Review Set 8
What is apoptosis?
"programmed cell death" -controlled by genetics -cells self destruct, undergo phagocytosis -occurs when cell # is excessive or when cells are injured
How do we get chronic pain?
"wear and tear" stressors to the nervous system similar to how stressors to the musculoskeletal system can lead to arthritis
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
Examples of "good" bacteria that can prevent diarrhea:
-Lactobacillus acidophilus -Lactobacillus bulgaris (often called Intestinex or Lactinex)
Emphysema: -what are the symptoms?
-S: dyspnea, minimal wheezing, barrel chest, prolonged expiration
What types of exercise activities should people with osteoporosis participate in?
-WB activities -resistance training -balance training
What do "bulk forming" laxatives do?
-absorb water and swell within the lower GI tract -stretch the bowel and stimulate peristalsis
What is secondary osteoporosis?
-acceleration of bone loss due to *chronic illness* or medication -Ex: glucocorticoids, hyperthyroidism
Early mobilization s/p amputation helps with what 2 random things?
1. wound healing 2. shaping residual limb
What gait speed is required to safely cross an urban street?
1.0 - 1.2 m/s
What is the "average" gait speed?
1.37 meters/sec (~3 mph)
What is the loose packed position of the radiocarpal joint?
10 deg of wrist flexion w/ slight ulnar deviation
How many molecules of ATP are produced from 1 molecule of palmitate (C16) in the TCA cycle?
106
What is the average cadence for gait?
110 steps/min (spm) (up to 120 spm)
How many items are on the Berg Balance Test?
14
How long does the Berg Balance test take to administer?
15-20 min
What is the cutoff score for Dynamic Gait Index (DGI)?
19
If a person uses an assistive device, it drops their DGI score to a:
19, limits the use of this test (floor effect)
How long is one cell of DNA?
2 meters long
How many vertical sine waves occur during one full gait cycle? How many "side-to-side" sine waves occur during one full gait cycle?
2 vertical 1 side-to-side
How often are RRD worn s/p amputation?
24/7
How often should ACE wraps be worn for an amputee?
24/7
What lab value helps to guide the dosage of vitamin D supplementation?
25 OH D
Up to how many mL of fluid can the bladder have before the internal urethral sphincter opens?
250 mL
For osteoporosis, the goal should be ____ minutes of activity ____ days of the week
30 min most days
What is the oldest dressing technique that is still frequently used s/p amputation?
ACE wrap
Lapar
Abdomen; Example: Laparoscopy
Macr
Abnormal largeness; Example: Marcroblast; Abnormally large, nucleated red blood cell
What ligaments hold the AC joint together?
Acromioclavicular lig Coracoclavicular lig
What are the different bases that could be found in DNA? How do they normally pair?
Adenine Thymine Cytosine Guanine AT or CG (energy efficient)
At what joint does circumduction of the digits occur?
CMC and MCP joints
How are kidney stones/renal calculi removed?
Can be dislodged by increased fluid intake, invasively, ultrasound, or muscle smooth muscle relaxants
What are the 2 openings in the nasopharynx?
Choanae: post. openings of nasa cavities Auditory tube: pharyngeal openings on lateral walls
What muscles control the external urethral sphincter in a male?
Compressor urethra M Sphincter urethrae M
What muscles control the external urethral sphincter in a female?
Compressor urethra M Sphincter urethrae M Urethrovaginal sphincter M
Esis
Condition
Ia
Condition of diseased or abnormal state Example: Amyluria; Excess of starch in the urine
What type of joint is the wrist joint (radiocarpal joint)?
Condyloid (synovial)
What type of joints are metacarpophalangeal joints?
Condyloid (synovial)
Kerat
Cornea; Example: Keratotomy; Incision of the cornea
What is the clinical gold standard to measure BMD?
DEXA (dual x-ray absorbiometry) measures BMD at multiple sites
What are the two types of nucleic acid?
DNA RNA
What is the smooth muscle of the wall of the bladder?
Detrusor muscle
Where is the bladder by puberty?
Empty bladder lies in the true pelvis
Megaly
Enlargement; Example: Cardiomegaly; Enlargement of the heart
Olig
Few, scanty; Example: Oligogalactia; Deficient secretion of milk
What is the anular ligament?
Forms a ring around the head of the radius to the radial notch of the ulna
Where is the bladder at 6 years of age?
Greater pelvis
What is important for signal transduction to work correctly?
Has to be tightly regulated
What conditions can interferons be used to treat?
Hepatitis B and C, and Kaposi's Sarcoma associated with HIV
What type of joint is the elbow?
Hinge (synovial)
Ischi
Hip joint; Ischium
Patient compliance is mandatory with which type of post-op dressing?
IPOP, not eligible to use this if they aren't compliant
What happens to the IRV of someone with a chest wall restriction?
IRV: decreases
If a drug is detroyed by stomach acid, how might it be administered?
IV or coated tablet form
What is unique about the joint capsule of the proximal radioulnar joint?
It is continuous with the elbow joint capsule
What canal does the ulnar nerve run through at the wrist?
It is superficial to the flexor retinaculum and runs through the ulnar canal/canal of guyon. This is a groove between pisiform and hook of hamate.
What is the function of the subscapular bursa?
It protects the tendon of subscapularis and communicates with the glenohumeral joint cavity
Does the clavicle fracture or dislocate more often?
It rarely dislocated due to the strong ligaments, it is more likely to fracture
Laryng
Larynx; Example: Laryngitis; Inflammation of the larynx
What is the close packed position for the MCP? IP?
MCP: full flexion IP: full extension
Mania
Madness
Kinesi
Movement; Example: Kinesiology; The study of movement
Myos (my)
Muscle; Example: Myocarditis; Heart muscle inflammation
What may be used in the medical management of CTS?
NSAIDs corticosteroids surgery (CT release)
Noct
Night; Example: Nocturia; Excessive urination at night
Nyctal
Night; Example: Nyctalopia; Night blindness
Nyct
Night; Example: Nycterine; Occurring at night
Papill
Nipple; Example: Dermal papilla; Small elevations that indent the inner surface of the epidermis
Oophor
Ovary; Example: Oophorostomy; Incision of an ovarian cyst
What type of incontinence is almost exclusively male?
Overflow/outflow incontinence
Ox(ia)
Oxygen; Example: Hypoxia; Insufficient oxygen
Are PPIs or H2 blockers more expensive?
PPIs
Patell
Patella (kneecap); Example: Patellectomy; Surgical removal of the patella
Where does the common iliac A split into external and internal iliac AA?
Pelvic brim
Iatry
Physician, treatment; Example: Psychiatry
Iatr
Physician; Example: Iatrogenic; Caused by a physician
Which meningeal layer is considered the vascular layer?
Pia mater vasculature runs within arachnoid mater on the pia surface
Which cranial fossa contains the occipital lobes, tentorium cerebelli, cerebellum, pons, medulla, and occipital bone?
Posterior
Which 3 arteries make up the posterior circulation of the brain?
Posterior cerebral Basiliar Vertebral **
Gravid
Pregnancy; Example: Gravidocardiac; Pertaining to heart disease in pregnancy
What is an additional function of the internal urethral sphincter in males?
Prevention of retroejaculation
Which muscles are in layer 4 of the anterior forearm?
Pronator quadratus
Which muscles are in layer 1 of the anterior forearm?
Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris (pass, fail, pass, fail)
Prost
Prostate gland; Example: Prostatolith; A calculus (stone) of the prostate gland
What is in the pudendal/Alcock's canal?
Pudendal N Internal pudendal A/V
How is one gait cycle defined?
R foot initial contact to R foot initial contact
Where is the subarachnoid space?
REAL space filled with CSF
In which type of dressing (soft, RRD, rigid) can simulated WB *start* to occur s/p amputation?
RRD (picture of pt holding towel looped under distal residual limb and pulling towards them to apply pressure)
What are the contents of the anatomical snuff box?
Radial artery, radial styloid process, scaphoid, trapezium, and 1st CMC joint
What is a patent urachus?
Rare condition where the urachus re-canalizes or remains open leading to dribbling of urine from umbilicus
Actin
Rays; Example: Actinogen; Any radioactive substance
What are examples of endogenous chemical agents?
Reactive oxygen species or free radicals
In what order does G-Protein coupled receptor signaling occur? Where are all the components found?
Receptor G protein complex Effector molecule all within the plasma membrane
Gram
Record; Example: Sonogram; Sound record
Is the bladder intra- or retro- peritoneal?
Retroperitoneal
What is the function of arachnoid villi?
Returns CSF to venous blood at the superior sagittal sinus
What type of joint is the sternoclavicular joint?
Saddle joint (synovial)
What is an automatic reflex bladder?
Same response found in an infant
Hom
Same; Example: Homogeneous; Same components
Ictal
Seizure, attack; Example: Peri-ictal; Events aroung the time of the seizure
Lepsy
Seizure; Example: Narcolepsy; Recurrent uncontrollable desire for sleep
Acu
Sharp; Acupuncture
What is the insertion of all of the elevators of the pharynx?
Side of pharynx
Later
Side; Example: Lateropulsion; The involuntary tendency to fall to one's side
Myelo
Soft, pith; Example: Myelopathy; A pathological change in the spinal cord
What 2 tendons form the anatomical snuff box?
The EPL and EPB tendons
What is the carrying angle of the elbow?
The angle appears when the elbow is fully extended and forearm supinated. The angle is about 10-15 degrees, with women having a slightly larger angle
What articulates with what in the intermetacarpal joints?
The bases of adjacent medial four metacarpals Thumb just articulates with trapezium
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.
How does the radius move around the ulna during pronation and supination?
The distal radius moves around the distal ulna medially and anteriorly
What is urge incontinence? (also known as an overactive bladder)
The need to urinate more than 7 times per day or 2 times at night
How does pronation and supination happen?
The radial head rotates within the annular ligament against the ulna
Why is joint cartilage important?
The thicker the joint cartilage the better because it functions to absorb shock
Why doesn't the ulna participate in the wrist joint?
Their is an articular disc located at the distal end of the ulna
What is the main artery of the posterior compartment of the forearm?
There is none
How do ACh M1 Receptor Antagonists work?
They block the M1 subtype of ACh muscarinic receptors
What are the transverse metacarpal ligaments?
They connect the heads of the medial 4 metacarpal together
Where do the sigmoid sinuses drain?
They drain the transverse sinuses into the jugular foramina & jugular VV
How are antacids used to treat ulcers?
They relieve gastric pain and facilitate ulcer healing
Hist
Tissue; Example: Histoblast; A tissue forming cell
Gloss
Tongue; Example: Glossitis; Inflammation of the tongue
What are sulfonamides usually prescribed for?
UTI (urinary tract infection)
What does the ureter carry and what does it carry it to and from?
Urine From renal pelvis to bladder
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)
Uvula deviation indicated a lesion in which CN? Which way does the uvula deviate?
Vagus uvula deviates toward the unaffected side
What are the 3 general types of headaches?
Vascular Muscular Traction/inflammatory
Where does the ureter enter the pelvis?
When it crosses the pelvic brim
When do elbow dislocations usually occur?
When the coronoid process of the ulna is chipped away
Leuk
White; Example: Leukocytes; White cells
Where is the pharynx widest and narrowest?
Wide: at hyoid Narrow: jxn w/ esophagus
Where is the golgi complex normally located?
Within the cell, attached to the ER
Gyn(gynec)
Women; Example: Gynecologist; Physician who specialized in diseases of women
Ergo
Work; Example: Ergostat; A machine to be worked for muscular exercise
Rhytid
Wrinkles; Example: Rhytidoplasty; The elimination of facial wrinkles by plastic surgery
What are the results of a radial nerve injury?
Wrist drop, inability to extend thumb and MCPs. You can test for this by having patient resist against you pushing against the dorsum of their hand
What imaging could you utilize to confirm/disconfirm that a patient has a scaphoid-lunate dislocation?
X-ray
Does the AC joint have an articular disc?
Yes, it is wedge-shaped and in between the fibrocartilage covered articular surfaces of the acromian and clavicle
Which articulations are the "yes" and "no" joints?
Yes: atlas & occipital No: atlas & axis
What is the ROM of the glenohumeral joint like?
Zhang said to just know it has a large ROM
A transtibial bi-valved RRD would extend to:
above the knee
What are interleukins and erythropotein?
cytokines
What are examples of tyrosine kinase-linked receptors?
cytokines or interferons
What properties of the intracellular environment may influence protein folding?
molecular chaperones pH ions temperature
Does a person lose consciousness in a simple, partial seizure?
no, memory and consciousness remain although awareness may be reduced
During a complex, partial seizure, is a person responsive?
no, person is unresponsive to people or activities
What causes Absence (of breath sounds)?
nonaeration or collapse of a lung
What does strong and painless mean when MMT?
normal finding
What can PTs do for treatment of Raynaud's disease?
not much education on smoking effects, use of medications, and wearing gloves in cold
Side effects of stool softeners include:
stomach cramps
Which 2 ligaments stabilize the atlantooccipital joint?
Anterior and posterior atlanto-occipital membrane/ligaments
What are the parts of the bladder (3)?
Apex Fundus Neck
What is the result of hypertrophy of the arachnoid villi?
Arachnoid granulations: form pits in inner table of cranial bones
Melan
Black; Example: Melanonychia; Blackening of the nails by melanin pigmentation
What type of incontinence results if parasympathetic efferents & afferents are disrupted?
Bladder can't contract and overflow incontinence is developed
Which muscles are in layer 3 of the anterior forearm?
Flexor digitorum profundus Flexor pollicis longus
Genu
Knee; Genurecurvatum
Where do the first 2 muscle layers of the anterior forearm originate from?
Medial epicondyle of humerus (flexors and pronators)
What is the O, I, N, F of flexor carpi ulnaris?
O: medial epicondyle I: pisiform N: ulnar nerve F: flexes and adducts (ulnar deviates) the hand
What is the O, I, N, F of pronator teres?
O: medial epicondyle and coronoid process of ulna I: lateral surface of radius N: median nerve F: pronate the elbow
What is the O, I, N, F of flexor digitorum superficialis?
O: medial epicondyle and parts of the ulna and radius I: body of middle phalanges N: median nerve F: flexes PIP, MCP, and the wrist joints
What is the O, I, N, F of abductor pollicis longus?
O: posterior surface of ulna & radius I: base of 1st metacarpal N: radial nerve F: abducts & extends thumb at CMC joint
A Berg Balance score in the range of 41-56 means:
-low fall risk -independent
What are intervention options for a Boxer's fracture?
-surgical -conservative w/ brace depends on the extent of injury
What is primary osteoporosis?
-associated w/ *aging* and dec gonadal function -unrelated to chronic illness
A Berg Balance score in the range of 0-20 means:
-high fall risk -wheel chair bound
What should tracheal breath sounds normally sound like?
-high-pitched, loud & hollow sounding -like wind rushing through a pipe -expiration is louder and might be more coarse
What are a lot of thing that can cause a restrictive lung disease? (read)
-hypoxemia -hyperventilation -kyphosis -extertional dyspnea -dry cough -hemoptysis -idiopathic lung fibrosis -asbestos -radiation fibrosis -obesity -neuromuscular impairment
What population is overflow/outflow incontinence common in?
Diabetic patients who lost ANS innervation to bladder Males who have BPH
Flav Yellow
Example: Flavin; One of a group of water soluble yellow pigments
Where do the lymphatics of the testes drain to?
Aortic/caval nodes
Which arteries and veins supply the rectum & anal canal?
Superior, middle, inferior rectal arteries and veins
What is the function of lysosomes?
To break down other molecues that are no longer needed (also foreign bodies) serve as a "clearing station"
What is the function of the nucleus in a cell? What is the boundary of the nuclear envelope made up of?
To contain genetic information, made of a phospho lipid bi-layer
Cyanosis
bluish discoloration of skin due to poor circulation or oxygenation
What is step length?
distance measured from heel strike of other foot to heel strike of measured foot Ex: distance from L heel strike to R heel strike
Do penicillins treat gram-positive or gram-negative bacteria?
gram-positive
Does vancomycin treat gram-positive or gram-negative bacteria?
gram-positive
If percussion over an area produces pain, it could indicate ______________
infection or tumor
Meningitis, brain abscess, encephalitis, rabies, tetanus (lockjaw) and poliomyelitis (infantile paralysis) are all caused by:
infections
Which muscles of the anterior forearm have a synovial sheath around their tendons?
FDS and FDP share a flexor synovial sheath, FPL has its own synovial sheath
_____________ care is critical to positive outcomes after an amputation
post-op
What muscles does the median nerve run between?
FDS and FDP, but it becomes superficial at the distal forearm and is in between the FDS and flexor carpi radialis tendons
What would be included in a patient's past history for someone suspected to have Kienbock's disease?
FOOSH compression fracture
What is the MOI for a scaphoid fracture?
FOOSH with wrist extension and radial deviation
What tool can be used to help establish the *need* to treat previously untreated patients for poor BMD?
FRAX- a website used to calculate 10 year risk for hip fracture or other major osteoporotic fracture
FYI: if something is suspicious from medical history questionnaire, you should probs ask more about it
FYI
FYI: loss of IADLs or ADLs can impact a person's identity
FYI
FYI: some clinicians may not differentiate b/w tracheal and bronchial sounds, calling them tracheobronchial
FYI
FYI: when a person has a seizure, you should update their medical history to include changes in precipitating factors (triggers) and the type of seizure
FYI
FYI: you should investigate any TIA immediately
FYI
What do interleukins do?
stimulate immune system cells
Adipo
Fat; Example: Adipogenic; Producing fat
With NMES used for edema, what level of muscle contractions do you want?
strong, visible, comfortable contraction
What are microtubules and microfilaments?
structures that make up the cytoskeleton in a cell
Paroxysmal Nocturnal Dyspnea
sudden acute dyspnea
What is sometimes referred to as the 6th vital sign?
walking speed
What portion of the ANS mediates bladder contraction?
Parasympathetic
What portion of the ANS is involved in the cavernous N?
Parasympathetic vasodilation of deep A of penis
Which portion of the ANS mediates the detrusor muscle of the bladder?
Parasympathetic pelvic splanchnic nn "rest & digest"
Where is ureter pain referred to?
Ipsilateral lower quadrant of abdomen, especially to groin & external genitalia (scrotum & labia majora) GVA: general visceral afferent
Where do (most of) the posterior compartment muscles of the forearm originate?
Lateral epicondyle of humerus (extensors and supinators) only ECRB, ED, EDM, ECU
Levo
Left; Example: Levoduction; Movement of an eye to the left
What are the names of the tonsils in the oropharynx?
Lingual tonsil (1) Palatine tonsils (2)
Mening
Lining of the brain and spinal cord; Example: Meningitis; Inflammation of the meninges
Tuberculosis: -what are the symptoms? -how is it diagnosed?
-S: can be vague: fever, weight loss, lethargy, loss of appetite -D: sputum sample
Pneumonia: -what are the symptoms? -how is it diagnosed?
-S: fever, chest pain, productive cough -D: sputum sample, chest x-ray or CT scan
Bronchitis: -what are the symptoms? -how is it diagnosed?
-S: might have barrel-chest & cyanosis -D: chest x-ray or CT, sputum sample
According to Cyriax, what are 5 abnormal end feels?
-capsular (early in range) -bone-to-bone (early in range) -spasm (abrupt end) -springy block -empty
What are some outcome goals that you would use NMES for?
-muscle re-education -edema reduction -contracture management -muscle strengthening -atrophy prevention??
Side effects of anti-spasmodic drugs:
-nausea -ab pain/distention -dry mouth -constipation -drowsiness/fatigue -dizziness
What are prodromal signs in a tonic-clonic seizure? When do these signs take place?
-nausea -irritability -depression -muscle twitching this happens hours before the seizure
Why is a telomere lost during replication?
-piece of DNA serving enzymes replicating having a place to occupy
3 types of anti-diarrhea agents: (review)
-stool thickeners -bulking drugs -anti-spasmodic drugs
When is the post-op protector applied after an amputation?
0-4 wks depends on surgeon
What is the cutoff score for a gait speed test?
0.56 m/s (roughly 10 sec to walk 6 m)
What type of muscle contraction do the following pps ranges result in? 1 pps 10 pps 25 - 30 pps
1 = twitch 10 = summation 25-30 = tetanus (most fibers will reach tetany by 50 pps)
During gait, the pelvis tilts laterally about ___ inches on the swing side
1 inch (mid-stance on right leg = left leg swinging = left side of pelvis drops ~1 in)
In the MMSE, for every correct response you get ____ points
1 point they are also scored by the # of times it takes them to get the right answer
In the mid-stance phase of gait, the GRF is _____ (anterior/posterior) to the ankle, which makes the ankle want to move into _______(PF/DF)
anterior DF
In the pre-swing phase of gait, the GRF is _____ (anterior/posterior) to the ankle, which makes the ankle want to move into _______(PF/DF)
anterior DF
In the terminal stance phase of gait, the GRF is _____ (anterior/posterior) to the ankle, which makes the ankle want to move into _______(PF/DF)
anterior DF
In the initial contact phase of gait, the GRF is ________ (anterior/posterior) to the knee, which makes the knee want to move into _______ (flexion/extension)
anterior extension (a.k.a. knee extension moment)
Kussmaul respirations, labored respirations, wheezing and stridor are all examples of _________________ patterns.
breathing
Cephalosporins and carbapenem attack an infection how?
by compromising cell wall synthesis
What are the 4 types of transport?
diffusion osmosis facilitated diffusion active transport
What is the MOI for mallet finger?
direct force causing forced DIP flexion
Laxatives are prescribed to promote:
elimination from the bowel and defecation
Initial contact happens when the foot hits the ______. What happens right after initial contact?
ground shock absorption
What happens to cells at high temperatures?
inactivation of enzymes protein misfolding protein coagulation damage to organelles disruption of cell membrane
What is cellular hypertrophy? What may cause it?
increase in cell size -training -hypertension (cardiac) -increased hormonal stimulation
What is the main indication for NMES used for contracture management?
increased ROM with prolonged stretching
What is the main indication for NMES used for muscle strengthening?
increased force production
What causes a myasthenic crisis?
increased stress: infection, trauma or alcohol intake
If palpation of a lymph node is swollen & painful it may mean _____________
infection
What are the terms Matt prefers to use over temporary and permanent prosthesis?
initial & definitive
Break down of time spent in stance phase for the following: -initial contact -loading response -mid-stance -terminal stance -pre-swing
initial contact + loading response = ~10% mid-stance = ~20% Terminal stance = ~20% Pre-swing = ~10% Total ~60%
Which phase of gait is also called the acceleration phase?
initial swing
Break down of time spent in swing phase for the following: -initial swing -mid-swing -terminal swing
initial swing = ~13% Mid-swing = ~14% Terminal Swing = ~13% Total ~40%
What is the difference between intrinsic muscles and extrinsic muscles?
initrinsic - originate and insert distally to the wrist (within the hand) extrinsic - originate at elbow or in forearm and cross the wrist to insert in the hand
How does a simple, partial seizure affect a person's vision or hearing?
it causes auditory and visual experiences such as ringing in the ears or sensation of light
What are sleep apnea and snoring? What causes it? How is it treated?
