/drugs
What percent of blood is plasma?
55%
trunk rotation grading
5: arms behind head, able to lift scapula off table 4: arms across chest, able to lift scapula off table 3: arms out in front, able to lift scapula off table 2: arms at sides, knees bent, able to lift head & neck off table 1: unable to move, support under shoulders & bring into partial ROM, feel for contraction -- have pt bring shoulder to opposite knee --
What is a footshell?
A plastic cover of a prosthetic foot, comes in different skin tones, comes with split toe options and is worn over a blade-style foot
What percent of patients who *don't* receive prophylaxis after a TKA develop a DVT? What about a PE?
DVT: 60% PE: 20%
What are the 6 components that are looked at when assessing the "system" of how a condition affects a patient?
Disorder/disease Body Individual Society Environmental Personal Factors
FYI: Some reports state that methylxanthines enhance diaphragmatic contractility, reduce patient complaints of dyspnea, and improve exercise tolerance and gas exchange
FYI
FYI: all bronchodilators for this module are listed under asthma treatment, but can also be used to treat other respiratory conditions such as COPD abd other infections
FYI
FYI: an inhaler should be sprayed two times before use to "prime" it
FYI
FYI: antitussive drugs have different names when packaged for respiratory problems than when packaged for pain control but are also use for treatmetn of musculoskeletal conditions
FYI
FYI: approximately 38% of nurses and 42% of radiation techs have suffered injuries due to moving, lifting or repositioning patients
FYI
FYI: basically all of the drugs talked about for treatment of asthma can apparently be used for treatment of allergies as well...and for other obstructive diseases like COPD
FYI
FYI: health professions are more dangerous than construction work or farming due to prevalence of back injuries incurred while lifting obese patients
FYI
FYI: somehow, neuroborreliosis is related to encephalitis
FYI
FYI: the effects, severity and progression of MS varies
FYI
FYI: the reality is that some PT's leave clinical practice due to injury and many are experiencing an injury that may be preventable
FYI
FYI: you can treat *rabies, tetanus and poliomyelitis* prophylactically with an immunization
FYI
Neo
New; Example: Neoplasm; New tissue growth
What are some associated symptoms that present with systemic pain that are a cause for concern?
muscular weakness, low grade fever, migratory arthralgias (joint pain)
If someone had pain that got worse or better with change in position and was intermittent, what might be the source of their pain?
musculoskeletal disorder or injury
The cause of ____________________ is unknown, but 75% of patients with it have a thymus disorder
myasthenia gravis
What does myasthenia mean? What does gravis mean?
myasthenia: muscle weakness gravis: serious
What structure is responsible for insulating nerve fibers?
myelin sheath
Which type of leukemia deals with precursors of granulocytes?
myelogenous leukemia
Most common site of colonization for MRSA:
nares
How may mediator-release inhibitors be administered?
nasal spray (not available in oral form)
How may decongestants be administered?
nasal spray, eye drops, syrup or pill (usually over-the-counter)
When thyroid cancer does metastasize (rare) where does it go?
nearby lymph nodes, and then to bone
A ______________ is an electrical current that spreads across neurons, in one direction, due to movement of ions across plasma membranes.
nerve impulse
Where is acetylcholine stored?
neuromuscular junction (NMJ)
Where is norepinephrine stored?
neuromuscular junction (NMJ)
When a neuron is stimulated by an AP, ______________ are released into the synaptic cleft
neurotransmitters
Which type of WBC do we have the greatest number of? Which type do we have the second greatest number of?
neutrophils (57-70% of WBC's) second most: lymphocytes (20-25%)
Are RBC's nucleated?
no
Are hormonal effects usually an all-or-none phenomena?
no
Are platelets nucleated?
no
Are restraints the same thing as positioning?
no
Can ALS go into remission?
no
Can neuron cells divide?
no
Do bronchodilators often require a prescription?
no
Do drugs that bind to cell membrane receptors enter the cell itself?
no
Do neurons regenerate in the CNS?
no
Does taking armrests off a wheelchair help reduce the lifting load?
no
Is a more potent drug always a better drug?
no
Is there much difference in the efficacy of different asthma medications?
no
Is it reasonable to expect that there are lift techniques that can ensure 100% safety?
no -pts are a bulky, assymmetrical load that is unpredictable and inconsistent
Which type of HVPC should produce a muscle contraction? Which type should not? options: dermal wounds, pain, edema/spasm/weakness
no contraction: dermal wounds & pain contraction: edema, spasm or weakness
Does research support the use of biofeedback?
no, but Stacia thinks this will change
Which division of the NS is responsible for stimulating the digestive system?
parasympathetic NS (mainly CN X)
What class of respiratory drug does ipratropium (Atrovent) fall under?
parasympathetic blocker
What is the most obvious risk factor for thyroid cancer?
past radiation to head, neck or chest
If a pt has pretty severe deformities (ex: Charcot deformity) but is not eligible for an amputation, which AFO would be the most helpful?
patellar tendon bearing
Which AFO looks kind of like a socket and offers more control than a ground reaction AFO?
patellar tendon bearing
Which AFO limits weight bearing? How does it do this?
patellar tendon bearing reduces force on *midfoot & heel* via a "rocker sole"
What is a common side effect of Paget's disease?
pathologic fractures
What is stage 3 LE?
pathological changes in the tendon and rupture
Independent assistance:
patient doesn't require any physical assistance or supervision to perform activity safely and within reasonable time
Max assistance:
patient performs 25-50% of the activity or requires assistance to complete the activity
Moderate assistance:
patient performs 50-75% of the activity or requires assistance to complete the activity
Minimal assistance:
patient performs 75-100% of the activity or requires assistance to complete the activity
Dependent assistance:
patient requires total assistance to safely perform the activity; this may include the use of special equipment
Supervision assistance:
patient requires verbal, tactile cues, directions, instructions; assistance provided to maintain safety, perform in acceptable time or technique
Transmission precautions apply to patients with:
patients with identified or suspected infections (ex: MRSA, VRE)
Describe social constructionism as it relates to people/patients
people make sense of their lived experiences through social interactions
How does level of education affect the risk of getting Alzheimer's disease?
people with fewer years of education have a higher risk for AD
What population are decongestants contraindicated for?
people with high BP (because decongestants can raise blood pressure, glaucoma is especially a concern)
Is the output polarity in MES constant or reversing during stimulation?
periodic reversal of polarity (could be days b/w reversals)
In which type of anemia do RBC's have a shorter lifespan?
pernicious anemia
Which type of anemia is characterized by very large, immature, nucleated RBC's?
pernicious anemia
Which type of anemia is caused by a deficiency of vitamin B12 or vitamin B9? What are those vitamins needed for?
pernicious anemia B12: DNA synthesis B9: folic acid
What term covers the events involving the action of a drug at the site of the target?
pharmacodynamics
In the signal cascade that results in the relaxation of respiratory smooth muscle, the final step is ________ of one of the contractile proteins. This inhibits what?
phosphorylation inhibits the interaction with actin
What is the order of the vagus nerve, phrenic nerve, sympathetic chain, and hilar region from anterior to posterior?
phrenic nerve - hilar region - vagus nerve - sympathetic chain
Heel spurs are often associated with what?
plantar fasciitis (spurs on sole/plantar area of heel achilles tendinitis (spurs on back of heel)
Metal on _____________ is the most common hip replacement type
plastic (polyethylene)
All blood cells develop from what kind of cell?
pluripotent stem cells
What is the prognosis of multiple myeloma?
poor prognosis, short life-expectancy of 3 years
Positioning for neuro:
position to normalize tone, prevent contracture, stretch shortened structures or accommodate contracture
When a breast tumor is removed, they test the margins for the presence of the tumor cells. What are the 3 results that could come back from testing margins?
positive: contains cancer cells to the edge of the biopsy negative: margins are normal tissue close: between positive and negative
In a dose/response curve, why does the curve become saturated?
possible reasons: -all receptors are bound to drug -downstream molecules are rate-limiting
In which direction do hip dislocations commonly occur?
posterior
What glide should be performed on the hip to help facilitate hip flexion and internal rotation?
posterior
What are 2 characteristics that might be searched for in an X-ray of someone suspected to have a non-displaced radial head fracture?
posterior fat pad sign (elbow effusion) anterior fat pad (sail sign)
Having a bilateral THA makes it difficult to adhere to which set of hip precautions?
posterior hip precautions
Which type of AFO stores & releases energy during gait?
posterior leaf spring
Which type of elbow instability involves an injury of the LCL that causes the proximal radius & ulna to ER together as a unit?
posterolateral rotatory instability
What is an exception to the types of receptors that are stimulated by postganglionic neurons in the sympathetic NS?
postganglionic neurons in sweat glands and blood vessels of skeletal muscles are cholinergic (normally SNS post-g neurons stimulate adrenergic receptors)
Standing transfer aids require:
postural control and lower extremity stability
combined lumbar & thoracic extension position
prone, hands at sides PT stabilize feet trunk starts off table
thoracic extension position
prone, hands behind head PT stabilize feet belly button at edge of table trunk starts off table
lumbar extension position
prone, hands behind head PT stabilize feet trunk is *not* off table
When a drug enters the body it usually binds to a _______________ which causes a change in this molecule.
receptor
How can tyrosine kinase receptors cause cancer?
receptor undergoes mutation that causes it to be turned on constantly w/out the presence of growth factors (ligands)
trunk flexion muscles
rectus abdominis int/ext oblique - bilateral
capital flexion muscles
rectus capitis ant & lateralis longus capitis
capital extension muscles
rectus capitis post major/minor obliquus capitis sup/inf splenius capitis longissimus capitis semispinalis capitis
What is the goal of pharmacological treatment with asthma?
reduce the frequency and severity of asthma attacks
Slide sheets are used for:
reducing friction to make a transfer easier
What MT could be used to treat a pulled elbow?
reduction maneuver (only if fx is ruled out)
Define concurrent therapy
refers to the administering of medical treatments at the same time as other therapies such as radiation
Beta-2 receptors induce _______ in smooth muscle cells by activating __________ to produce ________
relaxation adenyl cyclase cAMP
What is a modified radical masectomy?
removes entire breast and lymph nodes (chest muscles left intact)
What is a simple masectomy?
removes entire breast but no lymph nodes
What is the MOI of both Panner's disease & osteochondritis dissecans?
repetitive loading (overuse) which causes: P- ischemic necrosis of cap. OD- lesion to subchondral bone of cap.
What maneuver creates the most load on a PT?
repositioning a person in bed
The crossing quadripolar arrangement of electrodes in IFC results in ________ current with __________ equal to the difference between the two channels
results in "interference current" with beat frequency equal to the difference between the two channels
What are the results of the mutated or missing hemoglobin chains that occur in thalassemia?
results in abnormal Hb and RBC hemolysis
In MES for *wound healing* if the process of the wound size decreasing plateuas, what should you do?
return the cathode to the wound for 3 days
When flexing the hip in a closed chain movement, the acetabulum will roll ____________ (posteriorly/anteriorly) and glide _________(anteriorly/posteriorly)
roll anteriorly glide anteriorly
Which direction are the roll and glide at the distal radioulnar joint with pronation?
roll: anterior glide: anterior
Which direction are the roll and glide at the proximal radioulnar joint with pronation?
roll: anterior glide: posterior
Which direction are the roll and glide at the proximal radioulnar joint with supination?
roll: posterior glide: anterior
Which direction are the roll and glide at the distal radioulnar joint with supination?
roll: posterior glide: posterior
Rotational torque adapters for prosthetic feet provide ______________ mobility
rotation for standing & twisting movements
What activities are J-shaped prosthetic feet used or not used for?
running not for general walking (too stiff & no heel)
What areas of the body are typically affected by ankylosing spondylitis?
spine or spine & pelvis
cervical extension muscles
splenius cervicis longissimus cervicis semispinalis cervicis iliocostalis
Characteristics of C. diff:
spore forming gram + anaerobic bacillus (difficult to kill)
What is stage 4 LE?
stages 2 & 3 w/ fibrosis, soft matrix calcifications and faint calcifications along the epicondylar margins
Which type of KAFO only controls knee motion during the stance phase of gait and not the swing phase?
stance control locks during stance, unlocks during swing
If a pt has quad weakness that results in crouch gait, which type of KAFO would help the most?
stance control prevents knee flexion during stance, but when they dorsiflex, right before swing, it unlocks so they have the full swing motion
What is the alternative to tilt table for dependent standing?
standing frame
GB syndrome starts in the ____________ and travels to _____________ , _______________ and ______________
starts in legs and ascends to spinal nerves, neck and cranial nerves
Gains in ROM through passive stretching are only sustained through:
strengthening within the ROM limits achieved (must be a functional adjunct)
A TIA may be a warning sign before a _____________ occurs
stroke
ALS puts a patient at risk for:
stumbling and falls, due to muscle weakness
How do you define a pulled elbow?
subluxaton of the radial head
What are symptoms of hyperparathyroidism in the early stages?
subtle: depression or anxiety
What does a cerebral aneurysm that is a massive tear lead to?
sudden fatal inc in ICP and death
What is the MOI usually for a distal biceps tendon rupture?
sudden injury -usually when the elbow is forced straight against resistance and results in greater arm weakness than injuries to the biceps tendon at the shoulder
What is the MOI for a pulled elbow?
sudden pull on an *extended & pronated* arm
capital flexion position
supine
cervical flexion position
supine
combined neck flexion position
supine
cervical rotation position
supine GE: sitting
trunk flexion position
supine (arms & legs depend on grade)
trunk rotation position
supine legs straight
elevation of pelvis position
supine take shoe off on side you're testing
Glial cells are _________________ cells
supportive
True CECS is best relieved with _______
surgery
What treatment is provided usually after growth has stopped in a scoliotic curve greater than 30 deg?
surgery
What are the two main treatment options for a distal biceps tendon rupture?
surgical non-surgical
What needs to be done to treat acute compartment syndrome?
surgical intervention is necessary (fasciotomy or fasciectomy)
What is an example of local cancer treatment?
surgical removal of a tumor
According to Stacia, lordosis is also known as:
swayback
What can result if a Volkmann's contracture is not treated?
swelling can lead to ischemia and cause involvement of forearm flexors
Beta-blockers inhibit what part of the nervous system? Therefore, beta-agonists have what role in the respiratory system?
sympathetic they will stimulate the respiratory portion of the sympathetic system
Which divisions of the NS work antagonistically? What is the point of this?
sympathetic & parasympathetic NS to maintain homeostasis of the body
Which division of the NS is responsible for the fight-or-flight stress response?
sympathetic NS
Which division of the NS increases the general activity level in the body?
sympathetic NS Ex: inc CV, resp, & neuro functioning
What are symptoms of hyperparathyroidism later on? What are symptoms related to?
symptoms are related to release of bone calcium into blood excess PTH leads to: *bone damage, hypercalcemia & kideny damage* -bones may become so fragile that pathologic fractures or deformities can occur -compression fractures of vertebral bodies -kidney stones
If pain is very severe would this be more of an indication of systemic or musculoskeletal pain?
systemic
What are two categories of pain that may indicate a cancer diagnosis?
systemic musculoskeletal
What category of cancer treatment would chemotherapy, hormonal therapy, and immunotherapy fit into?
systemic treatment
What can significantly reduce the side effects of glucocorticoids?
taking via inhalation
T/F: pitchers are discouraged from pitching in more than 1 league if their seasons overlap
true
T/F: there are specialty prosthetic feet for certain activities such as skiing or swimming
true
T/F: there is no immediate cure for Reye's syndrome
true
T;F: the calcaneus is the largest bone in the foot
true
T/F: biofeedback should only be used with patients who at least have some control of the target muscle
true don't rule out the possibility that the pt might "find" control through biofeedback
Parasympathetic stimulation through the _____ nerve causes bronchoconstriction. Therefore parasympathetic ________ can be used to reduce asthma symptoms.
vagus blockers
Which type of elbow instability involves an injury of the ulnar collateral ligament (MCL)?
valgus instability
VRE stands for:
vancomycin-resistant enterococci
What material is an articulated AFO made out of?
various materials
Which type of elbow instability involves an injury of the lateral collateral complex in addition to a fracture of the coronoid process?
varus posteromedial rotatory instability
What is a symptom of a cerebral aneurysm that is a slow bleed?
vascular type headache
Excessive alcohol use can cause _____________, which can lead to fatty deposits occluding blood vessels
vasoconstriction
Is a high or low amplitude current used with MES? What action potential amplitude is MES capable of generating in the body?
very low- most units are <1 mA above 1000 micro-A
How does the infection that causes meningitis spread?
via blood, so it can be contracted directly through wounds
Is rabies a viral or bacterial infection? How is it transmitted?
viral bite of rabid animal or transplant of contaminated tissues
What is the most common cause of idiopathic cardiomyopathy? -case study-
viral infection
Is encephalitis usually of bacterial or viral origin? What spread the infection?
viral, spread by mosquitoes
Is poliomyelitis (infantile paralysis) a viral or bacterial infection?
viral- polio virus
Is herpes zoster (shingles) caused by a viral or bacterial infection?
virus- varicella-zoster virus
Which vitamin has been shown to be helpful with treating MS? What effects does it have?
vitamin D -remarkable 41% reduction in new MS events -improved physical function -no significant side effects -didn't raise blood calcium
What does mean corpuscular volume (MCV) measure?
volume of RBC's
Cell membranes are relatively impermeable to what kind of compounds?
water-soluble compounds -lipid-soluble compounds just diffuse through the membrane
What should you focus on with *assistive devices* in *late* PT interventions after a THA?
weaning them off of AD's if appropriate
Long acting asthma medications must be taken for _____ before the effects will be noticed
weeks
What are side effects of corticosteroids?
weight gain, fluid retention, high BP. diabetes, cataracts and osteoporosis
Best activity for flexible ROM:
weight-bearing activities
What are the 3 categories of abnormal cell division in the order of increasing severity?
well-differentiated moderately differentiated poorly differentiated
What are the main symptoms of asthma?
wheezing when breathing, coughing, tight feeling in the chest and trouble breathing especially at night or early in the morning
Why are they called G-protein coupled receptors?
when activated, G proteins bind to GTP
What is constructive interference?
when both waves are exactly the same and are produced in phase or originate at the same time - the interference is summative and they combine
The intrinsic and extrinsic pathways of coagulation start differently and then converge to become a common pathway at what step?
when factor X is activated into Xa
When is MES (LIS) used for aiding in *bone healing* for conditions such as fractures, spinal fusion or wounds?
when healing is delayed -Medicare criteria: 90 days w/out progress on a series of x-rays -CIGNA criteria: 1 cm gap or less
What is cuboid syndrome?
when the calcaneocuboid joint temporarily subluxes laterally and posteriorly, caused by a strong external force (aka locked cuboid, calcaneocuboid fault syndrome or subluxed buboid)
What is destructive interference?
when the waves cancel each other out (end up with amplitude of 0) when they are generated out of sync
What determines the events that happen in a signalling cascade? (after ligand binds to receptor)
which G-protein has been activated
How is the involvement/size of a tumor, metastasis or lymph nodes ranked with involvement?
with a 1,2,3 etc following the letter
How quickly does someone recover from a TIA?
within 24 hours
When do signs & symptoms of thalassemia appear?
within the first 2 years of life
Does myasthenia gravis affect men or women more frequently?
women
Are men or women more commonly affected by hyperparathyroidism?
women (2:1) usually after age 60
Does thyroid cancer affect men or women more?
women, ages 40-60
When is the typical onset of myasthenia gravis?
women: 20-30 men: 50+
WRMSD stands for:
work-related musculoskeletal disorders
Is a ground reaction AFO capable of tri-planar motion?
yes
Will a drug with a high affinity for a receptor still bind to the receptor even if the drug concentration is low?
yes
Are J-shaped prosthetic feet energy storing & releasing?
yes absorb during loading, release during toe off
Do you need a prescription for MES (LIS) for *bone healing*?
yes, care is prescribed & monitored by a physician
Are most people glad they got a THA after the surgery?
yes, eventually
Can you have an active lifestyle after a high tibial osteotomy?
yes, it allows for reasonable joint stability
Do heel height adjustable prosthetic feet exist?
yes, it is a specialty foot where the pt can change the heel height to accommodate various shoes without changing overall prosthetic alignment
What populations are calcaneal fractures more common in?
young to middle age males and industrial workers
Are younger or older PT's more at risk for WRMSD's?
younger PT's
Is total hip re-surfacing generally indicated for younger or older patients?
younger, more active patients
What are the branches of CN V2?
zygomatico-temporal, zygomatico-facial, and infraorbital
The acetabular labrum increases the articulation area of the hip joint by _____%
~10%
How many compounds within the body are known to activate G-protein receptors?
100+
Do alcohol hand rubs or soap kill more germs?
alcohol rubs
Although there is no identified cause of ALS, ____________ may be involved
genetics
combined neck extension position
prone -move head rest down- GE still prone?
capital extension position
prone -move head rest down- move to supine for GE (2 & 1)
cervical extension position
prone -move head rest down- move to supine for GE (2 & 1)
Alzheimer's disease affects ____ % of the population over 65 yo and _____ % of the population over 85 yo
11% 32%
How many intercostal nerves do we have?
11, the subcostal nerve goes under the 12th rib
Long acting asthma medications require about ____hours to have an effect and should be taken twice a day
12
At what age do the bones of the acetabulum fuse?
14-16 years old
"Physical restraints" definition from the FDA (read)
"a device, including but not limited to a wristlet, anklet, vest, mitt, straight jacket, body/limb holder, or other type of strap that is intended for medical purposes and that limits the patient's movements to the extent necessary for treatment, examination, or protection of the patient or others"
"Physical restraints" definition from the Centers for Medicare and Medicaid Services (read)
"any manual method or physical or mechanical device, material, or equipment attached or *adjacent* to the individual's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body."
With neuroborreliosis, what forms at the tick bite site?
"bull's eye" lesion (red with pale center) that gradually increases in size
What would happen to a transtibial amputee's gait if they were using an endoskeletal prosthesis and they got new shoes with a higher heel?
"drop off" gait hip flexion & knee flexion
cervical flexion grading
"keep your nose toward the ceiling and move your head toward the ceiling" pressure is straight down, just use 2 fingers 5, 4, 3 are normal grading 2: have pt turn to R & L as far as they can, score 2 if they can do this to both sides 1: feel contraction
cervical extension grading/procedure
"lift your head up toward the ceiling, but keep your nose pointed towards the floor" apply pressure straight down to back of head (don't try to rotate) 5: max pressure 4: mod pressure 3: can't tolerate pressure 2: partial ROM - GE position ("push straight down into the pillow") 1: feel contraction - GE position
capital extension grading/procedure
"look toward the wall in front of you without lifting your head" apply pressure to back of head & try to rotate it down 5: max pressure 4: mod pressure 3: can't tolerate pressure 2: partial ROM - GE position 1: feel contraction - GE position
combined cervical extension grading/procedure
"look up and back as far as you can" apply pressure to rotate & bring head down *normal grading*
What controls the level for beat frequency?
"select beat frequency to correspond to desired effect over treatment area"
capital flexion grading
"tuck the chin down towards the throat" apply rotational pressure *normal grading*
combined neck flexion grading/procedure
"tuck your chin down towards your chest" pressure is rotational and down *normal grading*
What is the average lifetime cost of MS treatment?
$1.2 million
FYI: thyroiditis is often seen first as an acute inflammatory response to autoimmunity in an autoimmune disease
(I think her point is that thyroiditis often happens secondary or in conjunction with autoimmune diseases)
The goals of all respiratory drugs can be classified under what 4 goals? Which two goals does the majority of drugs in this module fall under? (bold)
*1. promotion of bronchodilation for relief of bronchoconstriction* *2. Facilitation of the removal of secretion from the lungs* 3. improvement of alveolar ventilation or oxygenation 4. optimization of the breathing pattern
In MES for *wound healing*, where are the cathode and anode placed?
*First 3 days*: -cathode: in the wound area -anode: within 25 cm of wound *After 3 days*: -reverse polarity and place anode in the wound area
The pathophysiology of Parkinson's disease involves the presence of:
*Lewy bodies*: clumps of aggregated proteins within brain cells
Is acetylcholine more prominent in the CNS or PNS?
*PNS* - more specifically the autonomic NS (both sympathetic and parasympathetic NS) less commonly found in CNS
What is the life expectancy of someone with sickle cell anemia?
*Today*: 50+ years 1973: 14 years
For a K2 pt, what are the goals of the prosthetic foot they select for this pt?
*adapt to uneven terrain* for limited community ambulation
Where are the electrodes placed in HVPC for dermal wound therapy?
