Test Review

what is the max current density that should be used to initate iontophoresis when the current amplitude is 10 milliamps and the conductive SA is 20 cm^2

0.5 milliam/cm^2 current density = current amplitude / conductive surface area

Expected effects of isometric exercise

Higher HR and arterial BP BAD for cardiac patients Static exercise (isometric) hinders blood flow which produces the above (rise in BP is related to degree of intensity) Whereas dynamic exercise facilitates circulation! The valsalva maneuver hinders venous return to the heart look this up to be clear

Iliopsoas will limit hip extension regardless of the amount of what

Knee flexion

lateral aspect of the knee dermatome

L4/L5

Trap lesion will cause what

Dropping of shoulders, inability to shrug

Cervical capsular pattern

Lateral flexion and rotation equally limited Then extension

Colon or appendix pain

Lower back pelvis or sacrum

ligamentous lesion what dx tool

MRI can also show bone tissue without need to expose the pt to ionizing radiation needed for CT scans

Ligamentous injury that causes excessive tibial external rotation

Medial collateral Prevents ER and provides stability to the knee Could also be lateral collateral

What is a chemo therapy agent that is also a disease modifying anti rheum drug aka DMARD

Methotrexate Most commonly prescribed DMARD Also can immuno suppress and be used to treat cancer

FIM level 3

Mod assistance and completes the activity with 50% or more but less than 75%

junctional rhythm with regular HR what wave would be absent

P wave Junctional rhythm originates from the atrioventricular junction instead of the sinoatrial node, which normally causes the P wave. Therefore, the P wave will be missing. R, S, T waves come from the ventricles after stimulation from the atrioventricular junction and will be unaffected. originates from AV node instead of SA node

ECG

PVCs wide QRS complexes and absent P wave

Anosognosia

Perceptual disorder characterized by denial neglect and lack of awareness of the presence or severity of ones paralysis

right MCA stroke what do they have between these four answers horiz nystag ataxic gait apraxia rigidity

apraxia CLINICAL SX OF MCA STROKE horiz nystag and ataxic would be cerebellar problems horiz nystag - AICA ataxic - basilar

high ABI =

arterial calcification

CN 7

facial sweet and salty or testing facial expressions

resist the pts ability to keep the eyes tightly shut, what CN

facial CN VII

primary emphasis of PT for a child who has athetoid CP

facilitating cocontraction patterns and encouraging control in voluntary movement gradation (athetoid CP is characterized by involuntary movements that are slow and writhing) must gain CONTROL before strengthening a child with athetoid CP is less likely to have contractures, compared to children with other forms of CP, because of the constant movement of limbs

timing for emphasis

facilitation technique that uses max resistance to elicit a sequence of contractions from major muscle components of a pattern of motion allows overflow to occur from strong to weak muscles indicated when there is weakness and or incoordination and is commonlu used in conjunction with REPEATED CONTRACTIONS

toe in can be caused by

femoral anteversion, internal tibial torsion or metatarsus adductus

child with trisomy 21 what sx will they have

aka down syndrome hypotonia

Pronator teres syndrome can you pronate

Possible but weak

Contact dermatitis

Primary treatment is removal of the offending agent Treat with lubricants, topical, anesthetics, and or steroids Prosthetic wearers may require a thin sock if the problem doesn't resolve

up and overhead and touch the superior medial border of the contralateral scapula =

abduction and ER of shoulder

stereognosis

ability to identify an object without sight coin, key, comb verbally identify object by name

controlled mobility =

ability to move within a weight bearing position or rotate around a long axis

tectospinal tract

extrapyram mmotor tract contralateral postural muscle tone assocaited with auditory/visual stimuli

sx of underlying cardiac condition

feelings of heaviness in the chest and indicates a referral to a physician

pt with history of herniated disc, how should you improve HS length

flex one hip with the same knee extended in supine try to avoid forward bending bc can aggravate herniated disc

UMN spasticity what muscle would be affected

flexor carpi radialis NOT supinator, triceps, or extensor digitorum hypertonic motor disorder characterized by a velocity dependent resistance to passive stretch arises when corticospinal pathways become injured typical pattern = scapula retraction and downward rotation, shoulder adduction and IR, elbow flexion, forarm pronation, wrist flexion and adduction, finger flexion and thumb adduction

most apprp initially for diastasis recti 3-/5 if bracing abdomen

head lift keeps sepatation minimu minimize action of obliques and control intraabomdinal pressre want to avoid lower turnk roattin until 2 cm or less bc angle of attachment of obliques into the lineaa alba and perpeturate the diastasis

TBI pt with hard end feel what is happening

heterotopic ossification abnormal bone growth in tissues and is relatively common it pts following head injury s/s include decreased ROM, local swelling, and warmth

CN 12

hypoglossal protrude tongue

positive trochlear nerve test

inability to depress the eyes and or complaints of diplopia

medial rotation implicates what structures of shoulder

posterior GH capsule impingement (aka suprahumeral impingement)

reach behind back what is limtiing when MMT is normal and pain free

posterior capsular stiffness

beta blockers

reduce HR and decrease cardiac contractility

wrist cock up

carpal tunnel

independent variable

cause or treatment

pt falls to ground what do you do

chest responsiveness activate emergency (includes AED) response system check pulse begin chest compressions

sudden increase in the rate and depth of respirations, followed by a gradual decrease in resp and periods of apnea, what resp pattern

cheyne-stokes

homolateral synkinesis

condition often associated with hemiplegia where there is mututal dependency between the involved upper and lower extremities certain theories of neuro rehab avoid utilizing associated reactions while other theories utilzie them to increase movement

primary lymphedema

congenital or hereditary in which lymph node formation is abnormal

fx of 3rd metacarpal that occurred 2 months ago, pt currently has heat, swelling, erythema, and tenderness at the fracture site, which of the following courses of action would be most appropriate at this time

contact the physician sx indicate a potential nonunion fracture AROM or US may make it worse and increase inflamm compression glove is not appropriate

adverse effects of valsalva

decreased HR (slowing of pulse) and increased venous pressure and decreased return of blood to the heart when relax after, blood rushes to the heart and can overload the cardiac system and result in cardiac arrest the HR is lowered bc a cholinergic or vagal resposne is the result of PNS stimualtion providing inhibitory control of the vagus nerve over HR and AV conduction

squat test

rules in or out a hip fx hip fx will report increased pain with WB

psoriasis nails

small pits in nails with circumscribed yellowish tan discoloration (oil spot lesion)

peripheral nerve injury pattern

small, irregular shaped segments of the skin

decreased ROM during gait with CP can be due to...

static contracture or dynamic contracture

what strcutrues of the skin provide thermoregulation for the body by means of insulation?

subcutaneous tissue (aka superficial fascia) contains loose connective tissue and provides for storage of most of the body fat which is the main insulator for the body and provides significant thermoregulation epidermis has no fat storage dermis also has no fat rbut it does contian sweat glands and arterioles (this is how it contributes to thermoregulation through sweating and arteriole dilation and constriction but not through insulation) deep fascia underlies the superficial fascia and is not technically a part of the skin, it does not contain fat

burn to anterior chest can cause

thoracic kyphosis contracture seconday to the flexion forces associated with this area of the burn splinted into upright posture and retraction

pitting edema suggests

vascular or fluid balance issue

meat protein and fat provide ACID precursors

with HIGHER animal protein proportions leading to MORE rapid femoral neck bone loss

can spasticity effect NMES

yes limited spasticity improves the change of success with tx limited sensation will also limit and hyperactive DTRs mean spasticity is probably present so also limits

is a p value of 0.001 always significant even with a small sample size?

yes the problem with small sample sizes is the possibility of not having a great enough power of the test to pocik up differences if they truly exist

radiolucent

a substance that allows x-rays to pass through and appears black or dark gray on the resulting film

Best way to promote independent stair climbing if pt is having trouble bringing foot onto step

Practice stair climbing inside the parallel bars using a 3 inch step Any passive movements do not promote active learning (ie helping the pt bring the foot up passively) Marching or strengthening alone do not promote the same synergistic patterns of muscle activity as the desired skill

characteristics of cauda equina

flaccidity, areflexia, imapirment of BB LMN below L1

flexor carpi radialis

flex and abduct wrist may assist in pronation of the forearm and in flexion of the elbow

rupture of the flexor digitorum superficialis

proximal IP joint hyperextension slight flexion of hte DIP superficialis doesnt go all the way profundus does

midchest area would treat what area of the lungs

superior segments of the lower lobe

tight rectus what happens

thigh is on table knee kicks out past 90 degrees rectus is a TWO JOINT muscle

RBC/hemoglobin count is used for

to assess the oxygen-carrying capacity of the blood

leukoPENIA vs leukoCYTOSIS

too little vs too many

pt with foot wound that is not healing for 2 months with conservative care, what should you do

total contact casting accepted standard for off-loading pressure areas on the plantar surface of the foot daily changes make the total contact casting impractica and may also prevent a pt from taking advantage of the increased healing rates assocaited with total contact casting

increased risk for adverse drug reaction

use of herbal compounds serious risk factor for serous adverse drug rxn >75 female hepatic or renal insufficicnecy

how to document ROM that starts at 15 degrees and ends at 90 degrees

15-90 wrong = 0-15-90 (doesnt work) 15-0-90 (indicates 15 degrees hyperextension) 0-90 (can fully extend)

what would be a hypertensive response to a low level exercise in a pt who is at least 3 days post MI

160/90 may indicate cardiac ischemia

Metabolic syndrome (must have 3 or more)

Abdominal obesity >40 inches or 35 in women Elevated triglycerides 150 or higher Low high density lipoprotein aka less than 40 in men (or being on a med to treat this) less than 50 in women Elevated BP greater than 130 systolic and/or diastolic greater than 85 Fasting glucose level greater than 100

Peritoneal inflammation

Abdominal pain on coughing or light percussion Rebound tenderness also present

CPR for LBP and stabilization

Age less than 40 years old SLR greater than 91 degrees Aberrant motion present Positive prone instability test

Increased fear of going out in public

Agoraphobia

Trigeminal neuralgia

Aka tic douloureux General sensation to face as well as the lips corneas and anterior in third of the tongue Produces severe, sharp, stabbing pain in the distribution of one or more of the branches of the nerve Caused by peripheral lesion Hyperexcitsbikty Pressure of from a blood vessel

Observe a mole in post mastectomy pt that has changed in color (black to red to blue) what should you document

Atypical dysplasic Nevus Characteristics indicative of malignancy: Irregular borders (asymmetrical) Variations in color Diameters >6 mm Elevation ABCDE

Myasthenia gravis

Auto immune At neuromuscular junction resulting in serve muscle weakness most noteabky with repeated contractions Will see ptosis usually

Basilar artery

Brainstorm sx and PCA sx

talus

CONVEX

Palpating someone with PVD what will you find

Cool temp Putting edema of the dorsal of the foot Capillary refills greater than 3 seconds

Papule

Elevated nevus

Callus on lateral side of the 5th MT head what should you do for orthotic

Flexible foot orthosis with lateral rear foot post

Alar Ligament Test

Integrity of alar lig which attach tot he lateral aspect of the dens and the occiput

Mental rehearsal is the best strategy for what

Learning the correct sequence ie with gait In the non weight bearing position the patients anxiety is lessened, leaving the patient free to concentrate on the task at hand

AA what do you do if you suspect

Marked BP elevation Complains of mild to severe mid abdominal pain that increases on exertion Pulsing mass in lower abdomen

Gallbladder pain

Mid back and right shoulder

Capsular pattern of TMJ

Opening (with deviation to the involved side) normal is 35-50 mm Lateral deviation greater to the uninvolved side

Demerol

Opiate

Convex carpals on concave

Radius Opposite

Pneumothorax s/s

Recent fib fx Suddenly becomes short of breath during hour of coughing Looks panicked and complains of sharp pain in L chest Pain is the side of the pneumothorax Trachea deviated to the opposite side of the pain

Phase II cardiac rehab, being monitored with radiotelemetry, having difficult what would be criterion for terminating this exercise session

Reduce or terminate if... Onset of agina or other sx of exercise intolerance Systolic BP >240 diastolic >110 >1mm ST segment depression, horizontal or foe sloping Increased frequency of ventricular arrhythmias Second or third degree AV block or other ECG disturbances

hypotension and ESRD

SBP <90 DBP <60 <90/60 chronic hypotension will not cause ESRD but chronic HYPERTENSION is one of the primary causes of ESRD

status epilepticus

SE is defined as a continuous seizure lasting more than 30 min, or two or more seizures without full recovery of consciousness between any of them. this you definitely need to call emergency services

metabolism means

SYNTHESIS and BREAKDOWN not just breakdown

supination of a nonweight bearing foot

Soup with a DIP adduction of the forefoot PF of the subtalar and midtarsal inversion and outward rotation of the heel

roos test is for

TOS

TFCC injury

Triangular fibrocartilaginous complex injury on ulnar side

Leading cause of falls when going to the bathroom

Urge incontience

Acoustic neuroma

Vestibular schwannoma Unilateral sensorineural hearing loss along with vestibular sx

supraspinatus

abducion of arm

hypernatremia

agitation and dyspnea signs of hypernaremia

what med is assocaited with the possible appearance of raynauds

aspirin

what do abdominal binders do

assist pt with respiration in sitting by maintaining pressure that is normally lost in pts with lesions at T12 or above (aka with loss of abdominal and internal intercostals that normally help with expiration)

when is a infant considered premature

born at or before 37 weeks full gestation = 40 weeks still can put a baby at risk for CP but not as great as an ischemic condition

upslip

both PSIS and ASIS on the left would be elevated

descend stairs with cane

cane and affected lead down with the bad

full thickness burn

characterzied by a hard, parchment-like eschar coverin the area the color can be white, charred, tan, mahogany, black or red

talipes equinovarus

clubfoot sx or serial castig

grade III

complete tear

stenosis at C7-T1

damage starts at C8 bc exits BELOW C7 exit ABOVE lol there is no such thing as C8 vertebral body C1-7 exit above C8 exits between C7 vertebral body and T1 everyone else is BELOW

skin cancer

dark raised spot that bleeds with minimal contact

lymph drainage

decongest involved trunk quadrant before decongesting involved limb will remain blocked if do distal first

hematocrit can increase with...

dehydration, diarrhea, vomiting, excessive sweating, severe burns and the use of diuretics (increase in percentage of RBCs in volume of blood)

audible clicking what motion would be most imformative to confirm TMJ dysfunction

depression and elevation anterior disc displacement most revealing and diagnstic movement for TMJ

Meralgia Paresthetica

entrapment or injury to the lateral femoral cutaneous nerve, a purely sensory nerve injury affects sensation to the lateral thigh

epiphysis

epiphysis is a rounded end of long bone that has direct articulation with bone at the joint

BP for metabolic syndrome

equal or greater than 130/85

lats function

extend, adduct, medially rotate and hyperextend the shoulder does not signficantly affect the movement of the scapula

insertion site of biceps femoris

fibular head

internal consistency

form of reliability assessing the degree to which a set of items in an instrument all measure the same trait

trunk rule of 9s

front and back each comprise 18% 36% total for whole trunk

legs rule of 9s

front and back of leg each comprise 9% 18% for entire leg

white color describes what type of burn

full thickness

stage 3

full thickness involves damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia deep crater with or without undermining of adjacent tissue

radio scale

have an absolute zero point meaning that 0 represents a total absence of the property being measured length in cm and mass in kg are examples of ratio scales bc the numbers represent the actual amount of the attributes being measures HEIGHT AND WEIGHT

acute appendicitis, after notify physician what should you do

have the pt lie down and remain as quiet as possible (says to be "still" in the explanation) food or water may aggravate the condition and cause difficulites f surgery is needed exercise would also aggravate it further same for hot pack

adductors active during

heel off terminal stance

DF injury causes

high ankle sprain tibiofinular DF ER

posterior leaf spring is not recommended in presence of

hypertonia

thick and pink irregular

hypertrophic scarring

brown sequard

incomplete hemisection paralysis and loss of vib/position sense on same side (damage to corticospinal and dorsal column) loss of pain and temp on opposite side (damage to lateral spinothalamic)

a fib is characterized by...

inconsistent, irregular R-R intervals

KAFO is NOT used for

incoordination or to facilitate muscle activity

arm up and over head, what is it stretching

inferior capsule this is tightened when the arm is raised overhead a restriction here often accompanies prolonged periods of immob and results in difficulty lifitng the arm overhead

anterior knee pain during activity, resisted knee extension is strong but painful, TTP over patellar tendon, no structural faults, what protective device should he use

infrapatellar strap (most appropriate for treating patellar tendinitis in the absence of a patellar tracking problem)

ER

infraspinatus teres minor posterior delt

cannot put arm behind back, what is causing the limitation?

infraspinatus tightness (aka lateral rotator tightness) posterior deltoid could also contribute to this bc it is also an external rotator but it also helps with extension so it might be on more slack than the infraspinatus during this motion

secondary progressive

initial onset of the relapse and remitting followed by a progression of the disease at a variable rate that may include minor relapses and remissions

AVN

insidious onset

delaying practice of integrated tasks (only practicing partial tasks) can end up doing what

interfering with the transfer effects and learning integrated pracgtice is best for learning, partocularly with continuous movement daily practice of the same taks may improve performance, yet may not be best for long-term retention as it does not allow the individual to retrieve from cognitiev stores

peripheral

intermittent nystag slow and fast phases ((jerk nystag) with normal smooth pursuit and saccades

following a L CVA, a pt displays mild balance deficits along with weakness in the glut med, what is the most appropriate for this problem?

lateral weight-shifts in stance (will improve balance abilities and also involve glut med activation, any shift in body mass in a lateral direction involves hip abductors/adductors) partial squats (the answer I almost picked) would not provide balance practice/training and will strengthen hip and knee extensors more than hip abductors neither will sidelying right hip abduction

tight left hip abductors would...

make right hip higher when feet together (stretched) hips the same when spread apart (not stretched) left hip abductors pull the left hip downward

how to limit electrical hazards arising from ground faults

manually test each ground fault circuit interrupter on a monthly basis (this would be proactive monitoring) (these devices provide personal protection from electrical shock by identifying the presence of ground faults and quickly switching off power to that circuit) reporting all equipment defects or failures is reactive not proactive (so this would not be the answer) following the manufacturer recommendations for care and service should be followed but it does not specifically address the goal of limiting electrical hazards arising from ground faults (again not a correct answer) introductory inservice in isolation does not specifically address the prevention of ground faults

fetal alcohol syndrome characteristics

maxillary hypoplasia, elongated mid face, short, upturned nose short attention span and poor growth will have interventions focused on dynamic balance (only good answer in the choices) bc have deficits in fine motor dysfunction, visuomotor deficits, balance problems and weak grasp they do NOT demo spasticity, sensory integration issues, or severe delays in walking usually get diagnosed in preschool or school age because of behavioral issues and learning problems not because of physical delays

abductors active during

midstance

grade I sprain

mild injury without discernable laxity

hyperabduction or wright test

more suggestve of pec minor contrib to TOS

dural stretch

nerve stretches

can you strengthen muscles below the level of injury in SCI when it is an ASIA A

no

partial thickness wounds

no measurable depth so q tip is not accute to measure depth and difficult to reproduce

trochanteric bursitis, ROM limitations?

no, typically just lateral hip pain

spinothalamic vs dorsal column

nondiscriminative (spino) like pain temp touch discriminative (dorsal) like discriminative touch stereognosis kinesthesia

rebound test

nonequilibrium coordination test involving contraction of the biceps, sudden release of resistance, and sudden contraction of the triceps to retrain limb movement

pt is wearing only hospital socks (non-skid), what should you do before you transfer

nothing, perform the stand pivot transfer with the pt wearing the hospital issued socks they are appropriate for transfers bc they significantly improve traction when compared to traditional

cystic fibrosis obstructive or restrictive

obstructive airways are obstructed due to thick secretions

rearfoot valgus

often a compensation for forefoot varus

motor function of trigeminal

opening and closing of the mouth (jaw) rather than the eyes aka mastication

CN II injury

optic ipsilateral blindness

teres major

originates on the dorsal surface of the inferior angle of the scapula and the lower third of the border of the scapula inserts on the lesser tubercle of the humerus medially rotate, adducts and extend

QL origin

originates on the iliolumbar ligament and the iliac crest inserts on the inferior border of the last rib and the transverse process of the upper four lumbar vertebrae does not act on the hip

C5 ASIA A reports lightheadedness and ringing in the ears while sitting upright in a w/c what is causing this

orthostatic hypotension (common complication in pts who have an acute cervical injury, manifests with dizziness or light-headedness and ringing in the ears when in a vertical position such as sitting or standing) NOT autonomic dsyreflexia (increase BP and pounding HA)

indications for glenohumeral arthroplasty

osteoarthritis fracture of the humerus severe deterioration rheumatoid arthritis traumatic arthritis rotator cuff tear arthropathy (combo of rotator cuff insufficiency and glenohumeral cartilage destruction) proximal humeral fracture

case control

outcome of interest then look retrospectively at different exposures

benign tumors of epithelium/skin

papilloma and adenoma

anterior right thigh pain that increases with passive flexion of the knee in prone

passive flexion of knee in prone implicates L2-L3

knee jerk aka

patellar tendon reflex

dequervain tenosunovitis

progressive condition that affects the tendon sheath of the abductor pollicis longus and exxtensor pollicis brevis arthritis overuse involving repetitive tasks that involve overexertion of the thumb 1st digit or radial and ulnar deviation are most common predisposing facotrs finkelsteint est with de quervains

mobitz type 1 second degree block

progressive prolongation of PR until one drops

first degree heart block

prolonged PR interval

superior segments of the lower lobes what position

prone with two pillows under the hips

medial displacement of socket

prosthetic foot leaning medially

swan ganz cath

provide continous measurements of pulmonary artery pressure pts must attempt to avoid activities that increase pressure on the catheters INSERTION site

pt with global aphasia about to be d/ced home, what should you do to educate caregivers

provide organized treatment sessions during which the caregivers practice caring for the patient

18 month old child collapses into C shape when placed in sitting, what should you do to initially improve the childs posture

provide postural correction at the pelvis

adhesive capsulitis and scapula

pt compensates with scapular mobility

rhomboids mm fxn

retract, elevate and downwardly rotate the scapula

dorsal scapular nerve innervates

rhomboid major, levator scapulae

T10 SCI transfer

sit pivot

apical segments position

sitting leaning back 30-40 degrees

tympanic sound

sound when percuss on puffed cheek may be heard over a hyperinflated chest

thrombocytopenia vs cytosis

spontaneous bleeding vs tendency to clot, splenomegaly, and easy bruising

bladder infection pain

suprapubic area and lower back

incentive spirometry is used to assist a pt in achieving

sustained max inspiration visual feedback regarding performance during deep breathing exercises NOT diaphragmatic breathing not necessarily a component of incentive spirometry modification of deep breathing exercises in which the pt inspires through an open glottis encourages slow deep breathing to improve lung vomues ad reduce atelelctasis

slight burning sensation felt after 1 min of US to anterior thigh, what should you do

temporarily d/c treatment and examine the amount of coupling agent utilized (if the PT adds coupling agent and the pt still reports this sensation, the intervention should be d/c and the US unit should be formally inspected by a qualified technician) this can be due to inadequate coupling agent, loosening of the crystal or hot spots due to a high BNR NO NEED to contact physician unless the pt has been injured by a PT intervention or if there has been a change in the pts medical status continuing without changing something about the treatment puts pt at risk for harm

PT AIDE not PTA, what determines the extent to which aides are involved with pt care

the discretion of the PT (or PTA if allowable by law or regs)

opening a car door would stress

the elbow flexors and shoulder extesnors/scapular retractors

full inspiration =

total lung capacity

integration of ATNR

turns head to one side and brings hand to mouth on the same side

increase radial deviatioon

ulnar glide of the proximal carpal row

adductor pollicis innervat3ed by

ulnar nerve

medial cord

ulnar nerve median nerve medial pectoral

ulnar gutter splint

ulnar side of wrist

PD good training method

visual cues on floor effective at overcoming freezing deficit in proprioception for which visual cues may compensate procedural learning impaired in pts with basal ganglia lesions

what is decreased in emphysema

vital capacity

challenge balance

walking over uneven terrain

trauma to nail bed

white spots

T4 syndrome

• Glove-like distrubution of parestheia • May be bilateral • 1 or more levels may be affected

Impending MI

Angina, pain in chest jaw or arms Palpitations Tachycardia Unusual fatigue or dyspnea

reiter syndrome

Form of reactive arthritis - urethritis, conjunctivitis, and arthritis

Lateral pelvic tilt is meant to

Reduce peak rise of the pelvis Keeps peak of sinusoidal curve lower than it would be if it didn't drop Controlled through glut med on opposite side Knee flexion is another adjustment in keeping the center of gravity from rising too much

controlled mobility refers to

activites that emphasize weigh shifting and trunk control with rotation this type of activity may serve to decrease rigidity and improve the fluidity of gait in pt with PD

what would have the most impact on the thoroughness of the tests and measures section of an exam

acuteness of injury bc can cause limitations in the performance of the evaluation tests and accuracy of findings

opposite of cushings syndrome

addisons disease hypoplasia of the adrenal cortex

when should you conclude if a pt is not a candidate for PT

after attempts to alter the learning environment or the method of providing pt instruction prior to concluding a pt is not a candidate for PT

substance that is stimulated by decreased arterial pressure and acts as a vasoconstrictor

angiotensin polypeptide in the blood that causes vasoconstriction, increased BP and the release of aldosterone from the adrenal cortex

femoral antebersion

angle formed betweeen the femoral neck and femoral condules a bbirht it is approx 30 degrees decreased to 8-15 degrees by adulthood

tib posterior weakness what should you do

ankle PF and inversion

abd/add of wrist

another way to say radial and ulnar deviate

irreg HR >100 bpm, most accurate way to measure

auscultate the apical HR for at least 60 seconds "with an irregular HR greater than 100 bpm, auscultation is the msot accurate method of mesureing HR" rates faster than 100 bpm or slower than 60 bpm should be measured the full min !!!

PNF for pt showing some out of synergy movements

chop, reverse chop with right arm leading (affected arm leading)

lunate is

commonly SUBLUXED NOT fractured

anterior tibiofibular ligament resists

distal and posterior glide of fibular provides support to the distal tibiofibular joint

where to press with hip adduction and abduction MMT

distal femur

mallet finger

distal phalanx of the finger resting in a flexed position caused by a rupture or avulsion of the extensor tendon

THA, what rec activity has the least risk of causing prosthetic loosening or dislocation for this pt

distance freestyle swimming (not high impact and does not put into hip precautions)

hypermobility of CV joints would

expand chest wall

rubrospinal tract

extrapyram motor tract motor input of gross postural tone, facilitating activity of flexor muscles, and inhibiting activity of extensor muscles

posterior glide

flexion and IR

huff

forcefully exhale while keeping the mouth open after deep inspiration

SNS

increase in blood glucose

erythrocute sedimentation rate is used to identify

inflammatory or necrotic processes

fifth left intercostal space at the mid clavicular line

mitral valve apex of the heart

patellar stress fracture what wouldnt the pt be able to do

not be able to EXTEND the knee

does turning a doorknob affect impingement

not normally

is there edema with cubital tunnel?

not typically associated most likely with olecranon bursitis or distal humerus fracture

highly significant value for a p value

p = 0.001 means that the research it represents should be considered seriously in the treatment of patients with RA

pressure and vibration what structure

pacinian corpuscles PRESSURE!!! P-P

superficial venous thrombosis

pain and tenderness along the affected vein, usually the saphenous vein

fear and insecurity causes..

shorter step length bilaterally may exhibit shuffling in order to mimize single stance phase on either LE

longitudinal study

studys natural history of a disease

prone with bed flat used to drain

superior segments of lower lobe

diaphragmatic breathing purpose

to improve the pts ability to enlist the diaphragm for breathing and to minimize the action of the accessory muscles diaphragmatic breathing is not the most appropriate for a cardiac pt bc their dyspnea is not the reuslt of inefficient use of the diaphragm

greater trochs are not level, pelvis is not rotated and knee and ankle land marks are level, what is happening

femoral length disparity

nerve root injury pattern

small, irregular shaped segments of skin

V shaped notch on neck

suprasternal notch

melanoma treated with

surgery, chemotherapy, radiation or immunotherapy malignancy originating from connective tissues such as fat, cartialge, bone or muscle actions to avoid include limiting UV radiation exposure and examining the skin on a regular basis

controlled cough

two normal breaths then cough firmly on third exhalation

What condition would kegels make worse

Interstitial cystitis Pelvic floor is too tense or in spasm in response to pain and chronic inflammation of the bladder Often tender points or nodules in the pelvic floor with this condition Want to relax and lengthen for this condition and release trigger points Actually helps chronic constipation because when combined with biofeedback can strengthen and coordinate the actions of the pelvic floor and abdominal muscles

istructi pt in spefic movemenstarge

cogntive requires attention rpadil imvoep variabel cerfnaem f imprve are large slect omest egetifc strat

tibiofibular ligament test

compression of the shafts of the tibia and fibular at mid calf fibular compression test (also sometimes called a "high ankle sprain test" or "syndesmosis squeeze test"

how does superficial heat relax muscles

decreases teh nerve firing rate and muscle spasm

clinical manifestation of osteomyelitis

deep, constant, increasing with WB when present in the LE pts may report local pain and swelling

axillary nerve innervates

deltoid and teres minor

lyme disease

hiking trip neck stiffness rash

infected wounds can use

hydrogen peroxide dakins solution povidone iodine

numbness abdominal cramps

hyperkalemia

on uninvolved side, one quarter turn from prone with head down 30 degrees

lower lobes

teres major innervation

lower subscap

long thoracic motor, sensory or combo

motor only

paralysis on ipsilateral side and loss of pain temp and sensitivity on the contralateral side what type of SCI

brown sequards same side deficits due to damage to corticospinal and dorsal column opp side deficits due to damage to spinothalamic posterior cord - loss of stereognosis, proprioception, and 2 pt discrim MOTOR is INTACT central cord - UE > LE, greater motor deficits than sensory anterior cord - BILATERAL loss of of motor function and pain and temp

speeds test

bicipital tendinitis resisted shoulder flexion with forearm supinated and elbow flexed to 15 degrees

vaulting seen with

hemiparetic limbs

paroxysm

(n.) a sudden outburst; a spasm, convulsion

supinator can refer to

lateral elbow bc can be involved with radial tunnel sundrome

sartorius

lateral rotation abduction of thigh gum on shoe

compensation for weak hip abductors

lateral trunk flexion towards the unaffected side bc it unweights the affected side and utilizes momentum along with the abductors

WBC normal range

3.5-9.1x10^3

stance phase

60% of gait cycle

Brownish color in ankles indicates what

Chronic venous insufficiency

trochlear nerve CN IV

Motor: downward, inward eye movement superior oblique

Forward trunk lean what is weak

Quads

DF increases

flexion moment

1:1 ratio for e stim would be good for

muscle spasm relief

deltoid ligament test

straight eversion

C8 myotome

weakness of thumb extension

systemic cause of back pain

does it correspond with menstrual cycle (endometriosis often is cyclic in nature and crrestponds with the menstural cycle) p! during bowel movement is likle to indicate a mechncial cause of pain same for driving and decreaed pain with rest

rosacea

inflammatory skin disorder that causes facial erythema treated with antibiotics, vitamin A derivatives or laser surgery actions to avoid include avoiding spicy and oily foods, reducing sun exposure and limiting alcohol consumption

which lab values should a PT montor when treating a patient who is taking warfarin (coumadin)

international normalized ratio (INR) which prodives results that would not vary between labs therapeutic anticoagulation requires an INR of 2-3, as the INR increases above these values, the risk of bleeding during activity is increased

pt post CVA hip hiking what intervention should you do

marching while sitting on a therapy ball bc hip hiking is a response for weak hip and knee flexors or extensor spasticity do not what you apply pressure downward on the pelvic bc this will encourage hip hiking

scratch back what muscles

medial rotators

what structure is located in the epidermis

melanocytes located at the base of the epidermis prduce dark pigment called melanin which contributes to skin color and provides protection from UV light 0.05 mm thick on eyelids 1.5 mm thick on palms and soles of feet

80 y/o relies heavily on R extremtieis due to L hemiparesis, L UE has pain when lifted past 60 degrees, what positin would be best to facilitate simultaneous upper and lower extremity weight bearing for the patient

modified pantigrade weight bearing OUT OF SYNERGY well tolerated by elderly patients

PTA appropriate activity

modify pts home program to incldue exercises listed in clinics protocol for pts diagnosis should not give info on prognosis

palpate insertion of supraspinatus, what position

most accessible when interally rotated and extended brings supraspinatus out from under the acromion just anterior and inferior to the AC joint

CN III injury

oculomotor deficits in eye movements up, down, and in also controls the pupillary reflex which is intact

weight loss from diarrhea and vomiting, what is the pt at risk for

orthostatic hypotension electrolyte imabalcnes which can result in orthostatic changes in blood pressure

spinothalamic

pain and temp system consists of small diameter and relatively slow conducting afferent fibers conversely, the dorsal columns consist of large diameters, rapidly conducting afferent fibers

subscapular nerve innervates

subscapularis, teres major

hydrocephalus is associated with what child dx

spina bifida

cremasteric reflex stimulus

stroke skin of the superior and medial thigh UMN, LMN, and spinal injury at the L1-L2 level can cause the reflex to be absent normal response = elevation of the testicle on the same side as the stimulus

pt with relief when helped to move scapula during shoulder abduction what condition

subacromial impingement scapular abnormalities can cause impingement

qualitative research design would be most appropriate to address...

