REMEMBER THIS ISHHHH
What is upper limb tension test for ulnar nerve bias?
*CARRYING TRAY POSITION* 1. Shoulder depression 2. Shoulder abduction 3. Shoulder ER 4. Wrist and finger extension 5. Elbow flexion
What are the scores for Oswestry?
0-20 = mild >40 = severe 81-100 = bed bound HIGHER THE SCORE THE WORSE THE PATIENT IS
How many weeks does phase I last with ACL?
0-4 weeks
What is tonic labrinthine reflex?
0-6 months In supine = extension In prone = flexion Interferes with ability to initaterolling sitting balance and standing
What is the modified ashworth scale?
0: no increase in muscle tone 1: slight increase in muscle tone, ac relese or by minimal resistance at the end of range of motion 1+: slight increase in muscle tone, manifested by a catch, followed by minimal ressitnac 2: ]
When descending a ramp in a wheelchair, the patient should?
1. Apply friction to the handrims to slow the forward motion of the chair 2. Move hips to the back of the seat 3. Sit upright to avoid falling forward
What are the steps for SLUMP test?
1. Ask patient to flex thoracic, lumbar spine 2. Actively flex their cervical spine and therapist applies overpressure 3. Ask patient to actively extend their knee 4. Provide overpressure to ankle dorsiflexion
What conditions have wheezing?
1. Asthma 2. Bronchitis 3. Bronchiectasis *think obstructive conditions*
Results of screening indicate a possible right hip dislocation. The present of what is MOST consistent with this diagnosis?
1. Asymmetrical gluteal folds 2. Femoral telscoping 3. Limited passive hip abduction of right side 4. Leg length inequality
What does musculocutaneous nerve innervate?
1. Biceps 2. Coracobrachialis 3. Brachialis Injury = weakness with elbow flexion and forearm supination All muscles are located on anterior arm, along with sensory innervations to lateral forearm
What are symptoms of cauda equina syndrome? (below L1-L2)
1. Bilateral leg weakness 2. Severe low back pain 3. Bladder/bowel dysfunction (urinary retention) 4. Saddle anesthesia 5. Hyporeflexia 6. Neurogenic claudication.
What information is collected during graded exercise test?
1. Blood pressure 2. Heart rate 3. Perceived exertion
What are examples of central vestibular lesion?
1. Brainstem strokes 2. Head trauma 3. MS 4. Cerebellar degeneration
What are signs of venous insufficency?
1. Brownish pigmentation 2. Normal skin temperature 3. Edema Arterial insufficiency would have diminished pedal pulse, LE pain with exercise and loss of color
What conditions have rhonchi sound?
1. CHF 2. Pneumonia 3. Bronchitis Usually associated with conditions such as COPD, pneumonia, cystic fibrosis or bronchitis
What are some ways to treat BBPV?
1. Canalith repositioning 2. Eplys 3. Sermont (liberatory) maneuver
What happens when HR increases?
1. Cardiac output increases
When is nerve conduction test used?
1. Carpal Tunnel 2. Guillan Barre 3. Peripheral neuropathy
What are common conditions associated with hypothyroidism? (hashimoto's)
1. Carpal tunnel 2. CHF 3. Rhabdomyalysis
What is difference between carpal tunnel syndrome and cubital tunnel syndrome?
1. Carpal tunnel - compression of the MEDIAN nerve resulting in parasthesias, numbness and weakness, night pain 2. Cubital tunnel - in the elbow and is compression to the ULNAR nerve which leads to paresthesias in 4th and 5th digits (can be facilitated by sleeping with hand in flexed position or repeated leaning on a hard surface)
What is cognitive stage of learning?
1. Cognitive -patient relies on vision and demonstration -need guidance, direction -knowledge of results given since early on -do in closed environment -distributed practice time -blocked repetitive practice CLOSED, BLOCKED, DISTRIBUTED, PART TRAINING
What are signs to terminate exercise during phase I cardiac rehab?
1. DBP 110 or greater 2. SBP >210 or an increase of greater than 20 from resting 3. HR that increases 20 bpm above resting *
What happens with full immersion to neck level with aquatic therapy?
1. Decrease in heart rate 2. Decrease in systolic blood pressure 3. Decrease in Vo2 response to exercise 4. Increase in cardiac output 5. Increase in venous return 6. Increase in stroke volume 7. Decrease in vital capacity due to compression of chest wall under water caused by an increase in hydrostatic pressure
What are signs of metastases?
1. Decrease tolerance to weight bearing 2. Change in DTR's 3. Change in sleep habits
What are skin compositions changes associated with aging?
1. Decreased sensitivity to touch 2. Decreased perception of pain and temperature 3. Increased risk of injury 4. Impaired sensory integrity
What is physiology behind orthostatic hypotension?
1. Decreased venous tone which leads to pooling of blood in LE's when standing 2. Reduction in amount of blood returning to the heart which decreases ventricular filling and ultimately decreases cardiac output 3. Sympathetic system activated to compensate
Sequence of exercises for lymphedema?
1. Deep breathing 2. Trunk exercises 3. Proximal exercises 4. Distal exercises Start with breathing for relaxation so the tension in the body does not obstruct lymphatic flow Next step is to clear central and proximal lymphatic vessels in the abdomen, inguinal, cervical regions by doing trunk hip and neck exercises Next do proximal region exercises (shoulders, hips) Finally do distal exercises (hands, feet)
What is the treatment for forward head posture?
1. Deep cervical flexor strengthening 2. Shoulder retractor strengthening 3. Cervical extensor stretching 4. Pec muscle stretching 5. Upper trap and SCM stretching
What are 2 issues associated with prolonged steroid usage?
1. Delayed wound healing 2. Bad for bones
what are common conditions associated with hyperthyroidism?
1. Diabetes 2. Myasthenia Gravis 3. Adhesive capsulitis 4. Osteoporosis
What are benefits of ultrasound imaging?
1. Diagnoses tendon tears 2. Fluid collection within muscles, bursae, joints soft tissue 3. Can see early changes in RA 4. Soft tissue masses CAN NOT PENETRATE BONE AND VISUALIZE INTERNAL STRUCTURES OF BONE
What are signs of a pulmonary embolism?
1. Diaphoresis 2. Dyspnea 3. Apprehension 4. Chest pain 5. Hemopytosis
What is a common mental state manifestation of hypoglycemia?
1. Difficulty speaking 2. Difficulty concentrating
What pain is consistent with hip labral tear?
Groin pain that is aggravated with crossing affected leg over the other (flexion, adduction, internal rotation) FAI = hip labral tear
What is difference between HKAFO and RGO?
HKAFO = NO coordination RGO = Requires coordination
What are 3 PT implications for beta blockers?
HR and BP response to exercise will be diminished (use RPE) May see sinus bradycardia on ECG if patient is on beta blockers **** May see disparity in BORG because they are on beta blockers
What are PT implications for calcium channel blockers?
HR and BP response to exercise will be diminished (use RPE)Observe patient for signs of CHF such as worsening peripheral edema (this is a side effect)
What must e considered when designing a program for a patient with angina when the UE's are exercised?
HR and BP rise more steeply in relation to workload than when exercising the LE"s Angina = HR x SBP
If you have hypoparathyroidism (low calcium) what kind of symtpoms do you expect?
HYPERACTIVE symptoms 1. Tetany 2. Muscle cramps 3. Chvostek sign 4. Trosseau sign - carpal tunnel spasm when BP cuff is tight 5. Hyperactive DTR's
What is function of digitalis?
Increases the force of myocardial contraction in patients with congestive heart failure This increases cardiac output and decreases the preload, cardiac workload and myocardial oxygen demand Leads to prolonged PR interval on ECG by increasing the conduction time through the AV node Also produces shortening of the QT inerval and sagging in ST segment
What happens if you increase the pulse width with E-stim?
Increases the intensity of stimulation
What is the scoring for the TUG?
Independent = 10 seconds or less Increased risk but functionally independent = 20 seconds High falls risk = >30 seconds
What happens to heart rate when the carotid sinus is overstimulated?
Heart rate decreases
What is GMFCS level 1 (CP)?
Independent ambulation Climbs stairs without use of railings, runs, jumps BUT has limited speed, balance and coordination
What effect does calcium have on the heart?
Helps with contraction
What are side effects of warfarin and coumadin?
Hematura (blood in urine) and eccymosis (bruising)
What is difference between disc herniation and stenosis?
Herniation - unilateral symptoms, flexion aggravates Stenosis - bilateral, extension aggravates SLR is positive with both
What kind of diet should someone with Parkinson's have?
High calorie, low protein protein can potentially block the effectiveness of levadopa
Which of the following chronic hormonal responses to exercise may contribute to menstrual dysfunction?
High levels of cortisol, low levels of follicle-stimulating hormone (FSH) (exercise elevates cortisol levels which in turn suppresses secretion of GnRH which in turn suppresses LH and FSH Low levels of FSH lead to period issues
What are biofeedback settings for muscle relaxation?
High sensitivity A decrease in audio or visual feedback would be a good sign
What is treatment parameter for muscle relaxation?
High sensitivity with active electrodes placed close to each other As patient improves with relaxation, electrodes should be placed further apart and sensitivity should be increased even more
What kind of current/voltage should be given for wounds?
High volt monophasic current
What is GMFCS level 2?
Independent ambulation in most settings, climbs stairs with railing Requires assistive device with environments that challenge balance Wheeled mobility for long distances
What glide improves inhalation (ribs)?
Inferior glide Think "I,I"
A physical therapist treats a patient rehabilitating from spinal fusion in the lumbar spine. The surgical procedure required a bone autograft to stabilize the lumbar segment. What postoperative finding would be MOST likely based on the utilization of the bone graft?
Hip pain Bone graft for spinal fusion usually taken from anterior/posterior portion of iliac crest Post op is hip pain, bleeding
Following a partial-thickness burn over the entire anterior hip and anterior knee regions, the patient should be positioned with the hip in:
Hip: 0° of extension Knee: 20° of flexion. Hip should be in neutral (20*) to prevent a flexion contracture and the knee should be flexed to prevent an extension contracture
At what level can a patient perform community ambulation with a KAFO?Home ambulation with KAFOCommunity ambulation with an AFO (myelomengicele)
Home = L1-2 Community = L3-4 Community ambulation with AFO = L4-5
What is a hubbard tank and what is a highboy tank?
Hubbard = large, stainless steel whirlpool designed or immersion of enire body and is used primarily for treatment of patients with extensive burn wounsd Highboy tank = larger parts of xtremities and trunk. Permits sitting in chest high water with hips and knees FLEXED
What does the C8-T1 nerve roots form?
Median nerve supplying flexor pollicis longus C5-C6 nerve roots form the axillary nerve which supply deltoid and teres minor C5-8 and T1 form the radial nerve suppying the triceps and brachioradialis C7-C8 nerve roots form the ulnar nerve and radial nerve sup Someone who has
What kind of stool is seen with GI bleeding?
Melena (black stool)
What is the gold standard for determining body composition?
Hydrostatic Weighing (calculates density of the body by immersing a person in water and measuring the amount of water that is displaced)
What part of aquatic therapy is good for LE edema?
Hydrostatic pressure
Which principle makes aquatic therapy a good modality of choice for a patient with distal LE edema?
Hydrostatic pressure Pressure of the water exerts equal pressure around the LE that creates a pressure gradient encouraging the proximal flow of fluids which reduces edema
What is swans neck deformity?
Hyperextension of PIP and flexion of DIP Caused by a contraction of intrinsic muscles or tearing of the volar plate
A patient is performing a sit-up in a knee-bent position with the feet stabilized. If the patient has rectus abdominis weakness, which of the following can be expected during the curl-up phase?
Hyperextension of the low back
When is a tympanic sound heard?
Hyperinflated chest
What term describes the thickening of the skin often seen in patients with lymphedema?
Hyperkeratosis(typically observed in stage 3)
What do those with vestibulochoclear nerve lesion have?
Hypersensitivity to sound
Which is NOT a disorder resulting in obesity?
Hyperthyroidism (this instead makes you lose weight)
A middle-aged patient has been undergoing long-term corticosteroid treatment for pulmonary sarcoidosis. Due to the side effects of treatment, which intervention is the MOST important component to the patient's physical therapy plan of care? 1. Supplemental oxygen use. 2. Resisted exercise for proximal muscle strengthening. 3. Acapella for airway clearance. 4. Education on pursed-lip breathing.
2. Resisted exercise for proximal muscle strengthening.
a PT inspects a ramp. The ramp has two 24 foot sections connected by a landing area. How many inches is the MOST likely total height of the ramp?
48 inches Think two 24 means its 24 inches run you need 12 inches for every 1 inch rise so 48 inches has to have 48 inches of rise KEY WORD is 2 here DO NOT MISS IT
What is the percentage of body weight to use for mechanical separation of lumbar spine?
50%
What is average stride length?
56 inches or 144 cm
How long should you be immobilized after extensor tendon repair?
6 weeks (3 months)
What is the minimum space required to turn 180 degrees in a standard wheelchair?
60 inches
What percentage of gait cycle is stance?
60%
Ideally the height of a step should be no higher than?
7 inchesNo taller than 7 inches and 11 inches deep A step than is >8 inches is problematic
What is normal degree of hallux extension?
70 degrees
What is the loosed pack position for the humeroulnar joint?
70 degrees flexion
What should blood glucose levels be for patient safety?
70-250 mg/dL
What is the recommended exercise intensity according to the American College of Sports Medicine?
70-85% of max HR
What condition has digital clubbing?
75-85% of pulmonary disease has digital clubbing
What apgar score is considered normal?
8-10 Would not need resucitationa nd their heart rate would be over 100 bpm
What degree heat should pool be for those with MS?
80-84 degrees
What ABI indicates SEVERE PAD?
<.5 having adequate arterial blood flow is essential in considering application of compression for lymphedema
What is considered good triglycerides?
<150
What score is considered falls risk for Tinneti?
