practice Qs, lectures, stuff i need to keep in my brain
DMD
- Duchenne muscular dystrophy - x linked recessive - missing dystrophin gene -> destruction of muscle cells - exam: strength, ROM, functional testing, skeletal alignment, resp function, assess for AD need, gowers sign - trmt: maintain mobility as long as possible, maintain joint ROM Becker - less severe and less common form
common peroneal nerve entrapment
- Entrapment of common peroneal nerve at the head of the fibula - can result in foot drop - pain in lateral surface of the knee, leg, foot
myelodysplasia S1:
- FO - SMO - community ambulation
cardiopulmonary effects of aquatic therapy:
- HR: decreases - BP: decreases - SV: increases - CO: increases - VC: decreases - work of breathing: increases - VO2 max: decreases - WB: decreases - edema: decreases (though one question says hydrostatic pressure may increase pts BP)
signs of LMN lesion:
- Hypotonia - Hyporeflexia - Flaccid paralysis - severe muscle atrophy (neurogenic, where nerve has been injured) - weakness of whatever muscle is affected - fibrillations - fasciculations (denervation)
ASIA level D
- INCOMPLETE - MOTOR FUNCTION IS PRESERVED BELOW NEUROLOGICAL LEVEL - MOST MUSCLE GROUPS BELOW NEUROLOGICAL LEVEL HAVE A 3/5 MUSCLE GRADE OR HIGHER
JACHO
- Joint Commission on Accreditation of Healthcare Organizations - accredits hospitals, SNF, home health agencies, PPO, HMO, mental institutions
myelodysplasia L3-4:
- KAFO - WC for community mobility - household ambulation possible
What are reasons ABI may be less than 1?
- LE arterial occlusion - LE arterial thrombosis - LE arterial aneurysm
ASIA level C
- MOTOR INCOMPLETE - MOTOR FUNCTION IS PRESERVED BELOW NEUROLOGICAL LEVEL - MOST MUSCLE GROUPS BELOW NEUROLOGICAL LEVEL HAVE less than 3/5 MUSCLE GRADE
contact precautions:
- MRSA, VISA, VRE, clostridium difficle, lice, scabies, impetigo, gram (-) bacteria, uncontrolled diarrhea, aminoglycoside resistant HepA, HepB, dermatitis, rota virus - wash hands before entering and after leaving - gloves and gown only when in direct contact (remove before leaving) - private room or someone with same infection - minimize transport and pt wash hands if they leave
iontophoresis: dexamethasone
- MSK inflammation - (-) I SAD
airborne precautions:
- MTV: measles, tuberculosis, varicella, SARS, herpes zoster, chickenpox, smallpox - handwash upon entering and leaving room - N95 mask, gown and gloves if severe contamination, discard mask upon leaving - private room with negative airflow, keep door closed - minimize transport, pt wear surgical mask outside room
microprocessor foot
- Microcomputer controls the DF and PF - Improves ability to ambulate on incline, stairs, and uneven surfaces - Not widely used due to maintenance cost
myasthenia gravis
- NMJ disorder - caused by autoimmune mediated acteylcholine receptor damage - weakness that worsens during periods of activity and improves after rest - variable degrees of weakness, ranging from ptosis to critical resp weakness - diplopia
vesicular breath sounds
- Normal breath sounds made by air moving in and out of the alveoli - soft, low pitch - location: over most of lungs - inspiratory longer than expiratory
OSHA
- Occupational Safety and Health Administration - responsible for determining the safety of the work environment
exercise guidelines for diabetes
- don't exercise at peak insulin times - exercise at the same time each day - don't exercise outside the range of 100-250 mg/dL
iontophoresis: hyaluronidase
- edema reduction - (+)
pines and zems (amlodipine, verapamil, diltiazem)
- effects: decrease HR and BP - indication: CAD, HTN, arrhythmia - adverse effects: orthostatic hypotension, dizziness, lightheadedness, tinnitus, venous pooling - use RPE for exercise prescription - prolonged QT interval
hyperparathyroidism
- elevated blood calcium and decreased serum phosphate - can demineralize bone (bone weakness and decreased density) - s/s: proximal weakness, fatigue, drowsiness, myalgias, depression, glove/stocking sensory loss, osteopenia, confusion, gout
Craig scott AFO
- enables pt to stand with sufficient trunk flexion - swing to and swing through pattern is possible - single limb advancement is not possible
what to do if pt is talking about committing suicide?
- engage in appropriate conversation until the authorities arrive - have to take action - can call 911 if no help is available
benign prostatic hyperplasia
- enlarged prostate - lower cell turnover rate (more old than new) - sexual function not usually affected unless surgery is required - urination increasingly difficult, less elastic, never feels empty, UTIs
tarsal tunnel syndrome
- entrapment of the posterior tibial nerve - pain with passive ankle eversion - pronated foot - valgus deformity - weak toe flexion strength
deep partial thickness
- epidermis and dermis - mottles red and white areas - blanches to pressure with slow capillary refill - decreased pin prick sensation - can take up to 3 weeks - large wounds can be surgically managed - results in excessive scarring and the development of hypertrophic and keloid scars is a frequent consequence
superficial partial thickness burn
- epidermis and some dermis - weeping blisters - blanches to pressure with quick capillary refill - extremely painful - heals in 10 to 14 days (2 weeks) - minimal scarring
full thickness burn
- epidermis, dermis, and some subQ tissue - dry, rigid, leathery eschar - lack of pain, pressure, temperature sensation - about 4 weeks (more than 3) to heal - will require surgical closure - may have contractures
subdermal burn
- epidermis, dermis, and subQ tissues - charred, dry, and exposed deep tissue - requires surgical intervention - amputation and paralysis possible
midback/scapula pain:
- esophagus - gall bladder - stomach - pancreas - small intestines
calcaneovalgus
- excessive DF, forefoot curved out laterally, hindfoot in valgus
exercise and diabetes
- exercise may result in hypoglycemia - avoid exercise during peak insulin hours - insulin is absorbed much more quickly in an active extremity - provide carb snack initially and have more available - do not exercise in extreme cold or hot temps - exercise in morning is recommended to avoid hypoglycemia resulting from fluctuations in insulin sensitivity
ABI > 1.2
- falsely elevated - arterial disease - diabetes
anterior cord syndrome
- flexion injuries - bilateral motor and pain and temp
leg length discrepancy in stance phase
- shorter LE will PF to reach the ground - increased DF with early heel rise of long limb at heel off - perform hip hike on longer side to clear ground during swing
convex-concave rule for every joint
- shoulder: opposite - elbow: same - proximal radioulnar: opposite - distal radioulnar: same - wrist: opposite - fingers: same - hip: opposite - knee: same - ankle: opposite - toes: same
HbA1c
- simple blood test that measures your average blood sugar levels over the past 3 months - 4 to 5.6%: normal - 5.7 to 6.4%: prediabetes and a higher chance of getting diabetes - 6.5%+: diabetes - above 10% requires immediate insulin therapy
Acoustic Neuroma (Vestibular Schwannoma)
- slow growing tumor that develops from the balance and hearing nerves supplying the inner ear - s/s: hearing loss, tinnitus, loss of balance, vertigo, facial numbness and weakness or loss of muscle movement - touches vestibulocochlear and facial CNs
PNF for controlled mobility:
- slow reversal - slow reversal hold - agonistic reversals
digitalis (digoxin, lanoxin)
- slows down HR but increases strength of contraction (CO) - fewer and better contractions/beats - uses: systolic dysfunction in pts with CHF - causes prolonged PR interval, shortened QT interval - used for acute or decompensated HF, not long term - cardiac glycoside - side effects: digoxin toxicity, arrhythmia, palpitations, fatigue, GI disturbances, visual disturbance, hyperkalemia, confusion, delirium
SACH foot
- solid ankle cushion heel foot - limited motion - cannot be used on uneven terrain
T1-5 respiration
- some intercostal - erector spinae
biofeedback placement
- spasm/spasticity: low sensitivity, close electrodes (TLC - tight low close) - flaccidity/weak muscles: high sensitivity, far spaced she loves and fancies him
types of CP
- spastic: velocity dependent resistance of a muscle to stretch - dystonic: tonic hold of muscles and contributes to passive joint stiffness - ataxia: disorder of coordination, force, timing, associated with cerebellar involvement - athetosis: disorder of basal ganglia, characterized by involuntary movements that are slow and writhing
Bruunstrom stage 3
- spasticity increase, peak - voluntary in and difficulty getting out
characteristics of L CVA
- speech issues - overly aware of limits - afraid - apraxia - preservation - distractible - personality changes (cautious, compulsive, disorganized behavior) - difficulty with new information (decreased memory, difficulty generalizing and conceptualizing)
hip OA prediciton
- squatting is aggravating factor - active hip flexion causes lateral hip pain - scour test with adduction causes lateral hip or groin pain - active hip ext causes pain - passive IR less than or equal to 25 deg 3/5 = increased chance of OA
american college of cardiology foundation (ACCF)/american heart association (AHA) stages of heart failure
- stage A: at high risk for HF but without structural heart disease or symptoms of HF - stage B: structural heart disease but without sign or symptoms of HF - stage C: structural heart disease with prior or recurrent symptoms of HF - stage D: refractory HF requiring specialized interventions
ROM at ankle needed for normal gait:
- stance phase: 0-10 DF, 0-20 PF - swing phase: 0-10 PF
ROM at hip needed for normal gait:
- stance phase: 0-30 flexion and 0-10/20 hyperextension - swing phase: 20-30 flexion
ROM at knee needed for normal gait:
- stance phase: 0-40 flexion - swing phase: 0-60 flexion
cardiac rehab phase 3
- strength training - begin with elastic bands 50% of IRM - progress to mod loads, 12 to 15 reps - avoid UE resistance as soft tissue is still healing
pulmonary changes in pregnancy:
- subcostal angle increases - AP diameter increases by 2 cm - diaphragm elevated by 4 cm - RR unchanged, depth of respiration increases - TV increases - TLC unchanged or slightly decreased - increased in O2 consumption - work of breathing increased coz of hyperventilation - dyspnea
modalities: traction
- supine w pillow under knee: IV jts, facet jts, muscle elongation - prone: posterior disc herniation - increase IV space of: L5-S1 needs 40-60 deg hip flex, L3-4 needs 75-90 deg of hip flexion - disc protrusion, spasm, elongation: 25% body weight - joint distraction: 50 lbs or 50% body weight (initially 25%) - cervical: 710%
GBS diagnosis:
- symmetrical, bilateral, ascending - lumbar puncture: CSF will contain more protein than normal - stool test: viral/bacterial causes of autoimmune antibodies
responsibilities of the frontal lobe:
- voluntary movement - expressive language - managing higher level executive functions (plan, organize, initiate, self monitor, control ones responses) - attention
extension bias
-position preferred by pts with HNP -benefit from extension exercises in prone "McKenzie Exercises"
flexion bias
-position preferred by pts with stensosis, spondylosis, swollen facet joints -benefit from flexion exercises "William's Flexion"
occipital lobe lesion effects:
-primary visual cortex -contralateral homonymous hemianopia -inability to identify previous known objects
A physical therapist is performing cranial nerve testing on a 55-year-old male patient. The physical therapist gives the following command to the patient: "Close your eyes tightly and don't let me open them." Which of the following cranial nerves is being tested?
Facial nerve (CN VII) is efferent for muscles of facial expression, e.g. closing the eyes tightly. Oculomotor and trochlear nerve are responsible for extraocular movements of the eye. Optic and oculomotor together are responsible for the pupillary reflex.
lub and dub sounds
Lub - AV valves closing Dub - SL valves closing
normal RBC count
Male: 4.7-6.1 Female: 4.2-5.4 million cells per microL
difficulty abducting arm in neutral rotation position. what muscle is most likely weak and what is compensating?
Middle deltoid acts as an abductor with the arm in neutral rotation, while supraspinatus acts for only first 15 degrees of abduction. Biceps can be used to substitute the action of abductors when the shoulder is externally rotated. Patients who have deltoid or supraspinatus pathology sometimes use the laterally rotated position of shoulder because lateral rotation allows the biceps tendon to be used as a shoulder abductor in a "cheating" movement.
PT versus PTA
PT - initial eval - discharge - POC PTA - ther ex - progress notes (co-signed by PT)
what are PVCs?
PVCs are ectopic beats that originate in the ventricle, PVCs that come from the same irritable site are termed unifocal PVCs. Single PVCs does not compromise CO, if less than 7 per minute. Therefore, the patient can exercise at lower intensity with EKG monitoring and consultation with physician is not required here.
babinskis sign
Pathologic Reflex Abnormal response is dorsiflexion of the big toe and fanning of all toes. "Upgoing toes" Occurs with upper motor neuron disease of the corticospinal tract.
s/s of L CHF
Pathology of the left ventricular failure reduces the CO leading to a backup of fluid into the left atrium and lungs. The increased fluid in the lungs produces shortness of breath and cough. Persistent spasmodic cough, especially when lying down, occurs due to fluid movement from the extremities to the lungs.
hyperkalemia on ECG
Peaked T waves
depressors of the scapula
Pectoralis major and minor, serratus anterior, lower trapezius, latissimus dorsi
posterior cutaneous nerve of thigh
S1-S2 - posterior thigh
spinal segments that control bowel and bladder
S2-4
S3 heart sound
S3 (ventricular gallop)—in early diastole during rapid ventricular filling phase. Associated with increased filling pressures (e.g., mitral regurgitation, CHF) and more common in dilated ventricles (but normal in children and pregnant women).
What conditions are the abnormal heart sounds S3 and S4 associated with, respectively?
S3 is heard in early diastole (after S2) and is associated with CHF. S4 is heard in late diastole (before S1) and is associated with an MI or hypertension.
what is rate product pressure?
SBP x HR - good indicator of metabolic demand
anosognosia
A condition in which a person with an illness seems unaware of the existence of his or her illness.
A 30-year-old male presents with atrophy of the intrinsic hand musculature, drooping of the eyelids, sunken eyeballs, lack of sweating and pupil constriction. Patient complaints include sudden pleuritic pain and a hoarse voice. What clinical condition is MOST likely related to these findings? Thoracic outlet syndrome Rib fracture Cervical myelopathy Pancoast tumor
A growing Pancoast tumor can cause compression paravertebral sympathetic nerves leading to Horner's syndrome (drooping eyelid, lack of sweating, pupil constriction), compression of recurrent laryngeal nerve causing hoarseness of voice, compression of brachial plexus causing atrophy and weakness of muscles of arm and hand. TOS, rib fracture and cervical myelopathy will not cause Horner's syndrome.
location of appendicitis pain
RLQ
PNF for initial mobility
ROM - contract relax - hold relax - hold relax active movement - joint distraction - repeated contraction trunk - rhythmic initiation - rhythmical rotation - rhythmic stabilization
Metabolic Equivalent (MET)
A measurement used to describe the energy cost of physical activity as multiples of resting metabolic rate. One MET is 3.5 mL of oxygen consumption per kilogram per minute. Ex. standing = 1.5-2 METs, walking at a brisk pace = 5-6 METs, jogging = 7-8 METs, running 10 min mile = 10 METs
cardiac rehab phase 4
= community centers - clinically stable angina, medically controlled arrhytmias - 50-85% of functional capacity, 3-4 /wk, 45+ min - 6 to 12 months
exercise guidelines for hemoglobin:
>10 -> regular exercise 8-10 -> light exercise <8 -> no exercise
hypertensive crisis
>180 and/or >120 - pt needing prompt changes in meds if there are no other indications of problems or immediate hospitalization if there are signs of organ damage
exercise guidelines for hematocrit:
>25% -> light or regular exercise <25% -> no exercise
In regards to a normal gait pattern, dorsiflexors terminate their action by the end of which phase of gait? The end of loading response The end of terminal swing The end of terminal stance The end of midswing
A - Dorsiflexors (tibialis anterior, extensor digitorum longus, extensor hallucis longus) decelerate forefoot lowering and draw tibia forward following initial contact and loading response or contract eccentrically to slow plantar flexion.
lift off test
TESTING: Subscapularis (RTC) tear POSITION: Patients hand behind their back and ask them to pull it away from their back (+) TEST: Inability to perform the movement
Anterior Drawer Test (ankle)
TESTING: anterior talofibular ligament, deltoid ligament, and the anterior cartilage
A patient diagnosed with type 1 diabetes mellitus has a wound on the palmar surface of their first metatarsal head. Which of the following scales is MOST appropriate to classify this wound? 1) Bates-Jensen Wound Assessment Tool 2) Wagner Classification System 3) Gosnell, Braden, or Norton Ulcer Assessment Scale 5) Pressure Ulcer Scale for Healing
The Wagner Ulcer Grade Classification system is a tool designed for examination of the diabetic foot when neuropathy and ischemia are present. Grade 1: Superficial Diabetic Ulcer Grade 2: Ulcer extension, Involves ligament, tendon, joint capsule or fascia, No abscess or Osteomyelitis Grade 3: Deep ulcer with abscess or Osteomyelitis Grade 4: Gangrene to portion of forefoot
A 68-year-old patient was walking on a level surface when the patient suddenly lost their balance in the forward direction. Which of the following immediate safety actions should the PT take? Use their free hand to pull back on the upper trunk and position one hip against the patient's pelvis Use their free hand to pull the patient backward until they are sitting on the floor Use their free hand to pull the patient sideways until they are sitting on the floor Use both of their hands to slowly lower the patient to the ground
The PT's best option is to avoid lowering the patient to the floor, as it is dangerous for both the PT and the patient. By placing the PT's hip against the patient's pelvis, the PT protects the patient and themselves, and allows for better positioning to lower the patient to the PT's knee (if necessary).
An adult patient diagnosed with cystic fibrosis is receiving postural drainage and percussion. The patient is positioned in right side-lying with the foot of the bed elevated to 18 inches, and a pillow placed between and under the knees. Which lobe is being drained? Left lower lobe lateral basal Right lower lobe lateral basal Left lower lobe posterior basal Left lower lobe anterior basal
To drain left lower anterior basal segment, the patient is right side lying with foot elevated to 18 inches. For posterior basal (option C), patient lies on abdomen with pillow under hips. For Lateral basal (option A&B) the patient lies on abdomen, head down, then rotates 1/4 turn upward.
An increase in Q-angle can occur with...
a wide pelvis, femoral anteversion, coxa vara, genu valgum, and laterally displaced tibial tuberosity
Bates-Jensen Wound Assessment Tool
addresses 15 wound characteristics
L4 myotome
ankle dorsiflexion
S1 myotome
ankle plantar flexion
anode versus cathode
anode - positive cathode - negative
Sitting in a recliner, leaning slightly backward
anterior apical segments of upper lobes
Downbeating torsional nystagmus
anterior canal
shoulder flexors:
anterior deltoid, pectoralis major (clavicular fibers), coracobrachialis, biceps brachii
postural drainage: supine laying on bed with pillows under kness
anterior segments of upper lobes
swayback posture
anterior shifting of pelvis that results in hip extension, flexion of thorax on lumbar spine, decreased lordosis in lumbar spine and increase in kyphosis in thoracic spine
ALS (anterolateral system)
anterior spinothalamic: crude touch lateral spinothalamic: pain and temp - ascending - cross in spinal cord - opposite side POTS (pain opposite temp SCI)
aspirin and clopidogrel
anti platelets - prevents aggregation of platelets - uses: prevent stroke, MI - side effects: peptic ulcers, gastritis, risk of internal bleeding - long term use, prevention of CVA - stop 10 days before surgery
what is povidone iodine used for?
antibacterial, antiseptic used for the prevention and treatment of surface infections (skin disinfection)
adrenal gland
produces corticosteroids that will regulate water and sodium balance, the bodys response to stress, the immune system, and metabolism
thyroid gland
produces hormones that regulate metabolism
distention of the costal margin is descriptive of an abnormal finding for the ________, which is palpated typically below the left costal margin
spleen
egophony
spoken "ee" is heard as "ay" and nasalized
stork test
spondylolysis, on leg and hyperextension
3 stages of RTC impingement:
stage 1 - intermittent pain - age: 35 stage 2 - mild to mod pain - pain with activity stage 3 - pain at rest or with activity - may have pain at night - weakness of RTC and/or scap muscles
FEV1/FVC < 70% and FEV1 > 80% of predicted
stage 1 COPD: mild
- FEV1/FVC <70% - FEV1 50%-80% predicted - shortness of breath w/exertion - With or without symptoms of cough and sputum production
stage 2 COPD: moderate
- FEV1/FVC <70% - FEV1 30-50% predicted - greater shortness of breath w/exertion - decreased exercise capacity - fatigue - repeated exacerbations of their dz
stage 3 COPD: severe
FEV1/FVC <70% and FEV1<30% -chronic respiratory failure
stage 4 COPD: very severe
type 1 versus type 2 error
type 1 - false positive type 2 - false negative
huff cough
stimulates a natural cough reflex and is generally effective only for clearing central airways. While exhaling, the patient *opens the glottis* by saying the word huff. With practice he or she inhales more air and is able to progress to the cascade cough. - used to make more productive cough in COPD
2 PVCs
stop, but dont call 911
A 14-year-old female patient presents to the clinic with right thoracic scoliosis. All of the following interventions should be used when treating this condition, EXCEPT: Strengthening of low back extensors on left side Stretching of low back extensors on left side Stretching of lateral trunk flexors on left side Strengthening of lateral trunk flexors on right side
strengthening of low back extensors on left side. In scoliosis, the muscles on the convex side (scoliotic side) are stretched while the muscles on the concave side are shortened. Thus, with right scoliosis, muscles on the shortened side (left) must be stretched and the muscles on the scoliotic side (right) must be strengthened. Strengthening of low back extensors on the concave side will worsen the condition and should be avoided.
step versus stride length
stride - R to R step - R to L
the median nerve only provides sensation to...
the hand
ulnar nerve only supplies sensation to ..
the hand
ideomotor apraxia
the inability to carry out a simple motor activity in response to a verbal command, even though this same activity is readily performed spontaneously
MMT of Pectoralis major sternal head
the motion begins at 120° of shoulder abduction and moves diagonally down and in toward the patient's opposite hip. Resistance is given above the wrist in an up and outward direction.
cupulolithiasis versus canalithiasis
cupoluolithiasis - otoconia in utricle - persistent in duration - immediate canalithiasis - otoconia in semicircular canals - short in duration (<1 min) - within 1 to 40 sec
During examination, a physical therapist wants to assess the carpal bones of the hand. To make the trapezium more prominent, the PT would ask the patient to perform which of the following motions? a) Opposing the thumb to the little finger and radially deviating the wrist b) Opposing the thumb to the index finger and ulnarly deviating the wrist c) Opposing the thumb to the index finger and radially deviating the wrist d) Opposing the thumb to the little finger and ulnarly deviating the wrist
d) Opposing the thumb to the little finger and ulnarly deviating the wrist Trapezium is located immediately proximal to the base of the first metacarpal bone, just distal to the scaphoid. It can be made more prominent by opposing the thumb to the little finger and ulnarly deviating the wrist.
When using heating pads, which of the following scenarios is most dangerous and likely to result in burns? a) Using 6-8 layers of toweling between the hot pack and the patient b) A treatment time of 25 minutes c) A hot pack heated by immersion in water heated to 165 degrees Fahrenheit d) Checking the patient's skin for indications of a burn every 10 minute
d) checking pts skin for indications of a burn every 10 min should check every 5 min
spastic bladder/UMN/reflexic bladder
injury at or above T12 - intermittent catheterization, suprapubic tapping spastic bowel: digital stimulation, massage
Meissner's corpuscles
fine/light touch receptors in the dermis
Excessive knee flexion in early stance results from...
firm heel in a transtibial prosthesis. Premature knee flexion in late stance occurs if dorsiflexion stop is too soft. Insufficient knee flexion in early stance is due to soft heel cushion.
Bruunstrom Stage 1
flaccid
flexible versus fixed pronation
flexible - fix with medial post fixed - accommodate with lateral post
UE D2 flexion
flexion, abduction, ER
LE D2 flexion
flexion, abduction, IR
UE D1 Flexion
flexion, adduction, ER
LE D1 flexion
flexion, adduction, ER - more like walking
dressing for moderate exudate
foams
inadequate DF stop will cause...
foot slap
iontophoresis: iodine
for sclerotic scar (negative) I SAD
loftstrand crutches
forearm crutches, top of forearm cuff just distal to elbow
T6-10 respiration
intercostals and abs
effects pf thermal modalities
increase - CO, vasodilation, HR, RR, metabolic rate decrease - muscle activity, BP, blood to internal organs and resting muscle (goes superficial and active muscle), SV
describe lateral excursion
involves ipsilateral TMJ spinning in place with the contralateral TMJ sliding anterior
geotropic
- horizontal canalithiasis - side of more intense
ageotropic
- horizontal cupulolithiasis - side of less intense
nerve: superior gluteal roots: muscles:
L4-S1 - glute med & min - TFL
left homonymous hemianopsia is due to:
right occipital lobe lesion
nerve: medial plantar roots: muscles:
- abductor hallucis - flexor digitorum brevis - flexor hallucis brevis - lumbrical 2
normal BUN
10-20
hickman catheter
(indwelling right atrial catheter) inserts into the R atrium of the heart. The catheter permits removal of blood samples, administration of medications and monitoring of central venous pressure.
mononeuropathies
- disturbance of a single nerve (ex. CTS, guyons canal entraptment) - symptoms (sensory, motor, reflex) depend on nerve affected
only anti hypertensives
- diuretics - ACE inhibitors - ARB blockers
diarrhea caused by:
- diverticulitis - IBS - hyperthyroidism
talipes equinovarus
- (clubfoot) congenital deformity of the foot - includes: forefoot adductus, hindfoot varus, ankle equinus
Hoehn and Yahr stages of PD
- 1 (minimal or absent, unilateral only): symptoms on one side, slight tremor, some stiffness, slowing of movement - 2 (minimal bilateral, midline involvement, balance not impaired): both sides, no difficulty walking, face masking appearing - 3 (impaired righting reflex): both sides and minimal difficulty walking, some activities restricted but pt can live independently and continue work - 4 (all symptoms present and severe): both sides, moderate difficulty walking, increase assist in ADLs - 5: symptoms on both side and unable to walk, WC
paraffin bath
- 125 to 127 deg - 15 to 20 min - used on wrist and hands or feet which are irregular distal areas
hot pack
- 165 to 170 deg - 6 to 8 layers of toweling - check in first 5 min - 20 to 30 min trmt time
workstation recommendations
- 18 to 20 inch monitor - monitor screen 10 deg below horizontal, 20 in from eyes - wrist rest match front edge of keyboard for max comfort - mouse that contours hand - space under desk should be at least 30 in wide, 19 in deep, 27 in in height, 2-3 in between top of desk and thighs
Functional Independence Measure (FIM) levels of assistance:
- 1: total assistance (pt <25%) - 2: max assistance (pt 25-49%) - 3: mod assistance (pt 50-74%) - 4: min assistance (pt perform greater than 75%) - 5: supervision (requires verbal cues, setup, or standby) - 6: modified independent (pt requires assistive or adaptive device)
diastasis recti
- 2 finger distance separation - if 3 cm then avoid aggressive abdominal strengthening -> can only do head lifts - less than 2 cm: exercises okay, exception is double leg lifts - 4cm or more: stabilization exercises are priority
exercise guidelines for obese
- 250 to 300 min/wk - 3 to 5 days/wk - initially moderate (40-60% HR max) - progress to 50-75% - 45-60 min/day - moderate exercise
cardiac rehab phase 2
- 4 to 6 wks after MI - outpatient - 2 to 3 sessions/wk - 70-85% HR max - 30-60 min with warm up and cool down - walking, cycle, egometer
myelodysplasia L4-S1:
- AFO - ground reaction AFO - household or community ambulation (although may be limited)
leukopenia
- Abnormally low white blood cell count - less than 4000 - immunosuppression
superficial thermotherapy contraindications
- Acute musculoskeletal trauma - Arterial disease - Bleeding or hemorrhage - Over an area of compromised circulation - Over an area of malignancy - Peripheral vascular disease - Thrombophlebitis - heat intolerance (MS, hyperthyroidism)
complex regional pain syndrome type 1:
- Also known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn't directly damage the nerves in your affected limb - s/s: hypersensitivity to light touch, warmth, swelling, redness, hypersensitivity to head and/or cold - trmt: retrograde massage, progressive WB activities - avoid: thermal modalities, NWB activities which would promote more swelling due to disuse of muscle pump
wheeze
- a high pitched sound heard in expiration - caused by airway obstruction (COPD, asthma, aspiration of foreign bodies) - in severe obstruction it may be heard in inspiration as well
Tinetti Performance Oriented Mobility Assessment
- Asses risk of falling - Sit to stand and stand to sit with an armless chair, immediate standing balance with eyes open and closed, tolerating a slight push in standing, turning 360 degrees - original POMA scale has a total possible score of 28, developed for frail elderly (esp nursing home residents with a propensity to fall), - pts who score less than 19 are high risk for falls, 19-24 = mod risk, greater than 24 = low risk
berg balance test
- Assess risk of falling - 14 tasks scored 0-4 - Everyday living tasks, static, dynamic and transition movements in sitting and standing positions - Max score of 56 - Less than 45 indicates increased fall risk
antiarrhythmic drugs & anti hypertensives
- B blockers - Ca channel blockers
cardiovascular changes in pregnancy:
- BP low in 1st and 2nd trimester, may increase in last trimester - supine can cause compression of inferior vena cava (after 4th month), this declines CO and may cause supine hypotensive syndrome - left side lying: decreases compression of IVC, maximizes CO, decreases GERD as internal organs are relaxed, improves maternal and fetal circulation - blood volume increases - venous pressure in LE increases - CO increased - heart size and HR increases (10 to 29 bpm by full term)
peripheral vestibular pathologies
- BPPV - vestibular neuritis - labyrinthitis - acoustic neuroma
ASIA level A
- COMPLETE - NO SENSORY OR MOTOR FUNCTION PRESERVED IN S4-S5
Myesthenia Gravis
- Caused by a disorder in the transmission of impulses from nerve to muscle cell - worsens with exercise and improves with rest - characterized by muscle weakness including muscles of face, eyes, neck and does not depict change in urine color
CMS
- Centers for Medicare and Medicaid Services - determines wat and how much will be reimbursed by medicare for patient care
CARF
- Commission on Accreditation of Rehabilitation Facilities - accredits free standing rehab programs/facilities
ulnar tunnel syndrome
- Compression of ulnar nerve at Guyon's canal - etiology: sustained pressure, ex. biking, writing, trauma - s/s: paresthesia in little finger and ulnar side of ring finger, difficulty turning doorknobs, hypothenar atrophy, partial claw hand - trmt: ulnar gutter orthosis, ulnar nerve mobs, surgical release
posterior cord syndrome
- DCML bilaterally - iatrogenic
DF stop too soft DF stop too hard PF stop too soft PF stop too hard
- DF stop too soft: DF - DF stop too hard: PF - PF stop too soft: PF - PF stop too hard: DF
nerve: lateral plantar roots: muscles:
- abductor digiti minimi - flexor digiti minimi - adductor hallucis - quadratus plantar - interossei - lumbricals 3 to 5
rotator cuff repair
- PROM only for large tears x6-8w - begin PROM in supine to stabilize scap - gentle mobs in open pack (50 abd, little horiz add and ER) to prevent ant sup translation - RTC strength must be addressed before large primary movers - AROM flex and abd must be done without shoulder hiking - initiate strengthening with isometrics - no CKC x 6w - dynamic strengthening: 8 w for small tear, 12 w for large tear - caution with ER and passive IR if infra or supra repaired - caution with IR and passive ER if subscap repaired
tenodesis grasp
- Passive opening of the fingers when the wrist is flexed and closing of the fingers when the wrist is extended - SCI at level 6 - do not stretch finger flexors
R torticollis
- R SCM tightening - R side bending and L rotation - trmt: stretch into extension, L side bending, R rotation
hornblower sign
- RTC tear: teres minor - arm in 90 scaption and elbow flexed 90 - pt asked to ER against resistance - positive if unable to
what 3 volumes will always increase for obstructive disorders:
- RV - FRV - TLC
2 joint muscles
- Rectus femoris (hip flex and knee ext) - Sartorius (hip and knee flexion) - TFL (hip flexion, abd, IR) - hamstrings (hip ext and knee flex) - Biceps (elbow and shoulder flexion)
C1-2 respiration
- SCM, upper traps - phrenic stimulator - ventilator
ASIA level B
- SENSORY INCOMPLETE - YES SENSORY BUT NO MOTOR FUNCTION PRESERVED BELOW NEUROLOGICAL LEVEL (including S4-5)
what are some examples of restraints?