*anode* should be at or near the site
What is the only precaution for MES and HVPC? What causes this?
*chemical burns* can result from excessive electrical density due to: -intensity too high for size of active electrode -direct metal contact
What is a PRAFO indicated for?
*contracture prevention & pressure relief* -neuro involvement: CVA, SCI, TBI, etc. -orthopedic: hip fx, amputation -LT immobility: ICU
For a K1 pt, what are the goals of the prosthetic foot they select for this pt?
*enable safety & early stance* for transfers and level surfaces
For a K3 or K4 pt, what are the goals of the prosthetic foot they select for this pt?
*energy storage & return* for variable speeds
What population should be screened for type 2 diabetes mellitus (what are risk factors for DM?)
*everyone over 45 yo* every 3 years younger if: --*overweight* --high BP --*triglyceride level* > 250 mg/dl --*low HDL cholesterol* --1st degree relative w/ DM --*high risk ethnic group* --*delivered baby > 9 lbs* --impaired glucose tolerance --impaired glucose fasting --autoantibodies
What is disseminated intravascular coaguation (DIC)?
*excessive clotting and excessive bleeding in circulation* -abnormal clumps of thickened blood form in a blood vessel which consumes the majority of the body's clotting factors. this results in excess bleeding in other places.
T/F: only malignant brain tumors are life-threatening
*false* both can be life-threatening
T/F: gout usually causes constant, dull, aching pain
*false* gout occurs in intermittent attacks and causes severe pain
T/F: recovery from Guillain-Barre syndrome is usually insidious
*false* it is usually spontaneous
T/F: Reye's syndrome always causes severe pain
*false* manifestations vary in severity
T/F: all nerves are myelinated
*false* some are and some aren't
T/F: gout typically affects multiple joints
*false* typically affects a single joint, usually the big toe
In what situation would you want to use a single axis ankle over a SACH?
*for someone with quad weakness* Why? -you can set the posterior bumper to the softest setting to cause them to go to immediate foot flat so that the quads do not have to eccentrically control knee flexion What's the difference? SACH & single axis prosthetics pretty much do the same thing, single axis is just more adjustable
What *mobility* activities should you focus on with a pt acutely post-op *TKA*?
*gait training* w/ emphasis on normalizing gait to reinforce normal & functional knee ROM
Why was a patient advisory for total hip re-surfacing warranted in 2011?
*high 5 year failure rate* (they are still done, but they aren't quite as popular anymore)
Describe the appearance of RBC's in iron-deficiency anemia, pernicious anemia, and aplastic anemia.
*iron deficiency*: microcytic, lacking color *pernicious anemia*: macrocytic *aplastic*: normal appearance
Do males or females have a bigger hematocrit? What percentage of the blood is the hematocrit of each sex?
*males*- 45-52% (females- 37-48%)
What are some symptoms of myasthenia gravis?
*muscle weakness* and fatigue: -eyes & face -neck: head droop -mouth: hard to chew/swallow -arms
What are possible causes of aplastic anemia? (5)
*often idiopathic*, but can also be due to: -myelotoxins (drugs that damage bone marrow) -viruses (hep C) -autoimmune disease (lupus) -genetic abnormalities (myeloplastic syndrome)
Does fast-tracking recovery after a JA work?
*overall, yes* -dec time to return to fxn -dec opioid consumption -dec length of stay -dec risk of blood transfusion -dec mortality -no change in rates of readmission, falls or adverse events
When performing a complete blood count (CBC) on a patient with aplastic anemia, what would you expect to see?
*pancytopenia*: loss of all types of blood cells -anemia (reduced RBC) -leukopenia (reduced WBC) -thrombocytopenia (reduced platelets)
Which type of KAFO would be indicated for a patient who significantly hyper-extends at the knee? Why?
*posterior offset*- it moves the mechanical axis posteriorly relative to the knee joint as soon as the joint moves anterior to the weight line (a.k.a., the weight line moves posterior to the joint) they will move into knee flexion
Airborne precautions are used for patients with what conditions?
*respiratory infections* such as TB, chickenpox, measles
Although the specific cause of Alzheimer's disease is unknown, there is suspected involvement of what?
*several defective genes*: -amyloid precursor protein (APP) -presenelin 1 -presenelin 2
What causes a transient ischemic attack (TIA)?
*temporary, localized reduction of blood flow in the brain* causes of dec blood flow: -partial occlusion/arteriosclerosis -small embolus -vascular spasm -local loss of autoregulation
Do people generally recover well from THAs?
*yes*, regardless of PT interventions -80% of function is recovered w/in 8 mo -90% report satisfactory outcomes at 10 yrs -up to 60% return to athletic activities w/in 3 yrs
How long does shingles last?
-*lesions & pain persist for several weeks* -post-herpetic pain may persist for months or years in some cases
What are the 3 causes of scoliosis?
-*15% congenital*: due to problems with formation of spine or fused ribs -*10% neuromuscular*: poor muscle control, muscle weakness or paralysis -*60% idiopathic*: most common in adolescents
What is the difference b/w an agonist and an antagonist in terms of drugs?
-*agonist*: binds to receptor & activates it -*antagonist*: binds to receptor & inhibits it from becoming activated by either preventing other things from binding or by turning the receptor off via chemical modification
What are some symptoms of Addison's disease?
-*bronzed/tanned appearance* -*inc pigmentation of scars* formed after onset of disease -people of darker skin may develop *gray color* -weight loss -dizziness -low BP -abdominal pain -nausea
What are some symptoms of Grave's disease?
-*exopthalmos* -nervous, *anxious*, emotional -heat intolerance -weight loss despite inc appetite -sweating -diarrhea -tremors -fatigue -palpitations
What are *early* (rapid) signs of hypoglycemia?
-*hunger* -headache -dizziness -sweating -shakiness -*tingling sensation around mouth* -pale skin color -high HR
Which *modalities* should you include in your early post-op interventions after a *TKA*?
-*ice* & positioning -possible use of CPM -edema & pain management
What is the difference between lymphocytic and myelogenous leukemia?
-*lymphocytic*: precursors of lymphocytes (agranulocytes) are affected -*myelogenous*/myelocytic: precursors of granulocytes are affected
Why is nutritional supplementation included in fast-tracking recovery from a JA?
-*malnutrition* is associated w/ infection, delayed wound healing, inc LOS, rehab time & mortality -*peri-operative anemia* is associated w/ infection and inc LOS
What are the primary *indications* for why someone would get a joint arthroplasty? (signs the condition is bad enough to warrant a JA)
-*marked, disabling pain* -*decreased function* -marked ROM impairment -instability or deformity -recurrent dislocation -failure of prior interventions
What can a rotator cuff tear or tendonitis be due to? (5)
-*often* due to *improper biomechanics or direct injury* -*overuse* -*instability* -*impingement*
Which clinical syndromes of the elbow have symptoms on the *posterior* aspect of the elbow?
-*olecranon bursitis* -olecranon process stress fracture -triceps tendinitis
What are 2 possible MOIs for lateral epicondylitis?
-*overuse*: repetitive grasping w/ wrist in extension -*trauma*
What are signs/symptoms of achilles tendinopathy?
-*palpatory tenderness* -morning pain and stiffness -pain along tendon or back of heel that worsens with activity -severe pain the day after exercising -thickening of tendon -swelling that is always present and gets worse throughout the day and w/ activity
4 factors that lead to infections
-*patient*: immune status, length of stay, prior colonization -*technology*: invasive procedures, indwelling devices, antibiotic use -*health care worker*: hand hygiene, techniques -*hospital*: ventilation system, water system, equipment
What education should a pt w/ Panner's or OD receive?
-*rest, dec elbow activities* -explain MOI -change biomechanics -orient kids & parents to follow USA BMSAC recommendations
What are *late* signs of hypoglycemia?
-*slurred speech* -difficulty paying attention -confused -pale skin color -*sudden moodiness* -behavior changes such as crying for no apparent reason -clumsy or jerky movements -seizures -pass out
What is in plasma? (3)
-*water*: transport, exchange of body fluids & secretions -*proteins*: albumin, globulins/ antibodies, fibrinogen -*other*: AA, carbs, fat, vitamins, hormones, enzymes, electrolytes, waste
What are some reasons to suspect blood clotting disorders? (11)
---*bleeding in all the places*--- 1. more than normal bleeding in trauma 2. persistent bleeding from gums 3. repeated nose bleeds (epistaxis) 4. bleeding into joints (hemarthroses) 5. coughing up blood (hemoptysis) 6. vomiting blood (hematemesis) 7. blood in feces 8. low BP- due to bleeding 9. rapid pulse 10. feeling faint or anxious 11. petechiae or frequent purpura & ecchymoses
What ROM discharge goals should you have for a pt after a *TKA*?
-0 deg knee extension -90 deg knee flexion includes help from PROM in these values, the surgeon always wants to know ROM after a TKA, but not so much a THA
A neuronal pathway in the autonomic NS contains ____ (#) neurons and a _____________ (structure)
-2 neurons (pre & post ganglionic) -ganglion
FYI: ALS prevalency ----
-2 people in 100,000 have ALS -30,000 cases in U.S. at any given time -5,600 cases each year in U.S.
Describe phase I of TSA rehab: -how long does it last? -what types of ROM can they do? -what can they not do?
-2-4 weeks -PROM and AAROM -immobilization -no AROM
Standing frame
-3-point system of dependent standing -feet are blocked if needed to the floor -knee extension is achieved with the knee block -hip extension is done with electric or hydraulic lift
Roughly _____ % of all human cancers involve a mutation in the ______ protein that results in dividing cells leading to unctontrolled cell division
-30% -Ras protein
How many molecules of oxygen can each hemoglobin bind? Why?
-4 -because each heme group has 1 iron atom that's able to bind to 1 oxygen molecule, and each Hb has 4 heme groups
Describe the currents and set up for dual, bipolar IFC?
-4 electrodes -each pair to own channel (2 unmodulated med. freq sine currents) -2 parallel currents
Describe the currents and set up for quadripolar (crossing) IFC?
-4 electrodes -each pair to own channel (2 unmodulated med. freq sine currents) -4 leaf clover shaped field
Describe phase II of TSA rehab:
-4-6 weeks -AAROM and AROM
What is the normal resting membrane potential of a neuron?
-70 mV
Describe phase III of TSA rehab:
-8-12 weeks -AROM and strength -avoid OH activity
FYI: Huntington's disease affects 5 per 100,000 people
15,000 people in U.S.
In MES for *wound healing*, what parameters are used for: -amplitude -pulse duration -pulse frequency -waveform -treatment duration -treatments/day
-A: higher for denervated skin vs. normal skin -PD: long or continuous -PF: maximum -Wave: monophasic or biphasic -TD: 2 hrs w/ 4 hr rest time -#: 2-3 times per day
What *strengthening* activities should you include in your *early* post-op interventions after a THA?
-AAROM and *quickly progress to AROM* -*strengthening*: isometrics, heel slides, SAQ, LAQ, ankle pumps, abduction?, -Jason was taught to be cautious w/ SLR
An AC joint sprain/separation involves what ligament(s)?
-AC and/or coracoclavicular ligaments
What are the 2 types of acute leukemia?
-ALL: acute lymphocytic leukemia -AML: acute myelogenous leukemia
What are the 2 types of lymphocytic leukemia?
-ALL: acute lymphocytic leukemia -CLL: chronic lymphocytic leukemia
What are the 2 types of myelogenous leukemia?
-AML: acute myelogenous leukemia -CML: chronic myelogenous leukemia
How do you treat myasthenia gravis? (4)
-Ach esterase inhibitors -glucocorticoids -plasmapheresis: remove Ab -thymectomy
Sickle cell anemia is more common in people of _______________ ancestry. How many of these individuals are heterozygous for the trait and how many have the disease?
-African ancestry -1 in 12 African Americans is heterozygous for trait -heterozygous condition is somewhat protective against malaria -1 in 600 have the disease
What are some risk factors for developing VTE events (includes DVT and PE) after a TKA?
-BMI > 25 -COPD -a. fib -anemia -depression -hx of DVT
3 mechanisms of transfer of C diff
-C diff --> Environment --> Inoculation -Patient --> HCW --> Susceptible host -Surface --> Susceptible host
How are the nutritional requirements of a kid with cystic fibrosis different from a normal kid? -case study-
-CF kids have higher energy needs due to labored breathing and malabsorption -high calorie, fat, protein, vitamin diet
What are the 2 types of chronic leukemia?
-CLL: chronic lymphocytic leukemia -CML: chronic myelogenous leukemia
How do you diagnose neurologic dysfunction in general? (7)
-CT -MRI -cerebral angiography -doppler ultrasound -EEG -radionuclides (track perfusion) -lumbar puncture (analyze CSF)
What are potential complications of DM?
-CV disease -peripheral vascular disease -diabetic neuropathy -diabetic retinopathy -diabetic nephropathy -skin problems
In sickle cell anemia, what happens to hemoglobin when they are deoxygenated?
-HbS is unstable and crystallizes -changes the shape of the RBC from biconcave to sickle
What would happen if a K1 pt used a prosthetic foot with a rigid ankle & stiff heel? How would these forces be resisted within the prosthetic socket?
-Inc knee flexion moment -Could be unstable, esp w/ weak knee extensors -Residual tibia extends into the socket & creates *localized* pressures
What are some signs of ankylosing spondylitis? What are some systemic signs of it?
-LB pain -morning stiffness -pain lying down -rigid spine -systemic signs: fatigue, fever, weight loss, iritis (inflamm of eye)
Is animal testing necessary for testing LD50?
-LD50 of cell cultures usually doesn't match LD50 of animal testing -shows you can't replace animal studies w/ computer modeling or cell culture studies
MES is also known as: (read)
-LIS: low intensity stimulation -formerly known as MENS: microcurrent electrical nerve stimulators
What are 3 common ankle alignment & function problems to check for when assessing a pt for a LE orthotic?
-M-L stability -*foot drop* -PF contracture: likely to occur w/ foot drop
3 MDROs that KU hospital struggles with the most:
-MRSA -VRE -gram negative bacteria
What are the primary *causes* of why someone would get a joint arthroplasty? (medical conditions that lead to damage of the joint)
-OA -RA -traumatic arthritis -avascular necrosis -fracture repair
Examples of joint types for articulated AFOs: (read)
-Oklahoma -Gillette -Camber axis hinge -Metal upright
PPE for airborne precautions:
-PAPR and mask -(gown isn't required)
What conditions should be included in a differential diagnosis for calcaneal fracture?
-PF -retrocalcaneal bursitis -tarsal tunnel syndrome -calcaneal spur
Which specific movements does a multi-axial prosthetic foot allow?
-PF & DF -inversion & eversion -IR and ER
What TherEx should be provided for a pt w/ Panner's or OD?
-PROM & AROM -strengthen surrounding joints (arm, shoulder, & scapula) -core exercises -functional or sport-related exercises
In sickle cell anemia, what is the danger of having RBC's that are sickle shaped when they become deoxygenated? (long answer)
-RBC's are unable to pass easily through small arteries and can occlude the vessel and cause infarctions (brain, bones & other organs) -This causes *increased hemolysis* of RBC's in spleen: RBC's have a short lifespan, causes severe anemia, and causes hyperbilirubinemia, jaundice and gall stones. Can also lead to splenomegaly and frequent infections due to damaged spleen. This all results in delayed growth & development and could lead to congestive heart failure.
What conditions indicate the need of a reverse TSA?
-RTC is fully torn -RTC pathology -hx of failed TSA
If someone's hip (or THA?) is recurrently dislocating, what treatment might you consider?
-Spica brace -WB restriction & strict movement precautions -education, ADLs & home evaluation -communicate w/ pt, family & medical team
What are the types of lymphocytes? (3)
-T-cells -B-cells -NK cells
What *education* should you include in your early post-op interventions after a *TKA*?
-WB precautions -gait quality
Tilt table test
-a cardiovascular test used to evaluate the cause of syncope (unexplained fainting) -a person is brought into standing while HR and BP are monitored
What is erythroblastosis fetalis? How does this condition present differently in a first pregnancy compared to a second pregnancy?
-a condition that results when a mother's blood is Rh-, but the father is Rh+ which makes the fetus Rh+ -first pregnancy: Rh+ antigen from fetus enters mother's circulation & mother forms anti-Rh antibodies -second pregnancy: mother's antibodies enter fetal circulation and attach to Rh antigen on fetus RBC's causing hemolysis, results in severe anemia & brain damage in fetus
What are some other conditions that should be included in a differential diagnosis for achilles tendinopathy?
-achilles bursitis -ankle OA -partial achilles rupture -gastrocnemius strain
What are some symptoms of osteoarthritis? (5) (1 notable symptom)
-aching pain w/ weight-bearing -limited ROM -pain limited recreational activities -difficulty walking -*bony enlargement of DIP joints*
What should you do if someone who is hypoglycemic loses consciousness?
-act quickly, they need immediate treatment -injection of glucose or emergency treatment in a hospital is ideal
What is the MOI for triceps tendinosis?
-activities or sports with repetitive, forceful elbow extension -will continue to progress when adequate time is not allowed for tendon healing -instability of shoulder and scap may contribute
With pernicious anemia, what would you expect to see upon microscopic examination of RBC's?
-cells will appear very large (megaloblastic/macrocytic) -cells will be reduced in number in peripheral blood
What are some symptoms of adult rheumatoid arthritis? What are some systemic signs of RA? (1 notable symptom)
-affected joints are: extremely painful, stiff, red and swollen -limited ROM -*eventually joint becomes fixed & deformed* -systemic signs: fatigue, anorexia, mild fever, generalized aching
What are some risk factors for osteoporosis? (8)
-age 50+ yo -dec mobility -sedentary lifestyle -deficit of Ca++, vitamin D, protein -smoking -low BMI -asian or european ancestry -excessive caffeine intake
How do you treat meningitis? (4)
-aggressive antimicrobial therapy -specific treatment for ICP and seizures -glucocorticoids -vaccines
Preventative strategies for WRMSD
-aids & equipment to ease stress -pauses & changes in posture -warm up period
3 types of transmission-based precautions
-airborne -droplet -contact
What are side effects of antihistamines?
-allergic reaction resulting in difficulty breathing and a closing feeling in the throat -dizziness, drowsiness, nausea, dry mouth and muscle aches
What conditions may severe anemia lead to? (2)
-angina -congestive heart failure
Which clinical syndromes of the elbow have symptoms on the *anterior* aspect of the elbow?
-anterior capsular strain -biceps rupture -elbow dislocation -pronator syndrome
What are sx of a pulled elbow?
-arm held in extension and pronation -pain at elbow w/ movement -dec use of arm -can't flex or supinate forearm -may only be minimal swelling
Hypothyroidism puts one at risk for what conditions?
-arteriosclerosis -coronary heart disease
In a dose/response curve, what does it mean to say that the curve is saturated?
-as the dose of the drug inc, the effect will plateau -means even if you inc the dose, there is no further effect
What causes cystic fibrosis? -case study-
-autosomal recessive disorder -mutation in CFTR gene
What education should you provide a pt w/ lateral epicondylitis?
-avoid MOI (grip in wrist ext) during the inflam phase -instructions for athletes (elbow & wrist locked in ext & pron during forehand, hit ball in front of body, use 2 handed backhand)
What are some symptoms of scoliosis? (3)
-back pain -fatigue -uneven shoulders or hips
Which types of WBC's are granulocytes? What are their functions?
-basophils: release histamine -eosinophils: reduce the effects of histamine -neutrophils: phagocytosis
What *mobility* activities should you focus on with a pt acutely post-op THA?
-bed mobility -transfers -gait training -stair training -car transfer training or simulation MUST emphasize adherence to precautions during these activities
How does pain progress in CECS?
-begins during exercise -inc throughout activity -subside 10-20 mins after activity -recovery period will inc over time
What shape do RBC's have? Why?
-biconcave flexible discs -allows them to pass through thin capillaries
What are symptoms of *early* acute hyperglycemia?
-blood sugar > 180 mg/dL -blurred vision -thirsty -*ketones in urine* -dry skin -inc urination -tired (same as DM becoming a medical emergency)
What are symptoms of *late* acute hyperglycemia?
-blood sugar > 240 g/dL -nausea, vomiting -deep rapid breathing -large ketones in urine -fruity breath (same as DM becmoing a medical emergency with further decline)
What are the symptoms of DM becoming a medical emergency due to acute hyperglycemia?
-blood sugar is above 180 mg/dL -blurred vision -thirst -ketones in urine -dry skin -inc urination -extreme fatigue *with further decline:* -blood sugar is above 240 mg/dL -nausea, vomiting -deep rapid breathing -large ketones in urine -fruity breath
How do you diagnose sickle cell anemia? (2)
-blood tests (Hb electrophoresis) -DNA analysis (prenatal and postnatal)
What should be included in a differential diagnosis for plantar fasciitis?
-bone spurs (rule in/out w/ X-Ray) -achilles tendinitis (if pain behind heel more likely than PF)
Increased ICP is common in many neurologic conditions such as: (5)
-brain hemorrhage -trauma -cerebral edema -infection -tumors
List of *acute* neurologic problems Irina covered: (read)
-brain tumors -hemorrhage, ischemia -TIA -CVA/stroke -cerebral aneurysm -infections: meningitis, brain abscess, encephalitis, rabies, tetanus, poliomyelitis -infection-related syndromes: Guillain-Barre syndrome, post-polio syndrome, herpes zoster, reye syndrome
What is fibrinolysis and what is its purpose?
-breakdown of a fibrin clot by an enzyme called plasmin -acts as a protective mechanism to prevent excess clotting
Limitations of AROM:
-can't strengthen muscle group of beyond a 3/5 muscle grade strength -can't achieve normal function of cardiovascular conditioning
How are custom fabricated LE orthoses made?
-casting -measurement -negative mold -positive mold -fabrication -modification
When preforming a differential diagnosis for lateral epicondylitis, what are other conditions you should rule out? (7)
-cervical spondylosis -radial tunnel syndrome -PIN compression (post. interosseous N) -intra-articular loose bodies -tumors -avascular necrosis -osteochondritis dissicans
Which type of cell receptor acts the quickest and why? Where are these receptors often needed in the body?
-channel receptors -b/c they have fewer steps -quick responses are needed in the nervous system
3 types of restraints:
-chemical -physical -behavioral intervention
How do you treat leukemia?
-chemo -biologic therapy (interferons)
What PT interventions can be done for cystic fibrosis? -case study-
-chest therapy (percussion -light exercise -nutrition therapy -meds
Summary of cholera as a G-protein coupled disease.
-cholera toxin enters cell & alters protein Gs (s = stimulatory) -toxin keeps signalling pathway turned on all the time -receptor is bypassed since it doesn't have to be activated to activate Gs -Gs protein has activated its downstream signalling cascade -inc in Gs activity causes inc in water secretion in intestines leading to diarrhea associated w/ cholera
What conditions can lead to vitamin B12 deficiency?
-chronic gastritis or gastric surgery -dietary insufficiency of B12 is very rarely a cause
How do you prepare the pt's skin and where do you place the electrodes for biofeedback? a.k.a. how do you maximize the biofeedback signal?
-clip excess hair -alcohol wipe -coupling agent if needed -record over largest section of the muscle belly -orient electrodes along the direction of muscle fibers
How do you treat a stroke?
-clot-busting agents: tPA -surgery -glucocorticoids -treat underlying problem
PT approaches for obesity patients:
-collaborative decision making and creative problem solving -Min Assist Rule (open, honest dialogue about patient abilities and therapist capacity) -Incremental progression of upright mobility -early planning for discharge
The difference between infection and colonization:
-colonization: presence of bacteria in or on host without tissue invasion or damage (reservoir) -infection: presence of symptoms of infection
2 major reservoirs of C diff in healthcare setting:
-colonized or infected patients -inanimate objects "environment"
What does it mean to say that bilirubin becomes conjugated in the liver during breakdown of RBC's?
-conjugated means to reversibly combine with something -bilirubin is combined with glucuronic acid in the liver before it is excreted in bile
Ergonomic approach for injury reduction
-consider overuse prevention -redesign tasks or environment to minimize risk of injury
What are the MOI for chronic exertional compartment syndrome?
-consistent vigorous exercise -unknown
What are early signs of inc ICP? (4)
-dec level of consciousness -dec responsiveness, lethargy -severe headache -vomiting
What are the benefits of pre-op education before a JA?
-dec pre-op anxiety and pain -dec post-op pain med use -may dec length of stay
What is leukopenia? What type of infection is this associated with?
-decrease in WBC's -associated with viral infection and/or radiation & chemo
What are MT treatment options to consider for lateral epicondylitis?
