assignments/missed practice test ?
rancho los amigos scale level ii
generalized response Responds inconsistently and non-purposefully to external stimuli Responses are often the same regardless of the stimulus
What is asthenia?
generalized weakness
what are some conditions that would yield a positive sign of the buttock?
gluteal bursitis abcess tight glute max tightness of posterior capsule of the hip
Which changes in the gastrointestinal tract MOST likely are a result of the exercise?
has been found to improve the overall neuromuscular function of the colon, thus improving bowel transit time and decreasing the risk of constipation.
symptoms of a unilateral vestibular hypofunction
head tilt to one side resting (spontaneous) nystagmus oscillopsia dysequilibrium postural instability
describe rule of 9s for a kid
head: anterior: 8.5% + posterior: 8.5% trunk: anterior: 18% +posterior: 18% arms: 4.5% anterior +4.5% posterior (for each limb) legs: 6.5% anterior +6.5% posterior (for each limb)
describe polycythemia? what happens to blood viscosity, blood volume and BP?
blood viscosity: increased blood volume: increased blood pressure: elevated
A patient with ankylosing spondylitis reports having had a diagnostic test that showed "increased uptake" in the spine and pelvis. Which test was MOST likely performed?
bone scan test this test can see osteoclast and osteoblast activity
describe a counterforce brace
brace used to treat lateral epicondylitis brace is positioned with force over the wrist extensors
What is platypnea?
breathlessness or SOB caused with sitting which is relieved on lying down in supine position
Hyperthyroidism/grave's disease symptoms
heat intolerance low blood pressure tachycardia weight loss fatigue hyperactive reflexes increased sweating tremor nervousness polydipsia weakness increased appetite dyspnea.
what are the stages of wound healing?
hemostasis: must stop the bleeding inflammation: must stop the infection proliferation: construct the scar maturation: smooth out the scar
what are 5 causes of respiratory alkalosis
high altitude, pregnancy, fevers, hypoxia or increased tidal volume in vented patients
ideal temp for moist hot pack hot water storage?
hydrocollator should be bet 158-167 deg
Swan neck deformity
hyperextension of PIP passive flexion of DIP due to increased tension on stretch FDP tendon
guidelines for when to exercise before/after/during dialysis?
low intensity during dialysis moderate intensity after dialysis is recommended however exercise prior to dialysis can cause instability.
resting pressure and working pressure of short stretch bandages
low resting pressures that enhance lymphatic return at rest high working pressure that facilitate increased fluid return during muscle pumping activities.
what are some examples of why a patient would have an empty end-feel? what is meant by "empty"
cannot reach end-feel, usually due to pain ex: joint inflammation, fracture, bursitis
Gold sodium thiomalate is categorized as a...
categorized as a disease-modifying antirheumatic drug
clinical presentation of trochanteric bursitis
cause due to acute or cumulative trauma to lateral hip symptoms: lateral hip pain, but limitations in movement are not common
description of and indications for a milwaukee brace
cervicothoracolumbosacral orthosis that is basically a TLSO w/ an upward component to the mastoid and mandible used to correct scoliosis curvature
what are 4 causes of respiratory acidosis?
chest trauma, left congestive heart failure, airway obstruction and COPD
which joints do you use circumferential measurements vs. volumetric measurements to track edema?
circumferential: knee volumetric: wrist and hand
in a blood test, what is a condition that could show up as having an increase in erythocyte sedimentation rate and possible anemia?
clinical indicators of rheumatoid arthritis
what is occurring during S2
closing of aortic and pulmonary valves onset of ventricular diastole
Atalectasis
collapse of normally expanded and aerated lung tissue at any structural level (e.g., lung parenchyma, alveoli, pleura, chest wall, bronchi) involves all or part of the lung
eclampsia
common in pregnant women and those who have just given birth tonic clonic seizures in a woman with pre-eclampsia. Increasing risk include upper right abdominal pain, severe headache, and vision and mental status changes
what are the two branches of the sciatic nerve
common peroneal nerve tibial nerve
preclampsia
condition that can occur during pregnancy, symptoms: hypertension, protein in the urine, and severe fluid retention
Medial inferior pontine syndrome
contralateral hemiparesis of face and extremities and ipsilateral nystagmus. medial strabismus of ipsilateral eye
equation for the karvonen method
((HRmax-HRrest) *.6)+HR rest=low end and ((HRmax-HRrest*.8)+HRrest=high end
Three tracts and their functions of the spinothalamic tract?
(1) anterior (ventral) spinothalamic tract, which carries the sensations of crudely localized touch and pressure; (2) the lateral spinothalamic tract, which carries pain and temperature; and (3) the spinoreticular tract, which is involved with diffuse pain sensations
Colles fracture
(dinner fork deformity) is referred to as if the radius dislocated in a dorsal direction
smith's fracture
(garden spade deformity) would be described as the radius dislocating in a volar direction
what would one look at an F wave? what does this wave indicated
-allows one to study the proximal nerve segments during nerve velocity EMG. -elicited by the supramaximal stimulation of a peripheral nerve at a distal site
Presentation of SCFE
-decreased internal rotation, abduction, and flexion. -With passive flexion of the hip, the patient will frequently externally rotate the leg -Problems walking -Limping -Mild pain in the hips, groin or around the knees -Stiffness in the hip
A Physical Therapist examining ROM of the shoulder joint of a patient notices that the elbow flexes to 90 degrees with the shoulder flexed to 90 degrees, however elbow flexion increases to 120 degrees with shoulder in neutral. In this case what is the most probable cause of the decreased ROM of the elbow when the shoulder is flexed?