<19 Maximum score is 28
What score is considered falls risk for BERG balance scale?
<45 = increased risk for falls 56 is the maximum score Has 14 tasks
What reliability coefficients represent good reliability?
>.75 Mod reliability = .5-.75 Poor reliability = <.5
What are ABI values?
>1.3 = rigid, calcification 1-1.3 = NORMAL .99-.79 = mild .79-.4 = moderate, INTERMITTENT CLAUDICATION <.5 = SEVERE, PVD
What is a positive exercise tolerance (Graded exercise test)?
>2mm horizontal or downsloping St segment depression or >2 mm ST segment elevation
What degree of ROM would further increases patellofemoral pain syndrome?
>30 degrees Exercises should be kept between 0-30 degrees whether flexion or extension
What diameter of a wound is bad?
>5 mm or width of pencil erasor
What can be said with statistical p value?
A p value obtained less than the alpha level = statistical difference exists (a statistically difference exists between the 2 interventions) ex: p = .001 alpha = .05 p<alpha
What is the BEST indicator of their functional capacity correlating with long term and short term survival in pt's with CHF?
A patient's ability to walk 300 meters on the 6MWT has shown to be the best indicator of long term and short term morbidity and mortality in patients with congestive heart failure
begins at ground level and ends 18 inches above ground should be at least how many feet long?
A ramp must possess a minimum of 1 inch of rise for every 12 inches of run As a result, 18 inches of rise would require a ramp with a minimum of 18 feet of run (18 inches x 12 inches) / 12 = 18 feet
What is Hoover's test?
A test for malingering * 1. Place hand underneath each calcaneus 2. Patient asked to perform SLR on uninvolved extremity 3. See if patient exerts a downward force on involved side 4. This indicates they may be lying
Which statement is true regarding the relationship between validity and reliability?
A valid test must be reliable However if a test is reliable, it does not necessarily have to be valid
After sustaining direct trauma to his anterior leg, a construction work complains of severe pain, numbness, and tingling on the dorsum of the foot. on examination, the PT notes a tensely swollen leg, weak ankle dorsiflexors, and an absent dorsalis pedis pulses. what is the MOST LIKELY diagnosis?
Acute anterior compartment syndrome acute anterior compartment syndrome is usually the result of direct trauma or tibial fracture resulting in swelling and increased compartmental pressure that results in local muscle ischemia. the six p's of comparment syndrome are: pain, palpable tenderness, paresis, and pulselessness all of which were decribed in this questi
what is pain and tenderness with palpation over McBurney's point associated with?
Acute appendicitis is in the right lower abdominal quadrant
What is function of gracilis?
Adducts, flexes and medially rotates
What is function of pectineus?
Adducts, flexes and medially rotates as well
A patient diagnosed with Cushing's syndrome is referred to physical therapy. Which of the following signs and symptoms is NOT consistent with the Cushing's syndrome? A. Distension of the abdomen B. Swelling in the facial area C. Adrenal hypoplasia D. Cardiac hypertrophy
Adrenal hypoplasia NOT associated with cushings It should be adrenal hyperplasia
What is Uthoff's sign?
Adverse reaction to heat seen in MS
What is Horner's syndrome?
Affects cranial nerve III Results in decreased pupil size, a drooping eyelid, decreased sweating on the affected side of face
When is there peak muscle activity for tibialis anterior?
After heel strike
A patient with a long history of cigarette smoking has been admitted to the hospital and presents with tachycardia, signs of lung infection, abnormal breath sounds, and dullness to percussion? what should be the therapists INITIAL intervention focus on with this patient?
Airway clearance and secretion removal This person has pneumonia based on symptoms so it is important to assist with secretion clearance and improve gas exchange
What is the best dressing to use for an infected wound?
Alginate
What are the benefits of a rigid dressing for someone with an amputation?
Allows for early fitting of a prosthesis and weight-bearing and helps to alleviate edema and pain Requires more supervision As the residua limb heals, sutures are removed and the limb changes shape which means a new cast has to be made A patient with coronary artery disease received inpatient cardiac rehabilitation after a mild myocardial infarction (MI). The patient is now enrolled in an outpatient exercise class that utilizes intermittent training. What is the BEST initial spacing of exercise/rest intervals to safely stress the aerobic system?
What are the different fibers?
Alpha - LARGE, myelinated C fibers - unmyelinated
What causes those with advanced emphysema to have difficulty breathing?
Alveolar dilation Emphysema - abnormal and permanent enlargement of air spaces accompanied by destructive changes of the alveolar walls
muscle weakness and fatigue. Examination reveals leg cramps and hyporeflexia. The patient also experiences frequent episodes of postural hypotension and dizziness. Abnormalities on the ECG include a flat T wave, prolonged QT interval and depressed ST segment. These findings are suggestive of
Hypokalemia - Flat T waves prolonged QT
Hypokalemia does what to T waves? Hyperkalemia does what to T waves?
Hypokalemia: Inverted T waves... caused by thiazides/diuretics Hyperkalemia: Peaked T waves
What should you be considered about for a patient participating in aquatic therapy but taking anti-hypertensives?
Hypotension (increased vasodilation with aquatic)
What are levels of GMFCS?
I = walks without limitations II = walks with limitations III = walks with handheld device IV = power mobility; self mobility with limitations V = manual wheelchair
What are the 4 salter harris supracondylar fractures?
I: non displaced fracture across the growth place type II: fractures are angulated and displaced fractures displaced in 3 directions type III: also starts through growth plate but turns and exits through the end of the bone into the adjacent joint type IV: fracture through all 3 elements of the bone; impairs normal growth
A therapist decides a patient would benefit from joint mobilizations. Therefore, the therapists performs large amplitude oscillations up to tissue resistance for approximately 8 minutes. This is a grade ____mobilization
III
Would patients with cardiac transplants experienced an increase or a decrease in resting HR?
INCREASE due to lack of parasympathetic innervation
Which of the following laboratory values should a physical therapist monitor when treating a patient who is taking warfarin (Coumadin)?
INR NOT hemoglobin, hematocrit or RBC count
What is osteochondritis dissecans?
IS A BONE DISORDER Most often occurs in the knee leading to knee pain, swelling and feeling of giving way Causes: repetitive stress on the joint, low vitamin D
What is Nobles compression test for?
IT band syndorme
How do best strengthen hip abductors?
If L is weak want to do R stance with L leg kick outs to the side
What kind of tremors are associated with cerebellar lesions?
Intention (action) tremors (these are ABSENT at rest and elicited during muscle activation) cerebellar lesions also involve instability in both static and dynamic conditions, wide BOS, ataxia, dysmetria, dysdiadochokineia, intention tremor parkinson's is different and has a resting tremor
What muscles are stretched with FABER position?
Internal rotatators THINK if you are in external rotation then you must be stretching the opposite muscle with is the internal rotators If you want to stretch external rotatars then you must be positioned in internal rotation (kinda like adduction position)
What is function of teres major?
Internal rotation
What leads to medial whip with prosthetic?
Internal rotation at knee joint
What is the obturator sign special test for appendicitis?
Internal rotation of hip with hip and knee flexed to 90 degrees By doing this, the obturator muscle may come in contact with an inflamed appendix which will elicit pain
What is foot position for forefoot VARUS?
Inversion "Thumbs up position" Average = 0-10 is normal Compensated with rearfoot valgus
What is forefoot varus?
Inverted position of the forefoot in relationship to the rearfoot with the subtalar joint in a neutral position (INVERTED FOOT - BIG TOE THUMBS UP) Seen in those with high medial arch
What is athetoid CP characterized by?
Involuntary movements that are slow and writhing
What is raminste phenomenon?
Involved LE abducts with applied resistance to opposite leg
What is a full thickness burn?
Involves all of epidermis and dermis plus SUBCUTANEOUS FAT Minimal pain Third degree burn Requires graft Brown black charred appearancce and is dry and leathery
What is subdermal burn?
Involves complete destructin of epidermis, dermis and subcutaneous fat PLUS MUSCLE AND BONE Requires surgical intervention and extensive healing time
What is deep partial thickness burn?
Involves epidermis and majority of the dermis May have broken blisters and edema Mod level of pain cause now you have some damage to nerve endings MOST SCARS HERE * (keloid and hypertrophic) Healing in 21-35 days
What is a superficial burn?
Involves only the epidermis Area may be red with edema NO BLISTERS Healing without scarring in 2-5 days
What side is limited with opening for a patient with TMJ capsular pattern restriction?
Ipsilateral side If chin is deviated to the right at terminal opening then ROM would be limited on the ipsilateral side (right) Want to do a RIGHT TMJ, INFERIOR glide manipulation
What are case reports?
Is an in depth description of an individuals condition or response to treatment May be used to generate theories and hypotheses for future research but CANNOT test hypotheses or establish cause and effect relationships
If a patient with Sarcoidosis is performing a 6 minute walk test, would systemic signs or symptoms of sarcoidosis are most likely to limit the patient?
Joint Pain or Swelling
What is the clinical sign for Wilson's disease?
Kayser Felischer rings (from copper deposits)
What is difference between keloid and hypertrophic scars?
Keloid = GROWS OUT original margins Hypertrophic = WITHIN original border with thick fibrous tissue
If you have an increased Q angle, what do you get?
Knee valgus Norms 1. Men = 13 2. Women = 18 Landmarks are ASIS to center of patella and center of patella to tib tuberosity
A 75-year-old patient is 2 days post total hip arthroplasty. The surgeon used an anterior surgical approach. The physical therapist assistant should instruct this patient to avoid which movements of the hip?
LATERAL ROTATION AND EXTENSION************
What is seen with forward head posture?
LENGTHENED AND WEAK -longus colli, longus capitus and rectus capitus (upper deep neck flexors) SHORTENED -pec minor -SCM and anterior scalenes (superficial neck flexors)
What causes a high and low hematocrit and hemoglobin value?
LOW: anemia HIGH: dehydration, polycythemia, vomitting, excessive sweating, diuretics, diarrhea, severe burns (is high when the body's water content is decreased from the above which causes RBC to rise )
What does a high and low prothrombin time indicate?
LOW: blood coagulates too easily which indicates risk of developing a blood clot HIGH: coagulates too slow which indicates high risk of bleeding
If you have peripheral nerve injuries and lesions of the anterior horn cells. What kind of lesion is this?
LOWER MOTOR NEURON DISEASE (LMN)
What kind of surgery is usually performed for spinal stenosis and disk protrusion?
Laminectomy
What wheelchair modification is given to those with central cord syndrome?
Larger diameter wheelchair rims to help mobilize
When should knowledge of performance be given?
Later on in learning This one gives information about the QUALITY of the movement during exercise
What is dermatome for C7?
Lateral arm to middle finger (index, long & ring finger)
A patient has a limited motion in supination and calcaneal inversion at the subtalar joint. using manual techniques, what is the accessory motion that needs to be emphasized in order to increase motions that are limited?
Lateral glide (supination involves calceneal inversion, calceneal plantar flexion, and calceneal adduction (lateral tilt)
What dermatome comprises L5?
Lateral leg and dorsum of toes 2&3 Great toe extension and foot eversion
Where are arterial insufficiency ulcers located?
Lateral malleoli, distal toes, and dorsal foot (web spaces) Distal leg where arterial circulation is limited
What does an increased Q angle cause?
Lateral patella tracking want to strengthen VMO Increased Q angle is associated with genu valgum (icreased lateral compartmession copression and stretch on medial side) Use lateral buttress with patella stabilizing brace for increased Q angle
What PNF pattern helps move a patient OUT of synergy?
Lift pattern (D2 flexion) NOT GOOD -PNF D2 extension is in synergy so don't use Rhythmic rotation is for spasticity
What is the first sensation affected by a neurological condition?
Light touch (tested using camel hair, cotton or tissue)
What are some examples of superficial sensation?
Light touch, pain, temperature
What would lead to vaulting and early heel off during midstance? (GAIT)
Limited dorsiflexion excessive plantarflexion
What is Jewett brace?
Limits trunk flexion and encourages erect posture
What is mneumonic for positive polarity?
Little Melissa Chipotle Zoo OR Zebras chill like me L = lidocaine M= Magnesium sulfate C= Copper sulfate Z= Zinc Oxide
What is a deep tissue injury pressure?
Localized area of deep purple tissue surrounded by non-blanchable redness
Where are venous insufficiency ulcers located?
Medial aspect of leg specifically proximal to the medial malleolus *see hyperpigmentation and edema on affected leg, wound bed is shallow, edges are IRREGULAR*
What is dermatome for L4 (dorsiflexors)?
Medial malleolus
Would would be limited with posterior capsular tightness?
Medial rotation
What is dermatome for T1?
Medial side of antecubital fossa
What muscles should you strengthen with ulnar nerve lesion?
Lumbricals and interosseoi
What is action of lumbricals and how do you stretch them?
Lumbricals do MCP flexion and IP extension To stretch want to put MCP into extension and IP into flexion
During an initial interview and history, a patient with a right CVA seems unconcerned about obvious paralysis of the left arm and leg. When the therapist asks the patient to describe what happened, the patient says "I must have slept wrong and my arm and leg fell asleep." The patient further tells the therapist, "My family put me in this place so they could go on vacation." Which type of perceptual disorder BEST characterizes the patient's responses?
Anosognosia.
A patient's electrocardiogram report describes the presence of significant Q waves. This finding is suggestive of which of the following conditions? 1. Premature atrial complex 2. Myocardial infarction 3. Supraventricular tachycardia 4. Atrial fibrillation
Answer: 2. Myocardial infarction (Q waves are a small depression before the QRS wave that signify's a MI along with elevated ST segment)
What position relieves pain with uterine prolapse?
Lying down Aggravated by prolonged standing (LBP and perianal discomfort)
What is GMFCS level 5?
MANUAL WHEELCHAIR ALL SETTINGS
What is the vestibular system?
