Review Set 5

Crossover Impingement Test

*AC separation, RC impingement* patient is standing and clinician support at upper back while patient brings arm across chest, apply OP (COAG has PT on other side of patient bringing arm across) positive, location of pain- anterior (subscap, supraspinatus, long head biceps); superior (AC joint); posterior (infraspinatus, teres minor, posterior capsule)

Anterior Drawer Test

*ACL laxity or tear* Patient hooklying, sit on foot and pull tibia anteriorly positive- gap seen

Lachman's Test

*ACL laxity or tear* Patient supine, knee about 30deg flexion, using your knee as a bolster and stabilize thigh, pull tibia anteriorly positive- excess translation tibia anteriorly

GH Instability Ant/Post

*GH instability* patient seated with arms relaxed on thigh, stabilize GH joint with one hand, with other hand grasp humeral head and compress into joint then slide anterior/posterior positive- increased translation, reproduction of symptoms

ECRB Test (Elbow)

*Lateral Epicondylitis*

O'Brien's Test

*SLAP lesion* patient raise arm to 90deg flexion, horizontal adduction 10deg, IR and push down at distal arm. Then have pt ER and push down at distal arm. positive- pain inside shoulder joint with IR and pressure, relief with ER and pressure

Scour Test

*Tendinitis of adductors, possibly iliopsoas, or bursitis* Patient supine 90deg hip flexion and neutral rotation with knee bent. PT grabs patient knee with both hands and move hip into adduction while applying compression along femoral line, then into flexion and abduction positive- irregularity in movement, pain, and patient apprehension.

Hawkins-Kennedy Test

*Tendinitis/Impingement Syndrome of supraspinatus* patient- 90deg flexion, 90deg elbow flexion PT- stand in front of patient, try to IR arm (passive test) positive- reproduction of symptoms

Neers Test

*Tendinitis/Impingement Syndrome of supraspinatus* patient- IR humerus PT- behind/side of patient, stabilize scapula and try to move arm into flexion in the scapular plane (passive test) positive- pain

Finklestein's Test (Wrist)

*Tenosinovitis of APL and EPB* passive test have patient make fist with thumb inside fingers, stabilize forearm and ulnar deviate positive- reproduces pain over APL or EPB

Ober Test (IT band)

*Tight IT band* Patient sidelying -*test* in Modified Ober (knee in extension) -*treat* in Ober (knee in flexion)

Thomas Test (Hip flexor length)

*Tight iliopsoas, rectus femoris, TFL* Patient supine toward bottom of table, palpate ASIS and PSIS with proximal hand, support under testing leg with distal hand. Have them bring both knees to chest and then extend one leg 1- lower leg to table while monitoring low back for lifting 2-leg *does not* lower to table with *knee in flexion* extend knee and attempt to lower leg to the table 3- leg *does not* lower to table with *knee in extension*, flex knee and abduct hip and attempt to lower to table Results Leg *does not* lower with *knee in extension*- tight iliopsoas Leg *does* lower with *knee in extension*- tight rectus femoris Leg *does* lower with *knee in flexion and hip in abduction*- tight TFL

Ely's Test

*Tight rectus femoris* patient prone, support along sacral area with hand, observe for tilt of pelvis as you bring patients heel to their buttocks positive- heel doesn't reach buttocks

Which gland is glucagon secreted from?

*alpha cells* of pancreas

T/F: C2 (axis) fractures are often associated with neuro compromise

*false* relatively uncommon and usually due to distraction not fracture if it does happen

Does hyponatremia or hypernatremia lead to edema? Why?

*hypernatremia* -it causes fluid to move into the ECF due to higher solute concentration

What does it mean if your ABI is 1.0-1.2?

*normal*, BP in ankles is equal to or slightly greater than BP in arms

Which gland secretes ADH?

*posterior lobe* of pituitary

Is a unilateral facet dislocation stable or unstable?

*stable*, b/c unilateral. if it was bilateral it would be unstable

How do you test scapular adduction and downward rotation MMT? How is this graded?

- patient in prone slide hand into small of back and lift hand from there -Apply pressure to distal humerus and trying to pull arm into upward rotation and abduction - Apply pressure down and outwards from the body Grades: 5-3 are normal GE: sitting, same action, PT supports arm 2 is full ROM in GE 1 and 0 are normal

What are the 3 different types of chemical structures of hormones? Which category are ADH, aldosterone, insulin & glucagon, dopamine, glucocorticoids, T3 & T4, sex hormones, norepinephrine?

-*derivatives of tyrosine*: T3, T4, norepinephrine, dopamine -*steroids*: glucocorticoids, aldosterone, sex hormones -*peptides*: insulin, glucagon, ADH

What other C-spine injuries are associated with a Jefferson (atlas) fracture?

-*fracture of dens of C2* -transverse ligament tear -avulsion fracture -rarely: neuro injury

How is stamina affected with fatigue?

-*gradual* loss of energy (not increased weakness) out of proportion to energy expended -repeated experience may lead to decreased activity

What are some symptoms of Graves' disease?

-*hypermetabolism* -*inc SNS stimulation* -inc body temp -sweating -dec BMI -insomnia -hyperactivity

What is the information obtained from goniometry used for?

1. Determine absence/presence of dysfunction 2. Establish a diagnosis 3. Evaluate progress 4. Modify treatment 5. Patient motivation 6. Research effectiveness of treatment 7. Guide for fabrication of an orthosis or piece of adaptive equipment

What are the 3 parts of the gall bladder?

1. Fundus 2. Body 3. Neck

What may cause hypomagnesemia? (2)

1. GI: malabsorption or malnutrition 2. kidney: use of diuretics, excess aldosterone

What are the 2 veins of the stomach that we need to know?

1. Portal V 2. Esophageal VV

What is the function of the spleen? (3)

1. Removes old RBC's and platelets from blood circulation 2. Recycles iron and globin 3. Acts as a blood reservoir

What is the resting membrane potential of a cell?

-70 mV

Why is constipation such a big deal? How does it lead to a stretch injury of the pudendal N?

-GI & urinary systems are closely related and controlled by the same muscles -full rectum *puts pressure on bladder* -consistent straining causes *supportive dysfunction* and bad muscle patterns in pelvic floor & core -abd bloating dec diaphragm movement & function weakening the core -chronic pressure & straining can *stretch the pudendal N*

Most common types of cardiovascular disorders:

-Hypertensive heart disease -Coronary heart disease (angina pectoris and MI) -CHF -cardiac arrhythmias -congenital heart defects

What tissue changes occur after radiation?

-atrophy of skin and underlying muscle -scar formation & skin tightness

Effects of composites:

-autolytic debridement -allows exchage of moisture vapor

Things to remember about placement of a limb in a whirlpool:

-avoid pressure of limb on edge of whirlpool -don't let pt near turbine ejector

Describe a fixed pulley

-axis is anchored -pulley wheel only rotates -provides change in direction of F application only -mechanical advantage = 1 -Ex: lat malleolus & fibularis mm

Describe a movable pulley

-axis is the attachment point for F but is not fixed -pulley wheel rotates and translates -provides a change in direction of F -each movable pulley provides a MA of 2

What is the fastest control mechanism of serum pH?

-buffer pairs in the blood respond to pH changes immediately

The 4 types of laxatives: (review)

-bulk forming -stimulant -hyperosmotic -lubricants/stool softeners

Describe *conservative* stabilization of a C-spine injury:

-closed reduction -traction -bracing -etc.

What equipment is needed for a cold pack?

-cold pack of right size -towels/pillowcase -plastic wrap if need to adhere it in place -timer/call light/bell

People with which conditions can't take more fiber into their diet and therefore should take bulk laxatives?

-colostomies -ileostomy bags -IBS -anal fissures

What should you be sure to look at in an objective exam of patient with neuropathy?

-condition of skin, hair & toenails -deformities -pulses -sensation -shoe wear

If brain cells swell due to inc intracellular fluid (ICF), what symptoms might this cause?

-confusion -headache -weaknesss -seizures

What causes hypoparathyroidism? (4)

-congenital lack of parathyroid glands -tumor -surgery or radiation in neck -autoimmune disease

Dwarfism is caused by a deficit of what 2 substances?

-deficit of GH production/release -deficit of SRH (somatotropin releasing hormone)

When should you NOT use a BP cuff for hemodynamic monitoring?

-don't use on extremity with arterial line -lymphedema -AV fistula or graft -blood clot -ipsilateral side to a masectomy

Effects of hydrogels:

-donates moisture -cooling/soothing -autolytic debridement

How can you quick-measure the Q angle by utilizing the patella?

-draw a point in the center of the patella -draw a line from that point to the ASIS -draw another line from the patella to the tibial tuberosity -measure that angle

What does the pudendal N innervate?

-ext anal sphincter -urethral sphincter -scrotum, perineal body -superficial & deep transverse perineal mm -bulbospongiosus, ischiocavernosus, levator ani -penis

Hyponatremia causes impaired nerve conduction and fluid imbalance. What symptoms can this cause?

-fatigue -muscle cramps -abdominal discomfort -nausea -vomiting

What is the definition of fatigue?

-feeling tired physically, mentally and emotionally -having less energy to do the things you normally do or want to do

What are fenestra and clefts in terms of capillaries?

-fenestra: small openings b/w endothelial cells -clefts: sizable gaps b/w endothelial cells

What are the 3 most common MOI for the menisci?

-forceful compression and axial rotation, often with knee flexion -medial meniscus - flexion, axial rotation and valgus force -often occurs with an ACL tears (~50%)

What education should be provided for a patient with neuropathy in general?

-general diabetes self-care -foot & skin care -daily skin checks -proper footwear: breathable & adjustable, wide toe box, good support

What 3 factors can contribute to either genu varum or genu valgus?

-genetic predisposition -foot/hip alignment -tibial alignment

When asking a patient about pain over a 24 hour period, what are some points during the day that may be important?

-getting in bed -during the night -morning in bed -getting up

People with which conditions should not take anti-diarrhea meds?

-glaucoma -prostate disease -kidney disease -liver disease

4 generic names of hyperosmotic laxatives:

-glycerin -magnesium hydroxide -magnesium sulfate -sodium phosphate (MSG)

How is stamina affected with tiredness?

-gradual loss of energy in proportion to energy expended -restored by rest

What are side effects of PPIs?

-headache -diarrhea -constipation -ab pain -nausea -rash

Side effects of H2 receptor antagonists:

-headaches -dizziness -mild/transient GI complaints such as nausea and diarrhea

You may see a pulmonary artery catheter (swan ganz) on a patient who is very medically unstable and requires information to be monitored on what two things?

-heart function -lung perfusion

What does Matt call the following gait phases during stance: -initial contact -loading response -mid-stance -terminal stance -pre-swing

-heel strike -foot flat -mid-stance -heel off -toe off

At what ages is dehydration more serious in?

-infants -older adults

What are the branches of the pudendal N?

-inferior rectal -perineal -dorsal N to penis or clitoris

Why does a professional identity matter?

-learn through experience -grow confidence -professional identity formation & role transitions

What are 3 treatments for an aortic aneursm?

-maintain blood pressure at normal level -prevent sudden BP elevations due to exertion, stress, coughing, constipation -surgical repair

What would cause decreased synthesis of plasma proteins in the blood?

-malnutrition & malabsorption -liver disease (leads to edema)

What are some symptoms of pudendal neuralgia?

-muscle weakness in superficial mm -inc stretch reflex -irritable bladder -autonomic dysfunction (ED, voiding & rectal dysfunction) -pain: penis, scrotum, perineum, anorectal, and prostate -pain aggravated by sitting and relieved by standing -no pain w/ toilet seat though bc no pressure on SIT bones *prostatitis-like urogenital pain and voiding and sexual dysfunction* are the hallmark

What body systems to PT's work with?

-musculoskeletal -neuromuscular -cardiovascular -pulmonary -integumentary

How does a decrease in the sodium concentration affect aldosterone levels?

-results in more aldosterone production -aldosterone doesn't allow sodium to be excreted

Group I male pelvic pain symptoms: (read)

-short-term pain -precede by voiding complaints -onset 2-5 mo after trauma

How do you treat chronic pelvic pain?

-significant education, bc they've been misguided for years -stress management* -multidisciplinary approach (PT-musculoskeletal, psychological, medical)

What are 2 characteristics of acute pericarditis?

-simple inflammation of the pericardium -effusion may develop

How does hypokalemia interfere with neuromuscular function?

-skeletal & cardiac muscle are hyperpolarized which makes them less responsive to stimuli -causes fatigue and muscle weakness

Side effects of stimulant laxatives:

-stomach pain/cramping -diarrhea

Stimulant laxatives should be taken if:

-the bowel is full but the person feels that they can't empty it -if bulk-forming laxatives aren't appropriate

What are 5 factors that influence Q angle?

-tibial rotation -femoral rotation -width of pelvis -genu valgum -hip adduction

How thick are the walls of capillaries?

-very thin -they're made of a single layer of endothelial cells

Of the water in blood vessels, _____ % of it is in the veins and _____ % of it is in the arteries.

1. 85% veins 2. 15% arteries

What are the 3 layers of the eye?

1. Sclera: outer 2. Choroid: middle 3. Retina: inner

When there is heavy bleeding of the arm, where are the 2 sites of compression of the axillary artery?

1. Third portion of the artery, apply pressure on lateral wall of axilla against humerus 2. Beginning of the artery, apply downward pressure in the angle b/w clavicle and attachment of SCM

Pectus Carinatum

"Pigeon chest" involves a ridge projecting anteriorly, less common

Definition of walking: (comes to doctorate school, gets asked this ^^)

"the translation of the center of mass in a manner requiring the least energy expenditure"

Why is hyponatremia harmful? What effects does it have? (3)

1. impairs nerve conduction 2. causes fluid imbalance in compartments 3.dec osmotic pressure in ECF

Prosthetic causes of "internal foot rotation" gait deviations in a transtibial amputee: (2)

1. improper alignment 2. socket fit issues

How does the body attempt to compensate for fluid loss? (6)

1. inc thirst 2. inc HR 3. constrict cutaneous bv 4. dec sweating 5. dec urine production 6. water moves from inside cells to vascular bed to maintain blood volume & BP meaning cells can malfunction

What causes hypernatremia? (5)

1. insufficient ADH 2. loss of thirst mechanism 3. watery diarrhea 4. ingestion of large amounts of sodium w/out enough water 5. prolonged periods of rapid respiration

Prosthetic causes of "toe drag" gait deviations in a transtibial amputee: (4)

1. long prosthesis 2. poor suspension 3. excessive plantarflexion 4. insufficient socket flexion (can't flex their knee enough)

What are the 2 categories of cervical fractures?

1. occipital-cervical 2. subaxial (C3-C7)

What 3 mechanics drive the "screw-home" mechanism?

1. shape of medial femoral condyle 2. passive tension in ACL 3. lateral pull of the quadriceps

Amputee causes of "toe drag" gait deviations in a transtibial amputee: (4)

1. weak hip extensors on sound side 2. weak hip abductors on sound side (Trendelenburg) 3. poor posture 4. poor gait habits (Matt prefers to say weak flexors on residual side instead of weak hip extensors)

The incidence of diabetes insipidus in the general population is _______ in 100,000

3

Anti-spasmodic drugs shouldn't be taken for more than:

3 days

Climbing stairs places how much force on the patellofemoral joint?

3.3x body weight

What are normal serum potassium levels?

3.5 - 5 mEq/L

What rating scale does the MFSI-SF use?

30 item 0-4 scale

The bones are _____ % water

31%

There are ____ distinct periods along the cancer continuum where exercise has a logical role

6

How many layers of wax should you apply to an extremity with paraffin?

6 layers

How does cryotherapy work? What does it treat?

6 needles are inserted into the prostate to freeze it and destroy all prostate CA cells - *treats prostate cancer* temp lowered to -40 C for several minutes

The lungs are _____ % water

83%

_____% of all blood volume is found in the veins, while _____% of all blood volume is found in the arteries

85%; 15%

What rating scale does the BFI use?

9 item 0-10 numeric rating scale

What is Newton's second law?

A body subjected to a resultant force will accelerate in the direction of the force & the magnitude of acceleration will be proportional to the force magnitude F=ma or Weight=mg

What is a second class lever?

ARF Ex: gastroc/soleus complex

What does an accelerometer measure?

Acceleration forces including both static & dynamic forces -can determine angle of a device -can determine movement of a device

Pedometers and air bags in vehicles are examples of what type of instrument?

Accelerometer

What type of muscles are serratus posterior superior and serratus posterior inferior?

Accessory respiratory muscles

Which portions of the large intestine have its own mesentery?

All of the intraperitoneal portions except for the cecum Transverse: transverse mesocolon Sigmoid: sigmoid mesocolon Appendix

Empty End-Feel

Always abnormal. Pain is often the limiting factor preventing the patient from allowing full ROM

Aromatase

An enzyme in fat cells that converts androgens into estrogens to stimulate breast development and can cause gynecomastia

What are hyper reflex responses caused by?

An upper motor neuron lesion, meaning a lesion in the brain or spinal cord. You see a hyper response because the reflex is not being checked by the brain

What does the rectum turn into?

Anal canal

Where is the exiting point of the GI tract?

Anal canal

What does the end of the anal columns mark?

Anal valve

What passes through the diaphragm at vertebral level T12?

Aorta, thoracic duct, and azygos vein

Suspensory Ligaments

Attaches the breast to the skin

What does the axilla allow passage of?

Axillary artery and vein, brachial plexus

Which CN is responsible for accomodation for near sight?

CN III

What characteristics led anatomists to split the GI tract into foregut, midgut and hindgut?

Each region shared the same: Blood supply Innervation Location of referred pain Lymphatic drainage route

Too much fluid movement from capillaries into tissues and not enough fluid movement from tissue back into the capillaries results in what condition?

Edema

Late Signs of Breast Cancer

Edema, retraction of the nipple, dimpling of skin, abnormal contours

Levator Costarum

Elevates ribs during inspiration

What does a dynamometer measure?

Force

Define work What unit is it measured in?

Force applied over a distance W=F/d (measured in joules or Nm)

Which direction do the following forces act: gravity, shear, tensile and compressive? Are they coplanar or colinear?

Gravity: always vertically down Shear: coplanar, in opp direction Tensile: colinear, in opp direction Compressive: colinear, in similar directions to push together

What type of splanchnic nerves innervate the pancreas?

Greater splanchnic nerves

What test do you perform when examining the action of extraocular eye muscles?

H test (memorize this in notebook)

What is the most common cause of hypothyroidism in the U.S.?

Hashimoto's thyroiditis

Sternal Fistula

Holes in the sternum, also associated with certain heart defects

Excavato-

Hollow out

What is the order of lymph node groups in terms of drainage in the axilla?

Humeral - Subscapular - Pectoral - Central - Apical - Lymphatic trunk - subclavian

List the classifications of spinal fractures and which are stable vs unstable:

I: stable II: unstable III: unstable

When is loss of rotation always present?

In joints with 3 degrees of freedom such as the hip and shoulder

How do you document sensation?

Intact Abnormal (describe) Numbness/Tingling Diminshed or Absent Can include a picture of mapped area

Internal Intercostal Muscle

Interchondral portion raises the ribs, but the lateral fibers depress the ribs. It does not reach the thoracic vertebrae, but the epimysium does.

Types of Sensation

Light touch Vibration Cold/Hot Pain

What can PT's palpate?

Muscles, joints, bony landmarks, ligaments, tendons, deformities, lymph nodes, arteries, nerves

What are the 2 divisions of the retina?

Neural retina Pigmented retina

Does the cecum have a mesentery?

No

If the force passes through the axis, is there torque/moment?

No

How do we describe end-feel?

Normal: full ROM present AND normal anatomy of the joint stops the movement. It can be soft, firm or hard Abnormal: inc/dec ROM present. The movement is stopped by something other than the normal anatomical structures. It can be soft, firm, hard, or empty

Hard End-Feel (normal and abnormal)

Normal: limited by bony contact. feels like no give or bounce Abnormal: as before, feels like bony contact but due to fractures or loose bodies

Soft End-Feel (normal and abnormal)

Normal: limited by soft tissue, feels like a sponge or a "give" Abnormal: limited by soft tissue, feels "boggy" such as edema

Firm End-Feel (normal and abnormal)

Normal: limited by tendon, capsule, or ligaments. Feels like leather stretching, a little bounce Abnormal: as before, feels like a lack of give or bounce

Can you palpate your spleen?

Normally no, if you can you'll want to get it checked for splenomegaly

How do you treat a *type III* C2 (axis) fracture?

ORIF w/ fusion

Which ligament is thicker, ACL or PCL?

PCL

Are PPIs or H2 blockers more expensive?

PPIs

Should AROM or PROM be a bigger ROM?

PROM

Why should PT be included in primary care according to Stacia?

PT's can make the team more efficient by recognizing musculoskeletal & neuromuscular disorders, perform evals, give a diagnosis & prognosis and intervene without delay

Anterior Wall of Axilla

Pectoralis major and minor

What muscle is the exception to the general rule that one muscle is innervated by one nerve?

Pectoralis major: it is innervated by the medial and lateral pectoral nerves

What may result from atherosclerosis of the iliac arteries (in legs)?

Peripheral Vascular Disease -gangrene and amputation

What divides the liver into quadrate and caudate lobes?

Porta hepatis

What causes esophageal varices?

Portal hypertension causes most venous blood flow toward the lower esophagus to go to the azygos veins which causes esophageal varices

Where can the axillary artery not be compressed?

Proximal to the deep artery of the arm and distal to posterior circumflex humeral artery

What are the 2 main coronary arteries?

R/L coronary arteries, located on heart surface

Define statics

Study bodies at rest

Which ventral rami are the intercostal nerves?

T1-T11

What does the tubercle of the rib articulate with?

The TVP of the corresponding vertebrae

What does the upper part of the anal columns mark?

The anorectal junction

Where do the anterior, middle, and posterior scalene muscles insert?

The anterior and middle scalene muscles insert onto the first rib. The posterior scalene muscle inserts onto the second rib.

What is the second group of lymph nodes that is likely to become enlarged due to infection?

The apical group, which may obstruct the cephalic vein

What does the duodenum curve around?

The head of the pancreas, the duodenum is C-shaped

What does the mediastinum contain?

The heart, great vessels, trachea, esophagus, and thymus

What 2 branches come off of the intercostal nerves?

The lateral cutaneous branches and anterior cutaneous branches

What innervates the diaphragm?

The phrenic nerve from C3-5

Where are the anal sinuses?

The recesses between each anal column

Define friction

The resistance created as a result of 2 bodies being in contact with each other

What is a normal reflex response?

The response is present bilaterally and symmetrically

Reflexes Definition

The simplest reflex response that involves an afferent, efferent, and one synpase = monosynpatic reflex

Superior Thoracic Aperture/Thoracic Outlet

The space bound by T1, the 1st rib, and superior border of the manubrium

What is the axillary artery a continuation of?

The subclavian artery

Where does the internal thoracic artery receive blood from?

The subclavian artery

What is goniometry?

The technique of human joint measurement or measurement of angles

Why do older adults have lower water content compared to younger adults?

The thirst mechanism often does not work properly in older adults

Where do the intercostal arteries receive blood from?

The thoracic aorta and internal thoracic/mammary artery

What does the diaphragm separate?

The thorax from the abdomen

How are antacids used to treat ulcers?

They relieve gastric pain and facilitate ulcer healing

How do anti-spasmodic drugs work?

They slow down the speed at which the bowel travels through the intestines, so that more water can be absorbed from the stool to produce fewer and firmer stools

Where do ribs often fracture?

They typically break just lateral to their costal angle

How do lubricants/stool softeners work?

They use mineral oil to bring water into the fecal mass, thus softening the stool and permitting easier elimination

If someone sustains a lesion to their right optic tract, what will happen?

They will loose visual fields on the left side of both eyes (L homonymous hemianopsia)

If someone sustains a lesion to their optic chiasm, what will happen? (pituitary tumor)

They will loose your lateral visual fields resulting in tunnel vision (bitemporal hemianopsia)

Retromammary Space/Bursa Function

This allows the pec major to be contracted without moving the breast

Why do the 11th and 12th ribs end posteriorly?

This functions to help protect the kidneys

Medial Wall of Axilla

Thoracic wall (ribs 1-4 & intercostal mm) and serratus anterior

Why would a surgeon need to remove a rib?

To gain access to thoracic content

Venous Thoracic Outlet Syndrome

When the cervical rib compresses a vein causing swelling, discoloration, and pain

Arterial Thoracic Outlet Syndrome

When the cervical rib compresses the blood flow and causes a downstream bulge/aneurism in the subclavian artery

At what acidic and basic pH does cell death occur?

acidic: 6.8 basic: 7.8

When is the rotation of a prosthetic foot for a transtibial prosthesis assessed? options: bench, static or dynamic phase of alignment

bench & dynamic- want to ensure foot is in the correct position during midstance -but it is NOT a priority to assess this in standing (stasis)

What is non cancerous enlargement of the prostate gland called?

benign prostate hypertrophy

Does edema present locally or throughout the body?

can be either

What does CABG stand for?

coronary artery bypass graft

How do you treat a T-spine dislocation surgically?

decompression and fusion

Infection of a gland leads to what type of endocrine disorder?

deficit/reduced effects of a hormone

Malnutrition leads to what type of endocrine disorder?

deficit/reduced effects of a hormone

Vascular problems lead to what type of endocrine disorder?

deficit/reduced effects of a hormone

The pulmonary circulation carries __________ blood from the heart to the lungs and returns ___________ blood back to the heart

deoxygenated; oxygenated

Edema is more severe in _____________ areas.

dependent- where the force of gravity is the greatest Ex: ankles

How do you treat BPH?

depends on severity of symptoms -watch & wait -medication -surgery

Coronary blood flow is greater in diastole or systole?

diastole

By what process does sodium move from the blood to the ISF?

diffusion

What can malignant hypertension cause (2)?

encephalopathy profound cerebral edema

Capillaries are made up of a single layer of ________ cell and a collagen layer

endothelial

How is social interaction affected by tiredness?

engages in normal social activities

What do cardiomyocytes release when damaged?

enzymes

Why is it important to maintain serum pH?

enzymes act in a narrow pH range and the cell will die without properly functioning enzymes

Hyperplasia of a gland would lead to what type of endocrine disorder?

excess hormone levels

What muscles are being tested with wrist extension MMT?

extensor carpi ulnaris extensor carpi radialis longus extensor carpi radialis brevis

How common is Cushing's syndrome?

fairly rare, 40-80 per 1 million people

Is ADH involved in fluid loss or retention?

fluid retention

Define arteriosclerosis: What happens in arteriosclerotic conditions?

general term for all types of arterial changes Degernerative changes in small arteries and arterioles (mostly coronary) -wall thick and hardened -loss of elasticity -lumen gradually narrows and may become obstructed -leads to tissue necrosis

Knee alignment deviation falls into what two categories?

genu varum and genu valgum

With Rheumatic Fever, where is the only tissue site that scar tissue forms?

heart

What do inotropic drugs affect?

heart contractility

What is the male pelvis shaped like?

heart-shaped

How do you treat prostalgia fugax?

heat, massage, meditation & stress management

Is a male pelvis lighter or heavier than a female pelvis?

heavier

What does an anterior glide of the shoulder help with?

horizontal abduction extension external rotation

Does acidosis result in hypo- or hyper- kalemia?

hyperkalemia -H+ diffusion out of blood and into cells causes K+ diffusion out of cells and into blood

What do beta-blockers treat?

hypertension and dysrhythmias also reduce angina attacks

What is past history of injury referring to?

information with regards to previous episodes of the *same or similar* disorders

What organ is responsible for regulating potassium homeostasis?

kidneys

What causes diabetic ketoacidosis which leads to dehydration?

loss of fluid, electrolytes & glucose in the urine

What do antihypertensive drugs do?

lower BP

Are occipital condyle fractures common?

no, they are rare

What is the function of the LCL in the knee?

resists varus and extension forces at the knee (and extreme rotation)

What is the problem with laxatives?

they are frequently abused

Are atlanto-occipital dislocations (AOD) lethal?

yes, few survive (basically internal de-capitation)

Is the capsule around a testicle strong?

yes, it has layers (like onions and ogres)

What is another name for a unilateral facet dislocation of the C-spine?

"Bowtie" sign

The treatment for neuropathy costs as much as _________ per year

$13.7 billion amputations cost $1 billion per year

How do you calculate FiO2?

(LO2/min) * 3 + 21%

What is a "Backup" congestion resulting from CHF? What does it result in? What causes a backup congestion?