Abnormal breathing during sleep Cause: may be dropping of tongue, enlarged tonsils, or soft palate into oral pharynx Treat: weight loss, palatouvuloplasty (shorten soft palate)
How do receptor channels work?
Acetylcholine binds to a receptor, causes the channel to open, ion travels into the cell and causes a nerve impules
What is an example of ion channel receptors?
Acetylcholine receptor
Why should tetracycline not be prescribed to children or pregnant women?
it will deposit in bones or teeth of developing children and cause deformities
In a stroke, occlusion of ___________ arteries can cause severe effects such as:
large arteries coma, loss of consciousness or death *almost immediately*
On a gait speed test, a lower number indicates more or less distance covered per second?
less
What components make up the plasma membrane of a cell?
lipid bi-layer embedded proteins
Should penicillins be taken with or without food?
most without food because it will bind to the food and make it ineffective, exception is amoxicillin
What component of a physical exam is often overlooked and can prevent us from overlooking the obvious?
observation
What causes stridor?
obstruction in larynx or trachea
Where does the energy from G proteins come from?
phosphate bonds
Where do you measure bronchovesicular breath sounds?
place stethoscope over anterior wall over sternum at angle of Louis and along the costosternal borders of the sternum
Where do you measure tracheal breath sounds?
place stethoscope over trachea and larynx
With a FOOSH where the wrist was extended <35 deg (less than), what bone is likely to fracture?
radius fx
With a FOOSH where the wrist was flexed, what bone is likely to fracture?
radius or ulna
What is the objective of performing muscle re-education NMES?
re-establish motor control
Why is it called a G-Protein?
receives energy from a GTP molecule
What are the 4 ways that cells communicate?
receptors channels adhesion molecules signal transduction
Overuse injury for hand/wrist likely involves what?
repetitive tasks or tendinopathies/neuropathies
If glenohumeral motion was to happen in a closed chain setting, the roll and glide would be in the _________ (same/opposite) direction
same (glenoid moving on humerus)
What determines the fate of pyruvic acid?
the presence or absence of O2
What is the definition of ADLs?
the self care, communication, and mobility skills required for independence in everyday living
What is active transport? Does it use energy?
the transfer of molecules from low concentration to high concentration, does use ATP for energy
What about viral replication makes it difficult to treat in a viral infection?
they use the host cell to replicate
Rhonchi was formerly known as:
wheezing
Is estrogen replacement used to treat osteoporosis?
yes, although the evidence is unclear
Can RRD's control edema & protect limbs?
yes, they all do
Can vitamin D supplements be taken without food?
yes, they can be taken with or without food
What muscles contribute to adduction and abduction of the wrist joint?
The flexor and extensor on the same side create a deviation toward one side Ex: flexor carpi radialis and extensor carpi radialis longus and brevis contribute to abduction
Where is the weak point of the glenohumeral joint?
The inferior border, this is where dislocations always happen
Nat
Birth; Example: Natality; The birth rate
What are the results of an epidural hemorrhage?
Blood accumulates and compresses the brain which can lead to herniation or death if not treated
Hem
Blood; Example: Hematocrit
Myel
Bone marrow, spinal cord; Example: Myelitis; Inflammation of the bone marrow or spinal cord
Os(te)
Bone; Example: Osteolysis; Dissolution of bone
What do the meningeal AA mainly supply blood to?
Bones of the cranial cavity (poorly named)
Genic
Cause, form; Example: Carcinogenic; Cancer causing
Which dural sinus is located on each side of the sella turcica and body of the sphenoid?
Cavernous sinuses
What is cellular dysplasia? What may cause it?
Cells that vary in size and shape within a tissue -chronic irritation -DNA mutations -pre-cancerous cells
What is the innervation of longissimus capitis and cervicis?
Cervical SN
What is the innervation of semispinalis?
Cervical SN
What is the innervation of splenius capitis and cervicis?
Cervical SN
Which ligament hold the atlas to the dens of the axis?
Cruciform ligament
What happens to the ERV and FEV of someone with COPD?
ERV: decreases FEV: decreases
What happens to the residual volume (RV) as a person gets older?
ERV: decreases RV: increases
T/F: discs degenerate slowly, so their injuries take time to develop
False, discs degenerate very quickly
Which dural fold is below the tentorium cerebelli and projects between cerebellar hemispheres?
Falx cerebelli
Opt
Vision; Example: Opticokinetic; Pertaining to movement of the eyes
What is the function of the lateral venous lacuna?
Way to increase area of the superior sagittal sinus to allow more CSF to return to venous blood via arachnoid villi
After the ictal stage of tonic-clonic seizure, why does the person typically let out a cry?
abdomen and thoracic muscles contract which causes the cry the jaw is clenched and respiration ceases
In the load response phase of gait, the GRF is _________(anterior/posterior) to the hip, this makes the hip want to move into _________ (flexion/extension)
anterior flexion (a.k.a hip flexion moment)
In initial contact, the GRF is _______ (anterior/posterior) to the hip, this makes the hip want to move into _______ (flexion/extension)
anterior flexion (a.k.a. hip flexion moment)
Residual Volume (RV)
amt of air left in the lungs after a forced expiration
Expiratory Reserve Volume (ERV)
amt of air that can be expired past tidal volume (normal)
Inspiratory Reserve Volume (IRV)
amt of air that can be inspired above the tidal volume (normal)
Tidal Volume (TV)
amt of air that passes in/out of lungs during resting breathing
What separates the two bony attachments for the sternoclavicular joint?
an articular fibrocartilaginous disc (separates into medial and lateral compartments)
Osmotic laxatives are best given to people with:
an urgent need to empty the bowels
What are the most common side effects of sulfonamides that may be an indication of toxicity?
anemia and leukopenia
How is step angle measured?
angle measured between: -middle of heel to second toe -parallel to direction of gait
In the mid-stance phase of gait, the GRF is ______ (anterior/posterior) to the knee, which makes the knee want to move into _______ (flexion/extension)
anterior extension (a.k.a. knee extension moment)
In the terminal stance phase of gait, the GRF is ______ (anterior/posterior) to the knee, which makes the knee want to move into ______ (flexion/extension)
anterior extension (a.k.a. knee extension moment)
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
What type of drug discovered in the 1900s is arguably one of the most important discoveries in medical breakthroughs?
antimicrobial drugs
According to Kaltenborn, what is an abnormal end feel?
any end feel that occurs at another place or is of another quality than is characteristic for the joint being tested
Lip
Fat; Example: Lipoma; A fatty tumor
Myc
Fungus; Example: Mycostasis; Stopping the growth of fungus
What should you focus on in the mobility and gait training portions of amputee rehab?
Fxn Mob: bed mobility & transfers Gait: crutches & non-WB gait
What are the different intracellular signaling molecules?
G proteins Effector Proteins Second Messenger target proteins
What are the classes of cell surface receptors?
G-protein coupled receptors (GPCR) Enzyme linked receptors ion channel receptors
What are the cavernous sinuses connected by?
Intercavernous sinuses
What ligaments of the clavicle make it hard to dislocate?
Interclavicular lig Costoclavicular lig
Which artery runs through the cavernous sinus?
Internal carotid A
Where are most arteries of the pelvis from?
Internal iliac AA some from abdominal aorta: Superior rectal A Median sacral A Ovarian/testicular AA
What is the common synovial sheath?
It contains the tendons of the extendsor digitorum and extensor indicis. It is deep to the extensor retinaculum
What is the function of the glenoid labrum?
It deepens the glenoid cavity. It is a ring-like fibrocartilaginous structure. This makes it so that 1/3 of the humeral head surface is into the glenoid cavity
What is unique about the way the ureter enters the bladder?
It enters it obliquely which forms a natural one way valve
What happens to joint cartilage with age?
It gets worn down and joint problems are developed
What stabilizes the glenohumeral joint?
Lots of ligaments and muscles
Where does the brachial artery split and what does it split into?
Lower cubital fossa Ulnar and radial arteries
What are the names of the tonsils in the nasopharynx?
Pharyngeal/adenoid tonsil (1) Tubular tonsils (2)
What nerves does the superior gluteal N pass between?
Lumbosacral trunk S1
What is Waldeyer's tonsillar ring?
Lymphatic ring of the 4 tonsils in the nasal and oral pharynx
Onych
Nail; Example: Onchyomalacia; Softening of the fingernail
Which portion of the pharynx connects to the middle ear?
Nasopharynx
Neur
Nerve; Example: Neuranagenesis; Regeneration of nerve tissue
Are pathologies detected by tracheal breath sounds common?
No
Does the soft palate form a perfect seal to keep fluids out of the nasopharynx?
No
Does the wrist share a joint capsule with the intercarpal joints?
No
Does brachioradialis work in the anatomical position?
No, because the elbow does not bend laterally. If you bend the elbow it is able to flex the elbow
Does the internal iliac A normally have a middle division as well as an anterior and posterior division?
No, only has it 20% of the time
Do the venous sinuses of the dura contain valves?
No, there is no direct pathway for blood to flow through
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 is a safe dosage for you to tell a pt to supplement vitamin D with? What dosage can a pharmacist prescribe?
PT- up to 2,000 IU Pharm- up to 10,000 IU per day for 8-12 weeks
Algo
Pain, cold; Example: Algor; Chill or rigor, coldness
Palat
Palate; Example: Palatoplegia; Paralysis of the palate
What is the N of palato-, salpingo-, and stylo- pharyngeus?
Palato: CN X Salpingo: CN X Stylo: CN IX
What is the O of palatopharyngeus, salpingopharyngeus, and stylopharyngeus?
Palato: hard & soft palate Salpingo: auditory tube (cart) Stylo: styloid process
What muscles form the palatopharyngeal arch?
Palatoglossus m Palatopharyngeal m
Pancreat
Pancreas; Example: Pancreatalgia; Pain in the pancreas
What is the most common risk factor for cancer?
Stacia: previous history of cancer Irina: age
Which forearm extensors attach to the supraepicondylar ridge and which attach to the lateral epicondyle?
Supraepicondylar ridge: BR, ECRL Lateral epicondyle: ECRB, ED, EDM, ECU
What vessels supply blood to the MCP and IP joints?
Superficial palmar arch branches
Where is the epidrual space?
Superficial to dura mater
What drains the cavernous sinuses?
Superior & inferior petrosal sinuses
What makes up the hypogastric plexus?
Superior hypogastric plexus gives rise to R/L hypogastric NN which connect to a R/L inferior hypogastric plexus which gives rise to multiple pelvic organ plexuses
What runs in the superior border of the falx cerebri?
Superior sagittal sinus
Which arteries supply blood to the bladder?
Superior vesicle AA M: inf vesicle AA F: vaginal AA
What is the O of superior, middle & inferior constrictor mm?
Superior: pterygoid hamulus Middle: stylohyoid lig, hyoid Inferior: thyroid cartilage
Where does the glenohumeral joint get its blood supply from?
Suprascapular A Ant/Post circumflex humeral AA (branches of subclavian and axillary arteries)
What nerves innervate the glenohumeral joint?
Suprascapular N Axillary N Lateral Pectoral N
What is an example of a fibrous joint?
Sutures in the skull
What is the Marshall-Marchetti-Krantz procedure to treat stress incontinence?
Suturing vagina to neck of bladder
Hidr
Sweat; Example: Hidropoiesis; The formation of sweat
Gluc
Sweetness, sugar; Example: Glucometer; Glucose meter
What portion of the ANS mediates bladder retention?
Sympathetic
What may inhibit the ability of a male to urinate in a public restroom?
Sympathetic discharge can't open internal urethral sphincter
How is osteoporosis defined in terms of BMD T scores? How is oteopenia described in terms of BMD T scores?
T score of -2.5 or less T score of -1.0 to -2.5
What happens to a person's total lung capacity (TLC) if they are obese?
TLC decreases
What happens to a person's total lung capacity (TLC) if they have a neuromuscular disease?
TLC decreases
How does the total lung capacity differ between early and severe emphysema?
TLC severe > TLC early
What is the most common blood vessel that is torn to cause a subdural hemorrhage?
Tear of bridging veins b/w brain surface and dural sinus Cerebral veins as the enter the superior sagittal sinus
Lacrim
Tear, duct; Lacrimal gland
Many people with Guillain-Barre syndrome develop _______________ nervous system involvement
autonomic (cardiac arrhythmias, fluctuating BP, loss of ability to sweat)
How can surgical techniques reduce post-op complications?
by reconstructing a residual limb designed for prosthetic use
Which calcium supplement can be taken with or without food and has a risk of causing constipation?
calcium citrate should limit to 500 mg in a dose
Is Guillain-Barre syndrome usually develop insidiously or rapidly?
can be either (few hours to several days- exam question made it seem v acute onset)
Where do you measure vesicular breath sounds?
can be heard across most of the chest including anterior, lateral & posterior chest walls (w/ exception of the area of bronchial sounds)
At what age does asthma occur?
can occur at any age, but is common in kids
Do simple or complex partial seizures involve the temporal lobe or have psychomotor involvement?
complex, partial seizure
Total Lung Capacity (equation)
comprised of all 4 values *TLC* = TV + IRV + ERV + RV
At the SC joint, the manubrium is ________ (concave/convex) on its longitudinal diameter and ________ (convex/concave) on its transverse diameter
concave on longitudinal convex on transverse
Kussmaul's Respiration
deep, regular sighing respirations with an inc in respiratory rate
What would be your main clue in an objective exam to determine if a patient has a mallet finger injury?
deformity of the DIP
A seizure involves sudden, spontaneous, uncontrolled:
depolarization of neurons
In what plane and around what axis do clavicular motions take place in?
elevation/depression -frontal plane/sagittal axis protraction/retraction -sagittal plane/frontal axis rotation -transverse plane, longitudinal axis
Lyme disease can lead to what condition?
encephalitis
Reye's syndrome may start out as what condition initially?
encephalopathy (w/ symptoms like lethargy, headaches & vomiting)
What are interferons?
endogenous proteins that are inserted into the membrane of a cell after viral infection to make that cell appear as though it has already been infected by the virus
What is cellular respiration?
energy production through oxidation of fuel molecules
External moments influence which muscles need to ________
engage
What do lysosomes contain?
enzymes that break down other molecules (protease)
Asthma occurs in ________________
episodes
How does the capsular pattern of restriction present in the wrist?
equal limitation of flexion and extension
Describe the CPR of the MCP/IP joints
equal restriction in flexion/extension
Outcome measures support ____________________ practice
evidence-based
If PAM is unrestricted, it can be either normal or ________?
excessive (instability or joint laxity)
Antacids only treat the symptoms of:
excessive stomach acid
What is the difference between exogenous and endogenous chemical agents?
exogenous: from environment Endogenous: from inside the body
What is the MOI for a Colles' fracture?
extension + compression (FOOSH with wrist extended)
What is the close packed position of the radiocarpal joint?
extension w/ radial deviation
As you flex your fingers, which way do they rotate slightly?
externally (away from the body)
What is the MOI for a scaphoid-lunate dislocation?
fall or trauma to wrist
Orthostatic hypotension that occurs with Parkinson's disease can lead to an inreased risk of what?
falls
T/F: intermittent vs constant pain gives you a good idea of the origin of the pain (musculoskeletal vs visceral)
false
T/F: electrical stimulation can help with nerve regeneration
false it has no effect on nerve regeneration
T/F: only select patients should receive non-pharmacologic treatment for osteoporosis
false, ALL patients should
T/F: You should not use physical modalities to treat central sensitization pain
false, but they should never be used alone and always be incorporated as a part of the larger plan of care
T/F: tubular elastic dressings are always applied in a double layer of material
false, it can be double or single layering of material
T/F: FRAX can be used to determine the need for *pharmacologic* treatment in previously treated patients
false, it is usually for previously untreated patients
T/F: there is good evidence for the effectiveness of conservative treatment of CTS
false, limited evidence for efficacy of conservative treatment
T/F: there is no surgical repair option for a TFCC disc injury
false, there is a surgical repair option
T/F: The ulna directly articulates with the carpals
false, there is no direct articulation because of the TFCC
T/F: people with arthritis lose the loose packed position of the CMC of the thumb
false, they loose the close packed position (full opposition)
T/F: if a person has eaten recently, the gurgling bowel sounds will take place less often
false, will happen more often
What happens during circulation in lipid oxidation?
fatty acids exit adipocytes fatty acids circulate bound to albumin
What is the function of the costoclavicular ligament at the SC joint?
fibers "criss-cross" to stabilize and limit protraction, retranction and elevation of the clavicle
What is the MOI for a Smith's fracture?
flexion + compression (FOOSH with wrist flexed)
What motions are possible at the glenohumeral joint? What plane and axis does each take place in?
flexion/extension: sagittal plane, frontal axis abduction/adduction: frontal plane, sagittal axis horizontal ab/adduction: transverse plane, vertical axis internal/external rotation: transverse plane, vertical axis
What is the close packed position of the CMC of the thumb?
full opposition
Sneezing, coughing, sputum and breathing patterns are all ____________________ of the respiratory system.
general characteristics
What is in a patient profile?
general info: age, sex, ethnic group
Partial (focal) seizures lead to ____________ seizures
generalized
What is the most important stretch to get a transfemoral amputee to do?
hip flexor stretch to prevent contracture often done by laying in prone and pressing up
During pre-swing, since the GRF is posterior to the hip, causing it to want to extend, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
hip flexors *concentric contraction* attempting to *begin hip flexion*
During mid-stance, since the GRF is posterior to the hip, causing it to want to extend, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
hip flexors eccentric contraction controlling hip extension (glut med isometric to prevent hip drop during single support)
When testing PAM or joint glides, what are 3 possible classifications for joint movement description?
hypermobie normal hypomobile
How do kanamycin and neomycin work?
inhibit protein synthesis by binding directly to a ribosome to inhibit its function
How do macrolides work?
inhibit protein synthesis in bacteria
How does gentamicin work? How is it administered?
inhibit protein synthesis; intramuscular or IV
How do Didanosine and lamivudine (videx and epivir) work to treat HIV?
inhibit reverse transcriptase
How do tetracyclines work?
inhibiting protein synthesis on ribosomes
How does indinavir (Crixivan) work to help treat HIV?
inhibitor of protease specific to HIV-1
How does acyclovir work?
inhibits DNA synthesis and does not harm the host because it requires a viral protein to activate it
How does flucytosine work?
inhibits both DNA and RNA synthesis
What is vitamin E's role in preventing damage from free radicals?
inhibits production of free radicals by reacting with them to return to its reduced state (prevent oxidative phosphorylation)
Is the onset of a brain abscess rapid or insidious?
insidious
What are examples of tyrosine kinase receptors?
insulin or other growth factors (intrinsic enzymatic activity)
As you extend your fingers, which way do they rotate slightly?
internally (towards the body)
What is the primary side effect of the bacteria that prevent diarrhea?
intestinal gas
What are the drugs of choice when normal bowel movements have been impaired?
laxatives
In the mid-stance phase of gait, the GRF is ______ (medial/lateral) to the subtalar joint, which makes this joint want to move into ______ (pronation/supination)
medial pronation
What is the loose packed position of the CMC of the thumb?
midrange between abd/add and flex/ext (natural resting position)
What does MMSE stand for?
mini-mental status examination
What are antacids often used to treat?
minor GI discomfort after overeating or eating foods not appropriate for a person
What does strong and painful mean when MMT?
minor injury
What is the main indication for muscle re-education NMES?
muscle inhibition after surgery or injury (only if neuromuscular mechanisms are intact)
What happens in the clonic stage of a tonic-clonic seizure?
muscles alternately contract and relax (jerky movements) bowel & bladder incontinence may occur
What types of tissues serve as stabilizers for the hand and wrist?
muscles and ligaments
What are some common side effects of AZT?
myelosupression, GI issues and headaches (ocasionally myopathies)
Does flucytosine have a broad or narrow spectrum of anti-viral activity?
narrow
What are the 4 types of cell macromolecules?
nucleic acid proteins lipids carbohydrates
How many nitrogen are present in one AA?
one
What does each tRNA carry?
one amino acid sequence
How does exercise impact BMD in older men?
one study showed 2% net gain in *femoral neck* BMD
What serves as an explanation to why mRNA ends up a lot smaller than its DNA counterpart? Why is this actually a good thing?
only about 5% of the DNA chain contains information to make proteins, this way the mRNA can be transported through the nuclear envelope
For abduction/adduction of the CMC of the thumb, roll and glide are in the _________ direction
opposite
For the proximal radioulnar joint, roll and glide happen in the ______ direction
opposite
How are antacids ingested?
orally
How are acyclovirs administered?
orally, IV or topically
Where does the TFCC attach?
originates of the ulnar notch on the radius and attaches to the ulnar styloid process
What is Kienbock's disease?
osteonecrosis/ avascular necrosis of the lunate following a fracture
What is a major cause of the development of drug-resistant microorganisms?
overuse and inappropriate administration of antimicrobials
What are stressors that may cause cellular adaptations?
oxygenation temperature electrolytes molecular toxins
What is the function of the Golgi complex?
package synthesized proteins into vesicles to be delivered to other sites either inside or outside of the cell
In the pre-swing phase of gait, the GRF is _______(anterior/posterior) to the hip, which makes the hip want to move into _________(flexion/extension)
posterior extension (a.k.a. hip extension moment)
Walking speed can reflect underyling:
physiological processes
1 generic name of ACh M1 Receptor Antagonists:
pirenzepine
What is the most common ACh receptor antagonist prescribed for GI problems?
pirenzepine
What type of joint are the radioulnar joints?
pivot (held together by interosseous ligament)
What is an example of a lung expansion disease?
pleural effusion (build up of excess fluid b/w the layers of the pleura)
A classic sign of __________________ is when a person stops breathing at the point of pain (splinting), so their breath pattern is halting rather than smooth & continuous
pleural friction rub
What conditions might cause a pleural friction rub?
pleural inflammation due to lobar pneumonia or lung infarction
What is an attribute of vancomycin that determines how it can be administered?
poorly absorbed in GI tract
Since people don't live in the hospital, many acute care outcome measures are validated with other:
populations (Ex: community ambulators) this is still useful if used to make judgements related to discharge into community setting
What is Brudzinski's Sign?
positive: indicates meningitis neck flexion causes flexion of hips and knees
What is Kernig's Sign?