-deep transverse friction massage -Mill's manipulation -radial head mobilizations -cervical mobilizations
Hoyer lift indications:
-dependent patients -speciality (bariatric) lifts for large patients -consider when there is a prognosis of long term dependence on caretakers -variety of slings available to allow removal of sling after transfer, ADL's such as toileting -allows dependent lift from floor (not ideal but can be done)
When might a calcaneal fracture be treated conservatively?
-depending on severity -extra-articular fracture -treatment of choice for patients 50+ (esp w/ comorbidities)
What is selectivity in terms of drugs?
-describes how much affinity an agonist has for 1 receptor over another -it is a relative term since no drug is completely selective
WeeFIM
-designed for kids between 6 months-7years -3 domains: self-care, mobility, cognition
What are common comorbidities of acromegaly? (3)
-diabetes -high BP -CV disease
What are some risk factors for a stroke? (read)
-diabetes mellitus -high BP -smoking -sedentary lifestyle -congenital malformation of bv -aging (65+)
How do you become iron deficient? (4)
-dietary intake below minimum requirement -chronic blood loss: ulcer, hemorrhoids, cancer, etc. -impaired duodenal absorption of iron -severe liver disease: affects iron storage
What are some symptoms of rabies? (4)
-difficulty swallowing -foaming at mouth -fear of fluids -respiratory failure - death
List the different surgical approaches to a THA:
-direct anterior -anterolateral -direct lateral -lateral transtrochanteric -posterolateral -posterior mini -anterior mini
General treatment guidelines for elbow instability: (read)
-discourage a "no pain, no gain" attitude -avoid lifting, pushing or pulling -gradually reintroduce activities as long as they are pain-free
Limitations of PROM:
-doesn't prevent muscle atrophy or inc. muscle strength -can't improve contractile endurance -can't reduce adipose -limited maintenance of ROM if no functional adjunct
What education should you provide someone w/ a fx of the ME? (little leaguer's elbow)
-don't allow throwing for 4-6 wks -biomechanical analysis -follow the USA Baseball Medical & Safety Advisory Committee recomendations
What does fat secrete? (5)
-leptin -angiotensinogen -resistin -adiponectin -CRP
What are some things that should be considered when designing an orthotic? (read)
-dx -px -comorbidities -height -weight -cost -cosmesis -degree of deformity -degree of correction -musculoskeletal factors -mobility & stability requirements -anticipated functional level
How do you diagnose myasthenia gravis? (3)
-electromyography: test fatigue -serum antibody test: detect antibodies against Ach receptors -Ach esterase inhibitor
What are some potential complications of lung removal?
-empty space will be filled with fluid -one side of rib cage will expand and the other will collapse to compensate resulting in postural issues -tracheal and mediastinal shift
Secondary Parkinson's disease develops due to: (4)
-encephalitis -trauma -vascular disease -drug-induced
What are some symptoms of Cushing's syndrome? (not congenital)
-enlarged abdomen w/ purple stretch marks that may look like ascites -*poor wound healing* -thin skin -muscle weakness -*osteoporosis*, made worse by excess loss of calcium in urine
Describe the physical appearance of acromegaly: (7)
-enlarged hands & feet -thick skull -changes in facial features -can lead to carpal tunnel and arthritis -protruding jaw -large tongue -large shoe or glove size
What are some common elbow injuries that result from overuse?
-epicondylitis -little leaguer's elbow
List the different neurotransmitters that are types of catecholamines. (3)
-epinephrine -norepinephrine -dopamine (DEN)
Multi-facet approach to injury reduction includes....? (read)
-ergonomic approach -engineering approach -standard protocols -algorithms for pt handling -educational model of peer leaders
What protein regulates the production of RBC's? What organ makes this protein?
-erythropoietin -it is made in the kidneys, travels to bone marrow to stimulate production of RBC's when you are in a low oxygen environment
How is the LD of a drug determined?
-ethically can't use humans -these studies are done using in vitro assays such as cell culture -after this, animal studies are done to see when 50% of the animals experience serious side effects
The presence of hypochlorhydria or achlorhydria provides evidence of what condition? This condition is known to cause what type of anemia?
-evidence of gastric atrophy -causes pernicious anemia (hypochlorhydria means low HCl, achlorhydria means complete lack of HCl. HCl is important for gastric function)
What education should be provided to someone w/ a pulled elbow?
-explain the MOI -teach parents how to prevent & treat recurrences
Where is a tophus typically located? (3)
-extensor surfaces of forearm -joint bursae -pinnae of the ear
Contracture risk factors:
-extent & duration of immobilization -neurologic dysfunction -skin integrity
What are some complications that occur due to ankylosing spondylitis? (3)
-eye inflammation -hip/shoulder pain, stiffness -restrictive respiratory impairment
What are some *early* symptoms of hypothyroidism?
-fatigue -mild sensitivity to cold -mild weight gain -forgetfulness -depression -*upper eyelid droop* -thick, brittle nails -dry skin -sparse hair -*myxedema* often vague & unnoticed
What are some general signs of anemia?
-fatigue -pallor: pale face -dyspnea -tachycardia
What are some symptoms of poliomyelitis?
-fever -headache -vomiting -stiff neck -pain -*flaccid paralysis*
List pre-employment screening factors that help to determine the risk for that person injuring themselves in the workplace
-fitness level -genetics -height/weight -strength -age -stress -experience -tolerance of risk -competence
What abnormalities of the foot can place someone at an increased risk for developing plantar fasciitis?
-flat feet -high arches -pronation -abnormal gait (can all result in fascial tissue to become overworked or stretched resulting in tears and inflammation)
How do you assess knee alignment & function in an evaluation for a LE orthotic?
-flexion -genu recurvatum -genu varum -genu valgum
Why is it easy for humans to develop increased intracranial pressure? (2)
-fluids are not compressible, such as CSF or blood -the brain is encased in the skull which is rigid and nonexpendable
What are goitrogens?
-foods that block elements of synthesis of T3 and T4, but increase TSH secretion -can cause hypothyroid goiters when consumed in large quantities Ex: cabbage, turnips, lithium, fluoride
At which anatomical locations does a SMO provide stability?
-forefoot -midfoot -subtalar joint
What should be included in a differential diagnosis for cuboid syndrome?
-fracture or dislocation of the cuboid, calcaneus or forth/fifth metatarsals -peroneal or extensor digitorun brevis tendinopathy -plantar fasciitis -gout
What are the signs of acute leukemia at onset? (3)
-frequent or uncontrolled infections -severe hemorrhage (brain, GI) -signs of anemia
What are the effects of global cerebral ischemia? (3)
-generalized cerebral edema -loss of function -brain death (if not reversed quickly)
What are potential causes of hemolytic anemia? (5)
-genetic deficits (sickle cell) -immune reactions (incompatible blood transfusion) -infections (malaria) -changes in blood chemistry -toxins in the blood
The cause of MS is unknown, but what are some potential causes? (4)
-genetic or environment: inc risk for close relatives of affected pt -change in blood flow to neurons -infection (bacterial or viral) -autoimmune disease
What causes Parkinson's disease? (2)
-genetics -environmental toxins (I think this is primary PD)
Neurons are very sensitive to levels of what 2 substances?
-glucose -oxygen
What are signs/symptoms of cuboid syndrome?
-gradual onset of lateral foot pain -sensation of walking on a small rock -discomfort w/ palpation on the fibular groove on the plantar surface -occasionally the hook of the bone under cuboid breaks or a tear of the plantar ligament produces pain
3 legged prevention stool:
-hand hygiene -standard & isolation precautions -cleaning & disinfection (stool collapses w/out any 1 of these)
What does it mean to say that the protein hemoglobin is a tetramer?
-has 4 globins (2 alpha & 2 beta) -has 4 hemes
What are the 2 random symptoms of polycythemia that have to do with the head that I don't know how to write a question about?
-headaches -visual disturbances
What organs may be compressed due to scoliosis? (2)
-heart -lungs
What is the "use effectiveness" of a drug?
-helps compare 2 drugs in general population -based on the idea that people don't always take drugs exactly as prescribed due to limitations such as a drug can't be taken with alcohol
What parts of a complete blood count (CBC) are done to diagnose iron deficiency anemia?
-hemoglobin -hematocrit -MCV -serum iron -microscopic examination
What are side effects of decongestants?
-high BP -insomnia -irritability -difficulty urinating
For an above the knee amputation, focus on these motions:
-hip extension -hip adduction (to offset flexion and abduction of the hip)
For a below the knee amputation, focus on these motions:
-hip extension -knee extension (to offset hip flexion and knee flexion)
How is a heel spur diagnosed?
-history of pain and tenderness localized to area of bony involvement -X-ray to identify bony protrusion on calcaneus
What are some characteristics of a fracture? (read)
-history of trauma -obvious deformity -swelling -tenderness -altered sensation -inability to move broken limb -crepitus -pain (can cause shock)
What are some symptoms of a dislocation? (6)
-history of trauma -severe pain -swelling -tenderness -deformity -limited ROM
What are some possible psycho-social issues that need to be attended to with patients who have cancer?
-home life -social life -hobbies that patients enjoy -friendships -sports they want to get back to
What may cause a shoulder impingement? (2)
-hypomobility -hypermobility
Which *modalities* should you include in your early post-op interventions after a *THA*?
-ice and positioning -edema management
How do you treat polycythemia? (3)
-identify cause (primary or secondary) -drugs or radiation (suppress bone marrow activity) -periodic phlebotomy (draw blood & run tests)
When diagnosing leukemia, what would you expect to see with a peripheral blood smear?
-immature WBC's -altered/increased number of WBC's -decreased number of RBC's and platelets
Are blast cells mature or immature cells? Are they nucleated?
-immature, they are a precursor to mature blood cells -yes, they have huge nuclei
What immunizations should you give a child with sickle cell anemia?
-immunizations for pneumonia, influenza and meningitis since their ability to fight infections will become hindered due to damage to the spleen
What are some symptoms of dementia? (7)
-impaired: cognitive skills, thinking, judgement, learning, memory -confusion -behavioral & personality changes
Reactive strategies for WRMSD
-in response to injury or perceived risk of injury -substituting rx modality, change in physical technique -Ex: use of e-stim rather than MFR or substituting lift system for otherwise dependent lift transfer
How do you treat acute hypoglycemia? After treating, you wait ______ minutes and test their blood sugar again, if its less than ______ you should repeat the treatment, it its greater than ______ you should _______________
-inc blood sugar with 15 g fast acting sugar (3 glucose tablets, 1/2 cup fruit juice, or 5-6 pieces of hard candy) -wait 15 min and test blood sugar again, if its less than *70 mg/dL* then repeat the steps, it its greater than 70 then have them eat a meal or snack
Side effects of methylxanthines include:
-inc myocardial work load -heightened susceptibility to ventricular and supraventricular dysrhythmas CNS -stimulation -confusion -irritability -restlessness
What is leukocytosis? What type of infection is this associated with?
-increase in WBC's -associated with inflammation or bacterial infection
Contraindications for PROM:
-increase of symptoms or pain with PROM -caution with patients who have severe osteoporosis or those who have highly suspect bone integrity -gross joint instability
How does polycythemia affect blood pressure and consequently the heart?
-increases BP -causes hypertrophied heart
How does polycythemia affect blood volume and viscosity? What are potential consequences of this?
-increases both -blood vessels become distended -blood flow becomes sluggish -could lead to hemorrhages, thromboses, & infarctions
What are some contraindications for a JA?
-infection -severe/uncontrolled HTN -progressive neuro disease -dormant renal or respiratory insufficiency -dementia
What are some symptoms of osteomyelitis? (8)
-inflammation -edema -fever -fatigue -weakness -aching pain -guarding behavior -*inc pain w/ weight bearing*
What are some symptoms of sprains & strains? (4)
-inflammation -marked swelling -discoloration (hematoma) -limited strength or ROM
When does a person have pain from heel spurs?
-intermittent or chronic -knife-like or pin sticking into the bottom of the foot at first steps in the morning, dull ache later in the day -sharp pain after sitting for prolonged periods of time -pain w/ activity
What role does the protein Ras play in tyrosine kinase receptors?
-involved with growth hormone receptors -ligand binds to receptor, activates adapter protein which activates Ras protein -Ras activates MAP kinase which induces transcription of certain genes that lead to cell division
Summary of whooping cough as a G-protein coupled disease.
-involves protein Gi (i = inhibitory) -pertussis toxin enters cell & alters Gi so it can't inhibit its target & cascade stops here -this blockage of the Gi pathway in the lungs results in an inc of secretions in bronchial tubes that are difficult to clear resulting in whooping cough
Production & maturation of RBC's depends on availability of what substances?
-iron -B12, B6, B9 -folic acid
What could cause decreased blood flow to the brain that results in a CVA? (2)
-ischemia: occlusion of cerebral bv by an atheroma or embolus -intracerebral hemorrhage: rupture of cerebral artery in pt w/ high BP
What type of genetic disorder is hemophilia A? What population is it most common in?
-it is a X-linked recessive trait -means it is most prominent in men -women are often carriers, but it is rare that the disorder manifests in women
What is a multiple myeloma (a.k.a. plasma cell myeloma)?
-it is a neoplastic disease of unknown cause -involves inc production of plasma cells in bone marrow -production of other blood cells is impaired
What role does the tyrosine AA in a tyrosine kinase receptor play?
-it is phosphorylated by a kinase activity when the receptor is activated -this causes phosphorylation of the receptor itself & downstream phosphorylation of molecules initiating a cascade
Why is hydroxyurea used to treat sickle cell anemia?
-it stimulates the production of fetal Hb -reduces frequency of sickle cell crisis
What are some symptoms of infectious (septic) arthritis?
-joints are red, swollen & painful -limited ROM
High risk areas for contracture:
-knee flexion -hip flexion -plantar flexion -neck rotation -shoulder extensors, adductors, internal rotators
How do you become deficient in vitamin B12 in general? What role does intrinsic factor play?
-lack of absorption of B12 due to lack of intrinsic factor -intrinsic factor is secreted by gastric mucosa and is required for intestinal absorption of B12
If someone has weak dorsiflexors, what will their gait pattern look like?
-lack of pick up of toes during swing, drop foot -compensate w/ hip & knee flexion in the swing phase to clear the foot
What are some potential causes of Rickets? (4)
-lack of sun exposure -lack of being outside -lactose intolerant -genetic: kidney disorder
What are purpura and ecchymoses? What type of disorder are they a symptom of?
-large areas of bruises on skin -symptom of a blood-clotting disorder
What are typical symptoms of lateral epicondylitis?
-lateral elbow pain w/ gradual onset -pain w/ wrist ext -weakened grip strength
Which clinical syndromes of the elbow have symptoms on the *lateral* aspect of the elbow?
-lateral epicondylitis -LCL injury -capitulum fracture -Panner's disease -Osteochondritis dissicans -Radial head fx
Air pals are used for:
-lateral transfers -need 2 people to control the slide -make sure breaks are on -looks like an air mattress
Educational modeling for injury prevention
-leadership must model safe practice for others -solutions should be compatible with work flow -solutions should be compatible to operate at edge of risk & seek most efficient approaches
The reduced oxygen transport that is characteristic of all types of anemia causes what effects in the body? (2)
-less energy production in all cells: cell metabolism & reproduction is diminished -decreased regeneration of epithelial cells: GI ulcers
Risk factors for positioning for pressure relief:
-level of independence -orientation/level of consciousness -continence -sensory function -nutrition -girth
Do channel receptors have long or short signalling cascades?
-little or no signalling cascade -receptor activated by drug, alters shape of receptor, receptor changes a function in cell
What are the signs & symptoms of elbow instability?
-locking, catching or clicking of the elbow -sliding or shifting -feeling like your elbow might pop out of place (usually when pushing off from a chair) -athletes might have pain when throwing OH or have loss in throwing velocity
How does obesity effect acute hospital care?
-longer hospitalizations -poorer outcomes at discharge -more re-hospitalization and re-injury -higher mortality
What are zinc fingers? What do they do?
-loops of amino acids -held together in shape of fingers by interactions w/ zinc -zinc fingers are a portion of a nuclear receptor that interacts w/ the DNA by either activating or inhibiting transcription of a gene
What can triceps tendinosis lead to? (3)
-lost reaction time -increased work related disability claims -dec quality of life
What are symptoms of hypothyroidism later on?
-low HR -dec GI motility -slow neurologic functioning -dec body heat production -achlorhydria: absence of HCl from gastric juice -*symptom complex like fibromyalgia* (muscle aches & tender points) but is resolved with replacement therapy so it is not true fibromyalgia -*inflammatory arthritis* that is indistinguishable from rheumatoid arthritis
Benefits of PROM:
-maintain ROM to minimize contracture formation -minimize adhesion formation, promote joint and joint capsule integrity -inhibit or reduce pain -promote and maintain local circulation, reduce edema
Benefits of AROM:
-maintain muscle elasticity, strength, contractile endurance -increase local circulation, DVT prevention -increase joint motion and sensory awareness -maintain, possibly improve cardiopulmonary functions -decrease edema, especially of the UE -promote structural integrity of tendon-bone interface
PPE for droplet transmission precautions:
-mask -(gown/gloves not required)
What are signs/symptoms of a heel spur?
-may have no symptoms (50% of ppl don't) -pain
Flexible ROM limitation:
-may respond to stretching or positioning -BUT these gains are only sustained through functional use
During remission of MS, what happens to neural function?
-may return to normal for a short period of time -inflamm may subside
What does a sweat test measure and then diagnose? -case study-
-measures amt of chloride (salt) in sweat -high amt = positive -diagnoses cystic fibrosis
What are typical symptoms of medial epicondylitis?
-medial elbow pain -pain with wrist flexion and pronation
Which clinical syndromes of the elbow have symptoms on the *medial* aspect of the elbow?
-medial epicondylitis -MCL injury -*ulnar neuritis* -fracture
What are some risk factors for a distal biceps tendon rupture?
-men 30+ y.o. -smoking -corticosteroid medication use
What are side effects of parasympathetic blockers?
-mental depression (w/ low doses) with high doses: -delirium -hallucinations -decreased GI activity
With iron deficiency anemia, what would you expect to see upon microscopic examination of RBC's?
-microcytic (small cells) -hypochromic (lacking color)
Describe a 1st degree muscle tear:
-mild pain -no significant loss of strength or ROM
How do channel receptors work?
-molecule binds to ion channel & activates it -opens pore through center of receptor -allows ions to cross membrane
Which types of WBC's are agranulocytes?
-monocytes: become macrophages & do phagocytosis -lymphocytes: release cytokines, participate in immunity
What are some symptoms of Huntington's disease? (5)
-mood swings -personality changes -restlessness -choreiform (jerky) movements in arms and face -intellectual impairments
Describe the *knee joint* of an ideal candidate for a unicompartmental knee arthroplasty:
-more than 90 deg knee flx -less than 15 deg varus/valgus deformity -mobile patella -intact tibial plateau & femoral condyles -satisfactory ligament stability
What information can we get from studying the morphology of cells? How is this used to diagnose blood disorders?
-morphology shows the size, shape, uniformity and maturity of cells -can observe this with blood smears to distinguish types of anemia
Why is it ironic that obesity is a relative contraindication for a JA?
-most people getting a JA are obese and that is the reason they are having to get a JA -some surgeons will make them lose weight before they'll do surgery
What type of leukemia is characterized by multiple tumors in the bone? What symptoms does this cause?
-multiple myeloma -causes loss of bone and severe bone pain
List of *chronic* neurologic disorders Irina covered: (read)
-multiple sclerosis (MS) -Parkinson's disease -amyotrophic lateral sclerosis -myasthenia gravis -Huntington's disease -dementia -AIDS dementia -Alzheimer's disease
What *strengthening* activities should you include in your *late* post-op interventions after a *THA*?
-muscle groups: hip flexors, extensors & abductors -include resistance training if possible
Describe a 3rd degree muscle tear:
-muscle unable to contract -great deal of internal bleeding
What does amyotrophic mean? What does sclerosis mean?
-muscle wasting -hardening (of lateral corticospinal tract in ALS)
Examples of airborne precautions:
-negative airflow room -closed door
How does cortical atrophy happen in Alzheimer's disease? (2)
-neurofibrillary tangles -amyloid plaques
What are some risk factors for *dislocation* after a THA?
-neuromuscular impairment -cognitive dysfunction -fracture -hx of surgery -posterior approach -small femoral head size -prosthetic alignment -surgeon experience
What types of stimuli could generate an action potential? (4)
-neurotransmitters -light -sound -pressure
What is the term used to describe leukocytosis of: neutrophils, eosinophils, basophils, lymphocytes, and monocytes
-neutrophilia -eosinophilia -basophilia -lymphocytosis -monocytosis
How do you diagnose Alzheimer's disease?
-no definite test -exclude other disorders -medical & psychological history
How does ALS affect the following: -inflammation -cognition -sensory neurons -motor neurons
-no inflamm around nerves -cognition not impaired -sensory neurons unaffected -eye muscles unaffected, but other motor neurons are affected
How do you treat Huntington's disease?
-no therapy to slow progress of disease -only symptomatic therapy
What are 3 different classifications for radial head fractures according to Mason?
-nondisplaced -displaced w/o comminution -comminuted
Dwarfism: how does it affect... -body proportions -intelligence -skeletal maturation & puberty
-normal body proportions -normal intelligence -delayed skeletal maturation & puberty
What fasting plasma glucose levels correspond to normal, insulin resistance syndrome (IRS) and diabetes? (tests should be done on 2 different days prior to diagnosis)
-normal: below 100 mg/dL -IRS: 100-125 mg/dL -*diabetes: above 126 mg/dL*
What are signs/symptoms of chronic exertional compartment syndrome?
-numbness and tingling -limited ROM -visible bulge in the muscle -weakness -aching, burning, cramping
What are some risk factors for developing an infection after a TKA?
-obesity -anemia -malnutrition -diabetes DAMO
What are some *relative* contraindications for a JA?
-obesity -diabetes -under 50 or over 90 yrs old (many people who fit these criteria still have a JA)
What causes excessive lordosis? (3)
-obesity -discitis (rare, inflamm of IV discs) -slipping forward of vertebrae
DIC is often a complication of many primary problems. What are some of these primary problems? (4)
-obstetric complications -infections -carcinomas -major trauma
What is an Addisonian crisis? -who does it occur in -due to dec in ______________ -symptoms
-occurs in someone who has previously been diagnosed with Addison's disease -involves a *serious decrease in the production of cortisol and aldosterone* (gluco- & mineralo- corticoids) -symptoms: weakness, low BP, anorexia, nausea, emotional disturbances, etc.
Positioning for amputation patients:
-offset prolonged sitting with prone positioning -don't position with knee flexion in bed
What are signs and symptoms of a distal biceps tendon rupture?
-often a "pop" at the elbow -pain (severe at first but subsides after a week or two) -swelling -bruising -weakness in elbow flexion and supination -"popeye" deformity -gap in soft tissue at the anterior elbow
Where is each end of the G-protein coupled receptor located?
-one end in the ECF -receptor crosses membrane of cell 7 times -tail (other end) is inside the cell
What conditions are all included in Little Leaguer's elbow? (6)
-osteochondritis dissecans (of capitulum or radial head) -*apophysitis or fracture of ME* -UCL tear -ant capsule injury -olecranon trauma -growth plate fracture & growth abnormalities
What is the ideal age and weight of a patient for a TKA?
-over 60 yrs old -under 180 lbs
What causes acute hypoglycemia? (7)
-overtreatment w/ insulin -late or missed meal -more than normal amt of activity -exercising when insulin action is peaking -stress -drinking alcohol without food after insulin injection -delayed gastric emptying
What are some MOI for achilles tendinopathy?
-overuse -bone spur -sudden inc in activity -altered lower limb biomechanics -footwear -posture/leg length -impaired mm performance -trauma
In hemoglobin, what do oxygen, carbon dioxide and carbon monoxide bind to?
-oxygen: to iron atom in each heme -CO2: to a globin chain -CO: to iron atom in each heme
What are the differences between the 3 forms of hemoglobin: oxyhemoglobin, deoxyhemoglobin and methemoglobin?
-oxyhemoglobin: binds O2, bright red in color -deoxyhemoglobin: dissociated from O2, dark, bluish red -methemoglobin: can't bind O2, Fe+++, brownish red
What are signs/symptoms of acute compartment syndrome?