(behind affected ventricle) Output from ventricle is less than the inflow of blood Results in: -blood accumulating in circulation This type of congestion occurs when balance is not maintained between R and L heart output

External Intercostal Muscle

(hands in pockets) raises ribs during inspiration, they do not reach the sternum but their epimysium does

What is a "Forward" effect resulting from CHF? What does it result in? (3)

(less blood reaching various organs) Cardiac output *stroke volume* decreases Results in: -decreased cell function in peripheral organs -fatigue and lethargy -mild acidosis compensated by increased respiration

Ankle- Anterior Drawer Test

*ATFL* Patient short sitting on edge of table with foot relaxed, Stabilize tib/fib with one hand while grasping the calcaneus with other hand. Apply an anterior force, 10 deg PF Positive with excessive anterior movement of the talus, gap or painful sensation anterior ankle Positive- medial gapping and/or pain as compared to the opposite side

FABER test

*Assessment of anterior tendons, OA, adductors, capsular restriction* Bring patients foot over knee of opposite leg (crossing legs), therapist put one hand on contralateral hip and push knee down to floor Positive- pain in hanging or with pressure, if knee doesn't go down, or both

Piriformis test

*Assessment of piriformis* Patient in sidelying, 60deg hip flexion and stabilize pelvis, PT infront of patient positive= pain in posterior hip

Speed's Test

*Biceps Tendinitis* (not shown in picture but palpate tendon while applying resistance) palpate for biceps tendon, have patient supinate and move into arm flexion, PT applies resistance at distal forearm positive- tenderness in bicipital groove

Lateral Ankle Instability Test

*CFL* Have patient short sit on edge of table with foot relaxed. Stabilize the tib/fib with one hand while grasping the foot or (lateral talus and calcaneus) with the other hand. Apply an inversion force to the TC and ST joint, with hand over top of foot or on bottom of foot to move Positive- lateral gapping and/or pain as compared to the opposite side

Critical test- patello-femoral joint

*Faulty patellar tracking, patellofemoral pain* Patient sitting on edge of bed, PT grabs distal anterior ankle and applies resistance to quadriceps muscle. Perform 10s isometric contractions at varying degrees until pain/reproduction of symptoms. Therapist passively returns knee to extension and with quads relaxed and applies a medial glide to the patella. PT returns patient to painful angle and maintains patella glide while patient performs isometric contraction of the quads. Can then assess the remainder of the angles if irritability is not too high. positive- relief of pain with medial glide

GH Instability Inferior (Sulcus Sign)

*GH instability* patient seated, pull down on humerus, will see separation between humerus and acromion positive-excess inferior translation

Patellar Tap Test

*Joint Effusion* Patient supine with knee slightly flexed or in extension, PT taps patella OR: Patient supine with knee slightly flexed, grasp above or distal to patella to cause fluid to go under patella then tap

Varus Stress Test

*LCL* Knee slight flexion with leg off table, stabilize over thigh or lateral thigh, apply varus force at 0-5deg and then 20-30deg positive- excess motion

Lateral Collateral Stress Test (Elbow)

*Lateral Collateral Ligament* Varus at 5-30 deg elbow flexion stabilize at humerus and apply varus force (will move forearm medially) positive- gapping or pain at lateral side

Wrist Extension Test- Cozen's (Elbow)

*Lateral Epicondylitis* Have patient make fist and try to push into wrist flexion, support under elbow. *top left on picture*

Passive Stretch- forearm extensors, Mill's Test (Elbow)

*Lateral Epicondylitis* patient in pronation, elbow extension, wrist flexion. Passively stretch into further wrist flexion. *bottom left on picture*

Valgus Stress Test

*MCL* Knee slight flexion with leg off table, stabilize over thigh or medial thigh, apply valgus force at 0-5deg and then 20-30deg positive- excess motion

Medial Collateral Stress (Elbow)

*Medial Collateral Ligament* Valgus at 20-30 deg elbow flexion stabilize at humerus and apply valgus force (move forearm laterally) positive- gapping or pain at medial side

Wrist Flexion Test (Elbow)

*Medial Epicondylitis*

Passive Stretch- forearm flexors (Elbow)

*Medial Epicondylitis* patient in supination, elbow extension, wrist extension. Passively stretch patient into further wrist extension.

Phalen's Test/ Phalen's Reverse (Wrist)

*Median Nerve* phalens- place dorsum of hands together (like picture) reverse phalens- place palmar sufaces of hands together (like praying) positive- pain or paresthesia in median nerve distribution

Posterior Drawer Test

*PCL laxity or tear* Patient hooklying, sit on foot and push tibia posteriorly positive- gap seen

Posterior Sag

*PCL tear* Patient supine with knees flexed to 90 or in hooklying positive- tibia is subluxed posteriorly

Empty Can Test

*Partial RC Tear* patient- elevate arms to 90 in scapular plane and IR so thumbs pointed down PT- in front of patient, push down on patients forearm positive- weakness or pain in supraspinatus region

Drop Arm Test

*RC total tear* AB patients arm to 90 and as them to keep it there, release support and see if patient can hold in this position positive- inability to hold arm in position

Allen Test (Wrist)

*Raynaud's, circulation of hand* patient seated with elbow rested on table, compress both radial and ulnar arteries at the wrist and ask pt to open and close wrist 2-5 times. Release pressure from one side and observe filling pattern, should take <5 seconds. positive- poor circulation if blanching remains after pressure released from artery

Craig's Test

*Retro-version or Anteversion* patient prone, knee to 90, palpate greater trochanter, once GT is most protruded have patient hold this position then measure the angle. Positive- <8 deg= retroversion, >15 deg = anterversion

Tinel's Test Ulnar Nerve

*Ulnar Nerve* with patient's elbow slightly flexed, locate groove between olecranon process and medial epicondyle. Tap on groove 4-6 times. positive- tingling sensation in ulnar distribution

Trendelenburg's Test

*Weak gluteus medius* Look for patient's hip to drop on one side

What is the most common cause of an endocrine disorder due to *excess* level of a hormone?

*adenoma* which is a benign tumor originating in a gland -tumor can produces high level of a hormone (can also be the cause of a hormone deficit endocrine disorder though)

What does irritability of symptoms refer to?

*amount of activity* to produce an *exacerbation* of symptoms and the time to *subside* or ease

Apprehension or Relocation Test

*anterior GH instability* patient supine, shoulder 90 degrees AB, ER. While patients arm rested on your thigh, apply an ER force at distal forearm. If patient is apprehensive or reproduces pain, apply posterior force and repeat. positive- pain or apprehension with apprehension test, relief with posterior force

Which gland secretes growth hormone?

*anterior lobe* of pituitary -also secretes TSH, ACTH, FSH, LH and PRL

Femoral-acetabular impingement test

*anterior superior labral tear, piriformis test in Dutton's* Bring patients leg into hip flexion, AD, and IR positive- Pain in groin area= anteriorsuperior labral tear

Which types of forces typically cause cervical fractures?

*avulsion* compression impaction

Which gland is insulin secreted from?

*beta cells* (of islets) of pancreas

Apley's distraction test

*collateral ligaments test* patient prone, 90 deg flexion, distraction through tibia and rotate, use your leg to stabilize their thigh positive- reproduction of symptoms, pain

Girth Measurements- Knee

*edema* Patient with knee about 40deg flexion to find joint interline then return to extension. Measure at interline, 15-20cm above interline and 15cm below interline.

T/F: Charcot foot is caused by neurotrauma

*false*, it's unclear if the etiology is neurotraumatic, neurovascular or both

Negative Feedback Hormonal Control Example (read) -high blood glucose -low blood glucose

*high blood glucose* -beta cells of pancreas inc insulin secretion -insulin promotes transport of glucose into cells *low blood glucose* -alpha cells secrete glucagon -glycogenolysis in liver -gluconeogenesis in liver

Does insufficient ADH lead to hyponatremia or hypernatremia? Why?

*hypernatremia* -ADH prevents urination by promoting water retention -insufficient ADH would result in a large volume of dilute urine -loss of water leads to inc relative concentration of sodium which causes hypernatremia -Ex: diabetes insipidus

Does a loss of function of the thirst mechanism lead to hyponatremia or hypernatremia?

*hypernatremia* -decreased water leads to relative increase in sodium

Clunk Test

*labrum tear* (easier to do behind patient, don't forget support under posterior aspect humeral head) patient supine, put arm in 120-130 degrees flexion with one hand supporting under posterior aspect of humeral head, other hand hold humerus just proximal to elbow. Apply anterior force while compression and rotation to the humerus (into ER) positive- pain, clunk, grinding

Tinel's Sign Median Nerve (Wrist)

*median nerve* tap over volar carpal ligament with finger tip positive- paresthesia in median nerve distribution

McMurray's Test

*meniscus lesion* patient supine, flex hip and knee, palpate joint line -start with medial rotation with knee at 90 and apply varus force -then lateral roation of knee with valgus force positive= grinding or pain

Apley's compression test

*meniscus test* patient prone, 90 deg flexion, compress down on bottom of foot positive- pain sensation

Apprehension Test- Patello-femoral joint

*patello-femoral dislocation* patient supine with quad relaxed, place towel roll under knee, PT glides patella laterally and look for signs of apprehension positive- any signs of apprehension, quad contracts to control patella

Which gland secretes oxytocin?

*posterior lobe* of pituitary

Median Nerve Test

*pronator teres syndrome* "shake hands" with supination and elbow extension. Patient should try to keep the elbow relaxed while resisting supination.

Watson's Sign

*scaphoid instability* patient seated with elbow flexed to 90 and forearm pronated. Stabilize scaphoid and passively move wrist from UD to RD. Scaphoid should naturally glide volarly into your fingertip. positive- if scaphoid shifts dorsally, clicking heard

Does SIADH result in sever hypernatremia or hyponatremia? What effects does this cause?

*severe hyponatremia* -cerebral edema -headache, confusion, stupor -seizure, coma

Froment's sign (wrist)

*testing adductor pollicis, ulnar Nn* place a piece of paper between thumb and index finger and try to pull away positive- unable to keep paper between fingers or flexes IP joint

Hamstring Length Test- SLR

*tight hamstring* patient supine and do SLR normal= 80-90deg hip flexion

Hamstring Length Test- 90/90

*tight hamstring* patient supine and knee to 90deg flexion, have patient extend knee and measure angle normal = ?? degress

HIP IR/ER muscle length tests

*tight hip IRs/ERs* Patient prone, bring kne to 90deg flexion, move into hip IR/ER

In general, which vertebrae of the T-spine are most commonly injured?

*transitional vertebrae* -T1-4 (cervicothoracic) -T9-12 (thoracolumbar) *T12 and L1* are most frequently injured

What is the function of the liver? (3)

- Accepts nutrients from SI - Stores glycogen - Produces bile continuously

How do you test scapular depression MMT? How is this graded?

- Patient in prone arm on table, make a fist and punch towards feet - PT pull on arm and pt try to elevate arm Grades: 5= patient must lift body off table with fists in sitting 4 and 3 are normal 2 is in prone, PT support under shoulder and elbow 1 and 0 are normal

How do you test scpaular adduction MMT? How is this graded?

- Patient in prone, arm off side of table at about 90 degrees flexion - Bring elbow straight up towards ceiling while bringing scap towards spine - Watch for downwards rotation (rhomboid compensation) Grades: 5-3 are normal GE: same position, PT holds weight of arm and patient contracts 2= full ROM in GE 1 and 0 are normal

What are some potential causes of neuropathy?

-*DIABETES* -tumor -trauma -autoimmune disease -vitamin B, E or niacin deficiency -exposure to toxins -infection

How would visceral pain be described? Where might this pain be originating from?

-*diffuse, difficult to pinpoint* -deep, squeezing, poorly localized Originating from: -internal organs

Summary of hypo/hyper kalemia and calcemia and their affects on excitation of skeletal & cardaic muscle

-*hypokalemia*: less excitable skeletal & cardiac mm -*hyperkalemia*: more excitable skeletal & cardiac mm -*hypocalcemia*: more excitable skeletal m, less excitable cardiac m -*hypercalcemia*: less excitable skeletal m, more excitable cardiac m -*acidosis*: associated w/ hyperkalemia, & dec excitation -*alkalosis*: associated w/ hypokalemia & inc excitation

What is the function of ADH in low concentrations vs high concentrations?

-*low*: retain water by inc reabsorption in kidneys & collecting ducts -*high*: vasoconstriction to inc BP

What causes pudendal neuralgia?

-*nerve compression injury*: ligs or fascia entrapment, shift of osseous structures, changes in muscle tone, soft tissue or scar along nerve path -*stretch injury*: descent of the PFM, chronic constipation, repeated functional activities, surgical trauma, spine dysfunction or valsalva

What causes Addison's disease? -primary vs secondary adrenal insufficiency

-*primary adrenal insufficiency*: adrenal gland deficiency -*secondary adrenal insufficiency*: inadequate secretion of adrenocorticotropic hormone

How is stamina affected with exhaustion?

-*sudden* and unexpected loss of energy out of proportion to energy expended -deconditioning limits activities of daily living

What are some symptoms of interstitial cystitis?

-*urinary frequency, urgency & pain* -suprapubic and perineal pain -ulceration -mucosal tearing -glomerulations in bladder -hypersensitivity to K+ in bladder -often overlaps w/ other conditions

What equipment do you need for a contrast bath?

-2 water containers -thermometer -towels

Why do we set a prosthetic foot in 5-7 deg of ER in a transtibial prosthesis? What happens if the the prosthetic foot is IR or ER too much?

-5-7 deg of foot ER is the way to maximize lateral stability as well as energy return -if the prosthetic foot is perfectly straight you are maximizing energy return, but then you have no lateral stability -too much IR or ER of the foot will negatively impact the function of the foot & the pt's gait pattern

These are tests that measure *function* (read):

-6 minute walk -LEFS -NXT-12 -SPPB -Timed Up and Go -Functional Reach -DASH -SPADI -MoCA -Trail Making -Lymphedema Life Impact Scale

Sodium composes ____ % of ECF solutes which is important for maintaining _______ volume

-90% -ECF volume (including blood volume & blood pressure)

How do you treat a *type III* C2 (odontoid) fracture?

-<5 mm displacement & 10 deg angulation: *immediate halo* ->5 mm displacement & 10 deg angulation: *traction & halo* (very similar to type II)

How do you treat a *type II* C2 (odontoid) fracture?

-<5 mm displacement & 10 deg angulation: *immediate halo* ->5 mm displacement & 10 deg angulation: *traction & surgery* (very similar to type III)

What inhibits the secretion of aldosterone? (3)

-ANP -inc Na+ level in blood -dec K+ level in blood

A Hangman's fracture is also known as:

-C2 (axis, not dens) fracture -traumatic spondylolisthesis

How does having an externally rotated prosthetic foot affect the rest of your body during gait? (5) -knee -random thing -stance phase -pain -skin

-ER of knee at toe off -induces "medial whip" just after toe off -drop off at end of stance phase -causes low back pain -causes skin irritation due to rotational stress in socket

What things should be kept in mind when making a diagnosis/prognosis as a PT?

-ICF -evidence-based practice -professional values -quality assessment

How close should the IR panels be to the skin?

-IR panels should be touching the skin -skin should never be more than 1/2 inch from panels

What does pirenzepine do?

-Inhibits gastric acid secretion (at doses below those needed to affect the CNS) -relaxes the lower esophageal sphincter, making mvt of food into lower GI tract easier

Urologic pain may present in which areas?

-LB -flank -pelvis

Examples of "good" bacteria that can prevent diarrhea:

-Lactobacillus acidophilus -Lactobacillus bulgaris (often called Intestinex or Lactinex)

What are cams, how are they different from pulleys?

-Non-uniform ellipses used to improve the mechanical advantage of a system -Allows for variable resistance throughout the ROM to match the length-tension relationship of the muscle

Nutrition need changes for people w/ wounds:

-Protein: increase! -Carbs: increase to inc protein availability (55% of meal) -Fat: 30% of meal -Vitamins/minerals (collagen production dec in malnourished pts)

What is torque/moment? (3)

-The application of force at a distance from the point of pivot -Causes rotation around a stationary point T = F x d -Has magnitude & direction

What 3 enzymes, when elevated in the blood, are an indication of an MI?

-Troponins (most specific for MI) -Creatine Kinase (CK-MB more specific isoform for heart tissue) -Lactate Dehydrogenase (LDH)

What are the causes of CHF?

-a complication of another cardiopulmonary condition: -problem in heart itself (such as infarction or valve defect) -increased demand on heart (such as with hypertension or lung disease) or a combination of factors

Describe the difference between the following: atheroma thrombus embolus

-a thrombus (blood clot forms in veins) breaks off of an atheroma -an atheroma is a collection of fatty deposits within the arterial wall - an emboli (small piece of a blood clot) breaks off of a thrombus

Effects of wound fillers:

-absorb exudate -debride -fill dead space (prevent infection)

What do "bulk forming" laxatives do?

-absorb water and swell within the lower GI tract -stretch the bowel and stimulate peristalsis

What are the symptoms of chronic pelvic pain? (chronic non-bacterial prostatitis)

-aching pain in rectum -triggers: sitting -pain during/after ejaculation -dec libido -urinary frequency, urgency, hesitancy, painful -pain in penis, testicles, suprapubic, perineum, coccygeal, groin, low back -anxiety, depression, withdrawal

Why do vasodilators (nitroglycerin) work as a drug therapy for cardiac conditions?

-act as coronary vasodilators (inc blood flow) -reduced BP (may cause dizziness)

What may cause Cushing's syndrome? (3)

-adrenal adenoma (15%) -pituitary adenoma (70%) -iatrogenic conditions: administration of glucocorticoids for chronic inflammation conditions

3 lab values that measure visceral protein stores: ***

-albumin -prealbumin -transferrin

How does aldosterone affect potassium levels?

-aldosterone promotes retention of sodium & water and loss of potassium -too much aldosterone: hypokalemia -too little aldosterone: hyperkalemia

What is the purpose of thin capillary walls?

-allows exchange of nutrients & waste b/w blood & ISF (and therefore ISF and tissues)

What stimulates the secretion of aldosterone? (4)

-angiotensin II -inc K+ levels in blood -dec Na+ levels in blood -ACTH

What treatment should a low risk patient for developing foot wounds receive?

-annual foot exam -education -good footwear educate them about checking their feet, talk about diabetic shoes w/ a wider toe box, they should never be barefoot even within the home, should have a rubber sole on their shoe

What are 2 ways to treat infective endocarditis?

-antimicrobial drugs for several weeks, often IV (take blood culture to identify causative agent) -medication to support heart function

How do you test for acidosis or alkalosis?

-arterial blood gases (ABG) -anion gap

What are some things to keep in mind when verbally communicating with a patient? (7)

-ask 1 question at a time -avoid biased questions -speak slowly -*avoid medical jargon* -don't assume anything -believe the pt -show empathy

What are the functions of the PCL?

-assists with arthrokinematics -resists flexion (becomes increasingly more taut) -resists extreme valgus, varus and rotation forces

Fun facts about the heart:

-at 70 bpm, ~100,000 contractions /day -300 mg ATP used per heartbeat (30 kg per day) -heart pumps 2,000 gallons of blood per day -average human heart weighs 6-11 oz

Angina pectoris causes reduced O2 supply due to what conditions? (6)

-atherosclerosis -arteriosclerosis -vasospasm -myocardial hypertrophy (cardiac muscles outgrows blood supply) -severe anemia -respiratory disorder

What are 4 common causes of an aortic aneurysm?

-atherosclerosis -trauma -syphillis and other infections -congenital defects

What are the components of a lever?

-axis/fulcrum (A) -force (F) -resistance (R)

What does Stacia think us students should do to develop a professional identity now?

-become a member of APTA -see Sahrmann talk -volunteer for JaySTART

Why was the PT profession developed?

-began as reconstruction aides -started very modality based

Which structures are a part of the lower urinary tract?

-bladder -urethra

Effects of semi-permeable films:

-blister roof -moist wound environment -promote autolysis -protect wound/ dec friction

What causes a myocardial infarction?

-blood flow blocked for a long time -prolonged ischemia -> tissue necrosis

How do you diagnose endocrine disorders? (6) (probably read)

-blood tests: serum hormone levels -urine tests: hormones or metabolites -indirect test for a specific hormone action -gland stimulation or suppression tests to confirm hyper/hypo function -check for lesions: imaging -biopsy: rule out cancer

What are some examples of malignancy-related causes of pain in cancer patients?

-bone metastases -soft tissue metastases -visceral metastases -leptomeningeal metastases -epidural spinal cord commpression -malignant bowel obstruction -pathologic fracture -hemorrhage into a tumor -tumor-related neuropathic pain

Where is an arterial or femoral line usually placed (in what arteries)?

-brachial -radial -femoral

Multifocal bone mets are common with these 3 types of cancer?

-breast -lung -prostate cancer

How would neuropathic pain be described? Where might this pain be originating from?

-burning, tingling, electrical, stabbing or pins and needles Originating from: peripheral nervous system ex: carpal tunnel, nerve pinch, and diabetes

If someone has a pronated lower extremity, what are the characteristics of positioning that they will have? (5)

-calcaneal eversion -talar plantarflexion and adduction -tibial internal rotation -knee flexion -femoral internal rotation

If someone has a supinated lower extremity, what are the characteristics of positioning that they will have? (5)

-calcaneal inversion -talar dorsiflexion and abduction -tibial external rotation -knee extension -femoral external rotation

What are indications of hypercalcemia in a patient with bone mets?

-calcium from bones released into blood -constipation, nausea, loss of appetite, excessive thirst, frequent urination, dehydration -coma

Hyperparathyroidism causes an increase in __________ (mineral) release from bone which results in what 2 conditions?

-calcium release from bone -- osteoporosis -results in hypercalcemia

What is collateral circulation?

-capillary from "healthy" artery extends to the area supplied by an obstructed artery to acomodate blood flow (alternative source of blood)

In the systems review part of a PT exam, what systems should be reviewed?

-cardiovascular/pulmonary -endocrine -eyes, ears, nose, or throat -GI -genitourinary/reproductive -hematologic/lymphatic -integumentary -neurologic/musculoskeletal

What education should be provided for a patient with neuropathy specific to foot care?

-check feet daily -*always* wear shoes -don't apply lotion b/w toes -have nails clipped by health care professional -manage calluses w/ emery board/ped-egg -Vick's Vaporub or tea tree oil for onychomycosis -immediately report changes

How often should you check on a pt undergoing paraffin?

-check pt response to each layer -then about every 5 min -stop treatment if pt reports any unusual sensation

How often should you check the pt's response to the hot pack?

-check verbally for first 2 min -then about every 5 min (looking for unusual sensation, wheals, welts, burning sensation)

How often should you check the pt's response to the cold pack?

-check verbally for first 2 min -then about every 5 min (looking for unusual sensation, wheals, welts, skin color change to absolute white within 4 min)

4 generic names of H2 receptor antagonists:

-cimetidine -famotidine -nizatidine -ranitidine

How do you treat Charcot foot?

-complete immobilization in a total contact cast -protected WB

What treatment should a high risk patient for developing foot wounds receive?

-comprehensive assessment every 6 months - 1 year -education -certification for diabetic shoes (documentation is critical to get them these shoes)

What topics should you be sure to ask about in a subjective exam of patient with neuropathy? (6)

-contributing diagnoses to neuropathy (DM, HIV, etc) -PMH and social factors -complications (neuropathy, nephropathy, retinopathy, vascular disease) -history of LE surgery, ulcers, or amputations -current or past smoking -HbA1c (tells you how well their blood sugar has been controlled if diabetic)

For *all* cases in which neurologic compromise is suspected, early __________________ use and ______________ stabilization are indicated

-corticosteroid -surgical (usually ant cervical fusion with or without discectomy and decompression)

Effects of hydrocolloids:

-covers wound -prevents O2, bacteria or fluid from interacting w/ wound -*autolytic debridement* -promotes granulation & epithelialization

When a patient with neuropathy checks their feet at home, what should you tell them to look for?

-cuts -blisters -infection (anything that is red, swollen or weeping) -use a mirror if needed -enlist help of family

What interventions should be provided to a patient with (diabetic?) ulcers?

-debulk calluses -control moisture -dec infection risk (silver products & antibiotics) -edema management

How does hypocalcemia affect the heart?

-dec activation of heart muscle -weak heart contractions -decreased BP

What are the symptoms of Forward effect CHF?

-dec blood supply to tissues, general hypoxia -fatigue and weakness -dypsnea and shortness of breath -exercise intolerance -cold intolerance -dizziness

Describe *surgical* stabilization of a C-spine injury:

-decompression -post or ant fusion (post approach seems to offer inc stability)

What dietary modifications would be made as a treatment for cardiac disorders?

-decrease total fat intake -reduce salt intake -reduce weight

How does dehydration affect level of consciousness?

-decreases it -also causes light-headedness

Exercise can have what effect on patients with cancer? (3)

-decreases the risk of many cancers -may extend survival for breast and colon cancer survivors -may prevent or treat many of the psychological and physiological challenges of cancer

How does hypercalcemia affect neuromuscular activity?

-depressed NM activity -muscle weakness, loss of tone -lethargy, stupor, personality changes -anorexia, nausea

How does nuclear medicine test for atherosclerosis?

-determine tissue perfusion level -presence of collateral circulation

What is the purpose of kinesiology?

-develop rational evaluation -develop precise PT diagnosis -develop effective treatment of disorders that affect musculoskeletal system

What causes inc capillary hydrostatic pressure?

-develops due to higher BP or inc blood volume as a result of various conditions -Ex: congestive heart failure, pregnancy, kidney failure, or administration of excessive fluid (leads to edema)

How can you help a pt manage their stress? (6)

-diaphragmatic breathing- 5 min a day -identify stressors -modify work or home environment -positivity journal- gratitiude, 3 positive things per day, random acts of kindness -exercise recommendations -education in neuroscience of pain

What are some general treatment measures for cardiac disorders? (11)

-dietary modifications -regular exercise program -cessation of smoking -vasodilators -beta-blockers -calcium channel blockers -digoxin -anti-hypertensive drugs -diuretics -anticoagulants -cholesterol lowering drugs

2 generic names of anti-spasmodic drugs:

-diphenoxylate -loperamide (keep it on the ~DL~ if you're taking anti-spasmodic drugs)

What are the uses for an arterial line?

-direct continuous arterial BP (helps monitor response to medications or how a patient responds to exercise) -port for medications (inotropic)

What factors may be involved in converting painless bone mets to painful bone mets? (3)

-direct nociceptor activation by tumor -mechanical distortion related to microfracture -local release of growth factors and/or chemical mediators

How do you treat SIADH? (2)

-diuretics -sodium supplements

What are some good screening questions for pelvic dysfunction? (read)

-do you have leaking of urine w/ laughing, sneezing or coughing? -do you have a strong urge to urinate that you are unable to ignore? -do you have difficulty starting the stream of urine or have a weak stream? -Do you have difficulty emptying your bladder or bowel? -Do you have back or hip pain? -Do you have difficulty having a bowel movement? -Do you have leaking of feces or difficulty putting off urge to have bowel movement? -Do you have pain with intercourse or well-woman exams? -Do you have pain with prolonged sitting?

Signs of dehydration: ****

-dry mouth -cracked lips -sunken eyes -dark urine -poor skin turgor -trouble swallowing -smooth shiny tongue

How does hyperkalemia lead to cardiac arrhythmias?

-due to depolarization of the resting membrane potential of cardiac myocytes which leads to increased excitation

How does hypokalemia lead to cardiac arrhythmias?

-due to hyperpolarization of the resting membrane potential of cardiac myocytes -and due to prolonged repolarization -results in decreased excitation

How would deep somatic pain be described? Where might this pain be originating from?

-dull, aching, throbbing Originating from: -bone, joints, connective tissue and muscle

What is PT? What do their services do?

-dynamic profession w/ established scientific base & widespread clinical applications in the restoration, maintenance & promotion of optimal physical function -their services prevent, minimize or eliminate impairments of body functions & structures, activity limitations and participation restrictions

Diarrhea is often a temporary symptom of minor GI disorders, but can occur with serious conditions such as:

-dysentery -ulcerative colitis -cholera

How does vomiting affect pH?

-eary stages, from stomach: loss of HCl, Cl shifts from blood to stomach to replace lost Cl, leads to metabolic alkalosis and hypochloremia -late stages, from intestines: Cl moves out of RBC to replace bicarbonate in blood which leads to acidosis and hyperchloremia

Water loss in dehydration may be accompanied by loss of ______________________ .

-electrolytes -proteins

What is the difference between an electrolyte and a solute?

-electrolytes are molecules that have a charge -all electrolytes are solutes, but not all solutes are electrolytes

How is emotional reactivity affected with exhaustion?

-emotional numbness -may proceed without the individual perceiving a change

Effects of collagen:

-encourages deposition of collagen -absorbent (used for wounds stuck in the proliferative phase only)

Fatigue is abnormal when not relieved by: (3)

-enough sleep -good nutrition -a low-stress environment

What are important qualities of past history of injury that a PT should ask the patient about? (4)

-episode frequency -possible treatments and outcomes -comparison with current problem -activity limitation

5 generic names for PPIs:

-esomeprazole -lansoprazole -omeprazole -pantoprazole -rabeprazole *-prazole*

What are the goals of a foot exam?

-establish history -identify their risk of foot injury -intervene -pt education *early involvement is key!*

What is pitting edema?

-excess ISF moves aside when pressure is applied -a depression remains when the pressure is removed

How does obstruction of lymphatic circulation lead to edema?

-excessive fluid & proteins aren't returned to general circulation -instead they are stuck in the interstitium -causes localized edema

How does biofeedback work?

-ext or int electrodes used to measure EMG of pelvic floor muscles -software allows pt to receive auditory and visual feedback on a computer screen

What does the recovery after a surgery to correct scoliosis depend on?

