NPTE Review

talipes equinovarus

(clubfoot) congenital deformity of the foot in which it is plantar flexed and inverted

Fentanyl (Sublimaze)

*class*: Opioid Analgesic *Indication* supplement to general anesthesia, continuous, moderate to severe pain

Wartenberg's syndrome

-Compression of superficial radial nerve -Commonly caused by swelling within first extensor tunnel -May also be caused by compression within ECRB or brachioradialis -Dorsal surface of thumb NO MOTOR DEFICITS

dorsal column medial lemniscus

-Dorsal column: ipsilateral fibers in cord -Medial lemniscus: contralateral fibers in BS -Vibration, joint position sense (proprioception), fine touch (light touch), 2-pt discrimination tests: Pt close eyes and lightly stoke skin with cotton ball, positive if can't detect light touch Test kinesthetic: extremity moved through small increments and patient must identify if joint moved up, down, in or out when in MOTION, positive if patient unable to do so. Prioprioception similar but identify where joint moved to when rested Vibration: tuning fork 128 Hz- place at bony prominence in sensory area to be tested in random order Sterognosis- place object in and and patient has to identify it 2-pt- use aethesiometer or other, wide spread and then closer together and measure smallest distance perceived, compare to age-matched norms Graphesthsia- draw on hand and identify figure drawn Barognosis- different weights placed in hand and compare light to heavy Tactile loclization and texture other tests

posterior cerebral artery stroke

-Persistant pain syndrome -Contralateral pain & temperature loss -HH, apasia, thalamic pain syndrome -Visual agnosia, memory deficity, C/L homy hemi Prosopagnosia,

Povidone-iodine solution

-antiseptic solution most frequently used for cleansing the penis or the female perineum before catheterization -CAUTION: patient must be assessed for allergic response before using iodine

Postural drainage positions

-change position every 2 hours -improves secretion clearance and O2 -drains into trachea -atelectasis (only affected region) cystic fibrosis (all lobes)

What are the correlation statistic values?

.76-1.0 high .51-.75 mod .26-.50 fair 0.0-.25 low

INR norms

.9-1.1

What do the 10m walk test results mean?

0-.4 household ambulator .4-.8 limited community ambulator >.8 full community

Upper cervical spine flexion with traction

0-5 degrees

Shoe lift immediately post Achilles surgery boot removal

1-1.5cm NOT 2-3cm

Sequence for removing PPE

1. gloves 2. face shield or goggles 3. gown 4. mask or respirator

Midcervical spine flexion with traction

10-20 degrees

Glucose normal ranges

100-250

Hamstring length needed to create stable base in long sitting with SCI

110 deg allows for some anterior tilt of the pelvis, while still maintaining tension in the hamstrings to promote a stable base in long sitting.

Normal prothombin time (PT)

12-15 seconds, prolonged with liver damage, doubled for anticoagulants

GCS grading

13-15 mild 9-12 moderate 3-7 severe

normal platelt count

150,000-450,000

Normal cholesterol

150-200 (250 some sources) Elevated when excretion blocked by bile duct obstruction, reduced when severe liver damage prevents its synthesis

Hallux angle

20 degrees means patient shifts weight to metatarsals causing supination during push off

Low cervical spine flexion with traction

25-35 degrees

Normal serum albumin

3.5-5.5 decreased in liver damage, decreases with age

What degree of hip flexion is needed during traction for L5-S1 to open IV foreamen

45-60 deg

WBC norms and abnormal values

5.0-10x10^9 <5.0x10 with fever= no exercise >5.0x10^9 light exercise permitted with progression to resistive exericse

Normal total protein

6-8 gm/dL decreased when liver is damaged, synthesis is impaired

Normal PaO2

75-100mmHg

What degree of hip flexion is needed during traction for L3-L4 to open IV foramen

75-90 deg

How much knee flexion is needed to initiate strengthening

90 deg flex

Fall risk for POMA/Tinetti

<19

Panic values pH, pCO2, pO2, O2 sat

<7.2 or >7.6 <20 or >70 <10 or >40 <40 <60%

normal blood ammonia

<74 increased with severe liver damage, liver unable to break down ammonia

Diabetic fasting glucose

>126 mg/dL

Fall risk for TUG

>30 seconds

Signs and symptoms hypokalemia (mnemonic)

A SIC WALT Alkalosis Shallow respirations Irritability Confusion and drowsiness Weakness and fatigue Arrythmias Lethargy Thready pulse

Myositis ossificans

A condition where bone tissue forms inside muscle or other soft tissue after an injury. It tends to develop in young adults and athletes who are more likely to experience traumatic injuries. Most of the time, myositis ossificans occurs in the large muscles of the arms or the legs. cause a hard lump or bump to develop within the muscle, pain, and swelling. This is a gradual process and begins within a few weeks after the initial injury. Busing in muscle belly

Polycythemia

A disorder characterized by an abnormal increase in the number of red blood cells in the blood- increased BP, increase blood viscosity, increased blood volume

Wedge for excessive foot pronation

A medial wedge just proximal to the first metatarsal head- counteracts pronation

Mediopatellar plica syndrome

A plica is a fold in the thin tissue that lines your knee joint. Most people have four of them in each knee. They let you bend and move your leg with ease. One of the four folds, the medial plica, sometimes gets irritated from an injury or if you overuse your knee. This is known as plica syndrome. It can happen over time to people who run, ride a bike, or use a stair machine, or if you start exercising more than usual. It can also come after trauma to your knee, like bumping it on the dashboard during a car accident.

Lateral spinothalmic tract

A sensory pathway found in lateral spinal cord that transmits pain and temperature sensations from the skin Tests: Place hot or cold water on skin, have patient close eyes and place each test tube against the skin individually in a random order, positive if patient cannot idenify hot or cold Other test: pinprick, close eyes, spply sharp and dull ends to skin, positive if patient cannot identify sharp and dull

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

Webers test

A therapist places a vibrating tunning fork on top of the head, mid forehead, and ask the patient if sound is heard equally (normal) or if it is heard louder in one ear (lateralized;the defective ear). This test is called? Heard equally both sides=normal OR Conductive loss same side (hear better); sensoryneural loss opposite side (hear less)

athetoid cerebral palsy

A type of cerebral palsy in which movements are contorted, abnormal, and purposeless. Use cocontractions to gain control of voluntary movements to help treat

Stroke artery for contralateral hemiparsis and urinary incontinence

ACA

What is associated with bipolar disorder?

ADHD

What are the limitations of platelet count of <20,000

ADLs, AAROM-AROM, but no antigravity or resistive exercise, guard carefully

What type of orthotic to use for spastic hemiplegia?

AFO

Mediopatellar Plica Test

AKA- apprehension test Passively *flex the knee 30 degrees* & displace the patella medially with hand ___Palpate *under* the medial aspect of the patella for tenderness ___Bilaterally performed ___Positive finding: palpable tenderness ___Indication: inflammation of the mediopatellar plica

Which statistical test compares 2 or more tx groups while controlling the effects of variables (covariates)

ANCOVA E.g. tall and short subjects tested for gait using assistive devices. Here height is the covariate that must be controlled during statistical analysis

What are the limitations of platelet count of 30,000-50,000

AROM, submax isometrics, stationary bike, walking as tolerated, aqautic therapy, NO prolonged stretching or resistive exercise.

Most commonly used area to test nerve velocity in median nerve?

Abductor pollicis brevis

Meniere's disease

Abnormal condition within the labyrinth of the inner ear that can lead to a progressive loss of hearing. The symptoms are dizziness or vertigo, hearing loss, and tinnitus (ringing in the ears)., fullness in ear WONT SEE HEAD TILT TO ONE SIDE

Allodynia

Abnormal response to pain, pain from unpainful stimuli

Treatments for spastic bladder

Above T12 Trigger relfex Suprapubic taping

Enalapril (vasotec)

Ace-inhibitor Hypertension CHF

In iontophoresis what is used to treat calcium deposits?

Acetate Med: Acetic acid

APGAR scale: A (number 2)

Activity (muscle tone) 1-absent 2-flexed arms and legs 3-active

Hydrocolloids

Adhesive wafers containing hydroactive/absorptive particles that interact with wound to form gelatinous mass over wound bed. Occlusive or semi occlusive Indications: protect PARTIAL THICKNESS WOUNDS, autolytic debridement of necrosis/slough, MILD EXUDATE Advantages: maintain moisture, nonadhesive, comfortable, impermeable to external bacteria, autolytic debridement, MIN TO MOD ABSORPTION, reduce pain, waterproof, time saving, thin forms diminished friction

Swivel walker

Advance with swivel

Legg-Calve-Perthes Disease

Age 2-10 (some say 2-13) degeneration of femoral head due to avascular necrosis. disease is self limiting and has 4 phases: condensation, fragmentation, re-ossification and remodeling. presents with pain, decreased ROM, antalgic gait, positive Trendelenburg sign. primary treatment focus is to relieve pain and maintain femoral head in proper psition LIMITED ABD AND EXT

Random cause respiratory alkalosis

Aggressive deep breathing exercises Hyperventilation and respiratory alkalosis also may be induced by medical treatment. Iatrogenic hyperventilation is most commonly associated with aggressive mechanical ventilation. It may also be associated with aggressive deep breathing and lung expansion respiratory care procedures. Because these exercises clear the PaCO2 fast which results increase in pH.

Sensory branch of musculocutaneous nerve

Antebrachial cutaneous nerve- altered sensation in anterolateral aspect of the forearm

lateral costal breathing

Anterior chest flattening w/excessive flaring of the lower ribs in supine -used to expand one segment of the lung

DMD gait pattern

Anterior plevic tilt, walk up legs

Patient with CF likely to be on

Antibiotic not bronchodilator Cystic Fibrosis (CF) is a genetic disorder that causes severe damage to the lungs, causing a thick buildup of mucus in the lungs. Medical therapy focuses on limiting and treating lung damage caused by infection. Therefore, many patients with CF may be on one or more antibiotics at all times to prophylactically suppress infection.

APGAR scale: A

Appearance (skin color) 0-blue and pale 1-pink body, blue extremities 2-pink

anterior spinothalamic tract

Ascending tract (sensory pathways) that convey crude touch/ non-discriminatory touch Tests: test for pressure, use finger or cotton ball, apply firmly to the patient's skin with enough force to create indentation and stimulate deep receptors Positive if patient cannot detect presence of the pressure

A patient in ICU with acute burns to bilateral upper extremities is to be evaluated and treated. The medical chart reveals the patient received a skin graft 1 day prior to the dorsal surface of the right hand. What would be the INITIAL assessment the physical therapist would perform on the right arm?

