IER 2016
Lisfranc injury
-The Lisfranc injury (also known as the Lisfranc fracture, tarsometatarsal injury, or simply midfoot injury) is an injury of the foot in which one or all of the metatarsal bones are displaced from the tarsus. -The injury often occurs when an athlete has his or her foot plantar flexed and another player lands on his or her heel
uterine prolapse(cystocele)
-*Back and perineal pain aggravated by prolonged standing is common*. -Pain is often relieved by lying down (not aggravated). -Constipation and painful bowel movement are common with a rectocele.(not cystocele)
contraindications for iontophoresis treatment
*All applications of electrical stimulation are contraindicated in the presence of a pacemaker*.
transfer guidelines for patients with tetraplegia-C6-
*therapist should ensure the forearms are supinated with wrists extended and fingers flexed* =*Fingers are always flexed (not extended) to preserve tenodesis grasp*
the limitations of ultrasound imaging
-*Difficulty penetrating bone and therefore visualizing internal structure of bones* -Ultrasound images are typically used =to help diagnose tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle =abnormalities of the muscles, such as tears; =bleeding or other fluid collections within the muscles, bursae, and joints =benign and malignant soft tissue tumors =early changes of rheumatoid arthritis =fluid in a painful hip joint in children =lumps in the neck muscles of infants =soft tissue masses (lumps/bumps) in children.
supranuclear palsy
-*results in contralateral weakness of the lower face* - Early symptoms of progressive ___ ___ include paralysis of muscles responsible for downward gaze, rigidity of neck muscles, and facial muscle weakness.
hypothyroidism
- have numerous musculoskeletal effects, including myalgia (muscle pain) and *proximal muscle weakness* -Additional musculoskeletal effects include stiffness (not joint laxity), and prolonged deep tendon reflexes (DTRs) (not decreased DTRs).
Adam's forward bend test
- is the standard screening test for scoliosis. -During the test, the child will bend forward with feet together, knees straight, and arms hanging free. The therapist observes child from the back, looking for a difference in the shape of the ribs on each side. A spinal deformity is most noticeable in this position.
muscles of respiration
- muscles that contribute to inhalation and exhalation, by aiding in the expansion and contraction of the thoracic cavity. -The diaphragm and, to a lesser extent, the intercostal muscles drive respiration during quiet breathing. -Additional accessory muscles of respiration are typically only used under conditions of high metabolic demand (e.g. exercise) or respiratory dysfunction (e.g. an asthma attack the sternocleidomastoid and the scalene muscles (anterior, middle and posterior scalene) are typically considered accessory muscles of breathing. Both assist in elevating the rib cage. = Apart from these neck muscles, the following muscles have also been observed contributing to respiration: serratus muscles, pectoralis major/minor, trapezius, latissimus dorsi, erector spinae, iliocostalis lumborum, quadratus lumborum, levatores costarum, transversus thoracis, subclavius
cauda equina lesion for ambulation with crutches
-Cauda equina syndrome occurs when the nerve roots in the lumbar spine are compressed, disrupting sensation and movement. -Lower trapezius, latissimus dorsi, and pectoralis major; (shoulder depressors and extensors along with elbow extensors are needed for crutches) =shoulder extensor D Deltoid muscle L Latissimus dorsi muscle P Pectoralis major muscle T Teres major muscle Teres minor muscle Triceps brachii muscle
Bones of the hand
-Distal phalanx(MP): bone at the end of a finger. -Middle phalanx(MP): small, middle bone of a finger. -Proximal phalanx(PP): small bone of a finger, closest to the palm of the hand. - Metacarpophalangeal joint (MP): joint between the metacarpals.
prolapse of the uterus
-It is also called pelvic organ prolapse or prolapse of the uterus (womb). - Risk factors for uterine prolapse include =pregnancy, =childbirth, =chronic increases in intra-abdominal pressure such as lifting, coughing or straining, connective tissue conditions, and damage to or weakness of the muscles.
choice to maximize stroke recovery and improve trunk stabilization while minimizing heartburn
-Perform resisted holding in sitting using rhythmic stabilization-for trunk stabilization- =Heartburn is a common symptom of gastroesophageal reflux disease (GERD) and can be aggravated by positioning in supine, prone, or bridging. =Modifying the patient's position to upright can alleviate the symptoms and demonstrate to the patient the therapist's concern incorrect choice -Semi-Fowler position (supine, head and torso elevated 30 degrees) is not an effective position to work on trunk stabilization. -Bridging will aggravate heartburn. -Prophylactic use of antacids before therapy is not indicated.
joint play of the CMC joint of the thumb
-The carpometacarpal joint of the thumb is considered a saddle joint in which the articular surface geometry is generally concave in one plane and convex in a plane perpendicular to the other. -The proximal joint surface of the first metacarpal is generally convex in the palmar to dorsal direction and concave in the medial to lateral direction. -The articular surface of the base of the first metacarpal typically presents as the convex member of this joint when movement occurs in palmar abduction. Thumb palmar abduction thus involves a convex metacarpal surface moving on the concave surface of the trapezium. -Following the traditional concave/ convex rules of motion, one would expect a combination of palmar roll and dorsal translatory motion of the metacarpal on the trapezium during palmar abduction. In this case, a therapist would be sure to evaluate dorsal glide of the metacarpal on the trapezium
other toe injury
-Turf toe is a sprain of the MTP joint of the first toe due to hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground. - Calcaneocuboid joint subluxation (also known as cuboid syndrome) is defined as a minor disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint. The disruption of the cuboid's position irritates the surrounding joint capsule, ligaments, and fibularis longus tendon. -Hallux rigidus (stiff big toe) is a degenerative arthritis and stiffness due to bone spurs that affects the MTP joint at the base of the hallux. Symptoms include pain and stiffness in the joint at the base of the big toe during use (walking, standing, bending, etc.).
adrenal insufficiency
-a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol but may also include impaired production of aldosterone (a mineralocorticoid), *which regulates sodium conservation, potassium secretion, and water retention*. *Craving for salt or salty foods due to the urinary losses of sodium is common* =hyposecretion of adrenal glands =Addison's Disease Correct Answer: - Metabolic abnormalities seen in adrenal insufficiency include hyponatremia (decreased sodium concentration in the blood) *secondary to renal loss of sodium ions*. =*A decrease in cortisol results in an inability to regulate potassium and sodium*.
