Random Pre-Test-Day Information
How does juvenile rheumatoid arthritis (JRA) present (6)?
*"Fever in the joints"* 1. swollen, rubor, warmth - *lasts 6 weeks* 2. limping 3. fever 4. rash (trunk and extremities) that comes and goes with fever 5. stiffness, pain, and limited ROM 6. Pain is worst in the morning - do not schedule PT early in morning JRA = GENtle stretching
ACE Inhibitors (3)
*A*-pril, *C*ough, *E*dema 1. vascular smooth muscle relaxation but not heart 2. decrease blood volume - *dumping sodium and water that follows* 3. side effects: *OH, dizziness, bad nocturnal coughing, edema, hyperkalemia*
Sally is evaluating a child with APGAR screening test that demonstrates: 1. arms and legs flexed 2. HR: 80 bpm 3. some flexion of extremities 4. blue, pale skin color 5. slow, irregular breathing
+1 +1 +1 0 +1 = 4; moderately depressed, requires immediate care
A physical therapist reads in the medical record that a patient with suspected cardiovascular disease had a positive graded exercise test. Which piece of data would have been the MOST influential when concluding that the test was positive? 1. anginal symptoms 2. ventricular dysrhythmias 3. ST segment changes 4. supraventricular dysrhythmias
3. ST segment changes
A patient diagnosed with Meniere's disease presents with vertigo. Which sign or symptom is inconsistent with this medical condition? 1. hearing loss 2. tinnitus 3. vertigo lasting 30 minutes 4. head tilt to one side
4. head tilt to one side Meniere's disease is one of the possible causes of vertigo. Head tilt is more a sign of unilateral vestibular hypofunction
Calcium Channel Blockers (3)
A Very Nice Drug -ipine or -amil 1. *peripheral/coronary vasodilation and slows AV node signal by decreasing action potential* 2. decrease afterload and vasospasms 3. side effects: *peripheral edema, OH, dizziness, tachycardia, AV block, increases CHF (R sided)*
Beta Blockers (4)
-olol 1. decrease HR, BP, contractility, mVO₂ 2. side effects: *bronchoconstriction, weakens heart muscle, masks symptoms of hyperglycemia* 3. *contraindicated for pulmonary and CHF patients* 4. blunts physiological effects of exercise
When using EMG biofeedback to relax/decrease muscle activity in the beginning of therapy, what is the appropriate electrode placement? When used later in the plan of care, how should the electrodes be placed?
Begin with the electrodes closely spaced and bio feedback instrument sensitivity low to minimize cross-talk. Instructed patient to relax with deep breathing or visual imagery. Progress from low to high sensitivity as the patient gains the ability to relax the muscle and perform functional activities.
Berg Balance Scale - Outcome Measures
Best predictor for fall risks 0-4 for 14 tasks, >45/56 is normal 0-20 = high fall risk, 21-40 = med fall risk, 41-56 = low fall risk
Gait Speed (10 meter walk test) - Outcome Measures
Best predictor of functional decline and disability, <0.6m/s = risk for recurrent fall, <1.0m/s = well functioning with risk of health related outcomes, >1.2 m/s is normal
What are the key muscles of C5 SCI?
Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboids, and supinator
What are the causes of hyperkalemia (5)?
Body CARED too much for potassium 1. Cellular movement of potassium from intracellular to extracellular 2. Adrenal insufficiency 3. Renal failure 4. Excessive potassium intake 5. Drugs (potassium sparing, ACE inhibitors, NSAIDs)
What are the causes of hypokalemia (5)?
Body is trying to DITCH potassium 1. Drugs (laxatives, diuretics, corticosteroids) 2. Inadequate intake (anorexia) 3. Too much water 4. Cushing's syndrome 5. Heavy fluid loss (NG suctioning, vomiting, diarrhea)
In a laboratory blood analysis, an elevated level of alkaline phosphatase is found. What could this mean?
Bone or liver disease. Increases in alkaline phosphatase levels with local edema, heat, and erythema are indicative of heterotopic ossification (*ectopic bone formation*)
A 55-year-old patient, six months status post CVA with right hemiparesis, attends physical therapy on an outpatient basis. As the patient lies supine on the mat, the physical therapist applies resistance to right elbow flexion. The therapist notes mass flexion of the right lower extremity as the resistance is applied. The therapist should document this as: 1. Raimiste's phenomenon 2. Souques' phenomenon 3. coordination synkinesis 4. homolateral synkinesis
4. homolateral synkinesis
*Below what hematocrit level should a patient NOT exercise?*
< 25% > 25% light exercise as tolerated > 30% add resistance
What HDL level is at risk for metabolic syndrome?
< 40 mg/dL for men < 50 mg/dL for women
When is exercise contraindicated according to WBC count?
< 5,000 cells/mm3 with fever
What is fasting glucose level for hypoglycemia?
< 50-60 mg/dL
What is ideal level for A1C?
< 7%, above 10% requires insulin therapy
*What blood glucose level is a red flag for exercise?*
< 70 mg/dL or > 250 mg/dL
*What hemoglobin levels should a patient NOT exercise?*
< 8 g/dL; document and discuss with MD
What are the signs and symptoms of hypocalcemia (5) ?
CRAMPS - hyperexcitability of membrane potential 1. Confusion 2. Reflexes hyperactive 3. Arrhythmias (prolonged QT interval, prolonged ST interval) 4. Muscle spasms in LE 5. Positive Trousseau's 6. Sign of Chvostek's
What is scleroderma (progressive systemic sclerosis, PSS)?
CREST Syndrome usually accompanied by Raynaud's phenomenon. Polyarthralgia with flexion contractures; symmetrical skin involvement of distal extremities
Medications that end with -ipine and -amil are what kind of drugs?
Calcium channel blockers
Static Standing Balance Tests (4)
1. Romberg - feet together, EO and EC, 30 sec 2. Sharpened Romberg, EO and EC, 30 sec 3. SLS - < 10 sec, fall risk 4. Functional Reach Test - > 10" is normal, < 6" is limited functional balance
Who is indicated for a reciprocating gait orthosis (RGO) (2)?
1. SCI patients with T9-T12 level 2. spina bifida lesion, usually with children
What fasting blood glucose level is at risk for metabolic syndrome?
> 100 mg/dL
What is fasting glucose level indicating diabetes?
> 126 mg/dL on 2 separate days
What systolic blood pressure is at risk for metabolic syndrome?
> 135 mmHg and/or DBP > 85 mmHg
What triglyceride level is at risk for metabolic syndrome?
> 150 mg/dL or on medication
What is fasting glucose level for hyperglycemia?
> 180 mg/dL
*What value for international normalized ratio (INR) is exercise contraindicated?*
> 4.0 > 3.0 is risk for hemarthrosis
What waist circumference is at risk for metabolic syndrome?
> 40 inches for men > 35 inches for women
What BMI is morbidly obese?
> 40 kg/m2
What is normal HDL levels?
> 40 mg/dL, higher the better
Diagnosis that fall under COPD include....(5)
A - Asthma B - Bronchitis C - Cystic fibrosis D - bronchopulmonary Dysplasia E - Emphysema
What are the signs and symptoms of disc disruption?
1. deep, achy pain 2. increased pain with movement
What are clinical manifestations of RV failure?
1. dependent edema 2. weight gain 3. ascites 4. liver engorement 5. cyanosis 6. jugular vein distention 7. right-sided S3 heart sounds
A physical therapist attends an inservice entitled "Principles of Exercise for the Obstetric Patient." During the session, the speaker identifies several conditions that are considered to result in high risk pregnancies. Which of the following conditions would NOT be considered high risk? 1. diastasis recti 2. incompetent cervix 3. pre-eclampsia 4. multiple gestation
1. diastasis recti not high risk for pregnancy, can lead to lower back pain secondary to weak abdominal muscles other choices are high-risk multiple gestation - > 60% of twin and higher births are premature
What are cerebellar signs (7)?
1. dysarthria 2. dysmetria 3. dysdiadochokinesia 4. rebound phenomenon 5. ataxia/poor balance 6. intention tremor 7. nystagmus 3D RAIN
What diagnostic test can be used to determine lymphedema (4)?
1. ultrasound 2. doppler ultrasound - exclude venous disorders (e.g., DVT), better for circulatory blockages 3. lymphoscintigraphy (BEST) - lymphatic insufficiency, at rest and with exercise - trace radioactive dye 4. CT/MRI - evaluates skin thickening and traditional honeycomb pattern in soft tissue
What will ECG show on PVC (2)?
1. wide QRS wave 2. no P waves
What dimensions are necessary for a WC accessible environment (5)?
1. width: 24-26 inches from rim to rim 2. length: 42-43 inches 3. *minimum clear width for doorways and halls = 32 inches* 4. *90° turning space = minimum of 36 inches* 5. *180° turning space = 60 inches*
What conditions may occur more frequently after menopause (7)?
1. worsening fibromyalgia 2. CTS 3. Colle's fracture 4. impingement syndromes 5. adhesive capsulitis 6. osteoporosis 7. CHF and CVA
1. stands via bear stance or squat 2. upright knee walks 3. walks with high guard 4. creeps up stairs 5. propels walking toy 6. ball is pushed rather than thrown
12-14 Months (6)
1. assumes standing using rotation from sitting 2. manipulates objects in standing (drinking) 3. picks up objects off floor without falling 4. walks with low guard 5. walks backwards, sideways, and carries objects 6. runs stiffly 7. steps over obstacles
15-18 Months
What is normal platelet count?
150,000 - 450,000 cells/dL
rule of nines - anterior and posterior torso
18 and 18%
What is normal BMI?
18.5-24.9 kg/m2
1. BOS narrows 2. heel strike, toe off 3. runs without falling - headlong 4. advances on riding toys without pedaling 5. kicks a ball 6. overhand ball throw 7. stairs - ascends/descends with rail, step to 8. imitates jump 9. climbs forward on adult chair, then sits
19-23 Months
Dynamic Gait Index (DGI) - Outcome Measures
19/24 or < is fall risk
What is the duty cycle for muscle strengthening Russian electrical stimulation?
1:5 with a 1-5 second ramp up on time should always be less than off time
What resting ECG change is a contraindication for exercise?
2 mm ST depression contraindication is for resting ECG
At what age can an infant lift their head 45° in prone?
2 months
At what age does a child go up stairs foot-over-foot (reciprocal stair climbing)?
2 years
When does a child run well, go up stairs reciprocally?
2 years
When is the Landau reflex integrated?
2 years
how long does a grade II sprain take to heal
2-3 weeks
Catching a large ball, riding a tricycle, and running short distances are skills that are appropriate for children age __________?
2-3 years
What degree of cervical flexion should be used to target the lower cervical vertebrae? (C5-C7) Upper cervical vertebrae? (C1-C5)
20-30° of flexion 0-5° of flexion
What Cobb angle in a child with scoliosis would an orthotic intervention be indicated and until what age?
20-40° Age 10, older than that, candidate for surgery. Stretching programs not found to halt or improve scoliosis
What lumbar traction force is recommended to elicit soft tissue stretching and muscle relaxation?
25% of body weight
What BMI is overweight?
25-29.9 kg/m2
What are the MHz parameters for US penetration to target superficial tissues? And to target deep tissues?
3 MHz: 0.5-1 W/cm2 1 MHz: 1.5-2.0 W/cm2
1. jumps off step with two feet 2. stairs without railing - ascends reciprocal, descends step to 3. single hop on one foot 4. tandem walking 10 feet (1-3x off) 5. throw 8 inch ball and catch it when bounced 6. rides tricycle 7. reciprocal UE/LE pattern 8. somersault with aid 9. kicks ball 10. gallops
3 Years
When can an infant elevate their head to 90°?
3 months
At what age does a child jump with two feet?
3 years
When does a child go down stairs reciprocally?
3 years
When does a child ride a trike, catch a ball, jump with 2 feet?
3 years
At what age does a child run fast and avoid obstacles?
3-4 years old
A physical therapist uses metabolic equivalents (METs) as a method to establish exercise intensity for a 36-year-old female. The patient is recreationally active and has no relevant past medical history. Which MET level would be MOST consistent with the patient's anticipated maximal aerobic capacity? 1. 3 METs 2. 6 METs 3. 10 METs 4. 15 METs
3. 10 METs 15 METs is max capacity for highly trained athletes
What do patients with dyspraxia have difficulty with (4)?