positive: indicates meningitis pt resists leg extension when lying with their hip flexed
FYI: in a subjective examination, you might ask the patient if they smoke, and if so how many packs per day
possible answers: - 0 - 1/2 - 1/2 - 1 - 1 -2 - 2+
In the initial contact phase of gait, the GRF is ________ (anterior/posterior) to the ankle, which makes the ankle want to move into ________ (PF/DF)
posterior PF
In the load response phase of gait, the GRF is _____ (anterior/posterior) to the ankle, which makes the ankle want to move into _______(PF/DF)
posterior PF
In the mid-stance phase of gait, the GRF is ________ (anterior/posterior) to the hip, this makes the hip want to move into _______ (flexion/extension)
posterior extension (a.k.a hip extension moment)
What is the loose-packed position for the SC joint?
shoulder in anatomically neutral position
Are limb shrinkers (shrinker socks) or silicone liners tighter on the limb?
silicone liners by a long shot
For which type of post-amputation dressing is the use of non-fragrants soaps around the residual limb very important? Why?
silicone liners, b/c they trap moisture & when the user sweats the moisture mixes with the fragrance and is trapped on their skin and can cause irritation
Tonic-clonic (grand mal) generalized seizures may occur spontaneously or after:
simple seizures
What type of seizure is a Jacksonian seizure?
simple, partial (focal) seizure
Do simple or complex partial seizures have motor, sensory, autonomic and/or psychic involvement?
simple, partial seizure
Mid-stance is a phase of _________ support
single
Terminal stance is a phase of _________ support
single
_______________ support is when only one limb is in contact with the ground
single
Simple partial (focal) seizure usually stem from a ____________ area of damage in the ____________
single cortex
Someone's center of mass exhibits a _________ curve during gait
sinusoidal (happens in both vertical pattern and side-to-side pattern)
What does SBAR stand for?
situation background assessment recommendation
What non-bony structure increases the surface area for the articulation between the glenoid fossa and the head of the humerus? How much does this structure deepen the glenoid fossa?
the glenoid labrum deepens by up to 50%
What are indications of toxicity with vancomycins?
supression of adrenal system and hypercorticism (cushing's syndrome)
Is surgical or conservative intervention more likely after a Smith's/Colles' fracture?
surgical
Who is responsible for fall costs s/p amputation?
the hospital, if the pt is insured by Medicare
In a plaster or fiberglass cast RRD, compression is provided by which part of the dressing?
the layers of socks, the rigid part just protects the limb
What is a result of the accumulation of lactic acid?
the lowering of pH and creation of an acidic environment
Why is positioning s/p amputation important for the patient and family to have knowledge about?
to prevent contractures Note: never want a transfemoral amputee in abduction
T/F: osteoporosis is a chronic, progressive disease
true
T/F: surgical treatment of CTS has fairly good success rates at about 70-90%
true
T/F: treatment needs for osteoporosis should be continuously re-evaluated
true
T/F: you are unable to palpate lymph nodes unless they are swollen
true
T/F: a medical history may be helpful when determining if a pt has a brain abscess
true (abscess from ear, throat, lung or sinus infection inc pt's risk)
T/F: donning a shrinker sock after a recent amputation may require assist x2
true used once suture line has healed sufficiently, need to apply it carefully to avoid wound tension
T/F: you may have to gradually increase the amount of time the amputee wears the silicone liner when they are first using one
true want to progress from 2 hrs 2x/day, to 5 hrs 2x/day to eventually full day use
T/F: the prosthetic foot on an IPOP can be removed
true, can unscrew it so they don't have to have the weight of it in bed or something
T/F: nerve glides may help with symptoms of CTS
true, some effect, but not large effects
Different shrinker socks can vary in what ways from each other?
various lengths, widths & grades of compression
TIA's, strokes and cerebral aneurysms are examples of ______________ disorders
vascular
When are vancomycins used?
when penicillins are ineffective/contraindicated or with severe staphylococcal infections
When might tobramycin be prescribed?
when penicillins aren't effective
What is translation?
when the genetic information carried by mRNA is translated into a sequence of amino acids
When does the pre-swing phase of gait start and end?
when the opposite limb contacts the ground; ends just prior to lift off (includes toe off)
After an amputation, when do patients often forget they are missing part of their limb?
when they first wake up and go to get out of bed use precautions, such as placing a chair at EOB, to remind them before they fall & end up in the E.R.
Are chloramphenicols narrow or wide spectrum? What does this mean?
wide spectrum, act against anaerobic and aerobic gram-positive and gram-negative bacteria and rickettsiae
Do tetracyclines have a narrow or wide spectrum of activity? What does this mean?
wide spectrum, they inhibit gram-positive and gram-negative bacteria
What are the two categories of enzyme linked receptors?
with intrinsic enzymatic activity lack intrinsic enzymatic activity, but bind to and activate cytosolic tyrosine kinase
How quickly after an amputation can someone accomplish touch down WB with an IPOP?
within 24 hours
Where can molecules be transported?
within the cell inside to outside the cell outside to inside the cell
Where does aerobic oxidation take place within the cell? What is the name of the cycle it goes through?
within the mitochondria TCA/Krebs/Citric Acid Cycle
What AD may help with CTS?
wrist splint
If a person score in the range of 21-23 on the MMSE, do they have a cognitive impairment?
yes
When doing a gait speed test, is use of an assistive device permitted?
yes
Can a non-removable rigid dressing be used for WB?
yes w/ prosthetic components attached for ambulation
Can non-removable rigid dressings control edema or protect the limb?
yes, they control edema, pain & provide protection
How many seconds is one full gait cycle typically? How much of that time is spent in stance or swing phase?
~1 second stance: 0.6 seconds (60%) swing: 0.4 seconds (40%)
How much does the pelvis shift laterally during gait?
~1-2 inches towards weight-bearing side
What is the average stride length?
~144 cm or 56 in (double the average step length)
When are the sutures removed and limb shaping begins after an amputation?
~4 wks
What is the sensitivity/specificity level of Watson's test?
~70%
What is the average step length?
~72 cm or 28 in (half of the average stride length)
NMES is also called what?
EMS Electric Muscle Stimulation
Cubit
Elbow; Cubital fossa
Normal FEV1/FVC%
greater than 80%
What does erythropotein do?
stimulates RBC production
2 generic names of stool thickeners:
-kaolin -pectin (KP)
Eupnea
-rhythm is smooth -expiration is longer than inspiration
What does a pleural friction rub sound like?
"grating or clicking sound paper is rubbed together"
What are external moments created by?
GRF
Vital Capacity (equation)
*VC* = IRV + TV + ERV
If a person exhibits any of the 5 warning signs of a stroke, what should you do?
*Emergency First Aid for Stroke:* 1. call 911 & say pt has symptoms of a stroke 2. pt should be transported to hospital ASAP with record of common drugs used & medical conditions being treated 3. time between onset of stroke & treatment is directly related to the severity of the damage to the brain, *minutes count!*
Since the glenohumeral joint consists of the ________ (convex/concave) humeral head moving on the _________ (convex/concave) glenoid fossa, the roll and glide happen in the _________ (same/opposite) direction
*convex* humeral head *concave* glenoid fossa *opposite* direction
How are bi-valved RRD's made?
*custom made* from a cast or a pre-fabricated shell
What are some possible symptoms of a TIA?
*depends on location of ischemia* -muscle weakness in arm/leg -visual disturbances -numbness & paresthesia in face -transient aphasia or confusion
What sensory deficits may occur with a neurological disorder?
*loss of:* -touch -pain -temperature -position -sense of vision -hearing -taste -smell
When is velocity the lowest during gait?
*mid-stance* (middle of weight-bearing support on one limb, leg is vertical)
Which conditions is the drug Teriparatide contraindicated for?
*osteosarcoma*!! -Paget's Disease -inc bone alkaline phosphatase -open epiphyses -prior external beam radiation treatment -prior implant radiation (these are all risk factors for developing osteosarcoma)
What category of post-op dressing is an IPOP?
*rigid dressing* w/ a pylon & foot stands for immediate post-operative prosthesis
When does heel rise happen during gait?
*terminal stance* just before lifting the rear leg off of the ground to initiate swing
T/F: lifestyle factors impact your peak bone mass
*true* everybody has an individual full genetic potential for peak bone mass, but lifestyle factors determine if you will reach it
What are some examples of orders for PT for someone with osteoporosis? (read)
-"gait evaluation" -"safe walking program" -"LE strengthening program"
Describe a complex, partial seizure:
-*aura* may be present -*bizarre behavior*: repetitive & purposeful, but inappropriate movements such as waving or clapping -frequent visual or auditory *hallucinations* -feelings of deja vu
What are symptoms of Reye's syndrome?
-*disorientation* -hyperreflexia -hyperventilation -seizures -*stupor or coma* can follow quickly
Describe the progression of symptoms of Lyme disease over time.
-*early*: sore throat, dry cough, fever, headache -*later*: cardiac arrhythmias, neurologic abnormalities (facial N paralysis) -*very late*: pain & swelling in large joints --lyme disease leads to encephalitis--
What are symptoms of a brain tumor?
-*headaches in the AM* -headaches that inc in severity & frequency -vomiting -lethargy -irritability -personality & behavioral changes
What are some symptoms of a cerebral aneurysm? (5)
-*loss of visual field* -other visual disturbances -*photophobia* (inc sensitivity to light, occurs w/ small leak) -intermittent periods of dysfunction (confusion, slurred speech, weakness) -*nuchal rigidity* (stiff/exteneded neck due to muscle contractions)
Cheyne-Stokes Respiration
-*periodic breathing* associated with periods of *apnea* alternating regularly with a series of respiratory cycles -respiratory cycles gradually increase then decrease in rate & depth
What stimuli might trigger a seizure? (precipitating factors)
-*physical stimuli*: loud noises, bright lights -*biochemical stimuli*: stress, excessive premenstrual fluid retention, hypoglycemia, change in medication, hyperventilation
What is the difference between primary and secondary seizures?
-*primary*: idiopathic -*secondary*: acquired due to an identified cause like post-traumatic syndrome
What are the side effects of bisphosphonates?
-*upper GI irritation* -osteonecrosis of jaw -severe musculoskeletal pain -hypocalcemia -uveitis/scleritis -possible risk of atypical femur fractures
With a stroke, functional deficits increase during the first _____ hours as ______________ develops
-48 hours -inflammation
What qualifies as acute vs chronic bronchitis (time frame)?
-A: symptoms lasting 2-3 weeks -C: productive cough lasting more than 3 months
What are some everyday activities that could be aggravating factors for a patient's hand/wrist symptoms?
-ADLs -lifting/pushing/pulling -opening a door -writing
When reassessing motion with goniometry in an objective exam, what are the 3 different types of movement you should assess?
-AROM -PROM -flexibility
When testing PROM in objective exam, what are 3 things you should take note of?
-AROM not easily reached -gently apply overpressure -end feel
What are some things that are important to document for e-stim?
-Dx or description of condition being treated -documentation of intact nerve supply -POC description -description of therapy program -attended/unattended code
What are a couple examples for an acute injury/trauma that could result in hand/wrist symptoms?
-FOOSH -radius, ulna or carpal fx
According to Cyriax, what are 3 normal end feels?
-capsular -bone-to-bone -tissue approximation
What are some things you can do to live a bone healthy lifestyle?
-adequate Ca++ intake -optimal vitamin D levels -WB exercise -avoid tobacco and excessive alcohol use
What are some examples of weight bearing activities?
-aerobics -circuit training -jogging -jumping -volleyball -walking
What factors related to patient profile are helpful in a subjective exam for the hand/wrist?
-age -occupation (often associated w/ symptoms) -recreation -psychosocial factors
What could the popping sound be caused by that is associated with rales?
-alveoli suddenly opening up -when air passes through mucus plugs
Briefly describe ankle motion during gait starting from heel strike: (read)
-ankle in neutral at heel strike -quickly plantarflexes due to gravity acting on forefoot -slowly moves back towards neutral and into dorsiflexion during mid-stance -reaches determinant of gait just before heel rise (10 deg DF) -moves back towards neutral as heel rises and as foot lifts off ground
Adventitious Sounds -what are they? -what do they indicate?
-any sound that occurs along with normal breath sounds -typically indicates turbulence of air flow
In general, where are the joints located in the intercarpals?
-articulation between proximal and distal rows -articulation between individual carpals
What are some symptoms of Guillain-Barre syndrome?
-ascending flaccid paralysis -paresthesia -pain -muscle aching -vision & speech impairments
FYI: in a subjective examination, you might ask the patient if they have ever had any of the following:
-asthma -emphysema -cancer -TB -shortness of breath -difficulty breathing
How (generally) do antimicrobials work in targeting an infection? (3)
-bacterial or fungal cell wall synthesis -bacterial ribosomes for protein synthesis -enzymes in DNA replication
What in the objective exam may help determine if a patient has Raynaud's?
-blanching of fingers -+ Allen's test (blocking of U and R arteries) -skin color changes
Appearance of sputum due to hemoptysis. (hemoptysis: coughing up of blood) What condition is this usually a sign of?
-blood-tinged (bright red) -frothy (EW) -sign of pulmonary edema
What are some symptoms of multiple sclerosis? (8)
-blurred vision, diplopia (double vision), scotoma (spots in vision) -weakness in legs -progressive weakness & paralysis extending to upper limbs -paresthesia, areas of numbness, burning, tingling -dysarthria (trouble speaking) -loss of coordination -bladder, bowel & sexual dysfunction -chronic fatigue
What may be done in a surgical intervention for Kienbock's disease?
-bone graph or prosthetic lunate
The 4 types of laxatives: (review)
-bulk forming -stimulant -hyperosmotic -lubricants/stool softeners
How do you diagnose a pulmonary embolism?
-can be difficult to diagnose b/c initial symptoms are vague -take history: recent surgery, inactivity? -chest x-ray and CT scans are helpful
How does exercise impact BMD in post-menopausal women?
-can inc *lumbar spine* BMD by 1-2% -hip data somewhat contradictory
What are contraindications for NMES?
-cardiac pacemakers -Hx of cardiac arrthmias -phrenic or urinary bladder stimulators -deep brain stimulators -carotid sinus (scalene triangle) -temporal lobe -eyes -larynx locations -malignancy -thrombophlebitis -pelvic region in pregnant females -*increased pain during/ following treatment* -anxiety
What should you be sure to R/O before determining if someone has CTS?
-cervical -shoulder -elbow involvement -DD of pronator teres and anterior interosseous syndromes
4 generic names of H2 receptor antagonists:
-cimetidine -famotidine -nizatidine -ranitidine
Describe the middle stages of Alzheimer's disease: (5)
-cognitive function, memory & language continue to decline -problem-solving, mathematical ability and judgement & judgement are poor -apathy, indifference & confusion -difficulty with ADL's -wandering due to confusion and getting lost
In middle stages of Alzheimer's disease, what 3 skills continue to decline?
-cognitve function -memory -language skills
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 are some other measures that could be taken to help diagnose osteoporosis? (read)
-comprehensive metabolic panel -CBC -24 hr urine for Ca++, creatine, sodium -25-Hydroxy vitamin D -TSH -SPEP/UPEP if anemic -PTH -fall risk assessment
For home assessment, what might you consider with patient mobility?
-consider dynamic interaction between personal factors and prognosis to respond to PT -interaction between environmental factors and activity level or risk (support patient at their worst when they are at home)
What symptoms occur due to an occlusion of the anterior cerebral artery (frontal lobe)?
-contralateral muscle weakness or paralysis -sensory loss in leg -confusion -loss of problem-solving skills -personality changes
What symptoms occur due to an occlusion of the middle cerebral artery (cerebral hemisphere)?
-contralateral paralysis and sensory loss (mostly upper body or arm) -aphasia (when dominant hemisphere is affected) -spatial relationships affected if R side is damaged
Brain stem or cerebellar tumors may affect several ___________ and possibly cause __________ paralysis or ____________ problems
-cranial nerves -unilateral facial paralysis -visual problems
What information should you get with a medical history?
-current & past illness -family history
Things to observe about the integument (7)
-cyanosis -jaundice -pallor -streaks on skin -change in amt of hair -clubbing nails -pitting nails
What are the benefits of post-op amputation care in the hospital? (3)
-dec pain -dec LOS -dec time to prosthetic use
How does calcitonin treat osteoporosis?
-dec risk of vertebral fractures -(no data on hip fracture prevention) -taken as a nasal spray or injection
How does Raloxifen treat osteoporosis?
-dec risk of vertebral fractures -this is a type of SERM
What do rhonchi sound like?
-deeper & harsher breath sounds due to thicker mucus -can be high or low pitched
What are the general components of an objective exam? (5)
-determine structure involved -confirm/refute working hypothesis -establish objective baseline -identification of impairments -determine functional limitations, disabilities or changes in physical function
What are some early signs of Huntington's disease? (5)
-difficulty learning new info -loss of problem-solving skills -poor judgement -inability to concentrate -memory lapses
2 generic names of anti-spasmodic drugs:
-diphenoxylate -loperamide (keep it on the ~DL~ if you're taking anti-spasmodic drugs)
Diarrhea is often a temporary symptom of minor GI disorders, but can occur with serious conditions such as:
-dysentery -ulcerative colitis -cholera
Orthopnea How could you treat this?
-dyspnea that occurs when someone is lying down -to treat, raise upper part of body with pillows
What areas of the body do tremors affect in early vs late Parkinson's disease?
-early: hands (at rest) -late: hands, feet, face, tongue & lips
What components of the objective exam findings may indicate CTS?
-electrophysiology -ROM (deficit/painful?) -palpation (produce symptoms) -dec grip strength -positive phalens/reverse phalens/tinel's (special tests)
What are 3 components you can use to help assess a patient's felxibility?
-end feel -postural analysis -special tests (SLR, Thomas, Ober etc.)
5 generic names for PPIs:
-esomeprazole -lansoprazole -omeprazole -pantoprazole -rabeprazole *-prazole*
What are symptoms of COPD?
-extreme shortness of breath (work hard to take a breath) -always accompanied by wheezing
How does Parkinson's disease affect a person's face?
-face might resemble a mask -dec blinking -blank, staring face
What are some early signs of Parkinson's disease? (6)
-fatigue -muscle weakness/aching -dec flexibility -less spontaneous changes in facial expression -tremors in hands at rest -repetitive "pill-rolling" motions of hands
What are some symptoms of poliomyelitis? (6)
-fever -headache -vomiting *then....* -stiff neck -pain -flaccid paralysis
Initially ____________ paralysis is present in a CVA/stroke, ____________ paralysis develops several weeks later
-flaccid -spastic
Fine rales: -what do they indicate? -what do they sound like? -what conditions are they common with?
-fluid in terminal areas of the tracheobronchial tree -more of a "slurping" sound than a popping sound -more common with inflammation & congestion in the lungs
FEV1
-forced expiratory volume in the 1st second -measures the peak expiratory flow rate (PEFR)
Summary of important aspects of post-op amputation care: (read)
-fully evaluate each patient -select most appropriate device & protocol -team input & communication are critical -educate patient, family & rehab team -follow-up, follow-up, follow-up
Walking speed correlates with: (2)
-functional mobility -balance confidence
What are some examples of additional tests that can be performed in an objective exam that can give you more information? (read)
-functional tests (hop, double leg squat, max jump height) -gait analysis -balance tests (single leg stance, star test, timed up and go) -questionnaires
When looking at the ICF model's contextual factors, what are some examples of personal factors to consider when treating a patient and trying to help them establish their goals?
-gender and sex -age -other health conditions -coping style -social background -education -profession -past experience -character style
What are the risk factors for osteoporosis? (11)
-genetics -low Ca++ diet -low vitamin D stores -smoking -excess alcohol -hx of fracture -medications -malabsorption -excessive urinary Ca++ -hyperthyroidism -comorbid conditions
What should be included in your objective exam for patients who are post-op from either a Smith's or Colles' fracture? (3)
-girth measurement (edema) -PROM/AROM -functional tests (grip strength
People with which conditions should not take anti-diarrhea meds?
-glaucoma -prostate disease -kidney disease -liver disease
What are the 4 ligaments that serve to support the glenohumeral joint?
-glenohumeral ligaments (superior, middle, inferior) -coracohumeral ligament -transverse humeral ligament -coracoacromial ligament
4 generic names of hyperosmotic laxatives:
-glycerin -magnesium hydroxide -magnesium sulfate -sodium phosphate (MSG)
Describe the early stages of Alzheimer's disease: (3)
-gradual loss of memory and lack of concentration -impaired ability to reason and learn new info -behavioral changes: irritability, hostility, mood swings (Ellis Grey)
What are side effects of PPIs?
-headache -diarrhea -constipation -ab pain -nausea -rash
What are some symptoms of rabies? (6)
-headache -fever -nervous hyperirritability (sensitivity to touch) -seizures -difficulty swallowing -foaming at mouth
Side effects of H2 receptor antagonists:
-headaches -dizziness -mild/transient GI complaints such as nausea and diarrhea
What factors can influence our lung capacity? (4)
-height -gender -weight -age
The abdomen may sound __________ with air, but will sound ____________ with masses (organs).
-hollow with air -dull with organs
How often should someone get a bone density assessment done?
-if on treatment, every 1-2 years -if not on treatment but at risk, every 2 years
What are symptoms of a cerebral aneurysm that is a result of a massive rupture? What is the pt prognosis like?
-immediate, severe, blinding headache -vomiting -photophobia -seizures or loss of consciousness *death* may occur shortly after rupture
Hyperpnea
-inc depth of respiration -normal to inc rate -regular rhythm
What would someone's vital signs look like if they were experiencing inc intracranial pressure?
-inc systemic BP -dec HR
Describe a myasthenic crisis:
-inc weakness & fatigue -resp. impairment may develop
What are common post-op complications s/p amputation? (7)
-infection -slow healing -wound dehiscence -*contractures* -edema -fall trauma -pain: phantom & residual limb
What can cause someone to sneeze?
-inflammation -foreign material in nasal passages
What can cause pleural pain?
-inflammation -infection in parietal pleura
What is the MOA of Denosumab?
-inhibits osteoclast function -dec bone resorption
What phases of the gait cycle are categorized as part of the stance phase?
-initial contact -loading phase -mid-stance -terminal stance -pre-swing
What things may be included in rehabilitation of someone with Kienbock's disease?
-initial immobilization -thermal modality (to inc blood flow) -ROM/glides
What phases of the gait cycle are categorized as part of the swing phase?
-initial swing -mid-swing -terminal swing
What are some symptoms of amyotrophic lateral sclerosis?
-initial: UE weakness, muscle atrophy -stumbling, falls -muscle twitches, cramps -weakness, paralysis progress throughout the body -dysarthria -later: impaired swallowing and respiration
What are some symptoms of myasthenia gravis?
-initial: muscle weakness in face & eyes -muscles of arms & trunk affected next -impaired vision & speech (monotone) -difficulty chewing & swallowing -head droops (neck mm) -upper resp. infections -significant problems: dysphagia & aspiration
What are some potential problems that occur with O2 deficit in tissues?
-interferes w/ energy production -increase in lactic acid (acidity - issues w/ protein folding) -loss of Na++/K+ pump -Increased Ca++ into the cell
What can cause someone to cough?