- Side rails on bed - Safety belt restraints - Soft ties - recliners that restrict pts normal mobility
SAFE foot
- Stationary Attachment Flexible Endoskeleton - can be used on uneven terrain - greater mediolateral motion on rear foot - heavier, less durable
myelodysplasia thoracic, L2 level:
- THKAFO - parapodium - WC for all functional mobility - standing and walking for physiologic benefits
active insufficiency
- The point at which a muscle cannot shorten any farther - 2 joint muscle
vital capacity (VC)
- The total volume of air that can be exhaled after maximal inhalation - approx 80% TLC (around 4800)
phonophoresis
- US for transdermal delivery of meds - dexamethasone: anti inflammatory - methyl salicylate, lidocaine: analgesic - duty cycle: pulsed - trmt time: 5 to 10 min
bilateral vestibular hypofunction treatment:
- X1 yes, X2 no (unless asymmetrical involvement) - imaginary targets - walking
emphysema
- a condition in which the air sacs of the lungs are damaged and enlarged - obstructive - higher RV - absent or mucoid sputum (as opposed to sputum with a lot of neutrophils) - spirometry measures unimproved with bronchodilators
LLQ pain:
- diverticulitis - ulcerative colitis - IBS
signs of central vestibular pathology
- abnormal smooth pursuits and saccades - severe ataxia - usually no hearing loss, if so, it is often sudden and permanent - diplopia, altered consciousness, lateropulsion - acute vertigo not suppressed by visual fixation - pendular nystagmus - vertical nystagmus persists regardless of positional testing
leukocytosis
- abnormally high WBC count indicates bacterial/viral infection - greater than 11000 to 15000
cardiac rehab phase 1
- acute - after 24 hrs of beging stable - short sessions 2-3x day - 50-70% HR max - 10-15 min (phase 1) and 30 min (phase 2) - ADL, supervised ambulation
US contraindications
- acute and post acute (thermal) - acitve bleeding - reduced temp sensation - reduced circulation - DVT - infection - malignancy - breast implants - over carotid sinus or cervical ganglia - over epiphyseal plates in children - over heart/eyes/genitalia - over methyl methacrylate cement or plastic - over pelvic, lumbar, or ab areas in pregnant pt - thrombophlebitis - vascular insufficiency
rocker bar
- affixed to sole of the shoe proximal to the metatarsal heads to reduce distance the pt travels during stance phase - shifts load from the MTP jts to metatarsal shaft
Slipped Capital Femoral Epiphysis
- age 10 to 15 - overweight - displacement of femoral head due to slippage from growth plate - pain worse with activity - limping, difficulty WBing - surgical treatment to stabilize - pain in groin, medial thigh or knee - ROM limitation: flexion, abduction, IR
legg calve perthes
- age 4 to 8 - short stature, males - flattening of femoral head due to lost blood supply - femoral head necrosis, fragments, reossifies - pain worse with activity - limping, stiffness - conservative treatment - ROM limitation: abduction, internal rot, extension - may have hip flexion contracture
CRM (canalith repositioning maneuver)
- aka epley - treats horizontal canal canalithiasis - start in dix hallpike position (turn toward more affected ear), instead of sitting back up rotate neck 45 deg to the other side -> roll to sidelying with nose down -> slowly sit up with head still turned and flexed
BBQ roll
- aka lempert - for horizontal canal - CRM with head in 20 deg flexion, head turn 90 deg to affected side, moved to opposite side, to prone with neck in flexion, sit pt up
semont
- aka liberatory maneuver - treats cupulolithiasis - 1st turn head to opp side -> pt moved from sitting to sidelying -> 180 deg to sidelying on other side with nose down -> return to sitting
wernickes aphasia
- aka: fluent aphasia, sensory aphasia, receptive aphasia - lesion location: auditory association cortex in left lateral temporal lobe - okay speech but comprehension is impaired
brocas aphasia
- aka: nonfluent aphasia, expressive aphasia - flow of speech is slow and hesitant, vocab limited but comprehension is good
dressing for heavy/severe exudate
- alginates (max capacity) can be used for necrosis and drainage - disadvantage: very permeable to bacteria and urine
Functional Gait Assessment (FGA)
- ambulating backward, with narrow base of support, with eyes closed - total = 30 - <22 = predictive of falls - <20 = predict older adults residing in community dwellings who would sustain falls in the next 6 months
Residual Volume (RV)
- amount of air remaining in lungs after forceful expiration - always present in lungs - around 2 to 3 x TV (about 1200)
functional residual capacity (FRC)
- amount of air remaining in lungs after normal expiration - RV + ERV - around 2400
Expiratory Reserve Volume (ERV)
- amount of air that can be forcefully expelled after normal tidal volume - 2 to 3x TV (around 1200)
Inspiratory Reserve Volume (IRV)
- amount of air that can be forcefully inhaled after normal tidal volume - about 3100
noxious TENS
- amplitude: highest tolerated stimulus - pulse frequency: high or low - pulse duration: long (250 msec to 1 sec) - trmt time: 30 to 60 sec for each trigger point
conventional TENS
- amplitude: sufficient for sensory response - pulse frequency: high (30-150 pps) - pulse duration: short (50-100) - trmt time: variable in chronic conditions
brief intense TENS
- amplitude: sufficient for strong paresthesia or motor response - pulse frequency: high (60-200 pps) - pulse duration: long (150-500) - trmt time: 15 min in wound debridement
acupuncture-like TENS
- amplitude: sufficient to produce muscle twitching - pulse frequency: low (2-4 pps) - pulse duration: long (100-300) - trmt time: 20-45 min for analgesic effects
iontophoresis: lidocaine, xylocaine
- analgesic - (+)
iontophoresis: salicylate
- analgesic - (-) I SAD
intoeing can be the result of...
- antetorsion - internal tibial torsion - metatarsus adductus
RLQ pain:
- appendix - crohns
Fugl-Meyer Assessment of Physical Performance (FMA)
- assess balance specifically for pts with hemiplegia - each of the 7 items are scored from 0 to 2 - the cumulative test score for all components is 226 with availability of specific subtest scores (ex. UE max score = 66, LE score = 34, balance score = 14)
Symptoms of BPPV
- causes: infection, head trauma, vestibular weakness, advancing age - nystagmus, vertigo with change in head position, and occasionally nausea with or without vomiting, and dysequilibrium. - Each episode of vertigo typically lasts less than one minute
common peroneal nerve (sensory)
- division of sciatic nerve - anterior leg, dorsum of foot
timed up and go test (TUG)
- assess mobility and balance - person initially sits on a supported chair with firm surface, transfers to a standing position, and walks approx 10 ft, pt must then turn around without external help and walk back towards chair and sit - pt scored on amount of sway, excessive movements, reaching for support, sidestepping, or other signs of loss of balance - healthy adults are able to complete the test in less than 10 sec - scores of 11 to 20 sec are considered within typical for frail elderly or individuals with a disability - scores over 30 sec are indicative of impaired functional mobility and high fall risk
functional reach test
- assess standing balance and risk of falling - max distance one can reach forward beyond arm's length while maintaining a fixed BOS in the standing position - age related standard measurements: (20-40: M 16.7, W 14.6) (41-69: M 14.9, W 13.8) (70-87 M 13.2, W 10.5) - if pt struggles to reach their appropriate distance, increase risk of fall is present
dix hallpike
- assessment of vertical canals - head turned 45 deg toward affected ear in sitting - pt quickly moved into supine with head extended 20 to 20 deg off the table and rotated 45 deg toward her ear - tests ear closer to the floor
romberg test
- assessment tool of balance and ataxia that initially positions the pt in unsupported standing, feet together, UEs folded, looking at a fixed point straight ahead with EO (3 systems - visual, vestibular, somatosensory provide input) - if there is a mild lesion in the vestibular or somatosensory system, the pt will typically compensate through visual sense - next the pt maintains the same standing posture but EC, pt receives a grade of normal if they are able to maintain the position for 30 sec - an abnormal response occurs with inability to maintain balance with standing erect with the feet together and eyes closed, pt may exhibit sway to begin to fall - when visual is removes, instability will be present if there is a larger somatosensory or vestibular deficit producing the instability - if pt demonstrates ataxia and has a positive romberg test, this indicates sensory ataxia and not cerebellar ataxia
pleural rub
- auscultation in lower lateral chest area - occurs with inspiration and expiration - can be an indication of pleural inflammation
multiple sclerosis
- autoimmune - inflammation, demyelination of CNS - occurs more in females, caucasians - onset 20 to 40
left ventricular heart failure
- backup of blood into lungs - decreased CO - s/s: dry cough, wheezing, tachycardia, light headedness, pallor, cyanosis
right ventricular heart failure:
- backup of blood into systemic circulation - s/s: jugular venous distention, ascites, bilateral pedal edema
characteristics of VBA (vertebrobasilar artery syndrome)
- basilar artery infarct of bilateral pons - rapid progression from hemiparesis to tetraplegia - locked in syndrome: pt cannot move or speak but is alert and oriented
peds milestones: 10-15 months
- begins to walk unassisted - transitions in and out of squatting - floor to stand - pincer grasp, tower of two cubes
PT position during pt ambulation on level ground
- behind and slightly toward pts involved side - PTs hand nearest to pt should grasp under gait belt with forearm supinated - one hand on pt shoulder - move forward in step with pt, PTs foot moves with AD
flaccid bladder/LMN/areflexic bladder
- below T12 - intermittent catheterization - valsalva flaccid bowel: manual evacuation, valsalva
lipedema
- bilateral condition affecting LEs - affects proximal areas such as buttocks and thighs, not distal like feet - affects elasticity, skin sensitive to pressure and touch, bruises and painful - negative stemmer sign - rarely develop cellulitis
cholecystitis
- blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder - pain in RUQ, radiating to R scapula - N/V, low grade fever - special test: murphy sign (palpate near R subcostal margin, deep breath, if pain and tenderness on inspiration -> the test is positive fat, fair, food
DM type 2
- bodys resistance to insulin/defective insulin - occurs secondary to other dysfunctions - s/s: similar to type 1 with no occurrence of ketoacidosis
crackles
- brief, discontinuous, popping lung sounds that are high pitched - previously termed rales - can be heard in both phases of respiration
pancoast tumor
- bronchogenic tumor with superior sulcus involvement * Horner's Syndrome - upper lung tumor - pain referred in C8 to T2 nerve distribution - mimics TOS
what happens with too much anaerobic activity?
- build up of lactic acid - treat with deep breaths and gentle walking
iontophoresis: acetate
- calcium deposits - (-) I SAD
femoral impingement
- can be asymptomatic, pain arises when cartilage or labrum damage occurs - pain worsens over time - groin pain - pain with activity, repetitive flex, and at end range flex and IR - (+) FADIR - cam: more common in males - pincher: more common in females
Bruunstrom stage 4
- can move out w/ hard work - spasticity begins to decrease
R TMJ dysfunction w/ R side deviation
- capsulitis - disc displacement without reduction - hypomobility
aquatic therapy contraindications
- cardiac failure and unstable angina - resp dyrfunction, bital capacity less than 1 L - severe PVD - danger of bleeding or hemorrhage - severe kidney disease - open wounds w/o occlusive dressing, colostomy, skin infections
prostate cancer
- check PSA levels - rare in men younger than 45 - s/s: lower urinary tract obstruction, low back/hip/leg stiffness - stage 1: cancer cannot be felt during rectal exam, no evidence cancer has spread outside prostate - stage 2: tumor large enough to be palpated during exam, no spread - stage 3: cancer spread outside prostate to nearby tissues - stage 4: cancer spread to lymph nodes or elsewhere - metastasizes to bone (osteoblastic)
what conditions can manual lymph drainage be used for?
- chronic edema - lymphedema - venous insufficiency - CRPS
precautions to the use of trendelenburg position (head of bed dipped down 15 to 18 deg)
- circulatory system: PE, CHF, HTN - abdominal problems: obesity, ascites, pregnancy, hiatal hernia, N/V, recent food consumption - neuro: recent neurosurgery, increased intracranial pressure, aneurysm precautions - pulmonary: SOB
precautions to the use of sidelying position
- circulatory: axillo femoral bypass graft - musculoskeletal: humeral fractures, need for abduction brace, other situations that make sidelying uncomfortable, ex. shoulder bursitis
New York Heart Association Classification of Heart Failure
- class 1 (mild HF): no limit in physical activity (up to 6.5 METs), comfort at rest, ordinary activity does not cause dyspnea, fatigue, palpitation, or anginal pain - class 2 (slight HF): slight limit in PA (up to 4.5 METs), comfort at rest, ordinary activity results in fatigue, palpitation, dyspnea, or anginal pain - class 3 (mod HF): marked limitation in PA (up to 3 METs), comfortable at rest, less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain - class 4 (severe HF): unable to carry out PA (1.5 METs) without discomfort, symptoms of ischemia, dyspnea, anginal pain present at rest, increasing with exercise
wound management: yellow
- clean wound and remove yellow layer - cover with moisture retentive dressing, such as hydrogel or foam dressing - consider hydrotherapy with whirlpool or pulsatile lavage
colors of sputum
- clear: normal - yellow: cold - green: bacterial infection, purulent - pink frothy: pulmonary edema due to HF - red: bleeding - brown: blood or dirt - black: fungal infection, smoking - white/mucoid: COPD
pelvis/low back/sacrum pain:
- colon - appendix - pelvic viscera
beta blockers:
- compete with epinephrine and norepinephrine for adrenergic receptors in the heart - reduce HR and contractility (lower myocardial oxygen demand) - prescribed for pts with coronary artery disease and HTN - will lower HR during submax and max exercise - use something like Borg scale to measure tolerance
high radial nerve injury (humerus fracture)
- compression in spiral groove - triceps spared - wrist drop and thumb ext weakness - paresthesia post lat arm, post wrist/hand
radiculopathy
- compression of a nerve root - possible neck pain with arm pain, arm pain usually worse - usually a combo of pain, motor, sensory, reflex deficits - pain usually follows dermatomes, sensory symptoms are more reliable
wartenbergs syndrome (superficial sensory branch injuries)
- compression under ECRL and brachialis tendons (ex. tight watch) - positive tinels at site - pain/sensory disturbances on radial side of dorsum of hand
ronchi
- continuous low pitched, rattling lung sounds that often resemble snoring - can be heard in patients with COPD, bronchieactasis, pneumonia, chronic bronchitis, or cystic fibrosis
characteristics of vascular ACA
- contralateral hemiparesis and sensory loss - LE > UE - incontinence - apraxia - slow movement and thought (due to frontal lobe involvement) - problems with imitation and bimanual tasks
characteristics of vascular PCA
- contralateral homonymous hemianopia - memory deficits - visual agnosia - topographic disorientation - spontaneous thalamic pain - prosopagnosia (difficulty naming people on sight)
characteristics of vascular MCA
- contralateral spastic hemiparesis and sensory loss - UE > LE - dominant side/L: speech issues - nondominant/R: perceptual problem- apraxia, unilateral neglect, agnosia, depth perception, spatial relations - fine finger movement
UCBL
- controls hindfoot valgus - reduces subtalar motion - 3 point counterforces - control calcaneal eversion, forefoot abduction
wound management: red
- cover - keep moist and clean - transparent dressing over gauze dressing moistened with normal saline, hydrogel, foam, or hydrocolloid
causes of foot over supination in a CKC:
- coxa valgum - lateral rotation of femur, tibia, and fibula - genu varum - abduction and DF of talus - calcaneal inversion
wound management: black
- debride wound - enzyme, sharp debridement, or hydrotherapy - for wounds with inadequate blood supply and non infected heel ulcers, don't debride -> keep them clean and dry
shoulder abductors
- deltoid - supraspinatus - infraspinatus - subscapularis - teres minor - long head of biceps
parkinsons disease
- depletion of dopamine from substantia nigra - s/s: resting tremor, rigidity, akinesia, bradykinesia, postural instability - gait: festinating, anteropulsion, FOG, increased steps per turn, increased step to step variability, insufficient knee/hip/ankle flexion -> shuffling steps, insufficient heel strike with increased forefoot loading, reduced trunk rotation, difficulty with dual tasking
iontophoresis: zinc
- dermal ulcers - (+)
stabilizing boot
- designed for paraplegic pts - set at 15 deg PF - pt maintain stability by leaning backward will iliofemoral ligaments resisting backward fall
cauda equina syndrome
- difficulty with micturition - loss of anal sphincter tone or fecal incontinence - saddle anesthesia - widespread (>1 nerve root) or progressive motor weakness in legs or gait disturbance
C5-8 respiration
- diphragm, pec major and minor, SA, rhomboid, lats - weak cough - much teach cough assists
which muscles are primarily involved in pulling the hatch of a door closed?
- forceful downward rotation of the upper limb is necessary to perform the activity - lats primarily perform this task with medial rotation, adduction, and extension of the shoulder - ant and middle deltoid, levator scap, SA, upper and lower trap are useful in upward movements
FITT principle for DM pts
- frequency: 3 to 7 days/week - intensity: 11 to 13 on RPE scale - time: minimum of 150 min/week, can be progressed to 300 min/week - type: mod intensity aerobic exercises involving larger muscle groups
recommended e-stim parameters for muscle contraction
- frequency: 35-80 pps - pulse duration: 150-200 for small muscles, 200-350 for large muscles - on/off time: 1:5 (can progress to 1:3) - trmt time: 10 to 20 min
iontophoresis: copper
- fungal infections - (+)
transfer of training
- gain/loss in one skill by practicing another skill - ex. practicing on opposite side -> eat with strong hand
GI bleeding caused by:
- gastritis - peptic ulcers - ulcerative colitis
GERD
- gastroesophageal reflux disease - reflux of gastroduodenal contents into the esophagus - s/s: heartburn 30 min after eating and at night laying down, dysphagia, sour taste, hoarseness of voice, atypical pain of head and neck - complications: aspiration pneumonia, asthma, esophagitis - trmt: eat meals 3-4 hrs before sleep, exercise 2-3 hrs after eating or before meals, avoid spicy chocolate and fatty food, drugs (antacids, H2 receptor blockers, proton pump inhibitors)
considerations prior to using vibrating and shaking:
- general guidelines: pain made worse by technique - circulatory system: aneurysm precautions, hemoptysis - coagulation disorders: increases partial prothrombin time (PPT), increased prothrombin time (PT), decreased platelet count (below 50,000), or meds that interfere with coagulation - musculoskeletal conditions: fractured rib, flail chest, degenerative bone disease, bone metastases
causes of foot over-pronation in a CKC:
- genu recurvatum - anterior pelvic tilt - anteverted femur - coxa varum - medial rotation of femur, tibia, and fibula - genu valgum - adduction and PF of talus - calcaneal eversion
types of lymphedema measurements:
- girth: proximal - volumetric: distal - bioimpedance: pre-post surgery, the higher the resistance to flow the more ECF - lymphoscintigraphy: lymphatic insufficiency
hypoglycemia
- glucose <70 mg/dl - early signs: pallor, sweating, shakiness, poor coordination and unsteady gait, tachycardia, palpitations, dizziness, fainting, excessive hunger - late signs: slurred speech, drowsiness, confusion, loss of consciousness, coma
hyperglycemia
- glucose > 300 mg/dl - early signs: weakness, dry mouth, frequent scant urination, deep and rapid respirations, dull senses, confusion, diminished reflexes, excessive thirst - late signs: fruity breath, hyperglycemia coma
subjective ratings of pain with intermittent claudication
- grade 1: minimal discomfort or pain - grade 2: moderate discomfort or pain, pts attention can be diverted - grade 3: intense pain, pts attention cannot be diverted - grade 4: excruciating and unbearable pain
joint mob grades:
- grade 1: small amplitude at beginning of range - grade 2: large amplitude within range - grade 3: large amplitude up to limit of available range - grade 4: small amplitude at limit of available motion - grade 5: small amplitude, adhesions at limit of range
wagner grading system for diabetic ulcers
- grade 1: superficial ulcer of skin or subQ tissue - grade 2: ulcer extension, involves ligament, tendon, joint capsule, fascia, no abscess or osteomyelitis - grade 3: deep ulcer with abscess or osteomyelitis - grade 4: partial foot gangrene - stage 5: whole foot gangrene
iliopsoas tendonitis
- groin pain that can radiate to anterior thigh - resisted hip flex and ER are painful
CVA positioning: sidelying on more affected side
- head/neck: neutral, symmetrical - trunk: midline - more affected UE: scapula protracted, shoulder forward, arm placed in slight abduction and external rotation, elbow extended, forearm supinated, wrist neutral, fingers extended, thumb abducted - more affected LE: hip extended and knee flexed, both supported by pillows, alternate position is slight hip and knee flexion with pelvic protraction
CVA positioning: side lying on less affected side
- head/neck: neutral, symmetrical - trunk: midline, small pillow or towel can be placed under rib cage to elongate hemiplegic side - more affected UE: scapula protracted, shoulder forward, arm on supporting pillow with elbow extended, wrist neutral, fingers extended, thumb abducted
CVA positioning: sitting in armchair or WC
- head/neck: neutral, symmetrical, head directly above pelvis - trunk: spine extension - pelvis: aligned in neutral with WB on both buttocks - more affected UE: shoulder protracted and forward, elbow supported on arm trough or lapboard, forearm and wrist neutral, fingers extended, thumb abducted (resting splint as needed) - both LEs: hips flexed to 90, positioned in neutral with respect to rotation
CVA positioning: supine
- head/neck: neutral, symmetrical, supported on pillow - trunk: midline - more affected UE: scapula protracted, shoulder forward and slightly abducted, arm supported on pillow, elbow extended with hand resting on pillow, wrist neutral, fingers extended, thumb abducted - more affected LE: hip forward (pelvis protracted), knee on small pillow or towel roll to prevent hyperextension, nothing against soles of feet (for persistent PF a splint can be used to position the foot and ankle in neutral position)
Brown-Sequard Syndrome
- hemi section - gun or stab - ipsi DCML, ipsi cortico, contra lateral spinothalamic
CVA LE extension synergy:
- hip extension, adduction, internal rotation - knee extension - ankle PF, inversion - toe extension
anterior hip precautions
- hip flexion > 90, hip ext/add/ER past neutral - avoid combined hip flex/abd/ER - step to rather than through to avoid hip hyperextension - if glut med was incised or trochanteric osteotomy: no active, antigravity hip abd for 6 to 8 wks
associated stage
- how to do - practice and refine -> errors decrease - performance becomes consistent and cognitive activity decreases - feedback: visual decreases and proprioceptive increases, focus on variable feedback - variable practice order (serial or random) - closed to open environment - small gains, disjointed performance, conscious effort
autonomous stage
- how to succeed - performance is high level - error free - automatic movement - occasional feedback of errors evident - vary environment - competitive aspect - performance seems unconscious, automatic, and smooth
dressing for minimal exudate
- hydrogel dressing (cannot be used in infected wound) - hydrocolloids used for stage 2 or 3 with minimal exudate
Central Cord Syndrome
- hyperextension - UE more affected - small: bilateral loss of pain and temp - big: some motor bilaterally, some pain and temp bilaterally
signs of UMN lesion:
- hypertonia (velocity dependent) - hyperreflexia - muscle spasms (flexor or extensor) - weakness or paralysis of a whole side - disuse atrophy - voluntary movements in synergistic pattern
down syndrome s/s
- hypotonia - ligament laxity - delayed motor milestones (running and jumping the most delayed) - deficits in memory and expressive language - impairments in postural control and coordination - decreased quad and hip abductor strength
respiratory acidosis
- hypoventilation - low pH, high CO2 - ex. COPD, asthma, pneumonia, sleep apnea - headache, blurred vision, restlessness, wheezing, lethargy, fatigue, possible seizures, personality changes - bronchodilator
amyotrophic lateral sclerosis (ALS)
- idiopathic, genetic - UMN and LMN pathology - bulbar: dysphagia, dysarthria, pseudobulbar affect - resp weakness, dyspnea, exertional dry spnea - frontotemporal dementia - cognitive impairments - Lou Gehrigs disease - cervical extensor weakness
guyon's canal syndrome
- if compression prior to superior/deep bifurcation: weakness of ulnar intrinsics, sensory sx at hypothenar and palmar 4th/5th digits - if motor/deep branch, only motor symptoms - if sensory/superficial branch, only sensory symptoms - only palmar not dorsal
hamstring strain
- immediate pain during sprinting or decelerating - tearing sensation - tender with stretching hamstrings - posterior thigh pain, near buttock, worsened with resisted knee flexion - tenderness to palpation at ischial tub or along length of HS belly - can be due to dominance of HS over glut max, decreased endurance, or flexibility limitations
spinal shock
- immediately after trauma - absence of all reflex activity and impairment of autonomic regulation - hypotension and loss of control of sweating and piloerection
CONTRAST BATH
- immerse involved limb in 100 to 111 water for 4 min - then 55 to 65 water for 1 min
passive insufficiency
- inability of a two-joint muscle to stretch enough to allow full range of motion at both joints at the same time
functional incontinence
- incontinence due to mobility, dexterity, or cognitive deficits - trmt: clear clutter and prompted voiding
effect of exercise on CO and HR
- increase linearly with work - reaches plateau at 100% VO2 max
which factors indicate maturing gait?
- increased velocity - decreased cadence - increased step length - increased single limb stance time
vasculitis
- inflammation of blood vessels - ischemia and rash can occur
labyrinthitis
- inflammation of labyrinth - sudden onset of vertigo, N/V - positive head impulse test - duration: days to weeks * hearing loss, tinnitus
vestibular neuritis
- inflammation of nerve - sudden onset of vertigo, N/V - positive head impulse test - duration: days to weeks
chronic bronchitis
- inflammation of the bronchi persisting over a long time - neutrophilic sputum - bronchodilators improve spirometry scores
trochanteric bursitis
- inflammation of trochanteric bursa due to direct blow, irritation by ITB, or biomech/gait abnormalities - hip may rest in abduction or favor abduction with movement, asymmetrical standing, pain with stairs, tightness in ITB and (+) Obers - tenderness over lateral hip - popping or crepitus with flexion and extension - trmt: rice, activity mod, decrease repetitive activity, ITB stretching, steroid injections
appendicitis
- inflammation of vermiform appendix - progression can lead to swollen/gangrenous appendix - s/s: pain in RLQ, comes in waves progressing to steady, anorexia, N/V, elevated temp, leukocytosis, fever - tender at McBurneys point, rovsings sign for pain migration, blumbergs sign for rebound tenderness
action of the hamstrings during swing:
- initial and midswing: concentric contraction - terminal swing: eccentric deceleration
US parameters
- intensity: 0.8 W/cm2 or less for acute, 1.5 W/cm2 or more for chronic - frquency: 1 MHz for deep tissues (>3cm), 3 MHz for superficial tissues (<3cm) - sound head: 2 cm small areas, 5 cm regular areas - duty cycle: 100% continuous mode for chronic conditions, 20% pulsed mode for acute conditions
current characteristics: - intensity - frequency - pulse duration - duty cycle - MVIC
- intensity: amount of current delivered per unit area (how much) - frequency: how many times per time - pulse duration: amount of time the current is delivered - duty cycle: on time/(on time + off time) (lower is better) - MVIC: maximal voluntary isometric contraction (higher is better, but only up to 10% on injured muscle)
management of lymphedema
- interstitial pressure is increased by external forces: manual lymphatic drainage (proximal to distal with distal to proximal stroking) - dynamic pressure changes within the body: diaphragmatic breathing or muscle contractions - low/short stretch bandage (low resistance, high working pressure) - exercise: proximal to distal starting with cervical -> shoulder -> elbow -> wrist
IBS
- irritable bowel syndrome - spastic, nervous, or irritable colon - causes: emotional stress, anxiety, high fait, lactose foods - s/s: pain relieved by defecation, sharp cramps in morning or after eating, N/V, bloating, foul breath, diarrhea, symptoms disappear while sleeping - LLQ pain - trmt: stress reduction, dietary modification, exercise
excessive PF in CKC leads to:
- knee hyperextension - trunk lean forward
constipation caused by:
- lack of fiber/fluids - hypothyroidism - splinting/mm guarding * pain referral to lower abdomen, anterior hip, groin/thigh
head/neck and trunk chop
- lead arm (weak arm) begins in D1 flex and moves into D1 ext - assist arm (strong arm) holds from the top of the wrist and moves into D2 ext - upper trunk, head, and neck flex with rotation toward lead hand
head/neck and trunk lift
- lead arm (weak arm) begins in D2 ext and moves into D2 flex - assist arm (strong arm) holds from underneath the wrist and moves into D1 flex - upper trunk, head, and neck extend rotate toward lead hand
downward (medial) rotation of the scapula
- levator scap - rhomboids - pec minor
shoulder pain:
- liver - diaphragm - pericardium L: heart, tail of pancreas R: gall bladder, liver, head of pancreas, peptic ulcers
lasix (furosemide)
- loop diuretic - decrease BP - uses: HTN, CHF, edema, pulmonary edema - side effects: hypokalemia, hypocalcemia, hyponatremia, dehydration, orthostatic hypotension, reflex tachycardia, dizziness, lethargy - reduced preload and afterload
bronchial breath sounds
- loud, high-pitched, hollow sounds normally heard over manubrium - expiratory longer than inspiratory
Respiratory Alkalosis:
- low level of CO2 in the blood due to breathing excessively (hyperventilation) - s/s: dizziness, bloating, lightheaded, numbness or muscle spasms in hands/feet, chest discomfort, confusion, dry mouth, tingling of arms, heart palpitations - breathe into paper bag
hypoparathyroidism
- low serum calcium and high phosphorus - s/s: neck stiffness, muscle cramps, seizures, irritability, depression, muscle twitching, cardiac arrhythmias, paresthesias of fingertips and mouth
neurological level
- lowest level with sensory and motor function on both sides motor - lowest 3/ with 5/5 above sensory - lowest 2s
peds milestones: 7 months
- maintains quad and assumes sitting from quad - trunk rotation in sitting
kaposis sarcoma
- malignant tumor of the blood vessels associated with AIDS - forms in blood and lymph vessels - lesions appear as painless purple spots on the legs, feet, face
total lung capacity (TLC)
- max amount of air in the lungs - 6000
inspiratory capacity (IC)
- max amount of air you can inspire - TV + IRC - around 3600
cardiovascular function with age:
- maximal stroke volume decreases - contractility decreases - VO2 max decreases (due to decreased max HR more than decreased max SV)
subscapularis
- medially rotates arm - an important muscle of rotator cuff, stabilizing the humeral head in the glenoid cavity; thus preventing superior translation of the humerus. It is an important muscle in overhead sports. Tear of Subscapularis can weaken its hold over the Long head of the biceps causing difficulty in overhead activity.