-passive insufficiency of triceps: triceps have less slack at 120 degrees w shoulder flexed to 90 deg -active insufficiency of biceps: biceps can't shorten more at 90 deg of shoulder flexion, it needs the slack of the triceps too
A Patient incurred a myocardial infarction 5 weeks ago. The Physical Therapist is providing strength training to a patient. Which is the MOST appropriate protocol that can be given to a post MI patient at 5 weeks?
1-3 LB with light weights and elastic bands
what is a normal ABI?
1.19-0.95
For diagnostic purposes, what is the recommended number of chest radiographs to be performed on a patient when standard radiographs are ordered for a patient with suspected pulmonary pathologies?
2 radiographs posterior-anterior and left lateral view (unless pathology is on right)
what is the rate at which one should release the blood pressure cuff?
2-3 mmHg/sec
A patient complains of back pain that radiates to his buttock and leg when bending his trunk forward however the pain centralizes when he moves to an erect posture. What would be the best position and % of traction to use for him?
25% BW traction in prone to alleviate disc pathology
min width for w/c doorway clearance
32 inches
min req width to turn 180 degrees in w/c?
60 inches (think 5 ft by 5 ft)
what is the ratio of the circumference of the waist to hip ratio that indicates central obesity?
>.9
A first-time anterior dislocation of the glenohumeral joint subsequent to forced horizontal abduction with lateral (external) rotation is likely to involve which of the following structures?
Anterior capsule subscapularis anterior glenoid labrum
symptoms of tethered cord syndrome
Back pain worsened by activity and relieved with rest Leg pain, especially in the back of legs Leg numbness/tingling Changes in LE strength Deterioration in gait Spine tenderness, Scoliosis Bowel and bladder problems.
differentiate between boutonniere deformity and mallet finger?
Boutonneire deformity: DIP hyperextension Mallet finger is most commonly caused by the hit of a ball causing stress on the DIP resulting in hyperflexion. (click link for more)
at which level SCI will a patient have tendosis grip? why?
C6 SCI patient has some wrist ext due to extensor carpi radialis functionbut not finger flexion
rancho los amigos scale level vi
Confused, Appropriate: Moderate Assistance follow simple commands consistently retain learning for familiar tasks they performed pre-injury (brushing teeth, washing face) unable to retain learning for new tasks Demonstrates increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns Responses may be incorrect secondary to memory impairments but appropriate to the situation
Rancho Los Amigos Scale level v
Confused, Inappropriate Non-Agitated: Maximal Assistance can respond to simple commands with close supervision Responses are non-purposeful and random to more complex commands Behavior and verbalization is often inappropriate, and individual appears confused If action or tasks is demonstrated individual can perform but does not initiate Memory is severely impaired and learning new information is difficult Different from level IV in that individual does not demonstrate agitation to internal stimuli. However, they can show agitation to unpleasant external stimuli.
rancho los amigos scale level iv
Confused/Agitated: Maximal Assistance can be allowed to make some choices in their treatment! The individual is in a hyperactive state with bizarre and non-purposeful behavior Demonstrates agitated behavior that originates more from internal confusion than the external environment Absent short-term memory
Meconium Ileus, what is it? associated with which population?
early sign of cystic fibrosis bowel obstruction in the ileum
what are some abnormal reasons a patient would have a soft end-feel?
edema synovitis ligament instability/tear
what is a gait deviation that can be due to a leg length discrepancy?
Increased dorsiflexion with early heel rise of the long limb at heel off (terminal stance) increased plantar flexion of the short limb during stance
The patella acts to increase ____________, and patellofemoral compression forces are increased by _____
Increases Quadriceps moment arm force is increased by a more flexed knee position
A patient with a transfemoral amputation is wearing a prosthesis and exhibits lumbar lordosis during push-off of the prosthetic side. What is a likely cause of the lordosis?
Insufficient socket flexion can cause lordosis of the lumbar spine.
Volar subluxation of the MCP joints along with Ulnar drift is seen in ____
Deformity often seen in RA
Why is an inversion sprain more common than an eversion sprain?
Deltoid ligament is on the medial side and it provides support. Because of bony and ligamentous anatomy. Fibular malleoli extends further down than the tibial malleoli. Medial collateral ligament is stronger than the lateral one. Easier to tear the smaller ligaments on the lateral side.
if a patient has a C5-C8 SCI, what muscles will be used for respiration
Diaphragm, pectoralis major and minor, serratus anterior, rhomboids, latissimus dorsi
which oblique muscles are doing what during a bicycle crunch where the patient is lying supine and lifts his shoulders off the table to bring his right elbow towards his left knee.?
During rotation to left side, internal oblique of side towards which the movement occurs (left side) work external oblique of the opposite side work (right side).
normal arch index
between 0.210-0.260 >=pes planus <=pes cavus
Weakening (via a surgical procedure) of Tibialis Posterior muscle might help to improve equino varus foot. Which muscles would you consider strengthening pre and post-surgery?
