Review 2018 Set #6
Wrist (Radial Deviation)
* shoulder @90 of abduction, elbow @ 90 flexion* F- capitate SA- mid line dorsal side forearm, lateral epicondyle of humerus for reference MA- 3rd metacarpal
Wrist (Ulnar Deviation)
* shoulder @90 of abduction, elbow @ 90 flexion* F- capitate SA- mid line dorsal side forearm, lateral epicondyle of humerus for reference MA- 3rd metacarpal
forearm (pronation)
**elbow at side, start neutral, just proximal to wrist crease* F- lateral, proximal to ulnar styloid process SA- midline humerus MA- dorsal aspect forearm, proximal and parallel to styloid process of radius and ulna (over the top of wrist)
What are some self-calming and assisted-calming coping methods neonates may use?
*Self-Calming*: -hand to mouth -sucking -flexed posture -hands/feet to midline -closing eyes -gaze aversion -drowsy state *Assisted-Calming*: -nesting (position in flexion) -holding in flexion -rocking -swaddling -quiet voice
Vital Capacity (equation)
*VC* = IRV + TV + ERV
Symptoms: Uterine Prolapse
-"falling out" feeling -difficulty defecating or initiating urination
What clinical presentation is commonly seen with DCD?
-"puzzling" to figure things out -tripping over feet, bumping into others -clumsy, awkward movements -unusual gait pattern -difficulty generalizing learned skills
What are some examples of nuclear medicine?
-*SPECT*: single-photon emission computed tomography -*PET*: positron emission tomography -PET/CT and SPECT/CT -*bone scan*: radionuclide scintigraphy
How can you test the VOR? (4)
-*Slow VOR*: maintain fixed gaze on pencil & turn head side to side -*Head thrust*: flex head to 30 deg, PT cup pt head in hands & turn head slowly, then perform small amplitude, quick turn to one side and observe corrective saccades, if quickly turn to the L you are testing the L side -*Head shake*: (w/ Frenzel goggles), pt closes eyes, flex head to 30 deg, then rapidly oscillate head 20x horizontally, then pt opens eyes and observe for nystagmus -*Dynamic Visual Acuity Test*: check static acuity then move head at 2Hz, if pt loses 3+ lines this indicates hypofunction
Short Summary of Key Points of Imaging Types: (read)
-*X-rays* are usually the first order modality -*CT* is used to visualize complex anatomy -*MRI* is used to assess soft tissue
Which structures appear dark and which appear bright in a T1 MRI image? (read)
-*bright*: fat (bone), subacute hemorrhage, necrosis -*dark*: high water content (edema, tumor, infarction, infection, chronic hemorrhage)
Which structures appear dark and which appear bright in a T2 MRI image? (read)
-*bright*: high water content -*dark*: bone, fat, calcification, fibrosis, blood -useful for imaging CSF and edema
How does pronoged bedrest affect the pulmonary system?
-*decreased* lung volume/capacity -*decreased* respiratory muscle strength -*increased* risk of pneumonia -*increased* risk of PE
3 Major Components of Stability (of the Spine)
1. Passive (bones, ligs, etc.) 2. Active (muscles & fascia) 3. Neural
Diaphragm (central portion)
-C3,4,5 -cervical spine
A nystagmus may resolve spontaneously due to: (2)
-CNS adaptation -head-tilting (usually involuntary)
Which tests can be used in positional testing for a vestibular exam? (3)
-Dix-Hallpike -Roll test -Motion Sensitivity Quotient
In the NICU, what info do you want to get about their medical history?
-GA at birth -birth weight -APGAR -current post-menstrual age -medical complications -ongoing medical conerns-- diagnoses & medications
What are some structures of the external ear?
-Helix (outer rim) -Lobule (only part without cartilage) -Antihelix -Tragus -Antitragus -Concha (entrance into ear canal) -Incisure terminalis (surgically important because an incision can be made here without damaging the cartilage or perichondrium)
Equations: -Inspiratory Capacity -Vital Capacity -Functional Residual Capacity -Total Lung Capacity
-IC = IRV + TV -VC = IRV + TV + ERV -FRC = ERV + RV -TLC = IRV + TV + ERV + RV
How is the activity of the thoracic diaphragm and the pelvic diaphragm (PFM) related?
-Inspiration: --diaphragm contracts down --rib cage & belly expand --PFM relaxes & descends -Expiration: --diaphragm relaxes up --rib cage & abs contract --PFM contract & lift
Body Chart: RA trigger points
-R LQ of abdomen -refers to mid thoracic - lumbar spine (weird)
In the NICU, what tests & measures do you want to perform or observe?
-active movements -posture -muscle tone (via gentle PROM) -reflexes -feeding -standardized assessments Ex: Neonatal Individualized Developmental Care & Assessment Program (NIDCAP)
What could the popping sound be caused by that is associated with rales?
-alveoli suddenly opening up -when air passes through mucus plugs
The Dix Hallpike test can make people really dizzy & nauseous, what are some pro-tips for things to have ready if the nausea is particularly bad?
-ask if they have anti-nausea medication they can take ahead of time or afterwards -towel -water -ice pack on neck -peppermints -trash can (in case they get sick)
What are the 4 areas on a cell that an antibacterial drug can target to destroy that cell?
-bacterial cell wall -cell membrane -metabolic interference -interference with DNA and protein synthesis
What are normal values for the following aspects of gait? -base width -step length -stride length/gait cycle -cadence -gait speed
-base width: 5-10 cm -step length: 72 cm (23 in) - stride length/gait cycle (144 cm) -cadence: 90-120 steps/min -gait speed: 1.4 m/sec
Treatment: Coccydynia
-body mechanics -posture -positioning -PFM exercises -mobilization -soft tissue work in glutes & sacrum
The 4 types of laxatives: (review)
-bulk forming -stimulant -hyperosmotic -lubricants/stool softeners
How might nutrition in a patient be affected by prolonged bedrest?
-cachexia (wasting) -malnutrition -obesity
What are theories for causes of DCD?
-cerebellar involvement -impaired feed forward models -mirror neurons
What are causes of excess hip flexion? (all phases)
-contractures -painful or effused hip -shorter LE -proprioceptive loss
What do rhonchi sound like?
-deeper & harsher breath sounds due to thicker mucus -can be high or low pitched
What might trigger points in the R lower RA muscle result in?
-diarrhea -sx that mimic GI or gyne. disease
What are pain-related mechanisms that can lead to abnormal gait?
-excessive tissue tension -deformity -muscle weakness
What are symptoms of COPD?
-extreme shortness of breath (work hard to take a breath) -always accompanied by wheezing
How does the "core" contribute to stability of the SIJ?
-feed forward system -assists w/ force closure mechanism w/ mvmt -core contracts 10 ms before UE mvmt and 30 ms before LE mvmt to stabilize SIJ
Decrease in muscle mass is due to a combination of factors including?
-fiber atrophy -fiber loss -MU remodeling (type I fibers predominate)
Fine rales: -what do they indicate? -what do they sound like? -what conditions are they common with?
-fluid in terminal areas of the tracheobronchial tree -more of a "slurping" sound than a popping sound -more common with inflammation & congestion in the lungs
Prognosis: Diastasis Rectus Abdominis
-for some, it's gone in 6 weeks -for others, it lingers forever -our goal is to tighten up this fascia, not completely close it (fascia doesn't really come back to its old, elastic self)
FEV1
-forced expiratory volume in the 1st second -measures the peak expiratory flow rate (PEFR)
In the case of forefoot valgus, what are some visual characteristics of the foot and ankle when examining this joint in a non-weight bearing setting (NWB)?
-forefoot everted -subtalar joint neutral -calcaneus vertical and in line with tibia
In the case of rearfoot varus, what are some visual characteristics of the foot and ankle when examining this joint in a weight bearing (WB) setting?
-forefoot flat -subtalar joint pronated -calcaneus will be vertical
In the case of forefoot varus, what are some visual characteristics of the foot and ankle when examining this joint in a non-weight bearing setting (NWB)?
-forefoot will be inverted -subtalar joint neutral -calcaneus vertical and in line with the tibia
What are some symptoms of mild dementia? (5)
-forgetfulness -word-finding issues -confusion to time & place -poor judgement -minimal guidance w/ ADLs
What may be some reasons for hip hiking (pelvis is lifted on side of swinging leg, by contraction of spinal muscles and lateral abdominal wall)?
-functional leg-length discrepancy (shortening of swing leg secondary to reduce hip flexion, reduce knee flexion, and/or lack of ankle DF) -*functionally or anatomically short-stance leg* -hamstring weakness (lack of knee flexion) -quadratus lumborum shortening
What may be some reasons for hip circumduction during swing? (ground contact can be avoided by swinging leg if it is swung outward for natural walking to occur; leg that is in its stance phase needs to be longer than leg that is in its swing phase to allow toe clearance of swing foot)?
-functional leg-length discrepancy (shortening of swing leg secondary to reduce hip flexion, reduce knee flexion, and/or lack of ankle DF) -arthrogenic stiff hip or knee
What are the only 2 known risk factors for Alzheimer's?
-genetics -age
People with which conditions should not take anti-diarrhea meds?
-glaucoma -prostate disease -kidney disease -liver disease
4 generic names of hyperosmotic laxatives:
-glycerin -magnesium hydroxide -magnesium sulfate -sodium phosphate (MSG)
What is the Windlass mechanism?
-great toe extension results in the tightening of the plantar aponeurosis, which results in the transformation of the foot into a rigid lever for the "push off" stage of gait thus, assisting with ambulation
Developmental Coordination Disorder (DCD) is a chronic condition involving impairment in what skills:
-gross motor control -postural and/or fine motor performance -ability to perform skilled movements necessary for daily living such as performance of academic and self-care tasks
In order from largest to smallest, what are the relative diameter sizes of the following fiber types? -group III (A-delta) -group Ia (A-alpha) -group II (A-beta) -group IV (C) -A-alpha
-group Ia (A-alpha) -A-alpha -group II (A-beta) -group III (A-delta) -group IV (C)
List some methods of supportive care to allow optimal development of a premature infant:
-guided by infant's physiological rxns, behvaioral cues & stress signs -promotes optimal recovery & rest -supports the infant in achieving developmental tasks -decreased sensory stimulation -NIDCAP: neonatal individualized developmental care & assessment program -Kangaroo Care: infant is held skin-to-skin by a parent
Symptoms: Post-Partum Depression
-hasn't slept in 2-3 days -can't get out of bed -ignore basic grooming -lose/gain weight rapidly -seems hopeless -says kids would be better off w/out her -substance abuse -strange statements (Ex: plans to give kids to strangers) -extreme anxiety or obsession regarding the baby's health or safety -feels inadequate, numb, helpless -lack of feeling for baby or others -reports inability to care for baby
How do you deal with a family member of a dementia pt who complains? (4)
-have open communication -know that problems will occur and that family members will have feelings -try not to take the complaint personally -find solutions to help you provide better care
What are some general components to examining gait via observation?
-have person barefoot or with normal footwear -females in bra/briefs, males in shorts -general view (step/stride length, phases, speed, cadence) -observe starting at the foot and move upwards -examine in anterior, lateral and posterior view
What are side effects of PPIs?
-headache -diarrhea -constipation -ab pain -nausea -rash
Side effects of H2 receptor antagonists:
-headaches -dizziness -mild/transient GI complaints such as nausea and diarrhea
What is the normal order for the following structures to contact the floor during gait? -first metatarsal -heel -fifth metatarsal
-heel -5th -1st
What happens if a person lacks dorsiflexion?
-heel comes up early -knee hyper-extension
Looking at a force plate, where are the peaks in GRF in a normal gait?
-heel strike -push off
What factors can influence our lung capacity? (4)
-height -gender -weight -age
Why are resident flora beneficial to the host?
-help protect us from other pathogenic microbes (by taking up space they would otherwise occupy) -provide some nutrients like vitamin K and B12 -help stimulate the immune system activity to help with natural immunity
The SIJ moves as an effect of movement at which other joints?
-hips -lumbar spine
What are some common causes of excessive knee flexion? (all phases)
-knee flexor spasticity -contractures -painful or effused knee -shorter LE -proprioceptive loss -weak PF muscles
What is a neurologic disease cause of antalgic gait?
-lumbar spine disease with nerve root irritation or compression
What are the main reasons that patients may acquire a nosocomial infection? (5)
-many microbes present in setting -patients w/ undiagnosed infectious disease -shared environment -treatments may weaken immune system -health care workers are reservoirs
2 generic names of "bulk forming" laxatives:
-methylcellulose -psyllium
What are 4 factors that drive adaptation?
-overload -specificity -reversibility -individuality
What happens to excess ingested protein in the body?
-oxidized -oxidation of amino acids increases urea formation in blood which stimulates the kidneys to excrete the acidic urine
Symptoms: Coccydynia
-pain at coccyx -pain w/ BM -pain w/ sitting sx are often more related to the tissues that attach to coccyx than coccyx itself
Symptoms: Pelvic Floor *Hypertonus* (6)
-pelvic & LBP -sacroiliac & hip imbalances -incontinence -*voiding dysfunctions* -*constipation* -pelvic congestion (bold: diff from PFM weakness)
If someone is having trouble with visual input during gait, what are some things you could work with them on?
-practice walking alternating b/w eyes open and eyes closed; three steps with eyes open and then three steps with eyes closed
What should you do if your patient has stridor?
-refer them to a DR immediately -or send them to an ER if it comes on quickly
What are the 2 types of dementia?
-reversible -irreversibe
Bradypnea
-slow respiratory rate -deeper than usual -regular rhythm
What should vesicular breath sounds normally sound like?
-softer, almost muffled -lower sounds compared to others -sounds like listening through a pillow -inspiration is louder than expiration and may seem like it lasts much longer than expiration -no pause b/w end of expiration & beginning of inspiration
Side effects of stimulant laxatives:
-stomach pain/cramping -diarrhea
Symptoms: Menopause
-sudden pain w/ sex -dry, thin vaginal tissues -incontinence -prolapse due to loss of elasticity -osteoporosis
What are some muscle disorder causes of antalgic gait?
-traumatic rupture and contusion -cramp secondary to fatigue, strain, malposition, or claudication -inflammatory myositis
How many inches of lateral shift should occur during gait?
1-2 inch shift (towards WB side)
Function: pelvic floor muscles (5)
1. Supportive: organs & forms bottom of "core" 2. Sphincteric: urethra, rectum & vagina 3. Sexual: orgasm, arousal & relaxation 4. Stability: SIJ, pubic symphysis, lumbosacral & hip 5. Sump-Pump: venous & lymphatic
What does a pleural friction rub sound like?
"grating or clicking sound paper is rubbed together"
What are the 4 steps to managing a family member's anger?
1. listen w/ your ears & body 2. empathize 3. look for solutions 4. follow through
The trunk shifts laterally about ____ to ____ cm during gait
2.5-5cm
How many articular surfaces are found at the subtalar joint?
3
Anti-spasmodic drugs shouldn't be taken for more than:
3 days
There is a ___ to ___ % loss of strength per _______ during the first week with immobilization
3-4% loss of strength PER DAY during the 1st week
How long does it take sperm to travel the length of the epididmyis?
3-8 days
AAOS ROM Wrist (Ulnar Deviation)
30
AAOS ROM hip (adduction)
30
How many degrees of pelvic rotation should you have during gait?
6-10 deg
A DHI score of greater than ________ is associated w/ impaired functional mobility and increased fall risk
60
AAOS ROM Shoulder (extension)
60
AMA ROM Cervical (extension)
60
AAOS ROM Finger DIP (flexion)
90
AAOS ROM Finger MCP (flexion)
90
AAOS ROM Shoulder (LR/ER)
90
What is a deviated nasal septum?
A severe deviation may occlude a nasal fossa & prevent adequate drainage of nose & sinuses which would interfere with air flow on one side
What does the participation objective from the IV STEP Conference focus on?
Analyze & apply emerging measures & interventions to optimize participation w/in the pt-centered care model -include all people -less research on this -ex: how do we get people back to work?
What is the function of the vas deferens?
Connects epididymis to the ejaculatory ducts to the urethra
Finger MCP (flexion)
F- dorsal aspect MCP joint SA- dorsal midline metacarpal MA-dorsal midline prox. phalanx
Finger MCP (abduction)
F- dorsal aspect MCP joint SA- dosal midline metacarpal MA- dorsal midline prox. phalanx
Finger PIP (extension)
F- dorsal aspect PIP joint SA-dorsal midline prox. phalanx MA- dorsal midline middle phalanx
Finger PIP (flexion)
F- dorsal aspect PIP joint SA-dorsal midline prox. phalanx MA- dorsal midline middle phalanx
Thumb IP (extension)
F- dorsal surface IP joint SA-dorsal midline proximal phalanx MA- dorsal midline distal phalanx
Thumb IP (flexion)
F- dorsal surface IP joint SA-dorsal midline proximal phalanx MA- dorsal midline distal phalanx
Cervical (extension)
F- external auditory meatus SA- perpendicular to the ground MA- base of the nares
Cervical (flexion)
F- external auditory meatus SA- perpendicular to the ground MA- base of the nares
Talocrural (PF)
F- lateral malleolus SA- mid line lateral leg, fibular head MA- 5th metarsal
T/F: protozoa have a cell wall
False
Where does the ischiocavernosus muscle attach in females?
From ischiopubic ramus and perineal membrane Partially covers each crus of the clitoris
Where does the bulbospongiosus muscle attach in females?
From the perineal body and perineal membrane It runs on top of each vestibular bulb
What are the 4 paranasal sinuses?
Frontal Ethmoid Sphenoid Maxillary
Tapping on the bone superficial to the sinus will cause pain for which paranasal sinuses?
Frontal & maxillary
Distally, what does the corpus spongiosum expand to be?
Glans It covers the ends of the 2 corpus cavernosum which have fused at the distal end
List the surface structures of the penis (5)
Glans Corona Frenulum (Y at corona) Raphe (fusion line) Prepuce (foreskin)
What structure attaches inferiorly to the testis to prevent testicular torsion?
Gubernaculum which becomes the scrotal ligament at the end of the testis
What are the 3 parts of the epididymis?
Head Body Tail
What is anosmia?
Head trauma can result in shearing of the olfactory NN as they pass through the cribiform plate This results in the loss of the sense of smell
Where do the bulk of middle ear ossicles reside?
In the epitympanic recess above the tympanic membrane
What is a varicocele in relation to male genitalia?
Insufficent or absent valves within the spermatic veins which causes blood reflux within the pampiniform plexus
What is the function of the clitoris?
It is erectile tissue that solely functions as an organ of sexual arousal
What is cryptorchidism?
Malposition resulting in retention of the testes anywhere along the route of the descent Undescended testicle
What are hymenal caruncles?
May be around the vaginal opening especially in women who have delivered children
What are possible causes of contralateral trunk lean?
May be used to assist with pelvic elevation to ensure foot clearance if reference limb is *functionally too long* (owing to deviation or leg length discrepancy).. Compensation for contralateral hip joint pain, IT band tightness, or scoliosis
What is an important characteristic of microbes that is not true specifically for viruses? Why is this beneficial for diagnosis?
Most can live outside the body, allows a microorganism to be grown in a petri dish to help determine what it is and how to treat it by using certain drugs
What suspends the penis from the perineal membrane?
Muscles
Anterior (Ventral) Funiculus
Myelin Coat (good clean "fun")
Lateral Funiculus
Myelin Coat (good clean "fun")
Are pathologies detected by tracheal breath sounds common?
No
What is epistaxis?
Nosebleed common in young & old Kiesselbach's area: ant. ethmoid A, sphenopalatine A, greater palatine A, & sup. labial A. Frequent site of nosebleed
What does transversus abdominis become in the scrotum?
Nothing
"The voluntary consent of the human subject is absolutely essential"
Nuremberg Code
Will the PCO2 of the blood be the highest at the lungs or the muscles/periphery? What about PO2?
PO2: highest at lungs PCO2: highest at muscles, lowest at lungs
What are the muscles of the male external genitalia suspended from?
Perineal membrane
A pelvic floor PT may make recommendations on positions for labor and delivery of a child. What positions should you recommend?
Positions that optimize gravity: -avoid assymmetrical postures -birthing pool -exercise ball -upright & leaning fwd -assisted squat -4 point positions
During which phase of the gait cycle is the great toe in maximal extension?
Pre-swing (creates Windlass Mechanism)
What are the 3 parts of the male urethra?
Prostatic urethra Membranous urethra Penile/spongy urethra
What is the function of the sinus cilia?
Provide clearing action for sinuses, cilia propel towards ostium of sinus
What is the function of the cremaster muscle?
Pulls the testicles upward
When do you reach the most right and left displacement during a gait cycle?
R: mid-stance on right L: mid-stance on left
What does SNOUT stand for?
SN: sensitivity OUT: negative test rules out
Author of "My Father's Death"
Susan M. Wolf
What happens to a person's total lung capacity (TLC) if they have a neuromuscular disease?
TLC decreases
How does the total lung capacity differ between early and severe emphysema?
TLC severe > TLC early
What harm comes from Cholesteatoma?
The accumulation of dead stratified squamous cells that become trapped in the middle ear can destroy the middle ear structures by compression, due to inadequate blood flow
Anterior Median Fissure
The anterior, more open of the two grooves that partially divide the spinal cord in left and right halves
What might lead to a non-pathogenic microbe becoming pathogenic?
The host body's conditions change (develop from opportunistic infections)
Where does cholesteatoma usually start?
The pars flaccida, where a fibrous layer is lacking
Posterior Median Sulcus
The posterior, shallower of the two grooves that partially divide the spinal cord into left and right halves
How does the pampiniform plexus interact with the testicular artery?
The testicular artery intertwines with the pampiniform plexus which allows the arterial blood to be pre-cooled
How are antacids used to treat ulcers?
They relieve gastric pain and facilitate ulcer healing
How do anti-spasmodic drugs work?
They slow down the speed at which the bowel travels through the intestines, so that more water can be absorbed from the stool to produce fewer and firmer stools
How do lubricants/stool softeners work?
They use mineral oil to bring water into the fecal mass, thus softening the stool and permitting easier elimination
T/F: BPPV is easy to treat in PT
True! 80% success rate of fixing this within 1-2 visits
What are early signs of vestibular schwannoma?
Unilateral hearing loss (98% of cases); tinnitus (ringing in the ears); loss of balance; dizziness
Ethical relativism
beliefs and practices in a given culture are ethical if they represent traditional norms and values in that culture
Which bioethics principle encompasses pain management?
beneficence
Muscle mass peaks at what point in life?
between 25-30 years of age
List the 5 elements of informed consent as these apply to clinical practice and medical research
decision-making capacity disclosure understanding voluntariness authorization
current _______ is affected by the spacing of electrodes. Placing electrodes closer together results in _______ (superficial/deep) current _______
density superficial density
List the 3 theories of bioethics
deontological (duty-based) consequential theory (consequence-based) virtue theory (character-based)
What do bactericidal drugs do?
destroy organisms
Which geometric quality of an x-ray is also known as sharpness or resolution?
detail
What are the 2 geometric qualities of an x-ray?
detail distortion
What is the most common side effect assoc. with *magnesium containing* antacids?
diarrhea
What is the 5th vital sign
documented pain level
How do children w/ DCD interact with peers?
engage in less vigorous play, spend more time alone on the playground, and spend less time in team play
What is a bleed above the meninges called?
epidural hematoma
end feel Shoulder (flexion)
firm
end feel Subtalar (Inversion)
firm
end feel Talocrural (DF)
firm
end feel Talocrural (PF)
firm
end feel Tarsal (Inversion)
firm
end feel Thoracolumbar (Extension)
firm
The utricle and saccule are:
gravitation receptors
What is a sporadic infection?
in one person
What does leukocytosis mean? What is it an indication of?
increase in WBC count, indicates bacterial infection
What causes drug resistance?
increased use or misuse of antimicrobial drugs
Define: premature birth
less than 37 weeks GA
What is nuclear medicine?
the use of radiopharmaceuticals for diagnosis, therapy & research
What is VSED?
voluntarily stopping eating and drinking
Gray Comissure (greenish gray)
(Naked)The cross bar of the H (butterfly) that surrounds the central canal. Cell bodies & interneurons
What qualifies as indirect contact for spread of infection?
(involves intermediary object/organism) -contaminated hand -contaminated food -fomites/inanimate object (linen, door)
ROM Thoracolumbar (Extension)
(tape measure (~2 inches/5 cm) inclinometer (~25 degrees))
ROM Thoracolumbar (Flexion)
(tape measure (~4 inches/10 cm) inclinometer (~80 degrees))
Vestibular anatomy can be broken down into 3 parts: peripheral sensory apparatus, central processing system & motor output system. What is the function of each of these?
*Peripheral Sensory Apparatus:* (info comes in) -angular & linear acceleration -velocity -orients head w/ respect to gravity *Central Processing System:* (body processes it) -vestibular nuclear complex -cerebellum -somatosensory & visual input -reticular formation, cortex *Motor Output System:* (does something about it) -generates compensatory eye movements for gaze stability (VOR) -body movements for postural stability with locomotion (VSR)
What are the difference in symptoms of a peripheral vs. a central vestibular disorder?
*Peripheral:* -hearing loss -tinnitus -vertigo/dizzy*** -nystagmus -gait ataxia -impaired VOR *Central:* -oscillopsia -nausea -disequilibrium- lose balance, but not dizzy*** -ataxia -impaired smooth pursuit -impaired VOR -headache -diplopia
What are some physiological and behavioral signs of stress in a NICU patient?
*Physiological*: -change in HR -dec RR -inc BP -dec O2 sat -apnea -bradycardia -skin color change *Behavioral*: -gaze aversion -finger splays -trunk extension -facial grimace -leg extension -drowsiness -hyper-alertness
How does prolonged bedrest affect hematologic values?