anterior interosseus syndrome
- median nerve entrapment - pure motor: weakness of FPL, FDP (digits 2-3), PQ - forearm pain but no sensory symptoms - unable to make OK sign (kiloh nevin sign, ulnar adductor pollicis takes over)
pronator teres syndrome
- median nerve entrapment - weakness: FPL, APB, FDP (digits 2-3), OP, PQ * pronator teres spared - sensory: digits 1-3 and thenar eminence - special tests: (+) pronator teres syndrome test, (+) tinels in forearm, (-) phalens
levels of evidence (best to worst)
- meta analysis/ systematic review - RCT - cohort - case control - cross sectional studies - case series - case reports
thermoregulatory changes during pregnancy:
- metabolic rate and heat production lowers - normal fasting blood glucose levels lower
ABI 0.94 - 0.75
- mild arterial disease - intermittent claudication
peripheral vestibular pathology signs:
- mild ataxia - normal smooth pursuits and saccades - hearing loss (insidious - may recover), fullness in ears, tinnitus - acute vertigo suppressed by visual fixation - nystagmus with slow and fast phases - spontaneous horizontal nystagmus usually resolves within 7 days in a pt with UVH
mobilization for intestinal gas pain
- mobilization traces the location of the ascending, transverse, and descending colon - can address intestinal gas pain by promoting motility
Bruunstrom stage 5
- more difficult moves w/o synergies
criteria classification for RA:
- morning stiffness lasting at least 1 hour - arthritis of 3 or more joints - arthritis of hand jts: at least one jt area swollen - symmetric arthritis - rheumatoid nodules (only bouchard at PIP) - methotrexate - usually before age 50 - swan neck
corticospinal
- motor - descending - same side
frontal lobe lesion effects
- motor loss (primary motor cortex) - olfaction affected - broacs aphasia - apraxia - emotional, behavior control affected
droplet precautions:
- mumps (rubella), strep A, neisseria, meningitis, pneumonia, flu, pertussis - hand wash upon entering and leaving room - mask when within 3 ft of pt - contact precautions only when skin lesions are present - private room without negative airflow - minimize transport, pt wear mask outside room
iontophoresis: calcium, magnesium
- muscle spasm - (+)
s/s of MS:
- muscle weakness and clumsiness - optic neuritis - lhermitte sign - paresthesias - fatigue (exercise early in the day) - heat intolerance (avoid exercise that increases body temp) - intention tremor - emotional disturbance - UMN lesion signs - trigeminal neuralgia (tic douloureux): severe stabbing pain to one side of face, demyelination of trigeminal nerve - headache - paroxysmal limb pain (shooting pains) - charcots triad: intentional tremor, scanning speech, nystagmus (cerebellar involvement) - uhtoffs phenomenon: increased neuro symptoms in response to heat - gait: foot drop, vaulting, spasticity, swaying/drunken gait, sensory ataxia - decreased pupillary light reflex
hi-volt parameters
- negative electrode: promote healing of inflamed/infected wounds - positive electrode: promote healing of wounds without inflammation - 5 days/week with 45-60 min trmt sessions - 60 to 125 pps
huntingtons disease
- neurodegenerative genetic disorder - 35 to 55 y.o. - s/s: huntingtons chorea (involuntary jerking/writhing), rigidity or muscle contractures, slow or abnormal eye movements, impaired gait, balance, and posture, difficulty with speaking and swallowing, cognitive decline - cerebellar disorder
ordinal data
- nonparametric data - a type of data that refers solely to a ranking of some kind - ex. MMT grades, level of assistance, joint laxity grades
nominal data
- nonparametric data - data which consists of names, labels, or categories - ex. diff between males and females, blood type, types of breath sounds, types of arthritis
tidal volume
- normal breathing - about 500 mL
Chron's disease
- occurs anywhere in GI tract - skip lesions - s/s: pain relieved by passing gas, joint arthritis, abdominal pain, weight loss - RLQ pain
ulcerative colitis
- occurs in large intestine and rectum - continuous lesions - s/s: rectal pain, bleeding, LBP, fecal urgency, bloody diarrhea with mucus/pus, weight loss - LLQ pain
dysarthria
- one word at a time - broken into syllables - slow, slurred, hesitant speech - word use, selection, and grammar remains intact
superficial burn
- only epidermis - dry, red skin without open areas - heals in 5 days without scarring
traction
- onset: 28 weeks gestation - integrated: 2 to 5 months - stimulus: grasp forearm and pull up from supine into sitting position - response: grasp and total flexion of the UE
moro
- onset: 28 weeks gestation - integrated: 5 to 6 months - stimulus: drop pt backward from sitting position - response: extension, abduction of UEs, hand opening and crying, followed by flexion, adduction of arms across chest - problems with rolling and sitting if not integrated
plantar grasp
- onset: 28 weeks gestation - integrated: 9 months - stimulus: maintained pressure to ball of foot under toes - response: maintained flexion of toes
flexor withdrawal
- onset: 28 wks gestation - integrated: 1 to 2 mnths - stimulus: noxious stimulus to sole of foot - response: toes extended, LE flexes uncontrollably
crossed extension
- onset: 28 wks gestation - integrated: 1 to 2 months - stimulus: noxious stimulus to ball of LE fixed in extension - response: opposite LE flexes, then adducts and extends
symmetrical tonic neck reflex (STNR)
- onset: 4 to 6 months - integrated: 8 to 12 months - stimulus: flexion or extension of the head - response: head flexion - flexion of UEs, extension of LEs, head extension - extension of UEs, flexion of LEs - affects crawling if not integrated
palmar grasp
- onset: birth - integrated: 4 to 6 months - stimulus: maintained pressure to palm of hand - response: maintained flexion of fingers
asymmetrical tonic neck reflex (ATNR)
- onset: birth - integrated: 4 to 6 months - stimulus: rotation of head to one side - response: flexion of skull limbs, extension of jaw limbs, bow and arrow posture - can affect feeding if not integrated
positive supporting
- onset: birth - integrated: 6 months - stimulus: contact to the ball of the foot in upright standing position - response: rigid extension (co-contraction) of the LEs
symmetrical tonic labyrinthe (TLR/STLR)
- onset: birth - integrated: 6 months - stimulus: prone or supine position - response: prone - increased flexor tone of limbs, supine - increased extensor tone of all limbs - can affect rolling if not integrated
startle
- onset: birth - integrated: persists - stimulus: sudden loud or harsh noise - response: sudden extension or abduction of UEs, crying
4 causes of pelvic drop:
- opp glut med weakness - opp adductor magnus tight - same side sbd tight - same side adductor magnus weak
face validity
- outcome measure should measure what it looks like it will measure
Meniere's disease
- overproduction of fluid within the inner ear -> increase in pressure -> vertigo - s/s: hearing loss, tinnitus, aural fullness, duration of minutes to hours - recurrent and usually progressive
TMJ synovitis
- pain - inflammation - swelling - difficulty in opening mouth
radial tunnel syndrome
- pain over radial tunnel, 5 cm distal to lateral epicondyle - can mimic symptoms of tennis elbow - pain on radial aspect of prox forearm (most common presenting symptom) - no paresthesias and little to no muscle weakness - symptoms aggravated by positioning of arm in elbow ext, forearm pronation and wrist flexion
rectus femoris tendonitis
- pain usually at ASIS or just distal - groin pain during sprinting or extending knee
PIN syndrome
- radial nerve entrapment - pure motor nerve - weakness of wrist extensors (wrist drop) - pts typically present with dropped fingers and thumb - the function of the ECRL is always preserved and so the wrist can extend and radially deviate even in cases of severe neuropathy
complex regional pain syndrome
- pain, burning, allodynia, edema, changes in hair/nails/skin - can be due to surgery or trauma, inflammation lasts indefinitely - diagnosis: pain disproportionate to inciting event, no other viable diagnosis - type 1: no nerve involvement - type 2: nerve lesion - acute warm phase: limb sensitive and swollen - chronic cold phase: decreased temp, resolution of inflammatory appearance - meds: oral corticosteroids, analgesics, opioids, anticonvulsants, antidepressants - trmt: pain and edema control, mobility, facilitate active muscle contractions, mirror therapy, cardio, desensitization, pt ed (use affected limb in ADLs
Murphy percussion test
- palpation over R costovertebral angle causes pt pain, but not over L side - renal involvement
DM type 1
- pancreas produces no insulin - diagnosed mostly at childhood, but can be any age - s/s: polyphagia, weight loss, ketoacidosis, polyuria, polydipsia, blurred vision and dehydration
interval data
- parametric data - Differences between values can be found, but there is no absolute 0. (Temp. and Time) - ex. developmental and functional status scales
ratio data
- parametric data - data with an absolute 0 - ex. ROM, nerve conduction velocity, distance walked ROM - ratio
C3-4 respiration
- partial diaphragm, scalene, lev scap - glossopharyngeal breathing - mech vent
shoulder: horizontal addcutors
- pec major - deltoid (ant fibers)
shoulder adductors
- pec major - lats - teres major - subscapularis - coracobrachialis
shoulder medial rotators
- pec major - anterior deltoid - lats - teres major - subscapularis (when arm is by side)
RUQ pain:
- peptic ulcers - gall bladder pathology (ex. cholecystitis) - head of pancreas
severity of edema:
- pitting: significant but short duration edema with little or no fibrotic changes - brawny: hard with palpation, more severe swelling with progressive fibrotic changes - weeping: most severe and long duration form, fluid leaks from cuts or sores, wound healing is significantly impaired, occurs almost exclusively in LEs
metatarsal bar
- places posterior to metatarsal heads on sole of a shoe to assist in transferring stress from the MTP jts to metatarsal shafts during late stance
action of tibialis posterior
- plantar flexes and inverts foot - It stabilizes the medial longitudinal arch along with the peroneus longus and also balances the pull of the peroneal muscles, protect the spring ligament, and invert and stabilize the hind foot during toe off
shoulder: horizontal abductors
- posterior deltoid - teres major and minor - infraspinatus
MSK changes with pregnancy
- posture: forward head, kyphosis, increased lordosis, anterior pelvic tilt - postural stress continues even post partum due to lifting and carrying of baby - trmt: postural education, stretching of tight muscles and strengthen weaker ones, pelvic stabilization exercises, pelvic tilts - no supine in 3rd trimester
spironolactone
- potassium sparing diuretic - decrease BP - uses: CHF, HTN, combined with other drugs causing hypokalemia - side effects: hyperkalemia, gynecomastia, orthostatic hypotension, reflex tachycardia, dizziness, lethargy
motor learning principles suggest that psychomotor skills are best learned when...
- practice conditions allow errors to occur, when performers are encouraged to engage in active sensory encoding and retrieval processes and when knowledge of results is used minimally - varying tasks - varying environment - providing minimal feedback
lead up task
- practice in easier position then progress - reduce anxiety and increase safety - ex. kneel -> half kneeling -> standing
preeclampsia
- pregnancy induced acute hypertension after the 20th week of gestation - protein in the urine, and severe fluid retention, it can progress to maternal convulsions, coma, and death if it becomes severe (eclampsia) - hyperreflexia, edema, HA, sudden weight gain - BP of 140/90 +, second abnormal BP reading 4 hours after 1st one confirms the diagnosis PRE - proteinuria - rise in BP - edema
Effect of Preload and afterload on Stroke Volume
- preload: blood in ventricle at the end of diastole, aka left ventricular end diastolic pressure - increase preload = increase SV (easier to pump out) - afterload: resistance that the ventricle finds as it pumps out the blood from the heart - increase afterload = decrease SV (harder to pump out)
exercise precautions after ACL reconstruction
- progress exercises more gradually for reconstruction with hamstring tendon than bone patellar bone graft - hamstring tendon: progress flexion more carefully - patellar tendon graft: progress extension more carefully - CKC: when squatting dont move knees anterior to toes, avoid CKC strengthening of quads between 60-90 deg of flex - OKC: initially place resistance above knee until stable, avoid resisted OKC ext between 45-30 to full ext for at least 6 wks, as long as 12, avoid resistance to distal tib during quad exercise
plagiocephaly
- prolonged recumbence - tendency to lay on one side more than the other - parallelogram - ex. R plagiocephaly characterized by contralateral (L) bossing and ipsilateral (R) flattening
UE - thrust pattern
- pt begins with both UEs flexed and adducted, forearms supinated, hands flexed, and arms tucked in close to sides - pt instructed to open hands, turn and push up and across, extending both elbows and crossing both hands in front of the face - PT resists movement and shifts weight backwards to ensure both elbows stay fully extended
peds milestones: 4-5 months
- pull to sit without head lag - rolls prone to supine - feet to mouth - self supported sitting propped forward on arms
peds milestones: 8-9 months
- quad creeping - sits better from quad - cruises to sideways - can stand alone
crutch palsy (nerve high nerve palsy)
- radial nerve entrapment - posterior cord/radial nerve palsy - triceps loss and radial nerve symptoms
Guillian-Barre syndrome
- rapid onset of bilateral symptoms peaking at 2-3 weeks - distal to proximal (glove and stocking) - autoimmune response as the pts antibodies attack its own peripheral nerves - usually occurs after resp infection, GI infection, vaccination, childbirth, surgery - LMN disorder: diminished DTR, atrophy - pain in large muscles of the body - stiffness, cramping, burning
atrial fibrillation
- rate: 400-600 bpm - stop
reiter syndrome
- reactive arthritis - can cause pain in multiple joints - usually asymmetric, occurs after an infection, and is present for several weeks
myelodysplasia L1-L3:
- reciprocating gait orthosis (RGO) - HKAFO - WC for most functional mobility - short household ambulation possible
posterior leaf spring
- recoils during swing phase to produce DF
hydrochloro thiazide (HCT)
- reduce BP - thiazides - effects: HTN, CHF, edema - hypercalcemia, hyperuricemia, hyperlipidemia so must be avoided with the elderly, DM, renal dysfunction (inc calcium, inc glucose, inc cholesterol)
possible reasons for pelvic hip hike in swing phase:
- reduced hip flexion - reduced knee flexion - lack of ankle DF - tightness of PFs
prils (catopril, enalapril, lisinopril)
- reduces BP - uses: CHF, HTN - side effects: orthostatic hypotension, hyponatremia, hyperkalemia, dry hacking cough, decreased taste perception, angioedema - may react with diuretics and cause hypotension, with potassium sparing diuretics the problem may be hyperkalemia - NO REFLEX TACHYCARDIA
nonselective debridement
- removal of both nonviable and viable tissues from a wound - wet to dry: application of moistened gauze over area of necrotic tissue to be completely dried and removed - wound irrigation: moves necrotic tissue from wound bed using pressurized fluid - hydrotherapy: using a whirlpool with agitation directed toward a wound requiring debridement
selective debridement
- removal of only nonviable tissue from a wound - sharp debridement: scalpel, scissors, forceps - enzymatic debridement: use of topical application - autolytic debridement: use of body's own mechanisms to remove nonviable tissue
ASD
- repetitive behaviors (routines, highly focused interest, spinning of hands) - sensory processing issues - unable to develop relationships - hyporeactive or hyperreactive to sensory input - dyspraxia (inability to imitate movement) - exercise: tumbling too high risk, no fast paced environment - trmt: give specific info, behavioral interventions, encourage motor development, visual supports, use sequencing
action of the ACL
- resists excessive anterior translation of the tibia relative to the femur - checks hyperextension
action of the PCL
- resists excessive posterior translation of the tibia relative to the femur - MOI: dashboard injury, posteriorly directed force on anterior aspect of the proximal tibia with the knee flexed
PNF for stability
- rhythmic stabilization - alternating isometrics - slow reversal - slow reversal hold
peds milestones: 6-7 months
- rolls supine to prone - sits alone without support (hands free) - sitting equilibrium: protective extension forward - transitions quad to/from sitting
hypothyroidism
- s/s: cold intolerance, excessive fatigue, HAs, weight gain, dry skin, peripheral edema, peripheral neuropathy, proximal weakness, decreased reflexes - slow metabolism - hashimotos
thoracic outlet syndrome
- s/s: pain, paresthesia, numbness, weakness, discoloration, swelling, loss of pulse - vascular or neurogenic - etiology: compression from muscle hypertrophy (scalenes, pec minor) or anatomical abnormalities (fractured clavicle), faulty posture (forward head, increased thoracic kyphosis, protracted scapulae), scar tissue or pressure - trmt: correct posture, nerve mobs, stretching
what to do when pt is experiencing heat exhaustion
- s/s: pale, sweating profusely, pulse weak, breath shallow and rapid - trmt: drink water, ice pack for forehead and neck, remove any outer layer of clothing *no salt tabs
hyperthyroidism
- s/s: tachycardia, increasing sweating, heat intolerance, increased appetite, dyspnea, weight loss, inability to gain weight - fast metabolism - graves - associated with increased Ca depositions leading to periarticular or tendinous calcification (pain and reduced ROM, esp shoulder) - hyperreflexia
CVA UE flexion synergy
- scapular retraction, elevation, or hyperextension - shoulder abduction, external rotation - elbow flexion - forearm supination - wrist and finger flexion
pituitary gland
- secretes endorphins and reduces a persons sensitivity to pain - controls ovulation and works as a catalyst for the testes and ovaries to create sex hormones
Sensorineural vs conductive hearing loss
- sensorineural: impaired cranial nerve transmission or inner ear dysfunction - conductive: impaired sound transmission to inner ear - mixed: any combination of the above
carpal tunnel syndrome
- sensory deficits in median distribution sparing thenar eminence (palmar cut. branch) - atrophy of thenar muscles - may describe pain radiating distal to proximal - shaking hands relieves symptoms: flick maneuver - may report dropping objects - special tests: (+) tinels at wrist, (+) phalens and rev phalens
parietal lobe lesion effects
- sensory loss (primary sensory cortex) - taste affected - perceptual disorders like tactile agnosia (esp if lesion in R hemi)
herpes zoster
- shingles - initial symptoms of pain and paresthesia localized to affected dermatome - rash, unilateral, raised to palpation (<2mm height), pink with silvery white appearance
sarcoidosis
- systemic disease of unknown cause - triggering agent may be genetic, infectious, immunologic, or toxic - granulomatous inflammation in nodular form - s/s: dyspnea, cough, fever, malaise, weight loss, skin lesions, erythema nodosum, dry cough, chest pain, hemoptysis, pneumothorax, muscle weakness, aches, tenderness, fatigue that reduces functional capacity - heart lungs pt early - can develop reddish brown papules and plaques around the mouth
effect of exercise on BP
- systolic BP increases (work) - diastolic BP remains fairly constant (relaxation)
BP and exercise red flags:
- systolic can go up to 250 mmHg while exercising - diastolic can change by 20 before termination - there should not be a drop in SBP (more than 20) - RR can go up to 40 breaths/min
LUQ pain:
- tail of pancreas - spleen pathology
gluteus medius tendonitis
- tenderness just proximal to greater trochanter - pain reproduced by resisted abd of hip - d/d for trochanteric bursitis
piriformis tendonitis
- tenderness to deep palpation near hook of greater trochanter or muscle belly - pain reproduced by piriformis stretch - sciatic symptoms possible
shoulder lateral rotators
- teres minor - infraspinatus - teres minor
roll test
- test for horizontal canal - pt in supine and turn to both side, while head is in slight flexion - geotropic: toward ground, canalithiasis, side of more intense - ageotropic: toward ceiling, cupulolithiasis, side of less intense
concurrent validity
- test performed and compared to gold standard test and results are matched - ex. HR measured by peripheral pulses and compared with ECG
content validity
- test should measure specifically what the pt problem is - ex. for testing balance, BERG can be used
construct validity
- test should measure what its supposed to measure - ex. gonio should measure ROM and nothing else
neer test
- tests for subacromial impingement (supraspinatus or LHB)
opisthotonus posture
- the back is rigid and arching, and the head is thrown backward - sustained contraction of the extensor muscles of the neck and trunk
ideational apraxia
- they have no idea - they are not able to know the purpose of the object to begin with - an impairment in the ability to carry out a sequence of actions, even though each element or step can be done correctly
metatarsal pad
- transfers stress from the metatarsal heads to the metatarsal shafts reducing plantar stress
dressing for very mild exudate
- transparent films can also be used to reduce the risk of skin breakdown/shearing - transparent films should have a minimum of 1 in border (distance from wound)
upward (lateral) rotation of the scapula
- trapezius (upper and lower) - SA
neuroma
- tumor made up of nerve (cells) - no erythema - shooting pain
cubital tunnel syndrome
- ulnar nerve entrapment - pain/sensory symptoms at 4th/5th digits (dorsal and palmar) - possible pain at cubital tunnel - motor symptoms (later) in FCU, FDP 3/4, hypothenar muscles, ulnar interossei, adductor pollicis - tests: symptoms worse with elbow flexion test, positive fromet sign (FPL substitutes for weak adductor pollicis), wartenberg sign (inability to adduct little finger), tinels sign
BMI
- underweight: <18.5 - normal: 18.5-24.9 - overweight: 25-29.9 - obese: 30-40 - extreme obese: >40
pregabalin (lyrica)
- use: treat neuropathic pain associated with diabetic peripheral neuropathy, SCI, and postherpetic neuralgia - side effects: edema, weight gain, tingling in hands and feet, dizziness, drowsiness, difficulty with concentration - do not stop abruptly
edema associated with chronic venous insufficiency
- usually presents in a gaiter distribution (appearance of inverted bottle at calf)
MS diagnosis:
- usually two separate lesions in the CNS - CSF analysis: elevated immunoglobulins, oligoclonal IgG bands, slight protein elevation - decreased NCV
nitrates - NTG
- vasodilation of vessels - used for angina pectoris - given sublingually, 3 doses every 5 min - pt must sit/lay down when taking nitro due to side effect of hypotension - if after 3 tabs still no relief -> call EMS, pt may be having MI - side effects: dizziness, lightheadedness, HA, flushing, reflex tachycardia - only used for short term - long term angina: beta and calcium channel blockers - lower preload and afterload
signs of cerebellar disorder:
- vertigo - ataxia - nystagmus - intentional tremor - slurred speech - hypotonia - exaggerated broad based gait - disdiadochokinesia
tracheal breath sounds
- very loud, relatively high pitched - inspiratory and expiratory are equal - heard over trachea in neck
characteristics of R CVA
- very poor judgement - quick, impulsive - poor insight into disability - difficulty perceiving emotions - difficulty w/ abstract reasoning and problem solving - short attention span and short term memory loss
confrontation test:
- visual field test - involves having the pt looking directly at your eye or nose and testing each quadrant of the visual field by having them count the number of fingers you are displaying - test one eye at a time - CN II
niacin
- vitamin B3 - lowers cholesterol - requires lab test to check LFT, physicians prescription for dosage
cognitive stage
- what to do? - understanding of personal ability and demand of task - visual feedback - more attention required - feedback: balance extrinsic and intrinsic - KP: focus on errors as they become consistent - KR: focus on success of movement outcome - avoid distraction, closed environment - large gains, inconsistent performance
botullinum toxin (botox)
- works on CNS - blocks release of acetylcholine - use: muscle spasms seen with CP
myelogram
- x-ray of the spinal cord - invasive diagnostic test
osteoporosis T score
-2.5 and below
UMN diagnoses
-Cerebral Vascular Accident -Traumatic Brain Injury -Spinal Cord Injury -Multiple Sclerosis -Huntington's Chorea -Cerebral Palsy -Brain tumors -ALS (upper and lower)
Broncho-vesicular breath sounds
-Intermediate pitch and intensity -Often heard 1st and 2nd intercostal spaces anteriorly and in between the scapulae posteriorly - inspiratory and expiratory are equal
LMN diagnoses
-Poliomyelitis -Guillain-Barre -Peripheral Nerve Injury -Peripheral Neuropathy -Radiculopathy -Muscular Dystrophy -Myasthenia Gravis -ALS (upper or lower)
milroys disease
-an inherited type of primary lymphedema that typically presents in infancy -bilateral lower extremity edema is the most common symptom of this disease
achilles tendon repair
-conventional: immob for 6 wks - early remobilization approach: immed after surgery or after 1-2 wks - phase 1 (4-6 wks): active ROM on nonimmob jts, muscle setting exercise of DF, inverters, evertors, PFs (2 wks) - weight shifting while wearing orthosis - heel lift of 1-1.5 cm around 8 wks
Manual Grading of Accessory Joint Motion
0 - ankylosed 1 - considerable hypomobility 2 - slight hypomobility 3 - normal 4 -slight hypermobility 5 - considerable hypermobility 6 - unstable
stage of lymphedema
0 - latency - reduced capacity, no clinically apparent swelling, heaviness I - pits with pressure - spontaneously reversible with elevation, negative stemmer sign II - non pitting - not reversible with elevation, positive stemmer sign, fibrotic tissue III - elephantiasis - significant skin changes, severe fibrosis and papillomas, positive stemmer sign
normal INR
0.9-1.1 higher = increased risk of bleeding
angina scale
1 - Light, barely noticeable 2 - Moderate, bothersome 3 - Severe, very uncomfortable (preinfarcation pain) 4 - Most severe pain ever experienced (infarction pain)
pressure ulcer stages
1 - reddened area that does not go away, skin intact 2 - first 2 layers of skin, superficial in nature, shallow crater 3 - subQ FAT may be visible, deep crater 4 - down to BONE and including bone, deep crater + necrosis unstageable - unable to visualize wound due to necrotic tissue stage can get worse but not better
supine to sit test
1) Determines involvement of SIJ in functional leg length discrepancy 2) Pt supine in correct alignment. Assess symmetry of medial malleoli. Pull into long sitting and reassess 3) Affected side becomes longer: posterior rotation Affected side becomes shorter: anterior rotation
toe in is okay until ____ years of age
6
hamstring strain rehab
1) RICE, no stretch, lumbopelvic control and alignment 2) submax isometrics, cross friction massage, trunk stabilization, gentle stretch, CKC and WBing activities, endurance, avoid fatigue and compensation patterns 3) balance, eccentrics, controlled speed, dynamics, plyometrics prevention: mobility, warm up/cool down, glut strength, posture/pelvic tilt
edema/pitting scale
1+ indentation is barely detectable 2+ slight indentation visible when skin is depressed, returns to normal in 15 seconds (less than 1/2 inch) 3+ deeper indentation occurs when pressed and returns to normal within 30 seconds (1/2 to 1 inch) 4+ indentation lasts for more than 30 seconds (more than 1 inch)
ECG strip HR
6 big squares x10 = HR
action: closing of mouth (elevation) normal ROM: muscle:
temporalis, masseter, medial pterygoid
nerve: deep peroneal roots: muscles:
L4-S1 - tibialis anterior - extensor digitorum longus - extensor hallucis longus - peroneus tertius
nerve: quadratus femoris roots: muscles:
L4-S1 gemellus inferior
nerve: common peroneal roots: muscles:
L4-S2
nerve: superficial peroneal roots: muscles:
L4-S2 - peroneus longus and brevis
Waddell's signs
1. LBP with axial loading 2. LBP with passive rotation of pelvis and shoulders 3. discrepancy on findings between supine and seated SLR 4. cogwheel weakness 5. nondermatomal sensory loss 6. disproportionate facial expression, verbalization, or tremor during exam 7. superficial, nonanatomic tenderness to light touch 3/5 signs = + for nonorganic pain
RLA level VIII
1. Purposeful appropriate 2. Recalls and integrates past and recent events 3. Completes familiar tasks - even in distracting environment 4. Shows carryover of new learning 5. Aware and responsive to culture 6. Self-centered, argumentative, depressed 7. Explore vocational pursuits (ex: may drive) 8. Stand-by Assistance
types of MS:
1. Relapsing-remitting (most common): unpredictable attacks which may/may not leave permanent deficits followed by periods of remission 2. Primary-progressive: steady increase in disability without attacks 3. Secondary-progressive: initial relapsing remitting that suddenly begins to decline without periods of remission 4. Progressive-relapsing: steady decline since onset with superimposed attacks
nerve: tibial roots: muscles:
L4-S3 - gastroc and soleus - plantaris - popliteus - flexor digitorum longus - flexor hallucis - tibialis posterior
action: lateral deviation of mandible normal ROM: muscle:
10 to 15 mm lateral pterygoid (ipsilateral muscle) and medial pterygoid (contralateral muscle)
impaired glucose tolerance
100-125 mg/dl
cancer RPE
11-13
normal prothrombin time
11-15 seconds - ability to clot
floor to stand and walk
12 months
borg scale level suggested during uncomplicated pregnancy
12-14
fasting glucose level that indicates diabetes
126 or more measured on two separate days
stage 1 BP
130-139 or 80-89
normal sodium level
135-145
mobilize in WC every ____ min
15, lean forward by 45 deg, lean back by 65 deg
Normal platelet count
150,000-400,000/mm3
normal platelet count
150,000-400,000/mm3
point to a body part
18 months
gestational diabetes
190 md/dL
stages of RA:
1: early RA 2: antibodies develop and swelling worsens 3: symptoms are visible 4: joints become fused
ratio for WC ramp
1:12
nerve: sciatic roots: muscles:
L4-S3 - hamstrings - adductor magnus
couplet
2 consecutive PVCs with no normal beat between them, stop exercise
TM ligament allows up to ______ mm of mandibular opening to occur before it becomes tight, after that ....
20-25 mm after that the condyle translates anteriorly to allow further opening (15 mm)
pt has decreased hip flexion ROM, how much should the PT try to get for the pt to have normal gait?
20-30 deg
weight gain during pregnancy
20-30 lbs
Normal HCO3
22-26 mEq/L
normal HCO3
22-26 mEq/L <22 = acid >26 = alkaline
HR max
220-age
door width minimum for WCs
32 in -> ideal 36 in
ventricular techycardia
3 or more PVCs in a row (EMS)
action: retraction of mandible normal ROM: muscle:
3 to 4 mm temporalis (posterior fibers)
normal PaCO2
35-45 mmHg
normal PCO2
35-45 mmHg >45 = acid <35 = alkaline
action: opening of mouth (depression) normal ROM: muscle:
35-55 mm lateral pterygoid
to rotate 90 deg in a WC you need ______ in
36 60 in for 160 deg 60 x 60 for 360 deg
hallway width for WC
36 in
if pt is old, which % HR max
60-70%
Braden Scale for Predicting Pressure Sore Risk
6 subscales: sensory perception, moisture, activity, mobility, nutrition, and friction and shear
normal albumin
3.4-5.4 g/dL - decreases in burns
normal potassium
3.5-5
normal potassium level
3.5-5.0 mEq/L
Normal WBC count
4,500-11,000/mm3
exercise guidelines for WBC:
4,800-10,800 -> normal activity, unrestricted >5,000 -> light/regular exercise <5,000 w/ fever -> no exercise <1,000 -> no exercise and protective mask
scapula : humerus ratio
60 deg from scap 120 deg from humerus
Normal tidal volume of adult
500 mL (350mL is not a sign of resp distress)
functional ROM of mouth opening
40 mm
muscle grading
5- normal: complete range of motion against gravity with full resistance 4- good: complete range of motion against gravity with moderate resistance 3- fair: complete range of motion against gravity without resistance 2- poor: complete range of motion with gravity eliminated 1- trace: evidence of slight contractility with no joint motion 0- zero: no evidence of contractility
action: protrusion of mandible normal ROM: muscle:
7 mm medial and lateral pterygoid
normal pH
7.35-7.45
normal glucose
70-110 mg/dL
pt not old, no hx of problems, HR max?
70-85%
normal PaO2
80-100 mmHg
child can transfer an object from one hand to another
9 months
normal calcium
9-11
normal calcium level
9-11
Beighton Hypermobility Score
9-point scale: 1 point for each side of the body for the following: - 1. Dorsiflexion of the 5th finger> 90deg with forearm flat on table - 2. Passive apposition of the thumb to the flexor aspect of the forearm - 3. Hyperextension of elbow > 10deg - 4. Hyperextensibility of the knee >180deg - 5. Flexion of waist with palms on the floor (1 point)
McBurneys point
A point on the right side of the abdomen, about two-thirds of the distance between the umbilicus and the anterior bony prominence of the hip - pain in RLQ with appendicitis
A physical therapist is treating a patient with Cerebral Palsy. The patient is seen in standing with a toe-in posture. Which of the following postural strategies correlates with the observed foot position? a) Metatarsus Adductus, internal Tibial torsion, increased femoral retroversion b) Metatarsus Adductus, internal Tibial torsion, increased femoral anteversion c) Metatarsal Adductus, external tibial torsion, increased femoral retroversion d) Metatarsal Abductus, external tibial torsion, increased femoral retroversion
A position of toe-in would correlate with metatarsus adductus (forefoot adducted), internal tibial torsion (position of pronation), and increased femoral anteversion (associated with increased anterior pelvic tilt).
ventricular tachycardia
A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest. - 3 or more PVCs in a row - wide QRS waves - no P waves
MEDICAL OUTCOMES STUDY SHORT FORM 36 (SF-36)
A research instrument used to measure an individual's perception of his/her own health status and quality of life. - self report
A physical therapist is performing the Dix Hallpike test for a patient with suspected vestibular loss. When rotating the patient's head 45 degrees to right and quickly moving the patient's head into extension, the PT notices nystagmus and determines the test is positive. What is the MOST appropriate interpretation of the results? BPPV positive to right side BPPV positive to left side BPPV positive to both side BPPV positive to right side with nystagmus to left eye
A- The Dix-Hallpike test is the most common positional test used to examine for BPPV. The direction of the nystagmus is unique to the involved semicircular canal. During the test, if nystagmus is present on the side to which the head is rotated (right in this case), that side BPPV is positive.
apgar scoring system
A: Activity (Muscle tone) (0 - absent, 1 - arms and legs flexed, 2 - active movement) P: Pulse (0 - absent, 1 - <100, 2 - >100) G: Grimace (Reflex irritability) (0 - flaccid, 1 - some flexion of extremities, 2 - active motion) A: Appearance (Skin color) (0 - blue, 1 - pink body and blue extremities, 2 - completely pink) R: Respiration (0 - absent, 1 - slow, irregular, 2 - vigorous cry) severely depressed: 0-3 moderately depressed: 4-6 excellent condition: 7-10 1 min - how well baby tolerated birthing process 5 min - how well baby is doing outside mothers wound
platelet count below 20,000
ADLs, AAROM (AROM but no antigravity or resistive)
A 40-year-old male was admitted to an acute rehabilitation unit with neurological impairments, including altered mental status, dysarthria, and motor weakness. During the objective examination, the PT found that the patient also elicited hyperreflexia. What clinical condition is MOST appropriate considering the above findings? Cervical myelopathy Myasthenia gravis Amyotrophic lateral sclerosis Multiple sclerosis
ALS is a motor neuron disease characterized by the degeneration and loss of motor neurons in the spinal cord, brainstem, and brain, resulting in a variety of UMN and LMN signs and symptoms. LMN signs - muscle weakness, hyporeflexia, hypotonicity, atrophy, muscle cramps, fasciculations, UMN signs- spasticity, hyperreflexia, muscle weakness, Bulbar signs - dysphagia, dysarthria, sialorrhea, pseudobulbar affect due to the involvement of cranial nerves 5,7,9,10,12. Cervical myelopathy will not be associated with dysarthria, spasticity and cognitive impairment. Myasthenia gravis is not associated with spasticity and cognitive impairment. Multiple sclerosis has sensory impairment present along with the other UMN signs and motor weakness.
heart auscultation landmarks
APTM 2245
sartans (losartan, telmisartan, candesartan)
ARB blockers - decrease BP - uses: HTN, CHF, intolerant to ACE - side effects: hypotension, dizziness, lightheadedness, fatigue, hyperkalemia
after 4 minutes of constant load, submax exercise, VO2 reaches steady state, indicating that...