-pain above what the injury would indicate -muscle feeling tight/full -tissue discoloration -numbness or paralysis indicate permanent tissue injury
What are some symptoms of Rickets? (lots)
-pain in extremities, pelvis, spine ---deep pain, worse w/ palpation -slow growth -short stature -inc bone fractures/deformities -poor teeth -muscle cramps -waddling gait other picture: -soft spot on baby's head slow to close -"bony necklace" -curved bones -big, lumpy joints -bowed legs
What are signs/symptoms of a radial head fracture?
-pain on outside of elbow -swelling in elbow -difficulty with flexion/extension -inability or difficulty with pronation/supination
What are some symptoms of a repetitive strain injury? (3)
-pain that interrupts sleep -weakness -numbness
What are common sx of Panner's disease and Osteochondritis dissecans?
-pain/swelling of lateral & anterior elbow -limited ROM -clicking, locking (osteochondritis)
What are some symptoms of herpes zoster (shingles)?
-painful skin rash -paresthesia (tingling)
What are some signs of chronic thyroiditis?
-painless, enlargement of the gland (*goiter*) -irregular surface, which occasionally causes pressure on surrounding structures. This pressure may cause *dysphagia* or respiratory distress
What are some diagnostic tests for compartment syndrome?
-palpation -imaging (MRI or NIRS) -compartment pressure testing
What are 2 exercises you could give a patient who has medial epicondylitis as part of their HEP?
-passive stretch exercise -grip strength tool
Indications for AROM:
-patient is able to voluntarily contract, control and coordinate movement -functional goals and abilities necessitate AROM
Efficacy, in terms of drugs, does not account for what concept?
-pharmacokinetic properties -Ex: a drug is effective but can't reach the site
What are petechiae? What type of disorder are they a symptom of?
-pinpoint flat red spots on skin & mucous membranes -symptom of a blood-clotting disorder
What is the difference between plasma and serum?
-plasma: what's left from blood when you take the cells out -serum: plasma without fibrinogen
Which type of cells are essential for hemostasis/clotting? Why?
-platelets -because they initiate the coagulation cascade and plug small breaks in blood vessel walls
What are signs and symptoms of triceps tendinosis?
-point tenderness at the olecranon process -inc symptoms with resisted elbow extension (X-ray can be performed to rule out other conditions)
What are some symptoms of diabetes insipidus?
-polydipsia (excess thirst) -nocturia -*dehydration* -constipation -muscle weakness -dizziness -low BP
Pressure ulcers are caused by:
-poor circulation of fatty issues -limited ability to independently reposition or tolerate pressure relieving positions
What causes excessive kyphosis? (5)
-poor posture -spina bifida -congenital defects -spinal tumors or infections -Scheuermann's disease
What might be included in the HEP for a patient w/ Panner's or OD?
-postural correction exercises -strengthening of scap muscles -dynamic exercises applied to sport w/ instructor
Where are the preganglionic and postganglionic neurons located in an autonomic neuronal pathway?
-preganglionic: CNS -postganglionic: PNS
Which type of polycythemia is a neoplastic (cancer) disorder? How does this affect erythropoietin levels?
-primary -inc production of RBC's and other cells in bone marrow -serum erythropoietin level is low
Droplet precautions:
-private room -cohort patients (3 ft separation) -doesn't require special ventilation -door doesn't have to be closed
What type of disorder is Huntington's disease?
-progressive neurodegenerative disorder -also an inherited disorder, autosomal dominant
What are possible MOI for olecranon bursitis?
-prolonged pressure (leaning on elbow against hard surface) -trauma (direct blow to olecranon) -infection -other medical conditions (gout, RA)
How do you assess foot alignment & function in an evaluation for a LE orthotic?
-pronation -supination -skeletal deviations: hallux valgus
What are the steps of the coagulation cascade after the intrinsic and extrinsic pathways converge? (5)
-prothrombin activator activates prothrombin -prothrombin is cleaved into thrombin -thrombin cleaves fibrinogen into fibrin -fibrin makes molecules stick to each other to form a clot -cross-linking makes the clot stable
Examples of trim lines: (read)
-proximal -anterior -ankle -foot -metatarsal (picture of a posterior leaf spring)
Why is positioning done? (4)
-pt comfort -therapeutic benefit -pressure relief -joint integrity
Should biofeedback be used with patients who are cognitively impaired?
-pt needs to be aware enough to understand the feedback -but, a cognitively disabled person who may respond well to "novelty" biofeedback should not be overlooked
Germicidal wipe disinfectant contact times: purple, white, orange and red lid tops
-purple: 2 min -white: 3 min -orange: 4 min -red: 5 min
What is desensitization in terms of drugs?
-rapid decrease in responsiveness of a cell to a drug -cell changes the receptor so that it won't bind the drug w/ as high affinity or has less activity once stimulated Ex: phosphorylating the receptor to block its activity -one way cells control drug interactions
Sickle cell anemia is a genetic condition. Is it a dominant or recessive mutation of hemoglobin? Does this mean homozygotes or heterozygotes are affected?
-recessive mutation in Hb (written as HbS) -homozygotes are affected -heterozygotes are carriers
What is chronic exertional compartment syndrome?
-recurrent syndrome characterized by pain/disability during exercise or work, but relieved when the activity is stopped -develops over days or weeks -usually not dangerous
List high risk tasks for a PT
-repositioning pt in bed/chair -feeding bedridden pt -making an occupied bed -bathing/dressing a pt -putting stockings on a pt tasks that are complex, with multiple steps
The rules regarding restraints:
-requires DR order, renewed every 24 hrs -face-to-face evaluation every hour -exhausted restraint alternatives
Characteristics of VRE: (3)
-resistant to vancomycin -can live on surfaces for long amt of time -patients with this contaminate their immediate environment
What are 2 special tests to help diagnose medial epicondylitis?
-resisted wrist flexion -passive stretch
What education should you provide a pt with medial epicondylitis?
-rest & activity modifications -avoid MOI (wrist flx & forearm pronation)
For neuro patients, if static positioning is not enough, use positioning in conjunction with:
-resting splints -ROM -*weight bearing and functional activities*
What are some symptoms of Parkinson's disease? (4) ***
-resting tremors -muscular rigidity -difficulty initiating movement -postural instability
What are the overall goals of PT for a patient after a joint arthroplasty?
-restore function -decrease pain -gain muscle control/strength
What are the MOI for calcaneal fractures?
-result of trauma and high-impact situation (axial trauma - falls from height, MVA) -may occur in workplace -also possible with ankle sprain or stress fracture
What information can we get from studying reticulocyte count? (how well what structure functions?)
-reticulocytes are precursors to RBC's *** -this can give us an assessment of bone marrow function
Bed mobility includes the following maneuvers:
-rolling -scooting to HOB -scooting to EOB -supine to sit at EOB -supine to long sit
Which type of polycythemia is considered erythrocytosis? How does this affect erythropoietin levels?
-secondary -inc erythropoietin secretion and RBC's in response to prolonged hypoxia -compensation mechanism to provide more oxygen carrying capacity
Outsourcing strategies for WRMSD
-seek additional help -shift workload
What are symptoms of acute leukemia in general? (4)
-severe & steady bone pain -weight loss & fatigue -enlarged lymph nodes, spleen, and liver -headache, visual disturbances, drowsiness, vomiting
Contraindications for AROM:
-severe cardiopulmonary dysfunction -unhealed, unprotected fracture site, surgical site or site of soft tissue trauma -caution with acute inflammation of involved joint -patient tolerance: increase of symptoms of pain or substitution patterns
Describe a 2nd degree muscle tear:
-severe pain -muscle partially contracted -substantial loss of strength and ROM
Describe the appearance of a pt who is laying supine and has dislocated their THA:
-shortened limb -hip IR -"hurts like hell" Jason said this is very recognizable
What are some risk factors for type 1 diabetes?
-siblings have type 1 DM -parents have type 1 DM
Standing transfer indications:
-significant LE weakness/LE buckling upon standing -performing transfers with assistance of 1 person -less than 250 lbs -good to fair trunk control -cognitively capable of following basic functional commands
Indications for PROM:
-significant weakness, paralysis, comatose -pain limited AROM -prohibited active muscle contraction due to surgical procedure, trauma -tone reduction -sensory awareness, stimulation
What does it mean to say that pernicious anemia is a type of megaloblastic anemia?
-since the vitamin deficiency results in enlargement, it makes this a type of megaloblastic anemia -the specific deficiency of B12 or B9 makes it pernicious anemia
What can hormones bind to other than cell membrane receptors?
-sites in cytoplasm -nucleus -possibly other organelles
What are some symptoms of tetanus?
-skeletal mm spasms -jaw stiffness ("lockjaw") -difficulty swallowing -respiratory failure
When fatigue interferes with the following it is considered problematic:
-sleep quality -cognition -stamina -emotional reactivity -control over body -social interaction
What is down regulation in terms of drugs?
-slower process -involves dec # of receptors on membrane -once agonist binds to receptor & its action is induced, the receptor is internalized into cytoplasm of cell to be recycled or completely degraded -this dec # of receptors can last for days
Which organs remove old or damaged cells, including RBC's?
-spleen -liver
Standard and transmission-based precautions are designed to prevent:
-spread of germs from the patient to you and other way around -try to contain the source
What are potential causes of a brain abscess? (4)
-spread of organisms from ear, throat, lung or sinus -septic emboli -acute bacterial endocarditis -site of injury/surgery
What type of waveform is used with MES?
-square waveform -either monophasic w/ periodic reversal of polarity or biphasic
What are signs/symptoms of plantar fasciitis?
-stabbing pain that usually occurs with your first steps in the morning, with movement the pain normally decreases but can return after long periods of standing or rising after sitting -located close to where the fascia attaches to the calcaneus -burning, stabbing or aching pain in the heel of the foot
What is hemostasis?
-stopping of bleeding/clotting
What are some MOI for heel spurs?
-strains of foot muscles and ligaments -stretching of the plantar fascia -running, jumping, impact injuries (common in athletes) -repetitive overuse -other inflammatory diseases
What *strengthening and ROM* activities should you include in your *late* post-op interventions after a *TKA*?
-strength: muscle control & balance, emphasize functional activity -interventions to inc ROM: modalities, soft tissue mobilization
What TherEx should be provided to treat apophysitis or a fx of the ME?
-strengthening: esp for those w/ hypermobility -core strengthening
What types of TherEx might you use to treat lateral epicondylitis?
-stretching -strength training -*eccentric* muscle training
What types of TherEx might you use to treat medial epicondylitis?
-stretching -strength training -*eccentric* muscle training (same as LE)
What are signs/symptoms of a calcaneal fracture?
-sudden pressure pain in heel of foot -swelling, bruising -hematoma and edema -difficulty walking or WB -inability to move foot (can use X-ray or CT to diagnose)
How do you treat a cerebral aneurysm? (2)
-surgery before rupture -anti-hypertensive drugs
How do you treat a brain abscess? (2)
-surgical drainage -antimicrobial therapy
What are signs/symptoms of olecranon bursitis?
-swelling (first) -pain (with stretching of bursa) over olecranon, which worsens with pressure -redness/warmth (if due to infection)
How does the body try to compensate for anemia?
-tachycardia -peripheral vasoconstriction
Stacia's "creative steps" to avoid being fat:
-take the stairs -park as far away as possible from the building -walk when you're on the phone -deliver a message in person -instead of a lunch meeting, have a walking meeting
3 Buckets of Risk
-task -self (pesky human factor) -context (organizational issues that dictate the environment and commitment to safety)
What is the ED50 of a drug?
-the dose at which 50% of people report they had a positive response to the drug -also called therapeutic dose or TD50
What is the LD50 of a drug?
-the dose at which 50% of people taking the drug have adverse effects -LD: leathal dose -also called median toxic dose
What does potency mean in terms of drugs?
-the dose of a drug that produces a response -a more potent drug requires a lower dose to produce the same effect
What is the 50% effect level of a drug?
-the dose required to produce 50% of the maximal effect
"Why would a member of the Health Professions team need to know the specifics of the molecular interactions b/w a drug and its receptor?"
-the understanding of all pharmacological principles starts at the interaction of the drug w/ its receptor -w/out an understanding of this interaction, you won't be able to categorize drugs & you'll be reduced to memorizing drugs rather than figuring out their effects based on your understanding of physiology and pharmacology
What can happen as a result of the excessive clotting and bleeding involved with DIC?
-thrombi and infarcts -widespread, uncontrollable hemorrhaging -hypotension resulting in circulatory shock
What protein stimulates the production of platelets? What organ makes this protein?
-thrombopoietin -made by liver
Describe the typical deformity that takes place in the hands in adult rheumatoid arthritis:
-thumb: boutonniere deformity -digits: *ulnar drift* and ankylosis of the joints
What is acute compartment syndrome?
-tissue pressure becomes greater than the venous pressure, resulting in impaired blood flow -tissue ischemia -rapid development over hours or days -medical emergency
Epoetin alfa as a blood therapy is used for what purpose?
-to treat anemia related to cancer -to treat chronic renal failure
Bone marrow transplants as a blood therapy is used for what purpose?
-to treat cancers affecting bones -to treat severe immune deficiency -to treat severe blood cell diseases
Whole blood, packed RBC's and packed platelets as a blood therapy is used for what purpose?
-to treat severe anemia -to treat thrombocytopenia (dec platelets)
What is a complete blood count (CBC) and what information does this diagnostic test tell us?
-total count of RBC, WBC and platelets -differential count of WBC -hemoglobin, hematocrit, & mean corpuscular volume -used to diagnose blood disorders in general
What types of blood cells can pluripotent stem cells differentiate into?
1. *myeloid stem cells*: become blast cells and then RBC or any type of WBC besides lymphoctes 2. *lymphoid stem cells*: become blast cells and then lymphoctes
What are contraindications for HVPC? (11)
1. *osteomyelitis* 2. heavy scarring 3. thick adipose tissue 4. extreme edema 5. electronic implants 6. over transcranial area 7. over ant. cervical area 8. over transthoracic area 9. over neoplastic area 10. over hemorrhagic area 11. over pregnant abdomen/lumbar
What is the MOI of posterolateral rotatory instability of the elbow?
1. *trauma or dislocation* usually from a FOOSH 2. LCL instability 3. iatrogenic causes
How does an energy storage & return prosthetic foot work?
1. PF on initial contact 2. Internal keel structure absorbs energy during mid & terminal stance 3. Releases energy at pre-swing to provide smoother gait
What are indications for HVPC? (4)
1. Pain 2. Edema 3. muscle Weakness 4. Wound management PEWW
What are some specific examples of energy storage & return prosthetic feet for K3 users? (5)
1. Energy Storing foot (looks like a SACH w/ hardware in it) 2. Dynamic Response w/ multi-axial ankle unit 3. "Flex Foot" (long spring) 4. "Flex Walk" (short spring) 5. Shank Foot (powerful)
What are the 3 types of cell membrane receptors?
1. G-protein coupled receptors 2. tyrosine kinase receptors 3. channel receptors
What articulations occur within the knee joint? (3)
1. Medial femur-tibia 2. Lateral femur-tibia 3. Anterior femur-patella
What are the options for pain management after a JA?
1. PCA: pt controlled analgesia 2. epidural: indwelling 3. femoral N block: indwelling or injection 4. oral pain meds: can contribute to post-op nausea, dizziness, constipation, etc.
What are the 3 different types of encephalitis?
1. Western equine encephalitis 2. St. Louis encephalitis 3. West Nile fever
According to the Wells Prediction Rule Chart, what are some risk factors for a *DVT*? (10, each is worth one point)
1. active cancer 2. paralysis, paresis or immboilization of LE 3. bedridden for 3+ days or major surgery w/in previous 12 wks that required anesthesia 4. localized tenderness along distribution of deep veins 5. swelling of entire leg 6. calf swelling at least 3 cm larger than unaffected LE 7. pitting edema confined to bad LE 8. collateral superficial veins (non-varicose) 9. previous DVT 10. alternative diagnosis is at least as likely as a DVT (-2 pts) "ashley pennington believes lions scare cute purple cow-pigs aggressively" high risk: 2+ points mod risk: 1-2 points low risk: <1 point
In order for someone to be able to use a KAFO orthosis, what requirements must they meet? (2)
1. adequate cognitive function 2. hip flexion & extension strength at least 3/5
What beneficial effects does MES have? (6)
1. aids in wound healing 2. inc cell proliferation & motility 3. inc growth factor receptor levels 4. enhances electrical potential gradients of stimulated cells 5. collagen synthesis 6. DNA synthesis
Where does heparin block the coagulation cascade?
1. blocks conversion of prothrombin to thrombin 2. also blocks conversion of fibrinogen to fibrin
What are 2 advantages of a knee unicompartmental arthroplasty?
1. bone conserving: benefits younger pts 2. post-op rehab is shorter that a TKA
What are 5 possible causes of avascular necrosis?
1. can be idiopathic or congenital 2. sickle cell disease 3. fatty deposits or air bubbles 4. complication post-surgery 5. severe trauma (dislocation or fracture)
What are the functions of a *heel* rocker in a prosthetic foot? (4)
1. control PF 2. shock absorption 3. dec knee flexion moment 4. maintain forward progression
What are the 2 types of TSAs?
1. conventional 2. reverse (normal ball & socket arrangement is switched)
What are the 4 possible surgical interventions for avascular necrosis?
1. core decompression 2. bone transplant 3. bone reshaping 4. joint replacement
What are the causes of anemia? (4)
1. deficiency of a required nutrient (Ex: iron) 2. impaired bone marrow function 3. blood loss 4. excessive destruction of RBC's
What is the MOI for a medial epicondyle fx? (little leaguer's elbow)
1. excessive valgus stress 2. hyperextension 3. overuse may be caused by: -high pitch volume -early use of the curve and slider -inadequate instruction of biomechanics -lack of conditioning
What are the main functions of the foot & ankle joints? (3) (what does a prosthetic foot/ankle need to be able to do?)
1. force attenuation 2. ground accomodation 3. rigid lever arm absorbs shock on heel strike, adapts to ground surface in mid-stance and acts as a rigid lever for push off
What are the functions of a *forefoot* rocker in a prosthetic foot? (3)
1. forefoot locks & becomes rigid 2. heel rise against a rigid forefoot lever 3. energy storage in the PF
What are the different types of ankle foot orthoses (AFOs) we learned about?
1. ground reaction 2. patellar tendon bearing 3. solid ankle 4. semi-solid ankle 5. posterior leaf spring 6. articulated (7. metal upright)
What are the 3 steps to the Cobb Method of angle measurement in scoliosis x-rays?
1. identify upper and lower ends of vertebrae 2. draw lines extending along vertebral borders 3. measure Cobb Angle directly or geometrically
Which types of forces are *vertical shock absorbers* for prosthetic feet good at reducing? Which forces are they good at improving?
1. impact forces during stance 2. sheer forces w/in the socket 3. improves prosthetic rotational forces at heel strike
What do glucocorticoids do to control asthma long term? (6)
1. inhibit the migration of leukocytes and mast cells 2. reduce tissue stores of histamine and other mediators 3. stabilize mast cell membranes 4. supress kinin activity 5. potentiate catecholamine activity 6. reduce activity of phophodiesterase (enzyme that inactivates cAMP)
List the 4 types of anemia
1. iron deficiency 2. vitamin B12 deficiency 3. aplastic 4. hemolytic
What are the different types of knee ankle foot orthoses (KAFOs) we learned about?
1. locked knee 2. posterior offset 3. stance control
Pharmacodynamics is the study of what 3 things?
1. mechanism of action of drugs 2. therapeutic and toxic effects of drugs 3. relationship b/w chemical structure and activity of a drug
Primary malignant brain tumors: 1. defined or undefined margins? 2. invasive or noninvasive? 3. projections or no projections into adjacent tissue? 4. difficult or not to remove?
1. no well-defined margins 2. invasive 3. irregular projections 4. difficult to totally remove
What are the 2 types of high tibial osteotomies?
1. open wedge: add in piece of bone 2. closing wedge: take out piece of bone
Genetic testing is strongly considered when a patient meets what 3 criteria?
1. personal or family history that suggests an inherited cancer risk condition 2. the test results can be adequately interpreted (good test for that cancer) 3. The results provide information that would guide a person's future medical care
What are the 3 types of recurrent elbow instability?
1. posterolateral rotatory instability 2. valgus instability 3. varus posteromedial rotatory instability
What are the 4 areas of priority in fast-tracking recovery from a JA?
1. pre-op education 2. nutritional supplementation 3. pain management 4. early mobilization
Why might you choose biofeedback as an intervention?
1. prevent muscle compensation 2. help pt locate a muscle to activate it (body awareness) 3. help pt coordinate multiple muscles in activity
According to the Wells Prediction Rule Chart, what are some risk factors for a *PE*? (7, points vary)
1. s/sx of DVT (3) 2. PE as or more likely than an alternative diagnosis (3) 3. HR 100+ bpm (1.5) 4. immobilization or surgery w/in last 4 weeks (1.5) 5. previous DVT or PE (1.5) 6. hemoptysis (1) 7. malignancy (1 - past, present) "some people have invisible pets hogging money" high risk: 6+ points mod risk: 2-6 points low risk: <2 points
What are 2 ways to modify the area of recording in biofeedback?
1. size of electrodes 2. distance b/w electrodes
What are contraindications for using a KAFO? (5)
1. spasticity 2. poor balance or ataxia 3. knee flexion contracture >10 deg 4. uncorrectable valgus/varus >15 deg 5. hip flexion strength <3/5
What determines which G-protein will be activated in a signalling cascade?
1. specificity b/w receptor & its G-protein 2. concentrations of nearby G-proteins -creates flexibility in the system
Explain the process of breaking down hemoglobin/RBC's -what is heme broken down into? -what is globin broken down into?
1. spleen/liver remove old/damaged RBC 2. hemolysis of RBC 3. hemoglobin is broken down into heme and globin 4. globin is broken down into AA which are recycled 5. heme is further broken down into iron and bilirubin 6. iron is recycled to bone marrow or stored 7. bilirubin (unconjugated) transported by albumin to blood 8. blood transports it to liver where it becomes conjugated 9. excreted in bile
What are the different types of foot orthoses we learned about?
1. supramalleolar: SMO / DAFO
Where are the 2 locations that an infection may occur after a TKA?
1. surgical site 2. deep peri-prosthetic
What are potential causes of a blood-clotting disorder? (6)
1. thrombocytopenia (viral infection, chemo/radiation) 2. defective platelet function (aspirin) 3. vitamin K deficiency (needed for prothrombin synthesis) 4. liver disease 5. inherited defects of clotting factors 6. long-term use of warfarin (type of coumadin)
What are the functions of a *ankle* rocker in a prosthetic foot? (2)
1. to provide a "stable tripod foot flat" posture- heel, 1st & 5th MT 2. maintain forward progression
List the functions of blood (5)
1. transport 2. defense 3. hemostasis 4. buffering system 5. regulation of temperature
What are the 3 steps of hemostasis?
1. vasoconstriction 2. platelet adherence to the site of damage 3. blood clotting- formation of fibrin clot to reinforce ^
What % of the population has signs of the thalassemia trait?
1.7%
Post-polio syndrome occurs _____ to _____ years after recovery from the original poliomyelitis infection
10 to 40
By how much does the acetabular labrum increase the articular area of the hip by?
10%
trunk flexion grading
5: arms behind head, legs straight, clear scapula off table 4: arms across chest, legs straight 3: arms out front, legs straight 2: arms at side, knees bent, partial ROM- scapula doesn't clear (cough alternative) 1: pt unable to move, palpate for contraction --have pt sit up until their scapula clear the table --
thoracic extension grading
5: comes up & holds strong 4: comes up but waivers if they can't come up to parallel with the ground, move to combined lumbar & thoracic extension MMT
elevation of pelvis grading
5: hold foot w max pressure 4: hold w mod pressure 3: support straight leg, pt moves actively through full ROM 2: support leg, pt moves through partial ROM 1: palpate superior to PSIS, lateral to lumbar spine for contraction --have pt hip hike and PT try to pull their leg down--
lumbar extension grading
5: holds strong, clears belly button 4: comes up but waivers, clears belly button if they can't clear the belly button, move to combined lumbar & thoracic extension MMT
Heaviest contaminated area around the patient = ___ft radius
6 ft
Ischemia for ___ hours can produce contractures
6 hours
____to_____% of women will have potential breast abnormalities
6 to 8%
What age population is usually affected by: -Panner's disease -osteochondritis dissecans
6-12 12+
A shingles vaccine is available for people over the age of ______
60
Primary Parkinson's disease usually develops at age _______
60+
FYI: 1 million Americans have Parkinson's disease
60,000 Americans develop PD each year
What percent of calcanues fractures are displaced and intra-articular?
60-75%
Every _____ seconds someone in the U.S. develops Alzheimer's disease.