Interstitial cystitis
-also called painful bladder syndrome is a chronic condition in which you experience bladder pressure, bladder pain and sometimes pelvic pain, ranging from mild discomfort to severe pain. Your bladder is a hollow, muscular organ that stores urine.
patient with a 10-year history of discoid lupus erythematosus presents with multiple discoid skin lesions that are raised and red and contain scaling plaques with central atrophy on the lower extremities. Topical corticosteroid creams are being used. What should be the focus of the therapist's initial plan of care?
-def: chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas. These lesions develop as a red, inflamed patch with a scaling and crusty appearance. Correct Answer: Range of motion (ROM) exercises and prevention of deformity are important elements of the plan of care. =d/t pain there could be contracture. Incorrect Choices - Lightweight splints for joint protection can contribute to contracture development if worn too long. Furthermore, there are no reports of arthralgia in this case. -Regular exercise is important but should not be aggressive (resistive training). Also, long-term use of corticosteroids puts this patient at risk for osteoporosis. -Aerobic (treadmill) training might be indicated but is not an initial priority.
congestive heart failure
-def:a *weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues*. - occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs
What will a patient with a significant right thoracic structural scoliosis demonstrate on examination
1. Decreased breath sounds on the left. 2. Decreased thoracic rib elevation on the left. *3*. Increased lateral costal expansion on the right. 4. Shortened internal and external intercostals on the left. Correct Answer: -With a right thoracic scoliosis, the convex side is on the right. This would allow for increased aeration and mobility on that side. Incorrect Choices: -The ribs would elevate normally or more on the right side. -The *remaining choices would be true on the contralateral or shortened side of the scoliosis*. *The left side would have shortened muscle length and decreased aeration* *so need stretching while right side need strengthening*.
indications and contraindications for airway clearance techniques
A patient with a platelet count of 30,000 is at increased risk for bleeding-normal;50,000- Percussion may cause microtraumas and increased bleeding risk
effects of immersion
Full chest immersion in a pool can result in increased work of breathing as a result of increased hydrostatic pressure
delayed hypoglycemia
Alcohol consumption may cause increased risk of ____ especially with insulin or insulin secretagogues
postpartum-c section- intervention approaches
Breathing, coughing, and pelvic floor exercises
gait deviations associated with limited tibial advancement with stroke
Circumduction is the most likely compensatory gait deviation when tibial advancement is limited (e.g., spasticity of plantar flexors). =LE extensor spasticity
myositis ossificans
Correct Answer: -The *lesion begins to calcify at the periphery and works toward the center*. At less than 3 weeks post trauma, bone scan demonstrates increased uptake in the area. =*Osteosarcoma calcifies at the center and continues to the periphery*.
fall examination
Correct Answer: -*Sensory testing should be performed next after cognition test*, including somatosensations from the feet and ankles, vision and visual proprioception, and vestibular sensations. -Once the primary sensations have been tested, the Clinical Test for Sensory Interaction in Balance can reveal valuable information about the patient's ability to use sensory information under changing balance conditions. Incorrect Choices: *Following sensory testing, static balance tests can then be performed, then dynamic balance tests, and finally locomotor tests* =>*cognition->sensation->static/dynamic balance test->locomotion for fall test*
patient recovering from stroke demonstrates dyspraxia. On what should physical therapy intervention optimally focus?
Correct Answer: -*Dyspraxia is an impairment of skilled learned movement (a disconnect between the idea for movement and its motor execution)*. -*Task-specific practice using familiar activities and progression from parts to whole is the best choice to enhance learning*. Incorrect Choices: -Reeducation of weak muscles in isolated movements will not carry over to improved functional task performance. -Compensatory techniques may be necessary if the dyspraxia is severe and the patient fails to benefit from a remedial intervention program (not evident in this case). -Manual facilitation may benefit the patient during task practice, but both maximum use and practice of new tasks are not likely to benefit the patient
gait training approaches for PD
Correct Answer: -*Locomotor training using a personal listening device and 80 to 100 beats/min music* has been shown to improve rhythmicity and decrease FOG-freezing of gait- episodes in patients with PD. Incorrect Choices: - Part-to-whole training is not effective for motor skills with highly integrated elements (gait). - Light resistance will likely increase the patient's stiffness during gait (already a problem with PD). -BWSTI might be helpful to improve the rhythmicity of gait, but 40% unweighting is too high and 2.7 mph is too fast for this patient
reliability information
Correct Answer: -Reliability coefficients above 0.75 demonstrate good reliability. -This test demonstrated good reliability both for test-retest and interrater comparisons. Incorrect Choices: -Coefficients below 0.50 represent poor reliability, while coefficients from 0.50 to 0.75 demonstrate moderate reliability.
Modified Ashworth Scale
Correct Answer: A grade of 4 is given for *affected part( s) that are held rigid in flexion or extension*. Incorrect Choices: - A grade of 1 + is given when there is a slight increase in tone, manifested by a catch, *followed by minimal resistance throughout the remainder (less than half)*of the range of motion (ROM). -A grade of 2 is given for more marked increase in muscle tone through most of the ROM, *but the affected parts move easily*. -A grade of 3 is given when there is considerable increase in muscle tone, and *passive movement is difficult*
motor skill milestones
Correct Answer: Going up stairs *foot-over-foot* (*reciprocal stair climbing*) is a developmental skill normally achieved by 2 years. Incorrect Choices: - The ability to hop on one foot and stand on tiptoes is normally achieved by 4 years. - The ability to jump with two feet is normally achieved by 3 years
guidelines for interval training for nondeconditioned adult
Correct Answer: Guidelines for interval training call for performance of intermittent exercise of at least 10 minutes of duration Incorrect Choices: -Unless a person is extremely deconditioned, 5 minutes is too short of a work time to increase aerobic capacity. - Twenty minutes is the lowest end of the acceptable amount of exercise time per day. -Thirty minutes is the total recommended daily exercise time. It is still effective to break this up into three 10-minute bouts.
to prevent delayed hypoglycemia after exercise
Correct Answer: Slowly absorbed carbohydrates (*crackers, bread, or pasta*) can help prevent delayed-onset hypoglycemia. Incorrect Choices: - Rapidly absorbed carbohydrates (e.g., fruit juice, candy, honey) are given *during exercise* to help prevent hypoglycemia.