ATP demand is being met aerobically VO2 max is the max rate of oxygen consumption measured during incremental exercise
A PT is performing nerve conduction velocity testing for the median nerve. The muscle most commonly used to assess this nerve is the: Flexor digitorum superficialis Abductor pollicis brevis Extensor digitorum brevis Abductor digiti minimi
Abductor pollicis brevis To isolate the potentials conducted by motor axons of a mixed nerve, the evoked potential is recorded from a distal muscle innervated by the nerve under study. So, abductor pollicis brevis is tested for median nerve.
hyperkinesis
Abnormally increased and sometimes uncontrollable activity or muscular movements
An 85-year-old patient is admitted to the hospital for lung congestion. The patient's granddaughter (who is a physician from a different hospital) visits him in the hospital. She wants to look at her grandfather's medical record. The Physical Therapist should: Tell her to ask the consultant cardiologist for permission Tell her she cannot see the chart because she could misinterpret the information Tell her that she must have the permission of her grandfather before she can look at his chart Give her the chart and let her read it as she may have some insights
According to HIPAA privacy rule - Written consent must be obtained from the patient before any of their health information is disclosed. Those involved in the patient care have access to the medical reports.
A patient MUST HAVE an intact vestibular system to: Stand on a FIRM or STABLE surface with eyes closed Stand on a FIRM or STABLE surface with head/eye movement Stand on a FOAM or UNSTABLE surface with eyes closed Stand on a FOAM or UNSTABLE surface with eyes open
According to Sensory Organization Test, an individual should be stable in condition 5 and 6 to be considered having intact vestibular system. Patient should be stable with eyes closed/visual conflict and moving/foam surface.
CPR
According to the 2015 American Heart Association guidelines, a trained healthcare provider should initiate CPR and use an AED as soon as possible if the victim is unresponsive, pulseless, has no breathing or gasping. The recommended compression-to-ventilation ratio for adults in cardiac arrest is 30:2. Rescue breathing at the rate of 10-12 breaths/min is provided if the victim has pulse but no normal breathing.
TOS tests
Adson's, Wright, ROOS/EAST, Cyriax -Adson's = VASCULAR; rotate head toward affected side & extend head, shoulder ext/ER, deep breath & hold, check pulse -Wright = hyperabduction test; 90 abd/90 ER (Pm stretched), full abd -Cyriax = therapist stands behind & passively elevates scapulae, see if sx disappear -Roos/EAST = shoulder abd 90/elbow flex 90; open/close hands x 3 min trmt: stretch anterior muscle or mobilize first rib
A 48-year-old female lawyer presents to an outpatient clinic with history of low back pain. The PT measures her bilateral arch index at 0.30. Which of the following orthotic interventions is MOST appropriate for this patient? Heel lift Post under 5th metatarsal head Longitudinal arch support Transverse arch support
An arch index of more than 0.30 indicates low arch or pes planus. Providing longitudinal arch support will be most appropriate intervention. It can be supplemented by foot intrinsic muscle strengthening exercises. A Heel lift (Option A) will help in weight redistribution and increase plantarflexion. Post under 5th metatarsal head (Option B) is useful for forefoot varus or supination. Transverse arch (Option D) runs medio-lateral and is not accounted in arch index calculations.
A 15-year-old high school female athlete presents to your clinic with complaints of hip and knee pain after running. Part of your examination includes measuring the Q-angle, which is 20 degrees in this patient. She also presents with tenderness superior to the patella and has a positive Ober's test. All of the following conditions are associated with a higher Q-angle, EXCEPT: Coxa vara Genu valgum Femoral anteversion Femoral retroversion
An increase in Q-angle can occur with a wide pelvis, femoral anteversion, coxa vara, genu valgum, and laterally displaced tibial tuberosity. Femoral retroversion causes a decrease in Q angle.
femoral anteversion
An inward twisting of the femur (greater than 15 to 20 deg) that causes a person's knees and feet to turn inward or have what is known as a pigeon-toed appearance
During a subjective exam, an 18-year-old patient complains of prolonged morning stiffness in the lower back and gluteal region. The patient states that this persists for roughly 40 minutes before gradually decreasing when he sits down to eat breakfast. During the objective examination, the PT notes that the patient's symptoms increase with repeated extension. Which of the following disorders is MOST likely present? Ankylosing Spondylitis Sacroiliac arthritis Lumbar disc problem SI joint pathology
Ankylosing spondylitis (Bekhterevs or Marie-Str€umpell disease) is a chronic, progressive inflammatory disorder. The sacroiliac joints, spine, and large peripheral joints are primarily affected. Common characteristics of AF are insidious onset of middle and low back pain and stiffness for more than 3 months in a person (usually male) under 40 years of age. Stiffness is worse in the morning, lasting more than 1 hour; localized to the pelvis, buttocks and hips
innervation of psoas major
Anterior rami of L1-L3
femoral retroversion
Anything less than the 15% of normal antiversion
Two trained rescuers are performing CPR on an unresponsive adult with diabetes. They started with compressions, airway clearance, and then breathing. After two minutes, the AED delivered a shock. What is the rescuers' next step? Wait for one more shock because the AED delivers two shocks to reset the heart rhythm Perform CPR starting with compressions and follow the sequence Check the pulse to see if the AED has reset the heart's normal rhythm Remove the AED and let it charge again for reuse
As soon as the shock is delivered; CPR should be resumed and continued until prompted by AED to allow rhythm check. Minimize interruptions in chest compressions before and after shock.
During a gait training session, a PT notices that the patient is beginning to lose balance in the anterior direction. What IMMEDIATE action should the therapist take? Pull the patient backwards Allow the patient to re-gain their balance Bring the patient to one knee Push the patient forward
As the patient is beginning to lose the balance forward; pulling the patient backwards will help him to regain balance by performing a posterior weight shift. This is easiest to accomplish when assisted by the therapist.
nerve: nerve to piriformis roots: muscles:
L5-S1 - piriformis
A patient was recently discharged from the hospital following 12 weeks of rehabilitation for a complete spinal cord injury at T10. Which of the following equipment/assistive devices would be MOST essential to assist the patient with functional mobility given the patient's level of injury? Ambulation with lofstrand crutches Ambulation with lofstrand crutches and AFO Ambulation with lofstrand crutches and KAFO Wheelchair
At T10 spinal cord injury level, lower limb muscles are not innervated thus the patient requires wheelchair for functional mobility. At this level, the patient is independent with manual wheelchair in home and community. To ambulate for functional mobility the level of injury should be at least L3 or below.
A physical therapist is working with a patient who has a complete T6 spinal cord injury. In order to perform a successful transfer, the patient MUST use which of the following muscles? Quadratus lumborum to lift the pelvis Internal obliques to move the trunk Latissimus dorsi to lift the buttocks from the mat Erector spinae to stabilize the back in extension
At T6 spinal cord injury level, latissimus dorsi is innervated, the patient will need it to lift the buttock from the mat for a successful transfer. At this level of injury, quadratus lumborum, internal oblique and erector spinae are not innervated.
A 25-year-old patient had a traumatic fall off his bicycle 1 week ago. Since the injury, the patient has not been able to elevate his scapula. Based on the information given, what is the MOST likely physical therapy diagnosis? Anterior dislocation of shoulder Joint Posterior dislocation of shoulder joint Inferior dislocation of SC Joint Superior dislocation of SC Joint
At the SC joint proximal articulating surface of the clavicle is convex superiorly/inferiorly and concave anteriorly/posteriorly. During elevation, clavicle slide inferiorly and during depression it slides superiorly. Hence, the superior dislocation of SC joint will cause inability to elevate the scapula.
The student assistant tries but is unable to fully supinate his right forearm to make a flat surface for the books. What is the MOST appropriate intervention to help increase supination on the right side? Posterior glide of the radius at the proximal radio-ulnar joint Volar glide of the radius at the distal radio-ulnar joint Dorsal glide of radius at the distal radio-ulnar joint. Dorsal glide of ulna at the distal radio-ulnar joint.
At the distal radioulnar joint, concave radius moves over convex ulna. So, according to convex-concave rule, posterior/dorsal glide of radius at distal RU joint will increase supination. Volar glide of the radius at the distal RU joint and dorsal glide of radius at proximal radioulnar joint will increase pronation.
A physical therapist is examining a patient with hypomobile talocrural joint and finds that the range of motion of ankle dorsiflexion is limited. Which of the following mobilization techniques can be used to increase ankle dorsiflexion? Posterior glide of talus with small amplitude oscillations into tissue resistance at the limit of available joint motion Anterior glide of talus with small-amplitude rhythmic oscillations performed at the beginning of the range Posterior glide of talus with small-amplitude rhythmic oscillations performed at the beginning of the range Anterior glide of talus with small amplitude oscillations into tissue resistance at the limit of available joint motion
At the talocrural joint, convex talus moves over with the concave mortise made up of the tibia and fibula. So, according to convex-concave rule, posterior glide of talus can be used to increase ankle dorsiflexion. Grade I, i.e. small-amplitude rhythmic oscillations performed at the beginning of the range is primarily used for treating joints limited by pain or muscle guarding. Grade IV, i.e. small-amplitude rhythmic oscillations performed at the limit of the available motion and stressed into the tissue resistance is used as stretching maneuver to increase range of motion. So, grade 4 and posterior glide of talus will be the most appropriate mobilization techniques for the patient.
A physical therapist is examining a 15-month-old child with Down syndrome. The patient has neck pain, limited neck motion, and decreased strength of extremities as compared to the last PT session. Deep tendon reflexes of upper limbs are 3+. The MOST likely cause of these symptoms is: Upper motor neuron signs seen in Down syndrome Spinal cord impingement due to Atlanto-axial joint subluxation Lower motor neuron signs seen in Down syndrome Atlanto-axial joint subluxation causing lemniscal impingement
Atlantoaxial joint subluxation can cause spinal cord impingement and results in decreased strength, decreased ROM, decreased sensation, increase in muscle tone (spasticity), hyperreflexia, persistent head tilt.
S4 heart sound
Atrial Gallup; related to stiffness of the ventricular myocardium to rapid filling associated with a MI or chronic HTN
RLA level VII
Automatic/appropriate: Behaves appropriated and is oriented to place and routine but frequently displays shallow recall
A 48-year-old patient suffering from diabetes mellitus was referred to an outpatient clinic with a diagnosis of adhesive capsulitis. The physical therapist examined the patient and decided to utilize mobilizations as part of the initial treatment. During a grade 2 inferior glide on the glenohumeral joint, the patient complains of severe pain and irritability. Which of the following interventions is the BEST course of action for the PT to make? a) Do active assisted exercises and wait for pain to subside b) Moist heat, Glides applied in opposite direction to the direction of restriction c) Interferential therapy, moist heat and active assisted exercises d) Ultrasound, moist heat and active exercises
B Painful joint, reflex muscle guarding and muscle spasm can be treated with gentle joint-play techniques to stimulate neuro physiological and mechanical effects. Grades I and II are primarily used for treating joints limited by pain or muscle guarding. The Moist heat is given as an adjunct to reduce pain. Assistive exercises will not reduce the irritability.
A patient that is eight days status post ACL reconstruction (patellar tendon autograft) is being examined by a physical therapist. What is the MOST appropriate exercise to implement into the patient's home exercise program? Leg press on operated side Mini squats Limited range isokinetic at 30 degrees Active knee extension in short sitting
B - The patient is 8 days post ACL reconstruction, hence, partial wall squats is most appropriate as it causes minimum stress on the graft. The exercises options in A,C,D can create excessive stress on the graft and increase the chances of its rupture.-
L2 dermatome
Back, front of thigh to knee
L3 dermatome
Back, upper buttock, anterior thigh and knee, medial lower leg
diazepam, valium, clonazepam, alprazolam (xanax)
BZD - works on CNS - uses: muscle spasms, anxiety, insomnia, alcohol withdrawal - side effects: tolerance, dizziness, hallucinations, drowsiness, sedation, fatigue, hypotonia, increased risk of falls
vertigo lasting seconds to minutes
BPPV
On examination, a 30-year-old female patient complains of pain during extension and rotation of the cervical spine. During the examination, the PT notes a positive Bacody's sign. This is MOST consistent with a diagnosis of: Brachial plexus lesion Peripheral nerve lesion Cervical radiculopathy Cervical myelopathy
Bakody's sign, also known as shoulder abduction test is used to test for radicular symptoms, especially those involving the C4 or C5 nerve roots. A decrease in or relief of symptoms indicates a cervical extradural compression problem, such as a herniated disc, epidural vein compression, or nerve root compression. Abduction of the arm decreases the length of the neurological pathway and decreases the pressure on the lower nerve roots.
nerve: obturator internus roots: muscles:
L5-S2 - gemellus superior - obturator internus
nerve: inferior gluteal roots: muscles:
L5-S2 - glute max
A PT is demonstrating the task of dribbling a basketball to a patient. The PT instructs the patient to dribble the ball in their dominant hand and then encourages them to switch to their left hand. In what phase of motor learning is the patient MOST LIKELY in? Cognitive Associative Autonomous Proliferative
Bilateral transfer is performed in cognitive stage where the patient practices the desired movement pattern using the less affected extremity first and then with the affected extremity. The initial practice enhances formation or recall of the necessary motor program, which can then be applied to the opposite, involved extremity.
When examining a patient with a stroke, a physical therapist finds the patient's speech to be slow and hesitant. The patient is limited to one- or two-word responses, but appears to fully comprehend sentences. Which of the following is the BEST description of the patient's ability to communicate? Global aphasia Non-expressive aphasia Wernicke's aphasia Broca's aphasia
Broca's aphasia (nonfluent) is caused due to lesion involving third frontal convolution of the left hemisphere. The flow of speech is slow and hesitant, vocabulary is limited, and syntax is impaired. Speech production is labored or lost completely whereas comprehension is good. In Wernicke's aphasia speech flows smoothly with a variety of grammatical constructions but auditory comprehension is impaired. Global aphasia is severe aphasia with marked dysfunction across all language modalities and with severely limited residual use of all communication modes for oral-aural interactions
L5 dermatome
Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
A patient with a tracheostomy tube has been hospitalized for two days. During physical therapy the patient suddenly exhibits dyspnea, cyanosis of lips, and cramping of the right calf muscle. What should the therapist suspect based on the symptoms? Heart Failure Deep Vein Thrombosis Respiratory Distress Pulmonary embolism
C - Dyspnea, shortness of breath, or cramping in the calf muscles are common signs of respiratory distress. Mucus plugging, tube displacement, disruption or disconnection of oxygen can cause respiratory distress in a tracheostomy patient.
Where is lymphedema most common?
LEs dorsum of hands and feet
reasons for heel whips during swing phase (AKA)
LIME lateral whip internal rotation medial whip external rotation
location of diverticulitis pain
LLQ
cervical and lumbar side bend and rot
C2-7: side bend and rotation in same direction C0-2: opposite L: opposite
nerve: dorsal scapular roots: ? muscles: ?
C5 - rhomboid major and minor - levator scapulae
nerve: axillary roots: muscles:
C5 & 6 - deltoid - teres minor
nerve: U & L subscapular roots: muscles:
C5 & 6 - lower: teres major - both: subscapularis
nerve: suprascapular roots: muscles:
C5 & 6 - supraspinatus - infraspinatus
nerve: radial roots: muscles:
C5 - T1 - triceps - brachioradialis - aconeus - supinator - extensor carpi radialis longus & brevis - extensor carpi ulnaris - extensor pollicis longus and brevis - extensor digiti minimi - extensor indicis - extensor digitorum - abductor pollicis longus
nerve: subclavius roots: muscles:
C5&6 - subclavius
nerve: musculocutaneous roots: muscles:
C5-7 - coracobrachialis - brachialis - biceps
nerve: lateral pectoral roots: muscles:
C5-7 - pec major
nerve: long thoracic roots: muscles:
C5-7 - serratus anterior
nerve: median roots: muscles:
C5-T1 - prontator teres & quadratus - palmaris longus - flexor carpi radialis - flexor digitorum superficialis - flexor pollicis longus - aductor pollicis brevis - opponens pollicis - part of flexor pollicis brevis - lat 2 lumbricals only 2 muscles of anterior forearm not innervated by median nerve - FCU: ulnar - FDP: ulnar and median
nerve: thoracodorsal roots: muscles:
C6-8 - lats
spinal nerve between C6 and C7
C7 C7-T1: C8 T1-T2: T1
nerve: ulnar roots: muscles:
C8 & T1 - flexor carpi ulnaris - adductor pollicis - abductor digiti minimi - flexor digiti minimi - opponens digiti minimi - dorsal and palmar interossei - medial 2 lumbricals - medial half of flexor digitorum profundus
nerve: medial pectoral roots: muscles:
C8-T1 - pec minor
superior oblique supplied by
CN IV - Trochlear looking down and in
pt is having difficulty walking downstairs, which CN is most likely affected? pt is having difficulty looking from the center to the right, which CN is most likely affected? difficulty reading newspapers?
CN IV -> CN III CN VI CN IV -> CN VI -> CN III
CN responsible for sensation of anterior 2/3 of the tongue
CN V
lateral rectus supplied by
CN VI - abducens
nerve: accessory nerve roots: muscles:
CN XI - trapezius - SCM
what kind of lesion: both left and right eye show dilation
CN2 lesion (no stimulus, no reason to see a response)
what kind of lesion: one eye is dilating and the other is constricting
CN3 lesion
relationship between CO and HR
CO = HR x SV
Which of the following findings is MOST common in patients with COPD? Dorsal Kyphosis Hemoptysis Cor pulmonale Decrease Respiratory rate
COPD is characterized by airflow obstruction, air entrapment and pulmonary hyperinflation. In this, the thorax appears enlarged owing to loss of lung elastic recoil and hyperinflation. In COPD, the anterior-posterior diameter of the chest increases, resulting in dorsal kyphosis. Cor pulmonale occurs in later stages of COPD. Respiratory rate can be increased due to increased work of breathing. Hemoptysis occurs in some patients but dorsal kyphosis is the most common finding.
wheezing is associated with
COPD, asthma, CHF, bronchitis
vestibular: UMN or cerebellar signs
CVA
what is cellulitis?
Cellulitis is a painful infection of the soft tissue that is characterized by expanding local erythema, palpable lymph nodes, fever, and chills. Skin is hot, red and edematous. Most cases are caused by cuts, abrasions, insect bites, and local burns.
CTSIB
Clinical Test for Sensory Interaction and Balance 1) stable, EO: no disadvantages, all systems impaired 2) stable, EC: vision absent, somatosensory impaired 3) stable, VC: vision conflicting, somatosensory impaired 4) unstable, EO: somatosensory absent, vision impaired 5) unstable, EC: somatosensory and vision absent, vestibular impaired 6) unstable, VC: somatosensory absent and vision conflicting, vestibular impaired
A 2-year-old child with Down syndrome is being treated by a physical therapist in an outpatient clinic. The MOST appropriate intervention should include: Pushing a toy cart while standing Locomotor training using body weight support Rolling and somersault activities Rhythmic stabilization of postural extensors in sitting
Children with Down syndrome have hypotonicity; so weight bearing activities should be encouraged. Hence, standing is preferred over sitting. Pushing a toy cart is a functional activity which will help in improving the gross and fine motor skills. Somersault should not be done due to atlantoaxial joint instability.
Which resistance exercise would strengthen both the biceps and latissimus dorsi muscles? Chin-ups Deadlifts Back extensions Upright rows
Chin up exercise requires both elbow flexion as well as pull up action needed to strengthen biceps and latissimus dorsi
Emphysema/Chronic Bronchitis
Chronic Obstructive Pulmonary Disease (COPD)
A patient comes to an outpatient physical therapy clinic and is experiencing lower back pain. The therapist observes the posture seen in the below picture. This posture is BEST referred to as:
Common features seen with a kypholordotic posture- Head held forward with cervical spine hyperextended, scapulae may be protracted, increased lumbar lordosis, and increased thoracic kyphosis, pelvis anteriorly tilted, hip flexed, knee hyperextended
A patient sustained an injury to his knee. While in the hospital, imaging was ordered, and the patient was given a diagnosis of popliteal artery occlusion. What is the BEST treatment option for this patient in the acute care setting? Complete bed rest Ankle pumps in bed Use of compression stockings Application of heat for pain relief
Complete bed rest is advised in this situation, as the patient has an active occluded artery. Increased BP via the pumping exercises may increase the likelihood of a cardiovascular event, or increase the risk of tissue damage via hypoxia. Increasing pressure or heat is contraindicated in arterial deficiencies
RLA level VI
Confused, appropriate: exhibits goal-directed behavior but is dependent on external input for direction
RLA level V
Confused, inappropriate/ non-agitated: Appears alert with fairly consistent reactions, although increased complexity of commands causes more random responses - given control to pt when it is safe and appropriate
RLA level IV
Confused/agitated: has heightened state of activity with severely decreased ability to process information - quiet room with minimal distractions - watch for frustration and known when to change activities - provide safe choices for pt
A 55-year-old patient status post mid-tarsal amputation to the right foot has a Stage 4 pressure ulcer at the medial malleolus. The wound has necrotic tissue and heavy exudate is present. Which of the following is the BEST wound care option for this patient? Calcium Alginate Irrigation with pressure below 15 psi Continue with wet to dry dressing Hydrogel dressings
Correct Answer - A Alginate dressings are used for wounds with combination of necrosis and maximum exudate and for the wounds that require package and drainage. Hydrogel are used for minimal to moderate exudate and only amorphous hydrogel dressing can be used for infected wounds. Wet to dry dressings can be used for good mechanical debridement with moderate exudate and necrotic tissue.
Glossopharyngeal breathing can increase tidal volume and vital capacity, and also help strengthen inspiratory muscles. Patients with which of the following conditions would benefit the MOST from glossopharyngeal breathing? C4 spinal cord injury Bell's palsy Cystic fibrosis C7 spinal cord injury
Correct Answer - A 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. At C7 level the diaphragm is totally innervated, so the patient will not benefit from glossopharyngeal breathing. B&C will not be benefitted too
All of the following are signs and symptoms of Tethered Cord Syndrome in an adult, EXCEPT Increased Flaccidity Scoliosis Severe Back pain Urinary incontinence
Correct Answer - A Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord. Symptoms: Back pain, worsened by activity and relieved with rest. Leg pain, especially in the back of legs, Leg numbness or tingling, Changes in leg strength, Deterioration in gait, Spine tenderness, Scoliosis, Bowel and bladder problems.
A PT Assistant was treating a patient status post ACL reconstruction and asked the patient to complete knee extension exercises that were not in the original plan of care. After completing the exercises, the patient's pain was exacerbated and later determined that they were injured during the PTA's care. In this scenario, who is MOST responsible for the patient's injury? The primary physical therapist The treating physical therapy assistant The PT Aide in the clinic The PT Student who observed the situation
Correct Answer - B PT assistant is responsible for his own action as performing exercises under the original plan of care comes under professional responsibilities of PTA.
A 30-year-old female patient is being seen at an outpatient physical therapy clinic. She is a software engineer at a start-up company and uses public transit for her commute every day. The patient reports that she has difficulty maintaining her balance, especially when she is in crowded places at night. What aspect of balance should the physical therapist examine FIRST in this patient? Conscious Proprioception Vestibular Integrity Somatosensory Integrity Visual Integrity
Correct Answer - B When the patient is in a crowded environment at night or in public transport, there is visual conflict and unstable surface. In order to maintain balance she will depend on her vestibular system. Thus, if the patient is complaining of loss of balance, the vestibular integrity must be checked.
A PT is assessing a patient's lymph nodes 6 months post-chemotherapy treatment. When assessing the lymph nodes, which presentation LEAST likely requires referral to a physician? Hard and fixed lymph node Rubbery or firm lymph node Soft and non-palpable Palpable lymph node
Correct Answer - C Lymph nodes up to 1 cm in diameter of soft-to-firm consistency that move freely and easily without tenderness are considered within normal limits. Lymph nodes more than 1 cm in diameter that are firm and rubbery in consistency or tender are considered suspicious. Enlarged lymph nodes associated with infection are more likely to be tender, soft, and movable than slow-growing nodes associated with cancer.
Which of the following activities would LEAST likely increase the stress on the Iliotibial band? Running on canted surfaces Running on cambered roads Cycling with excessive seat height Sprinting
Correct Answer - D Activities on the level surface place minimal stress on ITB like sprinting, tennis, squash whereas the uphill, downhill surfaces place more stress on the knee joint. Also, cycle with excessive seat height increase the stress on ITB more than sprinting. cant & camber - uneven
A physical therapist observes a patient's wheelchair footrests touching the ground. What is the MOST LIKELY cause? Depth of the chair is too high Depth of the chair is too low Leg length is too long Seat height is too low
Correct Answer - D If the seat height is low, foot plate can touch the floor. Increased seat depth causes a kyphotic posture, sacral sitting and compromises circulation. Too low depth fails to support the thigh adequately and results in poor balance because of decrease in the base of support. Increased leg length encourages sacral sitting and forward sliding in the chair.
What type of incontinence condition is MOST often seen in patients with bladder infections and/or bladder tumors?
Correct Answer - D Urge incontinence is the involuntary contraction of the detrusor muscle with a strong desire to void (urgency) and loss of urine as soon as the urge is felt. Urge incontinence is often idiopathic but can be caused by medications, alcohol, bladder infections, bladder tumor, neurogenic bladder, or bladder outlet obstruction
A 20-year-old female is in her first trimester of pregnancy. She is complaining of lower back pain, and is struggling to perform exercises due to poor coordination. The therapist determines that modalities are currently the best option for treatment. Which of the following is MOST appropriate for the patient to use? Ultrasound to paraspinals Traction to lumbar region Cryotherapy via coldpack Interferential current electrical stimulation
Cryotherapy is superficial modality and is safe to use during 1st trimester of pregnancy. The use of deep heating agents, electrical stimulation, and traction is generally contraindicated during pregnancy.
A 45-year-old female comes to your clinic complaining of dizziness. She is especially concerned because she suffered a cerebellar stroke 1 month ago and is afraid of having another stroke. She has noticed that her dizziness gets worse when she lies down on her couch, turning towards her TV. Her symptoms resolve within a few seconds usually but she would like your professional opinion about her symptoms. The patient is MOST LIKELY suffering from which of the following conditions? Dix Hallpike condition Vestibulo-ocular reflex Ménière's disease BPPV
Correct answer is D. BBPV is defined as a condition in which otoconia are displaced into the SCC. Symptoms of BPPV include nystagmus and vertigo with change in head position, and occasionally nausea with or without vomiting, and dysequilibrium. Options B&C are not position related. Dix-Hallpike test is the most common positional test used to examine for BPPV.
After examining a 25-year-old individual with a body mass index of 31, the physical therapist designed an exercise training program. Which of the following is the BEST initial exercise prescription for this individual? 40% to <60% HRR, five days per week for 30-45 minutes 60% to <80% HRR, five days per week for 15-20 minutes 40% to <60% HRR, three days per week for 15-20 minutes 60% to <80% HRR, three days per week for 30-45 minutes
Correct Answer: 40% to <60% HRR, five days per week for 30-45 minutes A body mass index of 31 can be defined as obese. As per the ACSM guidelines, the initial exercise training for obese individuals should be moderate (40% to <60% of heart rate reserve/ HRR). Eventual progression to more vigorous exercise intensity (i.e. ≥ 60% HRR) may result in further health/fitness benefits. Frequency should be ≥ 5 days to maximize caloric expenditure and duration should be a minimum of 30 minutes per day progressing to 60 min per day of moderate intensity, aerobic activity. 15 to 20 minutes is not a long enough duration and 3 days per week is not a high enough frequency for obese individuals.
All of the following are absolute contraindications for exercise during pregnancy EXCEPT: Restrictive lung disease Preeclampsia Severe Anemia Chronic bronchitis
Correct Answer: Chronic bronchitis The woman with chronic bronchitis may participate in an exercise program under close observation by a physician and a therapist as long as no further complications arise. Exercises often require modification which should be discussed with the referring practitioner. Restrictive lung disease, preeclampsia and severe anemia are absolute contraindications to exercise during pregnancy.
A 65-year-old, morbidly obese male patient is admitted in ICU from last three weeks with diagnosis of heart failure. The physical therapist working in the ICU unit observes new symptoms of mild pain, warmth and swelling over the posterior aspect of left calf of the patient. The therapist shares the findings with the physician, who initiates the drug therapy. Which of the following drugs should be added in the treatment of this patient? Diazepam Nitroglycerin Heparin Lipitor
Correct Answer: Heparin. Deep venous thrombosis is potential complication for all immobilized patients. The most common symptoms of DVT are pain in the region of the thrombus and unilateral swelling distal to the site, redness or warmth, dilated veins, or low-grade fever. Anticoagulation, such as heparin can be used in the treatment of individuals at risk for or diagnosed with a DVT. Nitrates, such as nitroglycerin dilate the coronary arteries and are used to prevent or relieve the symptoms of angina. Diazepam is used to relax skeletal muscle and decrease muscle spasm. Lipitor is an anti-cholesterol agent used in the management of hypercholesterolemia and mixed dyslipidemias.
A 39-year-old female presents to physical therapy with new complaints of increased fatigue, cold hands and feet. Upon assessment, dependent edema was present bilaterally. Which of the following tests or measures are the MOST appropriate for a PT examination? Body temperature and lung auscultation for rales Heart rate and blood pressure MMSE and lung auscultation for rales Turgor and CBC
Correct answer is A. The patient is presenting the signs of CHF, so we will assess the body temperature and lung auscultation for rales. Rales are crackling/bubbling sounds suggesting fluid in the lung. Heart rate and blood pressure measurements are not specific to CHF. MMSE is done for neurological conditions. Turgor is for dehydration.
A 20-year-old male athlete presents to a PT clinic 5 days status post allograft ACL reconstruction. The patient is independent in ambulation with crutches. He has 53 degrees of active knee flexion and 67 degrees of passive knee flexion. He lacks 10 degrees of active knee extension and 5 degrees passively. What is the MOST significant deficit on which PT should focus treatment? Lack of active knee extension Lack of passive knee extension Lack of passive knee flexion Lack of active knee flexion
Correct answer is B. After ACL reconstruction, the main goal of the therapist is the prevention of extension lag. So, passive extension must be achieved first (by the end of the first 1 to 2 weeks). Once passive knee extension is achieved active knee extension can be achieved to prevent the Lag.
Following a stroke, a PT is giving a 62-year-old patient education about positioning in bed. Which is the BEST position to place the lower extremity when lying in supine? a) Pelvic retracted, knee in extension, ankle in neutral with nothing against soles of feet b) Pelvic protracted, knee on small towel roll, ankle in neutral with nothing against soles of feet c) Pelvic retracted, knee on small towel, ankle on small towel roll with support against soles of feet d) Pelvic protracted, knee in extension, ankle in neutral with support against soles of feet
Correct answer is B. Best position in supine for more affected LE following a stroke-The pelvis should be kept in protraction. The hip should be slightly abducted and flexed. The knee should be slightly flexed (to prevent hyperextension) and the ankle should be in neutral with nothing against the soles of feet. Foot splint can be used to maintain ankle in neutral in case of heel cord tightening and break down.
Which of the following rehabilitation activities will cause the MOST strain to an ACL following allographic reconstruction? Isometric quadriceps contraction at 60 degrees Isometric quads contraction at 15 degrees Isometric hamstring contraction at 15 degrees Simultaneous quadriceps and hamstrings contraction at 60 degrees
Correct answer is B. 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.
A patient is recovering from an incomplete spinal cord injury at the L3 level (ASIA D). The patient reports difficulty going down ramps with unsteady, wobbly knees. An appropriate intervention for this problem would be: Ultrasound therapy to reduce hamstring contracture Icing to decrease knee extensor spasticity Progressive resistance training for the quadriceps Stretching plantar flexors using a posterior resting splint
Correct answer is C At L3 level of spinal cord injury, the quadriceps muscles are innervated. Quadriceps femoris contracts eccentrically to control rapid knee flexion and to prevent buckling. Hence, progressive resistance training of quadriceps can prevent buckling and wobbly knees.
A physical therapist is working with an 18-year-old patient who has a complete T5 spinal cord injury. The patient has a stage 2 sacral pressure ulcer and is incontinent of bowel and bladder. Which is the MOST appropriate intervention for the patient? Apply low-volt monophasic pulsed current to manage the ulcer Perform independent curl ups and bridging exercises. Perform independent rolling from side to side Administer diet and medications to manage a flaccid bowel
Correct answer is C. Electric current to the sacral area is not advised for a SCI patient due to loss of sensation below T5. Curl ups and bridging is not achievable independently as the abdominals are not innervated. Managing a flaccid bowl will not heal the ulcer. Independent rolling is achievable with level of injury T5 and can be done to reduce pressure on the sacral area.