*decrease* in: -blood volume -O2 carrying capacity
How does prolonged bed rest affect the cardiovascular system (what does it *decrease*)?
*decrease*: -exercise tolerance/VO2 max -cardiac output -resting and max stroke volume -orthostatic tolerance
forearm (supination)
*elbow at side* F- medially and proximally to ulnar styloid process (wrist crease) SA- midline humerus MA-across ventral aspect forearm, proximal and parallel to styloid process of radius and ulna (over the top of wrist)
T/F: ultrasonography imaging is only used in OB/GYN practice
*false* -it is also useful for imaging musculoskeletal tissue -can be used during a physical exam & w/ active, functional activity
T/F: orthopedic hardware is ferromagnetic and cannot undergo MRI imaging
*false* but surgical clips usually are and pacemaker fxn can be compromised in MRI imaging
How does prolonged bedrest affect the cardiovascular system (what does it *increase*)?
*increase*: -resting HR -venous compliance -venous pooling
How does prolonged bedrest affect a patient psychiatrically?
*increases*: -anxiety -agitation -delirium -depression
What is a T1 MRI image?
*longitudinal magnetization*: -how long it takes protons to "relax" back to a resting state after an RF pulse
Should you get medical imaging done for a patient over the age of 50 with acute low back pain that has no signs of systemic disease?
*no*, symptomatic therapy is appropriate
hip (extension)
*prone* F- greater trochanter SA- midline pelvis MA- midline lateral femur
Shoulder (extension)
*prone* F- lateral aspect greater tubercle SA- midaxillary line of throax MA- lateral midline of the humerus, olecranon process, lateral epicondyle
hip (flexion)
*supine* F- greater trochanter SA- midline pelvis MA- midline lateral femur, lateral femoral epicondyle
Shoulder (flexion)
*supine* F- lateral aspect greater tubercle SA- midaxillary line of throax MA- lateral midline of the humerus, (olecranon process, lateral epicondyle reference)
Shoulder (MR/IR)
*supine, arm supported on table @ 90, humerus parallel to floor* F- olecranon process SA- perpendicular to floor MA- ulna, olecranon process, ulnar styloid process
Shoulder (LR/ER)
*supine, arm supported on table @ 90, humerus parallel to floor* F- olecranon process SA- perpendicular to floor MA-ulna, olecranon process, ulnar styloid process
Shoulder (abduction)
*supine, sitting* F- acromion proccess SA- parallel to midline of sternum MA- midline humerus, use medial epicondyle as a reference
Elbow (flexion)/(extension)
*towel under distal humerus, palm up* F-lateral epicondyle of humerus SA- lateral midline of humerus, acromion process MA- lateral midline radius, radial head and radial styloid process
What is a T2 MRI image?
*transverse magnetization*: -how long resonating protons remain "in phase" or oriented following a RF pulse
T/F: ultrasonography imaging is included in PT practice
*true* but should only be used to confirm a diagnosis
T/F: ultrasonography is operator dependent
*true* good technique requires practice
What color is contrast media on an x-ray?
*white* outline
Should you get medical imaging done for a patient over the age of 50 with acute low back pain and signs of systemic disease?
*yes*, conventional x-ray and simple lab testing can almost completely rule out underlying systemic disease
Intervention for child with DCD
-"top-down" approach -teach specific tasks/skills in environment where child will use skill -core strengthening, general strengthening exercises/activities -endurance activities -coordination exercises and activities -gait training -postural stabilization/exercises -use mirror for feedback -balance activities -break down tasks; teach/practice each step -HEP -extracurricular activities -referral to other necessary providers (OT, speech, mental health etc.)
Which tests could be used to assess static balance in a vestibular exam? (6)
-*Modified CTSIB* -Berg -BEST/Mini BEST -Functional reach -Rhomberg/sharpened- tandem -Single Leg Stance
How does prolonged bedrest affect the metabolic/endocrine system?
-*inc* insulin resistance -hypercalcemia/ renal stones -*inc* urinary excretion of Na+, K+, Ca++ and phosphorus
How do you do diaphragmatic breathing?
-*inhale*: expand abdomen w/out chest mvmt, this reflexively relaxes PFM -*exhale*: allow abdomen to fall, both diaphragm & PFM recoil back to rest position -*5 min per day*
What should be included in the physical exam for a vestibular pt?
-*oculomotor function* (saccades, smooth pursuit, visual acuity - static/dynamic) -*nystagmus* (spontaneous/gaze evoked) -*VOR* (slow, head thrust test), head shake -*sensory testing* -*ROM testing* (cervical) -*Motor testing* -*Balance testing* -*Positional testing* (Dix-Hallpike, roll test, motion sensitivity) not testing all of these with each patient, just the ones you need
Cheyne-Stokes Respiration
-*periodic breathing* associated with periods of *apnea* alternating regularly with a series of respiratory cycles -respiratory cycles gradually increase then decrease in rate & depth
Potential causes of dizziness Most common seen in clinic? (2 bold)
-*peripheral vestibular disorders* -*non-vestibular causes* (disuse equillibrium) -orthostatic hypotension -TIA from vertebro-basilar ischemia -panic attacks -migraines (dizzy spells w/wo headache)
What types of problem-solving questions should you ask about a dementia pt's challenging behaviors? (4)
-*physical*: hunger, bathroom, thirst, pain -*environmental*: hot, cold, visually distracting, noisy -*task-oriented*: is the task adjusted to pts level of dementia -*approach*: are we using prompts, cues & verbal direction based on the pts level of dementia (PETA)
Treatment: Post C-Section
-*scar massage* -gentle, mat-level exercises -focus on neuro control, then stability, then dynamic activity
How do you treat scar pain after childbirth?
-*scar mobilization*: taught to pt or sig other w/ oil -address MSK findings: pelvic girdle stability, pelvic floor tension or weakness, bladder & bowel health
What structures does the peripheral sensory apparatus (membranous labyrinth) include? (hint: 5 sensory organs + 2 others)
-3 semicircular canals (ant, post, lat) -2 otoliths (utricle, saccule) -motion sensors (hair cells) -endolymph
What qualifies as acute vs chronic bronchitis (time frame)?
-A: symptoms lasting 2-3 weeks -C: productive cough lasting more than 3 months
Which lobes of the brain do the following arteries largely supply? -anterior cerebral artery (ACA) -middle cerebral artery (MCA) -posterior cerebral artery (PCA)
-ACA: frontal -MCA: temporal/parietal -PCA: occipital
In the NICU, what reflexes should you check?
-ATNR -Moro -Rooting -Plamar Grasp -Plantar Grasp -Galant -Stepping
Which diseases might cause irreversible dementia? (10)
-Alzheimer's -Vascular dementia -Parkinson's -Huntington's -Pick's disease -Lewy Body disease -Creutzfeldt-Jakob disease -Normal pressure hydrocephalus -Brain trauma -Korsakoff's syndrome
What do you need to closely monitor during pregnancy?
-BP, HR, RPE -fluid retention -fluid loss -vaginal bleeding -contractions/hour
Cause & Compensation: Metabolic Acidosis
-Cause: dec HCO3- d/t ketones (diabetes) chloride or acid ions -Comp: inc RR
Cause & Compensation: Respiratory Alkalosis
-Cause: dec PCO2 d/t breathing out too much CO2 (hyperventilation, CHF) -Comp: kidneys conserve H+ ions and eliminate HCO3- ions
Cause & Compensation: Metabolic Alkalosis
-Cause: inc HCO3- d/t loss of chloride ions (vomiting) or excess ingestion of sodium bicarbonate (Tums) -Comp: dec respiration
Cause & Compensation: Respiratory Acidosis
-Cause: inc PCO2 d/t suppressed breathing (COPD, pulm edema, chest wall excursion issues) -Comp: kidneys conserve HCO3- ions and eliminate H+ ions
Which test could be used to assess dynamic balance in a vestibular exam? (6)
-DGI -FGA (higher level pt) -TUG -dual task TUG (w/ cognitive task) -10 meter walk -5x STS (older population)
What are the 3 main divisions of the ear?
-External -Middle -Inner
What does pirenzepine do?
-Inhibits gastric acid secretion (at doses below those needed to affect the CNS) -relaxes the lower esophageal sphincter, making mvt of food into lower GI tract easier
Examples of "good" bacteria that can prevent diarrhea:
-Lactobacillus acidophilus -Lactobacillus bulgaris (often called Intestinex or Lactinex)
In the NICU, which standardized assessments can you perform? (5)
-NAPI: Neurobehavioral Assessment of Premature Infants -TIMP: Test of Infant Motor Performance -NNE: Neonatal Neurobehavioral Examination -NBAS: Neonatal Behavioral Assessment Scale -Preemie-Neuro
In general, when you exercise, your O2 demand (inc/dec) and your CO2 production (inc/dec). This causes your peripheral blood vessels to vaso(constrict/dilate). Your heart reacts by (inc/dec) stroke volume and (inc/dec) HR. Your lungs react by (inc/dec) tidal volume and (inc/dec) RR
-O2 demand: inc -CO2 production: inc -vasodilate -inc stroke volume -inc HR -inc tidal volume -inc RR
What is contained in the middle ear?
-Ossicles (malleus, incus, stapes) -Eustachian tube -Mastoid air cells
Symptoms: iliosacral joint pain
-Pain: subcostal, 12th rib, & groin -piercing hip pain -pain w/ cough/sneeze
What is contained in the external ear?
-Pinna -Ear canal -Tympanic membrane
Tuberculosis: -what are the symptoms? -how is it diagnosed?
-S: can be vague: fever, weight loss, lethargy, loss of appetite -D: sputum sample
Emphysema: -what are the symptoms?
-S: dyspnea, minimal wheezing, barrel chest, prolonged expiration
Pneumonia: -what are the symptoms? -how is it diagnosed?
-S: fever, chest pain, productive cough -D: sputum sample, chest x-ray or CT scan
Bronchitis: -what are the symptoms? -how is it diagnosed?
-S: might have barrel-chest & cyanosis -D: chest x-ray or CT, sputum sample
Equation Review: -stroke volume (SV) -cardiac output (Q) -ejection fraction (EF) -respiratory exchange ratio (RER) -VO2 max
-SV = EDV - ESV -Q = SV * HR -EF = SV / EDV -RER = VCO2 / VO2 -VO2 max = Q * arteriovenous O2 difference
How does cardiac output change during exercise and with training?
-SV increases up until 50% of your max effort (VO2 max)*** -HR increases the whole time -after training, your Q may be the same or a little increased
What are the 3 layers of the ear drum?
-Strat. squamous epithelium (lateral/external surface) -Fibrous layer with circular and radial fibers (pars tensa and pars flaccida) -Mucous (respiratory) epithelium
Heart
-T1-5 -cervical anterior, upper thorax, (L) upper extremity
Ovaries
-T10-11 -lower abdominal, sacral
Testes
-T10-11 -lower abdominal, sacral
Kidney
-T10-L1 -L-spine (ipsilateral), lower abdominal, upper abdominal
Uterus including uterine ligaments
-T10-L1, S2-4 -L-S junction, sacral, T-L junction
Sigmoid Colon
-T11-12 -upper sacral, suprapubic, left lower quadrant of abdomen
Large intestine
-T11-L1 -lower abdominal, middle lumbar spine
Prostate gland
-T11-L1, S2-4 -sacral apex, suprapubic, T-L junction
Ureter
-T11-L2, S2-4 -groin, upper abdominal, suprapubic, medial, proximal thigh, thoracolumbar
Urinary bladder
-T11-L2, S2-4 -sacral apex, suprapubic, T-L junction
Esophagus
-T4-6 -substernal and upper abdominal
Lungs and Bronchi
-T5-6 -ipsilateral thoracic spine, cervical (diaphragm involved)
Spleen
-T5-T9 -left upper quadrant, left shoulder
Stomach
-T6-10 -upper abdominal, middle and lower thoracic spine
Pancreas
-T6-T10 -upper abdominal, lower thoracic spine, upper lumbar spine
Common Bile Duct
-T6-T10 -upper abdominal, middle thoracic spine
Liver
-T7-9 -right middle and lower thoracic spine, right cervical spine
Small Intestine
-T7-T10 -middle thoracic spine
Gallbladder
-T7-T9 -right upper abdominal, right middle and lower thoracic spine, caudal aspect scapula
Which muscles attach to the thoracolumbar fascia? (9)
-TA -obliques -multifidus -ES -lat dorsi -lower trap -quadratus lumborum -glute max -biceps femoris
Which 2 muscles of the middle ear function as shock absorbers?
-Tensor tympani -Stapedius
Define: "core" (a.k.a. deep stability system)
-a muscular corset that works as a unit to stabilize the body & spine -the center of the functional kinetic chain
What do "bulk forming" laxatives do?
-absorb water and swell within the lower GI tract -stretch the bowel and stimulate peristalsis
Characteristics of vestibular neuritis
-acute & unilateral -possible viral etiology -*prolonged, severe rotational vertigo w/ spontaneous nystagmus, imbalance and nausea* -hearing usually spared bc cochlear N is fine often go to the ER bc it's so bad & they don't know what's going on, then it gets somewhat better but they still aren't normal afterwards and then they show up in your clinic
What may be some reasons for abnormal internal hip rotation (toe-in gait)? (4)
-adaptive shortening of IT band -weakness of hip ER muscles -(excessive) femoral anteversion -adaptive shortening of hip internal rotators
What may be some reasons for abnormal external hip rotation (toe-out gait)?
-adaptive shortening of hip ER muscles -weakness of hip internal rotators -(femoral retroversion?)
What are factors that decrease host resistance? (9)
-age (infants and elderly) -pregnancy -genetics -immunodeficiency -malnutrition -chronic disease -physical/emotional stress -inflammation/trauma -impaired inflammatory responses
According to the Ottowa Knee Rule, a conventional x-ray should be ordered if:
-age over 55 OR -tenderness at fibular head OR -isolated tenderness of patella OR -inability to flex knee to 90 deg OR -inability to walk 4 WB steps immediately after injury in the emergency department
According to the Pittsburg Decision Rule for Knee Trauma, a conventional x-ray should be ordered if:
-age under 12 or over 50 AND/OR: -inability to walk 4 WB steps in the emergency deparment
What's involved in a "bottom-up" approach? (read)
-aimed at changing body structure/function impairments -rely on traditional theories of motor development belief that, by changing underlying deficits, task performance will improve -difficulty generalizing learned skill -minimal change in functional outcome with this approach
How does the ankle joint help with flexibility?
-allows adaption to terrain -absorbs shock
What changes in the neural stability system are seen in patients with LBP?
-altered timing of muscle firing, not strength -errors in core neural control is assoc. w/ inc risk of knee injury in female athletes means core dysfunction is as much a neuro-control issue as it is a strength issue
How do the PFM contribute to hip control & stabilization?
-anchors deep hip rotators -provides good hip joint mechanics -allows optimal power for the larger muscles
What are signs of excessive DF during gait?
-ankle collapses into more than 5 deg DF in midstance -ankle collapses into more than 10 deg DF in terminal stance -no heel off at terminal stance or pre-swing
What are Brandt-Daroff exercises?
-another method of treatment for BPPV -not first choice, takes more time, but it works, done if positional testing doesn't work -perform 5 reps 2x/day -hold each position 30 sec -*95% effective* -head position important-- look up when lying down
What are some common guidelines for drug therapy? (2)
-antimicrobial drugs should be taken for entire prescription length -if drug resistance known, use multi-drug therapy
Adventitious Sounds -what are they? -what do they indicate?
-any sound that occurs along with normal breath sounds -typically indicates turbulence of air flow
Function: diaphragm (in terms of spine stability)
-assist w/ trunk control -resting tone inc before mvmt to stabilize trunk -tonically active w/ sustained activity -modulates activity w/ respiration during peripheral activities
FYI: in a subjective examination, you might ask the patient if they have ever had any of the following:
-asthma -emphysema -cancer -TB -shortness of breath -difficulty breathing
What happens in the bacteremia stage of an infection?
-bacteria has entered blood stream (in small amounts) -infection destroyed by circulating phagocytes -may lead to septicemia
How would you practice timed walking, increasing speed and locomotor rhythm with a patient?
-begin walking at comfortable speed, gradually increase velocity -use pacing cues to vary speed -use metronome or brisk marching music to increase speed, improve locomotor rhythm -practice imposing short bursts of fast walking with walking at comfortable speed
What might trigger points in the RA just above the pubis result in?
-bladder spasm -urinary sphincter muscle spasm
How may antivirals act to interfere with virus? (specifically how do they inhibit the virus)
-block entry into host cell -interfere with reverse transcriptase -inhibit gene expression -inhibit assembly of virus
Appearance of sputum due to hemoptysis. (hemoptysis: coughing up of blood) What condition is this usually a sign of?
-blood-tinged (bright red) -frothy (EW) -sign of pulmonary edema
What are some general pathological categories that may cause antalgic gait?
-bone disease -muscle disorder -joint disease -neurologic disease -"other"
Where are your central & peripheral chemoreceptors assoc. with pulmonary ventilation located? What are their function?
-brain, carotid & aorta -detect CO2 or O2 levels in blood -inc/dec rate of breathing
How do you diagnose a pulmonary embolism?
-can be difficult to diagnose b/c initial symptoms are vague -take history: recent surgery, inactivity? -chest x-ray and CT scans are helpful
Define: core stability
-capacity of the lumbo-pelvic-hip complex to maintain equilibrium of the vertebral column w/in its physiologic limits by dec displacement & maintaining structural integrity -ability to control position & motion of trunk over pelvis for optimal production, transfer & control of force & motion
How might you work to improve compensatory responses to unexpected perturbations with a patient?
-change speed of treadmill or stop and start treadmill while patient is walking on it -practice resisted forward progression using an elastic resistive band w/ unexpected release of resistance -practice walking while recovering from small external perturbations given manually
Who is important to educate regarding an intervention for a child with DCD?
-child -family -school personnel -community etc. (may lessen impact of contextual factors -environmental and personal - that may restrict participation factors
Prognosis for DCD
-children don't "grow out of it" -at risk for developing negative physical, social, emotional, behavioral, and mental health consequences
How does DCD affect personal factors?
-children perceive themselves as less competent -low self-worth -greater anxiety -self-imposed isolation
4 generic names of H2 receptor antagonists:
-cimetidine -famotidine -nizatidine -ranitidine
What are some general aspects of set up for electrotherapy that you need to keep in mind? (4)
-clip excess hair -alcohol prep for skin -apply coupling agent if necessary (gel) -placement of electrodes (around motor end plate)
People with which conditions can't take more fiber into their diet and therefore should take bulk laxatives?
-colostomies -ileostomy bags -IBS -anal fissures
What are deformities that could lead to abnormal gait? (3)
-contractures -abnormal joint contours -ankylosis
What should you look for to ensure a pt's core is stable when performing a single leg stance?
-core recruits for stability -pelvic ring is symmetrical in all planes -deep hip & glutes maintain level pelvis -no trunk compensations
What are the different types of diagnostic tests that can be used for infections?
-culture and staining techniques -blood tests -immunologic testing of body fluids
When a dementia pt goes to live at an assisted living facility, what are some concerns a PT might have for the pt's family members? (2)
-dealing w/ losing primary caregiver role -accepting pt's new limitations including visiting the community
Goals of PT treatment for vestibular hypofunction
-dec disequillibrium, dizziness and oscillopsia -improve functional balance/gait -improve ability to see clearly during head movement -return to more normal level of activity do this by challenging the VOR & VSR to stimulate the vestibular system with a variety of movements
How does aging affect your heart's response to exercise overall? (read)
-dec max HR -bv are less compliant -dec signalling -dec # of receptors -overall, not as efficient by exercising, we can delay the onset of decline***
Purpose: diaphragmatic breathing
-dec sympathetic NS -inc parasympathetic NS -dec HR -dec inflam -boosts immune system -boosts happiness
What is the temporal lobe in charge of?
-declarative memory: remember facts & events (affected in AD) -understand speech -process auditory info from ears
What are different pathological mechanisms that could lead to abnormal gait?
-deformity -muscular weakness -pain -sensory and motor impairments
What is the series elastic component of elastic adaptations to resistance training? How does it work?
-describes the musculotendinous junction acting like a contractile unit -takes stretch and translates it back into force -your muscles get better at doing this with training
What is the parallel elastic component of elastic adaptations to resistance training? How does it work?
-describes the passive stretch coming from the non-contractile components of muscle (muscle membranes that lie parallel to muscle tissue) -functions to stabilize and protect muscles
What is the function of the lung receptors located in your alveoli assoc. with pulmonary ventilation?
-detect fluid in lungs via stretch -cause rapid, shallow breathing to dec duration of inspiration
What is the function of the mechanical receptors located in your muscles & joints assoc. with pulmonary ventilation?
-detect physical activity -inc breathing rate
What causes a nystagmus?
-difference b/w sides in the firing rate of the vestibular nuclei -one vestibular system is more active than the other
What has to be present for a child to receive a diagnosis of DCD?
-difficulty w/ activities that require motor coordination -significantly interferes w/ academic achievement or ADLs -no other explanation can be offered for the motor impairment - rule out any other underlying neurologic or medical condition -if cognitive impairment present, motor involvement tends to be more severe than typical presentation
2 generic names of anti-spasmodic drugs:
-diphenoxylate -loperamide (keep it on the ~DL~ if you're taking anti-spasmodic drugs)
What are the various modes of transmission that an infection may be spread by? (5)
-direct contact -indirect contact -droplet transmission -aerosol transmission -vector-borne transmission
Symptoms: Over-Active Female Athlete
-disordered eating -over-exercising -low weight -*irregular menstruation or amenorrhea* leads to: -*poor bone health* -pelvic floor dysfunction -psych conditions
What are some symptoms of delirium? (6)
-disorientation -memory loss -hyper-alertness -hyper-responsiveness -dec problem-solving skills -difficulty w/ abstract thought
What does reversibility mean when referring to adaptation?
-disuse results in loss of muscle mass (atrophy)
What are some general concerns to keep in mind when working with a pregnant patient? (6)
-do not lay in supine for more than 1-2 min after 1st trimester (avoid compressing sup vena cava) -gross hypermobility and laxity (will have altered end-feels w/ mobilizations, may want to dec pressure) -changes in center of gravity -keep their HR in a range where they can maintain a conversation -do not put heat over their belly -do not to e-stim over belly or low back
Diarrhea is often a temporary symptom of minor GI disorders, but can occur with serious conditions such as:
-dysentery -ulcerative colitis -cholera
Orthopnea How could you treat this?
-dyspnea that occurs when someone is lying down -to treat, raise upper part of body with pillows
What is the limbic lobe in charge of?
-emotion & emotional regulation (ex: fear) -memories that are formed w/ an emotional context
5 generic names for PPIs:
-esomeprazole -lansoprazole -omeprazole -pantoprazole -rabeprazole *-prazole*
What are some common hip deformities?
-excess hip flexion -limited hip flexion -leg discrepancy -excess varus/valgus -painful hip
What are some common knee deformities?
-excessive knee flexion -limited knee flexion -knee hyperextension -excessive varus or valgus -painful knee
Hypertonicity of which muscles often restrict movement of the lower ribs and prevents proper diaphragmatic excursion? (4)
-ext oblique -int oblique -RA -ES (hypertonicity of these mm will result in minimal expansion of rib cage during inspiration, so inspiration will have to mainly take place in the upper/ant chest instead of at diaphragm)
What are some symptoms of severe dementia? (4)
-extreme language impairment -may not recognize family -mobility impairment -need total care for ADLs
Cause: Male Pelvic Dysfunction
-fall -*chronic stress* -IBS -prostatitis/enlarged prostate -cancer treatment -depression/anxiety -hx of abuse (jobs are usually stressful)
How is nystagmus named?
-fast beat is towards more active side -fast beat side is the side it's named for (picture: assuming this is their right eye, fast beating to the R = R nystagmus, R side is hyperactive or L side is hypoactive)
In the case of rearfoot varus, what are some visual characteristics of the foot and ankle when examining this joint in a non-weight bearing (NWB) setting?
-forefoot inverted -subtalar joint neutral -calcaneus inverted
In the case of forefoot valgus, what are some visual characteristics of the foot and ankle when examining this joint in a weight bearing setting (WB)?
-forefoot will be flat on floor -subtalar joint will be supinated -calcaneus inverted
In the case of forefoot varus, what are some visual characteristics of the foot and ankle when examining this joint in a weight bearing setting (WB)?
-forefoot will be flat on the ground -subtalar joint will be pronated -calcaneus will be everted
What are some bone disease causes of antalgic gait?
-fracture -infection -tumor -avascular necrosis (Legg-Calve-Perthes, Osgood schlatters, kohler bone disease)
What may be some reasons for vaulting (ground clearance of swinging leg will be increased if the patient goes up on toes on stance phase leg)?
-functional leg-length discrepancy -*vaulting occurs on shorter limb side*
How does DEXA work? What does it measure?
-high & low energy *x-rays* are directed at bone from *2 sources* -the difference in *absorption* b/w the beams is used to determine bone density
What should tracheal breath sounds normally sound like?
-high-pitched, loud & hollow sounding -like wind rushing through a pipe -expiration is louder and might be more coarse
What are some examples of challenging behaviors that dementia pts might exhibit? (lots)
-hitting -resistance -name calling -swearing -exit seeking -refusing to eat -refusing to care -restlessness -repeating -urinating in plants, corners -late day restlessness -yelling out -sexual comments or acts -sleep difficulties -disrobing
Summary of person-centered care: (read)
-honor the pt's identity and how they see themselves -person centered care happens when an overall sense of well-being is encouraged and providers REALLY know the pt's preferences, habits, routines & history
What does an abnormal head shake test tell you?