Information to the brain regarding the position and movement OF THE HEAD with respect to gravity and movement - perterbations Somatosensory is in relation to support surface (foam). Examining proprioception would be the most common method for assessment of somatosensory ststem Visual system - allows individuals to perceive movement and detect the relative orientation of the body in space
On examining a patient with a decreased trunk side bending to the left, the physical therapist finds a closing restriction between L2-L3 vertebrae. What is the MOST appropriate intervention to improve the restriction?
Apply PA glide on L3 transverse process on the left side Applying a posterior inferior glide will move the L3 vertebrae superiorly and close to the L2 which helps improve the closing restriction (opens it up) DO ON TRANSVERSE PROCESS
On the third day following a cesarean delivery, what should a physical therapist's interventions include?
Breathing, coughing and pelvic floor exercises
What intervention should be used for osgood schlatter?
Infrapatellar strap for brace
A physical therapist is performing a supine hamstring stretch on a patient who has a T5 level spinal cord injury. The patient describes a pounding sensation in the ear. What should the therapist do FIRST?
Bring the patient to an upright position (POUNDING HEADACHE IN SCI = AUTONOMIC DYSREFLEXIA)
What is wheezing?
Bronchoconstriction of the lower airways (difficulty breathing) High-pitched CONTINUOUS noise Is an issue with expiration caused by narrowed airways
What is meralgia paresthetica?
Burning pain along anterolateral aspect of the thigh that increases with hip extension
When transfering a patient with pusher's syndrome from wheelchair to bed what should the PT have the patient do?
Clasp hands together to minimize push off
What is Reiter syndrome?
Clinical triad of uveitis, urethritis, and arthritis
How should electrodes be placed for biofeedback muscle relaxation?
Close spaced electrodes + low sensitivity THINK usually muscle strength increases so INCREASE sensitivity (high) muscle relaxation requires low vibes and sounds and quiet so think LOW sensitivity
What type of exercises should be used with ACL surgery recovery?
Closed chain Graft tissue is most vulnerable at 6-8 weeks
What does S1 sound represent?
Closure of the mitral and tricuspid valve There should NEVER be sounds heard between S1 and S2. If there is a sound in between, this is considered a systolic murmur
What is pleural friction rub?
Coarse grating or crunching sound heard during both inspiration and expiration where the visceral and parietal pleura are rubbing together
At what stage in the Rancho Cognitive Level scale should training involve the patient in decision making and monitor for safety?
Cognitive level VII
What are the major muscles of mastication?
Masseter and temporalis
Patient presents with stroke and has knee flexion (hamstring) spasticity, which gait deviation would be most likely or which phase of gait would be most impacted?
Initial contact or terminal stance THINK phase of gait where knee extension is NEEDED they are in so much flexion that they cant do extension
Phase of gait with maximal knee flexion
Initial swing - 60 degrees
A Physical Therapist is treating a patient with a weak tibialis anterior. The Physical Therapist has decided to utilize Functional electrical stimulation to improve ambulation. In which phase of the gait cycle should FES be applied?
Initial swing to mid swing (stimulate TA to avoid dragging during swing) Ground clearance occurs during swing phase from initial swing to mid swing
What type of treatment is used for legg calves perthes disease?
Conservative
What is intrarater reliability?
Consistency of repeated measurements made by the same person over time
What is interrater reliability?
Consistency or equivalence of measurements made by more than 1 person Different examiners
If you are doing percussion for a patient with cystic fibrosis and they cough up small brownish sputum with blood. What should you do?
Continue treatment with little modifcation unless more blood is noted Hemopytosis is rather common with cystic fibrosis as long as it is not a lot
What type of duty cycle is used for chronic injury?
Continuous mode + thermal effects
What is the most common cause of unilateral lymph node swelling?
Injury or infection involving the distal foot, leg, thigh or hip
A physical therapist is treating a patient with chronic range of motion limitation due to tight hamstrings. Which of the following applications of ultrasound and stretching is BEST to restore normal range of motion?
Continuous ultrasound at 1 MHz with stretching for 10 minutes during and immediately after the ultrasound treatment Want continuous cause its thermal and allows for soft tissue lengthening
How do you fix an anterior inominate?
Contract hamstrings because they posteriorly rotate
How do you fix a posterior inominate?
Contract hip flexors because these anteriorly rotate
What is characteristic of a deep tissue injury?
Intact blister with boggy feel
What is most likely seen with superficial partial thickness burns?
Intact blisters
What is stage 1 ulcer?
Intact, red/purple, warm Warmth and color change indicate it is a pressure injury intact, non-blanching, hyperermia (don't have ulcer yet, but extremely high risk for one)
What is duputyren's contracture?
Contracture of palmar fascia resulting in flexion deformity of the MCP and PIP*** Affects 4th and 5th digits Has nodules and thickened tissue near the distal palmar crease (tender and sensitive to pressure)
What does weakness of hip abductors do? (GAIT)
Contralateral dip of the pelvis during stance phase of the weak side Patient typically compensates with excessive trunk flexion and weight shifting over the stance leg
What are symptoms of lesions in brainstem?
Contralateral facial signs
What are 2 causes of congestive heart failure?
1. Diminished pumping ability of the ventricles due to muscle weakening (systolic dysfunction) 2. Diminished pumping due to stiffening of the heart muscle that impairs the ventricles capacity to relax and fill (diastolic dysfunction) With systolic dysfunction, the weak heart pumps a smaller volume of blood for each contraction of the ventricles (stroke volume), thereby reducing cardiac output
What are causes of PCL injury?
1. Direct blow to anterior tibia 2. Fall with foot in PF position (tripping) 3. Hyperflexion of knee
What are pressure INTOLERANT areas for transtibial amputation?
1. Distal anterior tibia
What does traction do?
1. Gliding separation of facets 2. General capsular stretch 3. Openening of intervertebral foramen Traction helps with ROM Traction can also release pressure on nerve fibers thereby increasing nerve conduction RA is a contraindication for traction
What is a positive graded exercise test?
1. Greater > 1mm of horizontal or downsloping 2. Downsloping ST segment depression
What are examples of LMN conditions?
1. Guillan Barre 2. Carpal tunnel 3. Duchenne muscular dystrophy
How do you perform Spurling's Test?
1. Head compression in neutral 2. Head extension with compression 3. Head in extension and rotation ipsilaterally Sitting, head side bent to uninvolved side
What is procedure for epley's maneuver?
1. Head rotated 45 degrees + extension to affected side 2. Rotate 45 to other side keeping the extension 3. Roll to sidelying on UNINVOLVED side 4. Slowly sit up Observe for vertigo and nystagmus and hold each position for up to 1-2 min
What are symptoms of trochanteric bursitis?
1. Lateral hip pain CAUSED BY TRAUMA 2. Worse with weight bearing and laying on that side 3. Pain reproduced with hip abduction and external rotation 4. May lead to antalgic gait pattern 5. Want to stretch ITB
What causes right pelvic drop?
1. Left glute med weakness 2. Right abductor contracture
What is construct validity?
Degree to which a theoretical consruct is measured by a test or measurement Ex: MMT scores would have a construct validity as indicators of innervation status of muscle if there was a relationship between MMT scores and results of EMG testing
What is external validity?
Degree to which results of research study are generalizable to popuations or circumstances beyond those included in the study Threats to external validity = interaction of treatment with specific type of subjects tested and the place (setting) and time (history) in which experiment is performed
What is difference between delorme and oxford?
Delorme: 1st set 50, 2nd 75, 3rd 100 of all 10 reps Oxford is the opposite (start at 100% and work way to 50)
A patient with complete spinal cord injury at the level of T11 is on a bowel program. Which of the following is the MOST effective bowel training program for this patient?
Digital stimulation of intact defecation reflexes. Above S2 is spastic bowel so can do tapping, or any kind of stimulation
Common cause of junctional rhythm? (junctional = AV junction = QRS)
Digitoxin toxicity
What kind of breath sounds are associated with emphysema?
Diminished breath or absent breath sounds
A patient reports pain in the posterior lower leg during the test performed in the photograph - passive SLR. Which of the following conditions is MOST likely present? 1. Herniated disc in the lumbar spine 2. Idiopathic lumbar scoliosis 3. Right-sided lumbar paraspinal muscle strain 4. Osteoarthritis of the lumbar facet joints
1. Leg pain elicited with straight leg raise may indicate lateral disc herniations Osteoarthritis - flexion would help
What is the series of structures starting at the coracoid process?
1. Lesser tuberosity 2. Biceps tendon 3. Greater tuberosity
What are some health complications associated with Downs Syndrome?
1. Leukemia 2. Respiratory infection
Cellulitis symptoms?
1. Local erythema 2. Red streaks 3. Palpable lymph nodes 4. Fever and chills Commonly seen with lympedema as a complication
What is acupuncture TENS?
1. Long duration 2. Low frequency 3. Mod amplitude CHRONIC PAIN
What are prosthetic causes of circumduction?
1. Long prosthesis 2. Inadequate knee flexion 3. Inadequate suspension 4. PF foot
Damage to somatosensory cortex can cause what?
1. Loss of sensation 2. Loss of PERCEPTION 3. Loss of proprioception 4. Loss of diminished motor control
Which of the following pathological conditions of the disc is characterized by the nucleus bulging against an intact annulus?
Disc protrusion (NOT herniation)
To prepare a patient with cauda equina lesion for ambulation with crutches, what upper quadrant muscles are most important to strengthen?
1. Lower trap 2. Lats 3. Pec major you need shoulder depressors and extensors along with elbow extensors in order to use crutches
What is mallet finger?
Distal phalanx in flexed position Caused by damage to extensor tendon
Where should pressure be highest with lymphedema compression?
Distally (higher pressure distally)
What is step length?
Distance measured between right heel strike and left heel strike
What is stride length?
Distance measured between right heel strike and the following right heel strike
A patient has shoulder joint impairments. The range-of-motion examination reveals restricted lateral (external) rotation and abduction of the shoulder. Based on arthrokinematic principles, which of the following mobilization procedures should be performed for the patient FIRST?
Distration before doing an anterior glide to help with ER
What is a positive vertebral artery test?
Dizziness and nystagmus indicating that the OPPOSITE side artery is being compressed
What considerations are there for A-lines?
Do not apply BP cuff above the infusion site Adjust the IV pole so its at the level of the heart Avoid activities that require infusion site to be above heart level for prolonged periods of time
What are anterior hip precautions?
Do not externally rotate, do not extend hip, do not adduct/cross legs
What is the different between a power recline wheelchair and a tilt in space wheelchair?
1. Power recline -can create shear forces on the ischial tuberosities and sacrum especically when returning from recline position. DO not use this one if they are at wrist of skin issues 2. Tilt in Space - does not create shear forces; so if unable to self relieve pressure THIS IS MOST APPROPRIATE wheelchair `
What are the different transtheoretical stages?
1. Precontemplation - NOT ready for change no intention of changing 2. Contemplation - not changing anything but is considering taking action within 6 months (willing to take a brochure) 3. Preparation stage - seriously considering taking actio in near future and is taking steps to begin acting (buying workout clothes) 4. Action 5. Maintenance
Want left side lying for what 3 conditions?
1. Pregnancy 2. GERG 3. Hernia
What movements cause pain with patellofemoral syndrome?
1. Prolonged sitting 2. Going down stairs (eccentric quads)
What is prone progression for a patient with disc protrusion?
1. Prone with pillow under waist 2. Prone 3. Prone on elbows 4. Prone press up 5. Standing extension (MOST and last progression)
What are some examples of deep sensation?
1. Propripception 2. Kinesthesia 3. Vibration
What kind of gait pattern does someone with legg calve perthes disease have?
1. Psoatic limp 2. Trendelenburg
What conditions lead to increased fremitus?
1. Pulmonary fibrosis
What symptoms do you have with a central vestibular lesion?
1. Pure vertical nystagmus that oscillates at equal speeds (pendular nystagmus) 2. Abnormal smooth pursuits 3. Abnormal saccadic eye movements
What is Froment's sign?
1. Put paper between thumb and index finger 2. Normal = both finger pads should stay extended during the test Abnormal = thumb flexes this means weakness of adductor pollicis with substituion by the flexor pollicus longus LESION OF ULNAR NERVE
What are ways to facilitate tone?
1. Quick stretch 2. Approximation
If a patient presents with complex region pain syndrome originating from an ankle injury, appropriate interventions would include?
1. ROM 2. Exercises focusing on progressive weight bearing 3. Retrograde massage 4. NO modalities - they do not handle hot or cold well
What lung values are increased with chronic obstructive disease?
1. RV 2. TLC 3. FRC
What are examples of nominal data?
1. Race 2. Gender 3. Names 4. Letters 5. Symbols 6. Religion 7. College major 8. Political party NON higher or lower
What is difference between cervical radiculopathy, strain and herniation?
1. Radiculopathy - arm pain in dermatomal distribution. Increased pain by extension and rotation or side flexion 2. strain - presents with pain on activity or when muscle is on stretch 3. Herniation - pain increase with either flexion or extension
What joints are concave on convex (SAME DIRECTION)?
1. Radiohumeral joint (does elbow flexion and extension) 2. Carpometacarphophalngeal (flexion and extension portion) 3. Tibiofemoral OKC (flexion and extension)
A patient who uses an insulin pump is beginning an outpatient aerobic conditioning session. The patient's current blood glucose level is 95 mg/dL (5.3 mmol/L). Which of the following responses is MOST appropriate for the patient? 1. Reduce the insulin infusion dose. 2. Increase the insulin infusion dose. 3. Continue insulin infusion at the current metered dose. 4. Rest for 1 hour, then remeasure blood glucose level.
1. Reduce the insulin infusion dose. Insulin pump delivery should be reduced, not maintained, in a patient whose current blood glucose level is 95 mg/dL. If the patient continued at the current rate, the insulin level would be too low. Increased insulin - decreases blood glucose levels Decreased insulin - increased blood glucose levels
What are causes of pelvic hike in swing phase?