Following weakening the tibialis posterior via surgery, strengthening tibialis anterior, extensors and fibularis longus/ tertius/ brevis. Similar, more stretching (planter flexors) and strengthening post-surgery
what are 2 causes of metabolic alkalosis?
GERD and vomiting
symptoms of childhood leukemia
General malaise, fatigue and lethargy, Prolonged or recurrent episodes of fever, Irritability, failure to thrive Shortness of breath and/or reduced exercise tolerance Dizziness and palpitations, Bleeding diathesis bleeding gums and/or easy bruising, Bone or joint pain, particularly in the legs, Troublesome constipation Prolonged cough, Headache, Nausea and vomiting, particularly if central nervous system (CNS) infiltration is present.
Painful arc range!
Glenohumeral arc: 45/60 degrees - 120 degrees; acromioclavicular arc: 170-180 degrees
primary risk factors for atherosclerosis
HTN hyperlipidemia cigarette smoking
ideal hand placement for PT when using a gait belt for PT grip strength and patient control
Hand placement with the forearm supinated
A 55-year-old man was running in the morning and suddenly collapsed on the track. You are the first to arrive on the scene and find the person unresponsive, pulseless and gasping, and you activate the emergency response system. As a healthcare provider, your next step should be... why?
Initiate CPR with cycle of 30 compressions and 2 breaths symptoms indicate cardiac arrest
A 45-year-old female comes to you complaining of limited extension in her elbow causing problems with setting things down e.g. grocery bags, etc. How will you determine whether the limited extension of the elbow joint is due to a biceps contracture or due to a problem in the humeroulnar joint?
If the restriction in elbow is due to bone on bone contact- the end feel would be hard.I f the restriction is not bone on bone, look for biceps contracture- check the elbow extension at two different shoulder positions (as the biceps is a two joint muscle crossing the shoulder and elbow).Also, biceps contracture might force the arm into supination, as biceps is a supinator.
Why do isometric quad contractions at 15 degrees extension cause stress to the graft following ACL allographic reconstruction?
Isometric exercise of quadriceps at 15 degrees will cause open chain (end- range) terminal extension. Contraction of the quadriceps in this position and range causes anterior tibial translation and can create excessive stress to the graft during the early stage of healing. So, open chain terminal knee extension is not advised post ACL repair.
Patient presents with leg length discrepancy, decreased hip EXT/ABD AROM. Limited in IR with both flexion and extension hip AROM. What do they likely have?
Legg Calve Perthes
rancho los amigos scale level iii
Localized Response: Total Assistance Responds inconsistently and specifically to external stimuli Responses are directly related to the stimulus, for example, patient withdraws or vocalizes to painful stimuli Responds more to familiar people (friends and family) versus strangers
pathway of lymph return through the le?
Lower extremities > Lumbar lymphatic trunks > Cisterna chyli > Thoracic duct > Left subclavian vein
role of an anterior stop in an AFO
limit dorsiflexion, aiding the patient with paralysis of the triceps surae to achieve propulsion during late stance
pneumonic to remember the level of diaphragm innervation
Mnemonic: C3, 4, 5 keeps the diaphragm alive!
rancho los amigos scale level vii
Oriented in familiar settings Able to perform daily routine automatically with minimal to absent confusion Demonstrates carry over for new tasks and learning Superficially aware of one's diagnosis but unaware of specific impairments: needs min supervision for learning and safety lack of insight, decreased judgment and safety awareness Beginning to show interest in social and recreational activities in structured settings
impact of hold-relax PNF technique
PNF strategy increase ROM contract for all muscles at limitation of ROM relax occurs as extremity moves through new increased ROM think pole flexibility technique
impact of rhythmic stabilizations PNF strategy
PNF strategy used to increase ROM and coordinate isometric contractions req isometric contraction of all muscles around a joint against resistance
impact of repeated contractions PNF strategy
PNF strategy: used for the initiation of movement and sustain a contraction through the range of motion therapist provides a quick stretch followed by isometric or isotonic contractions. providing resistance at the point of weakness can enhance the effectiveness of repeated contractions
What is Kehr's sign
Pain in the left shoulder with pressure placed on the upper abdomen, caused by free air or blood in the abdominal cavity
An inpatient is referred to physical therapy after undergoing coronary artery bypass surgery 5 days ago. The patient's medical history includes hypertension, hypercholesterolemia, and type 2 diabetes. What are some factors should a physical therapist consider when developing a plan of care? Why?
Premorbid physical activity level, current physical condition, and motivation to exercise Rationale: these are modifiable factors
A 24-year-old PT graduate student was using a phone with a broken screen and recently upgraded to a new phone. The student is constantly on the new phone and is having difficulty swiping upwards with their thumb. What is the BEST mobilization to improve the thumb range of motion so that the student can swipe happily thereafter?
Radial glide is used to improve thumb extension to help swipe upwards. At the first CMC joint, the trapezium is convex and the proximal metacarpal is concave for flexion and extension. Flexion and Extension are frontal plane movements of the thumb and concave base of first metacarpal moves over the convex trapezium
victim has pulse but no normal breathing...what do you do?
Rescue breathing at the rate of 10-12 breaths/min
heart sound heard when a patient has hypertension, left ventricular hypertrophy, increased left ventricular end diastolic pressure, pulmonary hypertension, and pulmonary stenosis
S4 heart sound will be heard
at what sci level will a patient show neurogenic shock? symptoms?