Assess ROM at shoulder and elbow only on the right side The initial assessment for the physical therapist to perform would to assess the ROM at the shoulder and elbow on the right side. Burn areas that have been very recently grafted, should not have ROM or dressing changes unless specifically directed by surgeons. Burns over joints will be at risk for scarring or contracture, and should be placed in a position of lengthening of the skin. Other joints that have not been recently grafted can receive ROM as tolerated.

S/S Hypercalcemia (mnemonic)

BACKME Bone pain Arrthymias Cardiac arrest Kidney stones Muscle weakness Excessive urination

McBurrey's point

Between R ASIS and umbilicus

Most appropriate PT assessment for CHF

Body temp and auscultation for rales

Bouchard's nodes

Bouchard's nodes are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (more proximal than Heberden's nodes which is DIP) SEEN OA NOT RA

What is not a side effect of levodopa/carbidopa?

Bradycardia does have dizziness/ involuntary movements, dyskinesia, arrhythmia, hallucination, orthostatic hypotension

Digitalis/Digoxin side effects

Bradycardia, bloody/tarry stools, Halos Digoxin toxicity is common- GI disturbances, loss of appetite, confusion, blurred vision, irregular pulse Hypoalemia- excessive potassium depletion

What muscles does the anterior interosseous innervate

Branch median nerve flexor pollicis longus pronator quadratus the radial half of flexor digitorum profundus (the lateral two out of the four tendons). and the inferior radioulnar, wrist and carpal joints.

anterior interosseous nerve

Branch of the median nerve that supplies the deep muscles on the anterior of the forearm (pronator quatratus) problem- unable to flex distal phalynx, thumb, and index finger

What nerve root level would correspond to a C6 radiculopathy?

C5-C6 (nerve on bottom affected)

brachial plexus

C5-T1 Ulnar trunk: C5 and C6 Lower trunk: C8 and T1 lateral cord: musculocutaneous Posterior cord: Radial/axillary Median cord: ulnar

Hypocalcemia s/s mnemonic

CATS Convulsions Arrhythmias Tentany Stridor and spasms

MCA stroke symptoms

CHANG Contralateral paresis (face and arm) Homonomyous hemianopsia Aphasia Neglect Gaze toward lesion UE>LE L side= aphasia R side= perceptual problems (unilateral neglect, depth perception, spacial relations, agnosia, apraxia)

Hypercalcemia causes (mnemonic)

CHIMPAN Calcium supplements Hyperparathyroidism Iatrogenic, immobilization Multiple myeloma Parathyroid hyperplasia Alcohol Neoplasm

Mechanical debridement contraindications

CLEAN GRANULATED WOUNDS

In iontophoresis what is used to treat muscle spasms?

Calcium (+) Med: Calcium choloride Magnesium (+) Med: Magnesium sulfate

Surgical contraindications

Cardiac disease, pulmonary disease, or diabetes SEVERE SPASTICITY Individuals can't tolerate surgery, short life expectancy, QOL can't be improved

Digitalis/Digoxin (Lanoxen/Digox)

Cardiac glycosides CHF- increases force of contractility of the ventricles of heart--> increasing the SV, decreasing the duration of contraction of ventricles

Hypomobile TMJ

Causes mouth opening restriction but NO PAIN

What do nitrates do?

Causes systemic vasodilation of med & large coronary vessels Inc. myocardial O2 supply Dec. myocardial O2 demand Dec. myocardial wall tension Dec. Preload Side effects: dizzy, light headed, flushing, head ache, reflex tachycardia

Central vs peripheral vestibular disorder

Central nervous system - brain stem vascular disease, arteriovenous malformations, acoustic neuromas and tumors of the brain stem and cerebellum, multiple sclerosis, and vertebrobasilar migraine Nystagmus: pure vertical pendular nystagmus (single axis). No rotational component Peripheral Include inner ear and vestibular nerve The most common peripheral vestibular disorder is benign paroxysmal positional vertigo, followed by uncompensated Ménière disease, vestibular neuritis, labyrinthitis, perilymphatic fistula, and acoustic neuroma. Nystagmus: Upbeating or downbeating (vertical with rotational component) or horizontal nystagmus

Which statistical test uses nominal data (blood types, breath sounds, type of arthritis) to find difference between 2 groups

Chi square test

Rosacea

Chronic skin disorder of the face with red inflamed areas appearing mostly on the nose and cheeks Advanced-see swelling of the nose (rhinophyma), bumps and pimples, migranes

When is hypokalemia usually observed?

Chronic toxicity or patients taking diuretics Decreases Na+/K ATPase rate and exacerbates pump inhibition due to digitalis

What drug interferes with metformin?

Cimetidine (antacid/antihistamine) (metformine use for diabetes)

Lymphedema compression garment classes

Class 1= 20-30 (mild lympth, only UE, fragile skin, elderly) Class 2= 30-40 (UE, stage 2 lymph, minimal compression LE) Class 3= 40-50 (LE, RARE UE, stage 2 LE lympth, high intensity repetitive activities) Class 4= 50-60 (Rarely used, ONLY LE, ONLY custom made)

Sharp debridement contraindications

Clean wounds, advancing cellulitis with sepsis, when infection threatens life, individual on anticoagulant therapy or has coagulopathy

Transparent film dressing

Clear, semipermable allowing O2 and moisture but no water, bacteria, or environmental contaminants INDICATIONS: Stage I and 2 pressure ulcers, secondary dressing, autolytic debridement, skin donor sites, cover hydrophilic powder and paste preparations and hyrogels Advantages- visualize wound, impermeable to fluids, transparent and comfortable, autolytic debridement promoted, decrease friction Used for superficial wounds or partial thickness wounds with minimal drainage

What is Constraint-induced movement

Constraint-induced movement therapy is a form of rehabilitation therapy that improves upper extremity function in stroke and other central nervous system damage victims by increasing the use of their affected upper limb

What muscles contract and what muscles relax with voiding

Contract detursor, relax pelvic floor

In iontophoresis what is used to treat fungal infections?

Copper (+) Med: copper sulfae

Methylprednisolone (Medrol)

Corticosteroid used for inflammation, severe alergies, flare ups of chronic illnesses

Gauze

Cotton or synthetic fabric that is absorptive and permeable to water and O2, may be wet, moist, dry or impregnated with petrolatum antiseptics or other agents, varying weaves and with different size interstices Indications: exudative wounds, dead space/tunneling/ sinus tracts, wounds with combo exudate or necrotic tissue WET TO DRY- mechanical debridement of necrotic tissue and slough CONTINUOUS DRY- heavily exudating wounds CONTINUOUS MOIST- protection clear wounds. autolytic debridement. delivery topical needs Advantages: readily available used with gels, saline, or antimicrobial to keep wounds moist, USED ON INFECTED WOUNDS, good mechanical debridement if properly used, cost effective filler, effective for topical delivery

Sign of respiratory distress

Cough, shortness of breath, chest/intercostal retractions with accessory muscles, increased RR and HR, decreased O2 sat, anxious. Thoracic soft tissue retractions For infants, nostrils flare, grunting,

Canalithiasis vs. Cupulolithiasis

Cupulolithiasis ➢Very latent in onset ➢Persistent in duration ➢Nystagmus : No change in intensity on repetition of maneuver Canalithiasis ➢Latent in onset (1-5 sec) ➢Short in duration (< 1 min) ➢Nystagmus :Decreases in intensity on repetition of maneuver Cupula persistent while canal is transient

Methotrexate (folex, trexall)

DMARDs Cancer, autominnume conditions RA

NSAIDs longest to shortest half life

Daypro (50 hours)>Feldene (about 50)/proxicam>naproxyn (12-17)>aspirin(10) Peak in blood stream about 3-5 hours after consumption

Capsulitis in TMJ

Decreased mouth opening, pain, no clicking, WITH DEVIATION

What does crackles imply

Decreased secretion clearance

Gauze disadvantages

Delay healing if used wrong pain on removal (wet to dry), labor intensive, require secondary dressing, avoid direct contact with granulating tissue vary change schedule, pack loosely into wounds so don't compromise blood flow and delay wound closure, use continuous roll of gauze for packing large wounds, too wet will macerate skin, use wide mesh gauze for debridement and fine mesh for protection, protect surrounding skin with moisture barrier ointment or skin sealant as needed

Malingering

Deliberate faking of a physical or psychological disorder motivated by gain.

In iontophoresis what is used to treat musculoskeletal inflammation?

Dexameasone (-) Med: dexametasone phosphate

Brudzinski's sign

Diagnostic test for meningitis. A placent placed i supine experiences pain with passive flexion of the neck and neck flexion causes hip and knee flexion as the patient attempts to decrease neural tension

Furosemide (Lasix)

Dieuretics Swelling (edema), CHF, liver or kidney disease, hypertension

Normal bilrubin

Direct .1-.3 Indirect .2-.8 Total .3-1.0 Urine 0

Direction of MLD stroking lymphedema`

Distal to proximal

What can cause decreased fluid but increased fibrosis in limbs?

Diuretics since remove fluid but not proteins

Diltiazem (cardizem) side effects

Dizzy, drowsy, mood changes, SOB, swelling

MOST common in patients with COPD

Dorsal kyphosis

Initial wound treatment if no patient referred and no ABI complete

Dressing change Before any debridement or compression treatment to be done, it is to determine if the patient has adequate circulation by having the results from the Ankle Brachial Index. It is best to be conservative on treatment until then.

What to consider if patient taking diuretics during exercise?

Drink lots of water to prevent dehydration and precipitation of drug elements in kidneys

Enalapril side effects

Dry cough, swelling, confusion, tachycardia Loss of taste Dizziness, headache Drowsiness, insomnia Dry mouth

Best time for diabetics to exercise?

Early morning (before breakfast)

Respiratory acidosis symptoms

Early: Anxiety, restlessness, dyspnea, headache Late: Confusion, somnolence, coma hypercapnia (too much carbon), hypoventilation, headache, visual disturbance, drowsiness, coma, depresse tendon reflexes, hyperkalemia, ventricular fibrillation CARBS- confusion, agitation, restless, blurred vision, seizures

What do diuretics not cause?