-extent of surgery -if there was a need for a thoracotomy

What other injuries are often associated with distraction-flexion injuries of the C-spine?

-facet dislocation -or PLL compromise

What are the MOI of the PCL? (4)

-falling on a flexed knee (with ankle plantarflexed) -forceful posterior translation of tibia or anterior translation of femur with knee bent (dashboard injury) -significant rotation or varus/valgus force with foot planted -severe hyperextension of the knee

Where are continuous capillaries located in the body?

-fat -muscle -nervous system -skin

What are the side effects of radiation?

-fatigue -*urinary frequency*, hesitancy or painful urination -rectal pain, diarrhea or bleeding -upset stomach, nausea -skin changes

What are other factors besides alignment that can be contributors to genu valgum?

-high BMI (overweight) -muscle imbalance -ligamentous laxity

What does a PT examination include? (3)

-history -systems review -tests & measures (may decide to use 1 or more tests based on pt condition)

List the contraindications for MIRE:

-history/current cancer -pregnant -don't put pads over eyes

What equipment do you need for a hot pack?

-hot pack of right size -towels/hot pack covers -timer/call light/bell

What pressures does the movement of fluid through a semi-permeable membrane depend on?

-hydrostatic pressure (push): determined by pressure of fluid -osmotic pressure (pull): determined by protein & electrolyte content

What are the MOI of the ACL? (4)

-hyperextension -excessive valgus force with foot planted -excessive knee rotation either direction with foot planted -decelerating, pivoting and cutting maneuvers

Renal failure can cause what electrolyte imbalances? (5)

-hyperkalemia -hypocalcemia -hypermagnesemia -hyperphosphatemia -hyponatremia

Is decreased digestive tract motility an effect of hypo- or hyper- kalemia?

-hypokalemia -excessive diarrhea causes hypokalemia, and constipation & anorexia is the body's response

How do magnesium imbalances affect neuromuscular function?

-hypomagnesemia: hyperirritability w/tremors -hypermagnesemia: depressed NM function & reflexes

List the major endocrine glands: (read)

-hypothalamus -pituitary -thyroid -adrenal cortex -adrenal medulla -pancreas -ovaries/testes

What equipment do you need to perform an ice massage?

-ice cup -towels

When would someone with scoliosis opt for surgery?

-if curvature is greater than 45-50 deg -ideally after growth is complete

When do you treat diabetes insipidus with replacement treatment?

-if its caused by an *ADH deficit*: replacement treatment is required -if is a *nephrogenic* cause then you don't use it

How do you treat a Jefferson fracture?

-if min: CO -if displaced >2 mm/ other fxs: traction & Halo -if sig: fusion

What equipment would you use to stabilize a *type III* occipital condyle fracture?

-if no AO instability: orthosis -if minimally: halo -if unstable: fusion

How do you treat a facet dislocation of the C-spine?

-immediate open or closed reduction -surgical stabilization -immobilization w/ cervical orthotic

What are other comorbidities that may cause pain in cancer patients?

-immobility -constipation -thrombophlebitis -unaddressed psychosocial and psychiatric issues

General treatment of a C-spine injury: (read)

-immobilization -ongoing neuro exam -imaging -stabilization

How does Addison's disease manifest in the body? (11)

-inadequate stress response -dec blood glucose -hyponatremia -hypovolemia -dec BP -hyperkalemia -fatigue -weight loss -dec body hair (lack of androgens) -*hyperpigmentation* of extremities -skin creases

How does hypocalcemia affect skeletal muscle?

-inc activation of skeletal muscle -inc excitability of nerve membranes -spontaneous stimulation of skeletal muscle due to dec in threshold for nerve excitation -muscle twitching, hyperactive reflexes, and tetany

What are the symptoms of "backup" effects of Right-sided failure?

-inc blood volume in systemic circulation -edema in feet, legs or buttocks -increased pressure in jugular veins (distension) -cerebral edema (headache, flushed face) -hepatomegaly, splenomegaly, digestive disturbances -ascites (abdominal distention) -vision disturbances (acute R side failure)

What metabolic changes does Cushing's have? (2) -gluconeogenesis -insulin

-inc gluconeogenesis (hyperglycemia) -insulin resistance (these things lead to glucose intolerance & DM)

What are the effects of hypercalcemia on cardiac and skeletal muscle? What condition does it create a predisposition for?

-inc heart contractions -dec neuromuscular activity (muscle weakness) -predisposition for kidney stones

How does dehydration affect the blood?

-inc hematocrit (%RBC) -hypovolemia (depletion of vascular compartment)

What *organ* or body specific effects do thyroid hormones have? (8) -bones -liver -intestines -brain -pituitary -etc

-inc or dec body temp -inc or dec HR -inc fat metabolism -- weight loss or gain affects.... -bones: growth & differentiation -liver: cell proliferation & respiration, triglyceride & cholesterol metabolism -intestines: peristalsis rate -brain: myelination, axonal growth & development -pituitary: synthesis of pituitary hormones

How does hypercalcemia affect the heart?

-inc strength of cardiac contractions -arrhythmias may occur

How do creatine kinase levels change with the occurrence of an MI?

-increase about 6 hrs after MI -peaks in 18 hrs -returns to normal in 24-36 hrs

How do troponin levels change with the occurrence of an MI?

-increase substantially within 4-6 hrs -peaks at 10-24 hrs -can be detected for up to 10-14 days

How do LDH levels change with the occurrence of an MI?

-increase within 24 hrs of an MI -peaks between 48 and 72 hrs apparently AST (asparate aminotranferase) also increases and has something to do with LDH

What equipment do you need to do IR?

-infrared lamp/applicators -towels -timer/call light/bell

How does calcium enter and leave the body?

-ingested in food -excreted in urine & feces

How does potassium enter and leave the body?

-ingested in food -excreted in urine & feces (not sweat)

How does sodium enter and leave the body?

-ingested in food & beverages -lost in perspiration, urine & feces

Group II male pelvic pain symptoms: (read)

-insidious -long standing symptoms w/ multiple consults, treatments & procedures

Where are fenestrated capillaries located in the body?

-intestinal villi -endocrine glands -kidney glomeruli

In general, injuries to the lumbar spine are often associated with:

-intraabdominal injuries -hindfoot & burst fractures

Signs of malnutrition:****

-involuntary weight loss -muscle wasting -edema (not related to cardiac disease) -poor wound healing -cracking at edges of mouth -hair loss -chronic infections -lethargy -poor skin turgor

What are some possible causes of hypothyroidism? (3)

-iodine deficit (needed for production of thyroid hormones) -tumor -surgical removal or treatment of gland

How does the antidiruetic hormone (ADH) help control fluid balance?

-it controls/reduces fluid output through urine -when ADH levels increase, reabsorption of water from kidney tubules into the blood increases

How does inc capillary hydrostatic pressure lead to edema?

-it forces movement of fluid out of the capillaries and into tissues -fluid cannot get back into the capillaries -Ex: pulmonary edema

What is a buffer and what is its purpose?

-it is a combination of a weak acid and its alkaline salt -it can neutralize any acid or alkali therefore maintaining a constant pH

How does hypercalcemia affect the excitability & stability of nerves?

-it makes them less excitable & more stable

How does hypocalcemia affect the excitability & stability of nerves?

-it makes them more excitable & less stable

2 generic names of stool thickeners:

-kaolin -pectin (KP)

What would cause a loss of plasma proteins in the blood?

-kidney disease -severe burns -hemorrhage (loss of plasma proteins leads to edema)

How does hypercalcemia affect the kidneys?

-kidney stones -waste accumulation (renal vasoconstriction = reduced renal blood flow = dec renal function = waste accumulation)

What is a nephrogenic cause of diabetes insipidus? Is this acquired or hereditary?

-kidney tubules do not respond to ADH -can be either (Ex: electrolyte imbalance, drugs)

Which structures are a part of the upper urinary tract?

-kidneys -ureters

How is the "screw-home" mechanism reversed?

-knee is unlocked by popliteus AND -internal rotation of the tibia on the femur (with open chain) OR -external rotation of femur on the tibia (with closed chain)

List the contraindications for cold pack:

-lack of normal temp sensation -cold hypersensitivity -vasospastic disorders -CAD -HTN

List the contraindications for ice massage:

-lack of normal temp sensation -cold hypersensitivity -vasospastic disorders -CAD -HTN

List the contraindications for hot pack:

-lack of normal temp sensation -heat hypersensitivity -impaired circulation -acute musculoskeletal condition -CAD -HTN

List the contraindications for paraffin:

-lack of normal temp sensation -heat hypersensitivity -impaired circulation -skin anesthesia -acute musculoskeletal condition -PVD (relative) -open wounds (relative)

List the contraindications for contrast bath:

-lack of normal temp. sensation -cold hypersensitivity -vasospastic disorders -CAD -HTN

Where are other sites of inflammation besides the heart that Rheumatic fever can affect?

-large joints (legs) -skin (rashes) -non-tender subcutaneous nodules -basal nuclei in brain (jerking of limbs and face)

What are the effects of atherosclerosis? (3)

-leads to a narrowing of the lumen (stenosis) -restricts blood flow -early in the disease process, the endothelial cells that line the coronary arteries become dysfunctional (stop producing vasodilators -> vasospasm -> blood clot)

When discussing present history of symptoms with the patient, what are things the PT should ask about? (4)

-length of time (ex: 2 weeks) -onset of symptoms (acute or chronic) -progression (stability) -comparison symptoms now w/ initial stage

What are precautions related to a femoral line with hemodynamic monitoring?

-limit hip flexion to >60 deg -bedrest for up to 90 mins after removal

Where are discontinuous capillaries located in the body?

-liver -bone marrow -spleen

Does increased capillary permeability lead to localized or widespread edema usually? What is inc capillary permeability usually a result of?

-localized most of the time -usually caused by an inflammatory response

What is the "screw-home" mechanism? When does it take place? What is its purpose?

-locking the knee in full extension coupled with about 10 degrees of tibial external rotation -happens during last 30 degrees of knee extension -increases joint congruity and stability

What are some things to keep in mind about your non-verbal communication around a patient? (3)

-look pt in the eye -show concern/belief -body language

How does loss of plasma proteins lead to edema?

-loss of plasma proteins causes dec plasma osmotic pressure -results in less fluid returning to venous capillaries and instead going into the interstitium

What would happen to a pt's RBC volume if she had lost a large amount of protein from her blood?

-loss of protein from blood means that the fluid now has less solutes than inside the cells -fluid would move into the cells and cause them to swell

With an endemic goiter, __________ (low/high) T4/T3 stimulate production of _______ which causes thyroid hyperplasia & hypertrophy

-low -TSH

How does dehydration affect urine?

-low volume -high specific gravity

How does dehydration affect BP and pulse?

-lower BP -rapid, weak pulse

What are the components of a vector? (4)

-magnitude -direction -point of application -line of application

List the contraindications for whirlpool:

-malignancy -sensory impairments -hypersensitivity to cold -thermal regulation impairment -pulmonary disease (full body immersion) -cardiac insufficiency (limit time to 10 min and monitor VS) -unstable BP -impaired circulation (limit temp. to 95 deg F) -cognitive impairment -edema -acute febrile episode -acute inflammation -RA -MS -fear of water

What are 3 common causes of pain in cancer patients?

-malignancy-related -anti-cancer therapies -other comorbidities (immobility, constipation, thrombophlebitis, unaddressed psychosocial & psychiatric issues)

How should you use a body chart to document the symptoms? (5)

-mark symptom location -describe symptoms (type of pain, superficial or deep) -clear other areas -assign a # to each complaint (P1, P2 etc.) -establish a relationship between symptom locations (or rule out)

What does an anion gap test measure, what condition does it help diagnose?

-measures differences b/w anions and cations -helps diagnose acidosis or alkalosis

What is measured in an arterial blood gases test? What condition does this help diagnose?

-measures: pH, O2 & CO2, bicarbonate, base excess or deficit -helps diagnose acidosis or alkalosis

What are 5 characteristics of positioning to look for with the patella?

-medial/lateral shift -medial/lateral tilt -anterior/posterior tiblt -internal/external rotation -patella baja/alta

How do you treat excess hormone endocrine disorders?

-medications -surgery -radiation

2 generic names of "bulk forming" laxatives:

-methylcellulose -psyllium

What are 4 of the most common antibiotics prescribed for peptic ulcers?

-metronidazole -clarithromycin -amoxicillin -tetracycline (M.C.A.T) <-- #blessed we didn't have to take that

What are the 3 types of adrenocorticosteroids?

-mineralocorticoids -- aldosterone -glucocorticoids -- cortisol -androgens

What are some side effects of cryotherapy?

-moderate pelvic pain -blood in urine -mild urinary urgency -scrotal swelling -possible inc in ED

Effects of alginates:

-moist wound environment -high absorptive capacity -protects against trauma & contamination

Effects of foam:

-moist wound environment -permeable to water vapor -bacterial barrier -hypergranulation tissue?

What nutrition education should a patient with neuropathy be given? What should their glucose levels be before and after a meal?

-monitor their BMI -encourage stable weight loss -fresh fruits & vegetables > frozen > canned -glucose levels before a meal should be 90-130 mg/dL -glucose levels after a meal should be less than 180 mg/dL

What changes in appearance take place with Cushing's syndrome?

-moon face (round, puffy) -buffalo hump (fat pad b/w scapulae) -truncal obesity -thin limbs (muscle wasting) -thin hair -fragile skin -hirsutism in women (excess hair on face, abdomen & legs)

Joint compression force of the patellofemoral joint is influenced by what 2 factors?

-muscle force of the quadriceps -knee flexion angle

What is lost with an amputation? (structures & biomechanics)

-muscles -length of lever arm -loading sensation -joint position

Side effects of anti-spasmodic drugs:

-nausea -ab pain/distention -dry mouth -constipation -drowsiness/fatigue -dizziness

How do you treat chronic non-bacterial prostatitis (chronic pelvic pain)?

-no curative drugs or medical treatments -antibiotics are unsuccessful -men often suffer yrs before finding answers -all urologic testing is negative

What are 3 key characteristics of cardiac muscle?

-no regeneration -autorhytmicity -thick LV wall

Describe a *stable* spinal injury:

-no significant bone or joint displacement -*ligaments remain intact*

What is myxedema? What disorder is it a symptom of?

-non-pitting edema in face -thickened tongue symptom of *hypothyroidism*

Insufficient water intake is common in what types of people?

-older adults -unconscious persons

What receptors are involved in the thirst mechanism? Where are they located? What stimulates them?

-osmoreceptors: sense the need for fluid -located in the hypothalamus -react to increase blood osmotic pressure

What catabolic effects does Cushing's syndrome have? (2) -bones -wound healing

-osteoporosis -dec protein synthesis (delayed wound healing)

LATS are antibodies that cause an ______________ thyroid, specific to ___________________ disease

-overactive -Grave's

What does arterial blood gas determination measure that serves as an indication of cardiovascular functioning?

-oxygen level -acid-base balance

Fatigue is commonly associated with what other symptoms?

-pain -comorbidity -stress -infection -sleep disturbance -poor nutrition -anemia -immobility

In a patient with bone mets, what are signs and symptoms of spinal cord compression?

-pain in back/neck -pressure on the SC can damage nerves -numbness, weakness, paralysis -difficulty urinating -constipation

Is pain, due to bone mets early on, constant or intermittent? What time of day is the pain at its worst? What alleviates the pain? How does the pain change later on?

-pain may come and go at first -pain initially worse at night and may get better with movement -later it can be constant and may be worse with activity

What equipment do you need for paraffin?

-paraffin wax -warming bath at 126 deg F -plastic gloves or wrap -hand towels -timer/call light/bell

What is transcellar fluid?

-part of ECF -present in various secretions in body cavities

What causes angina pectoris?

-partial block of blood flow to myocardium -temporary cardiac ischemia

Special considerations in ICU (read):

-patient conditions change quickly -multiple physicians/ people treating the patient -multiple lines of infection control -patient sedation level due to meds -ICU equipment is only monitoring, still need to observe the patient and treat them -trust your intuition

How do you test shoulder extension MMT? How is shoulder extension graded?

-patient in prone -arm at side, palm facing up -bring arm straight towards ceiling NO gravity eliminated position therefore full ROM = 3 -partial ROM is 2+/3- -rest of grades are normal

How do you test scapular adduction and depression MMT? How is this graded?

-patient in prone, arm in about 145 degrees of abduction -thumb pointed to ceiling, raise arm straight up Grades: 5, 4 and 3 are normal GE: same position, PT supports under shoulder and elbow 2= full ROM in GE 1 and 0 are normal

How do you test shoulder horizontal abduction MMT? How is this graded?

-patient in prone, arm off side of table at 90 degrees abduction -pull elbow straight towards ceiling GE: -sitting, PT support arm in same position under wrist and elbow as patient moves through motion Grades are normal

How do you test scapular elevation MMT? How is this graded?

-patient in siting, have them shrug their shoulders and have patient hold position, pull down on shoulders Grades: 5= scap holds and does not move with max 4= scap holds with mod 3= full ROM GE: patient in prone, PT supports under shoulder and under elbow 2= patient can shrug shoulder to ear in GE 1 and 0 are normal

How do you test shoulder flexion MMT? How is shoulder flexion graded?

-patient in sitting -flex shoulder to 90 deg, palm towards floor -apply pressure to distal humerus NO gravity eliminated therefore full ROM = 3 -partial ROM is 2+/3- -rest of grades are normal

How do you MMT wrist extension? How is this graded?

-patient in sitting, arm pronated with wrist hanging off table, lift wrist towards ceiling -PT places pressure on the metacarpals pulling into wrist flexion -GE with wrist in neutral (can have wrist fully on table if very weak) Grading is the usual

How do you MMT wrist flexion? How is this graded?

-patient in sitting, arm supinated with wrist resting on table -have patient lift hand towards ceiling and hold -PT uses two fingers to pull into extension (pressure on metacarpals 2-5) -GE with wrist in neutral Grading is the usual

How do you perform MMT for finger MCP flexion? How is this graded?

-patient in sitting, fingers in shape of "E" in sign language, wrist supinated and resting on table -straighten IP joints while flexing MCP joints (point fingers towards ceiling -PT use index finger across digits 2-5, apply pressure at distal end of prox phalanx -GE in neutral grading is the usual

How do you perform MMT for PIP flexion? How is it graded?

-patient in sitting, forearm supinated -PT block MCP joint, hold fingers 3-5 and thumb, have patient flex, make sure DIP is "wiggly" -PT apply pressure at distal end of middle phalanx -GE in neutral Grading is the usual

How do you MMT MCP extension? How is it graded?

-patient in sitting, hand pronated on table, fingers curled -extend only at MCP joint -can test individually or together -GE in neutral Grading follows the usual

How do you perform MMT for DIP flexion? How is it graded?

-patient in sitting, hand supinated -stabilize middle phalanx, grip underneath and have them just flex the DIP -GE in neutral Grading is the usual

How do you test scapular abduction and upward rotation? How do you grade this?

-patient in sitting, have them flex their shoulder to 130 deg, apply pressure to distal humerus NO GE position Grades: 5= scap does not move with max pressure 4= scap does not move with mod pressure 3= full AROM but no pressure tolerated 2= PT supports shoulder in flexion, slowly releases support as patient holds, scap moves to stabilize 1 and 0 are normal

How do you MMT MCP adduction? How is this graded?

-patient in sitting, palm down -adduct fingers together, try to pull apart individually -functional strength by starting in abduction and bringing into adduction -NO GE position -partial ROM = 2

How do you MMT MCP abduction? How is it graded?

-patient in sitting, palm down, start in adducted position -test functional strength by spreading fingers and "plucking" the fingers together, if they rebound quickly this is functional strength -NO GE position -partial ROM = 2

What are examples of other buffer systems besides the bicarbonate and carbonic acid buffer system? (3)

-phosphate -hemoglobin -plasma proteins

Fatigue is a normal response to: (4)

-physical exertion -emotional stress -boredom -lack of sleep

Pain can affect these areas of life: (3)

-physical functioning -daily activity -psychological and emotional stress

What are 3 diagnostic tests for cardiovascular function?

-physical test -blood tests -arterial blood gas determination

What are possible causes of genu recurvatum? (3)

-poor postural control -neuromuscular imbalance -fixed plantarflexed foot position (ex. calf contracture) (or a combination of any of these)

How do you treat a T-spine dislocation conservatively?

-postural reduction -bed rest -functional bracing

What are the 6 periods on the cancer continuum where exercise has a logical role?

-prescreening/screening -diagnosis -pretreatment -treatment -survivorship -palliative

What are some symptoms of acute bacterial prostatitis?

-presence of WBC & bacteria in urine -fever & chills -prostate pain -LBP -perineal pain -dysuria -difficult urination; urinary retention

What are factors that predispose someone to infection from infective endocarditis? (3)

-presence of abnormal valves in heart -bacteremia (presence of bacteria in blood) -reduced host defenses

Define Atherosclerosis: (3) What are some lifestyle factors that could contribute to this condition?

-presence of atheromas -occurs in large arteries -leads to tissue necrosis -related to diet, exercise and stress

What is exophthalmos? What disease is it a symptom of?

-presence of protruding, staring eyes, dec blink & eye movement -result of inc tissue mass in the orbit -may result in visual impairment -symptom of *Graves' disease*

What classifies a patient with neuropathy as a low risk for developing foot wounds?

-preserved sensation -no foot deformities -intact circulation

How does edema cause pain? (3)

-pressure on nerves -headaches w/ cerebral edema -stretches organ capsules

What are 3 treatments for pericarditis? not really treatments...

-primary problem must be treated -fluid may be aspirated and analyzed to determine the cause -if effusion is severe, immediate aspiration is needed to prevent tamponade and shock

How does the atrial natriuretic peptide (ANP) hormone help control fluid balance?

-produced due to high atrial BP -it reduces reabsorption of sodium (& water) -promotes sodium (& water) loss in urine -reduces blood volume -reduces blood pressure

What are some foot deformities that may develop in a patient with neuropathy?

-prominent metatarsal heads -hammer/claw toes -bunions -Charcot foot

How do you test shoulder IR MMT? How is this graded?

-prone, humerus parallel to floor (only elbow hanging off) with towel roll under elbow -rotate arem so palm comes towards ceiling -apply pressure to distal forearm rotating into ER GE: -sitting, like ER but opposite direction

How do you test shoulder ER MMT? How is this graded?

-prone, humerus parallel to floor (only elbow hanging off) with towel roll under elbow -rotate arm so back of hand comes towards ceiling -apply pressure to distal forearm rotating into IR GE: -seated position, arm next to side, bend arm against abdomen, support forearm in ER (make sure elbow does not come away from body) Grades are normal

How do you treat Rheumatic Fever? (4)

-prophylactic antibacterial agents -anti-inflammatory agents -drugs for arrhythmia and heart failure -surgical repair or replacement of the damaged heart valve

Effects of contact layers:

-protect wound base from trauma during dressing chages -intro topical meds & wound fillers to the wound

What is the function of the patellofemoral joint? (3)

-protects the tibiofemoral joint -improves mechanical advantage of the quadriceps by acting as a moveable pulley -decreases friction

How does increased capillary permeability lead to edema?

-proteins leak out of capillaries which causes an increased osmotic pressure in ISF

What instructions should you give the pt if they are going to apply a hot pack at home?

-pt shouldn't lie directly on the hot pack -moist heat application may penetrate tissues better -don't leave it on for more than 20 min

What are the symptoms of "backup" effects of Left-sided failure?

-pulmonary congestion (fluid enters alveoli) -cough (fluid irritates respiratory passage) -dyspnea (shortness of breath) -orthopnea (difficuly breathing with lying down) -paroxysmal noctural dyspnea (sudden awakening due to dyspnea during sleep)

How do you treat Graves' disease? (3)

-radioactive iodine (destroys thyroid tissue w/ little effect on rest of body) -surgical removal of thyroid -antithyroid drugs

How do you diagnose prostate cancer? (3)

-rectal exam -PSA -*biopsy*

What are the benefits of a regular exercise program with treating a cardiac disorder?

-regulates lipid levels (inc HDL and lowers serum lipid levels) -reduces stress levels

What is a radical prostatectomy? -removed? -spared? -repair? -altered?

-remove prostate, ligs & urethra -spare fat, nerve, bv around it -urethral repair & reconstruction -anastomosis heals & urethra narrows -bladder neck & ext urethral sphincter are altered

How does renal failure lead to hypocalcemia?

-renal failure causes retention of phosphate (dec calcium) -renal failure causes vitamin D to not be activated (dec calcium reabsorption in intestines)

What functional impairments can edema cause? (3)

-restricts ROM -restricts heart & lung movement -interferes w/ digestion & absorption

What may cause metabolic alkalosis?

-retention of bicarbonate -excessive ingestion of antacids -loss of HCl from stomach (early stage vomit, Cl- shift to stomach, hypochloremia in blood, bicarbonate replaces Cl- = alkalosis)

What is a laparoscopic prostatectomy?

-same resection and anastomoses as a radical surgery -surgery performed w/ voice controlled robotic arm -*benefits*: good lighting, modern optics, single operative views, relatively bloodless and fewer incisions

What classifies a patient with neuropathy as a high risk for developing foot wounds?

-sensory loss -foot deformities -vascular disease -callus formation -hx of ulcers -amputation

What are 4 diagnostic tests for atherosclerosis?

-serum lipid levels -C-reactive protein (CRP) -Exercise Stress test -Nuclear Medicine

What are the 4 functions of the menisci?

-shock absorption and distribution -stabilization -guide arthrokinematics -lubricate articular cartilage

What are some examples of antineoplastic therapy related pain in cancer patients?

-side effects from chemo, immunotherapy, hormonal therapy, radiation therapy -post-procedural and post-surgical pain

How do you test shoulder abduction MMT? How is shoulder abduction graded?

-sitting position, thumb pointing towards ceiling (to test full AROM) -have pt hold arm at 90 degrees with palm down to test -apply pressure to distal humerus NO gravity eliminated position therefore full ROM = 3 -partial ROM is 2+/3- -rest of grades are normal

What are the domains of fatigue in health and illness? (6)

-sleep quality -cognition -stamina -emotional reactivity -control over body processes -social interaction

What forms does sodium exist in within the body? (2)

-sodium chloride -sodium bicarbonate

In a facet dislocation of the C-spine, the __________ process of the vertebral body shifts (towards or away from) the dislocated side

-spinous -towards

What are the functions of the ACL? (3)

-stability in all motions but primarily in extension -maintain joint alignment during arthrokinematic movement -help with proprioception of the knee

Management of T-spine fractures varies based on: (read)

-stability, SC compromise -presence of rib or sternal involvement -loss of vertebral height

3 side effects of hyperosmotic laxatives:

-stomach pain -gas -cramps

3 types of anti-diarrhea agents: (review)

-stool thickeners -bulking drugs -anti-spasmodic drugs

What is malignant hypertension?

-subset of primary hypertension -extremely high BP that develops rapidly and causes organ damage >180/120 rapidly progressive with diastolic up to 140

Group III male pelvic pain symptoms: (read)

-sudden onset of pain w/ squatting/lifting -ER visit w/ no pathology

How would superficial somatic pain be described?

-superficial, sharp, well defined

How do you test shoulder horizontal adduction? How is this graded?

-supine, horizontally adduct across body -hold patient at 90 degrees adduction, apply pressure to wrist and pull into abduction -can test clavicular head by having patient at 60 degrees (like a seatbelt) and pulling out of position -can test sternal head by having patient at 120 degrees (opposite of clavicular) and pull out of position GE: -in seated, support patient arm under elbow and wrist Grades are normal

How does Cushing's syndrome affect inflammation and stress responses?

-suppresses inflammatory response -dec stress response

How do you treat an *unstable* vertical compression injury with kyphosis or canal compromise?

-surgery -rigid orthosis, potentially a halo

In general, how do you treat a L-spine injury?

-surgical stabilization (indicated by instability, displacement or neurologic deficit) -rigid orthotics (TLSO) -molded jackets, braces, corsets

What causes tissue adhesions? What is tissue adhesion formation influenced by?

-surgical trauma and scarring caused by dissection -influenced by the fibrosing effects of radiation

What *cellular* effects do thyroid hormones have? (5) -fat -protein -glucose -etc.

-synthesis of membrane Na/K ATPase to inc O2 consumption -enhance fatty acid oxidation to inc heat generation -protein synthesis & degradation to inc growth and differentiation -glucose utilization -cholesterol synthesis & LDL receptor regulation

Which structures are responsible for metabolizing (inactivating) hormones? (2)

-target tissue -liver

What happens in the vascular wall that results in atherosclerosis?

-tear in artery wall -abnormal deposition of lipids in the wall -vascular inflammation -leukocyte and macrophage (foam cells) infiltration -plaque formation -thickening of the vessel wall (can then lead to occlusion from a blood clot)

What is Trousseau's sign?

-tests for hypocalcemia -positive: atypical contraction of fingers when BP cuff blocks circulation to hand

What is Chvostek's sign?

-tests for hypocalcemia -positive: spasm of lip or face occurs when tapped in front of the ear

What does Chvostek's sign test for?

