Exam A:3

age milestone for stairs foot-over-foot (reciprocal stair climbing) hop on 1 foot and stand on tiptoes jump with 2 feet

2 4 3

supraspinatus tendinitis + subacromial bursitis will typically have a painful arc of motion from

60-120 + not end range

pt movement in R LE shows good recovery (out of synergy), what should be the focus of motor learning?

consistency of performance in variable environment pt demonstrated good functional recovery. Motor learning for autonomous stage of motor learning should be utilize variable practice in variable environment mental practice + breaking down tasks into components can be helpful in early cognitive stage of motor learning. serial practice order is indicated for middle, associative stage of motor learning.

elevated serum level found in pt w/

gout, diabetes, hypothyroidism, obesity

dysarthria

impaired articulation (motor speech disorder)

paroxysmal nocturnal dyspnea what is it and when does it occur

inability to lie flat when there is edema in the lungs

what med category lower blood pressure

nitrates diuretics beta-blockers calcium

SS of PE

rapid onset of dyspnea, sudden chest pain, cyanosis

graves' disease or hyperthyroidism clinical exam

tachycardia hyperreflexia decreased muscle strength

Glascow Coma Scale

typically used to assess acute concussion/TBIs, but is limited to assessing eye, verbal, and motor responses. does not assess brain reflexes

hypoglossal nerve (+) sign

deviation to the affected side inspected for muscle wasting, fasciculation, dysarthria ( articulation problem)

Cushing's syndrome clinical exam

kyphosis and easy bruising "moon face" buffalo hump

stages of complex regional pain syndrome

-Stage 1 = Hyperalgesia (increased sensitivity to pain), allodynia (all stimuli are perceived as painful), and hyperpathia (increased intensity) w/ edema, increased sweating, thin, shiny -Stage 2 = Pain, edema, atrophic skin and nail changes -Stage 3 = More pain, hardening edema, dry and cyanotic skin, osteoporosis, anklyosis

A human bit injury resulted in laceration of extensor tendons over MCP joints. Following surgical repair, pt was placed in a dorsal dynamic extension splint. Therapy is initiated in the 1st 24 hrs, w/ therapist instructing the pt to move in which way?

*passively extend the wrist + actively flex the MCP joints goals during 1st few weeks include preventing tendon rupture + promoting tendon healing as well as edema + pain control for scar management, perform AROM flex, isolated joint + tendon (hook and straight fist) perform passive ext via elastic recoil of dynamic splint, 10-reps hourly begin active MP flexion to 30-40 deg (via flexion block on dynamic splint) progress MP flexion as tolerated perform wrist + digit PROM in ext + tenodesis out of splint 10 reps hourly. Avoid making a full fist as this may place too much stress on the repai.

emg is used to document

1. diff types of peripheral axonal injury (axonotmesis, neurotmesis) 2. impairment of muscle recruitment

polyneuropathy involvement

B/L distal extremity motor, sensory, and autonomic impairments without UMN involvement

diagnostic imaging for pts w/ MS to help determine level of disease activity

MRI is highly sensitive for detecting MS plaques in white matter of brain + SC. Lesions are seen as areas of increased signal intensity (bright spots).

pt taking hormonal birth control are at increased risk for

PE or DVT

active expiration, which muscle is responsible

abdominal wall (rectus abdominis, internal + external obliques, transversus abdominis) drives intra-abdominal pressure up when they contract + thus push up the diaphragm, raising pleural pressure, which raises alveolar pressure, which in turn drives air out.

myofascial pain syndrome

active: tender to palpation + have characteristic referral pattern of pain when provoked latent: palpable taut bands that are not tender to palpation, but can be converted into an active trigger point ***chronic pain disorder characterized by localized trigger points + referred patterns of pain. pressure on sensitive points in muscle (trigger points) causes referred pain in seemingly unrelated parts of the body

hip flexion contraction exceed 15 def or there is limited lumbar spine extension range the pt will

adopt a forward trunk tilt in terminal stance in order to complete the step.