SCI will be above T6 present with hypotension, bradycardia, cyanosis, warm-dry extremities, decreased cardiac output, peripheral vasodilation and venous pooling
if a patient has a C1-C2 SCI, what muscles will be used for respiration
SCM, upper trapezius, cervical extensors
What position is optimal for BEST positioning for a patient with a CVA when lying on the hemiplegic side?
Scapula protracted shoulder forward arm placed in slight abduction and external rotation; elbow extended forearm supinated wrist neutral fingers extended thumb abducted.
role of the lower trapezius
Scapular depression, adduction, and upward rotation
Lung pathology including cancer and chronic hypoxia are associated with what nail type?
Severe clubbing of the nails is associated w these conditions
how do i bias the femoral nerve when performing the slump test?
Side-lying cervical flexion thoracic and lumbar flexion (slump) hip flexion (20 degrees of flexion) knee flexion ankle PF
How will tight hip flexors change spine kinematics during standing, lifting and sitting?
Standing: Tight hip flexor will change kinematic of spine by increasing anterior tilt of pelvis and lumbar lordosis. Lifting: Since hip flexors will shorten, during bending forward, tightness of hip flexors will not change the kinematics of the spine too much. However, kinematics of the spine might change during standing erect. Sitting: No significant change as the hip is flexed
how do i bias the obturator nerve during the slump test?
Supine cervical flexion thoracic and lumbar flexion (slump) hip flexion (90 degrees) hip ABDuction knee extension ankle DF.
1st trimester expected blood pressure changes?
Systolic slightly decrease with a greater decrease of diastolic pressure
What is the lesion above which a patient will not be a functional ambulator?
T12 and above will limit patient's ability for this function
components of the TNM system for cancer dx
T: size and extent of primary tumor N: extent of lymph node involvement M: presence of metastasis
description of and indications for a jewett brace
TLSO that has two plates anteriorly. one at sternum, one at the suprapubic region and one plate posteriorly at the lumbar area. limits trunk flexion and encourages an erect posture
what dermatome location corresponds to the biceps reflex test?
Tests the integrity of C5-C6. dermatome covers the lateral aspect of the upper extremity from the shoulder to the thumb (1st digit).
independent variable
The experimental factor that is manipulated; the variable whose effect is being studied.
A tracheal shift or mediastinal shift can occur due to asymmetrical intrathoracic pressure in the lungs. Which direction will the shift occur if that patient has a hemothorax?
The mediastinum shifts away from the affected side
A 25-year-old male sustained a 'glass cut' injury to the FDP tendon of her index finger during a street fight. The tendon was repaired and her surgeon wants it immobilized such that there is minimum tension on the tendon. What position would you recommend?
The recommended position will be: MCP, PIP, and DIP flexed. Wrist can be flexed depending on the choice of surgeon.
MMT position for latissimus dorsi
To test the muscle, the patient is prone with head turned to one side, arms at sides; test arm is internally rotated and the patient is instructed to raise arm off table.
describe the relationship bet VO2 max and age
VO2 max declines after age 25
what is in the dgi
Walking at normal and fast pace, walking while looking Left, right, up and down, walk-pivot-stop stair climbing walking over and around an obstacle.
In a restaurant, a therapist sees someone choking. He approaches the individual, and asks to help. The patient refused, and proceeds to collapse. What is the MOST appropriate next action for the therapist?
With an unresponsive patient, activation of the emergency response system, and initiation of CPR should be done. When a patient is unresponsive consent is considered unless the patient has signed a DNR.
synomns for cervical restrictions that say pain with extension?
restriction is: closing, descreased space, downglide
what is a bony impairment that can lead to spondylolisthesis
a defect in pars interarticularis note: a fracture of the pars interarticularis is known by something else
ecchmyosis
a flat, blue or purple patch measuring 1 centimeter (cm) or more in diameter.
how will a cerebellar lesion present?
a lesion in this cortex can cause ataxia; tremor; hypotonia; and asthenia
fremitus
a palpable vibration from the spoken voice felt over the chest wall
in order to improve knee flexion range of mobilization of the tibia on the femur...
a posterior glide of the tibia on the femur mobilization would be beneficial to improve ____ motion
describe meniere's disease
a recurrent and usually progressive vestibular disease. symptoms: low frequency hearing loss, episodic vertigo. "a sense of fullness and tinnitus"
pneumothorax
air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse.
normal eversion ROM
about 18 degrees
normal inversion ROM
about 30 degrees
hypothalamus: PNS or SNS?
activates the SNS
how can i make the hamstrings work harder when using a stationary bike? why?
add toe clips The toe clips limit ankle motion, which increases knee flexion and makes the hamstrings work harder.
bacody's sign
also known as shoulder abduction test is used to test for radicular symptoms, especially those involving the C4 or C5 nerve roots. +: decrease of symptoms indicates a cervical extradural compression problem...Abduction of the arm decreases the length of the neurological pathway and decreases the pressure on the lower nerve roots.
major indication for ACL reconstruction?
amount of ACL functional instability following injury a medial meniscus tear would increase this instability and need for particular treatment choice
cor pulmonale
another name for RIGHT sided heart failure
which tilt direction of the pelvis occurs with counternutation
anterior pelvic tilt will occur with this motion
describe a high guard postion?
arms being held at near shoulder level w retraction of scapulae
What kind of exercise is allowed if a patient has a platelet count of below 20,000?