MFIS-Modified fatigue impact scale-
Correct Answer: The MFIS is an appropriate measure to examine the physicaL cognitive, and psychosocial functional limitations of fatigue in patients with MS. Incorrect Choices: - The FIM is a 7 -level scale of functional performance and includes 18 items on self-care, sphincter control, transfers, locomotion, communication, and social cognition. -The WAQ examines functional performance of walking skills. -The OASIS is a measure of function in the home care setting and includes 79 core items, including sociodemographic characteristics, environmental factors, social support, health status, and functional status 1. Functional Independence Measure (FIM). 2. Walking ability questionnaire (WAQ). 3. Outcome and Assessment Information Set (OASIS). 4. Modified fatigue impact scale (MFIS
facilitation techniques of the rib cage
Correct Answer: - *Contraction of the diaphragm causes the ribs to move outward for rip expansion* with patient with restrictive lung disease secondary to circumferential thoracic burns demonstrates *decreased ability to expand the lower rib cage and push the abdominal wall anteriorly* Incorrect Choices: - Facilitating the rectus abdominis will cause trunk flexion, which will not increase lower rib expansion. -Anterior scalenes facilitation will assist with increasing the negative pressure on inspiration; however, it will not assist with expanding the lower rib cage. -Facilitation of the internal intercostals will cause the opposite motion than the desired lower rib expansion.
the actions of the rhomboids
Correct Answer: - *During the motions of shoulder flexion and abduction, concentric muscle activity of the serratus anterior occurs, providing upward scapular rotation*. *However, concentric activity of the serratus anterior would also induce abduction of the scapula due to its line of action*. -Excessive scapular abduction can be controlled through muscle actions from those that can provide scapular adduction. The *primary scapular adductors acting eccentrically to control excessive scapular abduction include the rhomboid and the trapezius muscle groups*. -Inadequately controlled lengthening of the rhomboids could contribute to hyperabduction of the scapula during the mid and later phases of shoulder flexion and abduction
needle electromyography (EMG) of the weak and atrophic biceps
Correct Answer: - *Inserting an EMG needle into a normal muscle causes a burst of electrical activity* (insertional activity) -*electrical silence with weak and atrophic biceps* Incorrect Choices: - *Fibrillation potentials are spontaneous activity seen in relaxed denervated muscle*, and - *polyphasic potentials are produced in the contracted muscle undergoing reorganization*.
cardiac rehabilitation guidelines and adverse responses requiring immediate attention
Correct Answer: - A *decrease in systolic blood pressure indicates an inability to maintain cardiac output*. - Exercise intensity should be immediately reduced or exercise stopped, depending upon the patient response. Incorrect Choices: - *Normal responses to exercise include a decrease in diastolic blood pressure, an increase in systolic blood pressure, and an increase in heart rate*
strokes impacting the internal capsule and facial palsy
Correct Answer: - A *stroke that involves the internal capsule would result in a supranuclear palsy*, *which affects only the contralateral lower half of the face*. -The specific pathway that is affected is the *corticobulbar tract, which contains upper motor neurons (UMN) that project from the motor cortex to the nucleus of the facial nerve (cranial nerve VII) in the brainstem*. =*The muscles in the upper half of the face are spared because both the right and left cerebral cortex project to the lower motor neurons (LMNs) in the facial nucleus that the innervate muscles of the forehead*. In contrast, the LMNs that innervate muscles of the lower half of the face receive input from the contralateral motor cortex only. Therefore, a stroke that affects the internal capsule (corticobulbar tract) prevents input from the motor cortex to the contralateral facial nucleus, causing paresis or paralysis of the muscles of the lower half of the face only. Incorrect Choices: - A lesion that affects all muscles on the left side of the face is consistent with an LMN or peripheral nerve lesion, such as idiopathic Bell's palsy or trauma to the left facial nerve. -A complete LMN lesion to the right CN VII would prevent motor commands from reaching all ipsilateral facial muscles, resulting in facial paralysis of those muscles. -A lesion that affects the left internal capsule or corticobulbar tract would affect only muscles on the lower half of the right side of the face
posturing in infants
Correct Answer: - A full-term infant in the NICU can have low Apgar scores, respiratory distress, or any one of a number of specific diagnoses (none listed in this case). *Initial tone and posturing involve some flexion of the limbs*. At 1 month, decreased flexion can be expected.
healthy individual has several risk factors for coronary artery disease. The client is interested in improving overall fitness and cardiac health. After an exercise tolerance test, which was asymptomatic, the client is referred for an exercise class. The MOST accurate measure of exercise intensity to monitor during the FIRST exercise session is:
Correct Answer: - An exercise tolerance test should be performed before commencing an exercise program for all high-risk individuals. The best measurement of exercise intensity in a newly tested and exercising individual is HR. =RPE can be used w/o exercise tolerance test but stem r/o no coronary artery disease. Incorrect Choices: - RPE will become a valuable measurement tool once the patient becomes adept at using it, but it would not be reliable for the first exercise session. - MET level is more of a measurement of workload, not an accurate measurement of an individual's response to exercise. - Respiratory rate is not used to prescribe exercise intensity.