-tests for hypocalcemia -tapping the face in front of the ear causes a spasm of the lip or face

What does Trousseau's sign test for?

-tests for hypocalcemia -when BP cuff blocks circulation to the hand, an atypical contraction of the fingers occurs

What is the Starling Law?

-the amount of fluid filtered across a capillary membrane is proportional to the net filtration pressure -net filtration pressure is a combination of hydrostatic & osmotic pressures

What causes the increased energy expenditure during gait seen with amputations?

-the more that's amputated, the greater the loss of the determinants of gait -this results in a greater energy cost of gait

How do stool thickeners work?

-they have ingredients that carry pectins or clays that thicken the stool -they also have an effect on bacteria/toxins that might cause diarrhea

Make sure you know the following terms: (read)

-toe lever arm -heel lever arm -socket flexion -external foot rotation

What are some ways to offload areas of the body to prevent pressure sores?

-total contact casts -orthotics/walking boots -surgical shoes -dressings (foam/felt) -cutouts (dec pressure points in shoe) -assistive devices -elevate heels w/ a pillow under calves

What are 3 characteristics of LDL?

-transport cholesterol from liver to cells -major factor contributing to atheroma formation -binds to a cell surface receptor (LDL receptor)

What are 2 characteristics of HDL?

-transport of cholesterol away from the peripheral cells to the liver - "good" lipoprotein -catabolism in liver and excretion

What causes hyperparathyroidism? (2)

-tumor -secondary to renal failure due to: dec clearance of phosphate or dec activation of vitamin D

What are some examples of ways that cancer causes neuropathic pain? (3)

-tumor compressing nerves or SC -cancer infiltrating the nerves or SC -chemical damage to NS due to cancer treatment

What would cause an obstruction of the lymphatic circulation?

-tumor or infection that damages lymph nodes -lymph nodes are removed in cancer (leads to edema)

What is a distraction-flexion injury of the C-spine?

-type of subaxial cervical injury -a distractive load is placed on a flexed neck -"whip-lash injury"

How is emotional reactivity affected with fatigue?

-uncharacteristic anxiety -tearfulness

What may cause hypercalcemia? (4)

-uncontrolled release of Ca ions from bones (bone tumors) -demineralization due to immobility (dec stress on bone) -hyperparathyroidism -inc Ca intake

What are side effects of ACh receptor antagonists?

-urinary retention -confusion -constipation -dry mouth

Potassium is excreted primarily in ____________ (urine or feces) under ______________ (hormone?) control

-urine -aldosterone

What is a Semmes Weinstein Monofilament test?

-use a 10g monofilament to apply pressure to about 10 locations on a patient's feet -if the pt can't feel any of them, this indicates decreased sensation -dec sensation puts them at risk for injury and eventual amputation

What is a vibratory sensation test?

-use a 128 Hz tuning fork to apply vibration sensation at various points on pt's foot -if they can't feel the vibration for more than 10 sec, this suggests sensory loss

What is a clip injury? How does it happen?

-usually involves the MCL with a contusion of the lateral femoral condyle -injury to the MCL in the knee by means of a valgus force along with mild knee flexion

What 2 substances are lost with sweating?

-water -sodium (also some chloride)

How do you treat atherosclerosis?

-weight loss -increase exercise -dietary modifications (lower total serum cholesterol and LDL) -control hypertension -cessation of smoking -anti-lipidemic drug (statins) -surgical intervention (angioplasty or CABG)

What are visual signs to discontinue ice massage?

-wheals or welts -skin color change to absolute white within 4 min (normal for skin to be red or dark pink after ice)

Define hypernatremia

-when serum sodium levels reach above 145 mEq/L (the norm is 142) -causes imbalance in sodium and water

Define hyponatremia

-when total body water content increases relative to sodium content -when serum sodium levels reach below 135 mEq/L (the norm is 142)

What equipment do you need for a whirlpool?

-whirlpool -thermometer -heated, well-ventilated space -towels

A PT assessment for male pelvic dysfunction should include:

-whole body assessment -rectal exam to assess pelvic floor strength, tone & patterns -screen for psychological considerations like stress, anxiety & depression

How is social interaction affected by exhaustion?

-withdraws from all social activities -withdrawal may be reinforced by others

When at rest, the sum of all forces is __________ ?

0

When at rest, the sum of all torques is. _________ ? What is this called?

0 Moment equilibrium

Scale of reflex documentation

0 No response 1+ Present, but depressed. low normal 2+ Average, normal 3+ Increased, brisker than average, possibly abnormal 4+ Very brisk, abnormal

Anything below an ABI score of ____ is concerning because circulation is considered impaired at this point

0.9

What is the MA of a fixed pulley?

1

A patient can have up to ___ (#) central venous line(s) and up to ___ (#) peripheral venous line(s)

1 central and multiple peripheral lines

What does it mean to say each movable pulley provides a MA of 2?

1 pulley requires 1/2 the force 2 pulleys requires 1/4 the force 3 pulleys requires 1/6 the force

What are the 3 phases of an alignment of a prosthesis and when does each take place?

1. *bench*: completed prior to placing the prosthesis on the patient 2. *static*: performed w/ pt standing 3. *dynamic*: observation during gait

If a prosthetic user has a gait deviation, what are 2 categories of potential causes?

1. *prosthetic causes*: identify alignment or design problems & adjust the prosthesis 2. *user/amputee causes*: identify bad habits or weakness and determine an intervention to fix it

List the branches off of the ophthalmic A? (5)

1. Ant/Post ethmoidal AA 2. Lacrimal A 3. Supratrochlear A 4. Supraorbital A 5. muscular AA to extraocular m

What are the names of the veins that the lower esophagus has dual venous drainage to systemic veins through?

1. Azygos vein (to IVC) 2. Hepatic portal vein (to liver)

Where are the 3 esophageal constrictions?

1. Cervical: at junction of pharynx and esophagus (upper esphageal sphincter) 2. Thoracic: at aortic arch & left main bronchus 3. Diaphragmatic: at its passing through the esophageal hiatus

What are the 5 layers of the cornea?

1. Epithelium 2. Bowman's layer 3. Stroma 4. Descemet's membrane 5. Endothelium "EveryBody Stands During Events"

What can we measure with a goniometer specifically?

1. Joint angle or position 2. ROM 3. Length of a muscle

What will happen if someone sustains an oculomotor CNIII lesion? ***

1. Lateral strabismus: eye rotates down and out 2. Ptosis: eyelid droop 3. Dilation of pupil 4. Loss of accommodation of lens

What symptoms does Horner's syndrome have? What causes the symptoms?

1. Ptosis: drooping of upper eyelid 2. Miosis: pupillary constriction 3. Anhidrosis: reduced sweating this is due to loss of sympathetic innervation of head, and is often unilateral

How many parts is the duodenum divided into and what are the parts called?

1. Superior (bulb) 2. Descending 3. Horizontal 4. Ascending

Which veins drain the orbit? (2)

1. Superior ophthalmic V 2. Inferior ophthalmic V

What information does palpation give us?

1. Temperature 2. Skin: moist/dry, sensation 3. Tissue density: thick scars, muscle spasms, swelling, edema 4. Deformities 5. Posture: asymmetry

Causes of CPR (capsular pattern restriction)?

1. Trauma: associated with significant joint effusion/swelling in acute stages of injury 2. Joint lesion/Arthritis: traumatic arthritis, acute rheumatoid arthritis, gout 3. Conditions that cause capsular fibrosis, immobilization or low grade inflammation

What items are included in a patient profile? (5)

1. age 2. occupation 3. daily activity level 4. hobbies 5. psychosocial factors

What are the 4 steps to "mind over bladder" (regaining control over strong urges to urinate)?

1. be still 2. perform 5-6 quick pelvic muscle contractions 3. perform 4-5 deep breaths 4. if it has been 2 hrs or longer walk calmly to bathroom, if not, wait for the urge to return and repeat these steps

What 3 things does the biopsychosocial model include?

1. biology 2. psychology 3. social environment

What role do phosphate ions play in the body? (5)

1. bone & tooth mineralization 2. important in metabolism (ATP) 3. phosphate buffer system (acid-base balance) 4. integral part of cell membrane 5. reciprocal relationship w/ serum calcium

Problems with what 2 structures could lead to an ADH deficiency which results in diabetes insipidus?

1. central (hypothalamic) 2. posterior pituitary

What patient information should be obtained in a subjective exam? (6)

1. chief complaint 2. site of symptoms 3. behavior of symptoms 4. history (trauma) 5. special questions 6. patient goals

List the 3 capillary types

1. continuous 2. fenestrated 3. discontinuous (clefts)

List the steps to solving a pulley problem

1. convert mass to F 2. count movable pulleys to find MA 3. MA = FA/RA 4. F(FA) = R(RA) solve for whatever is missing

What should you do before a modality treatment in general?

1. determine that a certain modality is the most appropriate intervention 2. gather materials 3. introduce yourself to pt 4. ask if they have any contraindications 5. explain physiologic effects in layman's terms 6. obtain consent to treat 7. determine pt position & drape 8. perform objective test 9. inspect light touch perception, circulatory status, any open wounds --perform modality--

List the types of subaxial cervical injuries: (read)

1. distraction-flexion injury 2. facet dislocation "bowtie" sign 3. vertical compression injury 4. compression-flexion injury 5. clay-shoveler's fracture 6. lateral flexion injury

PT's in the military have what special abilities? (2)

1. don't require referral 2. able to order x-rays & anti-inflammatories

What are the 2 pulses you should check on a pt with neuropathy's foot?

1. dorsal pedal 2. posterior tibial

What structures help us distinguish the small intestine from the large intestine?

1. epiploic appendices 2. taenia coli 3. haustra 4. semilunar folds

What are 5 steps of patient management in a typical PT visit?

1. examination of pt 2. evaluation of data & identification of problem 3. determine diagnosis 4. determine prognosis & plan of care (POC) 5. implement POC

What hormonal imbalances can lead to hyponatremia? (2)

1. excessive ADH secretion (means water is retained) 2. insufficient aldosterone

What could cause hypokalemia? (5)

1. excessive loss due to diarrhea 2. diuresis caused by diuretic drugs 3. excessive aldosterone 4. excessive glucocorticoids 5. decreased dietary intake- eating disorders, starvation, or alcoholism

What causes metabolic acidosis? (3)

1. excessive loss of bicarbonate ions- diarrhea, later stages of vomiting 2. inc use of serum bicarbonate 3. renal disease or failure- dec excretion of acids, dec production of bicarbonate ions

Prosthetic causes of "excessive plantarflexion" gait deviations in a transtibial amputee: (2)

1. excessive plantarflexion 2. insufficient socket flexion

Prosthetic causes of "heel rise" gait deviations in a transtibial amputee: (3)

1. excessive plantarflexion 2. insufficient socket flexion 3. poor suspension (think of it as a high march, not a butt kick-- anything that makes the prosthetic too long could cause this)

What may cause hyperchloremia? (3)

1. excessive sodium chloride intake 2. rapid infusion of istonic saline 3. loss of bicarbonate- diarrhea, vomiting in later stages)

Amputee causes of "vaulting" gait deviations in a transtibial amputee: (3)

1. fear of catching toe (gait habit) 2. weak hip flexors on residual limb 3. improper initiation of hip flexors on residual limb (first 2 same as circumducted gait)

What 2 socket & component settings are set in M/L bench alignment of a transtibial prosthesis?

1. foot slightly inset (~1/2" inset relative to mid patella), foot is basically shifted medially a bit 2. 2-5 deg of socket adduction

Prosthetic causes of "lateral varus moment" gait deviations in a transtibial amputee: (3)

1. foot too far inset 2. insufficient socket adduction 3. short prosthesis

Prosthetic causes of "valgum moment" gait deviations in a transtibial amputee: (2)

1. foot too far outset 2. excessive socket adduction

What forms does calcium exist in within the body? (2)

1. free (ionized) - active 2. bound (plasma protein, counterion)

Amputee causes of "drop off" gait deviations in a transtibial amputee: (2)

1. gait habit 2. IR of hip at toe off or at hip flexion

Amputee causes of "circumducted" gait deviations in a transtibial amputee: (4)

1. gait habit, use entire hip/pelvis to initiate gait 2. weak hip flexors on residual limb 3. lack of confidence in flexing the knee 4. *abduction contracture* (first 2 same as vaulting gait)

In both passive and facilitated diffusion, molecules move from a ________ concentration to a __________ concentration.

1. high 2. low

Amputee causes of "internal foot rotation" gait deviations in a transtibial amputee: (2)

1. hip weakness or contracture 2. poor gait habits (this is usually bc the user fell hard enough to cause the prosthesis to rotate, looks bad)

ADH, aldosterone, and ANP are all _____________ that function to control __________ balance

1. hormones 2. fluid balance

What are the 4 Starling forces?

1. hydrostatic pressure in the capillary 2. hydrostatic pressure in the interstitium 3. osmotic pressure in the capillary 4. osmotic pressure in the interstitium

What are the causes of hypocalcemia? (5)

1. hypoparathyroidism 2. malabsorption syndrome 3. deficiency in serum albumin 4. renal failure 5. alkalosis

Amputee causes of "lateral varus moment" gait deviations in a transtibial amputee: (3)

1. inadequate balance 2. weak knee muscles (lack of ML control) 3. narrow gait base (looks like pt is swaying his hips out to t he side on the prosthetic limb side)

What are the 4 causes of edema?

1. inc capillary hydrostatic pressure 2. loss of plasma proteins 3. obstruction of lymphatic circulation 4. inc capillary permeability

What effects does hypernatremia have on the body? (6)

1. inc thirst (if mechanism is still functional) 2. edema 3. firm subcutaneous tissue 4. inc BP 5. dry, rough tongue & mucous membranes 6. weakness, agitation

List the 4 subcategories of fluid that are a part of the extracellular fluid How much of the water in the ECF does each part have?

1. interstitial fluid, 75% 2. intravascular fluid, 25% (blood & lymph) 3. cerebrospinal fluid 4. transcellar fluids (3 & 4 combined are 1%)

What 2 socket & component settings are set in A/P bench alignment of a transtibial prosthesis?

1. line down center of lateral prosthesis should be slightly anterior to the ankle bolt, providing proper heel & toe levers 2. initial 5-10 deg of socket flexion

List the 7 effects of edema

1. local swelling 2. pitting edema 3. inc in body weight 4. functional impairment 5. pain 6. impaired arterial circulation 7. edema in skin

Prosthetic causes of "vaulting" gait deviations in a transtibial amputee: (4)

1. long prosthesis 2. poor suspension 3. excessive plantarflexion 4. excessive knee resistance or stability (first 3 same as circumducted gait)

Prosthetic causes of "circumducted" gait deviations in a transtibial amputee: (4)

1. long prosthesis 2. poor suspension 3. excessive plantarflexion 4. functionally long (?) (first 3 same as vaulting gait)

What causes hyponatremia? (5)

1. loss of Na+ from excess sweating, vomiting, diarrhea 2. use of certain diuretic drugs along w/ low-salt diet 3. hormonal imbalances 4. chronic renal failure 5. excess water intake

In active transport, molecules move from a __________ concentration to a _________ concentration with the help of __________ .

1. low 2. high 3. energy

What are the most commonly injured areas of the spine?

1. lower cervical spine 2. thoracolumbar junction (where rigid areas of the spine meet flexible areas)

What may cause hypophosphatemia? (3)

1. malabsorption syndromes 2. diarrhea 3. hyperparathyroidism

What is the function of water in the body? (3)

1. medium for metabolic reactions 2. transportation system of the body 3. facilitator of body part movement

List of occipital-cervical injuries: (read)

1. occipital condyle fracture 2. atlanto-occipital dislocation (AOD) 3. atlas (Jefferson) fracture 4. C2 (odontoid) fracture 5. C2 (axis) fracture

How many branches are in each part of the 3 artificial sections of the axilla?

1. one branch 2. two branches 3. three branches

What are the 2 classifications of glaucoma?

1. open-angle glaucoma 2. closed-angle glaucoma- iris bulges forward to block drainage

Prosthetic causes of "short step" gait deviations in a transtibial amputee: (4)

1. pain in socket 2. excessive plantarflexion 3. insufficient socket flexion (excessive knee ext) 4. toe lever arm too long (anything that makes it hard to move forward)

What factors should be considered when determining a patient prognosis? (6)

1. pathology 2. premorbid conditions 3. ability to compensate 4. healing process 5. pt age 6. pt's social, emotional & motivational status

What are Matt's 6 determinants of gait that affect energy expenditure?

1. pelvic rotation 2. pelvic tilt 3. knee flexion at mid-stance 4. foot & ankle motion 5. knee motion 6. lateral pelvic displacement

What are the 4 types of neuropathy?

1. peripheral 2. autonomic 3. proximal 4. focal

Amputee causes of "heel rise" gait deviations in a transtibial amputee: (2)

1. poor gait habits 2. fear of catching toe (heel rise looks like a high march)

What are the 3 functions of the prostate?

1. produce part of semen contents 2. assist in ejaculation 3. muscular valve to prevent retrograde urination & ejaculation

Amputee causes of "excessive plantarflexion" gait deviations in a transtibial amputee: (1)

1. pt has new shoes w/ a lower heel -knee is forced into genu recurvatum just after midstance -don't see any stance flexion occurring -don't get quite to foot flat, not able to get up and over the toe -"I feel like I'm walking up a hill" (shoe was set for a heel at like 2 inches, then if you change the shoe heel height to 1 inch, the prosthetic foot is excessively PF compared to the shoe, to get to foot flat you'd have to hyper-extend your knee)

Amputee causes of "short step" gait deviations in a transtibial amputee: (2)

1. pt lacks confidence 2. hip contractures

What should you do after a modality treatment in general?

1. reassess objective test to assess effectiveness of intervention 2. ask pt how the treated area feels 3. visually inspect the area for any adverse reactions

What can cause hyperkalemia? (5)

1. renal failure 2. deficit of aldosterone 3. K+ sparing diuretics 4. leakage of intracellular K+ into the ECF (w/ extensive tissue damage) 5. displacement of K+ from cells by prolonged or severe acidosis (diabetic ketoacidosis)

What may cause hyperphosphatemia? (2)

1. renal failure 2. tissue damage - release of intracellular phosphate w/ chemo

Prosthetic causes of "Trendelenburg" gait deviations in a transtibial amputee: (3)

1. short prosthesis 2. pylon inset (or socket outset) 3. socket fit issues

Prosthetic causes of "drop off" gait deviations in a transtibial amputee: (4)

1. short toe lever arm 2. excessive socket flexion 3. excessive dorsiflexion 4. incorrect foot type

Passive diffusion, facilitated diffusion and active transport are ways that _______________ move between compartments across a __________________ .

1. solutes 2. semi-permeable membrane

After the bile is produced in the liver, where does it go? (8 steps)

1. starts in the bile canaliculi 2. intralobular bile ducts 3. periportal bile ducts 4. bile ducts 5. left or right hepatic ducts 6. common hepatic duct 7. joined by cystic duct to form 8. common bile duct ***

Hypothalamus-pituitary-thyroid gland feedback: (read)

1. stimulus (cold or stress) 2. hypothalamus inc secretion of TRH into blood 3. pituitary glandular cells inc secretion of TSH into circulation 4. thyroid gland inc secretion of T3 and T4 into blood 5. target cells inc metabolism 6. negative feedback: high levels of T3 and T4 inhibit secretion of TSH and TRH

What are the 5 functions of the male pelvic floor?

1. supportive 2. sphincteric 3. sexual 4. stability 5. sump-pump (venous/lymph pump)

What are the 5 arteries that supply blood to the shoulder?

1. suprascapular artery (superiorly) 2. dorsal scapular artery (medially) 3. subscapular artery (laterally) 4, posterior circumflex scapular artery (laterally) 5. Acromial branch of thoracoacromial artery (laterally)

What 7 things occur at the sternal angle of lewis?

1. the junction of the manubrium with the sternum 2. intervertebral level between T4 & T5 3. bifurcation of the trachea 4. azygos vein drains into sup vena cava 5. 2nd rib 6. inf part of aortic arch 7. separates sup mediastinum and middle mediastinum

What are the causes of dehydration? (7)

1. vomiting 2. diarrhea 3. excessive sweating 4. use of diuretics 5. diabetic ketoacidosis 6. insufficient water intake 7. use of concentrated formula in infants

Amputee causes of "Trendelenburg" gait deviations in a transtibial amputee: (3)

1. weak hip muscles 2. weak gluteus medius 3. poor gait habits

Amputee causes of "valgum moment" gait deviations in a transtibial amputee: (2)

1. wide gait base/insecurity (wider = more stable) 2. weak ML knee control (weak muscles) (looks like pt pushed himself out to the side for stance on the prosthetic limb, looked very uncomfortable)

How prevalent is breast cancer in men?

1.5% of breat cancers occur in men, they are often not detected until late stages and can be more deadly

Hypertension is present in about ________ the patients diagnosed with an aortic aneurysm

1/2

How much of all the water in your body is considered extracellular fluid?

1/3

What time frame is the subacute/ tissue formation stage of symptoms?

10 days - weeks

You should apply ice massage no longer than ____ min or until patient reports ________________

10 min numbness

What % of C2 (odontoid) fractures are associated with neurological compromise?

10%

What is considered a "normal" range for Q angle? What is "average"?

10-15 degrees 13-15 degrees

What bones make up the thorax?

12 thoracic vertebrae, 12 ribs, 1 sternum

What is the normal sodium concentration in the serum?

142 mEq/L

There is ______ times more sodium in the ECF compared to in the cells .

15 x

How many lobes of glandular tissue does each breast have that drain into lactiferous ducts?

15-20 lobes

What is the normal treatment time for whirlpool?

15-20 min (lab handout said 10-30 min)

What % of T-spine injuries are associated with neurological compromise?

15-20%

What is the normal treatment time for IR?

17 min (8 min of this is the device warming up) Lab Handout said 30-40 min?

What is the normal ratio of T4 to T3 in the body?

17:1 (more T4 than T3)

The pericardium, also known as the pericardial sac, has ____layers

2 -pericardial cavity is between the 2 layers

What are the names of the 4 valves in the heart?

2 atrioventricular valves -tricuspid -bicuspid (mitral) 2 semilunar valves -aortic -pulmonary

Stool thickeners should not be taken for more than:

2 days

A straight leg raise places how much force on the patellofemoral joint?

2.6x body weight

How much of all the water in your body is considered intracellular fluid?

2/3

What fraction of spine injuries involve the C-spine?

2/3

How long do you apply a hot pack for?

20 min or less

How long should the pt have the wax from the paraffin on for?

20-30 min

Graves' disease affects 1 in ______ people

200

Room air is ___% O2

21

When describing behavior of symptoms over a period of time, what are the 2 time frames you should ask the patient about?

24 hrs 7 days

What type of exercise should a patient with neuropathy engage in?

30 min or more epr day, ideally both aerobic and resistance exercises consider foot integrity

How many parasympathetic ganglia "hang off" branches of trigeminal CN? What are they called?

4 ganglia: otic, submandibular, pterygopalatine, ciliary

How many parts of the pancreas are there and what are they called?

4 parts: Head (within duodenum) Neck Body Tail

How long can the effects of PPIs can last?

4 weeks

What % of spine fractures have neurological involvement?

40%

Mortality rates after an amputation increase by ___ % at one year, and by ___ % at 5 years ****

40% one year 80% five years

How many groups of lymph nodes are there in the axilla and what are they?

5 groups: apical, central, humeral, pectoral, and subscapular groups

How many times should you repeat the sequence of the contrast baths? What is the total treatment time?

5-6 times to provide a total treatment time of 25-30 min, ending with warm water

Running places how much force on the patellofemoral joint?

5-6x body weight

What % of diabetic patients will develop neuropathy?

50%

What percent of magnesium is located in the bone?

50%

Walking places how much force on the patellofemoral joint?

50% to 1.3x body weight

Water makes up _____ % of adult body weight

50-60%

How many branches come off of the axillary artery?

6

On average there should be about ____ cm distance between the spine and the medial border of the scapula

6

In the human body, the vascular system, if stretched out, would cover about how many miles?

60,000

The skin is _____ % water

64%

What time frame is the acute/inflammatory stage of symptoms?

7-10 days

What is a normal ICP level? What is pathological?

7-15 mmHg is normal 20+ is pathological

What is the normal serum pH?

7.4, slightly basic normal range: 7.35 - 7.45

A deep squat places how much force on the patellofemoral joint?

7.8x body weight

For the ACL, about _______% of injuries are non-contact

70

Water makes up ____ % of infant body weight

70%

In developing countries, ___% of the population carries the bacteria that can cause ulcers

70-80%

The brain & heart are _____ % water

73%

Lymphatic Drainage of Breast

75% of the breast is drained by axillary lymph nodes, 25% is drained by parasternal nodes

The muscles & kidneys are _____ % water

79%

In PT diagnoses, PT's use labels that identify the impact a condition has on function at the level of the body system and as a whole person

:)

Most PT's agree that there is a need for educators to facilitate the professional identity development of students

:)

The diagnostic process used by PT's defines which elements of the movement system contribute to deficits

:)

Where does the pancreas refer pain to?

A "belt" in the back, or in the front above umbilicus

What is Newton's first law?

A body at rest will remain at rest unless acted on by a resultant force (law of intertia/equilibrium)

What is a free body diagram?

A drawing that consists of all the forces acting on a system or body in correct proportion -identify F's & parameters for each -parallel F's can be add/subtract -concurrent F's determined w/ math

Capsular Pattern of Restriction Definition

A limitation of motion in a particular pattern caused by restriction of the joint capsule.

What are hypo reflex responses caused by?

A lower motor neuron lesion, there is no reflex arc because the reflex arc has been cut

What is a lever?

A simple machine used to inc/dec a mechanical advantage, often a rigid bar

What is "joint play"?

A small amount of motion that is not under voluntary control of the patient. It protects the joint so it may accept some pressure at the end range without tissue damage

What is the porta hepatis?

A transverse fissure on the inferior surface of the liver where the portal triad enters the liver hepatic ducts, lymphatics and the hepatic nerve plexus also enter the liver here

Pectoralis Minor

A: Depresses and protracts scapula N: medial pectoral nerve

Pectoralis Major

A: Flex, adduct, and internally rotate the arm N: medial and lateral pectoral nerves

Serratus Anterior

A: Protract scapula N: long thoracic nerve

Why can cornea's be transplanted without rejection?

ACAID: anterior chamber associated immune deviation, and lack of blood vessels

What is a third class lever?

AFR Ex: bicep muscle

Where are the anal columns?

Above the pectinate line, superior rectum

Why do we assess end-feel?

All joints are structured to limit PROM by tissues (capsules, ligaments, muscle tension, etc)

What may result from atherosclerosis of the aorta?

Aneurysm -occlusion -rupture and hemorrhage

What can cause sudden CN III palsy?

Aneurysm within the posterior communication A

What may result from atherosclerosis of the heart?

Angina Pectoris (partial occlusion of coronary arteries) Myocardial Infarction - MI (total occlusion of coronary arteries)

What does an inclinometer measure?

Angles

How does a vertical compression injury of the C-spine affect the anterior, middle & posterior columns of the spine?

Anterior & Middle: compresses and shortens Posterior: N/A

Which chamber of the eye is filled with aqueous humor?

Anterior chamber

What are the anterior and posterior scalene grooves for?

Anterior scalene groove is for the subclavian vein. Posterior scalene groove is for the subclavian artery.

Where is the anterior chamber of the eye?

Anterior to iris & pupil

Where is the liver positioned in reference to ribs (anterior vs posterior)?

Anteriorly: as high as the 5th rib (T5) Posteriorly: as low as the 9th-12th ribs

What are 2 diagnostic tests for Rheumatic Fever?

Anti-Streptolysin O (ASO) titer Heart Function Tests (EKG changes)

Dermatome

Areas of skin which receive innervation from a single spinal nerve

What vessels supply blood to and from the pancreas?

Arteries: splenic, gastroduodenal, SMA Veins: splenic, SMV

What vessels supply blood to and from the spleen?

Artery: splenic (from celiac trunk) Vein: splenic (drains to hepatic portal V)

Body of Sternum

Articulates with the manubrium, ribs 2-7, and xiphoid process

Premature Sternal Fusion

Associated with inc incidents of heart defects

Subcostal Nerve

At T12, it goes under the 12th rib and onto the abdominal wall

Where do lymphatics drain on the right side of the body?

At the junction of the right internal jugular and right subclavian veins

Where do lymphatics drain on the left side of the body?

At the thoracic duct

Which way does the inferior oblique muscle rotate the top of the eye?

Away from the nose (ER)

If you fracture the surgical neck of the humerus, what might you cause damage to?

Axillary nerve, anterior and posterior circumflex humeral arteries

What are noninvasive examples of hemodynamic monitoring?

BP cuff ECG Pulse oximeter

Why are there more side effects with ACh M1 Receptor Antagonists?

Bc there are ACh receptors located all over the body (including the brain)

Why is pancreatic cancer usually not detected early?

Because the pancreas is located so deeply When you find the cancer it is usually too late and that is why it is so deadly

Where is the axilla located?

Between the arm and thorax

Where is the third section of the axilla?