at this level of platelets, a patient is permitted to do: ADLs, AAROM (AROM but no antigravity or resistive exercise)
describe graves' disease
autoimmune disease due to hyperthyroidism presence of goiter heat intolerance nervousness tremor palpitations
rancho los amigos scale level viii
automatic-appropriate Consistently oriented to person, place and time Independently carries out familiar tasks in a non-distracting environment Beginning to show awareness of specific impairments and how they interfere with tasks, however, requires standing by assistance to compensate Able to use assistive memory devices to recall daily schedule Acknowledges other's emotional states and requires only minimal assistance to respond appropriately Demonstrates improvement of memory and ability to consolidate the past and future events Often depressed, irritable and with low frustration threshold
liver pain is often described as....
right upper quadrant pain and in ____ during exercise. pain is constant w no change throughout the day
What does S3 heart sound indicate?
can occur in healthy children and young adults (very fit ones) also can indicate heart disease or heart failure aka "ventricular gallop"
mneumonic for diaphraghm innervation
c3-4-5 keeps the diaphragm alive!
To make the trapezium more prominent, the PT would ask a patient to ....?
can be made more prominent by opposing the thumb to the little finger and ulnarly deviating the wrist.
what is an affect related to metabolism on the body due to a superficial partial-thickness to a deep partial-thickness burn?
creates hypermetabolism which means increased oxygen consumption and increased core temperature
Central Cord Syndrome
due to hyperextension injury UE are more affected than LE distal extremities are more affected than proximal
Symptoms of avascular necrosis at hip
decreased FABIR ROM pain in the groin and/or thigh TTP at hip joint
Which type of burn results in excessive scarring and the development of hypertrophic and keloid scars?
deep partial-thickness burns result in this type of scarring
role of a posterior leaf spring AFO
dorsiflexion assist orthosis that helps patients with dorsiflexor weakness or paralysis from dragging their toes during swing phase.
most cosmetically attractive foot for a post transtibial amputation person of retirement age. patient is socially active. why?
endoskeletal shank and SACH foot SACH foot is durability, low maintenance and cosmetically okay, it is also light. think NPTE is kind of ageist, so assume someone of retirement age isn't going to run a marathon
In children with cerebral palsy, hyperactivity of the tibialis posterior is a frequent problem. An 8 year old child has hyperactivity in his Tibialis Posterior throughout the walking cycle, such that it overwhelms the synergistic actions of other muscles. What would you anticipate to be the position of the foot at initial contact - throughout stance?
equino varus foot (weight on balls of feet and knees together/valgus) due to spasticity of posterior tibialis
describe alternating isometrics
facilitation tech aimed to encourage isometric strength With alternating isometrics, the patient "holds" his position, while manual resistance is alternately applied in a single plane from one side of the body to the other. No motion should occur. ind: instability in wb, poor static postural control, and/or weakness
describe timing for emphasis
facilitation tech uses max resistance to get a seq of contractions from major muscle components of a motor pattern. strong muscles cause overflow into weaker ones In: weakness, incoordination
describe rhythmic initiation
facilitation tech. starts w voluntary relaxation followed by passive movements within increments in range followed by active assistive movements, followed by resistive ind: hypertonicity, inability to initiate movement, motor learning deficits, communication impairment
describe approximation
facilitation technique where goal is to facilitate contraction and stability through joint compression compression force through gravity/use of weight belt, manual contact ind: impaired dynamic stability
SICK syndrome
fancy way of saying scapular dyskinesia... Scapular Malpositioning Inferior medial border prominence Coracoid pain and malposition DysKinesis of scapular movement
Examples of normal end-feels
firm hard soft
Bountonniere Deformity
flexion of PIP joint hyperextension of DIP due to rupture or attenuation of central band of extensor mechanism along with triangular ligament lateral bands slip in a palmar direction
what is Symmetrical tonic neck reflex? what can it impact if not integrated?
flexion of neck results in flexion of upper extremity and extension of lower extremity. Extension of neck results in extension of upper extremity and flexion of lower extremity. can negatively affect crawling
in order to facilitate palpation of the lunate, what motion should i use at the wrist?
flexion will facillitate palpation of this wrist bone in particular
what are some abnormal reasons a patient would have a hard end-feel?
fracture OA osteophyte formation
symptoms of pleural effusion
frictional rub, tachycardia jugular venous distention bilateral edema decreased breath sounds decreased fremitus. shortness of breath during all ADLs sharp "stabbing" pain increased with coughing.
irritable bowel syndrome symptoms
functional disorder of motility in the small and large intestines. relieved by defecation pain tends to disappear at night (while sleeping). LLQ pain, constipation, diarrhea
kind of shock due to severe blood loss. this causes decreased organ perfusion
hypovolemic
in order to improve knee extension range of motion, what type of mobilization would be used?
in order to improve this motion, an anterior glide of the tibia on the femur would be used
what is dysdiadochokinesia
inability to perform quick, alternating movements
Ideational Apraxia
inability to produce movement on command as the patient is unable to formulate the required motor task. however can do habitual tasks when not ordered to
What is polycythemia? clinical presenation
increase in number of red blood cells and concentration of hemoglobin->results in increased blood viscosity and higher BP. symptoms: fatigue, dyspnea, headache, dizzy, irritability, blurred vision, decreased mental acuity, sensory disturbances
swayback posture
increase in posterior tilt of the pelvis and the trunk and thoracic kyphosis in comparison to neutral posture
Normal aging effects respiratory function how?