joint mobilization techniques with knee
Correct Answer: - Anatomically, the medial femoral condyle is longer (has more articular surface) than the lateral. therefore, for the tibia to maintain maximum contact during the last 30 degrees (most evident during the last 5 degrees) of knee extension, external rotation of the tibia on the femur occurs in an open-chain movement. -This happens because the shorter lateral tibial plateau/condyle pair completes its rolling and sliding motion before the longer medial articular surface does. The continued anterior motion of the medial tibial condyle results in external rotation of the tibia on the femur
signs and symptoms of CRPS
Correct Answer: - CRPS includes symptoms of pain, vascular changes, and atrophy. -*Early signs* (stage 1) include =hyperalgesia (increased sensitivity to pain), = allodynia (all stimuli are perceived as painful), and =hyperpathia (increased intensity) with edema, increased sweating, and thin, shiny skin. Incorrect Choices: - Later signs and symptoms (stage 2) include increased pain with edema and atrophic skin and nail changes. - Late stage changes (stage 3) include spreading pain, hardening of edema, cool, dry, and cyanotic skin, *developing osteoporosis, and ankylosis*
patient with a 7 -year history of Parkinson's disease is hospitalized. The patient is ambulatory but requires close supervision to prevent falls. What should be the focus of the physical therapist's plan of care?
Correct Answer: - Caregiver training with safety instruction in contact guarding during level walking and stairs is the best choice to keep this patient functional in the home environment. Incorrect Choices: -Manual balance perturbation training will likely result in a rigid response, decreasing use of normal synergistic movements. -This patient should be kept safe and ambulatory for as long as possible and not be relegated to a wheelchair. -A rolling walker is contraindicated for patients with a forward, flexed posture (typical in patients with Parkinson's disease).
electrical stimulation approaches for glenohumeral subluxation
Correct Answer: - Electromyography (EMG) studies confirm that the supraspinatus prevents downward migration of the humeral head. - Shoulder alignment problems also influence subluxation (a downwardly rotated scapula, relative abduction, and internal rotation of the humerus). Incorrect Choices: The *deltoid is not active during this function*
rheumatoid arthritis
Correct Answer: - Extra-articular complications of the disease can include vasculitis. Incorrect Choices: - Disc degeneration is seen in degenerative disc disease. -*Psoriatic skin and nail changes and conjunctivitis and iritis can be seen in psoriatic arthritis*.
patient in the late stages of Parkinson's disease exhibits episodes of akinesia while walking. What should the therapist examine
Correct Answer: - Freezing of gait (episodes of akinesia) is typically associated with a *trigger* (e.g., turning, changing direction or speed, doorways). *Identification of triggers is helpful in developing the plan of care*. Incorrect Choices: -Freezing is most often evident during gait and typically involves the entire body, not individual segments of the body. -Associated dyskinesias may be present but do not typically influence freezing episodes
manual traction techniques
Correct Answer: - Generally it is believed that C1-2 separation would best be treated with a *neutral (0-5 degree) angle*. Incorrect Choices: - A position of 10 to 20 degrees would be appropriate for C3-4, -25 to 30 degrees for C5-7.
patient presents with a stage III pressure ulcer with a moist, necrotic wound. A hydrocolloidal dressing (DuoDERM) is being used. During the dressing change, the therapist detects a strong odor, and the wound drainage has a yellow color. What is therapist's BEST course of action
Correct Answer: - Hydrocolloidal dressings are typically changed every 3 to 5 days or when drainage leaks out. -*Reapply a new DuoDERM dressing and record the findings in the chart* -*An odor and yellowish color is to be expected as the dressing material melts*. Incorrect Choices: -The decision about what type of dressing to apply to a wound is the physician's in collaboration with the wound care team. -This is not an emergency situation
atelectasis and treatment approaches
Correct Answer: - In order to reverse atelectasis, the patient needs a technique to facilitate deep breathing. Incorrect Choices: -Reducing the patient's pain associated with the trauma will allow the patient to take deeper breaths, which will decrease atelectasis. -Segmental breathing will allow for prolonged inspiration with a breath hold. =The long inspiration will facilitate deeper breathing, which can reverse the atelectasis. =A breath hold will allow collateral ventilation via the pores of Kahn, which will result in increased pressures to inflate alveoli and therefore reverse atelectasis. - Incentive spirometry will cause increased deep breathing with visual feedback, which can reverse atelectasis. -Paced breathing controls the rate of breathing, not the depth of breathing, and will therefore be ineffective.
claudication and exercise
Correct Answer: - It has been established that *in order to generate collateral circulation in patients with ischemia (i.e., claudication), patients need to exercise with at least moderate claudication pain*. This level of blood and oxygen deprivation over time initiates the generation of collateral circulation. *This correlates to 2 out of 4 on the claudication scale*. Incorrect Choices: -The ABI is not practical to assess during exercise because the patient cannot be moving during this test. -While the RPE and HR max are at moderate levels, this may not be at an intensity that elicits claudication symptoms
joint mobilization guidelines
Correct Answer: - Joint mobilization generally begins in the loose-pack position but with improvement can progress to more closed-pack positions of the joint. -The loose-pack position of the glenohumeral joint is from 30 to 40 degrees in the scapular plane; *35 degrees of abduction and neutral rotation* Incorrect Choices: The closed-pack position for the glenohumeral joint is full abduction with full external rotation.
indications and guidelines for Kegel exercises
Correct Answer: - Kegel exercises are prescribed to strengthen weak pelvic floor muscles (levator ani) and to improve the motor control of these muscles. -However, *in individuals with interstitial cystitis (IC), the pelvic floor dysfunction is usually related to muscles that are too tense or in spasm in response to pain and chronic inflammation of the bladder*. This is just the opposite of the too-relaxed state that leads to incontinence. -Additionally, there are often tender points or nodules in the pelvic floor muscles of individuals with IC that can be treated with manual techniques. *Therefore the goal of physical therapy in these patients is to relax and lengthen tight pelvic floor muscles, and release trigger points*. Incorrect Choices: - Pelvic floor muscle weakness is a common cause of stress incontinence, and Kegel exercises are often prescribed to effectively treat this disorder. - Similarly, strengthening of the pelvic floor muscles can be very beneficial in women who suffer from a prolapse of the uterus or vagina. -Recent studies have shown that about half of all individuals with chronic constipation suffer from pelvic floor muscle dysfunction, and benefit from Kegel exercises combined with biofeedback to strengthen and coordinate the actions of the pelvic floor and abdominal muscles.