Developmental co-ordination disorder (DCD) 1. Fine motor skills 2. Gross motor skills 3. Motor planning 4. *Coordination* Trouble with movement
What is the moral duty to keep commitments that have been promised?
Fidelity
What kind of walker encourages forward trunk leaning and provides maximum anterior stability?
Forward walker or anterior rollator walker
What is a Monteggia fracture?
Fracture of the proximal third of the ulna with radial dislocation
Sound head size for US?
Ideal: 2 x ERA = tx area (5 minutes) Max: 4 x ERA = tx area
What is the clinical prediction criteria for a lumbopelvic manipulation?
If patient meets 4 out of 5, they are eligible for manipulation
Patient presents with knee recurvatum in stance and toe drag during swing phase of gait. What ankle/foot orthoses should be prescribed?
PF or posterior stop - incorporated into stirrup to limit PF
What are the signs and symptoms of Myasthenia Gravis (5)?
PPDD 1. ptosis 2. proximal greater than distal limb weakness 3. dysphagia 4. diplopia 5. fatigue
What is a premature beat arising from the ventricle? What would be missing in the ECG?
PVC, wide QRS wave, no P waves
What is a disease characterized by excessive bone reabsoption and formation in a haphazard fashion producing bone that is larger, less compact, more vascular, and more susceptible to fractures?
Paget's disease
What patient is indicated for a resting splint (cock-up splint) (5)?
Patients with: 1. RA 2. fractures of carpal bones 3. Colles' fracture 4. CTS 5. CVA with paralysis
What is indicated by an R wave that is close to the preceding R wave?
Premature Atrial Complex
What are signs and symptoms of Guilliain-Barre Syndrome (5)?
Rapid Onset 1) LMN disease affecting cranial and peripheral nerves with predominate feature of acute weakness 2) some sensory loss (stoking/glove) and paresthesias (tingling, burning) 3) *dysarthria, dysphagia, diplopia* 4) slow recovery (up to a year), mild weakness persisting and 3% mortality rate 5) *symmetrical muscle weakness progresses LE to UE and from distal to proximal*
What is the polarity of salicylate? What is its indication for iontophoresis?
Salicylate is used for pain relief/analgesia acetyl*salicylic* acid (aspirin for pain relief)
What does a sudden exacerbation of symptoms after eating indicate?
gallbladder inflammation
What treatment for adhesive capsulitis is considered the best choice of PT intervention for the disorder according to the evidence?
Stretching exercises - moderate evidence but stronger than modalities (diathermy, ultrasound) and/or joint mobilizations
When you hear a reciprocal click of the TMJ
TMJ disc displacement with reduction
What is the cranio-cervical flexion test?
Testing: deep cervical flexor muscles, the longus capitis, and colli (+) unable to perform or compensatory patterns 1. Pressure feedback unit placed under the C/S with patient supine and inflated to 20 mmHg. 2. Ask patient to chin tuck and hold for 10 seconds, pressure should increase to 22 mmHg 3. Patient relaxes and repeats increasing pressure to 24 mmHg for 10 seconds 4. Patient will repeat until reaches 30 mmHg
Crossed Straight Leg Raise
Testing: herniated nucleus pulposis or neutral tension/radiculopathy (+) reproduction of low back pain during the SLR of the uninvolved LE Patient supine with head, neck, and torso in neutral, maintain knee extension and neutral DF and lift the leg to the point of symptom provocation Perform on the contralateral, uninvolved LE
What is a cohort study?
a prospective (forward in time) study; group of participants (cohort) with a similar condition is followed for a defined period of time
What is a case-control study?
a retrospective (backward in time) study; group of individuals with a similar condition is compared with a group that does not have the condition to determine factors that may have played a factor
What is the purpose of an arterial line?
a thin tube typically inserted into the radial or brachial arteries or the femoral, posterior tibial or dorsal pedal artery for the lower extremities 1. measures arterial pressure in real time 2. Obtain samples for arterial blood gas analysis
How does Legg-Calve Perthes disease usually present and in what population?
affecting mostly boys 5-10 years old unilaterally Walks with a limp; hip ABD weakness
What is the zone of injury and how can it be detected on an ECG?
area immediately adjacent to central zone; *elevated ST segments*
What is Anterior interosseous syndrome and how does it present?
condition in which damage to the anterior interosseous nerve (AIN), a motor branch of the *median nerve*, causes pain in the forearm and a characteristic weakness of the pincer movement of the thumb and index finger; flexor digitorum profundus and flexor pollicis longus
What is the zone of infarction and how can it be detected on an ECG (3)?
consists of necrotic, non-contractile tissue; *deep Q waves, electrically inert* *ST elevation* *small R wave progression* compared to zone of ischemia
During auscultation of the lungs, ronchi (wheezes) are heard. What are the possible pathologies (2)?
constriction in the airways from either bronchospasm or consolidation (inflammatory in nature) 1. asthma 2. COPD "Ronchi in the bronchi" continuous
Describe the mobilization glide to increase distal radioulnar supination
dorsal/posterior glide
Describe the mobilization glide to increase mid carpal wrist flexion
dorsal/posterior glide
Describe the mobilization glide to increase proximal radioulnar pronation
dorsal/posterior glide
Describe the mobilization glide to increase radiocarpal wrist flexion
dorsal/posterior glide
What type of e-stim is used most often for wound healing?
high-volt pulsed current (HVPC)
How does dynamic arm exercises differ from LE exercises (4)?
higher HR higher SBP/DBP higher cardiac output higher rate pressure product (myocardial workload) (RPP = SBP x HR)
Fullerton Advanced Balance (FAB) - Outcome Measures
higher functioning adult, <25/40 is fall risk
*During exercise, what change in SBP is grounds for termination?*
drop in systolic BP > 10 mm Hg SBP should NOT drop during exercise
What is the medication Raloxifene used for?
treat and prevent osteoporosis in women who have gone through menopause. It can also decrease the risk of breast cancer in post-menopausal women who have osteoporosis or a high risk of breast cancer. watch for side effect of DVT
What does Klumpke's paralysis cause?
weakness of hand and wrist flexors (claw hand appearance common) 1. loss of lumbricals 2. loss of forearms flexors 3. all fingers are clawed potential for Horner's Syndrome
What is the Landau reflex?
when a child is lifted under the thorax in a prone position, the head, then back, and legs extend Superman
What is Souques' phenomenon?
when a patient raises the involved UE above 100° with the elbow extended. Produces extension and ABD of the involved fingers
What is Raimiste's phenomenon?
when the involved LE ABD or ADD with applied resistance to the uninvolved LE in the same direction
When is duodenal ulcer pain present? How does it differ from gastric ulcers?
when the stomach is empty, 2-3 hours after meal
What occurs on an ECG with a bundle branch block?
wide QRS wave
Does the tidal volume increase during pregnancy?
yes, tidal volume is increased RR unchanged
What are the three zones of a burn?
zone of coagulation zone of stasis zone of hyperemia
What happens to stroke volume, cardiac output, and HR during aquatic exercise?
stroke volume and CO increase HR stays the same or decreases
What is the purpose of a Swan Ganz Catheter (3)?
pulmonary artery catheter - long thin tube with a balloon tip on the end typically inserted into the right side of the heart 1. monitor pulmonary artery pressure 2. diagnose right heart failure 3. measure right ventricular filling pressure
Frothy sputum usually means...
pulmonary edema
When performing lumbar mechanical traction for posterior herniated disc, the hip and knee are placed in how many degrees of flexion?
prone position without a pillow herniated disc in posterolateral direction. *Prone positioning is desirable since pt in extension and directs forces anteriorly*
*What resting blood pressure is a red flag for exercise?*
resting SBP > 200 mmHg or DBP > 110 mmHg
What may be involved if a pregnant woman has stabbing pain into the buttocks and radiating pain into the posterior thigh/knee?
sacroiliac joint
Goals for a C6:
same as above plus: 1) promote tenodesis of wrist and fingers 2) independent bed activities, assistive devices PRN 3) min A transfers with ADs 4) independent WC locomotion on level terrain 5) WC placement in and out of car
What can a prolonged ATNR influence result in?
scoliosis or hip subluxation/dislocation if marked hypertonia
What is the normal posture of a neonate?
symmetrical flexed and abducted posture in UE/LEs 24 week premie: position neonate in prone with hips and knees in flexion and placing a hand by the mouth
What is a submaximal ETT
symptom limited or terminated at 85% of age predicted HR max maximal requires advanced cardiac life support (ACLS) trained individuals with proper equipment
What is normal total cholesterol levels?
< 200 mg/dL
When is exercise contraindicated according to HCT count?
< 25%
What Cranial Nerves are attached to the pons?
CN V - VIII
What is the polarity and use of calcium/magnesium in iontophoresis?
(+) Calcium is used to treat muscle spasm.
What is the polarity and use of copper and iontophoresis?
(+) Copper is used to treat fungal infections.
What is the polarity and use of hyaluronidase in iontophoresis?
(+) Hyaluronidase is used for edema reduction.
What is the polarity and use of hydrocortisone in iontophoresis?
(+) Hydrocortisone is used to treat inflammation.
What is the polarity and indication for the use of lidocaine in iontophoresis therapy?
(+) Lidocaine is used for pain reduction or analgesia
What is the polarity and indication for the use of xylocaine in iontophoresis?
(+) Pain reduction/analgesia
What is the polarity and use of zinc in iontophoresis?
(+) Zinc is used to treat dermal ulcers.
What is the polarity and use for acetate in iontophoresis?
(-) Acetate is used for reduction of calcium deposits (myositis ossificans)
What is the polarity and use of dexamethasone in iontophoresis treatment?
(-) Dexamethasone is used to treat inflammation.
What are the symptoms of hypoglycemia (8)?
*Low blood sugar = body release glucagon and epinephrine (fight or flight) & then crash* Early (liver and heart): 1. skin is pale, cool and diaphoretic 2. disoriented or agitated 3. tachycardia with palpitations 4. anxious, irritable Late (brain affected) 5. slurred speech 6. *headache* 7. weak/shaky 8. blurred vision
If p-value is > the level of significance:
--> do NOT reject the null hypothesis (no significance)
If p-value is ≤ the level of significance:
--> reject the null hypothesis (significant difference)
What is the normal range for international normalized ratio (INR)?
0.9 - 1.1
What ECG change is grounds for terminating exercise?
1 mm ST depression is grounds for terminating exercise
What are signs and symptoms of MS?
1) *Lhermitte's sign* (electric shock-like sensation throughout body when flexing the head) 2) ataxia, intention tremors, dysmetria 3) fatigue (especially afternoon) 4) *diplopia, optic neuritis* 5) vestibular issues - balance, dizziness 6) dysarthria and scanning speech 7) *spasticity and hyperreflexia (UMN signs)* 8) adverse reactions to heat *Exercise in morning when body temperature is lowest*
What is evaluated in an APGAR eval?
1) Activity (muscle tone) 2) Pulse 3) Grimace (reflex irritability) 4) Appearance (skin color) 5) Respiration
What are the trans-theoretical Model (Stages of Change) (5):
1) Pre-contemplation 2) Contemplation 3) Preparation 4) Action 5) Maintenance
Conditions in which a PTA can modify interventions (2):
1) Progress pt as directed by PT 2) Safety/comfort (i.e. change in patient status)
What are symptoms of Cerebral Palsy (5)?
1) UMN signs and increased DTR 2) increased muscle tone 3) abnormal postures and movements with mass patterns of flexion/extension, weakness and a tendency to contractures 4) scissoring gait, toe walking 5) visual, auditory, cognitive, oral-motor deficits
What is the dorsal column/lemniscal pathway for (3)?
1) discriminative/light/fine touch - barognosis (differentiate weight) stereognosis, 2-point discrimination, and graphestesia 2) vibration 3) proprioception - kinesthesia
What direction develops first with protective extension reactions?
1) downward (parachute) - 4 months 2) sideward - 6 months 3) forward - 7 months 4) backward - 9 months
What are symptoms of peptic ulcers (4)?
1) epigastric pain described as heartburn 2) burning, gnawing, cramping in the epigastric area near the xiphoid, back pain 3. weakness and diaphoresis 4. coffee-ground emesis - bleeding that has slowed or stopped
What are the key muscles of C8 SCI?
1) flexor digitorum profundus 2) flexor digitorum superficialis
What are the capabilities of C6 SCI?