What are the experiences of patients with spinal cord injuries in returning home and to school? others involved gathering and analyzing of statistical measures which would be QUANtitative

Weak hip flexors vs weak hip extensors gait deviation

Hip flexors - circumduction Hip extensors (glut med) - backward trunk lean

pinch piece of paper between thumb and index what myotome

T1 weakness of finger abduction and adduction

sensory integration

address deficits in sensory system to improve function and motor and perceptural impairments

malignant tumors of epithelium/skin

adenocarcinoma and basal cell carcinoma

ability to stand and walk indicates what

adequate dynamic balance

wound being with panafil and there is no fowl smell but green tinge what do you do

document and continue tx panafil is keratolytic enyme used for selective debridement a greenish or yellowish exudate can be expected if it had a foul smell then should contact physician

BUT peroneus tertisu

dorsiflexes and everts

L5 dermatome

dorsolateral foot weakness in extensor hallucis longus

descending step with axillary crutches

down with the bad crutch stays down when you go up crutch goes down when you go down

rhomboid minor

downward rotation retraction

complex ventricular arrhythmiias at rest indicate

high risk for increased morbid and mortal

if pelvis wasnt symmetrical what could be impacted

hip abductors if right hip is elevated, L hip abductors are tight

pt with a transfemoral amp consistently takes a longer step with the prosthetic limb, why?

hip flexion contracture causes decreased hip extension during late stance on the prosthetic side causing a shorter step on the uninvolved side and a longer step with the prosthetic limb commonly happens after transfemoral amp

VBI

drop attafks transient blindness dysarthria

orthostatic hypotension

drop of 20 mmHg systolic (more important to measure than diastole) drop of 10 mmHg diastolic

group of signs that are most typically associated with underlying vascular disease

dry scaly skin, hair loss, and color changes (venous)

Desiccation

drying out foam dressing would encourage this and eschar is associated with desiccation

psuedohypert of calf

duchenne

IIA and IIB fibers

fast twitch IIB is your typical fast twitch IIA is between type I and type II transformation of type IIB to type IIA fibers occurs in the early weeks of resistance training, transformation from slow-twtich to fast-twitch is unlikely

diminished sensitivity to certain movements and improve gaze stability are desired outcomes in ...

unilateral vestibular hypofunction

best time to determine pts baseline resp pattern

while the pt is unaware of the observation not while talking

long thoracic injury causes

winging of the scapula innervates serratus anterior

prospective cohort

would have to follow pts over time until outcome

undiagnosed type 2 diabetes most likely to have what

stocking-glove numbness of LEs

L1 SCI, cant achieve neutral hip extension, what should you do

stretch the hip flexors

pt reports right lower quadrant pain, when the pt is in the supine position with hips and knees flexed to 90 degrees, deep palpation in the right lower quadrant reproduces the pain, what is the most approp action

stretch the right hip flexor muscles

grade I sprain

stretching of the ligament or perhaps a small partial tear treatment = RICE

paronychia

inflaation to the prox and lateral nail folds red swolen and tender folds

most common sites of metastasis in breast cancer

lungs and bony skeleton CNS too but PNS is not (which makes one of the answers wrong that i thought about picking) liver too but not GI tract not spleen or pituitary lungs bony skeleton CNS (brain) liver

hands behind your head stretch

pec minor bc originates on the ribs (3-5) and inserts on the coracoid process of the scapula by drawing it inferiorly and anteriorly against the thoracic wall, it is stretched similar to the corner wall stretch

excessive anterior tilting of the scapula is most likely a result of tightness of what muscles

pectoralis minor to stretch this muscle you would have to tip it posteriorly

posterior leaf spring

plastic AFO with a trim line POSTERIOR to the malleoli primary purpose is to provide DF assist to prevent FOOT DROP pt needs MEDIAL/LATERAL stability to use this orthosis

withhold resistive exercise for pt with

platelet count of 18,000 just ADLs needs transfusion

contract-relax technique

requires that a patient exert voluntary control of muscle actions (can not be a severely cognitively impaired pt)

Find aching in right calf with tenderness swelling and warmth what do you do

Postpone ambulation and report findings immediately After one dose of low molecular weight heparin is given, ambulation is encouraged Compression stockings with a pressure gradient of 30-40 can assist with pain and reduce risk of post thrombotic syndrome

Sharp purser test

Aka transverse ligament test Assess integrity of the transver ligament of dens Positive decrese in sx during posterior translation, excessive head translation, or production of myelopathic sx when the neck is placed into flexion

impaired proprioception what nutrient

B12 intrinsic factor declines with age which helps body absorb viatmin B12 pernicious anemia gradually affects sensory and motor nerves causing impaired proprioception to develop over time myelin degeneration and loss of nerve fibers in the dorsal and laeral columns

acute injury, pain with tissue resistance or before tissue resistance?

BEFORE subacute = pain into tissue resistance, collagen formation and graulation tissue development occurs at an increased rate chronic = tissue maturation and remodeling (collagen fibers reorient in response to stresses place on connective tissue)

How to descend curb with WC

Backward but must use a tucked forward lean position in order to prevent falling backward Or they can descend forward using the wheelie position, large wheels landing first

sip n puff what level

C4

supinator innervated by

C5-6

FIM level 5

Cueing or stand by (CGA falls in level 4 min assist) no manual contact in level 5

TOS pt with muscle guarding in the upper trap and scalenes what technique should you use

Grade 4 manipulation to decrease guarding and pain

changes with age and CV system

HR changes with age but SV and ventricular volumes do not BP changes with age

PLB

Helps with pacing and collateral ventilation

CN for deviation of tongue

Hypoglossal Deviation ipsilateral to side of lesion Glossopharyngeal results in slight dysphagia, loss of taste in posterior third of the tongue and loss of gag reflex

LMN injury what is tone like

Hypotonia Along with decreased or absent reflexes and fasciculations

Earliest indication of PAD

I/M claudication Calf is most common but can affect thigh hip or buttock

Wheal

Irregular, transient superficial area of localized skin edema (hive or mosquito bite)

ECG with significant Q waves, suggestive of what?

MI a prominent, pathological Q wave is indicative of a transmural MI

FIM level 6

Mod I No manual contact Allows for equipment or extra time

what blood count would be increased with infection

WBC

peroneals

WEAK PF and evert

most relevant info for PT to determine if pt can serve meals

a performance assessment of meal serving in the natural environment self report or in clinical environemnt acceptable if performance approach is not feasible

continuous variable

a quantitative variable that has an infinite number of possible values that are not countable measured to finer and finer degree

tight inferior joint capsule at the shoulder would limit what

abduction

manual resistance-through-range technique

appropriate for a pt with a primary problem of muscular weakness

RA advise pt to rest when fatigued or before

before should be performed WITHOUT pain AND fatigue

juvenile RA, increased or decreased hip extension at terminal stance and toe off?

decreased

would juvenile RA cause increased or decreased cadence

decreased

decreased DF strength would demo..

dragging of toes pt would hike or circumduct the affected leg

volumme depletion

exaggerated increase in HR upon standing

best way to teach TBI pt to lock brakes on w/c (RUE is more affected)

have pt practice locking the brakes first with the left hand and then with the right "transfer of training" the more passive the performance (i.e. manual/verbal guided movement), the slower the learning will take place bilateral tasks are more difficult than one at a time (i.e. locking the brakes at the same time)

does hematocrit influcene BP?

no

pt in a persistent veggie state in a nursing home has developed a stage 2 pressure injury, has not improved in 4 weeks of standard wound care, who should you consult

nutritionist to investigate level of protein (not orthotist for bracing, not resp therapist for oxygen therapy, not surgeon for skin flap) orthotist would be if it was a result of contractures that would warrant braces oxygen is imperative but inadquate nutrition should be a primary concern for a pt in a veggie state skin flap would not be indicated bc the underlying issues preventing the wound from healing would most likely compromise the integrity of the skin flap

adson test (halstead)

positive - scalene involvement in pts thoracic outlet sx

rescue breathing aka

positive pressure ventilation refers to applying external pressure to force air into a pts lungs warranted when a pt is not breathing normally or has competently stopped breathing

R transtib fails to flex the R knee in early stance

posterior displacement of socket relative to the foot

elys test

prone passively flex knee positive indicated by spontaneous hip flexion and may be indicative of rectus femoris tightness

skin irritation found on pt with cervical collar, not painful but is becoming itchy, what should you do

provide the pt with a liner to use as a barrier between the skin and the orthosis IMPERATIVE to use a linger that maximizes comfort, promotes clealiness, limits moisture, and reduces skin irritation failure to select an appropriate liner may result in skin breakdown wrong answers hydrocortisone would help with irritation but would not address the primary cause power may assist to temporarily reduce friction over a particular area but it does not address the primary cause of irritation d/c the collar is not desirable bc it is perscribed based on medical need

wrist drop

radial most commonly injruied in radial groove of the humerus at snuff box would be mainly sensory bc bracnesh of radial

abductor pollicis longus innervated by

radial nerve

supinator innervated by

radial nerve C5-C7

tachypnea

rapid shallow breathing

dermatitis

red sclaing eddema

tertiary intention

synonymous with healing by delayed primary intention risk factors such as wound bed contamination, infection, and significant local edema increase the risk of healing complications and must be addressed before the wound can be appropriately closed by usual primary intention methods

prone knee flexion stresses....

the femoral nerve

positive oculomotor nerve test

tracking deficit, asymmetry or ptosis

does a pt with adhesive capsulitis have the ROM to do a push up

yes will have 90 degrees shoulder flexion normally

Infected wound can it heal spontaneously

Not expected

4 y/o skill

kicking a rolling ball, catching a small ball, and hopping on one foot

herpes zoster

red fluid filled vesicbesl tah vary in size

ACE inhibitors

reduce peripheral vascular resistance and increase venous capacitance

thrust and reserve thrust in or out of synergy

thrust out of syn reverse in syn

L thoracolumbar scoliosis, pelvic landmarks are symmetrical, which muscle will be tight?

Right QL

squeezing the calf with the ankle in neutral DF is used to test the integrity of the...

achilles tendon

DVT

aching calf pain, edema, and muscle tenderness

COPD is a combo of...

airway narrowing, parenchymal destruction, and pulmonary vascular thickening

max O2 uptake in UE test vs LE

UE is 30-40% LOWER

platform walker doesnt help with...

UE spasticity generalized UE weakness (but could help with DISTAL extremity weakness like poor grip strength) impaired UE sensation

MS

UMN spasticiy and hyperreflexia

ALS

UMN and LMN

Corticospinal lesions

UMN lesion

CN 11

accessory

peabody

appropriate for children from birth to 72 months of age

Muscle Strain pain

Pain on activity or when the muscle is stretched

central cord

UE > LE

inability to perform purpseful movements such as using a utensil

apraxia

Rovsings sign

Right low quadrant pain during left sided pressure or right lower quadrant pain on quick withdrawal (referred rebound tenderness)

DRG

dorsal root ganglia SENSORY

physis

growth plate epiphyseal plate

fourth left IC space along the lower left sternal border

tricuspid valve

Protrusion

3-6 mm

Normal fasting blood glucose

65-99 mg/dL

13/20 borg

70% of max HR

drop of what in systolic is abnormal

< or equal to 10 correlates with left ventricular dysfunction

ACA leg or arm sx

LEGS LEGS LEGS OPPOSITE OF MCA

Esophageal pain

Can refer to mid back, head or neck

Review FIM scoring of stairs or weird AD stuff

Can't add bc on plane

Common refersll for SI pain

Groin and buttock "SI sprain" was the exact wording of the answer

thomas test

Hip flexion contracture (iliopsoas; rectus femoris)

Two joint muscles that flex the hip and extend the knee

TFL and rectus femoris

CN VI injury

abducens nerve deficits are found in eye movements inward bc this nerve turns the eye out

functional reach

balance and falls

simple randon

every element of the population has an equal chacne of being selected

spasticity what end feel

firm

hip pathology

loss of IR

low pitched wheezes

obstuction such as bronchospasm

ulnar nerve injury at wrist

pt cannot fully adduct the little finger holds the finger abducted and extended "cyclists palsy"

anterior portion of the RC

subscap (internal rotator)

Hyperabduction test

- Tests for compression of subclavian artery underneath pec minor - Tester palpates patient's pulse, then fully abducts patient's arm. - Obliteration of pulse in abducted position indicates positive test. Patient is sitting, holds arms in shoulder abduction and ER (1 min), examiner palpates radial pulse

spondylolisthesis who typically has this

13 year old gymnast condition where one vertebra slips forward on the one below it due to bilateral fracture of the pars interarticularis, most commonly occurs at L4-L5 or L5-S1 chilren ages 10-15 who are involved in activities such as gymnastics, weight lifiting, volleyball, and pole vaulting are particualrly susceptible

Female athlete triad

14-20 years of age Disordered eating habits* Irregular or absent menstruated periods* Osteopenia (thinning of the bone density) Also good at ask about muscle pain, meds, and details of training regimen

3 incontinence questions

3IQ

superficial morton neuroma what US head

3MHz 0.79 in 2 cm sound head 5 cm is for larger treatment areas like lumbar spine

skill stage of motor learning

4th stage refers to ability to consistently perform functional tasks and manipulate the environment with normal postural reflex mechanisms and balance reactions skill activities include ADLs and community locomotion

WBC value

5-10,000 per mm^3 (>10,000 indicates acute infection)

dribbling a basketball, riding a bike, skipping what age

5-6 years old

submax mod intensity

50-70%

"higher" intensities what HR

50-75% of max HR

normal disgance for 6mwt

500m

frequency for walking program to improve CV fitness in senior citizens

5x per week since low intensity, needs more frequent sessions to minimize medical problems and promote long-term compliancee with this population, exercise intensity should start low and progress gradually according to tolerance and preference moderate intensity for 30 min on MOST days is the recommendation vigorous, drops to 3x per week

stretch duration recommendations

60 seconds end range and is comfortable indicates proper intensity

asymptomatic (no coronary heart disease) elderly individual with general deconditioning, what initial intensity?

60-90% HRmax aka 50-85% VO2 max aka 50-85% HR reserve duration should be discontinuous and exercise should be performed most days of the week

where in the range would it be painful with anterior GH instability

80-90 degrees of lateral rotation

closed packed position of the AC joint

90 degrees abduction (weird)

underweight BMI

<18.5

tinetti fall risk

<19 high 19-24 moderate

BERG fall risk

<20

normal cholesterol

<200 mg/dL

When is the TMJ considered hypomobile

<25 mm opening >50 mm hyper

berg cut off

<45 risk for multiple falls max = 56 14 tasks

hypoglycemia

<70 mg/dL

hyperglycemia levels

>130 mg/dL

Young adult with thoracic stiffness and pain that is worse in the morning and has become progressively worse over the past 6 months, Nero exam is negative, what dx

Ankylosing spondylitis Rheumatic disease (spondyloarthropathy) Chronic inflammation and irritation of the spinal joints results in stiffening if the joints and eventually abnormal fusion (ankylosis)

FIM level 4

Completes activity with minimal contact assistance and 75% or more of the effort

plantar fascitis (pes planus in pic) causing pain what would result in the greatest delay in recovery?

BMI of 36 and >50% limited great toe extension bc extra body weight places increased loads on the plantar fascia (even greater than just 25) and big deficit in range others would be history of additional lower extremity pathological condition, presence of other medical conditions or severe obesity

Meralgia paresthetica

Conditon involving the lateral femoral cutaneous nerve Nerve is responsible for innervation of the lateral aspect of the upper thigh Nerve passed medial by the psoas major before crossing in front of the iliacus and then under the inguinal ligament With increased weight and increased anterior pelvic tilt this nerve can be entrapped as it passes Thus it can be a common problem seen in pregnancy

discrete variable

Consists of separate, indivisible categories. No values can exist between two neighboring categories. one that can assume only distinct values

friction handrims is for what level

C6-7

volkmann ischemic contracture

Contraction of the fingers and sometimes, the wrist, with loss of muscular power with death and resultant contracture of the forearm musculature, that sets in rapidly after severe injury around the elbow joint

Pulsed current is too strong for patient what should you do to make them more comfortable

Decrease the pulse duration (reduces the electrical charge of each pulse, making the current more comfortable by decreasing the total current applied) Pulse duration is synonymous to INTENSITY And will be the only thing that has a direct effect on pt comfort Can potentially decrease the therapeutic effect if turned too low Increasing the amplitude would make the current feel strong If you decrease the pulse rate below 25 pps (the Low end of tetany which is what they want) then there would not be as good quality of a contraction

PD shows increased or decreased limits of stability

Decreased Flexed and stooped posture that alters the COG in the anterior direction Freezing orthostatic hypotension Will want to increase the limits of stability and improve center of pressure alignment (aka reduce anterior displacement) Do not decrease the limits of stability because the patient is too unstable and it is contraindicated

Complete T11 SCI what is the most effective bowel program

Digital stimulation of intact defecation reflex Will produce an UMN or spastic bowel with intact spinal defecation reflexes Boswell and anal sphincters respond to rectal/anal stimulation enabling a planned bowel elimination program Laxatives and stool softeners can assist the pt in manually stimulated elimination but the primary methodology is digital stimulation A LMN or flaccid bowel occurs with lesions at T12 or below with loss of spinal defecation reflexes Response to meds is less effective and manual removal of stool may be required

Vagus lesion

Dysphagia Hoarseness Paralysis of the soft palate

vital capacity

The total volume of air that can be exhaled after maximal inhalation. decreases with age

thermotherapy and CRPS

Thermotherapy, aside from the application of neutral warmth, may aggravate the pain associated with complex regional pain syndrome

What do steroids do side effect wise

They cause PROXIMAL muscle weakness

If your feel are pronated what happens at all the joints above

Tibial femoral and pelvic IR ER associated with high arches The pelvis must follow the rotation present in the lower limb

ankle sprain with PF and inversion what ligament

anterior talofibular which is a thickening of the naterior joint capsule that extends from the anterior surface of the lateral malleolus to the lateral facet of thee talus and the lateral surface of the talar neck functions to resist ankle inversion with the foot in PF regardless of the position of the foot, the anterior talofibular ligament is the most likely ligament to be torn with an inversion injury

location of ankle DF and toe extensors

anterolateral

metformin aka glucophage

diabetes

lateral placement of foot

increased step width

gait parameters for community mob

speed and knee extension strength

jaw jerk reflex tests what CN

trigeminal CN V

Cardiac Index (CI)

Normal range 2.5 to 4 L/min. Adequacy of the cardiac output of an individual. CO / body surface area

true positive in functional reach

pt with history of falls test positively

oculomotor nerve lesion what happens

ptosis and lateral deviation

swing phase

40% of gait cycle

bone between abductor pollicis longus and extensor pollicis longus

scaphoid

BPPV

Acute onset, positional, related to head movement

poor verbal comprehension can occur after

CVA receptive aphasia wernickes fluent aphasia

Talar tilt

Calcaneofibular

best practice to ensure early success

consistent practice using a blocked pattern variable and random practice would ensure learning but the pt would take longer to acquire the skill

panceas produces

digestive enzymes

prone traction for

disc

trigeminal nerve lesion

impaired facial sensation, difficulty with jaw opening, and impaired corneal reflex

silver sulfadizine

infected wounds

uncomplicated MI or cardiac surgery risk category

low risk

heart sounds

sounds between S1 and S2 are systolic murmurs, between S2 and S1 are diastolic

glucose intolerance

the body cells' inability to take up glucose from the bloodstream. high blood glucose

Bladder pain

Medial thigh and leg

pectineus innervation

L2-L3

postpolio

LMN does not present with sensory paresthesias and is typically asymmetrical

peroneal nerve NTT

SLR with PF and inversion

ganglion cyst

benign cyst located on top of a joint or covering of a tendon ganglion cysts most commonly occur on the dorsum of the hand at the wrist or on the dorsum of the foot if pain is present, it is usually caused by motion around a joint impacted by the ganglion cyst

secondary lymphedema

caused by injury to the lymphatic system (blockage dissection, fibrosis)

krause end bulbs

cold sensation

segmental breathing...

combines breathing control with manual cues to specific areas of the chest

dorsal scapular nerve injury, what muscles

levator scap rhomboids

irregularly shaped would at left medial malleolus, skin around the wound is darkend, what is it

venous insufficiency darked = "hyperpigmented" periwound

home program for chronic laterl epicondylagia

wrist strengthening and stretching condition extensor carpi radialis brevis and sustained grip ionto would be for acute

is bridging difficult for an older person

yes and does not involve WB through the UEs quadruped is also difficult for an elderly pt and does not allow for WB through the entire LE

Multiple different looking PVCs that are not in a row what should you do

Have the patient sit down, continue monitoring, and notify the physician immediately Not emergent so don't need a medical response team but do need to let the physician know This shows a high degree of irritability of the heart and could progress to v tach or v fib (cardiac standstill)

Hematocrit of 42% after minor surgery, is this normal

Men: 40-50% Women: 36-47% ^took this from quizlet "normal findings" is the answer a low hematocrit would indicate anemia but a hematocrit value of 42% is considered normal for an adult female

Prosopagnosja

Perceptual disorder characterized by an inability to recognize faces (face blindness)

simmonds test

aka thompson test asses for tear of the achilles tendon

naproxen is the same as

aleve (NSAID) max daily dose is 1500 mg

tearful and combative 4 y.o during casting, what should you do

allow the child to case a dolls leg while the therapist applies a cast to the child eases tension, giving the child power in a role can be helpful

advantage of rigid removable dressing

allows early weight bearing bc cna fit prosthesis earlire and WB helps alleviate edema and pain require MORE supervision bc there is no access avail to incisions and the dressing is fabricated by the surgeon or prosthetist as the limb heals, sutures are revmoed and the limb changes shape, a new cast must be made no variable pressure like bandaging with an elastic wrap or shrinker more costly bc applied by skilled individual

14 y/o with indisous onset of shoulder pain, apprehension with shoulder passively moved into shoulder abd and ER, what is the pathology

atraumatic instability (usually anterior) labral tears (answer i almost picked) are commonly associated with TRAUMATIC injury with SUDDEN onset

rood approach

based on sherrington and the reflex stimulus model believed that all motor output was result of both past and present sensory input rood intoruced the use of sensory stimulation to faciltiate or inihibit responses such as icing, brushing, in order to elicit desired reflex motor responses

why are you put in a knee immobilizer for patellar fracture

bc plays a large role in the knee extensor mechanism functioning as an anatomical pulley following a ptaellar fracture, the knee is typically immobilized in extension to prevent excessive force on the patella from the quads tendon

pts rights under omnibus reconcilitation act OBRA

bc restricts pts mobility and requires a physican order (vest restraint)

nonhealing LE wound, ABI, why would you do this

bc suspect arterial insufficiency

focal lesion in the region of the L basal ganglia

cogwheel resistance to passive ROM and tremor in the right extremities whereas clasp-knife phenomenon occurs as a result of injury to DESCENDING MOTOR PATHWAYS from the cortex or brain, not the basal ganglia

burn with marked edema, broken blisters, and waxy discoloration

deep partial thickness (mixed red or waxy white color) surface is wet from broken blisters and marked edema is the hallmark sign of this burn depth

end stage renal disease likely caused by what comorbidity

diabetes primary cause of ESRD, accounting for 40% of newly diagnosed cases high blood glucose levels overwork the kidneys by causing them to filter excessive volumes of blood, eventually leading to breakdown of the kidneys (diabetic nephropathy) when not treated early, this condition can lead to ESRD

what guideline to follow with O2 sats

discontinue exercise and let pt rest when the pts O2 sat is below 90% supplemental O2 may be indicated if O2 satis 90% or less

CRPS

foot and ankle usually pain allodynia hyperalgesia abnormal vasomotor response abnormal sudomotor

burning in buttock when sitting in w/c, what could be contributing to this

footplates are too high shifts weight posteriorly onto the buttocks, leading to pressure and pain

mouth to mouth and nose

for INFANTS less than 1 years old

excessively supinated foot during stance would be accompanied by

general medial rotation of the LE during stance high arch

most appropriate assessment for progress in an 8 y/o child who has cerebral palsy with spastic quadriplegia and limited mobility

gross motor function measure GMFM was constructed to evaluate progress voeer tiem in children with CP developed to evaluate change in motor status and proficiency due to therapeutic intervention has been validated for sensitivity to change in children with CP age 5 months to 16 years

lymphedema on LUE, AV shunt on RUE, where should you auscultate the pts BP

left popliteal fossa NO BP on lymphedema or AV shunt thigh is net best, first popliteal then posterior tib femoral triangle is too high for placment of a BP cuff

most commonly dislocated carpal bone

lunate scapholunate articulation is most common area for carpal instability scapholunate synovitis or posteir wrist syndroem presents with tenderness or swelling over the posterior wrist

no sign of quad contraction, most likely cause?

lesion in the femoral nerve if a muscle becomes denervated, a contraction cannot be produced by NMES whereas with a contusion, innervation is typically intact and therefore ES would produce a contraction

what happens if a dressing cannot handle the quantity of exudate

maceration (softening of connective tissue fibers due to excessive moisture, results in loss of pigmentation and is highly susceptible to breakdown or enlargement) a transparent film would be an example of a type of dressing that would be UNABLE to handle a significant amount of exudate conversesly an alginate dressing would be a good choice for a wound with high exudate since it is highly permeable and would therefore tend to absorb the exudate

orthotic for scoliosis helps with

maintaining improved trunk position for functional activities

a line primary purpose

measure BP or obtain blood samples more accurate than traditional measures of BP and does not require repeated needle punctures

dynamic gait index

measures ability to modify gait in response to task demands

cubital tunnel formed by

medial epicondyle olecranon ulnar collateral ligament

TFL action

medial rotation (think about when knee is bent) flexion of hip abduction

lateral (external) rotation with abduction would put what nerve on stretch

median would see sx in first and second fingers

pronator teres syndrone affects what nerve

median nerve

pronators are innervated by

median nerve

interventions for plantar fasciitis

midfoot stability functional foot and ankle ROM normal 5/5 foot and ankle strength minimal pain return to functional status for ADLs and vocational activities

grade II

moderate tear

tube feeding for pt who cannot take in an adequate supply of nutrients by mouth due to radiation, what should you use for short term feeding

nasogastric tube commonly used for liquid feeding, medication administration or to remove gas from the stomach gastric tube would be for more long term

water level with pt who has severe COPD and bilateral knee OA

navel helps to unload more and does not affect the ability of the lungs up to shoulders could affect the ability of the lungs to expand

KAFO and contractures

not commonly used to prevent muscle contractures but may be used when contractures are already present, if these contractures prevent upright positioning

is stretching good for scoliosis of 25 degrees

not found to halt or improve scoliosis if they are to be performed though, they should focus on the iliopsoas and low back extensors and lateral trunk flexors on the concave side of the curve

do burn pts use prophylactic antibiotics

not typically prescribed in this population secondary to adverse side effects

souques phenomenon

observed when a pt raises the invlved upper extremity above 100 dehrees with the elbow extended

chronic bronchitis restrictive or obstructive

obstructive due to airway obstruction caused by the mucus buildup

scaphoid fracture

occurs during a fall on an outstretched hand with the wrist DF and radially deviated most likely to be fractured with this type of MOI

raimistes phenomenon

occurs when the involved lower extremity abducts or adducts with applied resistance to the uninvovled LE in the same direction

characteristic signs of herpes zoster

pain and paresthesia (NOT numbness and burning) followed by a unilateral RASH (not scales) along the affected dermatome pain and paresthesia first then rash forms days later

msk pain

pain that decreases with rest

sx that indicates PT might not be appropriate with pt who has right shoulder pain

pain that subsides with right sidelying (would normally increase MSK pain but may DECREASE pleural friction/irritation and thus may decrease visceral pain) vs tenderness, trigger pts, pain

grade I sprain

pain with stress testing and minimal instability

lats MMT

palm UP (internal rotation) because palm down allows the long head of the triceps to substitute for the lats must make sure a patient has their palm up when they are in prone going to test the strength of their lats pt must demo they can do it palm up before the therapist should add resistance would not switch to GE unless pt demo'd they couldnt do it AG

what nerves are most active during emptying phase of micturition?

parasympathetic nerves from the pelvic plexus these fire in order to contract the bladder and begin emptying SNS are most active during the filling phase of micturition

swayback

pelvis is posteriorly tilted thoracic spine is in relative flexion

what blood test value suggests that chest percussion for airway clearance is contraindicated hematocrit white blood cells platelets hemoglobin

platelets normal range = 165,00-415,000 <50,000 pt is thrombocytopenic and would be placed on thrombocytopenic precautions until platelet count returns to normal these precautions include restricting chest percussion due to the increased risk of bleeding alternative chest PT may include coughing, deep breathing exercises, and using an incentive spirometer

most appropriate to practice in a 20 y/o pt with duchenne muscular dystrophy in maintaining independence

power w/c training over various surfaces usually not ambulatory by 14 transition into adulthood marks a time of continued progressive disability with a greater reliance on assistive technologies such as power w/c

R wave that is close to the preceding R wave indicates what

premature atrial complex

difficulty urinating in a pt with LBP and is 55 y/o

prostate enlargment difficulty initiating urine stream is not consistent with bladder cancer or renal failure

angina scale

quantifies chest pain

pt with insulin pump about to exericse (95mg/dL) blood glucose), what should they do

reduce the insulin infusion dose will safely increase the blood glucose level and they will not need a carb snack

pt is given 5 stabilization exercises, he says he understands but frequently becomes confused and is unable to perform them correctly, what should you do

reduce the number of exercises in the series

urge incontinence is related to

reduced bladder capacity or detrusor instability

knee immobilizer for pt s/p THA

reduces hip flexion by maintaining knee extension bc want to avoid hip flexion greater than 90 degrees serves as an external feedback mechanism to remind the pt that the hip is vulnerable to injury, good for pts who are unable to maintain posterior hip precautions independently

18 y/o with osteogenesis imperfecta, PT through school, mod independent in all mobility and utilizes public trans, what should you do for the pt

refer pt to vocational services developmentally appropriate for the workforce or further academic study a vocational counselor will provide the best guidance and support for the next setting/stage

tracheostomy

refers to an opening made in the trachea in order to insert a catheter or tube most often to facilitate breathing

test for posterior capsule tightness

retract the scapula with manual resistance and perform horizontal adduction retracting the scapula removes the confounding compensatory effect of scapular protraction and allows isolation of the GH joint (but does not show "functional" movement bc would require accompanying movements of the scapula) pts who have diabetes are likely to experience shoulder disorders/mobility limitations

contraindication for mechanical traction

rheumatoid arthritis bc subject to atlantoaxial sublux or to developing instbailigy next to ares of hypomobility

resting HR of a 32 y/o runner is 46bpm, why?

secondary to increased SV not a hypotensive disorder not an AV block not bc of stimulated SNS (exercise training will increase PNS activity and cause a small decrease in SNS discharge, training also decreases the intrinsic firing rate of the SA node, would explain the resting bradycardia in individuals who train aerobically)

size and shape of wound

sheet of plastic wrap on wound and use a marking pen to draw a tracing of the wounds perimetere

herpes zoster

shingles dermatologic distribution and is chracterized by burning pain

what characteristic is most likely to be found in a superficial partial-thickness burn?

shiny appearance also would be wet, weeping, and mottled red in color

tibialis posterior rupture

significant plantar flexor and invertor or ankle signifacnt affect functional strength evidenved by gait

L5 Myelomeningocele was just repaired, what is critical for the family to learn

signs of increased ICP hydroceph occurs in 25% of children with myelomeningocele and an additional 60% develop AFTER surgical closure between 80-90% with hydrocpeh will require a shunt recognizing signs of increased ICP and shunt dysfunction is critical bc these conditions can lead to addiiotnal functional and cog decline

biceps load test

similar starting position and used to check for glenoid labrum tear

important factor considering footwear for a patient with diabetes

snug fit around the heel (need to offer a supportive structure for stability and offer protection from and prevention of excessive friction) leather soles are too firm and not cushioned enough for diabetic pts (choose a soft lining for protection from and prevention of excessive friction and pressure) want soft leather that will conform to the abnormalities on the dorsal surface you want laces, straps, or velcro high on the foot to keep the foot secure and reduce frictional force

RPE based on what

subjective measure based on sensations experienced during PA including increased HR, RR, sweating, and muscle fatigue

dehydration tachy or brady

tachy

resp distress sx

tachypnea sternal retraction more rare but can be a sign paradoxic is also a sx of resp distress

weight loss rec

target weight loss no more than 2.2 lb or 1 kg per week

apraxia what strategy to teach transfer

teach one component at a time and physically guided through the task

contract relax

technique that applies a max contraction of the antagonistic muscle group as the extemity reaches the point of limitation therapist resists movement for 8-10 seconds with relaxation to follow the technique is repeated until there are no further gains in ROM

pricking the skin of the glans penis assesses...

the bulbocavernosus reflex normal = contraction of the bulbous urethra

functional reach test bont landmark

third metacarpal (third knuckle) test is reliable but standard error of measurement may be relatively high and the test measures sway only in the forward direction person is required to stand upright against a wall with a static base of support pt is then asked to MAKE A FIST and raise the arm nearest the wall to 90 degrees of shoulder flexion record beginning position pt then leands as farforward as possible and ending position is recorded beginning is subtracted from the ending position to obtain the final value

entrapment of nerve roots is rare in what part of the spine

thoracic this is where intercosrsal nerves originate thats why its rare for them to be compromsied

weakness with shoulder extension

thoracodorsal injury lats (primary extensor is injured)

PT is scheduled to administer whirlpool tx to a pt that is HIV positive, PT is concerned about her ability to complete the treatment since she sustained a small paper cut on her fourth digit approx 3 hours ago, what should you do

treat the pt using approp medial asepsis this will adequately prevent the possible transmission of blood or body fluids when health care professionals follow established standard precautions, they do not place themselves or the pt at any significant risk for being contaminated or infected by pathogenic microorganisms a PT CANNOT refuse to treat pts based on presence of HIV or any other potentially infections condition if you do not, you are violating the pts right to receive necessary health care services

scapula upwardly rotates early, compared to uninvolved scapula, PROM is normal, which of the following pairs of msucles best stabilizes the scapula to promote balanced force coupling

upper trap and serratus anterior upper trap pulls up serratus pulls out net effect = pull in different directions to accomplish same motion NOT upper trap and rhomboids because they are pulling in different directions to accomplish different motions

backpacking trip, pt has pain over the lateral aspect of the shoulder, weakness of elbow flexion and shoulder abduction, what dx

upper trunk of brachial plexus C5-C6

graphesthesia

verbally identify letters or numberstraced on the palm of the hand with a fingertip or eraser of a pencil

COPD what pulmonary function test would be decreased

vital capacity

no PF what phase of gait affected

toe off aka preswing greatest amount of PF needed

normal gait toe position

toes pointing forward or slightly outward

large amp at end range can you do on someone with pain

too aggressive if pt has pain

weight gain dx

hypothyroidism cushings syndrome organ disease CHF essential fatty acid deficiencies blood sugar imabalance

free enrve endings

pain and ITCH

povidone iodine used for

prevent surgical site infection acute traumatic wounds

faciliation techniques

used to increase tone in pts with hypotonia these techniques are not often used to treat PD since pts with this condtion typcailyl exhibit hyeprtonia or in more severe cases rigidty

is O2 sats affected by changing position?

no

is hyperflexion a common mechanism of an ACL tear?

no

is rebound tenderness associated with muscle guarding

no

Graphesthesia

Ability to recognize numbers, letters or symbols traced on the skin Barognosis is differentiate weights of identically shaped objects Pallesthesia is ability to recognize vibratory stimuli Like tuning fork on a bony prom Stereognosis recognize different objects by touch

ASIA A L4 functional outcomes

Ambulation using bilateral AFOs and canes or crutches Considered a LMN injury (cauda equina injury) Hip flexion, adduction and knee extension are intact Quads are fully innervated at L4

triceps

C6-8

Best position for US to Supraspinatus

Slight abduction and IR (empty can) Exposes the tendon from under the acromion process

Adsons

TOS

most appropriate activity for a physical therapy AIDE with a TKA pt undergoing general conditioning and training for independent household mobility

ambulation with a walker for endurance (endurance implies that the pt already possesses basic competence with this activity) stair training, progressive gait training, pt education about surgery are skilled activities that requires constant supervision from a PT

cavernous wound, how to identify volume 1. Take a photograph of the wound. 2. Measure the length and width using a disposable ruler. 3. Trace the wound onto an acetate measuring guide. 4. Measure the amount of hydrogel that fills the wound without spillage.

answer 4 measure the amount of hydrogel that fills the wound without spillage can also use water

greatest degree of sampling error

cluster sample which is a probability sample in whcih large subgroups are randomly selected first and then smaller units are selected from the clusters bc the technique requires two or more samples to be drawn, each sample is subject to sampling error successive random sampling of a series of units in the population often utilzied when a reseearcher is unable to know all elements in the population in advance

difficulty with what activity with capsular pattern for shoulder

combing hair (abduction and ER) external rotation (lateral rotation) limitation MAX abduction MOD internal rotation (medial rotation) MIN

type 2 diabetes, increased or decreased HR variability with exercsie

decreased due to dysfunction of the PNS and SNS

home health for pt sp THA, she is currently FWB and is able to ascend and descend stairs independently, pt expresses that her goal following rehab is to walk one mile each day, what should you do

design a home exercise program that emphasizes progressive ambulation that goal does not warrant continued PT services, the pt should assit the pt to achieve their individual goals by implementing a HEP that incldues progressive ambuation

grade II injury to R medial collateral ligament 3 weeks ago, insignicant PMH, what status of healing?

