Review 2018 Set #7
How is an end-feel felt?
By applying overpressure at the end of a passive range to asses the resistance of the tissues
Where do sperm go after they exit the seminiferous tubules?
Tubuli recti: tubules to... Rete testis: in mediastinum Efferent ductules: ducts leaving rete testis & become 1 epididymal duct which becomes vas deferens
What are the types of collagen that we need to know?
Types I, II, III, IV, and V
In endometriosis, where can endometrial tissue be found in the body?
Typically the ovaries, uterine ligaments or fallopian tubes Rarely it can also be found in the heart, lung, brain, knee and eye
Does an UE amputee learn more from an OT or from a fellow UE amputee?
UE amputee, the peer support is also extremely important
Is acceptance of a prosthesis often an issue with UE or LE amputees?
UE amputees, especially in pediatric patients
What does frequent bladder distension put an SCI patient at risk for?
UTI
What is passive ROM? (PROM)
Unrestricted motion of a joint that is entirely performed by an external force. Little to no voluntary contraction.
What is active ROM? (AROM)
Unrestricted motion of a joint that is produced by active contraction of the muscles causing voluntary movement
What structure is known for its close association with the uterine artery?
Ureter
How does the ureter pass in relation to the uterine artery?
Ureter passes under the uterine A "water under the bridge"
When performing a hysterectomy, what structure do surgeons have to be careful not to damage?
Ureter, because it is so close to the uterine A
55% of people with PVD that undergo an amputation will eventually undergo what procedure?
a bilateral amputation
Valsalva Maneuver
a breathing technique to trap & pressurize air in the lungs if held for an extended period, it can *dec Q* (even though it inc BP)
Define biophysical agents:
a broad group of agents that use various forms of energy
What is a characteristic of a pro-drug or a drug in its inactive form?
a drug that has higher level of activity in its metabolites once it has been processed by the liver
What are functional (K) levels?
a grade from 0-4 that determines if an amputee would be *able to use a prosthesis* and if so, which type(s)
Why is it important to examine the foot if a patient is suspected to have PFPS?
a pes planus (flat foot) can cause the ankle to "roll" medially, to compensate, the femur and tibia rotate internally, increasing the valgus force on the knee (causing PFPS)
Define: motor milestones
a set of functional skills or age-specific tasks that most kids can do at a certain *age range* Notes: really emphasized that these do not occur strictly at a particular age
What is a hybrid UE prosthesis? (didn't cover this in class)
a single prosthesis in which 2+ technologies are combined Ex: elbow is body-powered, but hand is externally powered
Why does a tight ITB contribute to PFPS?
a tight ITB places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the patellofemoral mechanism. This problem can lead to excessive lateral tracking of the patella.
What device may be helpful to transfer a non-ambulatory patient after an amputation?
a transfer prosthesis (looks like a normal prosthesis, but is only used for transfers and not ambulation)
When H+ levels begin to increase from CO2 or lactate accumulation, _____________ is formed to buffer the H+ to prevent acidosis.
bicarbonate ions
What is usually the limiting factor with drug distribution throughout the body? What is the exception to this?
blood flow rate (blood-brain barrier is exception)
Does atelectasis alter ventilation or perfusion?
both
Are pressure sores a problem for SCI patients in the acute, chronic or both phases of recovery?
both acute & chronic
Is a SCI patient likely to experience hypo/hyperthermia in the acute, chronic or both phases of recovery?
both acute & chronic
Is a SCI patient likely to experience pain in the acute, chronic or both phases of recovery?
both acute & chronic
Is a SCI patient more likely to experience autonomic dysreflexia in the acute, chronic or both phases of recovery?
both acute & chronic-- but usually only happens when LOI is T6 or above
Is a SCI patient likely to experience spasticity in the acute, chronic or both phases of recovery?
both acute and chronic
Pts w/ SCI are especially succeptible to developing UE injuries including shoulder injuries and carpal tunnel. What may cause these injuries?
both are overuse injuries from transfers, WC use, and vocations (this is a big problem with SCI patients)
If a drug is not lipid soluble, how does it have to be transported to target tissues?
bound to a protein, usually albumin
Define: neurogenic bowel
bowel will not empty w/ volitional control
Are pediatric amputations more common in boys or girls?
boys (3:2 ratio)
What AD might be utilized in the treatment of a ligamentous injury of the knee?
brace and crutches
What causes pneumonia?
an infection leads to inflammation of alveolar sacs which leads to: -fluid accumulation, may be pus -dec oxygen exchange -difficulty breathing
What is the definition of a general ligament injury?
an injury to the ligament that results from hyperpositional mechanical stress, that in turn, damages the ligament collagen fibers
Clients w/ a pulmonary disease may have ventilatory limitations on exercise. This means they become fatigued when the limits of _____________ are reached
breathing reserve
The PLL anchors __________ to the posterior IV discs options: narrowly, broadly
broadly
Asthma involves obstruction of _______________ .
bronchi
The ___________ have a similar structure to the trachea
bronchi
How does the respiratory system help regulate the acid-base balance?
by inc respiration when H+ levels inc allows more CO2 to be released in the blood & be transported to the lungs for exhalation
Emphysema, chronic bronchitis and bronchiectasis are all what type of pulmonary disease?
chronic obstructive pulmonary disease (COPD)
What respiratory condition is exercise tolerance testing done for?
chronic pulmonary disease
Is a SCI patient more likely to experience syringomyelia in the acute, chronic or both phases of recovery?
chronic***
What information should you get with a symptom history?
chronological development, onset (MOI), changes, treatment
What are the most common parameters used to indicate the rate at which a drug is eliminated?
clearance and half-life
What two things does patellar taping help with?
correction of: -patellar tilt -patellar glide
What are tests that could be done in the OE to help diagnose PFPS?
critical test (pain) apprehension test (instability)
What arrangement is utilized with interferential e-stim?
crossing quadripolar so the current from one set of electrodes "interferes with" current from the other set
What is different about the circuit amplitude of a quadripolar vector scan set up compared to other methods of delivery?
current amp of 1 circuit varies -50-100% of max other curcuit in this set up is fixed at one amplitude (allows field to rotate)
Stroke volume increases ____________ with workload
curvilinearly, until it reaches near max at ~50% of aerobic capacity increases only slightly thereafter
You should provide an amputee a wheelchair with a ____________ if they are at high risk for skin compromise or socket intolerance
cushion consider specialized cushions for LT use
How would prolonged AV conduction (1st deg block) affect the PR interval?
increased duration of PR interval some type of heart block is often the cause of the PR interval being greater than 0.2 seconds
How does training affect blood volume?
increases it, especially intense endurance training
How does training affect anaerobic threshold?
increases it-- they will be able to sustain aerobic metabolism longer
What is a surgical consideration for *cancer-related* amputee patients?
indicated in high grade tumors, proximal lesions, those risking pathologic fractures or neurovascular involvement or recurrent disease
If palpation of a lymph node is swollen & painful it may mean _____________
infection
What are some examples of parenteral drug administration?
injection respiratory tract topical conjunctiva urethra vaginal
What are all of the body's defenses attempting to overcome?
injury or disease
Which modality may be helpful for someone w/ a disc herniation? (McKenzie Protocol)
intermittent traction
When a neurotransmitter binds to a receptor & has an effect, the effect can be either _____________ or ______________
internalized or inactivated
Blood pressure reflects ______________ pressure during systole & diastole
intra-arterial
What Ther Ex should be included in the treatment of PFPS?
exercises to correct or minimize the biomechanical faults
Lung or pulmonary compliance is the ability of the lungs to ____________ .
expand
Restrictive lung disorders are a group of disorders with impaired lung _____________ .
expansion
Atelectasis, pleural effusion, pneumothorax, adult/acute respiratory distress syndrome (ARDS), and acute respiratory failure are all examples of what type of disorder?
expansion disorders
Is anterior spondylolisthesis a flexion or extension related injury of the spine?
extension-related injury
Which type of UE prosthesis is "electrically" powered or "myoelectric"?
externally powered prosthesis (powered by a battery)
Is the socket interface rigid or flexible?
extremely flexible plastic material which improves socket comfort
T/F: a limb shrinker is the same thing as a limb sock
false
T/F: intermittent vs constant pain gives you a good idea of the origin of the pain (musculoskeletal vs visceral)
false
T/F: interference area is much larger in a dual, bipolar arrangement than a quadripolar (crossing) arrangement
false with dual, bipolar the interference area is much smaller
T/F: there is one intervention that will work best for every patient
false "we have a menu of interventions to select from, we take into account many different factors to select the appropriate, effective, efficient interventions"
T/F: the knowledge that leads someone to whistle blow usually comes rapidly
false, gradually
T/F: phantom limb pain is normal after an amputation
false, phantom limb *pain*, although very common, is not considered normal
T/F: amputation is a relatively new procedure
false, they are among the oldest medical procedures
T/F: there are UE prosthetics that are considered "body upgrades"
false, this is bad advertising, be aware that your patients may have unrealistic expectations because of this
T/F: the use of biophysical agents without other interventions is still considered PT
false, unless there is documentation that justifies the necessity of their exclusive use
T/F: if a person has eaten recently, the gurgling bowel sounds will take place less often
false, will happen more often
T/F: you can attempt to make significant adjustments to a prosthesis to save the pt a trip to the prosthetist
false, you should def not do that
T/F: when applying an ACE wrap to an AKA, you should avoid the adductor tissue
false, you should include it to prevent an adductor roll
T/F: you should educate an amputee as quickly as possible with all the info they need about their new lifestyle
false, you should prioritize the most important info and gradually build on it to help not overwhelm the patient
T/F: at a fixed submax work rate, Q begins to decrease
false-- it remains essentially unchanged
T/F: in cervical stenosis, the spinal canal is narrowed at one vertebral level
false-- multiple levels in the neck can be involved
What causes contraction atelectasis?
fibrotic tissue in lungs or pleura
Presentation of a pt w/ SCI who has contractures: Why are contractures an issue?
fixed limitation of ROM over one/multiple joint(s) can lead to pressure areas & difficulty w/ ADLs
How does pulmonary edema reduce the amt of O2 diffusing into blood?
fluid collecting in alveoli reduces gas exchange
A dull sound over a lung might indicate:
fluid or another space-occupying lesion
Name the amputation: amputation of humerus, scapula & clavicle
forequarter amputation
Have neural stem cells been found in adults or just kids w/ developing brains?
found in both
What typically causes an intra-spongy herniation?
fracture of v. end plate
Where does small cell lung cancer come from?
from bronchi, oat cells, combination
Fibrosis can lead to loss of ____________ areas of the lungs
functional
Clinically & radiographically, it's not always possible to determine the stage of injury in a herniation. Therefore you have to look at _____________ and treat the pt as they present
functional changes
What is VO2 max a measure of?
gold standard for measuring cardiorespiratory fitness
It is easier to transfer toward a patients (good/bad) side
good side, make sure to block their bad side this is not always possible though, you can transfer to the bad side to progress exercises as well
Describe the different grades of anterior spondylolisthesis:
grade 1: 1-24% (conservative) grade 2: 25-49% (conservative) grade 3: 50-74% (poss. surgery) grade 4: 75-99% *poss. surgery) grade 5: complete slippage
Does degenerative disc disease have an acute or gradual onset?
gradual
What are the two types of WBC that play a role in inflammation?
granulocytes and agranulocytes
What does a body powered UE prosthesis rely on to function?
gross body movements that are captured through a harness Ex: shoulder flexion opens grip, shoulder extension closes grip
How does training affect submaximal SV?
higher in trained individuals at any fixed or submax workload (or any given time) allows them to work at lower HR
What are some characteristics of scar tissue?
highly collagen rich (produced by fibroblasts) -laid down haphazardly, not neatly arranged, produced in excess -formation of a scar
What are characteristics of granulation tissue?
highly vascular, red from new capillaries, fragile
What is the function of the v. end plate?
hold the IV disc in place
What other prosthetic option exists to replace a hand besides a prosthesis that looks like a plastic hand?
hook may not be accepted in some cultures
What causes the increased production of mucous secretions involved in chronic bronchitis?
hypertrophy and hyperplasia of mucous glands
A decrease in PCO2 in the blood is called:
hypocapnia
Is hypercapnia or hypocapnia caused by hyperventilation?
hypocapnia
The normal partial pressure of O2 is 90-100 mm Hg. A PO2 of 80 mm Hg is considered what condition?
hypoxemia
What is an example of a second group, restrictive lung disorder?
idiopathic pulmonary fibrosis
Contractualism Theory (Rawls)
if a reasonable person were placed in a situation where they didn't know their role, the person would choose the alternative that *supported the most disadvantaged person*
How do you know if an EKG has a 6 second strip marked so you can use it to calculate HR?
if every 3 seconds is marked with hash marks above the strip (could also know each big box is 0.2 seconds, so 5 big boxes is 1 second, & 30 big boxes are 6 seconds)
Even if a pt could use a bunch of AD's and be ambulatory, why might this not be the best option?
if it costs them a lot of energy, then ambulation may not be as functional however, the psychological component is very important to acknowledge and consider
When might a meniscal tear be treated conservatively?
if it is a stable lesion on the periphery and there are degenerative changes taking place that are associated with aging (when patient does not need to return to higher level activity)
How does the total surface area available for diffusion affect gas exchange?
if part of the alveolar wall is destroyed, SA is reduced, and less gas exchange occurs Ex: emphysema
When is open, provisional or delayed closure of an amputation indicated?
if severe infection is present
What does IPOP stand for?
immediate post-op prosthesis it is a plaster socket w/ a removable pylon & foot
When should you initiate positioning after an amputation?
immediately prone positioning ASAP, some pts will really not like this, esp dysvascular pts, Jason would push this harder if it is a younger pt
What takes place in the IV disc when it undergoes rocking?
in anterior rocking (flexion): -inc pressure on ant disc -dec pressure on post disc
Which pts w/ SCI may be potential candidates for ambulation? What may need to be utilized to make ambulation possible in pts w/ SCI?
incomplete & lower level lesions may need KAFO/AFOs or other AD's
What are the "local" effects of inflammation?
redness and warmth, swelling, pain (due to bradykinins and increased pressure of fluid on nerves) and loss of function
Signs of pressure sore formation:
redness that does not fade in 20 mins may progress to open wounds (causes can change as the person's body changes)
What are the 4 cardinal signs of inflammation?
redness, warmth, swelling and pain
Reactive Hyperemia
reduce blood flow for a short period of time w/ a BP cuff to induce temporary ischemia & then release it causing a temporary increase in blood flow which also inc sheer stress on vessels --- tries to mimic exercise bc you can't get a good measurement during exercise
Older patients who undergo a unilateral AKA will have difficulty doing what?
regaining upright independence
How to mast cells respond to injury?
release chemicals from granules that include bradykinin and histamines
Does hypercapnia result in respiratory acidosis or alkalosis?
respiratory acidosis
Does hyperventilation lead to respiratory acidosis or alkalosis?
respiratory alkalosis (excess amt of CO2 expired)
Are extremity or respiratory muscles more resistant to fatigue during long-term activity?
respiratory mm
The crossing quadripolar arrangement of electrodes in IFC results in ________ current with __________ equal to the difference between the two channels
results in "interference current" with beat frequency equal to the difference between the two channels
Location of SA node
right atrium
If aVF is positive and LL1 is negative, what is the axis?
right deviation
___________________ are justified claims that others have an obligation to respect. This means they do not depend on the goodwill of others, nor are they a privilege. Others may not interfere with these.
rights
What is the only other motion accompanying knee extension?
rotation (screw-home mechanism)
Is the risk of subsequent hospitalization greater after an amputation or salvage?
salvage
The ST segment always has a ________ contour
smooth
How should you position a walker for an amputee who is learning to do a stand-pivot transfer?
so that the pt can put their elbows into full extension
Which type of post-op dressing is an ACE wrap or incision dressed with 4x4's and Kerlix?
soft dressing
In which structure of a neuron are neurotransmitters (ntm) produced?
soma
After taking a _____________ , you should have a very good idea of what is going on. (subjective or objective)
subjective
Large emboli may cause _______________
sudden death
If a patient gets all of her cervical flexion from C6-C7 which results in a lot of anterior translation & shear forces in her spine, how could you educate her to move differently?
tell her to imagine there is a rod through her ears and when she looks down we just want the rod to spin-- inc flexion from upper CS
Why is it more difficult to initiate another AP after an AP takes place?
the K+ leaving the cell during an AP, hyperpolarizes the cell membrane making the difference b/w the membrane potential and the threshold stimulus greater than normal
How is excretion/elimination defined in relation to pharmacokinetics?
the ability of the body to remove the drug and its metabolites
How is absorption defined in relation to pharmacokinetics?
the ability of the drug to enter the bloodstream (usually from the GI tract)
Rule Utilitarianism
the action is right if it conforms to a rule that has been validated by principles-- meaning the action is generalized to most situations
Fick's Law of Diffusion
the amount of gas that moves across a tissue is proportional to the area of the tissue but inversely proportional to its thickness -thicker tissue-- less diffusion -bigger area-- more diffusion
Utilitarianism: the ________ justify the ________ options: means, ends
the ends justify the means (do whatever will benefit the most people)
What role do NSAIDs play in the inflammatory process? (chemical process)
the production of prostaglandins from arachidonic acid (COX process)
What is the "screw-home" mechanism? When does it take place?
the rotation that takes place within the last 5 degrees of extension in the knee. The femur rotates internally on the tibia (in closed kinetic chain) in order to "lock the knee" into full extension
What is systemic clearance?
the sum of all the individual clearance rates from the organs and tissues
______________ is a general overview that begins w/ an assumption about the very nature of doing right or wrong
theory
It is important when prescribing a drug that the concentration in the plasma is kept between the _______________ and ______________ for as long as possible
therapeutic range; toxic range
Why is it important to try and prevent the formation of a spinal deformity in a pt w/ SCI?
these may increase chances of pressure sores, overuse syndromes and respiratory compromise
How does flexion of the knee to 90 degrees effect the collateral ligaments?
they are both lax allowing internal and external rotation
How do cytokines play a role in inflammation?
they are small proteins that affect the behavior of cells and stimulate chemotaxis
How should you work on toe loading in prosthetic gait training?
they don't like to do this bc they feel like they're going to fall, watch them to make sure they load weight across the entire prosthetic foot surface
How do the nucleus & annulus move in relation to each other?
they move together as a unit
Which tissues will come into equillibrium with the drug first? In what order will it reach fat, visceral organs, and skeletal muscle?
those with the greatest blood flow -organs first (high blood flow) -skeletal mm (~30mins) -fat (1-2hrs)
In open chain movement of the knee, arthrokinematics involve _____ -on-_______ extension
tibial-on-femoral
HR Recovery
time after exercise for HR to return to resting rate
COPD involves progressive degeneration of _______________.
tissue
Why is it important for primitive reflexes to integrate by 9-12 months of age?
to allow voluntary movement
What is the purpose/ role of inflammation in the defense process?
to localize, neutralize and remove harmful agents to remove dead tissues
Why must muscle length be preserved in an amputation?
to prevent contracture and atrophy
Name the amputation: disarticulation at MTP joint
toe disarticulation
Is airway obstruction leading to atelectasis or non-aeration of tissue a symptom of partial or total obstruction of airways with asthma?
total obstruction -air diffuses out into tissues -no new air to fill the space -section of lung collapses
What causes obstructive or resorption atelectasis?
total obstruction of airway
Name the amputation: resection through long axis of metacarpals
transmetacarpal
Name the amputation: amputation through long axis of all MT's
transmetatarsal
What is the main purpose of the respiratory system?
transport oxygen into the blood and remove CO2 from blood
T/F: a tendon graft from the patellar tendon will heal much faster than a graft taken from the hamstring tendon
true
T/F: dual, bipolar arrangement for IFC has anectdotal evidence for decreasing spasm
true
T/F: episodes are recurrent in pt's with disc herniations
true
T/F: meniscal tears can be approached surgically or conservatively
true
T/F: phantom limb sensation is normal after an amputation
true
T/F: recognizing transfer activities by its components allow for a successful and safe progression through steps and also allow adjustment of transfer or termination if needed
true
T/F: the cause of phantom limb pain is unknown
true
T/F: you are unable to palpate lymph nodes unless they are swollen
true
T/F: you should focus on positioning of an amputee both in and out of bed
true
T/F: limitations exist in all UE prosthetic approaches
true multiple prosthetics may be needed to address functional deficits
T/F: amputations are associated with psychological trauma
true, need for an extended period of adjustment
T/F: many kids who have a congenital amputations chose not to wear a prosthetic
true, they learn how to do everything without the limb, esp. UE amputations
What disease occurs more frequently in poverty and crowding?
tuberculosis Ex: prisons, war, malnutrition, alcoholism, chronic disease, immunodeficiency
Which PT modalities transfer heat via conversion?
ultrasound
Does a bilateral BKA or unilateral AKA increase the energy cost of ambulation more?
unilateral AKA
Does the pain from facet dysfunction usually present bilaterally or unilaterally? What is the pain accompanied by?
unilaterally radiculopathy
Categorical Imperative
universal application according to Kant tells us what to do regardless of our desires, so it always applies to everyone
How do you re-hydrate IV discs?
unload the spine
How long does scar maturation take?
up to 1 year
In healthy people, if the R is upright and positive, then the T is typically:
upright & positive
What are Schmorl's nodes?
upward/downward protrusion of a disc into the adjacent v/ body, leaves an empty space (intra-spongy herniation, usually cause no sx)
What is destructive interference?
when the waves cancel each other out (end up with amplitude of 0) when they are generated out of sync
How does training affect maximal HR?
will either stay the same or decrease slightly
When is the PCL the most taut?
with the knee in extension
When is the ACL the most taut?
with the knee in flexion
Name the amputation: amputation of hand and carpals
wrist disarticulation
Can IV discs generate pain?
yes
Can unloading IV discs help them receive more nutrition?
yes
Do neurons have all the same organelles as a typical cell?
yes (nucleus, golgi, mitochondria, lysosomes & ER)
Can all unilateral BKA amputees be functionally independent?
yes, all of them can
Is disc degeneration considered normal?
yes-- it happens to everyone regardless of age, gender, body type, etc. however, it is only considered pathological when it causes pain
When working on bed mobility with a SCI patient, why is it a bad idea to let them use their hands on the mat with their hand flat to assist them with these tasks?
you want to preserve the tenodesis grip!! if you stretch this out and their LOI is above having hand control, they will no longer be able to use the natural tone of the hand to grip things
Traumatic amputations are more common among which population?
younger men
Can all bilateral BKA amputees be functionally independent?
younger patients can be
How long must tissue be unweighted to raise the tissue oxygen to unloaded level equivalent in order to prevent pressure ulcers?
~2 mins (1 min and 51 sec) (video recommended to do pressure relief for 15 sec every 15 minutes, or 30 sec every 30 min)
As the Q angle increases, the amount that the patella deviates _______ increases
laterally
A patient has a hx of an inferior MI and emphysema, what axis deviation would you expect them to have?
left axis deviation
The initial assessment of a SCI patient can be predictable based on the _____________ Knowing the expected outcome & reasons for variability will help with __________ and ______________
level of injury goal setting & treatment planning
The more ___________ ___________ a drug, the faster the drug will pass through the membrane
lipid soluble
How does training affect submaximal Q?
little difference b/w pre and post training
Where does most biotransformation occur?
liver
T/F: you don't need to monitor pt swelling and limb volume fluctuation after an amputation
lol, of course you do
Name the amputation: retains more than 50% of femoral length
long transfemoral
Name the amputation: retains more than 50% of tibial length
long transtibial
How do you treat TB?
long-term treatment with a combination of drugs (from 6 mo to 1 yr)
What does prolonged compression of the IV discs result in?
loss of disc height due to loss of water
What does low Vd indicate? What about a high Vd?
low indicates a drug being retained in the bloodstream, high indicates a drug that is being concentrated in tissues
Define hypotonicity:
low tone-- flaccidity, paralysis dec resistance to stretch compared to normal muscles
Blood gas levels indicate the level of function of the ___________.
lungs
What organ does TB primarily affect?
lungs
If you are having a person w/ DDD perform supine TherEx, what do you have to keep in mind?
make sure their back is supported to minimize muscle activity
If palpation of a lymph node is swollen & painless, and the node is immoveable it may mean _____________
malignancy
What can be done to speed the absorption of a drug? to slow it?
massage and/or application of heat cooling side of injection
What are the two types of tissue cells that play a part in inflammation?
mast cells and macrophages
How does evaporation work to decrease temperature?
material must absorb energy to evaporate & change form from liquid to gas or vapor, original material temperature decreases
What is the most useful method of directly assessing the pharmacokinetics of a drug?
measuring the drug concentration in the plasma
What type of barrier is the first line of defense in the body?
mechanical barrier
If there are no bowel sounds in a certain area, and it is an area associated with pain, it could be a ______________________
medical concern
How serious is syringomyelia?
medical emergency!! requires surgical management ASAP
What general level of frequency with interferential decreases impendence at the skin?
medium deeper current flow
Where is the primary control center for breathing located in the brain?
medulla & pons
Define hyperpolarization
membrane potential becomes more negatvie -- inhibitory
Meniscal injuries tend to happen more as a result of ______, whereas patellar injuries tend to result more from ______
meniscal - joint trauma patellar - overuse
If a P wave is inverted in leads I, II or aVF, what might be going on?
might be abnormal or d/t improper lead placement
What are some systemic effects of inflammation?
mild fever malaise (feeling unwell) headache fatigue loss of appetite
What manual therapy may be helpful for someone w/ DDD?
mobilize hypomobile joints -Ex: central PA, rotations
If a channel opens in response to a mechanical force (stretch, touch or pressure), temperature or chemicals, what type of membrane channel is it?
modality-gated
What types of cells are categorized as agranulocytes that play a role in the inflammatory process?
monocytes and lymphocytes
Pts w/ SCI are (more/less) likely to experience osteoporosis than healthy adults
more (basically assume every pt w/ SCI has some level of osteoporosis because they're not WB)
PFPS is more common in _______ at a ___:___ ratio
more common in women 2:1 ratio
Is the development of a DVT more likely in the acute, chronic or both phases of recovery after a SCI?
more likely during acute (flaccidity) phase
If a transfer starts to go badly, is it likely that you will be able to recover?
no, you should bailout and re-set
Will a person with DDD have a positive SLR test?
no-- will be negative
Which type of pain is this: pain caused by stimulation of pain receptors by mechanical, chemical, or thermal stimuli and associated with ongoing tissue damage
nociceptive pain
Is the body's second line of defense specific or non-specific?
non-specific
Will a person with a disc herniation have neuro sx? (mostly extrusions & sequestration)
only if they have nerve root compression
A sucking wound is a type of ______________ pneumothorax
open
How does the vascularity of the menisci change throughout the structure?
outter 1/3 = highly vascular middle 1/3 = relatively vascular inner 1/3 = avascular (also probably affects whether the injury can be treated conservatively or surgically)
A fluctuation of 10 bpm (inc or dec) in HR during exercise may be:
overtraining
What are the 4 processes that are responsible for biotransformation? What is the end goal of these?
oxidation reduction hydrolysis conjugation to create a more polar compound to be excreted by kidneys
What are the therapeutic effects of IFC?
pain urinary incontinence blood flow/edema management spasm reduction
What is phantom limb pain?
painful sensation in body part that is no longer present -can be constant or intermittent -can be triggered by an external stimulus -characterized as either cramping, squeezing, shooting or burning pain
Name the amputation: resection of 3rd, 4th and/or 5th MT's and digits
partial foot/ray resection
What is the most common surgical approach for a meniscal tear?
partial meniscectomy and repair
What does PAIVM stand for?
passive accessory intervertebral movements
What does PPIVM stand for?
passive physiological intervertebral movements
What manual therapy could be utilized in the treatment of a ligamentous injury of the knee?
patellar mobilization
Clearance through an organ depends on the _____________ of the organ and on the ability of the organ to ____________ the drug from the blood.
perfusion extract
How is a meniscus injury defined?
peripheral or transverse tears on the meniscus fibrocartilaginous tissue due to abnormal shear forces
What are the two categories that the action of drugs can be split into?
pharmacokinetics pharmacodynamics
What things might cause inflammation? (4)
physical damage infection ischemia exposure to chemicals
What is the fetal position?
physiological flexion
Blood volume increase seen w/ training is primarily due to an increase in:
plasma, so there is a relative decrease in hematocrit RBC volume inc, but plasma inc is greater
Which fibers of the annulus fibrosis are thinner?
posterior fibers-- but they are tightly packed together to be able to withstand the stresses placed on them
Are posteromedial or posterolateral protrusions of the IV disc more common?
posterolateral
If someone adopts a protective scoliosis where they shift to the opposite side of their disc herniation, what kind of herniation do they likely have?
posterolateral
If someone adopts a protective scoliosis where they shift to the same side as their disc herniation, what kind of herniation do they likely have?
posteromedial
What are precautions for open-chain training after an ACL reconstruction?