1) full shoulder motion 2) scap ABD 3) STRONG elbow flex 4) supination of C6 5) tenodesis
Symptoms of Down Syndrome (4)?
1) gross motor delay - hypotonia 2) speech/eating difficulties 3) cognitive/perceptual deficits that may cause fine motor or psychosocial delay 4) congenital heart defects especially septal defects
Goals for a T12-L3?
1) independent living 2) functional ambulator with KAFOs and lofstrand crutches, may use floor reaction AFOs
Goals for a T9-T12?
1) independent living 2) short distance household ambulator 3. independent floor to WC and tub transfers
What are skin changes from hepatic/biliary disease (4)?
1) jaundice 2) spider angiomas 3) bruising 4) palmar erythema
What are signs and symptoms of Post-Polio syndrome?
1) myalgia, cramping pain 2) joint pan with repetitive injuries 3) variable *asymmetrical proximal muscle atrophy* with decreased strength 4) excessive fatigue and decreased endurance which lead to loss of function 5) *environmental cold intolerance*
What are symptoms of appendicitis?
1) nausea, vomiting, fever, pain in waves 2) *pain is first steady and aggravated by movement* 3) periumbilical and/or epigastric pain 4) *RLQ/ right flank pain* 5) right testicular pain 6) coated tongue/bad breath 7) abdominal muscular rigidity
What are the key muscles of L4-L5 SCI?
1) paraspinals 2) medial hamstrings 3) quads 4) post/ant tib 5) extensor digitorum
What are signs and symptoms of Duchenne's Muscular Dystrophy (7)?
1) progressive weakness from proximal to distal starting at age 3 2) toe walking, waddling gait pattern 3) frequent falls 4) difficulty standing (Gower's sign) 5) difficulty climbing stairs 6) contractures/deformities due to muscle imbalance 7) cardiac issues *By age of 10-13, they can no longer independently ambulate. By 14, requiring on power-assisted WC*
What is Horner's syndrome (3)?
1) ptosis of the eyelid 2) miosis - pupil constriction 3) anhydrosis - lack of sweating on ipsilateral face
What are some treatment positions for premature infants (2)?
1) side-lying and prone with chin tucked that bring the shoulders forward to counteract retraction (uses tonic labyrinthe reflex to promote flexion) 2) gentle flexion of hips and knees in supine and supported semi-sitting
What primitive reflexes may be persistent with athetoid Cerebral Palsy (2)?
1) tonic reflexes (ATNR, STNR) 2) tonic labyrinthine reflex (TLR) blocks functional positions and movement
PT goals with a C5:
1) wt. shifting in WC 2) short sitting balance 3) transfers with AD 4) rolling with AD 5) supine to sit with AD 6) push manual WC using projection rims
When is the crossed extension reflex integrated?
1-2 months
A PT is exercising a cardiac patient and monitoring their vitals. What are adverse responses to in-patient exercise leading to termination (5)?
1. *diastolic BP ≥ 110 mmHg and systolic ≥ 200 mmHg* 2. *drop in systolic BP > 10 mm Hg* during exercise 3. *2nd or 3rd degree heart block* 4. angina, marked dyspnea 5. significant ventricular or atrial dysrhythmias with or without associated S&S
What are clinical manifestations of LV failure (7)?
1. *dyspnea, dry cough* 2. orthopnea 3. *pulmonary rales, wheezing* 4. hypotension 5. tachycardia 6. paroxysmal nocturnal dyspnea 7. *pallor/cyanosis*
signs and symptoms of bronchitis (4)
1. *wheezing / rhonchi breath sounds* 2. productive mucoid or purulent sputum with infection 3. may lead to R-sided heart failure/cor Pulmonale 4. *cyanosis* "Blue Bloaters" Paced breathing
What is normal ankle ROM during gait cycle from: 1. heel strike 2. foot flat 3. midstance 4. heel off 5. toe off
1. 0° PF 2. 15° PF 3. 10° DF 4. 15° DF 5. 20° PF
What is the normal knee ROM during gait cycle from: 1. heel strike 2. foot flat 3. midstance 4. heel off 5. toe off 6. initial swing 7. midswing 8. terminal swing
1. 0° of knee flexion 2. 15° of knee flexion 3. 5° of knee flexion 4. 0° of knee flexion 5. 40° of knee flexion 6. 40° of knee flexion 7. 60° of knee flexion 8. 0° of knee flexion
What is normal hip ROM during the gait cycle from: 1. initial contact 2. loading response 3. midstance 4. heel off 5. toe off 6. initial swing 7. midswing 8. terminal swing
1. 30° hip flexion 2. 30° hip flexion 3. 5° hip flexion 4. 10° hip extension 5. neutral 6. 20° hip flexion 7. 30° hip flexion 8. 30° hip flexion
What are signs and symptoms of slipped capital femoral epiphysis (SCFE) (3)?
1. AROM restricted in ABD, flexion, and IR 2. pain described as vague at knee, thigh, and hip 3. Trendelenburg gait S(CFE) is close to T(rendelenburg)
Patient history for risk of pulmonary emboli (5)
1. DVT 2. oral contraceptives 3. recent hip or abdominal surgery 4. polycythemia 5. prolonged bed rest
What are the symptoms of gallbladder disease (8)?
1. RUQ pain 2. jaundice (blockage of bile duct) 3. fever and chills 4. indigestion 5. nausea 6. excessive belching and flatulence 7. intolerance of fatty foods 8. persistent pruritus (itching) 9. sudden excrutiating pain mid-epigastrium with referral to back and right shoulder
PTA interactions with PT (3)
1. PT supervision does not need to be on-site or direct 2. telecommunication must be available 3. supervisory visit is required at least once a month or sooner if the patient's condition warrants greater frequency
What is Tetralogy of Fallot (TOF)?
1. Pulmonary stenosis: Right ventricle outflow obstruction - decreased blood flow to lungs. 2. Right ventricular hypertrophy: Right ventricular wall thickens r/t the outflow obstruction 3. Overriding aorta: Aortic valve enlarged, overrides the ventricular septal defect (VSD); De-oxygenated blood enters systemic. 4. Ventricular Septal Defect: De-oxygenated blood to left ventricle Prognosis: Mortality under 3%
What is lymphangitis?
1. acute bacterial/viral infection that spreads through the lymphatic system 2. red streaks are often seen in the skin proximal to infection site
What are the general contraindications for US (6)?
1. acute infections 2. impaired circulation, mentation/sensation 3. malignancy 4. thoracic area containing pacemaker 5. thrombophelebitis 6. abdomen, pelvis, or low back during pregnancy
A physical therapist consults with an orthotist regarding the need for an ankle-foot orthosis for a patient status post CVA. The patient has difficulty moving from sitting to standing when wearing a prefabricated plastic ankle-foot orthosis (AFO). The therapist indicates the patient has poor strength at the ankle, intact sensation, and does not have any edema or tonal influence. The MOST appropriate type of AFO for the patient would incorporate: 1. an articulation at the ankle joint 2. tone reducing features 3. metal uprights 4. dorsiflexion assist
1. an articulation at the ankle joint Plastic AFO with an articulating ankle joint is more cosmetic and lighter than a metal upright AFO
A patient reports significant discomfort in the lower leg during ultrasound treatment. The therapist believes the discomfort is caused by periosteal pain from the ultrasound. Which scenario is MOST likely associated with the patient's subjective report of discomfort? 1. an ultrasound unit with a high beam nonuniformity ratio (BNR) 2. an ultrasound unit with a low beam nonuniformity ratio (BNR) 3. a transducer with a large effective radiating area 4. a transducer with a small effective radiating area
1. an ultrasound unit with a high beam nonuniformity ratio (BNR) Low BNR produces more uniform beam and greater patient comfort. Higher BNR produces less uniform beam and greater risk for burns - must move US head more
In a patellar-tendon-bearing socket, what areas are the pressure sensitive areas?
1. anterior tibia condyle 2. anterior tibial crest 3. fibular head and neck 4. fibular nerve 5. distal cut end of tibia and fibula 6. patella bony prominences are pressure INTOLERANT
signs and symptoms of emphysema (4)
1. barreled chest 2. use of accessory muscles of ventilation 3. decreased breath sounds with/without wheezing 4. dyspnea Pursed lip breathing to keep airways expanded
What is receptive or Wernicke's aphasia?
1. severe disturbance in auditory comprehension 2. reading, writing, and word recognition impaired 3. fluid but nonsense speech: word flow diarrhea
What two musculoskeletal disorders could be manifested from a pathological liver?
1. bilateral CTS - lack of detoxification of ammonia by liver 2. rhabdomyolysis - liver failure due to statins such as Zocor, Lipitor, Crestor
What are the signs and symptoms of spinal stenosis (4)?
1. bilateral pain and paresthesia in back, buttocks, thighs, calves, and feet 2. pain decreases in flexion, increases in extension 3. pain increases with walking 4. pain relieved with prolonged rest
What is treatment for osteogenesis imperfecta (OI) (4)?
1. calcium, vitamin D, estrogen, calcitonin 2. joint/bone protection strategies 3. with approval from MD - functional and isometric strengthening (care with lever arms) 4. aquatics - short duration (adverse reaction to heat)
What are absolute contraindications of manual lymph drainage (MLD) (4)?
1. cardiac edema 2. PAD with ABI < 0.8 (normal being 1-1.4) 3. acute infections 4. acute DVT
What are PT treatments for plagiocephaly? What is the dosage?
1. caregiver education about prolonged supine positioning and CMT - use of positioners, seats and swings 2. cranial remodeling - helmet made of thermoplastic material lined with high density foam (worn 20-23 hours/day for 2-7 months; best outcome if helmet started at 4-6 months)
What are treatments for talipes equinovarus (Clubfoot) (4)?
1. casting or splinting 2. after casting, stretching is important 3. orthoses *(Dennis-Browne splints) throughout the day for 3 months and then at night for up to 3 years* 4. achilles/ tenotomy as last resort
What is lupus erythematosus (3)?
1. chronic, progressive autoimmune inflammatory disorder of connective tissues 2. butterfly rash with raised, red, scaly plaques 3. Systemic lupus erythematosus (SLE) - affects skin, joints, kidneys, heart, nervous system - can be fatal, affects young women
Who is provided health care under medicare (2)?
1. citizens 65 years of age and older 2. certain long-term disabilities such as chronic renal disease
Describe motor function of a patient with a spina bifida lesion at L1 (3)
1. complete trunk function 2. hip flexors 2/5 or less 3. loss of muscle function below L1
Describe motor function of a patient with a spina bifida lesion at L2 (3)
1. complete trunk function 2. hip flexors and adductors 3/5 3. quads 2/5 or less
Describe motor function of a patient with a spina bifida lesion at L3
1. complete trunk function 2. hip flexors and adductors > 3/5 3. quads 3/5
Describe motor function of a patient with a spina bifida lesion at L4
1. complete trunk/hip/knee function 2. ankle DF 3/5 3. medial knee flexors 3/5
Signs and symptoms of pulmonary edema (6)
1. dyspnea on exertion or paroxysmal nocturnal dyspnea 2. fatigue 3. pink frothy sputum 4. positive chest x-ray 5. crackles
What are signs and symptoms of Graves' disease (hyperthyroidism) (6)?
1. exophthalmia (bulging eyes) 2. tachycardia 3. heat intolerance 4. nervousness 5. tremor 6. palpitations
signs and symptoms of cystic fibrosis (5)
1. frequent respiratory infections (staph and pseudo) 2. *inability to gain weight* 3. *positive sweat electrolyte test* 4. rales, wheezing 5. productive of large amounts of mucoid, mucopurulent or purulent sputum
What is the function of a multi-axis foot?
1. has components that move slightly in all planes to aid in walking on uneven surfaces 2. cons: heavier and less durable than single-axis or nonarticulating foot
What synergy patterns are dominant in the LE following a CVA?
1. hip flexion 2. hip ADD/IR 3. knee extension 4. ankle PF 5. toe PF
What are contraindications to exercise during pregnancy (7)?
1. incompetent cervix 2. vaginal bleeding 3. placenta previa 4. rupture of membranes 5. premature labor 6. maternal heart disease 7. maternal diabetes
What physiological changes would a PT expect to see with a patient recovering from heart transplantation (2)?