contraindication for intermittent pneumatic pressure

ask "do you have difficulty breathing?" symmetrical B/L edema can signify CHF. Mod to severe CHF can lead to pulmonary edema + subsequent SOB. Intermittent compression may shift a sig amount of fluid from periphery to core circulation, thus increasing load on the heart and immediate risk for a cardiac event. it is important to screen pts for SOD as heart failure w/ pulmonary edema are contraindications to intermittent pneumatic compression

OA produces what type of pain w. which joints

asymmetrical pain with typical involvement of large weight bearing joints

POD 3 medial meniscus repair. What type of exercise should be avoided for the 1st 6-8 post operative weeks to protect the repair?

attachments of medial meniscus include the semimembranosus tendon, MCL, and fibrous capsule, + medial meniscopatellar lig. during open chain rested knee flexion, semimembranosus tendon will pull on the posterior aspect of the medial meniscus + in doing so may tear the surgical repair.

what is chemo and side effects

attacks rapidly dividing cells, but it also affects all rapidly dividing cells in the body, including all blood cell types. hemorrhage following heavy resistance exercise if pt's platelet count drops too low can be toxic to cells that line the GI ract + result in N/V, which may lead to poor nutritional intake + dehydration.

cervical myelopathy involvement

both LMN at the level of compression + UMN involvement distal to compressed cervical level but typically results in B/L LE involvement + both motor and sensory impairment (ataxia)

A PT substituting for an ill colleague + is unable to access the previous PT's notes in the medical record. In this case, what should the therapist do?

briefly examine the pt and intervene appropriately NOT: see if other coworkers can figure out how to access the info in the medical record if a PT accepts an individual for PT services, the PT will be responsible for the examination, evaluation, and intervention of a pt. At the least, a systems review + brief POC should be formulated before intervening. Electronic medical records help to minimize difficulties in handwriting interpretation; however, systems aren't perfect it is not co-worker's responsibility to interpret others' notes no one should have access to pt information if not involved in the care of that pt

fibromyalgia

chronic faitgue, sleep disturbances, generalized tender points, + irritable bowel syndrome "a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas." "often triggered by a stressful event, including physical stress or emotional (psychological) stress. Possible triggers for the condition include: an injury. a viral infection."

gallstones

classic symptoms nausea + RUQ pain, which radiate to the R scapula found in pts who are overweight or obese, female, + 4th decade of life occur more commonly in pts eating meals high in fat/cholesterol

lymphedema

complication that can occur after treatment of breast CA as a result of removal of lymph nodes, typically in axillary + pectoral regions. Radiation to axillary lymph nodes may cause lymphedema, but treatment is the breast in this case

a pt with restrictive lung disease secondary to circumferential thoracic burn demonstrated decreased ability to expand lower rib cage + push abdominal wall anteriorly. Therapist should consider the use of facilitation techniques to enhance function of which of the following rectus abdominis anterior scalene internal intercostals diaphragm

contraction of the diaphragm causes the ribs to move outward, which is the desired motion in this case. facilitating the rectus abdominis will cause trunk flex, which will not increase lower rib expansion. anterior scalene facilitation will assist w. increasing the neg pressure on inspiration; however it will not assist w. expanding the lower rib cage. facilitation of the internal intercostals will cause the opposite motion than the desired lower rib expansion.

