Review Set 4

What is an Acoustic Neuroma?

A benign Schwann cell tumor of cells which myelinate CN VIII, that arises from the vestibular portion of the nerve

Define manual muscle testing

A clinical procedure which manually assess muscle strength & contractility of a muscle

What is treatment for vaginismus like?

A comination of education, counseling & behavioral sciences. Vaginal dilation exercises under the direction of a PT or sex therapist.

What is vaginismus?

A condition involving involuntary spasms of the muscles surrounding the vagina which close the vagina and makes intercourse difficult or even impossible

What is spina bifida occulta?

A fairly common type of spina bifida. It involves a tuft of hair growing along the SP and incomplete closing of the backbone

What is otosclerosis?

A hereditary disorder causing conductive hearing loss, due to overgrowth of bone at the annular stapedial ligament, which prevents the stapes from moving at the oval window and leads to a loss of vibration

What is acute brachial plexus neuritis? What trunk of the brachial plexus does it involve? Is it a superior or inferior BP injury?

A neurological disorder of unknown cause, involves the superior trunk and severe pain around the shoulder. It is a superior brachial plexus injury

What is the carpal tunnel?

A passageway deep to the flexor retinaculum. 9 tendons pass through it and 1 nerve. Passes through tubercles of scaphoid & trapezium and pisiform & hook of hamate

What is functional muscle testing?

A performance-based muscle assessment

What is Myringotomy?

A surgical incision into the ear drum to relieve pressure or drain fluid with pressure equalization tubes

What is the perineal body?

A thick connective tissue mass that serves as the site of insertion of many urogenital muscles

What group do efferent axons of large myelinated nerves belong to?

A-alpha

What are the two types of nociceptors?

A-delta C fibers the different types help to distinguish between different types of pain (burning, stabbing, sharp, dull etc.)

Afferent axons of small myelinated nerves belong to which group of fibers?

A-delta (for diameters of 2-5 micrometers)

What group do efferent axons of medium myelinated nerves belong to?

A-gamma

What are some advantages and disadvantages of MRIs?

A: *good sensitivity*, images soft tissue well, no ionizing radiation, little distortion D: *low specificity*, expensive, contraindicated if pt has a ferrous metal implant or exposure

What are the ABCS of radiology?

A: alignment B: bone density C: cartilage S: soft tissue

What are the advantages and disadvantages of rigid removable post-op dressings?

A: allows skin inspection, consistent pressure, easily put on, protects residual limb D: may require *frequent re-fitting* (volume of residual limb changes)

What are some advantages and disadvantages of CT scans?

A: both sensitive & specific for *fractures*, useful for quick assessment of brain or neuro injury D: radiation exposure, discriminates density but limited in precise hist. differences, small volumes of tissue image as a uniform shade of gray

What are the advantages and disadvantages of soft post-op dressings?

A: cheap, lightweight, readily available D: inconsistent, weak compression, frequent re-wrapping & replacement, *doesn't prevent contracture*, difficult for pt to self-apply Jason sees this very often

What are the advantages and disadvantages of semi-rigid post-op dressings?

A: controls edema, adheres to skin, allows some ROM, breathable, cheap, easy to countour D: loses effectiveness as swelling goes down, not as protective, *doesn't prevent contractures* Jason said this is like a very soft cast

What are the advantages and disadvantages of rigid post-op dressings (IPOP)?

A: dec edema & pain, *prevents contracture*, protects limb, allows *early WB*, easier transition to definitive prosthesis D: difficult to apply, requires close supervision, *can't visualize wound* or residual limb Jason said he has never seen anyone use this, not overly common

What are the advantages and disadvantages of a bone scan (radionuclide scintigraphy)?

A: highly *sensitive* for early bone & joint disease, fast, reasonable cost D: easily influenced by osteoblastic activity or blood flow of any etiology, *poor specificity*

What are some advantages and disadvantages of x-rays?

A: time & cost efficient, non-invasive, low risk, good for screening D: may be normal when a pathology actually exists

Which type of amputation requires a waist belt for a limb shrinker?

AKA

If you want to use +/- other than Kendall, or want to precisely test the strength of a muscle through available ROM, which MMT scale should you use?

ART

If you decide to use + and - as a PT, which scale is the most objective?

ART or gravity-eliminating testing

Where does the inguinal ligament attach?

ASIS

Which CN passes through Dorello's canal?

Abducens N

Which is the most common CN palsy?

Abducens N

Which is the only cranial nerve to run through the cavernous sinus?

Abducens N

Where is the location of the primary neurons of the abducens N?

Abducent nucleus

If you test the patient's thumb abduction, adduction, extension, flexion, opposition, and reposition, what nerves are you testing the integrity of with each motion?

Abduction: median & radial Adduction: ulnar Extension: radial Flexion: median Opposition: median Reposition: none

What are the muscles in the hypothenar eminence?

Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi

What are the muscles in the thenar eminence?

Abductor pollicis brevis Flexor pollicis brevis Opponens polllicis

What lymphatics are responsible for the area of the rectum above and below the pectinate line?

Above: internal iliac nodes Below: inguinal nodes

What ligaments are above and below the pubic symphysis?

Above: superior pubic ligament Below: inferior pubic ligament

What is the end product of the 1st major pathway of catabolism of alcohol?

Acetaldehyde

What is the end product of the 2nd major pathway of catabolism of alcohol?

Acetate

How should you adjust a transfemoral prosthesis if the user has a hip flexion contracture? ********

Add socket flexion to the point where there is 5 deg more socket flexion than the flexion contracture, this is essentially giving them back 5 deg of hip extension

What are 3 special tests for TOS?

Adson's cotoclavicular or Halstead's maneuver Roos test

Opening the auditory tube during swallowing allows what?

Air from the nasal pharynx to move into the middle ear, which otherwise would have a pressure negative to atmospheric pressure

What is the lateral boundary of the greater pelvis?

Ala of ilium, iliacus muscle

Why do chronic alcoholics tend to bleed profusely if injured and for longer periods of time?

Alcohol interferes with the blood-clotting process in several ways. -dec platelets (thrombocytopenia) -disabled platelet function -dec fibrinolysis

What diretion of flow/shunting does the foramen ovale allow?

Allows right to left atrial flow

What direction of flow/shunting does the ductus arteriosus allow?

Allows right to left flow. Allows blood to bypass the lungs and enter the systemic system

Cholinesterase inhibitors, memantine and antipsychotic drugs could all be used to treat what disease?

Alzheimer's Disease

What is Klumpke's Palsy?

An injury to the inferior part of the brachial plexus, that results in a "clawhand": you can only flex the 1st and 2nd digit and the rest just partially

What is Backpacker's Palsy and what causes it?

An injury to the superior part of brachial plexus. A micro injury of the superior trunk due to carrying a heavy backpack.

What can cause a sudden CN III palsy?

Aneurysm especially within: post. cerebral A sup. cerebellar A post. communicating A

Which scalene muscles does the brachial plexus travel between?

Anterior and middle

What forms the medial cord?

Anterior division of the inferior trunk

What forms the lateral cord?

Anterior divisions of the superior and middle trunks

What does the median nerve innervate?

Anterior forearm and a little bit of the hand (8 muscles): flexors, pronators, palmaris longus, some thenar and lumbricals

What is the sacral promontory normally covered with?

Anterior longitudinal ligament

Degradation of neurotransmitter: the breakdown of the transmitter may halt neuronal activity. What drugs act on this step? (picture)

Anticholinesterase drugs

What structures does the perineum include in men? (3)

Anus Penis Scrotum

What structures does the perineum include in women? (2)

Anus Vulva (external genitalia)

What are the results of Erb's Palsy? What do you lose function of?

Appearance: "waiter's tip position" injured limb hangs by the side in medial rotation, loss of sensation on lateral aspect of upper limb, also causes muscle paralysis of deltoid, bicep, brachialis, and brachioradialis

Where is the perineum located?

Area between thighs that extends from the coccyx to the pubic symphysis It is the outlet of the pelvis

Where do parasympathetic visceral motor components arise from and terminate?

Arise: 4 brain stem nuclei Terminate: 4 peripheral ganglia

In normal capillary dynamics, which pressure is higher at the arterial end? At the venous end?

Arterial: Hydrostatic pressure (pushing fluid into interstitial space) Venous: Osmotic pressure (pulling fluid back into venous system)

What is the blood supply (artery & vein) to the part of the rectum above the pectinate line provided by?

Artery: IMA Vein: portal venous system

What is the blood supply (artery & vein) to the part of the rectum below the pectinate line provided by?

Artery: internal iliac A Vein: IVC

When doing MMT, where does the PT apply pressure? ***

At the distal end of the bone to which the muscle attaches (know this***)

If you damage the surgical neck of the humerus, what nerve are you also likely to damage?

Axillary Nerve

What vessel do the cords of the brachial plexus wrap around?

Axillary artery

What group do efferent axons of small myelinated nerves belong to?

B fibers (for diameters less than 3 micrometers)

If PROM=AROM, or you want to test the muscles of the cervical spine or small digits or scapula, or you want to do a quick screen for strength, which MMT scale should you use?

BT (break testing)

What conditions can both back sprains and strains lead to?

Back pain which in turn may cause protective reflex tonic muscle contraction (tight back) to guard the back from excessive movement

What is the flexor retinaculum?

Band of connective tissue that bridges between pisiform/hook of hamate and trapezium.

Summary of drugs that can be used to treat Epilepsy: (read)

Barbiturates Benzodiazepines Pregabalin Hydantoins Carbamazepine Vigabatrin Ethosuzimide Valporic acid

How are pelvic fractures treated that do not involve significant displacement?

Bed rest, external stabilization is not needed

Postsynaptic receptor: when the neurotransmitter finally binds to the post synaptic neuron, the signal is transduced to the next neuron. What is a drug that acts at this step? (picture)

Beta blockers

Why should pregnant women not consume alcohol?

Binge drinking of alcohol is thought to inhibit neural crest cell migration and can lead to heart, head, and neck defects

If the blood is pumped into the right ventricle, where does it go next?

Blood pumped out of the right ventricle will go toward the lungs which has a high resistance. The ductus arteriosus allows this blood to join the descending aorta to bypass the lungs.

What is the anterior boundary of the pelvic wall?

Body and ramus of pubic bone, pubic symphysis

Is MMT performed on functional patterns or specific muscles?

Both

Is the trigeminal N sensory or motor?

Both

What innervates the internal anal sphincter muscle?

Both sympathetic and parasympathetic Parasympathetic is from pelvic splanchnic NN

What are the branches off of the aorta from medial to lateral?

Brachiocephalic trunk, left common carotid artery, left subclavian artery

What is the most common type of MMT?

Break testing

Afferent axons of unmyelinated nerves belong to which group of fibers?

C fibers

What group do efferent axons of unmyelinated nerves belong to?

C fibers

What roots have fibers in the phrenic nerve?

C3-5

What roots have fibers in the upper subscapular nerve?

C5-6

What roots have fibers in the lateral cord?

C5-7

What roots have fibers in the lateral pectoral nerve?

C5-7

What roots have fibers in the long thoracic nerve?

C5-7

What roots have fibers in the posterior cord?

C5-T1

What roots give rise to the brachial plexus?

C5-T1 (sometimes C4)

What roots have fibers in the lower subscapular nerve?

C6-7

What roots have fibers in the thoracodorsal nerve?

C6-7

What roots have fibers in the medial cord?

C8-T1

What roots have fibers in the medial cutaneous nerve of the arm?

C8-T1

What roots have fibers in the medial cutaneous nerve of the forearm?

C8-T1

What roots have fibers in the medial pectoral nerve?

C8-T1

Innervation of tensor tympani:

CN V3 (mandibular trigeminal)

Innervation of Stapedius:

CN VII (facial)

Which CN does not exit from the brain?

CN XI, spinal accessory

Frequent attacks of acute asthma may lead to what condition?

COPD

PTs are responsible for monitoring pts following fractures and immobilization for possible development of ___________

CRPS should create a checklist of signs & symptoms to asses it

In what type of imaging does an x-ray tube and film move around a fulcrum?

CT scan

What would clinical presentation look like for a patient who has damaged their median nerve?

CTS: -burning, tingling or itching numbness in the palm of the hand and the fingers, especially the thumb, index and middle fingers Palsy: -ape hand with atrophy in the thenar eminence -no arm pronation, weak grip, no thumb abduction and opposition -sensory loss in thenar region

What is the cause of death of 67% of people with diabetes?

CVDs: -heart diseases such as CAD/MI and diabetic cardiomyopathy -stroke

Who is at the greatest risk for otosclerosis?

Caucasian women (and those who have 2 parents with otosclerosis)

What causes injuries of the brachial plexus and what are the results of an injury?

Cause: disease or injury Result: paraylsis or anesthesia

Which compartment of the hand is the common flexor synovial sheath located in?

Central compartment (sheath of FDS and FDP)

What is neurotmesis? What happens to the nerve? What happens in healing?

Characterized by not only *loss of nerve conduction, but damage to surrounding nerve trunk connective tissue*. In extreme cases of this injury category *complete transection occurs*. Commonly a *neuroma forms over the proximal stump* of the nerve, preventing normal continued regeneration to occur.

Why do chronic alcoholics eventually reverse their tolerance to alcohol?

Chronic alcoholics develop liver damage which reduces the amount of enzymes it can make to metabolize alcohol

Which peripheral ganglia do the parasympathetics of the oculomotor N synapse in?

Ciliary (V1)

What is the peripheral ganglion of the opthalmic branch of the trigeminal?

Ciliary ganglion

Is the Eustachian tube normally open or closed at rest?

Closed

What are the main termination branches of the superficial palmar arch of the ulnar artery?

Common palmar digital arteries which further branches into 2 proper palmar digital arteries

On the Daniels & Worthingham scale, what does a score of 2 mean?

Completes full ROM (not BT)

On the Kendall scale, what does a score of 3 mean?

Completes full ROM against gravity (no pressure)

On the Daniels & Worthingham scale, what does a score of 3 mean?

Completes full ROM against gravity (no pressure) and "breaks" with any resistance applied (BT)

On the Daniels & Worthingham scale, what does a score of 5 mean?

Completes full ROM against maximum resistance OR holds against max resistance (break testing, BT)

What is the palmar aponeurosis?

Continuation of fascia from the forearm and hand. It blends with the palmaris longus and flexor retinaculum.

What does the musculocutaneous nerve innervate?

Coracobrachialis, biceps, brachialis

What ganglion do the cranial nerves come from that also hitch hike along blood vessels such as the carotid AA?

Cranial nerves from the superior cervical ganglion

What would clinical presentation look like in someone who has damaged their ulnar nerve?

Cubital tunnel syndrome: -pain, numbness and/or tingling in the ring and little fingers Palsy: -partial claw with atrophy between the metacarpals and hypothenar region -loss of use of 4th and 5th digits for spherical and cylindrical power grip -thumb for adduction, finger abduction and adduction are lost -sensory loss in hypothenar region

What are the 2 diagonal PNF patterns called? Which body segments can these patterns be applied to?

D1 and D2 UE, LE and trunk

What is a widely used method of measuring bone mineral density?

DEXA (dual energy x-ray absortiometry)

Is diabetic nephropathy more common in people with DM1 or DM2?

DM2

What do straddle injuries result in?

Damage to external genitalia may bleed into the superficial perineal space The area the blood/urine can spread to is limited by the superficial perineal membrane and where it attaches Does not extend into thighs or around anus, does not go above arcuate line in abdomen

What is diabetic retinopathy?

Damage to the eye retina due to damage of retinal blood vessels by high glucose levels (hemorrhage) that can lead to vision loss

What day does the heart start to beat?

Day 22

What day does the intraembryonic circulation begin?

Day 25

What fascia is the perineal membrane a part of?

Deep fascia

What are the 3 parts of the external anal sphincter muscle?

Deep, superficial, and subcutaneous external sphincters

What does the axillary nerve innervate?

Deltoid and teres minor

What is the distance between the inferior* surface of the pubic symphysis and the sacral promontory called?

Diagonal conjugate

What can be estimated by transvaginal palpation? Why is this information helpful?

Diagonal conjugate Used to estimate the true & obstetrical conjugate which is the pathway of the baby

What is the perineum shaped like?

Diamond, can be separated into 2 triangles

Kendall's scale, Daniels & Worthingham, and ART are examples of what?

Different grading systems for MMT other than the normal numerical or quantitative scoring

Sympathetic fibers run in short & long ciliary NN to the back of the eye to innervate dilator or constrictor muscles of the pupil?

Dilator pupuillae muscles

What is the rate-limiting step of the 2 major pathways of catabolism of alcohol?

Dissociation of NADH to NAD+ which accepts H+ ions from each of the 2 major pathways. This reaction can affect other metabolic processes in the liver.

What does a mixed spinal nerve split into?

Dorsal and ventral rami

Which brain stem nuclei does the vagus preganglionic neuron start in?

Dorsal motor N. vagus

Why are people with Kaposi's sarcoma prone to develop other malignant tumorous processes?

Due to decrease in CD4 cells

How does the fossa ovalis close after birth?

Due to the pressure in the left atrium now being greater than the right atrium, the septum primum is pushed against the septum secondum thus closing the atrial shunt.

What is the difference b/w the pathophysiology of emphysema and chronic bronchitis?

E: destruction of alveolar walls, loss of elasticity, impaired expiration, barrel chest, hyperinflation CB: inc mucous gland size, inc secretions, inflamm, infections, obstruction

The oculomotor CN has parasympathetic and motor fibers. Which brain stem nuclei are the (preganglionic) parasympathetic fibers in? Which functions of CN III are due to the parasympathetics?

Edinger-westphall nucleus (this is b/c it is parasympathetic visceral motor) Parasympathetics control sphincter pupillae and ciliary muscles

What can induce right-to-left shunting in patients with a PFO?

Elevation in right atrial pressure, redirection of blood from the Eustachian tube, and straining and release phases of the valsalva maneuver

In MMT, if you are testing a single-joint muscle, you generally want to test near ________________ .

End range

What does the superficial perineal space contain?

Erectile tissue & muscles of the external genitalia

What is another name for the intermediate layer of the deep back muscles?

Erector Spinae group

What is the function of the pelvic diaphragm?

Essential for maintaining the proper positioning of the pelvic organs Essential for maintaining abdominal & thoracic pressure during micturation, defecation, child birth, and heavy lifting

Why is the consumption of methyl alcohol more rapidly toxic than the consumption of ethyl alcohol?

Ethyl: is oxidized quickly into acetate first and then CO2 & water Methyl: is only partially oxidized. It is quickly oxidized into formaldehyde, but slowly oxidized into formic acid which causes methanol poisoning

During cholesteatoma, the tympanic membrane is pulled into the middle ear by negative pressure due to:

Eustachian tube dysfunction

FYI: when viewing an x-ray film, the identification letters may be backward or upside down

Ex: L. AP or R. lateral

What is De Quervain's tenovaginitis stenosans?

Excessive friction of APL and EPB tendons that causes thickening of the synovial sheath. This causes pain that radiates down the forearm and thumb

Where is the lesser/true pelvis located?

Extends from pelvic brim to the pelvic floor/diaphragm

What do the posterior divisions mainly innervate?

Extensors (muscles in posterior region)

Which anal sphincter muscle is under voluntary control?

External anal sphincter

What structures does the urogenital triangle include in both males and females?

External genitalia and urethra of both sexes

What are the functions of the occulomotor N?

Extrinsic Eye Muscles: (motor)* levator palpebrae superior rectus medial rectus inferior rectus inferior oblique Intrinsic Eye Muscles: (para)* ciliary muscle sphincter pupillae muscle

What is the name of the U.S. government agency responsible for ensuring that drugs marketed in the U.S. are safe and effective?

FDA (food & drug administration)

What muscles can be used to test the integrity of the ulnar and median nerves?

FDP and lumbricals

FYI: Glutamate and aspartate strongly excite neuons in the brain

FYI

FYI: Lyrica is helpful in treating not only epilepsy, but also neuropathic pain, neuralgias associated with herpes, and fibromyalgia

FYI

FYI: Treatment of Parkinson's with antioxidants may actually slow the progression of the disease rather than mask symptoms

FYI

FYI: many of the drugs prescribed to treat epilepsy can also be used to treat anxiety and insomnia, but there are drugs also prescribed specifically for anxiety

FYI

Irina cautions you from looking up drugs on any website b/c anyone can put anything on the Internet. She lists lots of websites that she likes as drug references like the FDA

FYI

T/F: PNF session effects will result in lasting changes when used independently

False PNF alone will have ST effects, but if the new ROM is used in a functional way and strengthening is done within the new ROM the effects will last for longer

T/F: there is only one pressure acting on capillary fluids at both the arterial and venous ends.

False at both the arterial and venous ends of capillaries, both the hydrostatic pressure and the osmotic pressure exist, one is just higher at each end controlling fluid flow

What does most of the anal triangle contiain? What is this space called?

Fat to allow expansion of the anus during defecation Ischioanal/Ischiorectal fossa

Is the female or male true pelvis more wide & shallow?

Female

What is the subpubic angle of males and females? ****

Female: 90 degrees Male: 60 degrees

Is the pelvic outlet larger in females or males?

Females

Are patent ductus arteriosus more common in males or females?

Females, the ratio is 3:1

What type of joint is the pubic symphysis?

Fibrocartilaginous joint with an interpubic disc between the pubic bones

Which of the following muscles have a corresponding longus muscle: flexor digiti minimi brevis, flexor pollicis brevis, abductor digiti minimi, abductor pollicis brevis?

Flexor pollicis brevis Abductor pollicis brevis

What forms the roof of the carpal tunnel?

Flexor retinaculum

What do the anterior divisions mainly innervate?

Flexors (muscles in anterior region)

Where is the greater/false pelvis located?

From the iliac crests to the pelvic brim/inlet

What is the function of the abducens N? What does it pass through? Is it sensory, motor or both?

Function: lateral rectus (abd) Passage: superior orbital fissure Motor

What is the function of the puborectal sling and what is it formed by?

Function: maintain fecal continence, relieves pressure on anal sphincters Formed by: puborectalis portion of levator ani muscle

What is the function of the optic N? What does it pass through? Is it sensory, motor or both?

Function: sense of sight Passage: optic canal Sensory

What is the function of the olfactory N? What does it pass through? Is it sensory, motor or both?

Function: sense of smell Passage: cribiform plate Sensory

What is the function of the trochlear N? Where does it pass through? Is it sensory, motor or both?

Function: superior oblique: moves eye down, out, & slight IR Passage: superior orbital fissure Motor

_______ (neurotransmitter) is the most common neurotransmitter of the brain and is produced from glutamate

GABA

What are side effects of serotonin selective reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (same side effects for both)?

GI symptoms (nausea, vomiting, diarrhea, constipation)

NO (nitric oxide) is the transmitter of the __________ (organ system) smooth muscle cells that determines the activity level of those cells (also functions in the CNS)

GI tract

What is the difference between gross and specific testing for MMT?

Gross- common, assesses function of a patient overall Specific- more specific

What are the potential causes of an ulnar nerve injury?

Gunshots, stab wounds, fractures at distal humerus, olecranon, or head of radius

What does the ulnar artery pass through when it comes into the hand?

Guyon's canal along with the ulnar nerve

What are the different classifications of pelvic outlets? (4)

Gynecoid: typical female Android: typical male Anthropoid: elongated pelvis Platypelloid: flat pelvis

What 3 things can infection of the middle ear reduce?

Hearing, salivation, and taste

How do you test for De Quervain's tenovaginitis stenosans?

Hold thumb inside other fingers and ulnar deviate wrist. Should be very painful if positive

In the Kendall and Daniels & Worthingham scales, what scores are in the horizontal and vertical planes?

Horizontal: 0 - 2+ Vertical: 2+ - 5

Afferent axons of large myelinated nerves belong to which group of fibers?

Ia, Ib and II

When is a situation that you should get a patent foramen ovale fixed if you know about it?

If you are wanting to become pregnant

How can a pt with Kaposi's sarcoma be immunodeficient and still be hypergammaglobulinemic?

Ig levels are raised but decreased CD4 cells lead them to not be able to activate T and B cells which then would have activated Ig cells, so she is still immunodeficient

Where do the bulk of middle ear ossicles reside?

In the epitympanic recess above the tympanic membrane

Where are holes in the tympanic membrane usually made for myringotomy?

In the inferior half of the tympanic membrane, often posterior or near to the "cone of light", away from ossicles and chorda tympani N.

What is passive insufficiency in relation to MMT?

Inability of a 2 joint muscle to lengthen over 1 joint when it is already lengthened over the other joint. Ex: rectus femoris

What is active insufficiency in relation to MMT?

Inability of a 2 joint muscle to perform a concentric contraction* over 1 joint when it is shortened over the other joint. Ex: hamstrings

What is the purpose of producing hormones to relax pelvic joints during pregnancy?

Increase the birth canal size, especially the lateral dimension

What can be given to a premature infant to speed the closure of a patent ductus arteriosus?

Indomethican

What is tenosynovitis? (cause, symptoms)

Infection of the synovial sheath caused by an injury such as a puncture of the palm with a rusty nail. Symptoms include: swollen digits and painful movements. Infection can spread based on connection of sheaths.

What innervates the external anal sphincter muscle?

Inferior rectal nerve (branch of pudendal nerve, somatic NS)

What is a brachial plexus block?

Injection of anesthesia between the SCM and clavicle. This is done during an upper limb operation. Have to be careful not to cause a pneumothorax or injecting into the vessels instead of the axillary sheath

What is Erb's Palsy and what causes it?

Injury to superior part of brachial plexus caused by excessive separation of the head & neck such as falling with shoulder on ground or during child birth

Which anal sphincter muscle is tonically contracted but relaxes to release gas and fecal material?

Internal anal sphincter

Where are internal vs external hemorrhoids?

Internal: above pectinate line External: below pectinate line

What should part of a differential diagnosis for back pain include?

Intervertebral disc rupture/herniation, nerve inflammation/compression, degenerative changes in facet joints, metabolic bone disease, abdominal aneurysm, metastic cancer, myofascial disorders, back sprain/strain

What is the difference between intrinsic and extrinsic hand muscles?

Intrinsic muscles originate and insert in the hand. Extrinsic muscles originate from the anterior forearm and insert in the hand.

What bony structure causes the transverse diameter of the pelvic inlet to be smaller?

Ischial spines

What is the lateral border of the perineum?

Ischial tuberosities

What is the superficial branch of the ulnar nerve?

It branches distal to the flexor retinaculum and supplies the medial 1.5 digits on anterior surface (palmar musculature)

What is the deep branch of the ulnar nerve?

It branches just below the flexor retinaculum and supplies the hypothenar muscles, medial lumbricals, adductor pollicis, and all interossei muscles

What is the palmar cutaneous branch of the ulnar nerve?

It branches off before the wrist and passes superior to flexor retinaculum to supply skin of palm There is also a palmar cutaneous branch of the median nerve

What is the dorsal branch of the ulnar nerve?

It branches proximal to the wrist and supplies the medial half of the dorsum of the hand, 5th digit and half of 4th digit

What happens to the brachial plexus if an individual has hypertrophied scalenes?

It can impinge on the brachial plexus

What does the Eustachian tube do?

It equilibrate the pressure of the closed middle ear cavity with the air pressure in the nasal pharynx only during *swallowing and yawning*

What does the palmar aponeurosis form around the digits?

It forms 4 digital bands that attach to the proximal phalanges that each form a ligamentous sheath for the flexor tendons

What is the function of the external ear?

It functions to collect sounds

What is the function of the middle ear?

It functions to transmit vibration in air to fluid in the inner ear

When and why is folic acid important for pregnant women?

It helps form a closed off neural tube, this is formed at about 2 weeks gestation, so folic acid is needed early on in pregnancy and is recommended prior to conception

What is the function of the fibrous digital sheath?

It holds the tendons to the phalanges during flexion

What forms the middle trunk?

It is a continuation of the C7 root

Where is the pelvic brim/inlet located?

It is a plane marked by the: sacral promontory** pubic crest** arcuate line pectineal line

Why is the sacral hiatus clinically important?

It is a site of injection into the caudal epidural space

What motion causes compression of cords of the brachial plexus if done repeatedly?

It is a superior injury caused by hyperabduction of the arm (i.e. painting a ceiling) symptoms include pain running down the arm, numbness, tingling

Is serratus posterior an upper extremity or back muscle?

It is a true back muscle, it is just inferior to the rhomboids so it is important not to get the 2 confused

What population is vaginismus most often seen in?

It is an uncommon condition, but when it is seen it is frequently present in certain religious groups

Why should the sudden loss of smell not be ignored

It is associated with early... Parkinson's Alzheimer's Huntington's

What is the clinical importance of a PFO?

It is associated with paradoxical embolism and stroke

What type of joint is the sacroiliac joint?

It is both fibrous and synovial

What is the innervation of the rectum below the pectinate line like?

It is completely somatic below the line Above the line is somatic and visceral

Why is the puborectalis muscle less likely to be injured during child birth?

It is only attached anteriorly and is used to being stretched (defecation) If it is injured though it may result in fecal incontinence

What is the flexor retinaculum deep to?

It is under the palmar aponeurosis and palmaris longus tendon. It is a part of the palmar fascia

What happens if the ductus arteriosus is still patent after 3 months?

It is unlikely to spontaneously close and generally requires surgery

What happens to the interpubic disc during pregnancy?

It may increase in size and laxity which is a source of pelvic pain in pregnant women. This change may be permanent after pregnancy which causes an increase in lateral pelvic dimension

Is bed rest recommended for back strain?

It used to be, but recent studies show most of the time people get better faster if they go about normal activities (nothing excessive)

What kind of accidents may lead to displacement of the head of the femur through the head of the acetabulum?

Jumping accidents (parachuting)

Where do the cords start in the brachial plexus?

Just below the clavicle

What kind of movement do the lumbricals create?

L or Z movement

Which type of DM is "type 1.5"?

LADA (latent autoimmune diabetes in adults)

Are amputations due to cancer usually in the UEs or LEs?

LEs

How many stages of lymphedema are there? What are each of the stages called?

Latency Stage Stage I (reversible) Stage II (spontaneously irreversible) Stage III (elephantiasis)

What branches off of the lateral cord?

Lateral pectoral nerve

What does the thoracodorsal nerve innervate?

Latissimus dorsi

If a pt had a purple nodule on their shoulder and nodular lesions in their lungs and GI tract, what would you think caused this?