1. increased resting HR due to lack of parasympathetic innervation 2. blunted HR during exercise - decreased during exertion and peak levels; use RPE
What is Lyme disease (3)?
1. inflammatory disease caused by spirochete via tick bite 2. Differential diagnosis - "bull's eye" round rash and flu-like symtoms, later - arthritis and neuro disorders 3. Treatment - antibiotics
What are the muscles of the pelvic floor (2)?
1. levator ani (PIP: puborectalis, iliococcygeus, pubococcygeus) 2. coccygeus
Explain pelvic floor exercises (Kegel exercises) to a patient
1. lie down in hooklying position, seated, or standing 2. tighten pelvic floor by imagine peeing and then stop the flow of urine midstream 3. hold for 5-10 seconds. Relax for 10 seconds. Repeat 5x to start and progress to 10x, 3x/day Doing while peeing for real is not part of Kegel and may be harmful
What are signs and symptoms of uterine prolapse (6)?
1. lower back pain that is relieved by lying down 2. urgency/frequency 3. urinary incontinence 4. incomplete bladder empyting 5. increased perineal sensation 6. constipation and painful bowel
What are signs and symptoms of transient synovitis (4)?
1. most common cause of unilateral hip or groin pain in children aged 3-10 2. crying at night 3. antalgic limp 4. recent history of upper respiratory tract infection
What are the symptoms of cholecystitis (3)?
1. nausea & vomiting 1-3 hours after eating 2. fever 3. RUQ pain
**What synergy patterns are dominant in the UE following a CVA?
1. scapular retraction/elevation 2. shoulder ADD/IR 3. elbow flexion 4. forearm pronation 5. wrist and finger flexion
What is psoas and obturator sign?
1. pain in RLQ with hip extension from inflammation of peritoneum over psoas muscle 2. pain in RLQ with hip flex/IR at 90/90 (+) for acute appendicitis
What is required to be eligible for home services (4)?
1. physician certification 2. patient must be predominantly confined to home 3. at least part-time nursing or therapy services are needed 4. patient has potential to make progress
What are decreased breath sounds and decreased fremitus indicative of (2)?
1. pleural effusion 2. pneumothorax vibration does not travel through well
What is the cathode (negative pole) used for (3)?
1. promote granulation 2. control inflammation 3. inhibit certain bacteria bad - cat - kitty litter - grainy
What are signs and symptoms of Legg-Calve-Perthes Disease (LCPD) (3)?
1. psoatic limp due to weakness of psoas major 2. gradual onset of aching pain at hip, thigh, and knee 3. AROM limited in ABD and extension
Damage to CN III will cause what to happen (3)?
1. ptosis 2. loss of dilation of pupil 3. unable to move eye up/down/in Seen with MS and Horner's syndrome
What are decreased breath sounds and increased fremitus indicative of (3)?
1. pulmonary edema 2. consolidation 3. atelectasis
A physical therapist works with a nine-year-old child with Down syndrome. The therapist determines that the patient has abnormalities in muscular tone consistent with the diagnosed condition. Which technique would be the MOST beneficial when treating the patient's tone abnormalities? 1. quick stretch 2. deep pressure 3. prolonged icing 4. neutral warmth
1. quick stretch All other choices would result in inhibition, not appropriate for hypotonia
How would the hands of a patient with advanced rheumatoid arthritis present (4)?
1. radial deviation of the radiocarpal joints 2. ulnar deviation of the fingers 3. Boutonniere deformity of the thumb 4. Swan neck deformity of the fingers
Nitroglycerine (3)
1. relaxation of vessels (vasodilation) 2. *decrease preload and afterload* 3. side effects: *OH*, adverse response to *systemic heat* - "nitro is hot"
What steps should you taken when someone has a seizure?
1. remain with patient 2. remove potentially harmful nearby objects 3. loosen restrictive clothing and do NOT restrain limbs 4. establish airway, prevent aspiration by positioning patient in sidelying 5. wait for tonic-clonic activity to subside
What two spinal pathologies find relief in flexion?
1. spinal stenosis (love flexion and contralateral rotation/side bending) 2. facet irritation (extension is closed pack position)
What kind of insults can result in secondary lymphedema (4)?
1. surgery - removal of tissue and extensive lymph nodes due to cancer. breast cancer most common cause 2. radiation 3. infection - cellulitis or Filariasis 4. chronic venous insufficiency
How do you measure seat depth for a WC (2)?
1. take measurement of patient - posterior buttock to the posterior aspect of the lower leg in the popliteal fossa 2. subtract 2-3 inches from the patient's measurement
How do you measure seat width for a WC (2)?
1. take measurement of patient - width of the hips at the widest part 2. add 2 inches to the patient's measurements
What are the motor features of paralysis of ulnar nerve (5)
1. ulnar deviation 2. weakened wrist and finger flexion 3. weakened 4th and 5th finger flexion 4. loss of thumb adduction 5. most intrinsics
A patient receives neuromuscular electrical stimulation to the quadriceps femoris in supine position with 30° of knee flexion. No contraction is elicited, even though the patient reports a strong tingling sensation under the electrodes. Which of the following alterations is MOST appropriate in order to elicit a contraction? 1. Increase in current amplitude 2. Increase in pulse duration 3. Decrease in electrode size 4. Decrease in distance between electrodes
2. Increase in pulse duration pulse duration is the size of the hammer pulse rate is rate of hammering
A physical therapist treats a patient with a CVA that presents with speech and language deficits. The therapist incorporates phonetics into the plan of care. This intervention would be MOST essential for a patient diagnosed with: 1. Broca's aphasia 2. dysarthria 3. verbal apraxia 4. dysphagia
2. dysarthria PTs must avoid activities that require substantial verbal output with patient's of Broca's aphasia verbal apraxia is the planning and sequencing of speech, not physical articulation
A physical therapist reviews the parameters of several pain modulation theories using transcutaneous electrical nerve stimulation (TENS). When comparing sensory stimulation to motor stimulation, sensory stimulation requires: 1. greater phase duration 2. greater frequency 3. stronger amplitude 4. shorter treatment time
2. greater frequency
A patient's pulmonary function tests reveal that the patient has a forced vital capacity (FVC) of 4.0 liters and a forced expiratory volume in 1 second (FEV1) of 3.5 liters. These results would be MOST anticipated with a diagnosis of: 1. cystic fibrosis 2. idiopathic pulmonary fibrosis 3. chronic bronchitis 4. emphysema
2. idiopathic pulmonary fibrosis Patient in the above scenario has a restrictive lung disease since the FEV1/FVC ratio is normal (3.5/4 = 87.5). Obstructive will be < 70%
A physical therapist measures a patient for a wheelchair. When measuring back height, which method is MOST accurate? 1. measure from the seat of the chair to the base of the axilla and subtract two inches 2. measure from the seat of the chair to the base of the axilla and subtract four inches 3. measure from the seat of the chair to the acromion process and subtract two inches 4. measure from the seat of the chair to the acromion process and subtract four inches
2. measure from the seat of the chair to the base of the axilla and subtract four inches
A physical therapist attempts to monitor exercise intensity during an exercise session with a patient after cardiac transplantation. The MOST appropriate method is: 1. metabolic equivalents 2. perceived exertion scale 3. pulmonary function tests 4. target heart rate range
2. perceived exertion scale METS are for exercise selection, but NOT an objective measure of intensity
A 47-year-old patient with a diagnosis of CVA with left hemiplegia is referred for orthotic examination. Significant results of manual muscle testing include: hip flexion 3+/5, hip extension 3/5, knee flexion 3+/5, knee extension 3+/5, ankle dorsiflexion 2/5, and ankle inversion and eversion 1/5. Sensation is intact and no abnormal tone is noted. The MOST appropriate orthosis for this patient is a: 1. knee-ankle-foot orthosis with a locked knee 2. plastic articulating ankle-foot orthosis 3. metal upright ankle-foot orthosis locked in neutral 4. prefabricated posterior leaf spring orthosis
2. plastic articulating ankle-foot orthosis PLSO would not provide enough stability for the patient
If the forced expiratory volume in one second (FEV1) test is negative for airway obstruction in 99% of individuals without lung disease, then the measurement of FEV1 is: 1. sensitive 2. specific 3. reliable 4. valid
2. specific Probability of obtaining a negative test among individuals without the disease: true negative
During an examination, a physical therapist notes a yellow discoloration of the patient's skin and sclera of the eye. This discoloration would be LEAST likely observed with: 1. cholecystitis 2. ulcerative colitis 3. pancreatitis 4. hepatitis
2. ulcerative colitis All other choices have jaundice as a symptom
A physical therapist consults with a teacher regarding a child with autism who has impairments in sensory processing. Which piece of equipment would be the MOST useful to address the child's dyspraxia? 1. swing 2. weighted vest 3. sit and spin 4. rocking chair
2. weighted vest Weighted vest provides proprioceptive input for sensory disorders Other choices are all vestibular Dyspraxia = clumsy child syndrome
A physical therapist treating a child with cerebral palsy would like to utilize a reverse walker to help with the child's gait impairments. The PRIMARY rationale for prescribing a reverse walker instead of a traditional walker is because the child: 1. displays a Trendelenburg gait pattern 2. exhibits excessive upper extremity weakness 3. displays a forward trunk lean with gait 4. demonstrates excessive extensor tone
3. displays a forward trunk lean with gait Reverse walker will help improve posture and put more into shoulder and L/S extension. Would not want that if they already are in extensor tone.
According to proponents of evidence-based medicine, the BEST source of information upon which to make clinical decisions about therapy for an individual patient is a: 1. cohort study 2. randomized controlled trial 3. systematic review 4. case report
3. systematic review
A patient recently diagnosed with end-stage renal disease begins hemodialysis treatments at an outpatient dialysis center. Which frequency and duration of dialysis is MOST typical? 1. one time a week for five hours 2. two times a week for three hours 3. three times a week for four hours 4. five times a week for two hours
3. three times a week for four hours most common schedule
What BMI is obese?
30-39.9 kg/m2
ADA Accessibility Requirements: Hallway Narrowing Clearance
32" min width 24" max depth
ADA Accessibility Requirements: Hallway Clearance
36" width
What are the signs and symptoms of metabolic alkalosis? Hyper or hypo kalemia? Hyper or hypo ventilation?
4 T's 2 Hypo's 1. Tetany 2. Tachycardia 3. Tremors 4. Tingling 1. hypoventilation 2. hypokalemia ROME Alkalosis = hypokalemia
1. unilateral stance briefly 2. stairs with rail - ascends/descends reciprocal 3. hops on one foot several times 4. stands on tiptoes
4 Years
When can an infant sit with support?
4 months
Kicking a rolling ball, catching a small ball, and hopping on one foot are gross motor tasks that are most age-appropriate for a ___year-old?
4 year old Gross motor developmental assessment at age 4 years should include functional tasks.
At what age does a child hop on one foot and stand on tiptoes?
4 years
When does a child hop on one foot several times, climb, kick a rolling ball, throws a ball overhand, and stand on tiptoes?
4 years
When is ATNR integrated?
4-6 months
When is the palmar grasp reflex integrated?
4-6 months
A physical therapist completes a developmental assessment on an infant. Which pediatric reflex would the therapist expect to be integrated at the youngest age? 1. plantar grasp reflex 2. Moro reflex 3. Landau reflex 4. Galant reflex
4. Galant reflex 2 months
A 74-year-old female indicates that she has experienced increased urinary incontinence over the past year. What physiological change is MOST commonly associated with this condition in older adults? 1. reduced kidney filtration capacity 2. increased reservoir capacity of the bladder 3. spasm of the detrusor muscle 4. decreased urge sensation
4. decreased urge sensation detrusor muscle can become spastic with neurologic disorders but not with aging
A physical therapist treats a patient with end-stage renal disease for general deconditioning. Which other symptoms would this patient MOST likely demonstrate? 1. increased urine output and polycythemia 2. increased urine output and anemia 3. decreased urine output and polycythemia 4. decreased urine output and anemia
4. decreased urine output and anemia Renal failure - kidneys have a decreased ability to filter fluids, therefore urine output is decreased or absent
A 16-year-old male patient sprained his thumb in a volleyball game five weeks ago and continues to have decreased range of motion with carpometacarpal abduction. What joint mobilization technique would the therapist use to increase carpometacarpal abduction? 1. medial glide of the first metacarpal on the trapezium 2. lateral glide of the first metacarpal on the trapezium 3. anterior glide of the first metacarpal on the trapezium 4. posterior glide of the first metacarpal on the trapezium
4. posterior glide of the first metacarpal on the trapezium CMC flex/extension follow concave moving on convex rule
A physical therapist discusses the plan of care for a 61-year-old male diagnosed with spinal stenosis with the referring physician. During the discussion the physician shows the therapist a picture of the patient's spine obtained through computed tomography. What color would vertebrae appear when using this imaging technique? 1. black 2. light gray 3. dark gray 4. white
4. white Bone is extremely dense and appears white Less dense is darker
rule of nines - anterior and posterior single arm
4.5 and 4.5%
head rule of nines
4.5% front and back
When performing lumbar mechanical traction, what is the recommended degrees of hip flexion to target the L5 and S1 intravertebral space?