disorganized and unable to withstand high tensile forces 3 weeks it is BEGINNING to organize but it is not fully organized and is deficient in tensile strength

SCI pattern

generally bilateral not just one leg or the other

most appropriate technique to improve flexibility of the hip flexors

gentle, sustained passive hip extension others that could be effective... active hip extension to end range + active relaxation of hip flexors + repeat

hip lateral rotators

glut max, obturator internus, obturator externus, piriformis, gemelli, and sartorius weakness of the lateral rotators usually results in medial rotation of the femur accompanied by pronation of the foot and tendency toward a valgus position at the knee

limitation in SLR when in supine, PT flexes knee and gains no extra movement, what is the dx

gluteal bursitis (a gluteal pathology, others include an abscess, tightness of the gluteus maxiumus, and tightness of the posterior capsule) called the buttock test and differentiates from referred paini from the hip, sciatic nerve or hamstring muscles if amount of hip flexion does not increase when the knee is bent, indicated positive test for buttock pathology

2 day history of hot, swollen, first MTP joint, what dx

gout severe joint pain, occurring at night, typically in the first MTP others = erythema, warmth, and extreme tenderness and hyerptensitivity

calcaneofibular resists

inversion and DF

L CVA what is the most difficult position for pt to balance

half kneel with involved leg posterior bc posterior leg is responible for increased body weight asc ompared to tall kneeling overall increased stability demands placed on the affected posterior limb provides additional challenge to all of the supporting muscles in order to maintain hip extension and lower trunk control

NMES of quad, no contraction is elicited even though there is a strong tingling sensation, what do you do to elicit a contraction

increase the pulse duration (time from the beginning of the first phase of a pulse to the end of the last phase of a pulse) most pts find longer pulse durations more comfortable when larger muscles are being stimulated, longer pulses are needed to depolarize motor nerves!! amplitude is already strong enough

contraindication to I/M compression

local infection recent or acute DVT

pt with LBP with radiation to LE, peripheralization on extension and positive cross SLR ... best tx approach

lumbar traction CPR - sx in question plus presence of signs of nerve root compression avail in netters orthopedic clincal exam

weight loss program walk 3 days per week for 15 min for 3 weeks how should you progress

maintain current walking speed and increase duration to 30 min want to reach optimal duration of 30-60 min before increasing speed or intensity

high platelet count is typical with...

malignancy they are often increased as a manifestation of an occult neoplasm high platelet count is AKA thrombocytosis can also occur as a compensatory mechanism after severe hemorrhage, surgery, iron deficiency, and as a manifestation of certain cancers emphysema would have an increase in RBCs to carry oxygen with abnormal carbon dioxide and carbon monoxide levels metabolic acidosis doesnt have to do with platelets renal failure (what i picked) also doesnt have to do with platelets

components of CDT

manual lymph drainage compression therapy decongestive exercises restoration of skin with follow-up skin care

weak abdominal muscles and gait

may have difficulty maintaining standard step length secondary to weakness of the trunk and inadequate stability

are facial nerve paresthesia expected with TMJ joint hypermobility?

no TMJ is primarily supplied by three nerves that are part of the mandibular division of the trigeminal nerve CN V

popliteus function

Stabilizes knee joint [resists lateral rotation of tibia on femur. Unlocks knee joint [laterally rotates femur on fixed tibia]

persistent night pain classic sx of

cancer but may also be present in pt who has an occult bone fx occult - fracture that is not readily visible if MSK condition can be ruled out, night pain indicates the need for medical consultation

HF

dyspnea paroxysmal noctunal dyspnea orthopnea periheral edema

deceleration of shoulder during throwing

eccentric exercises of the lateral rotators

what decreases with age

glucose tolerance elasticity vital capacity

hip extension with knee bent what muscles

glut max hs would be need extended

L trans femoral amputation and an acute episode of LBP, which muscle can the therapist test for S1 nerve foot function on the pts left side

glut med

baroreflex impairment

a small increase or no increase in HR upon standing

abnormal response to increased exercise intensity

decrease in systolic BP of 20 mmHg

mobility stage of motor control

first stage ability to initiate movement through a functional range

C5 myotome

shoulder abduction

wrist drop

radial nerve ECRL ECRB Edigitorum

Timed GUG fall risk

>30 seconds

atrophic scar

thin and white aka acne scars

Pes valgus control

Scaphoid pad Flexible foot orthosis with a medial rearfoot post Ankle foot orthosis with full length footplate

Ménière's disease

Sensation of fullness in ears associated with abnormal fluid build up Tinnitus, vertigo, nausea, and hearing loss

froments sign damage to what nerve

anterior interosseous syndrome unable to flex the distal phalanx of the thumb and index fingers bc the AIN, which supplies the flexor pollicis longus and the radial half f the flexor digitorum profundus is entrapped

SI pain with what movements

flexion extension rotation

long term goal for C6

indpendent slide board bc young no additional complcating factors can compelte a respiratory breathing msucle exercise program can independenlt propel a manual w/c and negotiate mild obstacles such as 1:12 graderamps and 2-4 inch curbs

landau reflex

infant horizontal in prone infant will extend the neck and trunk

osteomyelitis

infection of the bone pain, fever, edema, erythema, and tenderness

apophysitis vs tendonitis

inflammation of apophysis which is a natural protuberance from a bone vs inflammation of a tendon at the insertion site

pulmonary fibrosis

inflammatory process affeting the alveoli that grossly distorts the architecture of the lung cause a decrease in lung compliance and a decrease in lung volumes including total lung capacity, vital capacity, functional residual capacity and residual volume

does active movement cause a relaxation response

no

pt is 18 and covered by pts insurance, which of the following actions is most appropriate prior to beginning PT

obtain informed consent from the pt a release by a medical physician is recommended but is not a necessity (a thorough examination and/or physical screening should be eprformed and a referral should be made if the pts condition warrants

child can be easily displaced and demos emerging protective reactions and slow trunk righting reactions in sitting position, which of the following functional activities is best for short term PT

obtaining a toy when placed out of reach within the childs ability to achieve bc this is an item in the third stage of sitting which occurs around age 6-7 months

pop in posterior leg with sudden onset of pain localized to middle third of lower leg NO functional loss of strength what injury

plantaris tendon rupture usually felt as a pop vestigal tendon - reminant tendon that has no significant role in function at knee or ankle

apophysitis of the ASIS

sprinter coming out of the starting block (due to origin of the sartorius and the traction force that comes with coming out of the starting block when the hip is extended and the knee is flexed)

boggy feel is associated with what stage pressure ulcer with blister

stage 2

TNM system what do they look at

tumor size involvement of lymphatic system presence of metastsis NOT rate of growth of the cancer cells (this is determined by examining cancer cells using a microscope, very relevant but doesnt factor into staging)

Bell's palsy

Ipsilateral LMN injury to facial

How to ascend curb with WC

Lift the front casters and ascend in a wheelie position Must use momentum and a strong push to elevate the front casters of the chair and propel the wc up the curb)

Elevated and retracted pelvis how do you remediate this

Light resistance to forward pelvic rotation during swing Will actively engage desired muscles and reciprocally inhibit the spastic retractors was

Guided movements not favorable bc

Minimizes active participation and active learning

Pupil construction to light what CN

Oculomotor The pupillary reflex (construction of the pupil) is a function of the efferent portion of the oculomotor nerve CN III Optic nerve provides the afferent signals to the brain and functions for visual acuity (interpretation of visual information) Trochlear does superior oblique muscle and helps to control extraocular eye movements (down and out) Abducens innervates lateral rectus and helps to control extraocular movements (lateral)

L5-S1 nerve roots stressed during

SLR

Pericarditis

Substernal pain that may radiate to the neck and upper back Difficulty swallowing Pain aggravated by movement or coughing Relieved by leaning forward or sitting upright History of fever chills weakness or heart disease

How to increase stability at a prosthetic knee

The prosthetic knee axis of rotation is normally aligned anterior to a line extending from the trochanter to the ankle (TKA line) A knee set to far anterior will cause it to buckle Too far posterior causes excessive knee stability and difficulty flexing the knee

limitation in knee extension what mob

anterior glide of the tibia OR superior glide of the patella (patella is convex)

automono

autoamt ci and erqure very little attentoin informaton

hip precau

avoid hip add and IR and flexion past 90

talus on calcaneus

calcaneus is CONVEX

lysholm knee

condition specifi c

oswestry

condition specific

atelectasis and breath sounds

crackles (rales)

barognosis, kinesthesia, graphethesia all transmitted through

dorsal columns

dehydration and hemoglobin

may be increased when the bodys water content is decreased from dehydration, diarrhea, vomiting, excessive sweating, severe burns, and use of diuretics LOW hemoglobin (iron containing molecule of RBCs tha binds with oxygen) indicates anemia and oxygen carrying capacity is decreased

recurrent LBP typical of

muscular strain

anteriomedial aspect of lower leg are part of

posterior compartment

carpal tunnel can also occur due to

pregnancy due to fluid retention or repetive trauma usually associated with repeated wrist flexin and extension I/M pain and parestheia

p wave inversion

premature junctional complex

diveritculitis

presecne of outpouchings in the wall of the colon or small intestine sx include passing of blood in the stool but not coffee ground emesis

most important to monitor as part of home program for pt with HF

presence of shortness of breath and dependent edema and fatigue and productive cough and cyanosis (sx of HF exacerbation) BP and HR changes and diaphoresis are not sx of HF exacerbation

lymphedema

swelling decreased ORM and volumetric measurements

single nerve root lesion will demo

weakness may not be apparent immeditely but emerge after a few seconds peripheral nerve more quick

atrophie blanche

white, scar-like areas associated with pain at rest and when standing smooth white plaques

babys head falling back when pulled to sitting at 1 month is this normal

yes birth to 3 months head will lag

pec minor

anterior tipping downward rotation

osteoporosis traction

contraindicated

violation of HIPPA 1. A physical therapist contacts a patient's physician to discuss the patient's progress without asking the patient for written consent to do so. 2. A physical therapist discusses a complicated case with a colleague while driving home together after work without first seeking the patient's consent. 3. A patient asks a physical therapist to release a copy of the evaluation and plan of care to an insurance carrier without providing written consent to do so. 4. A patient asks a physical therapist what surgery another patient underwent and is told that the second patient had a total knee arthroplasty 1 month ago.

answer 4 (should not divulge type of surgery or condition that a pt has without consent) consulting another PT in order to improve care is NOT prohibited

anterior lower ribs would treat what area of the lungs

anterior basal segments of the lwoer lobes

two days after a contusion and resultant hematoma of the R anterior tibia, pt notices numbness, tingling, and coolness in the lower leg, what is the cause?

anterior compartment syndrome (can be caused by a blunt trayma and presents with sensory deficits)

home modification for pt with diabetic neuropathy

anti-scald valves on hot water faucets

color changes, pallor on elevation and hyperemia in hanging

arterial insufficicency "rubor of dependency"

hip extension is important for

backwards stepping

biofeedback requires that pt is

cognititvely aware

supraventricular tachycardia indicated by...

diminished P wave but the duration of the QRS complexes occur within an appropriate interval

trochlear nerve lesion

elevation of invovled eye during forward gaze

histamine

endogenous chemical that is invovled in the normal regulation of a variety of physiologic functions such as gastric secretion as well as various hypersensitivity or allergic reactions

normal in an infact

genu VARUM bowlegged to accommodate for the flexed position in utero gradually straighten until they reach a neutral alignment between the 1-2nd years

PTs

give services free of charge as public service as their practice permits should be given at same level of care regardless of pt payment

right middle lobe

head down on L side, 1/4 turn backward

forefoot valgus associated with

high arches in WB

feet together slack on

hip adductors

CPR for LBP and manip

hypomob no sx distal to knee fewer than 16 days FABQ less than 19 1 hip with more than 35 degrees of IR

AC joint

i guess the clavicle is concave horizontal abduction you want to mob in the anterosuperior direction horizontal ADD you want to mob in the posteroinferior diection

best initial tx with suspect a fx

immobilize and refer to primary care or ER with the rec to order radiographs failure to manange a fractured scaphoid can result in avascular necosis due to its poor vascular supply thumb spica case for 4-8 weeks

precaution with I/M compression

impaired sensation peripheral neuropathy

pelvis first

in w/c alignment

lesion to posterior cord, what impairment would you see

inability to determine joint position sense (proprioception is the sense of a STATIC joint position, transmitted to brain via DORSAL COLUMN MEDIAL LEMNISCUS) temp is located in the ANTEROLATERAL spinothalamic tract pain (sharp/dull) is located in the ANTEROLATERAL spinothalamic touch awareness is located in the ANTEROLATERAL spinaothalamic location of touch (tactile localization) is located in DORSAL COLUMN MEDIAL LEMNISCUS bc more discriminative than touch awareness (ability to simply feel light touch)

complete achilles rupture

inability to flex the foot and INABILITY to walk run or jump

dysdiadochokinesia

inability to perform rapid alternating movements

cushings syndrome

increase glucocorticoids

what happens when I/M pneumatric compression inflates?

increase in interstitial tissue pressure and venous and lymphatic flow where as arterial blood flow is reduced arterial flow would increase during the deflation phase

CP function in 3rd trimester of pregnancy

increase in oxygen consumption CO increases 30-60% oxygen consumption increases 15-20% HR increases RR does not change

muscle fiber hyperplasia

increase in the number of muscle fibers, and if it occurs, it is in response to heavy resistance training and only accounts for a small percentage of the increase in strength

immersion causes,,,

increase need to urinate to eliminate fluid need to hydrate orally to replace fluid excreted from the system by renal endocrine and CV reponses to immersion decrease in systemic and local edema from this perioheral to central fluid shift response reduction in expiratory reserve volume but increase in inspiratory reserve volume only modest reduce in overall vital capacity

juvenile RA, increased or decreased anterior pelvic tilt throughout gait?

increased

blocked practice...

lack of variability not best for long term retention bc daily movement has variability

friction rub

large pleural effusion

inflaer

left PSIS would appear more lateral and the ASIS would appear more medial

volar radioulanr ligament

located at the wrist

implicit memeory

memory formed thorgh reps relfecie automatic harbtal in chafrcater does not reuqra arearnes atentoan adn relflecit ath oen wold nearhn learnign a secific movemnt sratagey

what blood count would be increased with inflammation

neutrophils (type of WBC)

osteomalacia

painful muscle weakness, bone pain, and tenderness alkaline phosphatase levels are elevated

standard hand rims what level

paraplegic (aka someone with full UE innervation) used for C8 level and below

coffee ground emesis (pt is taking heparin)

peptic ulcer other sx = weakness, diaphoresis, epigastric pain, and coffee ground emesis the coffee ground emesis results from bleeding that has slowed or stopped, with conversionof red hemoglobin to beown hematin by gastric acid heparin is an anticoagulant and is associated with a higher risk of GI bleeding

s/s exercise intolerance in cardiac rehab

persistent dyspnea, dizziness, anginal pain, sudden weight gain leg stiffness is NOT a s/s associated with exercise intolerance

typical behavioral changes with R hemisphere damage

poor judgement (difficulty in grasping the whole idea of a task or activity and therefore may have difficulty with reasoning and judgement) impulsive quick they are NOT overly cautious (this would be pts with LEFT hemisphere damage and includes being anxious and disorganized as well have having diffoculties communicating and in processing info in a sequential manner)

sitting with elbows resting on knees, why does pt with dyspnea benefit?

position allows increased strength of contraction of the diaphragm (the intraabdominal pressure rises and lengthens the diaphragm as it is raised upward, this allows the strength of the contraction to increase due to improved length-tension relationship)

what increases the height of a lift to clear the buttock?

protraction and depression

s/s of infection

pus redness pain and swelling general - fever chills and increased pulse rate labs - increased erythrocyte sedimentation rate and WBC count

CVA when teaching to roll to uninvolved side what should the pt avoid

pushing against a supporting surface with the uninvolved leg bc encourages extension of the trunk when rolling instead of flexion positioning the involved LE over the uninvoved is apropriate motion to begin training to encourage flexion of the trunk same for lifting head

data that is least likely to be obtained through gait analysis swing phase walking velocity quad strength knee extension ROM

quad strength muscle weakness cannot be measured directly with gait analysis, although gait analysis may include electromyogrpahy, this measure would not provide specific info on muscle strength, a thorough knowledge of muscle function and normal gait combined with the the results of MMT provides the therapist with the necessary info to assess muscle weakness gait analysis analyzes spatial and temporal variables associated with gait, evaluate the effectiveness of treatment, and examine the effects of meds, bracing or surgery

volume measurements of wound

questionable value to clinicaians

heel rise in the midstance phase of gait, what impairment is seen

shortening of the gastroc (aka decreased DF ROM) need 3 degrees of DF to acheive midstance otherwise will se premture heel off tight hamstrings would NOT cause early heel off

upper extremity hypertonicity =

shut dysfunction blurred vsion headache

shallow crater with a moist wound bed

stage 2

e stim is contraindicated in ...

the carotid sinus region and is a precaution for the very young

metabolism meaning

the chemical processes that occur within a living organism in order to maintain life. "the metabolism of fatty acids in the kidney"

brace with abdomal pillwot splint

used for PAIN CONTROL with mobility

thrust unloader brace

used for osteoarthritis in order to unload the medial femoral and tibial condyles

who should you exclude from exercise if they are experiencing what sx

ventricular arrhythmias at rest high risk for increased mobidity and mortality AACVPR recommends that pts with uncontrolled arrhythmias be excluded from exercise

seat width, seat depth how many inches do you add or subtract

width add 2 depth subtract 2

C5 tetraplegia, says he will walk again at discharge (he is not currently walking) how should you respond

"future advances in SC research may make your goal a reality" they say that responding in this manner leaves open the possibility that the pt may one day walk without providing the pt with a sense of false hope i chose "you can have a rewarding life even if confined to a w/c" they didnt like this bc they think the statement would be construed as negative given the pts proclamation and is made worse by the terminology "confined to a w/c" it also says the PTs should encourage pts to reach their goals even in cases where presently it may be unrealistic, in this scenario, the pt is not asking the therapist directly baout their future functional level, rather the pt iss simply sharing their optimism about the possibility of one day being able to walk, it would therefore be inappropriate for the therapist to do anything to diminish this optmism

Standing and walking

10-15 months If child is not walking by this point then referral to a neurologist or less exam is warranted

potential neuro problems APGAR score

3 at 10 min (indicates need for resuscitation 0-3) esp bc at 10 min will likely result in neuro complications appearance pulse grimace (reflex irriability) apperance (color) respiration

variable P waves that are not related to QRS complexes describe

3rd degree heart block

second stage of sitting

5-6 months holding a toy within the center of mass in sitting is also a skill that is likely to already be achieved in the second stage of sitting

Throbbing pain in lumbar region with activities on exertion like stairs or tennis but not with bending, twisting, sitting, standing, or walking, no pain or limitations with AROM, no neuro signs, what could this be

Aortic aneurysm Throbbing LBP that occurs only with activities that increase the HR is a red flag for aortic aneurysm Immediate medical referral is indicated

Type 2 diabetes running recommendations

Consume a carb before or during practice to avoid hypoglycemia During exercise of increasing intensity and duration, plasma concentrations of insulin progressively decrease Can cause exercise induced hypoglycemia Can occur up to 48 hours after exercise Need to reduce insulin dosage or increase carb intake before or after running Consuming carbs before or during the race is a preventative modulating effect on hypoglycemia Hyperglycemia would be a risk for T1D (uncontrolled) and therefore they should demonstrate glycemic control before starting an exercise program because consuming carbs will not lessen the likelihood if this occurring

Knee flexors do what for swing

Decelerate momentum from mid swing to deceleration

Ascites pain or discomfort

Fluid accum in abdomen Discomfort more than pain Often complain of SOB bc extra weight on diaphragm Fluid can also accumulate in the lungs (pleural effusion) and cause SOB

numerical pulse amplitude classification of a normal pulse

2+ same as reflexes normal under resting conditions 1+ is a diminished pulse and is the result of reduced SV and ejection fraction and/or increased vascular resistance 3+ moderately increased pulse amplitude and is associated with increased SV and ejection fraction 4+ is a markedly increased pulse amplitude and is assocaited with increased SV and EF

LBP with recent increased difficulty with urinating Neuro normal Murphy sign negative What is happening

Lower UTI Can refer to back Recent report of increased difficulty is a key factor Neg Murphy's sign decreases likelihood of kidney sx

Hypermobility with lig laxity end feel and pain with medial directed force at knee what ligament and grade

Medial collateral ligament MCL grade II Some fibers of the ligament are torn resulting in the hypermob/lax and some fibers are intact which would be painful upon stress Grade III would not have pain since all the fibers would be torn

Periarticular or oligoarticular JRA

Onset occurs in 40% of children with juvenile rheumatoid arthritis In some combination the knees, ankles, wrists, or elbows are the most frequently affected joints Hips are usually spared

Improve downgliding at T7-8

PA on transverse process of T8 I don't get this Says that the axis of motion for the mid thoracic vertebrae is above the spinous processes and below the transverse processes Therefore if extension/closure of T7-8 is required, the therapist hand placement should be at the transverse process of T8 or the spinous process of T8 PA pressures on the spinous processes above T8 will cause the spinous process to glide into and compress the spinous process of the segment below, so no arthrokinematic glide will occur A PA central glide to the transverse process of T7 will increase extension between T6 and T7

hoehn and yahr classification of disability scale

PARKINSONS

Somatognosia

Perceptual disorder impairment of body schemes Lack of awareness of body structure and the relationship of body parts of oneself or of others

foot intrinsics intervated at

S1-S2

sural nerve NTT (branch of tibial)

SLR with DF and inversion

Occluding vision allows you to assess what

Somatosensory integrity Refers to conscious relay pathways for discriminative touch, conscious proprioception, fast pain, and discriminative temperature Sensory examination must rule out vision in order to establish the reliability of testing sensory integrity of these pathways

jewett brace

TLSO that has two plates anteriorly at the sternal and suprapubic regions one plate posteriorly at the lumbar region brace primarily limtis trun flexion and encourages erect posture

rounded upper back and protracted shoulders increases risk for

TOS impacts the ANTERIOR SCALES OR PEC MINOR can impinge neurovascular bundle

adson test (halstead)

TOS anterior scalene and radial pulse subclavian artery

No statistical significance between cardiac rehab and relaxation and home relaxation what is the problem with the study

The activities of the nonrehab group were not properly monitored To ensure adequate control, the researcher should attempt to remove the influence of any variable other than the independent variable in order to evaluate its effect on the dependent variable In this study the investigator did not adequately investigate the usually activities of the control group The small number of subjects may also have contributed to lack of significance

Best initial exercise for primary lymphedema in young pt

Treadmill walking Easy biking Swimming Water aerobics Tai chi Considered low risk activities Should always be performed with compression garments or compression bandages Can progress to higher risk activities like jogging provides there is no exacerbation of their lymphedema

somatotype

a body-type classification system that describes people as predominantly muscular (mesomorph), tall and thin (ectomorph), or round and heavy (endomorph)

stage 1 ulcer

alteration of intact skin whose indicators, as compared to an adjacent or opposite area on the body, may include changes in skin color, skin temp, skin stiffness or sensation

when can you not use patient controlled analgesia

altered cognitive status hard for pt to understand rationale for the use of PCA and to follow the supplied instructions would be ineffective history of substance abuse MAY make the use of PCA undesirable, however, the ability to control the type of med, demand dose, and dose interval makes this option remain a possibility depending on the unique circumstances associated with the pts history of abuse

functional residual capacity =

amount of air in the lungs at the end of quiet exhalation

hemorrhage side effect of what med

anticoagulant and thrombolytic agents

elevating causes pallor and later reactive hyperemia in dependent position

arterial insufficiency cannot sustain BF when lef is elevated vasodilation caused by local mechanisms occurs in response to ischemia

inability to identify obejcts by touch

astereognosis

posterior cord

axillary enrve radial nerve thoracodorsal upper and lower subscap

tinetti

balance and gait using an ordinal scale of 0-2 max = 28 <19 high risk for falls

cerebellar glioma removal what intervention

balance training to promote stable BOS

differentiating different weighted objects vocab

barognosis (cortical sensation) different weights in same hand at different times OR different weights in each hand at same time

stemmers sign

base of second toe if able to pinch then it is negative

drugs to tx angina

beta blockers calcium channel blockers nitrates

atenolol (tenormin)

beta-adrenergic blocking agent used in the tx of hypertension or angina

pt in seated position with the pts back leaning against a pillow at a 45 to 60 degree angle, this facilitates what postural drainage

bilateral apical

neuroma sx

collection of axons and fibrous tissue that can cause sharp, shooting, and localized pain localized hypersensitivity may be an indicator that a neuroma has devleoped

deltoid ligament

collection of medial ligaments of the ankle ligament as a whole attaches proximally to the medial aspect of the medial malleolus and fans out to the various distal attachments

melanoma skin changes

colored, irregularly shaped lesion that can be mottled with light brown to black colors

lesion proximal to the dorsal root ganglion, sensory nerve conduction velocity test will reveal...

conduction time WNL bc NCV test will only measure the distal component of a peripheral nerve The technique would not be able to detect abnormalities in a lesion proximal to the dorsal root ganglion. If only sensory roots are injured, no electromyogram changes occur. bc only measures motor input

post MI, BP 120/80 and HR 90 to 130/84 and HR 105 what do you do

continue with treatment HR should increase between 12-24 bpm above the resting HR

normal micturition

contraction of detrusor and relaxation of pelvic floor detrusor empties relaxed pelvic floor allows urne to pass contraction of the pelvic floor would limit the flow of urine if the detrusor does not contract the result is incomplete bladder emptying

GB pt works on weight shifting in parallel bars, what is the objective for this activity

controlled mobility 3rd stage of motor control ability to move within a WB position or rotate around a long axis

ACE inhibitor what will occur in pool

decrease in BP

MI 5 days ago referred for low level treadmill test, pt reports several episodes of mild angina at rest, after meals and during the night since being hospitalized, what should you do

defer testing the pt bc showing sx of unstable angina after MI unstable angina warrants IMMEDIATE MEDICAL ATTENTION

q angle

degree of anglulation present when measuring from the midpatella to the anterior superior iliac spine and to the tibial tubercle normally 13 degrees for male and 18 degrees for female often assocaited with PF syndrome bc alters the quads line of pull in such a way that the patella tends to track more laterally along the femoral groove

stop test during graded exercise test if...

diastolic reaches 120 mmHg (anything over 115 is too high to continue testing) failure of heart to rise with increasing exercise intensity cyanosis or pallor

lateral trunk shift is assocaited with

disc related back pain or sciatica

hypertensiond meds

diuretics reduce overall blood volume vasodilators decrease peripheral resistance or venous return SNS activity inhibitors or act on kidney to decreae production of renin

pt with congestive HF and dyspnea during ambulation should you teach them PLB or energy conservation

energy conservation since the heart is unable to meet the metabolic demands of the body, pacing and energy conservation techniques are necessary for the pt to improve their tolerance for activities of daily living and potentially exericse (this fits goals of improving exercise tolerance and increasing knowledge of the disease process)

positive predictive value

estimates the prob that a person who tests positive on the screening test actually has the condition the screening test is intended to detect high value means strong estimate of the actual number of pts who have the condition

forefoot makes contact with floor first in pt s/p CVA why

excessive activity of PFs weak DFs decreased ability to perform fast reciprocal movements noncontractile soft tissue limitations of PFs

bed to w/c transfer how to you teach it

explain the transfer while demonstrating and have the care provider practice transferring the patient motor learning first occurs in the cognitive domain explaining the taks allows for processing of the skill on a cognitive level and then to progress to the associateive phase, where the goal is to fine tune the skill, one must perform and practice the skill give that transfer skills are very specific to the individual being transferred, it is important that practice with the patietn takes place

retriculospinal

extrapyramidal motor tract facilitation or inhibition of voluntary and reflex activity through the inflence on alpha and gamma motor neurons

why is the injection site of insulin important to consider?

faster delivery into the bloodstream if the injection site is in the exercised extremity aka insulin is absorbed much more quickly in an active extremity and could result in hypoglycemia during the short term

when would you recommend to workout 2x per day

for individuals who have difficulty sustaining exercise for 30 min continuously, or who prefer shorter bouts, should exercise for shorter periods i.e. 10 min several times each day

overflow

full but unable to empty so overflows

CN 9

glossopharyngeal can be assessed by taste or by assessing gag reflex

exophthalmos

graves disease eyeball protrusion fluid accumulates behind eyeball

when in sitting

gravity does not resist the diaphragm bc is moves down with gravity

PT performing gait training with a pt with R hemiparesis, extensor tone, what orthotic

hinged plastic AFO with PF stop would assist in decreasing extension synergy

when the femur is fixed what moves the trunk?

hip flexors such as iliopsoas, not quad

agniotensin

hormone involved in reg of BP release of this hormone causes vasoconstriction which results in increased BP

atelectasis of lower lobes, lateral basal segment

i guess you treat this the same as draining secretions but can also use deep breathing without palpation i guess drainage would be best

wound culture

identify microoganism causing an infection

if the electrodes were "bad" what would the pt feel

if the gel coating on the elctrodes was wearing out or drying out, the current density would be high in some aresa and could potentially cause a burn

medulla infarct

impaired tongue movement (hypoglossal CN 12) and swallowing (CN 10 vagus)

TBI pt who is often disoriented and can frequently become agitated with little provocation, where should you make initial contact with the pt

in the pts room (more familiar and less distractible) may become overstimulated in a gym due to over stimulation from other pts and the overall level of activity rancho los amigos level IV

COPD what clinical finding

increase AP to latrael chest ratio muscle wasting is common which causes peripheral weakness, impaired functional abilities, poor quality of life, and poor pronostic sign due to increased energy demands losses more weight be decreases activity

superficial heat will not...

increase core temp

what action in a pool would increase resistance for a pt

increasing the speed of movement

massed practice for...

individuals with fituge issues (15 min on, 10 min rest)

paradoxical breathing

inward abdominal or chest wall movements with inspiration and outward movement with expiration

wilson disease

kayser fleischer rings around the iris from copper deposits

impaired sensation in the entire left leg, right leg is normal, what happened

left hemisphere stroke often have impairments of superficial and/or deep sensations

pain relief for right sided foraminal stenosis

left side bending left rotation

what will affect healing time more than age, history of RA, and sedentary lifestyle?

long term use of steroids

most appropriate way to administer rescue breathing

mouth to mask ventilation avoids skin to skin contact one way valve and a filter most desirable

encourage retention

multiple reps = learning and retention instruction and demo = more learning not retention

hypothyroid sx

muscle aches (myalgia) bradycardia not ptosis, dysphagia, or tachycardia

lateral cord gives off

musculocutaneous median lateral pectoral

rate pressure product most indicative of which of the following cardiac factors

myocardial oxygen demand RPP = HR x systolic BP it is an indication o myocardial oxygen demand

osteochrondritis dissecans

necrotic bone lesion with no known cause knee, talus, elbow can be involved cracks form in the articular cartilage and the underlying subchondral bone. OCD usually causes pain and swelling of the affected joint which catches and locks during movement

airborne isolation

negative air pressure direction of airflow into the room from the adjacent space outside the room

developmetal coordination disorder what intervention

neuromotor task training motor learning of feedback memory cutes and practice

burning sensation along the medial aspect of the knee and lower leg, sensation is increased during resisted hip adduction and knee flexion, what dx

neuropahy of saphenous nerve (supplies medial aspect of leg and foot) entrapment can cause pain at the medial side of the knee and pain is described as burning that increases with knee flexion and hip adduction pbturator has no cutaneous innervation so pain would reside in the adductor thigh compartment

prior to intervention PT must

obtain pt consent for treatment clinic policy for privacy of pt info should be before EXAM not intervention

best initial intervention to improve functional mobility in an individual with a stable humeral neck fracture

pendulum exercises after 1 week, the sling should be removed to have the pt perform pendulum exercise to prevent shoulder stiffness (will be immobilized for 6 weeks) isometrics and ressistive exercises are not indicated this early heat would help with pain but not improve mobility

low ABI =

peripheral artery disease

progressive relapsig

progression of disease from onset as well as acute relapses in between relapses the disease continues to progress

cystic fibrosis

progressive autosomal recessive genetic disorder of the EXOCRINE galnds pancreatic insufficiency excessive pulmonary secretions excessive electrolyte section of sweat glands life expectancy increased to 35

60 y/o with insidious LBP no trauma or sig medical history, pt plays golf once a week and sits at a desk for 6 hours each weekday, poor posture and loss of lumbar ROM, what is the most likley CAUSE of the pts decreased ROM

prolonged sitting bc the back pain developed over time gradual creep of tissues When elongated, tendons and ligaments will either creep and recover (i.e. not get permanently longer) or get long enough to plastically deform (i.e. damaged fibers). golf would have contributed to a herniated nucleus pulposus and would have been a sudden onset (motions into flexion, rotation, side flexion or extension) he wouldnt have a spondylolisthesis bc it is usually found in gymnasts, weight lifters, and football linemen as a result of repetitive flexion and hyperextension forces, would also have radiating pain into the buttocks or postieor thigh

false positive in functional reach

pt with no history of falls tests positively

increased leg length

pt would have to VAULT over the longer leg, circumduct the longer leg during swing or hike the hip of the longer leg

midbrain infarct

ptosis from insult to oculomotor nerve CN 3

TB where and what should you use

pts room N-95 respirator

A patient with severe arthritis of the hips and knees is able to partially stand but cannot clear the armrest of the wheelchair adequately during stand-pivot transfers. Which of the following strategies is BEST to facilitate the transfer?

recommend that the family acquire a w/c with removable armrests (good for lateral swinging or squat pivot transfers) a strengthening/ROM program (one of the other answers) should be encouraged, but a w/c with removable armrests would allow the pt to transfer even during periods of exacerbation of the severe arthritis obviously wouldnt get a mechnical lift bc the patient can partially stand and want to encourage independence

superficial burn

red or erythematous, slight edema but blisters are absent

plantar fascitis

refers to inflammation of the plantar fascia at the proximal insertion on the medial tubercle of hte calcaneus spans from the calcaneus to the metatarsal heads pain and stiffness at the bottom of the heel

cerebellum

regulates movement, muscle tone, and postural control, sx include ataxia, tremor, hypotonia, and asthenia

PF pain

reports pain in the anterior knee that worsens during impact-loading activities

ST segment

represents the initiation of ventricular repolarization and is a sensitive indicator of ischemia of the ventricles

empty can test

resisted shoulder EXTENSION with the elbow extended and the shoulder abducted to 90 degrees and medially rotated

two prominent tendons visible on backside of knee, what are they

semitendinosus (medial) & biceps femoris (lateral)

posterior drawer

sensitive rule out true positive

golgi tendon

sensitive to msucle contraction force

hawkins kennedy test

shoulder impingement syndrome which could be caused by SUBACROMIAL BURSITIS or RC PATHOLOGY

min A for unsupported sitting, short term goal is to maintain correct alignment in sitting for 2 min when challenged, what is the FIRST step toward achieving this goal?