-horizontal nystagmus = peripheral -vertical nystagmus = central
Mechanism of Injury: SI, iliosacral & pubic symphysis joint pain
-hormone changes during pregnancy -habit of standing on one leg -childbirth -bad sleeping or sitting postures -hypermobility -muscle imbalances -weak stabilizers -fall on ischium -direct trauma to pubic bone (bike) -fall onto straight leg (miss step) -shear forces in sports -excessive hip abduction (esp w/ epidural) -secondary to other condition
Possible risk factors for pelvic girdle pain:
-hormones -biomechanics -trauma -inadequate motor control -stress of ligamentous structures
Risk Factors: Pelvic Girdle Pain
-hx of LBP, PGP or pelvic trauma -multiparous
What are a lot of thing that can cause a restrictive lung disease? (read)
-hypoxemia -hyperventilation -kyphosis -extertional dyspnea -dry cough -hemoptysis -idiopathic lung fibrosis -asbestos -radiation fibrosis -obesity -neuromuscular impairment
Cause: Menopause
-hysterectomy -cancer treatment -natural progression
What is the purpose of a NICU PT exam/eval?
-identify participation restrictions, particularly barriers to normal development -identify activity limitations, particularly in terms of parent-child interaction -identify body structure/function impairments that need intervention -identify methods of positioning, handling & ways to adapt the environment to optimize development
In nutation of SIJ, the base of the sacrum moves inferiorly & anteriorly. What happens to the ilia, ischial tuberosities & lumbar spine?
-ilia rotate -ischial tubes separate -LS extends
Why should PT's study diagnostic imaging? (6)
-improves PT/MD communication -improves PT evaluations -guides PT treatment plans -increases PT autonomy -emerging interest in manual orthopedic techniques -advancing imaging technologies
What motor *control* deficits might a child with DCD exhibit?
-inappropriate and ineffective muscular activation and sequencing -less effective method of muscular organization
How do *neuromuscular adaptations* to resistance training affect the following *physiologically*? -MU firing rate -MU recruitment -MU synchronization -reflex neural facilitation -coordination of antagonist mm -GTO
-inc MU firing rate -inc MU recruitment -inc MU synchronization -inc reflex neural facilitation -inc coordination of antagonist mm -inhibition of GTO (autogenic inhibition)
Hyperpnea
-inc depth of respiration -normal to inc rate -regular rhythm
What is the *functional result* of the following contractile adaptations to resistance exercise? -inc muscle mass -inc CSA -inc type II fiber area -inc intracellular lipid content -inc ATP utilization rate
-inc force generation -inc contractile capacity -inc strength (selective recruitment) -inc metabolic capacity -inc max contraction capacity
What is the *functional result* of the following *neuromuscular adaptations* to resistance training? -inc MU firing rate -inc MU recruitment -inc MU synchronization -inc reflex neural facilitation -inc coordination of antagonist mm -inhibition of GTO (autogenic inhibition)
-inc rate of force development -inc force production and duration -inc force production and efficiency -inc rate of force development -inc efficiency of force application -disinhibits max contraction (allows it)
List some obstetric complications:
-incompetent cervix -HTN -gestational diabetes -multiple gestation -placenta previa/abruption -oligo/poly-hydramnios -long-term disabilities
Symptoms: Pelvic Floor *Weakness* (6)
-incontinence -pelvic & LBP -*joint instability* -*prolapse* -pelvic congestion -muscle imbalance (bold: diff from PFM hypertonus)
Symptoms: Post-Partum Dysfunction
-incontinence -prolapse -pain: muscle, soft tissue, scar, nerve, compression injuries, LS, SI, coccyx, pubic symphysis joints
What are characteristics of a chronic infection?
-infection is not totally eradicated (destroyed) -microbe continues to reproduce -clinical signs present but milder than in an acute infection -periodic acute episodes may occur
What are characteristics of an acute infection?
-infectious disease fully develops -clinical manifestations reach peak -length depends on virulence of organism
What can cause someone to sneeze?
-inflammation -foreign material in nasal passages
What can cause pleural pain?
-inflammation -infection in parietal pleura
During which parts of the stance phase is there double support?
-initial contact -loading response -pre-swing
What are muscular weakness related mechanisms that can lead to abnormal gait? (3)
-insufficient muscle strength -disuse muscular atrophy -neurological problems
Associated disorders for DCD:
-intellectual disability -ADHD -learning disability -speech/articulation difficulties
What do antifungals do to combat infection?
-interfere with mitosis -increase membrane permeability
How do interferons work? What kind of infection do they "interfere" with?
-interfere with viral replication -increase resistance of nearby cells to viruses -stimulate immune system cells
What's involved in a "top-down" intervention? (read)
-intervention contextually based -task and environment specific -based on dynamic systems theories -development of skills rather than underlying skill components alone -focus on motor learning principles and emphasize role of cognitive processes in learning of new movements -direct teaching of functional skills in appropriate environments
Function: core/core stability (5)
-intra-abdominal pressure -continence -organ support -pelvic girdle stability -lumbar stability
What can cause someone to cough?
-irritation from nasal discharge dripping into oropharynx -inflammation -foreign material in lower respiratory tract
2 generic names of stool thickeners:
-kaolin -pectin (KP)
How does Matt's version of the 6 determinants of gait differ from Steve's? (3)
-knee flexion determinant is in early MS -ankle dorsiflexion & heel rise = "foot & ankle motion" -adds in "knee motion"
How does radionuclide scintigraphy (*bone scan*) work?
-labeled methylene is injected -scanning occurs 2-3 hrs after injection -high uptake indicates areas of inc bone activity or mineral turnover
What physical deficits might a child with DCD exhibit?
-lack of energy/fatigue -decreased strength
What are some symptoms of moderate dementia? (5)
-language difficulties -personality changes -suspiciousnes -inc need for security -need assistance with ADLs
Appearance of sputum due to bronchiectasis.
-large amt of purulent (pus) sputum -foul odor
Characteristics of BPPV-related nystagmus
-latency of 5-30 sec-- won't happen right away -should last <2 mins -symptoms fatigue w/ repeated tests -if up-beating & torsional: posterior SCC -if down-beating & torsional: anterior SCC
Symptoms: pubic symphysis pain
-legs feel heavy -dull ache: groin, post thigh, calf -burning heel pain -pain w/ sit to stand on opp side of dysfunction -pain w/ rolling in bed -pain w/ step up on unaffected side -"shuffle" gait
How is form closure of the SIJ achieved?
-ligament support -wedge shape design of joint -WB forces
In general, what do rales sound like?
-light, bubbly or crackling breath sounds w/ serous secretions -popping sound during inspiration
What motor *learning* deficits might a child with DCD exhibit?
-limited movement repertoire -lacks adaptability and flexibility in movements -variability and inconsistency in motor performance -unable to correct movement pattern
Stridor: -what does it sound like? -when is it heard? -what pediatric condition does it sound similar to?
-loud, musical sound during inspiration -worsened condition leads to stridor during inspiration & expiration due to tracheal stenosis -this is the same sound that is heard in kids with croup
HIV blood tests are very sensitive which means they have low _____________ rates and high _____________ rates
-low false negative rate -high false positive rate
Home pregnancy tests are very specific which means they have low ___________ rates and high ______________ rates
-low false positive rate -high false negative rate
To maintain the upright posture when standing, how might someone with a hip flexion contracture (limited hip extension) compensate?
-lumbar lordosis -knee flexion
What *participation* restrictions might a child with DCD exhibit?
-may be withdrawn due to difficulty w/ physical activity -limited social interaction w/ physical activities -difficulty w/ keeping up w/ peers on playground -difficulty w/ classwork -difficulty participating in PE or sports
List the 2 main regulatory centers within the respiratory center: What are their functions?
-medullary inspiratory center -medullary expiratory center control rate & depth of breathing, but the cortex can override these centers-- active expiration
What are 4 of the most common antibiotics prescribed for peptic ulcers?
-metronidazole -clarithromycin -amoxicillin -tetracycline (M.C.A.T) <-- #blessed we didn't have to take that
How high up does the diaphragm go? Why is this important to keep in mind?
-mid thoracic spine (~rib 8) -this means that the "core" really starts in the mid-thoracic range & runs to the pelvic floor
What should bronchial breath sounds normally sound like?
-more muffled than tracheal sounds due to more soft tissue -louder on expiration
How is delirium different from dementia? (3)
-more sudden onset -more rapid progression -can occur in the context of dementia
For an ipsilateral trunk lean, what phase of gait does this occur in? How is this gait deviation described?
-most commonly occurs during reference limb stance -lateral trunk lean toward reference extremity
For a contralateral trunk lean, what phase of gait does this occur in? How is this gait deviation described?
-most commonly occurs during reference limb swing -lateral trunk lean toward opposite extemity
What motor deficits might a child with DCD exhibit?
-moves awkwardly, slowly -rigid/jerky quality of movement -bumps into people/objects -frequent trips/falls -poor balance
How does prolonged bedrest affect the musculoskeletal system?
-muscle *atrophy* -*decreased* mitochondrial density -*dec* aerobic enzymes -bone demineralization/*osteoporosis* (Wolff's law)
Side effects of anti-spasmodic drugs:
-nausea -ab pain/distention -dry mouth -constipation -drowsiness/fatigue -dizziness
What does it mean when Rucker says "one view is no view" with regards to x-rays?
-need at least 2 views to visualize an object in 3D -ideally at views at 90 deg angle to each other -Ex: A/P and lateral
How is force closure of the SIJ achieved?
-neuromuscular control -TA, multifidus, PFM & diaphragm -anticipation of movement -SLS & SL squat are good ways to test this
What is the insular cortex in charge of?
-not well understood -sense of self & introspection
Red Flags of a vestibular exam that warrant further questioning: (12)
-numbness, tingling, weakness -unilateral or progressive hearing loss -slurred speech -tremors -poor coordination -UMN signs: Babinski, spasticity, clonus -loss of consciousness -visual field loss -memory loss -cranial n. dysfunction -spontaneous nystagmus in room light that persists at least 2 wks -vertical nystagmus w/o torsional component in room light
Evaluation results of the following with *acute* UVL (unilateral vestibular loss): -nystagmus -VOR -Romberg -Sharpened Romberg -single leg stance -CTSIB performance -gait -head turn w/ walking
-nystagmus- spontaneous, gaze evoked, light/dark -VOR abnormal-- both slow and thrust -Romberg-- often positive -sharpened Romberg-- unable to do -SLS-- unable to do -CTSIB- foam-- EC unable to do -gait-- wide base, slow cadence, dec rotation -unable to turn head when walking
Evaluation results of the following with *compensated* UVL (unilateral vestibular loss): -nystagmus -VOR -Romberg -Sharpened Romberg -single leg stance -CTSIB performance -gait -head turn w/ walking
-nystagmus--- spontaneous in dark -VOR-- abnormal w/ rapid thrust toward affected side -Romberg-- negative -Sharpened Romberg-- EO normal, EC can't do it -SLS-- normal -CTSIB- foam-- EC normal -gait-- normal -can turn head w/ walking with slow cadence normally get them somewhere between uncomp & compensated, can rate them as well, poorly or decompensated
What conditions can lead to a chest wall restriction? (4)
-obesity -spinal kyphosis -ankylosing spondylitis -neurological disorders
Things that should be included in an exam for a child suspected to have DCD:
-observation (during play especially) -parent report (with younger child) -teacher checklists -child report -PT examination -standardized gross motor testing (Timed Up and Down Stairs, BOT-2, DCDQ etc.)
Subjective portion of a vestibular exam: (questions to ask)
-onset of sx -description of sx: vertigo vs. disequilibrium -are sx spontaneous, induced by motion or position changes? -are sx worse w/ fatigue, in dark or busy environments? -frequency & duration of spells? -any near-falls? -stumbles, sidesteps, drifting with walking? -PMH (diabetes, heart disease, hypertension, headaches, migraines, arthritis, neck/back problems, weakness, hearing problems, visual problems, anxiety etc.) PMH conditions could make them dizzy (Ex: heart condition where their heart isn't pumping blood as well as it should or certain medications)
According to the Ottowa Ankle Rule, a conventional x-ray should be ordered if:
-pain in the malleolar area AND -tenderness at posterior aspect or tip of lateral malleolus OR -tenderness at posterior aspect or tip of medial malleolus OR -inability to WB immediately in emergency department
According to the Ottowa Foot Rule, a conventional x-ray should be ordered if:
-pain in the midfoot area AND -tenderness at base of 5th metatarsal OR -tenderness at the navicular bone OR -inability to WB immediately in the emergency department
What are some common causes of ankle deformities?
-painful heel (toe or forefoot contact at intitial contact) -PF contracture -spasticity -weak DF muscles (foot slap at LR)
What are general contraindications for electrotherapy? (8)
-patients with an electronic device/pacemaker -over carotid sinus -internally (mucosal lining damage) -over eyes -transcranially or in the upper neck in patients w/ hx of CVA, TIA or seizure (unless brain function monitored during stimulation) -transthoracically (careful of heart) -over any area w/ tendency to hemorrhage -over laryngeal or pharyngeal muscles
List the "core" muscles (a.k.a. deep stability system):
-pelvic floor (& hip girdle mm) -TA & obliques -multifidus (& glutes) -diaphragm (these 4 muscles make a box)
What should you look for to ensure a pt's core is stable when performing a single leg squat?
-pelvic ring is symmetrical for weight shift & squat -core contracts for stability -hip ER & QL on stance side are isotonic -ankle invertors & everters are isotonic -hip extensors, knee extensors, and PFs are ecentrically loaded
What should you look for to ensure a pt's core is stable when performing a squat?
-pelvic ring moves as one, in all planes -ischial tubes separate -PFM, glutes, quads, gastroc & soleus are eccentrically loaded -core recruits for stability -look at weight distribution, trunk mechanics & knee & hip motion
What serves as a "reservoir" to spread an infection?
-person with active infection -person who is asymptomatic but is carrying the infection -animal -contaminated food, soil or water
Where do you measure bronchial breath sounds?
-place stethoscope over upper lobes of lungs, close to the sternum along the anterior midline of the thorax at the jugular notch of manubrium -can also hear them along the costosternal region
What physiological changes occur w/ pregnancy?
-placenta produces estrogen & progesterone -relaxin & prolactin are produced -inc heart size & altered position -inc BP, HR, SV & CO -dec CO2, inc O2 -- more efficient breather -inc body water -inc kidney size & weight -altered bladder neck angle -breasts double? in size 1/2 way through -inc uterus size -cervix softens -inc vaginal mucosa & vascularity -dec GI motility-- constipation, reflux & heartburn -inc skin pigmentation & stretch marks
Conventional radiographs are also known as:
-plain films -films -x-rays
What causes the sound of a pleural friction rub?
-pleural membranes become inflamed which causes the lining to be rough and adherent -results in membranes rubbing against each other = pleural friction rub -cells are sticking together & causing pain
Sources of pelvic floor trauma during childbirth:
-position during delivery -size of fetus -speed of delivery (push too long or v fast) -forceps or vacuum extraction -episiotomy or tearing of perineum
If someone is having trouble with stopping, standing, and turning on cue, what are some things you could work with them on?
-practice abrupt stops and starts on verbal cue -practice turns on verbal cue, progressing from a quarter turn to half turn to full turn; progress from wide base turns w/progression to narrow base -figure 8 turns
If someone is having trouble with single and double limb support during gait, what are some things you could work with them on?
-practice controlled lateral and diagonal weight shifts -combine diagonal weight shifts with pelvic rotation movements and stepping forward and backward
If someone is having trouble with foot placement/toe clearance, what are some things you could work with them on?
-practice heel-toe initial contact, tactile cues can be provided to dorsal foot by tapping over pretibial muscles -practice high step marching in place and then high step walking accompanied by marching music -practice walking with even steps using foot prints attached to floor -practice increasing step length and/or step width using floor grids -practice walking with altered BOS, progressing from wide to narrow to tandem -practice step-to walking -practice walking on a 3 inch line taped to floor, half-foam roller, low balance beam
What are some examples of gaze stability exercises? What have these been shown to improve?
-practice looking at an object and rotating head side to side while maintaining gaze -progress this by inc speed, changing the background (checkerboard), stand on foam-- layer these in one by one -then tie it to a functional carry over: turn head during conversation, identify street signs in car, safely cross busy street, w/e sets off their sx improves VOR, dynamic visual acuity & dec fall risk
If someone is having trouble with forward progression and push-off, what are some things you could work with them on?
-practice push-ups (toe rises) in stance, progress to toe walking -practice heel-rises in stance, progress to heel walking -practice forceful push-off on cue during walking -practice alternating between heel-walking and toe-walking
If someone is having trouble with step-ups/step-downs, what are some things you could work with them on?
-practice stepping-up and stepping down with varied height progression -practice lateral step-ups -practice forward step-ups -practice stepping onto and off of varied surfaces
If someone is having trouble with walking against resistance, what are some things you could work with them on?
-practice walking against manual resistance using resisted progression -walking against resistance from resistive band around pelvis -pool walking (ideal initial supportive environment for patients with ataxia)
If someone is having trouble with head movements during gait, what are some things you could work with them on?
-practice walking alternating head movements; alternate b/w taking 3 steps w/ head to R and then 3 steps w/ head to L -practice walking w/ head movements on verbal cue
If someone is having trouble with upright postural alignment, what are some things you could work with them on?
-practice walking upright; assist patient in vertical trunk posture using manual and verbal cues ("look up and stand tall") -trekking poles or body weight support harness can be used to promote upright alignment and reduce UE support, forward head and flexed trunk position (common w/ use of AD like walker) -progress UE support provided by AD to light touch-down support, then to use of a trekking pole or wall for support as needed, and finally to no support
If someone is having trouble with walking sideward, what are some things you could work with them on?
-practice walking using lateral side-steps; resisted progression -practice walking using cross-steps -practice walking using braiding
If someone is having trouble with trunk counterrotation and arm swing, what are some things you could work with them on?
-practice walking with exaggerated arm swings -practice walking with wooden dowels; therapist is behind and holds one end of dowels, patient is in front and holds other end
What are the 4 objectives of the IV STEP Conference?
-prevention -prediction -plasticity -participation
For a forward trunk lean, what phase of gait does this occur in? How is this gait deviation described?
-primary stance -anterior lean of trunk relative to vertical
How do drug resistant microbes develop? (what do they produce and how do they work?)
-produce penicillinase -alter cell membrane composition -genetically mutate targets of the drug
How might you go about improving the duration of walking for a patient?
-progress to longer distances w/ decreased number of rest intervals
In the NICU, what are some interventions you should include that are unique to this population?
-promote normal newborn flexion (vital to development of body movement & control against gravity) -facilitate hand-to-mouth activity -midline position & symmetrical positioning facilitation -support posture & movement -optimize skeletal development & alignment -promote calm state -prevent head deformities & torticollis by changing positions every couple hours -if needed, recommend follow-up care such as early intervention services -provide discharge recommendations
What are sensory and motor impairments categories that could lead to abnormal gait?
-proprioceptive -spacticity -lack of selective control of the muscles (timing, intensity)
What happens with muscle hypertrophy? (4)
-protein is degraded when subjected to mechanical overload -stimulation of molecular pathways that favor protein synthesis -increase the size and amount of contractile elements & number of sarcomeres in parallel -augmentation of the diameter of individual fibers resulting in inc in CSA and strength
What benefits do non-pathogenic (natural flora) get from a host?
-provides them with a steady environment (temperature, moisture etc.) -we as hosts provide them with a steady supply of nutrients
How is the Dix-Hallpike test performed?
-pt starts in long sitting -45 deg cervical rotation -keep head rotated and take pt into supine w/ 20 deg cervical extension -pt must keep eyes open so you can check for nystagmus & vertigo symptoms if they are dizzy when they look to the right, start the test by having them look to the left and expect it to be negative, then when you test the right side if it is positive you can go straight into the treatment
Attachment: rectus abdominis
-pubic crest & ligs of pubic symphysis -costal cartilages 5-7 & xiphoid process -med borders connect via linea alba -enclosed in fascial sheath of TA & obliques
What social/emotional/behavioral deficits might a child with DCD exhibit?
-quiet -withdrawn -avoidance -acting out -low frustration tolerance -dec motivation -poor self-esteem
Tachypnea
-rapid, superficial breathing -regular or irregular rhythm
Other reasons PTs might use electrotherapy (read):
-reduction of acute edema/joint effusion -reduction of chronic edema -enhancement of wound healing -stimulation of circulation -strengthening of muscle -muscle/ movement re-education -reduction of muscle spasm and guarding -reduction of spasticity -inc/maintain ROM, contracture correction -use as a dynamic orthosis -infusion of pharmacologic agents
What is the purpose of habituation exercises?
-repeated exposure to a provocative stimulus to reduce the pathological response -more for motion sensitive patients, such as positional dizziness but not BPPV -progress by having them make the transitions faster or layering in other activities Ex: if they get dizzy when they lay on their L side, have them do this at a moderate pace several times until they are no longer sensitive to it, may be over several treatments
In the NICU, when observing muscle tone, what should you look for?
-resistance to PROM -expect tone to generally be dec in preemies & some full term infants -no opportunity to develop physiological flexion -inability to overcome effects of gravity
Eupnea
-rhythm is smooth -expiration is longer than inspiration
How does pregnancy affect the core?
-rib angle: more perpendicular -diaphragm: elevated 4 cm & must work harder -center of gravity: shifted -abdominal wall: distended (no kidding) -core: limited function -hormones: changes create a lax environment
Why do patients often report feeling a slight tingle prior to muscle movement, but before it becomes painful? (2)
-sensory fibers can be slightly bigger than motor counterparts (large = low threshold for depol) -cutaneous nerves are near the skin surface where the current density is the greatest
What impairments in function will a child show who has DCD? (read)
-sensory/perceptual deficits -motor deficits - balance/posture -motor control deficits -motor learning deficits -physical -social/emotional/behavioral
What are 3 *elastic* adaptations to resistance training?
-series elastic components -parallel elastic components -stretch-shortening cycle
How does the ankle joint help with stability?
-serves as a base of support -provides a rigid lever for push-off when walking or running
What are symptoms of a pleural effusion?
-sharp chest pain, worse with cough or deep breaths -cough -fever -hiccups -tachypnea -SOB: shortness of breath (lol)
Benefits of using an upright posture during child labor:
-shorter duration of 1st and 2nd stage of labor -experience less intervention -report less severe pain -report inc satisfaction w/ childbirth experience
When are patients in the NICU referred to PT services?
-signs of CNS impairment -specific NM or orthopedic problems -multiple medical or genetic problems
What *activity* limitations might a child with DCD exhibit?
-slow, clumsy gait -difficulty w/ self-care -difficulty w/ classroom fine motor skills (handwriting) -delayed and poor quality gross motor skills -delayed oral-motor skills
In the NICU, when observing active movements/strength, what should you look for?
-smooth & symmetrical? -antigravity? (Ex: kicking) -hands to midline? -hands to face/mouth? -pulling a tube? -LE extension to push against bed? -prone? -supported sitting?
What does an abnormal vesicular breath sound sound like?
-softer, more difficult to hear -loss of strong vesicular sound could mean a lack of ventilation
What should bronchovesicular breath sounds normally sound like?
-sound like vesicular on inspiration and bronchial on expiration -means pitch changes b/w insp. & exp. (high pitched insp. and muffled exp.) -appears to be a pause b/w breaths -in kids under 13 yo, sound covers more of the chest
What may be some reasons for inadequate hip extension/excessive hip flexion deviations, which results in loss of hip extension in midstance? (forward leaning of trunk, inc lordosis, and inc knee flexion and ankle DF) and late stance (ant pelvic tilt), and inc hip flexion in swing?
-spasticity or contracture of ipsilateral hip adductors -ipsilateral hip adductor weakness -coxa vara -hip flexion contracture -IT band contracture -hip flexor spasticity -pain -arthrodesis (surgical or spontaneous ankylosis) -loss of ankle DF (same as hip adduction)
What may be some reasons for increased adduction (scissors gait) which results in excessive hip adduction during swing, decreased BOS, and decreased progression of opposite foot?
-spasticity or contracture of ipsilateral hip adductors -ipsilateral hip adductor weakness -coxa vara (= genu valgum) -hip flexion contracture -IT band contracture -hip flexor spasticity -pain -arthrodesis (surgical or spontaneous ankylosis) -loss of ankle DF literal what...(same as hip flexion)
What should be tested in the oculomotor portion of a PT exam for a vestibular pt? (5) *** Abnormalities in which of these indicates sign of central dysfunction instead of peripheral?
-spontaneous/gaze-evoked nystagmus -*smooth pursuit*: maintain gaze at slow speed (H test) -*saccades*: look quickly b/w 2 objects -*VOR cancellation*: eyes & head move together while following own thumb moving side to side -VOR: maintain gaze as head moves (slow, head thrust, head shake, visual acuity tests) abnormalities in bold indicate central dysfunction
Purpose of VSR (vestibulo-spinal reflex)
-stabilize the body -responds to falling/tipping (test by putting them on something that tips)
For a backward trunk lean, what phase of gait does this occur in? How is this gait deviation described?
-stance or swing phase -posterior lean of the trunk relative to vertical
For a contralateral pelvic drop, what phase of gait does this occur in? How is this gait deviation described?
-stance phase -drop of contralateral iliac crest below ipsilateral iliac crest
What are some characteristics of antalgic gait? (6)
-stance phase on affected limb is shorter -swing phase of uninvolved side is shorter -shorter step length on uninvolved -decreased walking velocity -decreased cadence -*involved muscles might be inhibited and weak*
3 side effects of hyperosmotic laxatives:
-stomach pain -gas -cramps
3 types of anti-diarrhea agents: (review)
-stool thickeners -bulking drugs -anti-spasmodic drugs
What are common "complementary interventions" that can be done with a patient for working on gait?