Easy bruising -does cause dehydration, potassium depletion, electrolyte imbalance, muscle cramps

Likely characteristics of bronchogenic carcinoma on x-ray

Enlarged nodule, opacity, atelectasis

What to use if can't use sharp debridement

Enzymatic debridement ointment, foam dressing, compression A wound will not heal until the eschar is removed, so the most aggressive form of debridement tolerated by the patient and supported by circulation should be used. This patient does not tolerate sharp debridement, so an enzymatic debridement ointment should be used. The wound also has a moderate amount of drainage, so will need a foam dressing to absorb this away from the skin, and compression is indicated because of the edema and the cause of the wound. Autolytic debridement takes longer than enzymatic debridement

Treatment canalithiasis

Epley and brandt-daroff(45 deg head turn, sidelying, then rotate other side) Posterior Canal - Up beating torsional Nystagmus Anterior Canal - Down beating torsional Nystagmus (vertigo with bending over, emptying the dishwasher, weeding)

What is exphothalamus

Eye bulging Seeing with Graves disease (hyperthyroidism)

Retinal slip

Eye lags behind causing blurry vision

Vitamin A

Eyes epithelia tissue, normal growth and development deficiency: night blindness, rough and dry skin, and growth failure Toxicity: appetite loss, hair loss, and enlarged liver and spleen

Severe COPD stage three

FEV1/FVC <70% 30-49% FEV1 range

Moderate COPD stage two

FEV1/FVC <70% 50-79% FEV1 range

Very severe COPD stage four

FEV1/FVC <70% <30% normal OR <50% normal with chronic respiratory failure present

Mild COPD stage one

FEV1/FVC <70% >80% FEV1 range

Hypernatremia s/s mnemonic

FRIED SALT Flushed skin and fever (low grade) Restless, irritable, anxious, confuses Edema-peripheral and pitting Decreased urine output and dry mouth Skin flushed Agitation Low grade fever Thirst

CN for corneal reflex

Facial nerve

CN for decreased lacramations

Facial nerve

Taste to anterior 2/3 of tongue

Facial nerve

Vitamin B2 (Riboflavin)

Facilitates selected enzymes involved in carbohydrate protein, and fat metabolism Deficiency: inflammation of tongue, sensitive eyes, scaling of the skin no toxicity

What EMG potential will be seen with irritation/degeneration of anterior horn cell, nerve root compression or muscle spasm?

Fasciculations

Lupus risk factors

Female sex, childbearing age, and heredity are risk factors for lupus. Other factors may include pregnancy and race (more common in African-Americans, Hispanics, and Asian-Americans). History of a miscarriage, hormone deficiency, and peri-menopause are not typically associated with risk factors for lupus. There may be a hormonal component of lupus but hormone deficiency and other issues related to hormones are not typically risk factors for acquiring lupus. -have impaired strength and impaired sensation in the extremities since they can get periheral neuropathy

What EMG potential will be seen with LMN disease?

Fibrillation potentitials

Arcade of Frohse

Fibrous ridge at the proximal aspect of the supinator muscle that may compress the radial nerve. Near the radiocapitellar joint, the radial nerve branches into the deep, motor, posterior interosseous nerve and the superficial sensory branch. It is the deep branch that passes beneath the arcade of Frohse which is the most common site of compression of the radial nerve

What test is specific to labrum tear of hip?

Fitzgerald's test the patient lies supine while the physical therapist (PT) performs flexion, external rotation, and full abduction of the hip, followed by extending the hip, internal rotation, and adduction. To test for a posterior labral tear, the PT performs passive extension, abduction, external rotation, from the position of full hip flexion, internal rotation, and adduction while the patient is supine. Tests are considered to be positive with pain reproduction with or without an audible click[1] [2]. The Fitzgerald test has a sensitivity of .98[1][3].

Upglide cervical spine (L side)

Flex head, R lat bend, R rotation

Rectus capitis anterior major

Flexes occiput on the atlas

Posterior Leaf Spring AFO

Flexible co-polymer or carbon fiber that typically allows for stored energy potential Why select: ASSIST DF AND FOOT CLEARANCE during swing phase

hand muscles innervated by ulnar nerve

Flexor carpi ulnaris, flexor digitorum profundus, interossei, lumbricals 4,5, flexor pollicus brevis, adducor pollicus, hypothenar muscles (abductor digiti minimi)

RA common deformities

Forefoot pain often first complaint Extensor tendon shortenin with subluxation of heads of MTP joints causes HAMMER TOE or COCK UP DEFORMITIES VOLAR SUBLUXATIOn (NOT DORSAL) of MCP joint with ULNAR DRIFT seen in RA Rheumatoid nodules (NOT HEBERDEN'S NODES)

Facial Nerve (VII)

Function: Taste anterior 2/3 of tongue, muscles of facial expression, tearing, salvation Pathologies: ALS, bell's palsy, guillain-barre Tests: Raise eyebrows, frown, smile big, close eyes tightly and puff out cheeks and ability to taste sweet on anterior 2/3rds of toungue

Glossopharyngeal (IX)

Function: Taste from POSTERIOR 1/3rd of toungue AND SENSATION of posterior tongue and oropharynx, salvation Pathologies: ALS, medullary stroke, guillain-barre Tests: Ability to taste sweet on posterior 1/3 of toungue, swallowing, and phonation

Hypoglossal Nerve (XII)

Function: Toungue movements Pathologies: ALS, MS Tests: Phonation/articulation, tongue movement side to side, protrude tongue SAME SIDED DEVIATION AND ATROPHY

Oculomotor nerve

Function: elevates eyelids, constricts pupil, turn eye UP, DOWN, and IN Common pathologies: MS and horner's syndrome Test: pupillary reactions, H-test, saccadic/pursuit test

Trigeminal nerve (V)

Function: sensation from face, cornea, and ANTERIOR tongue (SENSATION NOT TASTE), muscles of mastication, and DAMPENS SOUND Pathologies: ALS, Trigeminal neuralgia Tests: Clench teeth/hold against resistance, corneal reflex, pain and light touch sensation (FOREHEAD, CHEEKS, AND JAW)

vagus nerve (CN X)

Function: thoracic and abdominal viscera, muscles of larynx and pharynx, sensation from oropharynx Pathologies: ALS, medullary stroke, guillain-barre Tests: Swallowing and phonation, gag reflex, say ah-uvula deviation test

What should be treated if patient has weak muscles, tight muscles, and functional scoliosis`

Functional scoliosis should be treated first If a patient has back muscle spasms, this is the likely culprit of functional scoliosis and should be addressed prior to extremity issues of hip abduction weakness/hip adductor tightness. Correcting the spine may consequently resolve some of the hip issues. Use STM of lumbar spine to correct

phenobarbital side effect

Fussiness, drowsiness, trouble sleeping, bowl problems

Primary lymphedema

Genetic, if not evident during childhood then often evident during pregnancy

Supine Roll Test - Determining the involved side

Geotropic nystagmus the involved ear (to treat) is generally the side with the stronger nystagmus (the endolymph/debris is moving toward the utricle - excitatory) Ageotropic nystagmus the involved ear (to treat) is generally the side with the weaker nystagmus (the endolymph/debris is moving away from the utricle - inhibitory).

APGAR scale: G

Grimace (reflex irritability) 0-floppy 1-min response to stimulation 2-prompt response to stimulation

What should be assessed if infant shows weakness with torticolis

Gross motor delays

Disc replacement with reduction TMJ

HAS CLICKING SOUND

Normal blood serum

HCT 45% Plasma 55% Platelets, WBC <1%

What is a rocker bottom used for?

Hallux rigidus

Vitals to monitor with decreased Hemoglobin

Heart rate and blood pressure The drop in the patient's hemoglobin levels reveals that the patient has acute blood loss due to the surgery. This acute blood loss causes decreased overall blood volume. When standing for the first time post-op, gravity can cause blood to pool in the lower extremities which results in inadequate intravascular volume to maintain a stable overall blood pressure and the subsequent symptoms of orthostatic hypotension. These symptoms can include: light-headedness, blurred vision, dizziness or syncope. The therapist would be prudent to monitor the patient's blood pressure and heart rate, especially when getting the patient to sitting and standing for the first time. The therapist would also want to establish good communication with the patient as to their symptoms. This would help to avoid a potential syncopal episode when ambulating with the patient for the first time.

When is the most knee extension during gait

Heel off

When to use sitting up and feet dangling position

Helps with heart failure and pulmonary edema by reducing venous return

Where does breast cancer metastasize to?

Hematogenous spread: bones, brain, lung, liver Consider bone scan and CT abdo, chest, pelvis

What is heart failures number one precursor?

High blood pressure

What is useful for wound with bacteria modality wise?

High volt electrical stimulation- has antimicrobial effect

Likely characteristics of pulmonary fibrosis on x-ray

Hila nodule, opacity, bronchietasis

Likely characteristics of tuberculosis on x-ray

Honeycombing, bronchiectasis

In iontophoresis what is used for edema reduction?

Hyaluronidase (+) Med: Wydase

MS signs and symptoms

Hyperactive deep tendon reflexes, vision changes, fatigue and spasticity are all symptoms of MS, drunken/ataxic gait

What is the usual electrolyte abnormality precipitated by digoxin toxicity?

Hyperkalemia

Complication of cushions syndrome

Hypertension, osteopenia, poor wound healing, low muscle mass, osteoporosis, obesisty

Important side effect of antipsychotics (latuda, abilify, geodon, clozaril)

Hyperthermia and muscle rigidity -dizziness/fainting, sudden but short tachycarida, yellow skin and eyes TARDIVE DYSKINESIA( involuntary movements of face and jaw muscles and is irreversible)

Ranchos Los Amigos

I- No response II- generalized III-Local response IV-confused agitated V- confused inappropriate, VI- confused appropriate, VII- automatic, appropriate, VIII- Specific appropriate

Autolytic debridement contraindications

INFECTED WOUNDS Wounds of immunosuppressed, dry gangrene or dry ischemic wounds

MS gait pattern

Impaired trunk circumduction, ataxic gait

Meconium Ileus

In cystic fibrosis, meconium plug obstructs intestine preventing stool passage at birth. EARLY SIGN Late signs- anorexia, clubbing, and diarrhea

SNS contributes to which initial exercise response?

Increase RR Increase HR from withdrawing PNS not stim of SNS

Why lean forward to improve breathing

Increase diaphragm contractions

What modification do you make to FES if patient feels current but is not getting a contraction?

Increase pulse duration-unless amplitude is correct then turn the machine off and check the connections

How to prevent burn in iontophoresis?

Increase size of cathode vs anode

Effects of full immersion hydrotherapy

Increased CO, reduced HR, reduced SBP, increased CO< decreased Vital capacity

Swayback deformity

Increased pelvic inclination to approximately 40 degrees and the thoracolumbar spine exhibits a kyphosis spine bends back rather sharply at lumbosacral angle

Which statistical test compares the difference between two independent samples/ groups

Independent t-test

Attenuation (US)

Inevitable decrease in energy intensity as the US travels through the tissue

Lymphangitis

Infection and inflammation of the lymphatic vessels Red streaks running distal to proximal is a hallmark sign of lymphangitis since the vessels run just under the skin and can be visible. Because it is an infection, there is often a break in the skin where entry occured.

Otitis media

Infection inner ear (behind the eardrum) causing fever and ear pain

Hemophilia joint destruction stages

Initially acute hemarthrosis (red, swollen, painful) Subacute (boggy, subtle joint changes over repeated bleeds) Chronic arthropathy. A patient with chronic arthropathy develops bony overgrowth, atrophy, limited range of motion or essential fusion of the joint, synovial thickening, and pain.