Which activity would help break up obligatory lower extremity synergy patterns in a patient with hemiplegia
Correct Answer: - Kneeling positions with the hip in extension and the knee flexed to 90 degrees, is an out-of-synergy position. -Balance training activities (e.g., reaching, ball throwing) enhance postural control while engaging cognitive control on the added activity (ball throwing). Incorrect Choices: -Marching with hip and knee flexion and hip abduction(hip abduction;pelvic elevation)) -toe tapping in sitting(PF) - foot slides using knee flexors in sitting(PF) all utilize movement in synergy or a synergy-supported position.
OSHA and MSDS guidelines
Correct Answer: - Material Safety Data Sheets-MSDS- are mandated by OSHA of the U.S. Department of Labor. These sheets give employees information about potentially hazardous materials in the workplace and how to protect themselves. -An incident/occurrence report is used to document situations that involve patients or staff that could have resulted in potential long-lasting or permanent harm and are part of an internal quality improvement program. The use of this cleaning agent may have some specific directions in method of application and precautions needed to be observed by the user. The MSDS would make this clear. Incorrect Choices: - Application of first aid in this case seems unnecessary since the symptoms abated very soon. -The aide may have used the cleaning agent inappropriately or not used proper precautions; therefore recommending that Housekeeping cease using it immediately is premature. - Filling out an incident report and having the aide seen by employee health is not a thorough enough response without going over the MSDS to prevent future problems.
What is pain and tenderness with palpation over McBurney's point associated with
Correct Answer: - Pain and tenderness with palpation over McBurney's point are associated with acute appendicitis. - McBurney's point is located half the distance between the anterior superior iliac spine (ASIS) and the umbilicus in the right lower abdominal quadrant. Incorrect Choices: - *A positive Murphy's sign (pain and tenderness over the costovertebral angle) is associated with acute cholecystitis or acute pyelonephritis*. -Hiatal hernia pain is usually sharp and localizes to the lower esophagus/ upper stomach area. -Gastroesophageal reflux disease (GERD) produces persistent burning pain in the esophagus, throat, or chest
cerebellar tumor presents with pronounced ataxia and problems with standing balance and postural stability. To help improve this situation, what would be BEST approach to incorporate in the intervention?
Correct Answer: - Rhythmic stabilization is a proprioceptive neuromuscular facilitation (PNF) technique designed to improve stability. =The high kneeling position is a good choice to begin with for the patient with pronounced ataxia. =The posture is upright; while the center of mass (COM) is lowered, the degrees of freedom are reduced by kneeling (foot and ankle control not required) and the base of support (BOS) is increased over standing. -KC; rhythmic stabilization Incorrect Choices: -Splinting and touch-down support are compensatory interventions not likely to improve recovery. - Perturbed balance activities are contraindicated for the patient with poor postural stability and pronounced ataxia. -Stabilizing reversals in side-lying are also not indicated as the side-lying position does not require upright control
*During early diastole the therapist also hears a low frequency sound of turbulence*. What suspected abnormal sound should the therapist record this as?
Correct Answer: - S 3 is an abnormal third heart sound due to poor ventricular compliance and turbulence. It is heard as a low frequency sound during *early diastole*. Incorrect Choices: -S 4 is an abnormal fourth heart sound due to exaggerated atrial contraction and subsequent turbulence. It is heard as a low-frequency sound in *late diastole*. -Heart murmurs are heard as a *swishing sound* in systole, diastole, or both systole and diastole. -Pericardial rub is heard as a leathery sound during systole
patient with a long history of cigarette smoking has been admitted to the hospital and presents with tachycardia, signs of lung infection, abnormal breath sounds in both lower lobes, and dullness to percussion. What should the therapist's initial intervention focus on with this patient
Correct Answer: - The patient has signs and symptoms consistent with pneumonia. -It is most important to assist with secretions clearance to assist with recovery from the infection and to improve gas exchange. Incorrect Choices: -Quitting smoking is an appropriate goal for this patient but would be best timed after the acute period has passed. - Patients with a history of chronic obstructive pulmonary disease (COPD), which is presumed in this case due to the long history of tobacco use, do benefit from inspiratory muscle training (IMT). However, this is best timed after the acute infection has resolved.
diagnostic approaches for JRA- juvenile rheumatoid arthritis-
Correct Answer: -The following are common symptoms of JRA: swollen, stiff, painful joints usually worse in the morning; fatigue; fever; swollen lymph nodes; and poor weight gain/slow growth. -Additionally, the physical therapist was unable to identify specific impairments that would be potentially contributing to the patient's complaints, *warranting referral to physician for additional testing*.
stress fractures
Correct Answer: - Symptoms of a stress fracture may include pain and swelling, particularly with weight bearing on the injured bone. -Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. -The differential diagnosis varies based on location but commonly includes = tendinopathy, =compartment syndrome, and =nerve or artery entrapment syndrome. Incorrect Choices: -Bone tumor is a possibility but not the most characteristic in this scenario. Pain may be increased at night. In this case there was pain at night but not increased. Activity may also increase the amount of pain. There may also be swelling with a bone tumor. Imaging is required. -Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Compartment syndrome can be either acute or chronic. =Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. There may be pain, decreased pulses, paresthesias, pallor, and paralysis. =Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion. However, the patient usually complains of a bursting type of pressure and pain, -Shin splints (medial tibial stress syndrome) is a common condition that can be distinguished from tibial stress fractures by nonfocal tenderness (diffuse along the mid-distal, posteromedial tibia) and a lack of edema.
flatfoot deformity
Correct Answer: - The *posterior tibial tendon helps hold up the arch up* and provides support when stepping off on the toes when walking. -If this tendon becomes inflamed, overstretched, or torn, one may experience pain on the inner ankle and gradually lose the inner arch on the bottom of the foot, leading to flatfoot (posterior tibial tendon dysfunction (PTTD)
Ober test
Correct Answer: - The Ober test is for tightness of the tensor fascia latae and iliotibial band. - With the pelvis stabilized and the hip kept in neutral rotation, the *Ober test would be considered normal if the thigh drops slightly below horizontal*.
patient post-traumatic brain injury (Rancho Los Amigos Levels of Cognitive Functioning Scale level III) has evidence of retained secretions on auscultation and chest films. What is the BEST mode of airway clearance for this patient?