-during PRE to strengthen hip musculature, initially place the resistance above the knee until knee control is established -avoid resistance, open-chain knee extension between 45-15 deg -Avoid applying resistance to the distal tibia during quadriceps strengthening
List some symptoms of emphysema
-dyspnea -hyperventilation w/ prolonged expiratory phase (barrel chest) -"pink puffers" (pink face color) -clubbed fingers -anorexia, fatigue, weight loss -secondary polycythemia (compensatory inc RBC)
What are symptoms of ARDS?
-dyspnea -restlessness -rapid, shallow breaths -inc HR -dec PO2 -combination of resp. & metabolic acidosis
Describe stage 1 TMJ dysfunction:
-early -disc is slightly anterior & medial to the mandibular condyle on occasion -inconsistent clicking -- disc displacement with reduction -painless clicking -*no restricted motion*
Management of HO:
-early detection is important so meds can be started! -continue w/ gentle ROM per MD orders, but don't do aggressive ROM, it may make it worse -can be removed via surgery, but it often comes back
What are indications of acute inflammation?
-early reaction -short duration (minutes to days) -neutrophils as main players -inflammation followed by repair
Describe stage 2 TMJ dysfunction:
-early/intermediate -disc is anterior & medial to the mandibular condyle more frequently -- clicking during reduction -inc episodes of limited mouth opening (or locking) -occasional painful clicking -occasional headaches
Management of hypo/hyperthermia:
-education -use of proper clothing (esp in winter) -avoid extreme temps
Which respiratory condition involves the destruction of alveolar walls and septae? This is due to the breakdown of what substance?
-emphysema -elastin (elastase breaks down elastin, have to inhibit this enzyme to stop the breakdown causing emphysema)
List some causes of *extreme* axis deviations (right or left): (5)
-emphysema -hyperkalemia -lead transposition -artificial cardiac pacing -ventricular tachycardia
How do you treat pneumoconiosis?
-end exposure to irritant -treat infection
What is a presynaptic terminal?
-end of an axon -releases ntm
In regards to primitive reflexes, when might you be concerned about the development of the neurological system of a child?
-if absent in the newborn -if present past 12 months
How may spinal deformities be managed?
-if caught early, proper positioning can prevent if from becoming worse (prone is the best position) -if flexible deformity, stretching w/ PROM, laying flat and/or prone will help -otherwise, has to be surgically corrected
How does training affect the capillaries around trained muscles?
-inc capillarization of trained muscles-- higher capillary to fiber ratio -greater opening of existing capillaries in trained muscles -more effective blood redistribution -inc blood volume
How can exercise training benefit a person w/ pulmonary disease?
-inc functional capacity -inc functional status -dec severity of dyspnea -inc quality of life
What are some things you should consider about when and where you perform a young child PT examination?
-time of day (naps) -parents' schedules -natural environment -naturalistic observation -comprehensive developmental assessment Last bullet: cognitive, motor, social, speech-language & adaptive skills in natural environment
Limitations of an oppositional UE prosthesis: (4)
-no active prehension (grip) -high cost if custom -durability -pt unrealistic expectations for cosmesis
Fair Opportunity Rule
-no person should receive goods & services on the basis of undeserved advantage -nor be denied stuff on the basis of undeserved disadvantage -collective choice forms the basis of morality
What prosthetic options exist for an UE amputee? (read)
-no prosthesis -oppositional prosthesis -body powered -externally powered -hybrid -activity specific -multiple prostheses
Is the damage due to chronic bronchitis reversible? What damage does it cause?
-no, damage is irreversible and progressive -inflammation, obstruction, & repeated infections
Criticisms of Kant:
-too rigid for real life -morality can't purely be derived from reason -conflict b/w 2 duties of equal importance results in an impasse -disregards consequences -- bad results
How do you treat bronchiectasis?
-treat primary condition -antibiotics -bronchodilators -chest PT
How do you treat ARDS?
-treat underlying cause -supportive resp. therapy
How does 1. light exercise 2. exercise up to 70-80% of peak exercise and 3. exercise past 80% of peak exercise affect your respiratory rate (RR) and tidal volume (TV)?
1. inc TV & RR 2. inc TV & RR 3. mainly inc RR
How does training in healthy, older adults affect the following: 1. VO2 max 2. BMD 3. body weight 4. % fat 5. insulin sensitivity 6. cholesterol 7. strength
1. increases it 10-40% -dec BP & HR 2. increases it 3. decreases it 4. decreases it 5. increases it 6. decreases it 7. increases it
What lung changes occur with chronic bronchitis? (4) -mucosa, glands, etc.
1. inflamed/swollen mucosa 2. hypertrophy of mucous glands--*inc mucous secretions* 3. fibrosis, thickening of bronchial wall -- obstruction 4. low O2 levels-- cyanosis
What are the 3 phases of healing?
1. inflammation phase 2. proliferation phase 3. maturation phase
The breakdown of alveolar walls in emphysema results in what effects? (4)
1. loss of elastic fibers (affects recoil) 2. loss of surface area for gas exchange 3. loss of pulmonary capillaries (affects ventilation-perfusion ratio) 4. dec support for other structures (small bronchi may collapse)
List the suprahyoid muscles (4)
1. mylohyoid 2. geniohyoid 3. stylohyoid 4. digastric: ant & post belly
What are the 3 types of electric potentials?
1. resting membrane potential 2. local potential 3. action potential
What are some factors that influence the rate of absorption? (4)
1. route of administration 2. dosage forms 3. circulation at the sight of absorption 4. concentration of the drug
You should also look for red flags in other developmental domains if you work with children. What are some examples of these domains? (4)
1. social-emotional 2. cognitive 3. fine motor 4. communication/language
Options to approach a whistleblowing situation
1. stave off a developing problem by "nipping it in the bud" 2. do nothing-- may be appropriate if more info is needed 3. remove the individual from the position, so they can't do further harm 4. blow the whistle
What are the 6 key areas of emphasis in prosthetic gait training?
1. step width 2. step length 3. toe loading 4. knee flexion 5. pelvic rotation 6. trunk rotation
List some causes of Right Axis Deviation: (6)
-normal in kids or tall, thin adults -R ventricle hypertrophy -chronic lung disease -anterolateral MI -L posterior hemi-block -pulmonary embolus no electrical activity in dead tissue (MI) or blocked bundle branches (hemi-block), inc activity if inc tissue (hypertrophy)
Describe the ideal prosthesis patient for a disc replacement after surgical tx for cervical myelopathy: (7)
-normal sagittal alignment -compression at disc level only -no posterior compression -no axial neck pain -primary operation: single level, unilateral radiculopathy -non-smoker -*negative Spurling Test*
On the exaxial system (pie chart), between what axes is considered a normal, right deviation or left deviation axis of the heart?
-normal: +90 to -30 (green) -R dev: more pos than +90 (blue) -L dev: more neg than -30 (red) -indeterminate: rare (black)
What ligamentous injuries of the knee may be treated conservatively?
-partial and isolated ruptures for all ligaments
What AD may be used to help treat PFPS?
-patellar taping -brace -insoles
Management of shoulder injuries/CTS in pts w/ SCI
-proper WC and work station set up -use of power chair when stress is too much on shoulders/wrists -surgical repair is an option but this makes the pt totally dependent for a while in recovery
Why is proteoglycan & collagen content of discs important?
-proteoglycans: water retention -collagen: viscosity of disc
What are the 4 functions of glial cells? (macroglia & microglia)
-provide structure -transmit info -help w/ neural development -repair following brain damage
What do you need to consider when selecting a WC for a SCI patient?
-pt functional level -ability to perform pressure relief independently -the type of terrain the pt will be on -amt of time person will be in WC -transfer techniques -will the pt be loading the WC into the car themselves/the weight of the WC -positioning desired -accessibility at home/destinations -# of caregivers -pt preference of style
What are some activities to work on with an amputee to improve bed mobility?
-push ups w/ arms -sitting forward -move up/down in bed -roll from one side to other -bridging
What is a postsynaptic terminal?
-receiving cell -contains receptors -could be a gland, muscle cell or another neuron
Percussion can be done with what 2 objects?
-reflex hammer -tapping fingertips
When is alpha1-antitrypsin released?
-released by neutrophils during inflammation -released by some pathogenic bacteria
What do people w/ disc degeneration often have a history of?
-repeated microtrauma to annular fibers -one significant trauma to disc -bone spur formation
How can you treat acute respiratory failure?
-resolve the primary problem -supportive treatment
Strengths of Human Rights
-rights of person trump overall consequences -allows victim's viewpoint to be the focus -widely understood & accepted internationally -provides a moral framework for law
If a pt is a paraplegic and a new WC user, what type of WC is usually more energy efficient?
-rigid frame -usually able to manage a manual WC
Anaerobic Threshold
-rise in CO2, disproportionate to rise in O2 -indicates the level of exercise where energy can no longer be solely supplied by aerobic metabolism
Examples of WC skills that pts w/ SCI in a WC need to learn (read)
-roll forward/backward -turns in place -pick up object from floor -gets over gap/threshold -stationary wheelie -descends stairs etc... these are just a few
Ross revised Kant
-said everyday rules are prima facie duties -genuine duties sometimes have exceptions when in conflict w/ others having greater importance
What is the purpose of a temporary prosthesis?
-shapes residual limb -early gait training & independence -*endurance training* -prevents contracture
What bacteria can cause bronchiectasis?
-streptococci -staphylococci -pneumococci -influenzae
Describe proper residual limb positioning in supine, prone and sitting:
-supine: knee extension, hip adduction -prone: hip & knee extension -sitting: knee extension neutral hip rotation for all 3 of these
Presentation of DVT:
-swollen calf or LE -warm to touch -painful if pt has sensation -may present like HO
What are some common treatments for TMJ dysfunction? (9)
-therapeutic exercise - postural correction -biofeedback/relaxation techniques -manual therapy -modalities -behavior modification & stress management -pharmacotherapy -injections -occlusal therapy (tooth/jaw alterations) -splinting
List some symptoms of chronic bronchitis?
-thick, purulent secretions -constant, productive cough -dyspnea -hypoxia -cyanosis (blue bloater) -hypercapnia -fatigue, weight loss
What is the function of the fallopian tubes?
1. to catch & transport an ovulated egg from ovary to uterus 2. it is the site of fertilization 3. provides nourishment for developing zygote for about 3-4 days
What are the 3 functions of the IV disc?
1. transmit load from one v. body to the next 2. allow movement b/w v. bodies 3. maybe proprioception
When does an ejaculate re-liquefy?
10-60 minutes later
How long does it take to build a human oocyte?
100-110 days 4 cycles
What percentage of sperm are considered normal?
15% or 40-50% Less than half
ACE wraps must be re-wrapped every __ to __ hours
4-6 hours
The 30 day mortality rate following a major leg amputation is as high as ___ % 5 year mortality rate is as high as ___ %
40% 70% (other lecture said 80%)
After an amputation, skin integrity and pressure tolerance is only ___ % of normal on the residual limb
40% important to keep in mind for massage
How many main types of collagen do we need to know?
5 (types 1, 2, 9, 10, and 11)
What is the ideal amount of pelvic rotation in prosthetic gait training? How should you work on this with the pt?
5 deg exercises for rhythmic pelvic rotations & figure 8 walking
How many groups of lymph nodes are there in the axilla and what are they?
5 groups: apical, central, humeral, pectoral, and subscapular groups
How does a SCI itself at level T8 and above affect the integrity of the skin? On top of these changes, what other factors put SCI patients at a high risk for decubitus ulcers?
*Physiologic Changes of Skin*: -thinning of the epithelial layer -changes to the collagen -hyperhidrosis *Other Factors*: -impaired sensation -physiologic changes ^^ -inability to perform pressure relief -moisture control issues d/t incontinence & sweating
How would you teach a SCI patient to perform the bed mobility tasks of rolling & supine to sit?
*Rolling*: -use of bed rails/devices/objects to grab -use of momentum (punch across body) *Supine to sit*: -onto elbows first, work to extend arms -roll to sidelying, hook LEs, push up from sidelying
What are the different types of post-op dressings after an amputation? (read)
-IPOP (rigid) -rigid removable -semi-rigid -soft
Management of DVT:
-IVC filter (inf vena cava) -sequential compression device (SCD) -medications -mobility -spasticity management
Limitations of hybrid UE prosthesis: (2) (didn't cover this in class)
-Less pinch if cable controlled terminal device -Difficult to lift battery-powered TD
What is the R wave progression in the precordial leads?
-QRS starts off primarily negative (rS) in V1 -gradually becomes primarily positive (qRs) -tallest R waves are in V5 or V6 -usually the R wave in V6 is smaller than V5
What special tests can be done to tests for a disc herniation? (mostly extrusions & sequestration)
-SLR +/- -Slump +/- -Distraction: dec pain?
Benefits of a hybrid UE prosthesis: (2) (didn't cover this in class)
-Simultaneous control of elbow & terminal device -Light weight (vs. all electric) -More grip strength (vs. body powered system)
What's the difference between transudative and exudative pleural effusions?
-T: watery effusion (hydrothorax, inc hydrostatic or dec osmotic pressures) -E: contain proteins & WBC (response to inflammation)
What types of summation can occur of *local* potentials?
-Temporal: one pre-syn neuron releases ntm many times w/in a time period -Spatial: many pre-syn neurons release ntm at the same time
Symptoms: cervical myelopathy
-UE or LE weakness -bowel & bladder dysfunction -gait disturbance
What should you focus on in rehab after CS surgery in the acute phase? (3)
-bed mobility -ambulation -stairs (FYI: be aware that when descending stairs, a brace may block their vision)
What is a resting membrane potential?
-diff in charge across a cell membrane at rest -*no net flow of ions* across it -capable of being excited so the membrane maintains an unequal distribution of ions across it
What is cor pulmonale?
-disease of lungs that causes R sided heart enlargement -can be caused by COPD
Exercise precautions for the advanced rehab stage after a meniscal repair (read):
-do NOT perform exercises that involve deep squatting, lunging, twisting or pivoting for at least 4-6 mo -do NOT begin jogging or running program until 5-6 mo
What causes the rise in CO2 upon reaching anaerobic threshold?
due to inc in anaerobic metabolism which yields lactic acid (lactic acid is buffered by bicarbonate which yields CO2 and H20)
During an AP, when Na+ ch. open, why does the Na+ rapidly flow into the cell?
due to the... -Na+ concentration gradient -+ charge attracted to - charge
During an AP, when the K+ ch. open, why does the K+ leave the cell?
due to the.... -+ charge repelled by new + ions -K+ concentration gradient
Which type of pain is this: pain that doesn't serve a protective function such as persistent, spreading, worsening, unpredictble pain, pain w/ small movements, or pain w/out a cause
dysfunctional pain
What role does bradykinin play in the inflammatory process?
elicits vasodilation, increases capillary permeability, causes pain by irritating nerve endings, stimulates chemotaxis (WBC to go to site of injury)
What is the general structure of collagen types I-III?
elongated fibril
The patella is embedded in the __________ and connected to the tibia by the ___________
embedded in the joint capsule connected by the patellar tendon
Clubbed fingers, barrel chest and "pink puffer" face are symptoms of what respiratory condition?
emphysema
The decision to use a wheelchair or not after an amputation is largely based on what?
energy cost of ambulation
Emphysema can lead to progressive difficulty of inspiration or expiration?
expiration
When the pressure in the alveoli is higher than in the atmosphere, what happens?
expiration
What education should be provided to someone w/ DDD?
explain... -the condition -positioning for relief/ADL's -proper body mechanics -lifestyle changes
People with asthma often have a ____________ history of allergic conditions.
family
How does gender affect VO2 max?
females have a lower VO2 max
In closed chain movement of the knee, arthrokinematics involve _____-on-______ extension
femoral-on-tibial
What is the function of endothelial cells in tissue regeneration?
fill wound cavity, promote angiogenesis
Changes in the resting membrane potential (ex: depol/hyperpol) result from a flow of ions through __________ channels
gated
What is in a patient profile?
general info: age, sex, ethnic group
What stimulates tissue regeneration to happen?
growth factors stimulate local cells to divide -endothelial cells proliferate and granulation tissue appears
How does tightness of the hamstrings and tightness of the calf contribute to PFPS?
hamstrings flex the knee, tight hamstrings place more posterior force on the knee causing pressure between the patella and femur to increase (calf basically works the same way)
Name the amputation: amputation of both LEs and pelvis below L4-5
hemicorporectomy
What can increased flexion forces on the spine coupled with a weakened annulus fibrosis cause?
herniated nucleus pulposus (flexion-related injury)
Air always moves from an area of __________ pressure to an area of ___________ pressure
high to low
Gas exchange across a tissue occurs from ___________ partial pressure to ___________ partial pressure options: low, high
high to low
Define hypertonicity:
high tone-- rigidity, spasticity, clonus inc resistance to stretch compared to normal muscles
When is the flexion moment arm for the knee at its highest (during OKC), resulting in increased patellar and quad tendon tension and increasing PJRF?
highest at 0 deg flexion (lowest at 90)
How does excess H+ affect the muscles?
impairs muscle contractility & ATP formation
Why is the superior thoracic artery not really needed?
It anastomoses with the intercostal arteries. Since the intercostals are already there, you could live without the superior thoracic artery
What is the shape of the axilla?
It is a pyramidal shape with one apex (top), one base (bottom), and four walls
Are amputations due to cancer usually in the UEs or LEs?
LEs
Practice determining an axis deviation from this EKG:
LL1: positive aVF: negative left axis deviation
EKG item: always the last downward deflection of the QRS complex
S wave
Cause: cervical myelopathy
SC compression
What are central lines?
Medicine given in large veins to avoid deterioration of the vein's endothelial lining often inject into R. int. jugular V. to get to the SVC quickly
What are the 3 regions of the broad ligament?
Mesometrium: main part Mesosalpinx Mesovarium
What is the function of spongy bone?
Metabolic activity Highly vascular
Which primitive reflex does Mildred recommend testing last and why?
Moro Reflex-- because child typically cries
What are the 4 types of tissue?
Muscle Nerve Epithelial Connective*
What are all of the triangles of the neck formed by?
Muscles
What can PT's palpate?
Muscles, joints, bony landmarks, ligaments, tendons, deformities, lymph nodes, arteries, nerves
Do seminal vesicles store sperm?
No, this is a misnomer
Is the first line of defense specific or non-specific? What does this mean?
Non-specific, does not distinguish between harmful or not harmful stressor
What are the cervical branches of the internal carotid A that are of importance?
None
Which glands are within the vagina itself?
None
Hard End-Feel (normal and abnormal)
Normal: limited by bony contact. feels like no give or bounce Abnormal: as before, feels like bony contact but due to fractures or loose bodies
What do oximeters measure?
O2 saturation in blood
If you compare the Q between a sedentary and trained individual, the greatest differences would be seen where?
SV
Which muscle of the neck passes through a tendinous sheath similar to a pulley and passes through both anterior and posterior triagnles?
Omohyoid
Sensation Definition
One's ability to sense, interpret, and discriminate among incoming sensory information
___________ is an important factor in determining individual differences in VO2 max
SV
Where is the paravesical fossa?
Only present when the bladder is distended, it is on each side of the bladder
What cells of bones are on the bony surface and highly mobile?
Osteoblasts Osteoclasts
What type of cells are in bones?
Osteoblasts - form bone Osteoclasts - reabsorb bone Osteocytes (90%) Bone lining cells
Which blood vessels supply blood to the uterus?
Ovarian A Uterine A Vaginal branch of uterine A
What is the odor of an ejaculate due to?
Oxidation of spermine from the prostate
Fun Fact: what's considered unmyelinated in the (CNS/PNS) is actually still somewhat myelinated-- it's just not completely surrounded by myelin
PNS
When should you initiate transfer training after an amputation?
POD #1 if pt is medically stable
EKG item: from the beginning of the P wave to the beginning of the QRS complex
PR interval (interval: includes a wave)
Which part of an EKG represents atrial depolarization plus the normal delay at the AV node? What is the purpose of this delay?
PR interval to optimize ventricular filling
EKG item: from the end of the P wave to the beginning of the QRS complex
PR segment (segment: doesn't include a wave)
Is the PR segment or interval isoelectric?
PR segment (means it's flat)
Should AROM or PROM be a bigger ROM?
PROM
What can be used as a marker to monitor for potential metases following surgical removal?
PSA (prostate specific antigen) recently criticized
Which portion of the ANS mediates an erection?
Parasympathetic
What is PFPS?
Patellofemoral Pain Syndrome retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. Multifactorial causes such as overload different biomechanical problems (pes planus and Q angle)
Anterior Wall of Axilla
Pectoralis major and minor
Increases in plasma volume seen w/ training are highly associated w/ changes in: (2)
SV & VO2 max
Which type of macroglial cell are the only macroglial cells in the PNS?
Schwann Cells
What are the two processes that make up the second line of defense?
Phagocytosis and Inflammation
Cardiac Output calculation**
Q = SV * HR
What is the rectouterine pouch between?
Rectum & uterus
What is the function of compact bone?
Resists torsion & bending
What is a vasovasostomy?
Reversal of a vasectomy Sperm may reappear in the ejaculate, but pregnancy rate are lower due to antisperm antibodies
What allows the vagina to rapidly lengthen?
Rugae: horizontal ridges
What is phantom limb sensation?
the sensation that an amputated limb is still present
A lateral shift is named in the direction of:
the shoulders' displacement relative to the hips
Define pharmacokinetics
the study of factors that are involved in getting the drug to its target in the body and how the drug is discarded (defined also as the mechanisms and regulatory processes that determine how drugs are transported throughout the body)
How do monocytes play a role in the inflammatory process?
they enter the tissues and become macrophages which act as phagocytes
What is a surgical consideration for *dysvascular* amputee patients?
they often present w/ comorbidities, neuropathy, vascular compromise, infection or osteomyelitis
How do neutrophils play a role in the inflammatory process?
they participate in phagocytosis
How does the thickness of the respiratory membrane affect gas exchange?
thicker membrane decreases gas exchange
Which modality may be helpful for someone w/ DDD?
traction-- unloads disc
Name the amputation: amputation of hand w/ preservation of wrist
transcarpal
Name the amputation: amputation through humerus
transhumeral
Of the pediatric amputations that are acquired, what is the most common cause? Are they usually UE or LE? What % are unilateral?
trauma LE 90% are unilateral
Which types of amputations more commonly experience phantom limb pain or sensation?
traumatic or later in life less common in congenital
Meta-ethics
tries to discover the nature & meaning of ethical reasoning -Absolutist Theories -Relativist Theories
What disease can survive in dried sputum for weeks?
tuberculosis
What causes compression atelectasis?
tumor exerts pressure on part of the lung
What is the MOI for a meniscal injury?
turn or twist or changing direction when weight bearing, but they can occur from the contact of the lateral or medial aspect of the knee while LE is planted
Are amputations more common in men or women?
twice as common in men
T wave
ventricular repolarization
RER caculation
volume of CO2 expired / volume of O2 inhaled VCO2 / VO2
What demarcates the top of the danger/careful zone?
Spinal accessory N
List the nerves of the posterior triangle of the neck.
Spinal accessory: SCM & traps Lesser occipital N Greater auricular N Transverse cervical N Supraclavicular NN
What is the most common risk factor for cancer?
Stacia: previous history of cancer Irina: age
What does AROM indicate?
Status of inert tissue, muscle's contractile ability against gravity, patient's ability or willingness to move
Which one of the anterior triangles of the neck is not paired?
Submental triangle
What does the subscapular artery supply?
Subscapularis, teres major, serratus anterior, and latissimus dorsi
What is the function of the suprahyoid and infrahyoid muscles?
Supra: pull the hyoid and larynx up Infra: pull the hyoid down
What is a hysterectomy?
Surgical removal of the uterus
What is the carotid sheath?
Surrounds common carotid A, vagus N, and internal jugular V Arrangement*: carotid A is medial and posterior, vagus N is posterior, and internal jugular V is lateral and external
What is pretracheal fascia?
Surrounds trachea, esophagus, and thyroid gland
What is the prevertebral fascia?
Surrounds vertebral column and deep neck muscles
Which portion of the ANS mediates emission?
Sympathetic
Which portion of the ANS mediates the vas deferens?
Sympathetic
Which part of an EKG represents the time when the ventricles are repolarizing?
T wave (& maybe ST segment)
What is torticollis caused by?
Tearing of SCM during birth Congenital
What is the jugular venous arch the site of?
Tends to connect the anterior jugular veins together fairly complicated anastomosis
Hyperventilation
inc in ventilation that *exceeds* the metabolic need for O2
What is in the ground substance/ECM of CT?