sit with symmetrical weight bearing with the pelvis anteriorly tilted and hold the position

relieve dyspnea

sitting with forward arm support increases intraabdomiannl prssure improves length tension relantionship of diaphragm allows accessory msucle use

13 year old considering ACL surgery what could affect her candidacy

skeletal maturity due to the potential impact on future bone growth, lack of skeletal maturity can be a contraindication to anterior cruciate lig surgery

p value less than alpha

statistically significant reject null

increased sx with traction what should you do

stop the intervention and reevaluate contraindicated if periph occurs during and follwing therapy

pt with history of heart disease is being treated for L GH dysfunction, pt reports left upper quadrant PRESSURE that continues after joint mob has ceased, what should you do?

stop the treatment and monitor the patients vital signs... because vague left upper quadrant pressure pain can be an anginal equivalent and indicate MI (given this possibility, one should stop and assess vital signs, esp in a patient with a PMH of heart disease) left upper quadrant pain is a red flag and a warning sign esp in pts with PMH of heart disease having the pt perform relaxation exercises and inquiring about cardiac sx may decrease sympathetic tone and decrease anginal sx but first vital signs should be taken since the pt is already have a potential cardiac sx

forward head posture intervention

strengthen deep cervical flexors and shoulder retractors stretch the SCM and upper cervical extensors and pec stretching

sign of dehydration in a 6 month old infant

sunken fontanelle increased respiratory rate cold hands and feet unable to cry

GE shoulder abduction

supine aka for deltoid and supraspinatus

postural drainage for anterior segment of upper lobe

supine with a pillow under the knees

umbilicus

t10

apophysitis of the iliac crest

tennis player rapidly changing directions (due to simultaneous contractions of the abdominals, glut med, and TFL)

triangulation

the use of multiple methods to study one research question data comes from one patient in a case study so that means they do not use triangulation

how to protect immunocompromised pt while treating them bedside

therapist should wear a mask and gloves during the treatment universal precaution recommendation when treating a pt in protective isolation the pt should wear a mask if out of the room

conductive education

therapy approach for children with CP and is focused on improving motivation and self-esteem

manual w/c with handrim projections what level

these projections add depth to the wheel and allow the pt to more easily propel the w/c indicated for a C5 where the lowest innervation includes the biceps, brachialis, brachioradialis, deltoid, rhomboids, and supinator although a pt with C5 may itilize handrim projections, the necessary energy expenditure may necessitate the use of a power wheelchair for mobility AKA POWERWHEEL CHAIR WITH JOYSTICK CONTROLS

lipogenic effect of insulin

thickening of subcutaneous tissues and a loss of subcutaneous fat, resulting in dimpling of the skin

why do you use foam for the treatment of a healing pressure injury that is producing a large amount of exudate

to prevent maceration it will NOT prevent the onset of infection only antimicrobial dressings will do that

why does a person with spinda bifida use a KAFO

to substitute for the lack of muscle activity KAFO is commonly used when msucles of the knee are weak and msucles of the ankle are absent

best walker for pt with extensor tone

traditional not reverse bc that will further increase their tone

CVA with affected LE, primary goal is to return to walking independnelty, what is the most effective intervention

treadmill training with harness and partial body weight support early upright walking appears to be effective in fostering return of walking in persons following a cerebrovascular accident partial body weight support allows for early upright walking wihtout risk to the patient or therapist

pt reports not feeling the output form a continous transcutaneous electrical nerve stimulation unit, although the unit appears to be functioning properly and the amplitude is adjusted appropriately, what is the PTs most appropriate immediate course of action?

turn the unit off and check the connections

most common reason for falls in the eldery (what activity)

turning around and sitting down in a chair usually during ADLs geting up and down from a bed or cahir, turning, bending, walking, climbing/descending stairs are all high risk activities only a small percent fall during clearly hazardous activies such as climbing s tep stool

sartorius fxn

two joint muscle flex, laterally rotate and abduct the hip gum on shoe

meissners corpuscles

type of mechanoreceptor responsible for detecting LIGHT TOUCH highest sensitivity when sensing vibrations lower than 50 hz

stratified random sample

type of prob sample in which elements of the population are chosen at random from homogeneous groups based on some characteristic organizing elements into homo groups before selection decreases sampling error

waiter hand pain when carrying trays what nerve would be impacted

ulnar bc looks like ULNTT for ulnar nerve

medial instability of the elbow

ulnar collateral ligament fan shaped ligament that serves to restrict medial angulation of the ulnar on the humerus extends from the medial epicondyle to the medial margin of the ulnas trochlear notch assessed via valgus force to the distal forearm

what motion helps palpate scaphoid

ulnar deviation will slide out from under the radial styloid process in the anatomical snuff box

ulnar drift

ulnar deviation of the digits due to the weakening of the capsuloligamentous structures of the MCP joints and the accompanying effect on the extensor communis tendons

long thoracic nerve lesion, what cant the pt do

unable to elevate the arm overhead bc weakness in the serratus anterior which works in combo with the trap muscle to upwardly rotate during elevation

perceptual motor

underlying deficit must be address before imrpove taks perifmance

is hip dislocation likely to occur in an infant?

unlikely to occur in infancy

paradoxical breathing

up and out motion of the upper chest bc of accessory muscle action inward motion of the abdomen

long sitting leaning back

upper lobes apical segments

tilt table

used for tps who are resticted to prologned bed rest and who have persistent porthaoisstai hyptension

aseptic ointment

used on contaminated or high risk wounds and cab be applied to non contaiminated wounds that demonstrate early signs of infection

visual analog scale

used to estimate perceptions of pain

hernia should avoid

valsalva for 4-6 weeks after surgery avoid straining for 4-6 weeks folliwng repair regardless of procedure

type of practice most appropriate for long-term motor learning for a patient with CVA

varied task partice with variable time intervals bc higher cognitive processes required

gait deviation with knee immobilizer

vaulting characterized by heel elevation during stance in combo with hip and knee extension performed to raise the pelvis in order to clear the contralateral limb during the swing phase when the knee is locked in extension, the normal degree of knee flexion required during the swing phase does not occur resulting in difficulty clearing the foot, which makes vaulting an effective compensatory strategy when the knee is unable to flex

forward bend evaluation is conducted to determine the presence of what clinical feature

vertebral rotation looking for a rib hump the rotary component not the lateral spinal deviation

physical restraint for an older adult living in a long term care that can be used by a PT without a physicians order

w.c tray used for proper positioning of the upper trunk that can be removed by the pt (does not need a physicians order bc it is being used for positioning and cab be revmoed when it is not in use) not a vest restraint not a elevated wcso cant reach groun not removeing ambualtory device

TBI 3 weeks ago, confused and agitated with decreased LE coordination and strength, what is the most appropriate intervention?

walking in the parallel bars with supervision (this permits the patient to use the bars if balance is lost and is a closed environment that is appropriate secondary to the heightened state of activity of the pt) biofeedback, group exercise, following written instructions would be too hard for someone with impaired attention

3+/5 serratus anterior how do you strengthen

wall push ups standing arm overhead lifts ith hand weights supine arm overhead lifts using weights sitting arm overhead lifts using a pully all can still strengthen but are too hard at this time will overload the msucle and cause pt to compensate and potentilly develop inaprpriate movement patterns

dark skinned pt what color will a stage 1 pressure ulcer be

warm and purple eschar would be black and leathery

mouth to nose ventilation

warranted in condition such as injuries to the mouth or jaw, missing teeth, or dentures exposes PT to body fluids

discriminant validity

way to asseses the construct validity of a measurement when measurements that are believed to assess different characteristics are shown to be different, or have a low correlation, then one measurement is said to have discriminant validity with respect to the second measurement

addisions disease weight loss or gain

weight loss often results from loss of appetite, chronic diarrhea and vomiting sx may include hypotension, weakness, anorexia and altered pigmentation

psoriasis description

well-defined, dry, erythematous, keratinous plaques most commonly found in the scalp, extensor surfaces of extremities, and in severe cases, the trunk

dermal ulcer over coccyx reveals a wound exposing the deep fascia, no necrotic tissue, exudate in minimal and borders are diffusely covered with granulation tissue (previous tx included wet to dry dressings with normal saline) what should you do

wound irrigation with pressure below 15 psi (aka low pressure) will help decrease colonization and prevent infection not wet to dry bc no more necrotic tissue alginate for ehavy exudate hydrogel would work bc it is nonadherent, keeps the wounds moist and protects graulation buds BUT it was in the same answer as whirlpool immersion which is now contraindicated for all wound management in the question

exercise program for lymphedema pt (UE) which do you do last

wrist circumduction BC EXERCISES ARE PERFORMED PROXIMAL TO DISTAL

is pool good for arrhythmias?

yes bc improvement in ischemic threshold (HR at which 1 mm horizon or downsloping ST sgement occurs) and or reduction in sympathetic tone

spondylolisthesis radiating pain?

yes into butt or posterior thigh

4 fingers mouth opening normal or no

yes normal

supraventricular dysrhythmias are these normal or no

yes not a big deal isolated trial ectopic beats small periods of supraventricular tachycardia these commonly occur during exercisee testing and do not have any diagnostic or prognostic significance for CV disease Supraventricular tachycardia (SVT), also called paroxysmal supraventricular tachycardia, is defined as an abnormally fast heartbeat. It's a broad term that includes many forms of heart rhythm problems (heart arrhythmias) that originate above the ventricles (supraventricular) in the atria or AV node

cetirizine what is it

zyrtec antihistamine

pt with back pain, when should the PT suspect the pain is of a non-mechanical origin

if it is not reproduced during ROM of the spine and hips Constant pain that is not dependent on position or activity and is increased with weight-bearing is a warning symptom Pain that awakens a patient from sleep, rather than pain that makes it difficult to fall asleep or pain upon waking, is considered a warning symptom

assocaitevei

refine skill veral cog may not beas ipfnta ofcis on regnigne thatna thatn SLECETING

de quervains what splint

thumb spica for 3 weeks

weakness in PF, forefoot inversion, and toe flexion what nerve

tibial not medial plantar bc that is a cutaneous nerve of the lower limb

trigeminal neuralgia

tic douloureux Sudden severe pain occurring in distribution of the nerve Typically occurs in the maxillary and mandibular division on one side of the face Rarely affects the ophthalmic division

25 yo anterior knee pain after volleyball tournament, no history of knee pain or recent trauma, what dx

"infrapatellar tendinitis" associated with eccentric overloading during deceleration activities such as repeated jumping and landing

peroneus tertius

-Origin distal anterior surface of the fibula also the interosseous membrane -Insertion dorsal surface of metatarsal 5 -Nerve *deep fibular nerve* -Actions *dorsiflexion and eversion of the foot* weak though

Normal lateral deviation

10-15 mm

stages of motor control

1. mobility 2. stability 3. controlled mobility 4. skill

ABI normal values

1.0 is normal 0.5-0.8 moderate compromise Below 0.5 severe

Female hemoglobin

12-16 g per 100mL

min pt score necessary to avoid being classified as possessing a cognitive impairment on mini mental

24 score less than 20 may be assocaited with dementia delerium schizophrenia or affective disorder 30 is a perfect score

Toilet seat height

17-18 inches

Average height person with left hemiplegia what should be the seat height for WC

17.5 inches (called a hemi or low seat chair) Lower seat height permits the patient to propel and steer the wc using the sound right upper and LEs The standard height (20 inches) would be too high to permit efficient use of the sound lower extremity for steering and propulsion

traction to reduce muscle spasm what %

25%

overweight BMI

25-29.9

I/M training for outpatient cardaic rehab post MI, best inital spacing of exercise/rest intervals to safely stress the aerobic system

2:1 not 1:1 (this would be more appropriate for initial inpatient rehab) 5:1 may be appropriate in final stages of outpatient PT

ECG 2

3 mm ST segment depression stop gait training and notify the nurse which is indicative of cardiac ischemia and is an indication to stop exercise and notify medical staff

rearfoot varus normal limit

3-4 degrees of inversion is considered to be within normal limits

peak incidence of RA

30-50 years of age females more affected juvenile = <16 y/o

Clearance of doors

32 inches (36 is ideal)

Horizontal bars shoud be positioned at

33-36 inches

11 y/o pt recovering from knee injury beginning a resistance exercise program to strengthen the quads, how many times a week

3x/week to avoid injury, it is important to allow an adequate recovery (2-3 days) between training sessions 1x/week is not a sufficient exercise volume to promote tissue adaptation 5x/week does not allow sufficient recovery time between sessions and could increase risk for overuse injury

Female hematocrit

37-47%

hematocrit normal range

39-46%

ramp has two 24 foot sections connected by a landing area, what is the most likely total height of the ramp

48 inches ONE foot run for every for each INCH of rise so the height in inches = the run in feet (do not count landing area bc it is flat)

Spinal accessory lesion

Minor problems in deglutition (look this up I'm on plane) and phonation along with weakness in ipsilateral shoulder shrugging

dyslipidemia exercise program

40-80% of heart rate reserve 5 or more times per week (mod intensity 5x or more a week) specifically for lipid lowering benefits

normal hematocrit

45%

most appropriate time for ice massage

5-10 min due to intensity of cooling vs ice pack were 15-20 min is within the established range

normal ejection fracture

55-70% anything less is abnormal measured by SV/end diastolic volume of L ventricle

90% SpO2 is also what

60 mmHg partial pressure of oxygen which represents a state of hypoxemia which is the most common indication for supplemental O2

Pull to stand

8-9 months

osteoporosis

METABOLIC condition compression and other fxs, low thoracic or lumbar pain, loss of lumbar lordosis, kyphosis, decrease in height, dowagers hump, postural changes

Clasp-knife phenomenon

A manifestation of corticospinal spasticity in which there is increased tone in either flexion or extension with sudden relaxation, as the muscle continues to be stretched, imparting a sensation likened to that of an opening clasp knife, which has initial resistance and then opens more easily.

hypermobile TMJ what would you see

indentation behind the condyle of the mandible

leg pain with walking, relieved by lying down and hanging leg off the side of the bed what test should you use

ABI compares or indexes the ankle BP to the UE BP and is a noninvasive measure of arterial blood supply

hyperEXTENSION injury

ACL

direct impact to outside of knee

ACL injury

myositis ossificans treatment

AROM in pain free range NOT friction massage bc contraindicat3ed in presence of acute inflamm, hematomas, delbiaited or open skin and decreased seasntion massage should be avoided in early treatment of mysitis ossificans initally stregntheing and massage should be avoided once rehab can begin FOCUS ON ROM not into resistance intiailly

upper right quadrant pain and tenderness, PT percusses over the costal margin at the point where the lateral border of the rectus inserts with the costal margin and pt complains of acute pain and stops inspiratory effort, what does this patients response indicate

Acute cholecystitis Sign described in question is Murphy's sign

Procedural memory

Aka unconcious or implicit memory Recall of skills and habits and emotional responses Integrated action of the frontal cortex (neocortex), thalamus and striatum of the basal ganglia

milwaukee brace

CTLSO upward extension to the mandible and mastoid used to help correct scoliotic curves

renal urologic dysfunction

CV area low back or grion

Pt collapses and falls to floor, PT is long rescuer at site, checks for a response and finds the pt unresponsive, after activating emergency response system (911) what should you do

Begin CPR and attach and use the AED as soon as possible Check for responsiveness Call 911 Get AED if possible and return to victim to provide CPR and defibrillation if needed Trained health care providers can use ventilations (1 breath every 8 seconds) with chest compressions (100 per min) Compression to ventilation ratio of 30:2

Deep partial thickness burn gets infected what happens if this happens

Can convert to a full thickness burn If it does not get infected it will heal in about 3-5 weeks

Disc L2/3

Can refer to the upper buttock region has a similar pattern of referral to that of the facet joints of the lumbar spine SI joint can also refer to lumbar and buttock region

Suspect lymphedema and stemmers is positive what else should you do (pt also has swollen warm and red ankle)

Cellulitis is a possibility Look for proximal red streaks and palpating of inguinal ligaments Red streaks emanating from the foot and ankle is a characteristic sign of a spreading infection Strep and staph are often culprits Enlarged or painful lymph nodes in the groin are another sign of possible infection and even lymohangitis This person needs additional medical care

bilateral D2F and D2E in or out of syn

D2F out of syn D2E in syn

posterior glide of the calcaneus is needed for

DF

Baclofen side effect

Drowsiness and muscle weakness Confusion Vertigo Dizziness Insomnia Occurs in less than 10% of patients (CNS depression sx listed above) Also hypotension Urinary frequency

Primary indications for calcium alginate dressing

Facilitate automatic debridement and absorb exudate Moisture retentive occlusive dressing Can reduce pain and promise faster healing (reepithelialization) Very permeable to bacteria, urine and so forth

Spatial relation disorders

Encompass a constellation of impairments characterized by difficulty perceiving the relationship between self and two or more objects

10x10 cm area with 5 cm sound head, how should you treat the upper back

Each side allowing 5 min for each section Do two areas independently to allow for more time for the tissue temp to rise If you move the transducer too fast to cover both sides in the allotted time does not allow enough time for the acoustic energy to produce heat because the head is not in a given area long enough (increasing treatment time will not affect the rate of heat production in this big of an area)

Hyaluronidase used for

Edema reduction

Best measure of exercise intensity

HR for newly tested and exercising individual RPE will be valuable once the patient becomes adept at using it but it would not be reliable for the first exercise session

Adverse reactions from warfarin

Hematuria ecchymosis (skin discoloration and hemorrhaging) Serious bleeding with drug toxicity

superficial partial thickness burn characteristic

INTACT blisters wound is bright pink, red, or mottled red

ACL and PCL prevent what motion

IR

teres major

IR adduction extension

Hemiplegia with hyperextension during midstance how should you intervene

Insert a heel lift in the left shoe This will delay forefoot loading and allow the tibia to progress further forward thus increasing flexion at the knee by anteriorly tilting the tibia Tight calf strap would encourage hyperextension at midstance bc doesn't allow tibia to move Increasing footplate increases lever arm that controls forward movement of tibia and knee extension moment Lateral post will affect frontal plane motion not Sagittal

Claudication exercise

Interval training of moderate intensity 30-60 min 3-5days per week Walk until INTENSE pain aka grade 3 on claudication (4 is max) and then rest until ischemic pain subsided before resuming exercise Continuous exercise would be contraindicated with persistent pain

Oppenheims test

Involves running a fingernail along the crest of the tibia Positive test is same as positive babinski

When do you want to screen for scoliosis

Just before puberty growth spirt aka between 9 and 11 for girls Boys should be screened between 11 and 13 because of the delay in onset of puberty

hit on L side of face with drooping on ips face, what nerve

L facial CN VII exies at the stylomastoid foramen auditory canal which i the anterior aspect of the ear flaccid paralysis or hypotonia if damaged in this location

stretch for torticollis (R lateral flexion)

L lateral flexion R rotation SCM

L hip drop what exercise

L sidelying with R hip abduction, extension, and lateral rotation

R shoulder pain that extends from the upper trap to the thorax between the scapulae, pt reports recent tendency to bruise easily and has dark-colored urine and clay-colored stools, what organ is impacted?

LIVER causes jaundice, dark urine, clay-colored stool, easy bruising, and right shoulder pain kidney will not cause the sx in the question (except for pain in the shoulder) pancreas pain is referred to the LEFT shoulder pain from cardiac dysfunction can be from the left or the right

Right sided pneumonia what position is best to improve PaO2

Left side lying with head of the bed in a flat position Will allow match of perfusion and ventilation Therapist needs to place the unaffected side in a gravity dependent position

How to alleviate pt pain when nerve root is compressed at C6

Lower cervical flexion

Reverse lachmans

PCL

Full thickness burns

Pain free in the middle but usually not the entire burn area But still painful because adjacent areas of partial thickness still have nerve endings and can be painful

Special tests for pronator teres syndrome

Passive supination to elongate the pronator which is tight (this would compress the nerve at that level) Active resistance of pronation which would also compress the nerve

What glide to improve ER

Posterior glide

Work site ergonomics

Reposition overhead height shelves to below should height It is not reasonable to expect an employee to stand all day at a desk to not reach overhead

Achilles tendinopathy intervention

Resisted eccentric PF Decreased pain and increases function Weak evidence to support stretching of the PFs and soft tissue mob (expert opinion only)

Sign that pt is in decompensated heart failure

S4 heart sound, crackles on lung auscultation, increased jugular vein distensjon Crackles = compressive atelectasis due to pulmonary edema (will have wheezes if it is severe enough)

restricted mobility of tibial nerve

SL raise with 10 deg of DF would irritate DF eversion toe extension

tibial nerve NTT

SLR with DF and eversion used to decrease adverse mechnical tension on nerves if use during tx the techniques freee up the nerve so that it can slide in its sheath mroe readily and not bcome trapped within the tissues

Unna boot

Semi rigid dressing that provides limb support

Best training for child just learning to sit

Sideward protective extension in sitting This protective reaction normally occurs at about the same time as sitting behind

Doing traction on a patient, their pain decreases a lot but their reflexes are not asymmetrical, what do you do

Stop the traction and consult with the patients physician Asymmetrical (new onset) reflexes indicates progression of neuro compromise and requires immediate attention Traction should always be re-examined if there are no improvements within 2-3 sessions or their conditions worsens

Limited right rotation caused by left thoracic facet joint capsular tightness at T6-7 what glide should you do

Superior and anterior glide on the left T6 transverse process With right rotation left superior facets move up opening the joint and stretching the capsule and right facets move down closing the joint and putting the carousel on slack

Pes cavus

Supination of the foot, supination of the talocalcaneonavicular, subtalar and transverse tarsal joints High arch Responds well to orthotic foot control especially in a child

Retro version

Toe out

Bad movements for osteoporosis pt with risk for fx

Trunk flexion or rotation because could cause compression fracture Slippage doesn't want extension because of the anterior shearing (aka spondy not this case)

complete C6 tetraplegia 3-day history of increased LE spasticity, left shoulder pain, and fever, which of the following conditions is most likely responsible for these findings?

UTI spasticity can be influence by internal factors such as UTI can also be associated with fever and can refer pain to the ipsilateral shoulder autonomic dysreflexia results in hypertension, not left shoulder pain or fever and has a rapid onset

Do you leak urine while sitting in a chair?

UTIs, some medical conditions (diabetes PD) and certain meds can cause leakage if urine at rest (sitting in a chair or rarely at night)

Group of volunteers (healthy college students) in study on XyZ what is wrong

Validity of the study was threatened with the introduction of sampling bias Used a sample of convenience Introduced systematic sampling error Random selection would improve the validity of this study

PCA stroke

Visual cortex deficits contralateral homo hemi Dyslexia difficulty reading Propsagnsks difficulty naming people on site Memory deficit temporal lob lesion

CTSIB

Visual reliance: pts. are unsteady in 2,3,6. Somatosensory reliance: 4,5,6. Vestib loss: unsteady in 5 and 6 Sensory selection problems are evident with loss of balance with 3-6 Clinical Test for Sensory Interaction and Balance

ATFL

When the foot is in slight PF, the ATFL is perp to the long axis of the tibia Will see greater translation of ankle during anterior drawer if the calcaneofibular lig is also torn Ideally test should be done in 90 degrees knee flexion to alleviate tension on the Achilles' tendon

talar tilt

calcaneofibular ligament

continuous cath for

pts with neuro deficits

teres major mm fxn

extends adducts MEDIALLY rotates the shoulder

tight anterior capsule at shoulder would limit what

extension lateral rotation based on convex concave rules

rule of nines what is given a higher percent in kids

head (legs are given a smaller percent) normally divided into 11 areas representing 9% with the genitalia representing the additional 1%

less than 6 METs functional capacity

moderate risk for increased morbitidy and mortality 3 or more weeks after a clinical event

tinea corporis

ringworm ring shaped pgiemnat paches coverd with sclaes

lisinopril

vasodilator

knee control while descending stairs what exercise

wall squats bc closed chair and eccentric

quantitative research design

what is the relationship between scores on a standardized graduate school admission test and completion of a doctoral program this would require statistical analysis to answer whereas the others were qualitative in nature and involves interviewing people to obtain their opinions

what color are bones on a CT scan

white CT usually used for spinal lesions and in diagnostic studies of the brain the greater the density of the object, the less penetration and threfore the whiter it will show up metal then bone then soft tossue then water then fat then aira

normal ejection fraction

55-75%

Potential adverse effects for prolonged corticosteroids

Atrophy and osteoporosis Joint pain Large doses will mimic Cushing's syndrome like moon face central obesity hypertension myopathy electrolyte and fluid imbalance Common CNS changes include insomnia and nervousness

Standing balance and strengthening what outcome measure

Berg 14 item of static and dynamic balance in sitting and standing Also examines sit to stand and stand to sit transitions

Norvasc

Calcium channel blocker

Schizophrenia

Chcarcterizdd by disordered thinking, fragmented thoughts, errors of logic or abstract reasoning, delusions, poor judgement and so forth Will have poor ability to perform multi step tests requiring abstract problem solving

Suspect a labral tear and suggest MRI when...

Common finding among pitchers and athletes who do a lot of throwing (esp in those who present with abnormal ROM and instability sx of catching and popping) MRI warranted to fully diagnose the constitution and to develop an appropriate treatment plan Beginning treatment without definitive testing is contraindicated

Hep B what precautions

Contact Nose Saliva Sweat Urine Feces Semen Vag secretions

22 year old 3 months pregnant complains of shoulder and leg pain with black eye and bruising at the wrist, direct access, what should you do?

Examine the patient and if abuse is suspected report the findings to the appropriate authorities Falls into high risk for domestic violence based on presentation Women between 17-28, who are single, separated or divorced or who are planning a separation or divorce are at high risk Bartered women usually have more than one injury, mostly occurring in the head, face, neck, breasts and abdomen Battered women represent 23% of pregnant women who seek prenatal care May not volunteer the info but more often than not when asked will reveal it In most states, a PT may be fined or indicted for failure to report

genu valgus associated with

IR of tibia and pronation of foot

Vestibular neuritis

Inflammation of vestibular nerve caused by a virus and typically produces sx of dysequilibrium, nystagmus, nausea and severe vertigo

stage 3 pressure injury, most appropriate agent to use INITIALLY

STERILE NORMAL SALINE used to just clean a wound

functional exercises and breathing exercises for pts who have

SUI

endotracheal tube

airway catheter inserted in the trachea for endotracheal intubation your normal tube on a vent

folliculitis is treated with

antiseptic cleansers or antibiotics common skin condition where the hair follicles become inflamed usually due to bacterial or fungal infection to avoid, shave with care, keep skin moist and well hydrated and avoid unsanitary hot tubs and pools

Phenylketonuria

autosomal recessive diseae that results in defect in the ability to metabolize the amino acid phenylalaine if left untreated, manifestations include intellectual disabiilty, tremors, muscular coordination deficits and seizures

osteoarthritis

chronic disease degen of articular cartilage typically in WB joints deformity and thickening of subchondral bone results in impaired functional status most common = hands hips spine and knees

MS

chronic disease caused by inflammation and demyelination within the CNS highly variable between pts

primary progressive

continuous worsening of sx from the onset without distinct relapses or remissions

inability to DF the foot and mild sensory disturbance between the first and second toes, what nerve

deep peroneal nerve often occurs with anterior compartment syndrome bc it passes under the extensor retinaculum innervates tibialis anterior, extensor hallucis longus and brevis, lumbricals, interossei, extensor digitorum brevis, and peroneus tertius muscles

cushing syndrome characteristic

distension of the abdomen (results from weakening of the muscles and elastic tissue in combo with abnoraml fat distribution, thinning of the skin with striae on the breasts, axillary areas, and abdomen are often obesrved) swellinig in the facial area MOON FACE cardaic hypertrophy (hypertension caused by potassium depletion and sodium and water retention which can lead to this) PTs may be more likely to treat pts who have developed medication-induced cushings syndrome, usually after receiving large doses of cortisol or cortisol derivatives hyperfunction of the adrenal gland

exam in long sitting

dix hallpiike maneuver BPPV will have torsional nystagmus if positive long sitting to head ahnging over the surface extended and rotated to 45 degrees nystagmus will occur in this position when the affected ear it toward the floor and should fatigue within 60 seconds

pt is bleeding from a small hand laceration what should you do first as a PT

don protective gloves covering the wound is the second action taken if the blood flow is excessive, the third action would be to elevate the wound above the level of the heart to reduce blood flow to the area applying pressure would be the fourth course of action (if arterial bleeding is present, it may be necessary to apply intermittent direct pressure to the artery above the level of the wound or direct perssure on the wound)

increase wrist flexion/extension

dorsal glide volar glide moving carpals on the radius and ulna

supine with head down roatted one quarter backward

drain lingula

peripheralization of LBP with repeated trunk flexion, what activity would aggravate sx

driving a car for several hours NOT "lifting light objects with the spine maintained in neutral" bc in neutral should not cause pain as spine is in optimal alignment with neither flexion or extension deformation

upper urinary tract problems such as kidney or ureter infection referral

groin pain

NDT techniques

i.e. rhythmic stabilization and alternating isometrics, are designed to improve postural stability or dynamic stability of a joint although it may assist in pts performance, will not address muscle stiffness

forced vital capacity of 4 L and forced expiratory volume in 1 second of 3.5 L, what dx?

idiopathic pulmonary fibrosis (inflamm of alveolar walls and subsequent fibrosis) airflow rates remain constant despite change in lungs ability to expand/decreased lung volumes/capacities can deduce that this pt has a restrictive lung disease since the FEV1/FVC is normal (3.5/4 = 87.5%) normal range is 80-90% will be <70% in pts with obstructive

increase in HR directly causes

increases in CO increases with metabolic demand SV usually plateaus around 35-40% of max exercise intensity after that, CO is augmented by increadses in HR

L3 lumbar nerve root impingement, what should you test

knee extension strength and sensation over the medial aspect of the knee (as well as back, upper buttock, anterior thigh and knee, and medial lower leg)

medial plantar nerve

larger of the two branches of the tibial nerve supplies cutaneous branches to the medial 3 and a half digits supplies motor branches to the abductor and adductor hallucis, flexor hallucis longus and brevis, flexor digitorum longus and brevis, quadratus plantae, soleus, gastroc, plantaris, and popliteus muscles

shorter step length and excessive knee flexion during midstance what is happening

left hamstrings contracture

best exercise level for an aerobic program for weight loss

less than or equal to 60% of maximum heart rate for 45 to 60 minutes, 5 to 7 days/week

do you make short term goals or long term goals first?

long term then choose short term goals to assist in attaining a long term goal in a step by step manner

postural weakness with rounded shoulders

long thoracic extensors (stretch weakness) not pec minor bc pt uses this muscle in chronically in its shorter range, MMT done in its longer range would have a weaker than normal result but in its shorter range would result in nromal or slightly stronger than normal result, muscle imbalances can occur when a pt strengthens the anterior pectoral muscles and ignores the upper back, results in tight pacs, weak rhomboids, and traps SCM has incraesed use during cervical extensin (forward head), this muscle would demosntrate a short-strong muscle imbalance same for suboccipital extensors

duchenne MD what posture

lordotic and winging of scap compensation to keep the COM behind the hip joint to promote standing ability flat thoracic back (relative extension) TFL contracture hamstring contrature hip extension ROM limited by tight hip flexors

brainstem infarct with left lateral medullary syndrome, what sx

loss of pain and temp sensation in the R side of the body combined with CN signs on the same side of the lesion*** CN one side with other deficits in the body is a clear sign of brainstem dysfunction corticospinal fibers are anteromedial and therefore would not be affected discriminitve touch and proprioceptive info travel medial (in medial lemniscus) and therefore would not be involved either

recent prostatectomy has urinary incontience, why?

loss of support to urethra bc prostate normally provides mechanical support to the urethra between the bladder neck and the penis incontinence lasting up to 6 weeks is expected after removal strengthening of the pelvic floor msucles can be a compensatory strategy for the loss of the support previously supplied by the prostate

low score on oswestry disability questionnaire

lower is better/favorable less disability can instruct pt in functinal conditioning program to prepare for discharge

treatment to decrease sympathetic stimulation include

maintained touch massage rocking deep breathing generalized warmth midline pressure

best w/c for C5 tetra during TRAINING session

manual with handrim projections appropriate for training but may not be used as the primary mode of mobility due to limtied UE innervation and the associated endurance tissues

test to assess pt equilibrium

marching in place dynamic reaction essential for upright posture and smooth transitional movements, equilibrium is assessed by testing the bodys ability to responsd to a change in body position or surface support to maintain body alignment marching in place requires a displacement of the center of gravity and places a demand on the body to maintain upright posture

25 min continous practice with 5 min of rest what type of practice

massed (rest time is much less) distributed is when practice time is equal to or less than rest time blocked refers to practice sequence organized around one task performed repeatedly, uninterrupted by practice of any other tasks (this type of practice is not related to the amount of time spent on performing a task) random practice several various tasks are ordered randomly across trials

low birth weight

may contribute to conditions in which a hypoxic/ischemic event can occur but by itself does not place the infant at risk for CP 2000 grams is equal to 4.4 lbs

QOL outcome measure

medical outcomes study 36-item short form SF-36 self report that covers eight domains of phscial functon role limtiat due to phs8cal robel role kintat due to emotionealeb fatigue general health perceptions

pt is "catching" her toe after removal of cast PT finds limited ankle DF, leg atrophy, and ankle weakness, what should the PT plan first emphasize

mobilization of the talocrural joint goals should be to restore joint kinematics and attain full range of pain-free motion joint mob should improve accessory motion, decrease guarding, and length the tissue around a joint AFO would be premature strengthening of gastroc or stretching of the tib anterior would help with PF which was not the chief complaint "catching" of toe does NOT mean foot drop

moderate intensity exercise and carbs for diabetic

moderate intensity exercise such as an HOUR of golfing or swimming would require an ADDITIONAL 10-15 grams (i.e. fruit or bread exchange) if blood glucose is between 100-180 prior to exercise

ejection fraction of 45% risk category

moderate risk for increased morbidity and mortality

ECG with ST segment depression less than 1mm risk category

moderate risk for increased morbidity and mortality >2mm would be high risk (they would not be excluded from exercise but may need increased monitoring by a therapist)

PLB purpose

most often with patietns who have chronic obstructive pulmonary disease goals are to reduce RR, reduce dyspnea, maintain a small positive pressure in the bronchioles which may help prevent airway collapse PLB can be used for any pt with dyspnea, however, it is not the "most appropriate" since the underlying cause is not pulmonary

does the time it takes to form a clot change if you are dehydrated

no

does walking backward on an inclined surface address glut med weakness?

no

is CHF a factor in developing ESRD?

no HOWEVER ESRD can cause CHF (bc hypertension, anemia comorbid?)