Between the lateral border of pec minor and inferior border of teres major

Where is the first section of the axilla?

Between the lateral border of the 1st rib and medial border of pec minor, enclosed in the axillary sheath

How do beta-blockers work?

Block beta-andrenergic receptors -> prevents SNS stimulation of heart contractions **prevents increase in the rate and force of contractions in a damaged heart

Define center of mass

Body mass is equally distributed around this point

Is water found on the inside or outside of cells?

Both

These are tests that measure *fatigue* (read):

Breif Fatigue Inventory Multidimensional Fatigue Symptom Inventory - Short Form FACT (Functional Assessment of Cancer Therapy) FACIT Fatigue Scale

How is an end-feel felt?

By applying overpressure at the end of a passive range to asses the resistance of the tissues

Bending Forward Test

By having the patient bend forward you can see what is tight, hips should be able to flex to 80-90deg Ex- tight gastrocs, PF to compensate

What type of occipital-cervical injury would you expect if a person was in a MVA and came forward and hit their chin on the dashboard?

C2 (axis) fracture (Hangman's fracture)

Which occipital-cervical injury has a high non-union rate?

C2 (odontoid) fracture

Which occipital-cervical injury is common in people with osteoporosis or young people that exhibit risk-taking behavior?

C2 (odontoid) fracture

There is a high mortality rate from cervical fractures above what vertebral level?

C4

What regions of the C-spine are most vulnerable to distraction-flexion injuries?

C5-6 and C6-7

What regions of the C-spine are most vulnerable to vertical compression injuries?

C5-7

Palsy of which CN is the most common?

CN VI

Respiratory acidosis and alkalosis is a result of changes in _______ levels.

CO2

A ventricular catheter allows for _____ drainage

CSF

What is the bulbar sheath?

CT capsule which attaches to the back of the sclera at the optic N and at the front at the sclerocorneal junction

What color is local swelling from edema?

Can be pale or red -depends on if the edema compresses the blood vessels and how close the edema is to the blood vessels

_____________ disorders are a major cause of death in North America

Cardiovascular

Sternocostal Joint

Cartilaginous joint between 1st rib and manubrium, Synovial joint between ribs 2-7 and sternum

What can cause CN VI palsy?

Caused by conditions which increase intracranial pressure which stretch abducens CN or diabetes

How does portal hypertension affect the esophagus?

Causes most of the blood to drain toward the azygos vein which results in esophageal varices

Which parts of the large intestine are retro- and intra- peritoneal?

Cecum: Intra Ascending: Retro Transverse: Intra Descending: Retro Sigmoid: Intra Rectum: Retro

Define center of pressure

Center point of weight of a body Point of application of the GRF

What is the only blood supply to the neural retina from?

Central Retinal A it pierces the dura mater and can be compressed due to high CSF pressures

How prevalent are cervical ribs and what is it an elongation of?

Cervical ribs occur in about .5-1% of the population. It is an elongation of the TVP of C7

What is created by the thickening of the bulbar sheath medially and laterally?

Check ligaments

Which layer of the eye is vascular and consists of the ciliary body and iris?

Choroid

Characteristics of sleep pattern under the "fatigue" category of the fatigue continuum include what?

Chronic disrupted sleep pattern -often require sleeping pills -do not feel rested after sleep

When looking at objects up close, what does the ciliary body do to accomodate?

Ciliary body contracts to pull zonular fibers closer towards the anterior chamber which releases the tension on them and allows the elasticity of the lens to round up and refract more light

What lies between the nasociliary N and the oculomotor N?

Ciliary ganglion (just above and lateral to optic N)

What does the subscapular artery branch into?

Circumflex scapular artery and thoracodorsal artery

What does the thoracoacromial artery branch into?

Clavicular artery Pectoral artery Deltoid artery Acromial artery

What are the branches of the celiac trunk?

Common hepatic A Left gastric A Splenic A

What ligaments suspend the liver from the diaphragm?

Coronary ligament Right triangular ligament Left triangular ligament Falciform ligament

How does old age affect body water content?

Decreases with age

How does obesity affect body water content?

Decreases with inc fat

Transverse Thoracic Muscles

Depresses ribs during heavy exercise, located on the inner surface of the chest wall (O: sternum, I: ribs 2-6)

Innermost Intercostal Muscle

Depresses ribs during heavy exercise. Runs the same way as the internal intercostal lateral fibers. Innermost is mostly lateral fibers and is epimysium anteriorly and posteriorly

Breast

Develop within skin as modified sweat glands

What condition is debatable on whether it is a non-modifiable or modifiable risk factor for atherosclerosis? Why?

Diabetes Mellitus Some say it is modifiable because of weight control, but Irina says that that is not totally the case because of the genetic component of Diabetes is non-modifiable

When determining a prognosis, what should the PT keep in mind?

Difference b/w what a person currently does and what they could potentially do helps determine goals for therapy and a prognosis

Do sympathetics constrict or dilate the eye? Which muscles of the eye do they innervate?

Dilate sympathetics innervate dilator muscles of the iris and the superior tarsal muscle to help raise the upper eyelid during fight or flight

Where does the axillary vein receive blood from?

Directly or indirectly from the thoracoepigastric vein

Where is the border between the midgut and hindgut?

Distal 1/3 of transverse colon

Where is the border between the foregut and midgut?

Distal to the duodenal papilla (beginning of duodenum)

What organs is the pancreas between?

Duodenum and spleen

What is venous nicking in relation to the eye?

During hypertension, arteries swell and restrict venous return as arteries cross over veins of the fundus of the eye

How often should a diabetic patient check their feet at home?

EVERY day

How often should a patient with neuropathy have their feet visualized at medical visits?

EVERY medical visit

What is presbyopia?

Either loss of lens elasticity with age or slow growth of the lens This is why adults need reading glasses Presbyopia = far sightedness

What are some examples of physical tests for cardiovascular functioning?

Electrocardiography (EKG, ECG) Echocardiography Chest X-ray

What type of end-feel can acute inflammatory disease, bursitis, fracture, surgery, psychogenic reasons cause?

Empty (always abnormal)

What type of gland is the pancreas?

Endocrine gland

Characteristics of sleep pattern under the "exhaustion" category of the fatigue continuum include what?

Erratic sleep pattern -periods of too much sleep or too little sleep -absence of circadian rhythm

What branches does the left gastric give off?

Esophageal branches

What does the stomach herniate through sometimes?

Esophageal hiatus

Which GI organ has dual venous drainage?

Esophagus

What passes through the diaphragm at vertebral level T10?

Esophagus and vagal trunks

What 2 things does the lower esophageal sphincter connect? What forms the muscle of the sphincter?

Esophagus to the cardiac orifice of the stomach Diaphragm musculature forms the sphincter

PT's should focus on determining selected tests and measures through initiatives such as ____________________________ (2)

Evaluation Database to Guide Effectiveness task forces (EDGE) PTNow

Palpation Definition

Examination by touch or feeling

What causes papilledema (optic disc)?

Excessive CSF pressure which causes the optic disc to swell and venous blood to pool in the veins on the surface of the retina

Gynecomastia

Excessive development of the male mammary gland due to ductal proliferation and periductal edema

What is glaucoma?

Excessive pressure within the eye due to blockage at canal of schlemm

Polymastia

Extra breasts that develop, this is rare

Polythelia

Extra nipples that develop along the milk line. Occurs in 1 in 20 males

What is the equation for force? What unit is it in?

F=ma (N or lbs)

What is a first class lever?

FAR Ex: neck

Coronary Heart Disease (CHD) Coronary Artery Disease (CAD) Ischemic Heart Disease (IHD) Acute Coronary Syndrome *All names for the same condition*

FYI

FYI: A peripheral IV line may be blocked if the medication being delivered is not needed temporarily

FYI

FYI: for all PIP/DIP mobilizations stabilize prox phalanx and mobilize distal phalanx

FYI

FYI: for all finger mobilizations the patient can be in sitting

FYI

FYI: other characteristics of chronic bone mets include direct invasion, secondary pathologic fracture or damage to adjacent structures

FYI

Physical Therapy reduced the values for the following in cancer patients: -self-reported fatigue -self-reported pain -BFI -MFSI-SF Increased 6 min walk test times also

FYI

The BFI and MFSI-SF seem to have pretty comparable data for reliability

FYI

What type of end-feel is elbow extension with biceps contracture?

Firm (abnormal)

What type of end-feel is MCP extension?

Firm (normal)

What type of end-feel is forearm supination?

Firm (normal)

What type of end-feel is knee extension?

Firm (normal)

What are the 2 types of pulleys?

Fixed or movable

At rest, is the lens round or flat?

Flat

The thirst mechanism and various hormones are the 2 ways our body controls what?

Fluid balance

What causes esophageal varices to rupture? What are the results of the rupture?

Food which results in extensive internal bleeding and vomiting fresh blood

What 1 socket & componenet setting is set in rotational bench alignment of a transtibial prosthesis?

Foot is ER 5-7 deg

What is Newton's third law?

For every action, there is an equal and opposite reaction

Define pressure

Force applied within an area (P = F/A)

What is the name of the instrument that is a rigid platform used to amplify and transduce forces?

Force plate

Ground/Joint reaction forces are equal and opposite to what?

Forces produced by humans

Base of Axilla

Formed by skin, subcutaneous tissue, and axillary fascia

Between forward and backup effects of CHF, which has similar symptoms for R and L sided?

Forward effects

What is in the center of the macula lutea?

Fovea centralis which is the area of greatest visual acuity

What order is the abbreviation VAN in?

From cranial to caudal

Subcostal Muscles

Function to depress ribs. Small slips of muscle that attach to the inner surface of lower ribs on the posterior portion of the thoracic wall. They skip a rib.

What are the 4 types of feeding tubes?

G tube (in stomach) J tube (in jejunostomy) Dobhoff feeding tube NG tube

Acromegaly is caused by an excess of _____ at what stage in life?

GH in adults

Gigantism is caused by an excess of _____ at what stage in life?

GH prior to puberty

What are the impressions of the liver?

Gastric impression (left) Renal impression (right) Colic impressions (right & left)

What branches does the common hepatic A give off?

Gastroduodenal A (then becomes proper hepatic A) Right gastric A Right hepatic A Left hepatic A Cystic A comes off somewhere, it varies

the NIH discovered that ulcers can be caused by:

H. pylori bacteria

Metabolic/kidney acidosis and alkalosis is a result of changes in ________ levels.

HCO3- (bicarbonate ion)

Eating stimulates the stomach to produce:

HCl

When a patient has a PEG tube or a NG tube, what position must the patient be in? Why?

HOB elevated to at least 30 degrees due to risk of aspiration

A pulse oximeter can continuously monitor what two vital signs?

HR and O2 sat

What are the different types of tracheal tubing? What makes them different?

HVLP (High Volume Low Pressure) fenestrated tracheal tube (upper airway pathology) Passy-Muir One-way speaking valve they each allow for different levels of containment of the airway

How do you treat a *type II* C2 (axis) fracture?

Halo +/- traction

Which of the following is the most stable form of immobilizing a C-spine injury: Aspen-4 post, Halo vest, Miami J collar, Philadelphia collar

Halo vest

If there is any *displacement* in a *type III* occipital-cervical fracture/injury, what intervention would you expect to see?

Halo vest, always

What type of end-feel is elbow extension?

Hard (normal)

What happens with Congestive Heart Failure (CHF)?

Heart is unable to pump out sufficient blood to meet the metabolic demands of the body

What vessels bring blood into the liver?

Hepatic artery: 20-25% Portal vein: 75-80% The artery supplies the liver's tissue, the portal vein gives it deoxygenated blood that needs to be filtered

What is a major regulator of acid secretion in the stomach?

Histamine

Possible abnormal reflex responses

Hyper- too much Hypo- too little

What happens if a rib is removed?

If the periosteum is left intact, then the bone will usually regenerate

What interventions may be necessary for a rib fracture?

If there is less than a 1mm separation, usually they don't need any sort of intervention.

Where does the small intestine connect with the large intestine?

Ileocecal junction

What muscle inserts at the costal angle?

Iliocostalis

When do you asses sensation?

In patients with musculoskeletal and/or neurological conditions

What happens if glaucoma is left untreated?

Increased intraoccular pressure which lead to inadequate blood supply to the retina and slow onset blindness

Indications for semi-permeable films: Contraindications:

Indications: -*superficial* -min drainage -partial thickness -*eschar* -granulation tissue Contra: -moist environment -risk for epidermal stripping

Indications for alginates: Contraindications:

Indications: -moist wounds -pressure wounds -infected wounds Contra: -dry wounds (alginates are used for a little extra absorption)

Indications for contact layers: Contraindications:

Indications: -partial or full thickness -min/mod drainage -donor or skin graft sites Contra: -dry, *shallow, eschar*, excess exudate

Indications of collagens: Contraindications:

Indications: -partial/full thickness Contra: -full thickness burns or eschar (provides scaffolding for host cell proliferation)

Indications for hydrogels: Contraindications:

Indications: -partial/full thickness -granulation tissue -necrotic tissue -burns Contra: -high exudate

Indications for composites: Contraindications:

Indications: -partial/full thickness -min to heavy exudate -granulation tissue -necrotic tissue Contra: -dependent on product

Indications for wound fillers: Contraindications:

Indications: -partial/full thickness -min/mod drainage -infected wounds -cavity wounds Contra: -dry wounds

Indications for hydrocolloids: Contraindications:

Indications: -partial/full thickness -necrotic tissue -scant/mod drainage Contra: -infected wounds (bc its very occlusive) -tunneling/undermining -lesions -caution w/ diabetic feet

Indications for foam: Contraindications:

Indications: -mod/heavy exudate -autolytic debridement -granulation tissue -compression -hypergranulation Contra: -dry wounds -cavity wounds (if used alone)

What is enlargement of upper limb lymph nodes caused by?

Infections of upper limb or cancer of shoulder or thorax

Most muscles of the eye originate either from the common tendinous ring or just above it... Which muscle is the exception to this?

Inferior oblique muscle it originates lateral to the nasolacrimal duct and inserts on the inferior surface of the sclera

What passes through the diaphragm at vertebral level T8?

Inferior vena cava

What does the subclavian artery branch into? (not sure if we need to know this)

Internal thoracic artery Thyrocervical trunk Vertebral artery Costocervical trunk Dorsal scapular artery

Blood Supply to the Breast

Internal thoracic artery, anterior intercostal artery, and lateral thoracic branch of axillary artery

Where do internal and external hemorrhoids develop? Are they painful?

Internal: above pectinate line, not painful, prolapse of rectal mucosa External: below pectinate line, painful

Nutrients leave capillaries and go to the _______________ before going to the tissues

Interstitium

Lateral Wall of Axilla

Intertubercular groove of humerus

What is used to determine joint forces?

Inverse dynamics- obtain kinematic data using video analysis system & force plates. Similar to FBD - JRF

Pectus Excavatum

Involves a sunken sternum. It is associated with heart defects

Why is the superior thoracic artery not really needed?

It anastomoses with the intercostal arteries. Since the intercostals are already there, you could live without the superior thoracic artery

Pericardiaophrenic Artery: what does it branch off of, what does it run with, what does it supply?

It branches off of the internal thoracic artery, it runs with the phrenic nerve, and it supplies the central part of the diaphragm

What does the cystic duct connect between?

It comes off of the gall bladder, joins with the common hepatic duct to form the common bile duct which then joins with the pancreatic duct to empty into the duodenum

Where did the diaphragm develop?

It developed up in the neck region and migrated down and carried its innervation along with it

When and where does the breast develop?

It develops at puberty on top of the pec major and serratus anterior muscles

What happens if the central retinal A is blocked?

It does not anastomose with other arteries so it would lead to blindness

Thorax: where is it and what is its function?

It extends between the neck and the abdomen. It functions as a cage for breathing, protects the heart, and supports upper arms

What happens if there is back flow of bile?

It goes back from the small intestine to the gall bladder This causes increase risk of problems because the small intestine has a lot of bacteria that is now in the gall bladder

As the moment arm increases, what happens to the magnitude of torque?

It increases

What is the function of the mesentery of the small intestine and where is it located?

It is a fan-shaped peritoneal fold that attaches the jejunum and ileum to the posterior abdominal wall It starts in the upper left, crosses vertebral column, and ends in the lower right (oblique)

What is the axillary sheath?

It is a fascial sleeve for the neurovascular structures going to the upper limb (axillary A, V, brachial plexus)

What is a PT diagnosis?

It is a label encompassing a cluster of signs & symptoms commonly associated with a disorder or syndrome

What is the esophagus made of and what does it allow passage of?

It is a muscular tube that allows passage of food from the pharynx to stomach through the posterior mediastinum

What is the shape of the axilla?

It is a pyramidal shape with one apex (top), one base (bottom), and four walls

What is the sternal angle?

It is also called the Angle of Lewis, it is the junction of the manubrium with the body. It is also where the 2nd rib attaches to the sternum.

What is the phrenico-esophageal ligament made of and where is it?

It is inferior fascia of the diaphragm Connects to the outside of the esophageogastric junction

What is the Z line transition zone? Where is it located?

It is located inside the esophageogastric junction and is the site of esophageal mucosa changing to gastric mucosa

Is the sphincter of Oddi normally open or closed?

It is normally closed, it is only open just after you eat

Where is the gall bladder located?

It is on the visceral surface of the liver in the fossa for the gall bladder Right hypochondriac region/Right upper quadrant

What is the portal triad, where is it and what is it comprised of?

It is the 3 vessels going in/out of the liver at the porta hepatis Hepatc artery (proper) Portal vein Common bile duct

What is the costal angle?

It is the angle of the rib just lateral to the tubercle. It is a frequent site of rib fracture.

What is the scalene tubercle?

It is the site of attachment for the anterior scalene muscle.

Where is the sphincter of Oddi and what is its function?

It is the smooth muscle located in the Ampulla of Vater that helps push the pancreatic juices and bile into the duodenum

What is unique about the facets of the 1st rib?

It just has a single facet, the superior facet. All the other ribs have a superior and inferior facet to articulate with 2 vertebral bodies.

What population is gynecomastia often seen in?

It occurs at puberty in obese males

When does the xiphoid process ossify?

It often doesn't ossify until the 4th decade of life

When does the liver produce bile?

It produces bile constantly

Where does the intercostal neurovascular bundle run?

It runs between the internal and innermost intercostal muscles

What does the lateral thoracic artery supply?

It supplies pectoral muscles, axillary lymph nodes, and the breast (important)

What does the superior thoracic artery supply?

It supplies the 1st and 2nd rib intercostal spaces and serratus anterior

What was ligamentum venosum in a fetus?

It was the fetal ductus venosus In a fetus, blood comes to the liver from the umbilical vein and is shunted to the IVC via the ductus venosus, so there was not much blood going through the liver

Where is the jejunum and ileum roughly?

Jejunum: upper left quadrant Ileum: lower right quadrant

When does the subclavian artery change into the axillary artery?

Just after it passes under the clavicle

How many lobes is the liver divided into functionally?

Just right and left lobes

Serum levels of magnesium depends on the serum levels of what other ions?

K+ and Ca++

Carina-

Keel of a boat

Inverse dynamics, work, power, pressure, and friction are all associated with what branch of dynamics?

Kinetics

How is the balance between L and R heart output affected with Left-sided CHF? Where does the blood pool?

L heart output < R heart output Blood accumulates in pulmonary circulation -> pulmonary congestion or pulmonary edema

How is the balance between L and R heart output affected with Right-Sided CHF? Where does the blood accumulate?

L heart output > R heart output Blood accumulates in systemic circulation -> peripheral edema

At approximately which vertebral level does the cauda equine begin?

L2

Which region of the L-spine is fairly stable and protected by musculature?

L2-L5

Pudendal neuralgia involves which nerve roots?

L4-S4

Which ligament is more narrow and one layer? (MCL/LCL)

LCL (lateral collateral ligament)

What are the 2 categories of lipoproteins?

LDL HDL

What is an example of a fixed pulley in the body?

Lateral malleolus and fibularis muscles

Which eye muscle is responsible for looking at the horizon?

Lateral rectus

What are the muscles of the eye innervated by?

Lateral rectus: CN VI Superior oblique: CN IV everything else: CN III

Which artery is important blood supply to the mammary gland of women?

Lateral thoracic artery

What branches does the splenic A give off?

Left gastro-omental A Short gastric A Posterior gastric A Pancreatic branches

Where is the axillary vein in relation to the axillary artery?

Lies on the medial side of the axillary artery, it has more branches and variations than the artery.

What can kinetics be used to calculate? (4)

Linear force Rotational force Momentum/impulse- F applied over t Work/energy- F applied over d

What is the 2nd largest organ of the body?

Liver

What is the largest gland in the body?

Liver

Which abdominal organ has a groove for the inferior vena cava?

Liver

What nerves are vulnerable during surgical removal of malignant lymph node cells in the axilla?

Long thoracic nerve and thoracodorsal nerve

What type of nerve impulses do the long and short ciliary nerves carry?

Long: pain from cornea & sympathetics Short: postganglionic parasympathetics & sympathetics

What is a cataract?

Loss in transparency of the lens which is common in old age

What is the equation for mechanical advantage?

MA = df / dr force arm / resistance arm

What does a dorsal MCP glide help facilitate?

MCP extension

Cardiac hypertrophy, high HR, T3 transport to cardiomyocytes and inc blood volume, preload and cardiac output increase the patient's risk for what condition?

MI

Inc troponin, CK, and CKMB levels indicate what condition:

MI

How does a left-sided CHF typically develop? What about a right-sided?

MI of LV -> LV failure -> left-sided CHF Pulmonary disease -> RV failure -> right-sided CHF

What is a common MOI for a lateral flexion injury of the cervical spine?

MVA or blow to the head

What are common mechanisms of injury for vertical compression injuries of the C-spine?

MVA or diving

What are common mechanisms of injury for distraction-flexion injuries of the C-spine?

MVA or sports

What is the less prominent area lateral to the papilla/optic disc called?

Macula lutea

What is the major and minor duodenal papilla?

Major: inside the opening of the hepatopancreatic ampulla/ Ampulla of Vater in the duodenum Minor: sometimes exists from an accessory pancreatic duct

Do males or females have higher water content?

Males -females have a higher percentage of fatty tissue

Do the medial or lateral nerve fibers from the retina cross over at the optic chiasm?

Medial fibers

The direct access law in Kansas, when a pt self-refers to a PT the PT has to tell them that a PT diagnosis is not the same as a ____________ diagnosis

Medical

Define kinetics

Motion, forces that create motion

Define kinematics

Motion, relationship b/w displacement, velocity & acceleration

According to Sahrmann, what is the identity of PT?

Movement system "To advocate for promoting both kinesiopathology and pathokinesiology as important movement system concepts"

Is the loss of motion in a capsular pattern of restriction a fixed degree of ROM in just one plane?

No, it is a fixed proportion of motion loss in more than one plane

Is the spleen a part of the GI tract?

No, it is a part of the immune system

Is bile constantly flowing into the duodenum?

No, there is a sphincter of the common bile duct that controls bile flow

Is the spleen a vital organ?

No, you can live without it

What are the modifiable risk factors for atherosclerosis?

Obesity Sedentary lifestyle Cigarette Smoking Poorly controlled hypertension

At rest, what intercostal space does the diaphragm extend to?

On the right side, it extends to the 4th intercostal space, and the 5th on the left side

Sensation Definition

One's ability to sense, interpret, and discriminate among incoming sensory information

Is the duodenum retroperitoneal or intraperitoneal?

Only the bulb is intraperitoneal, the majority of it is retroperitoneal

Where do most of the orbital structures receive blood from?

Ophthalmic A

What is the portion of the nerve between the back of the eye and the optic chiasm called?

Optic N

What is the name of the area where veins and arteries enter/exit the retina

Optic disc

What is the portions of the nerve between the optic chiasm and the lateral geniculate bodies called?

Optic tract

What is the most supportive type of ventilator setting?

PEEP

What are the 3 different ventilator settings?

PEEP (positive end expiratory pressure) CPAP (Continuous Positive Airway Pressure) PS (pressure support)

What is the drug of choice for treating ulcers and GERD?

PPIs

Are PPIs or H2 blockers more effective in reducing acid?

PPIs (can reduce acid up to 90%)

What book does Stacia love that is free to members of the APTA?

PT Guide for Physical Therapist Practice 3.0 -description of PT practice

How should the humeroulnar joint glide be performed?

PT places hands in elbow crease (pinki closest to crease), perform a "scooping" motion to distract the ulna, distract parallel to floor in a horizontal plane

Passive Hip Movements in WBing single stance

PT sit on stool and have patient hold onto your shoulders while you move them passively by moving the pelvis- F, E, AB, AD, IR, ER

What is opthalmoplegia?

Paralysis of 1+ extraocular muscles

What will happen if someone sustains an abducens CN VI lesion?

Paralysis of lateral rectus Eye rotates inward

What will happen if someone sustains a trochlear CN IV lesion?

Paralysis of superior oblique Eye rotates outward Pt will tilt their head toward the unaffected side

Which portion of the ANS innervates the ciliary muscle of the eye?

Parasympathetic from CN III

What innervates the sphincter muscles of the pupil?

Parasympathetics

Which portion of the ANS innervates the ciliary muscles?

Parasympathetics

Which portion of the ANS innervates the sphincter pupillae muscle?

Parasympathetics

Areola

Pigmented area surrounding the nipple, it has openings for many sebaceous glands

What branches does the ophthalmic A immediately give off after passing through the optic canal?

Posterior ciliary AA

Where is the fundus of the eye?

Posterior portion of the eye housing the retina

Where is the posterior chamber of the eye?

Posterior to iris & pupil but in front of the lens and ciliary process

Where is the second section of the axilla?

Posterior to pec minor

Where do the pre- and post- ganglionic parasympathetic nerves come from that innervate the eye?

Pre: Edinger-Westphal nucleus Post: ciliary ganglion (leave as short ciliary NN)

What are professional roles?

Prestigious & provide the role holder w/ autonomy and a degree of privilege

What is a PT evaluation? (different than examination)

Process by which PT's: -interpret tests & measures -integrate that data w/ info from history -determine diagnosis -determine prognosis -develop plan of care

Where is aqueous humor produced?

Produced by the ciliary body in the posterior chamber Flows out the pupil into the anterior chamber Drains into the Canal of Schlemm and into venous blood

Where is chloride stored?

RBC's

What are 4 diagnostic tests that can be used to diagnose an aortic aneurysm?

Radiography Ultrasound CT scans MRI

Where does the hepatic vein get blood from and what does it drain into?

Receive: deoxygentate blood that has been filtered by the liver Drain: inferior vena cava

Is the pancreas intra or retro peritoneal?

Retroperitoneal

True Ribs

Ribs 1-7. They attach to the sternum anteriorly with cartilage extensions

Floating Ribs

Ribs 11-12. These ribs lack costal cartilages

Which ribs are considered "typical" ribs?

Ribs 3-9

False Ribs

Ribs 8-10. Their costal cartilages do not attach to the sternum

If someone sustains a lesion to their right optic N, what will happen?

Right eye blindness

Which sagittal fissure of the liver runs by the IVC and gall bladder?

Right sagittal fissure

What separates the liver into its 4 lobes?

Right sagittal fissure Left sagittal fissure Horizontal fissure/Porta hepatis They create the letter "H" to divide the liver into the lobes

Is the liver on the left or the right?

Right side

What do the right & left gastric AA branch off of?

Right: common hepatic A Left: celiac trunk

What do the right & left gastro-omental AA branch off of?

Right: gastroduodenal A Left: splenic A

What ligaments form the left sagittal fissure of the liver?

Round ligament of liver and ligamentum venosum

What does SINSS stand for?

S: severity I: irritability N: nature S: stage S: stability

What joint handles a lot of force coupling?

Scapula

Posterior Wall of Axilla

Scapula, subscapularis, teres major, and latissimus dorsi

What is a professional identity?

Self-concept based on attributes, beliefs, values, motives & experiences

What does a corneal reflex involve? Which CN does it test?

Sensation: touch cotton ball to eye Afferent: CN V(1) Motor (close): CN VII Motor (open): CN III

What is the function of the suspensory ligament/zonules of the lens?

Series of CT strands that connect the lens to the ciliary body

When doing a foot exam of a patient with neuropathy, what characteristics of the skin and toenails should you look for?

Skin: thin? shiny? brawny/muscular? frail? dry? callused? hair present? Toenails: thickened? deformed? ingrown?

What is experienced by a patient if they have a small vs large pancreatic tumor?

Small: jaundice but no pain Large: jaundice AND pain

What type of end-feel can edema, lymphedema, and inflammation cause?

Soft (abnormal)

What type of end-feel are knee and elbow flexion?

Soft (normal)

What 3 sphincters are associated with the pancreatic duct?

Sphincter of common bile duct Sphincter of pancreatic duct Sphincter of Oddi

What joint handles a lot of compressive forces?

Spine

Where are splanchnic nerves and communicating rami in relation to the sympathetic chain?

Splanchnic nerves are medial, communicating rami are lateral

What is the largest lymphatic organ?

Spleen

What is the most vulnerable organ for rupture?

Spleen

Where does the duodenum start and end?