Water - resists compression Glycosaminoglycans (GAG) Proteoglycans
If we double the radius of a blood vessel, then the volume of blood flow through it will:
increase 16 fold
What are some changes in the blood that happen with inflammation? (6)
increase in WBC, altered proportion of WBC, increased amount of fibrinogen (plasma proteins), appearance of C-reactive proteins, increased sedemination rate, release of cell enzymes
How does vasodilation contribute to inflammation?
increased vasodilation allows more fluid to exit the capillary beds, and allows larger proteins to exit blood including leukocytes which then attract other molecules and produce macrophages and contribute to phagocytosis
What are 3 characteristics of patellar positioning that are common in patients who have PFPS?
increased: -lateral shift -lateral spin -lateral tilt
How does training affect maximal Q?
increases it
How does pleural effusion affect the pressure in the pleural cavity?
increases it -separation of pleural membranes, dec cohesion during inspiration
How does altitude affect HR?
increases it -- trying to make up for the dec O2 in the air
When atmospheric pressure is higher than the pressure in the alveoli, what happens?
inspiration
As the knee flexes, the patella enters the ________
intercondylar groove
The patella articulates with the __________ groove on the anterior aspect of the distal portion of the femur
intercondylar groove
Where is the interference at with a quadripolar (crossing) method of delivery?
interference at level of TREATMENT AREA
Interferential current is ________ modulated, whereas russian is ________ modulated
interferential - amplitude modulated russian - time modulated
What types of proteins do cytokines include?
interleukins lymphokines chemokines interferons
Why is imaging normally done for someone w/ a disc herniation?
just confirms the herniation
The ________ are the primary site for drug excretion.
kidneys
What structure(s) regulate BP at rest or long-term?
kidneys via fluid balance
Name the amputation: amputation through knee with intact femur
knee disarticulation
The annulus fibrosis is arranged in sheets called _____________ that are in ___________ rings
lamellae concentric
What is used b/w the residual limb and prosthetic socket?
limb sock
Which of the collateral ligaments is part of the joint capsule and medial meniscus?
medial collateral ligament "blends with the connective tissue of the knee joint capsule and medial meniscus along the path from the femur to the tibia"
What is the role of interferons in inflammation?
mediator of inflammation that is produced by leukocytes to prevent virus replication
How does phagocytosis work in the second line of defense?
neutrophils and macrophages serve to engulf and destroy bacteria, cell debris and foreign objects
Is a drug chemically altered in the absorption stage?
no
Is the damage done by COPD reversible?
no, irreversible lung damage
Can cell-mediated immunity protect you from TB?
no, normal neutrophil response does not occur
Is pulmonary ventilation a limiting factor for performance?
no, not even during a max effort
What respiratory condition involves the presence of excessive fluid in the pleural cavity?
pleural effusion
What respiratory condition involves air in the pleural cavity?
pneumothorax (leads to atelectasis)
A P wave that is taller than 3 mm is called a:
pointy P wave-- may indicate atrial hypertrophy
Biotransformation may help in excretion because it can create a more _________ compound that is more easily excreted by the kidneys
polar
If a wheelchair has an adjustable axel, how should you position it?
position it so their shoulder is over the axel or wherever the pt feels stable & confident
The PCL guides the _______ sliding movement of femoral condyles
posterior
What does a constant dosage delivery of IFC mean?
preset beat freq or set by user
What does a sweep dosage delivery of IFC mean?
preset beat frequency range
During which stage of TB is the person asymptomatic and can't transmit the disease?
primary stage
When are limb shrinkers used by an amputee?
prior to prosthetic fitting and wearing worn 24 hrs/day
How do lymphocytes play a role in the inflammatory process?
produce cytokines
What happens in the body's third line of defense? Is this specific or non-specific?
production of specific antibodies, cell-mediated immunity, this is a specific response
How is using the Nustep beneficial as a part of rehab for pts w/ SCI?
progressive aerobic exercise in chronic incomplete SCI has been shown to inc fitness & walking related outcomes
Ejection Fraction definition
proportion of blood pumped out of the L ventricle per beat
Which method of delivery for IFC may be used for a large treatment field?
quadripolar with vector scan
What is the best way to strengthen back extensors for someone w/ DDD?
quadruped reciprocals
Is cervical radiculopathy or myelopathy much more common?
radiculopathy
What diagnostic test can evaluate tumors and infections (such as pneumonia or TB)?
radiography (helps determine drug approach)
Neurotransmitters must bind to a ____________ to have an effect
receptor
Bronchiectasis arises from _____________ inflammation and infection.
recurrent
Which nerve innervates the disc at its level and the level above? Which 3 structures of the disc does it specifically innervate?
recurrent sinuvertebral N -outer 1/3 of annulus at level & level above -PLL -dura matter
In healthy people, what is the body's response to an increase in sheer stress on a blood vessel wall?
release nitric oxide -- (vasodilator)
How does training affect maximal BP?
remains unchanged
Surgical Treatment: cervical myelopathy
remove v body & disc (sometimes/always? follow up with a disc replacement)
What are the types of healing?
resolution (minimal tissue damage) regeneration (damaged cells replaced - cell reproduction a must) replacement (functional tissue replaced by scar tissue)
What are some things that serve as a first line of defense that are fluids?
saliva, tears, gastric juices, sweat glands
Once an AP is initiated, it is propagated along the entire length of an axon via:
saltatory conduction at Nodes of Ranvier
Is amputation or salvage more psychologically acceptable?
salvage
What is unconscious sensation?
sensory info that is processed at the SC or brain stem level (we don't process info like the sensation of the clothes we're wearing all the time)
Extrusions & _____________ herniations are likely to impinge on nerve tissues
sequestrations
Name the amputation: amputation through shoulder joint
shoulder disarticulation
If a pt w/ SCI has tight hamstrings, is it better to stretch them in long sitting or supine?
supine-- you are more likely to stretch their back extensors in long sitting, we want them to have a "tight" (not elongated) back for things like transfers
The inner surface of alveoli is covered by _________________ .
surfactant
What substance is spread as a thin film at the air-liquid interface in the lungs?
surfactant
How does a flexion-related injury of the spine occur?
sustained or repetitive lifting or bending
What is a simple or spontaneous pneumothorax?
tear on the surface of the lung
What patient population are intra-spongy herniations most common in?
teen boys-- end plates are still forming
How does salpingitis affect fertility?
With each episode, there is a reduction in fertility Damaged oviducts increases the risk of ectopic pregnancy also
Where is the ejaculatory duct formed?
Within the prostate Prostate secretes some stuff into the ejaculate here
Do you still need to inspect the skin if a pt is wearing a limb shrinker?
YES
What happens in a simple reflex response?
You tap the tendon which stretches the muscle, the muscle spindles feel the stretch, sensory fibers send the signal to the spinal cord, a motor neuron tells the muscle to contract
Most amputations (85%) in people with diabetes are preceded by:
a foot ulcer
What is active transport?
a process in which the solute crosses the membrane against a concentration gradient and requires ATP (this is not very common)
What is something you should look for biomechanically when a patient is squatting to help determine if they have PFPS or patellar tracking issues?
a valgus angle of the knee when squatting
What are vertebral end plates?
a very thin sheet of cartilage separating the v. bodies from the IV disc
What is "volume of distribution"?
abbreviated Vd, describes the distribution of a drug within the body. Can be calculated by : Vd=amt of drug administered/concentration of drug in plasma
Contractility definition
ability of the heart to pump blood out of the heart ****can double w/ exertion
What are the two categories of inflammation?
acute or chronic
Which type of pain is this: a direct result of actual or potential tissue injury due to a wound, disease process, or invasive procedure
acute pain
Is heterotrophic ossification (HO) a problem in the acute, chronic or both phases of recovery for a SCI patient?
acute-- mainly a problem within the 1st year
Amputation rates increase with ________
age
Where is type III collagen found?
alongside type I in less amounts (skin, tendon, bone)
Large, diagnostic Q waves represent ________ electrical activity in the myocardium
altered (Ex: if Q wave is deeper than 1/3 of QRS complex, could indicate MI)
Is the lifetime cost of an amputation or salvage of a limb higher?
amputation is up to 3x higher
What special consideration should you keep in mind with UE amputees and going out in public?
amputation is visually more apparent- they can't hide their amputation like a LE amputee can
What is spinal shock?
applies to all phenomena surrounding physiologic or anatomical transection of the SC that results in temporary loss or depression of all/most spinal reflex activity below the level of injury-- causes flaccidity initially after injury
_________________ is an aid to existing theories or other approaches
approach
What are the AMPRO and AMPnoPRO tests?
assesses *ambulatory potential* with (AMPRO) and without (AMPnoPRO) a prosthesis -good correlation w/ 6 minute walk test -distinguishes b/w functional (K) levels
What is the CHAMP test? What population is it commonly used for?
assesses progress towards *high level mobility* commonly used for military service members
When is the Apgar Test administered?
at 1 min and 5 min after delivery
What is a normal Apgar Score?
at 1 min, a score of 8-10 is normal 0-3 at 1 or 5 min indicates an increased risk of death (each of the 5 items are rated from 0-2 with a max score of 10)
Patients with hepatitis or cirrhosis of the liver will have an altered rate of _________________, how will this change?
biotransformation (decreased) -will result in more of the active drug in the bloodstream
What are the 5 different methods of delivery for IFC?
bipolar quadripolar (crossing) dual, bipolar stereodynamic method quadripolar with vector scan
PO2 and PCO2 are the partial pressures of oxygen and carbon dioxide in ___________ .
blood
What are the main players of inflammation?
blood cells (WBC), tissues and chemical mediators
What is an embolus?
blood clot or mass that obstructs an artery or it's branch
What two factors are considered when calculating clearance?
blood flow and extraction ratio
Teleological Theories: rightness & wrongness is judged based on ______________
consequences this means it is goal-driven***
Myelopathy is another name for what spine condition?
cord compression/dysfunction
Peripheral Vascular Disease is often associated with which conditions?
diabetes and smoking
Name the amputation: disarticulation at MCP joint
digit disarticulation
How is VO2 max measured?
direct or indirect calorimetry
What is the difference between extrinsic and intrinsic asthma?
-*extrinsic*: acute episodes triggered by type 1 hypersensitivity rxn to an allergen -*intrinsic*: hyperresponsive tissue in airway initiates an attack. stimuli include: stress, cold, exercise, drugs, etc.
What causes bacterial pneumonia? What about viral pneumonia?
-B: resident bacteria spreading along mucosa -V: direct virus
When is a granuloma formed? What is it made of?
-formed if cell-mediated immunity is adequate in the primary stage of TB -bacteria is walled off by CT -has a necrotic center -tubercle forms and calcifies -calcified tubercle microbes can remain viable in a dormant stage for *years*
What 3 pH imbalances can take place due to asthma?
-hypoxia leads to... -initially: respiratory alkalosis due to hyperventilation -then: respiratory acidosis due to dec ventilation -then: metabolic acidosis due to dec in metabolism and inc in lactic acid -finally: respiratory failure
How do you diagnose primary stage TB?
-indicated by a positive tuberculin (skin) test results -*type 4* hypersensitivity because it is cell-mediated -could also look for calcification on an x-ray
What are some risks associated with having pneumonia?
-inflammation of lungs -defense mechanisms, such as cilia, are reduced
What is surface tension (of water)?
-interactions of water molecules on the surface -each individual force isn't very strong, but the sum of the forces is very strong
What are some examples of lower respiratory tract infections?
-pneumonia -tuberculosis
What is the function of surfactant?
-prevents collapse of alveolus during expiration -reduces the effort to expand the lungs during inspiration (by reducing surface tension)
What are the 2 stages of TB?
-primary: 1st exposure -secondary: infection
What conditions involve reduced surfactant levels?
-pulmonary edema -lung injury -genetic diseases that cause mutations controlling surfactant production
What is the purpose of taking sputum samples?
-testing for presence of pathogens -determine antimicrobial sensitivity of pathogen
How does the ventilation-perfusion ratio affect gas exchange?
-ventilation (air flow) -perfusion (blood flow) ventilation & perfusion need to match for max gas exchange
What factors affect the diffusion of gases during gas exchange between alveoli and capillaries?
1. partial pressure of gases 2. thickness of respiratory membrane 3. total surface area available for diffusion 4. ventilation-perfusion ratio
Frequent attacks of acute asthma may lead to what condition?
COPD
What structure of the respiratory system is defined as: clusters of alveoli open to communicate with each other?
alveolar sacs
What is the end point for inspired air in the respiratory system?
alveoli
What structure of the respiratory system is the site of gas exchange with capillaries?
an alveolar wall comes in close proximity with a capillary wall
The normal partial pressure of CO2 is 35-45 mm Hg. A PCO2 of 60 is considered what condition?
hypercapnia (resp. distress)
What is pneumonia?
inflammation in lungs due to infection
The ____________________ of a gas reflects the relative concentration of this gas in the mixture of gases.
partial pressure
List the 6 divisions of the bronchial tree in order
primary bronchi --> secondary bronchi --> bronchioles --> alveolar ducts --> alveolar sacs --> alceoli
What structure of the respiratory system has: elastic tissue, smooth muscle cells, & C-shaped rings of cartilage
trachea
What type of hypersensitivity is asthma?
type 1 -occurs in people with hypersensitive or hyperresponsive airways
What structures are involved with an "unhappy triad?
ACL MCL medial meniscus
Which type of amputation requires a waist belt for a limb shrinker?
AKA
The external jugular V pierces the which of the neck fascial planes?
Investing fascia
Which type of pain is this: pain not resolved within 3-6 months
chronic pain
What does the subscapular artery branch into?
Circumflex scapular artery and thoracodorsal artery
Indications for imaging of the cervical spine:
-neuro deficits (otherwise, don't really need imaging?)
Sedentary individuals may decrease resting HR by _____ # bpm/week
1 bpm/week
Do braces help with PFPS?
"efficacy is still in debate"
What is a total meniscectomy?
"just when the meniscus is totally removed" casual...
What controls the level for beat frequency?
"select beat frequency to correspond to desired effect over treatment area"
(review documentation chart to know the language, abbreviations, goals, justification of services, time frames for re-examination, daily note format & discharge process)
(last slide)
Why do higher intensities of exercise elicit a higher cardiac output?
(question is directly off the slide 22, but don't have answer in notes -- if anyone has the answer to this, feel free to text me!)
What goes in the pediatric PT evaluation?
(same as adult) -identify strengths -identify barriers to mvmt/fxn -prioritize mvmt problems -hypothesize relationship of each of these factors to activity/participation limitations -develop goals (include child/family) -develop intervention plan
Karvonen Formula
(training range % (max HR - resting HR)) + resting HR
Advantages & Disadvantages: posterior surgical approach in CS
*Advantages*: -better access to lateral herniations -safer for bone spurs involving spinal column -avoids fusion *Disadvantages*: -w/out fusion there is continued disc collapse & pressure -disc may re-herniate -more technically difficult
What is the difference between bipolar and unipolar EKG leads?
*Bipolar*: positive & negative electrode placed on the body & EKG machine records the difference in electrical potential between them, will be an upward deflection on EKG if electrical impulses are moving towards the positive electrode *Unipolar*: one electrode placed on the body and the EKG machine sets a direction as positive and everywhere else is negative
What are some other methods to achieve pressure relief with an SCI patient other than using a WC?
*Forward Lean*: make sure they get space b/w their ischial tubes & the chair *Lateral Lean*: again, make sure they clear their ischial tubes
What does the thoracoacromial artery branch into?
Clavicular artery Pectoral artery Deltoid artery Acromial artery
List of things biophysical agents are intended to assist with: (read)
-*dec* unwanted muscular activity, pain, edema, inflam, CT restriction from injury -*inc* muscle force generation, rate of healing of open wounds & soft tissue, circulation, joint mobility, muscle performance, neuromuscular performance, tissue perfusion, remodel scar tissue, improve skin conditions -*maintain* strength after injury or surgery
What are things that may help a pt w/ SCI achieve a BM? (5)
-*positioning*: use gravity -*equipment*: may take them 20 min, have to have equipment to assist with pressure relief -*digital stimulation*: caregiver inserts a digit into rectum to try to stimulate the muscles by "going around" -*abdominal massage*: rub from one end of colon to the other to promote emptying -*valsalva maneuver*: bearing down
What are some things to keep in mind when selecting a transfer technique? (read)
-WB restrictions -side preferences -body habits -skin integrity -equipment availability -environmental limitations -pt strength, sensory awareness, balance, ability to follow commands
If a pt w/ SCI does not have a good bowel program, what are some things they might experience? (4)
-bowel does not respond well to program -bowel empties too often -*obstruction*: feces are impacted w/ diarrhea passing around obstruction -*ileus*: obstruction that causes absent/dec bowel sounds and no stool passing, can cause abdominal distension & impair diaphragmatic breathing
What AD could be utilized in the treatment of a meniscal injury?
-brace in acute/subacute phase limiting flexion until 4 wks -at 6 wks neoprene sleeve (improve proprioception)
Precautions in the Acute Phase After CS Surgery: (5)
-brace/collar for fusion pts -no ROM -keep HOB up -encouraged to sleep in recliner -no lifting >5-10#
What may persistence of primitive reflexes beyond 9-12 months indicate?
-brain abnormalities -delayed motor development
Things to look for in a home eval for a pt w/ SCI: (read)
-entrances (2 accessible are desired) -doorway width -turning radius from hall to rooms -surfaces on floor -financial resources -height of furniture -accessibility of kitchen/bathroom appliances -what is acceptable to the pt keep in mind, often times patients don't have the financial means to make adjustments to their home
What non-PT treatment should pt's w/ a disc herniation receive? (McKenzie Protocol)
-epidurals -steroids -surgery
Exercise precautions for the early and intermediate rehab stages after a meniscal repair (read)
-inc knee flexion gradually, esp if central zone repair (mod vascular) -if stationary bike is used for cardiopulm conditioning, set seat height as high as possible to limit knee flexion -during WB exercises (lunges and squatting) do not perform knee flexion beyond 45 deg (for 4 wks) or beyond 60-70 deg (8 wks) -postpone use of leg press machine until ~8wks and limit motion from 0-60 -avoid twisting motions during WB -postpone hamstring curls until ~8wks
What are the 3 skill levels of wheelchair skills? Why is this important for PT?
-indoor -community -advanced can use this as an outcome measure/goal in PT
Considerations when setting goals for pts w/ SCI
-level of lesion -ASIA classification -body type -premorbid strength and athleticism -age -gender -adjustment to injury (important) -support system keep in mind, the pt's true goal is to walk & have full use of their body again, even if they tell you otherwise, pt's with good psych adjustment will likely have a period of depression or difficulty at some point
Presentation for postural hypotension
-light-headed -low BP -yawning -passing out
What are the 3 groups of leads in a 12-lead EKG?
-limb leads (I-III) -augmented leads (aVL, aVR, aVF) -precordial leads (V1-V6)
What effects on function may persistence of primitive reflexes be associated with? (5)
-poor eye-hand coordination -difficulty reaching & grasping -difficulty feeding -delayed acquisition of motor milestones -poor postural control
What femoral arthrokinematic motions take place on the tibia with closed chain flexion of the knee? (2)
-posterior roll with lateral rotation -anterior glide
Things to remember when doing any transfer:
-use a gait belt -secure brakes on wheelchair or bed -remove or swing away footrests on wheelchair -minimize clutter -provide assistive devices and transfer techniques that adhere to restrictions and abilities -ONE person leads mobility activities, typically person closest to pt's head -always have a bailout plan
When during a woman's life does she have the greatest number of germ cells?
16-24 weeks gestation
What are the borders of the anterior triangle of the neck?
Anterior midline Inferior border of mandible Anterior border of SCM
What is the anatomical position of the uterus?
Anteverted and antiflexed ***
Where do lymphatics in the ovaries drain to?
Aortic/Caval lymph nodes
List the fascial planes of the neck.
Investing fascia Pretracheal fascia Prevertebral fascia Carotid sheath
Capsular Pattern of Restriction Definition
A limitation of motion in a particular pattern caused by restriction of the joint capsule.
What are hypo reflex responses caused by?
A lower motor neuron lesion, there is no reflex arc because the reflex arc has been cut
What is "joint play"?
A small amount of motion that is not under voluntary control of the patient. It protects the joint so it may accept some pressure at the end range without tissue damage
What are the advantages and disadvantages of rigid post-op dressings (IPOP)?
A: dec edema & pain, *prevents contracture*, protects limb, allows *early WB*, easier transition to definitive prosthesis D: difficult to apply, requires close supervision, *can't visualize wound* or residual limb Jason said he has never seen anyone use this, not overly common
What are the advantages and disadvantages of rigid removable post-op dressings?
A: allows skin inspection, consistent pressure, easily put on, protects residual limb D: may require *frequent re-fitting* (volume of residual limb changes)
Advantage of a rigid back WC: Disadvantage of a rigid back WC:
A: better posture & shoulder positioning D: hassle in loading into the car
What are the advantages and disadvantages of soft post-op dressings?
A: cheap, lightweight, readily available D: inconsistent, weak compression, frequent re-wrapping & replacement, *doesn't prevent contracture*, difficult for pt to self-apply Jason sees this very often
What are the advantages and disadvantages of semi-rigid post-op dressings?
A: controls edema, adheres to skin, allows some ROM, breathable, cheap, easy to countour D: loses effectiveness as swelling goes down, not as protective, *doesn't prevent contractures* Jason said this is like a very soft cast
What is in the danger zone of the posterior triangle of the neck? (5)
Accessory N Brachial plexus Phrenic N Subclavian A/V
What are hyper reflex responses caused by?
An upper motor neuron lesion, meaning a lesion in the brain or spinal cord. You see a hyper response because the reflex is not being checked by the brain
Which veins are in the anterior triangle of the neck?
Anterior jugular V Anterior communicating Jugular venous arch
Where do lymphatics drain on the right side of the body?
At the junction of the right internal jugular and right subclavian veins
Where is the weakest point of a tendon?
At the myotendinous junction
Where do lymphatics drain on the left side of the body?
At the thoracic duct
What does the axilla allow passage of?
Axillary artery and vein, brachial plexus
If you fracture the surgical neck of the humerus, what might you cause damage to?
Axillary nerve, anterior and posterior circumflex humeral arteries
BP calculation
BP = Q * total peripheral resistance
If you have a major bleed within the arm, where can you compress?
Base of posterior triangle of the neck
How can someone obtain AIDS from an ejaculate?
Because white blood cells are present in an ejaculate
Where is the retropubic space? Is it in the peritoneal cavity?
Behind the pubic bones Extraperitoneal space*
Where is the retrovesical fossa?
Between bladder and rectum Peritoneal space
Where is the axilla located?
Between the arm and thorax
Where is the third section of the axilla?
Between the lateral border of pec minor and inferior border of teres major
Where is the first section of the axilla?
Between the lateral border of the 1st rib and medial border of pec minor, enclosed in the axillary sheath
Which EKG leads are bipolar and which are unipolar?
Bipolar: all limb leads Unipolar: all augmented leads
What is the vesicouterine pouch between?
Bladder & uterus
Tendons are prone to degenerative changes due to a lack of _______________
Blood supply
What 2 things does the vagina connect?
Cervix to vulva
What nerve innervates the ant. belly of diagstric and mylohyoid?
CN V(3)
What is expected with sensation in SCI patients?
Complete SCI: -intact above LOI -absent below LOI Variances/Incomplete SCI: -intact below, or partial preservation -pain below LOI where sensation is absent
What is the optimal stimulus for regeneration of cartilage?
Compression & decompression of joint surfaces (receives nutrition this way)
What is the function of CT? (3)
Connect (ligament/tendon) Protect (cartilage) Support (bone)
How is the pressure in the penis capable of reaching above arterial pressures?
Contraction of muscles innervated by the pudendal N
What are the types of bone?
Cortical/compact Cancellous/spongy
What does the long axis of the vagina point towards?
Curve of the sacrum
When does menopause happen?
When there are no more oocytes left to stimulate
ST segment depression means: ST segment elevation means:
D: ischemia E: acute MI
Do you need to screen for cauda equina syndrome in the subjective exam if a person has DDD? disc herniation?
DDD: not necessarily herniation: yes! watch for severe back pain, possibly accompanied by leg pain, and a positive SLR
What CT changes occur with aging?
Decreased..... -water content -elasticity -max strength -adaptability
Describe zone 3 of cartilage
Deep Cells columnar Has collagen (perpendicular) Tidemark b/w calcified & non-calcified cartilage
Ligaments, tendons, & joint capsules are examples of what kind of CT?
Dense CT
What population is impotence common in?
Diabetic men
Where is the cricoid cartilage?
Directly inferior to the larynx, it goes all the way around in a ring-like fashion
Where does the axillary vein receive blood from?
Directly or indirectly from the thoracoepigastric vein
What is the function of cartilage? (3)
Dissipates/disperses forces Minimizes friction Protects bone
Through what structure do prosthetic secretions enter the ejaculatory duct?
Dozens of glands along the prostatic utricle
T/F: the International Classification of Functioning, Disability and Health, Child Youth Version (ICF-CY) is commonly used in a clinical setting
False-- mostly used in research -builds on ICF framework -addresses infancy, childhood & adolescence -addresses environmental factors w/ these age groups -captures growth & development
What is the internal termination of the endocervical canal in the uterine cavity?
Internal os
When does the vagina lengthen?
During intercourse and birthing
T/F: if the ST segment is elevated in one lead this is indicative of a MI
False-- if it's just one lead, then it's probably a blip and not a MI if it's elevated in multiple leads, that's more concerning
T/F: the rooting reflex is also known as the sucking reflex
False-- it is also known as the food finding reflex, the sucking reflex is different
What is the difference b/w the pathophysiology of emphysema and chronic bronchitis?
E: destruction of alveolar walls, loss of elasticity, impaired expiration, barrel chest, hyperinflation CB: inc mucous gland size, inc secretions, inflamm, infections, obstruction
Where is the pararectal fossa?
Each side of the rectum
Which portion of the cervix projects into the vagina? What is the name of its mucus filled opening?
Ectocervix External os
Which portion of the cervix is filled with mucus or menses?
Endocervix
T/F: if a SCI patient can propel a manual WC, you should always select a manual instead of a power WC for them
False-- they may be able to propel the manual WC, but consider how much energy they will have to expend doing so... is it worth it for that pt (esp. for LOI C7-T1) (exercise, psychologic benefit, ease in management vs. more complicated machine etc)
T/F: MMT can be reliably tested in children with Duchenne Muscular Dystrophy, Down Syndrome and Cerebral Palsy
False-- this is true for DMD & DS, but not reliable in CP
T/F: a SCI patient with complete injury can still make some strength gains and recover some motor function
False-- won't be able to do either, instead, will need to learn compensations for loss of motor function
T/F: a full bag on an external catheter indicates proper bladder emptying
False-- you can't assume this, you still need to check their catheter and residual volume
What are the components of CT?