Trochlear Nerve (IV)

Innervates superior oblique turns eye downward & laterally. (SO4) H-test

Biofeedback position for incontinence

Inside the vagina The correct answer is inside the vagina with a vaginal probe (electrode). The levator ani muscles do not come to the surface and the only way to know with certainty that the correct muscles are contracting is to have the electrode alongside the urethra within the vaginal vault. There are several different types of probes that do an effective job of biofeedback.

Treatment for flaccid bladder

Intermittent catherization and valsalva Below T12

What type of TOS does adsons test look for?

Interscalene triangle

Forefoot varus

Inversion of forefoot when subtalar joint in neutral Etiology: Congenital deviation of head and neck of talus Regain proper mechanical alignment, improve flexibility of shortened soft tissues, orthoses, education RE footwear. Causes over pronation during gait, force first MCP joint to ground

In iontophoresis what is used to treat scleroic scars?

Iodine (-) Med: Iodine

Enzymatic debridement contraindications

Ischemic wounds unless adequate vascular status has been determined Dry gangrene Clean granulated wounds

Angina random symptoms

It is common for angina to cause pain and sweating during the night. It is also fairly common for angina pain to refer to the shoulder region, not just down the left arm.

Which statistical test is a nonparametric test where 3 or more groups compared

Kruskal Wallis test Non-parametric- not normal (37 obese people and 3 normal weight, use non-parametric 2 grouped tests)

Medial hamstring reflex

L5-S1

Hand muscles innervated by the median nerve

LOAF muscles Lumbricals 1 and 2 (lateral two) Opponens pollicus Abductor pollicus brevis Flexor pollicus brevis

Hyperthyroidism TSH

LOW TSH

What are the motions of the sartoris

Lat rot and abd

How knee unlocks from closed chain extension

Lateral rotation of femur on the tibia

Left thoracic scolosis muscle activation treatment

Left quadratus lumborum, Left internal oblique, Left external oblique The patient presents with a left thoracic scoliosis causing right sidebending of the spine and trunk. The left quadratus lumborum, internal and external obliques cause left sidebending of the trunk, therefore these would be best for the therapist to facilitate.

What helps decrease hypotension

Legs higher than the head

Treatment of cupulolithiasis

Liberatory semont maneuver

What are the limitations of platelet count of 20,000-30,000

Light exercise (no PROM, light AROM permitted, walking as tolerated)

Kiolhertz Ultrasound debridement

Long-wave low frequency us typically operates at 20-50 kHz This is a SELECTIVE debridement, autoclaving of contact probe is usually required Indications: selective removal necrotic tisue, reduces bioburdent, increases angiogenesis, wound bed preparation for grafting or flap closure

What to do with 1 PVC?

Lower intensity but don't contact physician

What is atelectasis

Lung collapse due to plugged bronchioles that resulted in colapse of alveoli, or would that admits air into pleural cavity (pneumothorax).

Refer to R shoulder

Lungs, diaphram, pericardium

Hemoglobin normal values and abnormal ranges

M: 14-17 F: 12-16 <8: no exercise (document and discuss with physician) 8-10: light exercise permitted; avoid aerobic exercise 10-12: low intensity/impact exercise permitted, resistance training permitted

Hematocrit norm and abnormal values

M:42-52% F:37-47% <25 no exercise >25 light exercise, avoid resistive exercise >30 progress to resistive exercise

Signs and symptoms hyperkalemia (mnemonic)

MURDER Muscle cramps Urine abnormalities Respiratory distress Decreased cardiac contractility EKG changes Reflexes depressed

Ground reaction AFO

Made of solid plastic materiel with a solid ankle. Upper portion of AFO wraps around the anterior part of proximal tibia Why use: allow for control at both the ankle AND THE KNEE. Prevents knee from collapsing into flexion during stance by RESTRICTING DF at ankle

Which statistical test is a nonparametric test designed to test the null hypothesis with two independent samples from the same population

Mann-U Whitney

Where is the device placed for the rhinne test?

Mastoid process

What are the motions of the TFL

Med rot and abd

What occurs in a patient with a hemothorax?

Mediastinum shifts AWAY from the affecetd side

Wallenberg syndrome/ medullary stroke

Medullary CVA, level of the brainstem, unilateral VF paralysis, dysphagia, facial paralysis, contralateral sensory arm abnormalities. Only disorder in CNS that produces a full unilateral VF paralysis. aspiration during and after swallow, decreased UES opening

When prescribe posterior leaf spring AFO

Mild spastic CP or condition with isolated DF weakness or paralysis FOOT DROP Patient who require NO MEDIAL LATERAL SUPPORT Patient NEEDS MINIMAL RESTRICTION SAGITTAL PLANE ankle motion

Molded AFO

More cosmetic with ant/post/med/lat control

lupus (SLE) symptoms

NO MIGRANES

Mechanical debridement

NONSELECTIVE method debridement that removes foreign material and devitalized or contaminated tissue by physical forces (wet-dry gauze. dextraomers, pulse lavage with suction) may remove healthy tissue as well Indications:Wounds with MOIST necrotic tissue or foreign material present

Aspirin (Ecotrin)

NSAID relieves pain, fever, headache, inflammation

Tibial Plateua Fracture wb status

NWB for 12 weeks

Signs and symptoms of autonomic dysreflexia

Nausea and a decreased heart rate in addition to elevated blood pressure are common symptoms of autonomic dysreflexia. Pounding headache and flushed

Biotin

Necessary for action of many enzyme systems deficiency- low methylamine intake Toxicity- none

Vitamin K

Necessary for the synthesis of at least two of the proteins involved in blood clotting Deficiency: hemorrhage and deficiency blood clotting no toxicity

airflow in airborn isolation room

Negative air pressure, with the direction of the airflow into the room from the adjacent space outside the room

Exercise guidelines glucose 250-300 WITH ketones

No exercise, call EMS

Exercise guidelines glucose >300

No exercise, call EMS if symptoms and/or ketones present

Exercise guidelines glucose <70

No exercise, give 15g carbohydrate snack

Transparent films disadvantages

Nonabsortive difficult application channeling or wrinkling DONT USE WITH FRAGILE SURROUNDING SKIN OR INFECTED WOUNDS Allow 1-2inch wound margin around bed, shave hair, don't need secondar dressing, AVOID INFECTED WOUNDS OR HEAVY DRAINING WOUNDS

Hydrocolloids disadvantages

Nontransparent soften and change shape with heat or friction, odor and yellow drainage on removal from melted material, NOT RECOMMENDED FOR HEAVY EXUDATE, SINUS TRACTS, OR INFECTIONS, EXPOSED BONE OR TENDONS, OR WOUNDS WITH FRAGILE SURROUNDING SKIN, dressing edges may curl Pus looking thing normal with removal of dressing, allow 1-1.5 inch margin of halthy tissue around wound edges, taping edges prevents curling, frequency of changes depends on amount of exudate, change every 3-7 days as needed with leakage, avoid wounds with INFECTION OR TRACTS

Foam disadvantages

Nontransparent, non-adherent foams require secondary dressing, tape, or net to hold in place, some newer foams have tape on edges, poor conformability to deep wounds, NOT USED DRY ESCHAR OR WOUNDS WITH NO EXUDATE

Which side does the vagus nerve deviate to?

OPPOSITE SIDE (uvula deviates to R with weak L CN10)

What CN runs through the midbrain

Occulomotor (eyelid movement)

Neuromuscular scoliosis

Occurs as a result of tonal abnormalities and weakness in stabilizers of the spine. Although difficult to treat, therapists will often utilize techniques to balance out tonal abnormalities in order to improve a patient's function.

Digitalis toxicity

Occurs when you take too much digitalis (also known as digoxin or digitoxin), a medication used to treat heart conditions. Signs of toxicity include anorexia (first sign), nausea, vomiting, mental depression, delirium, diorentation, confusion, headache, visual disturbances, and an irregular heartbeat . To prevent DT, monitor your intake of digitalis to make sure you're not taking too much of the medication With recent changes to medicine, this patient may exhibit ST depression with digitalis toxicity. Understanding that ST depression can be also associated to ischemia and hypokalemia.

Vertebrobasilar artery stroke

Often catastrophic, often comatose, often quadriplegic, generally poor prognosis Causes locked in syndrome

What is a statistical test in which deviations from only one direction are considered?

One-tailed t-test DIRECTIONAL hypothesis, 1 end of distribution, either +ve or -ve Use implies that intervention could have only one effect -knee flexion will be HIGHER in obses group-implies only one direction

Huntington's disease symptoms

Onset between 30-50 yrs old: -Irritability and Antisocial behavior -Clumsiness -"Bobbing gait" -Dystonic posturing (twisted shoulder, fist clenched) -Jerking chorea movements superimposed on coordinated voluntary movement -cognitive decline -slow or abnormal eye movements -difficulty with production of speech or swallowing

Femoral artery occlusion symptoms

Pain in calf and foot

Kehr's sign

Pain that radiates to the left shoulder and down the left arm; results from a spleen injury or rupture. Caused by free air or blood in abdominal cavity

Facet dysfunction pain

Pain with ext Positive quadrant test

Which statistical test compares the difference between two matched samples?

Paired t-test

What was rhythmic initiation initially designed for

Parkinson's patients with rigidity

Indication stage 3 cardiac rehab

Patient is able to monitor perceived rate of exertion and heart rate during exercise

What is the iliopsoas muscle test?

Patient lies supine, lifts up leg, push down on thigh, + pain in RLQ ~ appendicitis or psoas abcess

When prescribe GRAFO

Patient who have knee buckling during stance phase or present with crouched gait posturing Patients with SCI, CVA, MS, GBS, or other neurological disease causing quad weakness NEED 3/5 MMT of QUADS and GOOD HIP STABILITY

Anterior hip precautions

Patients are to be positioned differently depending on the surgical approach taken by their doctor. Patients who have anterior dislocation precautions should avoid hip extension. The head of the bed should remained elevated to at least 30° to prevent unintentional extension. A pillow can be used behind the knee on the surgical side to further prevent hip extension. A trochanteric roll can also be used for the anterior approach patient, to prevent external hip rotation. In contrast, patients who undergo a THR with a posterior approach should be positioned in a flat bed (with the foot of bed elevation option disabled) with a trochanteric roll positioned just proximal to the knee to maintain hip neutral rotation. No pillows or bolsters should be placed under the knee on the surgical side.