68
What is the resting (loose-packed) position of the ulnohumeral joint?
70 deg elbow flexion 10 deg supination
What is the resting (loose-packed) position of the proximal radioulnar joint?
70 deg elbow flexion 35 deg supination
Roughly what % of MDs said you shouldn't jog after a THA?
70%, and the majority said don't run
Bariatric kits have a weight limit of up to:
775 lbs
How long does the hardware from a knee unicompartmental arthroplasty last?
8-10 years
Pitchers should not compete in baseball for more than ___ months in any given year
9 mo -at least 3 mo of rest from any drills is recommended
What percent of patients survive *10 yrs* after a THA? What percent of patients survive *20 yrs* after a THA?
90-95% 85%
Definition of obesity
>30 BMI
What percent of cancer is classified as 'sporatic'?
>90%
For a K1 pt, why is a SACH prosthesis helpful?
A compressive heel dec the knee flexion moment by shifting the GRF anteriorly
What are K levels?
A method of rating functional abilities & potential to ambulate
For a K1 pt, why is a single axis foot prosthesis helpful?
A single axis foot has bumpers that add resistance to DF & PF It would dec the knee flexion moment by shifting the GRF anteriorly quicker
What are the advantages and disadvantages of a *metal on polyethylene* hip arthroplasty?
A: *cost effective*, evidence supports use, predictable lifespan D: polyethylene debris may lead to *aseptic loosening*
What are the advantages and disadvantages of the *mini-incision approaches* to arthroplasty?
A: ST advantages- *less pain* & bleeding, go home faster D: little LT evidence, *technically demanding*
What are some advantages and disadvantages of an articulated AFO?
A: addresses multiple biomechanical functions, varying levels of adjustability D: size, weight & cosmesis
What are the advantages and disadvantages of a metal upright AFO?
A: easily adjustable, max stabilization, allows for fluctuating volume of LEs (lymphedema) D: major concerns for weight & cosmesis (Forrest Gump), only attached to 1 pair of shoes
What are the advantages and disadvantages of a *cemented THA*?
A: initially more stable, better ST and mid-term outcomes, less residual pain? D: longer surgery, harder to revise, potential for bad rxn to cement
What are the advantages and disadvantages of a *metal on metal* hip arthroplasty?
A: low friction/wear, *lower dislocation rate* D: possible carcinogenic effect of metal ions, metallosis
What are the advantages and disadvantages of a *ceramic on ceramic* hip arthroplasty?
A: low friction/wear, inert material D: *expensive*, requires expert insertion, possible joint noise (squeak)
What are the advantages and disadvantages of *hip re-surfacing* compared to arthroplasty?
A: lower dislocation risk, bone conserving, low wear/friction, quicker recovery & return to high demand activity? D: *higher early failure rates*, metallosis?, technically difficult, lack of LT data -overall, good advatanges, but they tend to fail
What are the advantages and disadvantages of an *uncemented THA*?
A: lower risk of CV or VTE events, *bone conserving*, more expensive?, better LT outcomes? D: inc risk of peri-*prosthetic fracture*, lack of good LT outcome data
What are some advantages & disadvantages of a locked knee KAFO?
A: maximal stability D: inc energy expenditure, creates functional leg length discrepancy
What are some of the advantages & disadvantages of a stance control KAFO?
A: provides stability during stance, allows knee flexion during swing D: larger, more expensive
What are the advantages and disadvantages of *hip arthroplasty* compared to hip re-surfacing?
A: well studied, easier to perform, suitable for wider range of patients, better LT outcomes? D: *higher dislocation risk*, more difficult to revise, more functionally limiting? (tend to discourage high impact activity afterwards)
What hormone deficiency causes diabetes insipidus?
ADH deficiency
If someone has weak dorsiflexors, which orthosis would you consider treating with?
AFO such as: posterior leaf spring or an articulated AFO (dorsi-assist or PF stop), the best choice should be based on the pt's case. be careful of post. leaf spring & dorsi-assist if they have tone though
What commonly happens neurologically in the later stages of AIDS?
AIDS dementia
What happens during depolarization of a neuron?
AP stimulus opens Na+ channels and Na+ moves into the cell
AAROM definition:
AROM plus external force to assist
How much fluid and white blood cells does the thoracic duct return to the circulatory system every day?
About 2 liters
Alzheimer's involves a deficit of which neurotransmitter due to loss of neurons caused by neurofibrillary tangles and amyloid plaques?
Ach
In myasthenia gravis, auto-antibodies attack ________________ at the NMJ What does this prevent?
Ach receptors this prevents further muscle stimulation
Which endocrine disorder can take place after surgery, pregnancy, accident, injury, trauma, infection, salt loss (strenuous exercise), or failure to take steroid therapy if the person has chronic adrenal insufficiency?
Addison's disease
What is it called when someone has previously been diagnosed with Addison's disease?
Addisonian crisis
Meta
After, beyond,change; Example: Metacarpus; Beyond the carpal bones
Post
After; Example: Postpartum; After childbirth
What motions does a SMO allow/restrict?
Allows: full dorsiflexion & plantarflexion Restricts: pronation & supination
What motions does a semi-solid AFO allow/restrict?
Allows: some dorsiflexion *in late stance* Restricts: provides some M-L stability
In a single axis foot, which muscles do the anterior & posterior bumpers take the place of?
Ant: eccentric PF Post: eccentric DF
Do the phrenic nerves run anterior or posterior to the root of the lungs to reach the diaphragm?***
Anterior
Where are pulmonary veins located on the hilum?
Anterior and inferior
What is the face defined as?
Anterior to external ears B/W hairline and chin
Which artery does the left recurrent laryngeal nerve run under?
Arch of the aorta just lateral to the ligamentum arteriosus
At what vertebral level does the trachea branch off into the right and left primary bronchus?
Around T4-T5
Peri
Around; Example: Pericardium; Enclosing the heart and roots of the heart
What is the function of orbicularis oris?
Articulation Mastication
What are the 3 parts of the thoracic aorta?
Ascending aorta, arch of the aorta, and descending aorta
What are the THA precautions for a anterior-lateral approach?
Avoid: 1. hip abduction 2. hip extension 3. hip ER
What are the THA precautions for a posterior-lateral approach?
Avoid: 1. hip adduction past neutral 2. hip flexion past 90 deg 3. hip IR
Ex
Away from, out; Example: Excoriation; Abrasion of skin
Deficiency of which vitamin leads to pernicious anemia?
B12 (most common) or B9 -they cause pernicious anemia by the same mechanism
With pernicious anemia, what would you expect to see when performing diagnostic tests to determine B12 serum levels?
B12 levels below normal
Mal
Bad; Example: Malodorous; Bad smell
What type of joint is the hip?
Ball & socket (synovial)
Why can pain from the heart, lungs and esophagus refer to the T1-5 dermatomes?
Because the visceral afferent nerves from these regions come back to the spinal cord at these levels
Pre
Before, in front of; Example: Preclinical; Before a disease becomes
Infra
Below, after; Example: Infrascapular; Below the scapula
Para
Beside, beyond; Example: Paramedic; Next to the doctor
Drugs that can be used to treat asthma (read)
Beta-agonists Glucocorticoids Parasympathetic blockers Methylxanthines Mediator-release inhibitors Leukotrine blockers
Inter
Between; Example: Interdigital; Between the fingers (or toes)
Somat
Body; Example: Somatometry; Measurement of the body
Does the phrenic nerve carry sensory or motor fibers?
Both
Where does the thoracic duct receive lymph from?
Both sides of the thoracic cavity and abdomen
Which nerve(s) innervate the voice box?
Both the right and left recurrent laryngeal nerves
Spir
Breathe; Example: Spirometer
You would use bleach wipes with _____ patients
C. diff infected
Which MDRO is a major cause of health care associated diarrhea?
C. diff.
What spinal nerves does the phrenic nerve arise from?
C3-5
95% of cases of ________ occur in the anterior and lateral lower leg compartments
CECS
What is the upper eyelid mostly innervated by?
CN III and sympathetics lev. palpebrae sup. is CN III tarsal muscle is sympathetics
What are the muscles of facial expression innervated by?
CN VII
What is the main cranial nerve that is involved with the parasympathetic NS?
CN X (vagus) innervates heart & GI tract
Vagus Nerve: what is the main type of fiber it contains and what areas does it supply?
CN X, major parasympathetic nerve supply to thorax and upper abdomen.
Each recurrence of MS involves additional areas of the _______
CNS
Primary malignant brain tumors rarely metastasize outside of the __________
CNS
Which division of the NS is serotonin found in? Which organs is it found in? Is it excitatory or inhibitory?
CNS mostly brain, some in GI inhibitory
Does oxygen or CO have a higher affinity for the iron atom in each heme group within Hb?
CO binds to heme 200x stronger than O2 = dangerous
How do you diagnose meningitis? (1)
CSF examination to determine causative organism via lumbar puncture
If there are no alleviating factors that help relieve a patient's pain, what might this be an indication of?
Cancer (systemic pain that does not get better)
What segments does the esophagus have?
Cervical, thoracic, and abdominal segments
Pector
Chest; Example: Pectoralis; Muscle of the chest wall
Steth
Chest; Example: Stethoscope
Thorac
Chest; Example: Thoracostomy; Incision of the schest wall for drainage
Ped
Child, foot; Example: Pediatrics
What percent of patients who *do* receive prophylaxis after a TKA develop a DVT? What about a PE?
DVT: 5% PE: less than 1%
Thromb
Clot; Example: Thrombophlebitis; Inflammation of a vein associated with a thrombus formation
What is the epicranial aponeurosis?
Connects frontalis and occipitalis (galea aponeurotica)
Scoli
Crooked, curved; Example: Scoliosis; Lateral curvature of the vertebral column
Which endocrine disorder leads to pathologic fractures, wedging of the vertebrae, kyphosis, osteonecrosis, bone pain & back pain? How does it do this?
Cushing's syndrome in severe cases, muscle weakness & demineralization of bone may lead to these conditions
How is Huntington's disease diagnosed?
DNA analysis
Where is the suprapatellar bursa located?
Deep to patellar tendon and above the patella
Tympan
Eardrum, middle ear; Example: Tympanectomy; Excision of the tympanic membrane
Phag
Eat, swallow; Example: Dysphagia; Difficulty in swallowing
FYI: PT's should be selective about how they work and what tools they use in order to protect yourself from injury. Should be aware that people are leaving the profession due to injuries
FYI
What is the function & innervation of orbicularis oculi?
Empty lacrimal sac and helps close eyelid CN VII
Hyper
Excessive; Example: Hypertension; High blood pressure
When are the MCL and LCL relaxed and taut?
Extension: taut Flexion: relaxed
Pod
Foot; Example: Podoarthritis; Inflammation of the joints of the feet
Which arteries supply blood to the scalp and within which layer of the scalp do they travel in?
External & internal carotid AA. Travel in the CT layer of "true scalp" (second layer)
Tars
Eyelid or instep; Example: Tasrtotomy; Surgical incision of the tarsus
In HVPC for pain therapy, what parameters are used? -frequency -mode -amplitude -length of treatment
F: arbitrary M: *continuous* A: arbitrary LOT: arbitrary *there isn't great evidence for this*
In HVPC for dermal wound therapy, what parameters are used? -frequency -mode -amplitude -length of treatment
F: arbitrary M: *continuous* A: arbitrary (*submotor*) LOT: arbitrary
In HVPC for edema/spasm/weakness, what parameters are used? -frequency -mode -amplitude -length of treatment
F: arbitrary (30-60 pps) M: *pulsed* on/off 1-5 or 1-3 A: arbitrary (produce tetanic contraction) LOT: arbitrary
FYI: Beta receptors are activated (by a drug) and they stimulate adenyl cyclase which starts a signal cascade that acts on the contractile proteins of smooth muscle cells to induce relaxation
FYI
FYI: Leukotrine blockers can be used to treat mild, persistent asthma, or can be combined with corticosteroids to treat moderate to severe asthma
FYI
FYI: Once the anti-leukotrines are bound, the receptor cannot be activated
FYI
FYI: PT's are among the top 10 professions with greatest risk of back injury
FYI
Summary: many receptors & downstream molecules w/in the signalling cascade have several forms or subtypes. While they work in similar ways, slight changes in the amino acid sequence can alter drug binding, effector stimulation or distribution of the receptor.
FYI
FYI: sudafed is a common expectorant, but it also contains pseudoephedrine, which is a sympathomimetic, meaning that it activates the sympathetic nervous system
FYI because I don't know what this means but feel like it might be important...
Which vein provides the major venous drainage of the face?
Facial V
Pseudo
Fake, false; Example: Pseudoparesis; A hysterical or nonorganic condition simulating paresis
Pyr
Fever, heat; Example: Pyrogen; A fever producing substance
Prim
First; Example: Primagravida; A woman pregnant for the first time
Sarc
Flesh, Connective tissue; Example: Sarcopoitic; Producing flesh or muscle
With what motions does the lateral meniscus move?
Flexion & extension
What motions are possible at the hip joint?
Flexion/Extension Abduction/Adduction Internal/External Rotation Circumduction
What is the most common prepatellar bursa injury?
Fluid accumulation due to kneeling on a hard surface Ballottable pattellar sign
What does FEV1 mean? What significance can this serve for patients diagnosed with lung cancer?
Forced Expiratory Volume in the first second -indicates whether they have enough lung capacity to have surgical removal of a lung
Quadr
Four; Example: Quadriplegia; Tetraplegia
Where does the left brachiocephalic vein run?
From behind the medial end of the left clavicle and then it passes obliquely behind the manubrium to the right side and joins with the right brachiocephalic vein
Where does the right brachiocephalic vein run?
From behind the medial end of the right clavicle and then it joins with the left brachiocephalic vein
What are the branches of CN V1?
Frontal (supraorbital, supratrochlear) and nasociliary (infratrochlear, external nasal)
In what position is the knee joint the most stable?
Full extension
The target effect of the receptor depends on which ______________ is activated.
G-protein -there are 25+ different G-proteins
What is the largest category of cell membrane receptors?
G-protein coupled receptors
What proteins act as signal transducers and amplifiers?
G-proteins
Huntington's disease involves a depletion of which neurotransmitters in what part of the brain?
GABA in basal nuclei Ach is also reduced overall
What is a characteristic of Guillain-Barre syndrome that distinguishes it from multiple sclerosis? ****
GB is temporary unlike MS GB is demyelination of PNS, MS is demyelination of CNS
H2 receptor blockers are used for the treatment of what kind of disorders?
GI and stomach
What are the body systems you should examine for possible signs of cancer?
GI tract Integumentary Circulatory Lymphatic Respiratory C.A.U.T.I.O.N. pneumonic also
What does GX, G1, G2, G3, and G4 mean with tumor grading?
GX: cannot be assessed G1: well differentiated (low grade) G2: moderately differentiated (intermediate grade) G3: poorly differentiated (high grade) G4: undifferentiated (high grade)
Where does the knee get its blood supply from?
Genicular AA off of the popliteal A
Which hyperthyroid condition is an autoimmune disorder?
Grave's disease (Hashimoto's thyroiditis is also an autoimmune disorder but it is a hypothyroid condition)
Poli
Gray matter; Example: Polioclastic; Destroying the gray matter of the nervous system
Which is the only splanchnic nerve type you can see on a cadaver?
Greater splachnic nerve
What are the 3 types of splanchnic nerves?
Greater thoracic, Lesser thoracic, and least thoracic
What type of histamine receptor is blocked by antihistamines in the treatment of respiratory disease?
H1
Which type of e-stim is known for having twin spikes in the wave?
HVPC
Are there different types of electrodes for MES or HVPC? What coupling agents are used for these?
HVPC- rubber carbon, electromesh glove/sock gel or saline soaked sponge
What is removed when "scalping" occurs?
Hair, skin, CT, and epicranial aponeurosis are pulled away as a unit loose CT gives way
Trich
Hair; Example: Trichoanesthesia; Loss of hair sensibility
Hemi
Half; Example: Hemiplegia; One side of the body is paralyzed
Scler
Hard, sclera; Example: Scleroderma; Chronic hardening of connective tissues
What endocrine disorder is associated with other autoimmune diseases such as lupus, type 1 diabetes mellitus, pernicious anemia, myasthenia gravis or rheumatoid arthritis?
Hashimoto's thyroiditis
What are the articular surfaces of the hip?
Head of femur and acetabulum
Therm
Heat; Example: Thermaesthesia; Perception of heat or cold
Huntington's disease involves a mutation in what gene?
Huntingtin gene defective Huntingtin protein that binds to other proteins, destabilizes & precipitates them which is toxic to neurons
__________________________ is a trinucleotide repeat neurologic disorder
Huntington's disease: trinucleotide - CAG (glutamine) repeats 30-40 times
FYI: myasthenia gravis is estimated to affect 20 per 100,000 people
I hate this
If you're doing this in order....
I sincerely apologize for the next 13 flashcards...
How may glucocorticoids be administered?
IV (ER) inhalers oral medication
What is Bell's palsy?
Idiopathic paralysis of facial muscles, usually unilateral Usually spontaneously resolves, rarely are the results permanent
What is something you might ask your patient if you are unsure of the possibility of cancer based on their symptoms and their family history?
If they have any known cancers...duh
What is hip extension limited by?
Iliofemoral ligament
How do hospital beds with chair capacity position the lower extremities?
In a dependent/lowered position that can't be achieved with the leg elevation feature of a standard hospital bed
What is cushing's syndrome?
Increased adrenal hormone production results in round face, red cheeks, and excessive hair growth
What is acromegaly?
Increased growth hormone produces enlargemend of both bone and soft tissues Head is elongated, prominent forehead, nose & lower jaw. Facial features appear widened
What is the "danger zone" in regards to infection in the face?
Infection could easily spread within this zone and potentially to the brain Blood usually flows inside to outside of the head, but because the facial V doesn't have valves the flow direction may be reversed into the cavernous sinus
Healthcare-associated infections
Infections acquired during admission in a healthcare setting, where there is no evidence that the infection was present or incubating at the time of admission
What does it mean for a cancer to be hereditary?
Inherited susceptibility via germline (egg/sperm) **VERY common within affected family**
What are the anterior and posterior drawer tests testing for?
Integrity of ACL and PCL respectively
Where does all of the blood that goes to the face come from?
Internal & external carotid AA
Where does the facial V drain?
Internal jugular V
What 2 veins come together to form the brachiocephalic vein on each side?
Internal jugular vein and subclavian vein
Where does the thoracic duct empty?
Into the junction of the left subclavian vein and the left internal jugular vein
Activities, after a ______, should be targeted to documented deficits, be well described, and limited in number
JA
Where is the descending aorta?
It begins at the sternal angle and descends just anterior to the vertebral bodies
Where is the ascending aorta?
It begins within the pericardial sac with the aortic valve and ascends behind the sternum to the sternal angle
Left vagus nerve: where does it enter the superior mediastinum? How does it reach the abdominal cavity?
It enters the superior mediastinum on the left of the aortic arch, it also stays posterior to the hilar region as it also descends along the esophagus to the abdominal cavity
Right vagus nerve: where does it enter the superior mediastinum? How does it reach the abdominal cavity?
It enters the superior mediastinum on the right side of the trachea, passes behind the right brachiocephalic vein and inferior vena cava and remains behind the hilar region and descends along the esophagus to abdominal cavity
What is the esophagus between posteriorly and anteriorly?
It is behind the trachea and in front of the vertebral column
Where is the thoracic duct in relation to the vertebral bodies?
It is just anterior to the V. bodies
What is the angle of inclination?
It is the angle of the femoral neck with the shaft of the femur Normal: 126 degrees
Where is the aortic arch?
It lies behind the manubrium and in front of the trachea. It arches over the right pulmonary artery and left main bronchus. It also gives off 3 branches.
With an AFO, are you more likely to see skin issues up high around the proximal tibia or down low around the ankle or foot?
Jason said he rarely sees issues up high, but he often sees skin issues around the malleoli or MT heads also on toes if they are gripping the bottom of the AFO (neuro pt's)
Which veins form the retromandibular V?
Junction of superficial temporal & maxillary VV Retromandibular eventually forms the external jugular V
Where should the left vagus nerve be in relation to the arch of the aorta?
Just lateral to the aortic arch
What type of foot prosthesis would be recommended for a pt with a K level of 0?
K0 will be bed or chair restricted a prosthesis is *not* medically necessary
What type of foot prosthesis would be recommended for a pt with a K level of 1?
K1 will need a prosthesis for transfers & level, household ambulation *SACH or single axis*
What type of foot prosthesis would be recommended for a pt with a K level of 2?
K2 will be a limited, single speed community ambulator *flexible keel or multi-axial ankle/foot*
What type of foot prosthesis would be recommended for a pt with a K level of 3?
K3 will be a variable speed, community ambulator *energy storing, multi-axial/dynamic response, flexfoot, flexwalk*
Which K level do most children, active adults or athletes w/ an amputation fall under?
K4
Which K level has no movement limitations?
K4
What is the function of the buccinator muscle?
Keeps food on the molars
Ren
Kidney; Example: Renography; Radiography of the kidney
What does disinfection do?
Kills or destroys disease-causing microorganism germs by thermal or chemical means
What is lateral epicondylitis also known as? What is medial epicondylitis also known as?
LE: tennis elbow ME: golfer's elbow or thrower's elbow
Describe a K level of 0:
Lack of ability or potential to ambulate or transfer safely w/ or w/out assistance A prosthesis does *not* enhance quality of life or mobility
Is the facial vein medial or lateral to the facial artery?
Lateral
Which of the menisci are more mobile?
Lateral meniscus The medial meniscus is more fixed to the tibia and joint capsule
Phac
Lens of the eye; Example: Phacolsclerosis; Hardening of the eye lens
If the knee is extended, is more or less hip flexion possible?
Less, because the hamstrings are tight
Phot
Light; Example: Photobiotic; Living only in light
Amyotrophic lateral sclerosis (ALS) is also known as:
Lou Gehrig's disease
Pneu(mat)
Lung, air; Example: Pneumonopathy; Any lung disease
Pulmon
Lung; Example: Pulmonary; Pertaining to the lungs or pulmonary artery
Which of the collateral ligaments attaches to the joint capsule of the knee?
MCL
_______ (type of e-stim) is approved by the FDA to treat chronic pain, but there is no evidence to support the effectiveness of it
MES
Which type of e-stim is "similar to the body's current"?
MES (b/c the amplitude is low)
How long does a MES treatment last? What about HVPC?
MES: 2 hrs, rest 4 hrs (2-3x/day) HVPC: 15-50 min
The parameters for MES and HVPC can vary based on different conditions that they are treating. What conditions are they?
MES: wound or bone healing HVPC: dermal wound, pain or edema/spasm/weakness
What is the second most common cause of disability?
MS
What condition is Guillain-Barre syndrome similar to and why?
MS -both: local inflammation, demyelination and axon destruction -leads to: impaired nerve conduction
What are the branches of the external carotid A?
Main branch: facial A which gives off sup/inf labial branches Terminal branch: superficial temporal A which gives off frontal, parietal, and transverse facial branches
Poly
Many; Example: Polymyositis; Inflammation of many muscles
If you injure the MCL what will you also likely injure and why?
Medial meniscus It attaches to the joint capsule and MCL, lateral meniscus does not attach to LCL
How do the results of cutting the facial N differ if it is cut medial or lateral to the lateral canthus of the eye?
Medial: cut branches will re-innervate their target muscles & function will be restored over time Lateral: cut ends need to be located & specifically reattached in order to increase the likelihood of re-innervation of muscles
MRSA stands for
Methicillin-resistant staphylococus aureus
Phren
Mind, diaphragm; Example: Phrenic nerve
Psych
Mind; Example: Psychogenesis; Mental development
Do we have more knee IR or ER and why?
More ER because the PCL is on the medial side and IR results in these 2 ligaments fighting each other
Stomat
Mouth; Example: Stomatomalacia; Softenting of the structures of the mouth
Leukotrine blockers are all categorized into the broader group of ________
NSAIDs
Unga
Nail; Example: Ungual; Pertaining to the nails
What are the branches of the opthalmic division of the trigeminal N? (2)
Nasociliary: external nasal N & infratrochlear N Frontal N: supratrochlear N & supraorbital N
Physi
Nature; Example: Physiotherapist; A physical therapist in Canada (and elsewhere)
Trachel
Neck; Example: Trachelocystitis; Inflammation of the neck of the bladder
Radic
Nerve root; Example: Radicular; Pertaining to a nerve root
Rhiz
Nerve root; Example: Rhizotomy; Transection of the nerve root
Proct
Rectum; Example: Proctocolonoscopy; Inspection of the interior of the rectum and lower colon
Are the ACL and PCL in the knee joint capsule?