Fibers Cells Ground substance
What are the 4 components of bone?
Fibers (type 1) Cells (osteoblasts) Ground substance Inorganic materials
What are the components of tendons?
Fibers (type I, dense, parallel, oriented to line of tension) Cells (fibroblast, tenocytes) G.S. (water, proteoglycan)
What are the components of ligaments?
Fibers (type I, varied arrangement, oriented in line of tension) Cells (fibroblast) G.S. (water, proteoglycan)
What type of end-feel is elbow extension with biceps contracture?
Firm (abnormal)
What regions is the uterus divided into?
Fundus: protrudes above uterine tube attachments Body: main part Isthmus: narrow connection of body to cervix Cervix: protrudes into vagina
What does the toe region in a stress-strain curve represent?
Good region, bundles are being straightened out a little bit
When is loss of rotation always present?
In joints with 3 degrees of freedom such as the hip and shoulder
When do you asses sensation?
In patients with musculoskeletal and/or neurological conditions
Where does an egg that does not get caught by the fimbriae end up?
In the rectouterine pouch Also called cul-de-sac of Douglas
What is impotence?
Inability to achieve or maintain a penile erection
What CT changes occur with diseases like diabetes?
Increased cross-linkage of fibers
What is salpingitis?
Infection/inflammation of fallopian tubes
What is enlargement of upper limb lymph nodes caused by?
Infections of upper limb or cancer of shoulder or thorax
What is another word for the external occipital protuberance?
Inion
What unique component does bone have that not all CT has?
Inorganic materials the other 3 components are in all CT
Which artery is important blood supply to the mammary gland of women?
Lateral thoracic artery
Where is the axillary vein in relation to the axillary artery?
Lies on the medial side of the axillary artery, it has more branches and variations than the artery.
What is a vasectomy?
Ligation/removal of part of the vas deferens
Types of Sensation
Light touch Vibration Cold/Hot Pain
What is the ansa cervicalis? What spinal nerves does it include? What muscles does it innervate?
Means loop of the neck, loops around the carotid sheath Arises from ventral rami of C1-3 All 4 infrahyoid mm, geniohyoid, and suprahyoid are innervated by this
What is the optimal stimulus for bone regeneration?
Loading along the axis of the bone
What are the most basic human rights?
Locke- life, liberty & property Jefferson- pursuit of happiness Meldon- pursuit of legit interests
What nerves are vulnerable during surgical removal of malignant lymph node cells in the axilla?
Long thoracic nerve and thoracodorsal nerve
Adipose, areolar, & tissue surrounding blood vessels & nerves are examples of what kind of CT?
Loose CT
What are examples of migratory CT cells?
Lymphocytes Macrophages (remove waste)
What are the ligaments that support the knee on the medial and lateral aspects of the joint?
MCL (medial collateral) LCL (lateral collateral)
What are pelvic ligaments made out of, and what typically passes within them?
Made out of fibrous CT that supports & connects structures. BV, nerves & lymphatics pass within pelvic ligaments and fascia
Where is the peripheral/main zone of the prostate?
Makes up 70% of prostate
What two special tests as part of the OE could help you to dx a meniscal tear?
Mcmurray Apley (compression)
What are the 4 viscoelastic properties of CT?
Plastic: changes that don't go back to their original shape Elastic: changes that do go back Creep: amt of change inc gradually as the load remains the same Fatigue: when tissue breaks
What is the first group of lymph nodes that is likely to become enlarged due to infection?
The humeral group
Goniometer
The instrument most commonly used to obtain goniometric measurements.
What happens if there is a pathology going on that reduces or stops blood flow to the inferior vena cava (where the axillary vein normally drains)?
Then the superficial veins of the anterior thoracic wall and abdominal wall allow a bypass to get the blood back to the heart through the superior vena cava
What does it mean to say the viscoelastic properties of CT are time-dependent?
The longer a load is applied the greater the deformation -relates to creep
What 2 things does the proper ovarian ligament connect?
The ovary to the uterus
What happens in benign prostatic hypertrophy?
The prostate enlarges and obstructs the passage of urine which can lead to retention and infection Inc difficulty with urination and retention of urine
What is a normal reflex response?
The response is present bilaterally and symmetrically
End-Feel Definition
The sensation felt by the therapist at the extreme end of the passive range
Reflexes Definition
The simplest reflex response that involves an afferent, efferent, and one synpase = monosynpatic reflex
What is the axillary artery a continuation of?
The subclavian artery
What is goniometry?
The technique of human joint measurement or measurement of angles
How common is salpingitis and who does it affect?
There are over 1 million cases of it per year in the U.S. Most common in 15-24 years
What is the basic unit of collagen? (like a sarcomere is to muscle)
Tropocollagen
T/F: pts with SCI may experience complications both in the acute and chronic states after injury T/F: postural hypotension can occur at any stage after a SCI (acute or chronic)
True False (typically only in acute)
T/F: With the ATNR primitive reflex, you may also see a similar response in the LEs
True- facial leg would extend & abduct, occipital leg would flex & abduct
What is the difference b/w bipolar and multipolar neurons?
based on # of processes that directly arise from the cell body -bipolar: 2 processes, dendrite & axon -multipolar: 3+ processes, multiple dendrites & single axon
Where is type IV collagen found?
basement membrane (kidneys)
Why do researchers think IV discs may play a role in proprioception? Why is this discovery important?
bc if you electrically stimulate an IV disc, it activates the multifidus muscle-- there's a link there that we don't fully understand yet it may help explain why deteriorated discs that have led to segmental instability also lead to a loss of motor control & even wasting of the multifidus
What does premodulated IF estim mean?
beat frequency & summation of currents occurs inside the machine (is a homogenous medium vs. body tissues)
Why does lung hyperplasia occur in emphysema?
because it is harder to expire, may need to treat this with lung reduction surgery
Why do drugs store well in adipose tissue?
because most drugs are lipid soluble
Why are macrophages needed in alveoli?
because the air you breathe in has foreign particles in it
Before you reach anaerobic threshold (AT) what is your primary fuel source? What about after you reach AT?
before: fat after: carbs
What is CO2 converted to when it diffuses into RBC's?
bicarbonate
When evaluating the pediatric examination findings, you use the tests & measures to determine: you use the findings of observation, mobility assessments or standardized assessments to determine: you use the findings of observation and interview to determine: options: ICF domains
body function/structure impairments activity limitations participation restrictions
Which element stimulates vesicles to migrate to the presynaptic terminal which then release their ntm?
calcium
Is a mild fever beneficial or not with inflammation?
can be beneficial, used to reset hypothalamic thermoregulatory set point, induced by release of fever-producing substances, impairs the growth and reproduction of pathogens and enhances immune function
Does asthma involve a partial or total obstruction of airways?
can be either
Is amputation bc of cancer due to primary cancer (osteosarcoma) or metastatic disease?
can be either
Does acute respiratory failure result from acute or chronic disorders? What are some examples?
can be either Ex: emphysema, neuromuscular diseases
Does summation of local potentials result in the neuron depolarizing or hyperpolarizing?
can be either-- can excite or inhibit the neuron
Why is inflammation a potential double-edged sword?
can be protective (removes harmful agents, removes dead tissues, enables healing) but with too much inflammation it can be harmful (misdirected, loss of function)
Does pneumonia develop as a *primary* condition or in response to another condition (*secondary*)?
can develop as primary or secondary
Define: heart rate
cardiac cycles or beats per minute
When calculating HR based on a 6 second EKG strip, do you count the number of QRS complexes or cardiac cycles in that time?
cardiac cycles-- one R wave to the next R wave (if you just count the QRS complexes and don't look to see if the tail after it is also in the 6 second strip then you may get a higher HR than it actually is)
Where is type II collagen found?
cartillage
How do chemical mediators contribute to the process of inflammation?
cause vasodilation and increased capillary permeability
How do leukotrienes play a role in inflammation?
cause vasodilation, increase in capillary permeability, and chemotaxis
ARDS (adult or acute respiratory distress syndrome): -what causes it? -what effects does it have?
caused by injury to the alveolar wall & capillary membrane results in the release of chemical mediators that causes: -inc permeability of alveolar capillaries -inc fluid & protein in alveoli and interstitium -damage to surfactant-producing cells
Why do smokers develop emphysema?
causes a deficiency of alph1-antitrypsin -needed to prevent elastase from breaking down elastin which would lead to dec recoil of alveoli = emphysema
Where is type V collagen found?
cell surface and hair
Where is the only location in the body that drugs cannot pass through the pores in capillary walls?
central nervous system
Why is infertility common in men s/p SCI?
d/t difficulty with temperature regulation and prolonged sitting-- results in inc scrotal temp.
What range of days post-injury fall within the maturation phase of healing?
day 9 and forward
What range of days post-injury fall within the inflammation phase of healing?
days 1-6
What range of days post-injury fall within the proliferation phase of healing?
days 3-20
If we double the length of a blood vessel, then the volume of blood flow through it will:
decrease by 50% (due to inc in resistance)
If you screen a person for cauda equina syndrome and it is negative, but you are concerned they may develop it, what should you do?
tell them if they were to experience CE sx (N/T in saddle area, problems w/ bowel/bladder) in the future, then they need to go to the emergency room this is usually needed for people w/ massive disc herniations
Name the muscle stabilization technique post-amputation: intact tendon(s) are re-attached to the bone
tenodesis
What is the most serious type of pneumothorax?
tension pneumothorax
Define intervention:
the *purposeful* interaction of a PT with a pt to produce changes in the condition that are consistent with the diagnosis and prognosis
How is CKC motion of the knee different than OKC reguarding the PJRF?
the CKC flexion moment increases with more flexion in the knee (closer to 90), whereas with OKC it increases closer to 0 deg flexion
Symptoms: CS nerve root impingement
-pain -weakness -numbness in UE
Components of a taking a history (read)
-pt profile -location of symptoms -symptom behavior -symptom history -medical history -review of symptoms
What is the difference between the top-down and the bottom-up approach? Which one is used in pediatrics more often?
*Top-down*: -used in pediatrics -start with what the child wants to accomplish -next identify strengths & weaknesses -then develop a plan *Bottom-up*: -used with adults -start with strengths & weaknesses -determine goals -then develop a plan
What are some post-op complications of amputations?
-*contracture* -swelling -phantom limb sensation or pain -personal grief and depression surgical complications: pain, infection, respiratory compromise, DVT, etc.
Presentation of HO:
-*sudden limitation of ROM* -most common: hips, knees, shoulders, & elbows -skin around/on joint may be warm
What takes place in the IV disc when it undergoes rotation forces?
-1/2 fibers of annulus on tension -1/2 fibers of annulus on slack
Which conditions increase your risk for PVD and amputation?
-DIABETES -obesity -HTN -HLP -nephropathy
What should the OT work on with an UE amputee who doesn't want a prosthesis?
-One handed techniques -Posture & ergonomics (could develop scoliosis due to lack of weight of one arm) annual follow-up to ensure functional requirements are met
Describe some activities you could do to work on balance training after an amputation:
-balance COG over the sound limb in parallel bars to get used to the loss of weight of limb -PT initially provide confidence during stand-pivot transfers and ambulation w/ AD -be able to balance on their own for at least 0.5 seconds
Once a pt with a SCI is stabilized and if they are mobile enough, what are some things that are very important to start working on in therapy for function?
-balance in short & long sitting -short sit used as pre-transfer activity -transfer training for pt and family if appropriate -remember to empower the pt to lead the transfer when possible (verbally or physically)
What TherEx should be selected for someone w/ a disc herniation? (mostly extrusions & sequestration)
-ex w/ optimal stimulus for disc -ex in a position of extension -self-paced walking -focus on hip motion & limit spine motion -correction of flex + rot across ADL's -small rotation in an unloaded position-- don't over-rotate bc it'll put even more tension on the AF
What goes in the systems review component of a pediatric PT exam?
-exam of anatomical/physiological status of CV, pulmonary, integumentary, MS, & NM systems -exam of communication, affect, cognition, language & learning style
What are typical aggravating factors for disc degeneration?
-extending -bending -sitting -sit--stand -lifting -sustained posture -sudden motions -end of ROM
What Q value roughly indicates someone 1. at rest 2. during exercise?
1. 5 L/min 2. 20 L/min
List the zones of the posterior triangle of the neck (2)
1. Carefree zone: superior region, mostly muscle 2. Careful/danger zone: inferior region, important nerves & vessels are here
In which leads is a P wave... 1. positive & rounded*** 2. negative*** 3. positive, negative or biphasic
1. I, II, aVF 2. aVR 3. III, aVL, V1-3
Plantar Grasp Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 9 months 3. pressure to ball of foot 4. flexion of toes (grasp)
Where is pelvic fascia?
CT layer that is external to the peritoneum, pelvic wall & floor muscles It is part of the subperitoneal endopelvic fascia (?)
What does it mean to say the viscoelastic properties of CT are rate-dependent?
CT resists a load applied quickly better than slowly -relates to viscous properties of the tissue
What is investing fascia?
CT that surrounds SCM in front and trapezius in back. Platysma is superficial to it and is not included in the investing fascia
What structure(s) regulate BP during exercise or short-term?
CV system
Describe zone 4 of cartilage
Calcified cartilage Small # of cells No blood supply
What is a posterolateral disc herniation? posteromedial?
PL: a bulge that's lateral to the nerve root PM: a bulge that's medial to the nerve root
Positive vs Negative Rights
Positive: claims to goods or services & expected receipt of those claims Negative: those that prevent interference w/ someone's right to do something (liberty) it is worse to interfere w/ someone's negative rights than positive rights
Name the amputation: amputation through the hip joint w/ intact pelvis
hip disarticulation
Afterload definition
how much work it needs to do to empty the heart (contraction)
Preload definition
how much work it needs to do to fill the heart (stretch)
___________ rights exist in order to protect the basic dignity of human life, basic freedom & well-being
human
You really have to watch patients to prevent valsalva maneuvers in which 3 patient populations?
hx of stroke or renal disease diabetic retinopathy
An increase in PCO2 in the blood is called:
hypercapnia
Is hyperventilation caused by hypercapnia or hypocapnia?
hypercapnia
With SCI patients, if they have spasticity, where is it located?
hypertonicity of extremities below LOI (occurs w/ all UMN lesions like SCI)
How does training affect VO2 max?
improves it 10-30%
If percussion over an area produces pain, it could indicate ______________
infection or tumor
Diabetes alone increases the risk of _________________ (associated w/ PVD) by 4-5 times, even after controlling for HTN, smoking and cholesterol levels
intermittent claudication
Which joint is the main WB joint of the spine?
intervertebral joints
Are the clinically important variations with the ST segment in terms of the duration or its level relative to the isoelectric line?
level relative to the isoelectric line ST deviations and T wave abnormalities are seen with myocardial ischemia
What do arterial blood gas determination tests measure?
levels of the following in the blood: -O2 -CO2 -bicarbonate -serum pH
How does age affect resting HR?
likely to increase due to dec parasympathetic control or little change (can dec if there is an abnormal heart rhythm -- bradycardia)
How does inflammation help as part of the body's second line of defense?
limits the effects of invading agents or injury
Cardiac output increases ________________ with workload
linearly
*Systolic* blood pressure increases ________________ with workload
linearly (same as Q)
How thick are the walls of alveoli?
lined by a single layer of epithelial cells
What is auscultation?
listening for body sounds
Where is type I collagen found?
most abundant, in skin, tendon and bone
Which races more frequently get peripheral vascular disease?
most common in African Americans and Hispanics
Is airway resistance & gas diffusion a limiting factor for performance?
not in healthy people, but it would in COPD
How does temperature affect HR?
not sure, but just know it affects it
What component of a physical exam is often overlooked and can prevent us from overlooking the obvious?
observation
Is asthma a type of obstructive or restrictive pulmonary disease?
obstructive
What is a surgical consideration for *traumatic* amputee patients?
often involve open, comminuted fractures w/ soft tissue loss and vascular/nerve disruption
Name the amputation: excision of a portion of one or more fingers
partial digit
Is air trapping and hyperinflation of lungs a symptom of partial or total obstruction of airways with asthma?
partial obstruction -air is expired partially -RV inc -more difficult to inhale
Name the amputation: excision of a portion of 1 or more toes
partial toe
How does inc surface tension of alveoli lead to atelectasis?
prevents expansion of a lung
What role do glucocorticoids play in treating inflammation? (chemical process)
prevents the production of arachidonic acid from membrane phospholipids
Alpha1-antitrypsin is a _____________ inhibitor.
protease (Ex of a protease: elastase)
Which type of neuron are most sensory neurons?
pseudounipolar
What is the most dependent portion of the male pevlic cavity?
Rectovesical pouch
What are extreme uterine positions associated with?
Reduced fertility
What does "flexion" of the uterus refer to?
Refers to the angle of the body of the uterus with the cervical canal Normal: antiflexed toward the front
What does "version" of the uterus refer to?
Refers to the angle of the cervical canal with the vagina Normal: anteverted, turned towards the front
What information does the repeated back extension movement testing, in our objective exam of a pt with a potential disc herniation, give us?
Repeated extension: mechanical loading of disc -if it dec leg sx (centralization): it is disc-related pain, we want to use this in our treatment, & they have a good prognosis -if it inc leg sx (peripheralization): we don't want to use it in our treatment, it could still be disc related, but it would be a larger herniation with a poor prognosis
In a healthy person, is the SA or AV node the pacemaker of the heart? Why?
SA node-- bc it has the highest concentration of intrinsic rhythmicity (means it has the highest intrinsic rate of ~72 bpm)
What separates the posterior and anterior triangle of the neck?
SCM
List the muscles under the prevertebral fascia in the posterior triangle of the neck.
Spenius capitis Levator scapulae Scalenes: all 3
Bronchiectasis is usually a ________________ condition
secondary
Which stage of TB is caused by invasion of dormant microbes or a new infection?
secondary stage
In making the decision to whistleblow or not, there needs to be the likelihood that whistle blowing will:
serve a good purpose w/ less harm done than if the wrong doing was continued
What are the physiologic effects of IFC?
set to depolarize peripheral sensory or motor fibers
Which type of force is the most detrimental to IV discs?
shear-- esp. in the lateral direction
Name the amputation: retains less than 50% of femoral length
short transfemoral
Name the amputation: retains less than 50% of tibial length
short transtibial
Which part of the nervous system is responsible for bronchodilation?
sympathetic nervous system
Is bradycardia or tachycardia sometimes caused by activity, stress, caffeine or inc sympathetic drive?
tachycardia (>100 bpm)
If you think there is a problem with a prosthesis, what should you check before calling a prosthetist?
take the prosthesis off and put it back on again Jason said 80% of the time this will fix the problem and the prosthetist will want to know you've tried this already
How is clearance defined?
the ability of organs to eliminate drugs
What is half life?
the amount of time required for 50% of the drug remaining in the body to be eliminated or inactivated
What is active-assisted ROM? (AAROM)
When the patient has some strength, but they need some help from the PT
Morality is derived from rationality rather than experience. Universal truths apply to all people, across all times & in all situations Is this ^ teleological or deontological?
deontological, Kant believed this
What is a sequestration herniation?
a free NP fragment has migrated into the vertebral canal
How is inflammation defined?
a response of vascular tissue to injury, a normal defense mechanism (automatic response)
Arteriovenous oxygen difference
difference b/w O2 content of arterial vs venous blood
Which type of ACE wrapping technique should you use to prevent the tourniquet effect?
figure 8 pattern
For CS surgery, is an anterior or posterior approach preferred?
anterior
In what condition do alveoli become airless?
atelectasis
Which type of UE prosthesis is "cable driven"?
body powered prostheses
How can anxiety or food intake affect RER?
both increase it
Chronic bronchitis is a disease of what respiratory structure?
bronchi (thickening of bronchial walls leads to obstruction)
What structure of the respiratory system is composed of smooth muscle cells but does not have cartilage?
bronchioles
What is happening pathophysiologically during asthma?
changes of bronchi & bronchioles -inflammation of the mucus membranes with edema -bronchoconstriction -inc secretion of thick mucus obstructing airways
What shaped field is created as a result of the quadripolar arrangement with vector scan?
circular shaped field of interferential current
Rights Ethics (Theory)
conduct is morally right when it respects human rights Dilemmas: clash b/w rights, which right has priority in a situation?
What is surfactant made of?
consists of lipoproteins
Interferential dosage can either be _______ or ________
constant sweep
What two types of "interference current" are there?
constructive destructive
What are the mediators of inflammation?
cytokines histamine bradykinin leukotrienes prostaglandins
What are 4 changes in the elderly that affect distribution levels and rates?
decrease in lean muscle mass increase in total body fat decrease in body water changes in albumin concentration
As we age the rate of clearance by the kidney ____________ dramatically
decreases
What happens to a person's total lung capacity that has a restrictive lung disorder?
decreases
How is biotransformation defined?
the chemical alteration of the drug
What is beat frequency?
the difference between the frequency of each channel
What is the purpose of the facets that the patella is in contact with through knee flexion/extension?
help with joint load distribution during knee flexion/extension
What is considered the "therapeutic dose" of a drug?
the level of concentration in the plasma that a drug reaches to where there is an effect felt
For which SCI patients is syringomyelia especially a problem for?
those w/ cervical injuries: bc one level can make a *huge* difference in function
Over 70% of UE amputations are caused by:
trauma
T/F: altitude or heat can affect HR recovery as well as resting HR
true
T/F: the pt and PT must have understanding of prosthetic components and their functional implications
true
What is the best position for disc re-hydration? Why is it the best? How long should you stay in this position?
-"unloaded 90/90 position" -supine w/ hips & knees at 90 deg flexion -minimizes muscle activity -maintain it for 15-20 min
What is the difference b/w the 3 types of gated membrane channels? -modality-gated -ligand-gated -voltage-gated
-*Modality*: open in response to specific sensory info -*Ligand*: open to ntm binding to channel receptor -*Voltage*: open to change in electrical potential
Consequentialist Theory Positions on Rights
-*Perfect Obligation*: duties that have inherent rights -- required -*Imperfect Obligation*: duties w/out rights attached -- obligatory, but left to our choice when to do it
Benefits of an externally powered UE prosthesis: (5)
-*Stronger grip force* (20 lbs) -Moderate to no harnessing -Minimal energy expenditure -Least body movement to operate -Moderate aesthetics
Define: Autonomic Dysreflexia:
-*acute elevation of SBP* of at least 20 mmHg -+/- bradycardia -triggered by non-noxious or noxious visceral or somatic stimulation below the level of injury (HCP's often miss this-- know abrupt fluctuations in BP is a sign of AD)
What is the normal duration/width and height of the QRS complex?
-.07 to 0.11 seconds (half a big box or less) -widths vary by lead, the widest QRS on a 12-lead EKG is the correct one -usually look at I and V1 -shouldn't be shorter than 6 mm in I, II III -shouldn't be taller than 25-30 mm in V1-V6
What takes place in the IV disc when it undergoes shear forces?
-1/2 fibers of annulus on tension -1/2 fibers of annulus on slack
What patient population are protrusion herniations most comon in? -age -pain -history
-20-50 yo -pain: poorly localized, dull ache in back/butt, no leg pain, worse in AM, later inc in intensity & area -history: sudden onset of localized back pain, may resolve w/ continued activity
What patient population are extrusion and sequestration herniations most common in? -age -pain -other
-20-55 yo -pain: low back pain & *leg pain* -N/T present -weakness (depends on if sensory, motor or both fiber types are being compressed by the herniation)
Describe the currents and set up for dual, bipolar IFC?
-4 electrodes -each pair to own channel (2 unmodulated med. freq sine currents) -2 parallel currents
Describe the currents and set up for quadripolar (crossing) IFC?
-4 electrodes -each pair to own channel (2 unmodulated med. freq sine currents) -4 leaf clover shaped field
A change in membrane potential from -70 mV to _____ mV produces an action potential, which is the *threshold stimulus*
-55 mV (15 mV depolarization)
Why are we taking PTRS 705? (read)
-6-8 questions on FSBPT Board Exam about this -focus on why we choose and use certain modalities -need to consider current best evidence of modalities
What are the contents of the annulus fibrosis?
-60-70% water -50-60% of dry weight is type I collagen -20% of dry weight is proteoglycans
What are the contents of the nucleus pulposus?
-70-90% water -15-20% type II collagen 65% of the dry weight is proteoglycans
What is the normal duration & depth of a Q wave?
-<.04 seconds -not deeper than 1/3 of the QRS complex
Even with hyper-reflexive bladders, SCI patients do not completely empty their bladder, there is a residual volume left which puts them at a risk for infection. At what residual volume do we need to look into other means of emptying their bladder?
-<100 cc residual volume is okay ->100 cc residual volume means you need to look into another means of emptying their bladder (this is done via imaging)
Management of postural hypotension:
-ACE wrap LEs -abdominal binder -TED hose -reclining WC or cardiac chair -medications (when other methods fail) this usually gets better with time, these management techniques are usually only necessary just at the beginning
What is the difference b/w an absolute & relative refractory period?
-Absolute: no amt of stimulus will produce an AP -Relative: stronger stimulus than normal will produce an AP
What is the difference b/w absolutist & relativist theories? (meta ethics)
-Absolutist: what is right is based on knowledge that's known to be true -Relativist: ethical principles aren't true or false, but are what any society, group or individual believes is right
Benefits of an oppositional UE prosthesis: (5)
-Aesthetic appearance -Light weight -Simple -Proprioceptive feedback -Function: opposition, holding objects, restore body image
What is the difference b/w afferent neurons, efferent neurons & interneurons? (functional classifications)
-Afferent: input- sensory to SC -Efferent: output- motor away from SC -Interneuron: connects afferent & efferent NN w/in the SC
What happens above & below a person's anaerobic threshold?
-Below: can maintain level of exercise comfortably -Above: can no longer sustain prolonged workload
If PCO2 increases, how does the body realize that its in a state of respiratory acidosis? How does the body then try to compensate?
-CO2 can now easily diffuse into the CSF -this lower the pH and stimulates the respiratory center -results in inc rate & depth of respirations (hyperventilation) which would inc the pH back to normal
What is the difference b/w convergence & divergence of neurons?
-Convergence: multiple inputs from multiple neurons terminate on a single neuron -Divergence: a single neuron branches & synapses on multiple neurons
Neurotransmitters can have either a direct or indirect effect, what is the difference?
-Direct: open LG ion channels -Indirect: open ion ch. via G-proteins & activates a cascade of intracellular events through a 2nd messenger
What are some PT interventions to treat phantom limb pain?
-E-Stim and US -mechanical stimulation: massage, percussion & vibration -desensitization & reprocessing -exercises -biofeedback: mirror box therapy, immersive virtual reality -(counseling)
Which neurotransmitter is the most prominent excitatory ntm? most inhibitory ntm?
-Excitatory: glutamate -Inhibitory: glycine & GABA
What is the difference b/w Guillain-Barre and Multiple Sclerosis?