A patient recently underwent a radical lymph node dissection secondary to prostate cancer. According to the patient's history, what is the MOST important education for the physical therapist to provide? Use alkaline soaps and cleansers on the skin Use a home compression pump with pressures >80 mm Hg Closely monitor any changes in the fitting of socks or shoes Routinely perform circumferential measurements of both lower extremities
Correct answer is C. Lymph node dissection interrupts and slows the circulation of lymph which in turn can lead to lymphedema. The patient can closely monitor for changes in the fitting of socks to look out for lymphedema as a complication. Pressures>50mmHg must not be used for lymphedema as it causes lymphatic collapse.
A 21-year-old female field hockey player has a history of several right leg hamstring strains. She has been performing frequent stretching exercises for the right hamstrings with minimal changes in ROM observed. What modality can PT utilize to BEST improve her ROM and facilitate stretching? Ultrasound Iontophoresis Short Wave Diathermy TENS
Correct answer is C. SWD is a deep heating modality and can be used to cover a large area like the hamstrings unlike ultrasound, whose heating is limited by the effective radiating area of the sound head. SWD helps in increasing soft tissue extensibility which can facilitate stretching and help improve the ROM.
A therapist is treating a patient with C5 Brown-Sequard syndrome that resulted from a gunshot wound. The therapist's examination will MOST LIKELY reveal: a) Loss of motor function and pain and temperature sensation, with preservation of light touch and position sense below the level of the lesion b) Loss of upper extremity function (cervical tract involvement), with preservation of lower extremity function (lumbosacral tract involvement). c) Sparing of tracts to sacral segments, with preservation of perianal sensation and active toe flexion d) Ipsilateral weakness and loss of position sense and vibration below the lesion level, with contralateral loss of pain and temperature sensation
Correct answer is D. Brown-Sequard Syndrome occurs from hemisection of the spinal cord, and is typically caused by penetration wounds i.e. gunshot, knife stab injury. The clinical features are asymmetrical. On the ipsilateral side as the lesion, there is paralysis and sensory loss. The ipsilateral loss of proprioception, light touch, and vibratory sense is due to damage to the dorsal column; paralysis results from damage to the lateral corticospinal tract. On the side contralateral to the lesion, damage to the spinothalamic tracts results in loss of sense of pain and temperature
A PT works with a 75-year-old female patient following a bone marrow transplant. The patient's platelet count is 25,000 cell/mm3. Which of the following interventions would be MOST appropriate? Log roll training and breathing exercises Progressive resistance exercises and infection control Bicycling and lower extremity stretching Patient education on fall prevention and progressive ambulation
Correct answer is D. For patients with platelet count 20,000-30,000- Light exercises (no PROM; light AROM permitted; walking as tolerated) and fall prevention is recommended. Below 20,000 - ADLs, AAROM (AROM but no antigravity or resistive exercise). Resistive exercises are contraindicated
A patient has been admitted to the hospital after a fall. While examining the patient, the physical therapist noticed bilateral lower extremity edema. What does the physical therapist suspect due to the clinical findings? Varicose veins Lymphedema Thrombophlebitis CHF
Correct answer is D. Proper functioning of heart depends on both ventricles; failure of one ventricle almost always leads to failure of the other ventricle. This is called ventricular interdependence. With RV failure, blood is not effectively ejected from the RV and backs up into the RA and venous vasculature, producing peripheral edema. Varicose veins are gnarled, enlarged veins, most commonly appearing in the legs and feet. Lymphedema is a chronic disorder characterized by an abnormal accumulation of lymph fluid in the tissues of one or more body regions. Thrombophlebitis is clot formation and inflammation in a vein.
klenzak joint
DF spring assist incorporated into stirrup
decerebrate rigidity
Decerebrate rigidity (abnormal extensor response) refers to sustained contraction and posturing of the trunk and limbs in a position of full extension.
A patient presents to the physical therapy clinic after complaining of anterior shin pain. During gait analysis, the PT notices that the patient is demonstrating drop foot. Despite the physician's diagnosis of shin splints, the PT notes the signs and symptoms are more consistent with anterior compartment syndrome. To confirm this diagnosis, what clinical findings MUST be present? Weak plantarflexors and paresthesia along the anterior lower leg Weak dorsiflexors and paresthesia along the anterior lower leg Weak plantarflexors and paresthesia between the 1st and 2nd toes Weak dorsiflexors and paresthesia between the 1st and 2nd toes
Deep peroneal nerve is most commonly injured (compressed) in anterior compartment syndrome in the leg. Compression may be caused by trauma, tight shoelaces, ganglion, or pes cavus. Motor loss includes an inability to dorsiflex the foot (drop foot), which results in a high steppage gait. Sensory loss is a small triangular area between the first and second toes.
Which of the following drugs would NOT be used to lower blood pressure in patients with hypertension? Thiazide Diuretics ACE inhibitors Calcium channel blockers Digitalis
Digitalis is used in the treatment of chronic heart failure. It decreases HR and increases the strength of contraction. Thiazide diuretics, ACE inhibitor, calcium channel blockers are anti-hypertensive drugs.
A 30-year-old male patient presents with left lower abdominal pain, bloody stools, and flatulence. The "pinch-an-inch" test result is positive. Which condition is MOST related to the symptoms described? Appendicitis Diverticulitis Crohn's disease Irritable bowel syndrome
Diverticulitis describes the infection and inflammation that accompany a microperforation of one of the diverticula. Symptoms include abdominal pain, low grade fever, nausea, change in bowel habits, left lower quadrant pain, bloody stool, and pinch-an-inch test may be positive at times. In appendicitis pinch-an-inch test may be positive but it is associated with right lower quadrant pain.
A 23-year-old healthy male plans to start working out as part of his New Year's resolution. The sympathetic nervous system would contribute to which of the following responses to ACUTE exercise? Increased peristalsis Increased heart rate Increased rate of breathing Skeletal muscle contraction
During an exercise, increased respiratory rate is due to the stimulation of beta 2 receptors - SNS that causes bronchodilation. Initial increase in HR is due to withdrawal of PNS and not the stimulation of SNS
during rotation to the left side which internal and external oblique fires?
During rotation to left side, internal oblique of side towards which the movement occurs (left side) work and the external oblique of the opposite side work (right side).
A patient recently sustained a TBI and is currently presenting at a Ranchos Los Amigos level IV. The PT wants participation from the patient during treatment. Which of the following is the MOST appropriate question that the PT should ask the patient to engage in the treatment session? Would you like to walk? Would you like to exercise in the hallways today? Would you like to work on ball or go for a walk? What would you like to do first?
During the treatment of RLA level IV patient, some control can be given to the patient when it is safe and appropriate. The PT can give options and let them choose rather than asking what they want. Give them control of activities within the limit of therapeutic intervention, so that the patient feels that he has some control over the situation.
With the patient seated at the edge of bed, the therapist instructs the patient to touch his nose with his index finger. The patient first flexes the elbow, and then adjusts the position of the wrist and fingers. The patient then further flexes the elbow, and lastly flexes the shoulder to generate contact between the index finger and the nose. What neurological impairment does the patient MOST likely have? Dysdiadochokinesia Titubation Dyssynergia Rebound phenomenon
Dyssynergia is a manifestation of cerebellar pathology where the movement is performed in a sequence of component parts rather than as a single, smooth activity.
capsular pattern of arthritis and the most helpful mobilization:
ER > abd > IR posteroinferior translatory glide
glascow coma scale:
EYE OPENING 4 - spontaneous 3 - open to speech 2 - open to pain 1 - no response VERBAL 5 - oriented 4 - confused conversation 3 - inappropriate words 2 - incomprehensible sounds 1 - none MOTOR 6 - spontaneous 5 - localizes pain 4 - withdraws to pain 3 - decorticate posturing 2 - decerebrate posturing 1 - no movement 15 = normal 13-14 = mild 9-12 = moderate 8- = severe
rule of 9s
Each arm= 4.5% front and 4.5% back, Anterior leg=9%, Posterior leg=9% Head=4.5% front and 4.5% back%, Back=18% Chest=18%, Perineum=1%
Which of the following strategies is optimal for BEST positioning for a patient with a CVA when lying on the hemiplegic side? Scapula retracted Forearm supinated Hip flexed and knee extended Fingers flexed and thumb adducted
Effective positioning of the hemiparetic extremities encourages proper joint alignment while positioning the limbs out of the abnormal postures typically assumed. When lying on the more affected side, forearm should be should be kept in supination.
Gosnell Pressure Sore Risk Assessment
Five subscales: mental status, continence, mobility, activity, and nutrition Each scale is rated 1 to 5, with 1 being the least impaired 16 is the critical cut-off score Least researched tool
A 29-year-old female endurance athlete presents to your clinic with chronic groin pain. She was referred by a doctor for groin pain increasing with activity. She has a history of anorexia and osteopenia. Her hip ROM is painful, along with palpation of the greater trochanter. Which of the following condition is MOST consistent with these findings? Avascular necrosis of the femoral head Iliotibial band syndrome Femoral neck stress fracture Greater Trochanteric bursitis
Femoral neck stress fracture in the endurance athlete can occur due to repeated loading or overuse injury. In this, the pain increases with activity and the presence of osteopenia increases the chances of stress fracture. Bursitis causes pain at rest. In Iliotibial band syndrome pain occurs with knee flexed at 30 degree over lateral condyle.
A piano player presents to a PT clinic with complaints of a trigger finger. While assessing the patient, the PT finds out that the patient has tender spots throughout his body. The patient also describes that some days he feels totally fine, while other days he is in great amounts of pain. What would be the MOST likely diagnosis? Fibromyalgia Myofascial pain syndrome Conversion disorder Depression
Fibromyalgia is a chronic condition characterized by widespread pain that covers half the body plus the axial skeleton, and has lasted for more than 3 months (11 of 18 tender points at specific sites throughout the body). In myofascial pain syndrome, pain is over trigger points due to muscle over use or repeated injury and it does not disappear. Conversion disorder is loss or alteration of physical functioning due to psycho-social conflict. Depression is altered mood of sadness, dejection and melancholy.
As prescribed by his physical therapist, a 32-year-old healthy male exercises on a stationary bike at a sub-maximal intensity. After 4 minutes of a constant load, his VO2 reaches a steady state, indicating which of the following? Levels of lactic acid in the blood have reached a steady state The ATP demand is being met aerobically The exercise will continue without further increasing his heart rate The respiratory rate is sufficient to meet the ATP demand
First few minutes of oxygen consumption is rapid and then levels off as the aerobic metabolism supplies the energy required by the working muscles.
Which of the following guidelines is appropriate for treating a patient with a hiatal hernia? Exercise in flat supine position Bending over activities recommended Can lift heavy weights Valsava maneuver should be avoided
For hiatal hernia, valsalva maneuver is to be avoided as it causes an increase in intra-abdominal pressure. The patient should avoid lifting heavy weights and flat supine position.
31-year-old pregnant obese female, in her third trimester, is diagnosed with damage of the pudendal nerve. The patient is referred to physical therapy clinic for pelvic floor strengthening. What is the BEST initial exercise prescription for the involved muscles? In a supine position; 5 contractions held for 3 seconds each In left side-lying; 10 contractions held for 5 seconds each In right side-lying; 10 contractions held for 5 seconds each In a seated position; 10 contractions held for 10 seconds each
For muscle strengthening, initial position can be supine or side-lying but as the patient is pregnant (in the third trimester), supine position should be avoided. Sitting will help strengthen the muscles against gravity and can be used in a more advanced phase, hence, left side lying with ten contractions held for 5 seconds each should be done. *seems like ladies are told to sleep on their left
An EMG was recorded in a 28-year-old female soccer player. After establishing a baseline EMG activity of the quadriceps during a squatting activity, the patient performs 3 sets of 10 repetitions. During the last set, the patient shows quadriceps fatigue and data shows a gradual increase in EMG signal. What is the MOST likely contributor to this increase in EMG signal? Increase in force production Decrease in force production Increase in fatigue Decrease in gluteal firing
Force production remains the same throughout, as the weight has not changed. Increase in fatigue is associated with an increase in EMG signal, as more neural activity is required to maintain the same level of force production.
Which of the following outcome measure scores would be MOST indicative of high fall risk if found during the examination of a 20-year-old male patient? Berg Balance Scale score of 49 Tinetti (POMA) score of 21 Functional Reach Test score of 9 Timed up and Go score of 9 seconds
Functional reach of less than 10 inches is indicative of fall. Scores of 45 or below in Berg balance scale have a high risk of fall, in TUG scores over 30 seconds are indicative of impaired functional mobility and high fall risk, in POMA score of less than 19 is considered high risk for falls.
RLA level II
Generalized response: exhibits inconsistent and non-purposeful reactions to stimuli
Which of following kinetic chain abnormalities is MOST commonly associated with foot supination? Anterior pelvic tilt Genu recurvatum Anteverted femur Genu varum
Genu varum results in tibial external rotation, leading to a forefoot position of supination. All other conditions result in pronated foot position.
The shoulder is the most mobile joint in the body, but because of its wide range of movements it is one of the most commonly injured. Which of the following is the MOST commonly dislocated joint in the shoulder? Acromioclavicular joint Sternoclavicular joint Scapulothoracic joint Glenohumeral joint
Glenohumeral joint is the most mobile joint. It is a multiaxial, ball-and-socket, synovial joint that depends primarily on the muscles and ligaments rather than bones for its support, stability. It has high mobility but little articular stability making it the most commonly dislocated joint of the shoulder complex.
CN in midbrain
III and IV CE MI PONS MEDU
A patient comes into your clinic with left elbow pain. During the subjective exam, the PT discovers that the patient often completes gardening tasks which require excessive wrist flexion and forearm pronation. What is the MOST LIKELY cause of the patient's elbow pain? Left sided heart failure Lateral epicondylitis Golfer's elbow Nursemaid's elbow
Golfer's elbow (medial epicondylitis) primarily involves tendinopathy of the common flexor origin, specifically the FCR and the humeral head of the pronator teres. It is an overuse injury, begins as a microtear at the interface between the pronator teres and FCR origins with subsequent development of fibrotic and inflammatory granulation tissue. The typical clinical presentation is pain and tenderness over the flexor- pronator origin, slightly distal and anterior to the medial epicondyle. The symptoms are typically reported to be exacerbated with either resisted wrist flexion and pronation or passive wrist extension and supination.
Ms. Mary is a 71-year-old retired physical therapist who presents with an 18-month history of left lateral thigh and chronic low back pain. Her pain is described as dull, and is exacerbated by prolonged walking, stair climbing, getting out of a car, and lying in bed. The pain occasionally radiates to the lateral left knee and limits her walking ability. There is moderate-severe pain elicited during palpation over the left trochanteric bursa and tensor fascia lata. Which condition BEST supports the objective findings? Peripheral vascular disease Hip-Spine syndrome (OA hip & degenerative stenosis of lumbar spine) Greater trochanteric syndrome Degenerative lumbar spinal stenosis
Greater Trochanteric Pain Syndrome (GTPS) involves the tendons and bursae surrounding the greater trochanter. An injury to these structures causes pain on the outside of buttock and thigh. Symptoms include 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. There is no neurological involvement like that in stenosis. For PVD pain does not increase upon palpation.
CN in medulla
IX, X, XI, XII CE MI PONS MEDU
benign prostatic hyperplasia (BPH)
HI FUN: hesitancy of urine, intermittent stream, frequency increased, urgency, nocturnal hypertrophy of prostate glands around urethra -> narrowing of lumen which increases urinary retention
Which one of the following sympathetic cardiovascular changes occurs in a patient with long-standing type 1 diabetes mellitus? HR becomes fixed Higher resting HR Lower resting HR Exercise increases HR
HR becomes fixed Long term complication of Type 1 diabetes mellitus is cardiac denervation syndrome which results in a fixed HR that is unresponsive to exercise, stress or sleep.
CO =
HR x SV
active insufficiency of hamstrings
Hamstring: -if knee flexed while hip extended, cannot complete full range
hemangiomas
Hemangiomas are non-cancerous growths that form due to an abnormal collection of blood vessels, visible on the skin. They are usually congenital.
what is herpes zoster?
Herpes Zoster is pain, tingling over the spinal or cranial nerve dermatome and red papules, vesicle along its course. shingles
A physical therapist is examining a 54-year-old patient and notices a right pelvic drop when walking at a self-selected walking speed. Which of the following is MOST likely the cause of this abnormality?
Hip abductor contracture on right or weak left hip abductor causes right pelvis drop. Weak right hip abductors or left hip abductor contracture causes pelvic drop on the left side.
wound irrigation pressure
Ideally range from 4 to 15 psi. - closer to 4 to prevent damage and protect granulation tissue
A physical therapist is treating a patient status post a cerebrovascular accident. The patient is struggling to successfully clear his airway. Which of the following interventions should the therapist use? Coughing Incentive spirometer Postural drainage Huffing
Huffing is a safe and effective technique for airway clearance. In huffing, abdominals are pulled up and in, rather than pushed out, causing decreased pressure in the abdominal cavity. Incentive spirometry is used to increase the inspiratory capacity.
All of the options below are potential complications of obesity during exercise EXCEPT: Precipitation of angina pectoris or myocardial infarction Hyperhydration and increased circulating blood volume Ligamentous injuries Chafing
Hyper hydration is not seen with obesity since obese people are susceptible to dehydration. They have increased heat intolerance as that they are less able to adapt to temperature changes, risk of hyperthermia and heat exhaustion.
A 65-year-old male patient presents with hyperacusis, loss of taste, and excessive dryness of the eyes. Given these symptoms, which cranial nerve is MOST likely affected? Optic nerve Vestibulocochlear nerve Facial nerve Glossopharyngeal nerve
Hyperacusis is defined as the collapsed tolerance to normal environmental sounds. Facial nerve controls the excessive movements of the stapedius bone and dampens the sound and its injury can cause hyperacusis. Facial nerve is also responsible for taste on anterior 2/3rd of tongue and its injury can lead to loss of taste. It also supplies submandibular and sublingual glands for salivation and lacrimation and its injury can lead to dry eye and decreased salivation. Optic nerve is responsible for visual acuity and pupillary reflex. Vestibulocochlear nerve is responsible for auditory acuity and vestibulospinal functions. Glossopharyngeal nerve is responsible for swallowing.
A 50-year-old patient complains of restriction of shoulder movements during daily overhead activities. The patient has a history of myasthenia gravis. During the examination, the therapist noted hyperactive reflexes. The patient was issued anti-inflammatory medication 4 weeks ago, but has had no resolution of symptoms. Which of the clinical conditions is MOST commonly associated with the above findings? Hypothyroidism Biceps tendinitis Hyperthyroidism Supraspinatus tendinitis
Hyperthyroidism is associated with increased calcium depositions leading to periarticular or tendinous calcification. Chronic periarthritis is also associated with hyperthyroidism causing pain and reduced range of motion, commonly in shoulder. Hyperactive reflex is also a common sign. Hypothyroidism causes decreased reflexes. Biceps and supraspinatus tendinitis does not alter reflexes.
A patient with Type 2 Diabetes Mellitus reports headache, weakness, sweating and tingling in fingers after exercising on a treadmill. The immediate response of the therapist should be: Activate the emergency response system Administer fruit juice to the patient Notify the primary care physician Modify the exercise to be less aggressive
Hypoglycemia is the most common problem for people with diabetes mellitus who exercise. Common symptoms associated with hypoglycemia include shakiness, weakness, abnormal sweating, nervousness, anxiety, tingling of the mouth and fingers, and hunger. Neuroglycopenic symptoms may include headache, visual disturbances, mental dullness, confusion, amnesia, seizures, and coma. Hypoglycemia can be treated in the conscious patient by immediate administration of sugar, and immediate acting glucose sources like half cup of fruit juice or sugared cola, 8 Oz of milk, two packets of sugar are sufficient to reverse the episode of hypoglycemia.
A patient presents with limited mouth opening of 25 mm due to pain. There is no complain of clicking sound or mouth deviation when he opens his mouth. The patient is unable to completely close his mouth with teeth clenched together. What is the MOST likely diagnosis based on the patient symptoms? Hypomobility Disc displacement with reduction Synovitis Capsulitis
Hypomobility (Option A) has decreased mouth opening but no pain. Disc displacement with reduction (Option B) has clicking sound. Synovitis (Option C) and Capsulitis (Option D) both have decreased opening but there is no deviation in Synovitis, making option C correct.
Salter-Harris Fracture Classification
I - entire epiphysis II - entire epiphysis and portion of metaphysis III - portion of epiphysis IV - portion of epiphysis, portion of metaphysis V - nothing broken off, compression injury of epiphyseal plate
CN in cerebrum
I and II CE MI PONS MEDU
what is impetigo?
Impetigo is superficial skin infection associated with inflammation, itching and small pus filled vesicles
Which of the following is the MOST appropriate long term goal for a PT to address in a patient with Down syndrome? Accelerate the rate of motor skills development Strengthen weak muscles Minimize the development of compensatory movement patterns Focus on rhythmic stabilization exercises
In Down Syndrome, it is important to address the development of compensatory movement pattern, as it can further exacerbate hypotonicity. While rhythmic stabilization exercises do support the above, they are not a viable goal, but rather an activity
venous ulcers
In a venous ulcer- the pulses are normal, drainage is moderate to high, granulation tissue is present in the wound bed, swelling of unilateral or bilateral LEs, dark pigmentation due to hemosiderin deposition and is usually located proximal to medial malleolus.
lordosis in stance phase (AKA)
anatomical - hip flexion contracture, weak extensors prosthetic - anterior socket wall discomfort
Which functional task is MOST difficult for a patient with Adhesive Capsulitis to complete? Reaching objects on a high shelf Brushing the hair Reaching behind the back to fasten a bra Reaching out a car window to use an ATM machine
In adhesive capsulitis, there is capsular pattern of restriction- lateral rotation> abduction>medial rotation. Combing hair requires external rotation and is thus most difficult to perform due to maximum restriction. Reaching objects on a high shelf needs flexion and abduction. Reaching out of a car window to use an ATM machine needs abduction. Reaching behind the back to fasten a bra needs internal rotation.
type of nystagmus in CNS lesion versus BPPV
In central nervous system pathology vertical and pendular nystagmus is observed. In peripheral vestibular system pathology horizontal nystagmus is observed.
All of the following are cardiovascular and respiratory effects of full immersion hydrotherapy (up to neck) EXCEPT: Increased cardiac volume Reduced heart rate and reduced systolic blood pressure Increased cardiac output Increased vital capacity
In full immersion hydrotherapy, vital capacity decreases as the lung expansion is inhibited due to hydrostatic pressure against the chest wall. SV and CO increase whereas HR remains same or slightly decreases.
A 13-year-old girl has been diagnosed with structural idiopathic scoliosis. The physical therapist notices a left thoracic and right lumbar curvature of her spine. Which postural deviation would be MOST expected in this patient? Thoracic vertebral bodies rotated to the right Elevated right shoulder Spinous processes of thoracic spine rotated to the left Posteriorly protruding left scapula
In left thoracic scoliosis, rotation of thoracic vertebra is towards the scoliotic side (left), spinous process deviate towards the concave side (right), right shoulder is low, left shoulder is high and left (scoliotic side) scapula is protruded.
A physical therapist is conducting wheelchair assessment of a patient with bilateral trans-femoral amputation. Which of the following wheelchair modification is most appropriate based on the patient's presentation? Rear wheels are positioned two inches anterior to the normal position Seat is lowered two inches to the normal position Castor wheels are positioned two inches posterior to the normal position Rear wheels are positioned two inches posterior to the normal position
In patients with bilateral lower extremity amputation, the rear wheel axles are positioned approximately 2 inches posterior to their normal position to widen the base of support of the chair and compensate for the loss of the weight of the user's lower extremities. In the hemiplegic wheelchair, the seat is lowered approximately 2 inches to allow better use of the user's lower extremities to propel the chair.
A right pleural irritation results in sharp localized pain aggravated by respiratory movement. Which of the following positions is MOST likely to reduce the pain? Right side lying Left side lying Prone lying Supine lying
In pleural pain, pain is alleviated by lying on the affected side (in this case- right side), which diminishes the movement of that side of the chest. This is called auto-splinting.
At home, which single exercise using one's own body weight as resistance is BEST to strengthen the chest and triceps? Chin ups Crunches Pec deck flyes Push ups
In push-ups, muscles act against the body weight; there is elbow extension against gravity leading to strengthening of chest and triceps.
A patient has a lumbar-level complete spinal cord injury during a car accident, and is now in the hospital. The PT is positioning the patient in bed to decrease the possibility of pressure ulcer development. Which of the following techniques would provide the patient with the MOST comfort while turning in bed? Log-roll Roll segmentally from shoulder to pelvic Roll segmentally from pelvic to shoulder Dragging a bed sheet
In spinal cord injury patient, distracting and rotational forces should be avoided and it is important to not move the person downward by pulling on the lower extremities. So, logroll the person when turning to avoid any discomfort and chance of injury. Dragging a bed sheet causes friction and injury, increasing the chances of pressure ulcer.
A PT is ordered to evaluate and treat a full term infant. After reviewing the chart, the therapist discovers that at 1 minute after birth the infant exhibited the following symptoms: bluish color in the body and extremities, heart rate of 85 beats/ minute, slow respiration, no response to reflex irritability, and some resistance of the extremities to movement. What was the infant's APGAR score at 1 minute after birth? 1 2 3 4
In the APGAR scale- A is appearance, P is pulse, G is grimace, A is activity, R is respiration. So, according to the scale: blue color-0, slow respiration-1, slight resistance to movement -1, no reflex irritability-0, HR<100bpm -1. Thus, the total is 1+1+1=3
A college student presents with complaints of right-sided neck pain. During the AROM examination, the physical therapist observes the following osteokinematic neck motions: full side-bending left, full rotation to the left, full forward flexion, limited and painful extension, limited and painful right side-bending, and limited and painful right rotation. Based on this pattern, what is the MOST likely arthrokinematic restriction? Restriction with downglide of a facet on the right Restriction with upglide of a facet on the right Restriction with downglide of a facet on the left Restriction with upglide of a facet on the left
In the cervical spine, rotation and side bending occur to the same side (except C1-2). With extension limited, the most likely restriction is a downglide. With right rotation, and right side bending, the right cervical facets would be going into a downglide. If this motion is limited, then restriction of downglide with facet on the right is the most likely problem.
somatognosia
Inability to identify body parts or their relationships to each other
A 70-year-old male patient presents to an outpatient clinic with sensory loss of the right face and arm. This patient is taking medications for hypertension, diabetes mellitus type 2, and hydrocortisone for a rash on his leg. The patient initially seems confused but otherwise has intact speech. The therapist would MOST likely suspect a lesion in which vessel? Left MCA superior division Left MCA inferior division Right MCA superior division Right MCA inferior division
Infarct in middle cerebral artery inferior division causes contralateral homonymous hemianopia, fluent aphasia (Wernicke's area). Superior division MCA infarct is responsible for Brocas aphasia.
DeQuervain's Tenosynovitis
Inflammation of the abductor pollicis longus and extensor pollicis brevis, resulting in pain, crepitation and swelling over the radial styloid, Finklestein's test is typically positive Conservative intervention includes: activity modification orthotic positioning tendon gliding exercises ergonomic education Eat Peanut Butter with APpLes All Peanut Lovers Eat Peanut Butter
A 55-year-old male has recently been diagnosed with single vessel coronary artery disease and is referred to cardiac rehabilitation. What is the MOST appropriate initial exercise prescription for this patient? 40% to 60% of maximum HR 65% to 75% of VO2 max Exercise 3 times a week for 20 to 40 minutes depending upon tolerance Exercise for 30 to 60 minutes depending upon tolerance
Initial exercise intensity for the patient should be 40-60%HR max. Gradually increase the duration and frequency of exercise and then the intensity.
A 40-year-old male patient presents to an outpatient clinic with diagnosis of low back pain. The patient has nerve root impingement on his left side caused by narrowing of the IV foramen between L3-L4. The plan of care includes exercises and mechanical traction using a motorized traction device. During the first patient visit, the MOST appropriate setting for using the traction device would be: 15% of body weight in supine with both knees flexed 25% of body weight in prone with no pillows 25% of body weight in supine, knee extended with trunk bending to the right side 50% of body weight in left side lying with both knees flexed
Initial lumbar traction is given at 25% of body weight. Bending to the opposite side and supine position will open the foramen. Option C has supine position, bending trunk to the right and 25% of the body weight making it the most appropriate.
A 35-year-old patient sustained a knee injury while playing in a pick-up soccer game over the weekend. On Monday morning, she visits a PT outpatient clinic for further evaluation. She tells the therapist that the accident happened when one of the opponents landed on her knee and pushed it inward. During the evaluation of knee ROM, the patient experiences a popping sound during terminal knee extension movements. Based on the evaluation which of the following conditions is MOST likely present? ACL injury PCL injury Medial Meniscal Injury Mediopatellar Plica syndrome
Injury caused by valgus strain with locking and popping during terminal knee extension is characteristic of meniscus injury. In ACL injury popping sound is heard at the time of injury and not during the movement.
A physical therapist administers a series of cranial nerve tests to a patient with a confirmed lower motor neuron disease. Assuming the patient has a lesion impacting the right hypoglossal nerve, which clinical presentation would be MOST likely? Right-sided tongue atrophy and deviation toward the left with tongue protrusion Right-sided tongue atrophy and deviation toward the right with tongue protrusion Left-sided tongue atrophy and deviation toward the left with tongue protrusion Left-sided tongue atrophy and deviation toward the right with tongue protrusion
Injury to cranial nerve XII (hypoglossal) causes atrophy or fasciculation of tongue, impaired movements and deviation of the tongue to the weak side (affected side) on protrusion.
to ambulate for functional mobility the level of SCI injury should be at least _____ or below
L3
lateral bend in stance phase (AKA)
anatomical - weak abductors, short amputation limb prosthetic - short prosthesis, inadequate lateral wall
A 50-year-old patient complains of diffuse pain in the anterolateral aspect of forearm. On examination, the therapist notes that all manual muscle tests are within normal limits except right shoulder & elbow flexion and forearm supination that are 3-/5. The MOST likely cause is: Disc herniation at C6-C7 level Median nerve injury Axillary nerve injury Musculocutaneous nerve injury
Injury to the musculocutaneous nerve results primarily in loss of elbow flexion (biceps and brachialis), shoulder forward flexion (biceps and coracobrachialis), and decreased supination strength (biceps). Injury to its sensory branch, the antebrachial cutaneous nerve, leads to altered sensation in the anterolateral aspect of the forearm. Disc herniation at C6-C7 level will affect the C7 nerve root and its symptoms include pain radiating along the back of the shoulder, posterior aspect of the forearm and into the posterior aspect of the long finger. Weakness of wrist flexors, triceps and finger extensors will also be present. Axillary nerve injury will not cause weakness in supination. Median nerve lesion will not cause weakness in shoulder flexion and forearm supination.
A group of PT students are compiling an injury prevention program for adolescent soccer players. During their research, they maximize their time by collecting data on the SEBT, the Single Leg Hop Test, and the Single Leg Balance test. In order to have the MOST consistent data, which form of reliability is most important? Intrarater reliability Test re-test reliability Interrater reliabliity Criterion validity
Interrater reliability - Consistency of scores between the raters must be established, since both therapists are collecting data on the same measurements.
A patient receiving physical therapy reports abdominal bloating and cramping that is relieved with defecation. The patient reports the left lower quadrant pain is more prevalent in the morning, or after eating, and these symptoms disappear at night. Which of the following gastrointestinal conditions is MOST consistent with the patient's symptoms? Ulcerative Colitis Diverticular Disease Crohn's Disease Irritable Bowel Syndrome
Irritable Bowel Syndrome is a functional disorder of motility in the small and large intestines. Abdominal pain or discomfort is relieved by defecation and the pain tends to disappear at night (while sleeping). The typical pain pattern consists of lower left quadrant abdominal pain, constipation, and diarrhea. Symptoms seem to come and go with no apparent cause and effect that can be identified by the affected individual. In Crohn's disease pain is felt in lower right quadrant. Ulcerative colitis is the inflammation and ulceration of the inner lining of the large intestine and rectum; it main symptoms are diarrhea, rectal bleeding. Diverticulitis is the infection and inflammation that accompany a microperforation of one of the diverticula. Option A,B,C are not relieved with rest.
Which of the following treatment guidelines is LEAST effective for patients with Alzheimer's disease? Group therapy with exercises that use verbal commands Exercises should be short and simple and done in the same order each day Group therapy with exercises that that use images Exercise program should include group interaction with physical touching such as holding hands or working in pairs
It is difficult for Alzheimer's patient to follow and remember verbal commands, so option A is least effective. Using images, short, simple and same exercises every day is beneficial for the patient.