Correct Answer: - The Vest Airway Clearance System provides high-frequency chest wall compression (HFCWC). It allows for control of inspiratory and expiratory flow rates. The device can be used in any position regardless of the patient's cognitive status. Incorrect Choices: -The first two choices-Active cycle of breathing and Autogenic drainage- require a patient to consistently follow commands and potentially complete the activity alone, which would be difficult for a patient in this cognitive stage of recovery. -Oscillatory positive expiratory pressure (PEP) using a FLUITER device requires a patient to breathe through a mouthpiece with inspiration unimpeded and long exhalation against a back pressure, also impossible for this patient.
patient with diabetic peripheral neuropathy and retinopathy is having difficulty with balance when ambulating at home. The patient has fallen three times in the last month. What is the first priority of the home physical therapist's plan of care?
Correct Answer: - The first priority of the home physical therapist should be gait training with a cane to ensure safety. -This compensatory strategy is necessary as this patient is demonstrating complications of diabetes, which are chronic and progressive of peripheral neuropathy. Incorrect Choices: -Color-coding steps and installing nightlights may also be necessary compensatory strategies to modify the home environment. However, they are not the first priority.
auscultation guidelines with pneumothorax
Correct Answer: - The fractured ribs will cause the patient to have pain and therefore not take deep breaths. More importantly, *the pneumothorax will cause an increasing positive pressure on the lung, not allowing it to inflate*. *The result will be minimal air movement and decreased or absent breath sounds*. Incorrect Choices: -Soft, rustling sounds are normal, vesicular breath sounds. These would not be present with these injuries. -Crackles would indicate atelectasis or secretions, but it would not be possible to hear these sounds with these injuries because there is minimal air movement. Likewise, wheezes wouldn't be possible to hear
gait abnormalities associated with muscle weakness
Correct Answer: - The hamstring muscles primarily control the forward swing of the leg during terminal swing. Loss of function-weakness of hamstring- may result in abrupt knee extension and increased hip flexion. Incorrect Choices: -Excessive compensatory hip extension on the sound side would help in pulling the weak side into flexion due to weak hip flexors. -Decreased hip flexion followed by increased knee flexion on the weak side would be the result of weak hip flexors and knee extensors during terminal swing. There would be abrupt knee extension as the hamstrings need to decelerate the tibia at terminal swing
loose-packed positions of the upper extremity
Correct Answer: - The loose-packed position of the humeroulnar joint is 70 degrees of flexion. -The loose-packed position for the radiohumeral joint is 70 degrees of flexion, 35 degrees of supination. -The loose-packed position is basically the resting position where the joint capsule and ligaments are most relaxed. Incorrect Choices: -Full extension is the close-packed position for the elbow. -The close-packed position is where the surfaces are maximally congruent to one another and capsule and ligaments are taut.
manual techniques for the ankle
Correct Answer: - The non-weight-bearing subtalar joint motion is described strictly by calcaneal movement. = Pronation consists of calcaneal eversion, calcaneal dorsiflexion, and calcaneal abduction (medial tilt), =whereas supination involves calcaneal inversion, calcaneal plantar flexion, and calcaneal adduction (lateral tilt). =concace talus and convex calcaneus Incorrect Choices: - Medial glide would improve eversion. - Anterior to posterior talocrural joint mobilizations appear to increase ankle dorsiflexion ROM, -while posterior to anterior would increase PF.
Berg Balance Test
Correct Answer: -The Berg Balance Test (BBT) is a test of static and dynamic balance in sitting and standing. -*It includes* 1. Sit-to-stand transitions. 2. Functional reach in standing. 3. Tandem standing. incorrect choice *Turning while walking is an item on both the Tinetti Performance-Oriented Mobility Assessment and the Dynamic Gait Index*.
coughing techniques for spinal cord injury
Correct Answer: - The patient will need an external force to facilitate a cough and to clear secretions with C5 =coughing need rectus abs force. =C5 has no hand motor function Incorrect Choices: - A phrenic nerve stimulator will facilitate diaphragm contraction. However, *the diaphragm does not participate in a cough*. - Glossopharyngeal breathing technique forces air into the lungs but doesn't assist with coughing or forcing air out. The patient doesn't have the motor function at this spinal cord level to manually assist himself or herself. -It is possible for the patient to use an arm of a chair or some other external pressure in order to be independent with C5 .