-GB: antibodies attack Schwann cells in the PNS -MS: antibodies attack oligodendrocytes in the CNS
SCI patient's ROM is usually expected to be WFL, but if it isn't, what may cause the limitation in ROM? (5)
-HO -other injury -premorbid contractures -arthritis -contracture from spasticity and insufficient PROM (chronic SCI)
Limitations of an externally powered UE prosthesis: (4)
-Heavier -More expensive -Limited sensory feedback -Extensive therapy training
What is the function of ligaments?
-Joint stabilization (mainly at end range) -Passive guidance of joints through ROM -Provide sensory feedback through mechanoreceptors
List some causes of Left Axis Deviation: (5)
-L anterior hemi-block -Q waves of inf MI -artificial cardiac pacing -emphysema -hyperkalemia
What conditions can cause pulmonary edema? (4)
-L sided CHF (leads to HBP) -hypoproteinemia (liver or renal disease = dec osmotic pressure) -inflammation in lungs -blocked lymphatic drainage
Where are the limb lead electrodes placed on the body?
-LL1: R arm (-) to L arm (+) -LL2: R arm (-) to L leg (+) -LL3: L arm (-) to L leg (+)
What is the difference b/w leak & gated membrane channels?
-Leak: always open, allows passive diffusion -Gated: open in response to a stimulus & close when the stimulus is removed
Limitations of a body powered UE prosthesis: (4)
-Little grip strength or pinch force (3-4 lbs) -Restrictive & uncomfortable harness -Requires muscle power & excursion -Poor static & dynamic cosmesis
What are some examples of trauma that often lead to amputation?
-MVA -combat -severe burn -electrocution
Benefits of a body powered UE prosthesis: (3)
-Moderate cost & weight -Durable or environmentally resistant -Proprioception through harness system
What are general guidelines for OKC and CKC exercises for *early stage* rehabilitation?
-OKC and CKC exercises should be combined -OKC exercises of knee extension should be performed within a limited range of 90 to approx 45 deg of flexion -CKC exercises such as leg press or squats should be performed within a limited range of 0-40 deg flexion
What is the definition of a sinus rhythm?
-P wave for every QRS (1:1 ratio) -P wave & QRS are in the same direction
What does the binding and release of oxygen to Hb depend on? (4)
-PO2 -PCO2 -temperature -plasma pH
Describe the relationship between the articular facets and the patella during knee flexion (starting from full extension)
-Patella starts at the most inferior point -from 20-90 deg knee flexion the patella is in contact with the femur via the lateral and medial facets -at 135 deg knee flexion the lateral patellar facet and odd facet are the only aspects contacting the femur (throughout this motion the patella moves from inferior to superior on the femoral condyles)
What are possible causes of absence or persistence of primitive reflexes? (4)
-TBI -cerebral palsy -genetic syndromes -developmental delay
What is capable of destroying mycobacterium tuberculosis?
-UV light, heat, alcohol, glutaraldehyde, formaldehyde
How would strengthening of the adductors, abductors and ER muscles of the hip help with symptoms of PFPS? (weakness or tightness of the hip muscles)
-VMO originates on the adductor magnus tendon (basis for recommending adductor strengthening) -abductor strengthening helps to stabilize the pelvis, dysfunction of the external rotators results in compensatory foot pronation (internal rotation of the hip due ti weakness of external rotators causes valgus position of knee and pronation of foot maybe?) (a simple stretch can improve muscular efficiency)
Symptoms of Autonomic Dysreflexia:
-can be asymptomatic -severe headache -anxiety -profuse sweating above LOI -flushing/piloerection (bristling of hairs) above LOI -dry/pale skin below LOI -blurred vision -nasal congestion -bradycardia, arrythmias, a-fib
Why do we need to address the alignment of the shoulder girdle after CS surgeries?
-can be source of cervical pain -affects alignment & stress on CS
What are some causes of amputations other than trauma or vascular disease/neuropathy?
-cancers (esp. bone cancers in kids) -infection -congenital limb defects
How is pneumonia classified? (4 categories)
-causative agent (viral, bacterial) -infection location(1 lung, 1 lobe) -pathophysiologic changes -epidemiologic data (nosocomial, community)
Where are central and peripheral chemoreceptors located?
-central: medulla -peripheral: carotid bodies, aortic body
What goes in the subjective history component of a pediatric PT exam?
-child/family goals -birth/medical history -*GA at birth/birth weight* -developmental history -social history, functional status, activity level-- self-care, behavior -communication abilities -cognition -home/child care/school environment -current complaints -current age -medical complications -ongoing medical concerns-- diagnoses/conditions, meds Notes: -social hx is important for older kids -most important: take the time to listen and *build rapport* w/ kids & family
Is pneumoconioses an acute or chronic condition? Is its onset rapid or insidious?
-chronic -insidious
What are 2 symptoms of bronchiectasis?
-chronic cough -production of a lot of purulent, foul-smelling sputum (1-2 cups per day) Ew...
What ligamentous injuries of the knee may be treated surgically?
-complete rupture of ACL or PCL -MCL and LCL (may opt for nonsurgical management if injury is isolated)
What is considered to be a third degree (severe) ligamentous injury?
-complete rupture of the affected ligament -complete loss of funtion of the ligament -functional disability of the knee complex (surgery)
What are the goals of PT in the post-surgical phase after an amputation? (after surgery, before prosthesis)
-compression -ROM -positioning -endurance
Cause: cervical stenosis
-congenital or acquired -compression of SC and/or NR -acute trauma w/ fx or HNP
What are some pathologies that can restrict motion?
-contracture -edema -adhesion -mechanical block -spinal disc herniation -adverse neural tension -weakness
Whare are some measure to take to treat acute asthma attacks?
-controlled breathing techniques -inhalers (bronchiodilators) -glucocorticoids
What are symptoms of pulmonary edema? (5)
-cough -orthopnea (SOB lying down) -rales -hemoptysis (cough up blood) -frothy, blood-tinged sputum ... Ew
What are some symptoms of asthma?
-cough -shortness of breath -tight feeling in chest -wheezing -rapid & labored breathing -expulsion of thick/sticky mucus -tachycardia
List some symptoms of pneumonia
-cough (may have green, yellow or bloody mucus) -fever -chills -headache -sharp chest pain -excessive sweating -clammy skin -loss of appetite -low energy -fatigue
What information should you get with a medical history?
-current & past illness -family history
Things to observe about the integument (7)
-cyanosis -jaundice -pallor -streaks on skin -change in amt of hair -clubbing nails -pitting nails
What are some typical treatment goals for a pt w/ DDD? (6)
-dec compression -dec faulty movement -inc nutrition -inc mobility -inc strength of core mm -inc function
What are some typical goals for a pt w/ a disc herniation in the acute stage? (7) (mostly extrusions & sequestration)
-dec inflam -dec muscle guarding -dec compression & tension on NN -protect the disc -centralize pain -correct shift if present -promote pain-free mobility
How does pulmonary disease limit exercise?
-dec max ventilatory volume due to obstructed flow -dec lung volumes -inc physiologic dead space
How do glucocorticoids treat inflammation?
-decreased capillary permeability, enhance effectiveness of vasoconstrictors (epi and norepi), reduce # of leukocytes and mast cells, reduce immune response
A deficiency of what substance can lead to emphysema? Why?
-deficiency of alpha1-antitrypsin -inhibits elastase from breaking down elastin
What are some contraindications for prosthetic use?
-dementia -institutionalization -advanced cardiopulm. or neuro. disease -bilateral transfemoral amputations w/ inability to transfer or stand -unacceptable energy expenditure for ambulation
What different types of transfers do pts w/ SCI need to be able to do? (7)
-dependent lift (manual or mechanical) -slide board (lateral, prone push) -swing pivot -car transfer -commode transfer -tub bench transfer -floor to chair transfer Notes: there are a lot of different ways each of these transfers can be performed, and one way will not work for every patient
Situation Ethics (Fletcher)
-derived from utilitarianism -*relies on goodwill to guide people* -consider consequences -proportionate good -actual needs prioritized over ideal needs -compassion of people
How should you determine a pediatric patient's PT goals?
-determined w/ child, parent, teacher & other team members -related to functional outcome -focused on participation & activities -realistic & achievable -easily understood -free of professional jargon -have a time frame -goals aren't intervention strategies
What are components of a good bowel program for an SCI patient?
-diet -physical activity -oral medications -rectal medications -bowel care Notes: regulate them so they are always emptying at the same time (usually after a meal)
Weaknesses of Human Rights
-disagreement on who or what has rights -rights can be relinquished -whose rights are more important?
Cause: CS nerve root impingement
-disc herniation -bone spurring MOI if acute: forced hyper-extension, rotation or both (test for this w/ Spurling's Test)
Criticisms of Virtue Ethics
-doesn't provide directions for decision making -morality depends more on experience than reason -results often don't maximize happiness
What does lung compliance depend on? (3)
-elastic properties of the tissue -alveolar surface tension (amt of surfactant) -thorax anatomy & flexibility
Should BWS ambulation be used in therapy for pts w/ SCI?
-evidence inconclusive that any single locomotor training approach is more effective than any other for improving walking post SCI -currently no evidence that robot-assisted gait training improves walking fxn more than any other locomotor training strategies
Describe the gross motor movement of a neonate:
-extend neck to drag face from side to side in prone -no head control: head bobs when held in sitting or upright position -movements are reflexive
When is surgery considered to treat cervical radiculopathy? (3)
-failed conservative tx after 2-3 months -progression of neuro deficits, esp. weakness -persistent numbness, esp. if dominant hand is involved
What is the difference between the first and second group of restrictive lung disorders?
-first: abnormality of chest wall, limits or impairs lung expansion -second: diseases affecting the supporting framework of lungs, not alveoli or airways
What are some indications that it may be chronic inflammation?
-follows acute inflammation -less swelling present -presence of more lymphocytes, macrophages and fibroblasts -tissue destruction -granulomas around foreign object -scar tissue
What is the purpose of a limb sock?
-friction absorption -fill socket volume -absorbs sweat
What are the residual limb requirements to be able to use a prosthetic?
-fully healed incision -no signs of infection -no drainage from incision site -*ability to tolerate WB* -frequent skin inspection
What goes in the tests & measures component (specifically) of a pediatric PT exam?
-gait/locomotion/mobility -balance -anthropometrics (size of child) -motor function-- *reflexes, milestones, postural rxns* -posture -ROM -strength -ADL/self-care -standardized assessments -ventilation/respiration -home/school/play -pain -arousal, attention, cognition -assistive device -orthotics
How do you calculate an axis deviation from an EKG? (3)
1. mean QRS axis is midway b/w 2 leads that register tall R waves of equal amplitude 2. mean QRS axis is directed at right angles to any extremity lead that has a biphasic isoelectric complex (idk what these methods are ^^) 3. look at EKG and see if LL1 and aVF have pos or neg QRS complexes*** --both positive: normal axis --aVF negative: left axis deviation --LL1 negative: right axis deviation
A local potential is produced by information at which 2 types of gated channels?
1. modality-gated channels of sensory neuron receptors (receptor potentials) 2. ligand-gated channels at post-synaptic membranes (synaptic potentials)
RR increases during exercise ______ times in normal adults and ________ time in conditioned athletes
1. normal: 1-3x 2. athletes: 6-7x
What 3 structures is an IV disc made up of?
1. nucleus pulposus 2. annulus fibrosis 3. vertebral end plate
Components of a physical exam (4)
1. observation 2. palpation 3. ausculatation 4. percussion
What are the different mechanisms that cause atelectasis? (5)
1. obstructive or resorption atelectasis 2. compression atelectasis 3. due to inc surface tension in alveoli 4. contraction atelectasis 5. postoperative atelectasis
How many branches are in each part of the 3 artificial sections of the axilla?
1. one branch 2. two branches 3. three branches
List some gross motor "red flags" in children: (10)
1. persistence of reflexes 2. lack of leg movement 3. "stuck" in head/neck/trunk hyperextension 4. extremely floppy 5. spasticity 6. athetoid movement 7. extremely rigid 8. inability to achieve midline head/extremities 9. only unilateral movement 10. "bunny hops" instead of creeping 11. walks on toes w/ adducted legs
When faced with questionable info that may make you think you need to whistleblow, what should you do?
-gather all relevant info -keep in mind you can't dismiss a complaint based on the characteristics of the person making it, you still need to consider it -determine if the wrong doing has created or is likely to create serious harm
What causes a deficiency of alpha1-antitrypsin? (3)
-genetic mutation -smoking -environmental pollutions
What are things you should consider when selecting interventions for a pediatric patient?
-goal of intervention -treatment options -evidence-based best treatment -impact on function-- activity & participation limitations -how will you progress it -prognosis of child
What manual therapy may be helpful for someone w/ a disc herniation? (McKenzie Protocol)
-grade I & II central PA may be helpful, but other techniques are better -rotation
What types of prosthetics do UE amputees often use?
-harnesses -body-powered cable control systems -myoelectric control systems are becoming more common
What medications may someone with a DVT need to be placed on?
-heparin -coumadin -lovenox
The abdomen may sound __________ with air, but will sound ____________ with masses (organs).
-hollow with air -dull with organs
Common causes of burns in pts w/ SCI:
-hot objects in lap (coffee, hot plate) -touching hot surfaces (concrete, recently used burner) -cigarettes -hot pack -hot water from bath/shower
What factors (besides lesion level) may increase the difficulty a SCI pt has with being weaned off of a ventilator? What may happen as a result?
-hx of smoking -pneumothorax -infection may need tracheostomy
If a pt w/ a disc herniation has a lateral shift, what should you do to correct it?
-identify direction of shift -identify if they have a flexion deviation -correct it by shifting their hips to the correct position, not their shoulders -perform reps of the correction -test additional movements -perform neuro testing -watch for inc in peripheral sx 90% of the time, this inc their sx & they may lose their balance if the pain is bad enough--- this doesn't work well
What are potential complications of inflammation?
-infection -deep ulcers -skeletal muscle spasm -local complications such as obstruction, loss of sensation or decreased cell function
What is a local potential?
-initial change in membrane potential -only spreads a short distance -if it's sufficient, AP will develop -either depol or hyperpol
Treatment: cervical radiculopathy
-initial: rest, NSAIDs, steroids -next: cervical traction -next: consider NR injection -last: surgery (2/3 of pts improve w/in 3 months w/out surgery)
When does phantom limb sensation occur?
-initially, right after surgery (90%) -may dec over time, or the pt may have the sensation throughout life -67% have it 6 months post-op
How is desensitization and massage done to treat phantom limb pain?
-initiate gentle touch & textural stimulation after wound is closed -initiate scar & deep friction massage -massage should be used as an adjunct to daily skin inspection & care routine
The decision to use a prosthesis after an amputation should be based on input from whom? and pt performance with what?
-input from patient, prosthetist, PT and MD -pt's performance w/ a temporary prosthesis
What is expected with strength & muscle tone for SCI patients?
-intact above LOI -absent below LOI -low tone (flaccidity) initially -inc tone (spasticity) after period of "spinal shock" has passed, may interfere with function -weakness proximal to SC lesion
If a pt has a SCI lesion at C6-7, how might this affect their respiratory function and expected outcome? What might they have difficulty with and what might they be at an increased risk for? What technique can you teach them to lower their risk?
-intact diaphragm -limited intercostal musculature -difficulty weaning from ventilator -*difficulty with secretions & coughing* -potential for pneumonia -Quad Cough: have them bend over & use both arms to push into their abdomen just below their xiphoid process to assist the cough
Describe stage 3 TMJ dysfunction:
-intermediate -disc is anterior & medial to condyle -- less frequent to no reduction/click -- disc thickens -chronic limited mouth opening -painful chewing, headaches, joint tenderness
Describe stage 4 TMJ dysfunction:
-intermediate/late -disc is anterior & medial to condyle -- no reduction -- disc is markedly thickened -restricted motion -chronic pain, headaches -*osteoarthritic changes begin to take place*
What should be included in HEP for a patient with a meniscal injury?
-isometrics and AROM at subacute phase -progress to bike and other activities in later phases
Why is TB hard to kill?
-it is a MDRO -it's resistant to drying and many disinfectants
What are some noteworthy differences between adult and pediatric amputations?
-kids have excellent circulation which enhances wound healing -kids have superior tissue tolerance which may allow early post-op prosthetic fitting -surgeons have to be careful not to disrupt growth plates in kids -surgeons must consider both longitudinal and circumferential growth that kids will experience
What are some examples of first group, restrictive lung disorders?
-kyphosis, scoliosis -poliomyelitis -amyotrophic lateral sclerosis -botulism -muscular dystrophy
What are 4 reasons disc degeneration might occur?
1. *biochemical changes*: dec proteoglycan synthesis, inc collagen/change in type 2. *nutrition deprivation*: injury/trauma, smoking- dec fluid transport 3. *mechanics*: repetitive trauma, shear forces 4. *genetics*
What are the 5 modes of heat transfer according to Stacia? (one's according to physics in bold)
1. *conduction* 2. *convection* 3. conversion 4. *radiation* 5. evaporation
What TherEx should you focus on with an amputee once they have their prosthesis?
1. *core work*- TA activation, Russian twists, etc. 2. *transfers*- sit-stand progression, wall squats, etc. 3. *balance*- perturbations, weight shifts, etc. 4. *gait*- stool stepping, resisted gait, lunges, etc.
Surgical Indications: cervical spine (3)
1. *fracture*: trauma 2. *myelopathy*: sensory disturbances in hands, intrinsic hand mm wasting, unsteady gait, hyperreflexia 3. *neoplasm*: >50, no relief w/ rest, unexplained weight loss, previous cancer
What is the most common cause of an UE amputation?
1. *trauma*- 69% (MVA, farming, burn, electric) 2. congenital- 59% 3. cancer- 24% 4. dysvascular- 3%
What are the 4 steps of progressive mobility training?
1. *upright tolerance*: dependent transfer tasks- Hoyer lift, stand assist lift, stretcher chair 2. *sitting stability*: slide board, squat pivot, 1/2 stand pivot 3. *standing stability*: stand pivot transfer, step pivot transfer 4. *gait training*: parallel bars, ambulation with assistive device, ambulation w/out assistive device
Sucking Reflex: 1. onset 2. stimulus 3. response
1. 0-6 months 2. touch lips 3. automatic sucking
What is the average age that children attained these gross motor milestones: 1. crawling on belly 2. sitting 3. creeping on hands/knees 4. pull to stand 5. independence stance 6. walking
1. 2 months 2. 6-7 months 3. 8-10 months 4. 9-10 months 5. 12-13 months 6. 14-18 months Notes: Mildred's slide says walking occurs at 9-15 months, she said she would accept anywhere from 9-18 months on the exam
How will a person's ROM be affected by a disc herniation? What considerations do you need to make when testing their ROM? (mostly extrusions & sequestration)
-large limitation in motion -guarded movement -careful w/ flexion testing -test extension first, then SB toward, SB away, and flexion last
What is a sucking wound?
-large opening in chest wall -air moving in/out makes a sucking sound -type of open pneumothorax
Landau Reaction Reflex: 1. onset 2. integration 3. stimulus 4. response
1. 4 months 2. 18 months 3. hold infant in horizontal suspension 4. extend neck, trunk & hips "superman"
Symmetrical Tonic Neck Reflex (STNR): 1. onset 2. integration 3. stimulus 4. response
1. 4-6 months (bridging reflex) 2. 8-12 months 3. head in flexion or extension in quadruped position 4. Flexed- flexion of UE & extension of LE. Extended- extension of UE & flexion of LE.
What is the average age that children attained these other gross motor milestones: 1. creep up/down stairs 2. walk up/down stairs with hand held, throws ball forward 3. runs stiffly 4. walks up/down stairs unsupported, kicks ball forward 5. runs well, walks up stairs alternating feet, catches ball w/ arms & body 6. walks down stairs alternating feet, jumps w/ both feet, hops on one foot 7. gallops 8. skips
1. 8-15 mo 2. 15-18 mo 3. 20 mo 4. 2.5 yrs 5. 3 yrs 6. 3.5 yrs 7. 4 yrs 8. 5-6 yrs
An UE prosthesis should meet which specific needs of a user? (6)
1. ADL 2. medical 3. vocational 4. psychological 5. avocational 6. specific tasks
What is an action potential?
-larger change in electrical potential -all-or-none response -spreads long distances via activation of voltage-gated ch. -large depol that's repeatedly regenerated along an axon -transmits info down axon to pre-synaptic terminal & causes the release of ntm
Describe stage 5 TMJ dysfunction:
-late -no reduction, perforation of retrodiscal tissues -degenerative changes of bone -- joint crepitus instead of clicking -painful function (variable)
Describe the relationship between the lateral femoral condyle and the lateral meniscus between 30 and 5 degrees of knee flexion
-lateral femoral condyle and lateral meniscus become more congruent -glide at the medial side becomes greater
What are signs and symptoms of a meniscus injury? (6)
-lateral of medial joint line pain -effusion -sensation of crepitus or popping -limitation in normal knee ROM -locking -instability during ambulation
After an AP, how is the resting membrane potential of a neuron restored?
-leak channels -Na+-K+ pump
Which of the 12 EKG leads have a positive QRS complex normally?
-limb leads: all positive -augmented: aVR negative, others positive -precordial: gradual progression of R wave getting bigger from V1-6
What could be involved with the education part of the treatment plan for a patient with a meniscal injury?
-limit WB (20% of bw) and ROM 70 deg flexion (wk 1) -increase progressively weight bearing and ROM -full WB at 5 wks and ROM at 130 knee flexion -unloaded flexion at 6 wks and loaded flexion at 7 wks
How would a person's ROM be typically affected by DDD? What movement impairments might you see?
-limited during acute episode -pain w/ flex/ext -pain w/ OP -sustained movements provoke sx -may have difficulty returning to neutral -ext and/or rotation impairment
Why should someone choose to not get an UE prosthesis?
-limited perceived functional benefit -dec sensory input -comfort (too hot/heavy) NOT bc of lack of coverage or lack of access!
What does a whistleblower need to document?
-list facts, not judgments or assumptions -days, times, whom, when, & where
What do the following changes in skin temperature mean: -localized inc -general inc -general dec
-localized: inflammation -inc: hyperthyroidism -dec: hypothyroidism
How do you diagnose a pulmonary embolism? (4)
-lung scan -MRI -pulm. angiography -x-ray
What are some of the goals of surgeons when performing an amputation?
-maintain adequate circulation for wound & incision healing -remove damaged tissue -preserve as many joints as possible, esp the knee -preserve max bone length -provide residual limb that will accept a prosthesis & tolerate WB
What are some general guidelines for an exercise program for an amputee? (read)
-maintain full ROM -strengthen trunk & extremities -work on balance -work on functional activities (bed mobility & transfers) -*CV endurance*
Describe the typical patient presentation for disc degeneration: -gender -age -occupation -type of pain
-male -40-50 yo -occupation: involves lifting, sitting or hx of contact sport/overuse -pain: constant/intermittent, low grade ache, morning stiffness/pain, rare leg sx (only have pain if there is nerve involvement)
What causes anterior spondylolisthesis?
-may be congenital or due to a fracture of the pars interarticularis -related to inc shear forces: inc sacrohorizontal angle, inc lumbar lordosis & hyper-extension
What are symptoms of an intra-spongy herniation?
-may heal w/out any sx -may cause an inflam response -may result in Schmorl's nodes these people usually have general back pain w/ no radiating pain
When evaluating an amputee acutely after surgery, what information do you need to get from them?
-medical hx -hx of present incident -mental status -precautions -social situation -pain level -sensation -phantom limb sensation or pain -ROM: passive, AA or active -strength -bed mobility -sitting/standing balance -transfers -locomotion: gait or wheelchair -endurance -home & work environment -barriers to care or adjustment -knowledge of limb care & prosthetic use
Management of spasticity for pts w/ SCI
-medical management! -medications: baclofen, valium, flexeril, etc.
List the aspects of a PT screen (2)
-medical screening questionnaire -medical history
What are 3 of the most common knee injuries?
-meniscus injury -ligament injury (ACL) -patellofemoral pain syndrome
During a primary infection of TB, when a microbe first enters the lungs, what happens?
-microbe is engulfed by macrophage & causes inflammation -if cell-mediated immunity is adequate, a granuloma is formed at the site of infection -if it is inadequate, the bacteria reproduce & begin to destroy lung tissue
What does a cellular response include with acute inflammatory response?
-migration of inflammatory cells (neutrophils) through chemotaxis to the cite of injury purpose of: -destroying infective organisms -remove damaged cells -release inflammatory mediators
What is considered to be a first degree (mild) ligamentous injury?
-minimal damage to collagen fibers -NO loss of ligament function -slight diminution of the ligament to resist external hyperpositional stress
What are the 6 areas of possible treatment?
-modalities -manual therapy -TherEx -HEP -education -assistive devices
Frank Starling Mechanism
-more blood in the ventricle causes a greater stretch & contract w/ increased force -inc ventricular contractility
How is oxygen transported in the blood?
-most is bound to Hb -about 1% of it is dissolved in plasma
What are some sources of motion restriction due to contractile tissue?
-muscle -musculotendinous jxn -tendon -tendinous--bone jxn
What is the etiology of TB?
-mycobacterium tuberculosis -aerobic, slow growing -transmitted by oral droplets from persons with active infection
What are the different ways surgeons can stabilize muscles after an amputation? (read)
-myodesis -tenodesis -myofascial -myoplasty -open (guillotine) closure -provisional closure -delayed closure
How are externally powered UE prostheses controlled?
-myoelectric signals -controlled by various input methods Ex: electrodes on biceps & tricpes
What is atelectasis? -what does it cause? -what does it interfere with?
-nonaeration or partial/complete collapse of a lung -alveoli collapse, inflammation & atrophy occurs -causes dec gas exchange & hypoxia -interferes with blood flow through the lung
What is the normal duration, height & appearance of a P wave?
-not wider than 0.11 sec (under 3 small boxes) -not taller than 3 mm -not notched or peaked
Bronchiectasis leads to _______________ of airways and weakening of the ______________ . _______________ accumulates in dilated areas and becomes infected.
-obstruction -muscle & elastic fibers -fluid
Natural Law Theory
-opposite of Divine Command Theory -actions in conformity & support of natural laws are morally correct
You expect a SCI patient to have pain at the injury site and nerve root pain. What are some less commonly thought of sources of pain they may have? (2)
-other unidentified injuries from trauma -neurogenic pain below the LOI Notes: it is common to have set backs in therapy d/t other injuries: Ex: they are capable of moving their L arm but d/t an injury it's supposed to be immobilized for 6-8 weeks
How does documentation vary in a pediatric setting? (read)
-outpatient peds is similar to adults -early intervention & school based are very different (will learn later)
What are 2 risks for those with pulmonary disease when exercising?