Start: pylorus of stomach End: duodenojejunal junction

What does AROM indicate?

Status of inert tissue, muscle's contractile ability against gravity, patient's ability or willingness to move

What is the function of the gall bladder?

Store bile

Define dynamics

Study bodies in motion

Define kinesiology

Study of human movement

Which is the largest branch of the axillary artery?

Subscapular artery

What are the branch(es) of the third section of the axilla?

Subscapular artery Anterior and Posterior circumflex humeral arteries

What does the subscapular artery supply?

Subscapularis, teres major, serratus anterior, and latissimus dorsi

What does the pectinate line divide?

Superior anal canal from inferior anal canal

Contraction of which muscles of the eye results in protrusion of the eye forward?

Superior and inferior oblique

What ganglion do the sympathetics that innervate the eye come from?

Superior cervical ganglion

Manubrium

Superior edge forms the suprasternal notch, it is an attachment site for clavicles, 1st and half of the 2nd rib

What artery is responsible for blood supply to the jejunum and ileum? How many branches does it give off to the SI?

Superior mesenteric A 15-18 branches

What vein takes blood away from the jejunum and ileum? What does it drain into? Why is this a good thing?

Superior mesenteric V It drains into the hepatic portal vein, so all the nutrients absorbed from the SI go straight to the liver to be processed and then released to the rest of the body

Which of the muscles of the orbit runs through a pulley, what is the pulley called?

Superior oblique muscle Trochlea = pulley

What are the functions of serratus posterior superior and inferior?

Superior raises the ribs during inspiration, inferior depresses ribs during expiration

What are the branch(es) of the first section of the axilla?

Superior thoracic artery

What does the axillary artery branch into?

Superior thoracic artery Thoracoacromial artery Lateral thoracic artery Subscapular artery Anterior circumflex humeral artery Posterior circumflex humeral artery "sue the lawyer, save a patient"

What innervates the superior and inferior anal canals?

Superior: visceral & somatic Inferior: somatic

What innervates the dilator muscles of the pupil?

Sympathetics

Costochondral Joint

Synchondrosis joint between rib and hyaline cartilage of the same rib

Costovertebral Joint

Synovial joint between the head of the rib with the body of the vertebra at a facet and demifacet.

Costotransverse Joint

Synovial joint between the rib tubercle and TVP of vertebra

At what vertebral level does the esophagus pass through the diaphragm?

T10 The esophagus is actually a thoracic organ, you can only see the distal portion in the abdomen

At what vertebral level is the esophageogastric junction?

T11

Which nerve(s) supply the testicles?

T11-12 via renal & aortic autonomic plexuses

Which area of the lumbar spine is most susceptible to injury?

T11-L2 region (idk why T-spine is in this)

Is T3 or T4 more active?

T3 is 5x more active than T4

Around what vertebral level does the small intestine refer pain to?

T5-9 Para-umbilical region

How do you know if a reflex is hyper or hypo?

Test bilaterally, an asymmetrical response from side to side with the same degree of stimulus is either hyper or hypo

What is a common problem with antacids?

The body gets feedback that acid in the stomach is too low, so it produces more acid to accommodate.

What does the appendix come off of?

The cecum of the large intestine

What empties into the descending portion of the duodenum?

The common bile duct joins with the pancreatic duct to form the Ampulla of Vater (hepatopancreatic ampulla) which enters the duodenum on its posteromedial wall

What does the head of the rib articulate with?

The corresponding V. body and the V. body immediately superior

Why must contacts be removed periodically?

The covering epithelium of the cornea receives oxygen from the air

In the torque equation, what distance does d represent?

The distance that is perpendicular to the axis line Unit: pound-foot or Newton-meter

Apex of Axilla

The entrance from the neck to axilla, the superior opening is called the cervicoaxillary canal

What runs through the superior thoracic aperture?

The esophagus, trachea, brachial plexus, and major blood vessels such as the subclavian artery

What divides the liver into left and right lobes?

The falciform ligament and left sagittal fissure

Which ribs have scalene tubercles?

The first and second ribs

What is the groove of the rib for?

The groove on its inferior surface is to house the passage of the intercostal vein, artery, and nerve

What is the first group of lymph nodes that is likely to become enlarged due to infection?

The humeral group

Goniometer

The instrument most commonly used to obtain goniometric measurements.

If you crack a rib, what structure will you typically crack with it?

The intercostal vein, but not the artery or nerve

Which parts of the large intestine can herniate?

The intraperitoneal portions because they are mobile Cecum, transverse colon, and sigmoid colon

What does the common bile duct join with when it enters the duodenum?

The main pancreatic duct When the join, they form the Ampulla of Vater and open into the duodenum at the major duodenal papilla

Is the liver covered by the peritoneum?

The majority of it is covered by the visceral peritoneum, but there is a "bare area" that is not at the top, middle portion of the liver between the ligaments

How is the central retinal A/V exposed to pressures produced by CSF?

The optic N is an extension of the CNS and is covered by meninges Venous blood has a hard time getting out of the eye if there is an excess pressure in the CSF

What is a joint reaction force?

The resultant of all forces acting on a joint (muscle, gravity, load). It will be equal & opposite to the sum of all x and y vectors.

End-Feel Definition

The sensation felt by the therapist at the extreme end of the passive range

What happens if there is a pathology going on that reduces or stops blood flow to the inferior vena cava (where the axillary vein normally drains)?

Then the superficial veins of the anterior thoracic wall and abdominal wall allow a bypass to get the blood back to the heart through the superior vena cava

When a patient has a pulmonary artery catheter, is it safe to do activities with them?

These patients are usually kept on bedrest, do not do any movements that disrupt or have potential to dislodge the PA line

What do the anterior and posterior circumflex arteries supply?

They anastomose with each other and supply the shoulder muscles such as teres major and minor, deltoid, and long head of triceps

What are demifacets?

They are located on the thoracic vertebrae and articulate with the ribs. There are superior and inferior demifacets of the vertebrae that articulate with the superior and inferior facets of the ribs.

How do ACh M1 Receptor Antagonists work?

They block the M1 subtype of ACh muscarinic receptors

Are cervical ribs big or small?

They can be small and rudimentary, but they can also be big and a potential hazard

What are potential complications of cervical ribs?

They can limit the already crowded thoracic aperture and lead to compression of the brachial plexus or subclavian artery

Do cervical ribs occur bilaterally or unilaterally?

They can occur either way

Where do the superior/inferior ophthalmic VV drain into?

They drain into the cavernous sinus and into the angular V and thus the facial V

What do all 3 intercostal muscles do?

They help keep the intercostal space from bulging or collapsing during respiration

What is the function of the mucosa with spiral folds in the gall bladder?

They prevent sudden increase in bile flow

What are the branch(es) of the second section of the axilla?

Thoracoacromial artery Lateral thoracic artery

Impulse is a type of force produced over _______________ ?

Time

What is the function of all scalene muscles?

To elevate the ribs during heavy inspiration (or bend the neck to one side)

What does serum lipid levels test for?

Total cholesterol: -LDL -HDL -Triglycerides

Which way does the superior oblique muscle rotate the top of the eye?

Toward the nose (IR)

What is the PT vision statement?

Transforming society by optimizing movement to improve the human experience

What may result from atherosclerosis of the brain?

Transient Ischemic Attack (partial occlusion of cerebral/carotid arteries) Cerebrovascular Accident (CVA) (total occlusion of cerebral/carotid arteries)

T/F: all atherosclerotic conditions are arteriosclerotic in nature, but not all arteriosclerotic conditions are atherosclerotic in nature

True atherosclerosis = arteriosclerosis with atheromas

What is passive ROM? (PROM)

Unrestricted motion of a joint that is entirely performed by an external force. Little to no voluntary contraction.

What is active ROM? (AROM)

Unrestricted motion of a joint that is produced by active contraction of the muscles causing voluntary movement

In what quadrant is the spleen located?

Upper left quadrant

What do hyperosmotic laxatives do?

Use osmotically active substances to produce a gradient that draws water into the bowel and small intestines (to inc. fluid content and stimulate excretion)

Define biomechanics

Use principles of physics to study how forces interact w/ a living body

When is a pulley used?

Used to improve a line of pull or the mechanical advantage of a system

What is the bulk of the globe of the eye filled with?

Vitreous body

What is the major component of most body parts?

Water

What is appendicitis? What population is it seen in? Where is the pain felt? What happens if it rupture? How is it treated?

What: acute inflammation of appendix Who: common in young people Where: vague pain around umbilicus Rupture: causes peritonitis, nausea, & vomiting Treatment: appendectomy, surgical incision at McBurney's point or laproscopy

Neurogenic Thoracic Outlet Syndrome

When the cervical rib compresses the brachial plexus. The brachial plexus runs from C5-T1, and spinal nerves C8 and T1 are often compressed. The symptoms present similarly to ulnar paresthesia

When does equilibrium occur with levers?

When the forces on one side of the axis equal the forces on the other side of the axis F (df) = R (dr)

What is active-assisted ROM? (AAROM)

When the patient has some strength, but they need some help from the PT

Costochondritis

When the rib/bone starts to pull away and stress the joint

Where is the right colic/hepatic flexure?

Where the large intestine touches the liver Junction of ascending and transverse colon

Where is the left colic/splenic flexure?

Where the large intestine touches the spleen Junction of transverse and descending colon

What is the McBurney point?

Where the root of the appendix attaches to the cecum

Define power What unit is it measure in?

Work divided by time P=W/t (measured in watts or J/s)

Does the appendix have a mesentery?

Yes, it has its own

What happens in a simple reflex response?

You tap the tendon which stretches the muscle, the muscle spindles feel the stretch, sensory fibers send the signal to the spinal cord, a motor neuron tells the muscle to contract

Why do your eyes hurt from reading something up close for too long?

You use up all the ATP in the ciliary muscles

What is Digoxin? What does it do? What does it treat?

a cardiac glycoside that comes from plants slows conduction of impulses and heart rate (less frequent and stronger contractions) Treatment for heart failure and atrial dysrhytmias

What is performed in an angioplasty? How is coronary stenting different?

a catheter is inserted into a clogged artery and a balloon is inflated to clear the artery stenting leaves a small metal mesh tube in the artery to prevent re-occlusion

The hypothesis a PT comes up with about a patient is also referred to as:

a clinical syndrome or dysfunction

How long does chronic pericarditis last?

a few months

There is a lot of diversity in cancer pain experience and appearance and the group of symptoms may suggest:

a specific cancer pain syndrome

What is a Dobhoff feeding tube?

a type of NG tube that terminates in the stomach

What motions does an inferior shoulder glide help with?

abduction flexion above 90 degrees (general motions above 90)

What is the most common MOI of the patellofemoral joint?

abnormal patellar tracking

What condition involves an excess of hydrogen ions and a decrease in serum pH?

acidosis

What endocrine condition causes enlarged hands & feet, thicker skull and a change in facial features?

acromegaly

What do stimulant laxatives do?

activate peristalsis by an unknown mechanism (they might inc. fluid accumultion in the small intestines)

Somatic pain is caused by the activation of what?

activation of pain receptors

Visceral pain is caused by what?

activation of pain receptors resulting from infiltration, compression, extension or stretching of the thorax, abdomen or pelvic viscera

Sodium moves in/out of cells via what type of transportation?

active transport via the sodium potassium pump (3 Na+ ions pumped out of the cell, and 2 K+ ions into the cell)

Does the greater sciatic notch of a male pelvis have a more acute or obtuse angle?

acute

What is infection/inflam of the prostate gland called?

acute bacterial prostatitis

What condition may develop as a result of a positive pressure ventilator system?

acute respiratory distress syndrome characterized by: respiratory failure atelectasis pulmonary infiltrates

How do you grade stage?

acute, subacute, chronic

What are the 3 "stages" of symptoms/healing for an injury?

acute/inflammatory subacute/tissue formation chronic/remodeling

Acromegaly is often associated with what type of tumor?

adenoma

What is the most common cause of pituitary disorders?

adenomas

Chronic pericarditis results in formation of _________ between pericardial membranes -> __________tissue

adhesions fibrous

A ventilator does what two things?

adminsters supplemental O2 and breathing support

Which gland is aldosterone secreted from?

adrenal cortex

Which gland is cortisol secreted from?

adrenal cortex

Which gland secretes adrenocorticosteroids?

adrenal cortex

In a primary adrenal insufficiency that causes Addison's disease, what could cause adrenal gland deficiency?

adrenal gland may be destroyed by autoimmune reaction or infection

Which gland are epinephrine & norepinephrine secreted from?

adrenal medulla

*Lower* injuries of the spine are more common in what age group?

adults

How prevalent is Charcot foot in people w/ diabetes?

affects 9% of people with diabetes

How does endocarditis affect the heart in Rheumatic heart disease?

affects heart valves -> disrupts blood flow and effectiveness of left ventricle Heart valves may scar -> stenosis -> rheumatic heart disease

What are the non-modifiable risk factors for atherosclerosis? How does each affect your risk?

age (risk inc with age) gender (women have lower risk) genetic factors (LDL receptor mutation)

What are ways that fixed O2 therapy can be administered?

air entrapment mask BPAP T tube (used to wean)

Which plasma protein makes up 60-70% of the proteins found in your plasma?

albumin

Of ADH, aldosterone and ANP, which affect water and sodium?

aldosterone & ANP -ADH only affects water

What condition involves a deficit of hydrogen ions and an increase in serum pH?

alkalosis

How does the Passy-Muir One-way speaking valve work?

allows air into the tracheostomy site, but not out of that site. Instead it has to pass by the deflated cuff on the tracheal tubing to pass out of the oral cavity

Define fluid homeostasis

amount of water entering the body is equal to the amount of water leaving the body

What is sclerosis as it relates to blood vessels?

an abnormal hardening of body tissue that causes the vessel walls to become less elastic

What is an AV fistula used for?

an access point for a patient on dialysis (if you learn a pt is on dialysis find out where the AV fistula is)

What are atheromas?

an accumulation of degenerative material (fatty acid deposits) in the tunica intima (inner layer) of artery walls

What is Rheumatic Fever?

an acute systemic inflammatory condition affecting connective tissue (heart, joints, skin) -may result from an abnormal immune reaction (anti-strep antibodies react w/ collagen = inflammation)

What is a goiter?

an enlargement of the thyroid gland

What is Rheumatic Heart Disease? What are 3 ways it can manifest?

an inflammation of the heart -endocarditis (most common) -myocarditis -pericarditis

Osmotic laxatives are best given to people with:

an urgent need to empty the bowels

What does it mean if your ABI is greater than 1.2?

ankle blood vessels are *incompressible* and toe brachial indexes should be considered

What is secondary hypertension caused by?

another identifiable medical condition -renal disease -endocrine disorder (adrenal tumor - hyperaldosteronism) *high aldosterone - retain salt - retain water - high BP* commonly linked to diabetes

If you want to facilitate knee extension, you would perform a/an ____________ tibial glide on the femur

anterior

The scrotum is an outpouching of the:

anterior abdominal wall with fascial layers continuous w/ fascia of the abdominal & pelvic cavities

What muscles are being tested with shoulder flexion MMT?

anterior deltoid supraspinatus coracobrachialis

Which gland is also called the adenohypophysis?

anterior lobe of pituitary

What structure stabilizes the anterior column of the spine?

anterior longitudinal ligament (ant 2/3 of v. bodies & annulus fibrosis)

When you extend your knee, which direction are the menisci going to move?

anteriorly

PPIs are thought to have ____________ properties that can help kill _____________

anti-bacterial; H, pylori (bacteria that causes stomach ulcers)

PPIs may also have an _________ action that helps decrease __________

anti-inflam; gastric irritation

How do you treat acute bacterial prostatitis?

antibacterials with good results but if poorly treated a chronic infection can result

What causes prostalgia fugax?

anxiety, stress & orgasm

Describe the vascular tree parts

aorta -> large artery -> small artery -> arteriole -> capillaries <- venules <- veins <- vena cava

What is sclerosis of the bone referring to?

areas of the bones becoming harder, happens in osteoblastic conditions

What does it mean if your ABI is less than 0.9?

arterial disease is present

What are invasive examples of hemodynamic monitoring?

arterial or femoral line pulmonary artery catheter

What is the most common predisposing factor for all other vascular diseases?

arteriosclerosis

In which portion of a SOAP note is a prognosis determined?

assessment/evaluation

In which portion of a SOAP note is a relationship identified b/w the subjective and objective exams?

assessment/evaluation

In which portion of a SOAP note is a working hypothesis developed?

assessment/evaluation

In which portion of a SOAP note is the problem determined?

assessment/evaluation

After a pathologic fracture, what could possibly be done with PT intervention?

assistive devices or bracing fall prevention

How often should a patient with neuropathy have a comprehensive foot exam done?

at least annually, more often if complications exist

What is the most common cause of MI?

atherosclerosis

Which occipital-cervical injury is often associated with TBI and SC involvement?

atlanto-occipital dislocation (AOD)

Which occipital-cervical injury is often a burst fracture of C1 (bil. or uni. ant & post arches) that sometimes causes other injuries such as a fracture of the dens of C2?

atlas (Jefferson) fracture

What do antacids do?

attempt to neutralize excess stomach acid in the case of heartburn or acid reflux

What type of disease is Graves' disease?

autoimmune disease -autoantibody against TSH receptor that causes inc production of thyroid hormones even though TRH from the hypothalamus is not stimulating it -results in hyperthyroidism

What type of disorder is Hashimoto's thyroiditis?

autoimmune disorder -autoantibodies attack thyroid gland proteins -inflammation in thyroid gland -gland underperforms

Which type of neuropathy affects the cardiopulmonary system, temp regulation, bowel, bladder and sexual function?

autonomic

Which motions should be avoided after a spinal fracture or fusion?

avoid flexion and rotation

Why is prolonged use of stool thickeners dangerous?

bacteria that are inhibited by the drugs are necessary for normal digestion

What is the base to acid ratio of the sodium bicarbonate - carbonic acid buffer?

base to acid ratio- 20:1 -our body produces more acids than bases, so the buffer system has more bases to neutralize them

When is a stool softener usually taken?

before bedtime (with the anticipated result occurring in the morning)

The coronary circulation begins at the?

beginning of the aorta

What are some general components of fatigue? (read)

behavior: effects on performance feeling: subjective experience mechanism: physiological, psychological context: environment, attitude

Chloride ion levels are complemented by the level of what other ion? What is the purpose of this?

bicarbonate ions -maintains electroneutrality in ECF -maintains acid-base balance ^

How do calcium channel blockers work?

block movement of calcium into : -cardiac muscle cells (decreasing cardiac contractility) -and into smooth muscle cells (vasodilation and antihypertensive effects)

What do PPIs (proton pump inhibitors) do?

block the hydrogen pump responsible for secreting acid into the stomach lumen

Endocrine glands secrete hormones into the _____________

blood

Is the bicarbonate concentration higher in the blood or in the cells?

blood

Is the chloride concentration higher in the blood or in the cells?

blood

Is the sodium concentration higher in the blood or in the cells? Why?

blood -due to sodium-potassium pump

An arterial line gives a continuous arterial ________ reading

blood pressure may vary from a cuff (which gives a higher systolic and lower diastolic measure)

How is "pre-hypertension"? defined How prevalent is it?

blood pressure between 120/80 and 139/89 1/3 adults has it

How does control over body processes change with tiredness?

body and mind work together

How does control over body processes change with exhaustion?

body over mind -overwhelming need to lie down -numbness in some body parts -state their bodies feel unfamiliar to them

With osteolytic bone mets, what happens to old and new bone?

bone is broken down without new bone forming

Calcium provides structural strength for what structure in the body?

bones & teeth

In primary hypertension, is systolic or diastolic pressure high?

both

Is parethesis (pins & needles) an effect of hypo- or hyper- kalemia?

both

Which ligament has two portions? ACL or PCL?

both

Does somatic pain generally involve superficial or deep structures?

both can involve superficial, cutaneous (body surface) structures (post-surgical incision) or can involve deep tissues (musculoskeletal) involves mets in bone

Do thyroid hormones have genomic or non-genomic effects?

both (means they can affect gene expression or other things)

Does hypo- or hyper- kalemia result in fatigue and muscle weakness?

both do

How do you treat scoliosis conservatively?

bracing and PT

What is cholesterol's purpose?

building blocks for membrane components, some hormones, vitamin D, bile acids

What is the best choice of drug for people with small, hard stools?

bulk forming laxatives

________________ are just high doses of fiber, so they are safe, even for kids

bulking drugs

Which type of T-spine injury is due to axial loading?

burst fracture

What is the procedure called where another vessel in the body is harvested and used to re-route blood from one of the coronary arteries?

bypass

Which electrolyte acts as a second messenger in signal transduction?

calcium

Which electrolyte is necessary for enzyme reactions such as blood clotting and ECM remodeling?

calcium

Deficit of which electrolyte can lead to skeletal muscle twitching and hyperactive reflexes?

calcium, hypocalcemia

Deficit of which electrolyte leads to increased activation of skeletal muscle but decreased activation of cardiac muscle?

calcium, hypocalcemia

If a patient has notable _______________ on their feet, they may not be able to feel the vibrations in a vibratory sensation test, which does not indicate sensory loss

calluses may need to adjust locations on the foot for the test to avoid calluses

Do hyperthyroid or hypothyroid conditions cause a goiter?

can be either (determined by T4/T3 levels)

How severe is decompensation in terms of pH imbalance?

can be life-threatening! -requires intervention to maintain homeostasis

Why does Carla say "good luck" when working with a patient who has a rectal catheter?

can easily be dislodged when sitting or transferring a patient, usually patients with very loose stools have these

PT interventions can have what effect on ICP?

can increase it even on patients who seem non-responsive

What precautions/contraindications go along with a PICC line?

can't do pool therapy -take caution when doing exercises or manual techniques with that limb

What is the function of veins?

capacitance function (blood volume)

What acts as a bridge between arteries and veins to form microcirculation?

capillaries

How does the body initially compensate for CHF?

cardiac hypertrophy -will maintain cardiac output for a period of time but will eventually fail (forward or backup effect)

How do you treat a atlanto-occipital dislocation?

careful immobilization & reduction, *halo and fusion*

How does Cushing's syndrome suppress the immune system?

causes atrophy of lymphoid tissue which leads to infections (Cushing's is due to excess of glucocorticoids, like cortisol, which are known to suppress the immune system)

How does serum acidosis affect potassium levels?

causes hyperkalemia

How does serum alkalosis affect potassium levels?

causes hypokalemia

What may cause serum pH to change?

cell metabolism leads to acidosis -formation of CO2 & carbonic acid -formation of nonvolatile metabolic acids: lactic, ketoacids, sulphates, & phosphates

Is the magnesium concentration higher in the blood or in the cells?

cells

Is the potassium concentration higher in the blood or in the cells? Why?

cells -due to sodium-potassium pump

Is the phosphate concentration higher in the blood or in the cells? Why?

cells, needed to make ATP

Internal jugular and subclavian venous lines are examples of ________

central lines

Where may the PA catheter enter? (bold are the most common)

central venous entry -*subclavian* -*internal jugular* -femoral -anticubital (basillic or brachial)

How do you treat a *stable* vertical compression injury with little kyphosis?

cervical orthosis

How do you treat a *type I* C2 (axis) fracture?

cervical orthosis

How do you treat a *type I* C2 (odontoid) fracture?

cervical orthosis

What equipment would you use to stabilize a type I or II occipital condyle fracture?

cervical orthosis or Halo

How is dehydration/fluid loss measured? How do you define mild, moderate and severe dehydration?

change in body weight -mild 2% decrease -moderate 5% decrease -severe 8% decrease

What is the equation for velocity?

change in d / change in t

What is the equation for acceleration?

change in v / change in t

How do abnormal potassium levels affect cardiac conduction?

changes in potassium level can alter cardiac conduction in a way that is life-threatening

What does compensation or adaptation refer to?

changes in the pt's environment and tasks

When does angina pectoris occur? What is a common symptom?

chest pain occurs when there is a deficit of O2 to meet myocardial needs -O2 supply impaired -heart works harder than usual (and needs more O2) -combination

P1 on a patient chart refers to the:

chief complaint

What age population does Rheumatic Fever and Rheumatic Heart Disease occur in? What triggers it?

children 5-15 y.o. develops a few wks after an untreated infection (group A beta-hemolytic Streptococcus)

What is the most abundant anion in the body?

chloride

Is arteriosclerosis chronic or acute?

chronic

Chronic non-bacterial prostatitis has recently been given a new name b/c the original name is grossly incorrect. What is its new name?

chronic pelvic pain

Which foot deformity involves hyperextension of the MTP with PIP and DIP flexion

claw toe

Which type of subaxial injury involves a fracture of a spinous process due to hyperflexion?

clay-shoveler's fracture (avulsive due to muscle contraction or direct blow)

Ventilatory support requires an established ________ system airway

closed

What may reduce the size of an infarct?

collateral circulation and/or anastomoses

What is the function of vena cava?

collection

What is ABI (ankle brachial index)?

compares the BP in your ankle to the BP in your arm normal is considered 1.0 - 1.2, meaning the BP in the ankles should be equal to or slightly higher than the BP in the arms

In general, what are the most common causes of T-spine injury?

compression metastatic disease trauma

Which type of T-spine injury results in failure of the anterior column?

compression fracture

Compression-flexion injuries of the C-spine are often accompanied by:

compromised stability, facet dislocation, ligament rupture, disc tearing

According to the convex-concave rule, if the tibia (convex/concave) moves on the femur (convex/concave), then roll and glide will occur in the _________(same/opposite) direction for the tibia.

concave tibia convex femur same direction

What determines pH?

concentration of hydrogen ions (H+)

What causes respiratory acidosis?

conditions that dec the ability of the resp. system to get rid of CO2 -acute: pneumonia, airway obstruction, chest injuries, drugs that depress the resp. control center -chronic: common w/ COPD

How is cognition affected with exhaustion?

confusion or "brain fog" -inability to find way home from familiar places -unable to keep track of appointments -dependency for daily needs that require memory or concentration

Morphine and other opiates are known to be ________

constipating (produce a general dec. in GI motility)

What is the most common side effect assoc. with *aluminum containing* antacids?

constipation

Patellar ________surface changes throughout knee motion

contact

What is the function of the hypothalamus (gland)?

control release of hormones from pituitary gland

What is a procedure that can help to diagnose atherosclerosis?

coronary angiogram

How does a myocardial infarction lead to cell death?

coronary artery occlusion -> prolonged ischemia -> cell death

Cessation of smoking decreases the risk for what heart condition?

coronary disease

A congenital defect of a gland would lead to which type of endocrine disorder?

could be either one: excess or deficit of hormone levels

What does complete absence of PTH lead to within a few days? Why does this happen?

death due to hypocalcemic tetany

How does calcitonin affect calcium levels?

dec amount of calcium in blood by: -inhibits bone reabsorption -inhibits Ca reabsorption by kidneys

How does dehydration affect the skin?

dec elasticity (turgor)

Inc calcitonin and phosphate levels _____________ (inc/dec) calcium levels

decrease

A pt's RBC osmolarity is 300 mOsm, and she is given a 1 L infusion of a solution with an osmolarity of 250 mOsm. Will her plasma osmolarity increase or decrease?

decrease -if you add a solution that is hypoosmolar compared to the original solution, there is not way the osmolarity of the first solution can go up

How does hypokalemia affect nerve impulse conduction? -how does it affect the resting membrane potential? -does it make the cell more or less excitable?

decrease in K+ outside the cell results in *hyperpolarization* of the membrane which makes the cell *less excitable* (explanation below) -hypokalemia means there is less K+ outside of the cell, and more K+ inside the cell -this causes diffusion of K+ from inside to outside the cell to happen more quickly which *hyperpolarizes* the cell membrane -the membrane potential is now even more negative which makes the cell *less excitable* since it will take a bigger action potential to reach the threshold to excite the cell

What is the goal of PT with patients who have chronic bone mets?

decrease pain to promote functional mobility, maximize safety

What does the H2 receptor antagonist class of drugs work to do?

decrease the amount of acid in the stomach

How does calcitonin affect calcium levels in the blood? How does it do this?

decreases amt of Ca in blood by: -inhibits Ca release from bone -inhibits Ca reabsorption by kidneys

How does acidosis affect cardiac contractility?

decreases it

How does dehydration affect sweating?

decreases it

Addison's disease involves ___________________ (high/low) amount of _____________________

deficiency of adrenocorticosteroid hormones (mineralocorticoids, glucocorticoids, androgens)

Define dehydration

deficiency of water in the body due to inadequate intake, excessive loss, or both

Surgical removal of a gland leads to what type of endocrine disorder?

deficit of a hormone

If a gland is destroyed, what type of endocrine disorder would this lead to?

deficit of a hormone Ex: insulin --> type 1 diabetes

What is present history of injury referring to?

details with regard to the current episode

What is the primary concern with someone with foot deformities?

development of callus/corn which may turn into a wound

What condition is named for the phrase "lack of sugar in the urine"?

diabetes insipidus

What condition involves the inability of the kidneys to retain water? This is caused by a deficit of what substance?

diabetes insipidus ADH

What criteria must a patient meet in order to have diabetic shoes covered by Medicare?

diagnosis of DM and 1 of the following: -hx of ulcers -pre-ulcerative callus -peripheral neuropathy w/ callus formation -foot deformity -poor circulation -partial or complete foot amputation

What is the most common side effect assoc. with *magnesium containing* antacids?

diarrhea

Chronic pericarditis limits movement of the heart during _______ and ________-> leading to _______ cardiac output

diastole and systole reduced

What is anastomose mean?

direct connection between small branches

What is a common side effect of bulk forming laxatives?

distended and painful abdomen

What is the function of large arteries?

distribution

What is the function of small arteries?

distribution and resistance

What is critical to get a patient diabetic shoes?

documentation of the symptoms they have that meet the criteria for insurance to pay for diabetic shoes

What muscles are involved with MMT MCP abduction?

dorsal interossi

Stool softeners work best if the person:

drinks a lot of water

What causes the development of mild acidosis with "forward" effect of CHF? How does the body try to compensate?

due to the accumulation of lactic acid (due to anaerobic environment - lack of blood flow = lack of O2); body compensates by increased respiration (decreasing CO2 levels creates a more basic environment)

Why is the L5-S1 region of the spine considered unstable?

due to the relatively small force needed to cause injury

How is deep somatic pain described?

dull or aching but still localized

What is important to remember about adding additional layers of wax with paraffin?

each subsequent layer should be a little more distal to the one before it, wait for wax to dry between layers

What is the most important PT intervention for a patient with neuropathy?

education!