What is the MOST appropriate method to confirm an L4 nerve root lesion? Check sensation over lateral foot Check Achilles reflex Check sensation over great toe Check medial hamstring reflex
L4 dermatome is medial aspect of foot, L5 is dorsum of foot and S1 is lateral aspect of foot. Few dermatomal diagrams depict great toe is supplied by L4. For reflexes: L5, S1- medial hamstrings reflex, S1, S2- Achilles reflex
sciatic nerve (sensory)
L4-5, S1 - anterior and posterior leg, sole and dorsum of foot
A PT examination reveals PSIS is low on the left and ASIS is high on the left. Interventions should most likely include:
L posterior innominate - stretch L hip extensors - then strengthen L hip flexors
what level is conus medullaris at
L1
nerve: obturator roots: muscles:
L2-4 - adductor longus, brevis, magnus - gracilis - obturator externus
saphenous branch of femoral nerve
L2-4 - anteromedial knee and medial leg
femoral nerve (sensory)
L2-4 - anteromedial thigh and leg
nerve: femoral roots: muscles:
L2-4 - iliacus - quads - sartorius - pectineus
Lateral cutaneous nerve of thigh
L2-L3 - lateral thigh
obturator nerve (sensory)
L2-L4 - medial thigh
Hemiballismus
Large-amplitude sudden, violent, flailing motions of the arm and leg of one side of the body
S1 dermatome
Lateral and plantar aspect of foot, buttock, back of thigh, lower leg
actions of latissimus dorsi
Latissimus dorsi is a shoulder extensor, adductor and internal rotator. 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
A 40-year-old male patient presents with right homonymous hemianopsia and right hemiparesis. He is unable to read, but he can communicate through writing. The MOST likely location of infarct is: Right MCA Right PCA Left PCA Left MCA
Left PCA infarcts can cause dyslexia i.e. difficulty with reading (calcarine lesion and posterior part of corpus callosum), homonymous hemianopsia (damage to primary visual cortex or optic radiation) and right hemiparesis (damage to cerebral peduncle of midbrain).
what is a kehrs sign?
Left shoulder pain with pressure placed on abdomen=> spleen rupture, stomach ulcer, recent laparoscopy
A 35-year-old female had a stroke 1 week ago and is being transferred to the acute rehabilitation unit of the hospital. This patient presents with right hemiparesis and aphasia. The patient's family asks the physical therapist which area of her brain was affected by the stroke. What is the BEST answer to this family's question? Right MCA deep territory Right PCA Left MCA deep territory Left PCA
Lesion in left MCA deep territory will cause right motor hemiparesis and aphasia. Options B & D do not cause a pure motor stroke. Right MCA lesion will cause left hemiparesis.
RLA level III
Localized response: reacts specifically to stimuli, through inconsistently
During surgery to remove an apical lung tumor, the long thoracic nerve was injured, but not severed. Muscle testing of the serratus anterior demonstrates its strength to be 3+/5. The BEST initial exercises to strengthen this muscle include: Standing arm overhead lifts using hand weights. Supine arm overhead lifts using weights. Sitting arm overhead lifts using a pulley. Standing wall push-ups
Long thoracic nerve supplies the serratus anterior muscle. Standing wall push-ups is a good initial exercise to strengthen serratus anterior as the patients strength is 3+/5. Progression will be push-ups while leaning against a countertop than push-ups in a horizontal position. Options A&C will not strengthen the serratus anterior.
Phenytoin/Phenobarbital
Long-acting antiepileptic medications for status epilepticus
All of the following are signs and symptoms of a later manifestation of cystic fibrosis EXCEPT? Anorexia Meconium Ileus Clubbing Diarrhea
Meconium Ileus (a bowel obstruction that occurs when the meconium in your child's intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine is an early manifestation of cystic fibrosis as it seen in infants) Anorexia, clubbing and Diarrhea are late manifestations.
L4 dermatome
Medial buttock, lateral thigh, medial leg, dorsum of foot, big toe
Ligament of struthers syndrome
Median nerve becomes entrapped with brachial artery under ligament Weakness in grip (FDP and FDS), wrist flexion (FCR) and 2nd/3rd digit flexion (FDP) Dull, achy sensation in forearm Brachial pulse may be diminished - pronator teres weakness
A patient reports to the clinic with complaints of wrist pain. During testing of the patient's grip strength, the therapist notices that the patient's lateral two fingers are unable to fully grip the hand dynamometer. The therapist can MOST likely conclude that which of the following structures has been damaged? Median Nerve Radial Nerve Antebrachial nerve Ulnar nerve
Median nerve injury at the forearm or elbow results in the "hand of benediction". The index and middle finger do not flex at the IP joints due to damage to median nerve that supplies the flexor digitorum profundus and superficialis. The medial digits (4th and 5th) are flexed due to ulnar nerve innervation of FDP.
A 28-year-old software engineer reporting difficulty at work is referred to an outpatient physical therapy clinic. The patient complains of pain and numbness and tingling sensations in her left forearm, elbow, and hand. The PT suspects a median nerve injury but Phalen's test is negative. To confirm the median nerve involvement, the PT should MOST likely expect pain and weakness during which of the following motions: Left forearm pronation, finger flexion and thumb adduction Left forearm pronation, finger flexion and thumb opposition Left forearm supination, finger abduction and thumb opposition Left forearm pronation, finger extension and thumb extension
Median nerve injury causes difficulty with forearm pronation due to impaired pronator teres muscle, difficulty with index finger flexion (due to impaired FDS and FDP) and thumb opposition (ape hand deformity) due to impaired thenar muscles which are all supplied by the median nerve.
A patient diagnosed with Ménière's disease presents with vertigo. Which sign and symptom is LEAST consistent with the condition? Hearing loss Head tilt to one side Vertigo lasting 30 minutes Tinnitus
Meniere's disease is a recurrent and usually progressive vestibular disease. It is associated with low frequency hearing loss, episodic vertigo. The patient may also complain of a sense of fullness and tinnitus. Head tilt to one side is not seen with Meniere's disease but seen with UVH
forward flexion in stance phase (AKA)
anatomical - weak quads prosthetic - unstable knee joint, short walker
A 65-year-old male had a right parietal lobe infarct 6 weeks ago. Since the CVA, he requires moderate assistance for ADLs, minimal/moderate assistance to ambulate in his home environment with a walker, and moderate assistance to maintain static standing balance. Based on the scenario, which of the following physical therapy interventions would be LEAST appropriate at this time in his recovery? Visual feedback for midline orientation Seated activities lifting both hands in midline Use of cane in unaffected side for walking ADL training using both hands to drink from a cup
Midline activities are main focus of treatment. Holding cane on unaffected side will further promote imbalance causing leaning to affected side, hence it should be avoided.
Marta is experiencing chronic pain and tenderness at the base of her neck. Her MRI reveals foraminal narrowing at the C5-C6 intervertebral joint. What will be the MOST appropriate physical therapy intervention? Provide an ice pack to relieve pain Perform cervical mobilization by moving the C5 vertebrae anteriorly Perform cervical mobilization by moving the C6 vertebrae anteriorly Applying traction at the level of C7
Mobilizing upper vertebra i.e. C5 anteriorly increases the space between C5-C6 causing flexion. Traction is not appropriate at C7 level. Ice pack will not increase the intervertebral foraminal space.
When treating a geriatric patient with osteoporosis, which of the following will be MOST important to include in a treatment plan to improve bone density? Treadmill with high incline Lumbar flexion resistance training Seated rowing machine Leg press resistance training
Muscle contraction (strengthening exercises, resistance training) and mechanical loading (weight bearing) deform bone which stimulates osteoblastic activity and improves BMD. Since, leg press causes weight bearing it can cause bone formation (Wolf's Law). Seated row machine will not allow weight bearing, hence not beneficial. Treadmill with high incline and lumbar flexion should be avoided in an osteoporotic patient to prevent vertebral compression fracture.
Sensory Organization Test (SOT)
Nashner and colleagues developed a sensory organization test (SOT/ CTSIB) to assess the CNS's ability to adapt between the three senses and to also clinically determine whether or not one of the three senses is impaired in an individual. As you can see from the picture, the test uses a tilting platform under the feet which can be set to tilt with anteroposterior body sway (to provide inaccurate somatosensory input), a blindfold (to eliminate visual input), and a visual surround enclosure which can be set to tilt with anteroposterior body sway (to provide inaccurate visual input). Note: the patient is in a harness to prevent falls. The SOT/ CTSIB measures body sway under 6 different sensory conditions:
RLA level I
No response: is completely unresponsive to any stimuli presented
Which of the following is CORRECT regarding the effects of aging on the respiratory system? Reduced airway resistance Reduced diffusion capacity Reduced RV Reduced FRC
Normal aging affects the respiratory function- increase in residual volume & functional residual capacity, increase in airway resistance but there is a decrease in diffusion capacity.
Strengthening exercise is contraindicated in the presence of any of the following laboratory test results EXCEPT: 20% Hematocrit Prothrombin time of 12 seconds Platelet count of 50,000 cells/mm3 INR - 3
Normal prothrombin time is 11-15 seconds, so 12 secs is normal and strengthening exercise should not be contraindicated. Normal INR value is 0.9-1.1, so with INR 3 strengthening exercises will be contraindicated. Normal hematocrit level is 37-52%, so for 20% hematocrit strengthening exercise will be contraindicated. Normal platelet value is 150,000-400,000/mm3, so with 50,000/mm3 platelets strengthening exercise will be contraindicated
ASIA level E
Normal: Sensory and motor functions are normal
pronation =
OKC: eversion, abduction, dorsiflexion CKC: eversion, adduction, plantarflexion
supination =
OKC: inversion, plantarflexion, adduction CKC: inversion, dorsiflexion, abduction
A 50-year-old female patient presents with right-sided arm weakness and sensory loss. The PT also notes that homonymous hemianopsia and global aphasia are also present. The MOST likely location of her brain injury is the: Left MCA superior division Left MCA stem Right MCA Superior division Right MCA stem
Occlusion of Left MCA stem causes right side hemiparesis, global aphasia, and contralateral homonymous hemianopsia. Superior division of MCA causes Broca's aphasia and inferior division of MCA causes Wernicke's Aphasia.
A PT is conducting a 6MWT to determine exercise capacity of a 50 year old male patient with hypertension who uses a quad cane for community ambulation. Which of the following is NOT true according to the 6MWT protocol? - The patient can walk as far as he can at a normal walking pace - Standardized encouragement will be provided periodically by the PT - The patient can use his quad cane during the test - The time stops when the patient stops to rest
Options A, B and C are all part of the protocol for the six minute walk test. The client walks as far as they can at their usual pace for 6 minutes while using their customary assistive devices and orthotics. They can stop and rest as needed, but the stopwatch continues.
A physical therapist is teaching transfer techniques to a T3 spinal cord injury patient. After transferring to the wheelchair, the patient reports blurred vision, ringing in the ears and light-headedness. Which of the following diagnosis is most relevant for this patient? Benign Paroxysmal Positional Vertigo Orthostatic hypotension Autonomic dysreflexia Hypoglycemia
Orthostatic hypotension is usually significant in people with SCI above T6 and is often experienced during early transitions to a more upright posture. Symptoms of orthostatic hypotension include blurred vision, ringing in the ears, light-headedness, and fainting. Autonomic dysreflexia is a pathological reflex (above T6) and the symptoms are hypertension, headache, profuse sweating, and increased spasticity. Hypoglycemia can cause light-headedness but it is not related to sudden change in posture. The main symptoms of BPPV include nystagmus and vertigo with change in head position, and occasionally nausea with or without vomiting, and dysequilibrium.
A 65-year-old male patient comes to the clinic with a history of diabetes mellitus for the past 15 years. The patient is unable to hold in urine and states that he chooses not to ambulate in the community due to this problem. Based on the patient's subjective report and symptoms, what condition does the patient exhibit? Stress incontinence Overflow incontinence Spastic bladder incontinence Functional incontinence
Overflow incontinence is over distention of the bladder and the bladder cannot empty completely. Urine leaks or dribbles out so the client does not have any sensation of fullness or emptying. It can be caused by deficient detrusor muscle, a hypotonic or underactive detrusor muscle secondary to drugs, fecal impaction, diabetes and lower spinal cord injury. With stress incontinence, pressure applied to the bladder from coughing, sneezing, laughing, lifting, exercising, or other physical exertion increases abdominal pressure, and the pelvic floor musculature cannot counteract the urethral/ bladder pressure. Functional incontinence occurs from mobility and access deficits such as being confined to a wheelchair or needing a walker to ambulate.
overflow incontinence
Overflow incontinence is over distention of the bladder and the bladder cannot empty completely. Urine leaks or dribbles out so the client does not have any sensation of fullness or emptying. caused by neurological condition that causes disruption of the activity of the detrusor muscle - trmt: medication and catheterization
A 40-year-old male patient presents with dyspnea upon exertion, and low endurance during ambulation and activities of daily living. What is the BEST breathing technique to enhance this patient's clinical presentation? Diaphragmatic breathing Lateral costal breathing Paced breathing Pursed lip breathing
Paced breathing is indicated when a person becomes dyspneic during an activity. In this, by breaking activities down into component parts and interspersing rest periods between each component, the total activity can be completed without dyspnea or undo fatigue. Pursed lip breathing is used to reduce dyspnea and facilitate relaxation for patients with COPD. Lateral costal breathing is used to expand one segment of the lung. Diaphragmatic breathing is used for relaxation.
rovsings sign
Pain in RLQ with palpation of LLQ indicative of appendicitis
A 44-year-old male with complaints of left shoulder pain is being evaluated by a physical therapist. After a thorough examination, the only abnormal finding is a positive Kehr's sign. Which of the following is NOT a potential cause of a positive Kehr's Sign? Recent laparoscopy Stomach ulcer Rupture of the spleen Trauma to head of pancreas
Pain in the left shoulder with pressure placed on the upper abdomen, caused by free air or blood in the abdominal cavity is called Kehr's sign. A positive Kehr's sign can be caused by perforation of viscus (e.g., stomach ulcer (Option B), after laparoscopy (Option A), or after rupture of the spleen (Option C). Trauma to head of pancreas causes referred pain to the right (NOT left) shoulder, which makes Option D correct.
A PTA is treating a home health patient who has moderate Alzheimer's disease. The patient had a CVA 6 months ago. Upon arriving to the patient's house, the patient's caregiver told the PTA that the patient has become combative. He starts shouting at the PTA and caregiver. What is the MOST appropriate response by the PTA? Tell the caregiver to administer a low dose of Lithium to calm the patient down Tell the patient that this is not appropriate behavior Immediately notify the neurologist on call Reschedule the therapy session for another day
Patient with moderate Alzheimer disease have increasing memory loss and confusion, restlessness, agitation, loss of impulse control and inappropriate behavior. Notifying the neurologist is not necessary as it is common behavior for Alzheimer's. The best is to reschedule therapy for another day.
A 55-year-old female patient is being seen by a PT 5 days status post unilateral mastectomy. The PT notes that the patient is unable to actively adduct the shoulder in the horizontal plane. Which of the following impairments is the MOST LIKELY origin of the patient's presentation? Stiffness secondary to lymphedema Pectoralis minor tightness Subscapularis weakness Pectoralis major weakness
Pectoralis major/ minor are muscles responsible for horizontal adduction. The pectoral muscles might have been damaged at the time of mastectomy causing weakness. Stiffness will affect all the movements and not only adduction. Subscapularis weakness leads to decreased internal rotation and adduction but is less affected with mastectomy.
Crackles are associated with
Pneumonia, CHF, COPD, and bronchitis
what is polycythemia?
Polycythemia is characterized by increases in both the number of red blood cells and the concentration of hemoglobin. People with polycythemia have increased whole blood viscosity and increased blood volume which can cause elevate blood pressure
To prevent maximal compressive force being placed on the patella, a therapist should avoid placing a patient in what position? Prone with the knee flexed to 30 degrees Seated with the knee flexed to 90 degrees Supine with the hip and knee flexed to 110 degrees Prone with the knee flexed to 110 degrees and the hip in slight extension
Positioning the patient in prone places the hip into an extended position. From this position, increasing knee flexion to 110 degrees results in passive insufficiency of the quadriceps, which creates higher compression at the patella. Since the quadriceps group is aligned anatomically with the shaft of the femur and not with the mechanical axis of the lower extremity, any quadriceps muscle contraction (regardless of knee flexion angle) results in compressive forces acting on the patellofemoral joint
A 34-year-old male with excessive lordosis often complains of having a "weak" back. He states that he has an aching pain in his low back, and is unable to lift heavy objects without pain. You tell him that the reason his back feels weak is because of faulty alignment. What is the MOST appropriate primary intervention to correct this problem? Strengthen the lower back extensors Anterior pelvic tilt exercises Use a back support in the form of a corset or brace Strengthen the abdominal muscles
Primary intervention for a mechanically weak back with faulty alignment is to provide a corset for stabilization and then later on progress with abdominal exercises for increased lordosis. Anterior Pelvic tilt and extension exercises will increase the lordosis.
2nd degree heart block type 1
Progressively longer PR interval until the P wave is not followed by a QRS, disease of AV node, monitor and continue with lower intensity
A 30-year-old female presents to a PT clinic with complaints of pain on the anterior aspect of her elbow and the palmar side of the first, second, third, and half of the fourth digits. What clinical condition below is MOST likely causing these symptoms? Carpal tunnel syndrome Pronator teres syndrome Wartenberg's syndrome Arcade of Frohse syndrome
Pronator teres syndrome is a compression neuropathy of the median nerve at the elbow between the two heads of pronator teres. It can lead to pain and numbness in the distribution of the distal median nerve (index finger, long finger, and radial side of ring finger) and weakness can develop in median-innervated muscles. Symptoms also include tenderness over pronator teres muscle at the anterior aspect of the elbow. Nocturnal pain and tinel's sign at wrist is positive for carpal tunnel syndrome. Wartenberg's syndrome is described as the entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits.
DCML
Proprioception, Vibration, Tactile Discrimination, 2 point discrimination, sterognosis, barognosis, graphesthesia - ascending - cross in medulla - same side
2nd degree heart block type 2
QRS dropped without warning, stop exercise
blood in abdominal cavity secondary to liver trauma refers to ...
R shoulder
left MCA stem
R side hemiparesis, global aphasia, contralateral homonymous hemianopsia
A PT was testing the gag reflex in a 45 y.o. male complaining of sudden change of voice quality. When PT asks the pt to say "ahh" the PT finds the pts uvula deviated to the L side. Which CN is most likely affected? a) L vagus nerve b) R vagus nerve c) L hypoglossal nerve d) R glossopharyngeal nerve
R vagus nerve, uvula deviates to contralateral side
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? Inferior glide Superior glide Ulnar glide Radial glide
Radial glide is used to improve thumb extension. At the 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 metacarpal moves over the convex trapezium so glide will be in the same direction. (Concave-convex rule)
atrial tachycardia
Rate: 150-250 beats per minute
atrial flutter
Rate: 250-350 - slow down
golgi tendon organs
Receptors sensitive to change in tension of the muscle and the rate of that change (velocity), muscle contraction force
A 33-year-old patient complains of a "creeping and crawling" sensation down her legs, accompanied by involuntary contractions of the calf muscles. These symptoms are increased at night. What condition below is MOST commonly related to these clinical findings? Vascular claudication Peripheral Neuropathy Neurogenic claudication Restless leg syndrome
Restless leg syndrome causes sleep disturbances, paresthesia, and uncomfortable sensations (itchy, pins and needles, creepy, crawly). In vascular and neurological claudication, pain increases with exercise and not at night.
rhabdomyolysis
Rhabdomyolysis is a potentially fatal condition is which myoglobin and other muscle tissue contents are released into the bloodstream as a result of muscle tissue disintegration. This could occur with acute trauma, severe burns, overexertion, from alcohol abuse or alcohol poisoning or with statins. It leads to muscle aches, cramps, weakness and soreness. Dark color of urine is due to liver failure.
A physical therapist is performing cranial nerve testing on a 55-year-old male patient. When observing the patient's right papillary response to light, the physical therapist observes that there is no constriction of the right pupil but the left pupil does constrict. Which cranial nerve is the MOST likely cause of this impairment? Left Oculomotor nerve (CN III) Right Optic nerve (CN II) Right Oculomotor nerve (CN III) Left Trochlear nerve (CN IV)
Right Oculomotor nerve (CN III) CN II is afferent and CN III is efferent component of pupillary reflex. Pupillary reaction (constriction) is tested by shining light in eye. When light is shown in the right eye, intact right CN II (optic) carries sensory information, which stimulates efferent CN III (occulomotor) to cause constriction of the pupil. As there is constriction of left pupil and no constriction of right pupil, it indicates that right CN III is affected.
A 28-year-old male presents to an outpatient clinic complaining of hip problems. The physical therapist notices a drop of the left hip during right mid-stance. The MOST appropriate treatment for this impairment would be: Standing hip abduction of the left leg Standing hip abduction of the right leg Standing extension of the left leg Standing flexion of the right leg
Right gluteus medius weakness causes left pelvic drop. In stance phase, gluteus medius is a pelvis depressor and can be strengthened by standing on the right side (weak) and doing left hip abduction. Standing on left leg and doing right hip abduction strengthens left gluteus medius. Standing extension of the left leg strengthens left gluteus maximus. Standing flexion of the right leg strengthens right hip flexors
Rinne vs. weber test
Rinne (under pinne): side of ear measuring air:bone conduction (AC>BC = normal, pt can hear fork at ear, BC>AC = conductive loss, pt will not hear fork at ear) Weber: top, measures hearing from one or both ears (ex. left affected, sound will be louder (lateralization) on affected/L side = conductive loss, sound heard louder on unaffected side = sensorineural loss)
A 22-year-old female student is referred to physical therapy for complaints of migraine headaches. The therapist notices that she has a rosy appearance over her cheeks, nose, and chin. She also admits to having burning episodes, accompanied by intermittent flushing of her cheeks, as well as gastrointestinal disturbances. Which of the following conditions BEST matches the clinical findings? Systemic Lupus Erythematosus Seborrheic dermatitis Rosacea Shingles
Rosacea is a chronic facial skin disorder, it causes redness of the cheeks, nose, chin, forehead that comes and goes. With advanced Rosacea swelling of the nose (rhinophyma) is seen. Bumps and pimples appear. Chronic facial flushing causes the telangiectasia. Migraines have found to be associated with Rosacea. SLE presents with a characteristic butterfly rash across the bridge of the nose but no migraines. Shingles are caused by Varicella-zoster virus. It causes rash or blisters on the skin that may be associated with severe pain (along the involved nerve root and associated dermatome)
obriens test
SLAP lesion
A patient is being evaluated in a hospital following acute kidney failure. During evaluation, the PT notes that the patient has ovular patches of skin that have hardened, and the patient's nail beds appear blue. What is the most likely cause of the patient's symptoms? Scleroderma Lupus Warts Psoriasis
Scleroderma is characterized by inflammation and fibrosis of many parts of the body, including the skin, blood vessels, synovium, skeletal muscle, and certain internal organs such as kidneys, lungs, heart, and GI tract. Warts are benign infection caused by human papilloma virus seen on skin especially hands, fingers, pressure points of feet. Psoriasis is an autoimmune disease of skin characterized by silvery scale plaques causing itching, dryness over knees, scalp, elbows, genitals etc. Lupus is chronic autoimmune disorder affecting skin, joints, kidney, and nervous system. It has characteristic butterfly rash across bridge of nose.
An adolescent female patient is diagnosed with right thoracic scoliosis with a 52 degree curvature. Which of the following is MOST likely a true statement based on the patient's diagnosis? The patient's thoracic vertebral bodies and spinous processes are rotated to the left The patient's right-side thoracic transverse processes are rotated anteriorly, carrying the ribs with them The patient's left-side thoracic transverse processes are rotated posteriorly In neutral standing posture, the patient has a left lateral flexion bias of the thoracic spine
Scoliosis is a deformity in which there are one or more lateral curvatures of the lumbar or thoracic spine Right thoracic scoliosis will have left lateral flexion (concave) and convexity towards right side. The rotation of vertebra, scapular prominence and rib hump is on the right side (convex) and the rotation of spinous process is towards the left side (concave /hollow).
sensitivity and specificity
Sensitivity = TP / (TP + FN) - ability of test to identify true disease without missing anyone by leaving someone undiagnosed specificity = TN/ (TN +FP ) - ability of test to be correctly negative in the absence of disease without mislabeling anyone
A PT consult is ordered for a 50-year-old gentleman in the late stages of ALS. In the patient's chart is an electromyography report and nerve conduction velocity test. All of the following findings are consistent with his diagnosis EXCEPT: Decreased amplitude of motor unit action potential Decreased duration of motor unit action potential Decreased sensory evoked potential Decreased polyphasic action potential
Sensory evoked potential will not be seen in ALS as ALS is a motor neuron disease affecting the motor nerves and not sensory nerves. A, B and D are findings consistent with ALS.
A 66 yr old patient was admitted to ICU following a cerebrovascular accident. The physician orders PT services to address position recommendations when lying on the hemiplegic side. For the protection of shoulder, the MOST appropriate position to place the patient's shoulder in is: a) Shoulder forward, slight abduction & external rotation b) Shoulder neutral, slight abduction only c) Shoulder forward, slight abduction and internal rotation d) Shoulder neutral, slight abduction & external rotation
Shoulder forward, slight abduction & external rotation A Effective positioning of the hemiparetic extremities encourages proper joint alignment while positioning the limbs out of the abnormal postures typically assumed. Positioning strategy in side lying on the more affected side - Scapula protracted; shoulder forward; arm placed in slight abduction and external rotation; elbow extended, forearm supinated, wrist neutral, fingers extended, and thumb abducted.
Which of the following is NOT a common side effect of chemotherapy? Skin rash Myopathies Thrombocytopenia Ulcers
Side effects of chemotherapy include anorexia, nausea, vomiting, diarrhea, ulcers, hemorrhage, bone marrow suppression, anemia, leukemia, thrombocytopenia, fatigue, skin rashes, neuropathies, and phlebitis and hair loss. Myopathy is not a side effect of chemotherapy.
A geriatric patient recently developed CHF. The patient has symptoms of nausea, vomiting, and gastrointestinal irritability. The patient also presents with mental confusion and frustration. Based on these symptoms, what clinical condition does the therapist suspect? Alzheimer's disease Dementia Digoxin toxicity Age related symptoms
Signs of digoxin toxicity in patients with CHF : Nausea, vomiting, headache, dizziness, confusion, abdominal pain, delirium, vision disturbance. With Alzheimer's and dementia, patient will experience significant memory loss.
A young adult underwent right Achilles tendon repair 6 weeks ago and is now cleared for full weight bearing. His physical therapist was giving him advice on proper shoe modification. Which of the following suggestion would be the BEST for this patient? Wear normal shoes; no modification is necessary Wear shoes with 1- 1.5 cm heel lift Wear shoes with a lower heel height than your regular shoes Wear shoes with 2-3 cm heel lift
Since the patient is six weeks post-op and fully able to weight bear; shoes with 1-1.5cm heel lift will keep the foot in slight plantarflexion and prevent excessive dorsiflexion that will cause strain on the repaired Achilles tendon. Shoes with 2-3 cm heel lift will cause extra plantarflexion and not recommended at 6 weeks. Normal shoes and lower than regular heel will cause excessive dorsiflexion that can strain the repaired tendon.
Which of the following is MOST appropriate to screen for in a patient with an acute exacerbation of Guillain-Barre Syndrome? Fatigue Spasticity Skin Integrity Respiratory function
Skin integrity is most important to check as loss of sensation is dangerous. Fatigue is common, but will not be as detrimental to patient. Respiratory function will be preserved initially. Spasticity is not seen with GBS.
Seattle foot
Slightly flexible plastic keel bends at heel contact; keel stores energy and recoils in late stance releasing energy for springy termination to stance, heavier than SACH
heel whip in stance heel off (AKA)
anatomical causes - fast pace prosthetic causes - knee bolt rotated - prosthesis donned in malrotation
A 24-year-old female is being evaluated for anterior knee pain. The patient walks without an assistive device and reports a dull constant pain when she is weight-bearing on the leg. She also has a history of multiple lateral ankle sprains from years of playing basketball. A clinical gait analysis reveals knee hyperextension during stance phase. The MOST LIKELY contributing factor to this gait presentation is: Soleus contracture retracting the tibia Contralateral abductor weakness causing a trunk lean Quadriceps contracture pulling the knee in hyperextension Degenerative joint changes causing a change in ground reaction forces
Soleus contracture retracting the tibia Contralateral abductor weakness causing a trunk lean Quadriceps contracture pulling the knee in hyperextension Degenerative joint changes causing a change in ground reaction forces
Modified Ashworth Scale (MAS)
Spasticity scale 0 = NORMAL 1 = Slight increase in muscle tone with a catch and release OR minimal resistance at end of ROM 1+ = Slight increase in muscle tone with catch followed by minimal resistance through rest (less than half) of ROM 2 = More marked increase in tone through most of ROM, but affected parts moved easily 3 = Considerable increase in tone, passive movement difficult 4 = Affected part rigid in flex or ext
SPIN and SNOUT
Specificity rules in (diagnosis/confirmation, few false positives), Sensitivity rules out (screening, few false negatives)
A patient comes to an outpatient physical therapy clinic complaining of pain during prolonged sitting and standing. The patient also reports cramping during walking, as well as numbness and a "tingling" sensation in their legs. Which of the following diagnoses is the MOST likely origin of the patient's symptoms?
Spinal stenosis is narrowing of the spinal canal causing compression of nerves. Symptoms include pain, numbness, cramping, muscle weakness. Pain increases with standing, walking, extension and is relieved by spinal flexion. Occlusion of the femoral artery will not cause numbness and tingling. Raynaud's disease is episodic spasm of small arteries and arterioles causing cyanosis, pallor, numbness and tingling at tips of fingers. SLE is chronic autoimmune disorder affecting the skin, joints and internal organs.
A patient is being seen in a PT clinic one week following PCL reconstruction. When planning for the patient's upcoming session, what exercise focus should the therapist consider implementing? Hamstring stretching Quadriceps strengthening in closed kinematic chain Hamstring strengthening Quadriceps stretching
Strengthening the quadriceps is emphasized for knee control after PCL reconstruction because it acts as a dynamic restraint to posterior tibial translation. Hamstrings strengthening will increase posterior translation of the tibia.
stress incontinence
Stress incontinence occurs when the support for the bladder or urethra is weak or damaged, but the bladder itself is normal. With stress incontinence, pressure applied to the bladder from coughing, sneezing, laughing, lifting, exercising, or other physical exertion increases abdominal pressure, and the pelvic floor musculature cannot counteract the urethral/ bladder pressure - trmt: strengthen pelvic floor muscles
autonomic dysreflexia
T6 or above - noxious stimuli below lesion - rise in systolic BP of 20-30 - more common with complete - more common in chronic stage - increase BP, decrease HR, HA, constricted pupils, flushing and goosebumps above lesion, dry and pale below, increased spasticity - sit up and lower legs
A 4-year-old child has been referred to physical therapy for weakness and "failure to thrive." The child's family reports a gradual onset of weakness and lack of desire to participate in play. After a brief examination, the child appears significantly fatigued. What condition would MOST likely be consistent with these symptoms? Cerebral Palsy Spina Bifida Patent ductus arteriosus Leukemia
Symptoms for children with leukemia: - General malaise, fatigue and lethargy, Prolonged or recurrent episodes of fever, Irritability, Growth restriction and/or failure to thrive, Shortness of breath and/or reduced exercise tolerance, Dizziness and palpitations, Bleeding diathesis, particularly causing epistaxis, 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.
Wells criteria
Symptoms of DVT (3 points) No alternative diagnosis better explains the illness (3 points) Tachycardia with pulse > 100 (1.5 points) Immobilization (>= 3 days) or surgery in the previous four weeks (1.5 points) Prior history of DVT or pulmonary embolism (1.5 points) Presence of hemoptysis (1 point) Presence of malignancy (1 point)
elevated BP
Systolic between 120-129 and diastolic less than 80
osteopenia
T score between -1 and -2.5
While working with a patient who has suffered CVA 6 weeks ago, a physical therapist chooses to promote recovery using NDT described by Bobath. Which technique is the therapist MOST likely to implement? Quick stretch to facilitate weak muscles Tactile cues to the pelvis and shoulders to control posture Constrain the uninvolved upper extremity and force the use of the involved extremity Perform progressive resistive exercises of bilateral upper extremities to increase muscle strength.
Tactile cues to the pelvis and shoulders to control posture NDT by Bobath is a problem solving and assessments approach. It plays an important role in movement patterns, postural control and directly affects the performance of functional task. Therapeutic handling is the main method for better functional and postural performances of task. Individuals are encouraged for active participation during treatment sessions. Also, functional training is emphasized for development.