1. Reduced hip flexion 2. Reduced knee flexion (aka knee extension) 3. Lack of ankle dorsiflexion 4. Tightness of plantarflexors (PF spasticity)
What is INTACT with myasthenia gravis?
1. Reflexes 2. Sensation Not intact = proximal>distal weakness, eye bulging, easily fatigued
What are 2 functions of insulin?
1. Regulates utilization of carbohydrates 2. Regulates level of blood glucose
What does an increased BUN (blood urea nitrogen) indicate?
1. Renal failure 2. Dehydration 3. Heart failure
What is treatment for excessive forefoot varus?
1. Rigid = medial wedge 2. Flexible = lateral wedge
What happens when sympathetic nervous system is stimulated?
1. Rise in heart rate 2. Dilation of bronchioles 3. Increase in blood glucose levels 4. Constriction of blood vessels
What are symptoms of arterial insufficiency ulcers?
1. SEVERE pain 2. Shiny skin 3. Absent pedal pulse 4. SMOOTH edges (well-defined, distinct) 5. Deep wound bed
What is high guard positioning?
1. Scapulae adducted 2. Shoulders horizontally adducted 3. Elbows flexed
What muscles are needed in a transfer from bed to wheelchair for a patient with C7 spinal cord injury?
1. Scapular protraction 2. Depression of scapula These help to increase the height of the lift to clear the buttock
What is PRESERVED with ALS?
1. Sensation 2. Eye movement 3. Bowel/bladder
What is conventional TENS?
1. Short duration 2. High frequency 3. Low amplitude *provides sensory relief* ACUTE PAIN
What are NG tubes used for?
1. Short term feeding 2. Administering meds 3. Removing gas Avoid forward movement of head and neck
What is seen with hypoparathryoidism?
1. Shortened 4th and 5th metacarpals 2. Cardiac arrythmias 3. INCREASED neuromuscular activity that can result in tetany and muscle spasms
When visually examining active abduction of the arm to 150 degrees, what is the normal composition of motion the therapist would expect?
100 degrees GH motion, 50 degrees ST 2:1 GH to ST ratio, 100 GH, 50 ST only choice that fits this ratio
What is average cadence?
110-120 steps/min
What is average adult cadence?
110-120 steps/min 120 full strides (a period of 120 seconds would be necessary to complete 120 strides ; 60 seconds would allow a patient walking at a cadence of 120 to complete 60 strides) Seconds = strides
What is intact with anterior cord syndrome?
Dorsal column (proprioception and vibration INTACT) Not intact = pain, temperature, motor paralysis bilaterally
The parent of a 4 year-old child who has myelomeningocele is interested in obtaining orthoses for the child's gait training. The child has an L1 neurological level lesion. Which of the following orthoses is the MOST appropriate selection for the physical therapist to discuss with the parent? A. Hip-knee-ankle-foot with locked hips B. Reciprocating-gait C. Knee-ankle-foot with a pelvic band D. Ankle-foot
If L1 CAN ONLY walk with support of RGO or a TLSO **
To what degree should knee flexion be by week 6 with ACL repair?
120 degrees
At rest, which of the following ratios of inspiration to expiration is normal?
1:2
What is the typical on:off ratio when using electrical stimulation for muscle re-education?
1:5 This is done in order to minimize muscle fatigue. As the patient gets stronger, you want to switch to ratio of 1:4 or 1:3 ratio of 1:1 may be used for muscle spasms
What does a patient's vital capacity have to be in order for it to be contraindicatd for them to participate in aquatic therapy?
1L or less
Where should electrodes be placed in order to reduce foot drop during gait?
2 electrodes placed on proximal anterior tibial region Ramp up and ramp down times should be approx 0-1 seconds each Use biphasic current
What is the most appropriate rate to release the pressure when obtaining the blood pressure measurement?- How far do you inflate cuff?
2-3 mmHg per second (inflate cuff to 20 mmHg above estimated systolic)
An 11-year-old patient who is recovering from a knee injury is beginning a resistance exercise program to strengthen the quadriceps. Which of the following exercise schedules is MOST appropriate for the patient? 1. 1 time/week 2. 3 times/week 3. 5 times/week 4. 7 times/week
2. 3 times/week resistance should be 3x a week to avoid overuse injuries
What is ESR?
ERS is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body. FASTER = INFLAMMATION
How is paced breathing done?
EXHALE WITH EFFORT This helps prevent someone from holding their breath exhale when ascending stairs whichc is the more vigorous part Inhale during easier part of activity Exhale during the lifting or with effort (concentric phase) and inhale during the lowering (eccentric phase) Other example: inhale while standing exhale while bending down to reach object
Glascow Coma Scale
EYE OPENING4 - spontaneous3 - open to speech2 - open to pain1 - no response VERBAL5 - alert and oriented4 - disoriented conversation3 - inappropriate words2 - incomprehesible/nonsense sounds1 - no response MOTOR6 - spontaneous5 - localizes pain4 - withdraws to pain3 - decorticate posturing2 - decerebrate posturing1 - no movement
What phase of learning should knowledge of results feedback be given?
Early on with visual feedback
What are symptoms of stress fracture?
Edema after an increase in activity is very characteristic Localized pain Present at night
What is pronator teres syndrome test?
Elbow flexed to 90 degrees Resist pronation and extension
What part is strongest in UE flexor synergy?
Elbow flexion Weakest = abduction and Er of shoulder
What is dominant position of a patient who has a synergy?
Elbow flexion, forearm pronation and shoulder adduction (WANT TO DO D2 lift pattern which is D2 flexion in order to get them out of synergy position)*
What should EMG show for a muscle at rest?
Electrical silence If there is a denervated nerve, you will see spontaneous electrical potentials or polyphasic potentials
A 31 year old female presents to a physical therapy clinic with agonizing, nauseating, exhausting, tiring and unbearable pain. What pain pattern is MOST related to the symptoms?
Emotional The adjectives used to describe the patient's pain are subjective in nature, and suggest a variety of origins. Agonizing, nauseating, exhausting, tiring and unbearable are all the words a patient might use to describe pain in emotional terms
What training would be abnormal in someone with myasthenia gravis?
Endurance training They fatigue very easily and are susceptible to heat intolerance
What do diuretics do and what do they cause with the elements?
Enhance secretion of sodium and potassium in the urine LEADS TO hyponatremia and hypokalemia Side effects of diuretics are agitation, dyspnea, Hyponatremia = clammy skin & hypotension Hypokalemia = hyperventilation & dizziness
Which of the following recommendations is MOST appropriate for a patient who has a diagnosis of diabetes mellitus and sensory neuropathies in both feet?
Ensure comfortable and proper shoe fit and break in new shoes slowly.
What is difference between equilirium vs. non equilbrium coordination?
Equilibrium = marching eyes closed, changing body positions non-equilibrium. heel to shin, finger to nose, rebound test
What happens with leg length discrepancy in sitting v. in standing position?
In stitting --> leg length does not affect the spinal posture In standing --> leg length affects posture
What is dysmetria?
Inability to control the range of movement and force of muscular activity (EXAMPLE: overshooting, undershooting/ placing foot on floor markers while walking)
What is dysdiadochokinesia?
Inability to perform rapid alternating movements EXAMPLE: 1. Rapid pronation and supination of forearms *as speed increases, there is typically a rapid loss of ROM and rhythym of movement* *Caused by damage to cerebellum*
What is Visual Agnosisa?
Inability to recognize familiar objects despite normal function of the eyes and optic tracts
What indicates nerve root signs?
Fading deep tendon reflex with repetitive tapping
How does scaphoid fracture usually occur?
Fall on outstretched hand
What is commonly used to treat an acute pulmonary embolism?
Fast acting anticoagulant (fibrinolytic) agentHeparin is often used directly following a pulmonary embolism
What would be a typical finding during the PT's examination of a patient diagnosed with myofascial pain syndrome?
Few localized TRIGGER points with REFERRED pain patterns during palpation
What abnormal electromyography potentials would be most indicative of LMN disease?
Fibrillation potentials
What are names to describe nerve that innervates tibialis anterior?
Fibular (peroneal nerve), deep peronenal nerve, common fibular nerve
A patient has an acute ankle strain involving the fibularis (peroneus) tertius. Ice massage should focus on which of the following locations?
Fibularis tertius = anterior to lateral malleoli
What is the most common cause of secondary lymphedema?
Filariasis - mosquito born illness (people get this when they come back from vacation in tropical area)
How to determine the volume of a wound?
Fill the wound with hydrogel or water
How do you perform Cozen's test?
Fist, pronate, extend, radially deviate against passive resistance
What happens if you have damage to facial nerve?
Flaccid paralysis of that side of face, drooping, drooling, hypotonia of facial muscles
Which of the following MUST occur in order for the heart to get enough oxygen while a patient is exercising?
Increase in coronary blood flow
How is cardiac output related to heart rate?
Increase in heart rate is associated with an increase in cardiac output
Which of the following factors accounts for the difference in physiologic change that occurs with full body immersion compared to partial body immersion in water with a temperature above 100°F (37.8°C)? (aquatic therapy)
Increase in hydrostatic pressure
What causes an increase in EMG signal?
Increase in quad firing Increase in quadriceps force production
How long does it take for muscle hypertrophy?
Increase in size of individual muscle fibers requires 4-8 weeks of moderate intensity to high intensity resistance training
What are non thermal effects of ultrasound?
Increased soft tissue repair Increased macrophage responsiveness Increased cell membrane permeability
Which of the following primary postural deviations is MOST common in a patient with complications from osteoporosis?
Increased thoracic kyphosis (dowagers hump)
What is function of parathyroid hormone?
Increases reabsorption of calcium and phosphate from bones into the blood
What does garlic do in those taking anticoagulants?
Increases risk of bleeding
What is standard deviation?
Measure of the spread of data about the mean With a bell-shaped distribution, approximately 1. 68% of the values fall within one standard deviation of the mean 2. 95% of the values fall within two standard deviations of the mean 3. 99% of the values fall within three standard deviations of the mean.
How do you measure extension lag of a pt?
Measure passive and active extension- pts that demonstrate extension lag have greater passive extension than active extension (common causes are ms weakness, inhibition by pain, pt apprehension)
What does swanz-ganz do?
Measure pulmonary artery pressure AVOID excessive movement of head, neck and arms
What is Barthel Index?
Measures how well the person can perform ADLs Maximum score is 100 Has 10 categories
What is the medical outcomes study 36-item short form?
Measures patient's quality of life
What are central venous pressure catheters used for?
Measuring pressure in superior vena cava or right atrium Evaluates right ventricular functioning
During testing of the patient's grip strength, the physical therapist notices that the patient's lateral two fingers are unable to fully grip the hand held dynamometer. The physical therapist can likely conclude which of the following structures has been damaged?
Median nerve "sign of benediction" - index and middle finger do not flex at the IP joints
What muscles are you ussing when pinching between thumb and tip of index finger?
Median nerve (anterior interosseous nerve)
Describe the general progression of coordination exercises?
Gradually decrease BOS while raising height of COM
What does a greater frequency with TENS indicate?
Greater frequency = more sensory
What is risk of long spinal fusion before 10?
Greater loss of trunk height and increased frequency of instrumentation failure Want to use TLSO as orthotic for scoliosis
A chest tube gets dislodge during PT treatment. if a patient fails to cover the defect, what could the patient develop?
Pneumothorax (with removal of the chest tube, there is an increased positive pressure on the lung tissue. The lung is not able to inflate so it succums to the pressure and collapses)
Which diagnosis is associated with obesity?
Polycystic ovary syndrome This causes enlarged and cystic ovaries that cause hormonal changesTend to have significant weight gain and may have trouble losing weight
What are cardiopulmonar manifestations in down syndrome?
Poor ability to clear secretions resulting in greater susceptability to pulmonary infections Postural abnormalities may lead to restrictive lung dysfunction Higher incidence of acute myeloid leukemia
A patient diagnosed with schizophrenia, disorganized type, is referred for gait training after a compound fracture of the tibia. The therapist suspects the patient has recently experienced an exacerbation of schizophrenia. Which behaviors support this conclusion?
Poor ability to perform multistep tasks requiring abstract problem-solving.
What are different hip precautions - posterior vs anterior?
Posterior - FADDIR Anterior - FABER
What glenohumeral mobilization increases internal rotation?
Posterior glide (posterior glide increases flexion and internal rotation)
What glide is used to increase knee flexion?
Posterior glide of TIBIA ON FEMUR Not the other way around
What is FABER test used for?
Posterior hip dysfunction, lumbar, SI joint associated with hip capsule
What is jerk test used for?
Posterior instability Supine with 90 degree forward flexion of shoulder and elbow flexed to 90. Examiner applies posterior directed force by holding the forearm
When to use a wrist crock up splint?
Posterior interosseous nerve syndrome or wrist extensor tenosynovitis
What do you want to avoid with a hamstring stretch?
Posterior pelvic tilt (this assists with stretching the rectus femoris)
Which subsitution is MOST common in order to attempt to exaggerate hamstring length?
Posterior rotation of the pelvis due to hamstring origin on ischial tubersotiy Patients often attempt to posteriorly rotate pelvis in short sitting by leaning backwards
Where should electrodes be placed to target posterior tib?
Posteromedial aspect
How should the head be positioned in the early stages for those with a TBI?
Postion head in neutral during early stages of recovery (posterior occiput is susceptible to pressure ulcers)
Wound agents?
Povidone-iodine is an antimicrobial agent and is used to manage infections. Has reported to improve healing in venous ulcer wounds Sterile normal saline is best to be used initially on wounds Silver sulfadiazine is indicated if an infection is present Zinc oxide is used as a skin protectant and acts as a moisture barrier. Used to treat diaper and incontinence associated dermatitis
Which of the following activities would be MOST appropriate to practice to assist a 20-year-old patient who has Duchenne muscular dystrophy in maintaining independence?
