(0) - Mega weekend review
First Degree = Increase in PR interval, Continue exercise Second Degree Type 1 = Progressive increase in PR interval until drop, Monitor exercise Second Degree Type 2 = Normal PR interval until sudden drop, Slow/Stop exercise Third degree = No relationship, Stop immediately and refer
AV Blocks Summary
"APTM 2245" Aortic: 2nd IC Right Side Pulmonary: 2nd IC Left Side Tricuspid: 4th IC L Side Mitral: 5th IC L side
Auscultation Sites
CN 8: Sensory: Vestibulocochlear nerve: Hearing and balance. Glosso"P"haryngeal: "P"osterior Tongue CN 9: Glossppharyngeal: Posterior ⅓ tongue: Taste and sensation: 9→ P. CN 10: Gag, swallow, elevate soft palate
Cranial nerve 7-9, 10 sensation of anterior 2/3 of tongue v.s tast of ant 2/3 of tongue
systole, S2 - diastole, S3 - beginning of diastole, S4 - end of diastole (before S1) S4 S1 S2 S3 is probably the most efficient way of reading the auscultation
Heart sounds
The combination of both the superficial and deep sensory mechanism. Stereognosis, two-point discrimination, barognosis, graphesthesia, tactile localization, recognition of texture, and double simultaneous stimulation.
Define cortical sensation
Proprioceptors: Receive stimuli from muscles, tendons, fascia. Position sense and awareness of joints at rest, kinesthesia and vibration.
Define deep sensation
Exteroceptors: Receive stimuli from the external environment via the skin and subcutaneous tissue Pain, temperature and light touch
Define superficial sensation
Hard "Bone-to-Bone" stiff sensation that is painless. Example: Elbow extension Soft: There is a yielding compression (mushy feel) Example : Elbow and knee flexion Firm: .Toward the end of ROM, there is an elastic resistance. Example : lateral rotation of the shoulder Empty: unable to determine end feel secondary to pain
Define the following end feels: Hard, soft, firm, empty
Gait - manner or style of walking Gait cycle - beginning of a walking event by one limb and continuing until the event is repeated again with the same limb (time from heel strike to the next ipsilateral heel strike) Stride - one complete gait cycle Step - beginning of an event by one limb until the beginning of the same event with the contralateral limb
GAIT - DEFINITIONS
EVM 456- Eye Opening 4 Verbal response 5 Motor Response 6 ESPN- Eye Opening E eye-opening spontaneously 4 S eye-opening to sound 3 P eye-opening to pain 2 N No response 1 Our Country Wins - Verbal Response 5 Oriented - 5 Confused - 4 Inappropriate words - 3 Incomprehensible sounds - 2 No response -1 Can't Live without my fans - Motor Response 6 Obeys Commands- 6 Localizes pain - 5 Withdraws from Pain - 4 Flexion to pain (decorticate)- 3 Extension to pain (decerebrate) - 2 None- 1
Glasgow Coma Scale 8 or less: Severe. Between 9 and 12: Moderate 13 to 15: Mild brain injury
Summary - MLD: Rt UE drains to right lymphatic duct and LE, TRUNK and Left side drain to thoracic duct. LYMphatic drainage : proximal to distal drainage, Exercises : proximal to distal Direction of stroking : Stroking distal to proximal
LYMPHEDEMA VS LIPEDEMA
7 Complete Independence (timely, safely) 6 Modified Independence (device) 5 Supervision (cuing, setup, coaxing) 4 Minimal Assist (Patient participation= 75% or more) 3 Moderate Assist (Patient participation= 50% - 74%) 2 Maximal Assist (Patient participation= 25% - 49%) 1 Dependent (Patient participation= less than 25%)
Levels of assistance
STEPS! 1. Look at pH Normal 7.35-7.45 - Answer is Compensated 2. Look at PaCO2 Normal 35-45 - Answer is Metabolic 3. Look at HCO3 Normal 22-26 - Answer is Respiratory 4. None of the three are normal Answer is Partially Compensated