PT asks PTA to complete an isokinetic test, PTA willing but indicates that he is a little rusty with set up, what should you do

observe the PTA complete the set up this allows the PT to assist the PTA as needed and at the same time ensures the device is set up correctly direct involvement of the PA is collaborative and may assist the PTA to complete the set up independently in the future NOT... provide verbal cues to PTA prior to set up (does not ensure proper set up) instruct PTA to refer to owners manual (does not ensure proper set up) ask another PTA to do it (PTA just needs assistance, they are capable of doing it)

lowest risk for cardiac event

occasional PVCs and functional capacotu of 6 METS (6 METs is the cut off for increased morbidity and motality, 3 or more weeks after a clinical event) vs 55% EF and 3 METs ST seg depression less than 2 with sustained supraventricular tachycardia ST seg degression more than 2 and left EF 45%

middle lobes

ovreposteiroa xillary folds palms over anterior chest

injury to fibularis brevis tendon test

palpation of the proximal (base) fifth MT used to rule out avulsion fx from a fibularis brevis tendon pull

Vitamin B12 deficiency

pernicious anemia can result in HA and cognitive changes Neuropsychiatric conditions such as dementia, ataxia, psychosis, and peripheral neuropathy can develop in the case of B12 deficiency Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12. Vitamin B12, also known as cobalamin, is an important water-soluble vitamin ( 1 ). It plays an essential role in the production of your red blood cells and DNA, as well as the proper functioning of your nervous system. Vitamin B12 is naturally found in animal foods, including meats, fish, poultry, eggs and dairy.

high arch associated with

pes cavus charcot marie tooth disease rocker bottom occurs after severe progression of the disease

serial practice

physical form of motor learning a practice sequence in which different skills performed are in a mixed order but in a fixed format.

procedure for measuring a wound that has well defined margins

place a nonsterile ruler close to the wound to obtain measurements and then discard the ruler after use ruler should NOT contact the wound and should be discarded after a single use

pt is in supine with an anterior pelvic tilt, to test the upper abdominal strength, what should be implemented FIRST

place a pillow roll under the pts knees aka first step is correct positioning of the patient should not stabilize the LE or the pelvis because it incraeses the activity in the hip flexors which would allow them to substitute for weak abdominals

anosognosia

severe denial or awarenss of the presence or severity of ones neruo defect or illness in generaly esp paralysis pts may deny that a paretic extremity belongs to them or lie as to the reasons why it doesnt move as it should

weak limb would cause...

shorter step on the weak side or use of compensatory techniques like vaulting or circumduction to advance the weak side

pt rehabing from a CVA has significant PERCEPTUAL deficits, what is affected in brain

somatosensory cortex loss of sensation, perception, proprioception, and diminished motor control SS cortex occupies the postcentral gyrus which is directly behind the central sulcus and is responsible for complex processing of sensory information specific: touch temp pain discriminative senses including stereognosis and position sense

anklylosing spondylitis what precaution

special precautions for osteoporosis associated with long-standing anylosing spondylitis should still be able to walk even with advacned stanges of AS sx is rarely used could have foot drop bc of compressed nerves but not likley to be bilaterla

back and leg sx with extension OP but none in flexion what does he have

spinal stenosis flexion would bother disc lesion, lumbar muscle strain, and SI joint sprain

mechnical traction in supine what does it treat

spinal stenosis spine is slightly flexed in this position and separates the spinous processes which increases the intervertebral foramen bilaterally

right lower lob atelectasis following abdominal sx, no adventitious breath sounds upon auscultation, what should you do

spirometry with segmental breathing exercises wouldnt be practice of incisional splinting when coughing because that is used for PAIN CONTROL and would not address the atelectasis

what stage of COPD indicates use of supplemental O2

stage IV of GOLD

most approp goal to be met in 2 weeks for pt who can only tolerate standing 5 min but was hurt at work

stand for 10-15 min without an increase in leg pain

most appropriate transfer 4 days s/p transtibial amputation for w/c to mat

stand pivot (used when pt is able to stand and bear weight through one or both of the LEs, pt must possess functional balance and ability to pivot) NOT sliding board (what I picked) bc generally used for a pt who has sitting balance, some UE strength, and can adequately follow directions

pt with difficulty getting nervous while talking to DR, what should you suggest she do

suggest to pt write down questions for the physician and bring them with her to the next scheduled visit (allows the pt to reflect on the info she would like to gather in advance and provides structure necessary to reduce the influence of the pts anxiety during office visits) not realistic for PT to go with the pt to her appointment (encourages dependency) offering to call the physician is similar to the above option (even though its slightly more practical, it uses the PT as an intermediary and does give the pt an active role) acknowledging that many people are nervous in front of physicians may make her feel better but does not provide the pt with a viable method to change her current behavior/help the situation

pricking the skin in the perianal region assesses...

superficial anal reflex normal = contraction of the rectal sphincter

PT intervention for an infant with torticollis

supervised prone positioning with the infant's head turned to the same side provides long duration stretch that is optimal for treatment of torticollis

vertebral artery test

supine head in extension lateral feldxion and rotation to the ipsilateral side positive tset is indicated by dizziness, nystagmus, slurred speech or loss of cnsciousness and may be indicate of compresisonf of bert artery

best position to initiate pelvic floor strengthening

supine aka horizontal plane bc gravity eliminated position sidelying is also GE but it is more awkward

GERD what position to avoid

supine (could faciliate relaxation of the lower esophageal sphinter and promote reflux from the stomach into the esophagus)

what position should you measure chest excursion during inspiration

supine (creates suppport and resistance to the diaphragm, there is a direct correlation between the amount of chest expansion and intercostal strength) primary muscles of inspiration = diaphragm and external intercostals expiration = abdominals and internal intercostals SITTING is higher level than supine for breathing PRONE is not recommended for a pt with SCI due to pts body weight and force of gravity upon the weakened muscles of respiration SIDELYING would not give accurate chest excursion data

common fibular nerve

supplies CUTANEOUS innervation over the posterolateral part of the leg and the knee joint but branches into superficial and deep which innervate muscles of the lower leg damage to this nerve can result in foot drop

empty can test and drop arm

supraspinatus pt would be sitting upright with the arm raised against gravity

isometric shoulder abduction what muscle

supraspinatus (originates on the middle 2/3 of the supraspinous fossa of the scapula and inserts on the greater tubercle of the humerus) abducts the shoulder and stabilize the head on the glenoid fossa isometric = tension develops but there is no change in length of the muscle

pain and weakness following a fall on an outstretched arm, pt is unable to raise the arm past 90 degrees without assistance and has lost the ability to actively laterally rotate the arm against gravity, what structures are damaged

supraspinatus, teres minor, infraspinatus

what factor affects prognosis of ALS

swallowing difficulties NOT bowel and bladder function bc pts with an initial onset of bulbar and resp weakness tend to have amore rapid progression to death than pts whos weakness begins in the distal extremtieis do not see cognitive or sphincter control problems in ALS MSK pain is not predicitve for prognosis in ALS

meaure right arterial pressure/pulmonary artery pressure with

swan ganz

early characteristics of lymphedema

swelling that is releived by elevation swelling adjacent and distal to the site of lymph dysfunction pitting edema

s/s of ESRD

sx characteristic of impaired fluid and waste excretion bc loses filter ability sx such as systemic and pulmonary edema

transition from sitting to quadruped position is a task that is generally achieved in the...

third quarter of the first year

difficulty descending stairs and trouble reading when a book is held in the lap, no blindness, each pupil constricts to light, eyes look straight and each is centered, which CN is affected

trochlear results in a deficit in looking inferomedially

diminished upward rotation of the scapula, what muscle is weak

upper trap (produces upward rotation of scapula via force coupling with the lower trap and serratus anterior) upper trap ALONE elevates the shoulder

what age is best for scoliosis screening 13 year old male or 16 year old female

13 year old male peak incidence of development of scoliosis is 11-13 in females and 13-14 in males AAOS recommends screening occur minimally for girls at 11 and (grades 6 and 8) and boys once at 13 or 14 (grades 8 or 9) called "adolescence" mild curve is 10 degrees and both male and female have the same risk but females have a greater risk of acquiring a large curve (i.e. 30 degrees) a 16 year old female is likely to be appraoching skeletal maturity and therefore would be older than the ideal screening time

Dark band on US how do you describe it

Hypoechoic Low collagen content will be dark (muscles) Whereas tendons and ligaments and bone have a higher collagen content and will be lighter almost white ("hyperechoic") Structures that completely lack collagen like blood appear to be black ("anechoic") Radiopaque and radiolucent are used to describe appearance on X-rays Metal would be radiopaque Areas that lack tissue appear black and are described as radiolucent

gag reflex CNs

IX and X 9 = glossopharyngeal sensory 10 = vagus motor

Reduced spasticity in CVA during sitting

Left shoulder abducted and externally rotated with elbow extended and weight supported on the palm of the hand Because spasticity is typically strong in the scapulas retractors, shoulder adductors, depressors, and IRs, elbow flexors and forearm pronator sand wrist/finger flexors

Fatigue and dyspnea after mild activity, later noticing persistent spasmodic cough while lying in bed, HR in the 140s and slight edema in both ankles what is happening

Left ventricular failure Could also have a S3 gallop, paroxysmal nocturnal dyspnea, orthopena, and s/s of pulmonary edema (dyspnea, pallor, cyanosis, diaphoresis, tachypnea, anxiety and agitation)

Recent cesarean (used to workout at the gym 3x per week running 5 miles every other day) what should she be doing at this time

Pelvic floor and gentle exercises for the first 4-6 weeks Other tx includes post op TENs, assisted breathing. Coughing techniques and gentle abdomin exercises with incisional support provided by a pillow

positive graded exercise test

ST segment changes standard criterion for a positive graded exercise test is greater than or equal to 1 mmof horizontal or downsloping ST segment depression NOT angina angina is a transient precordial sensation of pressure or discomfort resulting from myocaridal ischemia changes in anginal sx may reflect a change in coronary status, an increase or change in anginal sx should be recorded and receive immediate attention, although this is critical to assess, it is not independently indicative of a positive graded exercise test

digitalis is used for

a fib depresses electrical conductivity of erratic conduction into the ventricles (it workss by either enhancing PNS activity or depressing SNS, thus slowing the heart rate and depressing electrical conductivity) digitalis is a cardiac glycoside that is generally used in the management of arrhythmias though it is also commonly used to treat congestive heart failure

stroking the skin beneath the costal margins and above the inguinal ligament assesses...

abdominal reflex normal = contraction of the abdominal muscle in the stimulated quadrant

nonradiating LBP, extension increases sx, flexion does not reverse lordosis and is pain free, observes a step off, what treatment 1. abdominal strengthening. 2. sustained prone positioning on elbows. 3. exaggerated lumbar lordosis in sitting. 4. grade III posteroanterior glide to L5.

abdominal strengthening dx = spondylolisthesis abdominal strengthening and stabilization are KEY to conservative management extension is NOT indicated

lumbar lordosis what intervention

abdominal strengthening and iliopsoas stretching weak or inhibted abdominals and gluteus maximus tight ilio and erector spinae

pronation of a nonweight bearing foot

abduction DF eversion PRONe on a BED triplanar multi-joint motions that occur between the hindfoot, midfoot and forefoot abduction of the forefoot dorsiflexion of the subtalar and midtarsal joints eversion and inward rotation of the heel

recognition of textures

ability to differentiate among various textures such as cotton, wool or silk items may be identified by name or texture such as rough or smooth

stability refers to

ability to maintain a position or posture through cocontration and tonic holding around a joint like unsupported sitting with midline control

cervical hypertextension injury that caused bleeding into the central gray matter of the lower cervical spinal cord, what is the highest level of function the pt is likely to achieve?

ability to walk but difficulty with distal UE and hand function This is a description of central cord syndrome. Because the spinal tracts for the lower extremities are positioned more laterally in the spinal cord, upper extremities are more affected than lower extremities. Patients with central cord syndrome typically recover the ability to ambulate with some remaining distal arm weakness. Seventy-seven percent of patients with central cord syndrome will attain ambulatory function, and 42% will attain hand function.

osteoporosis and greater risk of fracture

abnormally low BMI thin pts have less cotic al bone and higher risk for fracture body build is realted to bone fragility

what over-the-counter med should you be worried about when a pt is also prescribed warfarin (coumadin)?

acetylsalicylic acid (aspirin) they are both anticoagulants most serious interactions with warfarin are those that increase anticoagulant effects and risk of bleeding

goal attainment scale

achievement of self-identified goals but does not indicate the impact of goal attainment on QOL

paraffin most beneficial for...

aching fingers resulting from chronic osteoarthritis (as long as theres no active swelling) dont want to apply heat to acute situations like edematous wrist for 1 week following sx, swollen elbow from RA exacerbation, painful hand from early stage CRPS

appropriate knee positioning when strength testing the hamstrings in the prone position will minimize

active insufficiency of the hamstrings and passive insufficiency of the rectus femoris

brachioradialis

acts as a shunt muscle, overcoming ccentrifugal forces acting on the elbow and also adds power to increase the speed of flexion

contraindication for manual lymph drainage

acute DVT (bc can dislodge) first months of pregnancy (however may be beneficial in later months to manage edema in the breast and lower extremities) conditions in which increased BF or circulation may cause worsening of sx are typical contraindications

MI 2 weeks ago, new reports of interrupted sleep, increased swelling of feet, SOB, HR is 120, RR is 28 and crackles in both lungs, what should you suspect

acute congestive HF pneumonia would not cause LE edema

normal hemoglobin range

adult male 13.3-16.2 (15) low would indicate anemia, acute blood loss, lead poisoning, and nutritional deficiencies of iron, folate, and vitamins B12 and B6 high would indicate cor pulmonale (R sided HF), pulmonary fibrosis, and polycythemia vera (i.e. abnormal increase in blood cells)

taylor brace

aka TLSO consists of two posterior rigid struts that attach inferiorly to a pelvic band and superiorly to axillary straps limits trunk motion in the SAGITTAL PLANE

endobronchial tube

aka carlens catheter flexible catheter for bronchospirometry and for isolation of a portion of the lung to control secretions into the remainder of the tracheobronchial tree during general anesthesia There are several conditions that may make one-sided lung ventilation necessary. Absolute indications include separation of the right from the left lung to avoid spillage of blood or pus from an infected or bleeding side to the unaffected side. Relative indications include the collapse of one lung and the selective ventilation of the remaining lung in order to facilitate exposure of the anatomical structures to be operated on in thoracic surgeries, such as the repair of a thoracic aortic aneurysm, pneumonectomy or lobectomy.

neurotin side effect

aka gabapentin ATAXIA is a common side affect (cerebellar deficit that impair pts ability to perform coordinated movements and participate in functional activities, PTs SHOULD include coordination activities in the POC if ataxia is present) this med is used to prevent and control seizures, is it also used to relieve nerve pain following shingles, trigeminal neuralgia and in the treatment of diabetic neuropathy primary side effects include fatigue, sedation, dizziness and ataxia

patients with advanced emphysema experience difficulty in breathing during exercise because of ....

alveolar dilation emphysema is characterizezd by abnormal and premanent enlargment of the air spaces distal to the terminal nonrespiratory bronchioles accompanied by destrictive changes of the alveolar walls would have HYPERTROPHY of secondary muscles of respiration

orthosis for CVA pt who has difficulty moving from sitting to standing when wearing a prefabricated plastic AFO, pt has poor ankle strength, intact sensation, and does not have any edema or tonal influence, what AFO should you use

an articulation at the ankle joint (would assist during weight shifting during sit to stand as well as ambulation bc allows tibia to advance over the fixed foot) more cosmetic and lighter than a metal upright AFO (however cannot be used on pts with fluctuating edema or significant sensory deficits bc it provides total contact) a metal upright AFO would be better suited for a pt with edema or significant sensory deficits bc does NOT have total contact (consists of two metal uprights connected proximally to a calf band and distally to a mechanical ankle joint and shoe) the ankle can be locked or set to have limited anterior/posterior capability

repeated contractions utilizes

an isometric contraction followed by subsequent manual stretching and resisted isotonic movement repeated contractions assist with enhancing motor neuron recruitment and stregnthening of a muscle or group of muscles

IS very beneficial for what dx

ankylosing spondylitis bc leads to spinal AND chest wall rigidity chronic inflammatory disease restrictive lung condition

spastic bowel dysfunction 1. Myelomeningocele at S2-S3 2. Spinal cord injury at T10 3. Spinal muscular atrophy 4. Cauda equina tumor

answer 2 bc all others are not UMN lesions spastic bowel occurs in pts who have a SCI above S2

best parameters for estim for extensor lag 1. Duty cycle of 50%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment tim 2. Duty cycle of 20%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 3. Duty cycle of 20%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time 4. Duty cycle of 50%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment tim

answer 3 duty cycle 20% (1:5), current intensity high enough to produce 60% of max voluntary isometric contraction, 10 min total treatment (10 contractions for 10 seconds with 50 seconds rest) want AT LEAST 8 contractions current intensity should be near maximal

OK sign what nerve

anterior interosseous nerve tip to tip pinch abnormal would be pad to pad pinch dye to extension of the DIP joint of the index finger and IP joints of the thumb (most likely due to weakness of the flexor pollicus longus) branch of the MEDIAN nerve that innervates the deep muscles on the anterior forearm, except the medial half of the flexor digitorum profundus

ataxia is a side effect of what meds

antidepressants opioid analgesics anticonvulsants

drug linked to falls in elderly

antidepressants prozac, paxil, zoloft strongly linked to falls in the elderly others linked include psychoactive meds (antipsycholtics, anticonvulsants/mood stabilizers, benodiazepines, opioids, sedatives) med that affect BP (antihypertensives), and meds taht cause diziness and blurred vision (anticholinergics i.e. for PD and allergy) meds that increase risk for bleeding i.e. aspirin and NSAIDs) can also increase risk of falls meds that lower blood sugar calcium supplements thyroid meds typically DO NOT increase fall risk neither do multivitamins

postural hypotension from what meds

antihypertensives (i.e. beta blockers) cardiac drugs (i.e. nitrates)

SNS activity

anxiety distractibility increased sweating abnormal circulation lowered pain threshold heightened reflex activity skin that is mottled and shiny hypersensitivity to tough rapid HR dilation of lungs increased muscle tension and strength rapid and shallow breathing

apophysis

apophysis is a normal developmental outgrowth of a bone, which arises from a separate ossification center, and fuses to the mother bone later in development.

osgood schlatter disease

apophysitis of the tibial tubercle it is not due to a traumatic incident and is commonly seen in pubescent individuals with a report of pain and tenderness over the tibial tubercle

GREATEST effect in closure and healing of an open wound

arterial perfusion of the wound area VITAL for healing and will determine the wound diagnosis and POC 0.8 or greater are likely to heal 0.5-0.8 high risk for nonhealing gangeenous likely in pts with AB of 0.5 and referral to vascular surgeon is necessary to spare the limb although size can affect the time required to close a wound, it does not have as much effect as vascular patency in bodys abiity to close a wound nutrition wound envieorne prognosis for ability to heal is owrst when vascular flow is absent or severely diminished 0.5

child with unilateral hip disartic, what activity would be the most difficult with advanced gait training

asceding a curb bc there are no external supports to assist with the activity

constant right shouler and scapular pain with no improvement, does not change with position, what should you ask

ask about intolerance to fatty foods in pts with renal calculi, there may be a history of past epiosdes of biliary colic and fatty food intolerance pt may also report nausea vomiting fever and upper quadrant pain

what important info to ask of pt with PVCs

ask if pt feels dependent on coffee, tea or soft drinks bc these drinks contain caffeine which is a stimulant that can precipitate PVCs can also ask about nicotine, stress, alcohol, and certain electrolyte imbalances

male pt with LBP has history of increased urinary frequency and difficulty initiating a urine stream, pt sees doctor biannually to monitor this, what should you do

ask if the urinary sx have changed since the pts last visit to the physician bc an increase in urinary function could be related to a medical condition, the most important thing to note is CHANGE

A patient being evaluated for a C4-C5 herniated disc also reports having periodic dizziness. Which of the following actions should the physical therapist perform INITIALLY?

ask questions about the precipitating factors for the dizziness need to clarify before going on

16 y/o female accompanied by her mother who makes several comments to her daughter that appear to be extremely upsetting and result in the daughter losing concentration, what should you do

ask the mother to return to the waiting area rationale.... this increases the likelihood that the child will be able to concentrate on the exercise instructions primary concern should be to establish an environment that is conducive to instructing the pt in the exercise program NOT document what happened (what I chose) rationale... appropriate option but it does not address the primary objective which is to allow the pt to receive exercise instructions in an appropriate learning environment also do NOT ask if pt is verbally abusive or discontinue the tx

high cholesterol levesl and atherosclerosis

asscoated with loso fo calciaction o bone

cross section

assess exposure and outcomes at a single point intime

Sickness impact scale SIP

assesses quality of life and level of dysfunction resulting from illness or injury

pulse amplitude

assessment of the quality of the pulse determined by the pulse taker absent diminished normal moderately increased or markedly increased

interossei muscles do what

assist to flex the metacarpophalangeal joint and are innervated by the deep branch of the ulnar nerve

addison disease

associated w decreased adrenocrotical secteions adrenal insufficiency

delayed primary intention

associated with acute wounds which have minimal associated tissue loss but are at high risk for developing complicatins like infection or dehiscence these wounds are temporarily left open until risk factors have been alleviated and then are closed by usual primary intention methods

froments sign

associated with adductor pollicis muscle paralysis positive = flexion of the distal phalanx of the thumb due to adductor pollicis muscle paralysis may be indicative of ulnar nerve compromise or paralysis THIS IS DIFFERENT FROM THE OK SIGN!!! WHICH IS AIN AND MEDIAN NERVE

secondary intension

associtaed with wounds that have significant tissue loss, necrosis or borders which cannot be reapproximated (i.e. full thickness wound, pressure ulcer) these wounds are LEFT OPEN and typically require specialized dressings and ongoing wound care to facilitate healing

trigeminal exits

at superior orbital fissure foramen rotundum foramen ovale facial sensation and mastication

where should PNF be applied if pt fails to exhibit the desired muscular response throughout a portion of the ROM

at the point where the desired muscular response begins to diminish

what should be assessed first when doing an abdominal screen of pt with suspected viscera referral

auscultation allows PT to hear clicks, rumblings, and gurgling sounds firm, gentle pressure should occur BEFORE palpation and percussion sincel the act of palpating or percussing may alter the frequency and intensity of bowel sounds then superficial palpation (assess for tmep, tenderness, large masses) then deep palpation (performed with flat of hand with firm/steady pressure, start in quadrant opposite area of pain, majority of viscera in normal adult are not palpable unless enlarged, do NOT perform if they did not tolerate superficial palpation) then percussioon (not a typical component of PT exam, advanced skill even for physicians)

graves disease weight loss or gain

autoimmune in which certain antibodies produced by the immune system stimulate the thyroid gland causing it to be overactive sx include mild enlargment of the thyroid (goiter), heaet intoelrance, nervousness, tremor and palpitations may cause weight loss due to overactive metabolism

screening tool that examines a pts ability to perform a variety of activities of daily living

barthel index consists of 10 activities of daily living and is often used as a screening tool in rehab longterm care and home care scoring ranges from 0-100 in increments of 5 100 indicates that the pt is independent

kabat, knott, and voss theory

based on premise that stronger parts of the body are utilized to stimulate and strengthen weaker parts normal movement and posture is based on a balance between control of antagonist and agonist movement patterns follow diagonals or spirals that each possess a flexion, extension and rotory omponent and are directed toward or away from midline

why would increasing depth not increase resistance in a pt with a flotation device

bc the pt is using a flotatin device and therefore their level of immersion would remain relatively constant

pt shows up to eval 25 min late for a 45 min block, 10 days status post arthroscopic medial meniscectomy, what should you do

begin the exam NOT ask pt to reschedule (what i picked) explanation.. PTs have to possess effective time management skills and adapt their schedule as necessary when warranted it is important for therapists to accommodate pts when they happen to be early or late for scheduled appts however they must also be careful that the accommodations do not disadvantage other pts the PT should have ample time (i.e. 20 min) to begin the eam, this may be particularly important bc s/o sx asking the pt to reschedule is a viable option however since there is still 20 min remaining in the session, it is likely that the therapist can effectively use this time

theory of reinforcing normal movement through key points of control and avoiding all reflex movement patterns and assocaited reactions is what theory

bobath often termed neurodevelopmental treatment (NDT) pt learns to control movement through functional activities that promote normal movement patterns that integrate function

what variable is necessary to estimate calories burned in 15 min of exercise

body weight MET value of the activity duration 1 MET = 3.5 mL O2 per kg of body weight per minute

increased flexion at the PIP joints and hyperextension at the MCP and DIP joints, what deformity

boutonniere deformity (caused by a rupture of the central tendinosus slip of the extensor hood) this along with swan neck and ulnar drift are commonly seen with rheumatoid arthritis

upper trap stretch

bringing contralateral arm to the opposite ear and pulling th head towards the contralateral shoulder while keeping the opposite shoulder depressed

manubrium

broad upper portion of the sternum quadrangular shape and articulates with the clavicles and first two ribs

premature baby can have

bronchopulmonary dysplasia arrested alveolar devlopment when the lungs are injured during develoment most common chronic lung diseae assocaited with prematurity

meralgia paresthetica

burning pain along the anterolateral aspect of the thigh that increases with hip extension

pain with WB with cubital tunnel?

can be associated with cubital tunnel would point more to cubital tunnel if the pain corresponded to an area consistent with the ulnar nerve distribution

positive dix hallpike what do you do

canalith repositining manuever for BPPV

TBI pt who is unable to follow commands and has a PT evaluation, when you arrive the pt is agitated, what should you do INITALLY

carefully observe the pts spontaneous behavior (will reveal info that is important for the eval) dont postpone the assessment, dont apply restraints, and not proceed with the assessment regardless of the pts agitated state in the explanation the PEAT says that formal measurements of ROM and strength are difficult, and the patient is unable to cooperate, the therapist should use only observation and estimate functional abilities

new onset of CP and dyspnea while walking on treadmill in cardiac rehab, what response

cease walking while the therapist reassesses the pts vital signs you do not need to activate the emergency medical system

most common integumentary complication of lymphedema

cellulitis does not present as a single defined ulcer painful infection of the soft tssue that is characterized by expanding local erythema, palpable lymph nodes, fever, and chills most cases are cause dby cuts, abrasions, insect bites, and local burns

vertical nystagmus

central vestibular lesion could be a CEREBELLAR lesion pendular nystagmus one that oscillates at equal speeds abnormal smooth pursuits and abnormal saccadic eye movements are also sx

favorable prognosis for pt who has posterior lumbar disc herniation

centralization and ability to restore extension mobility (BOTH are good indicators) NOT proximal sx and ability to restore flexion ROM (only proximal sx is a good indicator) negative result on crossed straight leg raise is also favorable

impaired sensory and motor function of L limbs and side of face, unable to sit indepen, what part of the nervous system is damaged

cerebrum facial signs indicate a lesion above the lower midbrain bc SC would not affect the face and lesion in most areas of the brainstem would have facial signs contralateral to the limb signs

down syndrome greater risk for resp infections, why?

chest muscle hypotonicity bc compromises resp expansion poor ability to clear secretions greater suscept to pulm infections postural abnormalities that may lead to restrictive lung dysfunction immune system dysfunction in children with down syndrome is assocaited with a higher incidence of acute myeloid leukemia, not the most common cause of increased resp infections also associated with cervical instabililty

clubbing of fingers results from

chronic hypoxia from heart disease, lng cancer, or hepatic cirrhosis

ulcerative colitis

chronic inflammatory disorder of the muscosa and submucosa of the colon, characterized by diarrhea and rectal bleeding

thiazide med hydrochlorothiazide what sx indicate an adverse effect

clammy skin dizziness hypervent hypotension DIURETICS secrete sodium and potassium in urine leading to hyponatremia and hypokalemia clammy skin and hypotension of signs of hyoptension dizziness and hyeprven is hypokalemia

middle trap stretch

clasp hand in front of the body at chest height with the shoulders and upper back rounded forward pull shoulder blades apart is the instruction

nominal scale

classification scale elements are assigned to mutually exclusive categories according to some category categories may be coded by name, number/symbol, which are used as labels for identification but have NO QUANTITATIVE VALUE i.e. gender, blood type, diagnosis

pec major

clavicular head of pec originates on the anterior surface of the medial half of the clavicle sternocostal head originates on the anterior surface of the sternum and 6 costal cartilages and the aponeurosis of the external oblique insert on the lateral lip of the intertubercular groove of the humerus flexes the humerus (clavicular head) extends the humerus (sternal head) collectively, they adduct and medially rotate the humerus

elderly pt being discharged from acute care, recommend to do short term rehab, pt doesnt want to but is defintely not safe to go home alone, requires mod assist for bed mobility, what do you do

clearly explain to the pt that the goal of d/c to a transitional care facility is for short-term rehab aka EDUCATE pt may better understand the need to become more independent before going home

steroid include myopathy would have most difficulty with...

climbing stairs PROXIMAL muscles of the LE and UE are affected first pts will usually be able to compensate for UE weakness without difficulty so LE is more the problem involvement of the trunk musculature is a late finding in the progression of steroid-induced myopathy (same for distal like fine motor in hand)

PT tapes pt with anterior and lateral aspects of the knee and now has no pain with prolonged sitting or ascend/descending stairs, what else should you do in addition to taping?

closed chain quad strengthening exercise (apparently both open and closed chain exercises are at least equally effective in reducing pain and improving function, slight advantage to closed chain, both methods resulted in improved function and decreased pain up to 3 months after concluding the exercise program) patellar mobs to stretch LATERAL structures (lateral may be tight and causing tracking issues) continuous US to improve elasticity of strucutes secondary to deep heating

supine with pillow under knees does what

comfortable position that reduces lumbar lordosis and strain

hinged knee brace

commonly used with medial collateral ligament or lateral collateral ligament injuries

slumped posture may cause resp compromise by...

compression of the diaphragm by abdominal contents bc diaphragm has to mvoe down (caudal) during inspiration slumped would move the diaphragm down and cause it to be compressed by the abdominal contents thereby resulting in resp compromise

DVT prevention ini C6 SCI

compression stockings bc unable to move legs ankle pumps not for SCI but other pts with intact motor standing frame for prevention of osteoporosis and bone density loss also useful for improve resp function

normal equilibrium response of a pt tilting side to side while seated on a rocker board

concavity of the trunk and shoulder ABDUCTION on the upward side protective extension includes extension and abduction to support and protect body from falling

bipartite patellar

condition common in childhood often bilateral and can manifest as pain and tenderness at the distal pole of the patella a bipartite patella is a congenital condition caused by failure of the patella to fuse it is typically asymptomatic, found incidentally, and does not require treatment painful bipartite patella following injury direct or indirect injury results in disruption of the fibrocartilaginous zone between the main patella and accessory fragment fibrocartilaginous zone cannot heal by bony union, resulting in persistent pain lack of arterial penetration from patella to osteochondral fragment vastus lateralis contributes to traction force in fragment separation and nonunion

pt has recently gained weight, who does this happen with

congestive heart failure occurs when heart can no longer meet the metabolic demands of the body, the hearts inability to pump a sufficicent amount of blood occurs when there is a insufficicent or defective cardiac filling and/or impaired contraction and emptying of the heaert weight gain primarily results from an increase in the amount of fluid in the body, pharama mangagement like duuretics help reduce the amount of fluid in the body

ANS dysfunction, what is NOT an indicator of increased sympathetic involvement

constriction of pupils (characteristic of PNS) PNS also decreases HR stimualtes digestion constricts teh lungs stimuates other internal organs

65 y/o pt reports swimming in morning, now has pain down both arms, SOB, and has continued to perspire, what should the PT do?

contact emergency medical services an MI is more apt to occur in the morning, during exertion and one is working with the arms overhead (i.e. swimming), the pt demos all of these warning signs and emergency medical services should be contacted immediately

referred for adhesie capsulitis, but during IE pt with limited ROM, decreased tol to WB and increased DTRs, what should you do

contact the pts referring physician bc sx do not fit dx of adhesive capsulitis ad may indicate a more serious pathological condition s/s of metastases include decreased tolerance to WB, change in DTRs and change in sleep habits

pt referred to PT for 1 visit for instruction on HEP, PT things the potential is excellent but would benefit from more than 1, what should you do

contact the referring physician and request approval for additional physical therapy visits will need to seek physician approval for the additional visits in order to be working under a physician referral although this does not guarantee that the visits will be approved by the physician or that the visits will be coverd by the third party payer, it provides the therapist with the opprotunity to act in the pts best interest NOT... schedule pt for extra sessions as warranted by the results of the exam (this is appropriate but should contact referring physician first in attempt to get visits approved) NOT... explain that health care reforms have drastically reduced the freq of PT visits covered by insurance (this is accurate but there is no indicatio that the pt would not have coverage for additional visits) NOT... explain to pt that she can continue with PT beyond 1 session but she will be liable for all expenses not covered by insurance (this should be understood by the pt but PT should take necessary steps to ensure that the services are both necessary and authhorized by the referring physician)

manual vibration hand placement

contact with the entire palm of the hand hand needs to be in FULL contact with the affected lung segment may partially or fully overlap the hands during vibration applied at the end of a deep inspiration and is maintained through the end of expiration viable alternative to percussion in acutely ill pts with chest wall discomfort or pain!!!! CUPPED hand is for PERCUSSION contact with ulnar border of the hand can be used to assess tactile fremitus which refers to the vibration of spoken words felt through the chest wall (can also use palmar surface) tactile fremitus provides info about the density of the lungs and the thoracic cavity contact with the distal phalanx of the middle finger is used for mediate percussion which is used to evaluate changes in lung density, the technique requires the PT to place the middle finger of one hand flat on the chest wall along the intercostal space between two ribs while the other fingers are lifted off of the chest wall, the opposing hand acts as a fulcrum using the middle finger to strike the middle finger of the opposite hand positioned on the chest wall, the quality of the generated sound provides the therapist with information on lung density

coordination synkinesis

coordination synkinesis refers to voluntary contraction of certain muscle groups on the invovled side that in turn gives rise to involvuntary contractions of synergistic muscles

which phase of running is most likely to aggravate the HS?

deceleration (terminal swing) the phase of the gait cycle where the hamstrings are most active in eccentrically controlling the hip flexion and knee extension with running or sprinting, the amount of strain put on the HS is much greater and the eccentric force needed to control hip flexion and knee extension can cause the hamstrings to be injured

ascites is msot likely to affect what respiratory value

decrease inspiratory reserve volume distention puts increased presssure upon the diaphragm and thoracic cavity, which may lead to a RESTRICTIVE lung pattern, decreased inspiratory reserve volume is a component of restricitive lung disase whereras... increased residual volume, increased functional residual capacity, and decreased FEV1 are all seen in obstructive lung disease (caused by secretions or bronchospasm)

pt on bedrest is also doing supervised exercise in bed, after 2 weeks what measure would best reflect CP system improvement?

decreased HR response to exercise (exercise will increase pts SV secondary to increased myocardial contractility, the increased SV will result in a reduced HR response with exericse) would not be decreased resp rate because early mobilziation increases minute ventilation (TV and resp rate) vascualr reflexes and responsiveness of blood vessels will also improve

initial signs of lymphedema

decreased flexibility in the digits of the hand changes in BP (what i chose is not an initial sign of lymphedema) numbness may be a possible sx, muscular atrophy due to nerve compression also may be a possible sx but it is unlikely an initial sign

C5 and T4 SCI would share what characteristic

decreased respiratory ability anyone with a cervical or high thoracic SCI are subject to respiratory impairments and demonstrate some compromise in resp function thoracic levels will still lack intercostal innervation responsible for chest expansion as well as expiration, in addition, muscles of the abdomen affect maintenance of intercostal pressure and the passive expiration of air

end stage renal disease, common sx

decreased urine output and anemia kidneys have a decreased ability to adequately filter fluids, therefore, urine output is significantly decreased or absent due to kindeys role in production of ERYTHROPOITEIN, pts with ESRD often dislay signs and sx of anemia will oftenpresent with impaired fluid and waste excretion aka systemic and pulmonary edema

pt with myasthenia gravis post myasthenic crisis in acute setting, what intervention is appropriate

deep breathing exercises and coughing MG has intact sensation so skin breakdown is not ususally an issue (cardinal features of MG is msucle weakness with fatigue) bc fundamental defect in MG is failure of neural transmission at the neuromuscular junction, e stim would not be appropriate MG should also avoid strenuous exercise so treadmill training with progressive incline is inappropriate

physician referral that includes only the pts name and the referring physicians signature, during the exam the pt indicates that she had knee surgery 2 weeks ago but cannot provide more specific info, PT attempts to call physician but is unable to reach anyone, what should you do?