45-60° of hip flexion
How much oxygen does the body consume per minute for performing ADLs?
5 METS
1. kicks ball well 2. stairs without rail - ascends/descends reciprocal 3. hops 16 feet 4. skips 5. jumps rope 6. roller skates 7. dresses self 8. swings self on playground swing
5 Years
Dosage for Percussive Chest PT
5 min/lobe 20 min/side for vented patients; percuss every lobe Vibration: through exhalation, 3x
What can an infant roll from prone to supine?
5 months
When does a child skip, kick a ball well, dress/undress self, riding a bicycle, dribble a basketball?
5 years
What is normal WBC count? When is exercise contraindicated?
5,000 - 11,00 cells/mm3 < 5000 cells/mm3 with fever; no exercise > 5000 cells/mm3 with fever; light exercise with progression to resistive exercise
What should the treatment time for ice massage be?
5-10 minutes or until analgesia occurs
When is the moro reflex integrated?
5-6 months
Dribbling a basketball, riding a bicycle, and skipping are skills that are appropriate for children age __________?
5-6 years
At what age does a child develop a hand preference?
5-8 years old
For mechanical traction in the lumbar region, what amount of force is required to cause separation? How much force is recommended during the first treatment?
50% of the patients bodyweight L/S requires 30-40 pounds to affect change
When can an infant roll supine to prone?
6 months
When is a positive supporting reaction integrated?
6 months
When is an infant independent in sitting?
6 months
When is the tonic labyrinthine reflex integrated?
6 months
What is normal LDL levels?
< 100 mg/dL, lower the better
What platelet level is contraindicated for exercise?
< 20,000 cells/dL - no exercise
What are both legs in a child with rule of nines?
6.5 and 6.5% front and back
What is normal fasting glucose level?
60-110 mg/dL
What is a normal APGAR score?
7 - 10
For mechanical traction in the cervical region, what percentage of the patient's body weight in required to cause separation? How much force is recommended during the first treatment?
7% of the patients body weight C/S requires 8-10 pounds to cause distraction
When performing lumber mechanical traction what degree of hip action is recommended to target the L3-L4 interveretbral space?
75-90° of hip flexion
When is STNR integrated?
8-12 months
When can an infant perform belly crawling, quadruped creeping, cruising sideways and pull to stand through kneeling?
8-9 months
When can an infant stand alone?
8-9 months
What is the head of the child with rule of nine?
8.5%
Activities-specific Balance Confidence (ABC) - Outcome Measures
80% high level of function, 50-80% moderate level of function, <50% low level of function, <67% fall risk
What should the temp of the water be for intense aerobic training?
80-84° similar for MS patients
When is the plantar grasp reflex integrated?
9 months
When performing lumbar mechanical traction for spinal stenosis, the hip and knee are placed in how many degrees of flexion?
90/90 position
Ottawa Knee Rules (5)
A knee x-ray is only required for knee injury patients with any of these findings: 1. age 55 or over 2. isolated tenderness of the patella 3. tenderness at the head of the fibula 4. inability to flex to 90° 5. inability to weight bear both immediately and in the casualty department (four steps: unable to transfer weight twice onto each lower limb regardless of limping).
What is a computed tomography (CT) scan?
A radiographic test that takes cross-sectional pictures/slices of the human body Still preferred for assessing cortical bone, especially spine fractures
What is a Positron emission tomography (PET scan)?
A scan that uses radioisotopes to assess cerebral blood flow and brain metabolism
An adult female patient's lab values show a hematocrit level of 30% post-op. This value is: A. anemic B. a sign of infection C. dangerously high D. within normal range
A. anemic Normal male 42-52% female 37-47%
A physician orders electromyography for a patient with a brachial plexus injury to objectively determine the extent of pathology. Which of the following responses is most indicative of a normal muscle at rest? A. electrical silence B. spontaneous potentials C. polyphasic potentials D. occasional motor unit potentials
A. electrical silence Normally innervated muscle is electrically silent at rest
A physical therapist is developing an exercise program for an 18-year-old patient. The patient is presently covered for physical therapy services by the parents' insurance. Which of the following actions is MOST appropriate for the therapist to take prior to beginning the patient's therapy? A. Obtain informed consent from the patient B. Obtain informed consent from the parents C. Encourage the patient's parents to leave the treatment area during therapy D. Require a release by a medical physician
A. Obtain informed consent from the patient The patient is not a minor and, therefore, can give informed consent
A patient who is 5 weeks post-myocardial infarction (MI) is participating in a cardiac rehabilitation program. The therapist is monitoring responses to increasing exercise intensity. Which finding is an indication that exercise should be immediately terminated? A. 1.5 mm of downsloping ST segment depression B. peak exercise HR >140 C. appearance of a PVC on ECG D. SBP > 140 mm Hg or DBP > 80 mm Hg
A. 1.5 mm of downsloping ST segment depression ≥ 1 mm ST depression is grounds for terminating exercise ≥ 2 mm ST depression contraindication is for resting ECG
A patient with MRSA infection has been discharged from an isolation setting with an open wound of the buttocks. Patient is now returning to PT as an outpatient. PT should adhere to which precaution? A. open wound must be contained within a dressing B. direct contact with the patient should be avoided C. glove are needed only with dressing changes D. treatment can be performed in the therapy gym if contact surfaces are covered
A. open wound must be contained within a dressing PT should be gloved for any direct contact with patient's intact skin or surfaces or articles in close proximity to patient. All equipment should be cleaned with approved germicidal agent before and after use Treatment in open gym is inappropriate for patients with MRSA
A patient is strengthening their abdominals, should they be in a: A. posterior pelvic tilt B. anterior pelvic tilt
A. posterior pelvic tilt tilt should be opposite to the side of body of target muscle
A patient has developed a thick eschar secondary to a full-thickness burn. What is the antibacterial agent most effective for infection control for this type of burn? A. sulfamylon B. nitrofurazone C. panafil D. silver nitrate
A. sulfamylon
Lower extremity Ligament Reconstruction Guidelines
ACL/PCL reconstruction: frequently immobilized in full extension for a period of 6 weeks Lateral ankle reconstruction: immobilized for 4-6 weeks in a combination of cast and/or rigid walking boot sinister SIX weeks: protective phase
What type of AD would you use for a spina bifidia lesion at the level of L1? What kind of community and household walker?
AD: parapodium, HKAFO, and RGO (coordination and cognition required) Community Mobility: WC Household Mobility: walker
What is the term for a family history of inherited lymphedema?
Milroy Disease - primary lymphedema
Medications that end with -lam and -pam are what kind of drugs?
Anti-anxiety
Medications that end with -mycin and -micin are what kind of drugs?
Anti-biotics
Timed Up and Go (TUG) - Outcome Measures
Assistive device <12 sec normal, 20-29 = impaired mobility, >30sec fall risk
Four Square Step Test (FSST) - Outcome Measures
Assistive device, >12 sec fall risk, >15 sec is 2x faller in 6 months
Tinetti Performance Oriented Mobility Assessment (POMA) - Outcome Measures
Assistive device, higher level of function, <19/28 = high risk of fall, 19-24 = med risk of fall, 25-28 = low fall risk
What are symptoms of Addison's disease (6)
BROWN HANDS 1. Brown pigmentation 2. Reduced strength 3. Orthostatic hypotension 4. Weight loss 5. Neurosis 6. Hyponatremia 7. Anorexia 8. Nausea 9. Dehydration 10. Sudden death
Which of the following conditions are malignant tumors of the connective tissue? A. Fibroma and chondroma B. Fibrosarcoma and chondrosarcoma C. Papilloma and adenoma D. Adenocarcinoma and basal cell carcinoma
B. Fibrosarcoma and chondrosarcoma A. Fibroma and chondroma - benign tumors of the connective tissue D. Adenocarcinoma and basal cell carcinoma - malignant tumors of the epithelium/skin
Which of the following changes occur when using intermittent pneumatic compression during the inflation (compression) phase? A. Decrease in venous blood flow and lymphatic pressure B. Increase in interstitial tissue pressure and venous blood flow C. Decrease in interstitial pressure and arterial blood flow D. Increase in arterial and venous blood flow
B. Increase in interstitial tissue pressure and venous blood flow During the compression phase, the arterial blood flow is reduced. Venous blood flow is enhanced, as is lymphatic flow. The interstitial pressure is increased, which forces fluid out of the interstitium into the lymphatic system. The compression of the veins and lymphatics forces fluids proximally. Arterial flow would increase during the deflation period.
A mother reports that her 6-month-old infant has had vomiting and diarrhea over the last 2 days. Which of the following signs would be the MOST accurate indication of severe dehydration? A. Decreased respiratory rate B. Sunken fontanelle C. Warm hands and feet D. Loud crying when touched
B. Sunken fontanelle The fontanelle will be sunken in infants who are dehydrated rapid respiratory rate Cold hands and feet are present in severe dehydration In severe dehydration, the infant would be unable to cry
In order to teach a patient proper hamstring stretching techniques, should they be in a: A. posterior pelvic tilt B. anterior pelvic tilt
B. anterior pelvic tilt tilt should be opposite to the side of body of target muscle
What is the most effective form of diagnostic imaging for patients with multiple sclerosis (MS) to help determine the level of disease activity? A. positron emission tomography (PET) B. magnetic resonance imagine (MRI) C. computer tomography (CT) D. transcranial sonography
B. magnetic resonance imagine (MRI) highly sensitive for detecting MS plaques in white matter of brain and SC
**Strengthening of the lateral pterygoid, anterior head of the digastric muscle, and suprahyoid muscles would be the MOST beneficial intervention to improve which of the following? A. mouth closing B. mouth opening C. mouth protrusion D. mouth retrusion
B. mouth opening: *anterior head of digastric and suprahyoid* - hyoid muscles are for mandibular depression mouth closing: masseter, temporalis, medial pterygoid, and lateral pterygoid protrusion: temporalis, medial pterygoid, and lateral pterygoid retrusion: temporalis and suprahyoid muscles
The components of a clinical question posed in order to search the literature for information about the effectiveness of a therapy include: A. subjective, objective, assessment, plan (S.O.A.P.) B. patient or problem, intervention, comparison, outcome (P-I-C-O) C. validity, reliability, applicability D. diagnosis, prognosis, intervention
B. patient or problem, intervention, comparison, outcome (P-I-C-O)
A patient recovering from surgery to remove a cerebellar tumor presents with pronounced ataxia and problems with standing balance and postural stability. To help improve this situation, what would be the BEST approach to incorporate in the intervention? A. LE splinting and light touch-down hand support B. rhythmic stabilization during holding in kneeling C. perturbed balance activities while standing on carpet D. stabilizing reversals during holding in side-lying
B. rhythmic stabilization during holding in kneeling PNF technique to improve stability. High kneeling is good for patients with ataxia: upright, lower COG, and increased BOS
Which intervention is best to improve left-sided neglect in a patient with left hemiplegia? A. hook-lying, holding, light resistance to both hip ABD B. rolling, supine to side-lying on right, using a PNF lift pattern C. sitting, with both arms extended, hands resting on support surface, active holding D. bridging with both arms positioned in extension at the sides
B. rolling, supine to side-lying on right, using a PNF lift pattern incorporating the involved left side into crossing midline other choices are all symmetrical activities
A patient with a 10-year history of MS demonstrates 3+ extensor tone in BLE. The PT needs to order a WC. What is the best recommendation for this patient? A. standard WC with elevating leg-rests B. tilt-in-space WC with a pelvic belt C. standard WC with a 30° reclining back D. electric WC with toe loops
B. tilt-in-space WC with a pelvic belt Pt with strong extensor tone needs controls over hips to maintain hips in flexion. Tilt-in-space design keeps child from coming out of chair when extensor spasms are active
What area is affected with expressive aphasia?