-irritation from nasal discharge dripping into oropharynx -inflammation -foreign material in lower respiratory tract
What are some symptoms of tetanus (lockjaw)? (6)
-jaw stiffness -difficulty swallowing -stiff neck -headache -skeletal muscle spasm -respiratory failure
Describe the late stages of Alzheimer's disease: (3)
-lacks awareness or interest in environment -incontinent -unable to function in any way
Appearance of sputum due to bronchiectasis.
-large amt of purulent (pus) sputum -foul odor
When looking at a person's level of function as it pertains to ADLs and home assessment, what are other areas of activity and participation you should examine? (read)
-learning and applying knowledge -general tasks and demands -communication -*movement* -self care -domestic life areas -interpersonal interactions -major life areas -community, social and civic life
How can a person's level of consciousness be affected by a neurological disorder?
-lethargy -confusion -disorientation -memory loss -unresponsiveness -difficulty in arousal (one of early changes noted?)
In general, what do rales sound like?
-light, bubbly or crackling breath sounds w/ serous secretions -popping sound during inspiration
List some general effects of neurological dysfunction (read)
-local (focal) effects -supratentorial & infratentorial lesions -L & R hemispheres -level of consciousness -motor dysfunction -sensory deficits -visual loss- hemianopia -language disorders- aphasia -seizures -inc intracranial pressure
What would be indications in your objective exam that may lead you to believe that a patient has Kienbock's disease?
-local tenderness -swelling -limited wrist motion -pain with gripping
What do the following changes in skin temperature mean: -localized inc -general inc -general dec
-localized: inflammation -inc: hyperthyroidism -dec: hypothyroidism
Stridor: -what does it sound like? -when is it heard? -what pediatric condition does it sound similar to?
-loud, musical sound during inspiration -worsened condition leads to stridor during inspiration & expiration due to tracheal stenosis -this is the same sound that is heard in kids with croup
How does Parkinson's disease affect a person's mouth/throat?
-low voice -slow, monotonous speech -dysarthria (hard to articulate speech) -difficulty chewing & swallowing -prolonged eating time -recurrent drooling -*impaired communication*
Describe how you would apply tubular elastic?
-may have 2 people do this the 1st time -stretch the dressing and let it glide off your fingers as you move up the limb to avoid shear forces -never want layers to stop in the same spot -if there are 2 layers, the first one should be more proximal
List the aspects of a PT screen (2)
-medical screening questionnaire -medical history
A Berg Balance score in the range of 21-40 means:
-medium fall risk -assisted ambulation
What are some symptoms of vascular dementia? (3)
-memory loss -apathy -inability to manage daily routine
What are some symptoms of Creutzfeldt-Jakob disease? (4)
-memory loss -behavioral changes -motor dysfunction -progressive dementia
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 some good dietary sources of calcium? (read)
-milk -yogurt -OJ w/ calcium -cheese -cottage cheese -soy milk -dark green leafy vegetables need 4 glasses of milk to reach your RDA of calcium (1200 mg/day)
What are some later symptoms of Huntington's disease?
-mood swings, personality changes -restlessness, choreiform/jerky movements in arms & face -rigidity, akinesia develop-- makes movement difficult
What should bronchial breath sounds normally sound like?
-more muffled than tracheal sounds due to more soft tissue -louder on expiration
What are potential conditions for which you could use NMES?
-muscle dysfunction due to CNS lesion (CVA, spinal cord, TBI) -post-op orthopedic -disuse atrophy -peripheral nerve injury -pain
What should you include in your PT intervention of someone with CTS under the exercises portion?
-nerve/tendon glides -posture education
The focal signs of a brain abscess indicate ______________ deficits and increased __________ develops
-neurologic -intracranial pressure
What are characteristics of anaerobic respiration?
-no O2 -cytoplasm -1 molecule of glucose -> 2 ATP molecules -results in pyruvic acid
What are some presentations you're looking for when screening the spine to rule involvement in/out?
-no history of trauma -radicular signs present -trauma with radicular signs -altered sensation in the limb -spinal cord signs -presents with abnormal patterns -suspected psychogenic pain
What are characteristics of a misfolded protein?
-non-functioning -unstable in solution -will precipitate -will be degraded to prevent harm
When are non-removable *rigid dressings* used s/p amputation? What are they made out of?
-not often due to advances in removable systems -they're applied in the operating room -usually a plaster or fiberglass cast
What conditions can lead to a chest wall restriction? (4)
-obesity -spinal kyphosis -ankylosing spondylitis -neurological disorders
What should be involved in your objective exam for someone with hand/wrist symptoms?
-observation (deformity, swelling, atrophy, color, scars) -ROM -strength -palpation -special tests -neuro/segmental exam -nerve mobility
What different assessments should you include in an objective exam? (9)
-observation/posture -scanning or screening of spine to rule it in/out -active movement -passive movement -joint play -MMT -special tests -palpation -functional tests
How can penicillin be administered?
-orally -intramuscularly -IV -intrathecal (subarachnoid space)
What are indications from the subjective exam that may help determine if a patient has a TFCC disc injury?
-pain along the ulnar aspect -crepitus (may also have difficulty with grip or weight bearing on the hand)
What clues will come up in the objective exam (mostly regarding pain) that will help you determine if a patient has a scaphoid fracture?
-pain in anatomical snuff box -*painful*/limited wrist movement -painful compression/load note: painful wrist motion more likely than limited wrist motion
When examining a patient for symptoms in the hand/wrist, what should you consider/ask questions about in the subjective?
-pain local or from elsewhere like the shoulder, forearm, or neck/thorax? -area of symptoms (palmar, dorsal, radial, ulnar) -description of the pain -N/T? pattern?
What in the objective exam would lead you to believe that a patient has a lunate dislocation?
-pain w/ palpation -limited/painful motion -positive X-ray -numbness/tingling in the median nerve distribution
What are some symptoms of herpes zoster (shingles)? (5)
-pain, paresthesia & vesicular rash develop in a line, unilaterally -pain and/or neuralgia may continue after the lesions disappear
What are things in the subjective exam that you would consider to be indications of CTS?
-pain/paresthesia -numbness -noctural pain -hand falling asleep -thenar atrophy
What would your objective exam reveal that may lead you to believe a patient may have a scaphoid-lunate dislocation?
-palpation abnormal -limited wrist motion -increased glide -positive Watson's test
Which 2 types of pain do you need to differentiate between early on in an evaluation?
-peripheral pain -central sensitization pain
Where do you measure bronchial breath sounds?
-place stethoscope over upper lobes of lungs, close to the sternum along the anterior midline of the thorax at the jugular notch of manubrium -can also hear them along the costosternal region
What causes the sound of a pleural friction rub?
-pleural membranes become inflamed which causes the lining to be rough and adherent -results in membranes rubbing against each other = pleural friction rub -cells are sticking together & causing pain
What are some common infections that penicillins are used to treat? (4)
-pneumonia -streptococcal infections -staphylococcal infections -prevention of rheumatic fever
What education should be provided to the patient and family after an amputation?
-positioning (prevent contracture) -skin inspection -family member assistance -hygiene -how to don/doff -sock management -TBI considerations
What are 3 components of the observation assessment in an objective exam?
-posture -movement limitation -caregiver support
What are 5 quick diagnostic tests you could perform to help determine if a patient has a scaphoid fracture?
-pressure in anatomical snuff box -compression of 1st metacarpal w/ axial load -pain with wrist extension -pain with resisted wrist pronation -pain when pt leans on palmar aspect of wrist (on a table) all of these will produce pain in scaphoid region
What are the theories of electrically stimulating denervated muscle?
-prevention of muscle atrophy -edema and venous stasis -decreased degeneration
When looking at the ICF model's contextual factors, what are some examples of environmental factors to consider when treating a patient and trying to help them establish their goals?
-products and technology -natural environment and human-made changes in the environment -services, systems and policies
What is the function of the coracoacromial ligament? (3)
-protect head of humerus -prevents superior dislocation of humerus -closes coracoacromial arch
What should you address with an amputee upon discharge? (read)
-protect: surgical wounds -educate: complications often develop w/out proper prosthetic care -selection of post-op device: driven by location & their access to follow-up appts
Components of a taking a history (read)
-pt profile -location of symptoms -symptom behavior -symptom history -medical history -review of symptoms
What are some visual signs someone might exhibit if they are experiencing inc intracranial pressure?
-pupil(s) fixed and dilated -ptosis: droopy eyelid -nystagmus
Tachypnea
-rapid, superficial breathing -regular or irregular rhythm
What are some things to consider in our interventions and matching those to the patient needs?
-reduce activity demands -ensure adequate supports -facilitate performance through use of environment -avoid further functional decline and excess disability caused by environmental factors (we won't be making changes but can recommend for patient benefit)
What should you do if your patient has stridor?
-refer them to a DR immediately -or send them to an ER if it comes on quickly
What are some things to consider when planning the objective exam? (read)
-reflection if you get everything -decide on peripheral or spinal exam -SINSS (identify precautions or indications) -extent of exam -predict movements/clinical tests that will confirm your hypothesis, sequence of tests and reassessment
Percussion can be done with what 2 objects?
-reflex hammer -tapping fingertips
What are risk factors for CTS?
-repetitive use of wrist and hand -diabetes -female -age -pregnancy -vitamin B deficiency
Side effects of stimulant laxatives:
-stomach pain/cramping -diarrhea
What should be focused on in post-op rehab after the repair of a Smith's/Colles' fracture?
-restore joint glides/motions -*scar massage* -soft tissue work -*edema management* -active exercises to promote circulation and nerve glides/movement *bold* are especially important in the hand because scar tissue can restrict motion, and there's not a lot of muscle to help pump out edema
What is the difference between smooth and rough ER?
-same general structure -rough has ribosomes which synthesize proteins -smooth participates in the production of lipids and cholesterol
What are some symptoms of meningitis? (8)
-severe headache -back pain -photophobia -nuchal rigidity -vomiting -irritability -lethargy progressing to stupor or seizure -fever & chills (infection)
With encephalitis, early signs of infection include: (6)
-severe headache -stiff neck -lethargy -vomiting -seizures -fever
What are *early signs* of someone experiencing increased intracranial pressure?
-severe headache -vomiting -papilledema-- swelling of the optic disc
What are symptoms of a pleural effusion?
-sharp chest pain, worse with cough or deep breaths -cough -fever -hiccups -tachypnea -SOB: shortness of breath (lol)
What are the different types of partial (focal) seizures?
-simple -complex
Bradypnea
-slow respiratory rate -deeper than usual -regular rhythm
What should vesicular breath sounds normally sound like?
-softer, almost muffled -lower sounds compared to others -sounds like listening through a pillow -inspiration is louder than expiration and may seem like it lasts much longer than expiration -no pause b/w end of expiration & beginning of inspiration
What does an abnormal vesicular breath sound sound like?
-softer, more difficult to hear -loss of strong vesicular sound could mean a lack of ventilation
What should bronchovesicular breath sounds normally sound like?
-sound like vesicular on inspiration and bronchial on expiration -means pitch changes b/w insp. & exp. (high pitched insp. and muffled exp.) -appears to be a pause b/w breaths -in kids under 13 yo, sound covers more of the chest
What can be done in the conservative treatment for TFCC disc injury? (3)
-steroid injection (for edema and pain) -PT (education, US, exercises) -splint or cast for 4-6 weeks
What are some examples of high risk medications someone with low bone mass might be on?
-steroids -aromatase inhibitors (treats breast cancer) -androgen deprivation therapy (treats prostate cancer)
3 side effects of hyperosmotic laxatives:
-stomach pain -gas -cramps
What should you focus on in the exercise program part of amputee rehab?
-stretching & ROM -strengthening: glutes, adductors, UE, core -balance
When MMT during an objective exam, what are 3 results that can happen?
-strong and painless -weak or painful contraction -strong and painful
What is the typical intervention for a lunate dislocation?
-surgical reduction -immobilization for 3-4 wks -limit wrist ext for ~2 mo. for healing
What characteristics in an objective exam might help you determine if a Boxer's fracture is present?
-swelling -pain w/ MMT
What are indications from the objective exam that may help determine if a patient has a TFCC disc injury?
-swelling -tenderness -weakness -possible instability -loading wrist into ulnar deviation & wrist extension (produce pain)
When testing AROM in the objective exam, what qualities of movement are you considering?
-symptoms reproduction -quantity of ROM -integrity of contractile and inert tissues -presence of muscle substitution -pattern of motion restriction (capsular or not) -full and pain free active ROM suggest normalcy
What are key point for objective exam (read)?
-tell pt what you are doing -test the normal side first -do active movements first, then passive, then restricted isometrics -do painful movements last -apply overpressure with care to test end feel -repeat movements or sustain certain postures or positions if history indicates -remember that with passive movements and ligamentous testing, both the degree and quality of opening are important -with ligamentous testing, repeat with increasing stress -with myotome testing make sure contractions are held for 5 seconds -warn the patient of possible exacerbations -maintain pt dignity -refer if needed
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 is symptom behavior?
-the way a person acts based on the symptoms -how does it change in 24 hrs Ex: sit to one side to alleviate pain
What should be done if bronchial sounds are heard in other areas? (Ex: bronchopulmonary segments, right middle lobes, or bilaterally in lower lobes)
-these are abnormal breath sounds and require immediate referral -could be indicative of fluid in lungs or compressed, consolidated lung
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
What should you know about post-op protocols s/p amputation? (5)
-they're *flexible* to meet pt needs & surgeon preference -should be *known by all staff* & initiated by surgical team -specific *instructions in pt chart* & bedside -*communicate* w/ prosthetist & PT -regular *staff training*
Appearance of sputum due to asthma or cystic fibrosis. If there is blood present, what does this mean?
-thick, sticky mucus -if there is blood present it could indicate a rupture of superficial capillaries or a sign of a tumor or TB
What are 3 special tests that test for CTS?
-tinel's -phalen's -reverse phalen's
What are the types of generalized seizures? (6)
-tonic-clonic (grand mal) -absence (petit mal) -myoclonic -infantile spasms -atonic (akinetic) -Lennox-Gastaut syndrome (febrile seizures)
Appearance of sputum due to a bacterial infection.
-yellowish-green -thick -cloudy
What are some later signs of Parkinson's disease? (7)
-tremors affects hands & feet, face, tongue and lips -inc muscle rigidity -difficulty initiating movements -slow movements -lack of associated involuntary movements (loss of arm swing when walking) -propulsive gait, stooped posture -complex activities become slow & difficult (ex: getting out of a chair)
What might cause secondary seizures? (7)
-tumor -infection -hemorrhage in brain -high fever in kids (febrile seizure) -renal failure -hypoglycemia -sudden withdrawal from sedatives, alcohol or drugs
When evaluating a patient's situation and how you might approach their therapy, what might be included in physical context and evaluation?
-understanding obstacles/barrier to participation -understand supports to participation -consider individual, groups and/or populations who use the physical space
What are side effects of ACh receptor antagonists?
-urinary retention -confusion -constipation -dry mouth
How does Parkinson's disease affect their autonomic function?
-urinary retention -constipation leads to UTI's and resp infections
Dyspnea
-use of accessory muscles for respiration (retraction of muscles b/w or above ribs) -accompanies at times by flaring of the nostrils
How does functional electrical stimulation work?
-uses multiple channel stimulators to recruit muscles in a sequence to facilitate functional movement through a microprocessor
What are the 2 types of vitamin D?
-vitamin D2 (ergocalciferol) -vitamin D3 (cholecalciferol)
What are 3 different intervention options for Mallet finger?
-volar splint -surgical fixation -exercises (after splinting or fixation)
What are the different ways rales can be described?
-wet or dry -fine, medium or coarse
What do wet rales indicate? What do dry rales indicate?
-wet: fluid is in the lungs & alveoli -dry: collapsed alveoli
FYI: if the patient answers yes to any of the history of resp conditions or smoking questions, what follow up questions should you ask?
-what do you do to keep your asthma under control? -when did you have cancer & what type was it?
How does exercise impact BMD in pre-menopausal women?
1-2% gains in BMD at *spine and hip* -resistance training > spine -high impact training > hip -menstrual status influenced these gains
What are 4 pharmacological treatments for osteoporosis?
1. *Bisphosphonates* 2. Teriparatide 3. Denusumab 4. SERM: selective estrogen receptor modulators
What are 3 good exercise interventions for patients with chronic pain? Which is the most effective? (bold)
1. *aerobic exercise that's dosed appropriately* 2. graded motor imagery (laterality training and mirror therapy) 3. functional movement/training
List the types of soft dressings & compression: (4)
1. ACE wrap 2. tubular elastic 3. shrinker socks 4. gel liners GAST
Where do kidney stones get stuck most often (3)?
1. Jxn of renal pelvis & ureter (ureteropelvic junction) 2. Where ureters cross pelvic brim 3. Jxn of ureters & bladder (ureterovesicle junction)
What are the 2 openings of the articular capsule of the glenohumeral joint?
1. Between the tubercles of humerus for the tendon of the long head of biceps 2. Ant & inf to coracoid to allow communications between synovial cavity of joint with subscapular bursa
What are 2 good education interventions for patients with chronic pain?
1. CBT (cognitive behavioral training) 2. TNE (therapeutic neuroscience education - subset of CBT)
When doing a gait speed test, what are the standardized cues for telling the patients how fast to walk?
1. CGS: comfortable gait speed, tell them to "walk at your usual speed" 2. FGS: fast gait speed, tell them to "walk as fast as you safely can"
What are the 3 regions of the pharynx?
1. Nasopharynx: post. to nasal cavities 2. Oropharynx: post. to oral cavity 3. Laryngopharynx: post. to larynx
What 2 layers can the dura mater be separated into?
1. Outer endosteal layer: periosteum of cranial bones 2. Inner/meningeal layer
List the 3 elevators of the pharynx.
1. Palatopharyngeus 2. Salpingopharyngeus 3. Stylopharyngeus
What are the 3 valves that help keep the pathways for food and air separate? What are their functions?
1. Soft palate: closes off naso- from oro- pharynx 2. Epiglottis: diverts food posteriorly to esophagus 3. Glottis: closes off vocal folds to keep food out of respiratory tract
List the 3 constrictors of the pharynx
1. Superior constrictor 2. Middle constrictor 3. Inferior constrictor
What are the 3 types of shoulder pain that Dr Zhang covered and how do you test for them?
1. Supraspinatus problem or bursitis, test with painful arc or shoulder drop test 2. Anterior pain, long head of bicep, tendonitis & bursitis, test with arm wrestle 3. Deep pain, subscapularis bursitis, test with IR
What are the 4 antivirals that we discussed?
1. acyclovir 2. AZT (azidothemidine) 3. indinavir 4. interferons
What are the 4 types of bisphosphonates? (read)
1. alendronate 2. risedronate 3. ibandronate 4. zolendronic acid (-dronate)
Who should receive medical treatment for osteoporosis?
1. anyone diagnosed w/ OP 2. those w/ low bone mass taking high risk medications 3. those w/ elevated FRAX risk scores
What are 2 types of calcium supplements?
1. calcium carbonate 2. calcium citrate
What emergency treatment should you provide for someone experiencing a seizure? (6)
1. clear space, gently place person on floor, position them on their side, cushion the head 2. clear potentially harmful objects from the area 3. don't force a specific position or restrain the person (lol #1) 4. don't put anything in their mouth 5. afterwards, offer reassurance & check breathing, orient pt to surroundings 6. if seizure continues or repeats, seek medical assistance
What are the 6 components of clinical problem solving which involves progress and reassessment?
1. collect data 2. evaluate data 3. develop treatment plan 4. apply treatment 5. reassess the results 6. progress the intervention
How can you work on improving an amputee's emotional well-being?
1. counseling 2. regular follow-ups w prosthetist & therapists 3. peer support: offer contact of someone who has gone through this, options of individual, group or online meetings
What are characteristics of a well-constructed residual limb? (6)
1. effective length 2. stable distal shape 3. good muscle coverage 4. proper skin coverage & tension 5. *closure in full extension & adduction for good ROM* 6. pre-op consultation w/ prosthetist
Summary of which post-op dressings provide protection from trauma: options: gauze/ACE wrap, shrinker sock, non-removable rigid, RRD, IPOP/rigid
1. gauze/ACE wraps: none 2. shrinker sock: minimal 3. non-removable rigid: excellent 4. RRD: very good 5. IPOP/rigid: very good
Summary of time to first prosthetic fitting with different post-op dressings: options: gauze/ACE wrap, shrinker sock, non-removable rigid, RRD, IPOP/rigid
1. gauze/ACE wraps: prolonged 2. shrinker sock: slightly shortened 3. non-removable rigid: shortened 4. RRD: shortened 5. IPOP/rigid: shortened
Summary of which post-op dressings allow/reduce edema and pain: options: gauze/ACE wrap, shrinker sock, non-removable rigid, RRD, IPOP/rigid
1. gauze/ACE wraps: significant amt present 2. shrinker sock: moderate 3. non-removable rigid: minimized 4. RRD: minimized if worn consistently 5. IPOP/rigid: minimized if worn consistently
Summary of which post-op dressings have what level of risk of allowing a knee flexion contracture to develop: options: gauze/ACE wrap, shrinker sock, non-removable rigid, RRD, IPOP/rigid
1. gauze/ACE wraps: very high 2. shrinker sock: very high 3. non-removable rigid: extremely low if thigh level cast, moderate if terminates under knee 4. RRD: extremely low 5. IPOP/rigid: low if worn consistently
What are some ways in which physical modalities can be helpful for patients with peripheral pain?
1. give pts a way to control their pain 2. give pts a window to perform exercises in 3. dec pain by inhibiting pain transmission at SC
Procedure to measure breath sounds
1. have pt cough a few times beforehand to clear tubes (if they have congestion) 2. place stethoscope at upper chest and move sideways & down across the chest 3. listen to a full inspiration/expiration prior to moving the stethoscope
What are goals of post-op treatment s/p amputation? (9)
1. heal wound 2. protect residual limb 3. dec pain 4. begin limb shaping 5. begin controlled WB 6. maintain or inc ROM & strength of entire body 7. teach pt to use mobility aids 8. accomplish fxnal activities 9. psych adjustments to limb loss
What are the 3 phases of rehabilitation after an amputation?
1. healing 2. maturation 3. definitive
What should you monitor in a physical exam about a person's respiratory system?
1. is breathing difficult or uneven? 2. are they using diaphragmatic breathing or the upper chest & accessory muscles? 3. can they talk comfortably while breathing or do they have to take a break before finishing sentences?
What 3 things are required in order for a joint to be classified as synovial?
1. joint capsule 2. joint cavity 3. joint cartilage
How are the following values affected by an obstructive lung disease? 1. forced expiratory volume (FEV1) 2. peak expiratory flow (PEF) 3. total lung capacity (TLC) 4. residual volume (RV)
1. lower 2. lower 3. normal or higher 4. higher
What are the 2 types of rigid dressings?