delay treatment until orders are received from the referring physician ensures that the PT has all of the relevant info prior to developing a POC allow the PT to be fully informed about relevent contraindications and precautions and allows the therapist to devleop a POC based on anticipated outcomes initiating treatment without specific knowledge of the surgical procedure could be considered a negligent act and may unnecessarily jeopardize the integrity of the surgical procedure

bilateral posterior calf pain with itching, body temp 98.8, normal temp of LEs, tenderness to palpation, and crusting of skin, what dx

dermatitis fever, itching, normal temp, inflamm, TTP, presence of vesciles (small blisters) and crusting, either unilateral or bilateral distribution cellulitis = fever, elevated temp of LEs, erythema, inflammation, tenderness, one or a few bullae (large blisters), no lesions, unilateral, NO ITCHING

dx that commonly uses corticosteroids

dermatitis (rash accompanied by pruritis and erythema, treated with corticosteroids, antihistamines, or immunomodulators) actions to avoid dermatitis includes wearing loose fitting natural fiber clothing, avoiding wearing plated jewelry, and lubricating the skin after bathing corticosteroids provide hormonal, anti inflamm and metabolic effects these agents reduce inflammation and vasocontriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines

alternating isometrics

designed to facilitate isometric holding first in agonists acting on one side of the joint, followed by holding of the antagonist muscle groups this technique is indicated when there is instability in weight bearing, poor static postural control and or weakness

after exam what should you do FIRST

develop a problem list (this happens before determining if PT is appropriate and making goals) explanation once an exam has been completed, the PT reviews all of the data and generates a problem list, this assists the PT to determine if PT services are warranted and to develop an effective and individualized pan of care

healthy, older, sedentary individual has normal vital signs at rest, during max aerobic exericse, what value should demonstrate minimal change?

diastolic BP venous oxygen changes significantly with exercise so does systolic BP

nitroglycerin helps to control angina by..

dilating peripheral arteries and veins NOT by inhibiting vasospasm of the coronary arteries (calcium channel blockers do this and also increase cellular metabolic rate which decreases myocardial oxygen demand and increases myocardial oxygen supply) beta blockers, calcium channel blockers, and nitrates are 3 different classes of meds that DECREASE myocardial oxygen demand, which helps to alleviate sx during an angina attack other meds such as antiplatelet, thrombolytic, and anticoag help to INCREASE myocardial oxygen supply by decreasing platelets ability to adhere and aggregate nitroglycerin acts in 3 ways to decrease myocardial oxygen demand: dilation of veins to decrease venous return (preload) dilation of arteries to decrease afterload relaxation of coronary artery smooth muscles to increase coronary blood supply beta blockers decrease myocardial demand by inhibiting the binding of epi and norepi to beta receptors which results in a decrease in HR, contractility, and CO/BP

PCL MOI

direct impact to anterior proximal tibia fall on stairs dashboard injury OR fall on knee with foot in PF position hyperFLEXION of knee

pt misses 3rd consecutive PT appointment and PT called after the second and did not get a call back, what should you do

discharge the pt from PT failure to attend scheduled therapy sessions, particularly without providing advanced notice, is a strong indication that the pt is not currently exhibiting an appropriate level of commitment to attaining established goals if you do not discharge this type of pt, you will be limiting the availability of PT services for other pts

whirlpool used for 10 sessions with little evidence of granulation, what should you do

discontinue whirlpool treatments we have an obligation to discontinue ineffective interventions make priority to discontinue ineffective treatments

menieres disease

disorder characterized by an overaccumulationof endolymph due to a lack of absorption excess endolymph backs up into the system and compromises the perilymphatic space HEARING LOSS TINNITUS VERTIGO FOR 30 MIN TO 24 HOURS you will NOT see head tilting to one side bc this is usually associated with the dx of unilateral vestibular hypofunction bc the vestibular nerve is affected unilaterally in UVH, the condition is characterized by an ocular tilt reaction consisting of head tilt, conjugate eye torsion, skew deviation and an abnormal weight shift to the side of the lesion however menieres disease usually only affects one ear

why would a pt post MVA with poor balance and PWB ambulate with a platform walker

due to a flexion contracture unable to straighten their arm to use a standard walker allows pt to bear weight in a flexed position can also be used for pain or deformities at the wrist or hand

normal sensation with US

dull warming not slight burning (this requires an immediate response)

osteoarthritis

dull, achy pain in WBing joints like hips knee etc

GERD occurs when contents from the.... enters the esophagus

duodenum mouth esophagus stomach and duodenum iliem and jejunum are part of small intenstine lower GI and not part of GERD

pt can put pants on in sitting but not in standing, what should you look at in your exam

dynamic standing balance

pt is taking anticoagulants, what side effect should the therapist be concerned about during the pts exercise

ecchymosis a discoloration of the skin resulting from bleeding underneath, typically caused by bruising. anticoag does NOT directly affect body fluid volume levels, they also do not generally cause hypotension

complete C6 injury can most likely perform complete AROM during which of the following actions

elbow flexion

up and touch ips shoulder

elbow flexion

cubital tunnel syndrome tests

elbow flexion test or tinel sign elbow flexion test (max flexion, supination, and wrist extension, positive is paresthesia) cubital tunnel is made up of the two heads of the flexor carpi ulnaris and the aponerosis that spreads between the two heads)

using both hands to lift bag of groceries =

elbow flexors

systematic sample

elements are chosen from lists of population members using specified intervals such as every 4th element

increased total lung capacity what dx

emphysema hyperinflat3ed loss of elastic recoil, obstruction to airflow is seen as an increase in total lung capacity, residual volume and functional residual capacity abnormal and permanent enlargement of the air spaces DISTAL to the terminal bronchiole, accompanied by the destructive changes in their walls collapse of airways during exhalation

PTA using ultrasound that causes electrical shock who is liable

every individual is liable for their own negligence however supervisors may assume liability of workers if they provide faulty supervision or inappropriate delegation of responsibilites PTs are liable for use of defective equipment if they contirbuted to its malfunction or continued to have it used in treatment without having it checked

nonathletic male with insignificant PMH reports palpitations that occur in absence of pain, dizziness, or lightheadedness, no fmaily history of heart disease, what is the most likely source

excess caffeine intake (brief palpitations of gradual onset and without any associated sx) hormonal changes is ruled out bc happens in females due to menopause or ovulation sedentary lifestyle does not cause or increase palpitations (exercise can both induce and reduce the frequency and onset of palpitations) palpitations of cardiac origin are associated with dyspnea, fainting, or severe light-headedness or dizziness

4+/5 DF and 3+/5 PFs, no compensation, what deviation will you see

excessive DF bc during foot flat to midstance, the gastroc and soleus function eccentrically to oppose the DF moment at the ankle and control the advancedment of the tibia weakness would result in ecessive DF during this pahse assuming no compensations were made by the pt

typical early clincal maifesation of CF

excessive appetite and weight loss affects EXOCRINE glands of the hepatic digestive and resp systems prone to chonic bacgterail infections and progressive loss of pulmonary function from progressive obstructive lung disease decreases bicarbonate secretions from the pancreas

compensatory posture for forefoot varus

excessive subtalar or midtarsal pronation PF first ray hallux valgus tibial/femoral/pelvic IR contralateral lumbar spine rotation

most important aspect of pt informed consent for PT

explaning the risks of intervention and asking for pt agreement informed consent requires three conditions 1 - the pt must be competent to understand the tx 2 - proper information must be given (risks, benefits, procedure) 3 - the pt must agree (volunteer)

extensor digitorum communis

extend the MCP joints in conjunction with the lumbricals and interossei, extends the IP joints also assists in abduction of the index, ring, and little fingers and in extension and abduction of the wrist

posterior deltoid mm fxn

extends, abducts, and laterally rotates the shoulder

with sponylolisthesis what motion do you want to avoid (pars articularis defect)

extension because there is an anterior slippage of one vertebra on the vertebra below and the anterior sheraing forces acting at the vertebra caused by the wedge shape and gravity would want to avoid extension which would exacerbate this flexion, rotation, and lateral flexion will cause the bony structures to separate and will not cause any negative compressive loads to the damged structures

lateral epicondyaliga

extensor carpi radialis brevis stretch = pronation, extension, and wrist flexion

tennis elbow tendon

extensor carpi radialis brevis (may also see changes in the extensor digitorum communis)

main muscle that weakens with bed rest

extensor muscles of LE (LE > UE in general) research has demosntrated that bed rest for 30 days decreases knee extensor strength by 20% while knee flexor strength experiences a nonsignificant decrease the loss of strength is primarily due to a decrease in muscle mass and cross-sectional area

rhythmic initiation

facilitation technique that begins with voluntary relaxation followed by passive movement through increments in range this is followed by active assistive movements progressing to resisted movements the technique is indicated with HYPERTONICITY, INABILITY TO INITIATE MOVEMENT, MOTOR LEARNING DEFICITS, and communication deficits

W sitting what is happening

femoral anteversion this is what i have results in excessive hip medial rotation and a loss of lateral rotation W sitting is excessive MEDIAL rotation tibial torsion doesnt really have to do with W sitting!!! external tibial torsiion would turn the foot out and internal would turn the foot in but would not lead to the sitting position of the child in a W femoral retroversion the child would have trouble sitting in a W

benign tumors of connective tissues

fibroma and chondroma

malignant tumors of connective tissue

fibrosarcoma and chondrosarcoma

scleroderma

fibrosis of skin, blood vessels, joints and internal organs primary characteristic of initial stage of the diseae is the development of bilateral non-pitting edema that is eventually repolaed by a thick, hard skin

common sx of later stages of lymphedema

fibrotic changes of the dermis within the DERMAL layer results in hardening of the limbs which eventually leads to increasing size of the limbs

aide reacts to new cleaning agent which subsides in 20 min what should you do

fill out an incident/occurrence report and review the materaial safety data sheet from occupational safety and health admin with the aide on how to properly handle the cleaning agent incident/occurrence report is used to document situations that inolved PATIENTS or STAFF that could have resulted in potential long lasting or poermanent harm and are part of an internal quality improvement program

anterior capsule tightness what end feel

firm same for muscular, ligamentous, and fascial shortening

abnormal lymph node

firm to hard mobile or nonmobile tender or nontender elevated skin temp is not expected

prolonged PR interval >,2 =

first degree heart block

inability to come to plank position to strengthen the serratus anterior would be associated with difficulty performing what shoulder movement

flexion apparently it is impossible to raise the arm above the head without the action of the serratus anterior

what wrist motion will allow you to palpate the lunate

flexion lunate is located in the CENTER of the proximal row of carpals between the scaphoid and triquetrum lunate is distringuished by its crescent-like outline and is just proximal to the capitate palpable just distal to the radial tubercle

swan neck deformity

flexion at the DIP hyperextension of the PIP caused by a contraction of the instrinsic muscles or tearing of the volar plate

medial epicon

flexor carpi radialis flexor carpi ulanris stretch = supinating forarm and extending wrist and elbow

ulnar nerve

flexor carpi ulnaris and the medial half of the flexor digitorum profundus hand intrinstics

holding briefcase what muscle

flexor digitirum profundus

medial border of foot along the first MT is higher than the lateral along the 5th MT, what does this indicate

forefoot varus inverted position of the foot pts with low arches in WEIGHT BEARING often exhibit forefoot varus with the subtalar joint in neutral

MS pt sits for 12 hours a day with good alignment and sleeps in sidelying, recently gained weight, what is at risk sacrum or greater trochs

greater trochs bc has good alignment so sacrum should be okay greater trochs at risk sleeping and getting compressed on the side of the w/c

basal ganglia

group of nuclei (putamen, caudate, substantia nigra, subthalamic nuclei, globus pallidus) that are located at the base of the cerebral corteex influences movement and postural control

dermis structures

hair follicles arrector pili muscles sebaceous glands sweat glands meissner corpuscles lymphatic and blood vessels nerve endings dermis is vascular whereas epidermis is avascular

S1 nerve root what muscle do you assess

hamstring

most effective means of preventing the spread of infection among pts with burns is...

hand washing The most common mode of spreading infection within BURN patients is through contact from hospital personnel topical chemotherapy is also means of reducing the occurrence of infection in burn pts but not effective without hand washing same for sterile dressings

roos test

hands up about to be shot for TOS

L tibial fx with 25% WB is using a single axillary crutch on the L side, what should you do?

have the pt use 2 axillary crutches (least restrictive device that the pt can safely use) given that the pt is familiar with use of crutches, having the patient use crutches bilaterally would be most appropriate (over walker or quad cane) crutches are used to improve balance and relieve weight bearing fully or partially on a lower extremity (they are typically used bilaterally) SINGLE DEVICES ARE NOT INTENDED FOR USE WITH RESTRICTED WEIGHT BEARING GAIT

end range horiz adduction

have to be able to move the scapula, aka if it is manual retracted wont be able to bring the pt into end range horiz adduction

emphysema with weight gain and 3+ pitting edema, what test should you do

heart auscultation bc indicates HF!!! not ABI bc thats for arterial disease same for capillary refill edema is associated with venous insufficiency s/s of HF = peripheral pitting edema, weight gain, jugular vein distension, diminished appetite, R upper quadrant discomfort, and a ventricular gallop (S3)

recent onset of unilateral pain in the temporalis region and upper neck area and a sensation of fullness in the ear, ROM for mouth opening is 4 fingers width, pain increases when the pt bites down on a cotton roll with the back molars and during palpation over teh area of the masseter msucle, no clicking during repeated mouth opening, which of the following interventions is most appropriate

heat and masticatory muscle relaxation technique bc absence of joint clicks, normal ROM, and increased pain during the biting down test indicate muscular or ligament involvement (most likely excessive msucle tension)

reverse walker purpose

helps with posture in pts who display a forward trunk lean with gait shoulders are in more extension and the scapulae are in more depression and retraction which leads to improved thoracic extension also have proven to be more energy efficient than traditional

pain in leg during SLR what condition does it indicate

herniated disc in the lumbar spine "leg pain elicited with SLR may indicate lateral disc herniations" scoliosis will not have pain elicited by SLR SLR could produce pain over the lumbar paraspinals if there is a strain but the pain would not move into the leg SLR would decrease pain in the lumbar spine in a pt with osteoarthritis of the lumbar facet joints bc encouarges lumbar flexion which would decrease pressure on the facet joints

device that is inserted into the internal jugular vein and travels through the superior vena cava and into the right atrium for removal of blood samples, administration of meds and monitoring of central venous pressure, what device is it?

hickman catheter (indwelling right atrial catheter) does all of those things potential complications include sepsis and blood clots WHEREAS central venous pressure catheter (what i picked) is a plastic IV tube usd to measure pressure in the R atrium or the superior vena cava, specifically, the device measures pressure associated with the filling of the right ventricle (aka diastolic pressure) aka does only one of those things

glossopharyngeal breathing is appropriate for a pt with a

high cervical SCI this type of breathing increases pulmonary function, esp tidal volume and vital capacity, where there is severe weakness of the msucles of inspiration

menstrual dysfunction

high levels of cortisol, low levels of follicle stimulating hormone exercise stress chronically elevates cortisol levels in athletes suppresses the secretion of gonadotropin release hormone which in turn results in suppression of lutenizing hormone and folcile stimaul romeon low levesl of FSH wil result in mentrual dysfunction

erythropoietin

hormone involved in the production of RBCs under hypoxic conditions, the kidneys will secrete this hormone to increase the production of RBCs

what is gastrin

hormone that stimulates the secretion of gastric acid in the stomach gastric acid is a fluid composed primarily of hydrochloric acid that aids in the digestion of proteins if this is inhibited, the result would not be GI damage, in fact there would be less GI damage sicne less gastric acid would be produced

what tests a patients limits of stability in the standing position

how far the pt can reach without losing balance the limit of stability in any direction is how far outside the BOS a person can move without losing balance

tripod sign

hs tightness pt is sitting with legs over edge of table at 90 degrees PT passively extends one knee positive = tightness in the HS or extension of the trunk in order to limit the effect of tight HSs

pt with pain on R side of face also has tenderness at the R TMJ, PT notes deviation of the mandible toward the L at the end of avail ROM opening, which of the following additional findings would be most expected?

hypermobility of the R TMJ deviation during opening is associated with hypomobility toward the TMJ deviation and hypermobility contralaterally

chronic bronchitis

hypertrophy of the submucosal glands in the large and small bronchi and trachea with hypersecretion of mucus sufficient to cause a productive cough forced expiratory volume in one second FEV1 is <65%

diabetic pt has onset of HA, blurred vision, and slurred speech, what are they experiencing?

hypoglycemia (represents CNS activity specifically due to decreased blood glucose to the brain) diabetic ketoacidosis would result in HA but other signs would include acetone breath, dehydration, weak and rapid pulse, and Kussmaul respiration progressing to hyperosmolar coma (polyuria, thirst, neuro abnormalities and stupor) kussmaul - deep labored gasping breathing

Actinomycosis (lumpy jaw)

i. Etiology: actinomyces israelii (anaerobic, gram +, non-acid fast, branched filamentous bacterium aka "sulfur granules"). Develops after trauma or tooth extraction, which provides a port of entry. ii. Population: iii. Location: oral cavity iv. Clinical: firm, indurated, swelling that is usually painless (sometimes slightly tender) with a draining fistula. The exudate has a foul smell and contains clumped colonies of microorganisms that are yellow and crystalline. will have s/s of chest pain, duspnea, fatigeu and fever

apgar scores used to determine...

if a child requires resuscitation at birth and are not predictive of CP or any other developmental condition 7-10 good, no resus 4-6 may need suctioning or oxygen 0-3 medial emergency and needs resus

when would a pt with diabetes be advised not to exercise

if blood glucose is >300 at this level the pt would be at risk for diabetic ketoacidosis WHY? bc probably means not enough insulin and if you exercise will have to break down more fats and therefore go into ketoacidosis Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

why do you do a reverse total shoulder

if there is a irreparable supraspinatus tear in cases where a rotator cuff tear cannot be repaired, reverse is indicated! the inverted alignment of the joint surface components allows for greater congruency and stability of the joint surfaces, decreased translation of the humeral component, and an increased deltoid moment arm (the procedure relies on the deltoid muscle instead od the rotator cuff to position and elevate the arm!!!) these features allow the pt to elevate their arm in the presence of an insufficient rotator cuff LOL aka a reverse is not the direction from which they operate, it is a "reverse" joint

anterior pelvic tilt associated with

iliacus flexibility deficits low back extensors are short and strong hip flexors are short and strong piriformis s not affected

sensory assessment of the superior medial aspect of the thigh would be an assessment of...

ilioinguinal nerve

pt with antalgic gait reports hip pain, loss of appetite and night sweats, pt has low grade fever, what test should you perform

iliopsoas muscle test screens for psoas abscess s/s as indicated in question stem

somatoagnosia vs apraxia

imapirment of body schema where there is a lack of awareness of a body structure and its relationship to other body parts, to oneself or to otheres pt is attempting to brush their hair, however, does not realize that the mirror image is not truly their body apraxia on the other hand is the inability to perform purposeful learned mvoements or activities despite the absence of a motor or sensory impairment that would hinder completion of the task

cerebellar dysfunctin

impairments in the timing of muscle activation delays ataxia is the general term to describe abnormal coordination of mvoements deficits in speed amplitude diection and force due to impariemtns in timing and duratin of msucle activation hypotonia initially bt pts recover noraml pssive muscle tone and reflexes quickly

strength gains after 1 week, what would you attribute it to

improved neuromuscular recruitment the initial rapid gain in the tension-generating capacity of skeletal msucle is largely attributable to neural responses, including increased recruitment in number of motor units firing and increased rate of synchronization of firing

hold relax active movement

improves initiation of movement to muscles tested at a 1/5 or less an isometric contraction is perforemd once the extremity is passively placed into a shortened range within the pattern overflow and facilitation may be used to assisst with the contraction upon relaxation, the extremity is moved into a lengthened position with a quick stretch the pt then returns the extremity to the shorted position through an isotonic contraction

when mobilizing the humeroradial articulation, the tx plane is considered to be...

in the concave radial head, perpendicular to the long axis of the radius plane is located in the concave partner and is therefore determined by the position of the concave bone TREATMENT PLANE = PARALLEL TO JOINT SURFACE AND PERP TO AXIS IN THE CONVEX SURFACE AXIS OF MOTION = LIES IN THE CONVEX ARTICULAR SURFACE The treatment plane lies in the concave articular surface and is parallel to the joint surface and perpendicular to the axis in the convex surface The axis of motion always lies in the convex articular surface The treatment plane moves with the concave surface moves The treatment plane remains essentially still when the convex surface moves

developmental coordination disorder

inaccuracy when trhowing a ball short distanceces throwing catching kicking

rhythmic stabilization used for

increase ROM and coordinate isometric contractions requires isometric contractions of all muscles around a joint against progressive resistance

urge incontinence goals

increase bladder capacity and decrease urinary frequency these will improve bladder control improve ability to inhibit automatic detrusor contractions body is trained to respond to a specific voiding schedule

PT using lumbar traction in pt who weighs 180 lbs and traction weight is initially set to 60 lbs, pt reports not feeling any pull, what should you do

increase the pull to approx 50% of pts body weight traction force of 30-50% of the pts weight is necessary to cause effective segmental vertebral separation this pt could have a force up to 90 lbs

peroneal nerve palsy what gait deviation what is least likely to happen

increased DF peroneal encompasses anterior and lateral compartment

contract relax used for

increased ROM as the extrem reaches the point of limitation the pt performs a max contraction of the antagonistic muscle group therpaist resists the movement followed by relaxation and passive movement into the newly gained ROM antagonistic muscle - (physiology) a muscle that opposes the action of another

hold relax used for

increased ROM uses isometric contractions facilitated for ALL muscle groups at the limiting point within the ROM relaxation occurs and the extremity moves through the newly aquired ROM

pt was dehydrated at time of blood sample, what would you see based on hydration status?

increased blood urea nitrogen level (looks at kidney function) an increased level can be indicaive of dehydration, renal failure, or HF normal = 10-20 mg/dL BUN = measures the amount of nitrogen in the blood that comes from the waste product urea, urea is made when protein is broken down in the body

consolidation

increased fremitus any type of secretions crackles adventitious sound

sensory deficits and muscle weakness in median nerve distribution, what would be expected with testing of the median nerve condution velocity and latency

increased latency and decreased nerve conductive velocity these two are inversely proportional to each other velocity = distance/time time = latency

loading response and muscles

increased quad activity (to limit knee flexion rate) and decreased HS activity (no longer needed to prevent knee hyperextension)

cardiac transplant 3 weeks ago, what physiologic response should be anticipated

increased resting HR (bc of the lack of parasympathetic innervation, HR is usually greater than 80 bpm) medical management focuses on controlling immune system rejection while minimizing potential side effects for several muscles after the transplant, the transplanted heart fails to respond normally to sympathetic nervous stimulation, but by ONE YEAR after surgery, approx 1/3 will exhibit a near normal HR response to exercise DECREASED HR with exercise and the initial increase in HR that accompanies exercise is often delayed DECREASED peak HR peak is generally 150 bpm after transplant

diabetes sx

increased thirst bc large amounts of urine excreted fat production is altered and fat breakdown occurs to liberate more glucose impaired protein synthesis bc amino acid transport into cells requires insulin

most essential to incorporate into exercise program post cardiac transplant

increased warm up and cool down because for several months after the transplant, the transplanted heart fails to respond normalyl to sympathetic nervouos stimulation specifically, the HR response to exercise and recovery is delayed, this requiring the increased warm up and cool down also would have a decreased targeet HR (but the abnormal HR response following cardiac transplant makes HR somewhat less valid as a means of quantifiying exercise intensity

how does superficial heat decrease pain

increases the pain threshold

TBI and higher life satisfaction

independence in bowel care being married <20 y/o (better outcome not higher life satisfaction)

increase in lordosis as lower legs

indicates weak abdominals standard method to assess lower abdominal strength is to flex the hips to 90 with knees extended and lower the legs while MAINTAINING the low back flat on the surface (if they cannot this indicates muscle weakness)

nursemaids elbow

inferior sublux of the radial head from the annular ligament

tenderness with palpation of the subacromial area, panful arc with passive motion, protective muscle spasms, empty end feel due to pain, what dx

inflamed bursae RC sprain and RC tendinitis would have full ROM and would NOT have an empty end feel fibrosis/AC would have a capuslar end-feel

GERD

inflammation of the esophagus due to a backward flow of gastric juices clinical sx include painful swallowing, heartburn, and dysphagia vomiting is NOT a classic sx

chrons diseae weight gain or loss

inflammatory bowel disease that usually affects the intestines decreased appetite however at the same time the chronic nature of the diseae increases an individuals caloric needs, this combo leads to significant weight loss

thrombophlebitis of the saphenous vein

inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. The affected vein might be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT) presents with generalized leg pain, swelling, increased temperature, and bluish discoloration

decreased sensation on lateral forearm

injury to musculocutaneous nerve C5-6

CHF with limited exercise tolerance, why?

insufficient SV during ventricular systole (smaller volume of blood for each contraction, reducing CO and resultant decrease in delivery of O2 to the active tissues limits pts ability to exercise) it is NOT a problem of insufficient arterial oxygen, RATHER the primary issue is that a smaller volume of blood is pumped with each contraction of the ventricles pumping problem - systolic HF OR filling problem - diastolic HF

what does pull to stand require of a child

intact protective extension and trunk righting

anterior drawer of ankle tests what type of injury

inversion injury

hold relax

isometric contraction at the end of avail range to increase ROM contraction is facilitated for all muscle groups at the limiting point in range relaxation occurs and the extremity moves through the newly acquired range to the next point of limitation until there are no further gains in ROM

high L PSIS what should you do

isometric contractions of the L glut max muscle enegy technqiue iliosacral dysfunction anteriorly rotated innominate

pontine infact affects

jaw movement CN V trigeminal

floor reaction ankle-foot orthosis encourages

knee extension

anterior glide of knee increases what and helps with what phase of gait

knee extension and heel off (terminal stance) bc 0 degrees of knee extension is necessary for normal function

weak quad what gait deviation might you see from heel strike to foot flat

leaning the trunk forward bc reduces the flexion moment at the knee (excessive PF would also reduce the flexion moment at the knee) during heel strike to foot flat, the quads work concentrically to hold the knee in extension, then eccentrically to control the amount of flexion

shorter step length of the right LE what is causing this

left knee pain because the pt will spend less time in left sided stance, because the pt will try to minimuze the time spent in stance (WB on the knee) to minimize pain, the pt will take a shorter step with the RLE a right iliopsoas contracture may cuase a shorter step length with the left lower extremity but not with the right lower extremity (the answer i picked)

6 y/o boy with hip pathology, what condition is most likely apophysitis legg calve perthes disease rheumatoid arthritis slipped capital femoral epiphysis

legg calve perthes disease (degeneration of the femoral head due to disturbance in the blood supply i.e. avascular necrosis, peak incidence is between FIVE AND SEVEN years of age, more common in BOYS) whereas... slipped capital femoral epiphysis (what i picked) refers to a separation between the ball of the hip joint and the femur at the growth plate where peak incidence occurs in PREADOLESCENTS who are OBESE or who have experienced a recent GROWTH SPURT apophysitis (peak incidence occurs in PREADOLESCENTS bc exercise and training increase the strength of the muscle and tendon more rapidly than bone in this age group)

greatest risk of contracting infection characteristic of blood

leukopenia total number of leukocytes is less than normal

postural drainage for the left upper lobe lingular segment

lies head down on the right side

most appropriate w/c for a pt s/p CVA with flaccid upepr and lower extremities (edema present) on L, normal on R, trunk is hypotonic, cognitively intact

light weight, solid seat, solid back, arm board and elevating legrests independent propulsion is facilitated by use of a lightweight w/c while a solid seating system assists with posture and activities, an arm board allows the flaccid UE to be supported and an elevating legrest will assist to decrease dependent edema anti-tippers are not necessary and pt will NEED an armboard sling seat and back would promote poor positioning and would not provide adequate stability necessary for pt

what can happen as a result of excessive DF?

likely to demonstrate an increase in knee flexion due to the lack of control of closed-chain DF

GB with 2/5 quad weakness what intervention

limited number of reps in sidelying AVOIDING fatigue of quads OVERWORK AND FAITUGE DHOULD BE AVOIDED JUST LIKE RA overwork will delay recovery

initial rehab for pt post CABG

low intensity walking resistance training shoulder start until minimum of 8 weeks after ergometer contraindicated immediately after surgery stationary bike not good bc could lean on handlebars

uncomplicated MI, which graded exercise test before hospital discharge

low level (submax) GXT at 4 to 6 days post MI this provides recs for ADL and early ambulatory exercise therapy and will not put too much demand on the healing myocardium at intensities higher than 70%, it can extend into the zone of necrosis into the zone of injury or zone of ischemia which will dleay dealing or in wrost care extend the MI using symptoms alone may not allow the pt to exercise at too high or too low an intensity

17 y/o injured knee two weeks ago, pt fell and landed on the R knee fully flexed, pt has I/M catching in motion and has been painful in full flexion, what is the dx

meniscal tear (sx of catching and PAIN AT END RANGE FLEXION)

A patient reports fatigue, proximal upper extremity weakness, and double vision that increases in intensity as the day progresses. The patient demonstrates bilateral ptosis of the eyelids, difficulty chewing, dysphagia, and inability to raise the eyebrows. Which of the following conditions is MOST likely present?

myasthenia gravis (sx increase as day goes on is key) bells palsy would not have difficulty chewing or trouble swallowing, although there may be residual food between the teeth and the cheek due to weakness of the buccinator ALS sx typically include tripping, stumbling, falling, loss of msucle control and strength in the hands and arms, difficulty speaking, swallwowing and/or breathing, chronic fatigue, muscle twitching and/or cramping characterized by both UNM and LMN UMN - stiffness (spasticity), muscle twitching (fasciculations), and muscle skaing (clonus) LMN - muscle weakness and muscle shrinking (atrophy)

epi and norepi

naturally occurring hormones from the adrenal glands epi - boots supply of oxygen and glucose to the brain and muscles while suppressing other non-emergency body processes such as digestion norepi - (hormone and a neurotransmitter) increases HR, releases glucose from energy stores and incrases blood flow to skeletal muscles

best prognosis for nonsurgical recovery neurapraxia axonotmesis neurotmesis complete nerve severance

neurapraxia (involves blockage that stops or slows conduction across that point in the nerve, conduction above and below the blockage is usually normal, and recovery is possible) with axonotemsis the neural tube is intact, but axonal damage has occurred with wallerian degeneration, sx may be required wallerian degeneration (active process of degeneration that results when a nerve fiber is cut or crushed and the part of the axon distal to the injury (i.e. farther from the neuron's cell body) degenerates) neurotmesis involves total loss of axonal function, with disruption of the neural tube, sx is usually required if nerve is completely separated then will need sx

is PAD a factor in developing ESRD?

no renal artery disease is characterized by impairments in the regulation of BP and is unlikely to result in ESRD

aneroid sphygmomanometer vs mercury

normal vs one with a temp gauge kinda thing both are INDIRECT measures of blood pressure pressure transducer in an artery is DIRECT measure of BP

spondylolisthesis traction

not used to correct slippage but it can effectively reduce neuro deficits from subsequent spinal nerve root impingement pt position used with mechanical traction is variable when treating spondy (forward slippage of one vert body on the one below it)

most appropriate to delegrate to physical therapy aide

observing a pt complete a mat exercise program (but they should no expand their duties beyond an observational role i.e. not allowed to modify, interpret, progress exercises) they are a non-licensed worked who is specifically trained under the direction and supervision of a PT, activities performed by an aide are limited to those tasks that do not require clinical decision making by a PT aka NOT allowed to.. monitor vitals perform goni measurments document

retropharyngeal abscess

occurs in children younger than 4 or is the result of trauma or dental infection

functional incontinence

occurs in pts who have normal urine control but who have difficulty reaching a toilet in time bc of muscle or joint pain

slipped capital femoral epiphysis

occurs when the capital femoral epiphysis becomes displaced. The patient is usually an adolescent male with limited hip range of motion and hip and thigh pain. This condition is not associated with quadriceps contusion. It is characterized by a sudden or gradual displacement of the femoral neck from the capital femoral epiphysis, while the head remains in the acetabulum

teres minor

originates on the upper 2/3 of the dorsal surface of the lateral border of the scapula and inserts on the greater tubercle laterally rotates shoulder

pain and weakness were elicited with the empty can test, what should be AVOIDED during the early treatment phase

overhead activities because work should only occur in pain-free range during the early stages i chose deep friction massage but apparently DFM can be used for pain relief and to decrease scar tissue for a patient who has a partial rotator cuff tear or impingement (i guess it said early stages and not "acute" so that might be why)

COPD pt who becomes short of breath when walking 5 ft with rolling walker, most appropriate technique in order to increase the distance the pt is able to walk w/o becoming short of breath

pacing (learn to work within his or her exercise tolerance, may mean walking slower or with breaks and would allow greater total walking distance without SOB) not IS (for inspiratory volumes and chest expansion, does not improve exercise tolerance) not diaphragmatic breathing (used to decrease work of breathing and improve diaphragmatic mvoement, does not improve exercise tolerance) not segmental breathing (for chest hypomobility to augment localized lung expansion)

radial tunnel syndrome

pain over the extensor msucle mass of forearm distal to the lateral epicondule long finger extension testing would produce pain weakness of finger and tumb extensors and extensor carpi ulnaris overuse not trauma

superficial vs deep sensations vs combiend cortical

pain, temp, crude touch, and pressure (SUPERFICIAL) vibration, kinesthesia (DEEP) 2 pt discrim (COMBINED CORTICAL) do in this order!!! bc if assessment of the superficial reveals an impiarment, then it would be unnecessary to test the more discriminative sensation like deep and combined cortical (superficial must be intact to allow meaningful testing of the discriminative sensations)

grade III ligamentous sprain of the radial collateral ligament of the MCP joint is most likely to exhibit pain during which of the following tests?