No
Are the talonavicular and talocalcaneal joints a part of the ankle joint?
No, but they help provide stability
Does Jason think Spica braces and other ADs to prevent hip dislocation are helpful?
No, he hasn't had much luck with them
Are all genetic mutations harmful?
No, they can be harmful, beneficial or neutral (some are uncertain effects)
Where is an action potential generated within a neuron?
Node of Ranvier
Where might axon collaterals emerge within a neuron?
Node of Ranvier
What are the gaps between the myelin (oligodendroglia/ Schwann cells) of neurons called?
Nodes of Ranvier
Nulli
None; Example: Nullipara; No births
Eu
Normal, good; Example: Euthermic; Normal temperature
Rhin
Nose; Example: Rhinencephalon; The part of the brain once thought to be concerned only with olfaction
In
Not; Example: Inoperable;
Do the frontalis and occipitalis muscles have bony attachments?
Occipital: superior nuchal line Frontalis: none
What is the test that predicts the likelihood of chemotherapy benefit and the risk of cancer reocurrence?
Oncotype DX diagnosis test
What is the one "cardinal rule" of PT?
One must always listen to the patient
What is the function of nasalis?
Open & close nostrils has a compressor and dilator part
Min Assist rule (especially with bariatric patients)
Open, honest dialogue about patient abilities and therapist capacity
Where does the ACL originate and insert?
Origin: anterior intercondylar tibia Insert: lateral femoral condyle
Where does the PCL originate and insert?
Origin: posterior intercondylar tibia Insert: medial femoral condyle
What are some pros & cons of a single axis foot?
P: rapid foot flat C: inc maintenance, inc weight
Which of the cruciate ligaments is medial to the other?
PCL (Zhang finger thing)
Is there a spring you can add into an orthotic, like an AFO, that can help with dorsiflexor or plantarflexor weakness?
PF: no- there isn't a spring large enough to be able to push your entire body weight forward DF: yes- the spring only has to be able to push your foot up, this is called a DF assist orthotic
Guillain-Barre syndrome is an inflammatory condition of the ______________
PNS
Pelv
Pelvis; Example: Pelvimetry; Measurement of the capacity and diameter of the pelvis
Perine
Perineum; Example: Perineoplasty; Plastic repair of the perineum
Who determines a person's K level? Can a person's K level change over time?
Physician w/ input from prosthetist yes
Top
Place; Example: Topagnosia; Loss of touch localization; inability to recognize familiar surroundings
Is the ankle most unstable during plantar or dorsi flexion?
Plantar flexion
Plasm
Plasma; Example: Plasmapheresis; Removal of blood,separation of blood cells and rinjection of packed cells
Pleur
Pleura; Example: Pleurisy; Inflammation of the pleura
Toxic
Poison; Example: Toxicophobia; Morbid dread of poisons
In a single axis foot, what compensation would you see if the posterior bumper was too stiff? What if the anterior bumper was too soft?
Post: knee flexion Ant: "drop off"- hip & knee flexion
Once you find the arch of the aorta, which vagus nerve will you find?
The left vagus nerve
Ton
Pressure; Example: Tonometer; Instrument for measuring pressure, especially of eyeball
Summary (read):
Prosthetic foot type is selected based on a patient's ability & potential -indoor vs outdoor walking -environmental obstacles -single vs. variable speed
Describe a K level of 3: What is their ambulation status?
Pt has ability or potential for ambulation w/ *variable* cadence. Likely to achieve *community* ambulation, w/ ability to traverse *most* environmental barriers, & may have activity that demands prosthetic use *beyond* simple locomotion for work or TherEx
Describe a K level of 2: What is their ambulation status?
Pt has ability or potential for ambulation, including lower-level environmental barriers such as curbs or stairs. (still fixed cadence) W/ a prosthesis, pt achieves a *limited community* ambulation status
Describe a K level of 4: What is their ambulation status?
Pt has ability or potential for prosthetic ambulation that *exceeds* basic ambulatory skills, exhibiting high impact, stress, or energy levels during activity.
Describe a K level of 1: What is their ambulation status?
Pt has ability or potential to use a prosthesis for transfers or ambulation on *level* surfaces at a *fixed* cadence W/ a prosthesis, pt achieves limited or unlimited *household* ambulation status
Sphygm
Pulse; Example: Sphygmomanometer; An instrument for measuring arterial blood pressure
What is the largest group of cells in blood?
RBC's
During an evaluation in which someone is being considered for a LE orthotic, functional ROM and muscle strength should be assessed at which locations?
ROM: midtarsal, subtalar, talocrural, knee & hip Strength: focus on general LE muscle groups (problems in one area may be stemming from problems in another area)
What is the function and innervation of levator palpebrae superioris?
Raises eyelid CN III
When are the ACL and PCL relaxed and taut?
Relaxed: never Taut: always The ACL and PCL always have tension to maintain stability of the joint
Pyel
Renal pelvis; Example: Pyelitis; Inflammation of the renal pelvis
Which arteries supply blood to the hip joint?
Retinacular arteries (from medial & lateral circumflex femoral AA, from deep artery of thigh, from femoral A)
What condition is common in children that live in a climate with little sun exposure?
Rickets
Is the azygos vein on the right or left side of the vertebral bodies?
Right side
Which artery does the right recurrent laryngeal nerve run under?
Right subclavian artery at about T1
What 2 bony surfaces is the hip joint capsule between?
Rim of acetabulum Intertrochanteric line/ridge
What are the 5 layers of the scalp?
S: skin C: CT, highly vascular A: aponeurosis, epicranial L: loose CT P: periostium ****
cervical flexion muscles
SCM - bilateral longus coli scalenes
cervical rotation muscles
SCM - unilateral
Which LE orthotic provides the highest level of foot control with no restriction to ankle function?
SMO / DAFO
Which division of the NS is epinephrine found in? Is it excitatory or inhibitory?
SNS excitatory
Which division of the NS is norepinephrine found in? Is it excitatory or inhibitory?
SNS excitatory (same as epinephrine)
Sial
Salivary; Example: Sialogenous; Producing saliva
Which type of cells form the myelin sheath of neurons in the PNS?
Schwann cells
Which type of glial cell provides myelin for axons in the PNS?
Schwann cells
Which type of energy storage & return prosthetic for a K3 user would be useful for a construction workerer or someone lifting a lot of weight?
Shank Foot also apparently good for a diabetic pt
Where do the muscles of facial expression insert?
Skin
Somn
Sleep; Example: Somniferous; Producing sleep
Polyp
Small growth; Example: Polypectomy; Excision of a polyp
Micro
Small; Example: Microtome; Small device to cut
What does SACH stand for?
Solid Ankle Cushion Heel
Do hemiazygos and accessory hemiazygos veins connect to the azygos vein?
Sometimes, if they do they would cross the midline on top of the V body to the azygos vein
Son
Sound; Example: Sonogram
Which type of encephalitis affects older people more seriously than younger people?
St. Louis encephalitis
What is SUV in relation to testing the lungs? What value raises concern for malignancy?
Standard uptake valve value greater than 2.5
How is the hip joint capsule strong yet loose?
Standing/walking: fibers are spiraled Rest/flexion: fibers are straight When the fibers are spiraled, the 2 articular surfaces are pulled closer together which makes them stable, when the joint is flexed the fibers are straight and the joint is loose
What divides the superior mediastinum from the rest of the mediastinum?
Sternal angle of Lewis
What branches does the internal carotid A give off via the opthalmic A? (3)
Supratrochlear A Supraorbital A Dorsal nasal A
What type of neuron are the splanchnic nerves?
Sympathetic preganglionic neurons
List the branches of the facial CN?
Temporal Zygomatic Buccal Mandibular Cervical
Where does the superficial temporal V drain blood from? Where does it drain to?
Temporal and face Drains into retromandibular V
Ten
Tendon; Example: Tenalgia; Pain in the tendon
What is genu valgum?
The Q angle is greater than normal "knock-kneed"
What is genu varum?
The Q angle is less than normal "bow-legged"
What is a Q angle?
The angle between the shaft of the femur and a line perpendicular to the floor
What is coxa valga?
The angle of inclination, between the shaft and neck of the femur, is greater than normal
What is coxa vara?
The angle of inclination, between the shaft and neck of the femur, is less than normal
What is immediately in front of, to the left, and right of the thoracic duct?
The azygos vein is to the right, the aorta is to the left, and the esophagus is in front of it
Where is the esophagus in relation to the trachea?
The esophagus is immediately posterior to the trachea
What branches off of the popliteal artery before it splits into posterior and anterior tibial AA?
The genicular branches
What do communicating rami communicate between?
The intercostal nerve and the sympathetic chain
Which brachiocephalic vein is longer?
The left
What primary bronchus does the aortic arch arch over?
The left main bronchus
What are all of the great vessels behind?
The manubrium, and the heart is behind the body of the sternum
Where does the vagus nerve originate?
The medulla
What is the iliofemoral ligament?
The most important of the 3 ligaments of the hip joint capsule. It is important for maintaining an upright posture
When the diaphragm, pericardium, or mediastinal pleura is irritated, where can afferents within the phrenic nerve transmit referred pain to?
The neck: dermatomes C3-5
What blood vessel(s) runs along with the phrenic nerve?
The pericardioaphrenic artery and vein
What does the esophagus connect?
The pharynx with the stomach
What happens when you unlock your knees?
The popliteus muscle contracts to laterally rotate the femoral condyles before flexion
What happens to the muscles and ligaments in your knees when you lock your knees?
The position makes your LE a solid column capable of bearing more weight, the thigh and leg muscles are relaxed and ligaments are taut
Which main bronchus is larger?
The right main bronchus
Which posterior intercostal veins always drain into the azygos vein?
The right posterior intercostal veins, it sometimes gets the left as well
What do the right and left brachiocephalic veins form when the join?
The superior vena cava
Where does the azygos vein dump into?
The superior vena cava
Why is it a good thing that C1 does not have a sensory component?
There is no room for a DRG between atlas and axis
What kind of nerves are in the cardiac, pulmonary, and esophageal plexuses?
They are all mixed plexuses that have sympathetic and parasympathetic fibers
Are the phrenic nerves inside or outside of the fibrous pericardium?
They are external to the fibrous pericardium
What's her opinion on gloves?
They are often overused and have a "false" sense of security that could allow a HCW to skip hand washing
Where are the pulmonary arteries?
They arise off of the pulmonary trunk which sits on top of the right ventricle
What happens to the femoral condyles when you lock your knees?
They medially rotate about 5 degrees on the tibial plateau
What is the appearance of a facial laceration like?
They tend to gape due to pulling of frontalis and occipitalis. Must be sutured to limit scarring
Per
Through; Example: Percuss; To shake through (by striking)
Thym
Thymus gland; Example: Thymectomy; Excision of the thymus
Thyr
Thyroid gland; Example: Thyrocele; Enlargement of the thyroid gland; goiter
What bony articulations is the ankle joint (subtalar) formed by?
Tibia & fibula with the talus
The thoracic duct is originally on the right side of the vertebral bodies and then shifts to the left, why is this?
To drain into the junction of the left subclavian and left internal thoracic veins
What is the hole in the acetabular labrum sealed by?
Transverse ligament of acetabulum
Salping
Tube; Example: Salpingitis; Inflammation of uterine or auditory tube
What is the MOI of valgus instability of the elbow?
UCL tear or sprain (valgus OH stress or repetitive OH activities cause lateral compression, medial tension and posterior shear)
Hypo
Under, deficient; Example: Hypotension; Low blood pressure
Ureter
Ureter; Example: Uteropathy; Disease of the ureter
Urethr
Urethra; Example: Urethratresia; Impeforation of the urethra
Hemophilia A involves a deficit or abnormality of what clotting factor?
VIII
Having a bilateral THA increases the risk of which potential complication?
VTE
Poikil
Varied, irregular; Example: Poikilocyte; An abnormally shaped erythrocyte
Hemizygos Vein
Vein on the inferior aspects along the left side of the thoracic vertebrae
Accessory Hemiazygos Vein
Vein on the superior aspect of the left side of the thoracic vertebrae
Phleb
Vein; Example: Phlebitis; Inflammation of a vein
Rachi
Vertebra, spine; Example: Rachialgia; A pain in the spine
Spondyl
Verterbra, spinal; Example: Spondylolisthesis; Forward displacement of a vertebra over a lower segment
Vas
Vessel, duct
What should you use instead of a Homan's Sign Test to determine the likelihood that a pt has a DVT or PE?
Wells Prediction Rule
Which type of encephalitis is common in kids?
Western equine encephalitis
Chylothorax
When lymph suddenly appears in the pleural cavity, can be reintroduced to the body so you don't lose all the WBCs
What is the unhappy triad?
When the ACL, MCL and medial meniscus are all torn in one injury
Where is the joint surface of the talus wider and narrower?
Wider: anteriorly Narrower: posteriorly
Intra
Within; Example: Intraocular; Inside the eye
What is the function of procerus muscle?
Wrinkles bridge of nose Helps open nostrils
In a dose/response curve, the drug that has the lowest value *for a given effect* on the (X or Y) axis is considered the most potent.
X
In a dose/response curve, the drug that reaches the greatest magnitude on the (X or Y) axis is considered the most efficacious.
Y
Do solid ankle AFO's have the potential to become articulated AFO's?
Yes, they can cut the orthotic and add in a hinge to make it articulated. This would save the pt money by not having to pay for an orthotic twice.
Can bodies have more than one type of azygos vein?
Yes, they can only have an azygos vein, they can have that plus a hemiazygos or any combination
After a drug binds to the G-protein receptor on the outside of the cell and activates the receptor, what binds to the receptor from within the cell?
a G-protein, these are activated by binding to the activated receptor
Define a radial head fracture
a break in the proximal portion of the radius (these make up 1/3 all elbow fractures)
What ADs might be necessary in the treatment of a ME fx? When is this necessary?
a cast is necessary in the case of excessive bone separation
What is necessary in order for bone marrow transplants as a blood therapy to be possible?
a close tissue match
What is VRE comparable to?
a fast moving locomotive
When is a tophus formed?
a few years after the first attack of gout
What is a mallet finger deformity? (2)
a finger pathology that involves: -avulsion of extensor tendon -usually due to direct blow causing forced extension
What are leukemias in general?
a group of neoplastic disorders involving WBC's
What is a swan neck deformity? (3)
a hand pathology that involves the following: -intrinsic hand muscle contracture -hyperextension of PIP joints -flexion of DIP joints (FDP is tensioned)
What is a boutonniere deformity? (4)
a hand pathology that involves the following: -rupture of central extensor tendon -lateral displacement of ext. mech, -flexion of PIP joints -hyperextension of DIP joints
What is an ulnar drift deformity? (2)
a hand pathology that involves the following: -tendons displace to ulnar side of MCP joints -often subluxed MCP joints
What causes a brain to herniate?
a large mass such as a tumor or clot
Does a posterior leaf spring AFO provide M-L stability?
a little bit
Define elbow instability:
a looseness in the elbow joint that may cause it to catch, pop or slide out of place during certain motions
If a pt is only partially able to assist, and they are between 100-200 lbs, use ________________
a sliding board and 2 people
What is a unicompartmental knee arthroplasty?
a surgical procedure often used to relieve arthritis in one of the knee compartments by replacing only that comparment sometimes called a partial knee
In the parasympathetic NS, postganglionic neurons release which neurotransmitter? This neurotransmitter then *stimulates or inhibits* which type of receptor on the target tissue?
acetylcholine cholinergic receptors (*muscarinic* Ach receptors)
In the parasympathetic NS, preganglionic neurons release which neurotransmitter? This neurotransmitter then stimulates which type of receptor on the postganglionic neuron?
acetylcholine cholinergic receptors (*nicotinic* Ach receptors)
In the sympathetic NS, preganglionic neurons release which neurotransmitter? This neurotransmitter then activates what kind of receptor on the postganglionic neurons?
acetylcholine cholinergic receptors (*nicotinic* Ach receptors)
What enzyme is responsible for degrading acetylcholine?
acetylcholine esterase
In which endocrine disorder do bones become heavier and broader?
acromegaly
A ____________ potential is produced by a stimulation that alters membrane permeability by ions moving across the membrane.
action
In overweight people, fat is the most ________________ endocrine organ in the body
active
Is acute hyperglycemia or hypoglycemia much more of a life-threatening condition?
acue hypoglycemia
Does acute or chronic leukemia have a higher proportion of immature, nonfunctional cells in the bone marrow and peripheral circulation?
acute
Does acute or chronic leukemia have marked signs and complications?
acute
Does acute or chronic leukemia occur primarily in children and young adults?
acute
Does acute or chronic leukemia usually have an abrupt onset?
acute
What are the two types of compartment syndrome?
acute compartment syndrome chronic exertional compartment syndrome
Active Resistive RROM:
addition of manual or mechanical resistance to active ROM exercise to increase muscle strength
Define adjuvant therapy
additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back
What is a tumor in the pituitary gland called?
adenoma
What is immunotherapy?
administration of allergy shots to iinduce tolerance in the body. They gradually increase the level of allergen in the body so that an allergic reaction is not mounted when it is seen from an exogenous source
Beta-agonists are often called _______ bronchodilators
adrenergic
Normal bronchomotor tone is a balance between what two influences?
adrenergic and cholinergic (sympathetic and parasympathetic)
Respiratory smooth muscle cells contain what type of receptors?
adrenergic beta-2 receptors
Does herpes zoster occur in adults or children?
adults
What are risk factors for CECS?
age type of activity/exercise overtraining
What are the 3 biggest factors that increase risk for cancer?
age - #1 risk factor smoking and tobacco use diet and obesity
What is the purpose of MES overall?
aids in healing at the cellular level
What are the 5 different quick acting asthma medications by generic name?
albuterol epinephrine isoproterenol metaproterenol terbutaline
Artificial blood products are compatible with what blood types?
all blood types
Does MS affect motor, sensory or autonomic neurons?
all of them
Corticosteroids can be used to treat what two conditions?
allergies and asthma *note: for treatment of allergies, corticosteroids must be taken over a period of a few weeks to notice an effect*
What are the 2 types of adrenergic receptors? Which neurotransmitters are they associated with?
alpha and beta alpha: norepinephrine beta: epi and norepi
Interferential uses ______ current at 2000-5000Hz
alternating current (AC)
Are nicotinic receptors capable of being stimulated, inhibited or both?
always stimulated (muscarinic is both)
During what step does amplification take place in a signalling cascade?
amplification can occur at each step in the cascade
Although the precise cause of Guillain-Barre syndrome is unknown, what is suspected to play a role in the cause of it?
an abnormal autoimmune response to a viral infection or immunization
How is coxa valga defined?
an angle of inclination in the hip joint that is ~150 degrees or more
How is coxa vara defined?
an angle of inclination in the hip joint that is ~90 degrees or less
What happens after a drug binds to a receptor on the cell surface?
an intracellular cascade of events (or it could block other drugs from binding to the receptor)
Polarity across a plasma membrane (neuronal membrane) exists due to what?
an unequal distribution of Na+ and K+ ions inside and outside of the cells also due to negatively charged proteins inside of the cell
Which type of TKA separates R and L femoral components w/ dec radii of rotation?
anametric knee
What glide should be performed on the hip to help facilitate hip extension and external rotation?
anterior
What directions can shoulder instability occur in?
anterior posterior multidirectional
Describe the usual presentation of thyroid cancer:
appearance of a hard, painless nodule on the thyroid gland (most palpable nodules are benign adenomas)
How common are shoulder JAs done?
around 23K per year (compared to 400K knees and hips per year)
What happens during repolarization of a neuron?
as the impulse moves along the membrane, Na+ channels close and K+ channels open allowing K+ to move out of the cell
What is stage 2 LE?
associated with pathological changes in the tendon (tendinosis) or angiofibroblastic degeneration
What term is used to describe the attraction and binding of a drug to a receptor?
association (Ka)
If a pt has dyspnea, wheezes, rales, chronic mild cough, and mold allergies, what is a possible diagnosis? -case study-
asthma
Antihistamines can be used for treatment of what two conditions?
asthma and allergies
Which type of glial cell contributes to the blood-brain barrier?
astroglia
Which type of glial cell provides a link between neurons and capillaries?
astroglia (also contributes to blood-brain barrier)
Cerebral aneurysms are initially small and ______________, but over time they ______________
asymptomatic enlarge
The benefits of an energy storage & return prosthetic foot are more apparent in what situation?
at faster speeds -smoother dynamics during gait -dec impact on sound side at heel strike
Where does a cerebral aneurysm usually occur?
at points of bifurcation, this is called a "berry" aneurysm
Quick acting asthma medications should be taken when?
at the first signs of an asthma outbreak, they will relieve symptoms within minutes
What populations is achilles tendinopathy common in?
athletes runners patients w/ calf tightness
What is the most common parasympathetic blocker?
atropine (Saltropine)
Biofeedback provides the pt and PT with _____________ and _____________ translation of activity
auditory and visual
What are the branches of CN V3?
auriculotemporal, buccal and mental
What kind of disorder is myasthenia gravis?
autoimmune disorder
Which division of the NS includes the sympathetic and parasympathetic branches of the NS?
autonomic NS
Which division of the NS is responsible for involuntary body functions?
autonomic NS Ex: cardiac & smooth muscle, glands, respiration
Thalassemia is a genetic condition. Is it of dominant or recessive inheritance?
autosomal recessive
Progression of _______ ________ can cause the development of a limp and joint stiffness in the hip
avascular necrosis
The _____________ of a neuron conducts impulses away from the cell body
axon
Why is there a more graded response to increasing hormone concentrations with intracellular/nuclear receptors compared to the amplification scheme seen in G-protein coupled receptors?
b/c each hormone-receptor complex interacts w/ 1 molecule of DNA
Why are reverse TSAs indicated over conventional TSAs if the patient has a RTC pathology?
b/c the reverse allows the use of the deltoid to lift the arm instead of RTC
Why are G-protein coupled receptors called 7 transmembrane domain receptors?
b/c they consistently cross the membrane of the cell 7 times
Why is blood loss associated with each surgical approach to a THA of interest to surgeons?
b/c you want to minimize blood transfusions
Why might liver enzymes (AST, ALT, LD) become moderately elevated? -case study-
backup effects of R sided CHF in hepatomegaly
How do you describe MDROs?
bacteria that are resistant to one or more classes of antibiotics
Meningitis is a ____________ infection in the meninges of the CNS
bacterial
Is tetanus a viral or bacterial infection? How is it transmitted?
bacterial- bacillus, spores can survive in soil for years (clostridium tetani) puncture wound, typically with a rusty object
Is neuroborreliosis (Lyme disease) a viral or bacterial infection? How is it transmitted?
bacterial- spirochete (Borrelia burgdoferi) transmitted by ticks
HVPC can be battery operated or a plug-in device. Which option has less voltage output?
battery operated
Why is it inappropriate to treat PF weakness with a posterior leaf spring that has a *sulcus trim line*?
bc sulcus trim lines provide a shorter lever arm, this would make toe off more difficult (we want a longer lever arm to give them a more rigid surface for push off)
What does premodulated IF estim mean?
beat frequency & summation of currents occurs inside the machine (is a homogenous medium vs. body tissues)
How does Hashimoto's thyroiditis cause destruction of the thyroid gland?
because it is an autoimmune disease so the gland is infiltrated by lymphocytes & antithyroidantibodies
Why is it common to see that pt with Cushing's disease can not rise out of a chair without help?
because the condition causes marked muscle weakness, and in this case the pt would have quad weakness
In pernicious anemia, why do RBC's carry less hemoglobin?
because their nuclei are so big
BKA stands for:
below the knee amputation
What are the 5 different methods of delivery for IFC?
bipolar quadripolar (crossing) dual, bipolar stereodynamic method quadripolar with vector scan
Where does coumadin block the coagulation cascade?
blocks synthesis of prothrombin by deactivating vitamin K
How does zileuton work?
blocks the action of the enzyme, lipoxygenase, which blocks leukotrines from ever being formed (helps inhibit future asthma attacks)
How does the bacterium that causes neuroborreliosis spread in the body?
blood
Diabetes mellitus can cause mortality over a long period of time, but immediate death can occur if:
blood glucose levels become acutely high or low *this is a medical emergency*
It is recommended that breaking pitches should not be thrown until:
bones have matured- indicated by puberty
Are muscarinic receptors capable of being stimulated, inhibited or both?
both
Is acetylcholine an excitatory or inhibitory neurotransmitter?
both
Is dopamine excitatory or inhibitory?
both
Should you limit high impact activities and activities w/ heavy rotational forces after a THA or TKA?
both
Which artery is typically affected in a Volkmann's Ischemic Contracture?
brachial A- usually after humerus fracture
Which organ is GABA found in?
brain
What organ is frequently affected in children with congenital HIV infection? What does this cause?
brain severe developmental delay
What are the most common sites of cancer metastasis?
brain respiratory lymph liver skeletal (bone)
What is a displacement of brain tissue called?
brain herniation
Where are the neurons located that are affected by MS?
brain, SC and cranial nerves (CNS)
Hungtington's disease involves progressive atrophy of the:
brain, particularly in the *basal ganglia* and frontal cortex
Reye's syndrome involves pathologic changes in which 2 organs? What changes occur in these organs?
brain: severely impaired function due to cerebral edema (swelling in brain) liver: becomes enlarged & develops fatty changes, can cause acute failure
Brain tumors are often secondary to what types of primary tumors?
breast or lung tumors
What are symptoms of carbon monoxide poisoning?
bright cherry-red color in lips & face
What are the generic names for the antihistamines? (7)
brompheniramine cetirizine chlorpheniramine desloratadine diphenhydramine fexofenadine loratadine
Airway obstruction can be caused by what conditions? (5)
bronchial astma emphysema chronic bronchitis lung infections lung cancer
_________ are the most common treatment of respiratory disease
bronchodilators
How are G-protein coupled receptors categorized?
by ligand type Ex: neurotransmitter, hormone, etc.