-oxygen desaturation -hyperventilation
What are some impairments that drive PT's to provide interventions? (5)
-pain -tissue healing -tissue extensibility -tone abnormalities -movement restrictions
How do pts w/ pain after SCI typically present?
-pain in shoulders as well as area of injury -soft tissue damage that goes along w/ injury -nerve root pain may also be present
Management of pain in pts w/ SCI
-pain modalities (careful if using hot/cold packs) -alternative exercise -acupuncture
Which PT modalities transfer heat via conduction?
-parrafin -hot pack
How do IV discs receive nutrition?
-passively: imbibition (type of diffusion) -actively: spinal motion only the outer 1/3 of the disc is vascular, this area receives the nutrients and travel to the avascular center of the disc via the above processes
What manual therapy may be included with the treatment of PFPS?
-patellar mobilization -lateral retinaculum stretching
What should be considered under the manual therapy portion of the treatment plan for a patient with a meniscal injury?
-patellar mobilizations and soft tissue massage at acute phase -progression to tibiofemoral mobilizations in the later stages if ROM is limited
Problems with disc replacements after tx for cervical myelopathy: (3)
-peri-prosthetic ossification -prosthesis migration anteriorly -prosthesis migration posteriorly
Describe the ROM of newborns:
-physiological flexion (fetal position) -limited hip & knee extension -increased dorsiflexion
What conditions are "pink puffers" and "blue bloaters" a part of?
-pink: emphsema -blue: chronic bronchitis
When selecting interventions for a pediatric patient, what are some ways to help engage the child and get them to participate more in therapy?
-play based therapy -incorporate child's interests -*natural environment*-- home, playground, classroom, PE class -incorporate toys & games -consider group session w/ another child Ex: games -gross motor: simon says, twister, hula hoops, bubbles, scooters -stretching: animal poses -strengthening: scooter activities for tummy time -balance: squat to pick up toy, step over lav, mini trampoline, obstacle cours
List some treatment suggestions for a pt w/ a disc herniation (read) (mostly extrusions & sequestration)
-position of comfort: 90/90 -unloading -good posture/body mechanics -don't force movements -gentle active motions -avoid bending/lifting -avoid sitting -use supports -abdominal bracing -modalities/traction
Potential for use of neural stem cells in the rehabilitation process: (read)
-possible role as brain cell implants for rehab after injury or disease (ALS, MS, SCI) -in mice, transplant resulted in myelination of axons & dec activity of glial cells -currently in many phase I studies in humans -stem cells are difficult to obtain from the brain -the umbilical cord & bone marrow can be sources of neural stem cells
What education should be provided to an amputee?
-post-op goals & expectations -positioning -pain relief -residual limb care -*protection of contralateral leg* -prosthetic info & time frame -encourage them to stop smoking if they are
What tibial arthrokinematic motions take place on the femur with open chain flexion of the knee? (2)
-posterior roll with medial rotation -posterior glide
Why is deciding to whistleblow so hard for the individual?
-potential blows to your ego, beliefs & hopes -potential loss of a friend or colleague -disruption of relationships w/in an organization -tests moral character of the whistleblower -takes courage, patience, fortitude, real desire to strive for justice & compassion -attempt to exhaust all internal resources to resolve the problem -fear of stigma or loss of employment
Define: primitive reflexes
-present in newborns -predictive, involuntary mvmt in response to a stimuli -integrate by 9-12 months
What takes place in the IV disc when it undergoes distraction forces?
-pressure dec on nucleus -pressure inc on annulus
What should you consider when selecting a wheelchair cushion for a SCI patient?
-pressure mapping -look for positioning component to cushion -it doesn't have to feel "good" to you -combine with a back if possible -a cushion is better than no cushion, regardless of the type of cushion
What unique complications might women experience with pregnancy who also have a SCI? (2)
-pressure sores -respiratory compromise
What are the goals of acute PT rehab with an amputee?
-prevent complications -allow healing -develop limb strength & ROM for prosthesis -maximize independence in mobility & ADLs -pre-prosthetic training & limb preparation -endurance training & initiation of HEP
Initially, what is the primary focus of acute care and early rehab for SCI patients? (3)
-prevent secondary complications -achieve upright tolerance -education
Management of contractures in pts w/ SCI:
-prevention -ROM -proper positioning in bed/WC -injections or baclofen pump for older injuries -surgical releases & tendon transfers
Management for pressure sores
-prevention/education! -proper WC, bed positioning & pressure relief -minimize sheer forces (no bare butt transfers) -pressure mapping for seating -proper nutrition -moisture management
What is the purpose of an osteomyoplasty?
-prevents "chopsticking" of distal bone ends of tibia & fibula -improves WB on residual limb
How will sexual function in women be impacted by a SCI?
-primary intervention: may need addt'l lubrication -phantom/psychological orgasm is possible
What should be considered under the Ther Ex portion of the treatment plan for a patient with a meniscal injury?
-progress ROM -isometrics -bike exercise -aquatic exercise progressing to isotonic -proprioceptive and balance exercises -flexibility -intensify the strengthening exercises -agility training and sport specific activities
What are general exercise precautions after a meniscus repair? (2)
-progress exercises and weight bearing more gradually after a central zone (mod vascular) meniscus repair or meniscus transplantations than after a peripheral zone repair (highly vascular) -if the pt experiences a clicking sensation in the knee during exercise or weight bearing activities, *report immediately* to surgeon
What are some general precautions for resistance training after an ACL reconstruction?
-progress exercises more gradually for reconstruction with hamstring tendon graft than bone-patellar tendon-bone graft -Progress knee flexor strengthening exercises cautiously if hamstring tendon graft was harvested and knee extensor strengthening if patellar tendon graft was harvested
Presentation of pt w/ syringomyelia****
-progression of muscle weakness proximal to LOI -change in level of motor function is a sign of a new pathology
How do you treat a pulmonary embolism? (6)
-prolonged bed rest -compression stockings -surgically inserted filter into vena cava (sometimes) -heparin or streptokinase -mechanical ventilation -embolectomy
What education should be provided to someone w/ a disc herniation? (McKenzie Protocol)
-proper body mechanics -good posture -lumbar support (these people need to maintain a lordotic posture as much as possible to prevent further herniation, places more pressure from IV joints onto facet joints)
What are some typical goals for a pt w/ a disc herniation in the subacute/chronic stage? (6) (mostly extrusions & sequestration)
-protect the disc -centralize pain -promote healing -address faulty motions -inc mobility & flexibility -educate on return to fxn & work
What may be included under education for treatment of a ligamentous injury of the knee?
-protection (WB and limited flexion) -importance of exercises -expectations
What is mirror box therapy?
-pt performs a movement w/ the unaffected limb -movement is viewed in a mirror -at the same time, pt attempts to perform the movement with their residual limb pain relief is hypothesized to be due to cortical restructuring
What are symptoms of a protrusion herniation?
-pt tries to unload spine w/ their hands when doing a sit--stand -lateral shift of trunk away from the pain -post. tilted posture to take the pressure of the herniation -*negative neuro signs* unless nerve root compression -limited/painful flexion: pushes NP further into area of tear
For a BKA, in which direction is the "pull" while applying an ACE wrap?
-pull medial to lateral -pull posterior to anterior
What are some of the most important tests/criteria for determining return to activity after ACL reconstruction?
-quad strength -hamstring strength -hop test
Suggestions for possible adaptations in home for pts w/ SCI needing to use a WC: (read)
-ramps (1 foot run/1 inch rise) -hardwood floors (avoid carpet) -no throw rugs -pedestal sink or cut out cabinet in bathroom -flat surfaces for bathroom sink -put frequently used items on lower shelf -roll out shelves -lazy susan -Alexa/clapper lamps -loops on cabinets -lever handles on doors (instead of twist knob) -raise floor of kitchen -stackable washer/dryer -remote control options
Sheer Stress (in terms of blood vessels)
-refers to friction on endothelial wall -depends on rate of sliding/flow and viscosity
What are some exercise precautions for return to activity after a meniscal repair?
-refrain from recreational and sports activities that involve repetitive, high joint compressions and shear forces -avoid prolonged squatting in full flexion
With acute inflammation, what are the three main responses that occur?
-release of chemicals from mast cells -vascular response -cellular response
COPD can lead to what 2 things?
-respiratory failure -development of cor pulmonale
What is a tension pneumothorax?
-results from open or closed pneumothorax -with each breath, air accumulates in the pleural cavity -this inc pleural pressure & atelectasis -BAD
Legal Rights
-rights backed by the law -created by constitutional guarantees -easier to protect negative rights -just bc it's the law doesn't make it moral -just bc it's moral, doesn't make it the law
Contractarian Theory Positions on Rights
-rights come from practical reasoning & collective choice or bargains -if all people are free & equal then positive rights would make it so that the most disadvantaged person would accept them
What are some things you should consider about when and where you perform a preschooler or school-aged child PT examination?
-schedule -natural environment -naturalistic environment -team approach -comprehensive developmental assessment Last bullet: cognitive, motor, social, speech-language & adaptive skills in natural environment
What are some sources of motion restriction due to noncontractile tissue?
-skin -ligament -bursa -capsule -articular cartilage -IV disc -peripheral nerve -dura mater
What are some general measures to treat asthma?
-skin tests for allergic rxns -avoidance of triggers -good ventilation -swimming & walking -maintenance inhalers
What might you observe about someone's posture if they have a disc herniation? (mostly extrusions & sequestration)
-slightly flexed posture -may have lateral shift
What are indications of chronic inflammation?
-slow onset (may follow acute) -longer duration (days to years) -lymphocytes and macrophages as main players -simultaneous inflammation and repair
What are symptoms of small and large pulmonary embolism?
-small: transient chest pain, cough, dyspnea -large: inc chest pain w/ cough or deep breath, sudden dyspnea -later hemoptysis & fever, hypoxia
Chronic bronchitis is caused by constant irritation due to what substances?
-smoking -air pollutions
Factors affecting functional outcomes of SCI patients: (5)
-social hx -*family support* -work hx -level of education -home layout (begin home modifications EARLY)
What is considered to be a second degree (moderate) ligamentous injury?
-some portion of the ligament is torn -discernible degree of functional compromise of the knee joint (protective brace and PT)
What might you notice w/ segmental motion PAIVM in a pt w/ DDD?
-some segments will be hypo-mobile and other segments will be hyper-mobile -minimal pain
Instability of the spine could lead to which type of injuries? (read)
-spondylolysis -spondylolisthesis -fractures
Where does non-small cell lung cancer come from?
-squamous cell carcinoma (epithelial cells) -adenocarcinoma (mucus producing cells) -large cell carcinoma (everything else)
How do you diagnose an active/secondary TB infection?
-staining sputum for M. tuberculosis -sputum sample & sensitivity of microbes to drugs -chest x-ray (cavitations)
How do you treat chronic bronchitis? (9)
-stop smoking -reduce exposure to irritants -treat infection -vaccination for prophylaxis -expectorants -bronchodilators -chest therapy (percussion) -low-flow O2 -nutritional supplements
Once a pt with a SCI has stabilized and can tolerate upright positioning, what are some things that may be worked on with therapy at that point? (5)
-strengthening -PROM (good time to let pt talk about feelings) -education for skin care & pressure relief -teach them methods of self-pressure relief -put them in control of asking someone to assist w/ pressure relief
What events would someone with a disc herniation typically have in their history during a subjective exam? (mostly extrusions & sequestration)
-sudden onset -usually due to repetitive bending or lifting
Safety suggestions for home for pts w/ SCI: (read)
-suggest cordless/cell phone -emphasize smoke detectors -encourage pt to call fire dept. and inform them of a person w/ disability in that home -adjust hot water heater to lower temp (reduce risk of burns)
What is a concern for babies that are born prematurely that has to do with the development of the respiratory system?
-surfactant is produced late in fetal development -babies born prematurely may have difficulty breathing which can lead to resp. failure
How does training affect systolic & diastolic BP during exercise?
-systolic: increases it -diastolic: remain the same or decrease slightly
How can a meniscal injury progress if not treated?
-tear could become longer with repeated injuries -a split can cause flap tears
What is symptom behavior?
-the way a person acts based on the symptoms -how does it change in 24 hrs Ex: sit to one side to alleviate pain
In the secondary stage of TB, what happens when microbes begin to reproduce and infect the lungs?
-they form large areas of necrosis causing erosion into bronchi & blood vessels and cavitations (openings) -cavitation promotes spreading into other parts of the lung -cough, fever, night sweats, weight loss and fatigue
What are some things you should consider about when and where you perform an infant PT examination?
-time of day (feeding & naps) -parents' schedules -natural environment -naturalistic observation -may be in random order based on infant's desires/needs
Bradycardia is defined as a heart rate of <60 bpm, however athletes often have heart rates lower than this. Is this a concern?
-training dec HR but inc SV, not much of a concern -bradycardia is more of a concern when a sedentary person has a low HR and low SV-- lack of blood volume getting to the body
How do you treat pulmonary edema?
-treat causative factors (duh) -supportive care (O2, antibiotics, upper body elevated)
What are pneumoconioses?
-type of restrictive lung disorder -general term given to any lung disease caused by long-term exposure/inhalation of irritating particles such as dust -could lead to fibrosis (stiff lung)
What are the 2 anatomic areas of the respiratory system?
-upper respiratory tract -lower respiratory tract
Factors limiting tolerance to activity in pts w/ SCI: (4)
-upright tolerance (d/t BP) -respiratory status -endurance -pain
How can wheelchairs help in the prevention of pressure ulcers?
-use a *tilt in space* WC to lean back & unload the ischial tubes -must be tilted to *65 deg* for any significant pressure relief to occur -a recliner WC will not provide pressure relief (needs to be a tilt in space)
What tests could be done as part of an OE to determine if a patient has a ligamentous injury of the knee? (4)
-valgus stress test (MCL) -posterior sag sign (PCL) -Anterior drawer test (ACL) -Lachman's test (ACL)
What are the different classifications of meniscal tears? (5)
-vertical longitudinal -oblique -degenerative -transverse (radial) -horizontal
What are examples of meniscal injuries that could be repaired with a partial meniscectomy? (3)
-vertical tears near the periphery -intact meniscus body -tissue defect length less than 2 cm
What is bronchoscopy used for? (3)
-visualizing the inside of airways -performing a biopsy -checking sites of lesion or bleeding
What are some muscular etiologies that can lead to PFPS?
-weakness of quads -weakness of medial quads (VMO) -tight IT band -tight hamstring muscles -weakness or tightness of hip muscles (adductors, abductors, external rotators) -tight calf muscles -tightness of rectus femoris
What pt changes indicate the need to refer the pt to their prosthetist?
-weight gain -volume change -ROM or functional changes -anything that consistently affects prosthesis fit
What is a poor R wave progression defined as and what does it mean?
-when R waves do not begin to dominate the QRS until V5 or V6 -may indicate a MI or injury of the ant LV -carries almost as much significance as Q waves
What are precautions for closed-chain training after an ACL reconstruction?
-when squatting in an upright position be sure that the knees do not move anterior to the toes as the hips descend because this increases shear forces on the tibia and could potentially place excess stress on the autograft -Avoid closed-chain strengthening of the quads between 60-90 deg knee flexion
If you still think there is a problem with a prosthesis after checking it, what information should you have ready for the prosthetist?
-which motions cause the pt pain? -is it a musculoskeletal issue or a pressure issue? -what is the condition of the skin of the residual limb? should also try to reproduce the problem with the prosthesis off
Criticisms of Utilitarianism:
-you can't assess all the possible consequences -there may be infringement on another person to achieve one's happiness -sense of duty is overlooked -respect for people can be overlooked -POV can be paternalistic -*using others as a means to an end*
Scale of reflex documentation
0 No response 1+ Present, but depressed. low normal 2+ Average, normal 3+ Increased, brisker than average, possibly abnormal 4+ Very brisk, abnormal
Where in the range for knee motion should CKC exercises be performed to decrease PJRF?
0-16 deg progress to 0-30
What is the duration of a normal PR interval?
0.12 to 0.20 sec (no longer than 1 big box)
Which poles of the patella are in contact with the femur during the following amounts of knee flexion: 0 (full extension) 15-20 45 90 Full flexion (135)
0: no contact 15-20: inferior pole 45: middle pole 90: (all facets?) Full flexion (135): odd facet and lateral aspect
What is the information obtained from goniometry used for?
1. Determine absence/presence of dysfunction 2. Establish a diagnosis 3. Evaluate progress 4. Modify treatment 5. Patient motivation 6. Research effectiveness of treatment 7. Guide for fabrication of an orthosis or piece of adaptive equipment
Differences between emphysema and chronic bronchitis: 1. location 2. cough 3. sputum 4. cyanosis
1. E: alveoli. CB: bronchi 2. E: some coughing, marked dyspnea. CB: constant cough 3. E: little. CB: large amt, purulent 4. E: no. CB: yes
What are the 2 types of postsynaptic potentials? (local potential on a postsynaptic terminal)
1. EPSP: depolarization, summation can lead to AP 2. IPSP: hyperpolarization, dec chance of AP
List the components of a Pediatric PT Evaluation: (read)
1. Examination: subjective hx, administering tests & measures 2. Evaluation: clinical judgement based on examination 3. PT Diagnosis: includes problem & what you want to work on 4. Prognosis: determines goals & interventions 5. Intervention: PT techniques to produce changes in condition 6. Outcomes: result of interventions
List the 5 regions of the fallopian tube
1. Fimbria 2. Infundibulum 3. Ampulla: longest, site of fertilization 4. Isthmus 5. Intramural: in wall of uterus
Which EKG leads are looking at the following areas of the heart: ***** 1. inferior 2. septal 3. lateral (higher up) 4. lateral (lower down) 5. anterior
1. II, III, aVF 2. V1, V2 3. I, aVL 4. V5, V6 5. V3, V4 There is some overlap b/w V1 & V2 and V3 and V4 shown in picture Picture: ignore most of it, just look at picture of heart, same as slides
What can we measure with a goniometer specifically?
1. Joint angle or position 2. ROM 3. Length of a muscle
What maintains a resting membrane potential? (3)
1. Na+-K+ pump --pumps out 3 Na+ for every 2 K+ pumped into the cell 2. anions too large to diffuse out 3. passive diffusion of ions
What are the 2 main regions of the prostate?
1. Periurethral zone 2. Peripheral/Main zone
What are the types of microglia & what do they do?
1. Phagocytes: engulf & digest cell debris & waste note: abnormal activation of these cells is involved in several diseases
What are the 3 sources of vaginal lubrication?
1. Plasma transudate: from increased blood flow 2. Cervical mucus glands 3. Bartholin's & Skene's glands near entrance to vagina
What are 2 ways a modulatory neuron can influence the presynaptic neuron to alter the intensity of the local potential generated at the postsynaptic neuron?
1. Presynaptic Facilitation: more ntm released 2. Presynaptic Inhibition: less ntm released
What are the functions of the cervix?
1. Prevent pathogens from entering uterus 2. Prevent sperm from entering uterus 3. Secretes mucous 4. Prevents pathogens from entering during pregnancy
What are the 3 major theories as to why endometriosis occurs?
1. Retrograde menstruation: through fallopian tubes spreading tissue into the peritoneal cavity 2. Metaplastic theory 3. Hematogenous/Lymphatic Spread
1. During exercise, up to 50% maximal capacity, the increase in Q is due to: 2. After 50%, the increase in Q is due to:
1. SV & HR 2. HR
What are the 3 components of an UE prosthesis?
1. Socket: suspension interface 2. Components: elbow & wrist 3. Terminal Device: hand or hook
What are the functions of the epididymis?
1. Sperm maturation 2. Sperm storage 3. Sperm disposal
Which 2 areas of the brain are most essential in producing new neurons in an adult? (bleh)
1. Subgranular Zone of the Hippocampal Dentate Gyrus 2. Subventricular Zone of the Lateral Ventricle Wall
What information does palpation give us?
1. Temperature 2. Skin: moist/dry, sensation 3. Tissue density: thick scars, muscle spasms, swelling, edema 4. Deformities 5. Posture: asymmetry
What do the following ICF domains mean: 1. body functions 2. body structures 3. activity (limitations) 4. participation (restrictions) 5. environmental factors 6. personal factors
1. physiologic & psychological functions of the body-- fxn of joints, bones, muscles, reflexes, etc. 2. structure of organs, limbs, trunk, muscles 3. performance of a task or action 4. involvement in life situations-- home, school, community, friends 5. physical, social & environment in which people conduct their lives 6. background of a person's life that isn't part of the health condition-- lifestyle, habits, coping styles
What are the 5 different types of pneumothorax?
1. closed 2. simple/spontaneous 3. open 4. secondary 5. tension
What are the 4 types of disc herniations?
1. intra-spongy herniation 2. protrusion (contained) 3. prolapse/extrusion 4. sequestration
How many channel stimulators are there with interferential?
2
Describe the currents and set up for bipolar IFC?
2 med frequency currents (1 channel) oval shaped field
What is the ideal step width in prosthetic gait training? How should you work on this with the pt?
2-4" they tend to inc this due to feeling unstable, instruct them not to do this
Are amputation rates due to cancer currently increasing or decreasing? Why?
*decreasing*, due to earlier diagnoses, improved chemo and limb salvage/ reconstruction techniques
T/F: a herniated disc cannot occur without nerve root involvement
*false* it can be with or without nerve involvement
What should absolutely be considered when choosing Ther Ex to treat a ligamentous injury of the knee?
*follow surgeon protocol*
Heat is *conducted* from the material at a ___________ temperature to the material at the ___________ temperature (higher or lower)
*higher to lower* (faster-moving molecules in warmer material collide w/ molecules in cooler material causing them to accelerate)
How do you work on static and dynamic balance with SCI patients? It is very beneficial for the patient to have their abdominal muscles intact in order to achieve this, at what LOI do SCI patients usually need to be in order to still have use of their abdominals?
*in short sitting*: -static w/ UE support -progress to static w/o UE support -progress to dynamic reaching over a stable base *in long sitting*: -larger BOS (easier to achieve) -easier to work on on a mat (firmer surface) -needed for independent dressing -if HS are tight, bend the knees to ant tilt the pelvis this will help them w/ their ADL's and transfers by giving them a solid base of support need to be SCI of T6 or lower in order to use abdominals
Do most bilateral AKA amputees use a prosthetic?
*no*
What is bronchiectasis?
*permanent dilation of the medium-sized bronchi*
Of the methods used to calculate HR from an EKG, which ones are used if the HR is regular and which are used if the HR is irregular?
*regular HR*: count boxes b/w QRS complexes *irregular HR*: calculate # of cardiac cycles over 6 seconds and multiply by 10
Highly trained endurance athletes may have a resting HR of:
30-40 bpm
What is the ideal amount of knee flexion in prosthetic gait training? How should you work on this with the pt?
30-60 deg exercises for knee flexion such as step overs w/ cones
Define: weight shifting
30-90% off-loading of at least one buttock for 15 sec
What does a normal ejaculate contain?
3mL of substance: 2mL from seminal vesicles 0.5 mL from prostate 0.5 mL from vas deferens
How many zones of cartilage are there?
4
How many eggs do ovaries ovulate over a life time?
400-500
How many methods of delivery are there for IFC?
5
What is the ideal amount of trunk rotation in prosthetic gait training? How should you work on this with the pt?
5 deg exercises such as trunk perturbations and manually facilitated rotation
Roughly ___% of rotation in the cervical spine occurs b/w C1 and C2
50% (FYI: if someone has a fusion b/w C1 and C2, you need to educate them that they will no longer be able to turn their head as far as they could, don't want them trying to force the motion)
How many branches come off of the axillary artery?
6
Average ejection fraction in healthy adults:
60%
What percent of pediatric amputations are congenital? acquired?
60% congenital 40% acquired
What is a normal heart rate set by the SA node?
60-100 bpm
Average resting heart rate:
60-80 bpm
If there are exactly 4 big boxes between each QRS complex, the rate is:
75 bpm (300, 150, 100, 75, 60, 50)
Which side of the neck is most often affected with torticollis?
75% of the time it is the right side
What population is benign prostatic hypertrophy/hyperplasia common in?
75-80% of it is found in non-asian men over 80 years old
London doctor said _____ % of the time, the pt will tell you what's wrong with them
80%
_____ % of pulmonary emboli originate from DVT in legs are are preventable
90%
At what range of flexion should OKC exercises be performed to reduce PJRF?
90-40 deg flexion
EKG item: collective depolarization of both atria
P wave
Describe the pressure gradient of a limb shrinker:
distal to proximal
In what direction should your pressure gradient be when applying an ACE wrap?
distal to proximal
The modality of traction uses ___________ forces and is therapeutic for which condition?
distraction herniated disc
What are the 5 parts of a stress-strain curve?