How does pericarditis affect the heart in Rheumatic Heart Disease?

effusion (excessive liquid accumulation in pericardium) -> impaired filling

Laxatives are prescribed to promote:

elimination from the bowel and defecation

What are the three layers of the heart?

epicardium (visceral pericardium) myocardium (cardiac muscle) endocardium (lining)

What is prostalgia fugax?

episodic, severe, localized pain in the rectum lasting from a few seconds to 10-20 min or more (fugax = fleeting) chronic pelvic muscle tension in a situation where it increases even more

What is another name for primary hypertension?

essential hypertension

Define hyperpathia

exacerbated pain response to nociceptive stimuli

Syndrome of inappropriate ADH (SIADH) is caused by an ______________ (inc/dec) of what substance?

excess ADH (retention of fluid)

If excretion of a hormone by the kidneys is impaired, what type of endocrine disorder would this lead to?

excess hormone levels

When do endocrine disorders develop?

excess or deficit (or reduced effect) of a hormone

Define edema

excessive amount of fluid in the interstitial compartment that results in swelling & enlargement of tissues

Cushing's syndrome is caused by _______________ (high/low) levels of ____________________

excessive level of glucocorticoids (ex: cortisol)

Antacids only treat the symptoms of:

excessive stomach acid

How is the MCL commonly injured/what is the MOI? (what motions)

excessive valgus force with foot planted (clip injury) or severe hyperextension

What is the common MOI for the LCL?

excessive varus force with the foot planted or severe hyperextension

What is the function of capillaries?

exchange of gas and nutrients/waste

What is the function of venules?

exchange, collection and capacitance

What can break the fatigue cycle?

exercise

_______ can play a vital role in cancer prevention and control

exercise

What muscles are involved in MMT of MCP extension?

extensor digitorum extensor indices extensor digiti minimi

Is calcium an important intracellular or extracellular cation?

extracellular

Is chloride a major intracellular or extracellular anion?

extracellular

T/F: the rate and timing of hormone secretion does not vary

false, it does vary Ex: thyroid secretions are constant but estrogen secretions vary in cyclic patterns

T/F: orchalgia is one of the most common forms of testicular pain

false, it is rare but still needs to be screened for (orchalgia: pain in unilateral testicle)

T/F: cryotherapy for prostate cancer is performed in a physician's office

false, performed in OR

T/F: T-spine compression fractures are often associated with neurologic compromise

false, they are not

T/F: pudendal nerve problems mainly occur in men

false, they occur in both men and women

T/F: it is a bad sign if a patient with neuropathy has hair on their feet

false, this is a good sign, hair can't grow unless there is good circulation

T/F: you only need to be concerned about checking a diabetic patient's feet if they have type 2 diabetes

false, you should check their feet regardless of the type of diabetes that they have

What contains the smooth muscle that contracts and lifts the testis up? Which muscle is this?

fascia cremaster muscle, involutary

Properly prescribed exercise can break the cycle of _______

fatigue

What is a common, debilitating symptom of patients who have cancer?

fatigue

What symptom is widely and commonly supported by the following organizations: -national comprehensive cancer network -lupus foundation of america -multiple sclerosis council -parkinson's disease foundation -arthritis foundation (rheumatoid arthritis)

fatigue

The BFI (Brief Fatigue Inventory) scale and the MFSI-SF (Multidimensional Fatigue Symptom Inventory Short Form) are used to measure what?

fatigue in cancer patients

Are ACL injuries more common in males or females?

females

What does a posterior glide of the shoulder help with?

flexion horizontal adduction IR

In general, which direction of force usually contributes to T-spine injury?

flexion force

Which type of T-spine injury is due to violent forward flexion and compression of the anterior vertebral body with transverse fracture of posterior elements?

flexion-distraction fracture

What muscles are being tested with wrist flexion MMT?

flexor carpi radialis and flexor carpi ulnaris

What muscles are involved in MMT of DIP flexion?

flexor digitorum profundus

What muscles are involved in MMT of PIP flexion?

flexor digitorum superficialis

Is aldosterone involved in fluid loss or retention?

fluid retention

What will happen if a cell is put into a hypotonic/hypoosmolar solution?

fluid will go into the cell and cause it to swell/burst

What will happen if a cell is put into a hypertonic/hyperosmolar solution?

fluid will go out of the cell and cause it to shrink

Which type of neuropathy involves a sudden loss of function in one nerve or group of nerves?

focal

Is a spinal fracture that involves 2 columns stable or unstable?

follow the middle column, if it's stable the injury is stable

When is a patient orally (endotracheal) intubated?

for a short duration of ventilatory support or for routine general anesthesia

When are anti thrombolytic devices used?

for patients who are immobilized long term or for patients recovering from a surgery that don't have a high level of mobility

How is cognition affected with tiredness?

forgetful and may have somatic symptoms (headaches)

What does FiO2 stand for?

fraction of supplemented O2 helps put the L measures on O2 tanks in terms of percentages

How does alkalosis lead to hypocalcemia?

free Ca++ will bind to albumin reducing calcium levels

What are the 3 types of aortic aneurysm?

fusiform: circumferential dilation along a section of artery saccular: bulging wall on one side dissecting aneurysm: develops when there is a tear in the intima of the wall and blood continues to disect or separate tissues

What characteristics does the BFI look at to determine level of fatigue?

general activity, mood, walking ability, normal work, relationships and overall enjoyment of life

What are some examples of special questions that could be asked during a subjective exam? (read)

general health medication blood pressure previous operations lab results imaging cardiovascular or pulmonary condition

What is a lateral distraction of the shoulder helpful for?

general mobility and pain reduction

What does a radiocarpal joint distraction help with?

general mobility and pain relief

What does metacarpophalangeal joint distraction help with?

general mobility and pain relief

The prostate is composed of:

glandular & fibromuscular tissue

What should you wrap the area in after the paraffin wax is on?

glove or plastic wrap to insulate heat and then a towel around that

PT hand position for radiocarpal joint distraction?

grasp at styloid process of radius and place other hand as close as possible to first hand

PT hand position for a radiocarpal volar glide?

grasp radial styloid process to stabilize, other hand as close as possible to first hand, pressure straight into floor

The osmotic pressure of blood is greater or less than the osmotic pressure of the interstitium?

greater -meaning fluid will move into the blood

The hydrostatic pressure of blood is greater or less than the hydrostatic pressure of the interstitium?

greater -meaning fluid will move out of the blood

What is hypotonic dehydration?

greater loss of electrolytes than water

What is hypertonic dehydration?

greater loss of water than electrolytes

How should one grip the patient's arm when performing a lateral shoulder distraction?

grip as close to the joint line as possible (using a towel) and have one hand in armpit and one on the deltoid muscle, place patient arm between your torso and arm for support

Where do the ureters refer pain to?

groin, upper/lower abdominals, suprapubic, scrotum, medial & proximal thigh, thoracolumbar

There are 5 symptom groups identified for male pelvic pain, which are the most common?

groups I, II and III

Does prostate cancer usually grow from in -> out or out -> in?

grows outside the prostate and works itself into it

Somatotropin is also known as:

growth hormone

Which foot deformity involves hyperextension of the MTP and DIP joints?

hammer toe

Are ACh receptor antagonists easier or harder to take than PPIs or H2 blockers?

harder (that's why they are rarely used)

Arteriosclerosis and stenosis are caused by _____ blood pressure What may result?

high -may lead to ischemia -damaged kidneys, brain, eye

What causes ANP to be produced?

high atrial BP -ANP promotes fluid loss to reduce blood volume & BP

How does decreased clearance of phosphate cause hyperparathyroidism?

high phosphate levels (and low calcium levels) in blood stimulate the release of PTH

What is hypertension? How prevalent is it?

higher than normal blood pressure caused by an increase in arterial vasoconstriction >140/90 (either value) 1/3 adults have it

Why do osteolytic bone mets result in fracture?

holes or osteolytic lesions develop when parts of bones dissolve, olsteolytic lesions are very weak

_________________ are considered chemical messengers

hormones

FYI: T3: triiodothyronine T4: thyroxine

hormones produced by the thyroid gland

Antacids usually contain a base such as:

hydroxide or carbonate/bicarbonate with aluminum, magnesium, calcium or sodium

What is genu recurvatum? How is it defined?

hyperextension of the knee beyond 10 degrees past neutral

In general, what is the most common MOI of the L-spine?

hyperflexion +/- shear, rotation, and axial compression

Is a toxic goiter a hyperthyroid or hypothyroid condition?

hyperthyroid condition

If a pt has with inc T3 and T4, inc creatine kinase and dec TSH levels indicate what endocrine condition?

hyperthyroidism (Grave's disease)

What may cause respiratory alkalosis?

hyperventilation, expel too much CO2 -caused by anxiety, high fever, overdose of aspirin, head injuries, or brainstem tumors

Does hypoparathyroidism lead to hypercalcemia or hypocalcemia? What effects does this condition have on cardiac & skeletal muscle?

hypocalcemia -weak cardiac m contractions -inc excitability of nerves (spontaneous contractions of skeletal m -- twitching)

Does alkalosis result in hypo- or hyper- kalemia?

hypokalemia

What serum levels of potassium indicate hypokalemia and hyperkalemia?

hypokalemia: less than 3.5 mEq/L hyperkalemia: greater than 5 mEq/L

Does hypo- or hyper- magnesemia lead to heart arrhythmias?

hypomagnesemia

A pt's RBC osmolarity is 300 mOsm, and she is given a 1 L infusion of a solution with an osmolarity of 250 mOsm. Was the infusion hyperosmolar, hypoosmolar or isoosmolar?

hypoosmolar/hypotonic

What structure controls hormone secretion by the pituitary gland? How does it do this?

hypothalamus it can secrete *releasing* hormones to "turn on" the pituitary or *inhibiting* hormones to "turn off" the pituitary

Is an endemic goiter a hyperthyroid or hypothyroid condition? What global regions does it occur in?

hypothyroid condition in regions with low iodine in food

What is cretinism? What disorder is it a symptom of?

impaired growth & severe cognitive deficits symptom of *untreated congenital hypothyroidism* (may be related to iodine deficiency during pregnancy)

What can edema cause impairment of?

impaired tissue perfusion- which is the supplying of blood to tissues

How does acidosis affect nervous system function? What are some symptoms?

impairs it (decreased excitability) -symptoms: headache, lethargy, weakness, confusion, coma & death

How is emotional reactivity affected with tiredness?

impatience

How do you grade stability?

improving, worsening, stable

What does autorhytmicity of the heart muscle mean?

impulses to start contraction are initiated within the cardiac muscle

How is cognition affected with fatigue?

inability to concentrate and belief that exercise or exertion will worsen fatigue

Exercise can ______ (inc/dec) muscle fiber quantity and strength

inc

Exercise can ______ (inc/dec) oxygen efficiency of muscles

inc

Exercise can ______ (inc/dec) the functional reserve of organ systems

inc

Exercise can _______ (inc/dec) feeling of well-being

inc

Exercise can ________ (inc/dec) quality of life

inc

How does aldosterone affect magnesium levels?

inc aldosterone: inc loss of magnesium

How does vitamin D affect calcium levels?

inc amount in blood by promoting Ca reabsorption in intestines

How does parathyroid hormone (PTH) affect calcium levels?

inc amount of calcium in blood by: -inc Ca reabsorption from bone -inc Ca reabsorption by kidneys -inc Ca absorption in intestines

How does alkalosis affect the nervous system? What are some symptoms?

inc excitability -symptoms: restlessness, muscle twitching, tingling, numbness in fingers, tetany, seizures & coma

What causes nervousness in hyperthyroidism?

inc stimulation of SNS

Exercise can _______ (inc/dec) cardiovascular function

increase

Exercise can _______ (increase/decrease) RBC production

increase

Inc PTH and vitamin D activation _____________ (inc/dec) calcium levels

increase

A pt's RBC osmolarity is 300 mOsm, and she is given a 1 L infusion of a solution with an osmolarity of 250 mOsm. As the infusion equilibrates with her blood, will her RBC volume increase or decrease?

increase -RBC's are now in a solution of plasma with lower osmolarity than before, there are now more solutes in the cells than outside, so the water will move into the cells and cause them to swell

How does hyperkalemia affect nerve impulse conduction? -how does it affect the resting membrane potential? -does it make the cell more or less excitable?

increase in K+ outside the cell results in *depolarization* of the membrane which makes the cell *more excitable* -hyperkalemia means there is more K+ outside the cell -this causes diffusion of K+ from inside to outside the cell to happen more slowly which *depolarizes* the cell membrane -the membrane potential is now more positive which makes the cell *more excitable* since a smaller action potential will be able to reach the threshold to excite the cell

How is joint loading of the patellofemoral joint influenced with greater knee flexion?

increased (a.k.a. - more force on the patellofemoral joint with more knee flexion)

How does dehydration affect body temperature?

increases it

When GH acts on target tissues *indirectly*, what effects does it have?

increases production of *insuline-like growth factor 1* (IGF-1) by a variety of tissues

What are the 3 effects of smoking? How do they harm the body?

increases vasoconstriction (inc heart workload) increases platelets adhesion (inc in thrombus formation) produced carbon monoxide displaces O2 in Hb (reduced O2 supply)

What is an alternate treatment for people with small, hard stools besides taking drugs?

increasing fiber in their diet

Why is biofeedback helpful for treating male pelvic dysfunction?

incredibly effective way of teaching use of pelvic floor muscles which can be difficult to train helpful for making brain to muscle connections

When is a face mask indicated over a nasal cannula for supplemental O2? What are the down sides?

indicated: -nose bleeding/nasal irritation -mouth breather drawbacks: -uncomfortable/obtrusive -interferes with speaking -obstructs coughing and eating

An arterial line can raise the risk for what?

infection (each time it is replaced the risk increases)

How does the patella move with knee flexion?

inferiorly and slightly medially

What does CRP test for?

inflammation

How does myocarditis affect the heart in Rheumatic Heart Disease?

inflammation in localized lesions (Aschoff bodies) -> interference with conductance (arrhythmias)

How do phosphate levels affect calcium levels?

influences Ca levels reciprocally -if they both exist at the same time they'll form calcium phosphate which we don't want, so the body will decrease one if the other is increased and visa versa

What muscles are involved with shoulder ER MMT?

infraspinatus teres minor

How does chloride enter the body?

ingested in food

What do statins do?

inhibit cholesterol production in liver

How do ACE inhibitors work?

inhibit the ACE enzyme that catalyzes conversion of angiotensin I (inactive) into angiotensin II (active) angiotensin II is a vasoconstrictor

How does high blood calcium affect PTH secretions?

inhibits them

What causes neuropathic pain?

injury to the nervous system

Which hormone works antagonistically to glucagon?

insulin

What does it mean if your ABI is 0.5-0.8?

intermittent claudications present

What does "viscera" refer to?

internal areas of the body that are enclosed within a cavity

What is the condition called that involves visceral pain causing muscle guarding, fascial tension and pain?

interstitial cystitis

What is the primary side effect of the bacteria that prevent diarrhea?

intestinal gas

Does fluid shift into cells or the ECF during hypernatremia?

into ECF due to higher solute concentration in ECF

Does fluid shift into cells or into the ECF during hyponatremia?

into cells due to higher solute concentration in cells (due to dec osmotic pressure in ECF) -causes hypovolemia, dec BP -swelling of cells

The osmotic pressure of blood causes fluid movement in or out of the capillary?

into the capillary -due to the solute concentration in the capillary being higher than the interstitium

The hydrostatic pressure of the interstitium causes fluid movement in or out of the capillary?

into the capillary -the movement due to this gradient is less than the hydrostatic pressure of blood, so the net hydrostatic movement is still out of the capillary

Is magnesium an intracellular or extracellular cation?

intracellular

When edema causes impaired arterial circulation, this can lead to what condition?

ischemia, which leads to tissue breakdown, necrosis, and ulcers

How does the respiratory system prevent pH changes in the serum?

it alters carbonic acid levels through changes in CO2 -inc in CO2 or H+ stimulates chemoreceptors which stimulates the resp. center to inc resp. rate -CO2 is expelled which reduces acidity

Why is hyperventilation with an ambu bag in an emergent situation bad?

it can make chest compressions less effective

How does calcium maintain the stability of nerve membranes?

it controls permeability & excitability needed for impulse conduction

How does the hormone, aldosterone, help control fluid balance?

it increases reabsorption of sodium (and therefore water) from kidney tubules into the blood

Why can cholesterol not be completely omitted from the diet?

it is used to synthesize critical compounds in the body such as membrane components and hormones

Which organ is responsible for excreting hormones after they have been inactivated?

kidneys

What is the most effective control mechanism of serum pH?

kidneys (modify excretion rate of acid & reabsorption of bicarbonate) -but it is also the slowest mechanism

If respiratory alkalosis is occurring, what organ will compensate and how?

kidneys will decrease HCO3- levels

*Upper* injuries of the spine are more common in what age group?

kids

In patients with multiple myeloma (case study), initial therapies can include: (read)

kinesiotape, compression pump, core strengthening, breathing retraining and meditation

What is the danger of effusion developing with acute pericarditis?

large volume of fluid accumulates in pericardial sac -> compress the heart (cardiac tamponade) -> impair expansion and filling -> dec cardiac output (which from talking about CHF theoretically could lead to mild acidosis due to lack of blood supply and anaerobic conditions in peripheral tissues)

Does the C-spine have a larger or smaller cord space compared to the T-spine and L-spine?

larger

Abnormally high Q angles are thought to be associated with ________forces on patella, which may lead to inc risk of pathology

lateral

Where does the ACL attach?

lateral medial tibia to medial lateral femur

Which menisci moves more during knee movement?

lateral menisci lateral moves about 12mm and medial menisci moves about 6mm

With external tibial rotation, how are the menisci going to move?

lateral menisci will move anteriorly medial menisci will move posteriorly (they move to maintain alignment with stationary femur)

With internal tibial rotation, how are the menisci going to move?

lateral menisci will move posteriorly medial menisci will move anteriorly (they move to maintain alignment with stationary femur)

Which menisci is more O-shaped and is attached to the capsule?

lateral meniscus

What muscles are involved with scapular depression MMT?

latissimus dorsi posterior deltoid teres major

What are the drugs of choice when normal bowel movements have been impaired?

laxatives

How does hypertension affect the kidneys? What happens as a result?

leads to decreased blood flow to kidney -decreased blood flow triggers kidney production of renin (which converts angiotensinogen into angtiotensin 1) leading to further vasoconstriction to compensate for decreased blood flow

Balance must be maintained between the _______ ________ _______ and the _______ _________ ________ , if not then heart failure will result

left heart output right heart output

When someone does have a supinated lower limb, how does this affect the length of the affected limb?

lengthens it

Are ACh M1 Receptor Antagonists more or less effective than H2 blockers at reducing acid secretion?

less effective

What HbA1c level should a patient aim to have?

less than 6.5 to 7

______ are transported in combination with proteins (lipoproteins)

lipids

Where are cholesterol and triglycerides synthesized?

liver

Where are lipids synthesized?

liver

What is an effective modality for pain relief (80-90%) in patients with chronic bone mets?

local field external beam radiation

Does obstruction of lymphatic circulation lead to localized or systemic edema?

localized

Hormone therapy is used in _____________ cancers or advanced disease

localized

What is an aortic aneurysm? Where does this commonly occur?

localized dilation and weakening of the arterial wall (defect in the tunica media) abdominal or thoracic aorta

What is a helpful strategy for bed mobility after a spinal fracture or fusion?

logrolling

Is a male pelvis long or short? wide or narrow?

long & narrow

Where are bone met related fractures most common?

long bones of the arms and legs vertebrae

ACh M1 Receptor Antagonists are just as effective as H2 blockers at _________

long-term healing of ulcers

What are the 3 different types of menisci injury? What may they progress into?

longitudinal (vertical tear) -> bucket handle tear radial tear -> parrot beak tear horizontal tear -> flap tear

What may cause hypochloremia?

loss of body fluids -excessive perspiration -vomiting (early stages, loss of HCl from stomach)

Where do the testes refer pain to?

lower abdominals, sacral

Where do clay-shoveler's fractures most commonly occur?

lower cervical or upper thoracic area, classically at C6 or C7

What muscles are involved in scapular adduction and depression MMT?

lower trapezius

What drugs are used on a short-term basis to relieve constipation?

lubricants/stool softeners

The need for surgical stabilization of a L-spine injury is predicted by the presence of:

lumbar kyphosis

Where do the kidneys refer pain to?

lumbar spine, ipsilateral flank, upper abdominal

What muscles are being tested with finger MCP flexion?

lumbricals and interossi

Which type of cancer has the highest mortality rate in males?

lung cancer

What is a major concern with large scoliotic curvatures?

lung restriction (dec air flow)

If the cause of a pH imbalance is due to the kidneys what organ will compensate?

lungs

Which cation is found in green vegetables?

magnesium

Which electrolyte is involved in enzyme reactions such as DNA & protein synthesis, glycolysis, and oxidative phosphorylation?

magnesium

Deficit of which electrolyte can cause neuromuscular hyperirritability with tremors?

magnesium, hypomagnesemia

What can be prescribed as an anti-constipation med?

magnesium-containing antacids

Before proceeding from the static to the dynamic phase of prosthetic alignment, what do you have to check?

make sure the user has "sunken down" into the socket appropriately -remove socks as needed -may try standing in // bars 2-5 min and wait for fluid to move out of the residual limb

Prostatitis, orchalgia/epididymitis, proctalgia fugax, interstitial cystitis and pudendal neuralgia are all conditions that can cause:

male pelvic dysfunction

The prostate gland surrounds which structure?

male urethra

How does an adenoma that is causing a pituitary disorder effect hormone secretion?

may cause excessive or decreased release of hormones

What are the effects of *large* adenoma that is causing a pituitary disorder?

may cause pressure in the skull -headaches, seizures, drowsiness, visual deficits

Which ligament of the knee has a superficial and deep layer and is part of the joint capsule?

medial collateral ligament (MCL)

If the lungs increase CO2 levels, this was most likely in response to what pH imbalance?

metabolic alkalosis

_________ is a common example of a bulking agent

metamucil

What is the mechanism of infective endocarditis?

microorganism attach to endocardium -> invade heart valves -> inflammation -> damage to heart valves

The prosthetic foot must be in proper rotation during which phase of the gait cycle?

mid-stance

What muscles are involved in scapular adduction MMT?

middle trapezius

What population does Hashimoto's thyroiditis primarily affect?

middle-aged women

What are characteristics of mild and severe patellofemoral pain syndrome?

mild: diffuse anterior knee pain severe: patellar subluxation/dislocation

How would the irritability of this patient's symptoms be rated? Plantar Faciitis "standing for 30 mins" aggravates "sitting for 5 mins" eases symptoms

min

How would the severity of this patient's symptoms be rated? Plantar Fasciitis "painful, but can perform all work activities"

min (says "low" on slide)

How does control over body processes change with fatigue?

mind over body -must "force" themselves to continue -increased sensitivity to light, noise, touch and taste -feeling cold or off balance -increased nausea and diarrhea

What are antacids often used to treat?

minor GI discomfort after overeating or eating foods not appropriate for a person

Should you focus more on strengthening or mobility after a spinal fracture or fusion?

mobility (progressive mobility training within neurologic prognosis)

Acute pain syndromes lasting a few _______________ can become chronic

months

What time frame is the chronic or remodeling stage of symptoms?

more than several weeks

Define filtration

movement of *water & solutes* through a semi-permeable membrane from a higher pressure to a lower pressure

Define osmosis

movement of *water* through a semi-permeable membrane from a lower concentration of solutes to a higher concentration

Failure of the defensive barrier in the stomach/duodenum leads to:

mucosal injury

What is sodium actively secreted into?

mucus & other secretions

What is the most prevalent cause of chronic pain in bone cancer patients?

multifocal bone pain

Small branches extend from the coronary arteries to supply which layers of the heart?

myocardium and endocardium

What are 3 ways of delivering supplemental O2? (not sure how this is different from variable O2)

nasal cannula face mask venturi mask

What are ways that variable O2 therapy can be administered?

nasal cannula open face mask closed face mask tracheostomy mask or collar

What are bulking drugs made of?

natural fibers from seed that form a gelatin when inside the GI tract

How do you treat orchalgia/epididymitis?

nerve blocks

Referred pain, allodynia, hyperpathia, and dysesthesia are all associated with what type of pain?

neuropathic pain

What is the leading cause of diabetic hospitalization?

neuropathy

When a nerve is irritated, it releases ________________ locally

neuropeptides (bradykinin, substance P, lactic acid)

With osteoblastic bone mets, what happens to new and old bone?

new bone is formed without breaking down the old bone

Do compensations for pH imbalances remove the cause of the imbalance?

no

Does primary hypertension usually have symptoms?

no

What is contraindicated on an extremity with an AV fistula?

no BP in that limb avoid pressure on that limb

Will taking a bulk-forming laxative help if there is a chance of blockage in the intestine?

no, it will make it worse

Are atlanto-occipital dislocations (AOD) common?

no, they are rare

How can severity and irritability of symptoms be rated?

non min mod max

How do you grade severity?

non, mid, mod, max

How do you grade irritability?

non, min, mod, max

Neuropathy is implicated in 50-75% of ______________ amputations

non-traumatic

What other injuries are associated with a lateral flexion injury of the cervical spine?

none, really -rarely involves ligamentous injury requiring surgical stabilization -"these injuries usually don't add up to much"

Characteristics of sleep pattern under the "tiredness" category of the fatigue continuum include what?

normal sleep pattern -able to respond to sleepiness -feel rested after sleep

central venous pressure is normally high or low?

normally very low

What is a drawback of a NG tube?

not well tolerated

What will happen if a cell is put into an isotonic/isoosmolar solution?

nothing

What is a type of scan that can show multiple bone mets?

nuclear medicine bone scan

What are two ways patients could subjectively demonstrate their fatigue?

number scale or writing/drawing

In which portion of a SOAP note are tests and measures done?

objective examination

What kind of incontinence does benign prostate hypertrophy (BPH) cause?

obstruction overflow incontinence with hesitancy and straining to void

How is visceral pain often felt or how does it present?

often presents as somatic pain due to convergence of nerves in dorsal root ganglion or referred pain

When are anti thrombolytic devices contraindicated?

on extremities with an AV fistula, graft or suspected/known DVT

How often are PPIs taken?

once a day (or twice in severe cases) they have lasting effects, unlike H2 receptor blockers which are taken before each meal

How does CHF develop?

one side of the heart fails first then progresses (depends on cause)

What is a reason someone would retain a tracheostomy long term?

only someone with a chronic upper airway pathology

Acute pericarditis may be secondary to what?

open heart surgery MI rheumatic fever systemic lupus erythematosus cancer renal failure trauma viral infection

What are the three kinds of airway access support?

oral nasal tracheal

How are antacids ingested?

orally

Oncotic pressure is the same thing as ___________ pressure.

osmotic

The movement of water between a cell and the extracellular space (blood/interstitium) is controlled by ________________ pressure .

osmotic

Prostate cancer, carcinoid, gastrinoma, small cell lung cancer, Hodgkin's disease, and medulloblastoma are cancers that cause bone mets that are predominantly __________ in nature

osteoblastic

Breast cancer, gastrointestinal cancers and squamous cancers that cause bone mets are mixed ________ and _________ in nature

osteoblastic and osteolytic

Why do osteoblastic bone mets still commonly result in fracture?

osteoblastic lesions are harder, but the structure of the bone is not normal and actually breaks more easily

Cancer cells that affect bone release substances that turn on _________ or make substances that turn on _________

osteoblasts osteoclasts

Uncoupled regulation of _________ and _________ leads to bone malformation

osteoblasts and osteoclasts

Renal cell cancer, melanoma, squamos cell cancers of the aerodigestive tract, non-small cell lung cancer, thyroid cancer, and non Hodgkins lymphoma are cancers that cause bone mets that are predominantly _________ in nature

osteolytic

The hydrostatic pressure of blood causes fluid movement in or out of the capillary?