1. non-WB 2. WB
How are the following values affected by a restrictive lung disease? 1. forced expiratory volume (FEV1) 2. peak expiratory flow (PEF) 3. total lung capacity (TLC) 4. residual volume (RV)
1. normal or lower 2. normal or lower 3. lower 4. normal, lower or higher (lol)
Components of a physical exam (4)
1. observation 2. palpation 3. ausculatation 4. percussion
What are the 6 determinants of gait?
1. pelvic rotation in transverse plane 2. lateral pelvic tilt 3. lateral shift 4. knee flexion 5. ankle dorsiflexion 6. heel rise
What are the categories of antibacterial drugs we covered? (8)
1. penicillin 2. vancomycin 3. Tetracyclines 4. Chloramphenicol 5. Macrolides 6. aminoglycosides 7. sulfonamides 8. isoniazid
What are 4 aspects of the SC joint that make it more stable to be able to support the UE?
1. periarticular connective tissues surrounding 2. articular disc that provides shock absorption inside 3. uniquely shaped joint coupled with 4. tight interweaving of the costoclavicular joint fibers
List the types of rigid removable dressings: (3)
1. plaster or fiberglass cast 2. bi-valved design 3. AmpuShield by Hanger
What does the rehabilitation treatment plan of an amputee look like after they are discharged? (read)
1. post-op pain management: massage, tapping, desensitization 2. scar mobilization 3. emotional well-being 4. functional mobility 5. gait training 6. assessment of other injuries 7. exercise program: strength, stretch, balance 8. weekly follow-up 9. pt/family education 10. contracture prevention
Describe the pattern of a tonic-clonic seizure: (8)
1. prodromal signs 2. aura 3. loss of consciousness: person falls to the floor 4. *ictal stage*: strong tonic muscle contraction 5. cry as abdomen & thoracic mm contract 6. *clonic stage*: mm alternate contract & relax 7. contractions gradually subside spontaneously, leaving body limp and conscious 8. *postictal stage*: person is confused, fatigued with aching mm and falls into deep sleep
What are four ways in which antivirals could act?
1. requiring action of proteins specific to the virus 2. blocking reverse transcriptase 3. block proteases that are unique to the virus 4. using interferons to block entry into host cell
What are the 3 main types of dressings for a pt s/p amputation?
1. soft dressings & compression 2. removable rigid dressings (RRD) 3. rigid dressings
What are the 5 warning signs of a cerebrovascular accident (CVA/stroke)?
1. sudden, transient weakness, numbness or tingling in face, arm/leg, or on one side of body 2. temporary loss of speech, failure to comprehend or confusion 3. sudden loss of vision 4. sudden severe headache 5. unusual dizziness or unsteadiness
Where do you measure breath sounds?
1. tracheal 2. bronchial 3. vesicular 4. bronchovesicular (picture in slides)
What muscles make up the soft palate? (5) What innervates them?
1. uvula 2. tensor palati 3. levator palati 4. palatopharyngeus 5. palatoglossus all innervated by CN X, except tensor palati is innervated by CN V(3)
Which carpometacarpal joint has its own joint capsule?
1st CMC joint
What happens in beta oxidation?
2 carbon fragments are released in repeated cycles producing acetyl-co-A which then enters the TCA cycle
Stool thickeners should not be taken for more than:
2 days
When listening over the bowels, you would expect to hear gurgling every _______ minutes at the least
2-5
Dementia develops late in the course of Parkinson's disease in _____ % of affected individuals
20%
What % of LE amputees fall in the hospital? Of these, what % are bad enough to require revision surgery? What % of revision surgeries result in higher level amputations?
20% 3% 47%
What percent of the total gait cycle is spent in double support?
20% initial contact, loading response and pre-swing
The clavicle has ____ degrees of freedom. What motions does this encompass?
3 DOF -elevation/depression -protraction/retraction -rotation
How many base pairs of DNA are found in humans? How many genes?
3 billion; 20,000-25,000 genes
What muscles form the pharynx?
3 constrictor muscles 3 muscles that elevate the pharynx
Anti-spasmodic drugs shouldn't be taken for more than:
3 days
How many trials should you include in a gait speed test?
3 trials (don't include the time it takes them to turn around)
SC joint dislocations account for about what percentage of shoulder girdle injuries?
3%
If a person walks less than _________ meters during a 6 minute walk test, they have poor short-term and long-term survival rates
300
How many molecules of ATP does 1 molecule of glucose produce in the Kreb's Cycle?
34 ATP
About what percent of time during a full gait cycle is spent in the swing phase?
40%
What percent of the total gait cycle is spent in single support?
40% mid-stance, terminal-stance (initial swing, mid-swing and terminal swing don't count bc the foot you are looking at is in the air)
A clavicular fracture accounts for ~ ____ to _____% of all shoulder girdle injuries and most commonly happens in what population?
40-50% of injuries males under 30 y.o. (due to contact sports and traffic-related injuries)
How many arterial arches from the ulnar artery are in the distal forearm and hand?
4
There is about ____cm of displacement side-to-side of the center of mass during a gait cycle
4 cm
How long can the effects of PPIs can last?
4 weeks
When does a pt receive an initial prosthesis and begin prosthetic gait training after an amputation?
4-12 wks give them a broad range
When does ongoing therapy and prosthetic adjustments begin after an amputation?
4-6 months
When is the incision fully healed and a cast made for a prosthesis after an amputation?
4-8 wks
What is the cutoff score for the Berg Balance Test?
45
What are the branches of the radial artery?
5 Radial recurrent artery, palmar and dorsal carpal branches, and superficial and deep palmar branches
There is about ____cm of displacement vertically of the center of mass during a gait cycle
5 cm
What groups can the posterior forearm muscles be divided into in terms of dissection? Does Zhang like this?
5 groups: Zhang likes this 3 lateral side- BR, ECRL, ECRB 3 for thumb- APL, EPB, EPL 3 for other digits- ED, EDM, ECU 1 for index- EI 1 for supination- supinator
What groups can the posterior forearm muscles be divided into functionally? Does Zhang like this?
5 groups: Zhang thinks its okay but likes another way better Flex elbow Extend, abduct, adduct wrist Extend digits Extend, abduct thumb Supinate
How long do absence seizures last?
5-10 seconds
What is the average value for step angle?
5-7 degrees
How many types of joints are there?
6
How many tendon sheaths are there for the forearm extensors (posterior compartment)?
6 1. APL & EPB 2. ECRL & ECRB 3. EPL 4. ED & EI 5. EDM 6. ECU
With pelvic rotation in the transverse plane, there are about ____ to ____ degrees of total motion
6 - 10
Which test can estimate VO2 max via an equation?
6 minute walk test
Which test is the gold standard for an endurance test?
6 minute walk test
How long may immobilization be required after a carpal fracture to allow proper healing?
6 mo
When does a pt receive a definitive prosthesis after an amputation?
6 mo - 1 yr a pt's quality of fit will improve, plateau, & actually start to get worse-- this is when you need to refer them back to a prosthetist for a definitive prosthesis
How long does it take to administer the MMSE?
6-10 minutes
A vaccine for herpes zoster (shingles) is recommended for people over the age of:
60
What is the ROM of the sternoclavicular joint like?
60 degrees ant/post 25-30 degrees inferior (allows for wide ROM of UE)
About what percent of time during a full gait cycle is spent in the stance phase?
60%
How long is a non-removable rigid dressing left on an amputee s/p amputation?
7-15 days less if there are signs of complications
What age is at risk for vascular dementia?
70+
In developing countries, ___% of the population carries the bacteria that can cause ulcers
70-80%
In the gait speed test, older adults averaged ____ to ____ % slower than young adults
71-95%
How many branches does the ulnar artery have and what are they?
8 anterior and posterior ulnar recurrent, common interosseous, muscular branches, palmar and dorsal carpal branches, superficial and deep palmar branches
How many items are on the Dynamic Gait Index (DGI)?
8 includes dynamic component and stairclimbing
What is the average value for step width?
8-10 cm or 3-4 in
What is the average human walking speed?
80 m/min (or 1.3 m/sec)
London doctor said _____ % of the time, the pt will tell you what's wrong with them
80%
What is the posterior cutaneous nerve?
A branch from the radial nerve that supplies the skin on the posterior forearm
What is the anterior interosseous nerve?
A branch of the medial nerve, runs along the front of the interosseous membrane with the anterior interosseous artery of the ulnar artery.
What is the cause of ulnar nerve injuries?
A direct hit against a hard object or fracture or medial epicondyle. The ulnar nerve is less commonly injured at the canal of guyon
What joint is the coracohumeral ligament a part of? What part of the joint capsule does it reinforce?
A part of the glenohumeral joint capsule that reinforces the superior side
What joint is the coracoacromial ligament a part of and what part of the joint capsule does it reinforce?
A part of the glenohumeral joint capsule, runs from the acromion to the coracoid process. It prevents superior dislocation of the joint
What happens in an elbow dislocation?
A posterior dislocation may occur due to a fall, overextension of the elbow, or a direct blow. Might be associated with fractures of the radius or ulna and the ulnar nerve may be injured
What is a urachal sinus?
A remnant of the urachus that connects to the umbilicus
What do the stretch receptors in the bladder stimulate?
A spinal reflex arc Causes parasympathetic firing leading to contraction of detrusor M causing urination if its strong enough to open internal urethral sphincter
What are the advantages & disadvantages of rigid dressings?
A: -dec falls -early intro to ambulation & prosthetic use -inc acceptance of limb loss D: -bulky & heavy -*poor suspension* -might apply too much weight too soon -*must have compliant pt* -trained & diligent rehab team required -time consuming -no visual wound inspection -post-op pain may be mistakenly attributed to dressing
What are the advantages & disadvantages of ACE wrapping s/p amputation?
A: -cheap -readily available -minimal tension across suture D: -re-apply often, -*doesn't prevent knee flexion* -non-WB -uncertain amt of compression -min protection from accidental trauma -complications if incorrectly done -requires flexibility -hand strength & endurance for indep. donning
What are the advantages & disadvantages of the AmpuShield RRD by Hanger Clinic?
A: -custom fit or fabricated- scans or measurements -allows wound inspection, dressing changes & PT -light weight -easy to clean -*adjustable compression* D: not for WB (nude-color RRD w/ black straps he passed around in class)
What are some advantages and disadvantages of the silicone liners?
A: -excellent adhesion -*equalized compression* -compression & properties of gel can minimize scar tissue -easily cleaned -early pt opportunity to learn to use silicone liner D: -*traps heat & moisture* -skin can macerate -requires hand dexterity to don/doff -min protection against trauma -needs daily cleaning & follow-up
What are the advantages & disadvantages of shrinker socks & tubular elastic?
A: -many sizes readily available -can be more effective than ACE wrap in dec limb volume D: -difficult to don w/out assistance -apt to roll down transfemoral limbs -replaced as they stretch out or volume dec -may irritate bony prominences or sensitive areas
What are the advantages & disadvantages of RRDs in general?
A: -removable for inspection -protects & compresses limb -improves healing -dec LOS -AmpuShield designs can be washed -bi-valved & AmpuShield limit knee flexion -mimics partial WB -used w/ soft dressings D: -potentially removable by non-compliant patients -requires skilled team -shorter version of plaster or fiberglass cast doesn't limit knee flexion -not designed for ambulation -may need to be replaced w/ sig. volume loss
How does the quality of compression provided by an ACE wrap, tubular elastic and silicone liners compare to each other?
ACE: uncertain amt of compression TE: uniform compression SL: equalized compression
What is the difference between an acute or chronic subdural hemorrhage?
Acute: often times an artery was torn, high pressure vessel, blood leakage is quick and spreads over brain and compresses it Chronic: often times a vein was torn, low pressure vessel, blood leakage is slow, more common
Where do the constrictor muscles of the pharynx insert? What are they innervated by?
All 3 insert on the median raphe of the pharynx All 3 are innervated by pharyngeal plexus (CN X) via the pharyngeal branch of the vagus
Where does the superficial muscle group of the anterior forearm all originate from?
All 5 muscles originate form the medial epicondyle
What diseases may result from proteopathies? (misfolded proteins)
Alzheimer's Parkinson's Huntington's Diabetes Mellitus Mad Cow Creutzfeldt-Jakob disease Amyloidoses
Which RRD do you want off for a minimum of 30 min 2x/day and why? options: plaster or fiberglass cast, bi-valved or AmpuShield
AmpuShield b/c don't want moisture to build up
What divides the sternoclavicular joint into 2 compartments?
An articular disc which is fixed to the articular capsule and by the interclavicular ligament
What is the sacciform recess and what is its function?
An extension of the fibrous capsule that is kind of an L shape that runs from on top of the ulna to in between the ulna and radius. It is important for the distal radioulnar joint to function
What is pronator syndrome?
An injury to the median nerve due to compression from the heads of the pronator teres. Results in pain and tenderness in proximal anterior forearm
Which cranial fossa contains the frontal lobes, crista galli, cribiform plate, and orbital plates?
Anterior
What compartments is the forearm divided into?
Anterior (anteromedial) and posterior (posterolateral) compartments
Do aneurysms occur in the anterior or posterior circulation more often?
Anterior 85% of the time
Which 3 arteries make up the anterior circulation of the brain?
Anterior cerebral Internal carotid ** Middle cerebral
Which compartment are the radial and ulnar arteries in?
Anterior compartment of the forearm
What are the branches of the median nerve?
Anterior interosseous nerve, palmar cutaneous branch, and recurrent branch of median nerve
Is an anterior or posterior dislocation of the humeral head more common?
Anterior, its caused by obtaining a blow to the arm when your shoulder is abducted
List the 3 cranial fossae
Anterior, middle & posterior cranial fossae
What is anterior, posterior and inferior to the bladder?
Anterior: pubic sympysis Posterior: rectum in males, uterus in females Inferior: prostate in males, and pelvic diaphragm in females
Where does the joint capsule of the distal radioulnar joint thicken?
Anteriorly and posteriorly
How many muscles are in the arm vs the forearm?
Arm: 4 Forearm: 19
Where is a nucleus typically found within a cell?
Attached to the ER
How does exercise impact BMD in kids?
BMD inc over 6 months at *hip & spine* -1-6% gains before puberty -0.3-2% gains during adolescence
What 3 muscles in the posterior compartment of the forearm are literally on top of each other?
BR - ECRL - ECRB
What type of joint is the glenohumeral joint?
Ball and socket (synovial)
What are the building blocks of DNA?
Base Sugar Phosphate
Why are there more side effects with ACh M1 Receptor Antagonists?
Bc there are ACh receptors located all over the body (including the brain)
Part
Bear, give birth to; Example: Parturient; Concerning childbirth
Gon
Become, seed; Example: Glucagons; Glucose producing
Describe the pathway of the superior sagittal sinus
Begins at crista galli, runs with falx cerebri, ends at internal occipital protuberance where it joins with the confluence of the sinuses
Lord
Bent forward; Example: Lordosis; Forward curvature of the spine
What is the most widely used global measure of gait and balance performance?
Berg Balance Test
Which test is the preferred method for research especially in neuro patients?
Berg Balance Test
Where does blood acumulate in a subdural hemorrhage?
Between dura and arachnoid mater
Where is the subdural space?
Between dura and fluid impermeable layer of arachnoid mater
Where in the meninges are there tight intercellular junctions to contain CSF?
Between outermost layer of arachnoid mater and dura mater
Where are the venous sinuses of the head located?
Between the 2 layers of the dura
Where are the subacromial and subdeltoid bursae?
Between the acromian and supraspinatus tendon. Between joint capsule and deltoid
Where is the subscapular bursa?
Between the tendon of subscapularis and the neck of the scapula
The tendon of what muscle passes through the joint capsule of the glenohumeral joint between the tubercles of the humerus?
Biceps brachii (long head)
Halluc
Big toe; Hallux valgus
What muscles does the radial nerve travel between?
Brachialis and brachioradialis, then it divides into 2 branches
Which muscle is an exception to the posterior compartment of the forearm in terms of those muscles being extensors?
Brachioradialis, it flexes the elbow instead and also supinates it. It is actually located on the anterolateral aspect of the forearm
What foramen does the middle meningeal A travel through and what does it branch off of?
Branches off maxillary A and goes through foramen spinosum Then it gives off a frontal & parietal branch
Fract
Break into pieces; Fracture
What is a hangman's fracture?
Breakage of the posterior arch of the axis
Mamm
Breast; Example: Mammogram; A radiograph of the mammary gland
Mast
Breast; Example: Mastectomy; Removal of the breast
Which cranial nerves form the wall of the cavernous sinus?
CN III CN IV CN V (1) CN V (2) CN VI is in the sinus but doesn't form the lateral wall
Bronchitis, asthma and emphysema are examples of what kind of disorder?
COPD
What is produced in the choroid plexuses within the lateral, 3rd and 4th ventricles?
CSF
Repeated attacks of TIA are a warning sign of:
CVA (stroke)
What are two conditions to where there may be clinical application for functional e-stim?
CVA and SCI
Is the auditory tube normally open or closed to the nasopharynx?
Closed, it opens only when one swallows to equalize air pressure
Cleido
Collarbone; Sternocleidomastoid
What fracture results in a dinner fork deformity?
Colles' fracture
What is the most commonly occurring fracture in the wrist joint?
Colles' fracture
What is known as the "Central dogma of biology"?
DNA makes RNA makes Protein
Chorea
Dance; Chorea-form movements
Necr
Death; Example: Necrology; Statistics or records of death
Which osteoporosis drug is considered for patients with kidney dysfunction?
Denosumab
Which osteoporosis drug is a humanized monoclonal antibody against RANKL protein?
Denosumab FDA approved in 2010
Lytic
Destroy, reduce; Example: Electrolytic; Destroy with electricity
Heter
Different; Example: Heterogenous; Different components
What causes AC joint dislocation?
Direct impact to shoulder or outstretched arm which tears the coracoclavicular ligament resulting in a downward separation of UE, the AC joint capsule is also torn
Path
Disease; Example: Pathophysiology; The physiology of disease
Lysis
Dissolution, loosening; Example: Hemolysis; Blood destroying
What articulates with what in the wrist joint?
Distal end of radius with the first row of carpals (scaphoid, lunate, triquetrum) Not pisiform
What articulates with what in the carpometacarpal joints?
Distal row of carpals with base of metacarpals
What are the branches of the ulnar nerve in the anterior forearm?
Dorsal cutaneous branch, Palmar cutaneous branch, Superficial branch, Deep branch, muscular branches
Where does the kidney develop?
Down in the pelvis and migrates up, the opposite of the gonads
What are some other means that can cause cell damage besides lack of O2?
Drugs Microorganisms Abnormal metabolites Nutritional deficits Imbalance of fluid or electrolytes Extreme temperatures
Ambly
Dullness; Example: Amblyopia; Dimness of vision
The falx cerebri, tentorum cerebelli, falx cerebelli, and diaphragma sellae are folds of what tissue?
Dura mater
What is between the 2 dural layers?
Dural sinuses
Ot
Ear; Example: Otoscope; Device to view ear
Myring
Eardrum; Example: Myringitis; Inflammation of the tympanic membrane
Oo
Egg, ovum; Example: Oogenesis; The process of formation of ova
Ov
Egg; Example: Oviduct; Passage through which ova leave body
Fractures of the skull can lead to which type of hemorrhage?
Epidural hemorrhage
Bleeding from a torn meningeal vessel may lead to what type of hemorrhage?
Epidural/extradural
Is(o)
Equal, same; Example: Isometrics
Where does the pharynx extend to and from?
Extends from base of skull to esophagus (~C6)
Which urethral sphincter is under voluntary control?
External urethral sphincter
Ocul
Eye; Example: Oculogyric; Pertaining to or causing movement of the eyeballs
Ophthalm
Eye; Example: Ophthalmia; Inflammation of the eye
When are fine, medium & coarse rales heard?
F: at the beginning of inspiration when air first enters tree M: at any stage of inspiration C: at any stage of inspiration
What muscles does the ulnar nerve run between?
FDP and flexor carpi ulnaris (it innervates both of these)
T/F: all RRD's are non-weight bearing
False There was a slide in Matt's presentation titled WB RRD's, basically was a RRD w/ a prosthetic foot attached, but he skipped it. All the ones we learned about are non-WB, although you can begin to simulate WB
Lepto
Fine, thin, slender; Example: Leptocephalus; An abnormally tall, narrow skull
What fissure does the falx cerebri run within?
Fissure between 2 cerebral hemispheres
Which muscles are in layer 2 of the anterior forearm?
Flexor digitorum superficialis
What is the only muscle that flexes the IP joint of the thumb?
Flexor pollicis longus
Why should infants never be allowed to drink while laying on their backs?
Fluid in the oropharynx can reflux up into the nasopharynx. This increases the likelihood of fluids being pulled into the auditory tube leading to middle ear infections
What is the heimlich maneuver?
Food gets stuck at the narrowest part- jxn of esophagus and pharynx, this causes reflex closure of the glottis. Heimlich results in forced increased abdominal pressure to expel stuck food
Where is the radial collateral ligament?
From the lateral epicondyle to the anular ligament of the radius
Where is the ulnar collateral ligament?
From the medial epicondyle to the coronoid process & olecranon of the ulna
Which arteries supply the frontal, temporal, and occipital lobes?
Frontal: ant. cerebral A Temporal: mid. cerebral A and post. cerebral A Occipital: post. cerebral A
How do you find the superficial and palmar arches?
Fully extend your thumb, the superficial arch is at the same level as your thumb. The deep arch is about 1 cm proximal
Which ligaments surround the glenohumeral joint?
Glenohumeral ligaments Coracohumeral lig Transverse humeral lig Coracoacromial lig
Why is it important for transfemoral amputees to have good glute strength?
Glute max. controls the flexion moment that occurs w/ initial contact & allows them to extend in mid-stance
Gingiv
Gum; Example: Gingivitis; Inflammation of the gums
the NIH discovered that ulcers can be caused by:
H. pylori bacteria
Eating stimulates the stomach to produce:
HCl
How do you test for subscapular bursitis?
Have pt medially rotate and place their arm behind their back. This should produce a lot of pain if positive
What articulates with what in the proximal radioulnar joint?
Head of radius with radial notch of ulna
What articulates with what in the distal radioulnar joint?
Head of ulna with ulnar notch of radius
What type of joints are interphalangeal joints? (DIP, PIP, IP)
Hinge (synovial)
What is a major regulator of acid secretion in the stomach?
Histamine
What are the articulations of the elbow joint?
Humeroulnar Humeroradial Proximal Radioulnar
Kyph
Hump; Example: Kyphosis; Abnormal convexity in the thoracic spine
What is whiplash? What are the results?
Hyperextension of the neck due to sudden acceleration ALL and ant neck muscles are often damaged, also fracutres of C1 & C2, ruptured discs, and hangman's fractures can happen
What is the mixed autonomic/visceral plexus in the pelvis called?
Hypogastric plexus
What may lack of O2 lead to?