Lesions most likely due to Kaposi's sarcoma

What causes carpal tunnel?

Lesions/damage of the structures within the tunnel such as inflammation, infection, excessive exercise, etc.

Which muscles form the pelvic diaphragm/floor?

Levator ani Coccygeus

What organ is responsible for the catabolism/detoxification of the major portion of alcohol ingestion?

Liver

What is anosmia? What causes it?

Loss of ability to smell Causes: skull fractures that shear CN's at cribiform plate and hypogonadism

What are the 5 terminal branches?

MARMU: musculocutaneous, axillary, radial, median, ulnar

Which type of DM is hereditary?

MODY (maturity onset diabetes of the young)

Which type of imaging uses pulses of radio frequency and a strong external magnet to generate an electromagnetic field?

MRI

What nerve root(s) is the levator ani muscle mostly innervated by?

Mainly S4

What nerve root(s) is the coccygeus muscle innervated by?

Mainly S4, but some S3 and S5

Is the female or male greater pelvis more narrow?

Male

Is a male or female pelvis heavier?

Male pelvis is heavier, female is lighter

What passes through the pelvic diaphragm in males and females?

Male: urethra and anus Female: urethra, vagina, and anus

What is active resistance testing (ART)?

Manual resistance applied during an actively contracting muscle. Requires more skill to accurately test.

What is break testing?

Manual resistance applied to test a limb to "break" a static positional hold. The joint is NOT actively moving through ROM.

What branches off of the medial cord?

Medial pectoral, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm

Is the ulnar nerve lateral or medial to the ulnar artery?

Medial to artery

What are the medial and lateral fibrous septa of the hand?

Medial: separates the hypothenar compartment from the potential midpalmar space Lateral: separates the thenar compartment from the potential thenar space

If you damage the distal end of the humerus, what nerve are you also likely to damage?

Median nerve

What is often injured when the wrist is lacerated either by accident or on purpose?

Median nerve injury that will result in carpal tunnel symptoms

In MMT, if you are testing a two-joint muscle, you generally want to test near _________________ .

Mid-position of the range

Which scalene muscles does the long thoracic nerve travel between?

Middle and posterior

In differential diagnosing from resisted testing, what does "strong and painful" mean?

Minor lesion of the tested muscle or tendon

What will be affected in carpal tunnel syndrome?

Mostly the 3 thenar muscles (esp opponens) and half of the lumbricals

The brain stem contains the nuclei for the cranial nerves. Are the motor or sensory CN's more medial?

Motor nuclei are more medial Sensory nuclei are more lateral

What type of nerve fibers are in the brachial plexus?

Motor, sensory, and autonomic (sympathetic)

On the Kendall scale, what does a score of 2 mean?

Moves through complete ROM in a gravity minimal plane

What does the deep perineal space contain?

Muscle of the urethra and a deep transverse perineal muscle that supports the free edge of the perineal membrane. Nerves and arteries are also in this space

What is an antagonist?

Muscle that acts in opposition to the action of another muscle/agonist

What is fixation substitution?

Muscles that normally fixate a joint compensate for a weak agonist

What is the pelvic diaphragm/floor? What does it attach to?

Muscular funnel that surrounds the anal canal Stretches from pubic symphysis anteriorly to the coccyx posteriorly, and is attached to the obturator internus muscle on each side (laterally)

What roots have fibers in each of the terminal braches of the brachial plexus?

Musculocutaneous: C5-7 Axillary: C5-6 Radial: C5-T1 Median: C5-T1 Ulnar: C8-T1

Serratus Posterior Superior (N & A)

N: first 4 intercostal nerves A: elevates ribs

Serratus Posterior Inferior (N & A)

N: last 3 intercostal nerves A: depresses ribs

Which part of the retina does the temporal visual field strike?

Nasal retina, which then crosses at the optic chiasm

In differential diagnosing from resisted testing, what does "strong and painless" mean?

No lesion or neurological deficit involving the tested muscle or tendon

Does the ulnar nerve pass through the carpal tunnel?

No, it passes through the ulnar/guyon's canal

Does all blood make it through the foramen ovale in utero?

No, the rest will be pumped into the right ventricle

Are patent foramen ovale considered to be an atrial septal defect?

No, there is no septal tissue missing

What branches come off of the 6 divisions of the brachial plexus?

None

What intrinsic muscles of the hand does the radial nerve innervate?

None, it innervates the lateral skin of the dorsum of the hand and thumb

Does the sacroiliac joint permit much movement?

Not normally, but during pregnancy it does due to hormones produced to relax the ligaments to allow the birth canal to be more flexible

Does the transverse diameter of the pelvic inlet limit vaginal delivery?

Not usually because ischial spines are not usually large enough to cause a problem

Does the pelvic outlet limit vaginal delivery?

Not usually because the coccyx is moveable

What are the 2 common grading systems for MMT?

Numerical scores (5-0) Qualitative scores (normal-zero)

If a pt has AIDS and Kaposi's sarcoma, what nutritional and PT interventions might be used and why?

Nutrition: healthy eating, inc calories & protein to counter cachexia & dec immune system PT: inc strength, aerobic exercise, improve balance, pain management

What do oximeters measure?

O2 saturation in blood

Spinalis

O: SP I: SP N: posterior rami of spinal n A: bil extend cerv/thorax, unil lateral flx, rotation Only talking about lumbar and thoracic regions of this muscle for this section

Latissimus Dorsi

O: SP T5-T12, thoracolumbar fascia, iliac crest, ribs I: bicipital groove of humerus N: thoracodorsal nerve A: adducts, extends, & IR arm

Rhomboid Minor

O: SP of C7-T1 I: root of spine of scap N: dorsal scapular nerve, C5 A: adducts scapula

Rhomboid Major

O: SP of T2-T5 I: medial border of scapula N: dorsal scapular nerve, C5 A: adducts scapula

Rotatores

O: TVP I: SP 1-2 segments superiorly N: A: slight rotation of spine

Levator Scapulae

O: TVP of C1-C4 I: medial border of scap N: dorsal scapular nerve, C3, C4 A: elevate scapula

Semispinalis

O: TVP of C4-T12 I: SP of 4-6 segments superiorly N: A: Extend & rotate the neck

Trapezius

O: base of skull, lig nuchae, spines of C7-T12 I: spine of scap, acromian, lat 1/3 of calvicle N: CN 11, C3, C4 A: adduct, elevate, depress, rotate

What is the O, I, N, F of adductor pollicis?

O: capitate, 2 & 3 metacarpals I: medial side of proximal phalanx N: ulnar nerve F: adducts thumb It has a transverse head (MC) and an oblique head (capitate)

What is the O, I, N, F of lumbricals?

O: flexor digitorum profundus tendons I: lateral sides of extensor expansion (dorsal side) N: same as FDP F: flexes MCP joints, extends IP joints of 4 fingers

What is the O, I, N, F of opponens pollicis?

O: flexor retinaculum, scaphoid, & trapezium I: 1st metacarpal N: median nerve F: abduction & IR of 1st CMC joint deep to abductor pollicis brevis, lateral to flexor pollicis brevis

What is the O, I, N, F of abductor pollicis brevis?

O: flexor retinaculum, scaphoid, & trapezium I: base of 1st phalanx N: median nerve F: abducts CMC joint of thumb

What is the O, I, N, F of flexor pollicis brevis?

O: flexor retinaculum, scaphoid, & trapezium I: base of 1st phalanx N: median nerve: superficial head, ulnar nerve: deep head F: flexes CMC joint of thumb

What is the O, I, N, F of flexor digiti minimi brevis?

O: hook of hamate & flexor retinaculum I: base of proximal phalanx of 5th digit N: ulnar nerve F: flexes the 5th digit at MCP joint

What is the O, I, N, F of opponens digiti minimi?

O: hook of hamate & flexor retinaculum I: medial border of 5th metacarpal N: ulnar nerve F: flexes & laterally rotates 5th digit at MCP joint

Serratus Anterior

O: outer surface of ribs 1-8 I: medial border of scap N: long thoracic nerve A: abducts & protracts scap

What is the O, I, N, F of abductor digiti minimi?

O: pisiform I: base of proximal phalanx of 5th digit N: ulnar nerve F: abducts 5th digit

Longissimus

O: posterior lateral surface of sacrum/iliac crest, supraspinous lig, and TVP I: ribs, TVP of thoracic & cervical, and mastoid process N: posterior rami of spinal n A: bil extend cerv/thorax, unil lateral flx, rotation Has a distinct logissimus capitis portion that is important to know

Iliocostalis

O: posterior lateral surface of sacrum/iliac crest, supraspinous lig, and ribs I: ribs at angle, cervical TVP N: posterior rami of spinal n A: bil extend cerv/thorax, unil lateral flx, rotation

Multifidus

O: sacrum/ilium, TVP I: SP 2-4 segments superiorly N: A:

What is the O, I, N, F of the dorsal interossei?

O: shaft of metacarpals I: extensor expansion, base of proximal phalanx N: all ulnar nerve F: abduct digits (DAB)

What is the O, I, N, F of the palmar interossei?

O: shaft of metacarpals I: extensor expansion, base of proximal phalanx N: ulnar nerve F: adduct digits (PAD)

What is the anteroposterior distance between the inner* surface of the pubic symphysis and the sacral promontory?

Obstetrical conjugate

What is the lateral boundary of the true pelvis?

Obturator internus muscle***

Which CN's come from the midbrain? (3)

Oculomotor Trochlear part of Trigeminal

What do pelvic fractures from car accidents usually look like?

Often involve displacement of the pubic symphysis posteriorly, breaking the superior and/or inferior rami The pelvis rarely breaks in one place (like a pretzel) ***

Which CN's are extensions of the CNS? (2)

Olfactory Optic

Where is the location of the primary neurons of the olfactory nerve?

Olfactory epithelium

Why should anosmia be tested bilaterally?

Olfactory loss may be unilateral

What is the main difference between the actions of the opponens pollicis and the opponens digit minimi other than the direction that they rotate their respective phalanges?

Opponens pollicis: does true opposition Oppnens digiti minimi: does not do true opposition

Which bones make up the bony pelvis?

Os coxae (2) Sacrum Coccyx

Which peripheral ganglia do the parasympathetics of the glossopharygneal N synapse in?

Otic (V3)

What is the peripheral ganglion of the mandibular branch of the trigeminal?

Otic ganglion Submandibular ganglion

Is a female pelvic brim oval or heart shaped?

Oval shaped Male is heart shaped

How is the blood flow directed through the foramen ovale in utero?

Oxygenated blood from the placenta passes through the umbilical vein, into the inferior vena cava, and into the right atrium. From here, the Eustachian valve of the inf vena cava jets the blood at the foramen ovale to send it into the left atrium thus bypassing the lungs

What may clinical presentation for radial nerve damage look like?

PINS: -pain and tenderness in proximal forearm, finger extension weakness, *numbness should not be present* Palsy: -wrist drop -high lesions affecting the triceps, cannot push, weak supination -unable to make fist or grip objects unless wrist is stabilized in extension -sensory loss in posterior arm, forearm, and hand on radial side in the case of *radial tunnel syndrome*

When should you initiate transfer training after an amputation?

POD #1 if pt is medically stable

In MMT, if AROM is limited, what should you check next?

PROM If PROM > AROM, score should be less than 3, if it is the same as AROM use BT or ART to score

What creates dimples on the back side near the sacrum?

PSIS

Which branch of the median nerve is not affected with carpal tunnel syndrome?

Palmar branch of median nerve will not be affected because it branches prior to the carpal tunnel

What are the branches of the deep palmar arch of the radial artery?

Palmar metacarpal arteries

What does oculomotor pass through? Is it sensory, motor or both?

Passage: superior orbital fissure Motor

How is a Roos test performed?

Patient sitting with arms in a "touchdown" position, palms facing forward, have them slowly clench fingers in a fist and straighten for 3 mins. Any reports of pain, heaviness, numbness and tingling is positive for TOS

What does the lateral pectoral nerve innervate?

Pectoralis major

What does the medial pectoral nerve innervate?

Pectoralis major and minor

What area of the body is the inferioposterior portion of the abdomen?

Pelvis

What are the external genitalia and urethra built up on for support?

Perineal membrane

What is the cause of vaginismus?

Possible causes include religious upbringing, psychological factors, past sexual trauma, or history of discomfort with sexual intercourse

What does the radial nerve innervate?

Posterior arm (tricep) and forearm (11 muscles: all the extensors, supinator

What covers the sacral hiatus?

Posterior sacrococcygeal ligament

Where do ulnar nerve injuries most often happen?

Posterior to the medial epicondyle of the humerus. They also happen at the cubital fossa, wrist, and hand

Fampridine is a generic name for what class of drug? Which are used to treat what condition?

Potassium channel blocker used to treat MS

What are the midpalmar and thenar spaces?

Potential spaces bound by fibrous septa. You generally don't feel these spaces unless they become fluid filled (due to infection or injury)

What are common variations of the brachial plexus?

Prefixed/postfixed brachial plexuses, formation of trunks, divisions, cords may be different, the median nerve might be formed from 2 branches of the medial cord

Lyrica is the trade name for what drug?

Pregabalin

Lymphedema can be divided into one of two classifications. What are they?

Primary Secondary

What is an agonist?

Prime mover

What can problems with one set of structures lead to?

Problems with a second set of structures

What hormones are produced during pregnancy that are responsible for making the pelvic joints more mobile, especially the pubic symphysis?

Progesterone Relaxin

What does PNF stand for?

Proprioceptive Neuromuscular Facilitation

Which peripheral ganglia do the parasympathetics of the facial N synapse in?

Pterygopalatine (V2) Submandibular (V3)

What is the peripheral ganglion of the maxillary branch of the trigeminal?

Pterygopalatine ganglion

When standing, the ASIS is in the same vertical plane as what other bony landmark?

Pubic symphysis

Which muscle is most likely to be compromised during child birth? What might this result in?

Pubococcygeus Urinary stress incontinence & may contribute to uterine prolapse

Relaxation of what muscle is essential during defecation?

Puborectalis along with external anal sphincter muscles

What are the parts of the levator ani muscle called?

Puborectalis muscle Pubococcygeus muscle Iliococcygeus muscle

What named nerve innervates external genitalia in both males and females?

Pudendal nerve

What is the function of the puborectalis muscle?

Pulls anorectal junction anteirorly creating an anorectal angle which aids in maintaining fecal continence **

Pressure equalization tubes are generally placed in which quadrants of the tympanic membrane?

Quadrats II (or III)

What artery travels in the anatomical snuff box?

Radial artery

If you damage the radial groove, what structures are you also likely to damage?

Radial nerve and deep arm vessels

Which side of the FDP tendons do the lumbricals arise from?

Radial side

What is digital tenovaginitis stenosans?

Repetitive forceful use of fingers that causes thickening of the fibrous digital sheath. FDS and FDP tendons may enlarge. Passive extension of the affected finger results in a snap sound like beads moving through constricted openings

Where is the location of the primary neurons of the optic nerve?

Retinal ganglion cells

What does the brachiocephalic trunk branch into from medial to lateral?

Right common carotid artery, and right subclavian artery

What are the 5 regions of the brachial plexus?

Roots, trunks, divisions, cords, terminal branches (nerves)

What is the only bony articulation that the shoulder has with the axial skeleton?

SC joint

What does SNOUT stand for?

SN: sensitivity OUT: negative test rules out

Stage II CRPS is thought to be caused by an over reactive ______

SNS

Sympathetic pain is a type of nerve pain due to the abnormality of the function of the ________

SNS see peripheral changes in somatic tissues

What does SPIN stand for?

SP: specificity IN: positive test rules in

What is the anterosuperior most portion of the sacrum, just below the junction of the sacrum with L5 vertebra, called?

Sacral promontory

What is the posterior boundary of the pelvic wall?

Sacrum, coccyx, and part of ilium/sacroiliac joint

Which 2 muscles pull on opposite sides of the cartilage of auditory tube to open the aud. tube during swallowing?

Salpingopharyngeus & tensor palatini

What is the superficial fascia called in females? (2 names)

Scarpa's fascia Colles' fascia

What is the superficial fascia called in males? (3 names)

Scarpa's fascia Darto's fascia (penis & scrotum) Colles' fascia (behind scrotum)

Is AIDS a primary or secondary immunodeficiency? Why?

Secondary because it was acquired. Primary would mean it was hereditary

What does cutaneous mean?

Sensation

What are the symptoms of carpal tunnel?

Sensation changes in median nerve area and thenar muscle weakness/atrophy which can result in being incapable of opposing thumb. Sensation change can radiate into forearm

What are the results of Backpacker's Palsy? (Which nerves are affected?)

Sensory deficits in the musculocutaneous and radial nerves. It may also cause muscle spasms

What is the function of the trigeminal N?

Sensory: face, scalp, nose, paranasal sinuses, eye, mouth & teeth Motor: 4 mastication mm, mylohyoid, ant belly of digastric, tensor tympani m, and tensor palati m

What is tic doloureux?

Severe, sudden pain in areas covered by the trigeminal N It can occur in only 1 branch or a combination of branches

The sympathetic postganglionic neurons that innervate the dilator pupuillae muscles run through which nerves?

Short and long ciliary nerves

What does the medial cutaneous nerve of the arm innervate?

Skin on medial side of arm and superior part of forearm

What does the medial cutaneous nerve of the forearm innervate?

Skin on medial side of forearm

What is the palmar brevis?

Small, superficial muscle above the hypothenar eminence. Aids in gripping, but isn't important. Animals use this when they run on the ground.

Why do some prefer ART over Kendall or D & W?

Some think it is more objective

What are potential causes of back pain?

Spinal cord, spinal nerves, vertebral bodies, intervertebral joints, intervertebral ligaments, muscles and their interactions with each other, etc

What is the difference between a back sprain and back strain?

Sprain: involves ligament damage (less common). Strain: involves muscle damage.

When do the bones of the os coxae start to fuse? When do they finish fusing?

Start: around puberty (12 girls, 14 boys) Finish: age 20-25

Name the 4 articulations that occur in the shoulder

Sternoclavicular Acromioclavicular Glenohumeral Scapulothoracic

What is Cholesteatoma?

Stratified squamous epithelial misplaced within the tympanic cavity (accumulation of dead skin that becomes trapped in the middle ear)

On the Kendall scale, what does a score of 5 mean?

Strong pressure

What nerves does the superior trunk give off?

Subclavius and suprascapular nerve

What does the subclavius nerve innervate?

Subclavius muscle

What does the upper subscapular nerve innervate?

Subscapularis

What are common injuries to the inferior part of the brachial plexus? (C8-T1)

Sudden pull of the arm superiorly such as grasping a tree to stop a fall or during child birth resulting in Klumpske's palsy

What anatomical space fills with fluid in a straddle injury?

Superficial perineal space

What 2 spaces are created by the presence of the perineal membrane?

Superficial perineal space Deep perineal space

Which muscle of the eye runs through a pulley?

Superior oblique

Which muscle is the main intorter of the eye? Damage to which CN results in its inability to work?

Superior oblique trochlear N lesion

Which brain stem nucleus does the facial preganglionic neuron start in?

Superior salivatory

What is superior, attached to, and inferior to the ischial spines?

Superior: greater sciatic notch Attached: sacrospinous ligament Inferior: inferior sciatic notch

What does the suprascapular nerve innervate?

Supraspinatus, infraspinatus, and glenoid joint

Name the amputation: ankle disarticulation w/ preservation of heel pad

Syme's

How do you diagnose and treat carpal tunnel?

Symptoms can be reproduced by pressing the wrists for about 30 seconds. Treatment includes surgical release of the carpal tunnel

What is in between the fibrous digital sheath and the flexor tendons of the digits?

Synovial sheath

Contrast MRI imaging increases the signal to a (T1 or T2) weighted image

T1

Do T1 or T2 MRI images have good gray/white matter discrimination?

T1

Which type of MRI image has short repetition and echo times?

T1 image

Are T1 or T2 MRI images useful for imaging CSF and edema?

T2

Which type of MRI image has long repetition and echo times?

T2 image

What happens during the primary stage of TB?

TB Infection -person is exposed/infected -doesn't have the active disease -is asymptomatic -can't transmit the disease

What happens during the secondary stage of TB?

TB disease -person has active infection -occurs when cell-mediated immunity is impaired -can be spread to others -highly infectious when there's personal close contact for a period of time

What is the "white line" of the pelvic floor also known as?

Tendinous arch of the levator ani muscle Epimysium of obturator internus

What does the lower subscapular nerve innervate?

Teres major, and inferior part of subscapularis

What harm comes from Cholesteatoma?

The accumulation of dead stratified squamous cells that become trapped in the middle ear can destroy the middle ear structures by compression, due to inadequate blood flow

Do the suprascapular artery and nerve go above or below the superior transverse scapular ligament?

The artery goes above and the nerve goes below it

Why is there a decrease in pressure in the right atrium after birth?

The blood flow from the umbilical veins is lost

What population commonly fractures the surgical neck of the humerus and how do they do it?

The elderly, caused by fall on to hand

What are MMT grades an expression of?

The examiner's evaluation of the strength/weakness of a muscle

Define pressure/resistance in relation to MMT

The external force applied by PT to determine the strength of the muscle

What is fixation/stabilization?

The firmness/stability of the body or body part Necessary to ensure an accurate test of a muscle, important for MMT Can be applied by table, pt's body or PT

What is a patent foramen ovale?

The foramen ovale is a hole between the right and left atria in a fetal heart. It should close after birth. Patent means failure to close, so a patent foramen ovale is when this hole does not close like it should after birth.

What is a possible explanation for the damage to the retina associated with methanol poisoning?

The formic acid produced from oxidizing methyl alcohol causes specific injury to the retina & optic N by inhibiting mitochondrial energy function

Can a patient move their arm if they fracture the surgical neck of the humerus?

The fracture is stable due to surrounding ligaments, so the patient can still move the injured arm passively with little pain

Where does the superficial membranous fascia (Colle's fascia) attach to?

The free edge of the perineal membrane just anterior to the anus

What is a potential complication of a postfixed brachial plexus?

The inferior trunk may be compressed by the 1st rib producing neurovascular symptoms

What is a possible explanation for how people develop tolerance to alcohol?

The liver adapts to the presence of alcohol in the body's system by increasing the amount of enzymes ADH and ALDH. This way it can clear the same amount of alcohol in less time.

What does the anterior wall of the ear contain?

The opening for the Eustachian tube and a bulge for the internal carotid a.

What are the branches of the deep palmar arch of the ulnar artery?

The palmar metacarpal arteries which anastomose with the common palmar digital arteries of the superficial palmar arch

Where does cholesteatoma usually start?

The pars flaccida, where a fibrous layer is lacking

What is a test position?

The position in which a muscle or muscle group is to be tested Usually start in a position that allows pt to move against gravity and move to anti-gravity if needed

What forms the posterior cord?

The posterior division of all 3 trunks

Why is there a significant increase in pressure in the left atrium just after birth?

The rise in blood flow to the lungs will also cause an increase in blood flow from the lungs which goes into the left atrium

What will never vary about the brachial plexus?

The terminal branches

What are the intermediate layer of the deep back muscles contained within?

The thoracolumbar fascia

What is called the "nerve of fine movements"?

The ulnar nerve because it innervates muscles involved in intricate hand movements

What happens just after birth to the ductus arteriosus?

The vascular resistance of the lungs decreases. Increased oxygen levels cause muscle contractions in the walls of the ductus arteriosus to contract which largely increases blood flow to the lungs.

Do ventral or dorsal rami make up the brachial plexus?

The ventral (anterior) rami of C5-T1 spinal nerves

Why are synovial sheaths important for the extrinsic muscles of the hand

Their muscle bellies are in the forearm and only tendons enter the hand, the sheaths help protect these tendons

Congenital Spinal Cord Defects: what is the range of severity and cause of these defects?

There are a range of defects from mild to debilitating including paralysis and death. The most common congenital spinal cord defect is due to failure of the neural tube to close completely. These defects are thought to be due to folic acid insufficiency

What is a prefixed and postfixed brachial plexus?

These are both variations of what spinal nerves contribute to the brachial plexus. Prefixed: C4-C8 Postfixed: C6-T2

How do most postganglionic sympathetic neurons, that innervate head & neck structures, travel? What are the 2 exceptions**?

They "hitch hike" along blood vessels, especially carotid AA Exceptions: deep petrosal NN and long ciliary NN ***

What are the function of the shunts in utero?

They allow blood flow to bypass the fetal lungs which are non-functional

What are the proper palmar digital arteries and where do they run?

They are branches off of the common palmar digital arteries of the superficial palmar branch of the ulnar artery. They run along the sides of digits 2-4

Why might someone who ingested a small amount of methyl alcohol be treated by giving them ethyl alcohol?

They are competitive substrates for the same enzyme. ADH will oxidize ethyl alcohol first which would reduce the rate of metabolism of methanol significantly

How do the tensor tympani and stapedius act as shock absorbers?

They contract to limit the transfer of energy for the air to the inner ear during loud sounds, which tightens the ossicular chain and thus protects the inner ear from excessive mechanical energy

Why are neural crest cells important?

They contribute to the cells that form the endocardial cushion and a wide variety of head and neck structures

What do kegel exercises involve and why are they used?

They involve isometric contractions of the pubococcygeus muscle and pelvic diaphragm in general Helps prevent urinary stress incontinence during/after pregnancy, also helps prevent injuries during child birth

What is a paradoxical embolism?

This occurs when an embolus arises in the systemic venous system or the right atrium and crosses the PFO during right-to-left shunting and enters the systemic arterial circulation

What is the purpose of the ear drum and middle ear ossicles?

To capture a high % of the energy of the vibrating air and transfer it to create vibrating fluid in the inner ear

What are Parcopa and Sinemet?

Trade names for Carbidopa and Levodopa

What is another name for the deep layer of the back muscles?

Transversospinalis group: multifidus, rotatores, semispinalis

List the superficial back muscles (8)

Trapezius, levator scapulae, rhomboid major and minor, latissimus dorsi, serratus posterior superior and inferior, and serratus anterior

What makes up the triangle of auscultation?

Trapezuis, latissimus dorsi, and medial border of the scap

What may produce an "ape hand"?

Trauma to the median nerve which would limit thumb movement in flexion and abduction (ape monkey bars)

All of the peripheral ganglia are associated with branches of which cranial nerve?

Trigeminal

Which is the largest CN?

Trigeminal

Which CN is in Meckel's/dural cave?

Trigeminal N

Where are the sensory primary neurons of the trigeminal nerve located?

Trigeminal ganglion

Where are the motor primary neurons of the trigeminal nerve located?

Trigeminal motor nucleus

What does TKA stand for and what is it in terms of prosthetics? (Hint: not total knee arthroplasty)

Trochanter Knee Ankle refers to stationary alignment line to identify the relative alignment b/w the center of the socket weight line (trochanter), the rotation point of the knee & the functional rotation point of the foot/ankle

Most cranial nerves exit from the ventral surface of the brain, which cranial nerve exits from the dorsal surface of the brain?

Trochlear N

Where is the location of the primary neurons of the trochlear N?

Trochlear nucleus

How many shunts are there in the heart prior to birth?

Two: foramen ovale and ductus arteriosus

Are UE or LE diagonal PNF patterns used more often?

UE

Is acceptance of a prosthesis often an issue with UE or LE amputees?

UE amputees, especially in pediatric patients

If you damage the medial epicondyle of the humerus, what nerve are you also likely to damage?

Ulnar nerve

Damage to what nerve would result in a loss of Z movement?

Ulnar nerve, it would cause a claw hand

Where is the brachial plexus in relation to the clavicle?

Underneath it

What are early signs of vestibular schwannoma?

Unilateral hearing loss (98% of cases); tinnitus (ringing in the ears); loss of balance; dizziness

What branches off of the posterior cord?

Upper subscapular, thoracodorsal, and lower subscapular nerves

What are the 2 triangles of the diamond shaped perineum called?

Urogenital triangle Anal triangle

Where do the 3 divisions of the trigeminal N pass through the skull?

V1: ophthalmic: superior orbital fissure V2: maxillary: foramen rotundum V3: mandibular: foramen ovale

Compare/contrast vascular system with lymph system based on the following: -closed/open system? -direction of fluid in system -volume

Vascular: -"closed system" -circulating system -fairly set volume Lymph: -open ended -one way flow -capacity can increase by 10X

What is the function of the inner ear?

Vestibulocochlear organs interpret different vibrations as nerve impulses and send them to the brain

What is substitution in terms of MMT?

When a muscle attempts to compensate for the lack of function of another muscle

What is Bruised Ear or "cauliflower ear"?

When the ear is struck hard enough to cause a hematoma between the cartilage and perichondrium. The cartilage dies and reduces in size under the hematoma, resulting in deformed cartilage

Meningomyelocele

When the meninges and spinal cord have "wandered out". This is almost always associated with neural defects, anywhere caudal to this area is usually non-functional.

Meningocele

When the meninges have "wandered out" of the spinal column and into the subarachnoid space due to the posterior arch failing to form

Rachischisis

When the neural tube does not close off and there is just neural tissue instead. This is why folic acid is recommended for pregnant women.

What is Kaposi-stemmer sign? What does it test for and when is it considered positive?

When you pinch the skin on the dorsum of the second toe tests for lymphedema positive when you're unable to pinch skin

What does the pectinate line mark the location of?

Where the columnar mucous membrane transitions to stratified squamous epithelium

When does the ductus arteriosus anatomically close?

Within 3 weeks

In what time period does the ductus arteriosus normally functionally close? Why is this a potential issue?

Within 36 hours. Normally women and newborns leave the hospital within 24 hours, so it is important to go to well baby exams

How can you diagnose the cause of hip misalignment?

X-ray

Do you still need to inspect the skin if a pt is wearing a limb shrinker?

YES

Should MMT be pain free for the pt?

Yes

Is MMT grading subjective?

Yes to an extent (use of gravity/active resistance provides an aid in objectively measuring the strength)

If you do not have a palmaris longus muscle, will you still have a palmar aponeurosis?

Yes, it is important for creating the toughness of your palm

If the ductus arteriosus is needed to remain open until surgery can be performed on a newborn, what can be done?