Broca's area
A physical therapist is developing an exercise program for a patient who has upper extremity lymphedema. Which of the following exercises should the patient perform last? A. Elbow flexion B. Cervical rotation C. Wrist circumduction D. Shoulder circumduction
C. Wrist circumduction Exercises - work proximal to distal
What is the best dressing for a wound that is red, painful, with a moderate to high amount of wound draingage (exudate)? A. hydrogel dressings B. semipermeable film dressings C. calcium alginate dressings D. gauze dressings
C. calcium alginate dressings dressings absorb large amounts of exudate (up to 20x their weight) and form a gel, maintaining moist wound environment while permeable to oxygen hydrogel for min to moderate exudate
During an US treatment, the patient flinches and states that a strong ache was felt in the treatment area? What is the therapist's best course of action? A. decrease the US frequency B. add more transmission medium C. decrease the US intensity D. increase the size of the treatment area
C. decrease the US intensity US results in rapid tissue temperature elevation and stimulation of the highly sensitive periosteum of the bone.
Falls are the #1 cause of injuries in the elderly. Which of the following is a primary concern when evaluating the home environment for fall prevention and safety education? A. carpet edges, throw rugs, and raised floorboards B. lighting in the stairways, bedrooms, and bathrooms C. grab bars in the bathroom mounted 48 inches from the floor or tub floor D. nonslip surfaces in the bathtub and shower
C. grab bars in the bathroom mounted 48 inches from the floor or tub floor bars should be mounted horizontally 33-36 inches from floor or tub floor
What Cranial Nerves are attached to the diencephalon?
CN I & II
What Cranial Nerves are attached to the midbrain?
CN III & IV
Bethany is two weeks post right total knee arthoplasty and has a past medical history of lymph node hypoplasia. The patient presents with 6/10 diffuse right calf pain, and the right calf is 1.5 cm greater than the left. Which of the following is the therapist's BEST course of action? A. apply long stretch bandaging to reduce edema B. alert the physician immediately for a high-risk of DVT C. record lower extremity pain/size and initiate manual lymphatic drainage D. hold treatment until the patient is cleared for physical therapy
C. record lower extremity pain/size and initiate manual lymphatic drainage ≥ 3 on Wells Clinical Prediction Rules for DVT is high risk 1-2 is moderate risk
A patient presents with chronic TMJ dysfunction. Limited lateral movement of mandible to the right as a result of muscular tightness. Which of the following muscles should be the focus of inhibitory or soft tissue lengthening techniques? A. right temporalis muscle B. right geniohyoid muscle C. right medial pterygoid muscle D. right digastric muscle
C. right medial pterygoid muscle (passive insufficiency) lateral excursion produced by contralateral medial/lateral pterygoids and ipsilateral temporalis muscles. *Tightness of ipsilateral pterygoids or contralateral temporalis may need lengthening in order to allow full lateral excursion*
A PT performs crutch training with a patient following total hip arthroplasty. The patient has orders for partial weight bearing. Which of the follow gait patterns would be the most appropriate? A. four-point gait B. two-point gait C. three-point gait D. swing-to gait
C. three-point gait for NWB or PWB
Following an exercise session for patients with heart failure in a Phase 3 cardiac rehabilitation program, what is prevented if the PT employs a gradual and prolonged cool-down period? A. exertional dyspnea B. tachycardia C. venous pooling D. hypertension
C. venous pooling Vasodilation while exercising to increase oxygen supply. Return to normal arterial dilation is delayed in patients with HF, and prolonged cooldown will prevent pooling
What are the signs and symptoms of respiratory acidosis? Hyper or hypo kalemia? Hyper or hypo ventilation?
CARBS 1. Confusion 2. Agitation 3. Restlessness 4. Blurred vision 5. Seizures ROME *Acidosis = hyperkalemia* Acidosis = Retaining CO2 (acidic) - *hypoventilation (low pH, low breathing)*
What Cranial Nerves are attached to the medulla?
CN IX - XII Spinal accessory really part of spinal column
What is the gold standard of treating lymphedema and what are the two phases?
Complete Decongestive Therapy Phase 1 (decongesting): MLD and compression bandaging - reduce size of the limb Phase 2 (maintenance): self management, use of compression garments, HEP
What is the defining characteristic of a Third Degree heart block?
Consistent P-P interval Consistent Q-Q interval atria and ventricles are not connected at all
Brown-Sequard Syndrome
Contralateral loss of pain and temperature Ipsilateral loss of motor, vibration sense, and proprioception
What is the purpose of a floor/ground reaction ankle-foot orthosis (GRAFO)?
Control at the ankle and the knee. Prevents excessive DF leading to excessive knee flexion in a crouched gait pattern or knee buckling during stance phase
A 5-year-old child has maxillary hypoplasia, an elongated mid face, and a short, upturned nose. The child has a short attention span and poor growth. Which of the following interventions would be most appropriate for the child? A. Gait training with a rolling walker B. Sensory desensitization activities C. Activities to inhibit spasticity D. Dynamic balance activities
D. Dynamic balance activities Fine motor dysfunction, visuomotor deficits, balance problems, and weak grasp are characteristics of children with fetal alcohol syndrome
Gary has been diagnosed with acute inflammatory demyelinating polyneuropathy (AIDP). The condition has progressed to the extremities and the trunk. The patient reports significant shortness of breath at rest. Which of the following additional findings is the most anticipated? A. vital capacity of 5.25 liters B. increased residual volume C. FEV1/FVC equals 0.65 D. FEV1 of 85%
D. FEV1 of 85% > 80% is normal or restrictive. All other choices are obstructive. Neuro disorders create restrictive pulmonary disorders Restrictive because less air inspired, but expiring it out is easier.
A patient with a brainstem infarction resulting in left lateral medullary syndrome is MOST likely to demonstrate which of the following symptoms? A. Hemiparesis in the left side of the body B. Hemiparesis in the right side of the body C. Loss of discriminative touch and proprioception in the left side of the body D. Loss of pain and temperature sensation in the right side of the body
D. Loss of pain and temperature sensation in the right side of the body lateral spinothalamic tract in the brainstem, which carries sensory information regarding pain and temperature, lies laterally and thus would be impaired in a lateral medullary stroke
Which of the following nerves are most active during urination? A. Sympathetic nerves from the hypogastric plexus B. Parasympathetic nerves from the hypogastric plexus C. Sympathetic nerves from the pelvic plexus D. Parasympathetic nerves from the pelvic plexus
D. Parasympathetic nerves from the pelvic splanchnic nerves to empty the bladder
A patient is in PT post-op recent prostatectomy and experiencing urinary incontinence. Loss of support to which of the following structures is most likely contributing to the incontinence? A. Levator ani B. Ductus deferens C. Ureter D. Urethra
D. Urethra Prostatectomy indicates removal of the prostate gland. The prostate gland provides mechanical support to the urethra between the bladder neck and the penis.
Severe epigastric and abdominal pain that radiates to the middle back and may worsen when lying supine is MOST characteristic of which condition? A. small intestine obstruction B. IBS C. appendicitis D. acute pancreatitis
D. acute pancreatitis small intestine is midabdominal, level of umbilicus Appendix is RLQ
A patient with cystic fibrosis (CF) has been admitted to the hospital in acute respiratory failure as a result of an infection. What is the BEST choice for use of airway clearance techniques? A. do not administer since it is contraindicated in acute respiratory failure B. administer two times a day to the patient's tolerance C. administer according to the patient's current home regimen D. administer vigorously once every 2 hours
D. administer vigorously once every 2 hours not contraindicated because the clearing the airway will alleviate the respiratory failure
A patient has the following limitations of the neck: limited and painful extension, limited and painful right side bending, and limited and painful right rotation. What is the arthrokinematic restriction? A. upglide of a facet on the left B. upglide of a facet on the right C. downglide of a facet on the left D. downglide of a facet on the right
D. downglide of a facet on the right pain on the right, restriction on the right downglide restriction - limited rotation and side-bending to right with limited extension FOES
A PT examines an adult patient that recently suffered a stroke that involved the right internal capsule. In addition to hemiparesis of the contralateral extremities, the patient also exhibits a facial palsy. Which facial muscle would most likely be affected? A. all muscles on the left side of the face B. all muscles on the right side of the face C. only muscles on the lower half of the right side of the face D. only muscles on the lower half of the left side of the face
D. only muscles on the lower half of the left side of the face internal capsule only affects contralateral lower half of the face. Upper half of the face innervated by both left and right cerebral cortex LMN in facial nucleus
An adolescent patient presents to PT with a 6-month history of pain in both hands. Subjective complaints consist of pain that is worse in the morning but gradually improves throughout the day and overall fatigue. The only significant objective data from exam was mild edema and pain at end ranges of motion. What should the PT do next in order to try to establish a diagnosis? A. administer the functional independence measure (FIM) B. examine for clubbing at the distal IP joints C. examine for Dupuytren's contracture D. refer the patient to a physician
D. refer the patient to a physician typical presentation for juvenile rheumatoid arthritis (JRA)
Exercises, e-stim, and biofeedback are most often used by PT to manage which kind of incontinence? A. urge incontinence B. functional incontinence C. overflow incontinence D. stress incontinence
D. stress incontinence used to strengthen levator ani in cases where increased intra-abdominal pressure results in sudden release of urine
Following a period of spinal shock, a patient with a complete SCI (ASIA A) at the T5 level is placed on a bladder training program coordinated by the nurse. A realistic ultimate outcome for this program would be independent voiding by using why of the following? A. crede manuever B. valsalva manuever C. timed voiding program D. suprapubic stroking or tapping
D. suprapubic stroking or tapping A spastic or reflexive (UMN) bladder contracts and reflexively empties. Reflex emptying can be triggered by manual stimulation techniques Other choices are for flaccid or LMN bladder that has no reflex action
An adult male patient's lab values show a hematocrit level of 45% post-op. This value is: A. anemic B. a sign of infection C. dangerously high D. within normal range
D. within normal range
What dysfunction do you suspect with the following symptoms? 1. pain and stiffness upon rising 2. pain eases through the morning (4-5 hours) 3. pain increases with repetitive bending activities 4. constant awareness of discomfort with episodes of exacerbation 5. describes pain as more soreness and nagging
Degenerative joint disease/OA
What is external validity?
Degree to which results of a study are generalizable
What is internal validity?
Degree to which the intervention being evaluated is responsible for the outcome being measured, and not the result of extraneous factors
Medications that end with -mide and -zide are what kind of drugs?
Diuretics
What are the symptoms of hypothyroidism?
Everything Slow and Low
*What are the signs and symptoms of hypokalemia (7)?*
Everything is Slow and Low: 7 L's 1. Lethargy (confusion) 2. Low, shallow respirations (due to decreased ability to use accessory muscles for breathing) 3. Lethal cardiac dysrhythmias - *EKG changes - depressed ST segment, flat T-wave, U-wave* 4. Lots of urine 5. Leg cramps 6. Limp muscles 7. Low BP & Heart Similar to hypercalcemia
4 GOLD Stages of COPD: How are they measured?
FEV1 Stage 1 (mild): FEV1 > 80% Stage 2 (moderate): 50% < FEV1 < 80% *Stage 3 (severe): 30% < FEV1 < 50% (barrel chested)* Stage 4 (very severe): FEV1 < 30% (supplemental O2)
What dysfunction do you suspect with the following symptoms? 1. stiff upon rising; pain eases within an hour 2. loss of motion accompanied by pain 3. patient will describe pain as sharp with certain movements 4. movement in pain-free range usually reduces symptoms 5. stationary positions increase symptoms
Facet joint dysfunction
Functional Gait Assessment (FGA) - Outcome Measures
Harder than DGI (7 items from DGI + 2 new ones) - high level community ambulator, <22/30 is fall risk
Where can renal and ureteral pain refer to?
Groin and genital area throughout the T10 and L1 dermatomes
What are the causes of hypercalcemia (7)?
HIGH CAL 1. Hyperparathroidism 2. Increased intake of calcium 3. Glucocorticoids 4. Hyperthyroidism 5. Calcium excretion decreased with Thiazides diuretics 6. Adrenal insufficiency 7. Lithium usage
What are the causes of hypernatremia (8)?