Hypoxia (low O2 in blood) Ischemia (low O2 in tissues) Infarction (cell death from low O2)
How does sympathetic discharge at ejaculation prevent retroejaculation?
It causes the internal urethral sphincter to close
What will happen as a result of an ulnar nerve injury?
If you ask the patient to make a fist, it will result in a "claw hand" DIP flx of digits 4-5 is lost Impaired adduction of digits Numbness & tingling in medial part of palm and digits 4 & 5
What will happen as a result of a median nerve injury?
If you ask the patient to make a fist, it will result in a "hand of benediction": PIP flx of digits 1-3 is lost, 4-5 is weakened. DIP and MCP flx of digits 2 & 3 is lost
How are the muscles of the anterior forearm organized?
In 2 groups and 4 layers: Superficial group: layers 1 and 2 Deep group: layers 3 and 4
Where are the muscles bellies of the forearm muscles located?
In the proximal part of the forearm, they become tendons as they continue into the wrist
What runs within the free edge of the falx cerebri?
Inferior sagittal sinus
What is the clinical importance of tendon sheaths?
Inflammation spreads within each sheath Make sure you inject into the right compartments
Itis
Inflammation; Example: Carditis; Inflamed heart
What is the insertion & innervation of all of the constrictor muscles of the pharynx?
Insertion: median raphe Innervation: CN X
Graph
Instrument to record; Example: Cardiograph; Heart recorder
Meter
Instrument used to measure; Example: Goniometer; Instrument to measure angles
What is an example of a cartilaginous joint?
Intervertebral discs Head with neck of femur
What happens to the tendon of supraspinatus after it becomes inflammed?
It also begins to calcify
Where does the median nerve run in relation to pronator teres?
It can run between the heads, through it, or underneath it. In certain cases this can cause the nerve to be impinged when the pronator teres contracts
What is the recurrent branch of the median nerve?
It is a branch of the median nerve that branches off after the flexor retinaculum and supplies the thenar eminence
What is the radial recurrent artery?
It is a branch off of the radial artery that comes off distal to the elbow and then goes back towards the lateral epicondyle
What is the pharynx?
It is a funnel-shaped muscular tube that is a common route for both food & air
What is the palmar cutaneous branch of the median nerve?
It is a small branch of the median nerve that does not travel through the carpal tunnel, so when patients have carpal tunnel, they will loose sensation in their fingertips but still have sensation in the palms of their hands due to this nerve
What is elbow tendonitis/lateral epicondylitis?
It is also called tennis elbow. Its caused by repetitive forceful flexion and extension of the wrist. This results in inflammation of the periosteum of the lat epicondyle and causes pain that starts here and radiates down the posterior forearm
What do we need to know about pelvic lymphatic drainage?
It is highly interconnected so drainage can pass in almost any direction to any pelvic or abdominal organ
Where can you palpate the abductor pollicis longus tendon?
Just lateral to the EPB tendon of the snuff box
What may help improve stress incontinence?
Kegel exercises Estrogen treatment in some post-menopausal women
Nephr
Kidney; Example: Nephroma; A tumor of kidney tissue
Gangl
Knot; Ganglion cyst
What nerve roots make up the lumbosacral trunk?
L4 and L5
What must be present for pyruvate to turn into lactic acid?
LDH (lactate dehydrogenase)
Phak
Lens of the eye; Example: Phakitis; Inflammation of the lens of the eye
What often causes a subluxation and dislocation of the radial head?
Lifting children by pulling their arms
Labi
Lips; Example: Labiogingival; Pertaining to the lips and gums
Artic
Little joint; Example: Articular; Pertaining to a joint
Hepat
Liver; Example: Hepatitis; Liver inflammation
Metry
Measurement; Example: Audiometry; Measurement of hearing
What is the function of CSF?
Mechanical & protective support for the brain, and serves as an ion sink
What does the joint capsule of the intermetacarpal and carpometacarpal joints include?
Medial 4 CMC and IMC joints have a common capsule 1st CMC has its own capsule
Where is the articular capsule of the glenohumeral joint strong?
Medially: attaches to glenoid cavity. Laterally: attaches to anatomical neck of humerus. Superiorly: attaches to scapula Inferiorly: capsule is loose
What does the bladder leave behind as it recedes into the pelvis?
Median umbilical fold over the urachus (urinary canal of fetus)
How many muscles do the median and ulnar nerves innervate in the forearm?
Median: 6.5 Ulnar: 1.5
Which cranial fossa contains the temporal lobes, dorsum sellae, posterior clinoid processes of sphenoid bone, and petros & squamous portions of temporal bones?
Middle
Galact
Milk; Example: Galactopyra; Milk fever
Lact
Milk; Example: Lactogen; A substance that stimulated mild production
Where does the obturator A normally come off and where does it come off sometimes?
Normal: internal iliac A Aberrant: inf epigastric A
Nas
Nose; Example: Nasogastric Tube; inserted in the nose to the stomach
What is the O, I, N, F of flexor pollicis longus?
O: anterior radius & interosseous membrane I: base of distal phalanx of 1st digit N: median nerve F: flexes IP, MCP CMC joints of the thumb, also flexes the wrist
What is the O, I, N, F of pronator quadratus?
O: distal anterior ulna I: distal anterior radius N: median nerve F: pronates forearm, also helps interosseous membrane hold the radius and ulna together
What is the O, I, N, F of extensor carpi radialis brevis?
O: lateral epicondyle I: base of 3rd metacarpal N: radial nerve F: extend and abduct the wrist, also steadies the wrist when making a fist
What is the O, I, N, F of extensor carpi ulnaris?
O: lateral epicondyle I: base of 5th metacarpal N: radial nerve F: extends and adducts wrist, and steadies it when making a fist (w/ ECRL and ECRB)
What is the O, I, N, F of extensor digiti minimi?
O: lateral epicondyle I: extensor expansion N: radial nerve F: extends DIP, PIP, MCP, and wrist joints It splits into 2 parts and the lateral tendon joints with the ED
What is the O, I, N, F of extensor digitorum?
O: lateral epicondyle I: extensor expansion N: radial nerve F: extends digits 2-5 at all joints
What is the O, I, N, F of supinator?
O: lateral epicondyle, radial collateral and annular ligaments I: lateral anterior/posterior surface of radius N: radial nerve F: supinates forearm along with biceps
What is the O, I, N, F of flexor carpi radialis? (and what does it lie just medial to?)
O: medial epicondyle I: 2nd metacarpal N: median nerve F: flex and abduct the wrist at the same time Lies just medial to the radial artery
What is the O, I, N, F of palmaris longus?
O: medial epicondyle I: flexor retinaculum & palmar aponeurosis N: median nerve F: protracts nails out we don't need this muscle anymore and about 16% of caucasians do not have it
What is the O, I, N, F of extensor pollicis brevis?
O: posterior radius I: base of proximal phalanx of thumb N: radial nerve F: extends thumb at MCP, CMC, and wrist, also abducts wrist
What is the O, I, N, F of extensor pollicis longus?
O: posterior radius (ulna according to google) I: base of distal phalanx of thumb N: radial nerve F: extends thumb at IP, MCP, CMC and wrist, also adducts thumb when extended
What is the O, I, N, F of extensor carpi radialis longus?
O: supraepicondylar ridge I: base of 2nd metacarpal N: radial nerve F: extends and abducts the wrist, also steadies the wrist when making a fist
What is the O, I, N, F of brachioradialis?
O: supraepicondylar ridge I: lateral surface of radius N: radial nerve F: flexes elbow, supinates forearm
What is the O, I, N, F of flexor digitorum profundus?
O: ulna & interosseous membrane I: base of distal phalanges N: digits 2 &3 median nerve, digits 4 & 5 ulnar nerve F: flex DIP, PIP, MCP and wrist joints
What is the O, I, N, F of extensor indicis?
O: ulna and interosseous membrane I: 2nd extensor expansion N: radial nerve F: extends the index finger at DIP and PIP independently, also helps extend wrist
What does the greater occipital N come out below?
Obliquus capitis inferior
What portions of the brain does the tentorium cerebelli separate?
Occipital lobes from the cerebellum
Which sinus runs in the junction of the falx cerebelli with the occipital bone?
Occipital sinus
Ger
Old age, aged; Example: Gerontologist; Physician who specialized in elderly adults
How do growth factor receptors work?
One kinase phosphorylates a protein that then becomes active, looks for its target and activates that by phosphorylation, activates another enzyme by phosphorylation, signal to move into the nucleus, causes another binding within the nucleus
Ician
One who; Example: Geriatrician
Mon
One; Example: Monospasm; Spasm of a single limb or part
Genesis
Origin, cause; Example: Pathogenesis; The development of disease
What does the deep branch of the radial nerve innervate?
Pierces the supinator and innervates all the extensor muscles (becomes the posterior interosseous nerve)
What does the diaphragma sellae cover?
Pituitary gland within the sella turcica
What type of joint is the distal radioulnar joint?
Pivot (synovial)
What type of joint is the proximal radioulnar joint?
Pivot (synovial)
What type of joint is the acromioclavicular joint?
Plane (synovial)
What type of joints are intermetacarpal joints?
Plane (synovial)
What type of joints are the intercarpal joints?
Plane (synovial) There is a small amount of gliding between carpal bones, they also often participate in wrist movement
What type of joints are carpometacarpal joints?
Plane (synovial) Except the 1st CMC joint is a saddle joint
What is the function of the 4 tonsils (8 total) in both the nasal and oral pharynx?
Protect the entrances to the respiratory & digestive tracts
What nerve innervates the posterior compartment of the forearm?
Radial nerve
Which muscles make up the suboccipital triangle?
Rectus capitis major Obliquus capitis superior Obliquus capitis inferior
Which 4 muscles are innervated by the subocciptal N?
Rectus capitis post. minor Rectus capitis post. major Obliquus capitis superior Obliquus capitis inferior
What motions cause inflammation of the supraspinatus tendon?
Repetitive use of the upper limb above the horizontal level or forceful throwing
What is the ROM of the AC joint like?
Rotation of the acromian is as much as 50 degrees under the clavicle
What keeps the humeral head in the glenoid cavity?
Rotator cuff muscles
What joint is the transverse humeral ligament a part of and what does it hold in place?
Runs from greater tubercle to lesser tubercle of humerus. It holds the long head tendon of the bicep in place. It is a part of the glenohumeral joint capsule.
What is the most common cause of a subarachnoid hemorrhage?
Rupture of an aneurysm as arteries pass within the subarachnoid space Results in severe headache, stiff neck, loss of consciousness
What nerves does the inferior gluteal N pass between?
S2 S3
What nerve roots make up the pudendal nerve?
S2, S3, S4 "keep poop, pee, & penis off the floor" Ext urethral & anal sphincters, motor & sensory to ext genitalia
What is the external urethral sphincter innervated by? What type of muscle is it?
Skeletal muscle somatic NS (Pudendal N)
What does the superficial branch of the radial nerve innervate?
Skin on dorsum of hand and some hand joints
Hypn
Sleep; Example: Hypnalgia; Pain during sleep
Gracile
Slender; Gracilis muscle
What is a urachal cyst?
Small fluid filled cyst above bladder and below umbilicus
What is the internal urethral sphincter innervated by? What type of muscle is it?
Smooth muscle Autonomic NS sympathetic: closed parasympathetic: open
Lei
Smooth; Example: Leiodermia; Dermatitis characterized by abnormal glossiness or smoothness of the skin
What actions cause involuntary leaking in stress incontinence?
Sneezing, coughing, laughing, or heavy lifting
What is an example of active transport that we discussed?
Sodium Potassium Pump -transports 3 sodium ions out of the cell and 2 potassium into the cell both are towards high concentration (maintains gradient from reversing)
What allows one to forcibly blow out one's mouth or nose?
Soft palate
What structure is also referred to as the velum?
Soft palate
Malacia
Softening; Example: Chondromalacia; Softening of the cartilage
What is the vallecula?
Space b/w base of tongue and epiglottis
Acanth
Spine, prickle; Example: Acanthocyte; A distorted erythrocyte with a thorny appearance
How are amyloid deposits formed?
Starts from proteins from AS, PD, TTR and other diseases Proteins misfolded and assemble into oligomers and fibers All aggregates share common amyloid fold
Ism
State of; Example: Dwarfism; State of being a dwarf
What are the joints of the pectoral girdle?
Sternocalvicular joint Acromioclavicular joint Scapulothoracic joint The last one is a conceptual joint and not a real joint
Lith
Stone; Example: Fecolith; Hardened stool
What is the function of the smooth ER in muscles?
Stores Ca++ in addition to its normal functions
Orth
Straight, correct,normal; Example: Orthopnea; Difficult breathing except in the upright position
What type of incontinence is almost exclusively female?
Stress incontinence especially common if they have given birth
Where is the joint capsule of the elbow strong and weak?
Strong: on each side Weak: anterior & posterior
Narc
Stupor; Example: Narcolepsy
Which type of hemorrhage results in a bloody spinal tap?
Subarachnoid hemorrhage
Are epidural or subdural hemorrhages very prominent in the elderly?
Subdural
Gen
Substance or agent that produces or causes ; Example: Pathogen Any disease-producing agent
What are the bursae of the elbow called and where are they located?
Subtendinous Olecranon Bursa: b/w olecranon and distal tricep tendon Intratendinous Olecranon Bursa: someimtes inside tricep tendon Subcutaneous Olecranon Bursa: in the subcutaneous CT over olecranon
Diadocho
Succeed, take over; Example: Diadochokinesia; Rapid, alternating movements
Gly(glycos)
Sugar; Example: Glycolysis
What groups can the posterior forearm muscles be divided into anatomically? Does Zhang like this?
Superficial and Deep groups Zhang doesn't like this
What 4 bones come together at the pterion?
Temporal Sphenoid Parietal Frontal
Which muscles help open the auditory tube when you swallow? (2)
Tensor palati m Salpingopharyngeus m
Which type of osteoporosis drug is an anabolic "bone building" agent?
Teriparatide taken daily as a subcutaneous injection
Orch (I, id)
Testis; Example: Ochiopathy; Any disease of the testis
What is a Z score (in terms of osteoporosis)?
The # of standard deviations from age matched mean density
What is a T score (in terms of osteoporosis)?
The # of standard deviations from the young adult mean BMD
What separates the 2 compartments of the forearm?
The 2 bones and the interosseous membrane
What branches off of the vertebral AA? (5)
The 2 vertebral AA come together to form the basilar A which then gives off.. Post. inf. cerebellar AA (PICA) Ant. inf. cerebellar AA (AICA) Sup. cerebellar AA Post. cerebral AA Post. communicating AA
What are the extensor expansions of the extensor digitorum?
The ED tendons flatten to form the extensor expansions that wrap around the back and sides of the head of the metacarpals and proximal phalanges. The proximal portion is called the hood. After the hood, the expansions divide into a central band that goes to the middle phalanges and 2 lateral bands that go to the distal phalanges
How are the tendons of FDS and FDP laid out?
The FDS tendons split in 2 and insert onto the middle phalanges, the FDP tendons run through this split to insert on the distal phalanges
What does the term leptomeninges mean?
The combination of pia and arachnoid meninges
What is the pudendal canal formed by?
The epimysium of the obturator internus muscle
What do we need to know about the ligaments in the wrist joint?
The joint capsule is strengthened on palmar, dorsal, medial, and lateral sides creating a whole bunch of ligaments Palmar & dorsal radiocarpal ligs Ulnar & radial collateral ligs
What does it mean when they say you can have either an anterior or posterior dislocation of the humeral head?
The long head triceps tendon is inferior to the joint, so the humeral head can either dislocate anterior or posterior to the tendon, but all dislocations are truly inferior dislocations
How do you test to see if the median nerve sensation is intact without also testing the ulnar nerve?
The median nerve innervates finger 1-3 and half of 4, the ulnar nerve innervates the other half of 4 and all of 5. So you would test sensation in one of the first 3 fingers
What is osmosis?
The movement of water from an area of low concentration of molecules to a high concentration of molecules (trying to achieve same ratio of water:molecules)
Why can the radial artery be used as a graft and the ulnar artery can't be?
The radial artery is connected to the ulnar artery by the arches, so blood supply will not be lost to those areas. The ulnar artery has additional branches that the radial artery does not connect to (common interosseous artery) so it cannot be used as a graft
Which of the olecranon bursae is the most problematic and why?
The subcutaneous bursa, when you rest your elbows on the table you are putting pressure on this bursa which can lead to bursitis of the elbow which is often called student's elbow
What forms the superficial and deep palmar arches?
The superficial and deep palmar branches of the ulnar artery anastomose with the superficial and deep palmar branches of the radial artery to form these arches.
What are intertendinous connections?
The tendons of the 4th and 5th digits and the 2nd and 3rd digits were initially fused. Their tendons are still connected in small segments
Which ligament of the elbow consists of 3 bands and what are the bands called?
The ulnar collateral ligament Anterior cordlike band Posterior fanlike band Oblique band
Where does a bladder in a newborn extend up to?
The umbilicus
What does the fibrous capsule of the intercarpal joints look like?
There is a Common Fibrous Articular Capsule that encloses all of the intercarpal joints
What are the anterior ulnar recurrent and posterior ulnar recurrent arteries?
They are 2 branches of the ulnar artery, they are called recurrent because they branch off of the ulnar artery below the elbow and then go back towards the medial epicondyle
Are the EI and EDM tendons medial or lateral to the ED tendon?
They are both medial to the digitorum
What is a synovial cyst of the wrist?
They are of unknown cause, often develop on dorsum of wrist and are fluid-filled. If it appears on the palmar hand it can compress the median nerve
What does it mean to say that the epidural and subdural spaces are potential spaces?
They are only present if a pathology occurs
What joint are the glenohumeral ligaments a part of and what part of the joint capsule do they reinforce?
They are part of the joint capsule of the glenohumeral joint. They reinforce the anterior aspect of the capsule
Where is the fibrous capsule of the MCP and IP joints strong?
They have collateral ligaments on the sides and a palmar ligament on the palmar side
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
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
What is the function of the joints of the pectoral girdle?
They usually coordinate with each other to move the scapula
Pachy
Thick; Example: Pachyblepharon; Thickening of the eyelids
Where is the sternoclavicular joint capsule thickened to form ligaments?
Thickening of the fibrous joint capsule at the front and back
What is the common interosseous artery?
This is a short branch off of the ulnar artery that soon divides into the anterior and posterior interosseous arteries. These are the main arteries of the forearm and go in front of and behind the interosseous membrane
What forms the palmar and dorsal carpal arches?
This is the "bracelet" of arteries around the wrist. The palmar and dorsal carpal branches of the ulnar artery anastomose with the palmar and dorsal carpal branches of the radial artery to form these arches
The laryngo pharynx becomes the esophagus and the larynx becomes the what?
Trachea
What does CN XI innervate?
Trapezius SCM
What does TFCC stand for?
Triangular Fibrocartilage Complex
What is the main nerve of the meninges?
Trigeminal N is in all 3 cranial fossae. Vagus and C2-3 help in the posterior fossa.
What is the area of the bladder called without rugae?
Trigone Between ureters and internal urethral opening
Onc
Tumor; Example: Oncotropic; Having special affinity for tumor cells
When moving into radial and ulnar deviation of the wrist, ulnar deviation is accompanied by ________, whereas radial deviation is accompanied by ________
UD w/ flexion RD w/ extension
Which ligament of the elbow do baseball players often develop a problem with?
Ulnar collateral ligament
Omphal
Umbilicus, navel; Example: Omphalorrhagia; Hemorrgage from the umbilicus
What is the straight sinus formed by?
Union of inferior sagittal sinus with great cerebral V
What is the junction of the ureter with the bladder called?
Ureterovesical junction
How do the ureters run in relation to the vas deferens?
Ureters are posterior to vas deferens "water under the sperm"
What is significant about the process of making proteins in a cell? (costs)
Uses energy, arranged in a way that we must use energy to synthesize proteins because it is more important to protect the genetic material
What causes the lunate to dislocate?
Usually happens to a dorsiflexed wrist, the lunate is dislocated into the carpal tunnel on the palm side of the hand and presses into the median nerve
Hyster
Uterus; Example: Hysterectomy
Metr
Uterus; Example: Metritis; Inflammation of the uterus
What does the suboccipital triangle contain?
Vertebral A Suboccipital N (as they pierce the atlantooccipital membrane**)
What is a spinal tap leak?
When a pathology causes a greater pressure above the tentorium cerebelli which results in the brain herniating through the tentorial incisure and CSF may leak from the spinal canal
When might macrolides be prescribed?
When penicillins are not appropriate for treatment
What is a shoulder separation?
When the AC ligament and coracoclavicular ligament tear and the shoulder drops (most severe type)
What is overflow or outflow incontinence?
When the detrusor M no longer contracts properly, results in constantly full bladder and tend to dribble constantly
What is cubital tunnel syndrome?
When the ulnar nerve is compressed by the 2 head of flexor carpi ulnaris. It causes the same symptoms as an ulnar nerve injury
What is circular breathing?
Wind instrument players close oral cavity w/ soft palate, quickly pull air into lungs, contract buccinator to blow into instrument, reopen oral cavity quickly by raising soft palate while exhaling
What is a supratentorial lesion?
a lesion in the cerebral hemispheres
What is happening when you sublux or dislocate the radial head?