NORMAL BLOOD GASES
D. Empty end feel Pain is limiting you!
PRACTICE QUESTION 1 A 46-year-old patient with shoulder pain is referred to physical therapy. The patient reports 4/10 pain at rest and 10/10 with any movement. When testing passive shoulder range of motion, which of the following end-feels would you MOST likely encounter? A. Soft end feel B. Firm end feel C. Hard end feel D. Empty end feel
C. Left Iliopsoas Contracture
PRACTICE QUESTION 11 A physical therapist observes that a patient walks into the clinic with an abnormal gait. On examination, PT identifies that the patient has a shorter step length on the right lower extremity. Which of the following problems is MOST likely the cause of the gait dysfunction? A. Right Iliopsoas contracture B. Left Gluteus Maximus contracture C. Left Iliopsoas Contracture D. Left gluteus medius weakness
A. Murphy's sign
PRACTICE QUESTION 12 A 37-year-old male patient presents to the clinic with complaints of low-grade, fever, nausea, and vomiting. The patient also mentions that he has a loss of appetite and a "dull pain" near the navel area. The PT suspects appendicitis; which test is LEAST likely confirm this diagnosis? A. Murphy's sign B. Psoas sign C. Obturator sign D. Rovsing's sign
D. Kidney A and B would be seen on imaging, so they are wrong. Diaphragm radiates pain to the shoulder.
PRACTICE QUESTION 13 A patient complains of constant back pain that radiates upward toward the thorax and anteriorly into the abdominal region. MRI and X-ray show negative findings. The PT should suspect the potential source of the pain is due to? A. Disc herniation B. Spondylolisthesis C. Diaphragm D. Kidney
B. Moderate assist
PRACTICE QUESTION 14 A physical therapist transfers a 50-year-old patient from the commode to a wheelchair. The physical therapist provides 30% of the effort to complete the transfer. Which of the following levels of physical assistance should be documented? A. Minimal assist B. Moderate assist C. Maximal assist D. Dependent
C. Facial Nerve; Absence of taste on anterior 2/3rd of the tongue
PRACTICE QUESTION 15 On examination of a 45-year-old male patient, the PT observes that the patient can clench his teeth but is unable to smile, whistle or close his eyes. The patient reports that most of the sounds around him seem unpleasant and too loud. Which nerve is affected and what other findings can help the PT confirm the diagnosis? A. Oculomotor nerve; Absence of corneal reflex. B. Trigeminal nerve; Absence of sensation on the face. C. Facial Nerve; Absence of taste on anterior 2/3rd of the tongue D. Vestibulocochlear nerve; loss of balance and equilibrium
C. Compression of the shafts of the tibia and fibula at mid-calf
PRACTICE QUESTION 16 To assess an anterior tibiofibular ligament injury, which of the following tests is MOST appropriate? A. Talar tilt with the ankle in neutral dorsiflexion B. Anterior drawer at the ankle with the ankle in neutral dorsiflexion C. Compression of the shafts of the tibia and fibula at mid-calf D. Squeezing the calf with the ankle in neutral dorsiflexion
D. Spinal Stenosis
PRACTICE QUESTION 17 A 65-year-old female suffering from low back pain describes that pain occurs bilaterally. She describes that the pain increases during standing. As the PT performed a SLR test on RLE, patient reports positive test and pain in right lower extremity. Which of the following would MOST likely correlate to this type of diagnosis? A. Spondylolisthesis B. Muscle strain C. Osteoarthritis D. Spinal Stenosis
C. Knee extension, Hip internal rotation and flexion, inversion of foot with plantar flexion of ankle