out of the capillary -due to the pressure in the capillary being higher than the interstitium

The osmotic pressure of the interstitium causes fluid movement in or out of the capillary?

out of the capillary -the movement due to this gradient is less than the osmotic pressure of blood, so the net osmotic movement is still into the capillary

What does the coronary circulation supply? What percent of total blood flow goes to this system?

oxygen and nutrients to the heart muscle itself 5%

The systemic circulation carries _________ blood from the heart to the body and returns __________ blood back to the heart It also carries _________ to the cells and picks up ________ products from the cells

oxygenated; deoxygenated nutrients; waste

In cancer patients, ______ is a complex symptom that affects most aspects of life

pain

Malformed bones may also mechanically trigger _____ receptors both within the bone and surrounding tissues

pain

What is often the first sign of bone metastases?

pain

What are the main symptoms of bone metastases?

pain fractures spinal cord compression hypercalcemia

Breakthrough pain is characterized by intermittent "_______ _____"

pain flares

Define allodynia

pain induced by non-painful stimulus after an injury (central sensitization)

When asking a patient about pain over a 7 day period, what is important to consider if symptoms "come and go"?

pain may be related to sport or work activities

What muscles are being tested with MMT for MCP adduction?

palmar interosi

Which hormone works antagonistically to calcitonin?

parathyroid hormone

Low blood calcium stimulates the secretion of what hormone? What effects does this hormone have? (3)

parathyroid hormone which... -releases Ca from bone -inc Ca (& dec phosphate) reabsorption from kidney -inc absorption of Ca from intestine

When asking patient about their history, you should ask about ________ and ________ history of injury

past and present

What is a common pathology of the patellofemoral joint that has to do with tracking problems?

patellofemoral pain syndrome

Acute bone metastases may result in what?

pathologic fracture

A common indication of bone mets is a ______ fracture that occurs within a pre-existing _______

pathologic fracture pre-existing lesion

Patient position for a radiocarpal volar glide?

patient in sitting with arm at 90 wrist off table, palm down

What is the patient position for a radiocarpal joint distraction?

patient in sitting with wrist off table

Patient position for humeroradial joint glide?

patient in sitting, elbow at a 90 degree flexion angle in front of them (have the patient sit towards the end of the table by the feet so the PT can stand at their side for leverage)

Patient position for a radiocarpal dorsal glide?

patient in supine, arm above head on pillow with palm facing up towards ceiling (place towel roll under wrist just proximal to joint)

What patient populations might have an intracranial pressure monitor?

patients with TBI or who have had brain surgery

What muscles are tested with shoulder horizontal adduction?

pec major

What is really going on with chronic pelvic pain (chronic non-bacterial prostatitis)?

pelvic floor mm tension & spasm

The over-the-counter version of H2 receptor antagonists are used to treat:

peptic ulcers

The heart is enclosed in the _________ sac

pericardial

Which type of neuropathy affects UEs and LEs?

peripheral

HPO4 (2-) and H2PO4 (4-) are ions of what electrolyte?

phosphate

When PTH stimulates the kidneys to inc Ca reabsorption, the reabsorption of ________________ decreases.

phosphate

What is the gold standard of treatment for male pelvic dysfunction?

physical therapy, alongside good medical management

1 generic name of ACh M1 Receptor Antagonists:

pirenzepine

What is the most common ACh receptor antagonist prescribed for GI problems?

pirenzepine

Which gland is considered the "master gland"?

pituitary gland

In which portion of a SOAP note is compensation or adaptation included?

plan of care

In which portion of a SOAP note is prevention included?

plan of care

In which portion of a SOAP note is remediation included?

plan of care

What are some possible materials that could lead to atheromas in atherosclerosis?

plaques consisting of lipids, cells, cell debris, fibrin clots

Does diabetes insipidus result in polyuria or oliguria? What effects does this have on urine output?

polyuria -large volume of dilute urine -dehydration & thirst -*no glucose in urine*

Visceral pain is often ______ localized

poorly

If you want to facilitate knee flexion, you would perform a/an ___________ tibial glide on the femur

posterior

Where does the PCL attach?

posterior condylar area of tibia to lateral side of medial femoral condyle

What muscles are being tested with shoulder extension MMT?

posterior delt

What muscles are being tested with horizontal abduction of the shoulder?

posterior deltoid

What structures resist genu recurvatum?

posterior knee capsule knee flexor muscles

What structure stabilizes the posterior column of the spine?

posterior ligament complex *and* vertebral arch structures

Which gland is also called the neurohypophysis?

posterior lobe of pituitary

What structure stabilizes the middle column of the spine?

posterior longitudinal ligament (post 1/3 of v. bodies and annulus fibrosis)

When you flex your knee, which direction are the menisci going to move?

posteriorly

What cation regulates intracellular volume?

potassium

What is the major cation in the ICF?

potassium

Alcoholism can cause deficits of which 2 electrolytes?

potassium & magnesium

Excess of what electrolyte can lead to paralysis or respiratory arrest?

potassium (hyperkalemia)

Are serum changes in potassium or sodium more detrimental to the cell?

potassium, just because we already have so little of it in the serum

Which cations are critical for nerve impulse conduction & muscle contraction?

potassium, sodium, calcium & magnesium

Are occipital condyle fractures lethal?

potentially, yes

What are general signs and symptoms of Rheumatic Fever?

presence of inflammation -low-grade fever -leukocytosis -malaise -fatigue Tachycardia

How is visceral pain often described?

pressure-like, deep squeezing, cramping or gnawing

How do H2 antagonists work?

prevent the histamine-activated release of acid under resting conditions and during stimulation with food

How does the PCL help with arthrokinematic movement of the knee in a WB (weight-bearing) setting?

prevents excessive anterior translation of the femur on the tibia

How does the ACL help with arthrokinematic movement of the knee in a NWB (non-weight bearing) setting?

prevents excessive anterior translation of the tibia on the femur due to pull of quadriceps

How does the ACL help with arthrokinematic movement of the knee in a WB (weight-bearing) setting?

prevents excessive posterior translation of the femur on the tibia

How does the PCL help with arthrokinematic movement of the knee in a NWB (non-weight bearing) setting?

prevents excessive posterior translation of the tibia on the femur

What type of hypertension is idiopathic and accounts for 95% of all high blood pressure?

primary hypertension

The information you get in a patient profile can give you a lot of hints about likely patient:

problems/diagnoses

What do anti-spasmodic opiates do?

produce a general dec. in GI motility

What is a Charcot Arthropathy (Foot)?

progressive bone destruction and ligament damage leading to arch collapse and impaired skin integrity

_________ contractions can reduce blood supply to cardiac muscle cells. Why?

prolonged because blood cannot be supplied to the heart muscle itself when it is contracting to send blood to the rest of the body

Chronic pain has a less distinct onset, has a _______ and _______ course, and is largely driven by central sensitization and ________ responses from acute injury

prolonged and fluctuating course neuroplastic

Is ANP involved in fluid loss or retention?

promotes sodium (& water) loss

What is the patient position for an anterior shoulder glide? What needs to be well supported?

prone with humerus in 90 deg abduction fully supported on table, arm hanging towards floor support the coracoid process well with a towel roll underneath the anterior shoulder

What is isotonic dehydration?

proportionate loss of water & electrolytes

The overwhelmingly most common kind of chronic non-bacterial prostatitis does not involve pathology of the:

prostate

Radiation, hormone therapy, cryotherapy, radical prostatectomy, and laparoscopic radical prostatectomy are all treatment options for:

prostate cancer

What does PSA stand for?

prostate-specific antigen

What is the function of PSA?

protein produced by the prostate that form the liquid secreted by the prostate during ejaculation (normal levels 0-4 ng/mL, if it is greater than 10 you should do a prostate biopsy)

A *lower* C-spine injury is assumed until:

proven otherwise

What is beneficial about a Venturi mask?

provides an accurate and constant FiO2 used during ventilator weaning, or when there is a concern about CO2 retention

Where should the PT's hands be when performing a posterior shoulder glide?

prox. arm - anterior surface of shoulder just lateral to acromion (push straight down) distal arm - support under elbow

Where is hand placement for an inferior shoulder glide?

prox: use web of hand to place pressure towards patient's feet at a place just lateral to acromion (hand on superior aspect of shoulder) distal: under elbow

Where are the PT's hands placed when performing an anterior shoulder glide?

proximal arm - just lateral to the acromion distal arm - crease of elbow, allow this hand to depress towards floor with glide

PT hand position for a radiocarpal dorsal glide?

proximal hand grasp at styloid process and bring wrist to neutral distal hand as close as possible, pressure straight into floor

Hand placement for a humeroradial joint glide?

proximal hand on distal humerus at the anterior cubital fossa (grasping epicondyles) distal hand only grasp top half of arm to pull on radial styloid process at the wrist (make a thumbs up and turn it sideways)

Which direction (A, P, M or L) is the 1. proximal and 2. distal internal socket pressure during the loading response phase of gait on a transtibial residual limb?

proximal: anterior distal: posterior

Which direction (A, P, M or L) is the 1. proximal and 2. distal internal socket pressure during the mid-stance phase of gait on a transtibial residual limb?

proximal: medial distal: lateral

Which direction (A, P, M or L) is the 1. proximal and 2. distal internal socket pressure during the initial contact phase of gait on a transtibial residual limb?

proximal: posterior distal: anterior (if you look at a picture, the proximal force is just below the knee and the distal force is at the most distal aspect of the residual limb)

Amputee causes of "external foot rotation" gait deviations in a transtibial amputee: (1)

pt wants foot to match sound side when standing, but bc of hip rotation during gait, foot becomes excessively ER (no prosthetic causes listed)

What is the function of the aorta?

pulse dampening and distribution

Hormone therapy is often used in conjunction with:

radiation

What type of therapy is commonly used for bone mets?

radiation

What do anticoagulants do?

reduce risk of blood clot formation

How do cholesterol-lowering drugs work?

reduce the amount of LDL and cholesterol content

If the target cell of gland becomes insensitive to a hormone, what type of endocrine disorder would this lead to?

reduced effects of a hormone Ex: type 2 diabetes

Define spinal stability:

refers to immediate or subsequent risk of SC and spinal nerve root injury

The prescription version of H2 receptor antagonists are used to treat:

reflux disorders & peptic ulcers

Exercise can ________ appetite and _______sleep quality

regulate appetite improve sleep quality

How to diuretics work? What are they helpful in treating?

remove excess sodium and/or water from the bloodstream (lower BP) help treat CHF (congestive heart failure)

How do you treat acidosis or alkalosis?

remove the underlying cause -meanwhile, to prevent further damage, you can add particular electrolytes or remove access of an electrolyte

How do you treat hormone defecit endocrine disorders?

replacement therapy

What is the function of arterioles?

resistance (pressure/ flow regulation)

What is the function of the MCL in the knee?

resists valgus and extension forces at the knee (and extreme rotation)

If the kidneys increase HCO3- levels, this was most likely in response to what pH imbalance?

respiratory acidosis

What controls the base to acid ratio of the sodium bicarbonate - carbonic acid buffer?

respiratory system & kidneys

What is the function of cortisol?

responsible for stress response -stimulate gluconeogenesis -anti-inflammatory -immunosuppressant

What causes exopthalmos in hyperthyroidism?

results from tissues and extraocular muscles becoming inflamed behind the eyes

How does decreased activation of vitamin D cause hyperparathyroidism?

results in dec absorption of Ca which triggers PTH

Is Cushing's syndrome characterized by loss or retention of sodium and water? What effects does this have?

retention (mineralocorticoid effect due to too many glucocorticoids in blood) -high BP -edema -hypokalemia -alkalosis

What does remediation refer to?

reversing impairments

What muscles are involved in scapular adduction and downward rotation MMT?

rhomboids

What does a pulmonary artery catheter provide information on?

right heart function indirectly about the left heart function with temporary inflation of balloon on catheter

How long do activity limitations apply to patients post-scoliosis surgery?

roughly 1 year

Where does the urinary bladder refer pain to?

sacral apex, suprapubic, thoracolumbar

Where does the prostate gland refer pain to?

sacral, lower lumbar, testes, thoracolumbar

The interaction of an antacid + HCL produces:

salt + water

How is social interaction affected by fatigue?

saves energy for participation in enjoyable activities -work-related problems

What does the exercise stress test test for?

screening for obstruction in arteries

The ___________ is a fibromuscular pouch of skin that contains the testes and the lower portion of the spermatic cords

scrotum

Pericarditis is usually ________ to another condition

secondary

What type of hypertension is also called inessential?

secondary hypertension

Filtration and osmosis happen across a ________________________ .

semi-permeable membrane (capillary wall)

What muscles are being tested with scapular abduction and upward rotation?

serratus anterior

What are some examples of blood tests that can be performed to test cardiovascular function?

serum lipid profile -cholesterol -triglycerides electrolyte levels -sodium -potassium -calcium

What does it mean if your ABI is less than 0.5?

severe arterial disease is present and some sort of bypass should be done

How is neuropathic pain described?

severe, burning or tingling

What two categories can behavior of symptoms be divided into?

severity irritability

The BFI measures the ________ and _______ of fatigue during the past _____ hrs

severity and impact of fatigue over past 24 hrs

How is superficial somatic pain described?

sharp, burning, pricking

When someone does have a pronated lower limb, how does this affect the length of the affected limb?

shortens it

Describe an *unstable* spinal injury:

show or have potential for significant displacement

Patient position for metacarpophalangeal joint distraction?

sitting

How does change in patient position affect ICP?

sitting and standing lowers this pressure

A pathologic bone fracture occurring in cancer patients may be due to what 2 types of tumors/mets?

skeletal metastases or primary bone tumor

What skin treatment should be done after radiation?

skin & CT mobility

What does hormone therapy do?

slows cancer growth through dec testosterone level in the body

What suspends the testicles in the scrotum?

smooth muscle (dartos) and the spermatic cord

If a transtibial amputee has a flexion contracture, how should you adjust their socket flexion set in bench alignment?

socket flexion should be at least 5 deg greater than the contracture measurement

Chloride levels follow the level of what other ion?

sodium

What is the primary cation in the ECF?

sodium

What is the major buffer of the ECF?

sodium bicarbonate - carbonic acid buffer

How do you treat a lateral flexion injury of the cervical spine?

soft or rigid collars

In a clay-shoveler's fracture, if the lamina are uninvolved, the injury can be managed with:

soft or rigid collars

What are 3 types of pain based on location?

somatic visceral neuropathic

If widespread edema results from inc capillary permeability, what is this usually a result of?

some bacterial toxins could cause this, or large burn wounds

What is used to initiate ambulation after scoliosis surgery?

some kind of assistive device

The post-op treatment of scoliosis is similar to:

spinal fusion

How do you treat hallux valgus?

splint & bunionectomy

PT hand position for dorsal and volar MCP glide?

stabilize MCP with one hand, mobilize with hand on prox phalanx

PT hand position for metacarpophalangeal joint distraction?

stabilize at MCP, gently distract with proximal phalanx

Are compression fractures *and* traumatic disc herniations stable or unstable?

stable

Is a spinal fracture that involves 1 column stable or unstable?

stable

Are clay-shoveler's fractures usually stable or unstable?

stable, often unrecognized

What is a PICC line? Why might this be used?

stands for: Peripherally Inserted Central Catheter -may be used if a patient needs a more long term administration of medication (at home)

How does dehydration affect the thirst center of the brain?

stimulates it

What is the function of tropic hormones of the pituitary?

stimulates other endocrine glands to grow and secrete their hormones (Ex: TSH)

When GH acts on target tissues *directly*, what effects does it have?

stimulates postnatal longitudinal growth (bone, cartilage)

Side effects of stool softeners include:

stomach cramps

What do triglycerides do?

store energy (fatty acids)

Where is calcium stored in the body?

stored in bone

What are the two forms of infective endocarditis?

subacute: defective heart valves are infected by normal flora acute: normal heart valves are infected by highly virulent organism (staph. aureus)

What part of the exam should information be drawn from to build a problem list?

subjective exam

In which portion of a SOAP note is information collected from the patient or a responsible party?

subjective examination

What muscles are involved with shoulder IR MMT?

subscapularis

The airway access line can also serve as _______ access

suction

Acute pain syndromes have a ______ , well-defined onset, a __________ cause, subject to sympathetic output (fight or flight response), and are expected to _______ with management

sudden an identifiable cause improve

What is the first sign of a pathologic fracture?

sudden onset of back or limb pain without trauma

What is claudication? Why does it happen?

sudden severe pain in calves that goes away if the pt sits down this happens b/c the vasculature can no longer support the muscle activity evidence shows the pt will develop collateral circulation if you force them to push through the pain

How does dehydration affect the eyes?

sunken eyes

How does the patella move with knee extension?

superiorly and slighly laterally

Patient position for lateral shoulder distraction?

supine

Patient position for posterior shoulder glide?

supine patient scoot towards side of table, hold patient arm abducted at 90 and hand towards ceiling

Patient position for an inferior shoulder glide?

supine, same position as a posterior glide, different hand position

Patient position for humeroulnar joint glide?

supine, using the opposite hand to stabilize humerus, towel roll under the distal humerus

How may a urinary catheter be inserted?

suprapubic foley (urethra) texas catheter

What muscles are being tested with shoulder abduction MMT?

supraspinatus middle deltoid

How do you treat a compression-flexion injury of the C-spine?

surgery and cervical orthosis

What is one option to prevent pathologic fracture?

surgical stabilization of long bones

Primary hypertension may be due to stimulation of what part of the nervous system? What is it more likely due to? What behaviors might lead to it?

sympathetic excessive angiotensin II levels salt, smoking, obesity

The coronary circulation is part of the ___________ circulation (systemic/pulmonary)

systemic

Compare the systemic and pulmonary circulations based on the following: -size -pressure -side of the heart supplying blood

systemic: -larger -higher pressure -left heart propels blood throughout body pulmonary: -smaller -lower pressure -right heart propels blood through lungs

How does the body try to compensate for Forward effect CHF?

tachycardia cutaneous and visceral vasoconstriction daytime oliguria (low urine output)

Angina Pectoris increases the demand for O2 in the body due to what?

tachycardia increased force of contraction (in hypertension) *heart is pumping less efficiently therefore there is less O2 being delivered to tissues, increasing the demand for O2*

If a patient cannot feel a 10g monofilament, that means that if the person stepped on a __________ they wouldn't be able to feel it

tack

Physical therapy is indicated for wounds that:

take longer than 14 days to heal

Hormones are secreted into the blood and then bind to _________________ cell receptors to elicit an effect

target

Compression-flexion injuries of the C-spine are also known as:

tear drop fractures

What is the primary reproductive organ in men?

testicles

What does severity of symptoms refer to?

the *intensity* of symptoms and the effect on *functional ability* (may involve various activities)

What does it mean if your ABI is 0.90-0.99?

the BP in your arms is slightly greater than in your ankles, still *acceptable* at this point

What are tissue adhesions?

the adherence between muscles, subcutaneous tissue and the skin

What is a concern when moving a ventilatory (trach) tube?

the air is humidified and water collects in the tube, make sure this is not dumped into the patient's airway

What are 2 tools used for releasing tissue adhesions?

the cup edge edge mobility tool

What does line of progression refer to?

the direction that someone is walking in

Which menisci is more C-shaped and attached to the capsule? What other ligament is this attached to?

the medial meniscus, is also attached with the MCL

Apply the ice massage until:

the pt experiences the 4th stage of ice application at treatment site = numbness

What is an H2 receptor?

the subtype of the histamine receptor in the stomach

Can PT be done during dialysis treatment?

theoretically in very limited PROM exercises, but really should wait until the patient is not on dialysis during treatment

How can hypertonic or hypotonic dehydration lead to movement of water b/w ICF and ECF?

these 2 types of dehydration would create a fluid imbalance which would cause the water to move towards equilibrium

Is it common to perform surgery on vertebrae after a pathologic fracture?

these surgeries are rare and are used to treat the neurological symptoms

Which organs do thyroid hormones affect?

they affect every cell and organ in the body because receptors for the hormones are expressed in virtually all tissues

How is a dynamic air flow bed part of the equipment used for critical care patients?

they are at risk for pressure ulcers so these beds help prevent those

What is a main concern with any catheter when moving a patient during PT?

they are gravity dependent so keep the bag below their bladder (and don't pull on the tubing)

How long do compensations for pH imbalances last?

they are limited and usually short-term

What is an aspect of aortic aneurysms that make them so dangerous?

they are often asymptomatic until they are large or rupture ...and when they rupture they most often lead to severe hemorrhage and death.

How does acromegaly affect bones and soft tissue?

they become broader & heavier soft tissues grow

How do ARBs work?

they block the receptors for ACE inhibitors therefore the conversion from angiotensin I to angiotensin II cannot occur = no vasoconstriction

Does hypo- or hyper- kalemia lead to cardiac arrhythmias which may progress to cardiac arrest?

they both do (as well as hypomagnesemia)

How does dehydration affect mucous membranes?

they dry out (Ex: dry mouth)

How do the kidneys prevent pH changes in the serum?

they modify the excretion rate of acids & absorption of bicarbonate ions -H+ is exchanged for sodium & H+ is excreted to reduce the acidity -bicarbonate ion is reabsorbed when sodium is reabsorbed under aldosterone control

Why do people with neuropathy often have dry, calloused skin on their feet?

they often lose their ability to sweat which results in this

How are the menisci shaped?

thicker towards the outside edges, attached by anterior and posterior horns

Proximal neuropathy affects which parts of the body?

thigh, hip and core muscles

Where are central lines inserted?

threaded into large proximal vein and into the right atrium

How does an MI develop?

thrombus from atheroma may obstruct artery -> partial occlusion -> vasospasm may occur leading to a completely occluded artery an embolus could also form from a thrombus and lodge in a smaller vessel blocking it

_______________ hormones control the rate of metabolism

thyroid

Which gland are T4 and T3 secreted from?

thyroid gland

Which gland is calcitonin secreted from?

thyroid gland

What type of hormones are essential for normal growth and development? (other than GH)

thyroid hormones

What stimulates the thyroid gland?

thyroid stimulating hormone (TSH)

In someone with genu varum, what might you see regarding their tibial alignment?

tibial varum

What are 3 accessory motions of the patella?

tilt spin (rotation) shift

What are the levels of the fatigue continuum?

tiredness (adaptation) fatigue exhaustion (non-adaptation)

When edema is in the skin, what is the skin susceptible to?

tissue breakdown from the pressure

What does "angere" mean? What does "pectus" mean?

to choke or throttle chest (latin roots for angina pectoris)

What are body charts used for?

to document the site of patient symptoms

Why is it important to ask a patient how long ago symptoms developed?

to figure out what "stage" of healing the patient might be in

What is the purpose of "systems review" when performing a subjective exam?

to guide questioning to make sure the PT examines each body system for normal functioning (ex. cardiovascular, pulm, neuro, GI, etc)

When are chest tubes used? How do they work?

to manage pleural effusion or pneumothorax attached to suction on the wall to create a negative intrapleural pressure to drain air or fluid from the thorax

Why do higher levels of O2 need to be humidified?

to prevent mucosal drying

What is TPN?

total parenteral nutrition (through central venous catheter) -patient cannot accept GI tract feeding

Which type of goiter is present in Graves' disease?

toxic goiter

Which type of goiter results from hyperactivity of the thyroid gland due to excessive stimulation by _________________?

toxic goiter excessive stimulation by TSH -feedback mechanism isn't working -inc T4/T3 levels don't provide negative feedback

It is easier for a patient to be weaned off of ________ ventilatory support, than oral or nasal support

tracheal due to lack of resistance from anatomical "dead space" found in oral and nasal pathways

Most all MIs are ___________. The majority of MIs involve the _______ ventricle. A scar is formed after an MI in ___ to ____ weeks. Fibrosis replaces _______________ beginning at day 7

transmural (involving all 3 layers of the heart) left 6 to 8 cardiomyocytes

In general, are cervical fractures usually due to a traumatic or non-traumatic cause?

traumatic (MVA, fall, violence, sports)

What is the typical MOI of a C2 (axis) fracture?

traumatic *hyperextension and distraction* causes bilateral pars interarticularis fractures (you're levering C1 on C2 and C2 basically just snaps and hyper-extends the neck)

T/F: C2 (odontoid) fractures are often associated with other C-spine fractures

true

T/F: SCI injuries are commonly associated with compression-flexion injuries of the C-spine

true

T/F: T-spine burst fractures are often associated with neurologic compromise

true

T/F: discontinuation of spinal orthotics allows for progression of activity

true

T/F: early mobility/ambulation should be promoted after a spinal fracture or fusion

true

T/F: immobilization is common post-surgical stabilization of the spine

true

T/F: some hormones work antagonistically

true

T/F: there are often no early signs of prostate cancer

true

T/F: the pelvis is highly innervated

true (iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, obturator, pudendal)

T/F: secretion of hormones may be controlled by more than one mechanism

true Ex: aldosterone

T/F: neuropathy is common after chemo

true, this is an example of exposure to toxins causing neuropathy

T/F: neuropathy may develop during or after a shingles flare up

true, this is an example of infection causing neuropathy

What are the 3 parts of a vessel wall?

tunica intima - with endothelial lining tunica media - smooth muscle cells tunica externa (adventitia) - outer connective tissue (mainly collagen)

Which layer of the vessel wall is significantly larger in the arteries than the veins?

tunica media

What is the specific structure of the ACL?

two bands twisted together (anterior medial band and posterior lateral band)

What are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)? What is their function?

types of antihypertensive drugs both prevent vasoconstriction

H2 antagonists are used for both acute and long term management of _____

ulcers

Define dysesthesia

unpleasant, abnormal sensation in an area of neurologic deficit

Are fracture-dislocations in general stable or unstable?

unstable

Is a spinal fracture that involves 3 columns stable or unstable?

unstable

Is a T-spine dislocation considered stable or unstable?

unstable, often involves failure of all 3 columns and TVP fracture or disrupted costal articulation

A lot of the nerves that innervate the pelvis originate:

up in the thoracic/lumbar region

What muscles are involved in scapular elevation MMT?

upper trapezius

How does an enlarged prostate affect urination?

urethra can be restricted

What is dry needling and why is it used?

use of acupuncture type needles to help the release and relaxation of soft tissues

What are causes of SIADH? (2)

usually temporary causes -triggered by stress -secreted by tumor

The normal alignment of the knee has about 5-10 degrees of_______?

valgus

Oxygen therapy can be ________ or ________

variable or fixed

What occurs during systole?

ventricles contract -blood forced up the aorta and pulmonary artery -blood delivered to body tissues atria relax

What occurs during diastole?

ventricles relax atria contract -blood forced into ventricles

How common is acute bacterial prostatitis?

very rare

Topical antibiotics are only effective for:

very small wounds (often used inappropriately)

What are the 3 types of nociceptive pain?

visceral deep somatic superficial somatic

What is "cardiac output"? What is the equation for it?

volume of blood ejected by a ventricle in one minute CO = HR x SV

What is "stroke volume"? What is the equation for it?

volume of blood pumped with each heart beat SV = EDV - ESV

What are the temperatures roughly of the warm and cold water in a contrast bath?

warm: 100-111 deg F cold: 50-64 deg F

In a contrast bath, how long is the body part immersed in the warm and cold baths?

warm: 3-4 minutes cold: 1 minute

How does the body attempt to maintain blood volume during dehydration? How does this affect the cells?

water moves from inside cells to vascular bed to maintain blood volume & BP meaning cells can malfunction

When might an ambu bag be used?

when a patient needs manually delivered air because they aren't breathing on their own or are having trouble breathing (remember slow breaths - 10-12 breaths per min)

When do you use O2 therapy?

when hypoxia is present (the % O2 is below 90%)

What is decompensation in terms of pH imbalance?

when the cause of a pH imbalance becomes more severe and the compensation mechanisms are exceeded or fail

When is a pulse oximeter considered reliable?

when waveform or pulse rate match ECG or palpated pulse

Where does the exchange of O2 and CO2 take place?

within the alveolar capillaries that are a part of the pulmonary circulation

Does interstitial cystitis affect men or women more often?

women

What population does Graves' disease usually affect?

women over 30 yo

What population is Cushing's syndrome most prevalent in?

women, 20-40 yo

After applying the layers of wax with paraffin, what do you do?

wrap the body part with cellophane and towels

What motion does radiocarpal volar glide help with?

wrist extension

What motion does radiocarpal dorsal glide help with?

wrist flexion

Are the menisci mobile?

yes

Can a patient exercise during whirlpool treatment?

yes

Can a pt buy a home paraffin unit?

yes

If a patient has neuropathy due to a vitamin B deficiency, will supplementing vitamin B fix this?

yes

Is testicular cancer treatable?

yes, even in later stages (affects males 15-34 yo)

Can PT be done on a patient with a chest tube?

yes, these should not limit activity. They can be temporarily removed from the suction for a transfer or to attach to suction for activity

What age group does orchalgia typically affect?

young men, so does testicular cancer