Pelvic floor compensation pattern for weakness

Pelvic floor will push outward, gluteal muscles will fire When pelvic floor dysfunction symptoms are present, it is likely that the patient will present with improper firing or timing of the pelvic floor musculature and the gluteal muscles will try to compensate. Norm is pelvic floor drawing inward and abd firing

What EMG potential will be seen with myopathies, muscle or peripheral nerve involvement?

Polyphasic potentials

Where take BP if lymedema in arms?

Popliteal artery in leg

Erb's palsy arm position

Positioning the shoulder in adduction and extension in supine A baby with acute Erb's palsy usually has inflammation in the area where the nerve damage is. Thus, ideal positioning would be to keep the nerves in a slack position as much as possible for the first 2-3 weeks. Positioning the shoulder in adduction and extension keeps the shoulder in a more neutral position and does not further stretch the nerves of the brachial plexus.

What EMG potential will be seen with denervated muscle disorders at rest, muscular dystrophy?

Positive sharp wave

Common injury for Hill sacs lesion

Posterior GH dislocation

Metabolic acidosis causes

Primary Cause: Addition of large amounts of fixed acids to body fluids; Contributing Causes: Lactic acidosis (circulatory failure), Ketoacidosis (diabetes, starvation), Phosphates and sulfates (Renal dz), Acid ingestion (salicylates), Secondary to respiratory alkalosis, Adrenal insufficiency diarrhea, renal failure, shock, salicylate OD, sepsis

Respiratory acidosis causes

Primary Cause: Hypoventilation (causes hypercapnia); Contributing Causes: COPD, Pulmonary dz, Drugs OD, Obesity, Mechanical asphyxia, Sleep Apnea, chest trauma, pulmonary edema (L sided heart failure), airway obstruction

metabolic alkalosis causes

Primary Cause: Retention of base or removal of acid from body fluids; Contributing Causes: Excessive gastric drainage, Vomiting, Potassium depletion (diuretic therapy), Burns, Excessive Sodium Bicarb admin can be caused by loss of gastric secretions, antacid (mistaken angina pain for GERD), low potassium levels

Respiratory alkalosis causes

Primary cause: Hyperventilation (causes hypocapnia) often from anxiety; Contributing Causes: Overventilation on a ventilator, Response to acidosis, Bacteremia, Thyrotoxicosis, Fever, Hepatic failure, Response to hypoxia, Hysteria high altitude, pregnancy, fever, excessive tidal volume in vented pts

Benzos

Promote sleep

What lumbar traction position is used for posterior herniated dics?

Prone

Maximal compression force on patella?

Prone with knee flexed to 110 and hip slight extension

Supra-malleolar orthosis (SMO)

Provides support right above the level of the malleoli to the toes. Supports neutral position of the subtalar joint and permits dorsiflexion and plantarflexion of the ankle.

DMD distal or proximal weakness?

Proximal

Direction exercise lymphedema

Proximal to distal (cervical rotation before shoulder abduction)

Direction of decongestion in lymphedema

Proximal to distal (clear trunk before limbs, clear way for fluid from limbs)

biological debridement (rarely used) contraindicaitons

Psychological stress from creatures reports of pain increasing

APGAR scale: P

Pulse 0-absent 1-<100 2->100bpm

Hypocalemia ECG

QT interval prolonged by lengthening ST segment

Hypercalemia ECG

QT interval shortening

Left MCA deep territory infarct

R motor hemiparesis and aphasia

Referral for head of pancreas

R shoulder

Stroke to what side causes hemi neglect

R side hemisphere

Hydrogels disadvantages

REQUIRE SECONDARY DRESSING, NOT USED HEAVY EXUDATE, may dry out and adhere to wound, may macerate surrounding skin Sheet form works well on partial-thickness ulcers do not use sheet form on INFECTED ULCERS, sheet form can promote growth of Pseudomonas and yeast, change every 8-48 hours, use skin barrier or wipe on surrounding intact skin to decrease maceration risk

cholecystitis quadrant location

RUQ

Hyperventilation

Rapid, deep breathing

Tachypnea

Rapid, shallow breathing

What are beta blocker used for

Rate control of hear

Golgi tendon organs

Receptors sensitive to change in tension of the muscle and the rate of that change

Consolidations

Region of normally compressible lung tissue that has filled with liquid instead of air. The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. It is considered a radiologic sign.

What EMG potential will be seen with myopathies, lesion of anterior horn cells, and peripheral nerves?

Repetitive discharges

Alginates disadvantages

Require secondary dressing, NOT USED IN DRY OR LIGHT EXUDATE WOUNDS, can dry wound bed May use dry gauze or transparent film as secondary dressing, change every 8 hours to 2-3 days (varies with exudate amount)

A patient with pelvic floor dysfunction has a history of surgical placement of a bladder sling. The therapist has used biofeedback in the clinic to help the patient recruit the pelvic floor muscles. Now the patient needs more strength and endurance in these muscles. What is the BEST home program to give the patient for pelvic floor strengthening?

Resisted pelvic floor contractions with weighted vaginal cones Weighted vaginal cones provide variable resistance while contracting the pelvic floor and also provide helpful feedback to the patient.

APGAR scale: R

Respiration 1-absent 2-slow and irregular 3-vigorous cry

Cheyne strokes

Respiration is an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea.

Dizzy with numb mouth

Respiratory alkalosis

What type of TOS does Roos test look for? (hyperabduction and wrights test also look for this)

Retropectoralis minor space tight pec minor

Side effect of statins

Rhabomyolysis- dark colored urine, muscle pain, stiffness

left Homo heminopsia is due to ____ occipital lobe lesion

Right

Roll/glide of distal RU joint with pronation

Roll and glide ant

Roll/glide of proximal pronation RU

Rolls ant Glides post

Three negative iontophoresis medicines

SAD Salicylate Acetate Dexamethasone

Signs and symptoms hyponatremia (mnemonic)

SALT LOSS Stupor Anorexia Lethargy Tendon reflexes diminished Limp muscles Orthostatic Hypotension Seizures Stomach cramps

Enzymatic debridement

SELECTIVE METHOD OF CHEMICAL DEBRIDEMENT THAT promotes liquification of necrotic tissue by applying topical preparation of collagenolytic enzymes to those tissues Indications: ALL Moist NECROTIC WOUNDS, eschar after cross hatching, homebound individuals, people WHO CANNOT TOLERATE SURGICAL DEBRIDEMENT

Autolytic debridement

SELECTIVE METHOD, natural debridement promoted under occlusive or semi-occlusive moisture retentive dressing that results in solubilization of necrotic tissue only by phagocytic cells and by proteolytic and collagenolytic enzymes inherent in tissues Indications: anticoagulant therapy, CANT TOLERATE OTHER FORMS OF DEBRIDEMENT, ALL NECROTIC WOUNDS IN PEOPLE MEDICALLY STABLE

Sharp debridement

SELECTIVE method of debridement using sterile instruments that sequentially removes only necrotic wound tissue without anesthesia and with little or no bleeding induced in viable tissue Indications: Scoring and/or excision of LEATHERY ESCHAR, excision of MOIST necrotic tissue

Where should weak muscles be placed in recovery phase of nerve injury?

SHORTENED POSITION-puts less pressure on the nerve

Platypnea

SOB relieve by lying and SOB in sitting and standing

Hypokalemia ECG changes

ST depression Decrease T wave amplitude Prominent U waves Prolonged QT interval

Pathological lordosis

Sagging shoulders (scapula protracted and arms mediall rotated), medial rotation of legs, and poking forward of the head so that it is in front of the center of gravitiy (commonly seen)

In iontophoresis what is used for an analgesic?

Salicylate (-) Med: sodium salicylate Lidocaine and xylocaine (+) Med: Lidocaine and xylocaine

What side will someone with a cerebellum infarct lean to?

Same side with loss of pain and temperature on opposite side

Massed vs. distributed practice

Scheduling the training in long training sessions rather than shorter sessions distributed over time.

Metabolic acidosis symptoms

Secondary hyperventilation (Kussmaul breathing) Nausea, vomiting, lethargy, coma bicarbonate deficit, headache, mental dullness, deep respiration, stupor, hyperkalemia, cardiac arrhythmia SHAMED- stupor, hyperkalemia, arrythmia, muscle twitching, emesis (vomiting), decreased cardiac output

Key side effect of muscle relaxants?

Sedation

Foams

Semipermable membranes that are either hydrophilic or hydrophobic. vary in thickness, absorptive capacity, and adhesive properties Indications: PARTIAL AND FULL THICK WOUNDS WITH MIN TO MOD EXUDATE, secondary dressing, provide protection and insulation Advantages: insulate wounds, some padding, nonadherent, comfortable, manage MIN to HEAVY EXUDATE, easy to use, can be used with deep cavities Used for partial thickness wound with various exudates

What hamstring muscles used for ACL repair?

Semitendinosus and gracilis

increased TENS frequency

Sensory level TENS

Optic nerve

Sensory nerve: sight/central and peripheral vision Pathologies: MS, middle/posterior CVA important tests: snellen visual acuity and confrontation

How is flexeril different fom other relaxants?

Shares same pharmacological characteristics with tricyclic antidepressant agents

How often should skin be checked for burns?

Should check within first 5 minutes

What is MOST appropriate to screen for GBS?

Skin check

Alginates

Soft, absobent, nonwoven dressing from seaweed. react with wound exudate to form viscous hydrophilic gel mass over wound. Indications: MODERATE TO LARGE EXUDATE, require packing and absorption, INFECTED AND NONINFECTED Advantages: absorb 20x their weight, fill dead space, support debridement, easy to apply used on infected wounds with heavy drainage

Swanz-Ganz catheter

Soft, flexible catheter inserted through a vein into the pulmonary artery. PAP pressure and function of the heart

Spastic vs flaccid bladder

Spastic = above T12 / above s2/s4 mictrition center, reflex intact-> leakage once full, suprapubic tapping Flaccid = below T12 mictrion center impaired, no reflex -> overfilling, valslava

Pressure ulcer stages

Stage 1: non-blanchable redness Stage 2: partial thickness loss Stage 3: full thickness loss, w/o undermining, see fat Stage 4: 3+ undermining, see tendon, muscle

Surgical debridement

Stage 3 or 4 or complicated pressure ulcer, most efficient method of debridement SELECTIVE and is performed by surgeon using sterile instruments in a one-time operative procedure, the procedure usually removes most, if not all necrotic tissue but may remove some healthy tissue in what is termed wide excision. Because may be associated pain and or bleeding, individual may require anesthesia and the procedure will likely require operating or special procedure room Indication: Advancing cellulitis with sepsis, immunocompromised individuals, when infection threatens life, clean wounds as preliminary procedure to surgical wound closure line, granulation and scar tissue may be excises

What can help with SI instability

Standing lat pull helps with force and form closure with thoracolumbar fascia attachment to ilia and bilateral, equal weight bearing

What injury could prevent scapular movement post fall?