You are pulling the radial head out of the anular ligament, manual relocation is possible with a special maneuver
What is a brain abscess?
a collection of pus and other material in the brain
If the environmental press is too high what may result?
a fall
How long do TIA episodes last?
a few minutes or longer, but no more than 1-2 hours
What happens in a Jacksonian seizure?
a focal motor seizure with clonic contractions in a certain area that then spread progressively
What are cytokines?
a group of endogenous proteins that have regulatory capacities within the immune system
What is an infratentorial lesion? What affects might this cause?
a lesion in the brain stem may affect motor & sensory fibers, respiratory & circulatory function, & level of consciousness
Outcome measures are a quantifiable measure of:
a patient's abilities and progress
What is a telomere?
a piece of DNA that is at the end of a chromosome, portion is lost with each cell division
The diagnosis of osteoporosis is made either by a DEXA scan or:
a prior non-traumatic fracture
What is postpolio syndrome?
a progressive condition with symptoms such as: -debilitating fatigue -weakness -pain -muscle atrophy
What is a TIA?
a short episode of impaired function due to a period of ischemia
Define a weight bearing activity:
a structured, force-generating activity that provides loading to skeletal regions, *above* that provided by activities of daily living
Is manual therapy an effective treatment for patients with chronic pain?
a variety of MT interventions may be effective for pain modulation
What type of seizure involves a brief loss of consciousness and sometimes facial movements such as eyelid twitching or lip smacking?
absence (petit mal) generalized seizures
What do stimulant laxatives do?
activate peristalsis by an unknown mechanism (they might inc. fluid accumultion in the small intestines)
What does an increase flux of Ca++ into a cell cause?
activation of: -proteolytic enzymes -apoptotic enzymes *cause cell death*
Whether you're performing an objective exam on the spine or peripheral joints, what movements should you test?
active passive resisted isometric
Under the education part of the PT intervention for CTS, what should you include when working with the patient?
activity modification ergonomic posture
A positive effect according to the Lawton's Ecological Model will occur near the _________ level?
adaptation (includes zone of support or stimulation)
How do RBC support themselves starting out?
aerobic metabolism
What are the 2 possible destinations of pyruvic acid?
aerobic respiration (if O2 is present) or turns into lactic acid
How prevalent is osteoporosis in the U.S.?
affects 10 million
What does it mean to say summation of contractions occurs in muscle re-education NMES?
after the first stimulus, the membrane repolarizes; overlapping myofilaments contract resulting in further shortening
The norms for the 6 minute walk test are based on:
age
What is facilitated diffusion? Does it use energy?
aided diffusion due to molecular size or chemical make up, does not use energy because it is still following gradient of high to low
What is a Watson's test?
aka: scaphoid shift test -patient seated, elbow at 90 deg w/ arm pronated -passively move from UD to RD while stabilizing scaphoid -+ result is increased movement, pain or clunk in dorsal direction
What is the function of the glenohumeral ligaments?
all function to stabilize the joint anteriorly: -superior at 60 deg elevation -middle at 90 deg elevation -inferior at 120 deg elevation
What is the function of the scapulothoracic "joint"?
allows for maximum movement at end ranges
What do the 3 letter "codes" of letters represent in mRNA?
amino acids
What is a by-product of protein break down? How is it rid of?
ammonia, through urea
How does the person feel after a complex, partial seizure?
amnesic (forgetful) and drowsy
What are the 3 antifungals we talked about?
amphotericin B flucytosine azoles
What is the most common pulmonary problem in kids?
asthma
Where are areas of major lymph nodes?
at major joints -elbow, wrist, knee, ankle
Extension of the wrist occurs mostly (>50%) where in the carpals?
at the RC joint
What are the types of cellular adaptations that can occur?
atrophy hypertrophy hyperplasia metaplasia dysplasia anaplasia
How does amphotericin B work?
attacks the unique lipiids in fungi compromising the stability of the fungus
What do antacids do?
attempt to neutralize excess stomach acid in the case of heartburn or acid reflux
What is Mallet finger?
avulsion of extensor tendon from the DIP
Why is prolonged use of stool thickeners dangerous?
bacteria that are inhibited by the drugs are necessary for normal digestion
What does a score of 19 on the DGI indicate?
balance/gait impairment or fall risk
What is the difference between a base and a base pair?
base is one strand, base pair is two strands
Why is looking at posture/body mechanics so important in someone with CTS?
because even though CTS isn't a neck issue, they may have limitations in neck movement that contribute to bad posture and CTS symptoms
Why is chloramphenicol prescribed sparingly?
because it is fairly toxic
Why does Jason prefer his patients with osteoporosis to walk instead of do the elliptical?
because the elliptical takes a lot of the WB component out of it, walking has more axial loading which will encourage osteoblast activity
Why are the bases in DNA called nitrogenous bases?
because they have nitrogen in their structure
Why are lung infections common with emphysema?
because viral, bacterial or fungal particles can easily get into the enlarged acini
When is a stool softener usually taken?
before bedtime (with the anticipated result occurring in the morning)
R hemisphere damage could mean a lead to what problems?
behavioral problems and dec appreciation for art & music
How is fuel obtained from fatty acids (lipids) for cellular respiration?
beta-oxidation
How do azoles work?
bind to cytochrome P450 enzymes
What causes the initiation of signal transduction?
binding of the ligand to the receptor
How does chloramphenicol work?
binds to ribosomes responsible for protein production in bacteria and inhibits their activity
What type of current does NMES use?
biphasic current
What is the MOA of bisphosphonates?
bisphosphonates inactivate osteoclasts to allow the bone to regenerate
How do aminoglycosides work?
block protein synthesis
How do isoniazid antibacterials work?
block synthesis of cell wall and interfere with cellular metabolism
What do PPIs (proton pump inhibitors) do?
block the hydrogen pump responsible for secreting acid into the stomach lumen
What are some signs of toxicity for ioniazid antibacterials?
blurred vision, eye pain, difficulty breathing and seizures
What are signs of toxicity with polymyxin?
blurred vision, swelling in the face, stiff neck, muscle weakness and headaches
In the terminal stance phase of gait, what is happening? When does it start and end?
body is progressing past the forefoot from mid-stance to just prior to contact of opposite limb
What happens during the mid-stance phase of gait? When does it start and end?
body progresses over the foot starts when the contralateral foot leaves the ground, ends when body is directly over the supporting limb
In the ICF framework table, the disorder or disease is listed at the top. What categories of consideration branch off of this?
body structures/function activities participation
What are possible side effects of flucytosine?
bone marrow toxicity and anemia
In an AmpuShield RRD, which strap (top or bottom) do you want to be the tightest?
bottom strap should be as tight as possible b/c this is your suspension top strap should be snug
What is the MOI for a Boxer's fracture?
boxing or punching (via axial load on 5th MC)
What happens during lipolysis in fatty acid oxidation?
break down of triglycerides to fatty acids and glycerol
Why is it called beta oxidation?
breaking of the beta carbon bond
Do azoles have a broad or narrow spectrum of anti-viral activity?
broad
Does amphotericin B have a broad or narrow spectrum of anti-viral activity?
broad
Which breath sound is a combination of vesicular and bronchial sounds?
bronchovesicular
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
What are 2 significant problems of myasthenia gravis?
dysphagia aspiration
What is the close and loose packed position of the glenohumeral joint?
c: maximum abduction and ER L: 60 deg abduction, 30 deg horizontal adduction
What is the most abundant second messenger?
cAMP
What are some *temporal variables* of gait? (read)
cadence stance time swing time single support double support average gait speed
Which calcium supplement is poorly absorbed if on a PPI?
calcium carbonate
Which calcium supplement requires stomach acid for absorption and must be taken with food?
calcium carbonate
What can serve as fuel molecules for cellular respiration?
carbohydrates (glucose) and lipids (fatty acids)
What are examples of exogenous chemical agents?
carbon monoxide tobacco smoke carbon tetrachloride
What manual therapy technique could be used to help treat CTS?
carpal bone mobilization
With a FOOSH where the wrist was extended >80 deg (greater than), what bone is likely to fracture?
carpal fx
What is CTS?
carpal tunnel syndrome (compression of the medial nerve)
What is the function of mRNA?
carries genetic information that has been copied from the DNA, serves as a "messenger"
What makes TB difficult to treat?
caused by mycobacteria which replicate slowly, develop drug resistance quickly, and thus do not respond well to traditional actibacterials
How does a simple, partial seizure affect a person's motor activity?
causes repeated motor activity such as jerking or turning the head or eye, jerky movements of the leg or by a sensation such as tingling that begins in one area and may spread
What prevents excessive growth with cellular reproduction?
cell cycle inhibitors
What is mitosis?
cell division (part of cell cycle)
What happens with cell reproduction?
cell growth controlled by growth factors goes through cell cycle until cannot reproduce
What are the stages of apoptosis?
cell shrinks membrane starts blebbing, organelles disintegrate nucleus and organelles collapse apoptotic bodies form macrophages phagocytose apoptotic bodies
Apnea
cessation of breathing
Absence (petit mal) generalized seizures are more common in what population?
children starting at age 5
What class of antibacterials causes "gray baby syndrome"?
chloramphenicol
What respiratory condition can cause clubbed fingers?
chronic hypoxia
Multiple sclerosis, Parkinson's disease, amyotrophic lateral sclerosis, myasthenia gravis, Huntington's disease, Alzheimer's disease, vascular dementia, Creutzfeldt-Jakob disease, and AIDS dementia are all types of __________________ disorders
chronic neurologic degenerative disorders
What information should you get with a symptom history?
chronological development, onset (MOI), changes, treatment
What aspects of a residual limb should be assessed weekly?
circumference & wound healing Notes: -measure BKA girth in full extension around the largest circumference -important to monitor wound healing bc keep in mind many people who have amputations were bc of diabetes, they may not realize they have a sore
At the SC joint, the ______ moves on the sternum. The purpose of this is what?
clavicle moves on the sternum purpose is to place the scapula in position to accept the head of the humerus
Impairment level measurements are __________________ as outcome measurements are _________________
clinical contextual (idk, but Carla said it was important in online lecture)
_____________ rales are a sign of involvement of the distal airway.
coarse
Which type of rales is almost always wet rales and almost always serious?
coarse rales
What is global aphasia?
combination of expressive and receptive aphasia
Lawton's Ecological Model relates what two variables?
competence and environmental press
Is surgical or conservative intervention more common after a scaphoid fracture?
conservative (w/ immobilization)
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
What is Raynaud's phenomenon?
constriction of small blood vessels of hands and toes (vasospasm)
When is a pleural friction rub heard?
continuous sound heard from the middle of inspiration to the beginning of expiration
At the sternal end, the clavicle is _______ (concave/convex) on its longitudinal diameter and ________ (convex/concave) on its transverse diameter
convex on longitudinal concave on transverse
What is a sign of toxicity with penicillins?
convulsions due to high levels in CSF
Define DNA replication
copying or doubling of DNA structures
Which ligament of the SC joint has two "bundles"?
costoclavicular anterior bundle runs superior and lateral posterior bundle runs superior and medial
What is the purpose of the Sodium Potassium Pump?
create membrane potential and maintain osmotic balance and stabilize cell volume
What occurs during an episode/attack of asthma?
dyspnea with significant wheezing
After an amputation, you want to return the pt to __________ at the highest level possible
daily life
Prolonged use of tobramycin may cause what?
damage to the optic nerve
What is cellular atrophy? What may cause it?
decrease in size of cells -reduced use -malnutrition -decreased hormonal stimulation -aging
What does the H2 receptor antagonist class of drugs work to do?
decrease the amount of acid in the stomach
What is a downfall of AZT?
develops resistance quickly, especially if not taken on a strict schedule
What can sulfonamides be used to treat in addition to bacterial infections?
diabetes mellitus, edema and gout
What is the most common side effect assoc. with *magnesium containing* antacids?
diarrhea
The sternoclavicular joint is a ________, saddle synovial joint
diarthrodial
What type of joint are the MCPs?
diarthrodial condyloid joint
What type of joint is the radiocarpal joint?
diarthrodial ellipsoid joint
The glenohumeral joint is what kind of joint (3 components)?
diarthrodial, synovial, ball-and-socket
What are symptoms of Raynaud's phenomenon?
diffuse pain cold numbness
Outcome measures capture function at ______________ level as opposed to the impairment level (strength/ROM)
disability
What causes necrosis?
disrupted cell metabolism lack of energy inflammation *membrane loses function, allows entry of enzyme that causes cell destruction, prevents Na++ from staying outside cell, causes swelling and bursting of cell
Where does Raynaud's phenomenon occur?
hands and feet
How is step width measured?
distance measured between two lines drawn between the midline of each foot during gait
What is stride length?
distance measured from heel strike to heel strike of the *same foot*
What is a common side effect of bulk forming laxatives?
distended and painful abdomen
If PAM is restricted, what are two tests that can be done to determine the source of the problem?
distraction and compression
What does weak or painful contraction during MMT mean?
disuse atrophy, inhibition, rupture, palsy or neuropathy
Adduction of the CMC of the thumb involves a _______ roll and a ______ glide
dorsal roll volar glide
Extension of the thumb involves a ______ roll and a ________ glide
dorsal/radial roll dorsal/radial glide
During load response, since the GRF is posterior to the ankle, causing it to want to PF, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
dorsiflexors eccentric contraction controlling PF of ankle
During initial contact, since the GRF is posterior to the ankle, causing it to want to PF, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
dorsiflexors eccentric contraction controlling plantarflexion
Initial contact is a phase of ______ support
double
Pre-swing is a phase of __________ support
double
__________________ support is when both limbs are in contact with the ground
double
Loading response is a phase of ___________ support
double support
When does the lowest point of a vertical sine wave occur during gait?
double support
Stool softeners work best if the person:
drinks a lot of water
What is the main indication of using NMES for edema?
duplicate regular muscle contractions to increase circulation through venous and lymphatics
What is differentiation?
each cell type differentiates (becomes specialized) to carry out particular functions
At what point during the gait cycle is knee flexion a determinant of gait? About how many degrees of flexion are in the knee at this point?
early in stance (loading response) 15-20 degrees --there is more knee flexion during the swing phase, but that is not part of the determinants of gait--
If compression: -eases pain -is painful What do each of these mean?
eases pain: joint capsule implication painful: joint surface implication
Which muscle group gives us most of our strength in the hand? Which is more stabilization focused?
flexors - strength extensors - stabilizers
What are the 4 boundaries of the carpal tunnel?
floor - carpal bones and palmar ligs roof - flexor retinaculum radial border - trapezium ulnar border - hook of hamate
A dull sound over a lung might indicate:
fluid or another space-occupying lesion
What is sometimes the first sign of a brain tumor?
focal or generalized seizures
What population uses BMD T scores?
for older adults to compare to the young adult mean density
What population uses BMD Z scores?
for pre-menopausal women and younger males to match them to a mean density
How does recruitment of fibers vary based on size for electrical-induced vs. voluntary muscle contraction?
for voluntary small slow twitch fatigue resistant fibers are recruited first, followed by large muscle fibers for electrical-induced large fast twitch fibers are recruited
What is the function of the cytoskeleton in a cell?
form cell structure and participate in cell movement and cell division
What is the direction of momentum during gait?
forward
For every standard deviation below the norm a person is in BMD, the ___________ risk doubles
fracture
The clavicle is more likely to ________ before the SC joint _______ (think injury)
fracture before it dislocates
What is a Boxer's fracture?
fracture in the neck of the 5th metacarpal
What is a Colles' Fracture?
fracture of the distal radius with dorsal displacement
What is a Smith's fracture?
fracture of the distal radius with volar displacement
When does pre-prosthetic training take place for someone who is having an amputation?
from pre-surgery to initial device before 0 wks
When does the mid-swing phase start and end?
from the max knee flexion to when tibia is vertical
When does the terminal swing phase start and end?
from when the tibia is vertical to just prior to initial contact (leg reaches to achieve step length)
Which type of seizure affect both hemispheres and includes loss of consciousness?
generalized seizure
Which type of seizures have multiple foci/origins in the deep structures of both cerebral hemispheres and the brain stem and cause loss of consciousness?
generalized seizure
Where do proteins go after they are synthesized?
get folded and packaged into golgi to be sent where needed
What is the main goal of interventions in someone with Kienbock's disease?
goal to restore blood supply/ revascularization
In the early stages of Alzheimer's disease there is a ____________ loss of memory and lack of ______________
gradual concentration
Gentamicin is used to treat what kind of bacterial infection?
gram-negative
During initial contact, since the GRF is anterior to the knee, causing it to want to extend, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
hamstrings eccentric contraction controlling knee extension
During terminal stance, since the GRF is anterior to the knee, causing it to want to extend, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
hamstrings eccentric contraction controlling knee extension
What population has the strongest hand intrinsic muscles? Feet intrinsic?
hand - climbers feet - barefoot runners
Why is asking about aggravating factors so important when examining a patient with hand/wrist symptoms?
hands/wrists are so involved with every day tasks and this can help determine the cause
Are ACh receptor antagonists easier or harder to take than PPIs or H2 blockers?
harder (that's why they are rarely used)
The ICF is a psychosocial model of what two things?
health and disability looks at what can be enabling
What are some side effects of tobramycin?
hearing loss, dizziness, muscle weakness and nausea
Why is it important for transfemoral amputees to have good UE strength?
helpful for assistive devices such as crutches and walkers
Walking speed can predict future events such as:
helps determine response to therapy
________________ strokes usually begin with a blinding headache and increasingly severe neuro deficits
hemorrhagic
What is acyclovir used to treat?
herpes simplex virus and varicella-zoster virus
One cranial nerve, or dermatome, on one side of the body is affected in which neurologic condition?
herpes zoster (shingles)
A 6 minute walk test is a measure for a higher or lower level of function?
higher
What type of joint are the IPs?
hinge
During initial contact, since the GRF is anterior to the hip, causing it to want to flex, which muscle group is active in trying to control this movement? What kind of contraction is that muscle engaging in?
hip extensors eccentric contraction controlling hip flexion
During load response, since the GRF is anterior (and medial) to the hip, causing it to want to flex (and adduct), which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
hip extensors and *hip abductors* eccentric contractions controlling hip flexion and adduction
During terminal stance, since the GRF is posterior to the hip, causing it to want to extend, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
hip flexors eccentric contraction controlling hip extension (glut med isometric to prevent hip drop during single support)
In the pre-swing phase of gait, what position are the hip, knee, ankle and MTP in?
hip: 0-10 degrees extension knee: 45 degrees flexion ankle: 20 degrees plantarflexion MTP: 70 degrees extension
In what position are the hip, knee and ankle in during the initial swing phase of gait?
hip: 15 degrees flexion knee: max flexion (~60 deg) ankle: 5 degrees plantarflexion
What position are the hip, knee and ankle in during the terminal stance phase of gait? Which is a determinant of gait? (answer in bold)
hip: 20 degrees extension knee: 0-5 degrees flexion *ankle: 10 degrees dorsiflexion*
In the loading response phase, what position are the hip, knee and ankle in? Which one is a determination of gait? (bold in answer)
hip: 20 degrees flexion *knee: 15 degrees flexion* ankle: 0-5 degrees plantarflexion
In what position are the hip, knee and ankle in during the terminal swing phase of gait?
hip: 20 degrees flexion knee: 5 degrees flexion ankle: neutral
In the initial contact phase, in what position are the hip, knee and ankle?
hip: 20-35 degrees of flexion knee: 0-5 degrees of flexion ankle: neutral
In the mid-swing phase of gait, what position are the hip, knee and ankle in?
hip: 25 degrees flexion knee: 25 degrees flexion to extension ankle: neutral
In what position are the hip, knee and ankle in during the mid-stance phase?
hip: neutral to extension (slight) knee: 0-5 degrees flexion ankle: 5 degrees dorsiflexion
What causes DNA to coil up? How does this process work?
histones through electrostatic interactions (have a positive charge)
If the optic tract or occipital lobe is damaged, what type of vision loss occurs?
homonymous hemianopia: -medial half of one eye -lateral half of other eye
What are 4 things that cell receptors are sensitive to?
hormones growth factors chemical transmitters drugs
Antacids usually contain a base such as:
hydroxide or carbonate/bicarbonate with aluminum, magnesium, calcium or sodium
People with vascular dementia usually have a past medical history of:
hypertension
You should use NMES for edema in conjuction with what other things?
ice and elevation
What are potential causes of Raynaud's phenomenon?
idiopathic trauma cold emotional stress
What is mutation?
if DNA in parent cell is altered and passed on, offspring cells will carry mutation
What special questions should you ask a patient with hand/wrist symptoms?
if they have RA/OA?
What are signs that you should discontinue WB with an IPOP?
if wound healing complications arise
What are possible interventions for a scaphoid-lunate dislocation?
immobilization modalities surgery depends on extent of injury
What populations would drugs that boost the immune system be indicated for?
immunosuppressed patients, people with chronic infections and cancer
What may cause a seizure? (3)
inflammation, hypoxia or bleeding in the brain
Where are fatty acids stored?
in adipocytes as triglycerides
Where is the beta2-adrenoceptor found?
in cardiomyocytes (cardiac tissue)
In which position do the IP joints have the most force?
in extension of the wrist (we extend our wrist when lifting something heavy)
Have interferons been successful?
in laboratory settings yes, in clinical settings their performance has been lackluster
When might penicillins induce seizures?
in people with renal failure
Where does translation take place within the cell? Why this location?
in the cytosol outside of the nucleus because the mRNA has to reach the ribosomes to make proteins
Where does transcription take place within the cell? Why this location?
in the nucleus where the genetic information is contained, the nuclear envelope serves as a protection for the genetic material from surrounding chemical reactions
What is aphasia in general? What are the 3 types called?
inability to comprehend or express language types: expressive, receptive, global
What is receptive aphasia?
inability to read or understand
What is expressive aphasia?
inability to speak or write
What is cellular hyperplasia? What may cause it?
increased number of cells -pregnancy -hormonal changes in puberty -liver regeneration -exposure to high altitudes
What happens to cells at low temperatures?
increased vasoconstriction reduced oxygen supply ice crystal formation
How does muscle re-education NMES affect the muscle tissue?
increases sensory input to the muscle
What is an alternate treatment for people with small, hard stools besides taking drugs?
increasing fiber in their diet
What is proliferation?
increasing number of cells
What are some examples of IADLs?
indoor home chores outdoor home chores/shopping driving, transportation work/school social interaciton
What do channels allow the passage of in cell communication?
ions
The symptoms of a TIA are related to the location of:
ischemia
Compression of the median nerve leads to what 4 things?
ischemia edema reduced nerve gliding fibrosis
For NMES used for muscle strengthening, resistance is applied to produce what type of contraction? What percent is your goal?
isometric 60% of MVIC is the goal
What type of antibacterial is the first line of defense in treating active TB?
isoniazid
What is the purpose of the 6 minute walk test?
it is a measure of exercise tolerance and endurance
How does AZT work?
it is a reverse transcriptase inhibitor
What is PQRST as it relates to symptom behavior?
it is key to ask these things with chief complaint: P: what provokes pain Q: quality of pain (sharp?) R: region of pain S: severity T: timing as it relates to other events
What is TNE?
it uses explanation of the physiology behind pain to tell the NS to lower the threat to the system itself (teach yourself that the "pain" isn't painful)
If PAM is restricted, what does this mean?
joint surface and/or surrounding tissues are implicated
Where is the COM during gait?
just anterior to S2 vertebra
When is velocity the highest during gait?
just before double support
At what point during the gait cycle is ankle dorsiflexion a determinant of gait? About how many degrees of dorsiflexion are in the ankle at this point?
just before heel rise 10 deg dorsiflexion
Polymyxin is an alternative drug for ______________?
kanamycin
What are some side effects of indinavir?
kidney problems and hyperbilirubinemia
What are some ways that gait can be analyzed? (3)
kinematics (limb movement) kinetics (GRF) electromyography (EMG studies)
Outcome measures provide a common ______________ among PTs across disciplines
language
In the initial contact phase of gait, the GRF is ______ (medial/lateral) to the subtalar joint, which makes this joint want to move into ______ (pronation/supination)
lateral pronation
In the pre-swing phase of gait, the GRF is ______ (medial/lateral) to the subtalar joint, which makes this joint want to move into ______ (pronation/supination)
lateral supination
In the terminal stance phase of gait, the GRF is ______ (medial/lateral) to the subtalar joint, which makes this joint want to move into ______ (pronation/supination)
lateral supination
Are ACh M1 Receptor Antagonists more or less effective than H2 blockers at reducing acid secretion?