PRACTICE QUESTION 18 A PT is evaluating a patient with tingling sensation on the anterior leg and dorsum of the foot. The PT suspects involvement of the common peroneal nerve. A positive finding on which of the following tests will confirm entrapment of the common peroneal nerve? A. Flexion and adduction of hip with knee extension and ankle dorsiflexion B. Hip flexion, knee extension, dorsiflexion of ankle with inversion of foot C. Knee extension, Hip internal rotation and flexion, inversion of foot with plantar flexion of ankle D. Knee extension, hip flexion, ankle dorsiflexion with everted foot
B. C4 dermatome
PRACTICE QUESTION 2 A patient presents with gradual onset of neck pain since the last 5 months, loss of sensation on the shoulder area, clavicular area and upper scapular area with weakness of the trapezius and levator scapula. The patient denied any tingling numbness radiating down the fingers. Which of the following is MOST likely to be affected? A. C2 dermatome B. C4 dermatome C. C5 dermatome D. T3 dermatome
B. A warm test tube placed on the skin. The patient wasn't able to recognize a light touch sensation, but he could recognize pain sensation indicating an injury to DCML and sparing of spinothalamic tracts. In this case he should be able to recognize the temperature sensation that is carried by STTracts. The other options (graphesthesia, stereognosis and vibration) are sensations carried by the DCML which seems to be affected
PRACTICE QUESTION 3 A PT is performing sensory examination of a patient post SCI. When PT strokes lightly on the patient's arm with a camel brush, the patient doesn't recognize the sensation. On pricking the patient with a neurological pin, the sensation is recognized. What other sensation is most likely recognized by the patient? A. Letters drawn on the hand. B. A warm test tube placed on the skin. C. The shape of an object placed in his hand D. Vibration from a tuning fork.
D. Localizing pain open eye to painful stimulus = 2 verbal response incomprehensible = 2 Need at LEAST 5 to get to 9, to put the pt to moderate which is localizing pain (5)
PRACTICE QUESTION 4 A 25-year-old fell off a ladder. On assessment, the PT found that the patient opened his eyes to a painful stimulus, and his verbal response consisted of incomprehensible sounds. He was diagnosed with a moderate brain injury. Which of the following is the MOST appropriate motor response to fit this diagnostic category? A. No motor response B. Abnormal flexion response C. Extensor response D. Localizing pain
A. Tricuspid valve All PT make 2245 Auscultation Sites "APTM 2245" Aortic: 2nd IC Right Side Pulmonary: 2nd IC Left Side Tricuspid: 4th IC L Side Mitral: 5th IC L side
PRACTICE QUESTION 5 A 48-year-old male patient reports of shortness of breath and swelling in lower extremities. During the baseline examination, the PT examines patient's heart sounds. Which valve is being auscultated in the picture? A. Tricuspid valve B. Pulmonary valve C. Mitral Valve D. Aortic Valve
B. Due to cardiac denervation, patient will have a reduced resting HR to achieve normal cardiac output due to denervation, HR is not under control so it will INCREASE Clinically, the patient with a denervated heart following transplantation will present with elevated resting HRs to achieve normal cardiac output, delayed elevation in HRs with exercise due to circulating catecholamines, decreased maximum HR responses, and slower decreases in HR values during the recovery phase of exercise
PRACTICE QUESTION 6 Which of the following statements regarding changes related to denervation post heart transplant is LEAST appropriate for the therapist to follow while exercising the patient? A. HR, RPE and BP must be measured while exercising the patient B. Due to cardiac denervation, patient will have a reduced resting HR to achieve normal cardiac output C. Patient will have delayed elevation of HR with exercise D. Patient will have slower decrease in HR values during recovery phase of exercise.