Superior dislocation of SC joint-

What expect to see with rigid forefoot valgus deformity during gait

Supination during stance phase and pronation during terminal stance The forefoot valgus deformity everts the forefoot, and when it is rigid, the lateral aspect of the foot can only contact the ground in stance by supinating (which transmits shock up to knees and spine rather than being absorbed by a pronated foot). The foot then switches to pronation when it needs to be stable for push off.

What lumbar traction position is used to treat IV joints, facet joints, and increase muscle elongation?

Supine with pillow under knees

Lumbar traction to open foramen

Supine, knees extended, with trunk bending to opposite side with 25% pull

Where to put FES for shoulder subluxation

Supraspinatus and posterior deltoid

Ankle DF with inversion tensions which nerve?

Sural nerve

What does incentive spirometry achieve?

Sustained maximal inspiration

Heberden's nodes

Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis NOT RA

Horner's syndrome

Sympathetic trunk/cervical ganglion damage, results in ptosis, pupil constriction, vasodilation, and absence of sweating

Where does the small intestine refer to on spine?

T10

Where does the kidney/ bladder refer to on spine?

T12

Where does the heart refer to on spine?

T4

Where does IBS refer to on spine?

T8

Hyperkalemia ECG changes

Tall peaked T waves Increased QRS duration P wave decreases in amplitude *flatten P waves and T wave peaked.

concurrent validity

Test performed and compared to the gold standard test and results are matched. Heart rate measured by peripheral pulses and compared with ECG readings

content validity

Test should measure specific problem of patient Balance- use BERG Individual items/content on test have to be relevant to construct it is testing

opisthotonus posture

The back is rigid and arching, and the head is thrown backward. Strong sustained contraction of extensors in neck and trunk

DF terminate action during gait when?

The end of loading response-slow PF

MCA stroke

The middle cerebral artery supplies the lateral aspect of the cerebral hemisphere including the frontal, parietal, and temporal lobes. Common symptoms of an MCA stroke include hemiparesis and hemisensory loss of the contralateral face and upper extremity with the lower extremity typically spared. It may also result in aphasia, which might be fluent aphasia (Wernicke's) or in this case, nonfluent (Broca's). Wernicke's aphasia is characterized by fluent, nonsensical speech and a lack of auditory comprehension. Broca's aphasia is characterized by a limited vocabulary with difficulty producing speech and intact comprehension.

face validity

The outcome measure should measure what is looks like it will measure related to patient problem. face validity is when an assessment or test appears to do what it claims to do Goniometer claims to measure ROM which it appears -involves opinions

Left versus right sided heart failure

The right side of the heart usually becomes weaker in response to failure on the left side. The right side of the heart brings in the circulated blood from the body and sends it to the lungs for oxygen. When the left side of the heart weakens, the right side of the heart has to work harder to compensate. Again, as the heart muscle loses strength, blood and fluid become backed up in the body. You may experience swelling and trouble catching your breath.

Mortons neuroma last resort treatments

The very last resort for neuroma is surgery and is only required for about 2% of patients. Chemical neurolysis (or sclerosing injections) is the appropriate last effort to provide relief and avoid surgery. The nerve causing pain is deadened by the chemical destruction of the nerve over a course of 7 weekly injections.

What are barbiturates?

They are downers that depress the CNS.

Slipped Capital Femoral Epiphysis (SCFE)

This condition usually occurs in 10-17 year olds (8-15 females) during rapid growth, when even minor trauma can precipitate its development. The epiphysis appears shorter and the epiphyseal plate wider, with smaller margins. LIMITED ABD AND FLEX AND IR

A physical therapist is intended to find out whether ankle fracture patients progress faster on hydrotherapy or land based exercises. The subjects are assigned into two groups. One group received hydrotherapy and another group received land based exercises. Their progress is compared after 4 weeks. If the therapist has to use the parametric test to analyze the results, which of the following conditions must be fulfilled?

This is a very important condition that must be fulfilled. The data must be on an interval / ratio level.

Ankle DF and eversion with toe extension tensions what nerve?

Tibial nerve

What occurs with prolonged stepping reflex

Tight calves

Flurosemide Side Effects

Tinnitus, jaundice, severe pain in upper stomach

Why are orthosis used in spina bifida?

To substitute for lack of muscle activity NOT muscle incoordination

Parkinson's S&S- TRAP

Tremors-often occurs at first in one hand, where it resembles the motion of rolling a pill between the thumb and forefinger Rigidity-shows itself in the cogwheel phenomenon: pushing on an arm causes it to move in jerky increments instead of smoothly. Akinesia/ Bradycardia-Hesitation, Slow movement. Difficulty rising from a sitting position is a common sign of disordered control over movement. Some patients report feelings of weakness and of being constrained by ropes or other forces. Postural instability-Leaning Forward or backward when upright reflects impairment of balance and coordination.

What nerve runs through the pons

Trigeminal (jaw movement)

Tongue sensation anterior 2/3

Trigeminal nerve

What is a test of statistical significance in which deviations from the null hypothesis is either direction are considered?

Two-tailed t-test NON-DIRECTIONAL, 2 ends of distribution, both +ve and -ve Only applies when test statistic is symmetrically distributed

Which statistical test tests 2 or more independent groups compared on 2 interventions?

Two-way ANOVA- can have 3+ groups but TWO interventions

A patient presents with the metatarsal heads inverted in relationship to the rearfoot when the subtalar joint is placed in a neutral position. During gait, the patient pronates the subtalar joint during midstance and terminal stance. What deformity is BEST described by this patient's presentation?

Uncompensated forefoot varus - the subtalar joint has to pronate in order to allow the 1st metatarsal to touch the ground

What structure is damaged with prostectomy

Urethra

Timed up and go vs Berg

Use timed up and go with AD, parkinsons Berg does not assess sit to stand or gait, just static balace

Most useful test in predicting need for mechanical ventilation

Vital capacity FVC <12 mL/kg indication for ventilator support PaO2<70 also an indication

Hydrogels

Water or glycerin based gels, insoluble in water, sheets, gels or gauze, variable absorption Indications: PARTIAL AND FULL THICK WOUNDS, wounds WITH NECROSIS AND SLOUGH, BURNS and TISSUE DAMAGED RADIATION Advantages: soothing/cooling, fill dead space, re-hydrate dry wound beds, autolytic debridement, conform to wound bed, MIN TO MOD ABSORPTION, transparent, nonadhearent, amorphous form used with infection used superficial to partial thickness infections with minimal drainage

Drop foot cause by anterior compartment syndrome clinical findings

Weak dorsiflexors and paresthesia between the 1st and 2nd toes

What can tear of subscapularis cause?

Weakens its hold over the long head of the biceps, causing difficulty in overhead activity

When to prescribe a articulated/hinged AFO

When solid AFO is too rigid beyond what patient needs Patient who NEED MEDIAL/LATERAL STABILITY at ankle but are active (stairs, ramps, curbs) Patients with spastic CP, knee hyperextension, or correctable ankle equinus

FES goal

When using functional electrical stimulation, the therapist should set the amplitude just high enough to provide the stimulation required to dorsiflex the ankle to approximately 10 degrees with the activation of the dorsiflexor muscles. The electrical stimulation will supplement the active contraction of the muscle, not eliminate the active use of the muscle during the functional task. A maximal contraction is not the goal - the muscles need only to contract enough to dorsiflex the ankle to 10 degrees during swing phase in order to clear the foot. Amplitude needs to be higher than a sensory level to assist a muscle with 3-/5 strength in generating sufficient muscle activation, but should not be so high that the ankle moves into full dorsiflexion without the active use of the dorsiflexor muscles.

What does a moderate amount of sanguineous drainage indicate?

Wound trauma, mild amount normal, moderate is not

In iontophoresis what is used to treat dermal ulcers?

Zinc (+) Med: Zinc oxide

hemangioma

a benign tumor made up of newly formed blood vessels

Hickman catheter

a central line tunneled under the skin via. This is used for providing antibiotics, nutritional solutions, and blood samples

Metabolic bone disease

a complex disorder of poorly mineralized bone because of endocrine changes and alterations in vitamin D, calcium, and phosphorus metabolism

ideomotor apraxia

a condition where a person plans a movement or task, but cannot volitionally perform it. Automatic movement may occur, however, a person cannot impose additional movement on command

Kernig's sign

a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down

Tethered spinal cord syndrome

a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column, resulting in low lying conus medullaris Symptoms: Back pain, worsened by activity and relieved with rest Leg pain, especially in the back of legs, Leg numbness or tingling, Changes in leg strength, Deterioration in gait, Spine tenderness, Scoliosis, Bowel and bladder problems.

Flat back

a patient has decreased pelvic inclination to 20 and a mobile lumbar spine

Nominal scale

a scale in which objects or individuals are assigned to categories that have no numerical properties Classification scale ex-blood type, breath sounds, arthritis

Interval scale

a scale of measurement in which the intervals between numbers on the scale are all equal in size NO TRUE ZERO POINT fahreheit, celsius scale

Ordinal scale

a scale of measurement in which the measurement categories form a rank order along a continuum Ranking scale MMT, levels of assist, pain, and joint laxity

Glasgow Coma Scale (GCS)

a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints 13-15 mild 9-12 moderate <8 severe 3 totally unresponsive

vesicles

a small abnormal elevation of the outer layer of skin enclosing a watery liquid : blister.

APGAR scale (what scores mean)

a standard measurement system that looks for a variety of indications of good health in newborns 7-10: normal 4-6: breathing assistance may be required <4: prompt life saving measures may be called for

Silver sulfadiazine cream

a sulfa medication used to prevent and treat bacterial or fungal infections -use for slough wounds

pursed lip breathing

a technique of exhaling against pursed lips to prolong exhalation, preventing bronchiolar collapse and air trapping; done to increase expiratory airway pressure, improve oxygenation of the blood, and help prevent early airway closure. used to decrease respiratory, reduce dyspnea and facilitate relaxation for patients with COPD

Kussmaul's Respiration

abnormal deep and high rate breathing

Vitamin E

act as an antioxidant and help to maintain the stability of cell membranes, important for RBCs Deficiency: breakdown of RBCs but rare Toxicity: decreased thyroid hormone levels and increased triglycerides

Parietal lobe lesion

affect sensory awareness interpetation and perception. abnormal movement patterns (somatosensory deficits) Modifications: for deficits in movement planning. L side=aphasia

When to use turning side to side posistion

after peritoneal dialysis when the outflow is inadequate

Maignes syndrome

also referred to as thoracolumbar junction syndrome, Maigne syndrome and dorsal ramus syndrome is caused by the unexplained activation of the primary division of a posterior ramus of a spinal nerve (dorsal ramus of spinal nerve). Hypermobile TL junction, L rotation pain and sensitivity above L iliiac crest and groin

Glomerulonephritis

an acute kidney infection and would have hematuria (blood in the urine), red cell casts (particles from the red blood cells), proteinuria (an increase of protein in the urine - usually indicates kidney damage), and have a dark color urine.