Toe region Elastic region Yield point Plastic region Failure point
What division of pharmacokinetics determines how much of the active drug reaches systemic circulation after administration?
absorption
The 4 divisions of pharmacokinetics are?
absorption distribution biotransformation excretion or elimination
Which neurotransmitter is the most prevalent in the PNS?
acetylcholine
What are some common drugs that can be used to treat inflammation?
acetylsalicylic acid (asprin), acetaminophen (tylenol), glucocorticoids (steroidal), non steroidal anti-inflammatory drugs (NSAID - ibuprofen or COX inhibitors)
Why is active recovery better than passive recovery?
active removes lactate in blood faster
What does Apgar stand for?
activity (muscle tone) pulse (HR) grimace appearance (color) respiration Chart is very close to the one in slides-- muscle tone 1 (limp), 2 (some flexion), color 1 (body pink, extremities blue, 2 (completely pink)
Which type of UE prosthesis is "adaptive" or a "recreational" prosthesis? (didn't cover this in class)
activity specific prostheses Ex: to play the violin, to ride a bike (often an adaptation to an existing prosthesis)
Increasing the serum concentration of drugs that rely totally on the kidneys for elimination can induce _______ _________ _________ within a week?
acute renal failure
The key principles of outpatient rehab after CS surgery are: 1. precision of mvmt vs. total ROM 2. posture in daily activities 3. alignment of shoulder girdle What does #1 mean?
address common mm impairments: -intrinsic neck mm weak/long-- compromises fine control, translation vs. sagittal rotation -extrinsic neck mm dominant-- adds compressive, rotational & shear forces (Ex: picture in slides of pt levator scap sticking out & being dominant to extend CS instead of ES mm)
The key principles of outpatient rehab after CS surgery are: 1. precision of mvmt vs. total ROM 2. posture in daily activities 3. alignment of shoulder girdle What does #3 mean?
address location of scapulae: -elevation vs. depression: should be overlying T2-7 -abduction: should be 3-4" -IR: scapulae should lie flat -anterior tilt: should lie flat
If symptoms don't change much with activity or body position, the origin is most likely musculoskeletal or visceral?
visceral
If there is no clear MOI, is the origin of pain likely visceral or musculoskeletal?
visceral
When pt describes the location of their pain, what should you keep in mind?
visceral referred pain -visceral pain is usually more dull and generalized -musculoskeletal pain is more sharp and focused
Which membrane channels are important for the release of ntm & propogation of APs?
voltage-gated
What is the function of water in the nucleus pulposus? What about the collagen & proteoglycans?
water: allows deformation under pressure collagen/proteoglycans: viscosity/stickiness
Normative Ethics
ways to assess right & wrong actions or behaviors asks more concrete questions related to morality
How does weakness of the medial quads, specifically VMO dysplasia contribute to PFPS?
weakness of the VMO allows the patella to tract too far laterally. Although the role of the VMO is controversial, VMO strengthening is often recommended. However, the VMO is difficult to isolate, general quad strengthening may be easier to accomplish
What is spondylolysis?
weakness or a stress fracture in the pars interarticularis, relevant to facets
What is constructive interference?
when both waves are exactly the same and are produced in phase or originate at the same time - the interference is summative and they combine
What does "cruise" mean in terms of the way a child moves?
when child holds onto a solid surface, like a table, and walks sideways around the perimeter of the surface
When is spasticity an issue for pts w/ SCI?
when it's interfering with function-- if you manage it to be the right amount, you can actually use it to help them function
When does the post-surgical phase after an amputation end?
when pt is provided with a definitive (not temporary) prosthesis
Define whistleblowing
when someone formally reports a person or institution engaging in impaired, unethical or incompetent behavior
What actually causes the meniscus to be injured during movement? What motion of the knee in particular does this happen with?
when the *meniscus fail* to follow the *excursion path of the femoral condyle* during *knee extension*
When is a definitive socket (permanent prosthesis) provided to an amputee?
when the volume of the residual limb has stabilized
When listening over the bowels, you would expect to hear gurgling every _______ minutes at the least
2-5
A unilateral BKA increases energy cost of ambulation by ___ % A unilateral AKA by ___ % A hip disarticulation by ___ % A bilateral AKA by ___ %
20% 49-65% 200% 280%
1 in _____ Americans will undergo an amputation
200
____ % of pts w/ traumatic SCI will report urinary incontinence and complete bladder emptying 1 yr after injury
21-36%
What types of cells are in CT?
Fixed/resident cells Migratory/circulating cells
What type of end-feel are knee and elbow flexion?
Soft (normal)
Which way do the cilia in the fallopian tubes beat?
Towards the uterus
What is a closed pneumothorax?
air can enter the pleural cavity from internal airways, no opening in chest wall
Arthrodesis is another name for what surgical procedure?
fusion
Define depolarization
membrane potential becomes less negative -- excitatory
Which PT modalities transfer heat via convection?
whirlpool
How is cervical cancer screened for?
PAP smears
Where in the stress-strain curve do we want to stay in for tendons?
Toe region and elastic region (can go into plastic a little)
Describe zone 2 of cartilage
Transitional Increased volume Has hyaluronic acid, proteoglycan, and collage (arch-like)
What is the function of tendons?
Transmit muscle force to bones Stabilize joints
Which ligament does the uterine A and V travel in?
Transverse cervical/Cardinal ligament
The posterior triangle of the neck is actually anterolateral to what structure?
Trapezius
What are some common sites of drug storage? What is the most common location?
adipose (primary location) bone muscle other organs (liver/kidney)
T/F: if the QRS complex is primarily negative on an EKG lead, the T wave should be negative too
True-- the T wave should have the same polarity as the QRS complex
What are pseudounipolar neurons? Are they a subclass of bipolar or multipolar neurons?
-bipolar neuron -have a single projection from the soma that divides into 2 axons -peripheral axon: carries info from periphery to soma -central axon: carries info from soma to SC
Presentation of hypo/hyperthermia:
-body unable to regulate temp -susceptible to external conditions
What would an x-ray of a person's spine w/ DDD look like? (3)
-bone spurs -degeneration of disc -sclerosis of facets & vertebral margins
What comes together to form the ejaculatory duct?
Vas deferens Seminal vesicles
What are possible causes of impotence (4)?
Vascular Neurological Psychological Endocrinological
Positive Support Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth (37 w pma) 2. 3-4 months 3. supported standing 4. legs support weight
Difference b/w ventilation & respiration
Ventilation: mechanical act of bringing air in & out of your lungs Respiration: gas exchange
Divine Command Theory
-a divine being set rules that provide guidance in moral decision making -good is equated to whatever the deity commands
Virtue Theories
-a person of high moral character acts in a way that upholds standards -it takes a certain type of person to do what is right (moral agent) -goodness is a matter of character
What is a protrusion herniation?
-a.k.a. contained herniation -NP migrates out through the tear in the inner AF fibers, but doesn't escape from the outer AF or PLL
What is an extrusion herniation?
-a.k.a. prolapse -NP escapes the entire AF & PLL, but remains attached to the disc
Of the augmented leads, which ones will have an positive or negative deflection in a normal EKG?
-aVR: negative (picture) -aVL: positive -aVF: positive depolarization of the heart is naturally down & to the left
Which direction does the EKG machine set as positive for each of the augmented leads?
-aVR: right -aVL: left -aVF: foot (down) Ex: for aVR, any electrical activity that goes to the right would have a positive deflection
Pros of possible exoskeleton use in the future for gait training with SCI patients:
-ability to walk while wearing the suit -dec pain -dec spasm -improved bowel/bladder fxn -dec incidence of UTI -CV fxn possibly inc -good psychosocial benefit -inc steps during therapy time -dec therapist workload
How is CO2 transported in the blood? (3)
-about 20% bound to Hb -about 7% dissolved in plasma -MOST diffuses into RBC's
How is the type of prosthesis chosen for an amputee?
-age -activity level -job demands -funding -compliance
Airflow during inspiration and expiration depends on __________________ gradient. This is known as _____________ law.
-air pressure gradient -Boyle's law
Universal Declaration of Human Rights
-all humans are free & equal in dignity & rights -equal before the law--innocent until proven guilty -freedom from cruel or degrading treatment, slavery, detention or exile
What is the function of water in the ground substance of CT?
-allows for passing of nutrients -resists compression
How does emphysema lead to decreased recoil?
-alveolar walls are destroyed due to breakdown of elastin -causes large, permanently inflated alveolar air spaces -leads to decreased recoil
How do you treat a pleural effusion? (4)
-analyze fluid to confirm cause -remove underlying cause -remove fluid & relieve pressure -treat respiratory impairment
What are signs and symptoms of PFPS?
-anterior pain, also could be medial and lateral -pain exacerbated by activity such as arising from sitting, descending stairs, kneeling, prolonged sitting w/ knee flexed -alleviated with rest with knee extended
What tibial arthrokinematic motions take place on the femur with open chain extension of the knee? (2)
-anterior roll with lateral rotation -anterior glide
What femoral arthrokinematic motions take place on the tibia with closed chain extension of the knee? (2)
-anterior roll with medial rotation -posterior glide
How do you prevent a pulmonary embolism? (2)
-assess risk factors -anticoagulants to prevent thrombosis
What is a secondary pneumothorax?
-associated with underlying resp. disease -Ex: rupture of a bleb on lung, erosion by tumor, tubercular cavitation
What are some potential adverse effects of glucocorticoids?
-atrophy of lymphoid tissue and thus decreased WBC (risk of infection) -decrease protein synthesis -delayed healing -delayed growth in children -retention of Na++ and water (high BP & edema)
What may cause a SCI patients tolerance to an upright position to vary? (2)
-autonomic dysreflexia (LOI at/above T6): can lead to life-threatening HTN -infection can cause reverse of tolerance
What may be included in the education part of treatment for PFPS?
-avoid MOI -prolonged sitting with knee flexed, stairs, kneeling etc can provoke -awareness of biomechanical faults
How do you treat emphysema?
-avoid resp. irritants (smoking) -breathing techniques -immunizations for flu & pneumonia -antibiotics -bronchodilators -O2 therapy -adequate nutrition -lung reduction surgery
Common sites for skin breakdown in pts w/ SCI (6)
-back of head/ears -shoulder blades/shoulders -elbows -tailbone/hip bones -outer knees/between knees/back of knees -outer ankles/between ankles/feet Pro Tips: put a pillow between their knees and a PRAFO on their feet to offload their heels
Clinical recommendation for gait training with a pt who has a SCI:
-begin gait training ASAP after incomplete SCI -use BWS gait training when necessary -use overground gait training when feasible -higher intensities are more effective
What are the types of macroglia & what do they do?
1. Astrocytes: provide structure, regulate neuronal signalling, neural development, blood-brain barrier, recovery from injury 2. Oligodendrocytes: produce myelin sheath in CNS 3. Schwann Cells: produce myelin sheath in PNS
When there is heavy bleeding of the arm, where are the 2 sites of compression of the axillary artery?
1. Third portion of the artery, apply pressure on lateral wall of axilla against humerus 2. Beginning of the artery, apply downward pressure in the angle b/w clavicle and attachment of SCM
Causes of CPR (capsular pattern restriction)?
1. Trauma: associated with significant joint effusion/swelling in acute stages of injury 2. Joint lesion/Arthritis: traumatic arthritis, acute rheumatoid arthritis, gout 3. Conditions that cause capsular fibrosis, immobilization or low grade inflammation
What are the 3 events of an AP?
1. VG Na+ ch. open & Na+ flows rapidly into the cell (depol) 2. VG Na+ ch. close 3. VG K+ ch. open & K+ leaves the cell (hyperpol)
What are the 6 drugs that are metabolized in the liver?
1. caffeine 2. benzodiazepines 3. warfarin 4. phenytoin 5. antihistamines 6. beta-blockers
What are the 5 over-arching categories of neurotransmitters? (read)
1. acetylcholine 2. amino acids 3. amines 4. peptides 5. nitric oxide
What changes does the body make to the air we breathe in?
1. air is heated 2. air is saturated w/ water vapor 3. removes pollutants from air
Difficulty with expiration that occurs in emphysema can lead to what lung changes? (6) -RV, ribs, chest, diaphragm, etc.
1. air trapping 2. inc in RV 3. overinflation of lungs 4. fixation of ribs in an inspiratory position 5. barrel chest 6. flattened diaphragm
At what ages are the following methods of muscle strength testing in children considered reliable: 1. MMT 2. hand-held dynamometers 3. isokinetics 4. functional strength testing
1. as long as the kid can follow instructions 2. as young as 2 yrs old 3. as young as 6 yrs old 4. based on milestones
Galant Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 3 months 3. stroke paravertebral skin in prone 4. lateral curvature of trunk & hip shift toward stimulated side
Rooting Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 3 months 3. touch to peri-oral area of a hungry infant 4. turns head & lips toward stimulus w/ mouth opening & a trial of sucking the finger "food finding"
Automatic Walking/Stepping Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 3-4 months 3. supported standing, lean child forward 4. high stepping movements with regular rhythm
Startle Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 3-5 months 3. loud noise 4. abduction & extension of arms, splaying of fingers, followed by flexion & adduction of arms, child typically cries (same as the Moro Reflex, except the stimulus)
Moro Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 3-5 months 3. sudden head drop backwards 4. abduction & extension of arms, splaying of fingers, followed by flexion & adduction of arms, child typically cries
Asymmetrical Tonic Neck Reflex (ATNR): 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 4-6 months 3. turn head to the side 4. facial arm extends & abducts, occipital arm flexes & abducts "fencing posture"
Palmar Grasp Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 4-7 months 3. pressure on palm of hand 4. flexion of fingers (grasp)
Tonic Labyrinthine Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth 2. 6 months 3. lift infant up in prone or supine 4. prone- flexor tone dominates. supine- extensor tone dominates
Flexor Withdrawal Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth (28 w pma) 2. 1-2 months 3. noxious stimulus to sole of foot 4. flexion & withdrawal of stimulated leg
Crossed Extension Reflex: 1. onset 2. integration 3. stimulus 4. response
1. birth (28 w pma) 2. 1-2 months 3. noxious stimulus to sole of foot 4. flexion of stimulated leg & then extension of opposite leg w/ adduction
How do we calculate HR from an EKG? (3 methods)
1. count # of QRS complexes in a 6 second strip and multiply by 10 2. find a QRS on the edge of a big box, count # of large boxes to the next R wave --1 box: 300 bpm --2 box: 150 bpm --3 box: 100 bpm --4 box: 75 bpm --5 box: 60 bpm --6 box: 50 bpm 3. 60 / R-R interval in seconds
How does age affect the following: 1. insulin sensitivity 2. HDL 3. lipoprotein lipase activity 4. peripheral vascular resistance
1. decreases it 2. decreases it 3. decreases it 4. increases it
What are the 4 components of a neuron?
1. dendrite 2. axon 3. presynaptic terminals 4. soma
What 3 changes take place to the structure/function of the disc in disc degeneration?
1. disc integrity dec w/ age 2. dec ability to retain water 3. ability to distribute load across disc changes
Which neurotransmitters are considered amines?
1. dopamine 2. norepinphrine 3. serotonin 4. histamine
Virtues that are valued in health care: (4)
1. empathy 2. humility 3. respect 4. commitment to helping others
What does the seminal vesicle secrete?
1. fructose: energy for sperm 2. prostaglandins: stimulate smooth muscle contraction in female 3. proteins for semen coagulation
2 general types of cervical spine surgery:
1. fusion 2. decompression (Ex: laminectomy, discectomy)
Which neurotransmitters are considered amino acids?
1. glutamate 2. aspartate 3. glycine 4. GABA GAGG
During exercise, amount of blood flow to all areas decreases except 1.___________ stays the same and 2.______________ increases significantly
1. heart 2. skeletal muscle
What does the prostate secrete? What does each thing do?
1. prostatic acid phosphatase (PAP): makes HIV more easily transmitted 2. prostate specific antigen (PSA): liquefaction of semen 3. Fibrinolysin: liquefaction of semen
How do we work on the following with SCI patients in PT: 1. upright tolerance 2. prevent contractures & skin break down 3. prevent pneumonia 4. promote GI function
1. reclining WC, cardiac chair, tilt in space WC 2. PRAFO on feet, pillow b/w knees, etc. 3. out of bed (OOB) activities 4. use of gravity in OOB activities
What RER values indicate 1. resting conditions 2. anaerobic metabolism and 3. maximal effort?
1. rest: 0.7 2. *anaerobic: >1.0* 3. max effort: >1.09
Describe the modern technique for an amputation: (read)
1. skin & muscle are divided to form ant & post flaps 2. primary AA & VV are dissected, clamped & severed 3. major NN are dissected, severed & allowed to retract into soft tissue 4. bone is severed, distal end is filed & beveled to produce a smooth surface 5. muscle & skin flaps are sewn together to form the residual limb
List the anterior triangles of the neck (4)
1. submandibular triangle 2. carotid triangle 3. submental triangle 4. muscular triangle
Which neurotransmitters are considered peptides?
1. substance P 2. endorphins 3. enkephalins
What are the 5 arteries that supply blood to the shoulder?
1. suprascapular artery (superiorly) 2. dorsal scapular artery (medially) 3. subscapular artery (laterally) 4, posterior circumflex scapular artery (laterally) 5. Acromial branch of thoracoacromial artery (laterally)
What sequence of events take place in the IV disc when it undergoes compression forces? (6)
1. v. bodies approximate 2. the nucleus deforms 3. relays pressure to annulus & end plates 4. radial bulging & EP bulging 5. resistance from annulus & trabecular bone of v. bodies 6. equilibrium & load transfer
What are the 4 steps to creating a fraud claim? (video 1 in lecture 23)
1. write down everything you know about the fraud 2. make a list of where essential documents are located- written & electronic 3. list everyone who was involved in the fraud 4. prepare a chart of the company's complete corporate structure
What is conversion?
conversion of a non-thermal form of energy (mechanical, electrical or chemical energy) into thermal energy
Normal maximal SV value
100-200 mL/beat
If replantation of a limb is attempted, it must occur within what time frame?
12 hour window
What is the ideal step length in prosthetic gait training? How should you work on this with the pt?
12" they often take short steps, encourage them to step longer with stool stepping, ball rolls, etc.
Respiratory muscles may use more than ___ % of the total O2 consumed during heavy exercise
15%
How many classifications are there for ligamentous injuries? What are they?
3 first degree (mild) second degree (moderate) third degree (severe)
What are the branches of the external carotid A?
3 anterior: superior thyroid A lingual A facial A 2 posterior: (just know the one) occipital A
Describe the set up for the stereodynamic method of delivery for IFC
3 pairs of electrodes all crossing at one central point (add additional circuit or output generator to generate 3rd med freq sinusoidal current (3D)
What may SCI patients require *at first* to maintain their BP in an upright position?
ACE bandages & abdominal binder the goal in acute care is to prepare them for an inpatient rehab, so you should progress them past the need for these supports in the near future
What is the second most frequent cause of death from cancer in males?
Adenocarcinoma
All electrical activity of the heart/leads intersects at:
AV node
When is uterine prolapse most likely to happen?
After child birth or due to obesity
What are aggravating & easing factors for extrusion and sequestration herniations?
Agg: -flexion -sitting -sit--stand -walking -reproduction of sx w/ *cough* Ease: -lying down -unloading
Why do we assess end-feel?
All joints are structured to limit PROM by tissues (capsules, ligaments, muscle tension, etc)
Where are collagen types 9, 10 and 11 found in the body?
All related to cartilage
Empty End-Feel
Always abnormal. Pain is often the limiting factor preventing the patient from allowing full ROM
The suprahyoid and infrahyoid muscles are a part of which triangle of the neck?
Anterior triangle
Surgical Complications in CS: anterior vs. posterior approach
Anterior: -problems swallowing -voice changes Posterior: -more pain due to going through more muscles
What CT changes occur with immobilization?
Bone- osteoporosis Cartilage- dec water content, atrophy Tendon- atrophy at MTJ, dec strength Ligament- atrophy, disorganization of fiber arrangement
What is Wolff's Law?
Bone is laid down in areas of high stress and reabsorbed in areas of low stress
At what LOI will a SCI patient need a power wheelchair? What are possible power controls for a WC?
C6 and above head control, sip and puff, joy stick
Within which triangle of the neck does the carotid A bifurcate into internal & external?
Carotid triangle
What type of CT is avascular?
Cartilage
Why are microfractures purposely created sometimes?
Cartilage doesn't have a good blood supply, this will increase blood supply and promote healing of cartilage
Where is type 2 collagen found in the body?
Cartilage, nucleus pulposus
If a SCI patient's LE's are stronger than their UE's, what may be the cause? If they have unilateral differences in strength, what may be the cause?
Central Cord Syndrome Brown Sequard Syndrome
What types of fibers are in CT? (fibers are 1/3 components of CT)
Collagen (reticulin) Elastin
If we are worried about a pt possibly falling out of their WC due to lack of abdominal control, what adjustment can be made to their WC?
adjust the seat-to-back angle for balance (make it more "bucketed")
Define enteral
administration through GI tract
Define Parenteral
administration through non-alimentary routes (other than GI tract)
What type of end-feel can acute inflammatory disease, bursitis, fracture, surgery, psychogenic reasons cause?
Empty (always abnormal)
Which layer of the uterine wall is highly responsive to hormonal changes every month?
Endometrium
What are the 3 layers of the uterine wall?
Endometrium Myometrium Perimetrium: visceral peritoneum
What is hysteresis in relation to the viscoelastic properties of CT?
Energy dissipates due to internal friction -relates to elastic properties of the tissue
Criticisms of Divine Command Theory
Euthyphro Dilemma: either side of the same coin has implications Does God command the good because it is good, or is it good because it is commanded by God?
Palpation Definition
Examination by touch or feeling
If someone is suffering from congestive heart failure, which blood vessel may fill up?
External jugular V
Residual Volume calculation
FRC - ERV (functional residual capacity-- volume of air in lungs at end of passive expiration)
FYI: if something is suspicious from medical history questionnaire, you should probs ask more about it
FYI
What is uterine prolapse?
Falling or sliding of the uterus from its normal position into the vaginal canal
T/F: the higher the level of injury for a SCI the less issues they will have with maintaining BP in upright position
False higher LOI = more difficulty w/ maintaining BP
T/F: the lateral collateral ligament attaches to the joint capsule
False it does NOT attach to the capsule or meniscus, therefore is completely an extra articular structure
T/F: the terms of weight shifting and pressure relief can be used interchangably
False-- 2 different techniques used to prevent pressure sores
T/F: pressure ulcers are not a big deal for SCI patients
False-- definitely a big problem
T/F: the R wave is rarely a downward deflection
False-- it is never a downward deflection
T/F: EKG's give you information about the muscle contractions of the heart
False-- just looking at electrical activity of the heart
T/F: a standing frame may help with bone density in pts w/ osteoporosis who have a SCI
False-- no research to support this, but there is evidence to support the psychological benefits
T/F: a Q wave can be seen in all EKG leads
False-- not all leads normally record a Q wave****
T/F: women with a SCI do not need to take birth control to prevent pregnancy
False-- pregnancy is still possible
What are examples of fixed CT cells?
Fibroblasts Osteoblasts Chondroblasts (forming cells)
What type of end-feel is MCP extension?
Firm (normal)
What type of end-feel is forearm supination?
Firm (normal)
What type of end-feel is knee extension?
Firm (normal)
What is the difference between first, second and third degree uterine prolapse?
First: cervix is less than half way down the vagina Second: greater than half way Third: cervix is beyond the vaginal entrance
What TherEx should be selected for someone w/ DDD?
Flexibility: --stretch, stabilize Exercise: --limit motion that reproduces pain (habitual extension/rotation) --segmental stability ex --disc hydration ex (unloaded)
Define stress*
Force per unit area (same as pressure) Unit: psi
Base of Axilla
Formed by skin, subcutaneous tissue, and axillary fascia
What is recommended for both boys and girls to prevent HPV?
Gardasil vaccine It protects against cervical cancer, anal cancer, esophageal cancer, anal warts, etc
Which glands are also known as the greater vestibular glands and lesser vestibular glands?
Greater: Bartholin's glands Lesser: Skene's glands
What is the vertical axis (height and depth) measured in on EKG paper? What is the horizontal axis measured in on EKG paper?
H/D: each small box is 1 mm (or 0.1 mV), each big box is 5 mm (or 0.5 mV) H: each small box is .04 sec, each big box is 0.2 sec
What virus is linked with 95% of cases of cervical cancer?
HPV human papilloma virus
How does training affect HR recovery?
HR returns to resting levels more quickly after exercise
What type of end-feel is elbow extension?
Hard (normal)
Which domain of the ICF model would you put the following under: -stress about illness -able to sit statically -decreased endurance & strength -watches television -leukemia -motivated -unable to ascend stairs -supportive family -difficulty with speech -no longer able to play football -avascular necrosis
Health Condition: -leukemia -avascular necrosis Body Structure/Function: -decreased endurance & strength -difficulty with speech Activity: -able to sit statically -unable to ascend stairs Participation: -watches TV -no longer able to play football Environmental: -supportive family Personal: -very motivated -stress about illness
Define stiffness
How much a substance will deform in response to force
Human, legal, liberty & welfare rights:
Human: morally valid, unalienable entitlements Legal: freedoms & benefits in a legal system Liberty: right not to be interfered with Welfare: right to receive essential goods when one is unable to earn them on their own
Natural vs Human Rights
Human: rights specific to humans Natural: rights apply to all living things
What is the order of lymph node groups in terms of drainage in the axilla?
Humeral - Subscapular - Pectoral - Central - Apical - Lymphatic trunk - subclavian
Possible abnormal reflex responses
Hyper- too much Hypo- too little
Which EKG leads normally record a Q wave?
I, aVL, V5, V6 (left lateral leads) small in aVF & V5
Vital Capacity calculation
IRV + ERV + TV
What is the most common form of parenteral drug administration?
IV injection
What is the most dangerous form of all types of drug administration? Why?
IV injection because of the quick onset of action
What modalities may be utilized in the treatment of a ligamentous injury of the knee?
Ice Compression Elevation E. stim
What modalities could be utilized in the treatment of a meniscal injury?
Ice TENS E. Stim (quads)
What modalities may be utilized in the treatment of PFPS?
Ice US E.Stim (VMO)
What is the fluid from in the first portion of an ejaculate?
Prostate gland
Where does the ejaculatory duct empty into?
Prostatic urethra They join it at an angle forming a one way valve
What is homologous (male) to the female vagina?
Prostatic utricle
How do you document sensation?
Intact Abnormal (describe) Numbness/Tingling Diminshed or Absent Can include a picture of mapped area
Where does most of the facial V drain into?
Internal jugular V but there is a communicating branch between external and internal jugular VV which allows the facial V to drain into both
What is at either end of the endocervical canal?
Internal os External os
What does the subclavian artery branch into? (not sure if we need to know this)
Internal thoracic artery Thyrocervical trunk Vertebral artery Costocervical trunk Dorsal scapular artery
What is the difference between the meaning of the terms "creeping" and crawling" in terms of children?
International: -creep: mvmt on belly -crawl: mvmt on hands & knees However, these terms are often reversed in the U.S., it is best to add descriptive terms after these words such as crawling on belly or creeping on hands & knees
Lateral Wall of Axilla
Intertubercular groove of humerus
What happens to the fetal prostate during the third trimester?
It enlarges as a result of hormones from the mother
What does multiparous mean?
It has 2 meanings: 1. producing more than 1 at birth = twins 2. having experienced 1+ parturition (birth)
What is the axillary sheath?
It is a fascial sleeve for the neurovascular structures going to the upper limb (axillary A, V, brachial plexus)
What is a vaginal pessary and what condition is it used to treat?
It is a plastic removable device that fits into the vagina to help support the uterus, vagina, bladder or rectum in order to reduce the risk of pelvic organ prolapse Non-surgical way to treat uterine prolapse
Where is the periurethral zone of the prostate?
It is immediately around the urethra
What is the function of the uterus?
It is the site of implantation of the blastocyte & growth of the embryo through the fetal period
What does the lateral thoracic artery supply?
It supplies pectoral muscles, axillary lymph nodes, and the breast (important)
What does the superior thoracic artery supply?
It supplies the 1st and 2nd rib intercostal spaces and serratus anterior
Which of the superior deep cervical lymph nodes drain the tongue, palatine tonsil, and submental regions and are of clinical importance in infection?
Jugulo-digastric nodes Jugulo-omohyoid nodes
When does the subclavian artery change into the axillary artery?
Just after it passes under the clavicle
What is responsible for the quick coagulation of an ejaculate?
Protein kinase from seminal vesicle
Which type of forces is the nucleus pulposus able to resist? What about the annulus fibrosis?
NP: compression AF: tensile
What is the optimal stimulus for disc regeneration? hint: different for nucleus & annulus
NP: intermittent compression/decompression AF: rotation-- modified tension in the line of stress
Define: Neurogenic bladder Hypo-reflexive bladder Hyper-reflexive bladder
Neurogenic: bladder will not empty w/ voluntary control Hypo: does not empty Hyper: empties too often (but likely not fully emptied ever - infection risk)
Do the head & neck veins have valves?