-strength -ROM -balance -transfers
Treatment: Uterine Prolapse
-strengthen PFM may help -fwd bending takes pressure off and provides ST relief of sx -usually gets better on it's own in ~12 weeks -but if it's true prolapse, surgery or pessary are the best treatments
Symptoms: Pelvic Girdle Pain
-sudden or gradual onset -~24-36 wk gestation or post-partum -pain: *post at SIJ, glutes*, pubic symphysis, groin, perineum, post thigh -lacks specific nerve root distribution -positive neural tension tests -difficulty: sit to stand, roll in bed, prolonged sitting or walking, dressing, carrying, stair climbing, SLS (do better when they're moving, but too much makes it worse)
What are 4 main reasons why PTs use electrotherapy?
-supplementation of functional activity -strengthening of muscle (atrophy) -reduction of acute pain -reduction of chronic pain
For an ipsilateral pelvic drop, what phase of gait does this occur in? How is this gait deviation described?
-swing -drop of ipsilateral iliac crest below contralateral iliac crest
For a pelvic hike, what phase of gait does this occur in? How is this gait deviation described?
-swing -elevation of ipsilateral iliac crest above contralateral iliac crest
What does pathogenicity refer to?
-the ability of a microbe to cause disease (also refers to a non-pathogen becoming pathogenic)
Stimulant laxatives should be taken if:
-the bowel is full but the person feels that they can't empty it -if bulk-forming laxatives aren't appropriate
What is neuroscience?
-the study of the NS -development, chemistry, structure, function & pathology of NS
What are the characteristics of tibial torsion? What is a possible implication of this?
-the tibia is rotated in the transverse plane along the vertical axis -may increase stress to the knee and foot structures due to misalignment
What is examined with a blood test in determining the source of infection?
-the variations in numbers of leukocytes -differential count (ratio of WBC types) -C-reactive protein -Erythrocyte sedimentation rate (ESR)
What should be done if bronchial sounds are heard in other areas? (Ex: bronchopulmonary segments, right middle lobes, or bilaterally in lower lobes)
-these are abnormal breath sounds and require immediate referral -could be indicative of fluid in lungs or compressed, consolidated lung
How do stool thickeners work?
-they have ingredients that carry pectins or clays that thicken the stool -they also have an effect on bacteria/toxins that might cause diarrhea
What does it mean to say that the SIJ's are bicondylar joints?
-they must be accompanied by a correlative mvmt at the other bicondylar joint -talked about this in reference to the frontal plane, if one SIJ moves, the other SIJ will move too -they can either move together (ant/post pelvic tilt) or in opposite directions (ilia rotation)
Appearance of sputum due to asthma or cystic fibrosis. If there is blood present, what does this mean?
-thick, sticky mucus -if there is blood present it could indicate a rupture of superficial capillaries or a sign of a tumor or TB
Treatment: Menopause
-topical treatment (estrogen or just oils for moisture) -strengthen or lengthen PFM -educate about lubricants -educate about body mechanics & avoiding straining -strengthen core
What's considered a positive Dix Hallpike test?
-torsional nystagmus in provocative position -appears w/in a few seconds & lasts <1 min -reversible if return to upright -fatiguable nystagmus response
What are some joint disease causes of antalgic gait?
-traumatic arthritis -infectious arthritis -rheumatoid arthritis -crystalline arthritis (gout and pseudogout) -hemarthrosis (bleeding into joint space) -bursitis
Summary for vestibular rehab (read)
-treat BPPV first if present -base treatment around impairments identified in eval. (gaze stabilization, habituation, static/dynamic balance, fall safety) -peripheral lesions respond better to vestibular rehab than central -gradually inc speed/complexity of movements -educate pt that they may feel a little worse before they get better
List some precautions or contraindications to performing a PT exam on a NICU patient:
-unable to tolerate handling: change in O2 sat, RR, HR or BP d/t handling -signs of physiological instability: stop/cancel PT exam Notes: use a conservative approach w/ premature infants
What are side effects of ACh receptor antagonists?
-urinary retention -confusion -constipation -dry mouth
How does Sara recommend you use an SI belt?
-use for short period of time -dec mobility of joints by providing force closure -best position: just below ASIS -should notice relief of pain & ease of lifting leg in supine or stand -may agg sx, so use individually (pretty straight forward-- try it in clinic, see if they think it helps, if yes tell them to order one, if no don't worry about it again)
Dyspnea
-use of accessory muscles for respiration (retraction of muscles b/w or above ribs) -accompanies at times by flaring of the nostrils
In the NICU, how is documentation different?
-usually have specific site requirements or daily note -NIDCAP
What are characteristics of exotoxins?
-usually produced in gram-positive bacteria -secreted in host body and diffuse through body fluids
List the 3 sensory systems that help us maintain balance: What happens if one of these isn't working?
-vestibular -vision -somatosensory If one isn't working well, the other two will have to work harder to maintain balance
What anatomical structures are not working correctly in central vestibular disorders?
-vestibular nuclear complex -central pathways serving VOR & VSR -brain stem or cerebellum
What sensory/perceptual deficits might a child with DCD exhibit?
-visual feedback managed differently and processed more slowly -deficiencies in kinesthetic processing -poor proprioceptive function -heavy reliance on visual feedback
What are some things you could do to improve a patient's ability to perform dual-task walking?
-walk and talk -walk and count by 3s -walk and bounce or toss a ball, carry a tray
If someone is having trouble walking backward, what are some things you could work with them on?
-walking backward...this is life-changing information -practice appropriate knee flexion in combination with hip extension
What are common causes of excessive DF?
-weak PF muscles (did not control the tibial advance - eccentrically) -knee and hip flexion contractures -inadequate toe extension
What may cause excessive hip adduction (pelvic drop)?
-weak glute med -ipsilateral adductor muscle contracture
What are the different ways rales can be described?
-wet or dry -fine, medium or coarse
What do wet rales indicate? What do dry rales indicate?
-wet: fluid is in the lungs & alveoli -dry: collapsed alveoli
FYI: if the patient answers yes to any of the history of resp conditions or smoking questions, what follow up questions should you ask?
-what do you do to keep your asthma under control? -when did you have cancer & what type was it?
Attachment: diaphragm
-xiphoid process -lower 6 ribs -lumbar spine -arcuate lig
Appearance of sputum due to a bacterial infection.
-yellowish-green -thick -cloudy
Specify 3 duties that doctors have to patients
...
Tuskegee
...
AAOS ROM Finger DIP (extension)
0
AAOS ROM Finger PIP (extension)
0
AAOS ROM Thumb MCP (extension)
0
How long is the Eustachian tube open for during a typical swallow?
0.1-0.9 seconds
What is the recommended protein intake for sedentary adults?
0.8 g protein/kgBW/day
How many deep dorsal veins, dorsal arteries, and dorsal nerves are there in the penis?
1 deep dorsal vein 2 dorsal arteries 2 dorsal nerves
What is the recommended protein intake for physically active adults?
1 g protein/kgBW/day
How many inches of lateral pelvic tilt should you have during gait?
1 inch (on swing side)
If a patient's nystagmus lasts longer than ______ after the Dix-Hallpike test, this may not be a vestibular disorder and you should probably talk to their physician
1 minute
Piaget's Development Theory
1. Amoral Phase: self-centered & thinking w/ their senses 2. Egocentric Phase: based on fun, don't follow rules 3. Heteronomous Phase: rules are taken seriously & concretely 4. Moral Relativism: morality comes from logical & abstract reasoning
Kohlberg's Moral Development Theory
1. Pre-Conventional Level: 1st stage- moral judgments are concrete, focus on reward & punishment, 2nd stage- emergence of moral reciprocity 2. Conventional Level: 3rd stage- basic understanding of norms & rules, aware of interests of others, 4th stage- identify social rules 3. Post-Conventional Level: 5th stage- concept of individual rights, 6th stage- theoretical endpoint of commitment to universal principles
What are the 10 Commandments of Dementia Care?
1. adapt & modify 2. enter their reality 3. one size doesn't fit all 4. learn to be flexible 5. normalization is important 6. adapt a task to individual's highest level 7. process is more important than the net result 8. "do what it takes" 9. family is an equal partner 10. through your caregiving, you are a rare and special person
List the steps to dealing with resistive behavior: (6)
1. back off 2. don't take it personally 3. offer encouragement 4. never argue 5. talk in a low, soft voice 6. never yell
International Charter for Human Values in Health Care (5)
1. compassion 2. respect 3. commitment to integrity & ethical practices 4. commitment to excellence 5. justice in healthcare
What are some things you should assess under the B in ABCS of radiology? (4)
1. cortical margin should be dense, w/ lower density cancellous bone & medullary cavity 2. WB surfaces should have higher density 3. low contrast, "washed out", bone suggests *osteoporosis* 4. excessive sclerosis may suggest an *arthritic* or rheumatic condition
List the steps to coping with a dementia pt's agitation and resistance: (7)
1. determine cause 2. be supportive 3. distract the pt and redirect to something purposeful 4. change activity 5. communicate- validation 6. use positive expressions 7. reduce stimulation
What are the 3 steps to a trauma survey? (read)
1. diagnose & evaluate any fracture or dislocation 2. match the MOI to the clinical presentation 3. assess treatment & monitor healing
What is distortion of an x-ray usually due to?
1. distance b/w the beam source, patient and image receptor 2. alignment & positioning issues
What are the main characteristics of a gram-positive cell wall? (4)
1. does not have LPS 2. does not have outer membrane 3. very thick layer of peptidoglycan that is exposed to environment 4. retains crystal violet stain
What are limitations of stride analysis of gait?
1. does not permit angular kinematic and kinetic analysis 2. requires that patients have distinct swing phase involving removal of floor contact
What are the 5 characteristics of spores?
1. dormant (inactive) form of bacterium 2. formed during unsatisfactory conditions from host 3. resistant to heat, drying and disinfectants 4. can survive for years 5. cannot reproduce in spore form
Purpose: Respiration (4)
1. exchange O2 (active) 2. exchange CO2 (passive) 3. control blood acidity 4. oral communication
What are possible causes of Hallux Abducto Valgus (4)?
1. genetics 2. improper shoe wear (toe box) 3. limited great toe extension (~70 degrees needed for gait) 4. overpronation (push off of medial side of great toe)
What are some things you should assess under the A in ABCS of radiology? (4)
1. gross bone size 2. # of bones 3. shape & contour of cortical outline 4. joint position & alignment
What are some things you should assess under S in ABCS of radiology? (3)
1. gross size of muscles 2. outline of joint capsule 3. periosteum
What are the main characteristics of a gram-negative cell wall? (4)
1. has LPS 2. has an outer membrane with a phospholipid bilayer 3. has a very thin layer of peptidoglycan (cell wall) 4. does not retain crystal violet stain
Procedure to measure breath sounds
1. have pt cough a few times beforehand to clear tubes (if they have congestion) 2. place stethoscope at upper chest and move sideways & down across the chest 3. listen to a full inspiration/expiration prior to moving the stethoscope
How does our body try to compensate for: 1. respiratory acidosis 2. respiratory alkalosis 3. metabolic acidosis 4. metabolic alkalosis
1. increased HCO3- 2. decreased HCO3- 3. decreased PCO2 4. increased PCO2
What lab value would tell us if someone was in: 1. respiratory acidosis 2. respiratory alkalosis 3. metabolic acidosis 4. metabolic alkalosis
1. increased PCO2 2. decreased PCO2 3. decreased HCO3- 4. increased HCO3-
What are the 5 different parts of the stance phase of gait? What percentage of the gait cycle is each phase?
1. initial contact (10% w/ LR) 2. loading response 3. mid-stance (20%) 4. terminal stance (20%) 5. pre-swing (10%)
What are the 3 different parts of the swing phase of gait? What percentage of the gait cycle is each phase?
1. initial swing (13%) 2. mid swing (14%) 3. terminal swing (13%)
What should you monitor in a physical exam about a person's respiratory system?
1. is breathing difficult or uneven? 2. are they using diaphragmatic breathing or the upper chest & accessory muscles? 3. can they talk comfortably while breathing or do they have to take a break before finishing sentences?
What are some things you should assess under C in ABCS of radiology? (4)
1. joint space width 2. subchondral bone 3. joint margins 4. epiphyses & growth plates
What are limitations of force plate and pressure plate analysis of gait?
1. limited usefulness in isolation 2. typically requires permanent installation 3. requires technically trained personnel for measurement and interpretation of results 4. expensive
What do the following abbreviations stand for: 1. LBW 2. VLBW 3. ELBW 4. SGA
1. low birth weight (<2500 g) 2. very low birth weight (<1500 g) 3. extremely low birth weight (<1000 g) 4. small for GA (<10th percentile)
How are the following values affected by an obstructive lung disease? 1. forced expiratory volume (FEV1) 2. peak expiratory flow (PEF) 3. total lung capacity (TLC) 4. residual volume (RV)
1. lower 2. lower 3. normal or higher 4. higher
A 74 y/o female presents to the ER with complaints of "nausea & vomiting" x 3 days. She currently resides in a SNF. She has one daughter who is present with her. The patient demonstrates mild confusion. Upon examination, her temperature is 100 deg F, diaphoretic, RR = 16, HR = 124 bpm, BP = 135/88 mmHg. ABG results: pH = 7.51, PCO2 = 40 mmHg, HCO3- = 33 mEq/L, PO2 = 92 mmHg, SaO2 = 96%. 1. What acid/base imbalance do they have? 2. What may be the cause of the condition? 3. Is this patient compensating for the imbalance?
1. metabolic alkalosis 2. vomiting x 3 days 3. not yet, PCO2 is 40 which is <45
What are the 5 main types of exotoxins? What part of the body do they affect?
1. neurotoxins (muscle spasm and paralysis - respiratory failure) 2. enterotoxins (vomiting center) 3. hepatotoxins (liver) 4. cardiotoxins (heart) 5. hemotoxins (blood)
How are the following values affected by a restrictive lung disease? 1. forced expiratory volume (FEV1) 2. peak expiratory flow (PEF) 3. total lung capacity (TLC) 4. residual volume (RV)
1. normal or lower 2. normal or lower 3. lower 4. normal, lower or higher (lol)
What are the 6 areas of the cerebral cortex?
1. parietal lobes 2. temporal lobes 3. frontal lobe 4. occipital lobe 5. limbic lobe 6. insular cortex
Advanced medical imaging in patients with acute low back pain should be reserved for:
1. patients who are considering surgery 2. patients whom systemic disease is strongly suspected
What are the 6 determinants of gait according to Steve?
1. pelvic rotation 2. pelvic tilt 3. lateral shift 4. knee flexion 5. ankle dorsiflexion 6. heel rise
What are strengths of force plate and pressure plate analysis of gait?
1. permits precise measurement of external loads 2. permits analysis of inverse dynamics 3. provides information regarding load patterns and distributions on stance limb
What are strengths of angular kinematic analysis of gait?
1. permits precise measurement of joint angular excursions 2. Objective and quantitative
List Maslow's Hierarchy of Needs from the bottom up:
1. physiological needs 2. safety needs 3. human needs 4. esteem needs 5. cognitive needs 6. aesthetic beauty 7. self-actualization 8. transcendence
What are three main characteristics of endotoxins?
1. present in cell wall of gram-negative bacteria 2. Released when bacterium dies 3. Vasoactive compounds
What are some of the functions of the cell wall in bacteria? (3)
1. protects 2. provides specific shape 3. serves as a basis to determine which of the two types the bacterium belongs to
What are strengths of electromyographic analysis of gait?
1. provides measurement of motor performance and functional role of musculature 2. enhances interpretation of kinematic and kinetic parameters
What are strengths of stride analysis of gait?
1. provides quantitative info regarding time-distance parameters 2. easy and fast 3. low space requirements 4. relatively inexpensive
What are limitations of electromyographic analysis of gait?
1. requires technical expertise for measurement and interpretation 2. subject to interference and artifact during sampling 3. invasiveness of intramuscular technique poses risk to patients
What are limitations of angular kinematic analysis of gait?
1. requires technically trained personnel for measurement and interpretation of results 2. high space requirements 3. limited portability 4. expensive
A 16 y/o male was involved in a MVA. He arrived in the ER by ambulance with an ET tube in place on 100% O2. Upon examination, he suffered a pelvic fracture, femur fracture, internal bleeding and lung contusions. HR = 130 bpm, BP = 90/50 mmHg, RR = 28, IVs x 2. ABG results: pH = 7.25, PCO2 = 65 mmHg, HCO3- = 21 mEq/L, PO2 = 55 mmHg, SaO2 = 85%. 1. What acid/base imbalance do they have? 2. What may be the cause of the condition? 3. Is this patient compensating for the imbalance?
1. respiratory acidosis (RR of 28 indicates he is hyperventilating) 2. anything that keeps the chest wall from expanding (internal bleeding) 3. not yet, bicarb is 21 which is <26
How would a pelvic floor PT assess the pelvic floor?
1. skin integrity 2. reflex testing 3. observe contraction, relaxation & elongation 4. vaginal or rectal palpation & MMT 5. sometimes surface EMG 6. combined w/ full MSK exam
How is the canalith repositioning maneuver performed? (treatment for BPPV)
1. start w/ Dix-Hallpike test & wait until nystagmus stops in supine 2. rotate head 45 deg to other side, keeping neck in slight extension 3. guide pt into sidelying towards direction head is facing and during that have them rotate head to be angled towards the floor, wait for sx to subside 4. guide pt back into sitting, keeping head in the 45 deg rotation 5. tell them not to shake their head around a lot the rest of the day, although research says it doesn't matter if they do this or not wait 30 sec *after sx go away* before moving onto the next step just to make sure the crystals have fallen first
What are limitations of observational analysis of gait?
1. subjective 2. unable to measure more subtle phenomena
What are the 4 points of normalcy we learned about when examining the ankle joint?
1. tibia is vertical 2. calcaneus is in line with the tibia 3. metatarsals are in a plane that is perpendicular to the calcaneus 4. metatarsals in same plane with each other
Where do you measure breath sounds?
1. tracheal 2. bronchial 3. vesicular 4. bronchovesicular (picture in slides)
What are some main characteristics of bacteria? (5)
1. unicellular organisms 2. do not require living tissues to survive 3. classified as prokaryotes 4. complex cell wall structure 5. divide by binary fission
What are strengths of observational analysis of gait?
1. widely available 2. Can be enhanced by simple videotaping 3. Allows classification of gross gait patterns 4. inexpensive
AAOS ROM knee (extension)
10
How many degrees of foot & ankle motion (dorsiflexion) are needed during gait?
10 deg (also includes heel rise determinant)
What is the functional value of dorsiflexion needed for walking?
10 degrees
What percent of patients acquire a nosocomial infection?
10-15%
AAOS ROM Finger PIP (flexion)
100
AAOS ROM hip (flexion)
120
AAOS ROM knee (flexion)
135
AAOS ROM Tarsal (Eversion)
15
AAOS ROM Thumb CMC (flexion)
15
How many degrees of knee flexion should occur early on (in mid-stance) during gait?
15-20 deg
At what age do varicoceles occur in men most often?
15-25 years old
AAOS ROM Elbow (flexion)/(extension)
150 / 0
AAOS ROM Shoulder (abduction)
180
AAOS ROM Shoulder (flexion)
180
Traditionalists (Massey)
1930's to 40's value patriotism, hard work, family member roles, privacy, loyalty & trust and social order
Baby Boomers (Massey)
1945-1965 grew up in good economic times value competition, change, hard work, success, body language, teamwork, anti-rules, inclusion, & fighting for a cause
Challengers (Massey)
1960's to 70's value individualism, wealth, power, inclusion, change, competition, skepticism of rules, teamwork & accomodation
Gen Xers (Massey)
1967-1977 inflation, unemployment, divorced families, sexual revolution value balance, entrepreneurial spirit, loyalty, creativity, independence, information, quality of work life & feedback
Gen Yers (Massey)
1978-1995 technology revolution, 9/11, inc crime value positive reinforcement, autonomy, positive attitudes, diversity, money, & technology
Synthesizers (Massey)
1980's to current values a mix of things, conservatism, skepticism, adaptation & creativity
What are 3 cylinders of erectile tissue of the penis called?
2 corpus cavernosum 1 corpus spongiosum
Stool thickeners should not be taken for more than:
2 days
What is the max level of protein intake that is recommended for adult athletes?
2 g protein/kgBW/day
AAOS ROM Talocrural (DF)
20
AAOS ROM Thumb CMC (extension)
20
AAOS ROM Thumb IP (extension)
20
AAOS ROM Wrist (Radial Deviation)
20
AAOS ROM hip (extension)
20
What is the functional value of dorsiflexion needed for running?
20 degrees
What percent of the total gait cycle is spent in single leg support? Double?
20% in double support 80% in single support
For (motor?) stimulation, generally we use ____ to ____ Hz stimulation with a _______ (long/short) pulse duration
20-40 Hz long pulse ( >300 ms)
When do the testes normally pass through the inguinal canal?
21-25 weeks or 8th month of conception
What is the normal concentration of HCO3- in blood?
22-26 mEq
By the age of 65 you've lost approximately ___ to ____% of muscle mass
25-30%
A radiograph is a ____-dimensional picture of a ____-dimensional object
2D picture of 3D object
Do women w/ pelvic girdle pain show inc or dec motion of the pelvic joints?
32-68% more motion (generally, this is an instability problem)
AAOS ROM Tarsal (Inversion)
35
ROM Thoracolumbar (Lateral Flexion)
35
What is the normal PCO2 of blood?
35-45 mmHg
How many degrees does the pelvis rotate during gait?
4 deg post on terminal stance 4 deg forward on terminal swing
How long can the effects of PPIs can last?
4 weeks
AAOS ROM Finger MCP (extension)
45
AAOS ROM MTP (flexion)
45
AAOS ROM hip (abduction)
45
AAOS ROM hip (lateral rotation)
45
AAOS ROM hip (medial rotation)
45
AMA ROM Cervical (Lateral flexion)
45
ROM Thoracolumbar (Rotation)
45
AAOS ROM Subtalar (Inversion)
5 (but often 2:1 ratio with subtalar eversion)
AAOS ROM Subtalar (Eversion)
5 (but often 2:1 ratio with subtalar inversion)
What amount is normal for pelvic drop/tilt during gait?
5 deg (~1 in)
During an erection, by how much does the blood flow to the area increase?
5-10 fold
AAOS ROM Talocrural (PF)
50
AAOS ROM Thumb MCP (flexion)
50
AMA ROM Cervical (flexion)
50
Muscle contractions generally don't exceed ____ Hz
50 Hz
What % of the gait cycle is made up by the stance phase? What about the swing phase?
60% 40%
_____% of the gait cycle (for one side) is spent in stance, and _____% of the gait cycle is spent in swing
60% in stance 40% in swing
Nerve conducts ___x faster than muscle, but is surrounded by a ______ layer and sheath
6x faster fat layer
AAOS ROM MTP (extension)
70
AAOS ROM Shoulder (MR/IR)
70
AAOS ROM Thumb CMC (abduction)
70
AAOS ROM Wrist (extension)
70
What is the cut off FEV1/FVC ratio for COPD?
70% or lower
In developing countries, ___% of the population carries the bacteria that can cause ulcers
70-80%
You have a loss of about ____% of muscle mass per decade after 30
8%
AAOS ROM Thumb IP (flexion)
80
AAOS ROM Wrist (flexion)
80
AAOS ROM forearm (pronation)
80
AAOS ROM forearm (supination)
80
AMA ROM Cervical (rotation)
80
What is the norm value for FEV1/FVC ratio?
80% of your air should be exhaled in 1 second Normal FEV1: 4 L Normal FVC: 5 L 4/5 = 80%
Sensory stimulation generally uses a frequency between _____ and ______ Hz
80-120 Hz
Do varicoceles occur on the left or right side of the scrotum more frequently? Why?
90% of the time on the left L testicular V drains into L renal V which may be compressed by SMA which increases the pressure in both veins
What is an Acoustic Neuroma?
A benign Schwann cell tumor of cells which myelinate CN VIII, that arises from the vestibular portion of the nerve
Dorsal Root Ganglion
A bulge on the dorsal root that contains the cell bodies of sensory neurons
What is an imperforate hymen?
A congenital disorder where a hymen fails to undergo apoptosis and thus remains intact & without an opening
What is otosclerosis?
A hereditary disorder causing conductive hearing loss, due to overgrowth of bone at the annular stapedial ligament, which prevents the stapes from moving at the oval window and leads to a loss of vibration
Central Canal
A narrow central cavity that is continuous with the ventricles of the brain
Dorsal Root
A nerve root that fans out into dorsal rootlets to connect to the posterior spinal cord. It contains the axon of sensory neurons
Ventral Root
A nerve root that is formed by the ventral rootlets connected to the anterior spinal cord. It contains the axons of the motor neurons
What is Hallux Abducto Valgus?
A progressive adduction of the first metatarsal and lateral deviation of the great toe, creating a larger medial angle at the first MTP joint
What is torsion of the testis?
A sudden twisting of the spermatic cord resulting in strangulation of the blood vessels serving the testis and epididymis
What is Myringotomy?
A surgical incision into the ear drum to relieve pressure or drain fluid with pressure equalization tubes
What are some advantages and disadvantages of MRIs?
A: *good sensitivity*, images soft tissue well, no ionizing radiation, little distortion D: *low specificity*, expensive, contraindicated if pt has a ferrous metal implant or exposure
What are the ABCS of radiology?
A: alignment B: bone density C: cartilage S: soft tissue
What are some advantages and disadvantages of CT scans?
A: both sensitive & specific for *fractures*, useful for quick assessment of brain or neuro injury D: radiation exposure, discriminates density but limited in precise hist. differences, small volumes of tissue image as a uniform shade of gray
What are the advantages and disadvantages of a bone scan (radionuclide scintigraphy)?