Visual agnosia

an inability to recognize objects

seborrheic dermatitis

an inflammation that causes scaling and itching of the upper layers of the skin or scalp/dandriff

Pantothenic acid

an intergral compoent of complex enzymes involved in metabolism of fatty acids deficiency-headache fatigue, and poor muscle coordination toxicity-diarrhea

What is silver dressing used for

antimicrobial to prevent infection, don't need to establish circulation

What does an ABI of 1.4 suggest

arterial calcification

Warts

benign infection caused by HPV seen on skin especially hands, fingers, pressure points of feet

acoustic neuroma

benign tumor on the auditory nerve (8th cranial nerve) that causes vertigo, tinnitus, and hearing loss

Metoprolol (Lopressor)

beta blocker Chest pain, hypertension, CHF, arrythmia

Likely characteristics that would be associated with sarcoidosis in x-ray

bilateral hilar adenopathy (enlarged lympth nodes of pulmonary hila), parenchymal (surrounding tissues involvement)

Aspirin side effects

bloody/tarry stools, nausea/vomiting, peptic ulcers

Fentanyl side effects

bradycardia, respiratory depression, low BP

Iliac artery occlusion symptoms

butt, hip, thigh of affected leg, diminished or absent femoral or distal pulses

Diltiazem (cardizem)

calcium channel blocker HTN, chest pain, arrhythmia

Secondary lymphedema

caused by a traumatic event to the lymph system--usually cancer treatment

MCA superior division stroke

causes brocas aphasia

Vertical nystagmus

central vertigo (CNS lesion)

sarcoidosis

chronic inflammatory disease in which small nodules (granulomas) develop in lungs, lymph nodes, and other organs. Symptoms include wheezing, coughing, SOB, and chest pain

scleroderma

chronic progressive disease of the skin and internal organs with hardening and shrinking of connective tissue ovular patches of skin that have hardened

Psoriasis

chronic skin condition producing red lesions covered with silvery scales. automune, silvery scale plaques causing itching, dryness over knees, scalp, elbows, genitals

Krause end bulbs

cold sensation

Vitamin C

combat infections and facilitates wound healing. Needed for the development and maintenance of bones cartilage connective tissue, and blood vessels Deficiency: anemia, swollen gums, loose teeth, and scurvy toxicity- urinary stones, diarrhea, and hypoglycemia

Ankle PF and inv tensions what nerve?

common peroneal

Choline

component of compounds necessary for nerve function and lipid metabolism deficiency- only occur when intake of methylamine is low no toxicty

internal carotid artery stroke

contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and/or apraxia Similar to MCA stroke since supplies mca/aca Warning signs- history of TIAs, temporary fading of vision in IPSILATERAL EYE eye

MCA inferior division stroke

contralateral homonymous hemianopia, wernicke's aphasia

Action of right external oblique

contralateral rotation internal obliques are same side rotators

Primary intervension for weak back with faulty alignment

corset for stabilization then progress to abdominal exercises for increased lordosis

What type of TOS does the military brace test look for?

costoclavicular space compression clavicle and first rib

Cervical cancer indication

dark brown or red tinged blood discharge from the vagina would indicate possible cancer.

Acute capillary muscle bed changes during vigrous exercise

decrease PO2

End stage renal disease blood pressure

decreased DBP

ALS EMG test findings

decreased amplitude of motor unit action potentials, decreased duration of motr unit action potentials, and decreased polyphasic action potentials -wont see decreased sensory evoked potentials since it does not affect sensory nerves

Characteristics of large electrodes

decreased current density, decreased impedance, increased current flow

What is not a physiological response to cold therapy during the first 15-20 minutes?

decreased tissue stiffness- can actually increased with prolonged cooling

Pleural effusion breath sounds

decreased to absent Decreased fretmus

Stages of acceptance

denial, anger, bargaining, depression, acceptance

Craig-scott KAFO

designed specifically for persons with paraplegia. allows a person to stand with a posterior lean of trunk.

What is NOT a side effect of narcotics/opoids

diarrhea do sometimes get motor incoordination, difficulty seeing in darkness

osteomalacia

disease marked by softening of the bone caused by calcium and vitamin D deficiency Aching, fatigue, wt loss, tender/pain

What muscles are affected with steroid induced myopathy

distal muscles

Metoprolol side effects

dizziness, fatigue, depression, bradycardia, dry mouth

Side effects of bacolfen

drowsiness, dizziness, weakness

Pain in supine with hips flexed to 90

dysfunctional iliopsoas

Left PCA infarct

dyslexia (difficulty reading), homonymous hemianopsia, and right hemiparesis

ototoxicity

ear poisoning caused by drugs, chemicals

Pronator teres syndrome

entrapment or compression of the median nerve between the two heads of the pronator teres S/S-pain and numbness in the distribution of the distal median nerve (index finger, long finger, and radial side of ring finger) tenderness over pronator teres at the anterior aspect of the elbow

Vitamin B12 (cobalamin)

essential for the functioning of all cells and aids in hemoglobin synthesis deficiency:pernicious anemia and various psych disorders Toxicity: not known

Hyperacusis

excessively sensitive hearing Facial nerve issue

Exercise guidelines glucose 250-300 W/o ketones

exercise with caution, retest in 15 minutes

Rectus capitis posterior major

extends occiput on the atlas, shortened with forward head posture and should be streched

How to compensate for STNR

facilitate trunk extension -leads to slumping while sitting, assists in crawling

Vitamin B3 (Niacin)

facilitates several enzymes that regulate energy metabolism Deficiency: pellagra and GI disturbances Toxicity: abnormal glucose metabolism, nausea, vomiting, and gastric ulcerations

Folacin (folic acid)

folacin is involved in the formation of rbc and in the functioning of gi tract deficiency- impaired cell division and alteration of protein synthesis toxicity-none

pneumococcal pneumonia

form of pneumonia caused by the bacterial species Streptococcus pneumoniae Rusty sputum

Right flank pain causes

gallbaldder

MCA stem stroke

global aphasia, homo hemi, hemiparesis

What interferes with the effects of insulin?

glucosamines -inject insulin during exercise and NOT BEFORE since causes intense hypoglycemic effect

Sequence for Donning PPE

gown, mask, goggles, gloves

when to use laying flat supine position

helps with shock

Fullerton assessment of balance

higher level balance scale

Cubitus recurvatum

hyperextension at the elbow, which shortens the triceps and lengthens the biceps at the elbow. Bringing the shoulder into extension while the elbow is hyperextended will put the triceps at a mechanically shortened disadvantage for contraction (active insufficiency).

What CNs run through the medulla

hypoglossal (tongue movement) and vagus nerve (difficulty swallowing)

Apraxia

impaired ability to carry out motor activities despite intact motor function (ideomotor and ideational) MCA stroke

Dowager's hump

in women, osteoporosis, thoracic vertebral bodies begin to degenerate and wedge in an anterior direction resulting in kyphosis

What occurs with maintained ATNR

inability to cross midline

ideational apraxia

inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for movement is impaired

psuedobulbar palsy

inability to make voluntary facial gestures

ataxia

inability to perform coordinated movements

Prosopagnosia

inability to recognize familiar faces/ difficulty naming people onsite

Articulated (HINGED) AFO

includes a metal joint or tubing or smaller amount of thermoplastic that allows for varying amounts of DF and PF Hybrid, hinged, or articulated AFO composed of CALF COMPONENT separate but articulates with a foot plate Used for: FREE UNRESTRICTED SAGGITAL PLANE MOTION at ankle WHILE LIMITING MEDIAL AND LATERAL MOTION Modifications: Posterior stop- a buttress on the posterior aspect of the AFO which stops EXCESSIVE PF Dorsiflexion stop- velcro strap on posterior aspect of AFO which LIMITS DF

Characteristics of small electrodes

increase current density increase impedance decrease current flow

vitamin D

increased blood flow levels of minerals, noably calcium and phosphorus Deficiency; faulty bone growth, rickets, and oseomalacia Toxicity: calcificaion of soft tissues and hypercalcemia

What does the patella do

increases quad tendon tension and increases PF force with more flexed posision

Arch index <.3

indicates pes plaus- need longitudinal arch support

What do emetic agents do?

induce vomitting

gouty arthritis

inflammation and painful swelling of joints caused by excessive uric acid in the body

Osteomyelitis

inflammation of bone and bone marrow

What is cystitis

inflammation of the bladder. The inflammation occurs from a bacteria infection, usually as an urinary tract infection. If the bladder infection is not treated, it can create a more serious health issue by infecting the kidneys. Strong cloudy ordor

trigeminal neuralgia

inflammation of the fifth cranial nerve characterized by sudden, intense, brief attacks of sharp pain on one side of the face

Posterior interosseous nerve

innervation of extensor carpi ulnaris Causes wrist drop if damaged

overflow incontinence

involuntary loss of urine associated with overdistention and overflow of the bladder caused by NEUROLOGICAL CONDITION results in disruption of the activity of the detrusor muscle Treated with meds and catheterization

Sress incontinence

involuntary urine leakage during laughing, coughing, sneezing, or exertion, Treat by strengthening pelvic floor muscles

Pyelonephritis

is a kidney infection that began from the bladder and would have urinary frequency and dysuria (painful urination).

Chemo Common side effects

jaundice, gray stools, dark urine, easy brusing/bleeding, anemia, fatigue, increase infection risk, DIARRHEA NOT CONSTIPATION OR MYOPATHIES, hair loss, skin rashes, phlebitis, ulcers, thrombocytopenia, anorexia

Scheuermann's Disease

juvenile kyphosis

Orthopnea

labored or difficult breathing that happened when decreased room for chest expansion while lying flat and relieved by sitting or standing because the gravity lower the abdominal organs which increase the space for more air entrance

Humpback or Gibbus

localized, sharp, posterior angulation in the thoracic spine fx or pathology

SCI best way to decrease possibility of pressure ulcers

log-roll want to avoid distracting and rotational forces ad do not move person downward by pulling on extremities

Contraindications to serial casting

long-standing contractures that are more than 6-12 months old, severe heterotropic ossification, open wounds, impaired circulation.

How to relieve plural irritation

lying ON THE AFFECTED SIDE- called auto splinting

Rhinne test

mastoid process then in front of ear. if AC > BC then normal or sensorineural hearing loss in that ear if BC>AC, then conductive loss in that ear, or a sensorineural loss in the opposite ear.