A 79-year-old patient is receiving physical therapy for gait instability. She is moderately ambulatory and has difficulty with community distances. Which of the following outcome measures is MOST appropriate to determine her fall risk? Fullerton Assessment of Balance Function in Sitting Test Berg Balance Scale 6- Minute Walk Test
The Berg Balance Scale is the most appropriate given that the patient is only capable of ambulating minimal to moderate distances. BBS is useful in predicting falls in the elderly. FAB and 6MWT are both too high level for this patient, while the FIST is too low level as it is a measure of early sitting in persons with limited functional ability
A 30-year-old female presents with agonizing, nauseating, exhausting, tiring and unbearable pain. What pain pattern is MOST consistent with these symptoms? Vascular Neurogenic Musculoskeletal Emotional
The adjectives used to describe the patient's pain are subjective in nature, and suggest a variety of origins. Agonizing, nauseating, exhausting, tiring and unbearable are all the words a patient might use to describe pain in emotional terms.
Q angle
The angle between the line of quadriceps force and the patellar tendon
A physical therapist notices that a patient is experiencing early toe-off during terminal stance in gait. Which of the following identifies a likely cause, AND an appropriate intervention to address that cause? Hip flexion contracture; prolonged stretch Hip adductor weakness; progressive strengthening Gastrocnemius weakness; ultrasound Great toe flexion weakness; progressive strengthening
The correct answer is A. Hip flexion contracture will lead to lack of hip extension in terminal stance and will result in early toe off. An appropriate intervention to address this is to provide prolonged stretching to the hip flexor musculature to improve ROM.
A physical therapist is overseeing a patient who is enrolled in an aquatic therapy program. When reviewing the patient's chart, the therapist notices that the patient has recently began taking furosemide (Lasix). Which of the following conditions should the therapist be MOST concerned about? Muscle cramping Orthostatic hypotension Bradycardia Heat intolerance
The correct answer is B. Lasix is a loop diuretic that increase the renal excretion of water and sodium, thus decreasing the volume of fluid in the vascular system. One of its side effects is orthostatic hypotension; the addition of systemic heat from the aquatic therapy will cause vasodilation, which places the patient at danger for low BP.
All of the following are guidelines in treating patients with GERD EXCEPT: Any intervention requiring a supine position should be scheduled before meals and avoided just after eating Encourage the patient to sleep on their left side for nocturnal reflex Modify patient's position to a more upright posture if symptoms persist during therapy Encourage the patient to sleep on their right side for nocturnal reflex
The correct answer is D. Lying on the right side straightens out the esophagus, increasing reflux so the patient should be encouraged to sleep on the left side with a pillow in place to maintain this position. The lower esophagus bends to the left, so reflux is minimized in this position
A patient with lower back pain presents to the clinic. The patient is experiencing radicular symptoms down the left leg, crossing the front of the knee, and their pain becomes worse with repeated extension. Based on these symptoms, what is the MOST likely cause? L4 nerve root irritation L5 nerve root irritation Spinal stenosis Piriformis syndrome
The location of the pain correlates with irritation of the L4 nerve root. Repeated extension would provoke irritation of a nerve root.
A male patient has signs and symptoms of intermittent claudication, unilateral pain in the buttock and thigh (sometimes exacerbating bilaterally), and a diminished femoral pulse. His pain is relieved by rest. Based on the clinical presentation, where is the site of the occlusion? Aortic bifurcation Iliac artery Femoral and popliteal artery Tibial and common peroneal artery
The location of the pain is determined by the site of the major arterial occlusion. The occlusion of iliac artery produces pain or discomfort in the buttock, hip, thigh of the affected leg, diminished or absent femoral or distal pulses. Femoral and popliteal artery occlusion produces pain in calf and foot. Tibial and common peroneal artery occlusion produces pain in calf and feet (occasionally)
Which nerve is commonly injured in the Arcade of Frohse?
The major branch of the radial nerve in the forearm is the posterior interosseous nerve, which may compress as it passes between the two heads of the supinator in the arcade or canal of Frohse.
A patient is admitted to a hospital for a left femur fracture after a recent fall at home. A review of the patient's medical chart reveals blood pressure (BP) of 165/90, triglyceride level of 160 mg/dL, and a fasting blood glucose level of 115 mg/dL. The patient's BMI is 40 kg/m2 with a 54-inch waistline. These findings are MOST consistent with a medical diagnosis of: Chronic heart disease. Type 2 diabetes Metabolic syndrome Cushing's syndrome
The metabolic syndrome is characterized by a group of metabolic risk factors in one person. The risk of serious illness increases in anyone with three or more of the following factors: waist size of more than 40 inches in male, more than 35 inches in female, Triglycerides>150mg/dl, elevated blood pressure (130/85 mm Hg or more), fasting blood sugar>100 mg/dl, HDL cholesterol less than 50 mg/dL for woman and less than 40 mg/dL for man.
All of the following management guidelines are followed in the recovery phase of nerve injury EXCEPT: Use electrical stimulation to reinforce active movement Protect weak muscles with a splint Place the weak muscle in its lengthened position Desensitize the extremity involved with contact particles such as beans or macaroni
The muscle should be positioned in its shortened position as it will put less pressure on the nerve. Positioning the muscle in lengthened position will increase the stress on the nerve. A, B, &D are management guidelines used in recovery phase.
An 85 year old patient was admitted to the hospital following a diagnosis of dehydration. The medical history of the patient indicates chronic congestive heart failure. The most appropriate plan of respiratory care for the patient is: Deep breathing exercises, coughing and turning, every 2 hours Vigorous percussion and vibration 4 times per day Postural drainage with gentle vibration, with the foot of the bed elevated, twice a day Postural drainage using standardized positions, twice a day
The patient has congestive heart failure so foot end elevation and standard postural drainage positions are contraindicated. Vigorous percussion and vibration is also not advisable. Turning, coughing and deep breathing every 1-2 hours is the best prophylactic treatment.
A 30-year-old pregnant woman complains of low back pain and discomfort. Upon examination the physical therapist finds that right ASIS is higher than the left ASIS, and right PSIS is lower than the left PSIS. While performing the long sitting special test, the right limb is shorter in supine and appears to get longer in sitting. Based on the examination, what is the MOST appropriate treatment? Stretch the Right Hip Extensors Stretch the Right Hip Flexors Strengthen the Right Hip Flexors Strengthen the Right Hip Extensors
The patient has right posterior innominate rotation i.e. PSIS is lower and the ASIS is higher on the involved side. It can be caused by tightness of right hip extensors. Hence, intervention is stretching tight hip extensors. Stretching the right hip flexors will increase right hip extensor tightness.
A patient comes into an outpatient clinic with symptoms of anxiety, hyperventilation, syncope, and cramping of the wrist. Upon PT evaluation, the therapist finds increased respiratory rate and a decrease in blood pressure. Based on the symptoms and findings, what condition does the patient present with and what is the MOST appropriate treatment? - Respiratory acidosis and bronchodilator - Respiratory alkalosis and having the patient to breath into a paper bag. - Bronchitis and paced breathing - Cystic fibrosis and endurance exercises
The patient is experiencing signs of respiratory alkalosis. Paper bag is a rebreathing device that allows the patient to inhale and rebreathe the exhaled CO2
A 24-year-old student is admitted to the hospital on Sunday morning following a night of partying with friends. The student presents with symptoms of nausea, vomiting, numbness and convulsions. The physical therapist reviews the patient's chart and notices the following lab values: HCO3 =27.9mEq/L, PaCO2 =47.9 mm Hg, and pH=7.49. What is the BEST diagnosis for this patient? Compensated Metabolic alkalosis Partially Compensated Metabolic alkalosis Uncompensated Respiratory acidosis Uncompensated Metabolic alkalosis
The patient is having metabolic alkalosis; it can be caused by excessive vomiting or upper gastrointestinal suctioning, diuretic therapy, or ingestion of large quantities of base substances such as antacids. To compensate metabolic alkalosis, lungs attempt to retain carbon dioxide (CO2) and thus hydrogen ions. Since pH is not yet within normal limits, it has not been totally compensated. Hence, partially compensated metabolic alkalosis
In an acute care setting, a physical therapist examines a patient exhibiting different blood pressure readings from bilateral arms, as well as a drop in systolic blood pressure. The patient's extremities are cold to the touch, and a bulge in the abdominal area is also present. Which of the following actions should the PT take FIRST?
The patient is showing the signs of a ruptured aneurysm which is a life threatening condition. Hence, it is essential to alert the start medical response team, as it is an emergency
Which of the following is the most realistic long-term goal for a patient who is receiving outpatient physical therapy services following a complete spinal cord lesion at T4? Effective cough technique Bed mobility Transfer from wheelchair to car Ambulation with KAFO
The patient's most realistic long term outcome is transferring from wheelchair to car. The patient would need to be at lumbar level to ambulate with a KAFO. Effective cough technique and bed mobility are short term goals for this patient.
A 19-year-old patient in ROTC comes to the physical therapy clinic and complains of anterior hip pain. During treatment, the patient starts flirting with the male physical therapist. The PT acts professionally and politely explains the professional guidelines, but the patient persists and makes the PT uncomfortable. There are no female physical therapists on staff. What would be the MOST appropriate response by the PT? Refuse to treat the patient and refer to another male PT Continue to treat the patient and ignore the flirting Report the patient to the clinic manager and notify the patient's ROTC supervisor Flirt back with the patient to keep open the possibility of dating in the future
The physical therapist has the right to refuse treatment if he is feeling uncomfortable. Referring to another male PT is appropriate, as we cannot assume that the patient can flirt with the second male PT too. Reporting to the ROTC supervisor is not required and is considered a HIPAA violation
A tracheal shift or mediastinal shift can occur due to asymmetrical intrathoracic pressure in the lungs. Which of the following will occur in a patient with a hemothorax? The mediastinum shifts towards the affected side The mediastinum shifts away from the affected side The mediastinum shifts superiorly The mediastinum caves inwardly
The position of the trachea shifts as the result of asymmetrical intrathoracic pressures or lung volumes. In hemothorax (collection of blood in the pleural cavity), intrathoracic pressure on the side of the hemothorax increases, and the mediastinum shifts away from the affected side of the chest.
A patient has a fracture of mid-shaft of humerus after falling on an outstretched hand. Which of the following nerves is most likely to be affected with this type of injury? Radial nerve Axillary nerve Median nerve Posterior interosseous nerve
The radial nerve can be injured if there is a fracture of the shaft of the humerus. The nerve may be damaged as it winds around behind the humerus in the radial groove and injury may occur at the time of the fracture, or the nerve may get caught in the callus of fracture healing. Axillary nerve can be injured with fracture of surgical neck of humerus. Most common causes of injury to median nerve are impingement in hypertrophied pronator teres and compression in carpal tunnel.
A physical therapist performs the slump test on a patient with diagnosed L4 disc herniation. Which of the following is the MOST important key indicator of a positive result? Pain in the low back area that increases with lumbar flexion Pain in the buttocks that is unchanged with head or ankle movement Pain in the posterior leg and calf that is relieved with cervical extension Pain in the lateral foot and calf that is relieved with ankle plantarflexion
The slump test is considered positive if the positioning (spinal flexion, knee extension and dorsiflexion) of the patient increases the symptoms or if the symptoms decrease with neck extension.
decorticate rigidity
The terms decorticate rigidity and decerebrate rigidity are often used to denote abnormal posturing in patients with severe brain injury. Decorticate rigidity refers to sustained contraction and posturing of the upper limbs in flexion and the lower limbs in extension
While evaluating a 30-year-old male with shoulder pain, the therapist applies pressure at the end range of shoulder abduction and external rotation. The patient feels a sudden PARALYZING pain and WEAKNESS in his shoulder. This finding is MOST LIKELY an indication of: Thoracic outlet syndrome Myotome involvement Anterior instability Cervical spondylosis
The therapist is performing anterior apprehension test or crank test. This test is primarily designed to check for traumatic instability problems causing gross or anatomical instability of the shoulder; positive anterior apprehension test indicates anterior instability.
A patient with T4 paraplegia is learning how to transfer his wheelchair up onto a curb by doing a wheelie. Which of the following verbal cues is LEAST helpful to complete this task? - Lean backward initially - Throw your weight forward as you advance the wheels forward - Place your hands at the 11 o'clock position for initial forward propulsion - Maintain the center of gravity over the rear wheels
Throwing the weight forward as we advance the wheel is not necessary. First step involves leaning back. After the initial propulsion, maintaining the center of the body over the rear wheel is essential. Placing the hands at 11'0 clock position assists in the initial forward propulsion
A physical therapist is teaching a patient with a spinal cord injury to negotiate a 4-inch curb with a manual wheelchair. The MOST appropriate instruction for the therapist to give the patient is: "Hook your arms around the push handles and descend backwards" "Ascend backwards with the large wheels first" "Ascend in a wheelie position by lifting the front casters" "Place the front casters down first during descent"
To perform a wheelie to negotiate the curb, the patient should lift the caster wheels first followed by the rear wheels to ascend, and to descend the curb patient maintains the wheelie so the back wheels land first, then the casters land.
A young male comes to the clinic complaining of significant pain in his thoracic spine. Upon palpation, the therapist finds tenderness at the right T6 inferior facet joint which is exacerbated with right rotation. On examination, the therapist notes closing restriction at right T6-T7 facet joint. Which of the following mobilization technique would be MOST beneficial? Posterior to anterior mobilizing force on the right transverse process of T5 Posterior to anterior mobilizing force on the left transverse process of T6 Posterior to anterior mobilizing force on the right transverse process of T7 Posterior to anterior mobilizing force on the right transverse process of T6
To promote closing, posterior-anterior glide is given on the transverse process of the lower vertebra on the affected side. So, to improve closing restriction between right T6-T7, posterior to anterior mobilizing force on the right transverse process of T7 will be most beneficial.
A computer programmer presents to a PT clinic with increased neck discomfort due to faulty posture. The physical therapist designs a rehabilitation protocol to decrease spasm of the upper trapezius. If the PT wants to apply real time biofeedback, which protocol would be the BEST to implement? Closely placed electrodes with high sensitivity Widely spaced electrodes with low sensitivity Closely placed electrodes with low sensitivity Widely spaced electrodes with high sensitivity
Trapezius is in spasm, the electrodes should be closely placed and with low sensitivity to minimize cross-talk. For spastic muscles we start with low sensitivity and gradually increase it while with flaccid or weak muscles we start with high sensitivity. Wide space electrodes recruits more muscle activity while closely spaced is for specific muscle.
bruce protocol
Treadmill running at 1.7 mph with 10% incline then every 3 minutes the speed is increased by 0.8 mph and 2% incline increase until exhaustion
A 35-year-old patient has difficulty turning door knobs. Which of the following muscles is an antagonist to the muscle responsible for this action? Biceps Triceps Supinator Extensor Pollicis Longus
Turning door knobs require the biceps to supinate with the elbow in flexion, while the triceps counteracts /neutralizes the flexion action
Which of the following is not an absolute contraindication for therapeutic ultrasound? In the region of thrombophlebitis Over epiphyseal plates of growing bone In the region of active bleeding Metal implants
Ultrasound may be used over areas with metal implants, such as screws, plates, or all-metal joint replacements, because metal is not rapidly heated by ultrasound, and ultrasound has been shown not to loosen screws or plates.
A patient presents to a clinic with complaints of dizziness and vertigo in certain positions. On examination, the PT found that patient has his head slightly tilted to one side, has conjugate eye torsion, and an abnormal weight shift in standing. These signs are MOST consistent with what condition? Unilateral vestibular hypofunction Otitis media Ototoxicity Malingering
Unilateral vestibular hypofunction is a term used when the balance system in the inner ear, the peripheral vestibular system, is not working properly in one ear. The most common symptoms include: Dizziness or vertigo, poor balance, especially with head turns, trouble walking, especially outdoors, in dark rooms, or in crowded places, blurred vision, especially when turning your head quickly. Nausea and vomiting in acute or severe cases. Otitis media is infection of the middle ear causing fever and ear pain. Malingering is fabricating a physical or a mental disorder for secondary gains. Ototoxicity is ear poisoning caused by drugs, chemicals.
urge incontinence
Urge incontinence, is the involuntary contraction of the detrusor muscle with a strong desire to void and loss of urine as soon as the urge is felt - trmt: treat infections
Kleiger's Test
Used primarily to determine extent of damage to the deltoid ligament and may be used to evaluate distal ankle syndesmosis, anterior/posterior tibiofibular (not talofibular) ligaments and the interosseus membrane With lower leg stabilized, foot is rotated laterally to stress the deltoid
Apley's Compression Test
Used to test the integrity of the lateral and medial meniscus - distraction -> ligaments
CN in pons
V, VI, VII, VIII CE MI PONS MEDU
A patient has a history of diabetes, hypertension, and chronic heart failure. The patient's venous filling time is 10 seconds, while Homan's sign and rubor dependency tests are both negative. These findings support which of the following diagnoses? Chronic venous insufficiency Intermittent claudication Arterial insufficiency Lymphedema
Venous filling time- The extremity is elevated and then lowered into a dependent position. The time it takes for the veins on top of the foot to refill is recorded. Normal filling time is 15 seconds. Greater than 15 seconds indicates arterial disease whereas less than 15 indicate venous disease. Rubor dependency test is negative indicating no arterial insufficiency. No signs of intermittent claudication and lymphedema are seen.
criteria for metabolic syndrome:
WEIGHT WE = waist expanded (>35 F, >40 M) IG = impaired glucose (>110 mg/dL) H = HTN (BP > 130/85) H = HDL low (<50 mg/dL F, <40 mg M) T = triglycerides >150 mg/dL
Gross Motor Classification for CP: Level 3
Walk with assistive mobility devices; limitations walking outdoors and in the community * with AD
Gross Motor Classification for CP: Level 1
Walk without restrictions; limitations in more advanced gross motor skills * without restrictions
A patient with arterial insufficiency is starting a walking program using treadmill. The patient complains of moderate pain and reaches a 2 on the claudication scale. What should the therapist do NEXT? * Nothing; pain is expected and is a normal response to walking * Have the patient sit down and continue walking when the pain subsides * Have the patient continue exercising but decrease the treadmill speed to 1.0 mph * Have the patient stop walking due to poor tolerance; use an arm ergometer instead
Walking programs are used for patients with claudication, which is a common condition in patients with arterial insufficiency. Walking programs should include intensity where patient reports 1 on claudication scale within 3-5 minutes, stopping if they reach a 2 (until pain subsides), total of 20-60 minutes intervals if necessary, 3-5 days per week. Therapist should record time of pain onset and duration
Mr. Stewart is a 74-year-old retired contractor. He came to physical therapy with complaints of chronic left lower back pain. Upon watching him walk to the treatment room, he has a prominent backward lean during stance phase of the left leg. From this observation, you hypothesize that the MOST likely cause of his gait deviation is: Weak hip extensors on the left Weak hip flexors on the left Weak hip extensors on the right Weak hip flexors on the right
Weak hip extensors cause backward lean in stance phase on the weaker side (left in this case). The backward lean moves the line of gravity behind the hip and reduces the need for hip extension torque. Weak hip flexors cause limited hip flexion on the affected side.
During a postural screen on a patient with chronic shoulder pain, a therapist observes excessive internal rotation of the shoulders and winging of the scapulae during overhead motions. The MOST appropriate interventions to address these problems should include: Strengthening of pectoral muscles and stretching of upper trapezius Strengthening of upper trapezius and stretching of pectoral muscle Strengthening of serratus anterior and stretching of pectoral muscles Strengthening of rhomboids and stretching of upper trapezius
Weakness of serratus anterior causes winging of scapula. Excessive internal rotation of humerus is caused by tightness of pectoral muscles. Thus, strengthening of weak muscles (serratus anterior and stretching of tight muscle (pectorals) is the intervention.
During a cranial nerve examination, PT asks the patient to open his mouth. The PT notices that the patient's uvula is angled towards the right side. Which cranial nerve is most likely affected and which side is most likely weak? CN 10, Weak Left CN 10, Weak Right CN 9, Weak Left CN 12, Weak Right
When cranial nerve X of left side is affected, it causes left side weakness and uvula deviates to the right side. Intact CN X (Vagus) maintains midline position of uvula, CN IX (glossopharyngeal) maintains the gag reflex. CN XII maintains position of the tongue
While under the oversight of a PT, a patient performs a neurodynamic mobility exercise to reduce neural tension in the upper extremity. Following the therapy session, the patient calls the clinic to report increased neural symptoms with prolonged paresthesias. The MOST appropriate response by the physical therapist during the next session would be to: Explain that this sensation is normal and continue working in the same range Refer the patient back to the orthopedic physician Explain to the patient that this sensation is abnormal and decrease the range used Re-evaluate the patient and determine if there is a different source of their pain
When performing neuromobilization, increased symptoms should be accounted for by decreasing the range that the exercises are performed in. The therapist would aggravate the patient's symptoms if the same range was utilized. No further medical action is necessary at this time.
stemmers sign
When the dorsal skin folds of the toes or fingers are resistant to lifting or cannot be lifted at all, the Stemmer's sign is said to be "present." It is an early indication of primary lymphedema. It is not seen with thromboanginitis obliterans, pulmonary embolism and dehydration.
A 66-year-old male patient with a right transfemoral amputation is referred to an outpatient physical therapy clinic for gait training. During the gait analysis, the physical therapist observes right medial heel whip during the pre-swing phase of gait with the prosthetic limb. Which of the following is the MOST likely cause of this deviation? The prosthetic foot is too far medially inset Inadequate medial rotation of the knee joint Excessive lateral rotation of the knee joint The socket is in excessive abduction
With a transfemoral amputation, during toe off a medial whip is seen when the knee joint bolt is externally rotated and lateral whip is seen when the knee joint bolt is internally rotated. Socket in excessive abduction causes abducted gait
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? Call EMS and wait for them, since patient didn't give consent to the PT Call EMS and begin CPR Give abdominal thrusts Position the patient in sideline
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
Which of the following is NOT a compensatory motion in response to excessive femoral retroversion? Lateral tibial torsion Lateral patellar subluxation Medial tibial torsion Ipsilateral subtalar pronation
With excessive femoral retroversion, related posture is lateral tibial torsion, subtalar supination. Compensatory posture is medial tibial torsion, subtalar pronation
At which neurological levels can a patient with an ASIA A spinal cord injury attain independent community ambulation as their primary means of functional mobility? Midthoracic (T6-9) High lumbar (Tl2-Ll) Low lumbar (L4-5) Low thoracic (T9 -10)
With lower lumbar L4-L5 (motor level) spinal cord injury most muscles are spared and the individual can attain independent ambulation in home and community. But with higher level injuries muscles of ambulation are not spared
A patient fails to attain established physical therapy goals within the number of visits initially set by the physical therapist. The patient has made substantial progress in therapy, however has plateaued over the last 4 sessions. The most appropriate action for the physical therapist is? Request additional visits from the referring physician Document a progress note that updates the patient's current status Talk to the patient regarding their compliance Discharge the patient from physical therapy with a home exercise program
With the patient's status plateauing, the therapist can no longer document that the patient's treatment is medically necessary. For this reason, it is best to discharge the patient with a home exercise program.
tissue appearance in imaging: air
X-ray: Black CT: Black MRI T1: Black MRI T2: Black
tissue appearance in imaging: fat
X-ray: Poorly visualized CT: Black MRI T1: White MRI T2: Gray
tissue appearance in imaging: bone marrow
X-ray: White CT: Gray MRI T1: White MRI T2: Gray
tissue appearance in imaging: bone cortex
X-ray: White CT: White MRI T1: Black MRI T2: Black
thrombocytopenia
a condition in which there is an abnormally small number of platelets circulating in the blood
The center of the ulcer is a localized area of deep purple tissue surrounded by non-blanchable redness indicating...
a deep tissue injury. In deep tissue injury, wound may present as a dark purple or blue hue with erythema or a blood-filled blister caused by damage of underlying soft tissue by pressure or a shear force.
Borg Rating of Perceived Exertion (RPE)
a subjective way of estimating exercise intensity based on a scale of 6 (no exertion at all) to 20 (max exertion)
hammer toe
a toe that is curled due to a bend in the middle joint of the toe - high toe box
anemia
anemia is a reduction in the oxygen-carrying capacity of the blood as a result of an abnormality in the quantity or quality of erythrocytes
After evaluating a baseball player, the PT concludes that there is insufficient deceleration during throwing. Which of the following strengthening techniques will be most effective in improving control of deceleration of the shoulder? a) eccentric exercises of teres minor and infraspinatus b) eccentric exercises of teres major and pec major c) concentric exercises of teres minor and infraspinatus d) concentric exercises of teres major and pec major
a) eccentric exercises of teres minor and infraspinatus both shoulder ERs
A patient was referred to physical therapy after a removal of the right upper extremity cast which extended to the forearm. Upon examination, the patient presented with decreased internal rotation of the forearm at the proximal radio ulnar joint. Which of the following mobilization technique is likely to improve internal rotation of the forearm? a) Postero-lateral glide and anterior roll of radius b) Antero-lateral glide and posterior roll of radius c) Postero-lateral glide of radius and anterior roll of ulna d) Antero-lateral glide of radius and posterior roll of ulna
a) postero-lateral glide and anterior roll of radius At the proximal radioulnar joint, convex rim of the radial head articulates with the concave radial notch on the ulna. In pronation (internal rotation of forearm), convex rim of the radial head slides posteriorly on the radial notch, opposite to the bone motion i.e. anterior.
low lateral upright will cause
abducted gait
Muscles of the thenar eminence
abductor pollicis brevis, opponens pollicis, flexor pollicis brevis
bruit
abnormal blowing or swishing sound or murmur of arterial or venous origin indicating atherosclerosis
tylenol
acetaminophen - block sensation of pain - uses: antipyretic, analgesic, HA, not anti-inflammatory - side effects: overuse can cause liver damage leading to jaundice, clay colored stool, no more than 6 tabs (500 mg) a day
normal values for infants versus adults
adult - HR: 60 to 100 - BP < 120/80 - RR: 12 to 20/min - PaO2: 80-100 - PaCO2: 35-45 - pH: 7.35-7.45 - TV: 500 mL infant - HR: 120 - BP: 75/50 - RR: 40/min - PaO2: 75-80 - PaCO2: 34-54 - pH: 7.26-7.41 - TV: 20 mL
because of the way the nerve roots exit, L4-5 disc pathology usually affects the ______ root rather than the ______ root
affects L5 rather than L4
CN with corneal reflex
afferent supplied by CN V and efferent supplied by CN VII
metatarsus adductus
aka "metatarsus varus" *common foot deformity noted at birth, causes forefoot to turn inward - hindfoot valgus and forefoot varus
abduction in stance phase (AKA)
anatomical - abduction contracture, knee instability prosthetic - long prosthesis, abducted hip joint
In an acute care hospital, a PT is working with a patient who has a spinal cord injury at T9. This patient has a wound with heavy exudate. The wound is deep, with a sparse amount of necrotic issue. What dressing would be MOST appropriate for this wound? Alginate Hydrogel Transparent dressing Non-adherent dressing
alginate
what kinds of dressings can be used for infected wounds?
alginates - foam is absorptive but occlusive - transparent films arent good for infection control, better for friction reduction - hydrocolloid is the most occlusive
ascending/descending curb with WC
ascending - front casters on curb first - push rear wheel up curb with momentum - lean back descending - backwards with forward head and trunk lean - big wheels first then casters
ascending and descending stairs with a cane
ascending - good foot goes first followed by cane and bad foot descending - bad foot and cane first followed by good foot
peds milestones: 2-3 months
assumes prone on elbows (when placed in prone)
P wave
atrial depolarization
normal BP:
less than 120/80 mm Hg
Rhabomyolysis
breakdown of muscle fibers; may be caused by heatstroke or heavy exercise - dark urine, lipitor (cholesterol lowering drug), elevation in creatine kinase
L1 dermatome
back, over trochanter and groin
impetigo
bacterial skin infection characterized by isolated pustules that become crusted and rupture
swanz ganz catheter
balloon flotation device that is inserted through the internal jugular vein or femoral vein to monitor blood flow and the function of the heart
Bruunstrom stage 2
basic limb synergies, UE in parallel, LE opposite, spasticity begins
ST segment
beginning of ventricular repolarization
-olols (atenolol, metaprolol, carvedilol, labetalol, propranolol)
beta blockers - decrease HR and BP, bronchoconstriction - indications: CAD, HTN, arrhythmia - adverse effects: orthostatic hypotension, dizziness, tinnitus, venous pooling, bradycardia - PR interval increases - use RPE for exercise prescription - do NOT use in asthma, COPD - no abrupt withdrawal
bronchodilator drugs
beta-2 agonists - short acting: salbutamol, albuterol (ventolin) - long acting: salmeterol, formeterol anti muscarinic (cholinergic) - short acting: ipratropium - long acting: tiotropium theophylline - uses: COPD and BA - side effects: tremors, palpitations (inc HR), GI disturbances, dry mouth
elbow flexors
biceps brachii, brachialis, brachioradialis, pronator teres, flexor carpi ulnaris
kind of edema in HF
bilateral edema including distal (pedal) edema
for PWB (50%) what AD is perscribed
bilateral, never unilateral crutches walker or WC
blocked versus random/variable feedback
blocked feedback - one source of feedback - KR is presented about the same segment on consecutive trials random/variable feedback - multiple sources of feedback - KR is presented about different segments on successive trials
warfarin (coumadin), heparin
blood thinners - prevents formation of clotting factor - uses: DVT, MI, stroke - side effects: bleeding, easy bruising, hemorrhage, hemarthrosis, lightheadedness - INR: can be 2-3 if on anticoagulants - short term use
protrusion occurs when...
both TMJs slide anteriorly
KR versus KP
both extrinsic feedback - KR: knowledge of results, end result - KP: knowledge of performance, nature of movement
superior (upper) division of MCA
brocas aphasia - pt has slow, hesitant speech - treatment: yes/no Qs
moe than 6 PVCs in a min
call 911
pinch an inch test
can be used for two things: - appendicitis: R side pain - diverticulitis: L side pain both associated with inflammation
krause end bulbs
cold
SLR: hip flexion, knee extension, ankle PF and inversion which nerve?
common peroneal nerve
A patient with a history of diabetes comes to the clinic with reports of ankle dorsiflexion weakness and diminished sensation over the anterior leg and dorsum of the foot. What is the MOST likely diagnosis? Common peroneal nerve lesion Saphenous branch of femoral nerve lesion Tibial nerve lesion Posterior cutaneous branch lesion
common peroneal nerve innervates the dorsiflexor muscles and sensation on anterior aspect of leg. Saphenous nerve (branch of femoral nerve) and posterior cutaneous nerve are sensory nerves with no motor function. Tibial nerve supplies the plantarflexor muscles and sensation on posterior aspect of leg and sole of foot.
McMurray test
compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus
Hawkins-Kennedy Test
compression of the supraspinatus tendon, subacromial impingement
concave convex rule at distal radioulnar joint
concave radius moves over convex ulna
arthrokinematics of mandibular depression
condyle rolls and slides anterior on the TM disc while the disc also slides anterior to maintain a congruent surface with the fossa
contraindications to postural drainage
contraindications: increased ICP, hemodynamically unstable, recent esophageal anastamosis, recent spinal fusion or injury, recent head trauma, diaphragmatic hernia precautions: pulmonary edema, hemoptysis, massive obesity, large pleural effusion, massive ascites
light in left eye: dilated right eye ->
contralateral CN3 affected
friction aide
control excessive movement in initial swing (flexion) and terminal swing (extension)
conus medullaris vs cauda equina
conus medullaris - bilateral - saddle distribution B - symmetric - UMN & LMN cauda equina - unilateral and asymmetric - saddle distribution - LMN - muscle weakness and decreased sensation - flaccid paralysis with no spinal reflex - flaccid bowel and bladder
scoliosis (convex vs concave side)
convex - pronators overwork, weak supinators, shorter leg - rib hump - high shoulder - vertebral bodies - stretched and weak concave - hip - supinators overwork, weak pronators, longer leg - SPs - short and tight
arthrokinematics of the AC joint
convex distal clavicle and concave acromion
concave convex rule at proximal radio-ulnar joint
convex radius moving on concave groove in ulna
standard axillary crutch dimensions
crutch is 6 in lateral and 6 in anterior to pt foot, axilla space of 2-3 in
dark blood versus light blood
dark blood - venous light blood - arterial
Femoral retroversion causes a __________ in Q angle
decrease
weakness of hip flexors will cause a _________ in step length
decrease
During vigorous exercise, a 30-year-old patient would expect what ACUTE changes to occur in the muscle capillary bed? Increase PO2 Decrease PO2 Increase pH Decrease temperature
decrease PO2 When the oxygen consumption in muscle suddenly increases, an immediate way to increase supply is an enhanced extraction of oxygen from the hemoglobin in the flowing blood. An enhanced extraction can, however, only occur either when the oxygen binding curve is considerably shifted to the right or when the perivascular pO2 decreases. The former requires rapid and significant local increases in pCO2 or H+ concentration. Therefore, most of the increased extraction should result from a decrease in perivascular pO2 due to enhanced oxygen consumption.