You can give the newborn prostaglandin

What is neurapraxia? How severe is this injury? What typically causes it?

a *low severity* injury that typically leads to *complete recovery*. Structure of the nerve remains *intact* but electrical conduction down the axon is interrupted, typically by *ischemia or compression*, additionally secondary injuries can be caused by vascular damage leading to intrafascicular edema

55% of people with PVD that undergo an amputation will eventually undergo what procedure?

a bilateral amputation

What is epilepsy?

a chronic disease that includes seizures in which cerebral neurons fire rapidly and out of synchrony, may be localized or spread throughout the brain

What is pseudoparkinsonism?

a condition brought on commonly by an antipsychotic drug, characterized by resting tremor, bradykinesia and rigidity (due to the blockage of dopamine receptors)

What is lipedema?

a disorder in which an unusual amount of fatty tissue is deposited, usually below the waist, causing progressive enlargement of the legs

What is apomorphine?

a dopamine agonist, can be used for severe cases of dyskinesia

What is GM-1 ganglioside?

a drug used to treat Parkinson's by having the aim of maintaining membrane integrity

Most amputations (85%) in people with diabetes are preceded by:

a foot ulcer

What are functional (K) levels?

a grade from 0-4 that determines if an amputee would be *able to use a prosthesis* and if so, which type(s)

What is a nociceptor?

a nerve fiber that responds to noxious stimuli

What is insulin?

a small protein (polypeptide) / hormone made in the pancrease by beta cells (islets of langerhans)

What is the main side effect of barbiturates?

a strong feeling of sedation, may also cause uncoordinated movement

Define radioopaque:

a substance with high attenuation (it is good at slowing down x-ray beams, less pass through it)

Define radiolucent:

a substance with low attenuation

What device may be helpful to transfer a non-ambulatory patient after an amputation?

a transfer prosthesis (looks like a normal prosthesis, but is only used for transfers and not ambulation)

Many elderly pts face physical, psychological and psychosocial issues that are difficult to cope with and can affect their:

ability and motivation to learn

Ethosuximide is specifically used to treat what type of seizure?

absence

What are the categories of neurotransmitters?

acetylcholine monoamines nitric oxide peptides amino acids

Ultrasonography is a successful imaging technique because different tissues have different _______________ qualities

acoustic

How does the control of the serratus anterior change with increasing shoulder elevation?

activity increases throughout

What does hydrostatic capillary pressure do?

acts as a suction that favors transport out of capillaries and into the interstitial space

Pain that has a recent onset of less than 3 months, close link with the pain generator, not a learned response, objective findings that coincide with pain generator, high anxiety levels and pain that is protective and necessary are all characteristics of what type of pain?

acute

Stage 1 of CRPS is ______ and lasts several weeks to several months

acute

What is an advantage of mitoxantrone in treating MS? What is a disadvantage?

advantage: more effective in treating lesions on nerves disadvantage: has more serious side effects like heart damage (can only be taken for 3 years)

When can an amputee begin to wear a rigid removable post-op dressing?

after suture/staple removal the cast is fit from an impression of the residual limb and is worn over the wound dressing or compression socks

Amputation rates increase with ________

age

What is the least radiodense substance in the body?

air

Rank the following from least dense to most dense: bone, fat, air, contrast media, water, heavy metals

air (black on film) fat water bone contrast media heavy metals (white on film)

What is a closed pneumothorax?

air can enter the pleural cavity from internal airways, no opening in chest wall

COPD involves obstruction of the _________________.

airways

What does it mean to say, "diagnostics are a tool, not the answer"?

all diagnostic findings, including imaging, must be applied in the context of clinical presentation

How do you determine how much resistance to apply when performing PNF pattern?

allow smooth movement and no pain

What structure of the respiratory system is defined as: clusters of alveoli open to communicate with each other?

alveolar sacs

What is the end point for inspired air in the respiratory system?

alveoli

Pulmonary edema involves fluid collection in what respiratory structures?

alveoli & interstitial area

Which race has a higher rate of diagnosed diabetes?

american indians/alaskan natives

There are many signal cascades that happen during the release of neurotransmitters, but what are two drugs that acts on this step? (picture)

amphetamines and botulinum toxin

Is the lifetime cost of an amputation or salvage of a limb higher?

amputation is up to 3x higher

Define density: (photographic quality)

amt of blackening on x-ray

What does activation of A-delta or C fibers result in?

an action potential that travels down the nerve to the dorsal root ganglion and then to the spinal cord

What structure of the respiratory system is the site of gas exchange with capillaries?

an alveolar wall comes in close proximity with a capillary wall

What is indicated by excessive sclerosis on an x-ray?

an arthritic or rheumatic condition

What causes pneumonia?

an infection leads to inflammation of alveolar sacs which leads to: -fluid accumulation, may be pus -dec oxygen exchange -difficulty breathing

Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with hip abduction (open chain)?

anterior

Starting with the hip in neutral, which way does the femoral head glide with external rotation (open chain)?

anterior

Starting with the hip in neutral, which way does the femoral head glide with hip extension (open chain)?

anterior

If someone is lacking hip extension, what would be a good joint glide to facilitate this motion?

anterior glide

With the SC joint, clavicular protraction involves a(n) ________ roll and a(n) _________ glide

anterior roll anterior glide

A barrel chest is an increase in diameter of the thorax in the ant/post or med/lat direction?

anterior-posterior

For many types of anxiety disorders __________ are the drugs of choice

antidepressants

Bipolar disorder may be treated in combination with Li+ and what other types of drugs?

antidepressants, antipsychotics (manic phase) and antiseizure (stabilize mood and manic symptoms)

What does reserpine do? (picture)

antihypertensive that impairs the ability of anrenergic (presynaptic) terminals to store norepinephrine

Selegiline and rasaliline are both types of?

antioxidant drugs

Examples of special x-rays: (read)

anything that is not A/P or lateral: -oblique -open mouth -sunrise/tangential -flexion/extension -upright, WB

When does gestational diabetes develop?

around week 24 of pregnancy

The cardiovascular system is made up of the ______ and ______ systems

arterial and lymphatic

Having excessive anteversion of the femur puts you at a higher risk for what pathologies?

arthritis patellofemoral and subtalar dysfunction

How is mitoxantrone administered?

as an injection, but must be done by a physician about once every 3 months

When should you initiate wrapping or shrinking after an amputation?

as soon as surgeon allows

When should you initiate ROM after an amputation?

as soon as the surgeon allows (usually immediately post-op)

What are the AMPRO and AMPnoPRO tests?

assesses *ambulatory potential* with (AMPRO) and without (AMPnoPRO) a prosthesis -good correlation w/ 6 minute walk test -distinguishes b/w functional (K) levels

What is the CHAMP test? What population is it commonly used for?

assesses progress towards *high level mobility* commonly used for military service members

When is effleurage done throughout a massage?

at the beginning and end

In what condition do alveoli become airless?

atelectasis

What is an open pneumothorax?

atmospheric air enters the pleural cavity through an opening in the chest wall Ex: trauma, surgery

The radio source and magnet used to create an MRI image cause what structures to align?

atomic nuclei align/resonate to this electromagnetic field

aripiprazole, clozapine, olanzapine and ziprasidone are all generic names for what class of drug?

atypical antipsychotics

PNF techniques use which 3 types of stimuli?

auditory visual tactile

How is type 1 diabetes an autoimmune disease?

autoantibodies form against islet cells, insulin, GAD (glutamic acid decarboxylase), IA-2 and 2B (tyrosine phosphatases)

How do symptoms of CRPS manifest in different systems (autonomic, psychological, inflammatory, motor and sensory)?

autonomic (skin color change, sweating, swelling) psychological (fear, anxiety, anger) inflammatory (nail growth, hair growth) motor (weakness, tremor) sensory (allodynia, hyperalgesia)

Why can't you diagnose a soft tissue injury with an x-ray (without contrast media)?

b/c soft tissue looks a lot like water (have similar radiodensities)

Primidone is a derrivative of what drug? What is it converted to in the body?

barbituates converted to phenobarbital

amobarbital, pentobarbital and phenobarbital are generic names for what class of drug?

barbiturates

Pentobarbital and phenobarbital are types of what drug?

barbiturates (used to treat epilepsy)

Why don't we move the knee center on every prosthetic user back 2 inches so that their knees never buckle?

bc they would have a very difficult time initiating swing or knee flexion in late stance

Why can't Parkinson's disease just be treated by a dopamine supplement?

because dopamine will not cross the blood-brain barrier to get to the basal ganglia where it is needed

Why does lung hyperplasia occur in emphysema?

because it is harder to expire, may need to treat this with lung reduction surgery

Why are macrophages needed in alveoli?

because the air you breathe in has foreign particles in it

Why don't blinded studies work well to test personalized medicine?

because the drug has been personalized for each patient so people are on different doses or different alterations of the drug

Adapting appropriate teaching strategies will allow older pts to:

become successful learners and more satisfied partners in care

Where is the film plate located relative to the patient in an AP image?

behind the patient

Where should you guard a patient when going up stairs?

behind them, hang onto the gait belt

What are down sides to benzodiazepines and nonbenzodiazepines?

benzo: addictive and strong sedative effect throughout the day non: small therapeutic index and can be addictive

Clonazepam, diazepam and Iorazepam are all generic name for what class of drug?

benzodiazepines

_______ have replaced barbiturates for anti-anxiety drugs but can cause tolerance and physical dependence

benzodiazepines

estazolam, flurazepam, quazepam, and temazepam are all generic names for what class of drug?

benzodiazepines

Over which ribs does the scapula cover in resting position?

between ribs 2-7

What is CO2 converted to when it diffuses into RBC's?

bicarbonate

How are LE veins able to return blood to the heart against gravity?

bicuspid valves (normally) prevent retroflow of blood

What do barbiturates do?

bind to the GABA receptor opening the chloride channel (reducing the membrane potential and making it less likely that an AP will occur)

What color is air on an x-ray?

black

Most new cases of ___________ are caused by diabetes

blindness among 20-74 year old adults

What do beta blockers do in the nervous system? (picture)

block the binding of norepinephrine to the beta adrenergic receptors of the heart and thus they slow down the heart beat and the force of contraction

What does Istradefylline (Nouriast) do?

blocks the receptor for adenosine in the brain thus reducing the bradykinesia movements seen with Sinemet treatment

PO2 and PCO2 are the partial pressures of oxygen and carbon dioxide in ___________ .

blood

What is an embolus?

blood clot or mass that obstructs an artery or it's branch

A functional MRI is a technique based on the increased ________________ that accompanies neural activity in the brain

blood flow

In a contrast MRI, tissue enhancement is proportional to:

blood flow to the tissue

In addition to measuring bone density, DEXA can also determine:

body composition

What is the modality of choice for detection & follow-up of metastatic bone disease?

bone scan (radionuclide scintigraphy)

What is the modality of choice for detection of stress fractures?

bone scan (radionuclide scintigraphy)

Does atelectasis alter ventilation or perfusion?

both

Are pediatric amputations more common in boys or girls?

boys (3:2 ratio)

What nerve(s) is/are affected by thoracic outlet syndrome?

brachial plexus

What are symptoms of thoracic outlet syndrome?

brachial plexus pain, paresthesia, nubness, weakness. Nerve tension when the plexus is stretched

The clinical features of Parkinson's disease includes:

bradykinesia tremors and rigidity

What are the goals of cross-fiber techniques on soft tissue?

break up/prevent fibrotic tissue (mechanical effect)

In a T1 MRI image, long bones appear: ***

bright/white

In a T2 MRI image, water appears: ***

bright/white

Asthma involves obstruction of _______________ .

bronchi

The ___________ have a similar structure to the trachea

bronchi

Chronic bronchitis is a disease of what respiratory structure?

bronchi (thickening of bronchial walls leads to obstruction)

What structure of the respiratory system is composed of smooth muscle cells but does not have cartilage?

bronchioles

How is an image produced in nuclear medicine?

by detecting the location & concentration of radioactive elements in tissues

How do you maximize the detail of an x-ray?

by positioning the object as close to the film plate as possible

What does ethosuximide act on to treat seizures?

calcium channels and the Na+/K+ ATPase

Does asthma involve a partial or total obstruction of airways?

can be either

Is amputation bc of cancer due to primary cancer (osteosarcoma) or metastatic disease?

can be either

Does acute respiratory failure result from acute or chronic disorders? What are some examples?

can be either Ex: emphysema, neuromuscular diseases

Does pneumonia develop as a *primary* condition or in response to another condition (*secondary*)?

can develop as primary or secondary

With wrist glides for flexion and extension, the midcarpal joint involves what two bones against each other?

capitate moves on lunate

With wrist glides for radial and unlar deviation, the midcarpal joint involves what bones moving against each other?

capitate moves on lunate

Ceruminous (wax) and sebaceous glands are restricted to that portion of the skin of the auditory canal that overlies _______

cartilage (not bone)

The tensor tympani muscle originated from:

cartilage of auditory tube

ARDS (adult or acute respiratory distress syndrome): -what causes it? -what effects does it have?

caused by injury to the alveolar wall & capillary membrane results in the release of chemical mediators that causes: -inc permeability of alveolar capillaries -inc fluid & protein in alveoli and interstitium -damage to surfactant-producing cells

Why do smokers develop emphysema?

causes a deficiency of alph1-antitrypsin -needed to prevent elastase from breaking down elastin which would lead to dec recoil of alveoli = emphysema

Is drug testing completed on isolated cell cultures or animals first?

cell cultures, then they apply for approval for animal testing

Gestational diabetes brings an inc. risk of:

cesarean and chronic HTN

What is happening pathophysiologically during asthma?

changes of bronchi & bronchioles -inflammation of the mucus membranes with edema -bronchoconstriction -inc secretion of thick mucus obstructing airways

donepezil, rivastigmine and galantamine are all generic names for what class of drug?

cholinesterase inhibitors

Pain that has a longer onset of 3+ months, loose link with pain generator, is a learned behavior, has no clinical findings, not broken by force and pain that serves no biological purpose are all characteristics of what type of pain?

chronic

Is diabetes acute or chronic?

chronic (life long condition)

Emphysema, chronic bronchitis and bronchiectasis are all what type of pulmonary disease?

chronic obstructive pulmonary disease (COPD)

Complex regional pain syndrome, fibromyalgia, neuropathic pain, headaches, TMJ, and chronic LBP are all examples of what type of condition?

chronic pain syndromes

What respiratory condition is exercise tolerance testing done for?

chronic pulmonary disease

Geometric qualities of an x-ray refer to the _____________ of the image

clarity

What happens to the clavicle during abduction of the shoulder between 0 and 60 degrees?

clavicle elevates ~30 degrees at the SC joint (rolls superiorly, glides inferiorly)

What are two accessory motions that happen with shoulder abduction? (read)

clavicle rotates and retracts 30 degrees, thoracic spine extends slightly

Structures that are (further/closer) to the film plate are more sharply defined and less distorted

closer

What sensory changes take place with aging?

communication, vision, inner ear and balance difficulties

Reflex sympathetic dystrophy is another name for what condition?

complex regional pain syndrome (CRPS)

What are some MOIs for damage to the common peroneal nerve?

compression from crossing legs, fracture at head/neck of the fibula

What may cause damage to the sciatic nerve?

compression from tight piriformis, hip dislocation or fracture of femur

What is the MOI for a lower brachial plexus injury (C8-T1)?

compression of cervical rib or stretching the arm overhead

Deviations in hip alignment can be __________ in nature or due to ____________

congenital; fracture

What is surfactant made of?

consists of lipoproteins

Once you begin massage, try not to break ______________

contact w/ pt's skin, so they always know where you are

What are 2 "companion" stretching techniques?

contract-relax hold-relax

A ___________ MRI involves intravenous or intra-joint injection

contrast MRI

Using barium-sulfate in a video swallow is an example of a:

contrast media

What is the role of antioxdants in the treatment of parkinson's?

control the synthesis or elimination of free radicals which, in parkinson's, can have elevated production of free radicals, or decrease in natural defense against them

What is the best way to determine the effects of a new drug?

controlled clinical trials

What is the only legal way for the FDA to conclude that a new drug has shown "substantial evidence of effectiveness"?

controlled clinical trials

With stage III CRPS, _____ skin is associated with a poor prognosis

cool

Prednisone and methylprednisolone are generic names for what type of drug?

corticosteroids

How does a coxa valgum hip create a less stable joint?

creates a more superiorly tilted head of the femur, which results in less acetabular coverage superiorly on the head of the femur

What is the most common MOI for all nerve injuries?

crush injury (wound of UE and LE fracture are also fairly common, but not the most common)

Where can ulnar nerve entrapment occur?

cubital tunnel, Guyon's canal

You should provide an amputee a wheelchair with a ____________ if they are at high risk for skin compromise or socket intolerance

cushion consider specialized cushions for LT use

What are the 3 sources of pain in inflammation?

damaged cells secondary plasma leakage and lymphocyte migration nociceptors

In a T2 MRI image, bones appear: ***

dark/black

What color is exposed film on an x-ray?

dark/black

The pharmacological goal in the treatment of epilepsy is to _________ neuronal activity, resulting in severe side effects

decrease

What happens to a person's total lung capacity that has a restrictive lung disorder?

decreases

How does excessive anteversion affect the muscle lever arm?

decreases -- increased joint forces

How does excessive anteversion affect joint stability? Why?

decreases due to more of the joint being exposed anteriorly (femoral head)

How does excessive anteversion affect external rotation? (not compensating)

decreases hip external rotation

How does fluid in alveoli affect gas exchange?

decreases it

Which type of massage technique is considered inhibitory to voluntary muscles?

deep tendon pressure of stretch (helps w/ charlie horse or cramps)

Are kids miniature adults?

def not

What should you always do before getting the patient up to do stair training?

demonstrate first

What are the 2 photographic qualities of an x-ray?

density contrast

What does the time frame until a prosthesis can be tolerated by an amputee depend on?

depends largely on skin tolerance & healing healing depends on circulation

What does metyrosine do? (picture)

depletes the presynaptic terminal of transmitter and blocks transmission of catecholamine neurotransmitters

Which geometric quality of an x-ray is also known as sharpness or resolution?

detail

What are the 2 geometric qualities of an x-ray?

detail distortion

T1 MRI images reveal:

details of anatomy in high resolution

What role do chemoreceptors play in the control of ventilation?

detect changes in levels of -CO2 -O2 -H+ in the blood or CSF

What does transduction mean in reference to first order neurons?

detection of noxious or damaging stimuli

How do you determine the correct size of limb shrinker for an amputee?

determine size by circumferential measurements and length

Prediabetes inc. the risk for:

developing DM2

Peripheral Vascular Disease is often associated with which conditions?

diabetes and smoking

What is the leading cause of ESRD (end stage renal disease)?

diabetic nephropathy

Define contrast: (photographic quality)

differences b/w adjacent tissue densities how easily can you tell one type of tissue from another?

As a PT, we need to learn to differentiate ______ pain from _______ pain, both of which are part of the peripheral nervous system

differentiate between *somatic* pain and *visceral* pain

If the PCO2 is 45 and the PO2 is 40, which way will gas exchange occur? PCO2 norm is 35-45 PO2 norm is 90-100

diffusion of CO2 into alveoli

If the PCO2 is 40 and the PO2 is 105, which way will gas exchange occur? PCO2 norm is 35-45 PO2 norm is 90-100

diffusion of O2 into blood

Name the amputation: disarticulation at MCP joint

digit disarticulation

Parkinson's disease is a disorder of the _________, which is made up of the _____ nuclei of the cerebrum

disorder of the basal ganglia made up of the deep nuclei of the cerebrum

Where on the hand can you test for sensation loss resulting from damage to the medial nerve?

distal tip of 2nd finger

Where on the hand can you test for sensation loss resulting from damage to the ulnar nerve?

distal tip of 5th finger

Describe the pressure gradient of a limb shrinker:

distal to proximal

In what direction should your pressure gradient be when applying an ACE wrap?

distal to proximal

What does the density of an x-ray depend on? (3)

distance time current

-schisis

division

What are side effects of hydantoins?

dizziness, drowsiness, uncoordinated movement, blurred vision, anemia, water retention, cardiac arrhythmias, and CHF

A loss of _______ has been associated with Parkinson's disease

dopamine

Parkinson's involves a deficit of what neurotransmitter?

dopamine

What neurotransmitters fall under the category of monoamines?

dopamine histamine epinephrine norepinephrine serotonin

What neurotransmitters are included in the term catecholamines? Why?

dopamine, norepinephrine and epinephrine because they share a common biosynthetic pathway that starts with the amino acid tyrosine

To assist with MCP extension of joints 2-5, you would perform what kind of glide?

dorsal

To facilitate wrist flexion, would you perform a dorsal or volar glide

dorsal

Since the wrists aren't in the anatomical position when performing glides, what direction are the glides referred to as?

dorsal (towards back of hand) volar (towards palm of hand)

Where on the hand can you test for sensation loss resulting from damage to the radial nerve?

dorsal web spaces

What are signs of toxicity for vigabatrin?

drowsiness, dizziness, weight gain and possibly confusion

The search for a drug to decrease cholesterol levels without significant side effects is a good example of _______________ .

drug design -summary: studied how the body makes/uses cholesterol, identified different steps of making it, isolated an acid & enzyme, used computers to find a drug to inhibit the enzyme, found a fungus that inhibited it, identified which chemical in the fungus did this, further analyzed this chemical & improved its effects, then animal testing was done

In summary for neurological pharmacology (read):

drugs of the CNS work primarily by *blocking the signaling cascade* at the synaptic terminal where two neurons are communicating with each other. The drugs will typically work by *decreasing neuronal activity* as indicated by the fact that the side effects frequently include *confusion and sedation*

What is a Pincer impingement of the hip? What does it limit?

due to the irregular shape of the acetabulum, it is more posterior and deeper, hip abduction pinches the superior labrum

What is a CAM impingement of the hip? What does it limit?

due to the shape of the femoral neck, creates poor level of clearance when flexing and abducting the hip (cannot clear the acetabulum)

What is Dalton's law?

each gas in a mixture moves along its partial pressure gradient *independent* of other gases

The FDA has little to do with early or late stages of drug testing?

early, they become involved when drug testing has been completed in animal models and is ready for human testing

What is an exception to the Basic Swedish Principle of working distal to proximal?

edema, start proximal to clear

_______________ is key for elderly pts to maintain their independence and health

education

What are limb shrinkers?

elastic shrinkers that help decrease swelling & assist in shaping the residual limb

Name the amputation: disarticulation of elbow

elbow diarticulation :)

Who is at the highest risk for dehydration, even above those who don't drink enough or sweat frequently?

elderly

When does a superior roll and inferior glide happen with shoulder motions?

elevation (flexion > 90 degrees, abduction)

What general motions are available at the scapulothoracic joint?

elevation/depression abduction (protraction)/adduction (retraction) upward/downward rotation

Clubbed fingers, barrel chest and "pink puffer" face are symptoms of what respiratory condition?

emphysema

What happens if you don't set the tibia in 5 deg of ER during bench alignment of a transfemoral prosthesis?

end up w/ a lateral whip (ER the tibia to account for pelvis rotation)

The decision to use a wheelchair or not after an amputation is largely based on what?

energy cost of ambulation

What is vigabatrin used to treat? How does it work?

epilepsy, it enhances the natural effects of GABA

What condition is carbamazepine used to treat? How does it work?

epilepsy, it works by affecting the sodium channels and acts on the presynaptic neuron to inhibit synaptic transmission

Carpometacarpal joint - digits 2-5

equal loss of all motions

metacarpophalangeal and interphalangeal joints

equal loss of flexion and extension

Lung or pulmonary compliance is the ability of the lungs to ____________ .

expand

Restrictive lung disorders are a group of disorders with impaired lung _____________ .

expansion

Atelectasis, pleural effusion, pneumothorax, adult/acute respiratory distress syndrome (ARDS), and acute respiratory failure are all examples of what type of disorder?

expansion disorders

Emphysema can lead to progressive difficulty of inspiration or expiration?

expiration

When the pressure in the alveoli is higher than in the atmosphere, what happens?

expiration

How does the thoracic spine react with shoulder abduction between 60 and 180 degrees?

extends slightly

Shoulder abduction is coupled with shoulder ___________ (motion) above 60 degrees to prevent shoulder impingement

external rotation

When does a posterior roll and anterior glide happen with shoulder motions?

external rotation extension horizontal abduction

Venous bulging stiffens the _________ matrix

extracellular

Efferent axons of large myelinated nerves innervate what?

extrafusal muscle fibers

Increased diameter of larger venules and veins bulge into the _____________ compartment, raising tissue pressure, resulting in what?

extravascular compartment venous edema

Every hour, there are 2 deaths and 251 ER visits for ______-related injuries among older adults

fall

T/F: a limb shrinker is the same thing as a limb sock

false

T/F: dementia is a normal condition of aging

false

T/F: effleurage can move deep muscle mass

false

T/F: massage can build muscle

false

T/F: massage can reduce fat

false

T/F: massage can reduce spasticity from CNS damage

false

T/F: older people have a hard time doing things for themselves so its best to take over and do things for them

false

T/F: people with dementia have "lost touch with reality" so they can't understand most of what you are saying to them

false

T/F: sudden weight loss is expected with elderly people

false

T/F: PTs are capable of independently interpreting imaging results

false -their role is managing care, directing imaging & relating imaging studies to clinical presentation, not reading the results

T/F: PTs in primary care, such as the military, increased diagnostic imaging orders

false -they decreased imaging by 50% -MDs are happy w/ this

T/F: a person who wanders should be restrained to protect him/her from injury

false goes for both chemical & physical restraints

T/F: a radiolucent object is more dense than a radioopaque object

false radiolucent objects are less dense than radioopaque objects

T/F: a CT scan provides detailed anatomical imaging of soft tissue

false replace soft tissue with bone

T/F: falling and fear of falling are a part of the normal process of aging

false should NOT be accepted as normal, instead find and address the cause of falls

T/F: Radiation exposure is a concern with DEXA

false the exposure to radiation in DEXA is roughly the same as flying on a plane from NY to LA and back

T/F: elderly people are less sensitive to medications

false they are more sensitive

T/F: it is helpful to reorient an agitated elderly person by making sure they understand what is real and what is not

false they can become even more agitated

T/F: when communicating to a confused senior, speak in a loud, sharp voice

false use an elevated voice, but a calm tone

T/F: a person who has dementia can remember things that happened recently, but have no memory of the distant past

false usually the opposite is true

What is a type 2 error in statistics?

false negative

Do x-rays have a high false positive or false negative rate? Does this mean they are not very sensitive or specific?

false negative not sensitive

What is a type 1 error in statistics?

false positive

Do bone scans get a lot of false positives or false negatives?

false positives (sensitive, not specific)

T/F: never begin a massage with a pt completely draped

false, always do this

T/F: you can only apply resistance in PNF techniques to facilitate concentric muscle contractions

false, can facilitate concentric & eccentric

T/F: phantom limb pain is normal after an amputation

false, phantom limb *pain*, although very common, is not considered normal

T/F: amputation is a relatively new procedure

false, they are among the oldest medical procedures

T/F: use of a walker for stair training is a good solution for long-term use of the walker

false, this is for short-term use of a walker, for recovery from a WB restriction period

T/F: you can attempt to make significant adjustments to a prosthesis to save the pt a trip to the prosthetist

false, you should def not do that

T/F: when applying an ACE wrap to an AKA, you should avoid the adductor tissue

false, you should include it to prevent an adductor roll

T/F: you should educate an amputee as quickly as possible with all the info they need about their new lifestyle

false, you should prioritize the most important info and gradually build on it to help not overwhelm the patient

People with asthma often have a ____________ history of allergic conditions.

family

What is it called when a pt has a lasting concern about falling that can lead to them avoiding certain activities that they remain capable of performing?

fear of falling serious, widespread problem among older adults

CRPS is more common in what gender?

females

What nerve is responsible for muscular innervation of the anterior thigh?

femoral

What causes contraction atelectasis?

fibrotic tissue in lungs or pleura

Which type of ACE wrapping technique should you use to prevent the tourniquet effect?

figure 8 pattern

You should be careful with how you lead with your hands during massage, for example, you should avoid what type of lead in the groin area?

finger tip lead

With the hip, flexion usually is associated with _________ __________, and extension is usually associated with __________ __________

flexion = internal rotation extension = external rotation

What is the only unpaired longus/brevis muscle in the hand?

flexor digiti minimi brevis

How does pulmonary edema reduce the amt of O2 diffusing into blood?

fluid collecting in alveoli reduces gas exchange

Name the amputation: amputation of humerus, scapula & clavicle

forequarter amputation

Dopamine degradation results in the production of a __________

free radical (1-methyl-4-phenylpyridinium)

When assessing alignment, what are the 4 lines you should be able to mentally draw when viewing a lateral x-ray of the cervical spine?

from anterior to posterior: 1. anterior vertebral line 2. posterior vertebral line 3. spinolaminar line 4. posterior spinous line

Where does small cell lung cancer come from?

from bronchi, oat cells, combination

In what plane does a positive trendelenburg happen?

frontal

Fibrosis can lead to loss of ____________ areas of the lungs

functional

What are side effects of ethosuximide?

gastric distress, nausea, vomiting, headaches dizziness, and euphoria

Are generic or trade drugs less expensive?

generic b/c companies that sell these drugs have lower expenses in bringing the drugs to market

Babies born from gestational diabetes have a risk of:

getting DM2 later

What is glycation?

glucose irreversibly sticking to a protein (diff. from glycosylation)

How does insulin act on an insulin receptor?

glucose transporters (Glut-4) move from cytoplasm to membrane (to allow glucose to pass inside the cell)

________ (neurotransmitter) is the simplest amino acid and is an inhibitory neurotransmitter released by interneurons within the spinal cord

glycine

The utricle and saccule are:

gravitation receptors

What color is water on an x-ray?

gray

What color is fat on an x-ray?

gray-black

What color is bone on an x-ray?

gray-white

Side effects of memantine:

hallucinations, confusion, dizziness and headaches

What should you be careful about when tucking the sheet or towel during massage?

hand placement

What do you have to have in order to do stair climbing with a walker, especially if the pt has a WB restriction?

handrail

Name the amputation: amputation of both LEs and pelvis below L4-5

hemicorporectomy

Name the amputation: resection of half of the pelvis

hemipelvectomy

Air always moves from an area of __________ pressure to an area of ___________ pressure

high to low

What muscle group is weak if someone has a positive trendelenburg?

hip abductors (glute med and min)

Name the amputation: amputation through the hip joint w/ intact pelvis

hip disarticulation

If you have muscle imbalance that causes posterior tilt of the pelvis, how will hip and low back be affected?