palpation of the radial portion of the thumb MCP joint got this confused with gamekeepers thumb, this is the opposite site valgus stress test pulls the thumb away from the other fingers

nurse maids elbow called

partial slippage of the annular ligament longitudinal traction on an extended elbow 2-3 y/o usually vs valgus extension overload syndrome which is seen in throwing atheles with repetitive stress tenderness around tip of olecranano pain with forced passive elbow extension increased valgus laxity for this condition necrosis of capitellum typcially affects dominant elbow of children mainly bosy betwetn 5-10 thorwin in yong child little legaue elbow

strong quad contraction with sudden knee flexion like landing from a jump

patellar tendon rupture

precaution with ionto

peripheral neuropathy bc decreased sensation

guillain barre

peripheral neuropathy in which there is inflammation and demyelination of perioheral motor and sensory enrve fibers early in the progression either upper or LMN may predonimate

rebound tenderness during palpation of the abdomen of a pt who has low back pain

peritoneal irritation rebound tenderness is a reliable sign of peritoneal inflammation

high risk for cerebral palsy in infant

periventricular leukomalacia (The condition involves the death of small areas of brain tissue around fluid-filled areas called ventricles. The damage creates "holes" in the brain. "Leuko" refers to the brain's white matter) ischemic disturbance around the brain ventricles causing white mattter damage this condition is the msot common ischemic pathology resulting in cerebral palsy any type of disturbance resulting in brain pathology can be predictive of CP

underwater ultrasound what should you do

plastic basin filled with tap water and move the transducer approx .25 inch away from the body surface (want is parallel to the body) the plastic basin will reduce reflection not a metal basin bc will increase intensity by reflecting waves not a whirlpool bc will also increase the intensity by reflecting waves you do not hold the transducer head directly on the skin when you use the immersion technique

pressure can reduce

pleural friction irritation and decrease visceral pain migratory pain is pain of systemic nature same for pain that awakens a pt a night

thrombosis of the iliac vein produces..

posterior lower leg swelling, pain or tenderness, dilation of superficial veins and pitting edema

posterior basal of lower lobes where should manual counterpressure be applied

posterior lower ribs

LBP with poor (2/5) strength of the lower abdominals, what initial exercise?

posterior pelvic tilts (isometric contraction of the abdominals and would be helpful for strengthening initially) need fair plus (3+/5) to do sit ups same for oblique sit ups

C4 tetra what type of w/c

power w/c with sip n puff controls they have innervation of the face, neck diaphragm, and traps (the pt should be able to verbally direct all aspects of w/c management and would be a candidate for a power wheelchair with head or mouth controls manual w/c uses to high of energy expenditure

primary motor cortex located in

precentral gyrus within the frontal lobe and contains the largest concentration of corticospinal neurons lies in front of the central sulcus and primarily controls contralateral voluntary movements

chronic venous insufficiency

presence of aching calf pain with prolonged standing percussion test in standing trendelenburgs test (retrograde filling test) skin will be dark and cyanotic

to prevent hypertrophic scar formation what is the best intervention

pressure garments worn 23 hrs/day have been found to reduce the formation or thickness of hypertrophic scars positioning may be used to maintain the soft tissue in a stretched position to counter scar contraction but this would not affect the thickness of the scar tissue A walking exercise program can be helpful for regaining strength and endurance and would apply some stretch to scar tissue but would not provide the compression necessary to prevent an increase in the thickness of the tissue (hypertrophic scar formation)

pt has an ulcer on the R lateral malleolus, min drainage, .5 cm deep, the pt has an ABI of 0.68, which of the following interventions should be undertaken first?

pressure off-loading because the wound is over a pressure area and pts who have vascular disease, the skin and its upporting structures have a decreased ability to endure pressures and are therefore at high risk for developing pressure injuries off loading is the first response

omeprazole what is it

prilosec proton pump inhibtor

TKA with surgical incision closed with staples what kind of wound closure primary or secondary

primary (associated with acute wounds which have minimal associated tissue loss like surgical wound, laceration, puncuture), clean edges and are reapproximateed and closed with sutures, staples, or adhesives to facilitate re-epitheliazation

FAIR test

prirofmis syndrome

epithelialization

process of epidermal resurfacing and appears as pink or red skin

atelectasis

prolonged static positoning monotonous tidal ventilation aka lack of variety managed with mobilization and manipulation body positions ie postural drainage to optomize alveolar ventilation and alveolar volume o

TBI pt with severe cognitive impairments and bilateral hip and knee flexion contractures, most appropriate intervention

prolonged stretch technique

PD what is best when working on controlled mobility

promote weight shifting and rotational trunk control

intervention for pt with moderate alzheimer disease and urianry incontiencne

prompted voiding (useful for pts who may have cognitive deficits and require reminders of regular intervals for voiding)

craigs test

prone knee flexed to 90 test is desigend to determine relative amount of femoral anteversion

hip extensor MMT

prone raise leg off toward ceiling PT stabilzies pelvis of the test leg while placing a resistive downward force at the distal end of the femur weakness=inability to maintain leg off table or compensation

back extensor MMT

prone raise trunk off surface with hands claspped behind the buttock or head PT stabilizes by placing a downward force to the legs so that they remain on the table weakness=inability to maintain trunk off of the surface of the table or attempted substitution

prone on elbows what comes before this

prone lying spine will be in a slightly extended position 1. prone with pillow under hips 2. prone 3. prone on elbows 4. prone press up 5. standing extension (hand on small of back with the fingers pointing downward and thumbs pointing anteriorly, then pt bends backward at the waist)

postrual drainage of bilateral posterior parts of the lungs

prone position over pillows with feet elevated 20 inches

NSAID GI side effect is caused by the inhibition of the production of which hormone

prostaglandins -- group of hormones that help protect the lining of the stomach by inhibiting gastric acid secretion and increasing the production of mucus in the stomach lining, when NAIDs inhibit this, the stomach becomes more susceptible to damage from the gastric acids minor stomach discomfort to GI hemorrhage and ulceration (risk factors include advacned age, history of ulcers, use of multiople NSAIDs, and use of other agents like anticoag)

antalgic gait

protective gait pattern stance time is decreased to avoid weight bearing on the involved side due to pain typically associated with a rapid and shorter swing phase of the uninvoled limb

pt loses balance while descending stairs during stair training, what should you do

provide bracing by moving toward the patient (therapist would make contact with the hand guarding the shoulder and then move toward the patient to help brace them) could consider leaning the pt to one side against a stairwell wall but make sure not to shift onto the affected side

pt performs stretch at end range for 60 seconds, while maintaining a posterior pelvic tilt. To ensure the most effective stretch during future performance, the therapist should make which of the following changes?

provide re-direction on proper body alignment posterior tilt should be AVOIDED bc this assists with stretching the rectus femoris instead of the HS

case report contribution to evidence-based practice

provides info that can be used to generate inductive hypothesis for future studies builds a foundation for clinical science practical approach to research in the clinical sciences because it is directly applicable to patient care but is also the least rigorous because of its lack of control and limited generalizability

pts blood glucose is 100 right before a scheduled walk of one half mile, this indicates that...

pt is safe to perform the activity (which is considered low intensity exercise) supplementing additional carbs is not needed for this level of intensity if the blood glucose was <100, the pt would increase food intake prior to performing the activity

bare feet safety risk

pt may slip if their feet are sweaty or if they fail to provide adequate traction also increases their risk of acquiring or transmitting microoganisms

biceps tendinopathy test

pt produces force into supination with the shoulder in neutral, elbow bent to 90 degrees and the forearm starting in pronation

false negative in functional reach

pt with a history of falls tests negative

true negative in functional reach

pt with no history of falls tests negatively

cough, CP, dull ache in leg, diaphoresis, unilateral pitting edema what is it

pulmonary embolism chest pain hemoptysis COUGH diaphoresis dyspnea apprehension unilateral LE edema may have been from DVT that may have embolized

second left intercostal space you will hear?

pulmonary valve

lever-style door handle

purpose of the lever-style door handle is to promote ease of access for individuals with limited grip strength by using other body parts (e.g., fisted hand, forearm, elbow)

negative prognostic indicator for surgical wound healing

purulent discharge on postop day 5 bloody day 1 is normal clear and watery day 3 is normal no discharge and raised suture line on day 10 is normal

first action with observed swollen lymph nodes

question pt regarding any recent dental or thoat infections if so, medical referral is necessary

medial (internal) rotation with abduction would put what nerve on stretch

radial

wrist drop and sensory loss in region of anatomical snuffbox injury to what nerve

radial

deep radial

radial divides into deep and superficial at the cubital fossa provides motor function to the msucles in the posterior aspect of the forearm which primarily extend the wrist and hand

increase ulnar deviation

radial glide of the proximal carpal row

supinators are innervated by

radial nerve

posterior interosseous nerve is a branch of what

radial nerve after it crosses the supinator innervates a majority of the msucles that extend the wrist and hand

long term retention

random order

ordinal scale

rank-ordered according to an operationally defined characteristic or proerty greater than less than relationship COMMON IN PT i.e. scales of sensation, balance, MMT

posterior cord syndrome

rare loss of proprioception, 2 pt discrimm, graphesthesia, and sterognosis below the level of the lesion pts typically present with a wide-based steppage gait

scales

ratio true zero ordinal greater than less than interval no true zero nominal no quantitative value

scleroderma description

raynaud phenomenon and tightening of the skin not usually a rash

acute grade I sprain of the AC joint, most painful

reach across chest and scratching opposite shoulder with hand

scapular winging would indicate difficulty with...

reaching forward for an object

L1-L3 spina bifida, what orthosis

reciprocating gait orthosis and rolling walker most likely will have MMT of 3/5 for hip flexors, hip adductors and knee extensors 3 or less in hip extensors and knee flexors ambulation would likely be limited to household or short distances bc the amount of energy required RGOs help with hip flexion and hip extension during ambulation (will help bc this child has insufficient strength) will allow for decreased energy expenditure a rolling walker would be more efficient than a standard walker (takes more energy and is more cumbersome)

granulation

refers to perfused, fibrous connective tissue that replaces a fibrin clot in a healing wound tissue is highly vascular and fills the defects of a full thickness wound

a p value of 0.001 means what

rejection of the null hypothesis (H0)

least effective for improve gait patterns of pts who have stage 1 PD

repetitive wall squats bc static want to do postural and balance activities within functional activities in early stages over strengthening visual and auditory stimuli have been shown to be effective for gait characteristics in pts with PD

PT treating child who has medial elbow pain and has been directed by the physician to rest the elbow, but the pts parents insist the pt play in an upcoming baseball tournament, what should you do

report concerns about the pts treatment adherence to the referring physician any concerns about the pts recovery should be communicated to the referring practitioner prior to action taping (which was one of the options) is used to prevent further injury during activity, taping is not indicated to allow participation when rest is recommended

attorney calls the PT department seeking info on status of their client, what should you do

require written authorization from the pt to release info cannot refer them to the pts insurance bc insurance info is part of the confidential record WRITTEN not verbal is required to release protected health info

how does resistance vary with an elastic band

resistance increases as the agonist shortens Elastic resistance is a function of elongation beyond its resting length. As an agonist shortens to move a joint through a range of motion, the elastic resistance increases because it elongates from its resting position.

oxycodone

resp depression orthostaic hypotension constipation medularry chemoreceptors less resopnsive to CO2 thus slowing resp rate realtive hypoxia and hypercapnia

opioids concern with pulm pt

respiratory depression which could reduce pt toelrance to exercise orthostatic hypotension is another one

13 y/o with juvenile RA with acute exacerbation, what splint should you recommend in order to prevent a knee flexion contracture

resting splint typically utilized during acute exacerbation allows the joint to rest while limiting the risk of contracture development functional and dynamic splints more commonly used when not in an acute exacerbation example of functional splint is for specific activity such as holding a writing or eating utensil) serial splint is a form of CORRECTIVE splinting

SCI restrictive or obstructive lung disease

restrictive decrease in total lung capacity, vital capacity, and inspiratory capacity

info from medical records to compare outcomes between groups what study design

retrospective cohort already recieved it

idiopathic pulm hypertension

right atrail pressure of 15 mmHg indication for lung transplant

pt with OA in the L hip walks with a L lateral trunk shift during left stance, PT should advise the pt to walk with a cane in what hand and for what purpose?

right hand, to reduce the force in the left hip abductors use of a cane in the contralateral hand has been shown to decrease EMG activity in the hip abductors, which would lead to a decrease in joint reaction forces (contact pressure equals force/contact area) One strategy is a trunk lean in the direction of the affected knee during a step (Figure 4a). This action moves the body's center of mass over the knee. In doing so, the lever arm for the adduction moment is shortened and the medial compartment load lessened.1 hip abductors on the same side must eccentrically control the adductor moment that occurs

patrick test

rule in or out hip joint dysfunction AKA FABER or figure 4 with OP

apophysitis of the ischial tuberosity is common in what type of person

runner competing in hurdles occurs due to the origin of the hamstrings on the ischial tuberosity and the traction force that accompanies hurdling when the hip is flexed and the knee is extended apophysitis = pain and inflammation over bony prominence common in kids

pt can make a fist but is unable to flex the distal phalanx of the ringer finger, why?

rupture of the flexor digitorum profundus tendon (this flexes the DIP and also assists in flexion of the PIP and MCP joints) superficialis does NOT do DIP, just PIP and flexion of MCP joints as well as flexion of the wrist

colon cancer or colitis referral

sacral pain

what way does a pusher push

same a hemiparetic side aka ipsilateral pushing pushes with the stronger extremities toward the hemiparetic side caused by a misperception of body orientation in relation to gravity pt also resists attempts to passively correct their posture to midline

interval scale

same rank-order characteristics as an ordinal scale but also demonstrates known and equal distances or intervals between the units of measurement unlike the ratio scale, the interval scale has no true zero point i.e. temperature

where can you administer an IV line in the LE

saphenous vein superficial vein that extends form the foot to the saphenous opening vein was the only listed option that is located in the LE majority of IV insertions are made into superficial veins (usually in UE, LE or scalp)

insidious resp issues and small, red nodules (granulomas) on face, particularly surrounding her mouth, this is typical of...

sarcoidosis occurs between 20-40 higher incidence in women 4x more prev in AA GRANULOMAS characteristic feature -- form on certain certain organs or over certain regions of the body (clusters of immune cells that affect diffuse areas, most commonly the lungs, skin, bones, muscles, and nervous system) prognosis is typically favorable however there are some instances where it can be life theatening

a flutter a fib v fib v tach

saw tooth irreg R-R interval (big mountain in the QRS) v tach a bunch of QRSs with no P waves v fib like saw tooth but no QRS (like flat lining)

least instrumental muscle to assist infant in pull to sit

scapular stabilizers (not necessary to overcome the force of gravity or generate a flexion moment required at the neck, trunk, or LE) most instrumental include... abdominals cervical flexors hip flexors (contributes to core stability)

pt with burns complains of severe pain with normal PT protocol, what should you do

schedule tx when pt pain med is most effective rehab following a burn is extremely painful soo this should be high priority

back height for W/C

seat of the chair to the base of the axilla and subtract FOUR inches below the inferior angle height of a seat cushion must be added to the final number if applicable

stability stage of motor control

second stage ability to maintain position or posture through cocontraction and tonic holding around a joint

crackles

secretions in peripheral airways

diazepam for anxiety, PT concerned about fall risk, why?

sedation side effect this med remains active in the body for many hours and as a result drowsiness may last into the NEXT DAY other side effects that increase fall risk = impaired balance, decreased neuromuscular function, and decreased central processing HIGH potential for DEPENDENCE and ADDICTION diazepam is a benzodiazepine in geri population, the liver metabolizes diazepam very slowly and the kidneys excrete it slowly, as a result, pt may experience potentially toxic med levels

sural nerve

sensory nerve branch of tibial posterior leg and lateral foot

pt with tetraplegia expereinces insidious onset of pain inferior to GH joint, soft tissue swelling, local warmth, and erythema, limited ROM, serum alkaline phosphatase levels are elevated, what is it

septic arthritis and ectopic bone formation septic arthritis is characterized by rapid onset, over hours or days, of monoarthritis with a joint that is swollen, red, tender, and warm with limited ROM increase in alkaline phosphaatase levels with the sx described in the stem are indicative of heterotopic ossification (aka ectopic bone formation) Alkaline phosphatase is an enzyme produced by bone cells. Increased levels would increase bone formation due to active osteoclasts

most appropriate ambulation parameter for pt with chronic arterial disease

short duration, frequent intervals treadmill and track walking are the most effective modes of exercise to reduce claudication the initial workloads are set to elicit claudication sx within 3-5 min, this is followed by a period of standing or sitting to allow sx to resolve THREE TO FIVE MIN BOUTS exericse-rest-exercise pattern is repeated throughout the exercise session due to the short duration of each bout of exercise before the osnet of sx, more frequent exercise bouts are indicated

hip flexor MMT

short sitting raise to ceiling PT stabilizes the iliac crest of the test leg and places a resistive downward force at the distal end of the femur weakness=inability to maintain leg off the table or attempted substitution

T4 SCI and propeling manual w/c

should be able to independenlty whereas C5 are likely to have some difficulty on uneven terrain

avulsion of C5-C6 where is the functional loss

shoulder abduction axillary nerve which supplies the deltoid and teres minor

splint for pt with burns to the axilla and should is used to avoid

shoulder adduction contracture and webbing of the axillary folds (medial rotation contracture can also occur) ideally the splint would conform to the entire arm from the wrist, through the axillary area, and down the trunk to the waist in order to provide the necessary support splint should be molded to the pt and secured with wraps, pads and other strapping AXILLA IS ONE OF THE MOST COMMON SITES OF SCAR CONTRACTURE FORMATION

split stirrup

simplifies donning the orthosis because the wearer can detach the uprights from the shoe. allows use of AFO with multiple shoes

pt on cardiac unit 2 days post MI, complains of chest pain, anxious, and wants to go back to bed to rest, what is the best initial course of action?

sit the patient down and monitor vital signs carefully during the rest period if angina is exercise induced, this is an indication to stop the exercise session and provide a period of rest during which time the patient is closely monitored, recovery is expected after a period of rest if the pt is still anxious after rest, it is reasonable to return the patient to the room and inform the nurse this is not an emergency situation

what can adherent scar tissue near the end of the bone in am apmutee lead to

skin breakdown

pt is frequently awakened at night by sx of GERD, what should you recommend

sleep in L sidelying and use pillows to elevate the head changing positions frequently can increase reflux (esp right sidelying and supine) sleeping while sitting up might be an ultimate solution if the pt is unable to avoid nocturnal reflux, it should not be the first recommendation

temporary paresthesia of ulnar nerve can happen when in what position

sleeping with the hand in a flexed position or repeated leaning on a hard surface

pt requires 2 person assist with transfers but has good dynamic sitting balance and UE strength, how should you teach his sole caregiver to transfer him

slide board with assistance

power grip

slight extension and ulnar deviation

active, pain free shoulder ROM that is moderately limited in horizontal adduction, what mob technique is appropritae

small amplitude oscillations into tissue resistance at the limit of avail joint motion in a posteroinferior direction good technique to increase tissue flexibility in the absence of pain

xiphoid process

small extension of lower portion of sternum cartilaginous at birth and ossifies and unites with body of the sternum by 40 years of age

lateral plantar nerve

smaller of two branches of tibial cutaneous branches to the alteral one and a half toes motor branches to the msucles of the sole of the foot that are not supplied by the medial plantar

posterior long arm splint

smith fracture distal radius immobilize forearm garden spade

apophysitis of the AIIS

soccer player kicking a soccer ball (due to forceful contractin of rectus)

acute RA involving the wrist joints, which intervention is most appropriate

splints with wrists in neutral position (helps rest the involved joints, prevent excessive movement, and reduce mechanical stress, all of which are desired outcomes in the acute phase of RA) strengthening can be difficult esp with pain in the acute phase same for active exercise (needed for functional fine motor tasks) has questionable benefit in the acute phase passive stretching would be inappropriate given the acute nature of the problem (would be important part of rehab when not in acute exacerbation) REST AND PROTECTION ARE PARAMOUNT

ulnar nerve entrapment at the level of the hamate, what would be the most specific exercise to improve the pts strength deficits?

squeeze therapy putty between the sides of the fingers (hand instrinsics) isolates the lumbricals and interossei which are innervated by the ulnar nerve and are affected when entrapment occurs at the tunnel of guyon level of the hamate is the tunnel of GUYON squeezing hand grip with elastic band resistance (what i picked) would not isolate muscles supplied only be the ulnar nerve, this exercise would be appropriate if the ulnar nerve was entrapped at the level of the cubital tunnel and not in the tunnel of guyon pinching, opposition, abduction would be for the median nerve

patella facing inward

squinting patella could indicate femoral anteversion and medial tibial rotation aka me associated with toeing in

reciprocal extremity movement requires what prereqs

stability and dynmaic postural control this is often encorporated in coordination training

lyme disease rash

start as a red spot taht expands with clearing of redness in the central area (bullseye)

TIA

starts with a dramatic onset of symptoms, which then improve. The ischemic episode typically lasts 5-20 minutes. there is not a rapid and continuous decline

physician thinks pt is faking it and asks you to provide documentation to demonstrate this impression, what do you do

state that the PT evaluation will include tests that will specificially assess for nonorganic signs and behavioral sx all pts should be given the benefit of the doubt until the clinician, with a high degree of confidence, can rule out an organic cause for the pain a number of tests can be performed to help determine if the sx are of a nonorgranic nature but it is very difficulty to judge the intent (psych vs intentional for gain) may recommend a psych eval if you find malingering i guess

stage IV on the hoehn and yahr classifcation what exercise program is best

stationary bike will have posutral instability and increased risk of falling

quad activity

stepping up on curb maximum torque of the knee extensors reaches a peak at about 60 degrees of knee flexion and decreases with further extension of the knee

most concerning home environment issue for pt s/p tibial plateau fracture that is NWB with a walker depth of bathtub or steps without HR

steps without HR bc ascending and descending stairs with a walker should ONLY be done if a HR is available and all of the feet of the walker fit on the stair treads depth of bathtub is not the primary aspect of concern pt will require a shower seat

pressure ulcer staging when starts as a 3 but now shows characteristics of a stage 1

still a stage 3 pressure ulcers CANNOT be classified retrogressively as they heal, therefore an ulcer that had been graded as a stage 3 would still be known as a stage 3 as it heals "modified" stage X is not a term used to describe healing status (distract-er answer)

pt cannot actively ER her shoulder to make a "field goal" position, what should you do

strengthen the posterior portion of the rotator cuff and mobilize the GH joint with the shoulder abducted to 90 lateral rotators = infraspinatus, teres minor anterior band of inferior GH ligament may need to be stretched since the ligaments restrains ER at 90 degrees of abduction

IR of shoudlers and winging of scap what do you do

strengthening of the middle and lower trap and stretch the pecs

radial collateral ligament

strong triangular band attaching to a depression below the lateral epicondyle and the lateral margin of the ulnar assessed by applying varus force

annular ligament

strong well defined band that attaches to the anterior and posterior margins of the radial notch of the ulna it acts as a restraining ligament preventing the downward displacement of the radial head

intervention for MS

submax performed in morning (this is when core temperature is the lowest)

Radiopaque

substances that do not permit the passage of x-rays

medial glide of the calcaneus is needed for

subtalar eversion

lateral glide of the calcaneus is needed for

subtalar inversion

strenuous intensity exercise and carbs for diabetic

such as 1-2 HOURS of hockey or basketball would require an ADDITIONAL 25-50 grams of carbs (i.e. half sandwich with fruit or milk) if blood glucose was measured between 100-180 prior to exercise

polymyositis

symmetric proximal muscle weakness with malaise and weight loss, no joint involvement

rheumatoid arthritis

symmetrical joint inflammation and pain with subluxations

anklylosing spondylitis

systemic condition that is characterized by inflammation of the spine and larger peripheral joints chronic inflammation causes destruction of the ligamentous osseous junction wtih subsequent fibrosis and ossification of the area MEN are 2-3x greater risk than women and onset is typucally seen between 20-40 years of age

most important thing to measure during mobility after bed rest

systolic blood pressure bc during bed rest when the leg muscles are not used regularly blood pools in the leg veins and is not pumped back in to the heart this results in diminished blood volume which serves to reduce blood pressure systolic blood pressure is the mximum arterial pressure during systole or contraction of the left ventricle SYSTOLIC THE MOST IMPORTANT measure to assess after prolonged bed rest due to risk of orthostatic hypotension a decrease in SBP by 20 mmHg or greater with vertical positioning or a decrease in DBP by 10 mmHg is indicative of orthostatic hypotension inability to ompensate quickly for changes in blood pressure when a person stands up suddenly, gravity tends to cause blood to pool in the veins of the legs and lower body (as a result the amount of blood returned to the heart is reduced and blood pressure falls) dizziness and light headedness are the most common sx normally the body quickly responds to a decrease in blood pressure, however, compensatory mechanisms may malfunction or function too slowly in patients who have been on extended bed rest

PT to do a sensory exam with neuro lesion what should you do first vibration 2 pt discrim temp kinesthesia

temperature bc it is a superficial sensation and should therefore be assessed prior to the other options other superficial = pain, crude touch, and pressure

isolate the supinator and minimzie action of biceps, how should you position the elbow

terminal elbow flexion maximally shortened position of biceps limits the ability to function as a supinator however, avoid max pressure at this position bc max shortened can cause cramping at biceps biceps can still generate reasonable force at 30, 60, 90 (goes up with increasing degrees) whenever you want to limit another muscle, place it in its most shortened position

mcburney test

test for appendicitis vomiting nausea low grade fever pressure in RLquadrant

bruininks-oseretsky test of motor proficiency

test of motor function for children 4 to 21 years of age primarily constructed to assess motor coordination and balance

rocker switch

to allow the lights to be turned on and off without requiring fine motor skills and use of fingers (e.g., fisted hand, lateral aspect of hand, distal forearm

one role of vestibular system

to maintain clear vision during head motion, vestibular function would affect ADLs in standing and sitting

most appropriate focus for quality improvement study of work hardening clinic

treatment plans of care (will most affect outcome vs referral sources, therapist certifications, types of dx)

pelvic floor gravity ASSISTED

trendelenburg aka hips higher than the heart

legg calve perthes disease what gait deviation

trendelenburg secondary to hip pain and or hip abductor weakness is very common in children who hav legg calve perthes diseae most common from 4-8

jaw jerk reflex what CN

trigeminal force is just below the lips with the mouth slightly open in most individuals the reflex is absent or very slight, however, in the presence of an UMN the masseter muscles will jerk the mandible upward both the sensory and motor components are through the trigeminal nerve

down syndrome

trisomy 21 chronosimal disorder that has an increased incidence in children of older parents mod to severe decrease in cognition is typical and mean life expectancy is 50-60 years of age

Romberg test: positive Gait: wide-based, slow, with decreased trunk rotation Loss of balance when asked to turn head while walking No sign of ataxia

unilateral vestibular lesion NOT BPPV bc would not have a positive rhomberg Patients with a unilateral vestibular lesion will experience vertigo, postural instability, oscillopsia, and disequilibrium. The wide-based gait is an attempt to minimize trunk rotation and movement of the head, which can increase sensory conflict and vertigo in the patient with a unilateral vestibular lesion.

pt has significant shortening of tissues around a joint after immobilization, want rapid, lasting changes in tissue length what do you do

use a dynamic splint worn multiple hours throughout the day uses the concept of creep (permanent deformation of tissue through the applicationof a low magnitude load over a long period of time, use of a dynmaic splint will allow the application of such a load and induce rapid changes over an extended period with minimal tissue damage and inflammation) stretching would take longer ballistic is not recommended for individuals after immob bc they are thought to create significant trauma to atophied tissues ROM is not stretching, would only maintain tissue length not increase it

total contact footplate orthosis

used to normalize tonal abnormalities and improve function and gait in pts with increased tone

correct use of quad cane

using quad cane next to uninvolved leg with the longer legs positioned away from the pt if the longer legs are positions towards the pt, can cause tripping hazard

PT teaching husband and husband becomes agitated and states he is unable to help his wife, what should you do to facilitate effective communication

verbalize the husbands feelings and ask him if his intended meaning was reflected correctly (active listening/reflection, rather than reacting to the persons words, helps to clarify what the person is saying) do not avoid apologies do not help to diffuse emotion-laden exchanges (lol what does this even mean) listening over writing it down is needed to diffuse the situation

avid runner has insidous onset of anterior leg pain that is localized, sharp, shooting in nature, and esp aggravated with heel strike during walking and running p! first occurred after an increase in running speed and hardness of the training surface 2 weeks ago, which of the following tests and measures is the most appropriate to determine the cause of the pain

vibration and percussion testing Most individuals with stress fractures report an insidious onset of pain that correlates with a change in equipment or training and is exacerbated by the offending activity. They will have localized bony tenderness and palpable periosteal thickening, especially if they have long-standing symptoms. Some persons have pain at the fracture site with percussion or vibration at a distance from the fracture. Joint range of motion is usually maintained. Persons with a tibial stress fracture will have pin-point tenderness on the tibia and have pain with three-point stress. (Magee, p. 856) If a stress fracture is suspected, a tuning fork may be used at the suspected fracture site to provoke symptoms wouldnt be compartmental syndrome bc it is localized pan (would also see decreased sensation after exertion and paresthesias)

intervention to assist with maintaining bone density for a pt with history of osteoporosis and previous vertebral fx

walking on a treadmill (associated with changes in bone remodeling and results in greater bone mass) activities with a major spinal flexion component, side bending, or spinal rotation should be avoided (golf, bowling, biking, rowing, sit ups) swimming and water aerobics are an excellent PA but it is not beneficial to offset the complications of osteoporosis or build bone density

partial thickness burn over entire anterior hip and anterior knee, how should you position pt

0 degree extension of the hip 20 degrees flexion of knee (prevents an EXTENSION CONTRACTURE)

functional DF

0-10

when to schedule PT with PD meds

1 hour after meds are administered

hemoglobin normal range

13.3-16.2 for males (15)

normal BMI

18.5-24.9

Min ramp slope

1:12 whereas 1:10 would be too steep for functional use

on:off ratio for muscle re-ed on e stim

1:5 equals 10 seconds on 50 seconds off good for MUSCLE STRENGTHENING can increase to 1:4 and 1:3 as pt progresses

catching a large ball, riding a tricycle, running short distances

2-3 y/o

obese BMI

35-39.9

percent of front of head for adult rule of 9s

4.5% each for front and back 9% total

PF discharge criteria

40 degrees

"moderate" intensity what HR

40-60% of max HR

Adduction and IR at the hip when performing a squat what is weak

Hip abductors and ER Common finding in patients with anterior knee pain Poor eccentric control using those muscles

wrist extension is innervated by

C6

Hyper extension injury, positive Lachmans what exercise should you do

Closed chain TKE Safe and effective secondary to the dynamic stability inherent with this type of exercise Open chain would place excessive load on the ACL

Amygdala

Collection of nuclei in the anteromedial temporal lobe, forming the core of the limbic circuits Important for triggering feelings and drive related behaviors

Dinner fork deformity

Colles fracture

Pt evaluated after a fall, multiple contusions along the left wrist and forearm with limited AROM with pain into extension, what are your next steps

Continue with the examination Premature to suspect abuse, end the exam or refer out

stair moon requries PF or DF

DF

gowers sign

Duchenne's muscular dystrophy (sex linked disorder chracterized y progressive muscular weakness beginning between the ages of two and five, life extepctancy is late teens to early 20s due to resp and cardiac failure) they also have psuedohypertrophy of the calf muscles however, all muscles are eventualy affected inclduing resp and cardaic muscles

Summed feedback

Feedback given after a set number of trials

Hip flexors do what for swing

Initiate

anteriorly rotated innominate

L PSIS is higher

best position for pt with stage III decubitus ulcer over her R ischial tuberosity with PMH of severe COPD

L sidelying with pillows between the knees relieves pressure on ulcer and maximizes the pts respiration prone and supine are not good choices neither would right sidelying bc could further impact the ulcer

abnormal sensation of lateral edge of the left foot, weakness of the hip abductors, what nerve root

L5-S1

Another name for distraction at the shoulder

Lateral glide

Loss of pain and temp on the L side of face along with loss of pain and temp on the R side of the body, all other sensations are normal where is the location of the lesion

Left posterolateral medulla Caused mixed sensory loss Pain and temp are affected but light touch and proprioception are not (medial lemniscus is not involved) Sensory loss will be completely contralateral above the medulla aka midbrain, Cortex or internal capsule (happens in the upper medulla)

Andragogical approach

Look it up I'm on the plane Talks about adult learners and how to involve the patient in goal setting and structuring their training sessions

Patient is unable to remember any new information from just prior to the surgery to the present Patient cannot recall text read min ago or remember people previously met How do you characterize this?

Loss of hippocampus and declarative memory function Declarative memory refers to conscious, explicit, or cognitive memory It is a function of the cerebral cortex and the hippocampus

Knee instability with prosthesis during stance what is happening

Prosthetic knee set too far anterior to the TKA line

26 y/o female with complaints of morning stiffness of hands and visible swelling, pt indicates that the stiffness seems to diminish with activity, what dx

RA sx include morning stiffness, limited ROM, effusion, pain with movement, low grade fever, smaller joints affected first but can progress to larger synovial joint chronic systemic autoimmune disorder 2-3x more common in women

Elderly pt post ORIF d/c home and wakes up and couldn't remember much with mild motor loss in right hand and anomia what is best course of action

Refer to physician immediately because the therapist suspects a stroke Focal signs of incoordination and anomia with cognitive signs like memory loss is indicative of impaired brain function and may be the result of small strokes Most likely choice given the spotty sx and sudden onset Dementia type would be gradual Do not delay telling physician, diagnostic workup Hospital admission and anesthesia can cause temp cog difficulties (delirium) but these should not persist with discharge home

hypertonic piriformis will also most likely have...