A: highly *sensitive* for early bone & joint disease, fast, reasonable cost, easily influenced by osteoblastic activity or blood flow of any etiology (detects bone cancer) D: *poor specificity*
What are some advantages and disadvantages of x-rays?
A: time & cost efficient, non-invasive, low risk, good for screening D: may be normal when a pathology actually exists
How does an orthosis fixing the ankle in neutral affect gait?
AFO in neutral causes excessive DF at LR (b/c you can't PF and normally at LR there is 10 deg of PF, therefore it's excessive DF), the effect is an excessive knee flexion as it follows the tibia
What are a couple examples of diseases that could develop from non-pathogenic microbes that became pathogenic at some point?
AIDS Chronic bronchitis in smokers
What are 2 types of modulation?
AM - amplitude modulation FM - frequency modulation
Which division of your nervous system innervates the smooth muscle that surrounds blood vessels?
ANS- sympathetic & parasympathetic NS
What is a hydrocele in relation to male genitalia? Is it congenital or acquired?
Abnormal accumulation of fluid in the sac of tunica vaginalis Can be congenital or acquired, but most congenital hydroceles spontaneously resolve during the first year of life
What fiber types innervate the penis? (4)
Afferent: dorsal N of penis (pudendal N) Parasympathetic: inc blood flow to erectile tissues Sympathetic: dec blood flow Motor: bulbospongiosus & ischiocavernosus mm
Opening the auditory tube during swallowing allows what?
Air from the nasal pharynx to move into the middle ear, which otherwise would have a pressure negative to atmospheric pressure
What does a fourth degree laceration of the birth canal include?
All of 1-3 degree plus: Rectal mucosa to expose rectal lumen
What does a third degree laceration of the birth canal include?
All of 1st and 2nd degree plus: Anal sphincter muscles
What does a second degree laceration of the birth canal include?
All of 1st degree plus: Fascia & muscles of perineal body
What changes in the active stability system has research shown to take place with LBP?
Altered core mm recruitment: --TA delayed --glute max delayed --deficient core & load transfer may be related to LE function & injury
What is the frenulum of the clitoris?
Anterior commissure of the labia minora, attach to undersurface of clitoris
Anterior (Ventral) Horn
Anterior projections of the gray matter that contain the cell bodies of somatic motor neurons and some interneurons
Name a philosopher who is associated with the virtue theory
Aristotle
What nervous system is involved in female arousal and female orgasm?
Arousal: parasympathetic Orgasm: sympathetic
What is the function of deep/Buck's fascia of the penis?
As erectile tissue expands with increased blood flow, the fascia presses on the deep dorsal vein to limit blood flow out of the penis to keep it erect
What happens if cryptorchidism is left untreated?
At 2 years old, 30-40% of undescended testicles had no spermatogonia Only 10% of untreated men remain fertile even if its only unilateral
In a gram-negative bacteria, where is the cell membrane located?
BOTH underneath and above the cell wall
If a patient presents with a problem that is likely vestibular, which diagnosis should you treat first when in doubt?
BPPV
What is the single most common cause of dizziness encountered in the clinic?
BPPV (Benign Paroxysmal Positional Vertigo)
What are the different types of microorganisms?
Bacteria Viruses Fungi Protozoa
What is a main difference between bacteria and viruses when referring to living conditions?
Bacteria can live outside of the host whereas viruses cannot
Why are enzymes significant when referring to bacterial toxins?
Bacteria produce enzymes that damage tissues and allow an infection to spread further and quicker
Why are there more side effects with ACh M1 Receptor Antagonists?
Bc there are ACh receptors located all over the body (including the brain)
What report was commissioned in response to the Tuskegee study?
Belmont Report
What is the purpose of having non-pathogenic microorganisms?
Beneficial to both the host and the microbes
What 2 things does the male urethra connect?
Bladder (internal urethral orifice) End of penis (external urethral orifice)
What type of muscle contracts during female orgasm?
Both smooth and skeletal muscle Smooth: vaginal wall Skeletal: pelvic floor
What is the penis the outlet for?
Both urine and semen
How does collagenase function as an enzymatic bacterial toxin?
Breaks down the collagen that supports the ECM, causing the cells to break apart from each other
Proximally, what does the corpus spongiosum expand to be?
Bulb of the penis
What does the artery of the bulb of the penis supply?
Bulb of the penis Bulbourethral glands
Contraction of what muscle expels both semen and urine from the base of the penile urethra?
Bulbospongiosus
Contraction of which muscles force blood into the clitoris glans and body?
Bulbospongiosus Ischiocavernosus
What muscles cover the base of the bulb of the penis and the 2 crura (crus)?
Bulbospongiosus Ischiocavernosus
Where are the bulbs of the vestibule in relation to the perineal membrane?
Bulbs of the vestibule are superficial to the perineal membrane
Innervation of tensor tympani:
CN V3 (mandibular trigeminal)
Innervation of Stapedius:
CN VII (facial)
Which nervous systems must be intact for female sexual response?
CNS, sympathetic NS, somatic NS, and vascular response
Bronchitis, asthma and emphysema are examples of what kind of disorder?
COPD
In what type of imaging does an x-ray tube and film move around a fulcrum?
CT scan
What are the 2 types of BPPV? How do you know the difference based on symptoms?
Canalithiasis (otoconia in SC canals- common) Cupulolithiasis (otoconia stuck to cupula- rare) DD with duration of nystagmus-- cupulo lasts longer
Who is at the greatest risk for otosclerosis?
Caucasian women (and those who have 2 parents with otosclerosis)
Is the Eustachian tube normally open or closed at rest?
Closed
Where are excellent sites for lodging of foreign objects (kids stick things up nose)?
Conchae and meatuses
What is an endemic?
Continuous transmission within a population
Which layer of erectile tissue of the penis houses the male urethra?
Corpus spongiosum
Where are the clitoral crura in relation to the perineal membrane?
Crura are superficial to the perineal membrane
What is an episiotomy and when is it done?
Cutting of the vagina to aid in birthing process
What might cause reversible dementia? (8)
D: drugs E: emotional disorders M: metabolic or endocrine disorders E: eye & ear dysfunction N: nutritional deficiencies T: tumor & trauma I: infection A: arteriosclerotic complications and alcohol
What is a widely used method of measuring bone mineral density?
DEXA (dual energy x-ray absortiometry)
What are the 2 main categories of viruses?
DNA RNA
What are the risks of prolonged bedrest? (8)
DVT Depression Poor balance muscle weakness nausea blood sugar changes dizziness with movement changes in hearing and vision
Author of "Organized Obfuscation: Advocacy for Physician-Assisted Suicide"
Daniel Callahan
"the well-being of the human subject should take precedence over the interests of science and society"
Declaration of Helsinki
What blood vessels are at the level of the deep/Buck's fascia of the penis?
Deep dorsal vein and dorsal arteries of the penis
Which arteries are in the center of the corpus cavernosum?
Deep penile arteries
Where does the fundiform ligament of the penis attach to?
Deep/buck's fascia to the linea alba superiorly "hammock"
Where does the suspensory ligament of the penis attach to?
Deep/buck's fascia to the pubic symphysis
How would a patient describe dizziness (vertigo) compared to disequilibrium?
Dizzy: the room is spinning (peripheral vestib. disorder) Disequilibrium: the world is moving and I am moving, my vision seems wavy (central vestib. disorder)
What are the 3 branches that the internal pudendal artery gives off in females?
Dorsal A of clitoris Artery of the bulb of the vestibule Perineal AA
What does the pudendal N branch into in females?
Dorsal N of clitoris Posterior labial NN Superficial & deep perineal NN
What are the 3 branches that the internal pudendal artery gives off in males?
Dorsal penile AA Deep penile AA Artery of the bulb of the penis
Which arteries are just deep to Buck's fascia?
Dorsal penile arteries
What happens to the ERV and FEV of someone with COPD?
ERV: decreases FEV: decreases
What happens to the residual volume (RV) as a person gets older?
ERV: decreases RV: increases
What category of bacterial toxins does E. Coli fit into? (be specific)
Enterotoxins (Exotoxin)
What are the bulbs of the vestibule?
Erectile tissue on either side of the vaginal orifice Homologous to the bulb of the penis
During cholesteatoma, the tympanic membrane is pulled into the middle ear by negative pressure due to:
Eustachian tube dysfunction
FYI: when viewing an x-ray film, the identification letters may be backward or upside down
Ex: L. AP or R. lateral
What do the external and internal oblique muscles become in the scrotum?
External: external spermatic fascia Internal: cremaster muscle
hip (abduction)
F- ASIS SA- ASIS contralateral MA- midline patella, anterior femur
hip (adduction)
F- ASIS SA- ASIS contralateral MA- midline patella, anterior femur
Cervical (Lateral flexion)
F- C7 spinous process SA- Thoracic spinous processes MA- dorsal midline of head (inion)
Subtalar (Eversion)
F- between malleoli on achilles tendon SA- posterior midline lower leg MA- posterior midline calcaneus
Subtalar (Inversion)
F- between malleoli on achilles tendon SA- posterior midline lower leg MA- posterior midline calcaneus
Thoracolumbar (Rotation)
F- center of cranial aspect of head SA- parallel to imaginary line between the two ASISs/iliac crests MA- parallel to imaginary line between two acromial processes
Cervical (rotation)
F- center of cranial aspect of head SA- parallel to line between two acromion processes MA- tip of nose
Thumb MCP (extension)
F- dorsal aspect MCP joint SA- dorsal midline metacarpal MA- dorsal midline proximal phalanx
Thumb MCP (flexion)
F- dorsal aspect MCP joint SA- dorsal midline metacarpal MA- dorsal midline proximal phalanx
Finger MCP (extension)
F- dorsal aspect MCP joint SA- dorsal midline metacarpal MA-dorsal midline prox. phalanx
Tarsal (Eversion)
F- in between malleoli, front of ankle SA- mid shaft tibia, tibial tuberosity MA- 2nd MT
Tarsal (Inversion)
F- in between malleoli, front of ankle SA- mid shaft tibia, tibial tuberosity MA- 2nd MT
Thumb CMC (abduction)
F- lateral aspect radial styloid process SA-2nd metacarpal MA- midline 1st metacarpal
knee (flexion)
F- lateral femoral epicondyle (superior to joint line) SA- mid line femur, greater trochanter MA- lateral midline fibula, lateral malleolus
knee (extension)
F- lateral femoral epicondyle (superior to joint line) SA- mid line femur, greater trochanter MA- lateral midline tibia, lateral malleolus
Talocrural (DF)
F- lateral malleolus SA- mid line lateral leg, fibular head MA- 5th metarsal *seated with legs off table*
hip (lateral rotation)
F- mid point patella SA- perp. To floor MA- anterior midline tibial (in between ankle malleoli)
hip (medial rotation)
F- mid point patella SA- perp. To floor MA- anterior midline tibial (in between ankle malleoli)
Big Toe MTP (extension)
F- over top of MTP joint SA- 1st MT MA- prox phalanx
Big Toe MTP (flexion)
F- over top of MTP joint SA- 1st MT MA- prox phalanx
Thumb CMC (extension)
F- palmar aspect first CMC joint SA- midline radius, radial head and radial styloid process MA-midline 1st metacarpal
Thumb CMC (flexion)
F- palmar aspect first CMC joint SA- midline radius, radial head and radial styloid process MA-midline 1st metacarpal
Thoracolumbar (Lateral Flexion)
F- posterior aspect S2 SA- perpendicular to the ground MA-posterior aspect spinous process C7
Wrist (extension)
F- triquetrum SA- lateral midline ulna, olecranon and styloid MA- 5th metacarpal
Wrist (flexion)
F- triquetrum SA- lateral midline ulna, olecranon and styloid MA- 5th metacarpal
Finger DIP (extension)
F-dorsal aspect DIP joint SA- dorsal midline middle phalanx MA- dorsal midline distal phalanx
Finger DIP (flexion)
F-dorsal aspect DIP joint SA- dorsal midline middle phalanx MA- dorsal midline distal phalanx
When are fine, medium & coarse rales heard?
F: at the beginning of inspiration when air first enters tree M: at any stage of inspiration C: at any stage of inspiration
How do restrictive lung diseases affect FEV1, FVC and the ratio?
FEV1: 2.8 L FVC: 3.1 L FEV1/FVC: 90% (lungs are thick/hard so they can't expand very well-- Ex: pregnancy, SCI, pulm fibrosis)
Formulate ethical arguments for and against physician assisted suicide
FOR beneficence requires doctors to relieve unbearable suffering respect for persons requires honoring a patient's informed wishes AGAINST sanctity of life may lead to acceptance of euthanasia patients change their minds once pain is controlled
FYI: myopathies, neuropathies, anorexia, paralytic ileus, altered clearance of drugs, altered circadian rythym and pressure ulcers might also result due to prolonged bedrest
FYI
FYI: small interventions like upright activities can make a big difference in the effects of bedrest
FYI
FYI: some clinicians may not differentiate b/w tracheal and bronchial sounds, calling them tracheobronchial
FYI
FYI: the better in shape a patient is in when starting prolonged bedrest, the faster they will experience the effects of bedrest... "life is unfair"
FYI
T/F: peripheral vestibular disorders are more difficult to treat in PT than central vestibular disorders
False-- central more difficult than peripheral
T/F: it is easier for the body to compensate for a central vestibular disorder compared to a peripheral vestiublar disorder
False-- easier to compensate for a peripheral vestib. disorder bc the brain is intact
What does vulva refer to?
Female external genitalia
What is vaginal lubrication during sexual arousal due to?
Fluid transudate passing through the vaginal mucosa, increased cervical mucous gland secretion, and increased Bartholin's glands secretion
What is the definition of ejaculation? Which sphincters must open/close? What muscle is involved?
Forceful removal of semen from the urethra Internal urethral sphincter closes, and external urethral sphincter opens Bulbospongiosus muscles contract forcing semen from the penis base
Spinal Nerve
Formed by the fusion of dorsal and ventral roots. They are mixed nerves because they contain both sensory and motor fibers
What does a first degree laceration of the birth canal include?
Fourchette Perineal skin Vaginal mucosa
What is the fourchette?
Frenulum posterior to the vaginal opening
Is the fundiform or suspensory ligament more superficial?
Fundiform
What are external moments around joints created by?
GRF
the NIH discovered that ulcers can be caused by:
H. pylori bacteria
How is cryptorchidism treated?
HCG treatment may sometimes stimulate testicular descent, otherwise early surgery is recommended
Eating stimulates the stomach to produce:
HCl
What 3 things can infection of the middle ear reduce?
Hearing, salivation, and taste
What can negatively affect nasal cilia/
Heat, cold, dryness & drugs
What is a major regulator of acid secretion in the stomach?
Histamine
What position is the knee in, in degrees, during each phase of the gait cycle?
IC: 0-5 flexion LR: 15 flexion MS: 0-5 flexion TS: 0-5 flexion PS: 45 flexion IS: 60 flexion MS: 25 flexion to ext TS: 5 flexion
What position is the hip in, in degrees, during each phase of the gait cycle?
IC: 20-35 flexion LR: 20 flexion MS: neutral/extension TS: 20 extension PS: 0-10 extension IS: 15 flexion MS: 25 flexion TS: 20 flexion
During the stance phase of gait, when is the GRF anterior or posterior to the knee? Does this make the knee want to move into flexion or extension?
IC: anterior (ext) LR: posterior (flx) MS: anterior (ext) TS: anterior (ext) PS: posterior (flx)
During the stance phase of gait, when is the GRF anterior or posterior to the hip? Does this make the hip want to move into flexion or extension?
IC: anterior (flx) LR: anterior (flx) MS: posterior (ext) TS: posterior (ext) PS: posterior (ext)
What position is the ankle in, in degrees, during each phase of the gait cycle?
IC: neutral LR: 0-5 plantarflexion MS: 5 dorsiflexion TS: 10 dorsiflexion PS: 20 plantar flexion, 70 MTP extension IS: 5 plantarflexion MS: neutral TS: neutral
During the stance phase of gait, when is the GRF anterior or posterior to the ankle? Does this make the ankle want to move into flexion or extension?
IC: posterior (PF) LR: posterior (PF) MS: anterior (DF) TS: anterior (DF) PS: anterior (DF)
What does overactivity of the internal oblique muscle affect the rib angle? external oblique?
IO: inc inf rib angle or rib flaring EO: dec inf rib angle or rigidity of rib cage
What happens to the IRV of someone with a chest wall restriction?
IRV: decreases
For a hip flexion deformity, _______ contracture can mimic a rigid _____ contracture
IT band contracture can mimic a rigid joint contracture
Where are holes in the tympanic membrane usually made for myringotomy?
In the inferior half of the tympanic membrane, often posterior or near to the "cone of light", away from ossicles and chorda tympani N.
What is sinusitis?
Inflammation of 1+ of the paranasal sinuses Often refers to bacterial infection secondary to viral infection
What is the most frequent site of cryptorchidism?
Inguinal canal It can also be in the abdomen or prescrotal area
What professional standards provide guidance on conflicts of interest?
Institute of Medicine (IOM)
What does IRB stand for?
Institutional Review Boards
What does the transversalis fascia become in the scrotum?
Internal spermatic fascia
Where does the superficial transverse perineal muscle attach?
Ischial ramus to the perineal body (was not bolded)
If a man undergoes a vasectomy, how is spermatogenesis affected?
It continues at a normal or slightly lower rate Testosterone levels appear unchanged Sperm are thought to be broken down within the epididymis
What is the hymen a mark of?
It demarcates the vulva from the vaginial orifice
What does the Eustachian tube do?
It equilibrate the pressure of the closed middle ear cavity with the air pressure in the nasal pharynx only during *swallowing and yawning*
What is the function of the external ear?
It functions to collect sounds
How does streptokinase work as an enzymatic bacterial toxin?
It functions to dissolve blood clots and bacteria may carry this "tool" to be able to penetrate the blood stream, allowing another means for spread of infection
What is the function of the middle ear?
It functions to transmit vibration in air to fluid in the inner ear
How does a vasectomy compare to other methods of birth control?
It has a failure rate below the pill, condom, IUDs, and tubal ligation
What does the tunica albuginea cover?
It is a connective tissue layer that surrounds each cylinder of erectile tissue and the innermost layer of testis
How urgent is torsion of the testis? Why?
It is considered a medical emergency, the testicle will die off in 4 hours if untreated.
What is emission in relation to male sexual function?
It is defined as the delivery of sperm from the vas deferens, prostatic secretions and seminal secretions into the prostatic urethra
What does it mean to say an episiotomy is done prophylactically?
It is done as a preventative measure, to limit tearing of the vagina and perineal body during birth
Does female orgasm affect fertilization?
It is not required, but it increases the likelihood of fertility success
What is detumescence and when does it occur?
It is the loss of erection that usually follows the sympathetic discharge required for emission/ejaculation
Where is the vestibule?
It is the space between the labia majora, generally closed
Name 2 philosophers that promoted the utilitarian theory
John Stuart Mill Jeremy Bentham
What is another name for deontological theory?
Kantianism
What is the function of the scrotum?
Keep the testicles and epididymis cooler than abdominal temperatures
Why are LPS significant in bacterial toxins?
LPS are crucial to baterial integrity when cell is alive, if the LPS is removed or damaged for some reason the cell will die, and release endotoxins into the body
How does someone compensate for weak quadriceps in the load response and midstance phases of gait?
LR - avoids knee flexion (15 deg) by pushing knee into extension MS - knee hyperextension
What happens if the person lacks knee flexion in the loading response or early mid-stance phase?
LR allows us to accept weight and progress forward, if you can't do this, you might be "pushed back" so you can't move forward as easily
What are causes of limited hip flexion? (based on phase of gait)
LR: -spacticity -contracture -dec tone -proprioceptive loss Pre/initial swing: -excess plantar flexion -contracture -knee pain or effusion -calf weakness (seems really wrong)
What are some common causes of limited knee flexion (based on phase in gait)
LR: -spasticity -contracture -dec tone -proprioceptive loss Pre/initial swing: -excess PF -contracture -knee pain or effusion -calf weakness -hip flexion contractures
In counternutation of SIJ, the base of the sacrum moves superiorly & posteriorly. What happens to the lumbar spine?
LS flexes
Do the labia majora or minora contain the round ligament of the uterus?
Labia majora
Do the labia majora or minora immediately surround the vestibule of the vagina?
Labia minora
Where does the ethmoid sinus refer pain to?
Lateral to the eyes
What does LPS stand for?
Lipopolysaccharide
What does the prediction objective from the IV STEP Conference focus on?
Look at ways to classify movement disorders & link it w/ accurate predicted outcomes -predict intervention to get optimal response via movement system diagnosis -ex: Berg Balance Scale classifies pts for risk of fall
List some complications of prematurity that you may see in their PMH:
Lungs: -compromised breathing -resp distress syndrome -bronchopulmonary dysplasia -chronic lung disease GI: -feeding problems Brain: -seizures -myelominigocele -microcephaly -hypoxic ischemic encephalopathy -intraventricular hemorrhage (IVH) -periventricular leukomalacia (PVL) Eyes: -retinopathy of prematurity (ROP)
Which type of imaging uses pulses of radio frequency and a strong external magnet to generate an electromagnetic field?
MRI
What are possible causes of ipsilateral trunk lean?
Most commonly occurs during reference limb stance. Compensation for *ipsilateral hip abductor weakness, hip joint pain, IT band tightness, or scoliosis*
What are the greater vestibular glands (Bartholin's glands)?
Mucus secreting glands with openings in the vestibule
Posterior (Dorsal) Funiculus
Myelin Coat (good clean "fun")
If someone puts on a lot of weight, will fat accumulate in the scrotum?
No, there is never fat in the scrotum
The otoliths detect ________ acceleration The semicircular canals detect ___________ acceleration options: angular, linear
O: linear SCC: angular
Are PPIs or H2 blockers more expensive?
PPIs
What is the drug of choice for treating ulcers and GERD?
PPIs
Are PPIs or H2 blockers more effective in reducing acid?
PPIs (can reduce acid up to 90%)
What does the prevention objective from the IV STEP Conference focus on?
PT role in preventing onset & progression of disabling diseases -*primary prevention*: before it happens-- ex: wear a helmet -*secondary*: procedure to detect & treat before pathological changes -*tertiary*: minimize impact of movement disorders on pt activity --ex: gait train to dec falls in PD pt
Define: Pelvic Girdle Pain
Pain in 1+ of the pelvic girdle joints: -pubic symphysis -lumbo-sacral joints -sacroiliac joints -hip joints (affects 20% of pregnant women)
Why are pudendal nerve blocks sometimes done?
Pain relief from child birth Traditionally done transvaginally
Where do the testicles drain blood to?
Pampiniform plexus (venous)
Are cavernous nerves sympathetic or parasympathetic?
Parasympathetic involved in development of an erection by increasing blood flow to corpus cavernosum
Which nervous system is required to make the penis erect? (also which nerves specifically)
Parasympathetic NS (pointy = parasympathetic) Cavernous nerves These nerves increase blood flow to erectile tissues
During which phase of the Tuskegee study did the PHS start offering free transportation for "special treatment?
Phase II
Where do testes initially develop?
Posterior abdominal wall
Posterior (Dorsal) Horn
Posterior projections of the gray matter that contain primarily interneurons and the axons of sensory neurons
What is the normal direction of mucous in the nasal cavity?
Posteriorly towards the nasopharynx It is most pronounced over the middle & inferior conchae
How common is cryptorchidism in premature boys vs boys under 1 year old?
Premature: 15-30% Under 1 yo: 2-5% Bilateral: 10%
Which gyrus is just anterior to the central sulcus and is sometimes called the pre-central gyrus?
Primary Motor Cortex (M1)
Which gyrus is just posterior to the central sulcus and is sometimes called the post-central gyrus?
Primary Somatosensory Cortex (S1)
What is the function of the testis?
Produce sperm & androgens
List the nerves/nervous systems that innervate the vulva (4)
Pudendal N (3 branches) Ilioinguinal N: mons Parasympathetic: dilates BV Sympathetic: constricts BV
Pressure equalization tubes are generally placed in which quadrants of the tympanic membrane?
Quadrats II (or III)
What is the supposed "G-spot"?
Refers to a region on the anterior wall of the vagina May be due to either erectile tissue of the bulb of the clitoris that surrounds the urethra or Skene's glands that surround it
What is circumcision? Why is it done?
Removal of a portion of the foreskin Both hygiene and religious purposes
List the parts of the clitoris (4)
Right & left crus: along inferior pubic rami Angle: superiorly attached to pubic symphysis Body: covered by prepuce Glans: distal end, most highly innervated (dorsal N of clitoris)
Which nerves innervate the pelvic floor mm?
S2-4
What does SPIN stand for?
SP: specificity IN: positive test rules in
The pelvic floor mm contain type 1 and type 2 fibers. ____% of these muscles are slow twitch, and ____ % are fast twitch
ST: 80% FT: 20% genetic factors & race influence the percentage of each type per person
Which 2 muscles pull on opposite sides of the cartilage of auditory tube to open the aud. tube during swallowing?
Salpingopharyngeus & tensor palatini
What does the superficial fascia of the abdomen (camper's and scarpa's) become in the scrotum?
Scarpa's: dartos muscle & fascia. Camper's: does not go into scrotum
What is an alternative test to the Dix-Hallpike test for those who cannot tolerate it d/t back or neck problems?
Sidelying Test: -start sitting at EOB -rotate neck 45 deg -take pt onto their side, keep head rotated -assess for nystagmus
Lateral Horn
Small lateral projections that are present only in the thoracic and lumbar regions of the gray matter. When present, they contain the cell bodies of motor neurons of the autonomic nervous system
Do protozoa have the capability of living independently?
Some do, some are obligate parasites
What is the function of the epididymis?