hip extension lumbar flexion

If you have muscle imbalance that causes anterior tilt of the pelvis, how will hip and low back be affected?

hip flexion lumbar extension

If you're standing on your right leg and you have a posterior pelvic tilt, what position will your hips and low back be in to keep you standing upright?

hips will be in extension low back will be in flexion

If you're standing on your right leg and you have an anterior pelvic tilt, what position will your hips and low back be in to keep you standing upright?

hips will be in flexion low back will be in extension

A patient _________ can help in a differential diagnosis to determine if pain is somatic or visceral

history

What does "mellitus" literally mean?

honey (means there is sugar in the urine)

Define permeability

how easily x-ray beams can pass through a substance to reach the film plate

After axillary lymph nodes are dissected, what determines if a patient is at high risk for lymphedema?

how many nodes are removed (11-13 = high risk) lymphedema can occur with as little as 1 axillary node removal

With shoulder abduction above 60 degrees, how does the humerus move?

humeral head glides inferiorly and anteriorly while rolling superiorly and posteriorly

What happens to the humerus during abduction of the shoulder between 0 and 60 degrees?

humeral head glides inferiorly while rolling superiorly

Phenytoin is a generic name for what class of drug?

hydantoins

An increase in PCO2 in the blood is called:

hypercapnia

Is hyperventilation caused by hypercapnia or hypocapnia?

hypercapnia

The normal partial pressure of CO2 is 35-45 mm Hg. A PCO2 of 60 is considered what condition?

hypercapnia (resp. distress)

_____________ develops slowly in type 2 diabetes

hyperglycemia

What causes the increased production of mucous secretions involved in chronic bronchitis?

hypertrophy and hyperplasia of mucous glands

A decrease in PCO2 in the blood is called:

hypocapnia

Is hypercapnia or hypocapnia caused by hyperventilation?

hypocapnia

The normal partial pressure of O2 is 90-100 mm Hg. A PO2 of 80 mm Hg is considered what condition?

hypoxemia

What is an example of a second group, restrictive lung disorder?

idiopathic pulmonary fibrosis

How does the total surface area available for diffusion affect gas exchange?

if part of the alveolar wall is destroyed, SA is reduced, and less gas exchange occurs Ex: emphysema

When is open, provisional or delayed closure of an amputation indicated?

if severe infection is present

When performing a hamstring length test, what is considered a positive reading?

if someone has tight hamstrings, and their PROM will be <80 degrees of hip flexion with them in supine and their leg stright

Why would you elect to use a hold-relax technique over a contract-relax technique?

if tight muscle is painful

Should you have the pt hang onto the handrail if they are using crutches on stairs?

if you do, tell them to put the crutches into one had, but you do not have to use the handrail

Define elongation:

image appears longer than the actual object

Define foreshortening:

image appears shorter/wider than the actual object

What is the main theory for what causes bipolar disorder?

imbalance between GABA (inhibitory) and excitatory neurotransmitters (norepinephrine, dopamine, glutamate and aspartate)

What does IPOP stand for?

immediate post-op prosthesis it is a plaster socket w/ a removable pylon & foot

When should you initiate positioning after an amputation?

immediately prone positioning ASAP, some pts will really not like this, esp dysvascular pts, Jason would push this harder if it is a younger pt

mitoxantrone is a generic name for what class of drug?

immunosuppressors

What do tricyclic antidepressants do? (picture)

impair the reuptake of amine transmitters back into the presynaptic terminal

Prediabetes is referred to as:

impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)

What does botulinum toxin do? (picture)

impairs the release of Ach from the presynaptic neuron

Where is the source of x-ray beams located relative to the patient in an AP image?

in front of the patient

Where should you guard a patient when coming down stairs?

in front of them, hang onto the gait belt

Where is the 1st order neuron located in a pain neuron system?

in the PNS- in the peripheral and visceral tissues

Where is the 2nd order neuron located in a pain neuron system?

in the SC- they then travel to the thalamus

Where is the 3rd order neuron located in a pain neuron system?

in the brain- they travel from the thalamus to various parts of the brain

What does "diabetes" mean?

inability to retain fluid (reflecting the observation that people with diabetes urinate frequently)

What is the #1 cause of "medial whip" or "lateral whip" gait deviations?

incorrectly donning the prosthesis amputees don't have a mark to let them know exactly how to align the prosthesis when they put it on, brand new patients have a hard time getting a sense of the correct amount of rotation they should have

What do amphetamines do? (picture)

increase the presynaptic release of cathecholamines

What causes venous edema?

increased intravascular hydrostatic pressure

How does excessive anteversion affect internal rotation? (not compensating)

increases hip internal rotation

How does retroversion of the hip affect external rotation?

increases it

How does pleural effusion affect the pressure in the pleural cavity?

increases it -separation of pleural membranes, dec cohesion during inspiration

How does hydrostatic pressure change to cause altered fluid flow in capillaries?

increasing with increases in arterial flow or blockage of free return into veins, exercise, pressure on veins and decreased mm pumps

What is a surgical consideration for *cancer-related* amputee patients?

indicated in high grade tumors, proximal lesions, those risking pathologic fractures or neurovascular involvement or recurrent disease

What does high uptake of the methylene injection in a bone scan indicate?

indicates areas of inc bone activity or mineral turnover

Starting with the hip in 90 degrees of flexion, which way does the femoral head glide with further hip flexion (open chain)?

inferior

Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with internal rotation (open chain)?

inferior

Starting with the hip in neutral, which way does the femoral head glide with hip abduction (open chain)?

inferior

If someone is lacking the last few degrees of hip flexion, what would be a good joint glide to facilitate this motion? What if they have knee pain?

inferior glide with hip at ~120 degrees if knee pain - perform the inferior glide at 90 degrees hip flexion instead

With the SC joint, clavicular depression involves a superior ________ (roll/glide) and an inferior ________ (roll/glide)

inferior roll superior glide

Which trunk(s) give off the medial cord?

inferior trunk (lower)

What is pneumonia?

inflammation in lungs due to infection

Once vasodilation of vessels and edema occur in the process of inflammation, what are the next 2 steps?

inflammation reaction rapidly proceeds to remove and repair the damaged tissue and pain develops as a protective mechanism

An exacerbation of MS is when the symptoms get worse for a period of time and includes an ____________ process

inflammatory

GABA is an _______ (inhibitory/excitatory) neurotransmitter that does what?

inhibitory neurotransmitter that opens a chloride channel allowing the negative ion to enter the cell and hyperpolarize the cell membrane

Describe how the control of the trapezius muscle changes with increasing shoulder elevation?

initiation: upper trap predominates at 90 deg: middle trap peaks later phases: lower trap predominates

What is contrast enhancement?

injection or ingestion of a radio-contrast medium prior to a radiographic study Ex: angiography, arthography, myelography, barium swallow, etc.

What are some factors that affect pain from person to person? (7)

injury (previous injury changes pain threshold) fatigue age (older people tolerate more pain) gender (women tolerate pain better) fear and apprehension racial and cultural characteristics emotional status

Where is intracellular fluid located?

inside cells... lol

Sedative-hypnotic drugs are used to treat what condition? What two categories can these drugs be split into?

insomnia benzodiazepines and nonbenzodiazepines

When atmospheric pressure is higher than the pressure in the alveoli, what happens?

inspiration

What does insulin act on?

insulin receptor (on cell surface)

What do you call it if there is a dysfunction lower than the insulin receptor level?

insulin resistance (body is resistant to insulin)

What is the only class of drugs used to treat MS that actually affects the progression of the disease rather than treating the symptoms?

interferon-based drugs

Summary of drugs used to treat MS: (read)

interferon-based drugs immunosupressors corticosteroids potassium channel blocker

interferon beta -1b, interferon beta-1a and glatiramer acetate are all types of what drug? What are they used to treat?

interferon-based drugs used to treat MS

Diabetes alone increases the risk of _________________ (associated w/ PVD) by 4-5 times, even after controlling for HTN, smoking and cholesterol levels

intermittent claudication

When does an anterior roll and posterior glide happen with shoulder motions?

internal rotation flexion < 90 degrees horizontal adduction

AC joint motion may be involved with fine tuning of what shoulder motions?

internal/external rotation anterior/posterior tilting

The lymph system plays a key role in the ________ fluid balance

interstitial

The net fluid exchange at the venous end of the capillaries results in fluid coming into or out of cells?

into capillaries (out of cells)

The fluid in the body is either __________ or _________

intracellular extracellular

Efferent axons of medium myelinated nerves innervate what?

intrafusal muscle fibers

What does capillary osmotic pressure do?

it is a pressure that causes fluids to pass from areas of lower concentration to higher (pulls water into capillaries)

How does memantine work?

it is an antagonist of the receptor (NMDA) that binds glutamate which is an important neurotransmitter in information processing, so it prevents excessive glutamate binding and thus prevents overstimulation from glutamate which leads to cell death (neuroprotective)

How does lithium treat bipolar disorder?

it is not known for sure but theories are... -it may directly decrease the release of amine neurotransmitters and increase their reuptake -may reduce the production of second messengers, cAMP and inositol triphosphate and affect intracellular enzymes

If someone stands with excessive supination in the foot, how does this affect the hip alignment and lower limb?

it would cause the following: -hip external rotation -extension of the hip -lengthening of the limb

If someone stands with excessive pronation in the foot, how does this affect the hip alignment and lower limb?

it would cause the following: -internal rotation of the hip -flexion of the hip -shortening of the limb

If gestational diabetes continues after >6 weeks of pregnancy, it means:

it's no longer gestational DM

What pathology may have an increased risk of occurrence from a coxa varum hip alignment?

joint fracture

What is a life-threatening complication of diabetes?

ketoacidosis

In TKA alignment of a transfemoral prosthesis, which of the 3 points is slightly off-set?

knee center is slightly posterior to the TKA line

Name the amputation: amputation through knee with intact femur

knee disarticulation

What pathology does retroversion of the hip put someone at an increased risk for?

labral tears

Is the angle of torsion in children larger or smaller than adults?

larger (starts at ~40 degrees and decreases towards the adult normal)

The median nerve is made up of what 2 cords?

lateral cord medial cord

Highly radiodense objects result in more or less radiodensity on the film?

less (object appears whiter)

How does coxa valgum affect the forces on the neck of the femur?

less bending and shear forces

Fear of falling can restrict a person's normal activities causing:

less independence

What do arterial blood gas determination tests measure?

levels of the following in the blood: -O2 -CO2 -bicarbonate -serum pH

What molecule (drug) has served a major role in the positive treatment of Parkinson's disease?

levodopa

Summary of drugs that can be used to treat Parkinson's (read)

levodopa (dopamine) Sinemet - levodopa with carbidopa istradefylline and apomorphine etilevodopa and melevodopa anticholinergic (trihexyphenidyl and benztropine) amantadine (bromocriptine and pergolide) antioxidants (selegiline and rasaliline) GM-1 ganglioside

How is the premature conversion of levodopa to dopamine prevented so more dopamine reaches the brain?

levodopa is combined with carbidopa which prevents the conversion to dopamine and therefore smaller doses can be given and a larger amount of dopamine can reach the brain

What is the point of petrissage?

lift subcutaneous tissue up and off of underlying structures

What is used b/w the residual limb and prosthetic socket?

limb sock

How thick are the walls of alveoli?

lined by a single layer of epithelial cells

What is the main treatment for bipolar disorder?

lithium

During an AP, the presynaptic AP travels down the membrane of the cell and depolarizes the presynaptic cell. Examples of drugs that act here are? (picture)

local anesthetics

What are some of the mechanical effects of massage on blood vesssels?

local capillary dilation via splanchnic autonomic fibers: -relaxation of voluntary mm -dec pain stimuli -inc in skin temp (???)

T/F: you don't need to monitor pt swelling and limb volume fluctuation after an amputation

lol, of course you do

What is effleurage?

long stroking, gliding movements following the length of a muscle

Name the amputation: retains more than 50% of femoral length

long transfemoral

Name the amputation: retains more than 50% of tibial length

long transtibial

How do you treat TB?

long-term treatment with a combination of drugs (from 6 mo to 1 yr)

How does coxa varum lead to an increased mechanical advantage for the hip muscles?

longer moment arm for the muscles to work and decreased joint reaction forces

What is the *clinical* presentation of an upper brachial plexus injury (C5-6)?

loss of shoulder abduction, external rotation weakness of the arm, loss of flexion and forearm supination (Waiter's tip - present w/ IR arm, pronated forearm and loss of shoulder flexion)

Do barbiturates have a low or high therapeutic index?

low

Alternative garmets (velcrow) have ______ resting pressure and _____ working pressure

low high

What is a side effect of DM meds?

low energy levels due to low blood sugar

With wrist glides for flexion and extension, the radiocarpal joint involves the movement of what two bones against each other?

lunate moving on the radius

Blood gas levels indicate the level of function of the ___________.

lungs

What organ does TB primarily affect?

lungs

Why is early detection of malnutrition important?

malnutrition is associated with diminished cognitive function, mobility, and a diminished ability to care for one's self

What is the role of Amantadine, bromocriptine and pergolide in the treatment of Parkinson's?

may be used in combination with levodopa to *facilitate release of endogenous dopamine*

The affected limb may have what appearance with stage 1 CRPS?

may be warm and red or dry and cool, pale

What does the treatment outlook for stage 1 CRPS look like?

may resolve spontaneously or should respond rapidly to appropriate treatments

What does it mean to say that x-rays are a *first order* diagnostic modality?

means it is often the first thing that is done

Stretching, elongating or mobilizing techniques are considered a _________________ effect of massage

mechanical

Loss of thumb opposition is a clinical sign of damage to which nerve?

medial nerve

What nerve(s) is/are affected by carpal tunnel syndrome?

median nerve

Where is the primary control center for breathing located in the brain?

medulla & pons

What should you be able to see specifically in long bones?

medullary cavity

What is dementia?

memory impairment causing cognitive, functional and behavior deterioration

Side effects of anticholinergic drugs?

memory impairment, hallucinations, dry mouth, constipation and urinary retention

What is the definition of PNF?

methods of promoting the response of the neuromuscular mechanism through stimulation of the proprioceptor

What are etilevodopa and melevodopa?

methyl and ethyl-esterified modifications of levodopa which should (hopefully) be able to cross the blood-brain barrier

Synthesis of neurotransmitter: presynaptic neuron will synthesize many neurotransmitters used in the synaptic cleft. Examples of drugs that act here are? (picture)

metyrosine

Which trunk(s) give off the lateral cord?

middle and superior (upper)

Parasympathetic innervation to all salivary glands and taste runs through the:

middle ear

The Eustachian tube slants from the:

middle ear to the nasopharynx

Realistically, the PT would expect to write a stair training goal using a walker with ______________ assistance of the caregiver

minimal

CRPS is often _________ and attributed to psychological problems

misdiagnosed

isocarboxazid, phenelzine and tranylcypromine are generic names for what class of drug? They can all be used to treat what conditions?

monoamine oxidase inhibitors (MAO) anxiety or antidepressants

Which races more frequently get peripheral vascular disease?

most common in African Americans and Hispanics

What motion(s) of the hip does an anterior glide of the hip facilitate?

mostly extension, but also some external rotation

What motion(s) of the hip does a posterior glide of the hip facilitate?

mostly flexion, but also some internal rotation

In general, do drugs prescribed for MS treat the symptoms or prevent disease progression?

mostly they treat symptoms of the disease (MS has many symptoms so patients likely to take multiple drugs)

What is akathisia?

motor restlessness, patients will pace the floor and experience insomnia

Geriatric patients commonly present with ____________ comorbidities in addition to their admitting diagnoses

multiple

ARDS is often associated with what other condition?

multiple organ dysfunction or failure

What are side effects of corticosteroids?

muscle wasting, abdominal adipose tissue, decrease in cognitive funtion

Why does a coxa valgum hip alignment affect the mechanical advantage of the hip muscles?

muscles have to generate more force and there is an increased joint reaction force

The lateral cord gives off what 2 major nerves of the UE?

musculocutaneous median

The PT should be able to recognize signs and symptims of non-___________ pain to help with a differential diagnosis

musculoskeletal

Name the muscle stabilization technique post-amputation: transected muscles are re-attached by suturing through drill holes at the distal end of the bone

myodesis

Name the muscle stabilization technique post-amputation: fascial envelope is sutured over the transected muscles

myofascial

Name the muscle stabilization technique post-amputation: suturing of one muscle group to its antagonist

myoplasty

Does prediabetes have clear symptoms?

nah

How are x-rays named?

named for the beam direction relative to the patient and the patient's position

How do you name a lateral/oblique x-ray?

named for the side *closer* to the film plate

The middle ear connects to the __________ with each swallow

nasopharynx

Many neurological drugs minic the action of _______ neurotransmitters or they block the ability of the _______ to bind to receptor and transduce signals

natural neurotransmitter

What are major side effects of Sinemet treatment?

nausea, abnormal muscle tone, tremors, confusion, hallucinations, cardiac arrhythmias and hypotension *dyskinesias* resistance may develop after a few years

What are side effects of valporic acid? What is usually an issue with a lot of seizure medications that is not an issue with this drug?

nausea, vomiting and other GI problems this drug does not cause sedation like many other seizure medications

What can constant, long term stimulation of nociceptors result in? What may cause the constant stimulation of these nociceptors?

nerve damage/changes chronic inflammation causes the constant stimulation of the nociceptors

Stage II CRPS follows what type of injury?

nerve injury

What are the different classifications based on Seddon's classification for nerve injuries?

neurapraxia axonotmesis neurotmesis

Neuropaptides may act as _________ or _________

neurotransmitters or hormones

__________ and their receptors are major targets for pharmacological intervention for the nervous system

neutrotransmitters

Are beta cells autoimmunely destroyed in type 2 diabetes?

no

Do zolpidem, zaleplon, and eszopiclone have many side effects?

no

Does massage done to only one area affect total body blood flow?

no

Do visceral organs have pain receptors? How do we feel visceral pain?

no there are pain receptors present in the walls of the arteries serving these organs allowing us the sensation of visceral pain

Is the damage done by COPD reversible?

no, irreversible lung damage

Can cell-mediated immunity protect you from TB?

no, normal neutrophil response does not occur

Are tricyclics selective reuptake inhibitors?

no, they block reuptake of all 3 types of amine neurotransmitters and are used when people do not respond well to selective reuptake inhibitors

Do you have to perform the full PNF pattern?

no, you can isolate a certain part of the body like the foot

As long as the chemical mediators of inflammation are present, the _________ will be stimulated and you will feel pain

nociceptors

Are zolpidem, zaleplon, and eszopiclone benzodiasepines or nonbenzodiazepines?

nonbenzos

eszopiclone, ramelteon, zaleplon and zolpidem are generic names for benzodiazepines or nonbenzodiazepines?

nonbenzos ... "others"

What is the primary neurotransmitter used by the postganglionic sympathetic neurons?

norepinephrine

PNF movement patterns are designed to mimic _______ movements. Do they do a good job at this?

normal/functional movements not really, that was the intent but when working on strengthening within those patterns, they don't apply that well to functional movement patterns

What is the theory behind using anticholinergic drugs to treat parkinson's?

normally dopamine and acetylcholine are balanced in the brain, since dopamine is reduced with parkinson's, reducing acetylcholine also should decrease the symptoms of parkinson's

What is D3?

not a real thing, practicing PT's often forget the difference b/w D1 and D2, so they make up their own thing and call it D3

Are Ted Hose helpful for edema?

not usually unless pt is non-ambulatory (small compression)

Stage 1 CRPS usually manifests after a ________ event or immobilization

noxious event

People with type 1 diabetes are rarely:

obese

Define magnification:

objects further from the film appear larger than closer objects

Is asthma a type of obstructive or restrictive pulmonary disease?

obstructive

What nerve is responsible for muscular innervation of the medial thigh?

obturator

What is a surgical consideration for *traumatic* amputee patients?

often involve open, comminuted fractures w/ soft tissue loss and vascular/nerve disruption

Personalized medicine has a long way to go, right now only the ______________ field is regularly using this approach.

oncology

A sucking wound is a type of ______________ pneumothorax

open

With SC elevation and depression, roll and glide happen in the _______ (same/opposite) direction

opposite

What would the origin of pain and the quality of pain be for a neurovascular injury?

origin: blood vessels quality: throbbing, pulsing, pounding *can migrate to different locations*

What would the origin of pain and the quality of pain be for a muscular injury?

origin: muscle quality: deep aching, poorly localized, dull or sharp

What would the origin of pain and the quality of pain be for a neuropathic injury?

origin: nerve quality: shooting, sharp, burning pain *electric shock type sensation with acute injury*

What would the origin of pain and the quality of pain be for a cutaneous injury?

origin: skin quality: sharp, superficial

What would the origin of pain and the quality of pain be for a visceral injury?

origin: visceral organs quality: deep aching, pressing, boring, stabbing *very poorly localized*

What is a side effects of anti-hypertensives?

orthostatic hypotension

What are side effects for drugs that induce endogenous dopamine release?

orthostatic hypotension, depression, hallucination, nausea, vomiting, confusion and insomnia

What pathologies could coxa valgum lead to an increased risk of?

osteoarthritis and dislocation

What is indicated by low contrast or "washed out" bone on an x-ray?

osteoporosis

People with type 1 diabetes are prone to:

other autoimmune diseases

The net fluid exchange at the arterial end of the capillaries results in fluid coming into or out of cells?

out of cells into interstitial space

In acute pain, pain ______ is more important whereas in chronic pain, pain ______ is more important

pain quality (intensity, pt description) pain behavior (observation, questionnaires, objective measures)

Afferent axons of small myelinated nerves innervate what?

pain temperature and visceral receptors

Afferent axons of unmyelinated nerves innervate what?

pain temperature and visceral receptors

What is phantom limb pain?

painful sensation in body part that is no longer present -can be constant or intermittent -can be triggered by an external stimulus -characterized as either cramping, squeezing, shooting or burning pain

What is the *clinical* presentation of a lower brachial plexus injury (C8-T1)?

paralysis of the intrinsic muscles of the hand

Which CN's come from the medulla? (5)

part of Trigeminal Glossopharyngeal Vagus Accessory Hypoglossal

Which CN's come from the pons? (4)

part of Trigeminal Abducens Facial Vestibulocochlear tiny bit of Vagus

What type of seizure is vigabatrin used to treat?

partial

Phenytoin is most effective in preventing what types of seizures?

partial and generalized tonic-clonic seizures

Name the amputation: excision of a portion of one or more fingers

partial digit

Name the amputation: resection of 3rd, 4th and/or 5th MT's and digits

partial foot/ray resection

Is air trapping and hyperinflation of lungs a symptom of partial or total obstruction of airways with asthma?

partial obstruction -air is expired partially -RV inc -more difficult to inhale

The ____________________ of a gas reflects the relative concentration of this gas in the mixture of gases.

partial pressure

Name the amputation: excision of a portion of 1 or more toes

partial toe

What does transmission mean in reference to first order neurons?

passage of the resulting sensory input from peripheral terminals to spinal cord

How is glatiramer acetate administered? How often must this be done?

patient can inject themselves, must be done either weekly or monthly this decreases the number and frequency of exacerbations of MS

When performing a piriformis muscle length test, what is considered a positive reading?

patient in prone with knee bent to 90 degrees, internally rotate the hip, less than 45 degrees PROM or sciatic pain present indicates a positive test

What specific traumatic injury has the highest rate of an associated nerve injury within 90 days post trauma?

pelvic fracture

What is tapotement?

percussive strokes w/ alternating hands in a rapid, rhythmic motion (hands should be relaxed)

What are some lower extremity syndromes caused by compression of a peripheral nerve?

piriformis syndrome peroneal nerve compression tarsal tunnel syndrome

The acromioclavicular joint is a _______ joint. Describe the arthrokinematics of this joint.

plane joint no arthrokinematics

What initially may be normal in type 2 diabetes?

plasma insulin levels

What respiratory condition involves the presence of excessive fluid in the pleural cavity?

pleural effusion

What respiratory condition involves air in the pleural cavity?

pneumothorax (leads to atelectasis)

Elevated venous pressure increases the volume of blood within __________ venules

postcapillary

Starting with the hip in 90 degrees hip flexion, which way does the femoral head glide with adduction (open chain)?

posterior

Starting with the hip in neutral, which way does the femoral head glide with hip flexion (open chain)?

posterior

Starting with the hip in neutral, which way does the femoral head glide with internal rotation (open chain)?

posterior

The ______ ramus supply structures in the midline of the body, whereas the ________ ramus supply the lateral and anterior body

posterior = midline anterior = lateral and anterior

If someone is lacking a large amount of hip flexion, what would be a good joint glide to facilitate this motion?

posterior joint glide or inferior joint glide with leg at 90 degrees

With the SC joint, clavicular retraction involves a(n) _______ roll and a(n) ________ glide

posterior roll posterior glide

Efferent axons of unmyelinated nerves innervate what?

postsynaptic autonomic

What is the function of benzodiazepines?

potentiate (enhance) the effects of GABA to hyperpolarize the neuronal membrane

What can happen if gestational diabetes is untreated?

premature death of baby or stillbirth

During therapeutic massage, be sure to gauge ______________ carefully throughout it

pressure

Efferent axons of small myelinated nerves innervate what?

presynaptic autonomic (for diameters less than 3 micrometers)

Why is lithium considered to possibly be neuroprotective?

preventing neuronal degeneration in certain parts of the brain and sustaining neuronal activity

How does inc surface tension of alveoli lead to atelectasis?

prevents expansion of a lung

What is another name for the 1st order neuron in a pain neuron system?

primary afferent neuron

List the 6 divisions of the bronchial tree in order

primary bronchi --> secondary bronchi --> bronchioles --> alveolar ducts --> alveolar sacs --> alceoli

During which stage of TB is the person asymptomatic and can't transmit the disease?

primary stage

When are limb shrinkers used by an amputee?

prior to prosthetic fitting and wearing worn 24 hrs/day

What is the cumulative effect of the interaction between nutrition and changes seen in aging?

progressive undernutrition, often goes undiagnosed

What may cause damage to the musculocutaneous nerve?

projectile wounds (GSW)

Where can medial nerve entrapment occur?

pronator teres, FDS, carpal tunnel

Alpha1-antitrypsin is a _____________ inhibitor.

protease (Ex of a protease: elastase)

What does P.R.I.C.E. stand for?

protection rest ice compression elevation

What are the 5 motions of the clavicle?

protraction retraction elevation depression posterior rotation

For a AKA, in which direction is the "pull" while applying an ACE wrap?

pull into extension and adduction

Which respiratory/vascular condition reduces the amt of O2 diffusing into blood and interferes with lung expansion?

pulmonary edema

What does spirometry measure?

pulmonary volumes airflow times

The posterior cord gives off what major nerve of the UE?

radial

What nerve(s) is/are affected by radial nerve compression?

radial nerve

Wrist drop is a clinical sign of damage to which nerve?

radial nerve

What are radiopharmaceuticals?

radioactive tracers used in nuclear medicine (PET, SPECT, bone scan) that are absorbed according to the metabolic properties of the tissue

The radiodensity of an object is inversely related to the:

radiodensity (amt of black) on the x-ray

An x-ray is simply a reflection of the _____________ of anatomical structures

radiographic densities

What diagnostic test can evaluate tumors and infections (such as pneumonia or TB)?

radiography (helps determine drug approach)

Is air radiolucent or radioopaque?

radiolucent

Is heavy metal radiolucent or radioopaque?

radioopaque

Bronchiectasis arises from _____________ inflammation and infection.

recurrent

Define attenuation

reduction in strength or density of an x-ray beam as it passes through something

What is geriatric syndrome?

refers to multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render an older person vulnerable to situational challenges multiple causations of a unified manifestation

PNF involves the use of the patient's strengths or ________ responses to minimize weakness

reflex responses

Stimulation of sensory receptors in the skin and superficial tissues is considered a _______________ effect of massage

reflexive

Older patients who undergo a unilateral AKA will have difficulty doing what?

regaining upright independence

What type of MS is mitoxantrone approved to treat?

relapsing-remitting that is also getting worse (secondary progressive MS)

What is an advantage of anticholinergic drugs for treatment of parkinson's?

relatively inexpensive

What is a controlled clinical trial?

researchers observe patients receiving a new drug compared to patients receiving a placebo

Storage of neurotransmitter: Neurotransmitters are often stored within the presynaptic terminal before they are used. What drug acts at this stage? (picture)

reserpine

Does hypercapnia result in respiratory acidosis or alkalosis?

respiratory acidosis

Does hyperventilation lead to respiratory acidosis or alkalosis?

respiratory alkalosis (excess amt of CO2 expired)

What are side effects of MAO?

restlessness, irritability, agitation, insomnia and hypertension

What is characterized as tardive dyskinesia?

rhythmic movements of the mouth, tounge and jaw (reversible with cessation of the drug)

If you're standing on your right leg and you have a contralateral (left) pelvic hike, how will your hips and back compensate to keep you standing upright?

right leg abduction lateral flexion to the left

If you're standing on your right leg and you have a contralateral (left) pelvic drop, how will your hips and back compensate to keep you standing upright?

right leg adduction lateral flexion to the right

What are the main *sections* of the brachial plexus?

roots trunks divisions cords nerves

At the SC joint, rotation of the joint occurs with what two shoulder motions? Can this rotation happen independent of other shoulder motions?

rotation occurs with *flexion and abduction* of the shoulder *no* SC rotation cannot occur without another shoulder motion

What is the main muscle group responsible for controling shoulder elevation?

rotator cuff

The thumb CMC and the SC joint are both ________ joints

saddle

For hip and low back muscle imbalances that occur, they cause deviations of the pelvis positioning in what plane?

sagittal

Is amputation or salvage more psychologically acceptable?

salvage

Is the risk of subsequent hospitalization greater after an amputation or salvage?

salvage

With SC retraction and protraction, the roll and glide happen in the ______ (same/opposite) direction

same

With wrist glides for radial and ulnar deviation, the radiocarpal joint involves what bones moving against each other?

scaphoid, lunate and triquetrum move on radius

What happens to the scapula during abduction of the shoulder between 0 and 60 degrees?

scapula is fixed until 30 degrees of shoulder motion at 30 degrees the scapula upwardly rotates at a 2:1 ratio (also causes AC joint rotation)

Motion at the acromioclavicular joint are pertinent with what motion?

scapular motions (upward/downward rotation) require AC joint motion to happen

What is the most common type of psychosis?

schizophrenia

What nerve(s) is/are affected by piriformis syndrome?

sciatic nerve

What syndromes could you use a sciatic nerve mobilization to help treat?

sciatic, tibial, sural and peroneal entrapment or compression

If an area of an x-ray appears "hyper-intense" (very white) what does this suggest?

sclerosis

Bronchiectasis is usually a ________________ condition

secondary

Which stage of TB is caused by invasion of dormant microbes or a new infection?

secondary stage

What are side effects of benzodiazepines?

sedation, ataxia, and behavioral changes

What are side effects of tricyclics?

sedation, confusion, delirium, tachycardia, dry mouth and urinary retention

A test that is ______________ will minimize type II errors

sensitive

If a test is very _________________, then the test will almost always be positive when the condition is present

sensitive

MRIs are _________ but not ___________ (sensitive/specific)

sensitive, not specific

______________ refers to a test's ability to correctly identify people with a condition

sensitivity

Pain and _______ changes are present with stage III CRPS

sensory

Diabetic neuropathy affects:

sensory, motor, or autonomic nerves

________ (neurotransmitter) may be involved in temperature regulation, sensory perception, sleep control and mood changes

serotonin

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline are all generic names for what class of drug? What condition are these used to treat (specifically)?

serotonin reuptake inhibitors treats anxiety - specifically generalized panic disorder and PTSD

Which class of drug is a mainstay in treating depression and blocks the serotonin reuptake into the pre-synaptic receptor?

serotonin selective reuptake inhibitor

citalopram, fluoxetine, paroxetine and sertraline are all generic names for what class of drug? What conditions can these be used to treat?

serotonin selective reuptake inhibitors anxiety or antidepressants

Desvenlafaxine and duloxetine are generic names for what class of drug? What conditions can these be used to treat?

serotonin-norepinephrine reuptake inhibitors anxiety or antidepressants

If a transfemoral amputee has a 10 deg hip flexion contracture, how should the prosthesis be adjusted?

set to 15 deg of socket flexion

Stage II CRPS generally lasts about how long?

several months (3-6 mo)

Is elongation a type of size/simple or shape distortion?

shape distortion

Is foreshortening a type of size/simple or shape distortion?

shape distortion

Name the amputation: retains less than 50% of femoral length

short transfemoral

Name the amputation: retains less than 50% of tibial length

short transtibial

What is the MOI of an upper brachial plexus injury (C5-6)?

shoulder depression and lateral flexion of the neck

Name the amputation: amputation through shoulder joint

shoulder disarticulation

Small pulmonary emboli might be ____________ unless they involve a large area of lung

silent

Is magnification a type of size/simple or shape distortion?

size/simple distortion

Where are nociceptors located?

skin deep tissues blood vessels (all in peripheral nervous system) (not in visceral organs)

What should you always inspect before you begin massage?

skin condition of the area

During therapeutic massage, try to make transitional movements as ___________ as possible

smooth

How should you position a walker for an amputee who is learning to do a stand-pivot transfer?

so that the pt can put their elbows into full extension

Tricyclic antidepressants are effective at treating what kind of anxiety?

social anxiety disorder

Which type of post-op dressing is an ACE wrap or incision dressed with 4x4's and Kerlix?

soft dressing

What does water have roughly the same radiodensity as?

soft tissue

T2 MRI images show:

soft tissue pathology and are ideal for acute trauma

What color is heavy metal on an x-ray?

solid *white*

What is a simple explanation for why we feel somatic pain for visceral structures?

somatic and visceral pathways run parallel to each other and have intersections in the spinal cord (Dr. Sharma)

Through a subjective and objective exam, you can use differential diagnosis steps to determine if pain is ______ or ______ in nature

somatic or visceral

How is excessive anteversion of the hip defined?

some say >~15 some say >~20 good...