A. Increased fremitus Decreased Fremitus - Indicates more Air: Less Vibration Increased fremitus - Increase in Secretions: More Vibration
PRACTICE QUESTION 7 A 49-year-old male was diagnosed with Pneumonia. The PT suspects a lot of secretions before starting pulmonary rehabilitation. Which of the following is MOST likely to be seen in the examination finding? A. Increased fremitus B. Decreased fremitus C. Hyper resonant percussion D. Increased breath sounds
D. Compensated respiratory alkalosis. pH is more towards the alkalosis levels, respiratory is alkaline and HCO3 levels is more in a acidic state SUMMARY : STEP 1- LOOK AT PH— PH was normal so ANSWER has to be compensated. STEP2 : Look at which of the two abnormal values are more deviated from Normal. HERE, PACo2 is more deviated from normal , so answer has to be Respiratory ( Due to CO2). It is alkalosis because reduced CO2 makes it more alkaline and not acidic. Which is why ANSWER is D ( compensated respiratory ALKALOSIS ) Step 1 : PH is compensated leaning towards Alkalosis. Conditon will be Alkalosis Step 2: Paco2 and Hco3 both abnormal Step 3: HCO is acidic , Paco2 is alkaline Hence, see who follows the steps which is Paco2 representing Respiratory. --> Compensated Respiratory Alkalosis
PRACTICE QUESTION 8 A 50-year-old male fainted in the office and was transferred to the ER for further evaluation. The medical history includes DM II and hypertension. The arterial blood gas results are as follows: Blood pH - 7.43, PaCO2 - 28 mmHg and HCO3 - 18 mEq/L. This is known as: A. Partially compensated respiratory alkalosis. B. Uncompensated respiratory alkalosis. C. Compensated metabolic alkalosis. D. Compensated respiratory alkalosis.
B. Stage 2
PRACTICE QUESTION 9 A 52-year-old female complains of R forearm/wrist discomfort. The patient had undergone mastectomy 1 year ago. During examination, the PT observes that the patient has increased swelling that does not change with arm elevation and initial signs of fibrotic changes. This PT identifies the stage of lymphedema as: A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4
TO remember: Start at lucky 13: Somewhat Hard. Then spell SHVEM. 13: "S"omewhat hard 15: "H"ard 17: "V"ery hard 19: "E"xtremely hard 20: "M"aximal exertion. SHVEM sounds like something you get on you in the ICU. For the other half of the chart it's just the opposite. Yuck I got some SHVEM on me. Then when you go in the opposite direction, it's just the opposite of SHVEM. Somewhat hard (13) Light (11) Very light (9) Extremely light (7.5) No exertion at all (6)
RPE Summary : Patient with Cancer: 11-13, Obesity: Up to 17, Pregnancy: 11-13
Serratus anterior = medial winging (open book palsy) Trapezius = lateral winging )sliding door palsy) - watch that SLIDING DOOR, it's a TRAP! —> Sliding door palsy (lateral winging) is TRAPezius. (LONG THORACIC N.) - OPEN BOOK test? Sir gets an A. —> OPEN BOOK palsy (medial winging) is (Sir) SERratus (A)nterior
SCAPULAR WINGING TYPES What two muscles are usually involved? Which type of scap winging do they lead to?
• Anterior cord syndrome: Motor function loss B/L, spastic paralysis below level of injury Loss of pain and temp B/L below level of injury • Posterior cord syndrome: Sensory loss B /L (loss of proprioception, vibration, stereognosis) • Central cord syndrome: Loss of pain and temperature Motor loss B/L to upper limbs only
SPINAL CORD INJURY SYNDROMES (brown sequard in pic)
SLR+ TED : Tibial (Eversion+Dorsiflexion) SLR + SID : Sural (Inversion+Dorsiflexion) SLR + PIP : Peroneal (Inversion+Plantarflexion
STRAIGHT LEG RAISE TEST DD
LIPedema: When you want to kiss someone taller then you on the LIPs, you have to stand on BOTH LEGS. LIPedema —> bilateral LE
Stages of Lipedema
DCML - fine touch, two-point discrimination, proprioception, vibration Anterior Corticospinal - motor Lateral Corticospinal - motor Anterior Spinothalamic - crude touch Lateral Spinothalamic - pain and temp
Summary of tracts
Vibration that is produced by the presence of secretions in the airways. Abnormal - • Decreased Fremitus - Indicates more air in that area. • Increased fremitus - Indicates increase in secretions in that area.
What is Fremitus? What indicates decreased and increased fremitus?
FOR APPENDICITIS Obturator sign • Examiner moves right lower leg laterally, resulting in internal rotation of femur • Pain on passive internal rotation of the flexed thigh. Psoas Sign Patient lies on left side. Examiner extends patient's right thigh Pain on passive extension of the right thigh.
What is a positive obturator sign? Psoas sign?