HIGH SALT 1. Hypercortisolim (Cushing's syndrome) 2. Increased salt intake 3. GI feeding without sufficient water 4. Hypertonic solutions 5. Sodium excretion decreased 6. Aldosterone problems 7. Loss of fluids 8. Thirst impairment
A patient suffered a right CVA, resulting in severe left hemiplegia and visuospatial deficits. In addition, there is a large diabetic ulcer on the left foot with pitting edema. The BEST choice for wheelchair prescription for this patient is?
Hemiplegic chair with elevating leg rest on the left designed to be low to the ground, allowing propulsion with the uninvolved UE and LE *Standard seat height is 20 inches* *Hemi- or low-seat WC has seat height of 17.5 inches*
What is the difference between osteoporosis and osteomalacia?
In osteoporosis, the bones are porous and brittle, whereas in osteomalacia the bones are soft
When using EMG biofeedback to increase muscle activity in the beginning of therapy, what is the appropriate electrode placement? When used later in the plan of care, how should the electrodes be placed?
Initially the electrodes should be spaced further apart to detect any muscle feedback. Eventually the electrodes should be placed closer together to minimize crosstalk, and yield smaller, more precise signals
What brachial plexus injury occurs when the C8 and T1 nerve roots are stretched during the birth process?
Klumpke's paralysis (brachial plexus injury)
Where does pain with IBS present?
LLQ pain which may be steady or intermittent, dull deep discomfort with sharp cramps in morning or after eating symptoms disappear during sleep
What are the causes of hypocalcemia (10)?
LOW CALCIUM 1. Low parathyroid hormone 2. Oral intake inadequate (alcoholism, bulemia) 3. Wound drainage (GI system) 4. Celiac's/Crohn's disease 5. Acute pancreatitis 6. Low vitamin D 7. Chronic kidney disease 8. Increased phosphorus 9. Using medications (loop diuretics) 10. Mobility issues
What sided CVA is Broca's aphasia mainly seen in?
Left sided CVA; right hemiplegia
What kind of meds are used to decrease tremors or bradykinesia in Parkinson's disease patients?
Levodopa; one side effect is choreoathetosis, a type of dyskinesia characterized by uncontrolled, involuntary movements. Onset could be 3 months after taking levodopa
What is the defining characteristic of a Second Degree Type I Mobitz I heart block?
Longer, Longer, Longer, Drop That is a Wenchebach PR interval gets long and longer and then drops a QRS after a P wave
What kind of walker encourages trunk extension, shoulder depression, elbow extension, neutral wrist, and may decrease scissoring of LE?
Posterior walker or posture control walker
What are symptoms of Cushing's syndrome (6)?
MORE CUSH 1. Moon face 2. Osteoporosis 3. Retention of water 4. Elevated BP 5. Central obesity 6. Unusual menstruation 7. Skin striae 8. Hypernatremia/Hyperglycemia (Fat people love chocolate covered pretzels)
*What are the signs and symptoms of hyperkalemia (6)?*
MURDER 1. Muscle weakness 2. Urine production - low or absent 3. Respiratory failure 4. Decreased cardiac contractility 5. Early signs of muscle twitching, cramps 6. Rhythm changes (wide QRS, depressed ST)
What is normal hemoglobin values?
Males: 14-17 g/dL Females: 12-16 g/dL
What kind of brace is indicated for scoliosis?
Milwaukee brace (23 hrs/day) for 3 years or Harrington rods. During 1 hr that the brace is off can do anything even horseback riding. Flexibility exercises
What special test can be used to screen for renal and ureteral pain?
Murphy's Percussion Test
What are the signs and symptoms of respiratory alkalosis? Hyper or hypo kalemia? Hyper or hypo ventilation?
NO CARDS 1. Numbness/Tingling 2. Orthostatic hypotension 3. Confusion 4. Anxiety 5. Rapid breathing 6. Dizziness 7. Seizures ROME *Alkalosis = hypokalemia* high pH, high breathing
What are the signs and symptoms of hypernatremia (5)?
No FRIED foods for you 1. Fever, flushed skin 2. Restless, agitated 3. Increased fluid retention 4. Edema 5. Decreased urine output, Dry mouth/skin
What is Rovsing's sign?
Palpation of LLQ increases pain in RLQ (+) appendicitis
What is a term used when someone fails to recognize another individual's rights and autonomy?
Paternalism
What premature complication is: necrosis of white matter adjacent to ventricles of brain due to systemic hypotension or ischemia, may result in cerebral palsy?
Periventricular leukomalacia (PVL)
If a patient has autonomic dysreflexia, what should you do?
Priority order: 1. if patient lying flat, bring to upright position 2. examine/reduce blockage of urinary drainage 3. loosen any tight clothing or restrictive devices 4. monitor vitals Notify medical and/or nursing staff ASAP
Specificity
Probability of obtaining a negative test among individuals without the disease: *true negative*. A positive result with *high specificity rules in the diagnosis* (SpPIn)
Sensitivity
Probability of obtaining a positive test among individuals who have the disease: *true positive*. When a test has a very high sensitivity, a negative result *rules out the diagnosis* (SnNOut)
What is the defining characteristic of a First Degree heart block?
Prolonged PR interval > 0.2 seconds
What is the defining characteristic of a Second Degree Type II Mobitz II heart block?
Prolonged but consistent PR interval (1st Degree) until a QRS complex is dropped
A patient presents with a unilateral capsular restriction of TMJ. What is the best intervention if upon opening, the chin deviates to the right?
Right TMJ, inferior glide manipulation
Which abnormal heart sound is NOT pathological in: 1. seasoned athletes 2. pregnant women 3. children
S3
What are the signs and symptoms of hyponatremia (5)?
SALT LOSS 1. Seizures and stupor 2. Abdominal cramping 3. Lethargic 4. Tendon reflexes diminished 5. Loss of urine and appetite 6. OH 7. Shallow respiration 8. Spasms of muscles
What are the signs and symptoms of metabolic acidosis? Hyper or hypo kalemia? Hyper or hypo ventilation?
SHAMED 1. Stupor 2. Headaches 3. Arrythmias 4. Muscle twitching 5. Emesis 6. Decreased cardiac output ROME Acidosis = hyperkalemia Kussmaul Respirations = hyperventilation
What is the difference between a SLAP and Bankart lesion?
SLAP lesion is a tear of the rim above the middle of the socket that may also involve the biceps tendon Bankart lesion is avulsion of the anterior-inferior capsule and glenoid labrum and might involve inferior GH ligament Both surgeries: avoid Apprehension position for 12 weeks. Arm in sling for 3-4 weeks
What type of bandage should you use for lymphatics?
Short-stretch compression bandages A. pressures generally 40-50 mmHg B. Garments need replacing every 3-6 months Low resting pressure and high working pressure
Sensory Organization Test - Procedure
Stage 1: EO, fixed surface, fixed visual surround Stage 2: EC, fixed surface Stage 3: EO, fixed surface, sway referenced visual surround Stage 4: EO, sway referenced surface, fixed visual surround Stage 5: EC, sway referenced surface Stage 6: EO, sway referenced surface and sway visual surround
If there is no infection, what stage of pressure ulcer is often treated with a dressing that occludes the wound from the environment?
Stage II
What type of ulcer presents as an abrasion, blister, or shallow crater?
Stage II
What stage of pressure ulcer often requires debridement, dressings, and advanced pressure alleviating measures?
Stage III
Stage of pressure ulcer: full thickness skin defect extending into the fat layer but not through fascia?
Stage III creates a legit crater
Medications that end with -sone are what kind of drugs?
Steroids
According to 2017 ACC/AHA guidelines, what is elevated BP?
Systolic: 120-129 mmHg AND Diastolic: < 80 mmHg
According to 2017 ACC/AHA guidelines, what is stage 1 HTN BP?
Systolic: 130-139 mmHg OR Diastolic: 80-90 mmHg
According to 2017 ACC/AHA guidelines, what is normal BP?
Systolic: < 120 mmHg Diastolic: < 80 mmHg
According to 2017 ACC/AHA guidelines, what is HTN crisis BP?
Systolic: > 180 mmHg AND/OR Diastolic: > 120 mmHg
According to 2017 ACC/AHA guidelines, what is stage 2 HTN BP?
Systolic: ≥ 140 mmHg OR Diastolic: ≥ 90 mmHg
What is indicated by a diminished P wave, but the duration of the QRS complexes occur within an appropriate normal (narrow) interval?
Supraventricular tachycardia
What does the detrusor muscle do?
The detrusor muscle remains relaxed to allow the bladder to store urine, and contracts during urination to release urine
What are the signs and symptoms of hypercalcemia (4)?
WEAK - loss of excitability in cell membranes 1. Weakness of muscles 2. EKG changes (shortened QT segment, depressed ST) 3. Absent reflexes, absent minded, abdominal distention 4. Kidney stone formation Similar to hyperkalemia
What does an infarct to the posterior inferior cerebellar artery (PICA) result in?
Wallenberg's syndrome (Lateral Medullary syndrome) - vertigo, nausea, hoarseness, dysphagia, ptosis, and decreased sensation in the ipsilateral face (Horner's syndrome) and contralateral torso and limbs
What is homonymous hemianopsia?
a deficit of either the right or left halves of the visual field, contralateral to the side of a cerebral hemisphere lesion
How is target heart rate calculated?
[(HR max - HR rest) *0.6 and 0.8] + HR rest
When does Horner's syndrome typically occur?
accompanies a stroke involving *anterior and posterior inferior cerebellar arteries*
What is a randomized control trial (RCT)?
an experimental study in which participants are randomly assigned to either an experimental or control group to received different interventions or a placebo
What is common with chronic kidney disease?
anemia
What is the frank denial, neglect, or lack of awareness of the presence of severity of one's paralysis?
anosognosia
Patient presents with: pale, shiny, dry skin, loss of hair, nail changes, and coolness of extremity Chronic arterial insufficiency or Chronic venous insufficiency?
arterial
What kind of ulcers are deep (edges are distinct and well-defined) and painful, with skin pale and cold, intermittent claudication, and poor pulses?
arterial insufficiency ulcers Deep = Arterial
How does a PT cognitively test for constructional ability?
asking a person to copy figures consisting of varying sizes and shapes or to draw a known item such as a clock
What is slow, involuntary, worm-like, twisting motions; usually seen in CP?
athetosis
What is the most common cause of autonomic dysreflexia?
bladder distention
What patholgies can lead to cor pulmonale (2)?
bronchitis or emphysema may create pulmonary hypertension which then puts more stress on the RV
What are the capabilities of C8 SCI?
capable of full use of all upper extremity muscles except intrinsics of the hand
What is the purpose of a Hickman Catheter (CVC)?
central venous catheter or central venous line which is a clear tube inserted in the jugular vein or other large vein and advanced to the superior vena cava 1. Deliver chemotherapy 2. Withdrawal of blood for analysis 3. Monitoring central venous pressure
Nominal Measurement Name some examples
classification scale; qualitative e.g., blood type, breath sound, arthritis type
What is the deformity of the hand without ulnar nerve innervation?
claw hand Permanent deformity with hyperextension of MCP and hyperflexion of IP 4-5
A patient presents with subacromial impingement. What ligament is compressing the supraspinatus tendon?
coracoclavicular ligament
Describe three-point gait pattern with crutches and what kind of patient is it indicated for?
crutches and involved LE are advanced together, followed by the uninvolved limb indicated for use with involvement of one extremity; NWB or PWB
What happens to the core temp during pregnancy?
decreases during exercises thermal stress to the fetus is reduced
What classification of burn injury: mixed red or waxy white color. The surface is wet from broken blisters, and marked edema is the hallmark sign of this burn depth.
deep partial thickness (2nd degree)
What muscle can be affected by nerve damage with an antero-inferior dislocation of the shoulder?
deltoids via axillary nerve
*During exercise, what elevated DBP is grounds for termination?*
diastolic BP ≥ 110 mmHg
What medication increases cardiac pumping ability and decreases heart rate? What effect would it have on an EKG?
digitalis; prolongs PR wave
What dysfunction do you suspect with the following symptoms? 1. no pain in recline or semireclined position 2. pain increases with increasing WBing activities 3. describes pain as shooting, burning, or stabbing 4. patient may describe altered strength or ability to perform ADLs
discal, with nerve root compromise (HNP)
What are the symptoms of hyperglycemia (7)?