A test that is ______________ will minimize type I errors

specific

If a test is very _________________, then it will almost always be negative when the condition is not present

specific

_______________ refers to a test's ability to correctly identify people who do not have a condition

specificity

What are the three types of power grips?

spherical cylindrical hook

rachi-

spine

During therapeutic massage, you should never apply pressure over which bony prominences?

spinous processes

Which transfer should be worked on with an amputee first? If the pt is unable to stand, what may be indicated instead?

stand-pivot transfer slide board

What are two ways to assess pain behavior?

standard questionnaires objective observation/measures

Where should you guard a patient when turning around at the top of the stairs?

stay a step below them, you always want to be downhill from them

Repetition of PNF patterns promotes the development of _______ and ________

strength and endurance

PNF methods are divided into techniques used for _________ and __________

strengthening and stretching

What are the goals of passive stretch & traction techniques on soft tissue?

stretch/inc flexibility & length (mechanical effect)

The physiological effects of massage depend on:

stroke/technique

Large emboli may cause _______________

sudden death

What happens in diabetes mellitus?

sugar (glucose) in urine and blood

Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with external rotation (open chain)?

superior

Starting with the hip in/near neutral, which way does the femoral head glide with hip adduction (open chain)?

superior

Which trunk(s) give off the posteior cord?

superior (upper) middle inferior (lower)

With the SC joint, clavicular elevation involves a superior ______ (roll/glide) and an inferior ______ (roll/glide)

superior roll inferior glide

What is thought to be the cellular mechanism cause of depression?

supersensitivity of the post-synaptic receptors to their ligands (many antidepressants formed with the thought that there are too many post-synaptic receptors)

Where can radial nerve entrapment occur?

supinator muscle

The inner surface of alveoli is covered by _________________ .

surfactant

What substance is spread as a thin film at the air-liquid interface in the lungs?

surfactant

What is lymphedema?

swelling in a body part due to excess accumulation of protein rich fluid in the interstitial spaces

Which part of the nervous system is responsible for bronchodilation?

sympathetic nervous system

If you think there is a problem with a prosthesis, what should you check before calling a prosthetist?

take the prosthesis off and put it back on again Jason said 80% of the time this will fix the problem and the prosthetist will want to know you've tried this already

What are some side effects of antipsychotic drugs?

tardive dyskinesia pseudoparkinsonism bradykinesia akathisia dyskinesia

What may cause damage to the tibial nerve?

tarsal tunnel syndrome compression site between medial malleolus and flexor retinaculum

What is a simple or spontaneous pneumothorax?

tear on the surface of the lung

Name the muscle stabilization technique post-amputation: intact tendon(s) are re-attached to the bone

tenodesis

What is the most serious type of pneumothorax?

tension pneumothorax

Define true negative

test detects nothing, and nothing is there

Define false negative

test detects nothing, but there is something there

Define false positive

test detects something that is not really there

Define true positive

test detects something that is really there

What is a modified ober test? What is considered a positive reading?

testing IT band length, patient in sidelying, therapist brings leg into hip extension and lowers leg until hip tilts, if the leg doesn't reach 10 degrees below horizontal, it is a positive test

What is Ely's test? What is a positive reading?

testing rectus femoris muscle length, patient in prone and if their heel cannot reach their gluteus (PROM) that is considered a positive reading

What are the Merck Index and the Physician's Desk Reference (PDR) ?

the 2 traditional drug references (used to look up drug info)

What creates the blood-brain barrier and why does it exist?

the CNS capillaries that have very tight junctions and a lack of fenestrations, the capillary basement membrane and astrocytes contribute. This exists to limit what enters the CNS and serves as a protective mechanism

Which traditional drug reference is considered to be for chemists and provides the full chemical name and structure of a drug?

the Merck

Which traditional drug reference is commonly seen in rehabilitation departments?

the PDR (Physician's Desk Reference)

How do zolpidem, zaleplon, and eszopiclone work in treating insomnia?

the affect the GABA receptor action (act on the benzo binding site of the GABA receptor) and only affect one part of the receptor, resulting in a specific action

How is the angle of torsion defined?

the angle between a line that runs through the femoral head and the neck, and a line that runs between the femoral condyles (rotation between the neck and shaft of femur)

Define angle of inclination:

the angle in the frontal plane between the neck of the femur and the medial side of the femoral shaft

You should hold acupressure or trigger pressure points ideally until:

the extinction of any pain pattern elicited, but no longer than 5 minutes or than your fingers can tolerate

Where is the primary location for non-fatal unintentional falls?

the home (inside the home and outside areas immediately surrounding the home)

What are trihexyphenidyl and benztropine?

the most commonly used anticholinergic drugs for treatment of parkinson's

What is pain behavior referring to?

the observed (potentially measurable) consequence of a painful experience that can be considered as a "distress" response

What determines the direction of gas exchange between the alveoli and the blood?

the partial pressures of gases

You should gauge massage pressure by:

the patient's tolerance

What is pain quality referring to?

the perception of nociception that is not directly measurable (self-reporting)

Definition of edema:

the presence of abnormal amounts of fluid in the extracellular tissue spaces of the body

What is phantom limb sensation?

the sensation that an amputated limb is still present

What must be true before drug testing can progress from phase I to phase II of a controlled clinical trial?

the testing did not reveal any major problems such as unacceptable toxicity

What is nuclear medicine?

the use of radiopharmaceuticals for diagnosis, therapy & research

What impact have lobbying groups had lately on the time required for a drug to be approved by the FDA?

their efforts have reduced this time -FDA is making an effort to get more drugs to market with less regulatory burden (more like Europe and Canada)

What do hydantoins do?

these are drugs that interfere with the movement of sodium across the membrane, thus stabilizing the membrane of the neurons. They may decrease K+ and Ca++ movement in higher doses

What are side effects of cholinesterase inhibitors?

these are rare... but: nausea, vomiting, loss of appetite and diarrhea

What do anticholinesterase drugs do? (picture)

these drugs block the break down of acetylcholine and thus are used for treatment of myasthenia gravis

How generally do antipsychotic drugs work?

they act on a subtype of the dopamine receptor, the D2 receptor located in the limbic system (inhibit D2 receptor)

How do Monoamine oxidase inhibitors (MAO) work?

they act on the MAO enzyme that normally degrades the amine neurotransmitter and removes it from the synaptic cleft (blocking enzyme results in more amine neurotransmitter in the synaptic cleft)

How do tricyclic antidepressants work?

they affect the concentration of both serotonin and norepinephrine

Why are interferon-based drugs helpful in treating MS?

they are thought to inhibit the immune system from attacking itself, and MS is considered to be an autoimmune disorder

What role to antipsychotics play in treating Alzheimer's?

they are used to control aggression and agitation (only to restrain patients for a brief period of time)

The newer antipsychotic drugs (atypical antipsychotic) work differently on the receptors how?

they are weak antagonists of the D2 dopamine receptors but strong blockers of the serotonin receptors (5-HT2 receptor)

How do immunosuppressors work?

they block the immune system from being able to attack cells from the person's body, but they also block the immune system from attacking foreign organisms

How do potassium channel blockers work?

they block the potassium channels in the neurons which makes the neuron more likely to fire and thus function better (potassium normally hyperpolarizes the cell, making it less likely to fire, thus blocking potassium will result in a neuron that is more likely to fire)

How generally do serotonin selective reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors and tricyclics work to treat depression?

they block the reuptake of neurotransmitters into the pre-synaptic neuron, which increases the amount of neurotransmitter in the synaptic cleft for a longer period of time, resulting in overstimulation of the post-synaptic neuron and a compensatory down regulation/desensitization of the post-synaptic receptors

How should you work on toe loading in prosthetic gait training?

they don't like to do this bc they feel like they're going to fall, watch them to make sure they load weight across the entire prosthetic foot surface

What is a surgical consideration for *dysvascular* amputee patients?

they often present w/ comorbidities, neuropathy, vascular compromise, infection or osteomyelitis

How do Cholinesterase inhibitors work?

they prevent the breakdown of acetylcholine (important in memory and reasoning)

In MRI imaging, what happens to atomic nuclei when the EM field is removed?

they realign to their resting state and release resonant energy this radio frequency signal is detected & processed into an MRI image

How are corticosteroids helpful in treating symptoms of MS?

they reduce inflammatory signals and thus will decrease the total time of the exacerbation and severity of symptoms

How does the thickness of the respiratory membrane affect gas exchange?

thicker membrane decreases gas exchange

What is the role of levodopa in the treatment of Parkinson's disease?

this molecule can cross the blood-brain barrier and reach the basal ganglia. This drug is then converted to dopamine in the brain where it can take action

What syndromes could you use a median nerve glide to help treat?

thoracic outlet syndrome and CTS

Who is compression contraindicated for (with edema management)?

those with ABI <0.5 -also possibly those with fluid volume overload

Which patients may benefit from compression to treat edema?

those with ABI between 0.8-1.1 (may tolerate moderate to firm compression)

What nerve(s) is/are affected by tarsal tunnel syndrome?

tibial nerve

COPD involves progressive degeneration of _______________.

tissue

What is the function of Pregabalin? What is its chemical structure similar to?

to bind to the calcium channels in the brain, inhibiting the role of calcium in the development of an AP has a chemical structure like GABA, but does not bind to same receptor

Why might a sunrise/tangential x-ray be taken?

to image the patellofemoral joint

Why might an open mouth x-ray be taken?

to image the upper cervical spine

Why must muscle length be preserved in an amputation?

to prevent contracture and atrophy

What is the goal of having a lymph system?

to return excess fluid and protein from interstitial spaces to the blood system

Name the amputation: disarticulation at MTP joint

toe disarticulation

How will a person with excessive anteversion walk when they are NOT compensating?

toe out

How will a person with excessive anteversion compensate with gait?

toeing in (to stabilize joint in acetabulum)

How should you give verbal commands when working on PNF patterns with a patient?

tone of voice should relate to what your goal is for using the PNF pattern. ex. loud & firm tone of voice for strengthening or soft tone for stretching

Valporic acid is a drug used to treat what types of seizures?

tonic-clonic and absence

Is airway obstruction leading to atelectasis or non-aeration of tissue a symptom of partial or total obstruction of airways with asthma?

total obstruction -air diffuses out into tissues -no new air to fill the space -section of lung collapses

What causes obstructive or resorption atelectasis?

total obstruction of airway

What structure of the respiratory system has: elastic tissue, smooth muscle cells, & C-shaped rings of cartilage

trachea

Where is air normally present in the body? (4)

trachea lungs stomach GI tract

chlorpromazine, fluphenazine, haloperidol, loxapine, molindone, thioridazine, thiothixene and trifluperazine are all generic names for what class of drugs?

traditional antipsychotic

Where should you train unstable patients on stairs?

training stairs in a rehab. gym, not on real stairs in a stairwell

Name the amputation: amputation of hand w/ preservation of wrist

transcarpal

What are the two main functions of the first order neurons?

transduction and transmission

Are hip flexion contractures more common in transtibial or transfemoral amputees?

transfemoral **** (almost every amputee)

Name the amputation: amputation through humerus

transhumeral

Name the amputation: resection through long axis of metacarpals

transmetacarpal

Name the amputation: amputation through long axis of all MT's

transmetatarsal

What is vibration in terms of massage techniques?

transmitting trembling motion from PT's hands onto tissue

What is the main purpose of the respiratory system?

transport oxygen into the blood and remove CO2 from blood

Over 70% of UE amputations are caused by:

trauma

Of the pediatric amputations that are acquired, what is the most common cause? Are they usually UE or LE? What % are unilateral?

trauma LE 90% are unilateral

Which types of amputations more commonly experience phantom limb pain or sensation?

traumatic or later in life less common in congenital

In which direction do x-ray beams travel in an AP image?

travel through the pt from anterior to posterior direction

How does stage II CRPS respond to treatment?

treatments can be effective but not as responsive as stage I CRPS

Reuptake of neurotransmitters: neurotransmitters can be taken back up into the presynaptic terminal as a common feature of neuronal signaling. This happens for recycled use of the neurotransmitters later on. What is a drug that acts on this step? (picture)

tricyclic antidepressants

amitriptyline and nortriptyline are generic names for what class of drug? What condition are these used to treat?

tricyclic antidepressants anxiety

amitriptyline, doxepin and imipramine are all generic names for what class of drug? What conditions can these be used to treat?

tricyclics anxiety or antidepressants

Stage 1 CRPS is associated with beginning signs of ______ changes

trophic

T/F: PNF is a technique that preceded the field of PT

true

T/F: PNF patterns have a functional relevance

true

T/F: an elderly person with dementia may resist personal care

true

T/F: conduction speed of large myelinated nerves is much faster than small myelinated nerves, and especially faster than unmyelinated nerves

true

T/F: contrast MRI allows for before and after contrast image comparisons

true

T/F: effleurage can have a physiological effect when moving from the periphery towards the heart

true

T/F: massage can build trust b/w pt and PT

true

T/F: massage can convey concern & respect for another in need

true

T/F: massage can energize or elevate mood

true

T/F: massage can increase pt's body awareness

true

T/F: massage can reduce stress & anxiety

true

T/F: most elderly people prefer to live as independently as possible in their own homes

true

T/F: one of the benefits of PNF is that it can be modified many different ways

true

T/F: phantom limb sensation is normal after an amputation

true

T/F: the PT should stay as relaxed as possible during massage application

true

T/F: the cause of phantom limb pain is unknown

true

T/F: the pt and PT must have understanding of prosthetic components and their functional implications

true

T/F: you can't do stair climbing using a walker with a platform attachment

true

T/F: you should drape patients during massage for modesty and warmth

true

T/F: you should focus on positioning of an amputee both in and out of bed

true

T/F: home modifications, such as stair climbers, offer only a partial solution

true (stair climber: moving chair on stairs like in the movie Up)

T/F: massage has been around for a long time

true -Eastern & Western medicine -Middle Ages -Rebirth in 16th cent. -Swedish Movement System 18-19th cent.

A test that is specific helps determine a:

true negative

A test that is sensitive helps determine a:

true positive

T/F: you should avoid going too low in the pectoral region

true, except with post-mastectomy

T/F: amputations are associated with psychological trauma

true, need for an extended period of adjustment

T/F: many kids who have a congenital amputations chose not to wear a prosthetic

true, they learn how to do everything without the limb, esp. UE amputations

Is it okay to talk with your patient during the massage?

try to keep conversations to a minimum

What disease can survive in dried sputum for weeks?

tuberculosis

What disease occurs more frequently in poverty and crowding?

tuberculosis Ex: prisons, war, malnutrition, alcoholism, chronic disease, immunodeficiency

What causes compression atelectasis?

tumor exerts pressure on part of the lung

When doing stair training with a walker, what should you do to the walker at the top of the stairs?

turn it around

Are amputations more common in men or women?

twice as common in men

Which type of DM is also called the "misfolding disorder"?

type 1

Which type of diabetes is formerly insulin *dependent*?

type 1

Which type of diabetes is usually juvenile?

type 1

What type of hypersensitivity is asthma?

type 1 -occurs in people with hypersensitive or hyperresponsive airways

Which types of diabetes can have a genetic predisposition?

type 1 and 2 (type 2 = multifactorial)

Which type of diabetes is formerly insulin *independent*?

type 2

Which type of diabetes usually has an adult onset?

type 2

The medial cord gives off what 2 major nerves of the UE?

ulnar median

Loss of thumb adduction (Froment's sign) is a clinical sign of damage to which nerve?

ulnar nerve

What nerve(s) is/are affected by compression on Tunnel of Guyon?

ulnar nerve

What nerve(s) is/are affected by cubital tunnel syndrome?

ulnar nerve

Which type of imaging creates anatomic images through sound waves?

ultrasonography

With what hand position is petrissage applied?

uni- or bi- manually with open "C" type position of the hand

Does a bilateral BKA or unilateral AKA increase the energy cost of ambulation more?

unilateral AKA

How long does stage III CRPS last?

unlimited amount of time

How long does scar maturation take?

up to 1 year

You should go up stairs leading with the (good/bad) LE and go down stair leading with the (good/bad) leg

up with the good, down with the bad

What are the names of the trunks of the brachial plexus? What root levels make up each trunk?

upper (superior) -made by C5 and C6 middle -made by C7 lower (inferior) -made by C8 and T1

Notes for acetylcholine

used by all motor axons from the spinal cord, plays important role in autonomic system, important in basal ganglia for controlling movement, implicated in development of Alzheimer's

What is an osteomyoplasty?

used in a *transtibial amputation* -osteoperiosteal flap (bone bridge) is harvested from the amputated tibia -flap is implanted, bridging the distal tibial & fibular ends -incision is closed over bone bridge

What is the point of the friction massage technique?

used to loosen/soften tight mm

What type of endogenous contrast agent is used in a functional MRI?

uses magnetic properties of deoxyhemoglobin

When can an amputee begin to wear a semi-rigid post-op dressing?

usually applied in the OR or PACU

Over 80% of LE amputations are caused by:

vascular disease or neuropathy

Pulmonary edema and pulmonary embolism are what kind of disorders?

vascular disorders

Which gait deviation is very common in transfemoral amputees?

vaulting

Lymphedema risk is increased in chronic ________ insufficiency

venous (creates phlebolymphedema)

The lymph system returns fluid to _______ system from the LE at the ______ venous angle

venous left

How well does stage III CRPS respond to treatment?

very resistant to treatment

When viewing a lateral x-ray film, in which direction will you view the patient?

viewed in the direction the x-ray beam traveled

When viewing an AP or PA x-ray film, in which direction will you view the patient?

viewed with pt facing the viewer in the anatomical position-- hands, feet & digits point upwards

Diffuse, poorly localized pain are characteristics of _______ pain

visceral

What chart is a helpful tool for a PT to determine if pain location may be due to a visceral origin?

visceral referred pain pattern table

Photographic qualities of an x-ray refer to the ________________ of the image

visibility

To assist with MCP flexion of joints 2-5, you would perform what kind of glide?

volar

To facilitate wrist extension, would you perform a dorsal or volar glide?

volar

Cardiac edema can be the result of one of two things?

volume overload (CHF) HTN

In a person with retroversion of the hip, how will their gait look when they are NOT compensating?

walk toe in

In a person with retroversion of the hip, how will they compensate during gait to make the joint more stable?

walk with toe out

Which lubricant for massage is used by most hospitals and clinics?

water-based lubricant

Why is it important to be able to recognize visceral pain as a PT?

we must be able to distinguish this type of main from musculoskeletal pain to know when to refer back to MD or advise patient to seek another treatment route

Once axillary nodes are removed (due to cancer) what further increases one's chance for lymphedema?

when chemo/radiation are added

When does the post-surgical phase after an amputation end?

when pt is provided with a definitive (not temporary) prosthesis

When guarding a patient during stair training, when should you move down a step?

when the pt is transitioning feet, you should stay still when the pt is moving

When is a definitive socket (permanent prosthesis) provided to an amputee?

when the volume of the residual limb has stabilized

What color is unexposed film on an x-ray?

white

Venous edema increases when?

with legs in dependent position

Medical treatment of one condition has the potential to:

worsen another condition

With stage 1 CRPS, movement affects pain how?

worsens it immobility of the limb serves as a protective position

Name the amputation: amputation of hand and carpals

wrist disarticulation

Define radiodensity

x-ray absorption capacity based on a substance's composition, density and thickness

A CT scan uses ________________ to produce cross-sectional images

x-ray attenuation

Can all unilateral BKA amputees be functionally independent?

yes, all of them can

Should you have the pt hang onto the handrail if they are using a cane on stairs?

yes, use whichever rail is available

Should you have the pt hang onto the handrail if they are using a walker on stairs?

yes, use whichever rail is available

How is a transverse CT scan read? (when you look at an image, which way are you looking at the person?)

you are always looking from the person's feet upwards

Traumatic amputations are more common among which population?

younger men

Can all bilateral BKA amputees be functionally independent?

younger patients can be

How do you isolate a muscle in MMT?

"can be done by putting muscles at a mechanical disadvantage, which is often built into the test position when testing a specific muscle"

What does an ulnar nerve injury look like?

"claw hand" Lean to radial side when you flex the wrist

A recent change in pharmacy is from the "one drug for all" concept to ___________________ instead.

"personalized medicine"

Classic Stacia-ism: (read)

"your first touch should be done with respect, you should address the skin, not invade it"

A high _____ is common in type 2 diabetes

% body fat

What happens in phase IV of a controlled clinical trial?

(a.k.a. postmarketing surveillance) -begins once drug is approved to market -monitor any problems that occur

What are the 7 steps for testing/mobilizing the *median* nerve?

(patient in supine) 1. shoulder depression 2. shoulder abduction (slight) 3. elbow extended 4. shoulder ER 5. supinate forearm 6. wrist and finger extension 7. contralateral cervical bending

What are the 7 steps for testing/mobilizing the *radial* nerve?

(patient in supine) 1. shoulder depression 2. slight shoulder abduction 3. elbow extended 4. shoulder IR 5. pronate forearm 6. flex wrist and fingers 7. contralateral cervical bending

What are the 7 steps for testing/mobilizing the *ulnar* nerve?

(patient in supine) 1. wrist and fingers extended 2. forearm supinated 3. elbow flexion 4. shoulder depression 5. shoulder ER 6. shoulder abduction 7. contralateral cervical bending

Fact or Myth: About 80-90% of patients return to work; the other 10% of people are never pain free no matter what is done

*Fact* most patients do want to get better and return to work/normal activities, some people are never pain-free and it is not known why

Fact or Myth: 6 months after an injury, 50% of the people that are still not back to work will never go back to work

*Fact* 6 months is a big landmark for PT goals to get patients back to work

Fact or myth: Within 2 months following an injury, the majority of patients get better regardless of intervention type or no intervention provided

*Fact* body will heal itself with time (to a certain extent), but some conditions can be recurrent in nature without treatment in acute state (LBP can become chronic and recurrent if not treated appropriately in the acute phase)

When is an instance where a PT might have some treatment plan for visceral pain? What is this type of pain called?

*centrally mediated pain* when visceral pain leads to chronic pain, this is something a PT can help treat

For the thumb, flexion and extension of the CMC joint involve the _________ (convex/concave) base of MCP in frontal plane moving on the ________ (concave/convex) surface of the trapezium. This means that the roll and glide happen in the ________ (same/opposite) direction

*concave* MCP *convex* trapezium *same* direction

For the prox and distal IP joints of digits 1-5, the ________ (convex/concave) base of the distal phalanx moves on the ________ (convex/concave) head of the proximal phalanx. This means that the roll and glide happen in the ________ (same/opposite) direction

*concave* base of distal *convex* head of prox *same* direction

For MCP joints 2-5, the ________ (convex/concave) base of the proximal phalanx moves on the _________ (convex/concave) head of the metacarpal. This means that the roll and glide happen in the _______ (same/opposite) direction

*concave* base of phalanx *convex* head of the metacarpal *same* direction

At the SC joint. retraction and protraction involve the __________ (convex/concave) clavicle moving on the __________ (convex/concave) sternum

*concave* clavicle moving on the *convex* sternum (manubrium)

The arthrokinematics of the humeroradial joint involve the _______ (convex/concave) head of the proximal radius moving on the _________ (convex/concave) capitulum of the humerus. This means the roll and glide happen in the __________ (same/opposite) direction

*concave* head of radius *convex* capitulum *same* direction

The arthrokinematics of the humeroulnar joint involve the _______ (convex/concave) ulna moving on the _______ (convex/concave) trochlea of the humerus. This means the roll and glide happen in the _________ (same/opposite) direction

*concave* prox ulna *convex* trochlea *same* direction

For the thumb, abduction and adduction of the CMC joint involve the _________ (convex/concave) base of MCP in sagittal plane moving on the ________ (convex/concave) surface of the trapezium. This means that the roll and glide happen in the ________ (same/opposite) direction

*convex* MCP *concave* trapezium *opposite* direction

At the SC joint, elevation and depression involve the ________ (convex/convace) clavicle moving on the _________ (convex/concave) sternum

*convex* clavicle moving on the *concave* sternum (manubrium)

Since the glenohumeral joint involves the _________ (convex/concave) humeral head moving on the __________ (convex/concave) glenoid fossa, the roll and glide happen in the ____________ (same/opposite direction.

*convex* humeral head moving on *concave* glenoid fossa, roll and glide in *opposite* directions

For the radiocarpal joints, the _______ (convex/concave) proximal carpal bones move on the _________ (convex/concave) distal radius. This means that the roll and glide happen in the __________ (same/opposite) direction

*convex* proximal carpals *concave* distal radius *opposite* direction

Are amputation rates due to cancer currently increasing or decreasing? Why?

*decreasing*, due to earlier diagnoses, improved chemo and limb salvage/ reconstruction techniques

The infraspinatus, teres minor and subscapularis muscles all _______ (elevate/depress) the humeral head

*depress* humeral head (inferior glide)

What is axonotmesis? What happens to the nerve? What typically causes it? What will happen in healing?

*disruption of the neuronal axon* takes place but the *myelin sheath is still intact*. Typically caused by a *crush based injury* and not a laceration. If the neuronal tubules are maintained in place, *regeneration and restoration of sensory or motor ability may return*

The infraspinatus and teres minor _______ (internally/externally) rotate the humerus

*externally* rotate

T/F: ultrasonography imaging is only used in OB/GYN practice

*false* -it is also useful for imaging musculoskeletal tissue -can be used during a physical exam & w/ active, functional activity

T/F: orthopedic hardware is ferromagnetic and cannot undergo MRI imaging

*false* but surgical clips usually are and pacemaker fxn can be compromised in MRI imaging

What is petrissage?

*kneading*-- compress & release movements

What is a T1 MRI image?

*longitudinal magnetization*: -how long it takes protons to "relax" back to a resting state after an RF pulse

The clinical application of PNF techniques focuses on _______ contact and ________ commands

*manual contact* -use of good body mechanics is key -use manual contact over mm that are working *verbal commands* -learn motor sequence -enhance motor output

Venous edema can be classified as what? Describe each breifly

*mild*: when associated with uncomplicated varicose veins *moderate*: edema with perforator involvement *severe*: edema is usually associated with acute deep system blockage

Do most bilateral AKA amputees use a prosthetic?

*no*

Should you get medical imaging done for a patient over the age of 50 with acute low back pain that has no signs of systemic disease?

*no*, symptomatic therapy is appropriate

Barbiturates are best used on what types of seizures?

*partial and generalized tonic-clonic* do not work well on absence and atonic seizures

What is bronchiectasis?