Symptoms acute pancreatitis

may be mild, non-specific abdominal pain, begins in mid-epigastrum or LUQ. May radiate to back, becomes more severe in hours -elevated lipase and amylase tests, epigastric pain, pain radiating to back and jaundice

Ratio scale

measurement that has a natural, or ABSOLUTE zero and therefore allows the comparison of absolute magnitudes of the numbers Intervals between values are equal distance walked, time to complete activity, range of motion, nerve conduction velocity

Central venous pressure catheter

measures blood pressure directly from right atrium a superior vena cava

Where is the deltoid ligament in ankle

medial ankle

Nerve innervates elbow pronators

median nerve

Vitamin B6 (pyridoxine)

metabolism of proteins, amino acids, carbs and fats deficiency: peripheral neuropathy, convulsions, and depression Toxicity: sensory damage, numbness of the extremities, and ataxia

What are the limitations of platelet count of 50,000-150,000

minimal to moderate restive exercises permitted allowed: sexual intercourse, MMTs, swimming, low bench step, stepping, biking (no grade; flat only)

Nevus

mole

Arterial line

monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. used to measure blood pressure or obtain blood samples. considered more accurate than traditional measures of blood pressure and does not require repeated needle punctures Measures arterial blood gases

Methylprednisolone side effects

mood changes, visual changes, rapid weight gain

Abnormal lymph nodes

more than 1cm diameter, firm and rubbery, or tender infection-tender, soft, and moveable

GBS signs and symptoms

motor weakness (distal to proximal progression), sensory impairments, and possible respiratory paralysis, problems talking, swallowing, and bowel and bladder

Methotrexate side effects

mouth sores, anemia, bloody or tarry stools

Exercise guidelines glucose 70-100

no exercise, give 15g carbohydrate snack, retest in 15 minutes

Is tylenol a anti-thrombic?

no- no impact on platelet aggregation large doses cause liver damage

What EMG potential will be seen with normal muscle

none

Eupnea

normal breathing

L CVA vs R CVA

oLd person- L CVA more cautious baby in a Rocker- R CVA more impulsive

Duty cycle US calculation

on time/ (on time+off time)

Rib dysfunction symptoms

one sided, sharp sensation, coughing, deep breathing, turning in bed and history of having the chest wall opened for heart surgery

Which statistical test tests 2 or more independent groups compared on 1 intervention?

one-way ANOVA -can have 3+ groups but ONE intervention

Tibial and peroneal artery occlusion symptoms

pain in calf and feet (occasionally)

Metatarsalgia

pain in the bones of the foot metatarsalgia; mechanical: tight triceps surae and collapse of medial arch (pronation); structural: neural or vascular compromise due to transverse arch changes

Random symptoms of stenosis

pain prolonged positioning, cramping during walking, numbness and tingling in legs

rufinni endings

pain sensation

Murphy's sign

pain with palpation of the RUQ/ R rectus during inspiration, indicative of cholecystitis (gall bladder)

horizontal nystagmus

peripheral vertigo (PNS lesion)

What occurs with a maintained STNR or TLR

poor posture and balance

Stroke artery for visual agnosia

posterior cerebral artery.

Kyphosis

posterior curvature of the spine, pathologically exagerated in the thoracic spine Causes-tuberculosis, vertebral compression fractures, scheuermann diesase, anaklyosing spondylitis, senile osteoporosis, tumeors

What is Aldactone?

potassium sparing diuretic- used when hypokalemia is a problem

cardinal feature of lung consolidation

presence of air bronchogram in radiograph, which is the infiltration of edema around the bronchi leaving a dark tubular structure surrounded by radio - opaque fluid.

INR >4.0 restrictions

progression of exercise contraindicted, discuss with physician

Gliosis

proliferation of astrocytes in an area of neuron degeneration leading to a glial scar. Seen in MS

What is omeprazole?

proton pump inhibitor -can cause blisters, ulcers, bloody urine, peeling skin, chest pain, sores

Nobles compression test

pt supine, examiner on ipsilateral side, passively flex hip and knee to 90 deg, contact lateral femoral condyle with superior thumb compressing ITB tendon, then extend the knee and hip while lowering the leg stretches ITB (+) RoS under thumb as leg reaches ~30 deg of extension indicates ITB contracture and friction rub against lateral condyle of femur

Pustules

pus-filled sacs such as those seen in acne, or pimples

Quad tendon repair expectations

range of motion is expected to be significantly limited during the first 0-2 weeks post-operative. The patient may be restricted to no flexion active range of motion or very limited range of motion from 0-30 degrees of motion in order to protect the repair site. If increased knee flexion range of motion is performed beyond what is recommended by the surgeon it could delay healing or cause a recurrent tear of the tendon.

What could a weak serratus cause difficulty with

reaching forward

Synovitis TMJ

restricted mouth opening, no clicking, pain, NO DEVIATION

INR >3.0 restriction

risk for hemarthrosis

What is the sensory nerve to medial leg and foot

saphoneous

carpal bones

scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate -trapezium comes out with opposition and ulnar deviation

unilateral vestibular hypofunction symptoms

scillopsia, a loss of gaze stabilization, and spontaneous nystagmus that can be suppressed with visual fixation. Additional problems include disequilibrium and ataxic gait pattern with consistent veering to the left.

Respiratory alkalosis symptoms

seizures, deep rapid breathing, hyperventilation, confusion, hypokalemia, light headedness, and tingling in the extremities, hypocapnea,, tetany, convulsions, cardiac arrhythmia NO CARBS- N/T, orthostatic hypotension, confusion, anxiety, rapid breathing, dizzy, seizures

What occurs with a maintained heel relfex

shin splints and heel pain

6 weeks post quad tendon repair

should have around 0-90 degrees knee motion

Bacody's sign

shoulder abduction test used to test for radicular symptoms, especially c4-c5 nerve roots- decrease in symptoms indicates a cervial extradural compression problem abduction decreases the length of the neurological pathway and decreases pressure on the lower nerve roots

symptoms of fetal alcohol syndrome

small head circumference, low nasal bridge, thin upper lip, small mandible, balance difficulties

wheal

small, round, raised area on the skin that may be accompanied by itching; usually seen in allergic reactions

Types of Cerebral Palsy

spastic, athetoid, ataxic, mixed

Pancoast tumor

squamous carcinoma posterior mediastinum; destruction superior cervical ganglion -compression paravertebral sympathetic nerves leading to horner's syndrome (drooping eyelid, lack of sweating, pupil constriction, compression of recurrent laryngeal nerve causing hoarseness voice, compression of brachial plexus causing atrophy and weakness of muscles of arm and hand

Lymphedema Stages

stage 0- swelling not evident but some report heaviness Stage 1 - fluid but subsides with limb elevaed , may pit but NO dermal fibrosis Stage 2- elevation of limb doesn't solve swelling, has dermal fibrosis, NO longer pits Stage 3- Lymphostatic Elephantiasis, pitting absent, skin has fat deposits, acanthosis, warty overgrowth

Parameters for cervical traction

start 7-10% body weight- stretch soft tissue or treat muscle spasm and disk protrusion 13-20% body weight for distraction sould not exceed 30 pounds

Pec major sternal head MMT vs clavicular head

sternal head 120 shoulder abduction, resist shoulder diagnoal pull to opposite hip clavicular head: horizontal adduction accross chest

Mixed incontinence

symptoms of urge and stress incontinence are present, although one type may predominate -symptoms of leakage with sneezing and a strong urge

Junctional Rhythm

the SA node is nonfunctional, P waves are absent, and heart is paced by the AV node at 40-60 beats/min

Paradoxical breathing

the chest to contract during inhaling and to expand during exhaling, the opposite of how it should move.

construct validity

the extent to which variables measure what they are supposed to measure Gony-measures ROM and nothing else Extent to what a tool actually measures a construct (test actually measures empathy, which is hard to determine)

Agnosia

the inability to recognize familiar objects. MCA stroke

urge incontinence

the loss of urine in response to a sudden, urgent need to void; the person cannot get to a toilet in time increase frequency in desire to void with decreased volume Treat by treating infection (UTI)

Round back

the patient with a round back has a long rounded curve with decreased pelvic inclination (less than 30) and thoracolumbar kyphosis, forward trunk flex and decreased lumbar curve

What are non-parametric tests

they do not test hypotheses concerning parameters, and hence are known as non-parametric tests examples: Chi-squared, mann-u whitney, Kruskal Wallis test -used for nominal (blood types) or ordinal level (MMT, levels of assist) data or interval (degrees farenheit) or ratio data (distance walked) that is NOT NORMAL

Predictive validity

tool can predict certain behaviors

Messiner's corpuscles

touch receptors/ texture

What does St. John's Wort do?

treats mild depression and can increase the side effects of drugs that have a sedating effect

What can cause hyperreflexia

tumor of spinal cord

diaphragmic breathing

type of breathing in which person fill their lungs fully by expanding the diaphragm; used for relaxation

functional incontinence

urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation (mobility, dexterity, cognitive decline) Treat by clear cutter and prompted voiding

INR >2.5 restrictions

use extreme caution and guard against falls

biological debridement (rarely used)

use of maggots to debride nonviable tissue Produce enzymes and phagocytize necrotic tissue and bacteria. stimulate granulation formation and epithelialization Indications: Individuals who cannot tolerate other forms of debridement All non-healing necrotic wounds in people medically stable

Baclofen (kemstro)

used for muscle spasms CNS acting muscle relaxant

Nitrofurazone solution

used to treat burns that have become infected. It is also used to treat skin infections due to skin grafts. It works by killing bacteria or preventing their growth -painful

Glossopharyngeal breathing

useful for high cervical lesions like C4- diaphragm partially innervated increases tidal volume and vital capacity, helps strengthen inspiratory muscles

What are the limitations of platelet count of <10,000

usually transfused

Kiolhertz Ultrasound debridement contraindications

vascular abnormalities (DVT, emboli) irradiated areas, tumors, organs, or electrical devices, Precaution over nerves, infections and anesthetic areas

Stroke artery for ipsilateral hemiparesis and nystagmus

vertebrobasilar artery, specifically Wallenburg's syndrome.

Shingles

viral disease that affects the peripheral nerves and causes blisters on the skin that follow the course of the affected nerves (dematome) causes rash or blisters

In iontophoresis what is used to treat Hyperhidrosis?

water (+/-)

Which statistical test measures individuals over time?

γ-Repeated measures ANOVA

Metabolic alkalosis symptoms

• Dizziness • Lethargy • Weakness • Disorientation • Seizures • Coma • Muscle twitching • Muscle cramps • Tetany • May also experience - Respiratory depression - Nausea - Vomiting excessive bicarb, depressed respirations, mental confusion, dizziness, numbness/tingling in digits, tetany, convulsion, hypokalemia, cardiac arrhythmia Quad T's- tetany, tachycardia, tremor, tingling