No, except the internal jugular V
Is the loss of motion in a capsular pattern of restriction a fixed degree of ROM in just one plane?
No, it is a fixed proportion of motion loss in more than one plane
How do we describe end-feel?
Normal: full ROM present AND normal anatomy of the joint stops the movement. It can be soft, firm or hard Abnormal: inc/dec ROM present. The movement is stopped by something other than the normal anatomical structures. It can be soft, firm, hard, or empty
Soft End-Feel (normal and abnormal)
Normal: limited by soft tissue, feels like a sponge or a "give" Abnormal: limited by soft tissue, feels "boggy" such as edema
Firm End-Feel (normal and abnormal)
Normal: limited by tendon, capsule, or ligaments. Feels like leather stretching, a little bounce Abnormal: as before, feels like a lack of give or bounce
What is the basic goal of UE prosthetics in general?
Provide appropriate function & appearance to increase *independence* with ADLs and improve *quality of life*
What is the uterus body:cervix ratio in a nulliparous adult, multiparous adult?
Nulliparous adult: 2:1 Multiparous adult: 3:1
Where can the axillary artery not be compressed?
Proximal to the deep artery of the arm and distal to posterior circumflex humeral artery
Which type of nerve block does not block pain from uterine contractions?
Pudendal nerve block
Define strain*
Percent change in length relative to a strain/load Ex: if something was stretched 2 inches due to a load, and it started at 12 inches, 2/12= 0.1667%
Which zone of the prostate is the site of prostatic cancer/adenocarcinoma?
Peripheral/main zone
What type of spaces are the vesicouterine and rectouterine pouches?
Peritoneal spaces (underlined for some reason)
Which zone of the prostate is the site of benign prostatic hypertrophy?
Periurethral zone
Which muscle of facial expression tightens when shaving the neck?
Platysma
What does the yield point in a stress-strain curve represent?
Point of no return- tissue will not be able to return to original shape after this point
What does the failure point in a stress-strain curve represent?
Point of tissue rupture
Are the ovaries on the anterior or posterior side of the broad ligament?
Posterior
A cluster of nerves pass out of the anterior or posterior border of the SCM?
Posterior border
Where is the second section of the axilla?
Posterior to pec minor
What is the retropharyngeal space?
Potential space of loose CT b/w prevertebral fascia and pretracheal fascia.
What are the 3 phases of growth of an oocyte?
Preantral growth Tonic growth Exponential growth
Mean Arterial Pressure (MAP) calculation
Q * TPR (total peripheral resistance)
VO2 max calculation***
Q * arteriovenous oxygen difference (Q= SV * HR)
An increase in _____ can be a risk factor for PFPS and improper patellar tracking
Q angle
Which part of an EKG is a negative wave preceding the R wave?
Q wave
EKG item: always the first downward deflection of the QRS complex
Q wave Notes: sometimes we don't even see the Q and that's still considered normal, the dip could just be really small
Which part of an EKG represents the time when the ventricles are in their absolute refractory period and will not respond to stimulation?
QRS & ST segment
Which part of an EKG represents the depolarization of the ventricular myocardium?
QRS complex
EKG item: from the beginning of the Q wave to the end of the T wave
QT interval (interval: includes R and T wave)
EKG item: always the upward deflection after Q
R wave
All positive waves of the QRS complex are called:
R waves if there are more than 1, the second wave is called R' (R prime)
What happens to RER with exercise?
RER inc w/ exercise as CO2 production inc at a greater rate than O2 consumption
What is the most dependent portion of the female pelvic cavity?
Rectouterine pouch
EKG item: from the end of the S wave to the end of the T wave
ST interval (interval: includes a wave)
Which part of an EKG represents the time when ventricular cells are in the plateau phase?
ST segment
EKG item: from the J point to the beginning of the T wave
ST segment (J point: junction of the end of the QRS complex with the ST segment) (segment: doesn't include a wave)
Is the ST interval or segment isoelectric?
ST segment (means it's flat)
Ejection Fraction calculation
SV / EDV (%)
Stroke Volume calculation**
SV= EDV - ESV
What are half of ectopic pregnancies thought to be due to?
Salpingitis
Posterior Wall of Axilla
Scapula, subscapularis, teres major, and latissimus dorsi
What do the Cowper's/ bulbourethral glands secrete?
Secrete mucous upon erotic stimulation to lubricate urethra
What type of force is cartilage especially good at decreasing?
Shear forces
Which glands may be responsible for female ejaculation with orgasm?
Skene's glands
Where is type 1 collagen found in the body?
Skin, bone, tendon, synovium
What type of end-feel can edema, lymphedema, and inflammation cause?
Soft (abnormal)
Which portion of the nervous system mediates ejaculation?
Somatic (if you separate it from emission, or sympathetic if you don't)
What are some factors that help determine whether or not a man s/p SCI will be able to achieve an erection/orgasm?
Some are able to achieve psychogenic or reflexic erections based on level of SCI: -psychogenic: T10-L2 -reflexic: S2-S4 Devices, implants, injections and medications can be used to achieve or enhance erection Phantom/psychological orgasm from erogenous zones above the level of injury may be possible
What kinds of forces can CT resist?
Stress/Strain*** Bending Torsion Tension Compression Shear
What is a sudden sharp pain in the labia majora likely due to?
Stretching of the round ligament of the uterus out of the inguinal canal and into the labia majora This happens in pregnant women *** test question
What runs between the anterior and middle scalene muscles?
Subclavian A Brachial plexus
The internal and external jugular veins eventually combine to form what?
Subclavian V
How do the subclavian A and V travel in relation to the anterior scalene m?
Subclavian V is anterior to the anterior scalene, subclavian A is posterior to it
Where do tumors of the lower lip and tip of the tongue often first metastasize to?
Submental lymph nodes
Which is the largest branch of the axillary artery?
Subscapular artery
What are the branch(es) of the third section of the axilla?
Subscapular artery Anterior and Posterior circumflex humeral arteries
Describe zone 1 of cartilage, what type of force does it resist well?
Superficial Resists glide/shear forces Has water & collagen (horizontal)
Which deep cervical lymph nodes are in the carotid triangle?
Superior deep cervical lymph nodes
What are the branch(es) of the first section of the axilla?
Superior thoracic artery
What does the axillary artery branch into?
Superior thoracic artery Thoracoacromial artery Lateral thoracic artery Subscapular artery Anterior circumflex humeral artery Posterior circumflex humeral artery "sue the lawyer, save a patient"
What is Dalton's law?
each gas in a mixture moves along its partial pressure gradient *independent* of other gases
Which ligaments are responsible for suspending an ovary?
Suspensory ligament Proper ligament of the ovary Broad ligament
Name the amputation: ankle disarticulation w/ preservation of heel pad
Syme's
Which portion of the ANS mediates detumescence?
Sympathetic
What happens during the primary stage of TB?
TB Infection -person is exposed/infected -doesn't have the active disease -is asymptomatic -can't transmit the disease
What happens during the secondary stage of TB?
TB disease -person has active infection -occurs when cell-mediated immunity is impaired -can be spread to others -highly infectious when there's personal close contact for a period of time
Describe the path of the vas deferens?
Tail of epididymis Spermatic cord Inguinal canal cross ext iliac bv widens into ampulla joins seminal vesicle to form ejaculatory ducts
What is the difference between tendinitis and tendinosis?
Tendinitis: acute inflammation Tendinosis: tendinitis that hasn't been allowed to heal = chronic
What is the optimal stimulus for regeneration of ligaments and tendons?
Tensile stress in the line of the fiber orientation
Compression is the opposite of what other type of force?
Tension
How do you know if a reflex is hyper or hypo?
Test bilaterally, an asymmetrical response from side to side with the same degree of stimulus is either hyper or hypo
How does weakness of the quadriceps contribute to PFPS?
The "quads" include the vastus medialis, vastus lateralis, VMO, vastus intermedius, and rectus femoris. Weakness may adversely affect the patellofemoral mechanism. Quad-muscle strengthening often recommended
What is the second group of lymph nodes that is likely to become enlarged due to infection?
The apical group, which may obstruct the cephalic vein
Which ligaments are responsible for stabilizing the uterus? (6)
The broad ligament and all its subcomponents Transverse cervical/Cardinal ligament Round ligaments of uterus: into labial majora Proper ligaments of ovary Uterine tubes Uterosacral ligaments Indirectly, pelvic floor muscles help too because pelvic structures like the vagina stabilize it too
What does a retroverted, retroflexed uterus look like?
The cervical canal is more parallel with the vagina and the body of the uterus is flexed toward the sacrum instead of the pubic symphysis
What does a retroverted uterus look like?
The cervical canal turns more parallel with the vagina
Apex of Axilla
The entrance from the neck to axilla, the superior opening is called the cervicoaxillary canal
What is Young's modulus?
The equation for calculating stiffness: Stress/Strain (Load/Deformation)
What is endometriosis? What are the symptoms?
The finding of endometrial tissue outside of the uterus Can cause menstrual pain, painful sex, & infertility
T/F: T wave inversion is not a big deal on an EKG
True-- T waves are fickle, not as reliable as ST depression or elevation in dx ischemia there are literally dozens of conditions that cause abnormal-looking T waves in leads with positive QRS waveforms
T/F: you can never get a PVC during the ST segment
True-- absolute refractory period
T/F: ROM can be reliably tested in healthy children
True-- for healthy kids, reliability varies w/ pathology (Ex: alteration in muscle tone may mean a change in ROM measurement may not signify a meaningful, functional change)
What do the anterior and posterior circumflex arteries supply?
They anastomose with each other and supply the shoulder muscles such as teres major and minor, deltoid, and long head of triceps
What is the function of GAG (glycosaminoglycans) in the ground substance of CT?
They create structure to the ground substance (it is the backbone with all the GAG's coming off of it)
Medial Wall of Axilla
Thoracic wall (ribs 1-4 & intercostal mm) and serratus anterior
What are the branch(es) of the second section of the axilla?
Thoracoacromial artery Lateral thoracic artery
What forms the "Adam's apple"?
Thyroid cartilage that covers the larynx
What does the plastic region in a stress-strain curve represent?
Tissue won't return to original shape after load is removed
What does the elastic region in a stress-strain curve represent?
Tissues are now taught and stretching a little, after the load is removed it will return to original shape
What is the purpose of carotid sinus massage?
To treat tachycardia massage increases the pressure in the vessel which increases parasympathetic outflow by vagus N to induce bradycardia
Which ligament of the uterus gets pulled on and produces lower back pain during pregnancy?
Uterosacral ligaments
Which reproductive organ is considered a wandering organ?
Uterus
Which of the precordial leads look at the right/anterior side of the heart?
V1 and V2
Where are the precordial lead electrodes placed on the body?
V1: right, 4th IC space V2: left, 4th IC space V3: halfway b/w V2 and V4 V4: left, 5th IC space, MCL line V5: AAL line, in line w/ V4 V6: MAL line, in line w/ V4 MCL: midclavicular line AAL: ant axillary line MAL: midaxillary line
The transition of the QRS from mostly negative to mostly positive normally occurs between which precordial leads?
V3 and V4
Total Lung Capacity calculation
VC + RV or FRC + IC (functional residual capacity-- volume of air in lungs at end of passive expiration, and inspiratory capacity)
Maximal oxygen consumption is also known as:
VO2 max
Which of the arteries that supply the uterus anastomose with each other?
Vaginal AA anastomose with Uterine AA
Dysfunction in the v. bodies or annulus affects the _________ function of the IV discs
WB
What is "nerve point"?
Where the cutaneous nerves of the neck all come out at roughly the same spot Where the external jugular disappears and the accessory N passes under SCM to traps. Lesser occipital, great auricular, greater occipital, and third occipital NN
Should you expect a SCI patient's PROM to be WFL?
Yes, but will have flaccid limbs
Are sperm in the tail of the epididymis capable of independent fertilization?
Yes, they have had time to mature so they can swim
Which zone of cartilage is more parallel to the joint surface?
Zone 1
Which zone of cartilage is the location of switching from cartilage to bone?
Zone 4
The key principles of outpatient rehab after CS surgery are: 1. precision of mvmt vs. total ROM 2. posture in daily activities 3. alignment of shoulder girdle What does #2 mean?
address the effects of slumping: -inc thoracic kyphosis -inc cervical lordosis -mm length changes-- long ant flexors, short/stiff post extensors (Picture of Upper Crossed Syndrome: long neck flexors, rhomboids & SA, tight pectoralis, UT and levator scap)
When can an amputee begin to wear a rigid removable post-op dressing?
after suture/staple removal the cast is fit from an impression of the residual limb and is worn over the wound dressing or compression socks
COPD involves obstruction of the _________________.
airways
Why do we need to address posture after CS surgeries?
alignment of thorax affects alignment of CS
What is the most common form of drug administration? Is it enteral or parenteral?
alimentary canal - usually orally or rectally (enteral)
Which part of an EKG represents the depolarization of the: 1. AV node 2. bundle of HIS 3. purkinje fibers
all too small in amplitude to be detected by electrode on the body surface
What is the function of the fiber orientation of the lamellae in the annulus fibrosis alternating in successive layers?
allows it to resist distraction, shear & torsional stresses
What might you notice w/ soft tissue palpation in a pt w/ DDD?
altered tissue texture
Interferential uses ______ current at 2000-5000Hz
alternating current (AC)
Pulmonary edema involves fluid collection in what respiratory structures?
alveoli & interstitial area
Drugs that rely totally on the kidneys for elimination include the ____________
aminoglycoside antibiotics
Cardiac Output definition
amount of blood pumped out of the heart per unit time
Our primary concern when examining HR rhythm is determining whether the source of the rhythm is the SA node or:
another area (ectopic foci)
The ACL guides _________ sliding movement of femoral condyles
anterior
What is (anterior) spondylolisthesis?
anterior slipping of one vertebra relative to another (facets are no longer able to hold the vertebra in place)
A barrel chest is an increase in diameter of the thorax in the ant/post or med/lat direction?
anterior-posterior
How does a PCL injury happen?
anteromedial blow to the flexed knee OR a fall onto the knee accompanied by hyperextension stress
Together the ACL and PCL provide the primary static restraint for ___________ stability of the tibiofemoral joint
anteroposterior
When is the earliest time the ventricles can respond to another stimulus on an EKG?
apex of the T wave
How much should you assist a patient with a transfer?
as little as possible, allow for max. patient effort
When should you initiate wrapping or shrinking after an amputation?
as soon as surgeon allows
When should you initiate ROM after an amputation?
as soon as the surgeon allows (usually immediately post-op)
How many total types of collagen are there?
at least 16
Where are areas of major lymph nodes?
at major joints -elbow, wrist, knee, ankle
What is an open pneumothorax?
atmospheric air enters the pleural cavity through an opening in the chest wall Ex: trauma, surgery
Applied Ethics
attempts to deal with specific realms of human action (apply normative ethics (theories) to specific situations)
What is the biggest benefit of IV administration of a drug?
avoids all delays and variables of absorption (ex. vomiting patients)
What role does the ECM play in tissue regeneration?
controls tissue organization, new cells are laid down on the extra-cellular matrix for something to adhere to
For which cervical condition is there very little indication for conservative treatment?
cervical myelopathy (one of the few times that surgery is indicated at presentation-- along w/ tumor, infection or trauma)
What happens to the collateral and cruciate ligaments of the knee with internal rotation?
collateral - lax cruciate - taut
What happens to the collateral and cruciate ligaments of the knee with external rotation?
collateral - taut cruciate - lax
Pts w/ SCI may eventually form a spinal ________ due to poor poor positioning and support
deformity Examples: -scoliosis -pelvic obliquities -kyphosis
Spondylosis, degenerative disc disease and degenerative joint disease are all examples of _____________________ changes in the spine
degenerative
What does the time frame until a prosthesis can be tolerated by an amputee depend on?
depends largely on skin tolerance & healing healing depends on circulation
How does training affect resting & submax systolic & diastolic BP?
decreases both
If we double the viscosity of the blood, then the amount of blood flow through it will:
decreases by 50%
How does age affect end-diastolic filling?
decreases it
How does fluid in alveoli affect gas exchange?
decreases it
How does age affect maximal HR?
decreases it (220-age = max HR)
How does a larger area of a blood vessel affect the velocity of the blood going through it?
decreases it (velocity is inversely proportional to CSA)
How does age affect VO2 max?
decreases it but it doesn't have to go down that much if you continue to train w/ age lower VO2 max w/ age inc risk of MI or CVA
How does voluntary hyperventilation affect ventilatory drive?
decreases it-- by inc blood pH (making it more basic)
How does age affect pacemaker cells in the SA node?
decreases them
How does training affect resting HR?
decreases w/ endurance training
According to the McKenzie Protocol for disc herniations, you should do TherEx that activates __________ muscles
deep
Are kids miniature adults?
def not
What is the following condition called: "displacement of nuclear material beyond normal confines"?
disc herniation
What is the typical frequency and duration of pediatric PT therapy sessions?
depends on setting: 1. Outpatient 2. Acute Care 3. Early Intervention-- individualized family service plan (IFSP), regulated by individuals with disabilities act (IDEA) 4. School Based-- individualized education plan (IEP), regulated by IDEA 5. Special Programs-- may be daily for 6 weeks, monthly, every 6 months or annually (limb deficiency clinic, reducing amplified pain syndrome clinic- RAPS)
What role do chemoreceptors play in the control of ventilation?
detect changes in levels of -CO2 -O2 -H+ in the blood or CSF
How do you determine the correct size of limb shrinker for an amputee?
determine size by circumferential measurements and length
Deductive Theories
determining moral truths from a set of laws or principles truths become a basis to guide action in concrete situations
If the PCO2 is 45 and the PO2 is 40, which way will gas exchange occur? PCO2 norm is 35-45 PO2 norm is 90-100
diffusion of CO2 into alveoli
If the PCO2 is 40 and the PO2 is 105, which way will gas exchange occur? PCO2 norm is 35-45 PO2 norm is 90-100
diffusion of O2 into blood
What are the two things that can cause physical damage to trigger inflammation?
direct cause (cut, sprain, bite) foreign body (splinter or glass)
What is convection?
direct contact b/w a circulating medium (air, water, etc.) and another material of a different temp.
What is radiation?
direct transfer of energy from a material w/ a higher temp to one w/ a lower temp (emission of energy in EM waves)
Active Hyperemia
directly proportional to increased metabolism/activity when you inc metabolic activity of an organ, it inc blood flow to the area
What are limb shrinkers?
elastic shrinkers that help decrease swelling & assist in shaping the residual limb
Name the amputation: disarticulation of elbow
elbow diarticulation :)
How does an atrial infarction or pericarditis affect the PR segment?
elevates the PR segment
Vessel occlusion causes ST (elevation/depression)
elevation
What does histamine do in the inflammatory process?
elicits vasodilation and increases capillary permeability
What are the two major routes of drug administration? (methods of entry into body)
enteral and parenteral
___________ typically are responsible for catalyzing changes in the drug's structure
enzymes
What type of ethical problem does a whistleblower often face?
ethical distress later said ethical dilemma bc you have a loyalty to your employers or colleagues & a duty to do what's in the best interest of your patients
How do body powered prosthetic users often adjust to the poor static & dynamic cosmesis of the device?
have an additional prosthesis that looks like a hand for special occassions
When should you gather necessary equipment for a transfer?
have it all ready to go before you get the pt to the EOB
Information for a person to want to whistleblow is usually __________ information
hearsay -legitimacy of rumors are questioned -mental stability or character of person making accusations is questioned
If a person's systolic BP fails to increase or actually decreases during exercise, what does this indicate?
heart failure-- need to stop exercise ASAP
On EKG paper, what do the terms height, depth & width refer to?
height: vertical distance above the isoelectric line (Ex: height of R) depth: vertical distance below the isoelectric line (Ex: depth of S) width: horizontal distance between things (Ex: width of QRS complex)
Name the amputation: resection of half of the pelvis
hemipelvectomy
What is PQRST as it relates to symptom behavior?
it is key to ask these things with chief complaint: P: what provokes pain Q: quality of pain (sharp?) R: region of pain S: severity T: timing as it relates to other events
What does axis refer to in terms of an EKG? Which leads are involved in determining this?
it is the average direction of depolarization of the QRS impulse travelling through the ventricles-- usually down & to the left limb & augmented leads (precordial leads are not used)
What does it mean to say that the STNR reflex is a bridging or transitional reflex?
it isn't present at birth, but it is present during infancy (4-6 mo)
FYI: you should focus on whether the pt can do the transfer safely and independently with the caretaker that's going home with them
it's not about the abilities of the PT that is working with them
Deontological Theories: rightness & wrongness depends on ______________
its intrinsic nature rather than on the situation or consequences the act itself is right or wrong, so it is *duty oriented*
ARDS is often associated with what other condition?
multiple organ dysfunction or failure
Which type of neuron is the most common?
multipolar Ex: motor nn, interneurons, & Purkinje cells
What might you notice w/ soft tissue palpation in a pt w/ a disc herniation? (mostly extrusions & sequestration)
muscle spasms
A neuron that is (myelinated/unmeylinated) will conduct AP's more quickly. A neuron that is (smaller/larger) in diameter will conduct AP's more quickly.
myelinated larger diameter
Name the muscle stabilization technique post-amputation: transected muscles are re-attached by suturing through drill holes at the distal end of the bone
myodesis
Name the muscle stabilization technique post-amputation: fascial envelope is sutured over the transected muscles
myofascial
Name the muscle stabilization technique post-amputation: suturing of one muscle group to its antagonist
myoplasty
What is the functional unit of the kidney?
nephron
A segmental neuro exam could indicate signs of a _____________ pathology
nerve root
A herniated nucleus pulposus may compress the ______________ which causes what effects? How can you screen for these effects?
nerve root effects: pain, altered sensation, muscle weakness, dec reflexes screen: can test sensation, weakness and reflexes with a *segmental neuro exam*
Which type of neurons can reproduce?
neural stem cells (not mature neurons)
Neural stem cells are undifferentiated precursors to both ___________ and _____________
neurons & glial cells
Which type of pain is this: direct consequence of a lesion or disease affecting nerves such as radicular or referred pain
neuropathic pain
What types of cells are categorized as granulocytes that play a role in the inflammatory process?
neutrophils basophils eosinophils
Which type of pain is this: pain where psychological processes play a large role
psychogenic pain
For a AKA, in which direction is the "pull" while applying an ACE wrap?
pull into extension and adduction
Which respiratory/vascular condition reduces the amt of O2 diffusing into blood and interferes with lung expansion?
pulmonary edema
What does spirometry measure?
pulmonary volumes airflow times
If you think a SCI patient is going into autonomic dysreflexia, do you want to raise or lower the head of the bed?
raise HOB-- decrease BP
Where do chemical mediators come from that play a role in inflammation?
secreted by cells or released by damaged cells
Normal Q waves represent _________ depolarization. They must be distinguished from pathologic Q waves which indicate:
septal MI
Dyspnea
shortness of breath during exercise, this is usually caused by the inability to readjust the blood PCO2 and H+ due to poor conditioning of respiratory muscles
If a patient w/ a disc herniation has a lateral shift, their __________ will be lateral to their __________ (options: hips, shoulders)
shoulders lateral to hips
Small pulmonary emboli might be ____________ unless they involve a large area of lung
silent
What is the most common way for drugs to move across a membrane in the absorption process? This means the rate of transfer is directly proportional to what? Can this process become saturated?
simple diffusion concentration gradient no
What is important to keep in mind during lateral transfers?
skin integrity, concerned about shear forces
What are some things that serve as part of the physical barrier in the first line of defense?
skin, mucous membranes, nasal hair, blood clots
What is the synaptic cleft?
space b/w pre & post synaptic terminals
How specific should documentation of transfer be?
specific enough that it could be reproduced by other members of the healthcare team, don't use too much PT lingo include type of assistive device that was used
How many stages of TMJ dysfunction are there?
stage 1: early stage 2: early/intermediate stage 3: intermediate stage 4: intermediate/late stage 5: late
Which transfer should be worked on with an amputee first? If the pt is unable to stand, what may be indicated instead?
stand-pivot transfer slide board
Inductive Theories (no clue)
start w/ a concrete situation & reject the belief that reliable action guides can be found use of reason does the essential work of ethical reflection
What is a consequence of taking a drug over a prolonged period of time?
the enzymes in the liver responsible for destroying the drug may become overly active, decreasing the effectiveness of the drug
What is a danger of liver damage when dosing a drug?
the inactivation of a drug can be significantly delayed, resulting in the risk of reaching a toxic level due to increased amounts of drug present in blood
Why would Matt prefer not to fit an individual with a prosthesis if they had intact bilateral thumbs, but bilateral amputations of all other digits? (picture on slide)
the loss of sensation (tactile, temp, etc.) would do more harm than the prosthesis would do good
Deontological Theories (Kant): the ________ justify the ________ options: means, ends
the means justify the ends
What is chemotaxis?
the movement of cells in response to a chemical signal
How is distribution defined in relation to pharmacokinetics?
the movement of the drug throughout the body to various tissues
What are Sharpy's fibers?
the outer fibers of the annulus connect directly to the v. bodes, when they enter the bone they're called Sharpy's fibers
What determines the direction of gas exchange between the alveoli and the blood?
the partial pressures of gases
What is formulation?
the process of dosing a drug so that it remains in the therapeutic range as long as possible without entering the toxic range
What is an osteomyoplasty?
used in a *transtibial amputation* -osteoperiosteal flap (bone bridge) is harvested from the amputated tibia -flap is implanted, bridging the distal tibial & fibular ends -incision is closed over bone bridge
When can an amputee begin to wear a semi-rigid post-op dressing?
usually applied in the OR or PACU
If a pt is a paraplegic and an experienced WC user, should you evaluate if their current WC is the best one for them?
usually no, maintain their present style of WC if it's working for them w/out too many issues
Most popular example of a teleological theory:
utilitarianism
A MCL injury results from a ______ stress
valgus
How does an ACL injury happen?
valgus and exernal rotation when the foot is planted to the ground OR internal rotation and hyperextension
What forces result in an unhappy triad?
valgus, flexion and external rotation while the foot is planted on the ground
A LCL injury results from a ________ stress
varus
Over 80% of LE amputations are caused by:
vascular disease or neuropathy
Pulmonary edema and pulmonary embolism are what kind of disorders?
vascular disorders
What causes tissues to become red and warm with inflammation?
vasodilation which causes increased blood flow
What do prostaglandins do in the inflammatory process?
vasodilation, increase in capillary permeability, pain
During exercise, when minute ventilation begins to increase at a quicker rate than before, what is this point called?
ventilatory breaking point (also near AT)
QRS complex
ventricular depolarization (& atrial repolarization)