At an outpatient clinic, a patient is undergoing a treadmill exercise test. The patient's resting blood pressure was 125/85 mm Hg. After 7 minutes on the treadmill, the therapist terminated the exercise test due to a blood pressure reading of 100/80 mm Hg. Which of the following findings is the BEST reason for terminating the exercise test? Increase in diastolic blood pressure response Decrease in systolic blood pressure response Increased systolic and diastolic blood pressure response Decreased systolic and diastolic blood pressure response
decrease in systolic BP response A progressive fall in systolic pressure of 10-15 mm Hg is an indication to terminate exercise session.
The following are all physiological responses to cold therapy during the first 15 to 20 minutes, EXCEPT: Decreased tissue stiffness Decreased circulation Decreased arthrogenic muscle inhibition Decreased muscle spasms
decreased tissue stiffness Prolonged cooling can cause increase in tissue stiffness. Options B, C&D are physiological responses to cold therapy.
Pacinian corpuscles
deep pressure and vibration
Dementia versus Delirium
dementia - gradual decline of cognitive function - typically symptoms become apparent over 60 y.o. - s/s: poor education carryover, impaired ADLs, emotional changes, decreased motivation, speaking/processing difficulties - anatomic changes in brain - slower onset - irreversible - alzheimers is the most common cause, it is a specific disease but dementia is not delirium - reversible - typically caused by acute illness or drug toxicity
C4 and above ADLs
dependent
what can an ABI > 1 be indicative of?
diabetes - arterial calcification in the legs - artery cannot be fully compressed for valid measurement
cushings disease versus syndrome
disease - pituitary adenoma - more ACTH secreted by pituitary gland, stimulates adrenal gland -> more cortisol released -> increased BP syndrome - adrenal glands tumor -> secrete more cortisol s/s same for both: moon face, excessive facial hair, cervical fat pad and truncal obesity - buffalo hump, easy bruising, poor wound healing, weight gain, children show poor growth in height
distributed versus massed practice
distributed practice - more rest - low motivation, attention, endurance - improve performance without fatigue - motor planning deficit massed practice - high skill and motivation - when endurance, attention, and motivation is high - ex. later stages
CPR do's and don'ts
do - compressions at 100-120/min - compress at least 2 in (5 cm) - allow full recoil after each compression - minimize pauses - ventilate adequately (2 breaths per 30 comps, each breath delivered over 1 sec, each causing chest rise) don't - slower than 100/min or faster than 120/min - compress less than 2 in (5 cm) or more than 2.4 in (6 cm) - lean on chest - pause compressions for greater than 10 sec - provide excessive ventilation
dos and donts for exercise during pregnancy:
do - modified squatting - quad pelvic tilt - standing push ups (modify exercises that usually occur in prone) don't - bilateral SLR: places stress in ab muscles and low back, can cause injury or diastasis recti
All of the following are guidelines to prevent pressure ulcers, EXCEPT Position the patient at a 30-45 degree oblique angle when side-lying Use a donut-type cushion when seated in wheelchair Elevate the head of the bed to no greater than 30 degrees when the patient is supine Encourage frequent position changes at least every 2 hours in bed, every hour while seated, and every 15 minutes if the patient can move himself
donut type of cushion should not be used for pressure reduction as the rim of the cushion creates pressure, which occludes capillaries and deprives the local tissue of a proper blood supply and flow.
radial nerve only provides sensation to ...
dorsal radial aspect of the hand
action of tibialis anterior
dorsiflexes and inverts foot
walkie talkie test
dual tasking
tight gastroc can cause what during midstance
early heel off
tight hip flexors can cause ______ in terminal stance
early toe off
action of the quads during stand to sit:
eccentric control of knee flexion
ST segment elevation versus depression
elevation greater than 1mm- MI (call EMS) depression - ischemia
Wartenberg's syndrom
entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits
epidermis versus dermis:
epidermis - keratinocytes, melanocytes, langerhans cells, basal cells dermis - collagen, reticulum, fibroblasts, macrophages, lymphatic glands, blood vessels, nerve fibers
compression wrap for joint support
equal pressure distal to proximal
Erb vs Klumpke palsy
erb palsy - C5 & 6 - MOI: stretch downward - loss of abd and lateral rotation of shoulder - policemans tip deformity (med rot of forearm, wrist and finger flexion) - radial loss of sensation klumpke palsy - C8 & T1 - MOI: stretching of arm overhead - paralysis of the intrinsics of the hand - claw hand - ulnar loss of sensation
Test-retest reliability
established when an instrument is used on two separate occasions with the same subjects i.e. the scores on the instrument/test are stable over a period of time
the correct way to expose the supraspinatus tendon for ultrasound treatment:
extension and medial rotation
UE D1 extension
extension, abduction, IR
LE D1 extension
extension, abduction, IR - more like walking
anteversion versus retroversion
excessive anteversion: in toeing retroversion: backwards
LE D2 extension
extension, adduction, ER
UE D2 extension
extension, adduction, IR
PNF for skill:
gait - agonistic reversals - normal timing - resisted progression - slow reversal - slow reversal hold - timing for emphasis
where are diabetic ulcers found?
generally located on WB surface of the foot (ex. 2nd toe or heel)
cane is always on the side of..
good foot
L5 myotome
great toe extension
inguinal hernia causes...
groin pain
A physical therapist is examining a 68-year-old patient in an outpatient clinic. The patient reports suffering from multiple falls on level surface in the past 6 months. During the initial examination, the patient is responsive and his cognition seems intact. Which of the following measures should the PT perform NEXT? Measure leg length to confirm limb symmetry Perform observational gait analysis Check Balance using Sensory Organization Test Refer the patient to physician to check for diabetic neuropathy
he sensory systems (vision, somatosensory, and vestibular) provide the CNS with important information about postural control and balance. Since the cognition of the patient is intact, the Sensory Organization Test should be done to check if visual, somatosensory, vestibular system is affected; as this test determines the effectiveness of the CNS to utilize and integrate different sensory inputs. It examines body sway during quiet standing under six different sensory test conditions.
ocular tilt reaction
head tilt, ocular torsion, skew deviation of eyes * 911 - central pathology
ruffini endings
heat
what is a typical location for shingles?
herpes zoster T11-12 dermatome along the iliac crest - rash - post surgery - pain
what kind of e-stim is used to help heal an infected wound?
hi-volt, negative in wound, around 100 pps
what kind of e-stim is used to help heal a clean wound?
hi-volt, positive in wound, around 100 pps
L2 myotome
hip flexion
active insufficiency of the right psoas will be caused by?
hip flexion and right lateral flexion of the trunk
R TMJ dysfunction with L side deviation
hypermobility
Hypertrophic versus keloid scar
hypertrophic - healed wound with thick fibrous tissue that remains within the original border keloid - excessive scar tissue growth outside of the original margins of the wound
Lhermitte's sign
identifies dysfunction of spinal cord and/or an upper motor neuron lesion. Patient is long sitting on table. Passively flex patient's head and one hip while keeping knee in extension. Repeat this step with other hip (+) TEST: pain down the spine and into the UE or LE
Talar Tilt Test
identifies ligamentous instability (particularly calcaneofibular ligament - inversion)
An 18-year-old female athlete presents to your clinic with sacroiliac pain. The pain is exacerbated with running and is relieved with rest. Your examination of pelvic alignment reveals a left lower posterior superior iliac spine (PSIS) and higher anterior superior iliac spine (ASIS). Your physical therapy interventions should MOST likely include unilateral isometric contraction of which of the following muscles? Gluteus Maximus Iliopsoas Gluteus Medius Adductor Magnus
iliopsoas In posterior innominate rotation, PSIS is lower and the ASIS is higher on the involved side (left in this case). It can be caused by tightening of hip extensors. Isometric contraction of iliopsoas (hip flexor) and stretching of hip extensors are interventions to treat posterior innominate rotation. Contraction of gluteus maximus will further increase the posterior innominate rotation.
CRPS main symptom
impaired sensation
Which of the following treatment guidelines below is LEAST important for diabetic sensory neuropathy? Foot care Orthotics Improving circulation Maintain HbA1c less than 7%
improving circulation
A golfer complains of sharp localized pain at the right side of his low back when swinging towards the right. Sitting, stooping and bending to the left relieves the pain. Based on the presentation, the MOST likely cause is: Sacroiliac Dysfunction Spondylolisthesis Facet Arthropathy Spinal Lateral Stenosis
in Facet arthropathy, pain is sharp, localized, increases with extension & ipsilateral rotation. Pain occurs while swinging to right and is relieved with flexion and contralateral rotation. Also, no sensory/motor changes occur as seen with stenosis. In spondylolisthesis, pain increases on extension, ipsilateral side bending and opposite side rotation.
dysmetria
inability to control the distance, power, and speed of a muscular action - hypermetria: overestimation - hypometria: underestimation
akinesia
inability to initiate movement
apraxia
inability to perform particular purposive actions, as a result of brain damage. (understand action but unable to perform it)
Dysdiadochokinesia
inability to perform rapid alternating movements
A chronic smoker diagnosed with COPD was tested for an arterial blood gas (ABG) analysis. After reviewing the patient's chart, the physical therapist is MOST likely to see which of the following changes in the ABG results?
increased PaCO2, decreased PaO2, decreased pH COPD causes dilation and destruction of the airspaces and alteration in pulmonary vasculature resulting in mismatch in ventilation in the alveoli and perfusion in the capillary membrane. This results in hypoxemia (decreased oxygen in the arterial blood) in the early stage of COPD and hypercapnea (increased carbon dioxide in the arterial blood) as the disease progresses.
bronchophony
increased vocal resonance with greater clarity and loudness of spoken words (99)
C7 transfers
indepndent and no slide baord
ST elevation
indicates myocardial infarction
inverted T wave
indicates myocardial ischemia
initial cardiovascular response to increased altitude versus over time
initial - increase in CO - tachycardia - no change in SV - BP may be slightly increased over time - CO returns to normal - HR remains increased - SV decreased - BP normal
light in left eye : dilated left eye ->
ipsilateral CN3 affected
backward lean during swing phase of gait. what is the most likely problem?
ipsilateral hip flexor weakness
hold relax
isometric contraction used to increase ROM. contraction is facilitated for all muscle groups at the limiting point in the ROM. relaxation occurs and extremity moves thru the newly acquired range to the next point of limitation until no further increases in ROM occur. used for patients that present with pain usually. (mobility)
alternating isometrics
isometric contractions performed alternating from muscles on one side of joint to the other side w/o rest (stability)
herpes is usually preceded by...
itching and soreness followed by a vesicular eruption
what must a pt with an ACL tear be able to do before returning to sports?
jump and land with stability
L3 myotome
knee extension
S2 myotome
knee flexion
femoral hernia causes...
lateral pelvic wall
Capsular pattern of restriction is present in adhesive capsulitis:
lateral rotation> abduction> medial rotation. Clinical studies have demonstrated that posterior glide is more effective than an anterior glide to increase glenohumeral external rotation range of motion (exception to the convex- concave rule). Patient's external rotation must be resolved first followed by abduction, and inferior glide are used to resolve abduction. So, posterior inferior glides should be given in this patient.
drainage for right lateral segment
left sidelying with LEs raised 18 inches
PD: medical management
levidopa/carbidopa (sinemet) is the gold standard, adverse effects: - dyskinesias (involuntary movements, peak of dose, initially facial grimacing/twitching lips/tongue protrusion, severe when it involves neck/trunk/limbs) - dystonia (prolonged involuntary contraction that causes twisting or torsion of body segments, clawing of toes or fingers, cramping of muscles, off periods)
platelet count between 20,000 and 30,000
light exercises (no PROM, light AROM permitted, walking as tolerated) and fall prevention
resting position of the jaw
lips together teeth slightly apart tongue behind top teeth
spondys
losis - >50 lolysis - 15 to 20 lolisthesis - 20 - feel better with flexion - worse with ext
asynergia
loss of ability to associate muscles together for complex movements
ipsilateral CN2 lesion:
loss of both direct and consensual responses
contralateral CN3 lesion:
loss of consensual pupillary light reflex
ipsilateral CN3 lesion:
loss of direct pupillary light reflex
low walls similar to _____ and high walls similar to ______
low - weak muscles high - tight muscles
hyponatremia
low level of sodium in the blood symptoms include nausea, headache, confusion, and fatigue
The presence of ecchymosis is noted in which of the following conditions? Decreased RBC Increased platelet count Decreased platelet count Increased haemoglobin count
low platelet count can lead to bruising, spontaneous bleeding under the skin leading to ecchymosis. Increase hemoglobin causes polycythemia. Decrease RBC causes anemia causing increased fatigue and reduced exercise tolerance.
hypokalemia
low potassium levels in the blood. Symptoms may include feeling tired, leg cramps, weakness, constipation, abnormal heart rhythm
weak, thready pulse may be due to
low stroke volume
what movements should a pt with osteoporosis avoid?
lumbar flexion and rotation
lymphatic load versus transport capacity
lymphatic load: amount of lymph fluid that needs to be transported transport capacity: max amount of fluid that lymphatic system can transport increased lymph load or decreased transport capacity = lymphedema
chest drainage tubes
may be used to remove air, blood, purulent matter from pts chest or pleural cavity, inserted through incision in chest and may be connected to a mechanical or gravity based system * bottle should be kept bellow level of inserted tube
central venous pressure catheter
measures blood pressure directly from right atrium & superior vena cava
A PT examines a patient who complains of foot pain while running. The examination shows that the patient has excessive foot pronation. Which of the following would be the MOST appropriate orthotic insert? A lateral forefoot wedge under the fifth metatarsal head A lateral rear-foot wedge under the calcaneus placing it in an everted position A medial arch wedge just beneath the head of the talus A medial wedge just proximal to the first metatarsal head
medial wedge just proximal to the 1st met head Excessive foot pronation causes flattening of the longitudinal arch, a medial bulge at the talonavicular joint, low medial longitudinal arch, and abduction of the forefoot on the rearfoot joint. So, a medial wedge is given to counteract the excessive pronation. A&B will further increase the foot pronation.
vertigo lasting minutes to hours
menieres disease
reasons for foot drop during midswing:
most likely due to inadequate contraction of the ankle DFs Ankle remains plantar flexed during swing and can be associated with dragging of the toes, typically called drop foot. It is caused by weakness or paralysis of foot dorsiflexors. Excessive extensor synergy causes tight plantar flexors. Excessive flexor synergy causes excessive dorsiflexion. Decreased proprioception does not cause foot drop. It causes sensory ataxia causing foot stomping gait.
during MMT how do we want to handle active and passive insufficiency?
minimize both
ABI 0.74 - 0.50
moderate arterial disease and rest pain
C6 and above ADLs
modified independent C5 - assistive with slideboard C6 - ind with slideboard
ALS
motor neuron disease characterized by the degeneration and loss of motor neurons in the spinal cord, brainstem, and brain, resulting in a variety of UMN and LMN signs and symptoms. LMN signs - muscle weakness, hyporeflexia, hypotonicity, atrophy, muscle cramps, fasciculations, UMN signs- spasticity, hyperreflexia, muscle weakness, Bulbar signs - dysphagia, dysarthria, sialorrhea, pseudobulbar affect due to the involvement of cranial nerves 5,7,9,10,12
What is CN VII responsible for?
motor: movement of facial expression, (except jaw) close eyelids, labial speech sounds (b, m, w and rounded vowels), dampening sound (hyperacusis), sensory tast- ant 2/3 of tongue, sensation to pharynx parasympathetic: secretion of saliva and tears
dyssynergia
movement performed in sequence of component parts
baclofen
muscle relaxant - use: muscle spasticity seen with MS< SCI, CP - side effects: hypotonia, confusion, dizziness, increased risk of falls, drowsiness, shallow breathing - given orally or intrathecally
rate pressure product
myocardial O2 demand, HR x SBP
ST depression
myocardial ischemia if downsloping 2-3 mm
T11 and below respiration
near normal function
ULTT1
nerve bias - Median nerve - Anterior interosseous nerve - C5,6,7 110 deg abd ER
ULTT2
nerve bias - Median nerve - Musculocutaneous nerve - Axillary nerve - ER - 10 deg abd
ULTT3
nerve bias - Radial nerve - IR - only one with pronation
seddons classification of nerve injury: neuropraxia, axonotmesis, neurotmesis
neuropraxia - segmental demyelination - temporary sensory symptoms axonotmesis - loss of axonal continuity but connective tissue covering remain intact - wallerian degen distal to lesion neurotmesis - complete severance of nerve fiber with disruption of connective tissue covering - muscle atrophy and sensory loss
uncompensated forefoot valgus, rearfoot is ...
neutral
posterior THA precautions
no hip flexion > 90 degrees no hip adduction (crossing over midline) no internal rotation
exercise guidelines for platelet levels
norm = 150,000 - 450,000 -> normal activity, unrestricted 150,000-50,000: some limitations 50,000 - 30,000: moderate limitations 30,000 - 20,000: light exercise 20,000 - 10,000: ROM, ADLs, walking or bike without resistance with physicians approval <10,000 and/or temp 100.5F: therapy on hold
ABI 1.19 - 0.95
normal
Bruunstrom stage 7
normal
lymph node palpation
normal - soft - non tender - non palpable abnormal - tender - hard, immobile - tumor - > 1 cm (swollen)
A patient came to a clinic with the diagnosis of end stage renal disease. The PT is most concerned about prescribing a program for general conditioning. During treatment, the PT notices that the patient is developing skin pallor, fatigue, and dyspnea. The PT monitors their vitals, and will expect which value to be MOST affected based on the patient's diagnosis?
normal or lower than normal DBP Patients with end stage renal diseases have decreased Diastolic BP. Increase in BP is a cause for renal failure.
ESR rate
normal: 0 to 22 mm/hr for men, 0 to 29 mm/hr for women
active insufficiency of the gluteus maximus
not a 2 joint muscle
postural drainage: sitting on chair, over pillow
posterior apical segment of upper lobe
Up-beating/Torsional Nystagmus...
posterior canal
Obstructive versus restrictive lung disease
obstructive - ex. COPD, cystic fibrosis, bronchiectasia - FEV1 decreases - FEV1/FVC decreases - TLC, RV, FRV increase restrictive - ex. sarcoidosis, pulmonary fibrosis, obesity, scoliosis, muscular dystrophy - FEV1 stays the same - FEV1/FVC stays the same - RV and FRC decrease or stay the same - TLC decreases
CN 3
oculomotor - eyes up/down/in - constricts pupil
1 unifocal PVC
okay, high intensity then slow down
enclampsia
onset of tonic clonic seizures in a woman with pre-eclampsia. Increasing risk of eclampsia include upper right abdominal pain, severe headache, and vision and mental status changes
morphine, oxycodone, hydrocodone
opioids - works at CNS - uses: severe pain, post op pain, anti-tussive - side effects: resp and CNS depression, bradycardia, constipation, slowed breathing, dizziness, drowsiness, slowness, addiction, tolerance - take meds 30 min prior to therapy - nalaxone for overdose
with a hip flexion contracture what happens to the opposite side?
opposite side step length decreases
A new patient comes to an outpatient clinic for aerobic conditioning and strengthening. The patient has an extensive cardiac history that requires him to take Beta-blockers. The physical therapist decides to start the patient off with treadmill training. What is the MOST important consideration for the therapist if the patient is on Beta-blockers? RPE scale will be the best tool to assess the patient's exertion level Call the physician to inform them that physical therapy is not indicated for this patient Patient's response to exercise should only be done by assessing blood pressure and pulse Tell the patient to take medicine immediately after exercising
or patients on B-blockers HR cannot be relied on for evaluating exercise intensity as HR will not show increase with exercise. In these patients, RPE is best tool to increase the accuracy of monitoring and the prescription of exercise intensity.
1st degree heart block
p-r interval is greater than 1 box, can be normal, seen in athletes, continue exercise
umbilical hernia causes...
pain around the umbilical ring in the mid to lower abdomen
shoulder extensors
posterior deltoid, latissimus dorsi, teres major and minor, pec major (sternocostal fibers), triceps (long head)
paraplegia vs hemiplegia
para - one half hemi - one arm and leg
if none of PaCO2, pH, or HCO3 are normal, answer is
partially compensated
scapula protractors
pectoralis major and minor, serratus anterior, lats
scapulothoracic jt
planar
pressure sensitive and tolerant areas (BKA)
pressure sensitive (no redness) - anterior tibia and tibial crest - fibular head and neck - fibular nerve pressure tolerant (transient redness) - patellar tendon - medial tibial plateau - tibial and fibular shafts - distal end (rarely, may be sensitive)
pressure level for home compression pump for lymphedema
pressure should not be higher than diastolic pressure, ex. >80
temporal lobe lesion effects:
primary auditory cortex wernickes aphasia auditory loss language comprehension
A physical therapist is treating a patient who has severe cognitive impairments and bilateral hip and knee flexion contractures. The MOST appropriate intervention to treat the patient's contractures is: Agonistic reversals Prolonged stretching Contract-relax technique. Alternating isometrics
prolonged stretching it will help in stretching the contracture, as in this procedure soft tissues are elongated just past the point of tissue resistance and then held in the lengthened position with a sustained stretch force over a period of time. Also, the patient is cognitively impaired; it will not be possible for the patient to follow commands. An important requirement for PNF stretching techniques is the normal innervation and voluntary control of the muscles.
compensated rearfoot varus would result in
pronation
drainage for lower lobes
prone with LEs raised 18 in
foot rotation at heel contact (AKA)
prosthetic causes - stiff heel cushion - malrotated foot
terminal impact in late swing (AKA)
prosthetic causes: -inadequate friction -taut extension aid anatomical causes: - forceful hip flexion
high heel rise in early swing (AKA)
prosthetic causes: inadequate friction slack extension aid
pustule vs wheals vs vesicles vs blisters
pustule - elevated lesion filled with purulent fluid - less than 1 cm in size (ex. acne) wheal - irregular areas of localized skin edema - irregular eruptions vesicle - elevated, fluid filled lesion up to 1 cm in size - ex. herpes blisters - vesicles if they are 0.5 cm to 0.2 in or less in diameter - bullae if they are larger - commonly result from pressure and friction on sites such as palms or soles
pressure ulcer scale for healing
quick, reliable tool to monitor the change in pressure injury status over time
zone of partial preservation
refers to complete injuries that have some innervation of dermatomes below the level of injury, but no S4-5
parathyroid gland
regulate calcium and phosphate metabolism
what effect does relaxin have on pregnant women?
relaxin causes an increase in tendon and ligament laxity, exacerbating any friction btw the patella and femur
uncompensated respiratory vs metabolic acidosis versus alkalosis
respiratory acidosis - decreased pH - increased PaCO2 - normal HCO3 respiratory alkalosis - increased pH - decreased PaCO2 - normal HCO3 metabolic acidosis - decreased pH - normal PaCO2 - decreased HCO3 metabolic alkalosis - increased pH - normal PaCO2 - increased HCO3
free nerve endings
respond to pain, temperature, and itch
Norton Scale
similar to braden but less in depth physical condition mental status activity mobility incontinence
hypothalamus
responsible for regulation of the ANS (body temp, appetite, sweating, thirst, sexual behavior, rage, fear, BP, sleep)
Symptoms of UVH
resting (spontaneous) nystagmus, oscillopsia (illusion of unstable vision), dysequilibrium, postural instability
A physical therapist positions a patient with Parkinson's disease in long sitting on a mat table. The PT's goal is to improve the trunk control by facilitating co-contraction of the antagonists. Which of the following PNF techniques would be MOST useful? Agonistic reversal Hold relax Rhythmic stabilization Contract relax
rhythmic stabilization Rhythmic stabilization is used to promote stability through co-contraction of the proximal stabilizing musculature of the trunk as well as the shoulder and pelvic girdle regions of the body. Performed in weight-bearing positions to incorporate joint approximation into the procedure, hence further facilitating co-contraction. Hold relax and contract relax are PNF stretching procedures to increase the ROM of tight muscles. Agonist reversals are mainly used for weak anti-gravity muscles for postural control.
A PT is treating a patient s/p CVA in an acute care setting . The patient is demonstrating perceptual deficits, dense hemiparesis, and is able to communicate verbally. Which location is the lesion MOST likely located in? Right Parietal Lobe Left Occipital Lobe Left Parietal Lobe Right Occipital Lobe
right parietal lobe Hemiparesis and perceptual deficits/neglect are all attributed to parietal lobe lesion in the nondominant hemisphere, typically the right. Aphasia would make this most likely a lesion in the left lobe.
where does trauma to the head of the pancreas refer pain to?
right shoulder
According to the roll and slide mechanism, during right forearm supination at the proximal radioulnar joint, the radial head will:
roll posterior and slide anterior As the forearm rotates into supination, the convex rim of the radial head slides opposite the direction of bone motion. So with supination, the head slides anteriorly and rolls posteriorly.
peds milestones: 3-4 months
rolls supine to sidelying
disc herniation affects which nerve root?
root corresponding with the lower vertebra of the pair ex. L2-3 disc L3 nerve affected
what kind of jt is the SC jt?
saddle clavicle is: - convex sup/inf - concave A/P
A patient is demonstrating an upper extremity flexion synergy following a CVA. Which of the following is MOST likely associated with this type of synergy? Scapular retraction Elbow extension Wrist extension Forearm pronation
scapular retraction Upper extremity flexion synergy components are scapular retraction/elevation, shoulder abduction and external rotation, elbow flexion, forearm supination, wrist and finger flexion. B & D are components of extension synergy.
selective versus non-selective NSAIDs
selective - block only COX2 - ex. celecoxib (celebrex) - antiinflammatory, antipyretic, analgesic - side effects: adverse cardiovascular effects, causing increased risk of MI, stroke non-selective - block COX1 & 2 - ex. aspirin, ibuprofen, motrin, naproxen - antinflammatory, antipyretic, analgesic - side effects: gastric ulcers, bleeding, N/V (cox 1 promoted gut health)
Gross Motor Classification for CP: Level 5
self-mobility is severely limited even with the use of *assistive technology
Gross Motor Classification for CP: Level 4
self-mobility with limitations; children are transported or use power mobility outdoors and in the community * severely limited
CN responsible for gag reflex
sensory - CN IX glossopharyngeal motor- CN X vagus, saying "ahhh"
test CN IX
sensory aspect of gag reflex, swallow (stimulate pharyngeal wall and see palate elevation)
sensory versus motor verus mixed CNs
sensory only: 128 mixed: 1(0)975 motor only: 3,4,6,11,12
ABI < 0.50
severe arterial disease
what kind of bandages are used for lymphedema?
short stretch bandages used in treatment of lymphedema. Short stretch bandages are made of extensible elastic material that provides high stability (support), low resting pressure, and high working pressure of the limb. The effectiveness of high working pressure is maximized by muscle and joint activity to pump the fluid proximally. Long stretch bandages have high resting pressure, hence not used for lymphedema.
ECG changes with hypercalcemia
shortened QT interval
hiatal hernia causes...
shoulder pain - post repair: should avoid stretching of anterior spinal and hip musculature before incision is fully healed
cyclobenzaprine (flexeril)
skeletal muscle relaxant - works on CNS - use: muscle spasms, myofascial pain syndrome, fibromyalgia - dizziness, hallucination, drowsiness, sedation, fatigue, hypotonia, increased risk of falls, dry mouth
how to avoid nocturnal reflux
sleep on your left side, right side straightens out your esophagus and increases reflux
bradykinesia
slow movement
asthetosis
slow, writhing movements, wormlike
RTC tear and immobilization time depending on size
small (<1 cm) - sling for 1-2 wks, removal for exercise day of surgery or day after medium to large (1 to 5 cm) - sling for 3-6 wks, removal for exercise after 1-2 days postop massive (>5cm) - sling for 4-8 wks, removal for exercise 1-3 days postop
Bruunstrom stage 6
spasticity gone
chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
postural drainage: prone laying
superior segments of lower lobes
compensated forefoot valgus would result in
supination
lateral rotation of the tibia would result in foot ______
supination
drainage for right middle lobes
supine with LEs raised 12 in
SLR: hip flexion, knee extension, ankle DF with inversion which nerve?
sural nerve
effect of sympathetic and parasympathetic nervous system on heart rate
sympathetic increases HR parasympathetic decreases HR
stage 2 BP
systolic at least 140 or diastolic at least 90
Hoffman's sign
tapping/downward flicking distal phalanx of long or ringer finger elicits flexion of the distal thumb; associated with corticospinal tract lesions
slow reversal
technique of slow and resisted concentric contractions of agonists and antagonists around a joint w/o rest btwn reversals. used to improve control of movement and posture. (stability, controlled mobility, skill)
Contract-Relax
technique used to increase ROM. as extremity reaches point of limitation the pt performs a maximal contraction of the antagonistic muscle group. therapist resists mvmt for 8-10 secs with relaxation following. technique is repeated until no further gains in ROM are noted during session (mobility)
vascular pain patterns
throbbing, pounding, pulsing, beating
SLR: hip flexion, knee extension, ankle DF and eversion with toe extension which nerve?
tibial nerve
extension aid
to assist knee extension in terminal swing
hypoglossal (CN XII) injury
tongue deviates to ipsilateral side with protrusion, ipsilateral tongue atrophy lick your lesions
A PT is performing manual therapy on a patient with mid thoracic pain. In order to close the T4-T5 facet joint, where is the BEST location for the PA mobilization to occur? Transverse processes of T5 Spinous process of T6 Transverse processes of T4 Spinous process of T3
transverse processes of T5
scapula retractors
traps, rhomboids
what is zinc oxide cream used for?
treat or prevent minor skin irritations such as burns, cuts, and diaper rash
elbow extensors
triceps brachii, anconeus
CNV
trigeminal - muscles of mastication - sensation from face - sensory part of corneal reflex
ULTT4
ulnar nerve shoulder ER
Janda's Crossed Syndromes
upper crossed - inhibited: scapular retractors, DNF - facilitated: suboccipitals, pecs lower crossed - inhibited: abs, glut max/med/min - facilitated: hip flexors, back extensors
elevators of the scapula
upper trapezius, levator scapulae, rhomboids
repeated contraction
used for general weakness or weakness at one specific point. Athlete moves limb isotonically against manual resistance until fatigue (at time of fatigue, stretch is applied at that ROM to facilitate greater force production)
iontophoresis: water
used for hyperhydrosis
rhythmic stabilization
used to increase ROM and coordinate isometric contractions. requires isometric contractions of all muscles around a joint against progressive resistance. pt should relax and move into newly acquired range and repeat. (mobility, stability)
arterial line
used to provide arterial blood gases
2 person lift
used to transfer pts to different heights or surfaces or to the floor
3 person lift/carry
used to trasnfer pt from stretcher to bed or treatment plinth
what is nitrofurazone solution used for?
used to treat burns that have become infected
brandt daroff exercises
uses: persistent/residual or mild vertigo (even after CRM), for the pt who may not tolerate CRM, HEP
edema associated with R side heart failure
usually symmetric and occurs in feet and ankles
CNX
vagus - thoracic and abdominal viscera - decrease HR - increase GI motility - lesion: uvula point to contra side
venous insufficiency versus arterial insufficiency
venous insufficiency - proximal to medial malleolus - irregular, shallow - flaking, dry skin, brownish discoloration - mild to mod pain - elevation decreases pain (dependency pain) - trendelenburg test positive - stasis dermatitis - edema - often bilateral arterial insufficiency - lateral malleolus - smooth edges, well defined, tends to be deep - lack of granulation tissue - cramping - pale, thin and shiny, hair loss, yellow nails - severe pain - elevation increases pain - history of DM and HTN
innervation of quadratus lumborum
ventral rami T12-L3
QRS complex
ventricular depolarization
T wave
ventricular repolarization
vestibular symptoms for days
vestibular neuritis
Gross Motor Classification for CP: Level 2
walk without AD, limitations walking outdoors and in community * without AD
asthenia
weakness
inferior (lower) division of MCA
wernickes aphasia - pt cannot comprehend - treatment: gestures and demonstration
SLAP lesion repair
when biceps tendon is detached progress cautiously - limit passive or active assisted elevation of UE to 60 deg for 2 wks and limit it to 90 for 3-4 wks - only perform passive humeral rot with shoulder in scapular plane for first 2 wks - progress to 30 deg ER and 60 IR at 3-4 wks - avoid tension on biceps (elbow ext with shoulder ext) for first 4-6 wks - avoid active biceps contraction for 6 wks
3rd degree heart block
when the atrium & the ventricles are beating independently, no correlation, stop immediately and refer
whispered pectoriloquy
whispered sounds heard loudly and clearly upon thoracic auscultation
WC seat width, depth and height
width - add 2 in to widest measure of hips depth - substract 2 in from posterior buttock to popliteal fossa height - 20 in for adult, 17.5 for hemiplegic, 18.75 for children - add 2 -> heel to popliteal fold - armrest height add 1
compression wrap for edema control
wrap with more pressure distally than proximally