*permanent dilation of the medium-sized bronchi*

Visceral organ pain is often "________" to or felt in another _________ structure distant or near the source of visceral pain

*referred* to or felt in another *somatic* structure

The supraspinatus muscle controls the ______ (superior/inferior) roll of the humerus, seats the head of the humerus in the ______ fossa, and prevents excessive __________ (superior/inferior) translation

*superior* roll of the humerus *glenoid fossa* *superior* translation

Like in any joint, the roll and glide must happen at the same ________ to keep the joint articulated

*time* roll and glide happen simultaneously

What is a T2 MRI image?

*transverse magnetization*: -how long resonating protons remain "in phase" or oriented following a RF pulse

T/F: ultrasonography imaging is included in PT practice

*true* but should only be used to confirm a diagnosis

T/F: ultrasonography is operator dependent

*true* good technique requires practice

Review of symptoms for MS:

*weakness* *tingling* numbness/impaired sensation poor coordination *fatigue* balance problems visual disturbances *blurred vision* involuntary rapid eye movements tremors spasticity muscle stiffness

What color is contrast media on an x-ray?

*white* outline

Should you get medical imaging done for a patient over the age of 50 with acute low back pain and signs of systemic disease?

*yes*, conventional x-ray and simple lab testing can almost completely rule out underlying systemic disease

On the ART scale what do + and - mean after the number score?

+ means less than half ROM with a certain resistance - means more than half ROM with a certain resistance

Effleurage can allow the PT to "listen" to their hands to search for:

-"hot spots" -edema -tightness -other injuries

What would clinical presentation look like if someone has damaged the sciatic nerve?

-"sciatica" pain radiating to posterior thigh and leg; atrophy of posterior thigh, leg/calf and foot -weak knee flexion, loss of ankle and foot control affecting all phases of gait -sensory loss of lateral and posterior leg, lateral and posterior lower leg, and part of the foot

How do you bill for massage?

-*CPT 97124*: effleurage, petrissage, tapotement -*CPT 97140*: CT massage, joint mobilization & manipulation, manual traction

What are some examples of nuclear medicine?

-*SPECT*: single-photon emission computed tomography -*PET*: positron emission tomography -PET/CT and SPECT/CT -*bone scan*: radionuclide scintigraphy

Short Summary of Key Points of Imaging Types: (read)

-*X-rays* are usually the first order modality -*CT* is used to visualize complex anatomy -*MRI* is used to assess soft tissue

Which structures appear dark and which appear bright in a T1 MRI image? (read)

-*bright*: fat (bone), subacute hemorrhage, necrosis -*dark*: high water content (edema, tumor, infarction, infection, chronic hemorrhage)

Which structures appear dark and which appear bright in a T2 MRI image? (read)

-*bright*: high water content -*dark*: bone, fat, calcification, fibrosis, blood -useful for imaging CSF and edema

What are some management guidelines for a peripheral nerve injury in the *chronic* phase of healing? (2)

-*compensatory function* (compensatory function minimized during recovery BUT is emphasized when full neurological recovery does not occur) -*preventative care* (emphasis on lifelong care to involved region) (reinnervation potential peaked w/ minimal or no signs of neurological recovery)

What are some post-op complications of amputations?

-*contracture* -swelling -phantom limb sensation or pain -personal grief and depression surgical complications: pain, infection, respiratory compromise, DVT, etc.

What is the difference between extrinsic and intrinsic asthma?

-*extrinsic*: acute episodes triggered by type 1 hypersensitivity rxn to an allergen -*intrinsic*: hyperresponsive tissue in airway initiates an attack. stimuli include: stress, cold, exercise, drugs, etc.

What are some management guidelines for a peripheral nerve injury in the *acute* phase of healing? (4 - immediately after injury OR surgery)

-*immobilization* (time dictated by surgeon) -*movement* (amount and intensity dictated by type of injury and surgical repair -*splinting or bracing* (to prevent deformities or tension on the injured side) -*patient education* (protection of the injury site)

What are some management guidelines for a peripheral nerve injury in the *subacute* phase of healing? (3)

-*motor retraining* (hold in shortened position, electrical stim / short pulses) -*desensitization* (multiple texture for sensory stimulation and vibration) -*discriminative sensory reeducation* (identification of objects with, then without visual cues) (signal of reinnervation - muscle contraction and increased sensitivity)

Starting with the hip in 90 degrees of hip flexion, which way does the femoral head glide with hip extension (open chain)?

-------- (does not apply?)

Evidence for massage: slide 5 (read)

-10 trials reviewed for effectiveness of diff types of massage on fibromyalgia -MFR: large, positive effects on pain, medium effect on anxiety/depression--- moderate evidence it's beneficial for FM -Swedish massage: not effective

How successful was the 19__'s method of traveling to South America to find new plants and trying to isolate any active compounds within them?

-1950's -very low success rate -what little success it did have was based on shear luck

Through the 19__'s, most drug discoveries were based on the identification of ___________ with medicinally active compounds.

-1970's -plants

What are the 5 points of the "functional position of the hand"?

-20-30 degrees of extension -slight ulnar deviation -35-45 degrees of MCP flexion -15 to 30 degrees of PIP and DIP flexion -35-45 degrees CMC abduction

What do CV drugs, psychotropic drugs and NSAIDs all have in common?

-3 most commonly involved in drug-related illnesses -3 most commonly prescribed in the elderly

It is estimated that only ______ in 5,000 compounds make it to human testing, and only ______ of them may be safe & effective enough to reach pharmacy shelves.

-5 in 5,000 -only 1 of the 5

What causes bacterial pneumonia? What about viral pneumonia?

-B: resident bacteria spreading along mucosa -V: direct virus

4 risk factors for gestational diabetes:

-BMI > 30 -prior baby > 10 lb -prior gestational DM -family history of DM

2 therapeutic interventions for diabetic nephropathy:

-BP control (ACE inhibitors) -dietary protein restriction

What are treatment options for breast cancer related lymphedema?

-CDT -lymph anastomoses (surgical) -mechanical pneumatic pumps

If PCO2 increases, how does the body realize that its in a state of respiratory acidosis? How does the body then try to compensate?

-CO2 can now easily diffuse into the CSF -this lower the pH and stimulates the respiratory center -results in inc rate & depth of respirations (hyperventilation) which would inc the pH back to normal

Which conditions increase your risk for PVD and amputation?

-DIABETES -obesity -HTN -HLP -nephropathy

What are some PT interventions to treat phantom limb pain?

-E-Stim and US -mechanical stimulation: massage, percussion & vibration -desensitization & reprocessing -exercises -biofeedback: mirror box therapy, immersive virtual reality -(counseling)

What are the 3 main divisions of the ear?

-External -Middle -Inner

Types of plasma glucose tests:

-Fasting -Random during the day if a person has severe symptoms -oral glucose tolerance test -hemoglobin A1C (HbA1C)

Glenohumeral joint

-Greatest loss of lateral rotation -moderate loss of abduction -minimal loss of medial rotation

What are symptoms of AIDS?

-HIV positive -immune deficiency (low CD4) -fatigue -low grade fever -cachexia -weight loss -shortness of breath -occasional colds leading to pneumonia -gynecological infection

What are some structures of the external ear?

-Helix (outer rim) -Lobule (only part without cartilage) -Antihelix -Tragus -Antitragus -Concha (entrance into ear canal) -Incisure terminalis (surgically important because an incision can be made here without damaging the cartilage or perichondrium)

What is the name of a grade I nerve injury? What is the disrupted element? What is the expected return for function if not repaired?

-I: Neuropraxia -Nerve conduction disrupted -Complete return expected within hours to weeks

What is the name of a grade II nerve injury? What is the disrupted element? What is the expected return for function if not repaired?

-II: Axonotmesis -axon disrupted (w/o myelin sheath involvement) -complete return expected at 1 mm/day (takes weeks or years)

What are the different types of post-op dressings after an amputation? (read)

-IPOP (rigid) -rigid removable -semi-rigid -soft

What happens with gestational diabetes?

-Inc. glucose levels leads to reduced insulin sensitivity (bc pregnancy hormones interfere w/ the action of insulin, allowing extra glucose to pass to the fetus) -the pancreas doesn't cope w/ higher demand for insulin

What happens with Type 2 diabetes?

-Insulin is produced but the body doesn't respond to it (relative insulin deficiency)

What conditions can cause pulmonary edema? (4)

-L sided CHF (leads to HBP) -hypoproteinemia (liver or renal disease = dec osmotic pressure) -inflammation in lungs -blocked lymphatic drainage

Evidence for massage: slide 6 (read)

-MFR effectiveness at treating orthopedic conditions -10 studies reviewed -evidence was mixed in quality and results, some studies found little to no effect

What does complete decongestive therapy (CDT) consist of?

-MLD -compression bandaging -remedial exercise -meticulous skin and nail care -instructions in self-care

What are some examples of trauma that often lead to amputation?

-MVA -combat -severe burn -electrocution

What is contained in the middle ear?

-Ossicles (malleus, incus, stapes) -Eustachian tube -Mastoid air cells

What syndromes could you use a radial nerve glide to help treat?

-PINS (post interroseous nerve syndrome) -tennis elbow -deQuervain's syndrome

What does the binding and release of oxygen to Hb depend on? (4)

-PO2 -PCO2 -temperature -plasma pH

What is contained in the external ear?

-Pinna -Ear canal -Tympanic membrane

What are the 3 layers of the ear drum?

-Strat. squamous epithelium (lateral/external surface) -Fibrous layer with circular and radial fibers (pars tensa and pars flaccida) -Mucous (respiratory) epithelium

What's the difference between transudative and exudative pleural effusions?

-T: watery effusion (hydrothorax, inc hydrostatic or dec osmotic pressures) -E: contain proteins & WBC (response to inflammation)

In combination lymphedema, is the following normal, increased or decreased? -transport capacity -lymphatic load How do you treat this type of lymphatic failure?

-TC: decreased -LL: increased Treat with CDT

In mechanical lymphedema, is the following normal, increased or decreased? -transport capacity -lymphatic load How do you treat this type of lymphatic failure?

-TC: decreased -LL: normal Treat with CDT

In dynamic edema, is the following normal, increased, or decreased? -transport capacity -lymphatic load How do you treat this type of lymphatic failure?

-TC: normal -LL: increased (like with acute injury) Treat with RICE

In hemodynamic edema, is the following normal, increased or decreased? -transport capacity -lymphatic load

-TC: normal/decreased -LL: increased due to R ventricular failure

Which 2 muscles of the middle ear function as shock absorbers?

-Tensor tympani -Stapedius

What is capable of destroying mycobacterium tuberculosis?

-UV light, heat, alcohol, glutaraldehyde, formaldehyde

What is the name of a grade V nerve injury? What is the disrupted element? What is the expected return for function if not repaired?

-V: neurotmesis -epineurium disrupted (axon and surrounding myelin/soft tissue) -none or difficult return of function if not repaired

What are 3 theories for the cause of CRPS?

-abnormal activity of the SNS -gate control theory (imbalance between normal receptors and nociceptors) -reflex muscle spasm *all deal with abnormalities in the sympathetic NS*

How is CO2 transported in the blood? (3)

-about 20% bound to Hb -about 7% dissolved in plasma -MOST diffuses into RBC's

The neurological drugs can act where? (7)

-action potential -synthesis of neurotransmitters -storage of neurotransmitters -release of neurotransmitters -reuptake of neurotransmitters -degradation of neurotransmitter -postsynaptic receptor

Evidence for massage: slide 2 (read)

-active release & joint mobs had sig changes in VAS & ROM pre and post intervention -sig difference in pressure pain thresholds for all muscles in active release group vs. all muscles but traps for joint mobs group -only 24 subjects

What may cause damage to the axillary nerve?

-acute dislocation -fractures of the humerus neck

The FDA realizes 15 years is too long to wait for some drugs to reach market. What effort did they make to help alleviate this problem?

-added a new way to categorize drugs as either standard or priority -*standard*: provides minor improvements over an existing drug -*priority*: believed to have advances in health care & move more quickly through the approval process. Still have to go through 3 phases of human testing

What are some trophic skin changes that take place in stage II CRPS?

-affected limb is edematous and cool -hair loss -cracked, brittle nails -motor changes

When is the vibration massage technique used?

-after deep pressure of a trigger point -for joints after deep stroking

How is the type of prosthesis chosen for an amputee?

-age -activity level -job demands -funding -compliance

According to the Ottowa Knee Rule, a conventional x-ray should be ordered if:

-age over 55 OR -tenderness at fibular head OR -isolated tenderness of patella OR -inability to flex knee to 90 deg OR -inability to walk 4 WB steps immediately after injury in the emergency department

According to the Pittsburg Decision Rule for Knee Trauma, a conventional x-ray should be ordered if:

-age under 12 or over 50 AND/OR: -inability to walk 4 WB steps in the emergency deparment

How does dementia affect treatment behaviorally?

-agitation or aggression -depression -lack of motivation -other abnormal behaviors

Airflow during inspiration and expiration depends on __________________ gradient. This is known as _____________ law.

-air pressure gradient -Boyle's law

What should you keep in mind when positioning a patient for a massage?

-allow greatest access to target area -pt comfort

What teaching strategies can you adapt to the pts cognitive level?

-allow inc processing time -take into account for after images -promote the formation of short-term memory

What is the trade name of a drug?

-also called brand name or proprietary name -assigned by pharmaceutical company -identifies drug as exclusive property of the company -usually does not relate to chemical nature of drug, but is catchy & easy to remember

How does emphysema lead to decreased recoil?

-alveolar walls are destroyed due to breakdown of elastin -causes large, permanently inflated alveolar air spaces -leads to decreased recoil

How do you treat a pleural effusion? (4)

-analyze fluid to confirm cause -remove underlying cause -remove fluid & relieve pressure -treat respiratory impairment

How do you prevent a pulmonary embolism? (2)

-assess risk factors -anticoagulants to prevent thrombosis

What is a secondary pneumothorax?

-associated with underlying resp. disease -Ex: rupture of a bleb on lung, erosion by tumor, tubercular cavitation

2 underlying causes of macrovascular complications of diabetes:

-atherosclerosis -HTN

What would clinical presentations look like in a patient who has damaged their musculocutaneous nerve?

-atrophy along the flexor surface of the arm -weakness of elbow flexion with forearm supinated -sensory loss to radial side of forearm

What is some specific info you should give a patient for preventative care if they have loss of sensation in an *upper limb* following a nerve injury?

-avoid handling cold, hot, sharp or abrasive objects -redistribute hand pressure by building up the size of the handles -avoid sustained grasps -wear protective gloves

How do you treat emphysema?

-avoid resp. irritants (smoking) -breathing techniques -immunizations for flu & pneumonia -antibiotics -bronchodilators -O2 therapy -adequate nutrition -lung reduction surgery

Describe some activities you could do to work on balance training after an amputation:

-balance COG over the sound limb in parallel bars to get used to the loss of weight of limb -PT initially provide confidence during stand-pivot transfers and ambulation w/ AD -be able to balance on their own for at least 0.5 seconds

What are some general principles of treatment for a peripheral nerve? (read?)

-be more gentle if pt condition is very irritable -stretch force applied to tissue resistance slower then held for 15-20 sec, released, then repeated 3-5x -neuro symptoms should not last when the stretch is released -positioning the patient at the point of tension (symptoms just begin), passively move one joint at the time to further stretch tissue -move the joint where the nerve is trapped at the end and carefully, respecting the symptoms

When tissues are damaged, the chemicals released into tissues have what effects? -bind to? -activate? -release? -result?

-binding of substance to specific receptor -activation of ion channels for depolarization -activation of other receptors and intracellular messenger systems -release of neuropeptides from neurons -vasodilation of vessels and edema

What are some treatment techniques that can be used in PT for CRPS?

-biofeedback -imagery? -behavioral modification -desensitization -edema control -TENS -soft tissue mobilization -thoracic mobilization (sympathetic input) -exercises for ROM and activity (not for strengthening) -mirror therapy (trick your brain)

What is the background of DM?

-body = unable to use glucose as a fuel molecule to produce ATP -cells can't uptake glucose due to insulin signaling impairement

How can pain be documented subjectively? (3)

-body chart (location and description) -intensity of pain -behavior of pain (over 24 hr period)

What respiratory changes take place with aging?

-breathing takes inc work -easy fatigue w/ effort

What are some causes of amputations other than trauma or vascular disease/neuropathy?

-cancers (esp. bone cancers in kids) -infection -congenital limb defects

What are things that cause disruption to normal fluid exchange at the capillary level?

-capillary permeability change -capillary hydrostatic pressure -injury to the tissue -obstruction to the lymph system

How is pneumonia classified? (4 categories)

-causative agent (viral, bacterial) -infection location(1 lung, 1 lobe) -pathophysiologic changes -epidemiologic data (nosocomial, community)

Where are central and peripheral chemoreceptors located?

-central: medulla -peripheral: carotid bodies, aortic body

Is pneumoconioses an acute or chronic condition? Is its onset rapid or insidious?

-chronic -insidious

What are 2 symptoms of bronchiectasis?

-chronic cough -production of a lot of purulent, foul-smelling sputum (1-2 cups per day) Ew...

What are precautions for therapeutic massage?

-chronic fatigue syndrome -fracture sites -osteoporosis -hypersensitive to touch -DM -complicated pregnancy -HTN -asthma -alcoholism -psychiatric illness -open lesions -kids w/ shunts (must elevate head)

Considerations for the elderly in PT treatment of pain (read):

-chronic pain common in older persons -1/5 of all elderly take analgesics regularly -45% of elderly that take pain meds have been seen by 3+ Drs in past 5 yrs -45-80% of nursing home patients have substantial pain that is undertreated -follow Americal Geriatrics Society Clinical Practice Guidelines for management of chronic pain in elderly

Things to know about compressogrip (read):

-circular knit, tubular stocking -ABI should be *0.8* or greater -moderate compression appropriate for venous insufficiency and edema associated with trauma in patients tolerating exercise rehab -20-30 mmHg

Evidence for massage: slide 1 (read)

-classified as low to very low evidence for effectiveness of massage to treat LBP -improvements in pain & function only existed in ST follow up

What are some challenges with geriatric rehab.? (7)

-comorbidities -dementia -education -multiple meds -dehydration/malnutrition -falls -geriatric syndrome

Evidence for massage: slide 3 (read)

-compared soft tissue mobs & PNF to ultrasound as control to treat shoulder impingement -sig improvement in pain reduction, ER and OH reaching in a single intervention -only 30 subjects

What are the goals of PT in the post-surgical phase after an amputation? (after surgery, before prosthesis)

-compression -ROM -positioning -endurance

What are mechanisms of injury for nerve injuries?

-compression/crush -laceration -stretch -radiation -electricity

What are the most common symptoms of inflammation? (6)

-constant pain -redness -heat -edema -tenderness of the affected area -limitation in function

Whare are some measure to take to treat acute asthma attacks?

-controlled breathing techniques -inhalers (bronchiodilators) -glucocorticoids

What are symptoms of pulmonary edema? (5)

-cough -orthopnea (SOB lying down) -rales -hemoptysis (cough up blood) -frothy, blood-tinged sputum ... Ew

What are some symptoms of asthma?

-cough -shortness of breath -tight feeling in chest -wheezing -rapid & labored breathing -expulsion of thick/sticky mucus -tachycardia

List some symptoms of pneumonia

-cough (may have green, yellow or bloody mucus) -fever -chills -headache -sharp chest pain -excessive sweating -clammy skin -loss of appetite -low energy -fatigue

What are some examples of specific friction massage techniques?

-cross-fiber -rolling -wringing

What may cause damage to the radial nerve?

-crutch palsy or saturday night palsy (compression site being radial sulcus) -posterior interroseous nerve syndrome (PINS) - (compression sites being radial head, ECRB and supinator)

What may cause damage to the ulnar nerve?

-cubital tunnel syndrome or compression in the Guyon's canal (GCS)

What are some benefits of exercise? (read)

-dec fear of falling -inc ROM, strength, endurance -dec depression -dec sleep disorders

What musculoskeletal changes take place with aging?

-dec muscle mass -dec bone density -changes in articular cartilage -variable resistance to manipulation

What changes seen in aging lead to undernutrition?

-dec sense of taste -dec sense of smell -loss of vision/hearing -dental problems -altered energy needs -dec physical activity -muscle loss -psychosocial (isolation) -environmental (financial)

How does having comorbidities affect the following (inc or dec): -rate of functional gains achieved w/ rehab -length of hospital stays -adverse health outcomes -preventative care -treatment for each condition -treatment intensity

-decreased -increased -increased -decreased -decreased -decreased

A deficiency of what substance can lead to emphysema? Why?

-deficiency of alpha1-antitrypsin -inhibits elastase from breaking down elastin

What are some physiological conditions that cause nerve root injury via compression (not trauma)?

-degenerative disc disease -degenerative joint disease -spondylolisthesis -spine deviations (all lead to narrowing of intervertebral foramen)

What are some contraindications for prosthetic use?

-dementia -institutionalization -advanced cardiopulm. or neuro. disease -bilateral transfemoral amputations w/ inability to transfer or stand -unacceptable energy expenditure for ambulation

What does the therapeutic category of a drug tell us?

-describes what effect the drug is expected to have (Ex: diuretics) -includes side effects of a drug

What is drug design?

-designing drugs to alleviate illnesses based on factors that cause certain illnesses -became popular in the 1970-80's

What reflexive effects does massage have on capillaries?

-determined by amt of pressure- 1st: white rxn (blanching) 2nd: red rxn (inc blood flow)

2 most common types of diabetic neuropathy:

-diabetic peripheral neuropathy (DPN) -autonomic neuropathy

What are some examples of medical conditions that can cause dehydration? (read)

-diarrhea -vomiting -heat stroke -high blood sugar -infections -excessive exercise

Comorbidities often result in increased: (3)

-disability -hospitalization -mortality

What is cor pulmonale?

-disease of lungs that causes R sided heart enlargement -can be caused by COPD

What may medical management of edema include?

-diuretics -dialysis -fluid restriction -albumin management

Which 2 classes of medications often have the side effect of dehydration?

-diuretics -laxatives

What are 4 side effects of sedatives and anti-histamines?

-drowsiness -balance problems -risk for falls -delirium

What happens in phase II of a controlled clinical trial?

-drug is given to people w/ condition the drug is intended to treat -but only to a few patients -if this goes well, progress to phase III

What happens in phase I of a controlled clinical trial?

-drug is given to small # of healthy volunteers. -assess most common acute adverse effects and examine doses that patients can take safely w/out high amt of side effects

When can a trade name exist for a drug but not a generic name?

-during the time that the drug is under patent -would happen if the original company decided to use a trade name

What are 4 different types of lymphatic failure? Which is considered edema or lymphedema?

-dynamic (edema) -mechanical (lymphedema) -combination (lymphedema) -hemodynamic (cardiac edema)

List some symptoms of emphysema

-dyspnea -hyperventilation w/ prolonged expiratory phase (barrel chest) -"pink puffers" (pink face color) -clubbed fingers -anorexia, fatigue, weight loss -secondary polycythemia (compensatory inc RBC)

What are symptoms of ARDS?

-dyspnea -restlessness -rapid, shallow breaths -inc HR -dec PO2 -combination of resp. & metabolic acidosis

What cardiac changes take place with aging?

-easy fatigue w/ effort -inc BP response -orthostatic hypotension

What are indications for therapeutic massage? (12)

-edema (localized) -skin tone -pulmonary congestion -adaptive shortening -muscle imbalance -altered ROM -neural tension -hypermobility -loss of tissue extensibility -inc wound healing -dec/*prevent adhesions* -to relax muscles

What are contraindications for therapeutic massage? (8) (not including precautions)

-edema from total system failure -acute inflam edema -site of suspected clot or aneurysm -tumors -over open lesions/conditions that spread -abnormal abdominal mass -non-union fracture -graft sites

A new compound is typically tested on isolated cells in culture. This allows the investigator to identify what aspects about the drug? (2)

-effect of the drug at a cellular level -determine dose at which the drug is toxic to cells

Which type of massage strokes are considered inhibitory or relaxing?

-effleurage -petrissage (slow, long, rotational strokes)

What does lung compliance depend on? (3)

-elastic properties of the tissue -alveolar surface tension (amt of surfactant) -thorax anatomy & flexibility

What can you do regarding positioning to help with edema?

-elevation of affected extremity above heart -prevention of tourniquet effect -avoid prolonged sitting and standing with inactivity -elevating legs in the seated position will not decrease edema but prevent worsening

Which respiratory condition involves the destruction of alveolar walls and septae? This is due to the breakdown of what substance?

-emphysema -elastin (elastase breaks down elastin, have to inhibit this enzyme to stop the breakdown causing emphysema)

How do you treat pneumoconiosis?

-end exposure to irritant -treat infection

Wrist

-equal loss of flexion and extension, slight loss of ulnar and radial deviation

Forearm

-equal loss of supination and pronation, only occurring if elbow has marked restrictions of flexion and extension

What does Starling's Equillibrium state?

-equillibrium between fluid forced out of the capillaries and the fluid absorbed back in -filtration is greater than re-absorption at the arterial end -re-absorption is greater than filtration at the venous end

Signs/symptoms of DM:

-extreme thirst -frequent urinating -feeling v hungry even when eating -extreme fatigue -blurry vision -cuts/bruises that are slow to heal -weight loss even though eating more (type 1) -tingling/pain/numbness in hands/feet (type 2) -hyperglycemia

What are some risk factors for developing a fear of falling?

-fair/poor perceived health -feeling unsteady -having 2+ falls

What things does the lymph system transport?

-fat - (cancer?) cells -protein -water -waste products -other foreign substances (bacteria) -hyaluronan?

How is trigger point massage done?

-find tender area -usually no lubricant -apply pressure w/ finger or thumb -duration: 1-5 min/point

What is the difference between the first and second group of restrictive lung disorders?

-first: abnormality of chest wall, limits or impairs lung expansion -second: diseases affecting the supporting framework of lungs, not alveoli or airways

What are *motor* symptoms of mixed peripheral nerve lesions (axonotmesis or neurotmesis)?

-flaccid paralysis -loss of reflexes -muscle wasting and atrophy -lost synergic action of muscles -fibrosis, contractures and adhesions -joint weakness and instability -dec range of motion and stiffness -disuse osteoporosis of bone -growth affected

Where can extracellular fluid be located?

-fluid in blood vessels (plasma) -interstitial fluid

What would a clinical presentation for damage of the common peroneal nerve possibly look like? (motor and sensory)

-foot drop (deep nerve) -eversion weakness (superficial nerve) -gait impairment during the load response with foot slap, excessive hip flexion to clear toes -sensory loss at anterior-lateral or lower leg and dorsal part of the foot

3 other complications of diabetes:

-foot probs -ketoacidosis -Alzheimer's

Things to know about Unna's boot (read)

-for treatment of dependent edema -mild compression accomplished by adding Coband as top layer -18-24 mmHG

When is a granuloma formed? What is it made of?

-formed if cell-mediated immunity is adequate in the primary stage of TB -bacteria is walled off by CT -has a necrotic center -tubercle forms and calcifies -calcified tubercle microbes can remain viable in a dormant stage for *years*

What is the purpose of a limb sock?

-friction absorption -fill socket volume -absorbs sweat

What are the residual limb requirements to be able to use a prosthetic?

-fully healed incision -no signs of infection -no drainage from incision site -*ability to tolerate WB* -frequent skin inspection

How should you prepare to give a therapeutic massage?

-gather materials -wash hands -remove your rings, watches, etc. -remove patient jewelry -wear loose clothing -pt remove as much clothing as is comfortable, but all clothing should be removed for full body massage

When examining a pt in a differential diagnosis screen, the PT should ask what questions relating to associated signs and symptoms if they suspect visceral referred pain?

-general health questions -questions unique to each organ system (endocrine, pulmonary etc.) to locate the pain

What causes a deficiency of alpha1-antitrypsin? (3)

-genetic mutation -smoking -environmental pollutions

If a patient, even a ___________ pt , has stairs and potential to reach indepedence on stairs, progression to use of _____________ might be more functional than a walker

-geriatric pts -axillary crutches

The neurotransmitter category of amino acids includes what neurotransmitters?

-glycine -GABA -glutamate -aspartate

Things to know about garmets for compression (read):

-gradient pressures -8-50 mmHg -compression based on ABI, severity of edema and patient tolerance -removed at night and cleaned

What are the different ways you can apply resistance during PNF techniques?

-gravity -manual resistance (prox/distal hand placement) -other means of resistance

Hip

-greatest loss of medial rotation and flexion -some loss of abduction -slight loss of extension -little or no loss of adduction and lateral rotation

What types of prosthetics do UE amputees often use?

-harnesses -body-powered cable control systems -myoelectric control systems are becoming more common

More PT treatment considerations for CRPS (read)

-have patient make a plan and write it down -start with low baseline and build up tolerance -do small amounts often rather than all at once -avoid prolonged activity and prolonged rest -motivation; hurt does not equal harm -movement is the key - general exercises, aerobic activity -weight bearing exercises -aquatic therapy -patient must participate

3 macrovascular diabetic complications:

-heart attacks -stroke -PAD (peripheral artery disease)

What is the point of effleurage?

-helps apply lubricant -inc superficial venous return -accustoms pt to touch

How does DEXA work? What does it measure?

-high & low energy *x-rays* are directed at bone from *2 sources* -the difference in *absorption* b/w the beams is used to determine bone density

D1 extension of the LE: -hip -knee -ankle -toes

-hip: extension, abduction, IR -knee: either -ankle: plantarflexion, eversion -toes: plantarflexion exact opposite of LE D1 flexion

D2 extension of the LE: -hip -knee -ankle -toes

-hip: extension, adduction, ER -knee: either -ankle: plantarflexion, inversion -toes: plantarflexion exact opposite of LE D2 flexion

D2 flexion of the LE: -hip -knee -ankle -toes

-hip: flexion, abduction, IR -knee: either -ankle: dorsiflexion, eversion -toes: dorsiflexion

D1 flexion of the LE: -hip -knee -ankle -toes

-hip: flexion, adduction, ER -knee: either -ankle: dorsiflexion, inversion -toes: dorsiflexion

What are some chemicals that are released into tissues after tissue damage that cause pain? (6)

-histamine -serotonin -bradykinin -acetylcholine -prostaglandins -cytokines

What are 2 side effects of diuretics?

-hypotension -incontinence

What 3 pH imbalances can take place due to asthma?

-hypoxia leads to... -initially: respiratory alkalosis due to hyperventilation -then: respiratory acidosis due to dec ventilation -then: metabolic acidosis due to dec in metabolism and inc in lactic acid -finally: respiratory failure

Things to know about Profore (4 layer compression wrapping) (read?)