Power wheelchair training Someone who is 20 would not be able to work on walking or transfers because by 10-12 they lose ability to walk
What is the baroceptor reflex?
Provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes heart rate to decrease and also causes blood pressure to decrease
What is cremasteric reflex?
Procedure 1. Scratch the skin of the UPPER MEDIAL thigh Response -A brisk and brief elevation of test on the ipsilateral side
What is the abdominal reflex?
Procedure 1. Stroke briskly and lightly with a blunt object from each quadrant of the abdomen in a diagonal TOWARDS the umbilicus Response -CONTRACTION of the abdominals and deviation of the umbilicus IN THE DIRECTION of the stimulus
What is the plantar reflex?
Procedure 1. Stroke lateral aspect of the sole of the foot from heel and go medially to base of great toe Response -normal is flexion of toes -abnormal which is babinksi would be fanning of the toes (extension)
How do you perform FABER test and what is a positive result?
Procedure 1. Passively flex, abduct and ER hip (figure 4) 2. Slowly lower the knee toward the table Positive = test leg remaininga bove opposite leg Means hip joint may be affected, SI joint may be affected or there is an iliopsoas spasm
What is content validity?
Providing evidence that a measuring instrument contains all relevant elements of a construct with no extraneous elements Example: McGill pain questionare may have greater content validity than a visual analgoue pain scale because in addition to pain intensity, it assesses the location, quality, and duration of pain
What is weak in someone with myasthenia gravis?
Proximal muscles Ocular muscles affected (diploplia and ptosis) Can also affect muscles involved in facial expression, chewing, swallowing (weakness of pharyngeal muscles) Muscles of eye typically affected FIRST
What is cheyne strokes respiration?
Progressively deeper and faster followed by a gradual decrease that results in temporary stop in breathing (apnea) stroke, TBI, congestive heart failure and end of life, opioids
What is pronation associated with at the tibia?
Pronation - internal rotation of tibia and valgus Supination, varus, tibial external rotation
During weight bearing, a soft tissue contracture resulting in supination of the forefoot will be compensated for by which of the following?
Pronation of the rearfoot
What position should patient be in traction table for a disk herniation?
Prone positioning
What are prostaglandins?
Protect the lining of the stomach by inhibiting gastric acid secretion and increasing the production of mucus in the stomach lining NSAIDS inhibit production of prostaglandins therefore stomach is more susceptible to damage from gastric acid
What are the 2 BEST measurements to estimate the myocardial oxygen demand at the start of symptoms?
RPP = HR x SBP 1. Heart rate 2. Systolic blood pressure
What is formula for RPP (rate pressure product) and what does it calculate?
RPP = SBP x HR Indicator of myocardial oxygen demand
What difference do you see in isometric testing between RTC vs. impingement?
RTC = weak resistive isometrics especially with flexion and abduction Impingement = strong resistive isometrics that are painful
Discuss difference between diagnosis of RTC tear and supraspinatus tendinitis in terms of AROM/PROM, mechanism of injury, etc.
RTC Tear: -MMT would provike symptoms because it is contractile -Limited AROM but normal PROM -trauma Supraspinatus tendonitis -normal AROM with a painful arc of motion or pain at end range -overuse
What nerve innervates brachioradialis?
Radial nerve Forearm in neutral
What nerve innervates the abductor pollicis longus?
Radial nerve When this muscle is affected, loss of thumb abduction could occur
What innervates abductor pollics longus?
Radial nerve (specifically posterior interosseous which is a branch of radial)
What are the MOST appropriate FES parameters for muscle weakness?
Ramp up- 2 sec; rate- 80 pps; on:off- 1:5. Ramp up time should be between 1-4 seconds Pulse frequency should be between 35-80 pps On:off ratio should be 1:5 Treatment time should be 10-20 minutes
What is the best way to control for confounding variables?
Random group assignments
What symtpoms are associated with tethered cord syndrome?
Rapidly progressing scoliosis, LE hypertonciity, changes in gait and changes ibowel/bladder
What kind of measurement scale has a true 0?
Ratio scale (height, weight, ROM) Ordinal scales - sensation, balance, manual muscle testing Nominal - mutually exclusive categories (name, number, symbols, gender, blood type, diagnosis)
A target heart rate is determined for individuals entering a training program in order to?
Regulate exercise INTENSITY Exercise intensity can be expressed as oxygen uptake during activity Heart rate and oxygen uptake have a relatively linear relationship
What kind of contraindication is mobilization in pregnancy during the 1st trimester?
Relative contraindication (NOT absolute) you are allowed to do if on a hypomobile segment Normal to have dull ache after joint mobilization
A wheelchair designed for a patient with paraplegia should include which of the following?
Removable desk top arms (this increases the ease of transfers since they are unable to use their LE's to assist with the transfer)
If someone is in confused/agitated level and is being combative what is the most approrpiate technique for calming the patient?
Removing patient from current environment and placing the patient in a quiet setting Should NOT do aanything to further apply sensory stimulus (rocking , music, tapping)
What is preferred strategy for better learnig and retention in associative stage?
Repeated practice
What is declarative learning?
Requires attention
What is cog wheel rigidity?
Resistance to passive movement in a jerky manner
What is function of osteoclasts?
Resorption (break down ) of bone think CLAST is CATASTROPHE
A patient who is performing vigorous treadmill test is most likely to have an immediate increase in RR to do which of the following?
Respiration rate increases in order to increase blood pH levels Vigorous exercise produces lactic acid Acid LOWERS blood pH There has to be a compensatory mechanism of increased RR in order to reduce the PaCo2 "ROME"
What might be seen with Guillan Barre?
Respiratory muscle fatigue or paralysis and may be susceptible to pulonary infection Secretions d ariway clearancae may be important for their pulmonary hygeine
What might be seen. withGulla Barre?
Respiratory muscle fatigue or paralysis and may be susceptible to pulonary infection Secretions d ariway clearancae may be important for their pulmonary hygeine
A patient has radicular pain due to C4-C5 intervertebral foramen stenosis on the right side. In addition to cervical flexion, which of the following combinations of cervical motions is likely to provide the MOST pain relief for the patient?
The area of the intervertebral foramen on the right increases with left side bending and left rotation
What does a tight extension aid in prosthetic limb cause?
Results in terminal swing impact during late swing
What is chondromalacia patellae?
Retropatellar knee pain a
What muscles contribute to excessive hyperabduction of the scapula during shoulder flexion and abduction?
Rhomboid excessive lengthening The primary scapular adductors acting eccentrically to control excessive scapular abduction are the rhomboids and the trapezius muscles
How does scoliosis change the ribs?
Ribs are more prominent posteriorly on the side of scoliosis (convex) More prominent anteriorly on the concave side Leg length is non-structural/functional scoliosis (does not have a rib hump) Those with structural would have rib hump, rotation towards convexity, vertebral rotation)
What does a central venous line measure?
Right atrial pressure Also route for med administration, blood sampling and emergent placement of pacemaker Inserted through superior vena cava to right atrium
If a patient has decreased trunk rotation, which phase of gait will be most affected?
Right initial contact
A patient is referred to physical therapy for right shoulder pain. Which of the following findings suggests that physical therapy intervention may not be appropriate?
Right sidelying often increases musculoskeletal pain but may decrease pleural friction/irritation and thus may decrease visceral pain
What would a therapist who is examining the breathing pattern of a patient with a complete (ASIA A) C5 spinal cord injury expect to observe?
Rising of abdomen due to no abdominal muscle tone on the abdominal viscera Note (ASIA A): -muscle weakness would be symmetrical -diaphragm is innervated at C4 so it would be working -muscle weakness would lead to restrictive disorder NOT obstructive
What does a continued ATNR cause issues with?
Rolling supine to prone
What is normal INR and how does it change if someone is on blood thinners v. not on blood thinners?
The international normalized ratio (INR) indicates blood's ability to clot The normal range for people who are not taking anticoagulant medications is 0.9-1.1 When patients are at a higher risk of blood clots or have mechanical heart valves, they take anticoagulants to thin their blood, thus increasing their INR to a necessary range of 2-3.5 When the INR is over 3-3.5, the patient is at a higher risk of bleeding and it may be necessary to limit exercise.
What is characteristic of the boutonniere deformity?
Rupture with volar slippage of the lateral bands
What indicates a positive graded exercise test?
ST segment changes greater than 1 mm of horizontal or downsloping depression since it indicates ischemia of the ventricles Definitely assess anginal symptoms but this DOES NOT indicate a positive graded test The graded test determines physiological repsonse during increased workloads Allows the determination of functional exercise capacity and detects PRESENCE OF ISCHEMIA
What ulcer stage is characterized by pink and moist wound bed?
STAGE II This stage has a loss of dermis presenting as a shallow open ulcer with a red pink wound bed WITHOUT granualation, eschar or slough May also look like an open/ruptured serum filled blister
What should you do if a patient's symptoms begin to peripheralize during traction? (I.e - increased pain with radiating sx)
STOP (reducing and changing angle is not sufficient enough)
Which of the following positions should be AVOIDED for at least 30 minutes following administration of alendronate (Fosamax)?
SUPINE Fosamax is for osteoporosis (want to avoid supine position for at least 30 min)
What is a positive prognostic indicator for motor recovery in those with an SCI?
Sacral sparing
Which bony prominence is MOST likely to sustain injury from pressure in a patient on bed rest in the supine position?
Sacrum (sacrum usually is most common one affected when in a supine position)
What is the annular ligament?
The ligament between the radius and ulna that allows for pronation and supination
What are signs of hip bursitis?
Severe pain over the bursa area Pain aggravated by active motion including activities such as walking Tenderness over greater trochanter Groin pain and hip pain which increases with walking
What is extinction phenomena?
Situation where only the proximal stimulus is perceived with extinction of the distal stimulus
What is grade IV (4) mobilization?
Small amplitude oscillation performed at the limit of the available motion and into tissue resistance Grade IV appropriate to address restrictions associated with capsular end-feels
When to use circumferential vs. volumetric measurements for edema?
Small body parts (wrist and hand) = volumetric measurement Here you are looking at amount of water displaced following immersion Circumferential measurements are used when you have edema of a larger body part such as the knee
What is rhonchi sound?
Snore like LOW pitched noise caused by fluid in large airways (thickening because of mucus or fluid) Best heard when breathing out (expiration)
What may lead to abducted lateral wall?
Socket may be too loose. Leads to circumduction
What is a normal finding for lymph nodes?
Soft and non palpable
What does an MRI show?
Soft tissue as well as bone tissue Good for knee evaluations
What stage of idiopathic frozen shoulder is most likely to present with intact rotator cuff strength and night pain?
Stage 1 - pain and decreased movement of ER Loss of ER with intact RTC strength This stage is usually less than 3 months
What is scoliosis screening test?
Standing and forward bend to touch feet Look at difference in shape of the ribs on each side
How do you test for position sense?
Therapist places one extremity then has the patient place the opposite extremity in the identical position
What happens when INR is increased?
There is an increased risk of bleeding during activity
What exercise works serratus anterior?
Standing wall push ups
What can you do in the moderate protection phase after a meniscal repair surgery?
Stationary cycling against light resistance - helps with ROM Once you hit week 8 then you can now do quad strengthening on a leg press, balance, squattting more
In patients with congestive heart failure, prolonged use of Lasix may lead to?
Thiamine deficiencyThis is concerning in this patient population because levels of thiamine correlate to the force of myocardial contraction and cardiac performance in general
When is segmental breathing used?
Those with chest hypomobility Meant to promote chest expansion and regional ventilation (those with decreased chest wall compliance) Helps with atelectasis and retained secretios Done with the hands over chest wall
How are indwelling right atria catheters put in?
Through the cephalic or jugular vein and threaded to the superior vena cava and right atrium
A patient is standing with excessive subtalar pronation. Which of the following indicates the obligatory motions that accompany this condition?
Tibial, femoral, and pelvic internal rotation. In closed chain
A patient is receiving physical therapy intervention for rheumatoid arthritis, which is in REMISSION. Which of the following interventions is MOST appropriate for the patient?
Strengthening exercises for weak muscles (Strengthening exercises are the most appropriate intervention for a patient who has rheumatoid arthritis in remission) Contract relax, end range mobs are contraindicated
What stretching is indicated with scoliosis?
Stretching of iliopsoas, low back extensors and lateral trunk flexors on concave side
How should you exercise those with MS?
Submaxima exercises at moderate intensity which is 50-70 and doing it in the mroning because the body's core temperature is lowest at this time Alternante work between UE and LE to not overfatigue one area
If hip internal rotation is limited, what could this mean?
Tightness of hip external rotators especially piriformis If something is limited, think tightness of opposite side** If you had hypomobility of the internal rotators this would cause limited external rotation NOTE TO SELF
What causes an avulsion fracture?
Sudden strong muscular contraction
What is blood glucose?
Sugar that is transported through the bloodstream to supply energy to the cells
What glide improves exhalation?
Superior glide
What patellar glide improves extension?
Superior glide
What nerve innervates the hip abductors?
Superior gluteal nerve
What nerve innervates the hip internal rotators?
Superior gluteal nerve (L4,5,S1)
What nerve root innervates the gluteus medius?
Superior gluteal nerve which is also L5, S1
What T score indicates osteoporosis?
T < -2.5
What is the dermatome for the umbilicus?
T10
At what level is sine of scapula?
T3
Does fibromyalgia have trigger or tender points?
TENDER pain >3 months for diagnosis Is more systemic, widespread rather than single point JOINT PAIN NOT COMMON with fibromyalgia it is more myofascial pain trigger = CRPS
Lucas presents with a history of right shoulder pain and difficulty reaching overhead. The initial symptoms have resolved, however the patient continues to demonstrate excessive upward rotation of the scapula. Which of the following muscles should be STRENGTHENED:
Mid trap We need a downward rotator (mid trap, rhomboid, levator scap, pec minor) to counteract the excessive upward rotation*
What causes lisfranc injury?