SI joint dysfunction tightness of spasm of the piriformis may have a significant influence on the SI joint, causing dysfunction muscle action = hip external rotator, abductor or extensor pain and paresthesias in the posterior thigh, not the anterior thigh innervated by L5-S2 can have gluteal atrophy with piriformis syndrome (one of 6 classic findings depending on the duration) but it is not the MOST likley event compared to SI dysfunction

Initial bandaging for lymphedema

Short stretch compression wrap aka comprilan Low resting pressure and high working pressure Enhances lymph resturn at rest, improve the activity of lymphangion (contractile unit of the lymphatic system) and facilitate increase return during muscle pumping activities Long stretch wraps have high resting pressures and low working pressure but can become like a tourniquet at rest and do not provide enough support during activity like ace wraps Custom not ordered until the limb reduction has reached a planetary which may take 4-6 months

Mixed incontience

Stress and urge

Rib stuck in max inspiration how do you mobilize

Superior direction at the head of the rib at the CV joint

Cellulitis

Suppurative inflammation of the dermis and subcutaneous tissues frequently accompanied by infection

Bruit

Swishing sound that occurs in the presence of narrowing of an artery Characteristic of peripheral vascular disease present on auscultation

Carpal tunnel

Sx worse at night Some thenar atrophy and sensory loss Reduced grip and pinch strength

Does spinal nerve impingement get worse with exercise

Yes Standing and walking Extension

Durable Power of Attorney (POA)

a document that permits an individual to appoint another person to make any decisions regarding health care if the principal should become unable to make decisions attorney, HR rep at pts jobs, and brother who provides financial support not authorized without written consent only POA

concurrent validity of a aneroid sphygomomanometer if it matches....

a pressure transducer inserted in the artery concurrent validity is demonstrated when the measurement to be validated and a gold standard are measured at relatively the same time so that they both reflect the same incident or behavior

bandwidth feedback

a procedure for delivering feedback in which errors are signaled only if they fall outside some range of correctness

absolute indication for terminating exercise test

a request to stop the test fatigue, SOB, falls in systolic BP in absence of ischemia, hypertensive responses are all relative but not absolute indications for stopping an exercise test

Stereognosis

a sense that allows a person to recognize the size, shape, and texture of an object

lateral weight shifting while prone on elbows, what technique would allow the pt to improve dynamic stability with this activity

approximation bc facilitates contraction and stability through joint compression compression force is most often applied to joints through gravity acting on body weight, manual contacts or weight belts

IT band syndrome where will it be tender

approx 2 cm above the knee joint line over the lateral femoral condyle caused by frequent flexion of the knee such as running or cycling IT band is a thickened strip of fascia that extends from the iliac crest to the tibial tubercle excessive contact usually when the knee is in approx 30 degrees of flexion NOT lateral joint line bc this would be for a meniscal injury

somatosensory stimulation for...

impairments such as neglect, somatosensory loss and impaired spatial relationship with resections of the PARIETAL lobe

hawkins test

impingement passive shoulder IR abd abduction with 90 elbow flexion

what does one attain half knee vs tall kneel

bilateral tall kneeling is an activity that is typically mastered after half-kneeling with the invovled leg anterior but before half kneeling with the involved leg posterior prolonged stretch and maintained pressure on the quad tendons in bilateral tall kneeling will tend to increase the inhibitory inflence and limit the effectiveness of the quads although the posture is challenging, the ability to asssit the involved extremity with the other makes it slightly less difficulty

cotton roll test

biting down test Patient bites down on an object with back molars (gapping/unloading ipsilaterally and compressing/loading contralaterally) • Patient complains of pain on one side of the jaw, have patient bite down on a cotton roll with the back molars on the side of complaint - Pain increases indicates symptoms of a muscular origin due to the activation of ipsilateral masticatory muscles - Pain decreases which indicates symptoms may be joint related (disk or retrodiskal pad) since unloading the joint results in a decrease in pain. • Can be confirmed by asking the patient to bite down on the cotton roll with the back molars of the contralateral side - It should result in pain on the ipsilateral side due to loading of the ipsilateral joint

tethered cord sx

bladder dysfunction occur at site of lesion as individualsd with spina bifida grow scoliosis rapid hypertonicity in LE changes in LE changes in gait changed in urolgoic fxn

flexion of the elbow muscles

brachialis brachioradialis biceps

anterior segments of upper lobes

supine with two pillows under the knees

sever's disease

calcaneal apophysitis painful bone disorder that results from inflammation of the growth plate in the heel, most commonly occurs during adolescence and rarely occurs once an individual reaches skeletal maturity pain is located on the posterior surface of the calcaneus

brace that allows spinal motion while increasing intra-abdominal pressure

corset brace non-rigid spinal orthosis that is made of fabric and contains pouches for the optional addition of flexible vertical stays because of this ^, it will not restrict spinal motion like rigid braces however, bc corset braces fit more snugly to the body, they are more effective at increasing intraabdominal pressure than rigid are

pt unable to heel walk, what is damaged

corticospinal skilled volluntary activity postiive babinski absent superficial abdominal and cremasteric reflexes loss of fine motor or skilled voluntary heel walking is commonly utilzied functional test to identify corticospinal tract involvement

splinting

coughing while holding a pillow against the chest sx pts to reduce pain while coughing

brunnstrom approach

created and defined the term synergy and initially encouraged it but we now know that is not good

low current density to avoid skin irritation during ionto what parameters should you pick

current amplitude of 4mA electrode with area of 12 cm current density = amplitude / electrode area size = .33 mA/cm^2

best orthotic for minor foot drop and pronation

custom molded thermoplastic ankle foot orthosis will permit correction of pts foot and ankle position as well as foot drop light weight cosmetic comfortable moreso thank metal with DF assist

furosemide

diuretic used for tx of hypertension aka lasix

beta blocker

decrease HR and lower BP

ASIA B

intact anal sensation, absence of bowel control

lateral costal area would treat what area of the lungs

lateral basal of the lower lobes

funny bone

medial epicondyle of humerus

quad contusion that after good initial progress the pt begins to report sharp pain of the anterior thigh and progressive loss of knee flexion what is happening

myositis ossificans (heterotropic bone formation on the femur, during quad contraction the msucel belly rubs across the bone, causing sharp pain)

stage 3 pressure injury to L heel with necrotic tissue, what is the initial emphasis to decrease for intervention

necrotic tissue needs to be decreased in order to make room for granulation tissues and enable wound healing depth diameter and exudate will probably increase as the necrotic tissue is debrided

heel strike

neutral

PD expresses concern about decling health and poor prognosis, what should you do

offer resources on support groups (better than just having them talk to one other PD pt) bc there would be several and can offer more variety of expereinces and talking with many other pts will allow choice and keep the locus of control within the pt

velocity

often expressed as stride length/cycle time meters/second normalization methods are used when comparing different velocities due to the correlation with leg length

triquetrum is behind the

pisiform

can you use lumbar traction in prone?

yes but idk when you would do it Patient comfort and the ability of the patient to remain relaxed during the treatment are considered when choosing which position to use. When using prone traction, the amount of lumbar flexion can be controlled by pillows under the pelvis and, as mentioned above, using the correct pelvic harness. Prone traction can be especially effective with the patient who has moderate to severe pain and/or muscle guarding. The patient can be positioned prone for modality treatments and the traction can follow without moving the patient. Another advantage of prone traction is that the therapist can palpate the interspinous spaces to ascertain the amount of movement that is taking place during the treatment allows for flexion during tx

rupture of politeus

decreased knee funcdtion and diffucltun unlocking the knee from an extended position

ramp with greater than what amount of feet must have a landing area

>30 ft

stair guarding

in front and to the side one foot on the step to which the pt will step and the other on the next step down

Best radiographic view for trimalleolar fracture

AP and lateral Includes both malleoli and posterior rim of tibia Demonstrates the distal tibia and fibula As well as the malleoli and the head of the talus The fractures of both malleoli will be visible with this view The lateral view will provide evidence of the fracture at the posterior rim of the distal tib Oblique view would be for the phalanges, MT, and intermetarsal joints Don't do PA for the ankle Coronal is not for this type of fx

10 yar history of scleroderma to improve functional stats and endrance, recently treated with corticosteroids for a bout of myositis, limied ROM and soft tissue along with hyperesthesia, what is the best choice for initial intervention

AROM and walking in a therapeutic pool scleroderma - chronic, diffuse disease of connective tissues causing fibrosis of skin, joints, blood vessels, and internal organs, pt typically demo symmetrical skin thickening and visceral involvement of the GI tract, lungs, heart, and kindeys along with hypersensitivity to touch the warmth and buoyance of the water will enhance the pts movement and decrease pain

anterior drawer test of ankle

ATFL anterior translation is greater if both the ATFL and calcaneofibular ligaments are torn

Vestibulocerebellar vs spinocerebellar

Aka Archicerebellum concerned with adjustment of muscle tone in response to vestibular stimuli It coordinates muscle actions to maintain postural coordination and balance control along with eye muscle control (all impaired in this example) Spino - aka paleocerebellum controls muscle tone and synergistic movements of the extremities on the same side of the body

muscle hypertrophy

increase in the size of individual msucle fibers requires an extended period (4-8 weeks) of moderate intensity or high intensity resistance training one week is too short of a duration for such change

if pt has tight rectus femoris but want to look at TFL what do you do

modified ober test (knee extended) (otherwise wont be able to extend the hip as much as you need to)

blue color of nail beds on the operative extremity what is happening

decreased peripheral flow

emphysema what breath sounds

diminished breath sounds or even absent

indicator of fall risk

functional reach of 7 inches (<10 indicates fall risk)

posterior interosseous nerve entrapment would result in what

functional wrist drop

right sided upper abdominal and shoulder pain

gall bladder

neers test

impingement syndrome passive shoulder flexion greater than 90 with application of light pressure on the acromion

carpal tunnel sx

night pain, muscle atrophy, decreased grip strength, decreased wrist mobility

adapted van, what is the highest spinal cord injury level where this would be realistic

C6 must be able to manipulate hand controls have ECR, infraspinatus, lats, pec major, pronator teres, serratus anterior, teres minor T1 will have strong grasp so they def can

pain and paresthesias on lateral aspect of right forearm and hand, sx reproduced with neck extension, what dx

C6 radic

manual w/c with friction surface handgrips what level

C6-C7 for pts who do not have functional grip

thumb IP extension innervated by ...

C6-C8

ulnar deviation myotome

C8

paresthesia over the hypothenar eminence, what is the most probable cause?

C8 nerve root involvement

serizures are associated with what child dx

CP

pt with 3 rcent surgeries in same arm past 2 years, burning pain in wrist and dorsal forearm and the wirst and hand often feel cold. s/s of...

CRPS burnign aching, ANS dysgnction edema movement disorder final stage affeced limb is COOLER

slump test

initiate test by asking pt to flex the thoracic and lumbar spine pt is then asked to actively flex their cervical spine (then PT applies OP to cervical flexion) then pt asks pt to actively extend their knee (then PT applies OP to ankle DF)

stroke 2 years ago unable to land on heel during heel strike for the past year, what should you do

night splint indicates a fibrotic contracture which would be more effectively treated with a prolonged static stretch than short bouts of stretching

tib anterior action

DF and INVERSION

psoriatic arthritis most likely to affect what joint

DIP joints of the hand inflammatory synovitis

homans sign

DVT PT passively DF the pts foot at the ankle with the knee kept straight positive = pain in the calf or popliteal space determiens risk for DVT does NOT confirm the diagnosis, but promotes the need for further testing (typically using a doppler US)

Contraindication to percussion

Decreased bone density Can cause rib fx

Right ventricular HF

Dependent edema usually pitting Weight gain Fatigue Right upper quadrant pain Anorexia Nausea Bloating Right sided S3 or 4 Cyanosis of nail beds Decreased urine output

Difficult activity if lost 10 degrees of DF

Descending stairs because must have DF during single limb support during descent

Weakness of the lateral pterygoids presents as

Deviation on protrusion to the opposite side of the muscle weakness

Hyperkalemia symptoms

Dizziness, muscle cramps, cardiac irregularities, weakness, nausea, diarrhea 1. Peak T waves 2. Wide QRS 3. Loss of P waves 4. Sine wave 5. Asystole

spinal muscualr atrophy

progressive autosomal recessive genetic disoreder characterize dby anteiro horn cell degeneration paralysis and intact cognitiion type 1 - werdnig-hoffman disease has a life expecancy of less than 3 years type 2 - kugelberg-welander has a normal life expectancy

bronchiectasis

progressive form of obstructive lung disease secondary to chronic bacterial infection, the chronic inflam changes tha resutl form the infection cause irreversible destruction and dilation of the airways primary characteristic -- persistent cough along with large amounts of purulent sputum

Core stability muscles

Erector spinae Glut max Hamstrings Trunk and pelvis = core Assist in counteracting the flexion moment from heelstrike to foot flat

Excessive hip flexion compensates for

Footdrop

reaching behind back would stress the

RC tendons

juvenile RA, increased or decreased PF at toe off and terminal stance?

decreased

Which GI sources of pain refers to the left shoulder

Spleen or diaphragmatic pain In the case of a ruptured spleen or abscessed spleen is known as kehrs sign

athetosis is associated with what child dx

athetosis

turning doorknob what muscle

biceps and supinator

center of carpal bones

capitate

forms of feedback

knowledge of results knowledge of performance

lift and reverse lift in or out of synergy

lift out of syn reverse in syn

med for RA

methotrexate (trexall)

IR what structure should you stretch

posterior capsule

ascultate over aortic valve

second right intercostal space at the right sternal border

autolytic debridement for shallow, dry, partially necrotic wound, what resource

transparent film

Child who just learned how to walk what do their hips do

Externally rotate their hips (toe out) for balance This increases their base of support Genu VARUM (Bowed legs) Flexion at the hips to keep COG forward Wide BOS aka hips in abduction Also demonstrate high guard of UEs to help maintain balance

Sundowning

Extremes restlessness Agitation Wandering Late afternoon Other Alzheimer's sx Impaired cognition, abstract thinking, inability to carry out activities of daily living, impaired judgement, inappropriate social behavior, lack of insight, repetitive behavior and voracious appetite

what factor would provide the most support for an ACL reconstruction

FUNCTIONAL INSTABILITY bc many individuals are able to continue to function at high levels despite a variety of ligamentous and meniscal injuries

apprehension test indicates that what structure is injured

"anterior GH joint" wording of the answer bc the joint would be affected in anterior GH instability not labrum

PT notes area of reddened skin without open lesions on the sacrum of nonambulatory pt what instructions to the pt is appropriate

"avoid lying in the supine position" ideal intervention would bt to position the pt off the area of injury, therefore, a pt with a pressure injury on the sacrum should not be positioned in supine position i chose "pad the reddened area" it says padding the area will not alter the area that the pt has in contact with a surface therefore it is not effective in reducing pressure

wrist ulnar deviation muscles

flexor carpi ulnaris, extensor carpi ulnaris

anterior interosseus supplies

flexor pollicis longus

ulnar nerve palsy sx

hypothenar eminence wasting opponens digiti minimi flexor digiti minimi abductor digitis minimi

progression of weakness over 4 day period that began with moderate wekaness in the LE and progressed to difficulty with all movement, has paresthesia but no loss of sensation

GB syndrome timeline resembles that of a subdural hematoma BUT sx that are symmetrical and paresthesias without anesthesia are NOT typical for a subdural hematoma

pt supine on elbows instructed to lean in between their fixed arms (i.e. direct upper posterior thorax toward the mat surface), what is the primary objective for this activity

GH ER (as well as extension and horizontal abduction) would technically be a ventral glide they are assuming the glide humerus is moving on the glenoid fossa in this question so use normal convex/concave rules

Alcoholic hepatitis and acute liver failure higher risk for

Gallstones and cholecystitis Same for pancreatitis

Functional vs normal mouth opening

25-35 is functional 35-50 is normal

frequency and duration of outpt dialysis for end stage renal disease

3x/week for 4 hours MOST COMMON SCHEDULE allows hemodialysis to accomplish the necessary therapeutic objectigvegs without being excessively burdensome for the pt hemodialysis = artificial kidney (hemodialyzer) which removes waste and extra chemicals and fluid from blood home dialysis (daily or nocturnal) may require a frequency ranging from 5-7 days per week

Ramp up and down time for FES on weak muscles that have spastic anatagonist muscles

4 s up with 5 s stimulation with 1 s ramp down Long ramp up time will not stimulate the antagonistic muscle Ramp down has no affect on timing so Above is also okay

sickle cell what should you be worried about

hypoxia hemocrit is normaly 36-46% decreased exercise tolerance

protective sensation monofilament

5.07 semmes weinstein (least amount of force that can be sensed by pt with only protective sensation intact) greater than this like ability to identify only 6 would be loss of protective senstaion abilti to sense lower like 4 or 3 would be normal sensation

In the milking maneuver for the elbow, the elbow is flexed to greater than ---- degrees

55 degrees and forearm is supinated shoulder is flexed therapist pulls down on patietns thumb generating a valgus stress

C1 vs C2-7 coupled motions

Opposite for C1 (side bend one way, rotate to the other) Same for C2-7

esophagus pain refers to

middle back dysphagia indicates this type of dysfunction

median nerve distribution sensory

JUST palm and fingers not into forearm

What glide to improve IR

Anterior glide

Intractable constipation referred pain

Anterior hip, group and thigh region In addition to pain and tenderness in the lower abdomen

What pathology is associated with medial femoral torsion and toeing in

Anteversion >15 degrees between the femoral condyles and neck of the femur

Relafen

Anti inflamm to treat RA but NSAID is not a DMARD

piriformis origin and insertion

Origin: Anterior surface of sacrum Insertion: Greater trochanter of femur

Lyme disease

Associated with flu like and or neuro sx Common "red or bulls eye rash"

Legg calve perthes disease

Avascular necrosis between 3-12 years old Male female ratio 4:1 Antalgic gait, disuse atrophy of hip and thigh muscles, painful limitation of abduction and IR

What exercise consideration is important for pts taking antipsychotic or antidepressant meds

Avoid aerobic exercises outdoors when temp is over 90 degrees Assuming they would be aggressive, agitated or have memory deficits would be discriminatory and inaccurate

Best exercise for pelvic pain and uterine prolapse

Kegels Strengthens pubcoccygeal muscles along with postural education and muscle re Ed

lesser occipital nerve

Extends into the muscles at the back of the skull cutaneous nerve supplying the skin of the neck and scalp posterior superior to the auricle aka back of the head

Level IV on ranchos TBI pt that tries to bite you during exam what do you do

Document the behavior and engage in a calming activity They are confused and agitated at this level Behavior is bizarre and no purposeful relative to the immediate environment Patient will be unable to corporate directly with formal examination or treatment lacking both selective attention and memory Therapist needs to observe and document the behaviors closely and engage the patient in a calming activity such as slow rocking A quiet closed environment is critical Because the patients sx are expected at this level, it is not appropriate to defer treatment or restructure the exam, the patients immediate needs must be addressed

Patient slips on wet floor but PT catches them and there is no injury what should you do

Document the occurrence as part of the risk management program This program monitors occurrences related to patient and staff risk for the intention of preventing future safety risk Not a punitive process, aka not punishable Sentinel event would be if there was injury to the patient Still need to document it in medical record because omission could put the facility at risk for future litigation OSHA is not a reporting agency for patient incidents

Taking pulse

Don't use thumb bc it's pulsatile Pronation can help facilitate palpating of the pulse but can be in any position Pulse is the same on each side in absence of pathology because it is a closed loop

Chrones disease why does it matter in an eval with B groin pain during WB

Evidence to suggest an overlap between this disease and autoimmune arthritic disease (ie psoriatic and reactive arthritis) Arthritis is the most common extra intestinal complication of chrones disease Joint pain with this disease can also be a common side effect of their meds aka steroids Will affect joint pain progress more than being overweight Diabetes would affect healing potential but the link is not as direct as chrones

New born at 2 weeks taking steps in supported standing, now at 8 weeks she is not, what should you say

Explain that this is normal and that this early automatic walking is a newborn response Stepping reflex that usually disappears in 2-3 months of age

crossed SLR

For a patient with back pain radiating down their right leg, also perform the crossed SLR maneuver. If elevating their LEFT leg passively reproduces pain down his/her affected RIGHT leg, this is highly predictive of a sciatic radiculopathy and disk herniation. The crossed SLR maneuver essentially stretches the left L4-L5-S1 nerve root and thus tugs on the right L4-L5-S1 nerve root. The 2010 Cochrane review shows that the crossed SLR has a low sensitivity (28%) but really high specificity (90%) for disk herniation.

Pt with diabetes and a large stage II ulcer on right heel, NwB for 2 weeks, what is the best choice for initial intervention

Goal to improve perfusion and relieving localized pressure Would should be cleaned with an antimicrobial agent, debrided of necrotic tissue and covered with a sterile dressing Hydrogel maintsin moisture in the wound bed, soften necrotic tissue and support automatic debridement Pressure relief is also important, education on protective foot care Application of a dry sterile gauze would be contraindicated and same for skin lubricants

stop exercise session if

HR drops by 15bpm diastolic increase or decrease GREATER than 10

When is knee maximally active

Heel strike or initial contact to stabilize the knee and counter knee flexion

high hemoglobin

High Hgb may result from your body needing to store more Hgb in red blood cells due to your environment, a condition that affects your heart or lung function, or lifestyle choices. living at high altitudes where there's not as much oxygen in the air, such as in the mountains smoking tobacco products, including cigarettes or cigars chronic obstructive pulmonary disease (COPD), a condition that inflames the lungs and blocks air from getting into your lungs heart or lung diseases that affect your ability to breathe, your lungs' ability to pass oxygen into your bloodstream, or your heart's ability to pump normally taking erythropoietin unnecessarily, such as to enhance high-level physical performance

Best e Stim for stage III decubitus ulcer on the plantar aspect of foot that isn't responding to conservative treatment

High volt Monophasic pulsed current Unidirectional current would produce a therapeutic effect at the active treatment electrode If there is no infection the cathode aka negative pile is recommended over the wound initially to promote healing and should be continued unless wound healing plateaus or degrades (then you would alternate the polarities) High volt has the strongest evidence

Phantom pain, left foot feels cramped and twisted in sitting what intervention should you do

Icing and massage to the residual limb Other common options are PULSED ultrasound or TENs Heating is not indicated with phantom limb pain Medical interventions for prolonged and intractable pain can include injections and surgical procedures like rhizotomy or neurectomy

Grade 1 and 2 mob benefits

Improve joint lubrication/nutrition as well as decreased pain and muscle guarding Will promote muscle relaxation, allowing a proper assessment of the patients joint mobility

PT concerned about undiagnosed fracture, what physical exam finding would indicate need for knee radiograph

Inability to flex the knee to 90 degrees Ottoawa knee rules Inability to flex knee to 90 Greater than 55 years old Tenderness at head of fibula Inability to bear weight (4 steps) immediately after injury and in ER

during subacute phase of treatment of an ACL injury, what intervention should the pt be independent in?

LE partial squats (will put less stress on the ACL and are appropriate for the subacute phase) open chain knee extension esp the last 25 degrees will put increased tension on the ACL although SLR puts no stress on the ACL, this would be an exercise for the ACUTE (not subacute) phase plyometric would be part of the functional phase

mild hemiparesis is able to stand and walk independently with a quad cane, reports difficulty transferring from sitting to standing, where will you find difficulty

LE strength

long-term history of BLE vascular insufficicency, otherwise healthy pt had a R transfemoral amputation, which of the following factors would most impact achievement of the long-term goal of funcitonal ambulation status of wound at amp site ROM at R hip condition of LLE ability to maintain upright posture

LLE condition bc left limb must function as the main support limb, any tx strat for ambulation must ensure that the remaining limb is optimally funcitoning and the limb is healthy is not "maintain upright posture" bc "although the ability to maintain upright posture is relevant, the integrity of the remaining limb is the greatest concern for this pt in establishing long term funcitonal goals"

Hypokalemia

Leg cramps Hyporeflexia Postural hypotension Dizziness Flat T wave Prolonged QT interval Depressed ST segment

Biofeedback to decrease muscle tension what is the proper initial protocol

Low detection sensitivity with recording electrodes placed closely together Close will decrease likelihood of detecting undesired motor units from adjacent active muscles (crosstalk) By setting the biofeedback sensitivity (gain) low, the therapist would decrease the amplitude of the signals generated by the hypertonic muscles and keep EMG outour from exceeding visual and Ir auditory range (scale)

Prescription for obese individual

Low intensity with longer duration 2x DAILY of 30 min at 45-70% vo2max Obese individuals are at increased risk of orthopedic injuries and require close monitoring

relapse and remitting

MOST COMMON characterized by relapses, periods of acute sx exacerbation, followed by remissions, periods without sx and without further progression

Adson's Test

Monitor pts pulse the arm extended pt asked to breathe in and turn head toward IL arm (+) Test = severely DEC/absent radial pulse * indicates compression btw anterior + middle scale of the neurovascular bundle

Hypothyroidism sx

Myalgia (exercise induced) and weakness (rhabdomyolysis) Decreased HR and CO No sensory changes

Ulnar nerve

Nocturnal numbness and sensory loss in the little finger and half of the ring finger Palm is typically not affected

Brocas aphasia

Non fluent or expressive Lesion to the third frontal convolution of the left hemisphere Relative preservation of auditory comprehension

Post-thrombotic syndrome (PTS)

Occurs in 20%-50% of patients despite adequate anticoagulant therapy. Results from chronic venous hypertension caused by - Valvular destruction (from inflammation, scarring) - Stiff noncompliant vein walls - Persistent venous obstruction Clinical manifestations - Persistent edema - Increased pigmentation, eczema - Secondardy varicosities - Lipodermatosclerosis - Pain, aching, heaviness, cramps, itching, tingling The walls of the vein can also become damaged and scarred after a DVT. When we do certain physical activities, like walking, the flow of blood through our veins increases. Scarred veins do not expand as normal veins do, so when the flow of blood increases and they cannot expand, it causes a throbbing pain and swelling in the lower part of our legs. Eventually, this can cause damage to the skin on the leg. It becomes dry around the ankles, discoloured, and itchy. It later becomes brown in colour, hard, and leathery to touch. A minor abrasion can then become a larger sore that doesn't heal. This is called a venous ulcer. In incredibly severe cases, the vein can be so badly damaged that it becomes completely blocked off. No blood is able to flow through it at all. This is the most serious type of PTS.

dequervain tenosynovitis

Often seen in new mothers holding their infants with their thumbs extended Inflammation of the tendon / tendon sheath of: 1. Abductor pollicis longus 2. Extensor Pollicis brevis S/S: - pain along radial styloid process when using thumb/wrist Dx: - Finkelstein's test Tx: 1. Rest 2. Splinting 3. Ice 4. NSAID's 5. Steroid Injx 6. Surgery for severe cases

hand tremor at rest 4 to 7 beats per second what condition

PD cerebellar is action tremors MS does not have a regular rhythm tremors are not associated with tardive dyskinesia

anterior glide of the calcaneus is needed for

PF

intubated cant particpate in what breathing exercise

PLB but can do diaphragmatic breathing, deep breathing, and lateral costal expansion diaphrag/deep/lateral costal - helpful for a patient who has synchronized intermittent mandatory ventilation in ventilator mode, in which the patient is allowed to breathe spontaneously between machine-delivered breaths

C5 fx of 90 y/o only describes neck pain and left knee pain but not other post injury changes, rehab prognosis based on...

PLOF establishes baseline for recovery knee ROM and UE sensation should be monitored cervical collar is apotential intervention but not a determinant of prognosis

lister tubercle

POSTERIOR extensor pollicis LONGUS wraps around the lsiter tubercle

most helpful in determining source of pts sx if has shoulder pain and decreased AROM date of onset PROM UE DTR MMT

PROM (bc "impossible to determine whether the problem is adhesive capsulitis, RC tendinitis/tear etc, PROM would be needed to make this determination") date is important but alone will not help differentiate between adhesive capsulitis and cuff tear (dont know why they just assume these two dx) "DTRs or neuro status would not be most useful in determining the source of sx" "although MMT is important info, simple MMT might not differentiate tendinitis from other problems such as adhesive capsulitis"

left posterior rotated innominate

PSIS Low on left ASIS high on the left PSIS moves first and farthest superiorly during stnadin flexion test gillets test left PSIS moves inferiorly and latearlly than right long sitting shows that the lef tmalleolus moves short to long sitting flexion test is negatibe

Graded exercise test GXT and what should terminate it

Positive GXT indicates myocardial ischemia with increasing exercise intensities Optimal test duration is 8-12 min but can be terminated if sx of exertional intolerance are evident These include... ECG changes from baseline (>2 mm horitxonal or downsloping ST segment depression or >2 mm ST segment elevation) Onset of moderate to severe angina (some angina is expected with increasing work) Drop in systolic BP with increasing workload Serious arrhythmias Signs of exertional intolerance (pallor, cyanosis, cold or clammy skin) Unusual or severe shortness of breath (some is expected) CNS signs (ataxia, vertigo, visual or gait problems, confusion) Hypertensive response equal or greater than 260/115

Good exercise to help with stair climbing weigh transfer

Partial wall squats Quads are responsible for most of the energy generation needed to transfer up stairs to the next level PFs assist during forward continuance and hip extensors also actively contract concentrically to assist

Lhermitte

Passive flexion with pain down spine and into upper or lower limbs Used to identify dysfunction of the SC associated with UMN lesions and is typically positive in MS

Vertebral artery test

Passively place pt head into extension and side flexion in a supine position Then the head and neck are slowly rotated to the laterally flexed side and held for 30 seconds Positive = syncope, lightheadedness, nystagmus or visual disturbances Some doubts about sensitivity/spec of this test, the patients initial complaint of dizziness with some cervical movements would indicate that it be applied in this case

Granulomatous

Pertaining to any small nodular aggregation of a certain kind of cells.

Successful feeding is dependent on...

Positioning Head upright, trunk erect, pelvis neutral, hips flexed to 90, feet resting flat Facilitates upper extremity function (grasp and release) as well as swallowing

New skill how do you teach it, difficulties learning how to use a wc

Provide consistent feedback (given after every trial to improve initial performance) using a blocked practice

Best way to improve shortened step length

Provide posterior directed resistance to the right ASIS during stance Aka light resistance and stretch to the pelvis during mid to late stance will facilitate forward pelvic rotation on that side and enhance forward movement of the limb during swing

Horners syndrome

Ptosis, miosis (pupillary constriction), and anhydrosis (lack of sweating) all on the same side of the face and ipsilateral to the lesion Skin vasodilation is also typically present Results from a lesion that affects the sympathetic pathway to the head May be caused by trauma interruption of blood supply tumors or cluster headaches CN III oculomotor nerve contains parasympathetic fibers that innervate the pupillary constrictor muscles therefore loss of sympathetic innervation results in unopposed pupillary constriction

What happens with a tight extension aid

Results in terminal swing impact during late swing (aka too early of initiant contact?) It is supposed to assist in knee extension during the latter part of swing phase

Impaired sensation and paralysis on left song with left side of lower face and trunk similarly impaired, where is the location of the lesion

Right parietal lobe Tracts cross in the medulla so the right brain is involved not the left Involvement of the face indicates a lesion above the level of the midbrain A lesion in the brain stem would produce facial signs contralateral to the limb signs

Moderate flexor and extensor synergies (flexion > extension), goal is to strengthen the shoulder muscles first to promote elevation of the arm, what should you do

Shoulder flexion with elbow extension Early activity to promote this would also be in sitting bending forward with elbow straight and hand touching floor

Teenager with vague left hip and groin pain that worsens with weight bearing Limited and painful IR, antaglic gait, and a weak glut med what does she have?

Slipped capital femoral epiphysis SCFE Ranges between 10 and 16 years old Male female ratio 3:1 Left to right ratio 2:1 30% bilateral Weakness is due to alteration of the length tension relationship

Cementless fixation posterior approach R THA what is the most appropriate transfer

Stand pivot transfer to the sound side Want to protect from dislocation or subluxation Don't want to transfer to the surgical side initially because can move hip into adduction Want to do stand over squat to avoid hip flexion

Impetigo

Staph infection with small macules (unraised spots) or vesicles (small blisters)

Peripheral neuropathy

Symmetrical Distal to proximal Dying back of the longest fibers in all the nerves from distal to proximal Decreased sensation and pain, parethesias, dysesthesias aka abnormal sensations such as numbness tingling or prickling

lower right aspect of rib pain, intense which occurs at night, Active passive of thoracic spine pain free, lasts for 15 min and subsided, no MOI or pain with activity, mild tenderness inferior to the right lateral rib cage what is happening

Systemic disease This was the actual wording of the answer Insidious with no injury and no pain with activity No reproduction of sx with physical exam Red flag for systemic condition that should be referred to a medical doctor

Costoclavicular test

TESTING: TOS, Pinched between clavicle and 1st rid POSITION: Palpate radial pulse, retract pt shoulder, ask them to take a deep breath and hold, pull patients arm down and back while palpating pulse (+) TEST: Pulse becomes thready or not as strong

4 y/o who has spinal muscular atrophy is unable to sit without UE support but rolls independently bilateral hip and knee flexion contractures that make use of the childs standing frame uncomfortable which of the following intervnetions are most appropriate

Teach the parents range of motion exercises and positioning, encourage play in prone and sitting positions, and order customized seating insert for a power wheeled mobility device. --literature supports that children who have SMA and who do not develop sitting ability are unlikely to walk and will require power mobility, may become independent in a power w/c by age 1-2 NOT Teach parents proper transfers, facilitate upright positioning in kneeling and standing positions, and refer to an orthopedist for serial casting to address contractures. (TOO ADVANCED)

Hawthorne effect

The influence that the subjects knowledge of participation in the experiment had on the results of the study

How to increase stability at a prosthetic knee

The prosthetic knee axis of rotation is normally aligned anterior to a line extending from the trochanter to the ankle (TKA line) A knee set to far anterior will cause it to buckle Too far posterior causes excessive knee stability and difficulty flexing the knees

tongue thrust conditions

Tongue thrust appears when the tongue presses forward too far in the mouth, resulting in an abnormal orthodontic condition called an "open bite." The condition is most common in children. It has a myriad of causes, including poor swallowing habits, allergies, and tongue-tie. these condition and deviations during protrusion which can be caused by msucle or disc problems and therefor is not very discriminatory retrusion may be painful in pts with intracapulsar injury but not as useful as depression

least appropriate for treatment of pt with ankle sprain and prolonged corticosteroid use

plyometrics bc decreased connective tissue strength

Herpes zoster

Viral infection with red papules along the course of a nerve or dermatome

use of a suprapubic catheter

When a urethral catheter is used, the urethra may become damaged over time, causing urinary leakage around the catheter. The balloon of a urethral catheter can also damage the bladder neck, leading to urinary leakage. A catheter that is forced through the external sphincter (the muscle that keeps people continent) can also cause damage The catheter is less likely to be sat on and accidentally 'pulled'. If a suprapubic catheter becomes blocked, urine can drain via the urethra (although this may not be possible for everyone). This can act as a 'safety net' for people who get autonomic dysreflexia when their catheter blocks. With a suprapubic catheter, a person has an alternative entry point to their bladder (via the urethra) A suprapubic catheter leaves the genitals free for sexual activity The site of a suprapubic catheter is easier to keep clean The procedure is reversible. When a catheter is removed permanently, the hole heals quickly. A larger size catheter can be used suprapubically, reducing the risk of a blocked catheter

Rotary winging

When the inferior angle of one scapula is rotated father from the spine than the inferior angle of the other scapula

best way to facilitate healing of the patellar ligament after using it for ACL reconstruction

active knee ROM low loads no immob bc will lead to adhesions and decrease ROM along with weak unorganied tissue that is less able to tolerate nrmal stresses enentually placed onto it

L5 radic TENs prior to manual

brief intense TENs provide rapid onset short term pain relief prior to painful procedures similar to oconvential but curretn intensity is increases to pt tolerance low rate tens has a long onset modulation is used to preent accommodation not provide relief of pain

pounding sensation in ear SCI pt what should you do

bring pt to an upright position only need to notify physician if cant find source or cannot reduce BP

CAB

chest compressions, airway, breathing

dependent

effect or response

pain with tarsal tunnel

in an daround the ankle region and may extend into the toes

ventricular dysrhythmias are they always bad

no some ventricular dysrhythmias including PVCs often occur in healthy individuals other forms are multiform premature venticular contractions or small periods of ventricular tachycardia are often associtaed with significant CV disease and may require a graded exercise to be terminated although it is critical to assess, this alone is not indicative of a positive graded exercise test

do you want to use axillary crutches after a brachial plexus injury?

no bc has the potential to transmit pressure through the axillary region which could exacerbate the brachial plexus injury lofstrand are the better choice

does erector spinae have an impact on hip extension

no do not attach to femur and have no impact on hip extension extend the trunk on the legs

can back extensors cause hip extension

no does not attach to femur

bayley III

norm referenced for children from birth to 42 months old (3.5 years old) infant development

best cleanser on beefy, red wound

normal saline

meningitis classic history

pre exisiting resp infection that gets into the blood stream

positive dix hallpike, upbeating torsional nystagmus starting 5 seconds after the pt assumes the position and lasting for 10 seconds, the pt reports vertigo, what happened

removal of debris from the canal if it was dislodging the debris form the cupula the vertigo and nystagmus would have persisted as long as the pt is n the provoking position

seizure what do you do first

remove objects from the immediate area pt who is having a seizure normally only needs protection from injury in the environment calling emergency medical services occurs after do NOT inesrt a tongue protector do NOT restrict movement

LE strength PNF technnique

repeated contractions designed to initiate movement and promote strength PT provides quick stretch followed by isometric or isotonic contractions (providing resistance at the point of weakness can enhance the effectiveness of repeated contractions)