contrast bath and edema

contrast bath would require the pt to be treated in a dependent position, which would further contribute to edema formation

straight leg raise vs crossed straight leg raise

crossed straight leg raise is considered a highly specific test -- which when positive helps to rule in dx of herniated nucleus pulposes or lumbosacral radiculopathy SLR is highly sensitive + helpful to ruling out lumbosacral radiculopathy when negative

how is myelin basic protein obtained and what can you find from it

determined following a lumbar puncture with aspiration of cerebral spinal fluid. elevated levels suggestive of demyelinating diseases such as multiple sclerosis

how to improve 1st metatarsophalangeal joint ext dorsal (anterior) glide of proximal phalanx on metatarsal plantar (posterior) glide of proximal phalanx on metatarsal

dorsal (anterior) glide of proximal phalanx on metatarsal concave surface moving on convex surface

cause of metabolic acidosis + SS

drug or chemical toxicity renal failure severe diarrhea diabetic ketoacidosis HA, fatigue, drowsiness, nausea, hyperventilation, + convulsions

pacemaker

dual sensing pacemaker assess depolarization of atrium or ventricle. if depolarization does not occur wn the set time limits of the device, the pacemaker will initiate depolarization, which results in a ventricular contraction pacemaker has no effect on heart

Coma Recovery Scale-Revosed

examines multiple domains (auditory, visual, motor, verbal, communication, and arousal) of consciousness + function to include brain stem reflexed (pupillary light reflex, corneal reflex, spontaneous eye movements, oculocephalic reflex, postural responses) it is recommended for use in multiple settings (acute care, inpatient/outpatient rehab, long term care/skilled nursing) + pts w/ various health conditions (TBI, stroke, brain tumor) that result in altered levels of consciousness.

cervical myelopathy ss

exhibit upper motor neuron signs such as hoffman's babinski clonus hyperreflexia ataxia loss of strength in upper extremities clumsiness B/L UE paresthesia ***"any positive signs or symptoms warrant an immediate referral as this condition often requires urgent surgical decompression to prevent further neurological deterioration"

quad weakness compensation during gait

hyperextension of the knee forward trunk lean to put COG in front of the knee

fluent aphasia

impaired auditory comprehension fluent speech that is normal rate + melody "say phrases that sound fluent but lack meaning." wernicke's aphasia receptive aphasia

dyspraxia what is it and

impairment of skilled learned movement (a disconnect between the idea for movement + its motor execution) task-specific practice using familiar activities and progression from parts to whole is the best choice to enhance learning compensatory techniques may be necessary of the dyspraxia is severe + pt fails to benefit from remedial intervention program. Manual facilitation may benefit the pt during task practice, but both maximum use and practice of new tasks are not likely to benefit the pt.

pulmonary edema results from

increased intravascular pulmonary pressure this doesn't occur in R ventricular failure bc there is a reduction in forward flow + therefore there are lower pulmonary arterial pressure

Paget's disease what can be seen in clinical exam commonly involved areas

increased skin temp over affected long bones focal inflammatory condition that produces disordered bone remodeling there is increased vascularity associated with bone remodeling, leading to increased skin temperature in affected areas bone that are commonly involved are pelvis, skull, femur, tibia, spine, shoulders, and ribs

glascow outcome scale-extended

is a structured interview that does not include physical examination items. It is often used in research studies to classify global function outcome states (death, vegetative, mod/severe disability)

can manual technique be done in area of chest tube

it is possible. it is often the area in most need of airway clearance. It is important to consider pain management when doing this intervention. percussion and shaking are not contraindicated, but it is important to consider that this may be agitating to pt w/ severe brain injury. Also, placing the pt in Trendelenburg should be avoided in the acute period to eliminate increases in intracranial pressure percussion and shaking can be completed B/L + w. the chest tube in place. It is important to attend to pt comfort + chest tube positioning when in R SL

HLA-B27 detect

lab test for ankylosing spondylitis reactive arthritis juvenile rheumatoid arthritis

an older adult with 3 year hx of PD is referred 2/2 to initial + mild difficulties with balance. Pt has had 2 near falls in the past 3 mos w/ both occurring after he was accidently bumped in the community. Which of the following examination items is BEST to asses the pt's currently balance + fall risk?

mini-BEST past fall result of delayed reactive postural control (the ability to recover balance after an external perturbation) BBS, FGA, TUG-cog do not directly assess reactive postural control

nerve conduction velocity

most useful measurement of demyelination in polyneuropathy. Conduction time is measured by recording the evoked potential from either a motor or sensory nerve. Speed of nerve transmission is directly related to level of myelination.