Store & mature sperm Sperm disposal Absorption of fluid Secretion of components that modify sperm
What is Cholesteatoma?
Stratified squamous epithelial misplaced within the tympanic cavity (accumulation of dead skin that becomes trapped in the middle ear)
What does the plasticity objective from the IV STEP Conference focus on?
Summarize critical periods for emergence of neuroplasticity & strategies for maximizing experience-dependent plasticity --ex: dosage, timing, technology -plasticity is the capacity of neurons & neural circuits to change, structurally & functionally, in response to experience
Is Darto's fascia a part of the superficial or deep fascia of the penis?
Superficial Males: dartos, scarpas, and colles = superficial fascia
What blood vessels are at the level of the superficial fascia of the penis?
Superficial dorsal veins of the penis
What anatomical space do the female external genitalia lie in?
Superficial perineal space
What anatomical space do the muscles of the male external genitalia lie in?
Superficial perineal space SPS = sexually pleasurable structures
How are varicoceles treated? How does this affect fertility?
Surgical removal of veins which results in increased sperm production back to normal varicoceles are associated with reduced fertility if left untreated
Which nervous system needs to be activated for emission?
Sympathetic NS It innervates smooth muscle walls of vas deferens, prostate, & seminal vesicles
What is the suspected reason for why there is a refractory period in which men can not have a second orgasm?
Sympathetic discharge is thought to lead to this refractory period
Contrast MRI imaging increases the signal to a (T1 or T2) weighted image
T1
Do T1 or T2 MRI images have good gray/white matter discrimination?
T1
Which type of MRI image has short repetition and echo times?
T1 image
Are T1 or T2 MRI images useful for imaging CSF and edema?
T2
Which type of MRI image has long repetition and echo times?
T2 image
Body Chart: TA & oblique mm trigger points
TA: center of abdomen, below xiphoid process Obliques: oblique angle from ASIS to groin
What is a commonly known drug-resistant bacterial infection?
TB
What happens to a person's total lung capacity (TLC) if they are obese?
TLC decreases
Thoracolumbar (Extension)
Tape Measure
Lumbar (Extension)
Tape Measure Inclinometer
Thoracolumbar (Flexion)
Tape Measure (C7 and S2)
Lumbar (Flexion)
Tape Measure- S2 and 15cm above S2 (~T12)
What does the scrotum contain?
Testicles & epididymises
What are men with a history of cryptorchidism have an increased risk for?
Testicular germ cell cancer 10% of testicular tumors occur in these patients
What is a common problem with antacids?
The body gets feedback that acid in the stomach is too low, so it produces more acid to accommodate.
What does the anterior wall of the ear contain?
The opening for the Eustachian tube and a bulge for the internal carotid a.
What is the only part of the penis that contains muscle?
The root of the penis has muscle that contracts to restrict venous blood flow
What causes a congenital hydrocele?
The tunica vaginalis does not completely seal off from the peritoneal cavity (Normally the processes vaginalis becomes separated from the peritoneal cavity and is sealed off, then it is called the tunica vaginalis)
How is the activity of TA and the diaphragm related?
Their activity is linked w/ opposing patterns: --Inspiration: diaphragm inc, TA dec --Expiration: TA inc, diaphragm dec
What is the function of the nasal cilia?
They are extremely important for clearing the nose, especially the posterior 2/3 of the nasal cavity
Are the testes intra- or retro- peritoneal?
They are retroperitoneal in the abdomen so they remain so in the scrotum
How do ACh M1 Receptor Antagonists work?
They block the M1 subtype of ACh muscarinic receptors
What is the function of the fundiform and suspensory ligaments of the penis?
They both suspend the penis
How do the tensor tympani and stapedius act as shock absorbers?
They contract to limit the transfer of energy for the air to the inner ear during loud sounds, which tightens the ossicular chain and thus protects the inner ear from excessive mechanical energy
How do vasoactive compounds in endotoxins act in the body?
They dilate blood vessels and increase capillary permeability which can result in endotoxic shock due to loss of vascular fluid
What happens to the muscles of the vulva/superficial perineal space in elderly women?
They may atrophy and become paper thin
Author of "Physician-Assisted death in the United States: Are the Existing "Last Resorts" Enough?"
Timothy E. Quill
What is the purpose of the ear drum and middle ear ossicles?
To capture a high % of the energy of the vibrating air and transfer it to create vibrating fluid in the inner ear
Why are the fundiform and suspensory ligaments of the penis sometimes cut?
To lengthen the penis
Where does the sphenoid sinus refer pain to?
Top of the head
What are two main spirochetes we learned about?
Treponema palladium Vibrio cholerae
T/F: PT is not very effective at treating migraine related dizziness and should be treated medically first
True
T/F: a nystagmus will always tick in the same direction, regardless of where the person is looking
True
T/F: viruses can cause cancer
True
T/F: Viruses do not have structures and/or metabolic processes that can be targeted by drugs.
True for all except reverse transcriptase in RNA viruses (so technically false)
T/F: the parasympathetic NS & sympathetic NS work antagonistically
True-- they work together to maintain balance
Is the tunica albuginea or Buck's fascia thicker?
Tunica albuginea
What does the peritoneum become in the scrotum?
Tunica vaginalis
What are the most common causes of BPPV for those under and over 50 years of age?
Under 50: TBI Over 50: vestibular degeneration
What do hyperosmotic laxatives do?
Use osmotically active substances to produce a gradient that draws water into the bowel and small intestines (to inc. fluid content and stimulate excretion)
What reflex would this be? Extensor activity is induced on the side to which the head is inclined (tipped towards), and flexor activity is induced on the opposite side. The head movement counters the movement registered by the vestibular system.
VSR
Which nerve is the primary parasympathetic nerve supply to the thorax and upper abdomen?
Vagus N
Do the following present with peripheral or central disorders? -vertigo -nystagmus -balance problems -smooth pursuit, saccade problems -hearing problems
Vertigo/dizziness: more in peripheral Nystagmus: peripheral-- jerk (fast beat), central--vertical/pendular Balance: more affected in central Smooth pursuit, saccades: abnormal in central Hearing: peripheral (hearing loss, tinnitus, fullness in ears)
What is the function of the inner ear?
Vestibulocochlear organs interpret different vibrations as nerve impulses and send them to the brain
How do viruses lead to cancer?
When DNA of the virus mixes with DNA from the cell, this can cause rapid reproduction of the cells in an attempt to spread the infection, also resulting in numerous amounts of cell growth leading to cancer
What is Bruised Ear or "cauliflower ear"?
When the ear is struck hard enough to cause a hematoma between the cartilage and perichondrium. The cartilage dies and reduces in size under the hematoma, resulting in deformed cartilage
What is phimosis? What condition can it lead to?
When the foreskin is too tight It can lead to smegma- cheesy accumulation of dead skin and sebaceous gland secretions under the foreskin
Why can gram staining bacterium be beneficial in choosing a treatment?
Whether a bacteria is gram-positive or gram-negative, this indicates whether or not that species will be responsive to certain drugs for treatment (gram-positive usually more receptive to drugs than gram-positive)
AAOS ROM Finger MCP (abduction)
XXX
If your patient's chart has HTN listed in their PMH, is it okay to still exercise them?
Yes! - exercise helps dec resistance in bv walls which allows it to relax & allow blood to flow more smoothly which dec the demand on the heart-- overall exercise dec BP
Does an AFO change a person's gait?
Yes! it creates moments that change the knee & hip joint positions relative to the GRF
Are the bulbs of the vestibule connected to the clitoris?
Yes, by a commissure recently discovered by the Australia lady
What are plasmids?
a circular structure containing DNA fragments (not part of chromosomal information) that contain genetic information conveying drug resisitance *in other words it contains info for the protein that may break down a drug*
What is peptidoglycan?
a complex protein and carbohydrate molecule that makes up the cell wall in both gram-positive and gram-negative bacterium. Much more of this present in gram-positive
What is neutropenia?
a decrease in the number of neutrophills (would this indicate a viral infection?)
What is a spinal nerve comprised of?
a dorsal & ventral root combine w/in the intervertebral foramen
What is Equinus? What is a common cause of this?
a plantar flexed foot -caused by tight gastrocnemius and Achilles's tendon
Define ethics
a science of morals in human conduct
How is burst modulation (bursts) defined?
a series of combined pulses during pulsatile current (PC)
What are viruses?
a small obligate intracellular parasite (must be living in a host to survive) that have a protein coat or capsid (sometimes an envelope)
Define radioopaque:
a substance with high attenuation (it is good at slowing down x-ray beams, less pass through it)
Define radiolucent:
a substance with low attenuation
What is prompting?
a verbal, physical or gesture cue which reminds a pt of what to do next
Which neurotransmitter do the postganglionic parasympathetic neurons secrete? What is the receptor for the ntm on the affected tissue called?
acetylcholine cholinergic receptor "acetylcholinergic"
Ultrasonography is a successful imaging technique because different tissues have different _______________ qualities
acoustic
What are possible causes of pelvic hike?
action of quadratus lumborum to assist with limb clearance when hip flexion, knee flexion and/or ankle DF are inadequate for limb clearance
What do stimulant laxatives do?
activate peristalsis by an unknown mechanism (they might inc. fluid accumultion in the small intestines)
How does diaphragmatic breathing have a "calming effect"?
activates the parasympathetic NS (more energy efficient, best taught in supine)
To make a prosthetic work better for the user, you can make adjustments to the prosthetic or to the user. Which one is the PT responsible for?
adjustments to the user
Terminal sedation
administration of large doses of sedatives
How do neurotoxins result in muscle spasms and paralysis? (What part of the signal transduction pathway do they affect?)
affect G proteins in signal transduction pathway
Which ethnic group does Alzheimer's affect the most?
affects all races and ethnic groups equally
What is the origin/function of A-beta fibers?
afferent from discriminative touch, pressure receptors
What is the origin/function and number associated with A-delta fibers?
afferent from pain and temperature receptors (fast pain) III
Type C fibers have what origin/function? What number is associated with type C fibers?
afferent from pain receptors and free nerve endings (slow pain) IV (4)
What is the least radiodense substance in the body?
air
Rank the following from least dense to most dense: bone, fat, air, contrast media, water, heavy metals
air (black on film) fat water bone contrast media heavy metals (white on film)
Immobilization affects ________ components of strength
all
What does it mean to say, "diagnostics are a tool, not the answer"?
all diagnostic findings, including imaging, must be applied in the context of clinical presentation
What is a potential side effect of antibiotics?
allergies or digestive tract discomfort due to change in resident intestinal flora
end feel knee (extension)
always firm
What does it mean to be a prokaryote?
among other things, there is no distinct nucleus present in that organism
What are 4 basic aspects of electrotherapy?
amplitude pulse width phase duration wavelength (one pulse)
Current is measured in _______
amps (A)
Residual Volume (RV)
amt of air left in the lungs after a forced expiration
Expiratory Reserve Volume (ERV)
amt of air that can be expired past tidal volume (normal)
Inspiratory Reserve Volume (IRV)
amt of air that can be inspired above the tidal volume (normal)
Tidal Volume (TV)
amt of air that passes in/out of lungs during resting breathing
Define density: (photographic quality)
amt of blackening on x-ray
What does an increase in neutrophil count indicate?
an acute infection
What is indicated by excessive sclerosis on an x-ray?
an arthritic or rheumatic condition
Define law
an enacted or customary rule in a community that is recognized as enjoining or prohibiting certain actions
What is monocytosis? What does it indicate?
an increase in the number of monocytes, indicates infectious monomucleosis or tuberculosis (bacterial infection)
What develops when pathogenic microbes invade host tissues?
an infection
Osmotic laxatives are best given to people with:
an urgent need to empty the bowels
Describe 3 methods used in bioethics
analysis reasoning fact finding
Where can fungi be found?
animals, plants, humans, food
Anions are ________ charged atoms and are attracted to the ________ (cathode/anode)
anions are negatively charged and are attracted to the anode
The positive electrode is also referred to as the ______ and is placed _______ (distally/proximally)
anode placed proximally
Telemedicine
another word for distance medicine
If a patient is lacking motion in plantarflexion of the ankle, what joint glide would help facilitate this motion?
anterior talar glide
What information do the anterior, lateral & dorsal columns of the spinal cord carry? options: sensory, motor, both
anterior: motor lateral: mixed dorsal: sensory
PPIs are thought to have ____________ properties that can help kill _____________
anti-bacterial; H, pylori (bacteria that causes stomach ulcers)
PPIs may also have an _________ action that helps decrease __________
anti-inflam; gastric irritation
What classification of drug are penicillin, polymyxin, tetracycline and sulfonamides?
antibacterials
What tests are performed during immunologic testing of body fluids?
antigen identification antibody titer
What classification do antibacterials, antivirals, and antifungals fit into with drug classification?
antimicrobials
What are the 4 classifications of antimicrobial drugs?
antimicrobials antibiotics bactericidals bacteriostatics
Examples of special x-rays: (read)
anything that is not A/P or lateral: -oblique -open mouth (upper C-spine) -sunrise/tangential (patella) -flexion/extension -upright, WB
Define bioethics
application of ethics to medicine and all life sciences
Carol Gilligan
argued that a female's highest value is personal responsibility while for male's it is legalistic equality
Where are most of the fast twitch fibers in the pelvic floor muscles located?
around the urethra & anus
What is VOR (vestibulo-ocular reflex)?
as the head moves one direction, the eyes move in the opposite direction with equal velocity (VOR gain= eye vel/head vel= -1)
Make sure to not to over ____________ dementia patients
assist
A PT should know the types of ___________ needed based on cognitive level for an Alzheimer's pt
assistance evaluate the skills that remain and assist to the extent the pt needs it
What is the most common pulmonary problem in kids?
asthma
When is the lung pressure equal to the atmospheric pressure?
at rest
Which division of the ANS is in charge of our HR at rest? How does this change during exercise?***
at rest: PNS at 60-70% of HR max: transitions to SNS
The radio source and magnet used to create an MRI image cause what structures to align?
atomic nuclei align/resonate to this electromagnetic field
What do antacids do?
attempt to neutralize excess stomach acid in the case of heartburn or acid reflux
List at least 3 aspects of moral competencies
attentiveness critical curiosity awareness of thought and emotion recognition of, and response to, cognitive and emotional biases willingness to acknowledge and correct errors
List 4 subcomponents of respect for persons
autonomy veracity fidelity avoidance of killing
Explain the role of culture, and bias, in medicine and patient care
avoid cultural biases understanding how patient's culture affects their understanding of disease reduce miscommunication which can lead to poor outcomes
What are two factors in relation to axon characteristics that effect depolarization by e-stim?
axon myelination and diameter
Why can't you diagnose a soft tissue injury with an x-ray (without contrast media)?
b/c soft tissue looks a lot like water (have similar radiodensities)
What are some of the most common trunk and pelvic deviations during gait?
backward trunk lean forward trunk lean ipsilateral trunk lean contralateral trunk lean contralateral pelvic drop ipsilateral pelvic drop pelvic hike
What happens in the septicemia stage of an infection?
bacteria is circulating and reproducing in bloodstream (bad)
Why is prolonged use of stool thickeners dangerous?
bacteria that are inhibited by the drugs are necessary for normal digestion
What does penicillin target?
bacterial cell wall synthesis (gram-positive cell wall exposed to environment - this is why penicillin works on gram-positive but not gram-negative)
Why are the signs of infection and inflammation similar?
because one of the ways the body responds to infection is with inflammation to try and fight it off
What characteristics of the flu virus make it hard to predict exactly the best treatment?
because the flu virus mutates so rapidly and can be composed of nucleic acids from different strains (H1N1 for example)
Why are lung infections common with emphysema?
because viral, bacterial or fungal particles can easily get into the enlarged acini
When is a stool softener usually taken?
before bedtime (with the anticipated result occurring in the morning)
Where is the film plate located relative to the patient in an AP image?
behind the patient
Therapeutic misconception
belief that a drug is efficacious when it has not been conclusively proven to be so
What color is air on an x-ray?
black
What do PPIs (proton pump inhibitors) do?
block the hydrogen pump responsible for secreting acid into the stomach lumen
A functional MRI is a technique based on the increased ________________ that accompanies neural activity in the brain
blood flow
In a contrast MRI, tissue enhancement is proportional to:
blood flow to the tissue
Cyanosis
bluish discoloration of skin due to poor circulation or oxygenation
In addition to measuring bone density, DEXA can also determine:
body composition
The CNS is basically the neural structures that are covered by ____________
bone
What type of tissue in the body is the poorest conductor?
bone
What is the modality of choice for detection & follow-up of metastatic bone disease?
bone scan (radionuclide scintigraphy)
What is the modality of choice for detection of stress fractures?
bone scan (radionuclide scintigraphy)
Gen Zers (Massey)
born after 1995
Does communication involve the use of short-term or long-term memory?
both
Is communication verbal or nonverbal?
both
How do obstructive lung diseases affect FEV1, FVC and the ratio?
both go down, FEV1 is lower in obstructive conditions compared to restrictive FEV1: 1.3 L FVC: 3.1 L FEV1/FVC: 42% (like trying to breathe out as fast as you can through pursed lips)
Which of Maslow's Hierarchy of Needs are considered deficiency needs? What does this mean?
bottom 4 -- no longer motivators when they are met (biological, safety, belongingness & love, & esteem)
Medical informatics
branch of biomedical and health informatics that has to do with understanding and promoting the effective organization, analysis, management, and use of information in health care, and transforming healthcare through information technology
Kussmaul respirations, labored respirations, wheezing and stridor are all examples of _________________ patterns.
breathing
Classic signs of BPPV
brief episodes of vertigo associated w/ changes in head position relative to gravity may happen with: -lying down/sitting up -*rolling in bed* -bending over -looking up may also experience nausea, imbalance or trouble walking
In a T1 MRI image, long bones appear: ***
bright/white
In a T2 MRI image, water appears: ***
bright/white
Which breath sound is a combination of vesicular and bronchial sounds?
bronchovesicular
What is the best choice of drug for people with small, hard stools?
bulk forming laxatives
________________ are just high doses of fiber, so they are safe, even for kids
bulking drugs
What can Hallux Abducto Valgus lead to?
bunion formation
How can deep breathing dec pain?
by dec sympathetic NS activity and inc parasympathetic NS activity
How is an image produced in nuclear medicine?
by detecting the location & concentration of radioactive elements in tissues
How do you maximize the detail of an x-ray?
by positioning the object as close to the film plate as possible
What motions of the bones in the ankle are occurring with open chain pronation?
calcaneal eversion calcaneal abduction calcaneal dorsiflexion
What motions of the bones in the ankle are occurring with closed chain pronation?
calcaneal eversion talar adduction talar plantar flexion
What motions of the bones in the ankle are occurring with open chain supination?
calcaneal inversion calcaneal adduction calcaneal plantar flexion
What motions of the bones in the ankle are occurring with closed chain supination?
calcaneal inversion talar abduction talar dorsiflexion
In general, with open chain movements of the ankle, which bone(s) is(are) providing most of the available motion?
calcaneus
Where do you measure vesicular breath sounds?
can be heard across most of the chest including anterior, lateral & posterior chest walls (w/ exception of the area of bronchial sounds)
At what age does asthma occur?
can occur at any age, but is common in kids
Ceruminous (wax) and sebaceous glands are restricted to that portion of the skin of the auditory canal that overlies _______
cartilage (not bone)
The tensor tympani muscle originated from:
cartilage of auditory tube
The negative electrode is also referred to as the _______ and is placed _______ (distally/proximally)
cathode placed distally
Cations are ______ charged atoms and are attracted to the ________ (cathode/anode)
cations are positively charged and attracted to the cathode
A vertical nystagmus is more indicative of a _________ vestibular disorder
central (vertical or pendular nystagmus)
Which sulcus separates the frontal lobe from the parietal lobes?
central sulcus
Apnea
cessation of breathing
What do vasoactive compounds act similarly to in the inflammatory process?
chemical mediators of inflammation
What structures do bacterium contain floating within the cytoplasm? (4)
chromosomes (one long strand of DNA) ribosomes RNA Plasmids
What are the two types of infection?
chronic and acute
What respiratory condition can cause clubbed fingers?
chronic hypoxia
What does an increase in lymphocytes and monocytes indicate?
chronic infection
Geometric qualities of an x-ray refer to the _____________ of the image
clarity
What are examples of culture and staining techniques used to determine the type of infection?
clinical specimines like sputum or blood drug sensitivity tests
Structures that are (further/closer) to the film plate are more sharply defined and less distorted
closer
What are two main types of bacilli?
clostridium tetani clostridium botulinum
What is the key feature of DCD?
clumsiness and poor motor control
_____________ rales are a sign of involvement of the distal airway.
coarse
Which type of rales is almost always wet rales and almost always serious?
coarse rales
What are the 3 main groups that bacteria can be divided into?
cocci bacilli spirochetes
List the 4 professional competencies of bioethics
cognitive integrative relational moral "Caring Is Really Manly"
__________________ is an exchange of information that requires an action or response
communication
List at least 3 aspects of relational competencies
communication skills handling conflict teamwork teaching others
Inversion/varus/supination of the foot is compensated from what foot position in NWB?
compensated from forefoot valgus or plantarflexed 1st ray in NWB
Eversion/valgus/pronation of the foot is compensated from what foot position in NWB?
compensated from rearfoot or forefoot varus in NWB
What are possible causes of forward trunk lean?
compensation for quad weakness. Forward lean reduces knee extensor movement and thus demand on vasti. May also be used to accommodate hip or knee flexion contractures
Total Lung Capacity (equation)
comprised of all 4 values *TLC* = TV + IRV + ERV + RV
Is the posterior articular surface of the talus concave or convex?
concave
Define morality
conforming to accepted rules and standards guiding human behavior
What is the difference between consequential theory and utilitarian theory?
consequential theory aims at goodness utilitarian theory aims at happiness
Morphine and other opiates are known to be ________
constipating (produce a general dec. in GI motility)
What is the most common side effect assoc. with *aluminum containing* antacids?
constipation
When is a pleural friction rub heard?
continuous sound heard from the middle of inspiration to the beginning of expiration
What are possible causes of ipsilateral pelvic drop?
contralateral hip abductor weakness, hip adductor spacticity, or hip adduction contracture
A ___________ MRI involves intravenous or intra-joint injection
contrast MRI
Using barium-sulfate in a video swallow is an example of a:
contrast media
Is the anterior and middle articular surfaces of the talus concave or convex?
convex
Is the superior surface of the talus concave or convex?
convex
What does an abnormal head thrust test tell you?
corrective saccades are a sign of a peripheral vestibular problem (UVL or BVL)
How is pursed lip breathing beneficial?
creates some back pressure so your alveoli stay open during the exhale (inhale through nose, exhale through pursed lips)
In the human body: skin thickness, level of hydration, and skin creams can all affect ______ flow
current
__________ is measuring the movement of charged particles
current
How is phase defined?
current flow in one direction for a finite period of time (number of current flow switches per pulse)
What does Ohm's law state?
current is directly proportional to the voltage and inversely proportional to the resistance (I = V/R)
If you find trigger points in a pt's abdominal wall, specifically the obliques and/or TA, what condition might this indicate?
current/previous visceral disease (tests for cutaneous allodynia are the greatest indicator of a visceral source of pain)
In a T2 MRI image, bones appear: ***
dark/black
What color is exposed film on an x-ray?
dark/black
What does leukopenia mean? What is it an indication of?
decrease in WBC count, indicates viral infection
Immobilization causes a(n) _______ in protein synthesis, resulting in loss of ______ mass and contractile/ sarcoplasmic protein
decrease in protein synthesis loss of muscle mass
How do bacteriostatic drugs act?
decrease rate of reproduction
What does the H2 receptor antagonist class of drugs work to do?
decrease the amount of acid in the stomach
How does an antiviral attack a virus?
decreases virus reproduction but cannot destroy it (may control but not cure)
Kussmaul's Respiration
deep, regular sighing respirations with an inc in respiratory rate
Communication, prompting, challenging behaviors and family or caregiver involvement are all challenges facing PTs in _______________ care
dementia
What are the 2 photographic qualities of an x-ray?
density contrast
T1 MRI images reveal:
details of anatomy in high resolution
Define contrast: (photographic quality)
differences b/w adjacent tissue densities how easily can you tell one type of tissue from another?