Midfoot crush injury caused when plantar flexed and having another player step on mid foot
A patient has developed a PF contracture. Which phase of gait cycle will be affected?
Midstance to heel off cause here it requires 0-15 degrees of DORSIFLEXION
If you have issues with hip flexion, what phase of gait will be most affected?
Midswing
What would indicate systemic pain rather than musculoskeletal origin?
Migratory pain Pain that awakens a patient at night
What indicates systemic nature pain?
Migratory pain, pain that awakens at night
After how long can you start resistance training with someone after a coronary artery bypass surgery?
Minimum of 8 weeks Also contraindicated to do upper extremity exercises with ergometer due to incisional precautions
What is something not seen in bilateral vestibular hypofunction that IS seen in unilateral vestibular hypofunction?
NO vertigo or nystagmus seen in bilateral hypofunction DO NOT do habituation exercises in someone with bilateral vestibular hypofunction since they do not have vertigo
What kind of aphasia is brocas?
NON FLUENT APHASIA expressive
Are there BP or HR changes with heart failure?
NOOOOOO monitor for SOB and dependent edema mainly
would NMES work on patient with myasthenia gravis?
NOOOOOOO ther defect is in the neurotransmitters at neuromuscular junction
What are side effects of Levadopa?
Nausea, vomitting, cardiac arrythmias, loss of appetite, dry mouth, diarrhea To militgate these effects, levadopa is often combined with drugs that increase the effectiveness of levadopa in small doses such as carbidopa and bensarasizde
What is rule for iontophoresis?
Negative polarity always goes with a negative ion
What is normal exercise response to exercise in regards to DBP?
No change or a moderate DECREASE in DBP
what is Kruska Wallis Test?
Non parametric test used with THREE OR MORE independent samples
What is respiratory rhythm for a normal individual and one with COPD?
Normal has 1:2 ratio with inspiration being half as long as expiration COPD has 1:3 or 1:4 which indicates a much longer expiratory phase
What is cadence?
Number of steps an individual will walk over a period of time
When do you hear wheezing on auscultation?
Obstructive conditions
What is test-retest reliability?
Obtained by adminstering the same test on separate occassions over a period of time to the same individual
What nerve innervates the hip adductors?
Obturator nerve
What is psoriatic arthritis?
Occurs in those that have psorasis Most likely affects DIP of hand
A patient is seen in a PT clinic for a traumatic knee injury. the patient sustained the injury by falling "up the stairs" in their house and striking the proximal tibia directly against the edge of a step. during the examination of the patient, therapist notes diffusing bruising around the tibial tuberosity. what structure was most likely injured?
PCL This is a typical PCL injury where knee is flexed and something forcefully strikes anterior tibia, displacing it posteriorly
How should electrodes be placed?
Over muscle belly and lined up parallel to the muscle fibers
When evaluating wheelchair positioning for an individual with CP, the PT should FIRST examine the position of the child's?
PELVIS The mobility of the pelvis in all 3 planes will in turn determine the alignment and support needed at the trunk, head and extremities
Which cells would arrive FIRST after an acute wound?
PLATELETS form to temporarily stop bleeding
What sitting balance grade is automatically given to someone that requires physical assistance (even if contact guard or min A)
POOR
What is GMFCS level 4?
POWER WHEELCHAIR
What is the purpose of modulation mode on E-stim machine?
PREVENT ADAPTATION
What is Hoen and Yahr Classiication of Disability Scale used for?
Parkinsons disease to describe their disability
What are symptoms of trigeminal nerve neuralgia?
Paroxysmal and severe pain originating from the manidbular or maxillary division of CN V (trigeminal)
Where is pain felt with polymyalgia rheumatica?
Pelvic and shoulder girdle
What is correct sequence for doffing PPE?
THINK ALPHABETICAL 1. Gloves 2. Goggles 3. Gown 4. Mask 5. Hands
What conditions would have a positive whispered pectoriloguy?
THINK CONSOLIDATION 1. Cystic fibrosis 2. Bronchitis 3. Pneumonia Negative = emphysema
A patient with excessive anterior pelvic tilt has what muscle problems?
TIGHT -hip flexors, lumbar extensors WEAK/LENGTHENED -abdominals -glutes
What is Taylor brace?
TLSO that limits trunk flexion and extension
What is cancer staging system?
TNM T- primary tumor N - lymph node M - metastasis
Are labral tears traumatic or atrumatic?
TRAUMATIC
Those with C6 injury can perform sliding board transfer independently. TRUE OR FALSE?
TRUE At C6, the wrist extensors, lats, infraspinatus, pec major, serratus anterior would be innervated
T/F low load progressive resistance exercises are ok to begin for hamstrings in phase 1 (around 2-4 weeks)
TRUE Can do low load exercises for hamstrings Can also do weight earing closed chains quats, heeltoe raises, SLR and initiate open chain knee extension (90-40 degrees)
What are the possible ECG changes with exercise that can occur in a patient with CAD and prior MI?
Tachycardia at relatively low intensity of exercises with ST segment depression May also see occassional PVC's
How do you assess the calcaneofibular ligament?
Talar tilt test with ankle in neutral position
What kind of change in pitting occurs with lymphedema from stage 1 to 2?
Pitting to NON-PITTING
How do you measure the size and shape of a partial-thickness wound?
Place a sheet of plastic wrap on the wound and use a marking pen to draw a tracing of the wound's perimter on the plastic *Note: partial-thickness does not have depth so you wouldnt place a Q-tip inside wound*
What is dermatome for S1 (plantarflexors)
Plantar aspect of foot and lateral heel
Where are neuropathic ulcers located?
Plantar surface of foot (usually on bottom of big toe - between big toe and 2nd toe)
What is position of foot with clubfoot?
Plantarflexion Internal rotation Adduction of forefoot Varus of hindfoot Use seral casting and splinting
What is action of fibularis (peroneous) longus and brevis?
Plantarflexion and eversion
What ankle position would bias the deep fibular nerve?
Plantarflexion and inversion
A patient with ALS with dysphagia and diminished gag reflex is most susceptible to what disease?
Pneumonia
A patient with a 10 year history of MS demonstrates 3+ extensor tone in both LE's, the PT needs to order a wheelchair. What is the best recommendation for this patient?
Tilt in space wheelchair with pelvic beltYou need control over the hips to maintain the hips in flexion and the tilt in space design assists in keeping the patient from coming out of the chair when extensor spasms are active Tilt in space is good for extensor tone
What are side effects of lasix (furosemide)?
Tinnitus (ringing in ears) Jaundice Severe pain in upper stomach
A physical therapist assistant treats a patient with Parkinson's disease using whole body vibration. Which symptom associated with Parkinson's disease would this intervention most influence?
Tremor vibration helps tremors
A patient is initiating a pelvic floor strengthening program. Which of the following positions would be considered gravity assisted?
Trendelenburg (trendelenburg position, with the hips positioned higher than the heart, is considered a gravity-assisted position for this exercise, given the location of the pelvic floor muscles and the action of these muscles when tightened, which pull upward toward the abdomen)
A patient with osteoporosis and no fractures complains of increased middle and lower back pain during breathing and other functional activities. What is the MOST beneficial exercise intervention for this patient?
Trunk extension and abdominal stabilization exercises. WANT TO AVOID ANY FLEXION OR ROTATION so answers with those in it are out
What is secondary prevention?
Try to detect a disease early and prevent it from getting worse (injury already occurred) (ex: regular exams to such as mammograms, daily medication) Tertiary is trying to improve your quality of life and reduce the symptoms of a disease you already have (groups, rehab programs) Primary is improving overall health of population (immunization, laws, education)
A physical therapist treats a patient post stroke. Which of the following actions would be the MOST likely to facilitate elbow extension in a patient who has hemiplegia?
Turn the head to the affected side ATNR reflex produces extension of side that head is turned to and flexion on opposite side Patients post CVA are likely to exhibit abnormal tonic reflexes
A therapist wishes to examine the balance of an elderly patient with a history of falls. the Berg balance test is selected. which area is NOT examined during this test?
Turning while walking Berg DOES NOT look at gait. It only assesses static and dynamic balance
A 14-year-old with a body mass index of 33 kg/m2 and a history of limited participation in physical activities is referred for exercise training. The nutritionist has prescribed a diet limiting his caloric intake. What is the BEST initial exercise prescription for this patient? 1. Three weekly sessions of 60 minutes at 50% VO2max. 2. Three weekly sessions of 50 minutes at 75%-85% VO2max. 3. Three weekly sessions of 30 minutes at 65%-70% VO2max. 4. Two daily sessions of 30 minutes at 45%-70% VO2max.
Two daily sessions of 30 minutes at 45%-70% VO2max. initial exercise should do low intensity with longer duration exercise
What does a high specificity limit?
Type I errors (false positives)
What does a high sensitivity limit?
Type II errors (false negatives)
What is a clinical symptom of MCA?
UE affected and apraxia
What is traction response?
UE flexion when traction is applied to the arm
What symptoms are associated with shunt dysfunction?
UE hypertonicity, blurred vision and headache
What is the difference in maximal oxygen uptake between UE and LE?
UE uses 30-40% LESS maximal oxygen uptake than the LE's HOWEVER heart rate and systolic BP are higher for any given workload when performed with the UE's compared to LE's
What nerve is responsible for power in the hand?
ULNAR NERVE
What are signs of cervical myelopathy?
UMN signs - hoffman, babinski, clonus, hyperreflexia, ataxia Positive HOFFMANS sign
When should you use gaze stability exercises?
UNILATERAL VESTIBULAR HYPOFUNCTION
What hand deformity is seen with RA?
Ulnar drift which is 1. Radial deviation of radiocarpal joint 2. Ulnar deviation of the fingers
What kind of glide should be done to assess radial deviation?
Ulnar glide (downward glide with wrist in neutral position)
A patient who is a waiter has hand pain when carrying trays overhead. Which of the following nerve tension tests is MOST likely to have a positive result?
Ulnar nerve (the overhead positioning of carrying food tray is similar to end position of ulnar nerve tension test) - depression, abduction, ER, elbow flexion, forearm pronation/supination, wrist and finger extension
What nerve innervates the adductor pollicis?
Ulnar nerve (C7,8,T1) test ulnar nerve with carrying tray position
Someone with juvenile RA ( 8 y.) is developing bilateral knee flexion contractures. Which of the following is LEAST recommended?
Ultrasound to hamstring insertions to increase tissue extensibility NOT GOOD cause it could expose the epiphyseal areas
What is POOR sitting balance?
Unable to maintain balance without external support or assistance Even if you are minA it is considered poor balance
What does trendelenburg look like?
Uncompensated = contralateral pelvic drop (opposite side of pelvic drop has the glute med weakness); trunk lean towards weak side pelvic on swing leg drops Compensated-trunk lean towards stance limb (side with glute med weakness also known as unaffected side) I think affected side means the side with the drop
What are dynamic stabilization exercises?
Unconscios control and loading of a joint They introduce ballistic and impact exercises Example = practicing forehand stroke by hitting a ball against a wall
What is first degree heart block?
Uniform but prolonged PR interval (greater than .20 seconds)
What does herpes zoster (shingles) look like?
Unilateral symptoms along a DERMATOMAL pattern Typically 1st symptom is one-sided pain, tingling or burning followed by rash that involves spine around to the from of abdomen along a dermatome vasicular eruptions along lateral wall that cause pain and blistering
What is said about those with spinal muscular atrophy who cannot sit?
Unlikely to walk and will require power mobility
What causes stridor?
Upper airway obstruction
What are frenkels exercises?
Used for ataxia
When is monopolar technique for E-stim?
Used for wounds, edema, iontophoresis
What is the fulcrum test?
Used to detect femoral shaft stress structures Positive = pain or apprehension when pressure is applied
What is the squat test
Used to screen for MSK source of hip pain such as a fracture
How are undermining and tunneling documented?
Using the face of the clock as a guide 1. 12 o'clock = patient's head 2. 6 o'clock = patients feet Tunneling at 3 o
If you see edema do you think arterial insufficiency or venous insufficiency?
VENOUS edema is due to incompetent valves Long standing edema (chronic) causes staining of the legs because of increased iron from blood pooling
What is 3rd degree heart block?
Variable P waves that are not related to QRS complexes
What is an example of an extraarticular complication associated with chronic RA?
Vasculitis
What kind of nystagmus is seen with central lesion?
Vertical and pendular nystagmus Abnormal smooth pursuit Abnormal saccades In peripheral, you see horizontal nystagmus
A 30-year female patient is being seen at an outpatient physical therapy clinic. She is a software engineer at a start up company and uses public transit for her commute every day. The patient reports that she has difficulty maintaining her balance, especially when she is in crowded places at night. The physical therapist should MOST LIKELY examine:
Vestibular integrity Patient is in a crowded environment or public transport with visual conflict, so she will depend on her vestibular system This is condition 6 on CTSIB
What kind of therapy is commonly used in those with global aphasia?
Visual action therapy (VAT) non-verbal treatment composed of 12 progressively difficult levels They trace common objects followed by matching objects to the tracing. later progress to gesture and verbalizing about objects
What should a therapist be MOST concerned about when treating a patient with anorexia nervosa?
Vital sign instability (orthostatic hypotension, irregular pulse, bradycardia, hypothermia)
Which of the following measurements should be taken and compared before and after treatment to MOST accurately determine the effectiveness of mechanical compression for upper extremity lymphedema?
Volume of water displaced when the extremity is immersed in the tank
A physical therapist assistant is documenting the changes in a patient's edematous hand. Use of which of the following tools allows MOST accurate measurement of the observed changes?
Volumeter
A physical therapist plans to apply ultrasound over an extremely IRREGULAR body surface area. Which. method of ultrasound administration would be the MOST appropriate?
WATER IMMERSION (good for irregular body surfaces cause transducer does not need to be in direct contact with the treatment area) A gel coupling agent is not required with water immersion since water serves as the coupling agent
What exercises for osteoporosis?