increase in residual volume increase functional residual capacity increase in airway resistance decrease in diffusion capacity.
what are some abnormal reasons a patient would have a firm end-feel?
increased tone tightening of the capsule ligament shortening
what are facilitation techniques used for?
interventions designed to reduce the effects of impairments and disabilities while promoting motor recovery and improved function
symptoms of pleurisy
inflammation of the parietal pleura. Because the visceral pleura is innervated by the intercostal nerves, chest pain is usually felt over the site, but pain may be referred to the lower chest wall, abdomen, neck, upper trapezius muscle, and shoulder...exacerbated with movement
patient population that benefits from glossopharyngeal breathing
is useful for patients with high level cervical lesions like C4 level SCI, as at this level the diaphragm is partially innervated and use of accessory muscles is seen.
describe hypomobility of TMJ
lack of TMJ movement, but no pain
describe capsulitis of TMJ
lack of TMJ movement, deviation and pain
describe synovitis of TMJ
lack of TMJ movement, no deviation, and pain
how will a patient w a lesion in the somatosensory cortex present?
lesion in this cortex can cause impaired sensory processing, impaired perception
symptoms of a peripheral nerve injury
lesions typically do not present with pain. Weakness/sensory symptoms are specific to the nerve involved.
indications for use of calcium carbonate? side effects?
med that is a bone mineral regulating age use to enhance and max bone mass w/ preventing bone loss side effects: nausea, decreased appetite, constipation, dry mouth
gabapentin indication? side effects?
med used to control seizures, diabetic neuropathy; pain relief for shingles/trigeminal neuralgia side effects: ataxia
A 60-year-old patient sustained a fall on an outstretched arm and hand (wrist in extension). He says that when he fell "the elbow was straight and his hand was out away from his body". This resulted in tendency for the forearm & hand to move into valgus. What structures are vulnerable to injury?
medial collateral ligament is most susceptible to injury when the fully extended elbow is violently forced into excessive valgus Other structures on the medial side will also be vulnerable.
indications for silver sulfadiazine? potential side effects
medication is a topical antibiotic used to fight infection after serious burns side effects: GI issues, allergic reactions, decrease in WBCs
Which phase of the gait cycle has the maximum torque for the Hamstring muscles? Why?
midswing acts eccentrically to control excessive knee extension as they move towards the terminal swing phase of gait.
what are the stages of motor control in order for least proficient to most proficient
mobility stability controlled mobility skill
what are the most common way to provide short-term feeding for a pt. who cannot get enough nutrients by mouth?
nasogastric tube
what does the superficial peroneal nerve innervate (motor and sensory? nerve root
nerve root: L4-S1 motor: everters of the foot sensory: dorsum of foot and anterolateral aspect of the leg except the web space between the big toe and second toe
rancho los amigos scale level i
no response, total assistance, coma
description of and indications for a corset brace
non-rigid spinal orthosis made of fabric and has pouches to add additional vertical stays as needed does not restrict spinal motion, but can fit more snuggly to body and increase intraabdominal pressure
secondary risk factors for atherosclerosis
obesity stress activity level
Describe Brown-Sequard Syndrome
occurs from hemisection of the spinal cord due to penetration wounds i.e. gunshot, knife stab injury. The clinical features are asymmetrical. -ipsilateral: paralysis and loss of proprioception, light touch, and vibratory sense -contralateral: loss of sense of pain and temperature
What does S4 indicate?
occurs just before S1 indicates: MI,hypertension, coronary bypass surgery assoc w/ atrial contraction and increased resistance to ventricular filling "atrial gallop"
flatback posture
occurs when there is a loss either of lordosis or kyphosis or both, making the spine straight.
difference between orthopnea and platypnea
orthopnea: difficulty breathing while lying supine which is relieved when sitting up platypnea: difficulty breathing while sitting and relieve with laying down
compare and contrast: osgood schlatter vs sinding larsen johansson
osgood schlatter: tibial tuberosity avulsion found in adolescents sinding larsen johansson: pain at the bottom of the kneecap (patella). It is caused by swelling and irritation of the growth plate there
describe the barthel index
outcome measure 10 ADLS used in rehab, long term care facilities, and home care score: 0-100 in increments of 5. 100 means pt is independent
describe the berg balance scale
outcome measure 14 ADLS scored 0-4 max score =56, a higher score indicates higher disability and increased fall risk
describe the tinetti performance oriented mobility assessment
outcome measure for balance and gait ordinal scale of 0-2 max score: 28 <19 =high fall risk
5 P's of compartment syndrome
pain pallor paresthesia pulselessness paralysis
Describe fremitus
palpable vibration produced during breathing caused by partial airway obstruction. Caused by: mucus or other secretions in the airway, bronchial hyperreactivity, or tumors
if a patient has a C3-C4 SCI, what muscles will be used for respiration
partial diaphragm, scalenes, levator scapulae
Best position in supine for more affected LE following a stroke
pelvis: protracted hip: slightly flexed and abducted knee: slightly flexed ankle: neutral, with nothing against the feet
acceptable vital sign levels for phase 1 cardiac rehab?