Is voltage directly proportionate or inversely proportionate to the depth of current flow into body tissues?
directly (greater voltage = deeper)
What does it mean to be pathogenic?
disease-causing
What does the density of an x-ray depend on? (3)
distance time current
What is a common side effect of bulk forming laxatives?
distended and painful abdomen
Domain/Turiel Theory
distinguishes the difference b/w morality & convention morality: structured by concepts of harm & fairness convention: structured by understanding of social organization
What can result from excess protein intake?
diuresis and dehydration (excessive production of urine leads to dehydration) "pee of all the extra protein"
The dorsal root carries _________ info, and the ventral root carries _________ info options: sensory, motor
dorsal: sensory ventral: motor
In forefoot valgus, which direction will the big toe be pointing (up or down)?
down
Stool softeners work best if the person:
drinks a lot of water
What do steroids affect?
drive more hypertrophy in muscles (don't affect neuromuscular adaptation)
Antibiotics are what?
drugs derrived from organisms
When do viruses actually mutate?
during replication
What occurs during an episode/attack of asthma?
dyspnea with significant wheezing
Info about the (ABC) Activities-Specific Balance Confidence Scale
each activity (ADL) listed is rated as a % confidence in ability to perform <50 score = low physical functioning 50-80 = moderate >80 = high level of function *score of less than 67 indicates fall risk*
What does it mean to say that there is a fatiguable nystagmus response during the Dix Hallpike test for example?
each time you re-test this, their sx will be reduced
What does it mean for an antimicrobial to be broad spectrum?
effective against both gram-positive and gram-negative microbes
What does it mean for an antimicrobial to be narrow spectrum?
effective against either gram-positive OR gram-negative organisms
What is the origin/function of A-alpha fibers?
efferent to muscle (extrafusal) fibers
Phase III
efficacy side effects 1000-3000 people
Laxatives are prescribed to promote:
elimination from the bowel and defecation
Asthma occurs in ________________
episodes
Name 3 sources of ethical guidance for physicians and medical students
ethics consultant SGU's Student Manual clinical ethics committees
Are protozoa eukaryotes or prokaryotes?
eukaryotes
Are fungi eukaryotes or prokaryotes?
eukaryotes (have nucleus)
How is frequency defined?
events in a defined amount of time
What should your analysis include for a patient with contralateral trunk lean?
examine contralateral gluteus medius strength, hip pain and IT band tightness and for trunk ROM. Examine for factors contributing to swing limb being too long (e.g. limited knee flexion or excess PF during initial swing or a leg length discrepancy)
What should your analysis include for a patient with backward trunk lean?
examine hip extensor and flexor strength
What should your analysis include for a patient with ipsilateral trunk lean?
examine ipsilateral gluteus medius strength; hip pain and ipsilateral IT band tightness and for trunk ROM
What should your analysis include for a patient with forward trunk lean?
examine quadriceps strength and hip and knee for contractures
What should your analysis include for a patient with pelvic hike?
examine strength and ROM at knee, hip, and ankle; examine muscle tone at knee and ankle
What should your analysis include for a patient with ipsilateral pelvic drop?
examine strength, flexibility, and tone of contralateral hip abductors and adductors
What should your analysis include for a patient with contralateral pelvic drop?
examine strength, flexibility, and tone of ipsilateral hip abductors and adductors
How would a person compensate in the pre-swing phase of gait if they have limited knee flexion?
excessive ankle DF
How would a person compensate in the stance phase of gait if they have limited knee extension?
excessive ankle dorsiflexion (allows an upright posture in the presence of a fixed flexion contracture)
Antacids only treat the symptoms of:
excessive stomach acid
How might a person's trunk change in the swing phase of gait if they have limited knee flexion?
excessive trunk lateral displacement to the contralateral side to the foot clearance
How might a person's trunk change in the stance phase of gait if they have limited knee extension?
excessive trunk lateral displacement to the ipsilateral lateral side to compensate for shorter leg
What are some common ankle deformities?
excessive: -plantarflexion -dorsiflexion -inversion/eversion
What are the two types of bacterial toxins?
exotoxins endotoxins
The planes of the canals are close to the planes of the ________ muscles, allowing simple connections relating individual canals to ________ muscles
extraocular ocular
T/F: consumption of excessive protein facilitates protein synthesis
false "consumption of excessive protein does not necessarily facilitate protein synthesis"
T/F: smaller fibers will display conduction failure before larger fibers in the presence of asphyxia/anoxia, compression and cold
false larger fibers display conduction failure before small fibers in the presence of those things
T/F: larger fibers have a higher threshold to depolarization from externally applied electric current
false lower threshold
T/F: the immobilization period is much longer than the recovery period
false recovery period is longer than immobilization period
T/F: the anode is also referred to as the "active electrode"
false the anode is referred to as the "reference electrode" and the cathode is referred to as the "active electrode"
T/F: PTs are capable of independently interpreting imaging results
false -their role is managing care, directing imaging & relating imaging studies to clinical presentation, not reading the results
T/F: PTs in primary care, such as the military, increased diagnostic imaging orders
false -they decreased imaging by 50% -MDs are happy w/ this
T/F: a radiolucent object is more dense than a radioopaque object
false radiolucent objects are less dense than radioopaque objects
T/F: a CT scan provides detailed anatomical imaging of soft tissue
false replace soft tissue with bone
T/F: Radiation exposure is a concern with DEXA
false the exposure to radiation in DEXA is roughly the same as flying on a plane from NY to LA and back
What is a type 2 error in statistics?
false negative
Do x-rays have a high false positive or false negative rate? Does this mean they are not very sensitive or specific?
false negative not sensitive
What is a type 1 error in statistics?
false positive
Do bone scans get a lot of false positives or false negatives?
false positives (sensitive, not specific)
T/F: behavior is random
false, it is non-random and has a purpose behind it
T/F: orthotics & prosthetics do not have an impact on gait
false, they cause notable changes
T/F: muscle strength is more important than endurance when it comes to spine stability
false-- endurance is more important
T/F: the thoracolumbar fascia cannot contract
false-- it contains alpha-smooth muscle actin called myoblasts w/ contractile capability
T/F: it is difficult to diagnose pain at the pubic symphysis
false-- it's really easy, usually just hurts right over the area & may have a waddling gait
T/F: the TA & multifidus are the most important muscles to rehab to achieve spine stability
false-- no single most important muscle
T/F: during a task, muscle contributions are constant
false-- they change constantly depending on the task & force production required
T/F: moderate muscle activity is required to produce enough pressure to provide stability
false-- very small amt of muscle activity needed
What tissues serve as insulators?
fat and skin
What are systemic signs of inflammation?
fever, fatigue and weakness, headache, nausea
end feel Cervical (Lateral flexion)
firm
end feel Cervical (extension)
firm
end feel Cervical (flexion)
firm
end feel Cervical (rotation)
firm
end feel Finger DIP (extension)
firm
end feel Finger DIP (flexion)
firm
end feel Finger MCP (abduction)
firm
end feel Finger MCP (extension)
firm
end feel Finger PIP (extension)
firm
end feel Lumbar (Extension)
firm
end feel Lumbar (Flexion)
firm
end feel MTP (extension)
firm
end feel MTP (flexion)
firm
end feel Shoulder (LR/ER)
firm
end feel Shoulder (MR/IR)
firm
end feel Shoulder (abduction)
firm
end feel Shoulder (extension)
firm
end feel Thoracolumbar (Flexion)
firm
end feel Thoracolumbar (Lateral Flexion)
firm
end feel Thoracolumbar (Rotation)
firm
end feel Thumb CMC (abduction)
firm
end feel Thumb CMC (extension)
firm
end feel Thumb IP (extension)
firm
end feel Thumb IP (flexion)
firm
end feel Thumb MCP (extension)
firm
end feel Wrist (Ulnar Deviation)
firm
end feel Wrist (extension)
firm
end feel Wrist (flexion)
firm
end feel forearm (supination)
firm
end feel hip (abduction)
firm
end feel hip (adduction)
firm
end feel hip (extension)
firm
end feel hip (lateral rotation)
firm
end feel hip (medial rotation)
firm
end feel forearm (pronation)
firm (sometimes hard)
What is the difference between first and second generation drugs?
first generation is original drug class second generation is a later version that is often: -more effective -more affordable -more easily administered
Which functions of the ankle are pronation and supination most associated with?
flexibility
In populations with more soft tissue type injuries, what kind of foot would we expect them to have?
flexible foot (muscles and other tissue having to work harder to stabilize everything due to excessive motion)
How does a forefoot valgus affect someone's gait?
foot supinates too soon
How does eversion/valgus/pronation of the foot affect the foot itself and floor contact patterns?
foot: -loss of shock absorption -plantar fasciitis -callus formation -overuse symptoms contact patterns: -heel is unchanged -1st metatarsal contact is prolonged -5th metatarsal contact is missing until late
How does inversion/varus/supination of the foot affect the foot itself and floor contact atterns?
foot: -loss of shock absorption -prone to ankle sprain -calluses -morton neuroma contact patterns: -lack of contact for 1st metatarsal -premature contact for 5th metatarsal -heel may be normal or contact absent
Define: FEV1
forced expiratory volume in 1 second
When assessing alignment, what are the 4 lines you should be able to mentally draw when viewing a lateral x-ray of the cervical spine?
from anterior to posterior: 1. anterior vertebral line 2. posterior vertebral line 3. spinolaminar line 4. posterior spinous line
For the few types of fungi that are pathogenic, what type of infections can they cause? (2)
fungal mycotic
Sneezing, coughing, sputum and breathing patterns are all ____________________ of the respiratory system.
general characteristics
What do increased levels of C-reactive protein and ESR indicate?
general inflammation (infection)
What is the primary motor cortex in charge of?
generates neural impulses that control the execution of movement
What is equipoise?
genuine uncertainty about which arm of a clinial trial will provide the most benefits or harms to patients, research subjects, or future patients
How is accommodation defined?
getting used to a feeling and diverting attention from it
Are global or local muscles considered "mobilizers" that are responsible for limb mvmt?
global mm
Do global muscles typically contract concentrically or eccentrically? local muscles?
global: concentric local: eccentric
Supererogatory
going beyond what is required or expected
What does the ramping of modulation refer to? Why would this be done?
gradual increase and/or decrease of amplitude to allow for more comfortable muscle contraction because of the gradual increase in intensity
What are the two categories of bacteria based on cell wall structure?
gram-positive gram-negative
How are gram-positive bacteria distinguished visually from gram-negative?
gram-positive retain the crystal violet gram stain whereas gram-negative bacteria do not
What color is water on an x-ray?
gray
Is the thalamus considered white or gray matter?
gray (also basal ganglia & deep neuronal cell bodies)
Is the "H" portion of the spinal cord white or gray matter?
gray-- largely cell bodies contains the dorsal, lateral & ventral horns
What color is fat on an x-ray?
gray-black
What color is bone on an x-ray?
gray-white
The __________ (greater/lesser) the voltage, the "deeper" we can drive current into the body
greater
During exhalation, the pressure inside the lungs is (greater/lower) than the pressure outside the lungs.
greater pressure inside lungs (d/t inspiratory muscles relaxing & elastic recoil)
Normal FEV1/FVC%
greater than 80%
end feel Subtalar (Eversion)
hard
end feel Tarsal (Eversion)
hard
end feel Finger MCP (flexion)
hard/ firm
end feel Wrist (Radial Deviation)
hard/ sometimes firm
end feel Thumb MCP (flexion)
hard/firm
Are ACh receptor antagonists easier or harder to take than PPIs or H2 blockers?
harder (that's why they are rarely used)
When does the highest and lowest velocity occur during a gait cycle?
high: just before double support low: mid-stance
When do you reach the highest and lowest vertical point during a gait cycle?
high: mid-stance low: double support
What qualifies an infection to be an epidemic?
higher than normal transmission or spread to new geographical area
People with BPPV tend to have a (low/high) rating on the DHI
higher, which means a greater handicap (>46)
In the initial contact phase, which muscles are controlling hip, knee & ankle motions?
hip: extensors (ecc) knee: hamstrings (ecc) ankle: dorsiflexors (ecc)
In the loading response phase, which muscles are controlling hip, knee & ankle motions?
hip: extensors, abductors (ecc) knee: quads (ecc) ankle: dorsiflexors (ecc)
In the pre-swing phase, which muscles are controlling hip, knee & ankle motions?
hip: flexors (*conc*) knee: quads (ecc) ankle: soleus & gastroc (*conc*)
In the terminal stance phase, which muscles are controlling hip, knee & ankle motions?
hip: flexors (ecc), glute med (iso) knee: hamstrings (ecc) ankle: soleus (ecc) controls anterior tibial movement
In the mid-stance phase, which muscles are controlling hip, knee & ankle motions?
hip: flexors (ecc), glute med (iso) knee: little m. activity needed ankle: soleus (ecc), control ant tibial movement (DF)
What is the Roll test used to test for and treat? How is it performed?
horizontal canal BPPV Test: -start in supine w/ head elevated 20 deg -turn head 90 deg to one side -wait for symptoms to subside & test other side -if positive, both sides will be positive, treat the more involved side Treat: -turn head 90 deg toward involved side -wait for symptoms to subside -keep head rotated while pt gets body into prone -rotate their head towards the floor -wait for symptoms to subside -helping pt come up by going to hands & knees and then into sitting -if can't go onto hands & knees, have them continue rolling another 1/4 turn and then come to sitting
Changes in muscle composition occur within _______
hours
Define permeability
how easily x-ray beams can pass through a substance to reach the film plate
Define: Inspiratory Reserve Volume
how much air you can breathe in in addition to normal breathing (doesn't include TV)
Define: Expiratory Reserve Volume
how much air you can breathe out in addition to normal breathing (doesn't include TV)
What determines pH?
hydrogen ion concentration
Antacids usually contain a base such as:
hydroxide or carbonate/bicarbonate with aluminum, magnesium, calcium or sodium
How does quad overactivity affect the stance phase of gait?
hyperextension during middle stance and inhibit knee flexion during loading response
Define elongation:
image appears longer than the actual object
Define foreshortening:
image appears shorter/wider than the actual object
Therapeutic misrepresentation
implying that a drug is efficacious when it has not conclusively been proven to be
Where is the source of x-ray beams located relative to the patient in an AP image?
in front of the patient
What are characteristics of spirochetes?
include spiral forms and vibrio
List at least 3 aspects of integrative competencies
incorporation of scientific, clinical, and ethical judgment appropriate use of reasoning strategies linking of interdisciplinary and clinical knowledge managing uncertainty examining and refining one's own reasoning strategies
How does the body compensate for excessive plantarflexion in midswing?
increased hip and knee flexion (may also hike pelvis on ipsilateral side)
Identify 3 impacts of climate change on health
increased incidence of malaria, dengue fever, other diseases reduced food yields and water supplies changing patterns of infectious disease including HIV
How does someone compensate in the lateral plane for an excessive knee varus alignment?
increased trunk movement in the lateral plane during stance phase (also inc movement in the sagittal plane)
How do *contractile adaptations* to resistance exercise affect the following *physiologically*? -muscle mass -CSA -type II fiber area -intracellular lipid content -ATP utilization rate
increases all of them
How does electrode size effect the intensity?
increases it (small electrode can still deliver a lot of current) THIS HURTS!! Therefore using a larger electrode will improve the comfort level
What is an alternate treatment for people with small, hard stools besides taking drugs?
increasing fiber in their diet
What does high uptake of the methylene injection in a bone scan indicate?
indicates areas of inc bone activity or mineral turnover
What type of patients are admitted to the NICU (a.k.a. special care nursery)?
infants with a variety of diagnoses both preterm and full term
What is a nosocomial infection?
infection that occurs within a health care facility (hospital, nursing home, physician office, dental office etc.)
1972 Canterbury vs. Spence
informed consent must be clear and understood
What are the different periods of the gait cycle? (Rancho Los Amigos)
initial contact load response midstance terminal stance pre swing initial swing midswing terminal swing
What causes the initial increase in strength that we see during resistance training?
initial increase in strength due to neural adaptations hypertrophy of muscle follows several weeks later
What is contrast enhancement?
injection or ingestion of a radio-contrast medium prior to a radiographic study Ex: angiography, arthography, myelography, barium swallow, etc.
How in an infection spread through vector-borne transmission?
insect or animal is intermediate host or vector
How is amplitude defined?
intensity or maximum voltage
Everything beyond the _____________ foramina is considered the PNS
intervertebral
What is the primary side effect of the bacteria that prevent diarrhea?
intestinal gas
What are possible causes of contralateral pelvic drop?
ipsilateral hip abductor weakness, hip adductor spacticity, or hip adduction contracture
What does it mean to say that Alzheimer's disease is a human disorder?
it affects exactly the things that make us human (quote on slide)
What does it mean for a microorganism to be non-pathogenic?
it does not cause disease under normal conditions
If you injected someone with saline to increase their blood volume, how would that affect their aerobic capacity?
it would allow your heart to stretch more during filling and greater contraction with increased force, which would increase performance (Frank Starling Mechanism)
What attachment allows the pelvic floor muscles (PFM) to contribute to local hip control & stabilization?
its direct connection w/ obturator internus via tendinous attachments
The external moment at a joint depends on the GRF vector's relationship to the _____________ which is influenced heavily by the __________ at a joint and determines which muscles need to ___________
joint axes ROM engage
List at least 3 aspects of cognitive competencies
knowledge information management application of information to real-life situations use of tacit knowledge and personal experience self-directed acquisition of new knowledge recognition of gaps in one's own knowledge ability to generate useful questions awareness of, and ability to make adjustments for, one's own biases
How are impulses for the VSR transmitted?
lat/med vestibulospinal tracts to SC
In-Betweener's (Massey)
late 1940's to 50's value conformance to rules & protocol, individualism & beginning of experimentation
What glide is associated with subtalar eversion?
lateral glide
What mechanically is happening at the subtalar joint with eversion in an open chain motion?
lateral glide of the calcaneus on the talus
Which sulcus separates the temporal lobes from the frontal & parietal lobes?
lateral sulcus
What are the drugs of choice when normal bowel movements have been impaired?
laxatives
Define: Stress Incontinence
leaks w/ inc abdominal pressure (Ex: sneeze) (said if she gets women up to 2/5 strength they often stop leaking)
Define: Urge Incontinence
leaks w/ strong urge to go (Ex: overactive bladder) (need bladder re-training)
Highly radiodense objects result in more or less radiodensity on the film?
less (object appears whiter)
Are ACh M1 Receptor Antagonists more or less effective than H2 blockers at reducing acid secretion?
less effective
In general, how do the peaks on a force plate cnange from a healthy individual to one who has had a stroke?
less force produced overall, less pushoff (more muffled peaks in force)
How does someone compensate in the lateral plane for an excessive knee valgus alignment?
less pelvic tilt during stance phase
FEV1/FVC% of an obstructive ventilation disorder (indicates asthma)
less than 70%
When tension in the thoracolumbar fascia develops, the tension is transmitted to which passive structure?
ligamentum flavum & assists w/ lumbar alignment
What is the MSQ (motion sensitivity quotient)?
list of activities/positions that you put them in & see how bad their sx are in them and how long they last -16 positions tested (positional test like Dix-Hallpike) -rate intensity/duration of dizziness in that position 0-10 = mild 11-30 = moderate 30-100 = severe
Are global or local muscles considered "load transfer" mm that have trunk & fascial attachments & stiffen the core?
local mm
Are global or local muscles more designed for endurance?
local mm
Info about the DHI (dizziness handicap inventory)
long questionnaire the pt fills out -total score: 0-100 -each point scored as 0= no, 2= sometimes, 4= yes -higher scores = greater handicap 0-14 = no activity limitation 16-26 = mild limitation 28-44 = moderate > or = 46 = severe (>60 = impaired functional mobility & inc fall risk)
Describe apneusis
long, gasping inspiratory phase followed by a short, inadequate expiratory phase
Obstructed Breathing
long, ineffective expiratory phase with shallow, inc respirations
ACh M1 Receptor Antagonists are just as effective as H2 blockers at _________
long-term healing of ulcers
What does an abnormal dynamic visual acuity test tell you?
loss of 3+ lines indicates hypofunction of vestibular system
During inspiration, the pressure inside the lungs is (greater/lower) than the pressure outside the lungs.
lower pressure inside lungs (d/t ext intercostal & diaphragm moving the ribs up & out which increases the lung volume)
What drugs are used on a short-term basis to relieve constipation?
lubricants/stool softeners
What can be prescribed as an anti-constipation med?
magnesium-containing antacids
What is the primary somatosensory cortex in charge of?
main sensory receptive area for the sense of touch -all senses relay info here & lobes try to make sense of it -touch, vibration, proprioception, pain, etc.
What is an example of how a virus can be spread through vector-borne infection?
malaria
What are 3 examples of a protozoal disease?
malaria trichomoniasis amebic dysentery
If a person leaks urine ocassionally, does this mean you need to work on strengthening PFM?
maybe-- but could also be that they need to decrease tone in those muscles
What does it mean to say that x-rays are a *first order* diagnostic modality?
means it is often the first thing that is done
What glide is associated with subtalar inversion?
medial glide
Are medium or fine rales louder?
medium rales
What should you be able to see specifically in long bones?
medullary cavity
If a patient with diabetes has a pH = 7.2, PCO2 = 32 mmHg and HCO3- = 18 mEq/L, what acid/base imbalance do they have? Are they compensating?
metabolic acidosis yes-- PCO2 is low to try to make pH more basic
_________ is a common example of a bulking agent
metamucil
What happens in the subclinical stage of an infection?
microbe reproduces in body but does not cause signs or symptoms
Parasympathetic innervation to all salivary glands and taste runs through the:
middle ear
The Eustachian tube slants from the:
middle ear to the nasopharynx
What happens if the person lacks plantarflexion?
might jolt the body forward
What are the stages of Alzheimer's?
mild, moderate & severe stages
Amplitude is generally measured in ______
milivolts (mV)
What is the purpose of ensuring a pt meets all 6 determinants of gait?
minimizes energy expenditure by minimizing their change in COM
What are antacids often used to treat?
minor GI discomfort after overeating or eating foods not appropriate for a person
How is a person's minute ventilation affected by having a stroke?
minute ventilation is roughly unchanged-- TV decreases, but RR increases
How do fungi reproduce?
mitosis
With bedrest, early _______ has proven beneficial outcomes
mobilization
What aspect of electrotherapy can delay accommodation?
modulation
If more nerves are depolarized, what does this mean?
more sensory or muscular activity
What percent of the cell wall is made up of peptidoglycan in a gram-positive bacteria?
more than 40%
The _____ (more/less) voltage difference we introduce with e-stim, the more ______ we depolarize
more voltage = more nerves depolarized
What are some characteristics that affect pathogenicity and virulence?
motility toxins (including enzymes) adherence to tissue ability to avoid host defenses
Failure of the defensive barrier in the stomach/duodenum leads to:
mucosal injury
In general, what are rales caused by?
mucus obstruction in distal airway or collapse of acini
What causes mycotic infections?
multicellular organisms (molds)
What are the 2 types of cholinergic receptors for acetylcholine? What are the 2 types of adrenergic receptors for norepinephrine?
muscarinic & nicotinic alpha & beta
What tissues serve as conductors?
muscle nerve loose collagen tendon ligament
What results from a clostridium tetani or clostridium botulinum infection?
muscle spasms and generalized paralysis (if severe may be lethal)
What is the origin/function of Ia fibers?
muscle spindle (primary) afferent)
What does overload mean when referring to adaptation?
muscle tension must be developed at adequate intensity and duration
List the standards for a successful therapy session for dementia pts: (5)
must: -be appropriate -have a purpose -be done voluntarily -take advantage of the pts retained abilities -ensure an opportunity for success
How are x-rays named?
named for the beam direction relative to the patient and the patient's position
How do you name a lateral/oblique x-ray?
named for the side *closer* to the film plate
What causes rhonchi?
narrowing of the pulmonary tree within the trachea, bronchi or bronchioles
The middle ear connects to the __________ with each swallow
nasopharynx
What are bulking drugs made of?
natural fibers from seed that form a gelatin when inside the GI tract
What is the difference b/w needs & values?
needs: things people must have values: a principle, standard or quality of worth
1960 Nathanson vs. Kline
negligent radiologist failed to inform patient of procedure risk
What category of bacterial toxins does clostridium tetani and clostridium botulinum fit into?
neurotoxins (exotoxin)
Define: neonate
newborn
Will taking a bulk-forming laxative help if there is a chance of blockage in the intestine?
no, it will make it worse
In pelvic floor rehab, are you typically trying to get pt's to recruit rectus abdominis?
no-- try to get pt's to turn it off
What two categories are microorganisms split into?
non-pathogenic pathogenic
What causes Absence (of breath sounds)?
nonaeration or collapse of a lung
If the harms and benefits are proportionate, is nonmaleficence or beneficence more important?
nonmaleficence
Which neurotransmitter do the postganglionic sympathetic neurons secrete? What is the receptor for the ntm on the affected tissue called?
norepinephrine adrenergic receptor
Define magnification:
objects further from the film appear larger than closer objects
What causes stridor?
obstruction in larynx or trachea
Resistance is measured in _______
ohms (little horseshoe symbol) with direct current or impedance (Z) with alternating curreny
Where are non-pathogenic microorganisms "resident flora" usually found?
on body surfaces (skin, mucous membrane) within body (bowels, rectum, vagina) not in internal tissues (brain, muscles, blood)
How often are PPIs taken?
once a day (or twice in severe cases) they have lasting effects, unlike H2 receptor blockers which are taken before each meal
How many degrees of freedom does the talocrural joint have?
one
What qualifies as an "infectious microorganism"?
one that can reproduce in the body
What is a pandemic infection?
one that has been transmitted on most continents
What are possible treatments for Hallux Abducto Valgus?
only if severe will surgery possibly be performed
1914 Schloendorff vs. NY Hospital Society
operation without consent is an assault
How are antacids ingested?
orally
What is indicated by low contrast or "washed out" bone on an x-ray?
osteoporosis
What is hyperplasia?
overload may stimulate proliferation of myocytes from satelite cells
What are local signs of infection?
pain, swelling, redness, warmth bacterial - purulent exudate viral - serous, clear exudate
The electrodes should be oriented in a direction that is ___________ to muscle fibers
parallel
What type of protozoa typically are pathogenic?