WEIGHT BEARING if any answer has something on flat surface choose that Even choose over aquatic
What are symptoms of a disk derangement (central disc herniation)? / also for lumbar disc bulge
WORSE with flexion better with walking and are rarely bilateral (usually unilateral)
Walker sequence?
Walker, affected foot, unaffected foot
During the course of PT treatment in the ICU, a radial artery line gets pulled out of the artery, what is the first action the PT should do?
Want to apply immediate pressure to stop bleeding You can Place a BP cuff on the involved extremity and inflate the cuff until the bleeding stops
What kind of exercises do you want to give to those with spondylolisthesis?
William flexion exercises --> used to strengthen abdominals and reduce lumbar lordosis AVOID Extension cause this hurts them. Flexion alleviates pain.
What is the correlation between aging and wound healing?
With advanced aging, the rate of epidermal proliferation decreases
What to know about Levadopa and Parkinson's?
With parkinsons want to AVOID protein as this can block the effectiveness of Levadopa medication Instead, want a high calorie, low protein diet Blood pressure is low during medication "on" time Want to perform exercise 45 min-1hr after taking levadopa (this is because reductions in strength and exercise performance as common during "off" times
A pt complains of right buttock pain after slipping. The right hip had been forced into internal rotation. Lumbar active motion testing is full and pain free. Neurological findings are unremarkable. S1 provocation testing is unremarkable. Passive hip internal rotation is limited with pain and pulling noted in the right buttock region. Resisted external rotation produces pain in the same region. Based on these findings, the MOST LIKELY dx would be a. Piriformis strain b. Sacroiliac sprain/strain c. Lumbar disc herniation at L5/S1 d. Quadratus lumborum strain
a. Piriformis strain Forceful hip internal rotation would overstretch and potentially strain the piriformis muscle. Limited passive hip internal rotation would reproduce symptoms from a tight or tense piriformis. Pain with resisted external rotation and would suggest a contractile problem with the piriformis
Treatment of a patient with hemophilia who has a subacute hemarthrosis of the knee should INITIALLY include:
active assistive ROM exercise to the knee (in this stage of hemarthrosis, there is still some bleeding into the joint space but not as much as what would be seen in acute phase). Therefore, the patient will benefit from ROM exercise to prevent contractures
Patient reports paian and weakness with overhead activities and has difficulty flexing the arm past 90. PT finds the results of impingement are positive without RTC tear. Which of the following interventions should be FIRST introduced to patiet?
active assistive shoulder ROM Early on should be about improving pain free ROM such as with a cane ER should be strengthened not stretched
What is role of exercise with insulin?
aerobic exercise causes vasodilation by increasing skin blood flow This would deliver the insulin more rapidly
How do you test constructional ability?
ask a person to copy figures consisting of varying sizes and shapes or to draw a clock
How do you test orientation?
ask for person, place and time
What is bronchophony?
ask patient to say "99" Normal: indistinct sounds Abnormal: clear, higher, and louder THINK CONSOLIDATION if clear and higher sound
How do you assess abstract ability?
ask someone to interpret a common proverb or to describe similarities or differences between 2 objects
A physical therapist assistant reads in the medical chart that a patient is taking digitalis. The patient is MOST likely taking this medication to treat:
atrial fibrillation
A physical therapist examines the abdomen of a patient with suspected referred shoulder pain from the viscera. Which examination component should be assessed FIRST?
auscultation
What phase of gait do you have most knee flexion (hamstring activity)?
initial swing
What does valsalva maneuver do?
it increases the workload of the heart but not peripheral formation Leads to slowing of the pulse, decreased return of blood to heart, and increased venous pressure Upon relaxation, blood can rush to heart and overload causing cardiac arrest
The patient diagnosed with left lateral epicondylitis has no resolution of symptoms after 2 weeks of treatment. The PT begins a reexamination and finds the left biceps reflex is 1+. The therapist should perform a complete examination of the?
mid cervical region
Phase of gait with max hip flexion
midswing - 25 to 30 degrees
What do cholinergics do?
mimic the actions of the parasympathetic nervous system and include cholinergic stimulants and cholinergic inhibitors (anticholinergics). They have varying effects on smooth muscle and gland functions. CHOLINERGICS = PARASYMAPTHETIC
What do adrenergics do?
mimic the actions of the sympathetic nervous system and include vasodilators (stimulants) and vasoconstrictors (depressants). ADRENERGICS = SYMPATHETIC
According to the treatment based classification system for the cervical spine, a patient that presents with acute localized symptoms would most likely respond best to
mobilization/manipulation
During assessment of a patients thoracic spine the patient reports pain reproduction along the right thoracic spine during left rotation. This would be classified as a
opening restriction
What is the most common substitution to exaggerate hamstring length is?
posterior rotation of the pelvis
For patient with plantar fasciitis or even tarsal tunnel problem, what specific muscle do you want to look at and why?
posterior tibialis because it supports the medial longitudinal arch
What does specificity look at?
probability of a NEGATIVE test
What does sensitivity look at?
probability of a POSITIVE test
A physical therapist assistant works with a patient on wheelchair mobility. The patient has a history of cerebrovascular accident with right-sided hemiparesis. Which of the following wheelchair adaptations would be MOST beneficial for the patient to ensure safety during stand pivot transfers?
pull-to wheel lock with brake extensions (this helps assist with hemiplegia so they can grasp better with the noninvolved arm)
Which of the following provides a noninvasive way for a physical therapist assistant to measure oxygen saturation in arterial blood?
pulse oximeter (oxygen saturation)
What is the dermatome for C6?
radial side of hand to thumb & index finger *thumb*
What is ulnar drift with RA?
radiocarpal radial deviation with MCP and IP ulnar deviation
What should you do if someone is perseverating?
redirect their attention to a new task and reward successful completion
According to the canadian C-spine rule, a 65 year old patient arrives to your office with radicular pain extending down their right arm, acceptable treatments for this patient include
refer patient for x rays
What happens to blood pressure as we age?
resting blood pressure increases with age
The exercise program for an 80-year-old patient with long-standing Parkinson's disease will MOST likely include:
rhythmic initiation of trunk rotation
What are MRIs best for?
rotator cuff tears Herniated disks bone tumors torn knee ligaments
What is characteristic of stage 2 pressure injury?
shallow crater with a MOIST RED WOUND BED
What are values that can be used for mechanical, intermittent pneumatic compression of LOWER EXTREMITY?
should be between 40-80 (HIGHER THAN WHAT IS recommended for UE)
A patient diagnosed with shoulder pain of unknown etiology is referred by his physician for magnetic resonance imaging. Results of the test reveal a partial tear of the infraspinatus muscle. Which muscle group would be the MOST seriously affected by the injury?
shoulder external rotators Infraspinatus does ER
What is there to know about coupled movements of cervical spine?
side bending and rotation occur in the same direction from C2-7 regardless if the spine is in flexion or extension
An iontophoresis electrode should NOT be placed over an area that has:
skin abrasions
when a pt is sitting, and there is an anterior weight shift through the pelvis, what is the response
concentric spinal extension must occur in order to maintain an upright position in sitting
What is the muscle action for infraspinatus?
external rotation and horizontal abduction *if forget think of special test for infra where you are pushing out*
What intervention may be useful for someone with sacroiliac dysfunction?
external stabilization with a support belt
What are symptoms of post-polio syndrome?
focal and asymmetric They have weakness, easily fatigued, muscle pain, cold intolerance
What is valsalva maneuver?
forcible exhlation with the glottis, nose and mouth closed which increases intrathoracic pressure and causes slowing f pulse, decreased return of blood to heart and increased venous pressure On relaxation, blood rushes to the heart and can overload the cardiac system leading to cardiac arrest
What is normal capillary refill time?
full color return in <2 seconds
What is stage III ulcer?
full thickness with damage to subcutaneous tissue
A physical therapist assistant is analyzing a patient's posture and observes that the plumb line falls through the greater trochanter, anterior to the patella, and just anterior to the lateral malleolus. What can the assistant document about the patient's posture?
genu recurvatum (knee hyperextension) is present
A physical therapist assistant reads in the medical record that a patient has recently been diagnosed with diabetes mellitus. Which of the following entries in the medical record would be MOST consistent with type 1 diabetes, however, would rarely be evident with type 2 diabetes?
high level of ketones in the blood
To assist with pelvic muscle contractions, which of the following muscle groups should be strengthened?
hip adductors
What is bicipital tendonitis?
inflammatory process of the tendon of the long head of the biceps Deep ache directly in front and on top of the shoulder Comes on gradually over time and can be heavily influenced by activity
A patient ambulates with excessive foot pronation, what will the therapist's examination likely reveal?
valgus position of the heel
what is the common synergy position of the foot in swing phase for CVA patients?
varus (inverted)
A patient who has angina would MOST likely be prescribed which of the following types of cardiovascular medication?
vasodilator (decreases BP)
What condition is hydrotherapy contraindicated with?
venous insuffiency (dependent position makes it worse)
What helps with freezing with Parkinson's?
visual stimuli
What pain location is most consistent with bladder infection?
suprapubic area
What do those that have fibromyalgia have difficulty with?
sustained overhead activities (i.e easily fatigue)
Is RA symmetrical or asymmetrical?
symmetrical
What is Bell's Palsy?
temporary facial paralysis caused by virus damaging the VII cranial nerve Is secondary to herpes zoster virus Characterized by inability to close eyelid due to weakness Typically resolves on its own within 2 weeks
To minimize the action of the biceps during supination what is the best position to place the elbow in?
terminal elbow flexion (here the biceps is maximally shortened so it does not assist)
If you have issues with hip extension, what phase of gait will be most affected?
terminal stance
What differentiates a flutter from a fib?
the regularity of the atrial rhythm Atrial flutter = rapid atrial tachycardia (saw tooth). This rapid rate creates decreased filling time of the ventricles resulting in diminished amount of blood being ejected from the heart. heart beats fast but is REGULAR producing saw tooth p waves Atrial fibrillation = erratic electrical conductivity within the atria. Heart beats very fast like with a flutter but the rhyhtm is IRREGULAR Both a flutter and a fib have extremely rapid rates of atrial depolarization but a flutter is REGULAR (consistent and predictable rhythym) and a fib is IRREGULAR Digoxin is used to treat a flutter*
Which action using biofeedback would demonstrate an increase in vastus medialis recruitment in a patient post anterior cruciate ligament tear?
the sensitivity is decreased and more complex tasks are added
What is Paget's disease?
the thickening and enlargement of the bones heightened osteoclastic activity Bones appear enlarged but lack strength
To maximize contunuity of patient care, the PT should begin discharge planning when the:
therapist performs initial evaluation of patient
A physical therapist assistant completes a manual muscle test where resistance is applied toward plantar flexion and eversion. This description BEST describes a manual muscle test of the:
tibialis anterior think that resistance is always applied in the opposite of what the muscle action is DONT get tripped up here
A physical therapist assistant treats a patient exhibiting a Trendelenburg gait on the right lower extremity. The plan of care includes functional electrical stimulation (FES) to help improve the patient's gait pattern. Which of the following methods BEST describe how the functional electrical stimulation treatment should be applied?
to the right hip abductors during STANCE PHASE on the right
What is silver sulfadiazine used for?
topical agent for burns Interferes wth bacterial nucleic acid production by disrupting folic acid synthesis Is a broad spectrum agent that is applied directly to the skin Side effect is that it can produce a decrease in the number of WBC below 5,000
What 2 types of dressings are used for absorption?
1. Alginate 2. Foam
What are symptoms associated with cerebellar pathology?
1. Ataxia 2. Dysmetria 3. Hypotonicity 4. Dysdiadochokinesia 5. Nystagmus 6. Tremor 7. Scanning speech
What are examples of ordinal data?
1. Pain scale 2. Cancer stages 3. BORG 4. Manual muscle testing Data that has a number that is higher or lower
What are pressure tolerant areas in transtibial amputation?
1. Patellar tendon 2. Fibular shaft 3. Gastroc
What does an elevated erythrocyte sedimentation rate signify?
Autoimmune disorder
What happens with posterior tibial tendon dysfunction?
Collapse of medial arch since tibialis posterior is weak (leads to hindfoot valgus and swelling in medial aspect of ankle)
What is contraindicated with arterial insufficiency?
Compression of LE
What is the most specific test for duchenne muscular dystrophy?
Creatine phosphokinase
What does the deltoid ligament resist?
Eversion of the talus
What is boutonniere deformity?
Flexion of PIP and hyperextension of DIP Caused by a rupture of the central tendinous slip of the extensor hood
What is afterload?
Force the let ventricle must generate during the systolic phase and is directly related to the resistance in the aorta and peripheral arteries *an increase in afterload, will cause stroke volume and cardiac output to decrease*
What position is used to promote oxygenation through maximal chest expansion?
Fowler's (almost sitting upright)
What type of sputum is observed with pulmonary edema?
Frothy
What is lymphedema pressure?
High working pressure, low resting pressure
What is the formula for inspiratory capacity?
IC = TV + IRV
What leads to firm end feel?
Ligament or capsular tightness
What is ITB syndrome?
Localized pain 2 cm above the knee joint line over the lateral femoral condyle Caused by activities requiring frequent flexion of the knee - 30 degrees (running, cycling) ITB extends from iliac crest to the tibial tubercle
What is ape hand deformity and what nerve is involved?
MEDIAN nerve weakness with thumb opposition and flexion + wasting of the thenar eminence
What is classification for lymphedema?
Mild: <3 cm Mod: 3-5 Severe: >5 This represents the difference between affected and unaffected limb
What is cause of primary lymphedema?
Milroy's disease All secondary is surgical or trauma
Should compression garments be worn at night?
NO only compression bandages at night Garments are meant for daytime
What is okay with Bruce protocol?
P wave increase ST upsloping
What is leg calve perthes disease?