phase 1 HR: less than 20 bpm increase from resting dypnea: expected to a certain point (be reasonable) SBP: decrease of up to 10mmHg DBP: must remain less than 110mmHg
what is the clock pneumonic to remember the ligaments of the ankle?
picture the outside of your right ankle with your lateral malleolus as the center of the clock ATFL runs approximately to 3 o'clock CFL to 7 o'clock PTFL to 9 o'clock.
compare and contrast pneumothorax and atelectasis in terms of which way the trachea will deviate
pneumothorax: trachea deviates and pushes to CONTRALATERAL side atelectasis: trachea deviates and pushes to IPSILATERAL side
which tilt direction of the pelvis occurs with nutation
posterior pelvic rotation "I'm going nuts or postal"
how do i stretch the iliopsoas? explain?
posterior pelvic tilt and contralateral flexion of the trunk. iliopsoas flexes the hip and laterally ipsilaterally flexes the trunk-->to lengthen it needs the opposite motions, so that's ext and contralateral flexion. just do this motion in your body.
best technique to use when instructing an individual with intellectual disability
practice, review, and facilitate overlearning of concepts and techniques.
common symptoms of diverticulitis
presence of formation of pouches and abscesses in the wall of the large intestine pain is referred to left lower abdomen and lower back.
Role of a plastic hinged AFO (or a posterior steel stop)
prevents the ankle from plantar flexing so that a patient with weak dorsiflexors will not catch their toes and stumble during swing phase
common symptoms of Duchenne muscular dystrophy
progressive disorder, x-linked recessive onset: bet 2-5 y/o symptoms: proximal weakness, falling, toe walking, excessive lordosis, psuedohypertrophy of muscle groups
describe roos test
pt has arms in 90 deg of abduction, ER and elbow flexion pt. opens and closes hands for 3 min test is + for thoracic outlet syndrome if pt is unable to maintain position, weakness, sensory loss
describe the allen test
pt has test arm in 90 degrees of abduction lateral rotation and elbow flexion pt asked to rotate head AWAY from test shoulder. PT monitors radial pulse +for TOS is pulse disappears
describe wright's test
pt in sitting or supine PT moves patient's arm into max ABD while monitoring radial pulse + if radial pulse disappears
describe the functional reach test
pt makes fist, raises arm to 90 flexion. PT measures length of limb pt leans as far forward as possible w 90 of shoulder flexion PT measures distance from beg to ending postion bony landmark: 3rd met
describe adson manuever
pt sits or stands while PT monitors radial pulse and asks patient to rotate their head towards their test shoulder pt extends their head while PT laterally rotates and extends patient's shoulder. + for TOS is radial pulse disappears
static wrist and hand position of a patient who has advanced rheumatoid arthritis. Which positioning would MOST likely be observed based on the medical diagnosis?
radial deviation of radiocarpal joint: due to boney changes ulnar deviation of fingers: due to displacement of extensor tendons
A 27-year-old girl had a flip phone for the past 4 years and finally upgraded to an iphone 8. She has been on her new phone constantly and is now having difficulty swiping upwards with her thumb. She explains this to her friend who is a PT student. To improve her thumb's range of motion without difficulty, what is the BEST mobilization or glide the PT student should perform?
radial glide to improve thumb extension the thumb metacarpal is concave in flexion/extension as it articulates with the trapezium!!
what is a sampling error
refers to the dif bet samples drawn from the same pop due to chance.
hypothalamus SNS activates?
regulates the following bodily functions: pupil dilation increases blood pressure increases respiration rate increases glucose production decreases digestion increases sweating increases muscle activation
significance of the rate pressure product (SBP *HR)
represents the myocardial oxygen demand of the heart
describe the rancho los amigos scale overall
scale measuring of I-VIII, lower score indicates higher disability used to measure levels of consciousness
UE flexion synergy
scapular retraction/elevation shoulder abduction external rotation elbow flexion forearm supination wrist and finger flexion
Score on Berg balance scale that indicates a high risk of fall
score of 45 or below
characteristics of critical limb ischemia
severe pain in legs and feet at rest: can be relieved by placing legs in dep position or getting up to walk around decrease in lower limb temperature
describe a normally healing scar
soft, is slightly raised to palpation, and is pink with a silvery white appearance.
what conditions is kehr's sign associated with?
stomach ulcer after laparoscopy after rupture of the spleen
A patient is able to perform heel sitting without any discomfort, but complains of pain when the therapist pushes his heel toward his buttocks with bent knees during prone lying. What should the therapist do to address this problem?
stretch the rectus femoris IT IS A TWO JOINT MUSCLE
what are some characteristics of pulmonary fibrosis that i would see on an x-ray?
tell-tale signs on an x-ray: reticular or net like pattern due to destruction and fibrosis of the lung tissue.
describe Greater Trochanteric Pain Syndrome
tendons and bursae surrounding the greater trochanter. An injury to these structures causes pain on the outside of buttock and thigh. Symptoms: TFL and trochanteric bursa can be tender to palpation, pain over the outside part of the upper leg, from the hip to the knee along the thigh that's worse with activities such as standing, walking, or running.
when is a test considered SPECIFIC. just think about the laws governing how you would set up an equation. what would you want if you were trying to get the right answer in a basic algebra equation?
test is negative in persons who do not have the disease, will rarely present with a false positive TN/(TN+FP)...get rid of everything in the equation that isn't a TRUE positive.