creatine kinase level are used to help diagnose conditions associated with

muscle damage such as rhabdomyolysis and myocardial infarction

where does exertional edema occur

occurs in the R ventricular failure as a result of deconditioning after a period of time.

hip and knee contracture what compensation during gait can you see

opposite extremity having to circumduct, hip hike, steppage gait

gout clinical examination

pain, redness, swelling of the 1st metatarsal joint limited to few joints, typically affecting 1st metatarsal, knee, or wrist

classification of patellofemoral pain syndrome patella tilt or patellar apprehension test

patella tilt test is a nonprovocative test used to identify reduced patellar mobility (+) test. Test is used to determine the structural tightness of the lateral patellar retinaculum. also classifies pt into category of patellofemoral pain with mobility impairment patella apprehension test is utilized to determine if patellar instability is present.

pressure tolerant areas of transtibial residual limb

patellar tendon medial tibial plateau tibial + fibular shaft + distal end these are expected areas of redness

forward head posture, w/ excessive thoracic kyphosis + rounded shoulder would have which muscle shortening

pec minor rectus capitis posterior major upper trapezius cervical paraspinal scalene levator scapulae suboccipital muscle

L phrenic nerve of pt was accidentally severed during thoracic surgery. Which muscles should the PT strengthen in order to provide substitute function?

phrenic nerve arise from neck + innervated diaphragm. diaphragm is responsible for 45% of air that enters the lungs during quiet breathing. During quiet breathing, predominant muscle of respiration is diaphragm. As it contracts, pleural pressure drops, which lower the alveolar pressure + draws in air down the pressure gradient from mouth to alveoli expiration during quiet breathing is predominantly a passive phenomenon; as respiratory muscles relax, the elastic lung and chest wall return passively to their resting volume. w/ paralysis of the diaphragm, the accessory muscles of respiration should be strength: scalene + SCM

risk factor for osteoporosis

postmenopausal age, low body weight, loss of height, sedentary lifestyle, tobacco use, hyperthyroidism (Graves' disease) ss: severe + localized thoracic-lumbar pain, increased pain w/ prolonged upright posture, decreased pain in hook-lying, loss of height, kyphosis

pt taking diuretic to manage hypertension. adverse side effect of taking diuretic what are the clinical signs

potassium deplietion diuretics inhibit potassium, sodium, + water resorption by the kidneys. For pt taking diuretics, therapist must monitor for possible symptoms consistent w/ potassium depletion + dehydration muscle weakness, fatigue, cardiac arrhythmia, abdominal distension, nausea

ALS

presence of upper and lower motor neuron involvement without sensory loss early or in ALS stage 1, pt will often display mild focal weakness w/ asymmetrical distribution to include symptoms of hand cramping + fasciculation

"During upright exercise, the normal blood pressure response is to observe a"

progressive increase in systolic blood pressure with no change or even a slight decrease in diastolic blood pressure. The slight decrease in diastolic blood pressure is due primarily to the vasodilation of the arteries from the exercise bout.

posterior rolling walker is used to

promote an upright postures (eliminate forward lean seen in use of the standard anterior walker). wheels improve walking speed + reduces energy expenditure.

A PT has decided to use mechanical lumbar traction on a pt w/ posterior herniated nucleus pulposus at L4-5 + signs of nerve root compression. if tolerated by the pt, what is the BEST positioning for this treatment?

prone, with no pillow under the hips or abdomen neutral or extended position of supine allows for separation of the vertebral bodies while preventing excessive stress on the posterior structures