Thomas test
Correct Answer: - The posterior thigh does not touch the table, and the knee can be flexed as many degrees beyond 80 degrees as the hip is flexed. - *The Thomas test is utilized to test for hip flexor length and to distinguish between one joint and two joint hip flexor tightness*. With low back and sacrum flat on the table, a normal one joint hip flexor length would be with thigh flat on the table. *Normal two joint hip flexor length would be 80 degrees of knee flexion*
elderly female patient is being evaluated for recurrent thoracic back pain. During the history, the patient reveals a smoking habit, and she drinks four to six cups of coffee a day. Activity level is low, consisting of daily trips to the local coffee shop to socialize with friends. Body weight and height are below normal. Medical history includes Graves' disease. The therapist decides to consult the primary physician for further workup. What is the suspected problem
Correct Answer: - This patient is exhibiting several risk factors for osteoporosis: postmenopausal age, low body weight, loss of height, sedentary lifestyle, tobacco use, and hyperthyroidism (Graves' disease). -Signs and symptoms include =severe and localized thoracic-lumbar pain, =increased pain with prolonged upright posture, =decreased pain in hook-lying, = loss of height, and *kyphosis* (dowager's hump). -Grave's diseas and osteoporosis excessive quantities of thyroid hormone either due to over-production from the thyroid gland or due to excessive intake in the treatment of hypothyroidism can also accelerate bone loss resulting in a decrease of bone density. This in turn may lead to increased fracture risk. - Her pain is most likely due to compression fractures, which can be confirmed on x-ray. Osteoporosis can be confirmed with a bone density scan. Incorrect Choices: - Osteoarthritis produces asymmetrical pain with typical involvement of large weight-bearing joints. -Gout pain is limited to only a few joints, typically affecting the first metatarsal, the knee, or the wrist. -Spinal stenosis typically occurs in the lumbar spine and is accompanied by pain when standing and walking, extending into the buttocks and proximal thigh, nocturnal pain, and lower motor neuron (LMN) signs
wheelchair prescription guidelines for patient with obesity
Correct Answer: - This patient is obese. A bariatric wheelchair with heavy-duty, extra-wide wheels is necessary. -The *rear axle is displaced forward compared to the standard wheelchair to allow for more efficient arm push*. Incorrect Choices: -Moving the front casters closer to the drive wheels would decrease stability (not increase). -Friction rims and anti tipping devices are adjustments that may be necessary for the patient with a spinal cord injury.
stretching techniques for spinal cord injury
Correct Answer: -*Hamstrings need to be fully ranged to 110 degrees in the supine position*->best illustrates selective stretching-hamstring- when working with a patient with a spinal cord injury (C6 complete) This allows for function in the long-sitting position (e.g., dressing, leg management during transfers). Incorrect Choices: -Ranging the hamstrings or low back extensors in long sitting will result in overstretched low back extensors (needed for stability in sitting).
the use of continuous ultrasound
Correct Answer: -Continuous ultrasound (US) is used for its thermal effects, and *the higher the intensity, the greater the probability of causing a tissue temperature rise that would result in an increased metabolic rate in the area applied*. Incorrect Choices: - US has no effect on muscle hypertrophy. -Thermal US would decrease, not increase the stiffness of collagen tissue. -Heat is contraindicated for acute inflammation. *Thermal US would exacerbate the symptoms associated with acute inflammation*.
dysmetria with MS
Correct Answer: -Dysmetria is a coordination problem in which the patient is unable to judge the distance or range of movement (overshoots or undershoots a target). -Adding manual resistance with PNF-dynamic reversal- can assist the patient in slowing down the movement and achieving better control. Incorrect Choices: - The patient lacks speed control. Low-resistance, fast-speed isokinetic training is contraindicated. - The resistance of water (pool therapy) could help control the speed of movements, but the temperature is too warm (patients with MS demonstrate heat intolerance). - Weight cuffs could also help slow the movements down, but would unnecessarily fatigue the patient (patients with MS demonstrate problems with excessive fatigue).
patient with type 1 diabetes mellitus has generalized osteoporosis. What is the BEST exercise to include in this patient's plan of care?
Correct Answer: -Extensor stabilization exercises in weight-bearing postures provide the best stimulus to bone (e.g., standing, holding against resistance, *standing partial squats*). Incorrect Choices: -High-load, short-duration activities (jumping, running, weights) provide less stimulus to bone while posing increased risk of muscle strain and injury. -The buoyancy of water limits the load on bone during aquatic exercises
patient presents with insidious onset of low back pain that started 10 days ago. Examination reveals an Oswestry Disability Index score of 40%, a Fear Avoidance Belief Questionnaire for Physical Activity score of 16, hypomobility at L4-5 with posteroanterior (PA) glide, and pain that radiates into the right buttock. Lumbar active range of motion (AROM) is painful at 50% of expected range in all directions. Hip passive range of motion (PROM) is within normal limits. Abdominal strength is fair. Based on this data, what is the BEST intervention for this patient?
Correct Answer: -If a patient presents with four out of five criteria listed in the examination findings, the patient has a 95% chance of benefiting from *manipulation using the lumbopelvic regional thrust manipulation technique*. =KC; intervention approaches for low back pain Incorrect Choices: -Abdominal stabilization is a good secondary intervention. Since the patient does not fit the clinical practice rules for abdominal stabilization, it should not be the first choice for intervention. -Positional distraction would be appropriate for radicular pain; however, that is not the case here.
lateral pterygoid and suprahyoid muscles.
Correct Answer: -The muscles involved in opening include =the lateral pterygoid, =digastric muscle, and =suprahyoid muscles. Incorrect Choices: - The muscles that assist with mouth closing are =the masseter, = temporalis, =medial pterygoid, and = lateral pterygoid. -The muscles that assist with protrusion are =the temporalis, =medial pterygoid, and = lateral pterygoid. -The muscles that assist with retrusion are =the temporalis and =suprahyoid muscles
cervical spinal cord injury-C5- effects on respiration
Correct Answer: *Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera* -The abdominal musculature provides external stability to the abdominal viscera. Without this, the viscera displaced with respiration. -condition is brought about by loss of muscular tone, particularly of the abdominal muscles, *with relaxation of the ligaments which hold the viscera in place* Incorrect Choices: -With an ASIA A injury, the muscle weakness would be symmetric. -The diaphragm is innervated by C3-5 nerve roots, so it will be functioning in this patient. -Muscle weakness will cause a restrictive disorder (inability to generate negative pressure), not an obstructive disorder (air trapping).