How can you make biofeedback functional?
by recording multiple muscles to train timing
What compound facilitates smooth muscle cell relaxation and inhibits mast cell degranulation in respiratory smooth muscle?
cAMP
Adrenergic bronchodilators work through what two compounds?
cAMP and cGMP
______ facilitates smooth muscle contraction and may enhance mast cell release of histamine and other mediators resulting in bronchoconstriction
cGMP
What is a heel spur?
calcium deposits on the calcaneus
How long does aplastic anemia last?
can be a temporary or permanent condition
If a person has a bilateral TKA done, do they do both knees in the same surgery?
can be concurrent or staged
How can a SMO be used to manage tone?
can raise the toes to give them a little bit more of a stretch
What type of breast tumor qualifies as noninvasive (in situ)?
cancer cells stay inside the milk ducts/lobules in the breast (not in normal breast tissue)
Perturbations in the normal growth factor signalling cascade can result in ___________________ transformations.
cancerous
In what order do the following structures ossify? At what age do they ossify? -olecranon -radius -capitulum -lateral epicondyle -trochlea -medial epicondyle
capitulum - 1 yr radius - 3 yrs ME - 5 yrs Trochlea - 7 yrs Olecranon - 9 yrs LE - 11 yrs
Avascular necrosis not only leads to the loss of bone, but _________ as well
cartilage
All anemias, regardless of the ______________ , have the same features .
cause
How does polycythemia affect the spleen and liver?
causes them to become congested and enlarged
What structure of a cell determines the absorption and distribution/elimination of a drug?
cell membrane
Where is a classic receptor located on a cell?
cell membrane (a.k.a. plasma membrane)
What is the largest known category of receptor?
cell membrane receptors
Which type of receptor is often linked to second messenger molecules within the cell?
cell membrane receptors
What shaped field is created as a result of the quadripolar arrangement with vector scan?
circular shaped field of interferential current
After a *THA or TKA*, you want to progress to what kind of activities ASAP?
closed chain & functional activities
There are a lot of over-the-counter drugs that contain a small amount of antitussive (opioid) drug, but in general, any drug that contains ________ for a respiratory problem would have an antitussive drug in it
codeine
MS is more prevalent in what geographical regions?
cold temperate zones
Injury to the lining of blood vessels exposes ________________ fibers, which platelets adhere to to form a clot
collagen -part of the intrinsic pathway of coagulation cascade
What are some MOI for plantar fasciitis?
common in: -runners -people who are overweight -those who wear shoes w/ inadequate support -overload from physical activity -excessive running and jumping -inc in difficulty or intensity of exercise too quickly -arthritis that result in inflammation in tendons (elderly) -diabetes can cause additional heel pain -walking or exercise in improper shoes
In what geographical region is poliomyelitis common and rare?
common: endemic in West and Central Africa rare: North America
Most biceps tendon ruptures are _________ (partial/complete)
complete
What will eventually happen to a JA if a person lives long enough?
component loosening/failure
If a pt has dyspnea, weight gain, edema, cyanosis, persistent cough, wheezes, rales, purkinje fiber weakness, low cholesterol & lipids, what is a possible diagnosis? -case study-
congestive heart failure (irina) -not asthma b/c of edema and weight gain -MI is not likely b/c she has low lipid and cholesterol levels
What is a synapse?
connection between: -2 or more neurons -neuron and effector cell
Do you treat PD and OD conservatively or non-surgically?
conservative- rest & activity modification conservative vs. operative, depends on characteristics of lesion
Is the output polarity during HVPC constant or reversing during stimulation?
constant
Interferential dosage can either be _______ or ________
constant sweep
What course does systemic pain follow that might cause concern in thinking about a cancer diagnosis?
constant or cyclic/progressive pain that keeps a patient awake at night, also that cannot be altered/alleviated with change in position (organ dependent)
Bronchial ___________ can result from abnormal bronchomotor tone, inflammation and mechanical obstruction?
constriction
What two types of "interference current" are there?
constructive destructive
Which type of HVPC uses continuous modes and which use pulsed modes? options: dermal wounds, pain, edema/spasm/weakness
continuous: dermal wounds & pain pulsed: edema, spasm or weakness
What is a bronchospasm?
contraction of the respiratory smooth muscle cells
"Position of comfort is position of ____________"
contracture
The more proximal a trim line is, the more ___________ you will have
control of a joint the closer the trim line is to a joint, the more it can stabilize the joint
Articulated orthotics often use springs to:
control the amt of motion available the looser the spring the more motion available at that joint
What is the function of dopamine? Which neurological disorder involves the reduction of dopamine levels in the body?
controls muscle activity Parkinson's disease
What are the 2 most common types of breast biopsy for diagnostics?
core needle surgical (lumpectomy)
Alzheimer's disease involves progressive ____________ atrophy
cortical
Dementia is a progressive chronic disease that involves decreased ______________ function
cortical
High doses of ___________ is the most common drug to cause avascular necrosis after trauma
corticosteroids
Antitussive drugs are given to supress a _____ by acting on what part of the nervous system?
cough act on the cough center of the brain in the CNS
What are the categories of pain that can be examined to help differentiate between systemic or musculoskeletal pain?
course/duration aggrevating factors Relieving Factors Quality Intensity Assocaited Signs/Symptoms
What arrangement is utilized with interferential e-stim?
crossing quadripolar so the current from one set of electrodes "interferes with" current from the other set
What is different about the circuit amplitude of a quadripolar vector scan set up compared to other methods of delivery?
current amp of 1 circuit varies -50-100% of max other curcuit in this set up is fixed at one amplitude (allows field to rotate)
Long acting asthma medications should be taken when?
daily, no matter if there are asthma symptoms present or not
What is involved with a *partial* distal biceps tendon rupture?
damage to the soft tissue but the tendon is not severed
What does ALS eventually result in?
death due to respiratory failure, usually 2-5 years after diagnosis
Allegra-D, Claritin-D, Zyrtec-D, Benadryl Allergy and Sinus, and Tylenol Allergy and Sinus These are all examples of what combination of drugs?
decongestants and antihistamines
Does hematocrit increase or decrease with blood loss?
decrease -you lose fluid and cells proportionally, but RBC's take longer to replenish
The blocking of the H1 receptor has what effects?
decrease mucosal congestion, irritation and discharge caused by inhaled allergens, they may also reduce coughing and sneezing associated with common colds
How do decongestants work?
decrease swelling normally experienced with inflammation by shrinking the blood vessels and making them less leaky, thus reducing fluid in the area
Would you increase or decrease the sampling frequency in biofeedback for a pt with a neck spasm that you want to get to relax?
decrease the frequency
Once acute compartment syndrome has developed in the forearm, which group of mm is most commonly affected?
deep tissue flexors (muscle fibrosis and tissue shortening can occur)
What is Volkmann's contracture?
deformity of the hand, wrist, and fingers resulting from an acute compartment syndrome in forearm (wrist flexion & MCP extension)
Parkinson's disease is a progressive ________________ disorder
degenerative
What is often the first thing Brittany looks at in a LE orthotic evaluation?
degree of pronation or supination can lead to a lot of other problems
Multiple sclerosis involves progressive _____________ of neurons
demyelination
The ______________ of a neuron conducts impulses toward the cell body
dendrite
A stretcher chair or "cardiac chair" allows a:
dependent lateral transfer
Qualitative research studies relies on participants having _______________ descriptions.
detailed
What causes avascular necrosis (osteonecrosis) of the hip joint?
deterioration of the femoral head due to occlusion of the medial or lateral circumflex artery
When is the onset of gigantism?
develops in kids before the age when the epiphyses of the bones close
What motions may be restricted at the proximal radioulnar joint with a capsular pattern restriction?
equal limitation of supination and pronation
Examples of devices that do not count as restraints:
devices used for: -routine physical exams -to protect pt from falling out of bed -to allow pt to participate in activities w/out the risk of physical harm
What type of joint is the acetabulofemoral joint (hip)?
diarthrodial spheroidal (ball and socket)
Only after the constricted airways are _______ can mucociliary transport and removal of secretions begin
dilated
What term is used to describe the removal of a drug from its receptor?
dissociation (Kd)
What is the purpose of fascia surrounding muscles?
divides muscles, nerves and blood vessels into specific compartments -holds these systems in place -collagen make up does not allow for easy stretch or expansion
Parkinson's disease is caused by a decreased number of _________________ in what part of the brain?
dopamine secreting neurons substantia nigra
________________ resulting in fewer receptors of cell surface partially explains why addicting drugs require higher and higher doses to elicit the same response
down regulation
What are side effects of mediator-release inhibitors?
dry mouth and throat, airway irritation and possible bronchospasm
7 of every 10 cases of breast tumors are _____________ ______________
ductal carcinoma
DME stands for:
durable medical equipment
What are some benefits of a SACH prosthetic foot? (3)
durable, simple, inexpensive
In Cushing's syndrome, muscle wasting can be so extensive that the condition stimulates muscular ___________________
dystrophy (tissue wastes away) this literally makes no sense...that's a genetic disease...
During which steps of a signalling cascade is pharmacological intervention possible?
each step can be a site for pharm. interventions
What is an important aspect about diagnosing Volkmann's contractures?
early detection is key (tools to measure intercompartmental pressure)
Should recomendations for discharge planing and assistive devices or other equipment after a *THA or TKA* be done as an early post-op intervention or later on?
early post-op interventions- there's currently a motion to fast-track discharges
Are conventional TSAs cemented or un-cemented?
either
How is mild genu recurvatum often treated?
either a shoe insert or AFO to give them a little bit more of a flexion moment this isn't enough if they have extreme genu recurvatum
How are rotational torque adapters AND vertical shock absorbers incorporated into a prosthetic foot?
either built into the prosthetic foot or attached as a separate component
The ____________ is important for the transmission of power from the shoulder to the hand
elbow
What is the close-packed position of the radiohumeral joint?
elbow flexed to 90 deg forearm supinated to 5 deg
What is the MOI of posteromedial varus rotatory instability of the elbow?
elbow subluxation AND fracture of the coronoid process AND avulsion or rupture of the LCL usually from a FOOSH
In which type of prosthetic construction can you adjust the relative position of the foot underneath the prosthesis? exoskeletal or endoskeletal
endoskeletal
Which type of prosthetic construction allows the feet to be interchangeable? exoskeletal or endoskeletal
endoskeletal
Which type of prosthetic construction can facilitate multiple alignment options? exoskeletal or endoskeletal
endoskeletal
What activates the intrinsic pathway of the coagulation cascade?
endothelial injury in blood vessels
Which elbow structures are affected in: -Panner's disease -osteochondritis dissecans
entire capitulum lateral or central part of capitulum
_________ in low doses is the form of drug typically sold in non-prescription inhalers
epinephrine
Is glutamate excitatory or inhibitory?
excitatory
The wrist extensors originate on the ____________ epicondyle The wrist flexors originate on the _____________ epicondyle
ext: lateral flx: medial
Are custom fabricated LE orthoses better for short or long term use?
extended or permanent use
What is the close packed position of the ulnohumeral joint?
extension with supination
Which coagulation pathway is quicker, the intrinsic or extrinsic pathway?
extrinsic pathway
Osteoarthritis puts one at risk for:
falls
T/F: interference area is much larger in a dual, bipolar arrangement than a quadripolar (crossing) arrangement
false with dual, bipolar the interference area is much smaller
T/F: the effectiveness of PT at rehabilitating a THA is well supported with evidence
false "insufficient evidence exists to establish the effectiveness of physiotherapy exercise following a primary hip replacement for osteoarthritis" Jason said this is what we're up against, and this is often b/c we tend to not be aggressive enough with PT
T/F: malignant tumors of the thyroid are common
false tumors are common, but malignant thyroid tumors are very rare
T/F: if you do not know what a pt's hip precautions are, you should ask the pt
false, a pt may assume they have posterior precautions based on their own "research" or the experiences of others, you should check they're chart
T/F: with a ground reaction AFO, the strut goes up the lateral side of the ankle
false, it can go up either side people are more bony on the lateral malleolus and medial struts better allow for shoe inserts
T/F: +2 or more assistance represents conveys the pt's abilities
false, it conveys the "level of burden" Ex: obese pt could only be min assist but may require 2 people to accomplish that
T/F: there are no ADs to help with medial & lateral epicondylitis
false, there are braces to help with both of these conditions, but evidence doesn't support their effectiveness
T/F: there is a single best prosthetic foot overall
false, there are only best prosthetics for an individual's needs
T/F: the heel height of an endoskeletal prosthesis can be adjusted
false, they are aligned to one heel height, so shoes can dramatically affect overall alignment
T/F: evidence supports the use of anesthetic wound infiltration for TKAs and THAs
false, they are effective for TKA but questionable for THA
T/F: custom-fit LE orthoses are considered "off the shelf"
false, they are pre-fabricated devices that are *modified* to fit a specific patient
T/F: locked knee KAFO's are well liked by patients
false, they are really disliked, they're not fun to wear
T/F: the locking mechanism of stance control KAFO's is always the same
false, they vary (Ex: bail lock, drop lock, etc.)
T/F: Smaller incisions mean the surgeons do not have to have as much technical skill
false, this means the surgeon should have more skill
T/F: total hip re-surfacing is a new technique
false- first attempted in 1950s, widespread use since 2000, approved by FDA in 2006
If a patient presents with possibly concerning symptoms, what are some other factors you might examine to determine the likelihood for cancer?
family history of similar cancers change in stools race (some cancers more prevalent) changes in appetite or weight loss
What is the largest endocrine organ in the body?
fat
What is morbid obesity?
fat as a disease
Is scoliosis more common in males or females?
females
ALS involves progressive muscle weakness and loss of _______________ (gross/fine) motor coordination
fine
Which biofeedback variable can be adjusted to answer the question: "How much do you want each little twitch to count?"
frequency
Where are 2 typical locations of a brain abscess?
frontal or temporal lobes
What plane and axis does hip abduction/adduction occur in?
frontal plane sagittal axis
What is the resting (loose-packed) position of the radiohumeral joint?
full extension full supination
What is the close packed position of the hip?
full extension of the hip (20 dgrees) combined with slight internal rotation and slight hip abduction
In late PT interventions after a *THA and TKA*, you should emphasize _____________ activities
functional
How do you determine the best prosthetic foot for an individual?
functional abilities & associated needs keep in mind, this may change over time
FIM stands for:
functional independence measure
Ankylosing spondylitis involves inflammation that leads to:
fusion
Which biofeedback variable can be adjusted to answer the question: "How much do you want to encourage small changes in muscle activity?"
gain
What are some risk factors for heel spurs?
gait abnormalities that place excessive stress on the calcaneus, ligaments and nerves
What genes are affected in thalassemia?
genes for alpha & beta hemoglobin chains are mutated or missing
Cancer is a _______disease
genetic
What is the definition of compartment syndrome?
increased intracompartmental pressure in a confined fascial space due to bleeding, swelling or another cause that decreases blood flow and can deprive the compartment contents of oxygen, nutrients and waste removal which can result in ischemia or pain
Shoulder instability is described how?
increased movement of humeral head relative to the glenoid fossa
What is polycythemia?
increased production of RBC's (erythropoiesis is the production of RBC's)
In meningitis, the infection leads to inflammation which leads to what 2 things?
infection -> inflammation -> inc ICP and edema
What causes hematogenous osteomyelitis?
infection from other place that travels through blood to bone
What causes osteomyelitis?
infection in bone, usually bacterial
What is exogenous osteomyelitis?
infection in deep wound
What is encephalitis?
infection of the parenchymal or connective tissue in the brain, SC and maybe meninges
What 2 things may exacerbate AIDS dementia?
infections and tumors
Where is the weakest part of the hip joint capsule?
inferior and posterior aspect
How would medial epicondylitis be defined?
inflam in the insertion of the FCR & Pronator Teres (interface between these muscles)
What usually occurs around a brain tumor that additionally inc ICP?
inflammation
Remember that beta agonists do not depress ______, they only ______ airways
inflammation dilate
Glucocorticoids reduce airway ________ and ________ thus decreasing the chances of having an asthma attack
inflammation and swelling
How is lateral epicondylitis defined?
inflammation in the *insertion* of ECRB and ECRL
What is epicondylitis?
inflammation of one of the epicondyles, which includes both the periosteum and the tendons
What is thyroiditis?
inflammation of the thyroid
What is stage 1 LE?
inflammation w/o alteration in tendons
Droplet precautions are used for infections such as:
influenza, mumps, meningococcal disease or pertussis
Is GABA (Y-aminobutyric acid) excitatory or inhibitory?
inhibitory
The stretcher chair is a great option for:
initiating upright activities particularly if the patient has potential for poor tolerance of the upright position
What is a good short term conservative treatment option for lateral epicondylitis?
injection (results last for ~6 mo, PT better for LT)
If you turn down the gain on biofeedback, what happens to the relationship between input and output?
input is greater than output
How does iron deficiency affect hemoglobin within a RBC?
insufficient iron impairs Hb synthesis and results in low Hb concentration in cells
trunk rotation muscles
int/ext oblique - unilateral
Where is the interference at with a quadripolar (crossing) method of delivery?
interference at level of TREATMENT AREA
What general level of frequency with interferential decreases impendence at the skin?
medium deeper current flow
What *strengthening* activities should you include in your *early* post-op interventions after a *TKA*?
isometrics, ankle pumps, heel slides, SAQ, LAQ (w/ assist), SLR
Concentric and eccentric contractions are 2 types of _______ contractions
isotonic (constant load)
What part of the nervous system does poliomyelitis affect?
it attacks *motor* neurons of the SC and medulla
How does TPA block the coagulation cascade?
it catalyzes the conversion of plasminogen to plasmin which breaks down blood clots
What effects does an action potential have on the neuronal plasma membrane?
it increases the permeability of the neuronal plasma membrane so that ions can move across it
How does ASA (aspirin) block the coagulation cascade?
it inhibits platelet function/aggregation
Iron deficiency anemia is frequently a sign of what?
it is a sign of an underlying problem
Ipratropium has fewer side effects than atropine because?
it is more poorly absorbed into the system
How does plasmin affect blood clots?
it is the enzyme responsible for fibrinolysis, so it breaks down clots
How does the virus that causes rabies spread in the body?
it travels along peripheral nerves to the CNS and salivary glands, it then causes inflamm & necrosis
What would happen to a transfemoral amputee's gait if they were using an endoskeletal prosthesis and they got new shoes with a higher heel?
it would induce knee instability
What are some symptoms of gout (gouty arthritis)?
joint: red, swollen & painful
Are the systemic effects more marked in the adult or juvenile form of rheumatoid arthritis?
juvenile
Is the adult or juvenile form rheumatoid arthritis usually more acute?
juvenile
In MES for *wound healing*, if there is an infection present, how should you adjust your treatment?
keep the cathode in the wound until 3 days after the infection clears
What feature of a PRAFO prevents hip IR and ER while the pt is in bed?
kick-stand
In a ground reaction AFO with an anterior shell, the pre-tibial cuff facilitates what motion?
knee extension (which results in hip extension)
In a ground reaction AFO with a posterior shell, the tibial cuff facilitates what motion? (not in lecture, from lab notes)
knee flexion (which results in hip flexion)
Which sx might make the diagnosis of a pulled elbow more difficult?
lack of accuracy about where the pain is or isn't localized -may think the kid has injured their shoulder or wrist if you're not specific about locating where their pain is bc of the presentation of pulled elbow
Droplet transmission of infections involves small or large droplets?
large -generated when pt coughs, sneezes or speaks
How are the electrodes arranged for HVPC?
large dispersive electrode with: -1, 2 or 4 active electrodes -handheld electrode electrodes are of equal size
What types of joints are affected by juvenile rheumatoid arthritis? (large or small)
large joints
What is a tophus in terms of gout?
large, hard nodule that consists of urate crystals
Do plaques develop early or later on in MS? Where do they develop?
later in larger areas of inflamm and demyelination, vary in size
Finger extension, Cozen's test and Mill's tests are all special tests for which condition?
lateral epicondylitis
Is lateral or medial epicondylitis more common?
lateral epicondylitis
Is shingles more or less contagious than chicken pox?
less contagious
In HVPC, the high voltage component means the device will have less capacitance than others. (less ability to store an electric charge). Based on this, will HVPC have more or less tissue impendence? Will it be more or less comfortable for the patient?
less impedance more comfortable C (capacitance) = Q (charge) / V (voltage)
What percent of blood is WBC's & platelets?
less than 1%
What is the failure rate of a prosthetic in a THA?
less than or equal to 1% per year
A competitive agonist is competitive because if you add more _______ you will compete the drug off the receptor and _______ will bind more than the drug, and the opposite is true
leukotrine (for both blanks)
_________ will not stop an attack or even reduce symptoms once an asthma attack has started
leukotrine blockers
What is the chair test? What is it testing for?
lifting a chair with pronated hand testing for lateral epicondylitis (will produce pain there)
What is the only way to decrease lifting load on a PT's back?
lifting devices
Any compound that binds to a receptor is called a _____________.
ligand
Articulated orthotics often use pins to:
limit one motion and allow another or just restrict all motion
What is the difference between limited-stage and extensive-stage small cell lung cancers?
limited: spread to area b/w lungs or to lymph nodes above collar bone extensive: spread to other places in body
Platelets are a fragment of what type of cell?
megakaryocytes (large bone marrow cells)
Although the cause of Reye's syndrome is not fully determined, what is the cause thought to be linked to?
linked to viral infection in kids treated with aspirin
Drugs must be _________ - soluble in order to bind to an intracellular receptor or it must have a specific transporter in the cell membrane.
lipid-soluble, so it can diffuse through the cell membrane
A variety of injuries seen in the elbow of young pitchers is known as:
little leaguer's elbow
Fat near the ______________ (organ) is more dangerous
liver
A posterior leaf spring stores energy during _________ and releases energy to facilitate ___________
loading swing helps them clear their foot
What are the 3 types of surgical removal for lung cancer?
lobectomy (lobe) wedge resection (small part) pneumonectomy (whole lung)
What type of breast cancer occurs 1 in every 10 cases and involves the lymph nodes?
lobular carcinoma
What 3 categories can cancer treatment be divided into?
local, locoregional, systemic
Is a brain abscess a localized or systemic infection?
localized
What is a cerebral aneurysm?
localized dilation in the wall of an artery
How does having a bilateral TKA affect recovery time compared to a unilateral TKA?
longer recovery, may require inpatient rehab
What is searched for with genetic testing?
looks for specific inherited changes (mutations) in a person's chromosomes, genes or proteins
Does the hip joint have maximal joint congruency in the close or loose packed position?
loose packed
What happens to the shape of the femoral head with the progression of avascular necrosis?
looses blood supply, flattens due to weight of the body
What is a significant inward curve at the low back called?
lordosis
What causes a Volkmann's Ischemic Contracture?
loss of blood supply to the forearm
The earliest lesions in an occurance of MS cause loss of myelin in which neurons?