-ideal for venous insufficiency wounds with heavy drainage -mimics high working pressure and low resting pressure for tolerance at night -*used mostly in presence of ulcerations* -ABI should be *0.8* or greater -30-40 mmHg

Why is animal testing done before releasing a new drug? (3)

-identify the potential of the drug -identify side effects -determine a safe dose

What may cause damage to the median nerve?

-impingement in hypertrophied pronator teres (pronator syndrome) or CTS

Why should PT's study diagnostic imaging? (6)

-improves PT/MD communication -improves PT evaluations -guides PT treatment plans -increases PT autonomy -emerging interest in manual orthopedic techniques -advancing imaging technologies

How does venous edema lead to ulcers?

-inc pressure in veins due to insufficient return causes leakage of fluid into interstitial space -edema and blood products cause inflammation -inflammation leads to skin failure

Summary of how retroversion of the femur affects the structural alignment of the hip joint:

-increased hip external rotation -femoral head sits more posteriorly in the joint *compensate with gait by toeing out

Summary of how excessive anteversion of the femur affects the structural alignment of the hip joint:

-increased hip internal rotation ROM -decreased hip external rotation ROM -decreased joint stability due to more joint exposure anteriorly -decreased mm lever arm - increased joint forces *compensate with gait by toeing in

What causes alteration in capillary permeability?

-increases with vasoactive substance (histamine) release -increase or decrease in tissue temp

How do you diagnose primary stage TB?

-indicated by a positive tuberculin (skin) test results -*type 4* hypersensitivity because it is cell-mediated -could also look for calcification on an x-ray

Things to know about short-stretch bandaging (read):

-inelastic/stretch less than 100% -cotton -Unna boot -ABI of *0.8* or greater -20-50 mmHg

Secondary Lymphedema is caused by damage to the lymph system. What may cause this?

-infection (celluitis) -trauma -radiation therapy -surgery (lymph node dissection) -chemo -tumors -lymphatic filariasis

What are some risks associated with having pneumonia?

-inflammation of lungs -defense mechanisms, such as cilia, are reduced

What do selegiline and rasaliline do?

-inhibit monoamine oxidase, which is an enzyme that breaks down dopamine -directly limit # of free radicals in surrounding area -enhance body's defense against FR

What are the different vessels in the lymph system called?

-initial lymph vessels -lymph capillaries -precollectors -collectors -lymph trunks

When does phantom limb sensation occur?

-initially, right after surgery (90%) -may dec over time, or the pt may have the sensation throughout life -67% have it 6 months post-op

How is desensitization and massage done to treat phantom limb pain?

-initiate gentle touch & textural stimulation after wound is closed -initiate scar & deep friction massage -massage should be used as an adjunct to daily skin inspection & care routine

The decision to use a prosthesis after an amputation should be based on input from whom? and pt performance with what?

-input from patient, prosthetist, PT and MD -pt's performance w/ a temporary prosthesis

What is some general info you should give a patient for preventative care if they have lost or diminished sensitivity after a nerve injury?

-inspect skin regularly -provide prompt treatment to wounds or blisters -compensate dryness w/ massage creams and oils

What develops in type 2 diabetes?

-insulin resistance (bc insulin sensitivity is dec.) -insulin production (initially)

What is surface tension (of water)?

-interactions of water molecules on the surface -each individual force isn't very strong, but the sum of the forces is very strong

What happens with Type 1 diabetes?

-islet beta cells = destroyed -no insulin = produced in the body

Why is TB hard to kill?

-it is a MDRO -it's resistant to drying and many disinfectants

How does having comorbidities affect a pt's rehab potential?

-it is limited -focus on prior level of function and pt goals

When is MMT not appropriate?

-kids -upper motor neuron lesions w/ significant tone

What are some noteworthy differences between adult and pediatric amputations?

-kids have excellent circulation which enhances wound healing -kids have superior tissue tolerance which may allow early post-op prosthetic fitting -surgeons have to be careful not to disrupt growth plates in kids -surgeons must consider both longitudinal and circumferential growth that kids will experience

What are some examples of first group, restrictive lung disorders?

-kyphosis, scoliosis -poliomyelitis -amyotrophic lateral sclerosis -botulism -muscular dystrophy

How does radionuclide scintigraphy (*bone scan*) work?

-labeled methylene is injected -scanning occurs 2-3 hrs after injection -high uptake indicates areas of inc bone activity or mineral turnover

What happens in phase III of a controlled clinical trial?

-large # of participants with disease of interest -effect of drug is not always easy to assess -drugs rarely miraculously reverse fatal illnesses, but instead reduce risk of death, and reduce symptoms

What is a sucking wound?

-large opening in chest wall -air moving in/out makes a sucking sound -type of open pneumothorax

In what ways does a coxa valgum hip alignment change the following: -limb length -femoral shaft alignment -hip stability -mechanical advantage of mm

-lengthens the limb -femoral shaft more aligned with vertical weight bearing forces -decreases stability -decreases mechanical advantage of the hip muscles

Carpometacarpal joint - digit 1

-loss of abduction (more so than extension)

Foot interphalangeal joints

-loss of extension greater than flexion

Metatarsophalangeal joint - digit 1

-loss of extension greater than flexion

Metatarsophalangeal joints - digits 2-5

-loss of flexion greater than extension

Knee (tibiofemoral joint)

-loss of flexion is greater than extension

Elbow complex

-loss of flexion is greater than loss of extension -rotations full and painless except in advanced cases

Midtarsal joint

-loss of inversion (adduction and medial rotation); other motions full

Subtalar joint

-loss of inversion (varus)

How does dementia affect treatment functionally?

-loss of muscle strength -CV deconditioning

What are *sensory* symptoms of mixed peripheral nerve lesions (axonotmesis or neurotmesis)?

-loss of or abnormal sensation -loss of vasomotor tone: warm flushed (early); cold, white (later) -skin may be scaly (early); thin smooth and shiny (later) -shallower skin creases -nail changes (striations, ridges, dry, brittle, abnormal curving, luster lost) -ulceration

Ankle (talocrural joint)

-loss of plantarflexion greater than dorsiflexion

What are sympathetic symptoms of mixed peripheral nerve lesions (axonotmesis or neurotmesis)?

-loss of sweat glands (dryness) -loss of pilomotor response

HIV blood tests are very sensitive which means they have low _____________ rates and high _____________ rates

-low false negative rate -high false positive rate

Home pregnancy tests are very specific which means they have low ___________ rates and high ______________ rates

-low false positive rate -high false negative rate

What syndromes could you use an ulnar nerve glide to help treat?

-lower brachial plexus entrapment -ulnar nerve entrapment

What are the components of massage? (read)

-lubricant -draping -position -behavior of therapist -preparation -application

How do you diagnose a pulmonary embolism? (4)

-lung scan -MRI -pulm. angiography -x-ray

The lymph system includes what anatomical structures?

-lymph nodes -tonsils -thymus -spleen

What are different things that all help with lymph flow?

-lymphangion contraction -A/PROM -Arterial pulsation (deep vessels) -massage -respiration

What are some of the goals of surgeons when performing an amputation?

-maintain adequate circulation for wound & incision healing -remove damaged tissue -preserve as many joints as possible, esp the knee -preserve max bone length -provide residual limb that will accept a prosthesis & tolerate WB

What are some general guidelines for an exercise program for an amputee? (read)

-maintain full ROM -strengthen trunk & extremities -work on balance -work on functional activities (bed mobility & transfers) -*CV endurance*

What are side effects of Li+?

-major danger is accumulation = toxicity -metallic taste in mouth, resting hand tremor, diarrhea, nausea and vomiting, slurred speech, dizziness, vertigo, increased muscle tone and confusion

What does the hemoglobin A1C (HbA1C) test do?

-measures a person's avg. blood glucose level over the past 3 months -measures the level of glycated Hb

When evaluating an amputee acutely after surgery, what information do you need to get from them?

-medical hx -hx of present incident -mental status -precautions -social situation -pain level -sensation -phantom limb sensation or pain -ROM: passive, AA or active -strength -bed mobility -sitting/standing balance -transfers -locomotion: gait or wheelchair -endurance -home & work environment -barriers to care or adjustment -knowledge of limb care & prosthetic use

What are 3 general treatment strategies for pain?

-medication -PRICE -rehabilitation

Describe the structure of a peripheral nerve?

-mesoneurium -external epineurium (hold fascilces together) -internal epineurium (hold fascicles together) -grouped fascicle -perineurium -endoneurium -single fascicle -myelin -axon

During a primary infection of TB, when a microbe first enters the lungs, what happens?

-microbe is engulfed by macrophage & causes inflammation -if cell-mediated immunity is adequate, a granuloma is formed at the site of infection -if it is inadequate, the bacteria reproduce & begin to destroy lung tissue

Peptides are responsible for controlling the following:

-modulate pain perception -regulate temperature -stimulate contraction of the smooth muscle cells of the gut

How is cryotherapy effective in treating edema?

-most effective after acute trauma -constricts blood vessels, temp reducing arterial flow. Rebound effect leads to improved blood flow following treatment with ice. (if you ice long enough the arteries vasoconstrict, then vasodilate leading to improved blood flow when ice is removed)

How is oxygen transported in the blood?

-most is bound to Hb -about 1% of it is dissolved in plasma

How will tissue regeneration affect physical therapy?

-much of our chronic care business will go away -treat pt after transplant initially, but then they will be fixed

What are different aspects of treatment for CRPS? (6)

-multidisciplinary management -patient education -medications -rehabilitation -sympathetic block -peripheral nerve block *early diagnosis is crucial to a good outcome*

What neural systems are included in the periphery? (3)

-muscle spindle receptors -golgi tendon organs -motor endings on the muscles

What are some factors that increase the risk of falls? (lots, info from 3 slides)

-muscle weakness in LE -foot problems -HR and rhythm problems -history of falls -vision & sensation problems -dizziness -multiple meds -difficulty with walking/balance (slow walking speed, small steps) -dec flexibility in LE joints -dec coordination -dec reflexes & longer rxn times -dec activity

What is the etiology of TB?

-mycobacterium tuberculosis -aerobic, slow growing -transmitted by oral droplets from persons with active infection

What are the different ways surgeons can stabilize muscles after an amputation? (read)

-myodesis -tenodesis -myofascial -myoplasty -open (guillotine) closure -provisional closure -delayed closure

What is the chemical name of a drug?

-name reflecting its molecular structure -long & cumbersome name

What tests and measures may be done for lymphedema?

-near infrared imaging -MRI -US

What does it mean when Rucker says "one view is no view" with regards to x-rays?

-need at least 2 views to visualize an object in 3D -ideally at views at 90 deg angle to each other -Ex: A/P and lateral

3 microvascular diabetic complications:

-nephropathy -retinopathy -neuropathy

Foot problems in people w/ diabetes can be caused by:

-nerve damage -impaired wound healing

What are factors involved with weakness?

-nerve involvement -intrinsic muscle damage -neuromuscular inhibition -stretch weakness -atrophy/disuse -fatigue -pain -edema

What is tissue regeneration?

-new field where new organs are grown -sample is taken either from the patient or stem cells to grow the tissue -if it is taken from the patient there is no chance of tissue rejection

Characteristics of latency stage of lymphedema:

-no visible/palpable signs of edema -subjective complaints possible

Is the damage due to chronic bronchitis reversible? What damage does it cause?

-no, damage is irreversible and progressive -inflammation, obstruction, & repeated infections

Characteristics of Stage III lymphedema:

-non pitting edema -fibrosis -skin changes (dry and scaly) -fluid may leak from extremity

What is atelectasis? -what does it cause? -what does it interfere with?

-nonaeration or partial/complete collapse of a lung -alveoli collapse, inflammation & atrophy occurs -causes dec gas exchange & hypoxia -interferes with blood flow through the lung

Who should not use cryotherapy to treat edema?

-not indicated on patients with impaired perfusion/arterial insufficiency

What can be done in risk reduction for lymphedema?

-obesity (weight gain after diagnosis - associated w/ dec lymph function) -minor UE infections (lost freq lymph complication) -injury or trauma to affected limb -overuse of limb

How can pain be documented objectively? (4)

-observation (skin/temp) -edema -ROM -function

Bronchiectasis leads to _______________ of airways and weakening of the ______________ . _______________ accumulates in dilated areas and becomes infected.

-obstruction -muscle & elastic fibers -fluid

Where does primary lymphedema mostly occur? When does primary lymphedema develop? What causes primary lymphedema?

-occurs most often in LE -may be present at birth or may develop later in life -impaired development of lymph system

Some American Geriatrics Society Clinical Practice Guideline points (read):

-on initial presentation, older persons should be assessed for pain -persistent pain should be recognized as significant problem -variety of terms should be used to screen older adults for pain -for those w/ cognitive or language impairments, nonverbal pain behavior and information from a caregiver should be sought -thorough analgesic medication history should be collected -physical exam should include functional tests -pain reassessed frequently -patient education is important part of the intervention -when treating a geriatric patient, the PT should first assume that the pain has a physiological basis until they are sure otherwise

Evidence for massage: slide 4 (read)

-only 4 subjects..... -soft tissue mobs to lateral aspect of knee in athletes w/ patellofemoral pain -3 of 4 subjects improved on LE functional scale

Most drug references include dosing regimes, since PT's do no prescribe, why is this information needed?

-only important when you suspect improper intake of drugs by your patient

After the patent for a drug expires, what happens?

-other companies can start selling the drug as a generic version or they can make their own trade name -original company can also keep selling drug under original trade name

What characteristics must be present for a *definite* CRPS diagnosis? (4)

-pain and tenderness in distal extremity (disproportionate to injury) -signs/symptoms of vasomotor instability -swelling in extremity -dystrophic skin changes usually present

According to the Ottowa Ankle Rule, a conventional x-ray should be ordered if:

-pain in the malleolar area AND -tenderness at posterior aspect or tip of lateral malleolus OR -tenderness at posterior aspect or tip of medial malleolus OR -inability to WB immediately in emergency department

According to the Ottowa Foot Rule, a conventional x-ray should be ordered if:

-pain in the midfoot area AND -tenderness at base of 5th metatarsal OR -tenderness at the navicular bone OR -inability to WB immediately in the emergency department

When a drug is first made by a pharmaceutical company it is protected by a __________ typically for ____ years.

-patent -20

What are some characteristics of a patient's pain in a subjective exam that may indicate chronic pain? (7)

-patient focused on the pain -pain persists beyond healing time frame -pain is poorly localized/referred -vague description of pain -severely limited function -high anxiety and fear -work history (related to job)

How do you test/mobilize the sciatic nerve?

-patient in supine -straight-leg raise -ankle dorsiflexion

What is a blinded study?

-patients receiving the drug don't know if they are getting the placebo or drug & neither does the physician -the effects for the experimental and control groups are compared

How does personalized medicine affect physical therapy?

-patients who are on the same drug might have different side effects from the drug since it has been "personalized" for each patient -PT will have to keep track of a lot more drug information

Which type of massage strokes are considered excitatory or stimulating?

-percussion -friction -vibration -knuckling (quick, short strokes)

How might stage II CRPS affect the following clinical features: -pain -joints -muscle -bone -skin

-persistent pain exacerbated with any stimulus -edema spreads and joints stiffen -muscle wasting begins -osteoporosis begins -cutaneous and trophic (change in soft tissue due to dec nerve supply) present

What can a PT do to help reduce falls? (5)

-physical activity -education -environmental modifications -fall risk assessment -review medications

How does injury to tissue cause altered fluid flow in capillaries?

-physical disruption causing protein escape into interstitium -any condition that increases amount of osmotic substances in interstitium (imbalance of salt - regular hormones)

What conditions are "pink puffers" and "blue bloaters" a part of?

-pink: emphsema -blue: chronic bronchitis

Characteristics of Stage I lymphedema:

-pitting edema -puffy appearance in the hand -reduces with elevation

Characteristics of Stage II lymphedema:

-pitting is less visible -lymphedema does NOT respond to elevation typically -fibrosis may become apparent

Conventional radiographs are also known as:

-plain films -films -x-rays

What are some examples of lower respiratory tract infections?

-pneumonia -tuberculosis

What are categories of edema prevention and intervention?

-positioning -cryotherapy -compression -activity -medical management

What education should be provided to an amputee?

-post-op goals & expectations -positioning -pain relief -residual limb care -*protection of contralateral leg* -prosthetic info & time frame -encourage them to stop smoking if they are

What are indications for MMT?

-postural asymmetry -pain -reported weakness/fatigue -mechanism of injury -difficulty with function -prolonged disuse

What are the three types of prehension?

-precision grip or pinch (when control or delicate action is needed - variations) -power pinch (lateral pinch) -power grip (large forces w/ no need for precision)

What are the goals of acute PT rehab with an amputee?

-prevent complications -allow healing -develop limb strength & ROM for prosthesis -maximize independence in mobility & ADLs -pre-prosthetic training & limb preparation -endurance training & initiation of HEP

What is the purpose of an osteomyoplasty?

-prevents "chopsticking" of distal bone ends of tibia & fibula -improves WB on residual limb

What is the function of surfactant?

-prevents collapse of alveolus during expiration -reduces the effort to expand the lungs during inspiration (by reducing surface tension)

What are the 2 stages of TB?

-primary: 1st exposure -secondary: infection

How does stage III CRPS affect the tissues?

-progressive atrophy of the skin, subcutaneous tissue, muscle and bone -skin is thin and shiny

How do you treat a pulmonary embolism? (6)

-prolonged bed rest -compression stockings -surgically inserted filter into vena cava (sometimes) -heparin or streptokinase -mechanical ventilation -embolectomy

What environmental modifications can a PT make to reduce falls? (7)

-protect stairs w/ hand rails on both sides -de-clutter stairs -use highest safe wattage in light fixtures -nightlights -non-slip mats, install adhesive safety strips in bath/shower -install grab bars in bath/shower -choose latex-backed bath mat to avoid slipping when getting out of bath/shower

Things to know about ACE bandage - long stretch (read)

-provides mild compression -high working, high resting pressure -can decrease dependent edema

What happens in the oral glucose tolerance test (OGTT)?

-pt drinks a high-glucose liquid (75-100g of glucose) -plasma glucose level = measured at 2 hours

How does dementia affect treatment cognitively?

-pt has difficulty following directions -pt can experience hallucinations or delusions

How is Halstead's maneuver performed? What is a positive test?

-pt in sitting, arms down -PT palpate radial pulse -pt protrudes chest while depressing and retracting the shoulders -decreased pulse is positive for TOS

How is Adson's test performed? What is a positive test?

-pt in sitting, arms down -PT palpate radial pulse -pt turns head towards clinician and extends neck -decreased pulse is a positive result for TOS

What is mirror box therapy?

-pt performs a movement w/ the unaffected limb -movement is viewed in a mirror -at the same time, pt attempts to perform the movement with their residual limb pain relief is hypothesized to be due to cortical restructuring

For a BKA, in which direction is the "pull" while applying an ACE wrap?

-pull medial to lateral -pull posterior to anterior

How is connective tissue massage done?

-pull skin in opposite directions, perpendicular to the muscle -pinching technique over the muscle

What conditions involve reduced surfactant levels?

-pulmonary edema -lung injury -genetic diseases that cause mutations controlling surfactant production

What are some activities to work on with an amputee to improve bed mobility?

-push ups w/ arms -sitting forward -move up/down in bed -roll from one side to other -bridging

What 2 rationales support the hold-relax stretching technique?

-reciprocal inhibition via muscle spindle -*psychologic effect*

What are 3 goals of performing neural mobilizations?

-release tension, compression or entrapment due to inflammatory conditions in the surrounding connective tissues or nerves -release adhesive scar tissue -free up the nerve to slide in its sheath

When is alpha1-antitrypsin released?

-released by neutrophils during inflammation -released by some pathogenic bacteria

What are the functions of the lymph system?

-remove waste and excess fluids from body tissues -production of immune cells -absorption of fatty acids -transportation of chyle

How can you treat acute respiratory failure?

-resolve the primary problem -supportive treatment

COPD can lead to what 2 things?

-respiratory failure -development of cor pulmonale

What is a tension pneumothorax?

-results from open or closed pneumothorax -with each breath, air accumulates in the pleural cavity -this inc pleural pressure & atelectasis -BAD

What education should be provided to reduce falls?

-risk factors for falls -fall prevention -fall injury reduction -home safety -physical activity -medical management

With shoulder abduction above 60 degrees, how does the clavicle move?

-rotates posteriorly 30 degrees at SC joint around longitudinal axis -retracts 30 degrees at SC joint (rolls and glides posteriorly)

D2 extension of the UE: -scapula -shoulder -forearm -wrist -fingers

-scap: depression, protraction -shoulder: extension, adduction, IR -forearm: pronation -wrist: flexion -fingers: flexion exact opposite of UE D2 flexion

D1 extension of the UE: -scapula -shoulder -forearm -wrist -fingers

-scap: depression, retraction -shoulder: extension, abduction, IR -Forearm: pronated -wrist: extension -fingers: extension exact opposite of UE D1 flexion

D1 flexion of the UE: -scapula -shoulder -forearm -wrist -fingers

-scap: elevation, protraction -shoulder: flexion, adduction, ER -forearm: supination -wrist: flexion -fingers: flexion

D2 flexion of the UE: -scapula -shoulder -forearm -wrist -fingers

-scap: elevation, retraction -shoulder: flexion, abduction, ER -forearm: supination -wrist: extension -fingers: extension

What is phenotypical drug discovery?

-scientist no longer knows the target molecule -instead, they know what the end effect should be & search for drugs that produce this final effect Ex: diabetes researcher may look for a drug that increases the release of insulin from pancreatic islets

What 4 things are decreased in patients with diabetic peripheral neuropathy?

-sensation -temperature/vibration -proprioception -pain sensation (these all occur in a "stocking-gloves pattern)

In stage III CRPS, how might the following be affected: -trophic changes -mobility -swelling/edema -cutaneous tissues -bones

-severe trophic changes -severe immobility of affected limb -edema often has resolved -cutaneous tissues atrophied and changes in nails -X-rays show osteoporosis

What is the purpose of a temporary prosthesis?

-shapes residual limb -early gait training & independence -*endurance training* -prevents contracture

What is the generic name of a drug?

-shortened version of chemical name -often as a variation of chemical name -also called nonproprietary

In what ways does a coxa vara hip alignment change the following: -limb length -femoral shaft alignment -hip stability -mechanical advantage of mm

-shortens the limb -femoral shaft has increased bending moment at neck of femur (less in line with vertical forces than normal) -increases joint stability (relative to valgum) -increases mechanical advantage of the mm

How do you know which side to use a cane on?

-should be used on contralateral side **greatest reduction in force on the affected hip with use on opposite side, not a significant change in body weight reduction, BUT it does significantly reduce the muscle force required by the hip abductors on the opp side

What are some general measures to treat asthma?

-skin tests for allergic rxns -avoidance of triggers -good ventilation -swimming & walking -maintenance inhalers

How does having comorbidities affect a pt's rate of progress? Why?

-slower progress -due to pain, SOB, fatigue, dec flexibility -document progress & barriers

What is friction in terms of massage techniques?

-small circular strokes w/ deep pressure done w/ thumbs -linear strokes done w/ sides of hand, finger tips, back or heel of hand

What are symptoms of small and large pulmonary embolism?

-small: transient chest pain, cough, dyspnea -large: inc chest pain w/ cough or deep breath, sudden dyspnea -later hemoptysis & fever, hypoxia

Chronic bronchitis is caused by constant irritation due to what substances?

-smoking -air pollutions

When may activity be helpful in edema management? What exercises would be beneficial?

-some edema can be reduced actively with muscle contraction improving fluid return (when edema is secondary to trauma or reduced mobility) -calf pump -bike -walking

Afferent axons of large myelinated nerves innervate what?

-spindles -golgi tendon organs -touch and pressure receptors

Where does non-small cell lung cancer come from?

-squamous cell carcinoma (epithelial cells) -adenocarcinoma (mucus producing cells) -large cell carcinoma (everything else)

What would clinical presentations look like in a patient who has damaged their axillary nerve?

-squared shoulder from deltoid muscle atrophy -shoulder abduction and ER weakness -sensory deficit on lateral deltoid

How do you diagnose an active/secondary TB infection?

-staining sputum for M. tuberculosis -sputum sample & sensitivity of microbes to drugs -chest x-ray (cavitations)

How do you treat chronic bronchitis? (9)

-stop smoking -reduce exposure to irritants -treat infection -vaccination for prophylaxis -expectorants -bronchodilators -chest therapy (percussion) -low-flow O2 -nutritional supplements

What bacteria can cause bronchiectasis?

-streptococci -staphylococci -pneumococci -influenzae

What are some of the mechanical effects of massage on soft tissue?

-stretch/inc flexibility & length -break up/prevent fibrotic tissue -inc muscle health by dec metabolic acids, improving tissue nutrition & enhancing waste exchange (helps rid muscle of fatigue) -dec scar tissue

What neurotransmitters are included in the category of peptides?

-substance P -neurotensin -endorphin -bradykinin -vasopressin -dynorphin

Describe proper residual limb positioning in supine, prone and sitting:

-supine: knee extension, hip adduction -prone: hip & knee extension -sitting: knee extension neutral hip rotation for all 3 of these

What are the 3 functions of the hand?

-support (to brace or stabilize, serve as a platform) -manipulation -prehension (grip and pinch)

What is a concern for babies that are born prematurely that has to do with the development of the respiratory system?

-surfactant is produced late in fetal development -babies born prematurely may have difficulty breathing which can lead to resp. failure

What may cause an obstruction to the lymph system that causes disruption of normal fluid flow in capillaries?

-surgical removal of lymph nodes -systemic conditions

What are signs/symptoms of lymphedema?

-swelling of part or all of your arm or leg, including fingers or toes -feeling of heaviness or tightness -restricted ROM -aching/discomfort -recurring infections -hardening and thickening of the skin (fibrosis)

What is included in diabetic peripheral neuropathy?

-symmetrical distal degeneration of peripheral nerves -impaired nerve regeneration

What is required for diagnosis of lymphedema?

-symptoms as described -2 cm inc in girth or more inc in limb volume or a 5% or greater limb volume change (measured w/ tape measurer or Bioelectrical Impedence Analysis (BIA)

During an objective exam in a differential diagnosis screen, the PT should pay attention to these 3 things:

-symptoms change with testing -selectively stress MSK tissues -recognize common MSK pain patterns

What should the PT keep in mind about body mechanics during massage application?

-table height -hands relaxed-- avoid hyper-extension at fingers -don't lock elbows -move from hips/knees -bend knees -deep breathing

How do you perform a contract-relax stretching technique?

-take muscle to point of limitation -end-range contraction with rotation into opposite direction of stretch (10 sec) -relax and passively move limb to new range -repeat if indicated

How do you perform a hold-relax stretching technique?

-take muscle to point of limitation -end-range isometric contraction into direction of stretch (10 sec) -relax and passively move limb to new range -repeat if indicated

What should you document after you administer therapeutic massage?

-techniques used -duration of each technique -pt position

What is the purpose of taking sputum samples?

-testing for presence of pathogens -determine antimicrobial sensitivity of pathogen

What is targeted drug discovery?

-the researcher knows the target molecule that they want to affect -they find/create a compound that will have the desired effect

Why were pharmaceutical companies hesitant to make anti-HIV drugs more widely available?

-these drugs have to be taken daily, exactly the way they were prescribed -otherwise this could result in a resistant form of HIV which would be devastating to the efforts made to cure the disease

In the secondary stage of TB, what happens when microbes begin to reproduce and infect the lungs?

-they form large areas of necrosis causing erosion into bronchi & blood vessels and cavitations (openings) -cavitation promotes spreading into other parts of the lung -cough, fever, night sweats, weight loss and fatigue

Why are drug-related illnesses more common in the elderly?

-they have inc sensitivity of diseased tissue to drug toxicity -potential for drug interactions -difficulties in pt compliance w/ an increasing number of drugs

What are general characteristics of nociceptors? (4) -what do they require to be activated? -threshold -acute vs chronic pain -adaptation?

-they require tissue damage or painful stimulus to be activated -their threshold is intensity driven and is different from person to person -the relationship of tissue damage and pain intensity changes from acute to chronic pain -there is no adaptation that occurs to a painful stimulus

How successful has targeted drug discovery been?

-they thought it would increase the liklihood of finding new drugs, but it has been quite poor in reality -in 2010, phenotypical drug discovery was developed to replace this

List some symptoms of chronic bronchitis?

-thick, purulent secretions -constant, productive cough -dyspnea -hypoxia -cyanosis (blue bloater) -hypercapnia -fatigue, weight loss

2 major glomerular wall changes assoc. w/ diabetic nephropathy?

-thickened/glycated wall (GFR decreases) -more permeable (microalbuminurea/albuminurea)

What are the most common signs of dehydration in the elderly?

-thirst -dry mouth -headaches -dizziness -weakness -UTI -cramping in arms/legs -dry, warm skin -flushed face -irritability -constipation

Is there truth to the statement that people who eat & drink at the same time, instead of just drink, stave off the problems developed by chronic alcoholism?

-this is based on the premise that alcohol absorption is slowed in the stomach when food is present -this does not carry over to the rate at which one develops blood clotting problems due to alcoholism

What are some upper extremity syndromes that are caused by compression of a peripheral nerve?

-thoracic outlet syndrome -cubital tunnel syndrome -radial nerve compression -carpal tunnel syndrome -compression on tunnel of Guyon

What 4 muscle groups are involved with a muscle imbalance that results in a posterior tilt of the pelvis? Are they lengthened or tightened?

-tight hip extensors -tight rectus abdominus -lengthened hip flexors -lengthened erector spinae

What 4 muscle groups are involved with a muscle imbalance that results in anterior tilt of the pelvis? Are they lengthened or tightened?

-tight hip flexors -tight erector spinae -lengthened hip extensors -lengthened abdominals

What may clinical presenation look like with damage to the tibial nerve?

-tingling, burning or a sensation similar to electric shock, numbness, pain including shooting pain felt on the inside of the ankle and/or bottom of the foot Palsy: -inability to plantar flex ankle or flex the toes -gait impairment during terminal stance = "drop off"

Can a drug have more than one trade name or generic name?

-trade: yes -generic: no

How do you treat pulmonary edema?