What is the primary reason a patient with advanced chronic obstructive pulmonary disease (COPD) has improved/increased aerobic capacity with bilateral upper extremity support during activity training
Correct Answer: It facilitates reverse action latissimus dorsi function to maximize ventilation =*Stabilizing the upper extremities allows the latissimus dorsi to function such that it lifts the rib cage*, *thereby increasing negative pressure within the thorax and improving ventilation*. =Lats as accessory inspiration muscle =Lats flex shoulder thus lifting rib cage for better ventiltion.
adverse postoperative effects, especially in older adults
Correct Answer: Patient fails to recognize the therapist on the third consecutive postoperative visit warrants contact with physician. - *Postoperative delirium is characterized by incoherent thought and speech, disorientation, impaired memory, and attention*. -Elderly patients usually manifest delirium following a lucid interval of 1 postoperative day or more, a condition known as interval delirium. -Symptoms are often worse at night. Alternatively, the condition can be silent and unnoticed, or misdiagnosed as depression. However, the effects of elderly postoperative delirium are evident in increased morbidity, delayed functional recovery, and prolonged hospital stay. Fortunately, the postoperative cognitive dysfunction is a reversible condition in the majority of elderly surgical patients. -Preoperative risk factors of bilateral total knee arthroplasty are associated with a significantly higher incidence of acute delirium than unilateral total knee arthroplasty in patients over 80 years. -Failing to recognize the therapist after three visits is an indication of a declining mental condition. This would definitely be a safety consideration *as the patient may not be able to follow all the precautions and may also put himself or herself in danger by walking without an ambulatory aid, etc*. Wound infection is also a consideration. Contacting the surgeon is necessary.
boutonniere deformity characteristics
Correct Answer: Rupture with volar slippage of the lateral bands - *Finger position marked by extension of the metacarpophalangeal ( MCP) and distal interphalangeal (DIP) joints with flexion of the proximal interphalangeal (PIP) joints*. -Through injury or disease the central extensor tendon (extensor digitorum communis [EDC]) of the involved finger ruptures. The tendon then displaces palmarly relative to the PIP joint (volar slippage). The lateral bands become tight and are attached to the distal phalanx, extending it. The flexor digitorum profundus (FOP) is now unopposed, and it pulls the PIP joint into flexion. The result is a deformity that looks like a "buttonhole" or boutonniere in French. Incorrect Choices: -The DIP joint will be in extension (not flexion) since the terminal tendon is intact. -Contracture of the EDC tendon will not happen because the EDC becomes the central slip and the lateral bands. - The lateral bands are still intact with a boutonniere deformity, and they come together to form the terminal tendon that is also intact. -Hyperextension of the PIP is the opposite deformity of the boutonniere. The torn central slip can no longer extend the PIP joint and is therefore stuck in flexion
What is the primary reason this garment decreases edema?
It exceeds the internal tissue hydrostatic pressure. =The external pressure caused by the compression garment essentially increases the amount of pressure on the tissue. *This causes a relative increase in the hydrostatic pressure in the extravascular space compared with the intravascular space*.
obesity guidelines
Obesity is associated with -hypertension, -dyslipidemia, -*hypoinsulinemia (type 2 diabetes)*? -hyperglycemia.
platform(loftstrand) crutches
Platform crutches allow weight bearing on the forearms and are used for patients *who are unable to bear weight through their hands*
gait training guidelines with transtibial prosthetics
Pressure-tolerant areas of the typical transtibial residual limb include =the patellar tendon, =the medial tibial plateau, =the tibial and fibular shafts =the distal end
limb amputation
Residual limb healing is most important to prevent infections and possible revision surgery or further amputation.
normal platelet counts and contraindications for resistive exercise in patients with cancer
Resistive exercise is contraindicated in patients with =significant bony metastases, =osteoporosis, or =*low platelet count ( < 20,000)*.
BEST intervention if the patient has a classic TMJ unilateral capsular restriction?
Right TMJ, inferior glide. - In the photo, the chin has deviated to the right at terminal opening. - The active range of motion (AROM) will be limited with ipsilateral opening and a lateral deviation to the side of restriction for patients with a TMJ capsular pattern of restriction
PNF approaches and intervention approaches for PD
Sitting, bilateral symmetrical UE PNF D2 flexion patterns using rhythmic initiation =The sitting posture is a good starting position for a patient with postural instability since the base of support (BOS) is wide and the center of mass (COM) is lowered compared to standing Incorrect Choices: -Progression can occur from sitting to standing postures, but beginning in standing is not a good choice. -*Supine, UE PNF lift, and reverse lift patterns using rhythmic initiation can be used to improve rolling in patients with PD*.
intervention approaches for PPS-post polio syndrome-
Therapeutic aquatics, 3 days/week for 20 minutes
corticobulbar tract
Voluntary motor command from motor cortex to head and neck
Vest Airway Clearance System
can assist in airway clearance for patients suffering from airway clearance dysfunction, secretion retention and/or ineffective cough or secretion clearance due to immobility, deconditioning or muscle weakness.
posterior rollator walker with four wheels
child with spastic diplegia
discoid lupus erythem
chronic disorder, primarily of the skin, characterized by lesions that are covered with scales; wolflike appearence in some patients
holding on
clinging
Sideward protective extension in sitting
for sitting training for infants at 6 months
Anterior glide of shoulder
help increase external rotation (ER), *which is a component of full elevation*
arthralgia
joint pain
pelvic floor muscles
levator ani and coccygeus
Bilateral quadriceps presses against resistance in sitting
not useful for osteoporosis.
vertebral artery test
performed by passively moving the head and neck into extension and side flexion, then rotation to the same side and holding for 30 seconds ->positive sign;Dizziness or nystagmus occurs, indicating that the *opposite side* artery is being compressed
positive ober test
positive response
rectocele
protrusion of the rectum
Ranging the hamstrings or low back extensors in long sitting
ranging hamstring in long sitting
suprahyoid muscles
the group of muscles responsible for opening the jaw
Pneumothorax
the presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.
Common signs and symptoms of scoliosis
• Uneven shoulder heights • Head not centered with the rest of the body • Uneven hip heights or positions • Uneven shoulder blade heights or positions • Prominent shoulder blade • When standing straight, uneven arm lengths • When bending forward, asymmetrical left and right sides of the back -A right thoracic scoliosis would result in a *rib hump, which is an indicator of a rib cage deformity due to the rotation of the vertebrae*. This happens because of coupled motion in the spine. =Rotation rules: *lumbar and thoracic spine rotation and side bending occur to the opposite side*. Incorrect Choices: -With a left scoliosis, one would expect a high left shoulder, a prominent left scapula, and a right hip that protrudes.