less effective
FEV1/FVC% of an obstructive ventilation disorder (indicates asthma)
less than 70%
What are the general components of signal transduction?
ligand binds to receptor intracellular signaling molecules
When you initially see a pt after an amputation what do you expect their limb to look like? What are some things you should know about the pt?
limb: swollen, painful, hyper-sensitive, weak know: PMH, MOI, comorbidities, emotional well-being
What is the function of the interclavicular ligament at the SC joint?
limit depression and support weight of UE
Describe the CPR for the CMC of the thumb
limitation of abduction and slight limitation of extension
What is an empty end feel?
limitation without tissue resistance (pain)
If distraction: -is limited -is painful -eases pain What do each of these mean?
limited: contracture of connective tissues painful: tear of connective tissue eases pain: articular surfaces implicated
What is auscultation?
listening for body sounds
How does exercise impact BMD in young men?
little data, but likely beneficial
During mid-stance, since the GRF is anterior to the knee, causing it to want to extend, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
little muscle activity is needed here, so this is all N/A
What organ is affected the most with macrolides toxicity?
liver
What is an indication of toxicity with tetracyclines?
liver toxicity (in patients with renal impairment)
During which phase of gait is foot flat achieved?
loading response immediately after initial contact until the opposite extremity leaves the ground
What are symptoms of a scaphoid-lunate dislocation?
localized pain, swelling, clicking, pain with wrist extension
The ___________ of a brain tumor determines the focal signs
location
Describe apneusis
long, gasping inspiratory phase followed by a short, inadequate expiratory phase
Obstructed Breathing
long, ineffective expiratory phase with shallow, inc respirations
ACh M1 Receptor Antagonists are just as effective as H2 blockers at _________
long-term healing of ulcers
What happens to RBC when they reach maturity?
lose nucleus lose ER lose mitochondria
L hemisphere damage could cause a loss of what 2 functions?
loss of logical thinking and communication
Absence of tone is an indication of ________________ motor neuron damage
lower
What drugs are used on a short-term basis to relieve constipation?
lubricants/stool softeners
What is the most commonly dislocated carpal bone?
lunate
With a lunate dislocation, what wrist motion would be limited? Which motion should you limit during rehab?
lunate is dislocated volarly which would limit wrist flexion because the bone is dislocated volarly, you need to limit wrist extension to prevent further dislocation
What are the 3 types of RNA?
mRNA tRNA rRNA
What can be prescribed as an anti-constipation med?
magnesium-containing antacids
What is transcription?
making mRNA from its DNA template
If palpation of a lymph node is swollen & painless, and the node is immoveable it may mean _____________
malignancy
What is cellular metaplasia? What may cause it?
mature cell type is replaced by a different mature cell type, chronic irritation from GERD or chain smoking
What is the max score in MMSE? What is the cutoff for a normal score?
max: 30 cutoff: 24, everything below is considered abnormal
What is the CPR for the SC joint?
maximal shoulder elevation
What is the close-packed position for the SC joint?
maximal shoulder elevation
How long do seizures last?
may last a few seconds or minutes
What population do complex, partial seizures occur in?
may occur in children or adults
How frequently do absence seizures take place?
may occur many times a day
When doing a gait speed test, how far do the participants walk?
measure the time it takes them to walk 6 meters
In the load response phase of gait, the GRF is ______ (medial/lateral) to the subtalar joint, which makes this joint want to move into ______ (pronation/supination)
medial pronation
If there are no bowel sounds in a certain area, and it is an area associated with pain, it could be a ______________________
medical concern
Are medium or fine rales louder?
medium rales
AIDS dementia involves a gradual loss of what 2 things? It also involves impaired ____________ function
memory & cognitive ability motor (ataxia, weakness, & abnormal reflexes)
_________ is a common example of a bulking agent
metamucil
Define osteoporosis:
micro-architectural deterioration of bone tissue leading to loss of bone mass decreased peak bone mass coupled w/ accelerated bone loss
What can outcropping of cell membranes appear as?
microvili or cilia
Flexion of the wrist occurs mostly (> 50%) where in the carpals?
mid carpal joints
When does the highest point of a vertical sine wave occur during gait?
mid-stance
When does the greatest amount of deviation from mid-line occur during a side-to-side sine wave?
mid-stance on right or left
A seizure causes abnormal ______________ or ______________ activity and possibly loss of consciousness
motor or sensory
Failure of the defensive barrier in the stomach/duodenum leads to:
mucosal injury
In general, what are rales caused by?
mucus obstruction in distal airway or collapse of acini
What causes rhonchi?
narrowing of the pulmonary tree within the trachea, bronchi or bronchioles
What are bulking drugs made of?
natural fibers from seed that form a gelatin when inside the GI tract
What should you do if a non-removable rigid dressing starts to smell weird?
need to tell prosthetist or MD, needs to be cut off right away to inspect residual limb for infection
For NMES the active electrode should be ________
negative
Kanamycin and Neomycin are prescribed to treat gram-____________ bacterial infections?
negative (rods)
For NMES the negative electrode should be placed ________ and the positive electrode placed ________
negative - distal positive - proximal
What kind of charge is associated with DNA? What part of the DNA structure causes this?
negative charge comes from the phosphate molecule
What does NMES stand for?
neuromuscular electrical stimulation
What cells are considered to be "Terminally differentiated"?
neurons and cardiomyocytes
What is a neoplasm?
new growth, often a tumor
Do people who have experienced an absence seizure have memory of the epidosde?
no
Does the sternoclavicular joint have any active ROM?
no
If a patient has a lunate fracture, are they always at risk for developing Kienbock's disease? What may increase the risk?
no if the fracture is not treated or unsuspected, or in the case of a non-union fracture, these are all things that increase someone's risk of developing necrosis
Will taking a bulk-forming laxative help if there is a chance of blockage in the intestine?
no, it will make it worse
Do azoles have many side effects?
no, maybe some GI problems
Where are electrodes placed in relation to the contracture site for NMES used for contracture management?
on the antagonist muscle group (patient should NOT actively contract muscle group)
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
When is it especially appropriate to use physical modalities to help alleviate pain by inhibiting pain transmission at the SC?
pain caused by conditions that can't be directly modified (Ex: cancer, fractures, or PNS pathology)
Which type of seizures have a single/focal origin and often are in the cerebral cortex and may not involve altered consciousness?
partial seizure
What does PAM stand for?
passive articular mobility
What is arguably the most important aspect of the PT's intervention after a scaphoid fracture?
patient education -encourage patient to comply with immobilization and wearing the brace to prevent necrosis of the bone
What is an aura in a tonic-clonic seizure? When does this take place?
peculiar visual or auditory sensation immediately before the loss of consciousness
With pelvic rotation in the transverse plane, how hoes the pelvis rotate in relation to the advancing limb?
pelvis on the side of the advancing limb moves *anteriorly* (right limb advancing = right ileum rotates anteriorly)
What category of antibacterials is the most widely prescribed and effective class?
penicillins
What populations are contraindicated for isoniazids?
people with acute liver disease, history of liver damage or acoholism
What populations are sulfonamides contraindicated for?
people with kidney damage/irritation pregnant or lactating women people with previous bone marrow depression
The over-the-counter version of H2 receptor antagonists are used to treat:
peptic ulcers
Ataxic Breathing
periods of apnea alternating irregularly with a series of shallow breaths of equal depth
Which type of pain are modalities more effective at treating?
peripherally sourced pain
During pre-swing, since the GRF is lateral to the subtalar joint, causing it to want to supinate, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
peroneals eccentric contraction controlling supination
During terminal stance, since the GRF is lateral to the subtalar joint, causing it to want to supinate, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
peroneals eccentric contraction controlling supination
What happens in the postictal stage of a tonic-clonic seizure?
person is confused, fatigued and has aching muscles falls into deep sleep
What are contextual facors listed in the ICF framework when considering a person's level of function?
personal environmental
How is an enzyme rendered inactive?
phosphytases remove the phosphate which renders it inactive
In the pre-swing phase of gait, the GRF is ______ (anterior/posterior) to the knee, which makes the knee want to move into _________ (flexion/extension)
posterior flexion (a.k.a knee flexion moment)
In the load response phase of gait, the GRF is ______ (anterior/posterior) to the knee, which makes the knee want to move into _______ (flexion/extension)
posterior flexion (a.k.a. knee flexion moment)
In the terminal stance phase of gait, the GRF is ________(anterior/posterior) to the hip, which makes the hip want to move into ________(flexion/extension)
posterior extension (a.k.a hip extension moment)
During mid-stance, since the GRF is medial to the subtalar joint, causing it to want to pronate, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
posterior tibialis *concentric* attempting to *supinate the foot*
During initial contact, since the GRF is lateral to the subtalar joint, causing it to want to pronate, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
posterior tibialis eccentric contraction controlling plantarflexion
During load response, since the GRF is medial to the subtalar joint, causing it to want to pronate, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
posterior tibialis eccentric contraction controlling pronation
During SC rotation, the clavicle rotates _______ (anteriorly/posteriorly) during shoulder abduction and flexion
posteriorly (clavicle spins on articular disc)
The more severe the original polio infection is, the more severe the effects of ______________ syndrome will be
postpolio syndrome
Outcome measures provide _____________ validity. For example: fall risk.
predictive
If a person's score on a gait speed test is below 0.56 m/s, what does this mean?
predictive of recurrent falls
What does anything under 45 on the Berg Balance Test indicate?
predictive of recurrent falls
How do H2 antagonists work?
prevent the histamine-activated release of acid under resting conditions and during stimulation with food
What is the function of the coracohumeral ligament?
prevents excessive ER and extension
What is signal transduction?
process by which a cell converts one kind of signal or stimulus (extracellular) into another (cellular responses) -uses sequence of events to communicate outside the cell to inside the cell
What is the main function of mitochondria?
produce ATP for cellular activities
What do anti-spasmodic opiates do?
produce a general dec. in GI motility
What happens to RBC as they mature?
produce hemoglobin have enlarged ER small golgi apparatus lose lysosomes
What is glycogenesis?
production of glycogen from glucose
What is gluconeogenesis?
production of new glucose from proteins and fat
What is Guillain-Barre syndrome?
progressive muscle weakness and areflexia/flaccid paralysis that starts in the legs
Describe the gait of a person with Parkinson's disease;
propulsive gait: short, shuffling steps with inc acceleration
What does Ritonavir (Norvir) do to treat HIV? What makes it less useful?
protease inhibitor, interacts with a lot of other drugs, and HIV needs to be treated with a combination of drugs
What process must happen once a protein is synthesized before it can be functional?
protein folding
Muscle contractions are described according to _________
pulse frequency
During load response, since the GRF is posterior to the knee, causing it to want to flex, which muscle group is active in trying to control the movement? What kind of contraction is that muscle group engaging in?
quadriceps eccentric contraction controlling flexion of the knee
During pre-swing, since the GRF is posterior to the knee, causing it to want to flex, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
quadriceps eccentric contraction controlling knee flexion
If a tumor grows rapidly, signs of inc intracranial pressure develop slowly or quickly? Rapidly growing tumors usually present with headaches at what time of day?
quickly morning
Is the onset of meningitis rapid or insidious?
rapid/sudden
What does status epilepticus mean?
recurrent or continuous seizures without recovery of consciousness (must be treated immediately)
What does a FEV1/FVC% measurement represent?
represents the proportion of a person's vital capacity that they are able to expire in the first second of forced expiration
The prescription version of H2 receptor antagonists are used to treat:
reflux disorders & peptic ulcers
What is the function of the posterior SC ligament at the sternoclavicular joint?
reinforce joint capsule and limit anterior movement of medial end of clavicle
What is the function of the anterior SC ligament at the sternoclavicular joint?
reinforce the capsule and limit posterior movement of medial end of clavicle
How can you reduce the risk of falls that lead to revision surgery s/p amputation?
removable rigid dressing (protects the residual limb in case they fall)
What is a side effect of gentamicin?
renal function impairment
What is a benefit of flucytosine?
resistance develops rarely
What has been a major issue in clinical settings with vancomycins recently?
resistance with enterococci
What type of responses to altered conditions can occur in cellular adaptation?
reversible (ceases when stressor removed) or irreversible (eventually results in death)
How are silicone liners applied?
rolled over limb (not stretched) can be removed for incision inspection
When screening the spine in an objective exam, what should you consider?
ruling out the possibility of referral symptoms especially from the spine (helps ensure correct diagnosis, shouldn't last more than 5-10 mins)
What type of joint is the CMC of the thumb?
saddle/sellar
External moments act in the _______ plane
sagittal
The interaction of an antacid + HCL produces:
salt + water
For flexion/extension of the CMC of the thumb, the roll and glide are in the _______ direction
same
For the distal radioulnar joint, roll and glide happen in the ________ direction
same
What is smooth ER called in muscles?
sarcoplasmic reticulum
With a FOOSH where the wrist was extended and radially deviated, what bone is likely to fracture?
scaphoid
What does Watson's test help confirm?
scaphoid-lunate dislocation
What does MMSE screen for?
screening tool for cognitive impairment
Which etiology of seizures occur after head injury or infection?
secondary/acquired
Children with congenital disorders, like cerebral palsy, may have _______________ resulting from brain damage
seizures (primary/idiopathic etiology)
What type of bacteria is tobramycin used to treat?
serious gram-negative bacteria and staphylococci (gram-positive)
What is the role of an enzyme? What is an enzyme made up of?
serve as a catalyst to a reaction, enzymes are proteins (not all proteins are enzymes)
What is the most common cause of COPD?
smoking
What are the two types of ER?
smooth and rough
According to Kaltenborn, what are 3 normal end feels?
soft firm hard
During mid-stance, since the GRF is anterior to the ankle, causing it to want to DF, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
soleus eccentric contraction control anterior tibial movement (DF)
During terminal stance, since the GRF is anterior to the ankle, causing it to want to DF, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
soleus eccentric contraction controlling anterior tibial movement (DF)
During pre-swing, since the GRF is anterior to the ankle, causing it to want to DF, which muscle group is active in trying to control this movement? What kind of contraction is that muscle group engaging in?
soleus and gastroc *concentric contraction* for pushoff
What are local (focal) effects in terms of neurological disorders?
specific effects based on the area of the brain or spinal cord that's affected
What is the function of the TFCC?
stabilizes the radioulnar joint and protects against compressive forces
Velocity changes during gait with each ______
step
The optimal balance between competence and environmental press that is optimal for patient improvement is called the level of _____?
stimulation if one variable is too high it can result in a negative effect
What is the typical standing posture of someone with Parkinson's disease like?
stooped, leaning forward
What are the key steps of lipid oxidation?
stored in adipocytes lipolysis circulation transport to mitochondria beta-oxidation
What is the function of the transverse humeral ligament?
strengthens shoulder capsule
What are 4 *distance variables* of gait? (read)
stride length step length step width step angle
Which breath sound can sometimes be heard without a stethoscope?
stridor
What happens in the ictal stage of a tonic-clonic seizure?
strong thoracic muscle contractions briefly in flexion, followed by extension of the limbs and rigidity in the trunk
For NMES used for muscle strengthening, what level of muscle contraction do you want to achieve?
strong, visible contraction
With NMES used for muscle re-education, you want what level of muscle contraction?
strong, visible muscle contraction
With NMES used for contracture management, what level of muscle contraction do you want to achieve?
strong, visible, comfortable contraction
After taking a _____________ , you should have a very good idea of what is going on. (subjective or objective)
subjective
Define gait:
successive episodes of losses and recoveries of balance
What is the backbone of DNA?
sugar and phosphate
How does high SPF sunscreen affect vitamin D production?
sunscreen protects you from developing skin cancer, but prevents you from getting enough vitamin D to prevent osteoporosis
The results from a 6 minute walk test are not validated to fall risk, but instead are validated to:
survival rates
What must happen before massage and tapping can take place in amputation rehab.? Why is massage & tapping a part of amputation rehab.? How often should it be done?
suture line must be fully healed to prevent skin breakdown w/ prosthetic use 2-5 min, 3-4x/day
What is the general function of ER?
synthesize macromolecules (proteins, fats, carbohydrates)
How can tetracyclines be administered?
tablets, capsules, topically or IV
How do vancomycins work?
target bacterial cell wall synthesis
How do penicillins work?
target bacterial cell wall synthesis by inhibiting peptidoglycan synthesis
What determines how many times a cell can reproduce?
telomeres
What is an acini?
the area of a lung that one terminal bronchus supplies (not the same thing as alveoli)
The manifestations of multiple sclerosis are determined by:
the areas of demyelination
What is glycogenolysis?
the breakdown of glycogen into glucose
What are instrumental ADLs (IADLs)?
the more complex skills - such as caring for dependents, maintaining a home, performing household chores and tardwork, shopping, and structured play that are important components for maintaining independent living
What is a significant sign that someone is in the late stages of Alzheimer's disease?
the person does not recognize his or her family
What is an H2 receptor?
the subtype of the histamine receptor in the stomach
What is diffusion?
the transportation of molecules from high to low concentration through a semi-permeable membrane Does NOT require energy
What is the problem with laxatives?
they are frequently abused
Where do brain tumors metastasize? What does this mean for their prognosis?
they do not metastasize outside of the CNS they will cause death before they are large enough to cause general effects
How do sulfonamides work?
they inhibit bacterial synthesis of folic acid that is needed for synthesis of nitrogenous bases (enzyme in DNA synthesis)
Why are penicillins so widely used?
they treat a broad spectrum of infectious agents
What happens to the LE when the initial swing phase occurs? When does the initial swing phase start and end?
thigh advances, foot clears the ground from when limb leaves the ground to maximum knee flexion
Why is asking about past history for a patient so important?
this can help determine their prognosis recurring issue = worse prognosis
Why is protein folding beneficial?
this form is thermodynamically efficient
Who should receive a referral to PT for osteoporosis?
those who have: -fall risk -unstable gait -noted weakness
How is fuel obtained from carbohydrates (glucose) for cellular respiration?
through glycolysis and aerobic respiration
What are some signs of toxicity for kanamycin and neomycin?
tinnitus, extreme vertigo, decreased renal clearance, increased level of blood urea nitrogen (BUN)
Why does the knee of the posterior limb flex slightly (~15-20 degrees) when the anterior limb makes initial contact?
to accept the weight of the body
What is the goal of diffusion?
to achieve equillibrium
What is the function of rRNA?
to associate with a set of proteins to form ribosomes, also they catalyze the formation of amino acids into protein chains
Why do RBC need enlarged ER?
to be more efficient and produce more hemoglobin
Why might it be important to ask a patient which is their dominant hand?
to compare if the dominant side symptoms are the same or different
What is the function of tRNA?
to decode the sequence delivered by the mRNA into a protein (transfers the information from mRNA to a place where proteins are made (ribosomes))
What is one theory for the purpose of the 6 determinants of gait?
to minimize energy expenditure by minimizing change in COM and to create an efficient movement pattern
T/F: a secondary evaluation of a patient with osteoporosis should include fall risk
true
Why is it important for transfemoral amputees to have good adductor strength?
to prevent the residual limb from going into abduction (Note: in a normal LE, the femur rests in adduction) if it goes into abduction, glute med. will no longer be on stretch and you won't have as much support when you go into SLS
How may tobramycins be administered?
topically, injections or inhalers
The pelvis shifts laterally ________(towards/away) the weight-bearing limb during gait
towards
What is the most likely limitation of amphotericin B?
toxicity causing renal impairment/failure (renal damage almost eminent in all patients)
What are some basic examples of ADLs?
transfers bathing grooming dressing feeding toileting
What are functions of a cell?
transport ingestion (endocytosis) secretion (exocytosis) respiration communication reproduction
What are the 2 bones that articulate to make the CMC joint of the thumb?
trapezium and 1st metacarpal
What is the MOI for a TFCC disc injury?
trauma (typically FOOSH) OR overuse injury from repetitive pronation & gripping with load through the wrist
What are the causes of CTS?
trauma or overuse of flexor muscles (posture of hands)
The MOI for hand/wrist symptoms is likely one of the two following:
trauma/acute overuse
Classification of clinical syndromes (read):
traumatic/FOOSH: -colles/smith fractures -scaphoid fx -Boxer's fx -mallet finger -lunate dislocation -scaphoid-lunate dislocation -Kienbock's disease -TFCC disc injury Overuse: -CTS Disease specific: -Raynaud's phenomenon -complex regional pain syndrome
The goal of rehabilitation with hand/wrist symptoms is to return to function, how should this influence your plan with therapeutic exercises?
try to relate them to functional tasks rather than performing mundane/flexion and extension exercises
Which soft dressing would be good for bulbous, sensitive limbs?
tubular elastic
H2 antagonists are used for both acute and long term management of _____
ulcers
The 3 general types of seizures include partial, generalized and __________________ seizures
unclassified
What is cellular anaplasia?
undifferentiated cells with variable nuclear and cell structures (characteristic of cancer)
PAM can be classified as restricted or _________?
unrestricted
Increased tone and hyperreflexia are indications of __________________ motor neuron damage
upper
How is desensitization done in amputation rehab? What should you make sure not to do while performing desensitization? How often should it be done?
use different textures over residual limb to make them less sensitive to touch never want to stretch the suture line during this 2-5 min, 1-2x/day
What should you do if no one is available to help you don a tubular elastic?
use one of those cylindrical applicators that are open on both ends to apply it
Do penicillins have any negative side effects?
usually no, except for in people with hypersensitivity reactions to the drug
An external moment depends on the GRF _______________'s relationship to the _____________ axes
vector joint
If symptoms don't change much with activity or body position, the origin is most likely musculoskeletal or visceral?
visceral
If there is no clear MOI, is the origin of pain likely visceral or musculoskeletal?
visceral
When pt describes the location of their pain, what should you keep in mind?
visceral referred pain -visceral pain is usually more dull and generalized -musculoskeletal pain is more sharp and focused
What symptoms occur due to an occlusion of the posterior cerebral artery (occipital lobe)?
visual loss
Abduction of the CMC of the thumb involves a _______ roll and a _______ glide
volar roll dorsal glide
Flexion of the thumb involves a _________ roll and a ________ glide
volar/ulnar roll volar/ulnar glide
In which direction is the lunate commonly dislocated?
volarly
How does fatigue vary with voluntary vs. electrical-induced muscle contraction?
voluntary has varied motor unit response = less fatigue electrical-induced the same motor units respond
How is the firing of neurons different with voluntary muscle contraction vs. electrical-induced muscle contraction?
voluntary is asynchronous whereas electrical-induced is synchronous
For voluntary muscle contractions, the movement is _______ depending on ________. Whereas for electrical-induced muscle contraction is a(n) __________ response, depending on _________
voluntary is graded depending on load electrical-induced is all or nothing depending on intensity
What may increase the amount of lateral pelvic tilt during gait?
weak gluteus medius (Trendelenburg if significant)