Rancho Los Amigos Level of Cognitive Functioning

recommended for various settings and is used to delineate 8 levels of cognitive + behavioral function in patients recovering from mod to severe TBI does not assess brain reflexes

myasthenia gravis involvement

results in fatigue and ultimately weakness in multiple in B/L UE + LE but does not result in UMN involvement typically have involvement of bulbar (extraocular, facial, muscle of mastication) + proximal limb-girdle muscles if overworked pt will exhibit changes + difficulty w/ prolonged speaking, eating, reading weakness w/ repetitive testing of exercise of proximal limb muscles

what causes dependent edema

right ventricle fails >>> increased fluid will back up >>> traveling backward from the R ventricle, into R atrium + then periphery

symptoms of hypoglycemia

shakiness perspiration irritability pallor weakness blurred vision HA slurred speech hunger

pt w/ arnold-chiari malformation has ventriculoperitoneal shunt in place. Becomes agitated + irritable, then drowsy and listless what is the next step

signs of shunt blockage. emergency services are indicated

pt undergoing radiation therapy often experience

skin irritation swelling fibrosis of CT ipsilateral trunk + UE mobility may be painful + limited if the target of radiation therapy is the breast or in the axilla

water intoxication ss

sleepiness, confusion, decreased alertness, poor motor coordination, hyperventilation

what is recommended for delayed onset hypoglycemia

slowly absorbed carbohydrates (crackers, bread, or pasta) rapidly absorbed carbohydrates (fruit juice, candy, honey) are given during exercise to help prevent hypoglycemia. Food with saturated fats (beef jerky, string cheese) should be limited. Carrot sticks + cherry tomatoes do not have major effect in preventing hypoglycemia

nonfluent aphasia

speech is slow, hesitant, awkward, interrupted, produced w/ effort pt tend to have food awareness of their deficits and comprehension expressive aphasia broca's aphasia

common symptoms of jevenile RA

swollen stiff painful joints worse in the morning fatigue fever swollen lymph nodes poor weight gain/slow growth text: the only sig objective data from examination was mild edema and pain at end ranges of motion ^ PT was unable to identify specific impairments that would be potentially contributing to pt's complaints, warranting referral to physician for additional testing

Polymalgia Rheumatica

systemic inflammatory disorder that primarily affects proximal muscles in the shoulder + pelvic gridles, and muscular arteries such as temporal arteries erythrocyte sedimentation rate C reactive protein weakness, malaise, low grade fever, sweats, weight loss, depression, vision changes, fatigue, temporal headaches

a pt with postpolio syndrome is referred to PT for exercise training. the pt reports recent general fatigue and weakness along w/ muscle and joint pain. what is the best initial intervention?

therapeutic aquatics. warmth of the water can ease muscle + joint pain, + buoyancy can assist fatigued limbs. An initial exercise duration of up to 20 min per session in 2-4 min intervals is recommended

Raynaud's disease

vasospastic disorder characterized by intermittent episodes of small artery constriction of digits of the fingers (rarely the toes), causing temporary pallor and cyanosis

recommendation for previously untrained post menopausal pt w/ dx of osteoporosis

walking 30 min 3x/wk. wbing, non-jarring exercises have been proven to reduce or slow bone loss without causing vertebral compression should avoid high-impact exercises to limit excessive vertebral loading (aerobics + jogging) exercise intensity should be lower at 1st (50% of 1 rep max + more frequently than 1 time per week)

A physical therapist is treating a terminally ill patient with AIDS at home. What would be a major psychological focus or consideration when managing this patient? -discontinue treatment if the pt/therapist relationship becomes overly dependent -encourage expression of feelings and memories -keep the pt's friends + relatives up to date on the pt's treatment + state of mind -discontinue any activities that may cause the pt discomfort in order to keep anxiety levels low.

when treating pt w/ terminal illness, therapist should provide support + understanding of grief process, encourage expression of feelings + memories, and respect privacy, cultural, or religious customs the therapist needs to maintain boundaries of treatment and not discharge the pt. keeping friends + relatives updated would violate the pt's privacy unless specific permission is given by pt. Pt should be kept involved in the decision planning in order to reduce anxiety.