-treat causative factors (duh) -supportive care (O2, antibiotics, upper body elevated)

How do you treat bronchiectasis?

-treat primary condition -antibiotics -bronchodilators -chest PT

How do you treat ARDS?

-treat underlying cause -supportive resp. therapy

If a pt has AIDS and Kaposi's sarcoma, what would their treatment be like?

-try to boost immune system to treat Kaposi's sarcoma -currently no cure for AIDS

What are the 4 different types of precision grip or pinch? Which is the most precise? Which is also known as 3-jaw chuck?

-two-point tip to tip (most precise) -three-point tip to tips -two-point pad to pad -three-point pad to pads (3-jaw chuck)

5 classifications of DM:

-type 1 -type 2 -gestational diabetes -maturity onset diabetes of the young (MODY) -latent autoimmune diabetes in adults (LADA)

What do you need to document after performing MMT?

-type of grading system -position of pt -actual muscle strength grade -anatomical part & type of movement -comparison of both sides -presence of pain during test

What are pneumoconioses?

-type of restrictive lung disorder -general term given to any lung disease caused by long-term exposure/inhalation of irritating particles such as dust -could lead to fibrosis (stiff lung)

What characteristics indicate a *doubtful* CRPS diagnosis? (2)

-unexplained pain and tenderness in an extremity -diagnostic blocks can indicate sympathetic involvement

What are 3 goals in rehabilitation when the object is to treat pain?

-unload the area/joint -change in posture/position -ROM within pain free range

What are the 2 anatomic areas of the respiratory system?

-upper respiratory tract -lower respiratory tract

What is muscle stripping?

-use one thumb over the other to apply direct pressure along the length of the muscle -separates mm fibers and inc blood flow to promote healing

In MMT, how does a PT apply resistance?

-usually in the line of pull of the muscle -build pressure gradually -apply pressure at the distal end of the body part onto which the muscle inserts

What characteristics must be present for a *possible/probable* CRPS diagnosis? (3)

-vasomotor instability and/or swelling -pain and mild to moderate tenderness -dystrophic skin changes present

What systems may be altered to cause edema/lymphedema?

-venous -lymph -cardiac -renal -hepatic -low albumin ... not a system but ya... -trauma

How does the ventilation-perfusion ratio affect gas exchange?

-ventilation (air flow) -perfusion (blood flow) ventilation & perfusion need to match for max gas exchange

What are some characteristics of *pain behavior* that you can examine on a patient with chronic pain? -verbal -vocal -facial expression -physical actions -function -social actions

-verbal: patient constantly complains of being in pain -vocal but not verbal: screams, sighs -facial expressions -phycical actions: guarding, bracing, rubbing, limping -function: change/limitation in activity, use of medications -social actions: nor going to work or social events

Type 1 diabetes can be triggered by:

-virus -cold weather

What is bronchoscopy used for? (3)

-visualizing the inside of airways -performing a biopsy -checking sites of lesion or bleeding

In the history of pharm lecture, how is thalidomide used as an example of why animal testing is necessary?

-wasn't FDA approved -never legally sold in U.S. but was in Asia -only tested on rats which were immune to the toxic side effects -*if it had been tested on more animal species, toxic effects would have been seen* -consequence: many kids in Asia were born with terrible deformities

What are symptoms of Kaposi's Sarcoma?

-watery diarrhea -purplish nodule -skin lesions -swollen lymph nodes -intestinal & lung lesions -pleural effusion

What is personalized medicine?

-we each have different genetics that affect how drugs work in our bodies -a drug could be altered/developed, based on our DNA, to work best for us

What is some specific info you should give a patient for preventative care if they have loss of sensation in a *lower limb* following a nerve injury?

-wear protective shoes that fit properly -inspect feet regularly for pressure points (reddened areas) -modify shoes or provide protection if they occur -do not walk barefoot -shift weight frequently when standing for long periods

What pt changes indicate the need to refer the pt to their prosthetist?

-weight gain -volume change -ROM or functional changes -anything that consistently affects prosthesis fit

If you still think there is a problem with a prosthesis after checking it, what information should you have ready for the prosthetist?

-which motions cause the pt pain? -is it a musculoskeletal issue or a pressure issue? -what is the condition of the skin of the residual limb? should also try to reproduce the problem with the prosthesis off

How does the relationship of tissue damage to pain intensity change with acute vs. chronic pain?

-with acute pain there is a linear relationship -with chronic pain there is a nonlinear relationship (may not need a lot (or any) injury to feel chronic pain)

How long is the Eustachian tube open for during a typical swallow?

0.1-0.9 seconds

What is the average conduction speed of unmyelinated nerves?

0.2-2.0 m/sec

Ketoacidosis = common complication in type __ diabetes

1

Someone with prediabetes should check for DM2 every:

1-2 years

What TherEx should you focus on with an amputee once they have their prosthesis?

1. *core work*- TA activation, Russian twists, etc. 2. *transfers*- sit-stand progression, wall squats, etc. 3. *balance*- perturbations, weight shifts, etc. 4. *gait*- stool stepping, resisted gait, lunges, etc.

What are the 4 specific tapotement techniques mentioned in lecture?

1. *tapping*: striking w/ fingertips 2. *hacking*: striking w/ ulnar borders of hands 3. *cupping*: striking w/ cupped hands 4. *pinchment*: alternate pinching w/ thumb & index finger

What should you look for in bench alignment in the M/L view of a transfemoral prosthesis? (3)

1. 5-7 deg socket adduction 2. 5 deg ER of tibia 3. heel falls just under the ischial tuberosity in the socket (transtibial socket adduction is only 2-5 deg, it also doesn't have the tibia ER setting)

What are the 4 branches off of the mandibular division of the trigeminal that are sensory?

1. Buccal N 2. Auriculotemporal N 3. Lingual N 4. Mental N

List the 4 peripheral ganglia and which division of the trigeminal its associated with

1. Ciliary (V1) 2. Otic (V3) 3. Submandibular (V3) 4. Pterygopalatine (V2)

In differential diagnosing from resisted testing, what does "weak and painless" mean?

1. Disorder of nervous system or NMJ 3. Complete rupture of tested muscle or tendon 4. Disuse/atrophy

Differences between emphysema and chronic bronchitis: 1. location 2. cough 3. sputum 4. cyanosis

1. E: alveoli. CB: bronchi 2. E: some coughing, marked dyspnea. CB: constant cough 3. E: little. CB: large amt, purulent 4. E: no. CB: yes

Prosthetic causes of "medial whip" gait deviations in a transfemoral amputee: (5)

1. ER of knee 2. tight socket 3. incorrect foot rotation 4. cylindrical socket shape vs. anatomical 5. heel too stiff (1-2 are exact opposite, 3-5 are the same as lateral whip)

Which brain stem nucleus does the oculomotor pregnaglionic neuron start in? in other words, what is the location of the primary neurons of the oculomotor nerve?

1. Edinger-Westphal (parasympathetics) 2. Nucleus of the oculomotor N (motor)

Prosthetic causes of "lateral whip" gait deviations in a transfemoral amputee: (5)

1. IR of knee 2. loose socket 3. incorrect foot rotation 4. cylindrical socket shape vs. anatomical 5. heel too stiff (1-2 are exact opposite, 3-5 are the same as medial whip)

What are the 3 branches off of the ophthalmic division of the trigeminal? (subbranches too)

1. Lacrimal N 2. Frontal N: supratrochlear & supraorbital 3. Nasociliary N: long ciliary, short ciliary, infratrochlear (internal & external nasal NN)

What are the 6 branches off of the mandibular division of the trigeminal that are motor?

1. Medial pterygoid N 2. Masseteric N 3. Deep temporal N 4. Lateral pterygoid N 5. N to mylohyoid 6. N to ant. belly of digastric

In differential diagnosing from resisted testing, what does "weak and painful" mean?

1. Serious pathology 2. Acute inflammatory process that inhibits muscle contraction 3. Partial rupture of muscle/tendon 4. Minor muscle damage + inflamm.

What should you look for in bench alignment in the A/P view of a transfemoral prosthesis? (2)

1. TKA should travel from the trochanter down to the front of the heel 2. initial 5-10 deg of socket flexion (if 0 deg contracture)

What are the 4 branches off of the maxillary division of the trigeminal?

1. Zygomatic N: zygomaticotemporal & zygomaticofacial 2. Infraorbital N 3. Superior alveolar NN 4. Pterygopalatine N

Amputee causes of "abducted gait" deviations in a transfemoral amputee: (2)

1. abduction contracture 2. poor gait habit due to insecurity- widen base to inc stability (same as wide gait)

Amputee causes of "wide gait" deviations in a transfemoral amputee: (2)

1. abduction contracture 2. poor gait habit- pt insecure & widens base to inc stability (same as abducted gait)

Difficulty with expiration that occurs in emphysema can lead to what lung changes? (6) -RV, ribs, chest, diaphragm, etc.

1. air trapping 2. inc in RV 3. overinflation of lungs 4. fixation of ribs in an inspiratory position 5. barrel chest 6. flattened diaphragm

What are the Basic Swedish Principles of massage? (5)

1. all strokes w/ pressure are towards the heart 2. begin & end w/ effleurage 3. work distal to proximal 4. force should be applied in the direction of the muscle fibers 5. the focus is to return the body to a complete, non-encumbered flow of energy

What are the 4 different modifications of a sciatic nerve test? What does each test?

1. ankle DF and eversion (tibial n) 2. ankle DF and inversion (sural n) 3. ankle PF and inversion (c. peroneal n.) 4. hip adduction and IR (general tension)

When do we use MMT?

1. as part of a physical exam 2. assist w/ differential diagnosis, prognosis, & treatment of neurological, neuromuscular & musculoskeletal disorders

What are the types of MMT?

1. break testing 2. active resistance testing 3. functional muscle testing

Describe the pattern of using a cane to go down stairs:

1. cane 2. bad LE 3. good LE

Describe the pattern of using a cane to go up stairs:

1. cane 2. good LE 3. bad LE

What are the 5 different types of pneumothorax?

1. closed 2. simple/spontaneous 3. open 4. secondary 5. tension

What are some things you should assess under the B in ABCS of radiology? (4)

1. cortical margin should be dense, w/ lower density cancellous bone & medullary cavity 2. WB surfaces should have higher density 3. low contrast, "washed out", bone suggests *osteoporosis* 4. excessive sclerosis may suggest an *arthritic* or rheumatic condition

What 4 different petrissage techniques were mentioned in lecture?

1. cross stroke 2. scissoring 3. kneading 4. knuckling (links to videos of these in PP)

Describe the pattern of using crutches to go down stairs:

1. crutches 2. bad LE 3. good LE (1 & 2 almost happen together)

Amputee causes of "uneven pelvic rotation" gait deviations in a transfemoral amputee: (4)

1. dec pelvic rotation 2. fear of falling 3. weak abductors, excessive adductors 4. habit

What are the 13 most common geriatric syndromes?

1. dementia 2. depression 3. delirium 4. falls 5. pressure ulcers 6. inappropriate prescribing of medications 7. incontinence 8. iatrogenic problems 9. failure to thrive 10. sleep disorders 11. osteoporosis 12. sensory alterations 13. immobility & gait disturbances

What are the 3 steps to a trauma survey? (read)

1. diagnose & evaluate any fracture or dislocation 2. match the MOI to the clinical presentation 3. assess treatment & monitor healing

What is distortion of an x-ray usually due to?

1. distance b/w the beam source, patient and image receptor 2. alignment & positioning issues

Therapy goals for "lateral whip" gait deviations in a transfemoral amputee: (3)

1. encourage proper donning 2. strengthen hip ERs 3. stretch hip flexors & adductors

Therapy goals for amputees with "medial whip" gait deviations: (2)

1. encourage proper donning 2. strengthen internal hip rotators & extensors

Prosthetic causes of "knee instability" gait deviations in a transfemoral amputee: (5)

1. excessive dorsiflexion 2. knee aligned in unstable position- need to move it more posterior to fix it 3. insufficient socket flexion- esp. w/ contractures 4. poor foot alignment 5. incorrect knee settings (upon IC, knee flexes the user had to forcefully extend it back which results in a jerky motion in MS)

Amputee causes of "heel rise" gait deviations in a transfemoral amputee: (1)

1. excessive use of hip flexors to initiate swing, overpowering knee unit

What are the 3 types of substitution?

1. fixation substitution 2. substitution from another agonist 3. substitution from an antagonist

Prosthetic causes of "lateral trunk bend" gait deviations in a transfemoral amputee: (3)

1. foot too far outset 2. high medial wall 3. aligned in abduction

Amputee causes of "medial whip" gait deviations in a transfemoral amputee: (3)

1. gait habit 2. *socket not donned properly* 3. ER of hip at toe off/hip flexion (1-2 are same, 3 is exact opposite, compared to lateral whip)

Amputee causes of "lateral whip" gait deviations in a transfemoral amputee: (4)

1. gait habit 2. *socket not donned properly* 3. IR of hip at toe off/hip flexion 4. tight adductors, IRs or flexors (1-2 are same, 3 is exact opposite, 4 is new compared to medial whip)

Amputee causes of "vaulting" gait deviations in a transfemoral amputee: (3)

1. gait habit- fear of catching toe*, hard to break 2. weak hip flexors on residual limb 3. improper initiation of hip flexors on residual limb

Steps to prepare for MMT (4)

1. gather materials 2. pt should be pain-free for duration of test 3. environment should be quiet 4. explain test to pt

Describe the pattern of using crutches to go up stairs:

1. good LE 2. crutches 3. bad LE

What are some things you should assess under the A in ABCS of radiology? (4)

1. gross bone size 2. # of bones 3. shape & contour of cortical outline 4. joint position & alignment

What are some things you should assess under S in ABCS of radiology? (3)

1. gross size of muscles 2. outline of joint capsule 3. periosteum

What should you look for in static alignment of a transfemoral prosthesis? (5)

1. height of prosthesis 2. verify knee center matches sound side 3. pylon is vertical 4. trim lines & comfort of socket 5. knee is stable, foot is flat, & back has a normal lordotic curve

Amputee causes of "external foot rotation" gait deviations in a transfemoral amputee: (1)

1. improperly donning socket

Amputee causes of "internal foot rotation" gait deviations in a transfemoral amputee: (2)

1. improperly donning socket 2. flexed at hip during gait, typically w/ walker or crutches, looking down at the ground

Therapy goals for "lateral trunk bend" gait deviations in a transfemoral amputee: (2)

1. improve balance 2. strengthen core

Amputee causes of "lateral trunk bend" gait deviations in a transfemoral amputee: (3)

1. inadequate balance 2. short residual limb (lack of adductors to prevent the lean) 3. habit

Prosthetic causes of "heel rise" gait deviations in a transfemoral amputee: (3)

1. inadequate extension aid 2. insufficient knee friction 3. improper knee selection

What lung changes occur with chronic bronchitis? (4) -mucosa, glands, etc.

1. inflamed/swollen mucosa 2. hypertrophy of mucous glands--*inc mucous secretions* 3. fibrosis, thickening of bronchial wall -- obstruction 4. low O2 levels-- cyanosis

Prosthetic causes of "uneven pelvic rotation" gait deviations in a transfemoral amputee: (3)

1. instability of prosthesis 2. poor suspension 3. proximal trim line too high or tight

What are some things you should assess under C in ABCS of radiology? (4)

1. joint space width 2. subchondral bone 3. joint margins 4. epiphyses & growth plates

Prosthetic causes of "external foot rotation" gait deviations in a transfemoral amputee: (4)

1. knee ER 2. foot ER 3. socket design issues 4. tight adductor channel in socket -results in a medial whip-

Prosthetic causes of "internal foot rotation" gait deviations in a transfemoral amputee: (4)

1. knee IR 2. foot IR 3. socket design issues 4. excessive quad pressure

Amputee causes of "circumducted gait" deviations in a transfemoral amputee: (4)

1. lack of confidence in flexing knee 2. abduction contracture 3. weak hip flexors 4. habit- using entire hip & pelvis to initiate gait

What does a CN III lesion result in? (review)

1. lateral strabismus- eye rotates down and out 2. Ptosis- lid droop 3. Pupil dilation 4. loss of lens accomodation

Prosthetic causes of "circumducted gait" deviations in a transfemoral amputee: (3)

1. long prosthesis 2. excessive knee friction 3. excessive knee stability (2 & 3: can't flex knee, doesn't allow heel rise)

Prosthetic causes of "toe drag" gait deviations in a transfemoral amputee: (3)

1. long prosthesis 2. excessive plantarflexion 3. excessive knee friction

Prosthetic causes of "wide gait" deviations in a transfemoral amputee: (3)

1. long prosthesis 2. high medial wall 3. insufficient femoral stability (basically the same as abducted gait in function, in this case they prefer the wide gait, in abducted they can't always control it) (same as abducted gait answers)

Prosthetic causes of "abducted gait" deviations in a transfemoral amputee: (3)

1. long prosthesis 2. high medial wall 3. insufficient femoral stability, may cause distal-lateral femoral pressure, not able to keep femur in its natural adduction angle -induces medial whip- (same as wide gait)

Prosthetic causes of "vaulting" gait deviations in a transfemoral amputee: (5)

1. long prosthesis 2. poor suspension 3. excessive plantarflexion (easy to fix) 4. excessive knee resistance/stability* 5. inadequate knee extension assist

The breakdown of alveolar walls in emphysema results in what effects? (4)

1. loss of elastic fibers (affects recoil) 2. loss of surface area for gas exchange 3. loss of pulmonary capillaries (affects ventilation-perfusion ratio) 4. dec support for other structures (small bronchi may collapse)

What are the different mechanisms that cause atelectasis? (5)

1. obstructive or resorption atelectasis 2. compression atelectasis 3. due to inc surface tension in alveoli 4. contraction atelectasis 5. postoperative atelectasis

Describe the pattern of a walker to go down stairs:

1. one side of walker to next step, hold the back side of the walker 2. bad LE 3. good LE

Describe the pattern of using a walker to go up stairs:

1. one side of walker to next step, hold the front side of the walker 2. good LE 3. bad LE

What are two ways of measuring pain quality?

1. pain intensity (numeric scale or quantitative threshold measure) 2. pain description (sharp/dull, constant/intermittent)

What factors affect the diffusion of gases during gas exchange between alveoli and capillaries?

1. partial pressure of gases 2. thickness of respiratory membrane 3. total surface area available for diffusion 4. ventilation-perfusion ratio

What are the 4 factors of gait?

1. patient 2. socket fit 3. prosthetic alignment 4. physical therapy

Advanced medical imaging in patients with acute low back pain should be reserved for:

1. patients who are considering surgery 2. patients whom systemic disease is strongly suspected

Amputee causes of "uneven timing" gait deviations in a transfemoral amputee: (3)

1. pt insecurity 2. weak hip muscles 3. poor balance

Describe the appearance of some of the reflexive effects of massage: (5)

1. red flare or streak from arteriole dilation 2. red wheal from release of histamines & prostaglandins 3. dec in pain 4. inc in lymph flow 5. some studies say it changes chemicals in the blood

PNF is a series of techniques that use what 3 principles of normal movement?

1. rhythmic and reversing motions 2. diagnonal motions 3. synergy of agonists & antagonists

Describe the modern technique for an amputation: (read)

1. skin & muscle are divided to form ant & post flaps 2. primary AA & VV are dissected, clamped & severed 3. major NN are dissected, severed & allowed to retract into soft tissue 4. bone is severed, distal end is filed & beveled to produce a smooth surface 5. muscle & skin flaps are sewn together to form the residual limb

Prosthetic causes of "uneven timing" gait deviations in a transfemoral amputee: (5)

1. socket pain 2. weak extension aid 3. unstable knee 4. leg length discrepancy 5. poor suspension (unsure what this looks like)

What should you look for in bench alignment in the transverse view of a transfemoral prosthesis? (3)

1. socket rotation 2. knee rotation: 3-5 deg ER 3. foot rotation: 5-7 deg ER

What are the 6 key areas of emphasis in prosthetic gait training?

1. step width 2. step length 3. toe loading 4. knee flexion 5. pelvic rotation 6. trunk rotation

Therapy goals for "uneven pelvic rotation" gait deviations in a transfemoral amputee: (3)

1. strengthen aBductors 2. stretch aDductors 3. gait training

Therapy goals for "knee instability" gait deviations in a transfemoral amputee: (2)

1. strengthen hip extensors 2. stretch hip flexors

Therapy goals for "toe drag" gait deviations in a transfemoral amputee: (2)

1. strengthen hip extensors (of sound leg) & abductors 2. encourage pelvic motion to initiate enough knee flexion for swing phase

Therapy goals for "vaulting" gait deviations in a transfemoral amputee: (2)

1. strengthen hip flexors 2. work on timing & symmetrical pelvic rotation

Therapy goals for "uneven timing" gait deviations in a transfemoral amputee: (2)

1. strengthen hip flexors & extensors 2. improve balance

Therapy goals for "wide gait" deviations in a transfemoral amputee: (2)

1. stretch abductors 2. strengthen core, RL & sound limb (same as abducted gait)

Therapy goals for "abducted gait" deviations in a transfemoral amputee: (2)

1. stretch abductors 2. strengthen core, residual limb & sound leg (same as wide gait)

Therapy goals for "circumducted gait" deviations in a transfemoral amputee: (3)

1. stretch abductors 2. strengthen hip flexors 3. gait training

What are some of the mechanical effects of massage on the pulmonary system?

1. vibration w/ postural drainage: loosens mucous plugs 2. percussion/tapping strokes: (didn't say what this does)

Amputee causes of "knee instability" gait deviations in a transfemoral amputee: (2)

1. weak hip extensors 2. hip flexion contracture (things that would make your knee buckle)

Amputee causes of "toe drag" gait deviations in a transfemoral amputee: (4)

1. weak hip extensors on sound side (or residual limb hip flexors) 2. weak hip abductors on sound side (hip drop on residual limb) 3. poor posture 4. poor gait habits

How well are the following lubricants absorbed by the body or when are they used? 1. almond oil 2. baby oil 3. pure lanolin 4. cocoa butter 5. water-based 6. tiger balm

1. well absorbed 2. not well absorbed, wipe down pt after 3. used for scars or when there's a need for a lot of friction 4. pleasant smell, expensive, can clog pores 5. well absorbed 6. expensive, can irritate some people, mostly used in athletic settings

Therapy goals for "heel rise" gait deviations in a transfemoral amputee: (2)

1. work on coordination & encourage symmetrical motion of the femurs 2. work on timing of flexor firing

Therapy goals for "external foot rotation" gait deviations in a transfemoral amputee: (1)

1. work on donning correctly

Therapy goals for "internal foot rotation" gait deviations in a transfemoral amputee: (2)

1. work on donning correctly 2. more upright position during ambulation

What are 2 possible explanations for why the contract-relax stretching technique works?

1.*neurophysiological effect* (autogenic inhibition via GTO - controversial) 2. *psychological effect* -accepted that this may work with the neurophysiological effect or replace it to explain why PNF works

What does the ulnar nerve innervate?

1.5 muscles of forearm: flexor carpi ulnaris, and medial portion of flexor digitorum profundus. Also innervates almost all of the hand except 3.5 muscles

What is the outlook for patients treated with levodopa for parkinson's?

1/3 - respond well for rest of life 1/3 - respond well for 5-7 yrs 1/3 - respond well for 4-5 yrs additional medication will be required after that time

About ___-___%e of the population has insomnia

10-15%

If replantation of a limb is attempted, it must occur within what time frame?

12 hour window

What is the ideal step length in prosthetic gait training? How should you work on this with the pt?

12" they often take short steps, encourage them to step longer with stool stepping, ball rolls, etc.

What is the average conduction speed of small myelinated nerves?

12-30 m/sec for diameters 2-5 micrometers) 3-15 m/sec for diameters less than 3 micrometers

On average, it takes a drug _____ years to go from drug discovery to the market.

15

What is the normal value for hip angle of torsion?

15 degrees of anteversion

Insulin was discovered in year:

1921

Humulin was made in year:

1982

What 2 enzymes are responsible for the 2 major pathways of the catabolism of ingested alcohol?

1st: alcohol dehydrogenase (ADH) 2nd: aldehyde dehydrogenase (ALDH)

In what order do you progress the type of ROM in PNF patterns?

1st: passive 2nd: active assistive 3rd: resisted

Alzheimer's = linked to type __ diabetes

2

What is the ideal step width in prosthetic gait training? How should you work on this with the pt?

2-4" they tend to inc this due to feeling unstable, instruct them not to do this

A unilateral BKA increases energy cost of ambulation by ___ % A unilateral AKA by ___ % A hip disarticulation by ___ % A bilateral AKA by ___ %

20% 49-65% 200% 280%

The error rate in radiological interpretation by radiologists may be as high as ____ to ____ %

20-30%

______% of people with diabetes have diabetic nephropathy

20-40%

What is the average conduction speed of medium myelinated nerves?

20-45 m/sec

1 in _____ Americans will undergo an amputation

200

To date, there are at least ____ different peptides secreted by cells that act as __________

25 that act as neurotransmitters

An estimated ____-____% of breast CA patients will develop lymph during their lifetime. This risk may increase to ____% after radiation therapy.

25-30% 48%

What percent of adults have a patent foramen ovale (PFO)?

27%

With shoulder abduction above 60 degrees, how does the scapula move?

2:1 ratio humerus to scapula AC joint upwardly rotates 30 degrees

A radiograph is a ____-dimensional picture of a ____-dimensional object

2D picture of 3D object

PAD (peripheral artery disease) occurs in 1 in __ people over 50 w/ diabetes

3

You should do at least ____ repetitions of each Swedish stroke

3

How many stages of CRPS are there? Is this condition progressive from one stage to another?

3 no

Traditionally, pain is considered a _____ (#) neuron system

3 1st, 2nd and 3rd order neurons

When should the septum primum anatomically fuse to the septum secondum by?

3 months

After 12 months post-lymph node biopsy/dissection, what percent of women who get a sentinel node biopsy are at risk for lymphedema? Axillary node disection?

3% for sentinel 20% for axillary

The book does not advocate using + or - for scoring MMT except for _____________ .

3+ and 2-

When testing a potential new drug, how many species of animals must it be tested on? Why?

3+ species because the effect may be different

Gestational diabetes occurs in ___% of all pregnancies in the US

3-5%

In MMT, if AROM is full, the score should be at least what?

3/5 use BT or ART from here

What is the ideal amount of knee flexion in prosthetic gait training? How should you work on this with the pt?

30-60 deg exercises for knee flexion such as step overs w/ cones

Over _____% of all elderly residents in nursing facilities are on at least one psychotropic drug such as an atidepressant, antipsychotic, or sedative

35%

Diabetic nephropathy occurs in ___% of dialysis pts

35% (one third are DM1 and two-thirds are DM2)

How many cords are in the brachial plexus?

3: lateral, posterior, and medial

How many trunks are in the brachial plexus?

3: superior, inferior, middle

How many arteries do we have in one finger?

4 arteries, 2 on each side

ACE wraps must be re-wrapped every __ to __ hours

4-6 hours

When does a 4 chamber heart form?

4-6 weeks

Lymphedema occurs in _____% of breast cancer patients

40

What degrees of motion are considered "functional" ROM of the wrist needed to complete ADLs?

40 degrees flexion/extension 10 degrees radial deviation 30 degrees ulnar deviation

The 30 day mortality rate following a major leg amputation is as high as ___ % 5 year mortality rate is as high as ___ %

40% 70% (other lecture said 80%)

After an amputation, skin integrity and pressure tolerance is only ___ % of normal on the residual limb

40% important to keep in mind for massage

______% of people with diabetes have diabetic retinopathy

40-45%

How many terminal branches do you end up with in the brachial plexus?

5

What is the ideal amount of pelvic rotation in prosthetic gait training? How should you work on this with the pt?

5 deg exercises for rhythmic pelvic rotations & figure 8 walking

What is the ideal amount of trunk rotation in prosthetic gait training? How should you work on this with the pt?

5 deg exercises such as trunk perturbations and manually facilitated rotation

What are the 3 aspects of resting position of the scapulothoracic joint? (upward rotation, IR and anterior tilt)

5-10 degrees upward rotation 35 degrees internal rotation 10 degrees anterior tilt

Type 1 DM = __% of all DM

5-10%

An estimated ___ to ___% of patients who underwent a sentinel node biopsy will develop lymphedema

5-14%

Diabetic neuropathy occurs in __% of people w/ 20 years of diabetes

50%

How many compartments of the palmar hand are there and what are they?

5: Thenar: thenar mm Hypothenar: hypothenar mm Central: flexor tendons, lumbricals, superficial arterial arch Adductor: adductor pollicis Interosseous: interossei mm

How many roots make up the brachial plexus?

5: C5, C6, C7, C8, T1 (when he says roots he does not mean spinal roots, they are ventral rami)

What percent of pediatric amputations are congenital? acquired?

60% congenital 40% acquired

How many divisions are in the brachial plexus?

6: each trunk divides into anterior and posterior

With wrist extension, what is the normal ROM? How much of this motion comes from the radiocarpal vs. midcarpal joints?

70 is normal 45 from RC 25 from MC

What is the average conduction speed of large myelinated nerves?

70-130 m/sec

1 in ___ women will develop breast cancer during their lifetime

8

When do heart valves become functional?

8 weeks

With wrist flexion, what is the normal ROM? How much of this motion comes from the radiocarpal vs. midcarpal joints?

80 is normal 30 from RC 50 from MC

What percent of people will suffer from back pain at some point in their life?

80%

What passes through the carpal tunnel?

9 tendons and 1 nerve. Tendons of FDS, FDP, and FPL Median nerve

___ % of Americans have diagnosed/undiagnosed diabetes

9.3%

_____ % of pulmonary emboli originate from DVT in legs are are preventable

90%

The hand is involved in _______% of UE activities. What percent of UE activities are the following structures involved in? -thumb -index finger -long finger -ring finger -little finger

90% thumb = 50% index = 20% long finger = 20% ring finger = 10% little finger = 5%

Type 2 DM = __% of all DM

90-95%

What is a major down fall of levodopa?

99% is converted to dopamine *before* crossing the blood-brain barrier, thus a high dose is required to obtain an effect. This results in many side effects

Normal glucose level:

<100 mg/dl

How is retroversion of the hip defined?

<15 degrees and of course some say <8 degrees because why not...

Diabetes glucose level:

>126 mg/dl (on 2 occasions)

With the OGTT, diabetes glucose level =

>200 mg/dl