Craig's test
test that identifies abnormal anteversion
Ely's test
test that identifies tightness of rectus femoris.
which nerve are you testing w the triceps reflex?
tests radial nerve obvious, but good to review...
A physical therapist instructs a patient to expire maximally after taking a maximal inspiration. The therapist can use these instructions to measure which of the following lung volumes?
the NPTE accepted answer is vital capacity. the wording is stupid.
what is q angle
the angle between the quadriceps muscle and the patellar tendon
describe anterior drawer test
the patient lies in the supine position with the clinician standing to the side of the patient's involved knee. The clinician grasps the lower leg of the patient just distal to the joint space of the knee and the patient's knee is flexed to 90 degrees so that the foot is flat and the lower leg is not rotated. +=ACL tear
arcade or canal of Frohse.
the supinator arch. formed by a fibrous band between the two heads of the supinator muscle. The deep branch of the radial nerve passes through it
impact of contract-relax PNF strategy
this PNF strategy is meant to increase ROM when extremity reaches max range, pt performs a max contraction of antagonist against therapist resistance this is then followed by relaxation and passive movement into increased ROM
describe a contralateral step-to pattern if pain is on pt's L leg
this antalgic gait pattern is characterized by: left limb is in stance r limb has a shortened swing time
What does an arch index of more than .30 indicate?
this arch index indicates low arch or pes planus
benefits of using a reverse walker
this assistive device would help decrease a patient's potential forward trunk lean pt must hold the device w/ shoulders more in ext, scapulae in more depression and retraction which improves thoracic ext. can also be more efficient that traditional walkers
what is occurring during S1?
this heart sound indicates the closing of the mitral and tricuspid valves indicating the onset of ventricular systole
aldosterone does what???
this hormone maintains the electrolyte imbalance by sodium conservation as well as assists to maintain the homeostatic balance
indications for use of dantrolene sodium? side effects?
this medication is a post-synaptic muscle relaxant, commonly used to treat spasticity by interfering w release of calcium side effects: drowsiness, confusion, and weakness. may limit patient's ability to complete exercises such as sit to stand transfers
what effect does digitalis have on an ekg strip and why?
this medication prolongs the PR interval because it increases the conduction time through the AV node it also produces some sagging of the ST segment, which is not pathological. think "salvador dali's mustache"
role of latissimus dorsi
this muscle is glenohumeral extensor and medial (internal) rotator
baroreceptor reflex
this reflex causes: reflexive dilation of peripheral vasculature and bradycardia--->leading to a decrease in cardiac output. MEANING: regulates increases in blood pressure from affecting the brain
benefits of a heel lift
this shoe modification will help in weight redistribution and increase plantarflexion.
what is the most likely reason a patient would have a reverse total arthroplasty?
this surgery would be chosen due an irreparable supraspinatus tear inverted joint increases boney congruency; decreases translation of humerus, and increases deltoid moment arm->allows patient to elevate arm as a result
impact of a w/c axle being placed farther posteriorly than usual which patients commonly use this type of w/c?
this w/c adjustment is commonly used for patients w/bilateral amputations to increase stability negative effects: increases rolling resistance, makes doing a wheelie harder, increased turning radius, and increases amount of energy need to propel chair
mobilization used to improve accessory patellofemoral joint motion
this would be a lateral glide mobilization of the patella
description of and indications for a taylor brace
thoracolumbosacral orthosis, consists of 2 posterior rigid struts that attach inferiorly to pelvic band and superiorly to axillary straps limits trunk motion in sagittal plane
describe a plumb line in normal standing posture
through lobe of the ear through shoulder joint through hip joint though the greater trochanter slightly anterior to the midline of the knee joint anterior to the lateral malleolus.
describe a grade III ACL sprain
total ACL tear
Describe Osgood-Schlatter disease
traction apophysitis at tibial tuberosity common in teens in sports that req a lot of running, jumping, swift directional changes, and rep knee flexion.
CLOSED PACK position for ulnohumeral joint radiohumeral joint radioulnar joint
ulnohumeral joint: extension with supination radiohumeral joint: 90 degrees of flexion with 5 degrees of supination proximal (superior) radioulnar joint: 5 degrees of supination.
how i improve ER in a PT with adhesive capsulitis?
use a posterior glide...even though it makes no sense
two conditions that require use of an AED?
ventricular tachycardia ventricular fibrillation (in addition to getting them to an er)
on a crowded train, in the dark, what system MUST be functioning in order for you to maintain your balance and why?
vestibular system in this scenario, you have an unstable surface-proprioception can't help you, and because it is dark, your eyes can't help you in order to figure out these questions, think about which system would REMAIN in the test. the one that remains is the one being tested
S4 heart sound
vibrations of the ventricular wall during the rapid influx of blood during atrial contraction from an exaggerated atrial contraction (atrial kick).
what does a positive sharp wave look like?
waves that are typically biphasic with a sharp initial positive deflection (below baseline) followed by a slow negative phase
describe shoe modification for hallux valgus?
wide toe box: reduces friction and pressure on first MTP medial support: decrease pronation reduced heel height: decreases forefoot pressure
what happens to the patella and tibia during okc knee flexion?
with this motion we see inferior glide of the patella and internal rotation of the tibia
what happens to the patella and tibia during okc knee extension?
with this motion we see tibial external rotation and superior glide of patella