everything is ELEVATED/HYPER like metabolic ketoacidosis 1. skin is dry and flushed 2. fruity breath odor 3. frequent urination (polyuria) 4. unusual thirst (polydipsia) 5. extreme hunger 6. unusual weight loss (10 lbs in 1 month) 7. extreme fatigue 8. irritability 9. blurred vision 10. tachycardia/hypotension 11. hyperventilation
What are the key muscles of C6 SCI?
extensor carpi radialis, infraspinatus, lats, pecs, serratus anterior, and teres minor Bench press muscles, except for triceps
Type II Error
false negative; accepting the null hypothesis when it is false
Type I Error
false positive; rejecting the null hypothesis when it is true
During auscultation of the lungs, rales (crackles) are heard. What are the possible pathologies (5)?
fluid buildup in the alveoli or smaller airways 1. Bronchiectasis 2. Bronchitis 3. pneumonia 4. fibrosis 5. CHF 6. pulmonary edema "Rales in the tails" discontinuous
What is the function of a Minerva orthosis/cervical thoracic orthosis?
good control of all cervical motions and indicated for stable C/S and T/S fractures or fusions
What is concurrent validity?
the degree to which a new test correlates with an established test of known validity (the gold standard).
what is the order of donning isolation garments
hat shoes mask goggles visor face shield gown gloves
What is a sudden, jerky, forceful, and flailing involuntary movement on one side of the body?
hemiballismus
What does an APGAR score ≤ 4 indicate?
immediate care
Why does gastritis develop (4)?
in association with serious illness or various meds such as: 1. aspirin 2. other NSAIDs (greater than 3 months) 3. corticosteroids 4. food allergies caused by helicobacter pylori
Ratio Measurement Name some examples
intervals between adjacent values are equal AND there is a true zero point *R*atio = *R*OM
Interval Measurement Name some examples
intervals between adjacent values are equal, but there is no true zero point e.g., temperature
What is pneumonia?
intra-alveolar inflammatory process secondary to bacteria, virus, or aspirated material within the lungs bacterial - *gradual onset of days with productive cough* viral - *more abrupt onset with a dry cough*
What can ST depression indicate?
ischemia if 2-3 mm
In wound healing, what is the purpose of panafil?
keratolytic enzyme used for selective debridement
Describe the mobilization glide to increase subtalar INV
lateral glide
Patient presents with forefoot valgus. What foot orthoses should be prescribed?
lateral sole wedge
What side should a patient lay on if they have nocturnal reflux?
left side The lower esophagus bends to the left, so reflux is minimized in this position.
if the mandible deviates to the right with depression- what is the affected side?
left sided TMJ hypermobility right sided TMJ hypomobility hypermobile side will have pain and indentation
What is the function of a Jewett (TLSO)?
limits flexion and encourages hyperextension of spine
What does palmar erythema indicate?
liver or renal issues
What is the purpose of a peripherally inserted central catheter (PICC)?
long thin tube inserted into a peripheral vein and advanced to the superior vena cava. *Long-term* 1. Administration of chemotherapy drugs 2. Extended antibiotic therapy 3. Parenteral Nutrition 4. Administration of drugs that should not be injected peripherally
*What is normal hematocrit values?*
male 42-52% female 37-47%
Describe the mobilization glide to increase subtalar EV
medial glide
Patient presents with forefoot varus. What foot orthoses should be prescribed?
medial sole wedge
What nerve damage would affect flexion of digits and precision grip?
median nerve
How do you measure the seat height for a WC?
minimum clearance between the floor and the footplate is 2 inches, measured from the lowest point on the bottom of the footplate
What is the function of a single-axis foot (SAFO) and who is it not good for?
most common articulating foot that permits PF and DF 1. for individuals with bilateral transfemoral amputations 2. cons: permits PF and DF only, limited on uneven terrain. NOT GOOD FOR ELDERLY
What is osteochondritis dissecans?
most common is a separation of articular cartilage from underlying bone (pothole) usually involving medial femoral condyle near intercondylar notch. Less frequently at femoral head and talar dome occurs in adolescents between ages of 12-15
What is the function of a KAFO with a drop ring lock?
most common knee control - locks the knee in extension. Upon standing, the ring drops over the joint preventing the knee from bending. A spring-loaded retention button is used to hold the ring up and unlock one hinge at a time
What polarity is the cathode and what drugs are used during iontophoresis?
negative pole "bad (-) cat is SAD" iodine (softens scars) Salicylate (pain relief) Acetate (calcium deposits) Dexamethasone (anti-inflammatory)
What is the moro reflex?
occurs when there is a sudden change in position of the head in relation to the trunk (ex: drop a patient backward from sitting) and the infant extends and abducts the UEs with hand opening and crying. Perform last
What is pre-eclampsia?
onset after 20 weeks of gestation with: 1. proteinuria 2. systemic vasoconstriction 3. HTN and end-organ damage 4. hemolysis 5. elevated liver enzymes 6. low platelets
What is softening of the bones without loss of the bone matrix caused by a vitamin D deficiency in adults?
osteomalacia
What is the zone of ischemia and how can it be detected on an ECG (2)?
outermost area of zone of infarction; 1. *ST wave depression* 2. *inverted T wave* Bizarro World
What kind of finger splint is indicated for Mallet finger?
palmar DIP gutter splint to support distal phalange
If you have cirrhosis of liver due to alcohol, you probably have what else?
pancreatitis
In wound healing, what is the purpose of sulfamylon?
penetrates through eschar and provides antibacterial control
What polarity is the anode and what drugs are used during iontophoresis?
positive pole hydrocortisone (anti-inflammatory) lidocaine (pain relief) magnesium or calcium (muscle spasm) lithium (gout) zinc (dermal ulcers) copper (fungal infections)
What happen to the inferior vena cava in the supine position?
pressure in the inferior vena cava rises because of the compression by the uterus just below the diaphragm supine hypotension syndrome
How frequently should a bariatric patient perform aerobic exercises?
progress to 4-6 times per week in the 2-5 MET range as tolerated
What is albumin?
protein indicative of renal disorder if elevated in blood levels
What nerve is affected with benediction hand?
proximal median nerve injury Active deformity when asked to make a fist
Describe the mobilization glide to increase radiocarpal wrist ulnar deviation
radial glide
What nerve compression is "crutch palsy"
radial nerve
Ordinal Measurement Name some examples
ranking scale; intervals between ranks may not be equal or known e.g., MMT grade, levels of assistance, pain
What muscle can be affected by nerve damage with a medial and posterior dislocation of the shoulder?
rhomboids via dorsal scapular nerve
What neurological technique is indicated for spasticity, rigidity, hypertonicity, inability to initiate motion (apraxia), motor learning deficits, or communication deficits (aphasia)?
rhythmic initiation (RI) - voluntary relaxation followed by PROM through increasing ROM, followed by AAROM progressing to PRE PD patients benefit from RI for trunk rotation
What neurological technique is indicated for instability in WBing and holding, poor antigravity control, weakness, ataxia, limited ROM caused by muscle tightness, painful muscle splinting?
rhythmic stabilization (RS) - simultaneous isometric contractions of both agonist and antagonist patterns performed without relaxation
What kind of finger splint is indicated for Swan Neck deformity?
ring splints over PIP joint to prevent PIP hyperextension
In what body part is weakness first seen with ALS?
seen in the hands first Lou Gehrig held bat in his HANDS
What is the scoring criteria for the Glasgow Coma Scale?
severe: 1-8, moderate 9-12, and minor (13-15) 4-Eyes, 5 - *V*erbal, 6-pack abs - Motor
What is the Galant or trunk incurvation reaction?
sharp stroke along paravertebral line from scap to top of iliac crest results in lateral trunk flexion toward stimulated side integrated at 2 months
Which UE muscles help with ambulatory aids (3)?
shoulder depressor and extensors 1. lower trapezius 2. pectoralis major 3. latissimus dorsi they help to elevate the body slightly.
What is the Modified Ashworth Scale and how is it performed?
six grades used for grading spasticity. Lower score is better Spasticity is defined as increased resistance to passive stretch that is velocity-dependent.
When setting up e-stim pads, how far apart should the electrodes be?
space between the electrodes should be at least the diameter of the electrodes being used. The farther apart = deeper the penetration The closer = superficial penetration
What is Froment's sign?
special test of the wrist tests for palsy of the ulnar nerve - specifically the action of adductor pollicis -froment sign can refer to cogwheel effect (seen in essential tremor)
What dysfunction do you suspect with the following symptoms? 1. pain is related to position 2. flexed positions decrease pain, and extended positions increase pain 3. describes symptoms as a numbness, tightness, or cramping 4. walking for any distance brings on symptoms 5. pain may persist for hours after assuming a resting position
spinal stenosis
What has poorly defined margins, present flat red area, ulcer, grows more quickly, common on face, neck, and back of hand; much higher risk of metastasizing?
squamous cell carcinoma
when you hear an opening click of the TMJ what does that describe
the reduction of the disc
What TMN stage of cancer: tumor is locally more advanced; spread to lymph nodes
stage III
What is a meta analysis?
statistical analysis that combines the results of multiple conceptually similar scientific studies; results in higher statistical power
What is indicated by a large, pathological Q wave?
transmural myocardial infarction Also look for ST elevation
In wound healing, what is the purpose of nitrofurazone
superficial agents that attack surface organisms
What classification of burn injury: damage to the upper layer of the dermis and epidermis. Bright pink or red appearance, BLISTERS, moist surface, weeping
superficial partial thickness burn (2nd degree)
*What change in blood pressure is orthostatic hypotension?*
systolic drops > 20 mm Hg or if diastolic drops > 10 mm Hg
For an ACL reconstruction, other that patella tendon, what is the next most common tendon(s) for autograft?
tendons of semitendinosus and gracilis 2/3 Pes Anserine muscles
What is the function of a Taylor brace?
thoracolumbosacral flexion, extension control orthosis with axillary shoulder straps to limit upper trunk flexion
What are the key muscles of C7 SCI?
triceps, extrinsic finger extensors, flexor carpi radialis
What is a systematic review?
type of literature review in which primary studies are summarized, critically appraised, and statistically combined
Describe the mobilization glide to increase radiocarpal wrist radial deviation
ulnar glide
What nerve damage would affect power grip and flexion on medial side digits?
ulnar nerve
What type of incontinence may occur with pregnancies?
urinary stress incontinence
Patient presents with excessive pes varus (supination) or genu varum. What foot orthoses should be prescribed?
valgus or lateral heel wedge - provides support along the lateral side of the heel
What is an independent variable?
variable that is controlled or manipulated by the researcher x-value
What is a dependent variable?
variable that is measured y-value
Patient presents with pronation and flexible pes valgus. What foot orthoses should be prescribed?
varus post or medial heel wedge - controls eversion of calcaneus and internal rotation of tibia
What dysfunction do you suspect with the following symptoms? 1. pain is consistent in all spinal positions 2. pain is brought on by physical exertion 3. pain is relieved promptly with rest (1-5 minutes) 4. pain is described as a numbness 5. patient usually has decreased or absent pulses
vascular claudication
What effects does nitrate have on the heart?
vasodilator (nothing else) - decrease preload, BP, and oxygen demands - makes it easier for heart to work
What kind of ulcers are painless and superficial with good peripheral pulses?
venous insufficiency ulcers Shallow = Venous
What kind of ulcers are typically shallow and irregular and located over bony prominences?
venous insufficiency ulcers usually reported as burning, throbbing, cramping, aching, and leg fatigue
Describe the mobilization glide to increase distal radioulnar pronation
ventral/anterior glide
Describe the mobilization glide to increase mid carpal wrist extension
ventral/anterior glide
Describe the mobilization glide to increase proximal radioulnar supination
ventral/anterior glide
Describe the mobilization glide to increase radiocarpal wrist extension
ventral/anterior glide
When constructing a ramp with handhails, how high should the rails be and how far should they extend past the ramp?
waist high for ambulators (34-38 inches) should extend 12 inches beyond the top and bottom of runs; ramp should have level landing at top and bottom
How does the patient present with Erb's palsy?
waiter's tip deformity shoulder is ADD and IR C5-C6 - usually involving 1. suprascapular (supraspinatus, infraspinatus) 2. musculocutaneous (biceps brachii,coracobrachialis, brachialis) 3. axillary (teres minor, deltoid)