parasitic protozoa
Review of SNS: The preganglionic cardiac & pulm neurons originate from T1-5 in the SC and pass from the SC into the ______________ The postganglionic neurons reenter the spinal NN via _______________ and run along the great vessels and distribute elsewhere to the viscera (bronchi & vascular muscle)
paravertebral sympathetic ganglion chain gray rami
1957 Salgo vs. Leland Stanford Jr.
patient not informed about procedure risks
Describe the position of the following joints during the *midstance* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 0 deg hip: 0 deg knee: 0 deg flex ankle: 5 deg DF toes: 0 deg (neutral)
Describe the position of the following joints during the *midswing* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 0 deg hip: 25 deg flex knee: 25 deg flex ankle: 0 deg (neutral) toes: 0 deg (neutral)
Describe the position of the following joints during the *preswing* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 5 deg bkwd rotation hip: 0 deg knee: 40 deg flex ankle: 20 deg PF toes: 60 deg MTP ext
Describe the position of the following joints during the *initial swing* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 5 deg bkwd rotation hip: 15 deg flex knee: 60 deg flex ankle: 10 deg PF toes: 0 deg (neutral)
Describe the position of the following joints during the *terminal stance* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 5 deg bkwd rotation hip: 20 deg hyperext knee: 0 deg flex ankle: 10 deg DF toes: 30 deg MTP ext
Describe the position of the following joints during the *inital contact* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 5 deg fwd rotation hip: 25 deg flex knee: 0 deg flex ankle: 0 deg (neutral) toes: 0 deg (neutral)
Describe the position of the following joints during the *terminal swing* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 5 deg fwd rotation hip: 25 deg flex knee: 0 deg flex ankle: 0 deg (neutral) toes: 0 deg (neutral)
Describe the position of the following joints during the *load response* portion of gait: -pelvis -hip -knee -ankle -toes
pelvis: 5 deg fwd rotation hip: 25 deg flex knee: 15 deg flex ankle: 10 deg PF toes: 0 deg (neutral)
Deontological theory
people should adhere to rules and regulations regardless of outcome
Consequential theory
people should seek to maximize benefits to the maximum number of people
The over-the-counter version of H2 receptor antagonists are used to treat:
peptic ulcers
Ataxic Breathing
periods of apnea alternating irregularly with a series of shallow breaths of equal depth
Which anatomical structure is not working correctly in peripheral vestibular disorders? What conditions might this include?
peripheral sensory apparatus -vestibular neuritis -labrynthitis -BPPV -Meneir's -perilymphatic fistula -acoustic neuroma
What does polymyxin target?
permeability of bacterial cell membrane
The plane of each semicircular canal plane is ________ to the other canals The horizontal canal sits at a ______ degree angle from the horizontal
perpendicular 30 deg
What are characteristics that are generally associated with a rigid foot?
pes cavus high arch
What are characteristics that are generally associated with a flexible foot?
pes planus flattened arch
List 3 potential conflicts of interest in medicine
pharmaceutical companies paying medical professionals, patient advocacy groups, researchers, continuing medical education providers advertising medical care overtreatment/undertreatment (pre-payment)
What do you have to consider when prioritizing the order of events in a vestibular exam? (read)
pick/choose wisely with tests or you'll have a 3 hr exam and a very nauseous patient
1 generic name of ACh M1 Receptor Antagonists:
pirenzepine
What is the most common ACh receptor antagonist prescribed for GI problems?
pirenzepine
Where do you measure bronchovesicular breath sounds?
place stethoscope over anterior wall over sternum at angle of Louis and along the costosternal borders of the sternum
Where do you measure tracheal breath sounds?
place stethoscope over trachea and larynx
What is an example of a lung expansion disease?
pleural effusion (build up of excess fluid b/w the layers of the pleura)
A classic sign of __________________ is when a person stops breathing at the point of pain (splinting), so their breath pattern is halting rather than smooth & continuous
pleural friction rub
What conditions might cause a pleural friction rub?
pleural inflammation due to lobar pneumonia or lung infarction
Which tests should you always perform last in a vestibular exam?
positional testing-- most symptom provoking & they won't want to do anything afterwards
FYI: in a subjective examination, you might ask the patient if they smoke, and if so how many packs per day
possible answers: - 0 - 1/2 - 1/2 - 1 - 1 -2 - 2+
Phase IV
post marketing
Which SCC are tested by the Dix Hallpike test? Which SCC are tested by the Roll Test?
posterior & anterior SCC horizontal SCC (likely positive to both sides)
What arthrokinematic motions are associated with talocrural dorsiflexion in an open chain position? (roll and glide)
posterior glide anterior roll
How may a person with limited hip flexion compensate during the swing phase?
posterior pelvic tilt or excessive knee flexion
What arthrokinematic motions are associated with talocrural plantarflexion in an open chain position? (roll and glide)
posterior roll anterior glide
If a patient is lacking motion in dorsiflexion of the ankle, what joint glide would help facilitate this motion?
posterior talar glide
Explain the implication of the goals of medicine described in the course companion
prevent disease and injury promote and maintain health relieve pain and suffering care for and about patients avoid premature death pursue a peaceful death for patients
How do H2 antagonists work?
prevent the histamine-activated release of acid under resting conditions and during stimulation with food
What do anti-spasmodic opiates do?
produce a general dec. in GI motility
Specify 3 duties that doctors and medical students have to society
protection of public health protection of global health promotion of equitable distribution of scare health resources
What does tetracycline target?
protein synthesis
What are interferons? Are they a good thing or a bad thing?
proteins produced by the host cells in response to a viral invasion (increase host resistance = good thing)
Telehealth
provision of healthcare informaiton and/or services from a provider in a different location than the patient or person seeking information
Distance medicine
provision of healthcare services, clinical information, and/or education over distance and time using information communication technology.
The motor end plate is generally found at the ________ 1/3 of the muscle
proximal
Does the SIJ or pubic symphysis joint have less motion?
pubic symphysis-- cartilaginous joint, not synovial
If someone has nerve pain that radiates into the labia in a woman or head of penis in a male that's aggravated by sitting, rectal pain/burning and constipation, which nerve would you expect is involved?
pudendal N
Frequency may be measured in what? (3)
pulses per second (pps) cycles per second (cps or Hertz) beats per second (bps)
What are possible causes of backward trunk lean?
purposeful to reduce demands on weakened stance limb gluteus maximus or to assist with limb advancement when hip flexion capability is limited
The semicircular canals form 3 coplanar pairs. This pairing is associated with a ________ change in the quantity of canal output
push-pull-- Ex: if you turn your head to the left, the left side will be activated and the right side will be activated less if these aren't paired up right you can get sx of dizziness
What are radiopharmaceuticals?
radioactive tracers used in nuclear medicine (PET, SPECT, bone scan) that are absorbed according to the metabolic properties of the tissue
The radiodensity of an object is inversely related to the:
radiodensity (amt of black) on the x-ray
An x-ray is simply a reflection of the _____________ of anatomical structures
radiographic densities
Is air radiolucent or radioopaque?
radiolucent
Is heavy metal radiolucent or radioopaque?
radioopaque
Identify 2 ethical concerns about the use of information communication technology (ICT) in medicine
reduce patients to data sets or objects some web sites provide unreliable information that could harm patients some online support groups may be misleading, which could weaken patient trust in physicians and medicine
What is the purpose of adding a coupling agent (like US gel) to an electrotherapy treatment?
reduces resistance
Define attenuation
reduction in strength or density of an x-ray beam as it passes through something
What is virulence?
refers to how strong the infecting agent is (can be used interchangably with pathogenicity)
The prescription version of H2 receptor antagonists are used to treat:
reflux disorders & peptic ulcers
What is substituted judgment?
regarding a patient unable to make medical decisions about himself or herself, an attempt to ascertain what the patient would have wanted if he/she understood the present circumstances and prognosis
What is utility?
representation of the greatest benefit/harm ratio that can be obtained
What does a FEV1/FVC% measurement represent?
represents the proportion of a person's vital capacity that they are able to expire in the first second of forced expiration
How does deontological theory view patient confidentiality?
requires physicians to uphold their duty to maintain patient confidentiality under all circumstances
__________ is the relative opposition to movement of charged particles
resistance
Which is the most important: beneficence, nonmaleficence, respect for patient's autonomy
respect for patient's autonomy
Which bioethics principle encompasses confidentiality, harm principle, and paternalism?
respect for persons
List the 5 principles of bioethics
respect for persons beneficence nonmaleficence utility justice "Real Boys Never Use Jewels"
How is an infection spread through droplet transmission?
respiratorty or salivary secretions are expelled from infected individual
If a patient with pneumonia has a pH = 7.6, PCO2 = 33 mmHg, and HCO3- = 20 mEq/L, what acid/base imbalance do they have? Are they compensating?
respiratory alkalosis yes-- HCO3- is low to try make pH more acidic
Neural control of the motor neurons that innervate the respiratory muscles is regulated by the _________________ center
respiratory center
What happens when an RNA virus enters a eukaryote and starts replicating?
reverse transcriptase reverts the viral RNA into DNA, which the cell begins to replicate as part of its own DNA, allowing spread of the virus
What is considered 1 gait cycle?
right foot initial contact to right foot initial contact
In populations with more stress-fracture type injuries due to lack of shock absorption, what kind of foot would we expect them to have?
rigid foot
What are the two types of feet?
rigid foot flexible foot
Phase I
safety dosage range side effects 20-80 people
Phase II
safety efficacy side effects 100-300 people
What plane and axis does talocrural motion take place in?
sagittal plane frontal axis
The exact amount of motion that takes place at the SIJ is under debate, but it is thought to occur primarily in the _____________ plane
sagittal-- but it does move in all 3 planes
The interaction of an antacid + HCL produces:
salt + water
If an area of an x-ray appears "hyper-intense" (very white) what does this suggest?
sclerosis
Which vestibular structure regulates VOR?
semicircular canals
A test that is ______________ will minimize type II errors
sensitive
If a test is very _________________, then the test will almost always be positive when the condition is present
sensitive
MRIs are _________ but not ___________ (sensitive/specific)
sensitive, not specific
______________ refers to a test's ability to correctly identify people with a condition
sensitivity
Define: Diastasis Rectus Abdominis
separation of RA along linea alba
Is elongation a type of size/simple or shape distortion?
shape distortion
Is foreshortening a type of size/simple or shape distortion?
shape distortion
Does sensory stimulation generally involve a long or short pulse duration?
shorter
What happens if a person lacks hip flexion?
shorter step length (common in OA)
Effects of bedrest are _______, but are ____________
significant but reversible
What does SBAR stand for?
situation background assessment recommendation
Is magnification a type of size/simple or shape distortion?
size/simple distortion
What infections do staphylococcus areus, streptococcus and diplococci cause?
skin infection respiratory infections pneumococcus
Note: when turning up the intensity with an electrotherapy, it is important to go _____
slow
Body Chart: multifidus trigger points
small circles along each side of the spine ranging from mid-thoracic region down to coccyx
How is an infection spread through aerosol transmission?
small particles from respiratory tract are suspended in the air and can travel farther between people than droplets
What is the most common cause of COPD?
smoking
end feel hip (flexion)
soft
end feel Elbow (flexion)/ (extension)
soft (flexion) /hard (extension)
end feel Thumb CMC (flexion)
soft or firm
end feel knee (flexion)
soft or firm
What does water have roughly the same radiodensity as?
soft tissue
T2 MRI images show:
soft tissue pathology and are ideal for acute trauma
What color is heavy metal on an x-ray?
solid *white*
In order to provide exercises that challenge the vestibular system's role in postural stability & balance, we can decrease their ______________ inputs What exercises can we do this with?
somatosensory & visual inputs -stand w/ feet together -head turns while standing or walking -EO/EC -foam surfaces -walk backwards, turning, ramps & curbs -bounce on Swiss ball or trampoline -walk in busy environment needs to be challenging! need to make them fail in a controlled environment so the brain can correct it, not appropriate for HEP, know pts will get frustrated
A test that is ______________ will minimize type I errors
specific
If a test is very _________________, then it will almost always be negative when the condition is not present
specific
_______________ refers to a test's ability to correctly identify people who do not have a condition
specificity
DCD presents as a _________ disorder
spectrum
What are the 4 levels of infection?
sporadic endemic epidemic pandemic
What are 3 different types of waveforms?
square sine spike
What are the 2 main functions of the ankle?
stability and flexibility
The pelvic floor is a primary ______________ for the pelvic girdle. It functions alongside local & global muscles.
stabilizer Ex: like multifidus, it contracts right before you reach for something or take a step
What are some common spherical forms of cocci?
staphylococci streptococci diplococci
Velocity changes during gait with each:
step
Side effects of stool softeners include:
stomach cramps
What should you do about challenging behavior that dementia pts exhibit?
stop judging and become curious, ask problem-solving questions
What does individuality mean when referring to adaptation?
strength gains can be variable between people during resistance training
What is the stretch-shortening cycle?
stretch creates potential energy that can enhance forces produced by contractile elements
Which breath sound can sometimes be heard without a stethoscope?
stridor
What are the 3 "stages" of an infection?
subclinical bacteremia septicemia
What is a bleed below the meninges called?
subdural hematoma
Define gait:
successive episodes of losses & recoveries of balance
Paroxysmal Nocturnal Dyspnea
sudden acute dyspnea
Define: Mixed Incontinence
sx of stress & urge incontinence
What do sulfonamides target?
synthesis of essential metabolites
Treponema palladium and vibrio cholerae result in what infections?
syphilis and cholera respectively
Name 3 barriers to effective pain relief
taboos against opioids cultural stereotypes doctors that do not know how to respond accordingly or effectively to pain
What are the two main joints that make up the ankle?
talocrural subtalar
In general, with closed chain movements of the ankle, which bone(s) is (are) providing most of the available motion?
talus and calcaneus
ROM Lumbar (Extension)
tape measure (~1.5 cm)
ROM Lumbar (Flexion)
tape measure (~6.5 cm)
What is the difference between telehealth and distance medicine?
telehealth is centered around the delivery of information that can be done by non-physicians distance medicine is specific to the provision of medical care by physicians or qualified members of the healthcare team
Define true negative
test detects nothing, and nothing is there
Define false negative
test detects nothing, but there is something there
Define false positive
test detects something that is not really there
Define true positive
test detects something that is really there
Define: Functional Residual Capacity
the amount of air remaining in the lungs at the end of a normal tidal exhalation-- the sum of ERV + RV (represents the point at which the forces tending to collapse the lungs are balanced against the forces tending to expand the chest wall)
In reference to a waveform, what does balanced refer to?
the amount of charge being delivered represented by the area "under" the waveform is equal between the pulses of a biphasic waveform
What is an acini?
the area of a lung that one terminal bronchus supplies (not the same thing as alveoli)
Guidelines for developing exercises to induce vestibular adaptation: (get the brain to adapt so pt no longer gets dizzy)
the best stimulus to induce adaptation is one that produces an error signal, so use exercises that cause a little dizziness to help "retrain the brain" -adaptation takes time -adaptation of vestibulo-ocular system is context specific -adaptation affected by voluntary motor control -patients should work at the limit of their ability
Define culture
the customs and achievements of a particular civilization
Why is a subdural hematoma worse?
the dura matter can't help decrease some of the pressure on the brain like it can w/ an epidural hematoma
Massey's Value Cohorts
the events that occurred during the time one was growing up shapes us as a generational group called a value cohort
Biphasic alternating current involves the continuous flow of electrons that is bidirectional. What does this mean?
the flow of electrons is constantly changing direction/reversing its polarity
How does a rearfoot varus affect someone's gait?
the foot pronates too much (in excess)
Define: Vital Capacity
the max amount of air that can be exhaled following a max inhalation-- the sum of IRV + ERV + TV
Define: Inspiratory Capacity
the max amount of air you can take in after normal tidal exhalation-- the sum of TV + IRV
Define: Total Lung Capacity
the max volume to which the lungs can be expanded-- the sum of all pulmonary volumes
During inspiration, muscles contract & the lungs expand so the lung pressure is less than atmospheric pressure. Air rushes into the lungs until: After inspiration, the thorax is expanded and lung pressure ____ atmospheric pressure The thorax returns to resting dimensions when the lung pressure is greater than the atmospheric pressure. Air rushes out of lungs until:
the pressures balance is equal to the pressures balance
Define: Minute Ventilation
the product of TV and RR
Define informatics
the science of processing data for storage and retrieval
What is an H2 receptor?
the subtype of the histamine receptor in the stomach
How is pulse defined?
the time from the beginning to the end of an electrical event
Why are viruses sometimes hard to treat?
their genes can mutate quickly making it hard to treat
How does hemolysin (streptolysin) fit into the category of bacterial toxins? (what does it do)
these lyse RBC
What is the problem with laxatives?
they are frequently abused
What is the main characteristic that distinguishes the bacilli group of bacteria?
they are rod-shaped organisms
How do RNA viruses work?
they contain reverse transcriptase enzyme to convert RNA back to DNA
When someone has a leg length discrepancy, how might they compensate in walking with the shorter limb?
they could supinate more to effectively lengthen that limb
If someone has more than 1 inch of hip drop during gait, what does that mean?
they have a weak gluteus medius (Trendelenburg Gait)
How might someone with a swollen ankle compensate with gait?
they may adapt a position of *15 degrees of PF* since this is the position in which the intraarticular pressure is the least
How might someone with a swollen hip compensate with gait?
they may adapt a position of *30 degrees hip flexion* since this is the position with the least amount of intraarticular pressure
How might someone with a swollen knee compensate with gait?
they may adapt a position of *30 degrees of knee flexion* since this is the position with minimum intraarticular pressure
When someone has a leg length discrepancy, how might they compensate in walking with the longer limb?
they might pronate in excess to effectively shorten that limb
How can equinus affect someone's gait?
they never reach the 10 degrees of dorsiflexion functionally required for walking, let alone running
How does a forefoot varus affect someone's gait?
they pronate for a prolonged period of time (long and later pronation)
In MRI imaging, what happens to atomic nuclei when the EM field is removed?
they realign to their resting state and release resonant energy this radio frequency signal is detected & processed into an MRI image
What does pulsatile (PC) mean?
three or more pulses grouped together - may be unidirectional or bidirectional
What is a characteristic of tibial varum? How might this affect gait?
tibia has a bowed out appearance, may affect knee and foot mechanics
Due to the wedge shape of the sacrum, it is self-locking, this means the greater the WB the ____________ the joint is held
tighter
When does the pelvis tilt down during gait?
tilts down on the side of the swinging limb during single leg support
Symmetry refers to the amount of _____ and _______ of each phase of the pulse
time and amplitude
Why might a sunrise/tangential x-ray be taken?
to image the patellofemoral joint
Why might an open mouth x-ray be taken?
to image the upper cervical spine
Professionalism
to publicly profess expertise and commitment to a particular area
How would a person present in the initial swing phase of gait if they have limited knee flexion?
toe drag
What happens in midswing if there is excessive plantar flexion?
toe drag
Which of Maslow's Hierarchy of Needs are considered enduring needs? What does this mean?
top 4 -- continue to motivate when they are met (cognitive, aesthetic, self-actualization, & transcendence)
What qualifies as direct contact for spread of infection?
touching infectious lesion, sexual activity or contact with infected blood or bodily secretions
Where is air normally present in the body? (4)
trachea lungs stomach GI tract
What does specificity mean when referring to adaptation?
training must stress the muscles/ fibers/ motor units that need to perform *very* important
Hip, knee or foot ______ in addition to corns, bunions, blisters or _________ may cause antalgic gait
trauma ingrown toenails
In which direction do x-ray beams travel in an AP image?
travel through the pt from anterior to posterior direction
T/F: a pulse can contain one or more phases
true
T/F: contrast MRI allows for before and after contrast image comparisons
true
T/F: it's helpful to look back on the 6 determinants to figure out what might be causing some of the observed changes
true
T/F: large fibers offer less resistance to ion movement and therefore conduct action potentials faster
true
T/F: smaller fibers will display conduction failure before larger fibers in the presence of anesthetics or toxins
true
T/F: spine stability involves co-contraction of muscles and coordination throughout a movement
true
T/F: stability of the spine involves all 3 systems: active, passive & neural
true
T/F: the affects of aging on muscle mass can be slowed but not prevented with training
true
T/F: there is no specific pathologic process or neuroanatomic site has been associated with DCD
true
T/F: there is little evidence that resistance training causes hyperplasia to any significant degree in humans
true (accounts for <5% of increase in CSA)
T/F: physiologic effects of a burst of pulses is the same as a single pulse
true because the time between bursts is too short to have an effects on muscle contraction
A test that is specific helps determine a:
true negative
A test that is sensitive helps determine a:
true positive
The thoracolumbar fascia is a critical structure for load transfer b/w:
trunk & LE
What gait deviations could you observe in a lateral view for each of the following areas? trunk pelvis hip knee ankle foot toe
trunk - anterior or posterior lean pelvis - forward and backward rotation hip - flexion and extension knee - flexion, extension, and hyperextended ankle - plantarflexion and dorsiflexion foot - heel (rise or contact), forefoot contact, and foot slap toe - extension, up, clawed
What gait deviations could you observe in an anterior view for each of the following areas? trunk pelvis hip knee ankle/foot toe
trunk - lateral lean and rotation pelvis - lateral tilt and drops *hip* - rotation: ER/IR, adduction, abduction, circumduction *knee* - varus/valgus ankle/foot - toe-out or toe-in (may indicate hip IR/ER) toe - up or clawed (bold indicates preferable view)
What gait deviations could you observe in a posterior view for each of the following areas? trunk pelvis hip knee ankle/foot
trunk - lateral lean and rotation pelvis - lateral tilt and drops hip - rotation: ER/IR, adduction, abduction, circumduction knee - rotation *ankle/foot* - eversion (valgus) and inversion (varus) (bold indicates preferable view)
How does the body compensate for excessive plantarflexion in stance?
trunk is anterior to the hips
In someone with pelvic drop, which side would they lean with the trunk to compensate?
trunk will lean to the stance (weak) side to maintain COG above stance limb
Does multifidus have more type 1 or type 2 fibers?
type 1 = endurance/postural muscle
Which type of fibers atrophy at the fastest rate?
type I
H2 antagonists are used for both acute and long term management of _____
ulcers
Which type of imaging creates anatomic images through sound waves?
ultrasonography
Name 3 challenges to obtaining informed consent
uncertain mental or legal status coercive influences incomplete understanding by patient
In a gram-positive bacteria, where is the cell membrane located?
underneath the cell wall
Are protozoa unicellular or multicellular?
unicellular
What causes fungal infections?
unicellular organisms (yeasts)
Monophasic direct current involves the uninterrupted ___________ flow of electrons toward the ____ (+/-) pole
unidirectional flow towards (+) pole
In forefoot varus, which direction will the big toe be pointing (up or down)?
up
How long does it take the abdominal fascia to heal after childbirth?
up to 93% of its original strength in 5 months, but at inc risk of injury for the first year moderation should be used in return to sport until pt's are free from other sx
How do you know what habituation exercises to have someone perform? How many times/ for how many weeks should habituation exercises be performed?
use MSQ (motion sensitivity questionnaire) to indicate which movements/positions bother them and have them do the ones that make them mild to moderately dizzy -pick up to 4 movements from test results -perform 2-3x per day (head mvmt encouraged) -may take up to 4 weeks for sx to decrease
Define philosophy
use of reason and argument in seeking truth and knowledge of reality, especially of the causes and nature of things, and of the principles governing existence
What type of endogenous contrast agent is used in a functional MRI?
uses magnetic properties of deoxyhemoglobin
How might the use of a smaller electrode be advantageous in certain situations? How would you use a larger electrode instead?
using a smaller electrode over the target tissue will give the greatest effect to the nerve or muscle motor point place a larger electrode further from the treatment area
end feel Finger PIP (flexion)
usually hard
In 1 gait cycle, how many vertical & horizontal sine waves take place?
vertical: 2 horizontal: 1
How many cm of vertical and side-to-side displacement occur during a gait cycle?
vertical: 5 cm side-to-side: 4 cm
___________ is responsible for maintaining gaze stability at >60 deg/sec _______ is responsible for maintaining gaze stability at <60 deg/sec
vestibular system (semicircular canals) smooth pursuit
When viewing a lateral x-ray film, in which direction will you view the patient?
viewed in the direction the x-ray beam traveled
When viewing an AP or PA x-ray film, in which direction will you view the patient?
viewed with pt facing the viewer in the anatomical position-- hands, feet & digits point upwards
What is the harm principle?
violations of respect for persons are justified when these prevent harms to others
Describe 3 aspects of virtue and character in medicine and medical education
virtue is developed through habitually leading a moral life virtue and character is gained through experience altruism
Photographic qualities of an x-ray refer to the ________________ of the image
visibility
___________ measures the change in electrical potential between two points
voltage
What is the equation for current flow?
voltage/resistance I = V/R or V = IR
Voltage is measured in _______
volts (V)
Define: Tidal Volume
volume of air normally inhaled & exhaled per breath
Define: Residual Volume
volume of air that remains in the lungs after a forceful expiratory effort
Rhonchi was formerly known as:
wheezing
What does it mean to have an antalgic gait?
when a person has adapted a walking pattern to avoid pain
How may someone "recover" after unilateral vestibular loss (UVL)?
when someone asks you why they are getting better you can try to explain this to them: *cell recovery*: -damaged/inflamed neurons may recover *spontaneous recovery*: -nystagmus, skew deviation and postural asymmetries recover spontaneously -recovery of resting firing rate due to denervation, supersensitivity and axonal sprouting *vestibular adaptation* -expose the brain to dizziness to induce a visual slip so it can figure out how to adapt -have to make them fail so the brain sees this as an error & fixes it -requires both visual input and movement of head and body *substitution* -COR complements the VOR at low frequency -smooth pursuit and saccadic eye movements help -visual and somatosensory cues used more
Is the corpus callosum considered white or gray matter?
white
What color is unexposed film on an x-ray?
white
What is the corpus callosum?
white fiber pathways crossing from one hemisphere to the next
Is outside the "H" portion of the spinal cord white or gray matter?
white-- tracts up/down to the brain & rest of the body contains the dorsal, lateral & anterior columns
How does someone with limited hip extension (hip flexion contracture) present during gait?
with a forward trunk lean (to place center of gravity back over supporting foot)
Define radiodensity
x-ray absorption capacity based on a substance's composition, density and thickness
A CT scan uses ________________ to produce cross-sectional images
x-ray attenuation
Do fungi have any benefits?
yes (foods or antibiotic drugs)
How is a transverse CT scan read? (when you look at an image, which way are you looking at the person?)
you are always looking from the person's feet upwards
What is the normal pH of blood?
~7.4 (narrow range of pH to function normally, most pathologies disturb acid-base balance)