loss of myelin in white matter of brain or SC occurs as an inflamm response
ALS involves: a ___________ (loss/damage) of upper motor neurons in the _______________ which results in _________________ a ____________ (loss/damage) of lower motor neurons in the ___________________ which results in ________________
loss of upper motor neurons in cerebral cortex which results in spastic paralysis and *hyperreflexia* damage of lower motor neurons in brainstem & SC which results in dec muscle tone and *hyporeflexia* or flaccid paralysis
Does diabetes insipidus involve excess retention or loss of water? What condition can this lead to?
loss, leads to severe dehydration
What is a Riancorp LTU-904?
low level laser used in PT treatments for cancer patients
When a drug is in (low or high) concentration in the ECF, it has little effect on the neighboring cells.
low, the concentration must be high enough to increase the chances of a drug molecule interacting with its receptor
What are the 3 types of breast tissue removal?
lumpectomy simple masectomy modified radical masectomy
A patient with a persistant cold, a dry cough, shortness of air with exertion and a medical history including obesity and heavy smoking should be screened for what?
lung cancer
What other tissue around the breast should be tested for cancerous cells?
lymph nodes
Which type of leukemia deals with precursors of agranulocytes?
lymphocytic leukemia
Is pernicious anemia a type of macrocytic or microcytic anemia?
macrocytic
Is osteomyelitis more common in males or females?
males
What population does ankylosing spondylitis usually affect?
males 20-40 yo runs in families
What is the range for a normal carrying angle (cubital angle) in males and females?
males: 11-14 female: 13-16
What are 4 diagnostic tests that can be used to screen for breast cancer?
mammogram MRI ultrasound biopsy
If a pt is coughing and not covering their cough, what PPE should you wear?
mask
If you are in a situation where you could get splashed in the face with body fluids, what PPE should you wear?
mask
How long does neuroborreliosis infection remain in the body?
may persist for months
What information can we get from measuring prothrombin time (PT) and partial thromboplastin time (PTT)?
measures function of various clotting factors in the coagulation process
What information can we get from measuring bleeding time? (how well what structure functions?)
measures platelet function
What does a differential count measure?
measures proportion of different WBC's
*Cromolyn sodium* was first discovered in 1960 in Britan in a plant and is part of the _____________ inhibitor family
mediator-release inhibitor
What type of drug is cromolyn sodium?
mediator-release inhibitor
What category of asthma drugs can be used either prophylactically or in response to acute asthma attacks?
mediator-release inhibitors
How is Parkinson's disease diagnosed?
medical history & neurologic exam there is no lab test
Does Jason support the use of CPM devices after a JA?
no, he thinks they are worthless, but some surgeons really like them may have some use for people who are in the ICU for a long time and aren't very responsive "the effects of CPM on knee ROM are too small to justify its use"
Does padding alone over a high pressure area reduce the pressure force?
no, in some cases it may increase pressure -pressure relief is accomplished by removing the area from pressure force altogether or distributing pressure over a larger area
Will the patient feel tingling with MES?
no, it doesn't activate sensory nerve fibers
Is an asthma attack the same for all people?
no, it is completely individual meaning that there are different triggers and the reactions are unique as well
Is lifting the only high risk activity of health care workers?
no, risk is across numerous domains
Are rheumatoid nodules present in juvenile rheumatoid arthritis?
no, they are absent
Are Ka (association) and Kd (dissociation) good indicators of drug efficacy?
no, they only indicate the percentage of receptors that are bound to a drug and don't predict amt of activity after binding
OSHA data reveals that health care is 2nd to manufacturing in ______________________ illnesses.
non-fatal occupational illnesses
What are the 2 categories that breast tumors can be split into? What is more common?
noninvasive (in situ) invasive***more common
Are modalities or TherEx needed in the treatment of a pulled elbow?
nope once reduction is successful, the child will regain most of their fxn w/in minutes & there shouldn't be much swelling
In the sympathetic NS, postganglionic neurons release which neurotransmitter in response to a stimulus from a preganglionic neuron? This neurotransmitter then activates what kind of receptor on the target tissue?
norepinephrine adrenergic receptors (could be alpha or beta)
Most people who only have chronic thyroiditis will have a _________________ functioning thyroid
normally -20% will be hypothyroid -less than 5% will be hyperthyroid
Are there many side effects of quick-acting asthma medications?
not many but notable points are: -too much albuterol can increase asthma symptoms -side effects vary from person to person -should not be used in people taking beta blockers
Does having 2 people repositioning or lifting reduce the load?
not significantly
Is an AD helpful to treat a pulled elbow?
not usually may be indicated if the child still will not move the arm, observe for 24 hrs
What type of receptor are zinc fingers located on?
nuclear (intracellular) receptors
In leukemia, are the WBC's being rapidly produced mature or immature cells?
one or more types of WBC are immature (blast), undifferentiated, nonfunctional cells
What patient characteristic is strongly associated with high failure rates in a knee *unicompartmental* arthroplasty?
obesity
______________ is a condition that involves a high amount of body fat in relation to lean body mass or a BMI greater than 30 (fat is not supported by the person's frame)
obesity
Expectorants, Mucolytics and antitussive drugs are used to treat what kind of respiratory disorder?
obstructive lung diseases
OSA stands for:
obstructive sleep apnea
Jaundice, yellowing of the skin and sclera of eyes, is a condition that may take place during breakdown of RBC's. Why would this happen?
occurs if unconjugated bilirubin accumulates in the blood during the breakdown of RBC's
Does MS affect the full length of the neuron or patches of the neuron?
occurs in diffuse patches
Describe the pattern of neuronal loss that occurs with ALS
occurs in diffuse pattern, may be asymmetrical
Define achilles tendinopathy
occurs when the tendon degenerates and becomes inflamed. The tendon may swell and cause pain
What is triceps tendonosis?
occurs when there is degeneration of the collagen in the tendon from repeated overuse
When does a sickle cell crisis occur?
occurs whenever oxygen levels are lowered, causes severe pain due to ischemia of tissues and infarction
Does multiple myeloma (a.k.a. plasma cell myeloma) occur in younger or older adults?
older
What is olecranon bursitis?
olecranon bursa which lies b/w skin and olecranon becomes inflamed/irritated
Which type of glial cell provides myelin for axons in the CNS?
oligodendroglia
Which type of cells form the myelin sheath of neurons in the CNS?
oligodendroglia (oligodendrocytes)
All ________ drugs are antitussive because they all have the side effect of suppressing cough
opioid
In open chain movement, the roll and glide of the hip will occur in __________ (same/opposite) direction
opposite
How are leukotrine blockers administered?
orally
The more severe the ____________________ the more severe the effects of post-polio syndrome
original infection
What are the main risk factors for patients taking glucocorticoids long term to control asthma?
osteoporosis, slow healing wounds and muscle wasting (because these drugs have catabolic effects) other long term effects include: immunosupression, GI disturbance, emotionally labile, insomnia, retardation of growth, hyperglyceremia, and sodium and water retention
If you turn up the gain on biofeedback, what happens to the relationship between input and output?
output is much greater than input
Does Jason think the mini-incision approach is better than a standard approach?
overall, yes, although there is still limited evidence
What are the therapeutic effects of IFC?
pain urinary incontinence blood flow/edema management spasm reduction
What are symptoms of a medial epicondyle fx? (little leaguer's elbow)
pain in medial elbow w/ edema
How is shoulder impingement described?
pain with overhead activities due to encroachment of soft tissue
Is the ganglia in an ANS pathway located close to the target organ in the sympathetic or parasympathetic NS?
parasympathetic NS
Which division of the NS is responsible for aiding in recovery after sympathetic activity?
parasympathetic NS
PAPR stands for:
powered air purifying respirator (looks like a space suit)
Which type of LE orthotic is used for someone who is limited financially? -pre-fabricated -custom fit -custom fabricated
pre-fabricated
Which type of LE orthoses provide limited fit and function? -pre-fabricated -custom fit -custom fabricated
pre-fabricated and custom fit
Which type of LE orthotic can be used for diagnostic procedures? -pre-fabricated -custom fit -custom fabricated
pre-fabricated and custom-fit
Antihistamines are available either over-the-counter or as a _______
prescription
What does a constant dosage delivery of IFC mean?
preset beat freq or set by user
What does a sweep dosage delivery of IFC mean?
preset beat frequency range
What does PRAFO stand for?
pressure relieving ankle foot orthosis
If you choose not to use bone cement in a JA, what are you relying on to keep the prosthesis in place?
pressure, if there's too much pressure it'll fracture the bone
How does cromolyn sodium work?
prevents the influx if calcium ions into the mast cells, blocks the degranulation process of these cells and inhibits further release of mediators that cause bronchoconstruction
Which type of polycythemia is considered "polycythemia vera" or true polycythemia?
primary
What are the 2 types of polycythemia?
primary and secondary
What is the main difference between primary and secondary polycythemia?
primary: cancerous inc RBC production secondary: inc RBC production in response to hypoxia
Do private practices or hospital settings see more WRMSD's for PT's?
private practice
What is erythropoiesis?
production of RBC's
What is leukopoiesis?
production of white blood cells
What are some symptoms of post-polio syndrome?
progressive and debilitating fatigue, weakness, pain and muscle atrophy
The purpose of stabilization is to ________ movement
prohibit
Obesity in critically ill patients is related to:
prolonged duration of mechanical ventilation and intensive care unit length of stay (associated with morbidity, but not with excess mortality)
How does hemophilia A affect bleeding time?
prolongs bleeding time after minor tissue trauma
What is essential in order for a person to survive meningitis?
prompt diagnosis and treatment
Mediator-release inhibitors can be given _______ in cases of chronic asthma to prevent immediate hypersensitivity due to mast cell release of specific mediators that produce bronchoconstriction
prophylactically
What determines the osmolarity and viscosity of blood?
proteins & solutes -hematocrit also determines viscosity
Vitamin K is required for synthesis of what molecule involved with coagulation?
prothrombin
If a pt is unable to complete partial ROM with their knees bent during trunk flexion MMT, what can be done to give the pt a second chance of achieving a grade of a 2?
pt in supine, bring them into partial trunk flexion & support neck and shoulders and tell them to cough if they are capable of coughing, give them a 2
How often is MES (LIS) used when helping with *bone healing*?
pts use it for extended, multiple, daily periods of time
In a ground reaction AFO with an anterior shell, the rigid foot plate facilitates:
push off
elevation of pelvis muscles
quadratus lumborum
Which method of delivery for IFC may be used for a large treatment field?
quadripolar with vector scan
Do neurotransmitters induce a quick or slow response?
quick
Drugs given to treat asthma symptoms are categorized according to their ___ acting or ____ acting mode of action
quick or long
What is an example of locoregional cancer treatment?
radiotherapy
Does the infection causing meningitis spread insidiously or rapidly?
rapidly
How is the therapeutic index (TI) of a drug determined?
ratio of LD50 / ED50
What is *gain* in terms of biofeedback?
ratio of output (machine reading) to input (muscle contraction)
What plane and axis does hip flexion/extension occur in?
sagittal plane coronal (frontal) axis)
Contractures develop in the ________ direction of the muscle contraction
same
Greatest risk areas for wounds and burns
scars that cross or extend past a joint
What is formed due to the demyelination of neurons that occurs in MS?
scars- lesions & plaques
How is scoliosis most often identified?
school screenings (observe alignment of SP's in standing and look for rib hump while they bend forward)
What is a lateral curvature of the spine called?
scoliosis
What is the MOI for cuboid syndrome?
secondary to overuse, increasing body weight, training on uneven surfaces or lateral ankle sprain
a negative ________ lymph node indicates a >95% chance that the remaining lymph nodes in the axilla are also cancer free
sentinel
Which neurotransmitter is implicated in mood changes?
serotonin
Which neurotransmitter is responsible for regulating behavior, digestive processes, mood changes and sleep?
serotonin
What are the physiologic effects of IFC?
set to depolarize peripheral sensory or motor fibers
What can abnormal nuclear receptor activity lead to?
severe pathological findings
Which type of forces are *rotational torque adapters* for prosthetic feet good at reducing?
shear forces
What condition leads to global cerebral ischemia?
shock: impaired perfusion of the entire brain
What is the foundation of any LE orthotic?
shoes
When a pt gets a new LE orthotic, they also need to get new:
shoes this is bc the sole of their current shoes will have worn a certain way that promotes their mal-alignment
HVPC has (short/long) stimulation periods and an interpulse time that is ____ times as long as the stimulation time
short periods 50 times
Are custom-fit LE orthoses better for short or long term use?
short term / temporary
Are pre-fabricated LE orthoses better for short or long term use?
short-term / temorary
Shoulder arthroplasties were initiated in the early '50s primarily for what condition?
shoulder fractures
What is the most common inherited blood disorder in the U.S.?
sickle cell anemia (~1 in 5000 people)
What type of breast tissue removal is typically done on the unaffected side when a patient has breast cancer unilaterally and elects to have a double masectomy with reconstruction?
simple masectomy done on unaffected side (no removal of lymph nodes since not affected)
If a patient has a K level of 1 and has weak quads, what might be a good foot prosthesis for them?
single axis foot or SACH
What is *area* in terms of biofeedback?
size of area to be sampled
What are potential complications of radiation treatment?
skin reactions axillary cording lymphedema
Which layers of the scalp are a part of the "functional scalp"?
skin, dense CT, aponeurosis
What AD might be used to treat Panner's or OD?
sling in acute phase
Do hormones iniduce a quick or slow response?
slow, but is usually longer lasting
What are the two types that lung cancers are divided into? Which is more dangerous and why?
small cell non-small cell *small cell more dangerous because it grows faster (1 of 8 cases)
What types of joints are affected by adult rheumatoid arthritis? (large or small) Is it usually unilateral or bilateral?
small joints bilateral
After eating or after going to the bathroom, what hand hygiene method should you use?
soap & water
Which AFO offers maximum motion control in all planes (plantarflexion, dorsiflexion, pronation, supination)?
solid ankle
What may a harmful gene mutation increase the risk of?
some other disease such as cancer
The _______ cells divide, the "wilder" they become in appearance and behavior.
sooner
_______________ of a drug is the molecular basis for the side effects any drug will have
specificity -the more specific a drug is, the fewer side effects it will have
What is the function of the myelin sheath of neurons?
speed up the rate of conduction of nerve impulses
Evidence supports the use of __________________ and NSAIDs combined with acetaminophen as an effective way to manage pain during a JA?
spinal anesthesia
How is triceps tendinosis different from tendinitis?
tendinitis occurs with inflammation of the tendon resulting from micro-tears when overloaded (tendinosis definition on prev. slide)
What is involved with a *complete* distal biceps tendon rupture?
tendon is completely detached from its attachment point
In which neurological infection does the exotoxin that causes the infection enter the NS and *inhibit the release of GABA*?
tetanus
What is the most common genetic disorder in the world?
thalassemia (type of hemolytic anemia)
FYI: before administering emergency care, it is always best to try to determine whether the person is having an episode of hyperglycemia or hypoglycemia
thank you, stacia
What does Tx, Nx or Mx mean?
that quality of the tumor cannot be assessed
What happens after a G-protein is activated by binding to a G-protein receptor? How is the signal amplified by G-proteins?
the G-protein.... -binds to receptor -becomes activated -moves away and can then act on a number of other molecules in the cell -then another G-protein binds to the receptor (repeat = amplification)
How is a tumor "staged" (what are you looking for in someone's chart)?
the TMN assignments
What happens during an allergy attack?
the allergen will trigger the immune system, activating mast cells to release histamine into the blood. Histamine binds to receptors on the walls of blood vessels causing local inflammation and swelling, followed by leakage along the wall
How does Alzheimer's affect the physical appearance of the brain?
the brain is smaller in size with narrower gyri and wider sulci
What is beat frequency?
the difference between the frequency of each channel
What is a membrane potential?
the difference in electrical charges across a neuronal plasma membrane
What is the first messenger in a signalling pathway?
the drug
What does affinity mean in terms of drugs?
the drug's ability to bind to its receptor
What is the cellular end point of a drug ?
the final effect a drug was intended to have
Variables of biofeedback (gain, frequency & area) are manipulated to provide:
the greatest motivation to the pt
What information can we get from doing a chemical analysis of serum?
the levels of the components such as iron, vitamin B12, B9 (folic acid), cholesterol, urea, glucose, etc.
What is a resting membrane potential?
the membrane potential when a neuron is resting or inactive
Encephalitis results in some permanent damage. What causes this?
the necrosis and inflamm that develop due to the infection
Define hematocrit
the proportion of cells (RBC) in blood, percent by volume of cells
In a endoskeletal transfemoral prosthesis, considerable attention is given to the relative position of: Why is this?
the prosthetic knee over the prosthetic foot knee instability will be induced if the alignment is too far forward or backward
What happens after repolarization of a neuron?
the refractory period, and then the cell returns to resting state when the channels close and the Na+/K+ pump returns Na+ outside the cell and K+ inside the cell
In HVPC, the *interval* between waves, a.k.a. twin spikes, can be adjusted. What happens as the time between the waves decreases?
the spikes overlap more and the stimulation is perceived as stronger
What determines the patient's hip precautions after a THA?
the surgical approach to the joint
What is a osteotomy?
the surgical cutting of a bone or removal of a piece of bone
The acetabular labrum widens adjacent to the acetabular notch to become what?
the transverse acetabular ligament
What causes AIDS dementia?
the virus invades the brain tissue
What are some focal signs of meningitis?
there are no focal signs because there is no localized mass of infection
What does T0, N0 or M0 mean?
there is no evidence relating to that specific quality of the tumor assessment (no distant metastasis etc.)
Which surgical approach to a THA is the best?
there isn't a lot of evidence that supports the use of one over another
What is the purpose of the 4 screws in an endoskeletal prosthesis?
they act against an inverted pyramid and enables angular alignment changes which affect the relative "length" of the "toe" and "heel" of the foot
Where are the trim lines around the ankle in a semi-solid ankle AFO?
they bisect the malleoli
How do leukotrine blockers work?
they block the formation of leukotrines
How do methylxanthines work?
they cause reversible airway dilation by inhibiting phosphodiesterase that causes degradation of cAMP (basically it inhibits the degredation of cAMP which is a compound that promotes bronchodilation)
How do the effects of secondary brain tumors compare those of primary brain tumors?
they cause similar effects
What do amyloid plaques in Alzheimer's disease lead to?
they disrupt synaptic connections and lead to neuron death
Where are the trim lines around the ankle in a solid ankle AFO?
they encompass the malleoli
Why are methylxanthines considered more dangerous?
they have a small therapeutic range (10-20 mg/ml) so they can quickly become toxic
What is the function of colony stimulating factors?
they impact which way a pluripotent stem cell will differentiate
Do neurons regenerate in the PNS?
they may be able to regenerate if the cell body is viable
Mucolytics are helpful for people with extremely _____, sticky mucous secretions such as with what condition?
thick... ew cystic fibrosis
Does Paget's involve thickening or thinning of long bones?
thickening
How do mucolytics work to treat obstructive lung diseases?
thin the mucous of the lungs, but do not assist in removal (cough reflex usually takes care of this)
Does scoliosis affect the cervical, thoracic or lumbar areas?
thoracic & lumbar
What is another name for platelets?
thrombocytes
In hypoparathyroidism, if hypocalcemia becomes severe, what symptoms will this cause?
tingling spreads & intensifies producing painful muscle tension, spasms, grimacing, laryngospasms & heart arrhythmias
What activates the extrinsic pathway of the coagulation cascade?
tissue and platelet injury
Why do PTs use the tilt table?
to accomplish dependent standing for a patient
What is the end goal of hormones that bind to nuclear receptors?
to activate or inactivate genes
What is the overall treatment goal of elbow instability
to avoid an elbow flexion contracture and minimize elbow stiffness while maintaining elbow stability
Artificial blood products as a blood therapy are used for what purpose?
to compensate for loss of RBC's
What is the purpose of a neuron releasing neurotransmitters into the synaptic cleft after it has been stimulated?
to depolarize the postsynaptic neuron dendrites
The ultimate goal of biofeedback is:
to encourage appropriate motor activity
Plasma or colloid volume-expanding solutions as a blood therapy is used for what purpose?
to maintain blood volume
What is the goal of immediate treatment of a Volkmann's Ischemic Contracture?
to re-establish circulation
Why might surgical intervention for a distal biceps tendon rupture be needed?
to regain full strength
Why are interferons used in biologic therapy to treat leukemia?
to stimulate the immune system
Why is a high tibial osteotomy done?
to surgically realign the knee joint
What is a neurofibrillary tangle in terms of Alzheimer's disease? What do they lead to?
too much phosphorylation makes the molecule unstable, microtubules fall apart (neurofibrillary tangle) and causes eventual death of the neurons
A multi-axial prosthetic foot absorbs gait ___________ to reduce ___________ forces on the residual limb ***
torque shear
Which type of goiter could be secondary to excessive stimulation by TSH?
toxic goiter (hyperthyroid condition)
Na+/K+ pump is a ________________ protein
transmembrane
What precautions should you take if a patient is in isolation?
transmission precautions
"Isolation" is associated with _________ precautions
transmission-based
What plane and axis does hip internal/external rotation occur in?
transverse plane vertical axis
AC joint sprain/separation usually involves a _______ _______
traumatic injury
Define Neoadjuvant therapy
treatment given as a first step to shrink a tumor before the main treatment (usually surgery)
T/F: Paget's disease is often asymptomatic
true
T/F: catecholamines are present in the brain
true
T/F: dual, bipolar arrangement for IFC has anectdotal evidence for decreasing spasm
true
T/F: level of assistance conveys the pt's abilities
true
T/F: locked knee KAFO's are not very common
true
T/F: most MDs think returning to golf or swimming after a THA is okay
true
T/F: neurons are highly specialized cells
true
T/F: olecranon bursitis can be treated either surgically or non-surgically
true
T/F: pre-fabricated LE orthoses are considered "off the shelf"
true this is technically true bc an orthotist doesn't need to modify them, but they need to be "fit" by a licensed orthotist to make sure it's working for them well
T/F: the focus on fast tracking recovery after a JA is on dec stay in hospital by ensuring a smooth pathway w/ the best available clinical treatment from admission to discharge and beyond
true (quote from MD in PP)
T/F: levels of assist is required in all documentation to communicate to others the level of participation or effort to expect
true -should also document the verbal and tactile cues used
T/F: a brain hemorrhage can also increase ICP
true this causes local ischemia along with other inc ICP symptoms
T/F: a brain tumor can cause the brain to herniate
true tumors can cause herniation due to inc ICP
T/F: evidence supports the use of peripheral N blocks to optimize analgesia after a JA procedure
true, but they inc the risk of muscle weakness & falls
T/F: there are now games that are based on muscle activity
true, this helps make biofeedback more fun for kids
What is the theory of using electrical stimulation with AVN?
try to stimulate bone growth with the electrical current (can potentially be used during surgery)
Would you turn the gain up or down for bigger muscle contractions or to encourage maximal contractions?
turn the gain down so that the input is greater than output
Would you turn the gain up or down for a pt who doesn't have much activity in their muscles?
turn the gain up so that the output is much greater than the input
What types of treatment interventions are offered for type I, II and III radial head fractures?
type I - non-operative type II - non-operative or surgical depending on severity type III - surgical intervention
All of __________________ receptors have a site in the intracellular portion of the protein that contains at least one tyrosine amino acid.
tyrosine kinase receptors
What type of receptor are insulin receptors?
tyrosine kinase receptors (exception b/c crosses membrane 2 times)
What type of receptor do growth factors frequently utilize?
tyrosine kinase receptors (same thing as enzyme-linked receptors)
What are the 3 main ligaments that stabilize the elbow?
ulnar collateral radial collateral annular
An excessive cubital angle may result in what condition?
ulnar palsy (excessive cubital angle stretches the ulnar N)
What are qualities of pain that might be an indication of cancer?
unilateral (can be bilateral) deep aching throbbing diffuse (waves/spasm)
What are side effects of leukotrine blockers?
upset stomach, fatigue, dizziness, headache and rash (similar to those taking a placebo)
In MES for *wound healing*, how does the amplitude setting change for normal skin compared to denervated skin?
use a higher amplitude for denervated skin compared to normal skin normal: 200-400 micro-A denervated: 400-800 micro-A
What is a modification that might be made for a JA surgery for higher risk patients?
use of epidural anesthesia instead of general anesthesia
What is internal radiation therapy?
uses needles, seeds, wires or catheters to deliver dose
What increases the risk of C diff acquisition?
using antibiotics (and ingesting the spores)
What is the normal value for angle of inclination of the hip? In which population is this value typically larger? smaller?
~125 degrees larger in children (~145 in a 3 yr-old) smaller in the elderly (~120)
How long does it take for the final Volkmann's contracture deformity to develop when compartment syndrome is neglected?
~6 months