Peak incidence from 5-7 More common in B>G
What type of hip surgery is associated with high post-surgical dislocation rate?
Posterolateral approach due to posterior capsule damage
What is main cause of cerebral palsy?
Prenatal cerebral hypoxia (periventricular leukomalacia) = ischemic brain
When is a spinal fusion performed?
Presence of axial pain from unstable spinal segments, advanced arthritis or uncontrolled peripheral pain Bone is usually harvested from iliac crest to help fuse vertebrae together Rehab: emphasis on core stabilization and proper body mechanics
What is ASIA B?
Sensory Incomplete (intact sensation, absent motor including sacral segments) Absence of bowel control
What type of bandages should be used with lymphedema?
Short stretch with low resting pressure
What are CT scans usually used to diagnose?
Spinal lesions Soft tissues = greay Vertebrae = white
What bony prominence would NOT be suceptible to pressure injury when a patient is sitting in a properly sized standard wheelchair?
Spine of scapula If it were a properly fit wheelchair then the back height should fall below the inferior angle of the scapula (measured from seat to floor of axilla -4 inches)
What is the method in which nitroglycerin is taken?
Sublingual Nitroglycerin decreases myocardial oxygen demand, preload and afterload through dilation of arteries
What is traction positioning for someone with spinal stenosis?
Supine with knees flexed and legs resting on on stool (this causes lumbar spine flexion and separation of the spinous processes)
What is formula for total lung capacity?
TLC = VC + RV
What type of gait pattern should be used after a joint arthroplasty (PWB)?
Three-point gait pattern (used when 1 limb is affected)
What is the formula for vital capacity?
VC = Tidal volume + Inspiratory reserve volume + expiratory reserve volume
What represents 75% of the lung volume?
Vital capacity
Can you use heel lift with achilles tendonitis and repair?
YES (this helps reduce traction on Achilles tendon and promote healing)
What is semi fowlers position and when is it used?
45 degrees of HOB elevation + pillows under knees for support Used for patients with congestive heart failure
What is considered FAIR sitting balance?
Able to maintain balance unsupported but cannot accept ANY challeneges or go outside BOS without LOB
What is considered good sitting balance?
Able to sit unsupported, move out of BOS and accept SOME challenges without LOB
What to know about patellofemoral syndrome?
Abnormal lateral tracking of patella due to weak VMO Want to do medial patella glides to stretch lateral fascia and move patella more medially since its tracked laterally Avoid anything with >30 degrees of flexion or extension Had an increased Q angle (which leads to knee valgus, pronation, tibia IR) Have anterior knee pain that is worse with stair climbing and prolonged sitting Target VMO as main muscle to strengthen
What medication should NOT be taken with warfarin?
Acetylsalicylic acid (aspirin) - also is an anticoagulant/ Taking both could cause excessive anticoagulation and be harmful
What is the primary goal of phase I cardiac rehab?
Achieve a safe and independent level of activity that can be carried out at home Phase II - increasing aerobic capcity,
Which action on the heart or vascular system results from utilization of a cholinergic drug?
Activates the parasympathetic nervous system which causes relaxation of the vessels and decreases the work load on the heart
Sensory-level electrical stimulation is MOST appropriate for a patient with which of the following conditions? A. Chronic low back pain of somatic origin B. Acute ankle sprain with edema C. Supraspinatus tendonitis D. Active Raynaud's syndrome
Active Reynaud's Syndrome The sensory level E-stim would help increase peripheral vasodilation For tendonitis, iontophoresis would be better cause it can deliver anti-inflammatory meds For chronic low back pain since it says chronic it can't be sensory level. it would need to elicit motor. Sensory is for acute injuries Sensory would not be helpful for edema. If it just said acute ankle sprain then yes
Following reattachment of the flexor tendon of the fingers, the patient is in a splint. one physical therapy goal is to minimize adhesion formation. what should the PT teach the patient to perform after 72 hours post surgery?
Active extension and passive flexion of IP joints Since it is a flexor tendon repair you can do active extension but you CANT flex IP joints so for that part you need to do it passively
Appropriate knee positioning when strength testing the hamstrings in the prone position will minimize:
Active insufficiency of the hamstrings and passive insufficiency of the rectus femoris Active = shortening Passive = lengthening
What type of current should be used for functional electical stimulation?
Biphasic pulsed current
What is function of ACE inhibitors?
Block angiotensin I conversion; vasodilation and decreased peripheral resistance 1. Vasodilation 2. Reduce peripheral resistance 3. Increase venous capacitance
What are side effects of aspirin?
Bloody stool, vomitting, peptic ulcers LIVER TOXICITY
A patient demonstrates some out-of-synergy movements in the right upper extremity indicative of stage 4 recovery after a left cerebrovascular accident (CVA). Which proprioceptive neuromuscular facilitation (PNF) pattern represents the BEST choice to promote continued recovery of the right upper extremity?
Both chop and reverse chops patterns move the affected arm out of synergy
What degrees of scoliosis require bracing and which require surgery?
Bracing: 25-40 degrees Surgery: >40 (harrington rods, posterior spinal fusion)
What would tight anterior capsule limit?
Extension and external rotation
If someone has a tight anterior GHJ capsule, what motions will they have difficulty with?
Extension, ER (basically anything that requires an anterior glide)
Which tendons loop around Lister tubercle?
Extensor pollicis longus This one performs extension of the IP joint of the thumb
What does a positive support reflex create?
Extensor tone through LE's and trunk Want to use trunk flexion with LE weight bearing activities to avoid mass extensor pattern in standing
What is internal consistency?
Extent to which items or elements that contribute to a measurement reflect one basic phenomenon or dimension Example: in PT a functional assessment scale should only include items that relate to a patients physical function -Reliability of items within tests -Do items measure aspects of the same thing?
A young, athletic patient complains of deep hip and groin pain with a clicking sensation. the patient's symptoms are aggravated by deep squats and sports activities. hip IR is limited and the FABER and FADDIR are both positive. what is MOST LIKELY diagnosis?
FAI femoralacetabular impingement Symptoms 1. Anterior groin or hip pain 2. Positive FADDIr and or FABET 3. IR<20 degrees 4. Snapping, clicking 5. CAM or pincer
Kidney pain referral pattern
FLANK PAIN
What is hip capsular pattern?
Flexion>adduction>internal rotation
What muscle is weak if you have difficulty holding a briefcase?
Flexor digitorum profundus
What kind of repair should you use tendon gliding exercises?
Flexor tendon rupture repair
What would lead to a boggy end feel?
Fluid within joint (ex: blood)
What is Mann Whitney U test?
For non-parametric Tests null hypothesiswith TWO independent samples from the same population
What is brief intense TENS?
For procedural pain 1. Long duration 2. High frequency 3. High current amplitude
What is spondyloslisthesis?
Forward translation of a vertebral body with respect to the vertebral body below Break in pars interarticularis (bilateral) L5-S1
Parameters for muscle strengthening ESTIM
Frequency 35-80 ppsDuration 150-200 for SMALL mm 200-350 for BIG mmOn:off 10 seconds on 50 secs off (1:5)Ramp 2 seconds
Which ROM is most important to obtain for an individual with a T12 spinal cord injury to walk?
Full hip extension
What are considered the "pain arcs" for ROM for both the glenohumeral painful arc and the acromioclavicular painful arc, respectively?
GH: 90- 120 degrees AC: at end range of ROM (170-180)
What kind of coordination does an RGO require?
GOOD COORDINATION
When to use GRAFO versus a KAFO?
GRAFO = MMT 3-/5 minimu KAFO = MMT <3/5
Which primitive reflex is first integrated (disappear)?
Galant reflex
What is Murphy's sign for?
Gallbladder. gallstones
If a patient has a biceps femoris tendon repair, when can you intiate the following interventions?
Gentle isometric strengthening: This can be done immediately to prevent adhesions of th tendon to the sheath and promote alignment of healing tissue Wait 6-8 weeks for: 1. Closed kinetic chain 2. Passive ROM to END RANGE (can do to restricted range) 3. Concentric exercises
What gait deviation would weak knee extensors (quads) lead to?
Genu recurvatum
Which of the following skeletal conditions is NORMAL in a newborn infant?
Genu varum (bow-legged) This is in order to accomodate for flexed position in utero
A 33 year old physical therapy student presents to an outpatient clinic with history of low back pain. The patient walks home each night from the library carrying a heavy bag of NPTE books in his right hand. On examination, the PT notes right hip pain and 3+/5 strength of the right hip abductors. Which of the following is the MOST appropriate suggestion to help alleviate patients symptoms?
Get a roller bag with wheels, and roll it on the left side
What should you NOT do when there is a restriction with weight bearing?
Give a unilateral single device such as a unilateral crutch Always give a device that provides both sided support
Why is pursed lip breathing helpful for emphysema?
Gives increased resistance to the airways on exhalation. This causes increased pressure which helps prevent airway collapse associated with emphysema
What are contact precautions?
Gloves, gown, wash hands (NO MASK REQUIRED)
A physical therapist identifies a limitation in movement after performing a straight leg raise test on a patient in supine. The therapist then passively flexes the patient's knee on the test leg, but is unable to gain any additional hip flexion range of motion. The MOST likely diagnosis is?
Gluteal bursitis (BUTTOCK TEST WAS POSITIVE) Can not be trochanteric bursitis because limitations in movement are NOT typically present Usually pain present in lateral hip due to trauma
The patient complains of pain with mouth opening that makes it difficult with chewing. Examination revealed active mouth opening to be within normal limits which is
35-44mm
What is an acceptable height for handrails to be placed?
36 inches 34-38 inches
What is dermatome for L5 (long toe extensors)?
3rd MTP joint dorsal surface
Which frequency and duration of dialysis is most typical with a pt that has ESRD?
3x a week for 4 hours
A patient with a TBI exhibits strong spasticity in both LEs (limbs are held in rigid extension). using the modified ashworth scale, the therapist gives this response which of the following grades?
4 A grade of 4 is given for affected parts held rigid in flexion or extension
At what rate should you be moving ultrasound head?
4 cm
A patient with a traumatic brain injury presents with hemiparesis. The examination reveals slight cutaneous and proprioceptive impairment, fair (3/5) strength of the shoulder muscles and triceps, and slight spasticity of the biceps. Voluntary control of the patient's left arm has not progressed since admission. The therapist decides to use functional electrical stimulation (FES), placing the active electrode on the triceps to facilitate active extension of the elbow. Which of the following is the BEST choice of timing sequence for FES in this case? 1. No ramp up, 8-second stimulation, 2-second ramp down. 2. 1-second ramp up, 9-second stimulation, no ramp down. 3. 0-second ramp up, 8-second stimulation, 2-second ramp down. 4. 4-second ramp up, 5-second stimulation, 1-second ramp down.
4-second ramp up, 5-second stimulation, 1-second ramp down.
The PT is completing general activity recommendations for a group home of young adults with emotional and behavioral issues. All patients are chemically controlled with either antipsychotic or antidepressant medications. Full-time supervision is available for any activity recommended. Which exercise considerations would be important in this situation? 1. Avoid games with throwing activities to prevent injuries. 2. Promote rhythmic movement to soothing music to avoid agitation. 3. Promote activities with sequential movements to improve memory. 4. Avoid aerobic exercises outdoors when temperature is over 90°F.
4. Avoid aerobic exercises outdoors when temperature is over 90°F. Overheating is detrimental to individuals who are on antipsychotic or antidepressant medications
A 39-year-old male patient with a 20-year history of smoking reports cramping pain of the buttock, thigh, and calf that is worse when walking. Which of the following findings is MOST likely present? 1. Forward stooping while walking 2. Pain in the calf with abrupt dorsiflexion 3. Brown pigmentation of the lower extremity 4. Blood pressure that is greater in the arm than in the leg
4. Blood pressure that is greater in the arm than in the leg This scenario of smoking + leg cramping that is worse when walking indicates PAD answer 4 which is describing intermittent claudication. If the BP is greater in the arm than in the leg would indicate ISCHEMIA which is consistent with PAD BP lower in ankle than arm = ISCHEMIA*
A mother brings her 8-week-old infant to be examined at early intervention clinic because she noticed that the infant was taking steps in supported standing at 2 weeks but is not able to do it now. What should the therapist do given the infant's symptoms and behaviors? 1. Recommend that the mother bring the infant to a pediatric neurologist. 2. Explain that this was abnormal and it is a good sign that it has disappeared. 3. Recommend that a full developmental examination be performed by the early intervention team 4. Explain that this is normal and that this early automatic walking is a newborn response.
4. Explain that this is normal and that this early automatic walking is a newborn response. spontaneous stepping reflex is normal and is usually integrated (aka gone) by 2 months
What should you avoid in someone with TBI?
Avoid cervical flexion, percussion, vibration, and trendelenburg
What are the precautions following total shoulder arthroplasty?
Avoid extension and ER to protect healing subscapularis muscle and anterior portion of the capsule
A patient demonstrates a forward head posture and has a positive result on the Adson test. Which of the following cervical positions would be MOST effective for stretching the involved muscle(s)?
Axial extension, contralateral side bending, ipsilateral rotation (THIS STRETCHES ANTERIOR SCALENE)
At what SCI level can a patient be IND with LE dressing, manual WC on level surfaces, and bed mobility/transfers with board?
C6
What is highest SCI level where adapted driving is realistic?
C6 SCI serratus, teres minor, wrist extensors, lats and pec major are now innervated
At what SCI level can a person be IND with most ADL's, bowel and bladder, WC mobility and pressure relief, bed mobility, transfers, and driving?
C7
At what SCI level may a patient possibly be able to transfer from floor to wheelchair?
C8
What dermatome corresponds to the hypothenar eminence?
C8
If ulcer is black and leathery, how do you grade this?
CANNOT BE - eschar means it is unstageable*****
Someone with AIDS is most likely to have what?
CD4 count of <200
What symptoms are associated with anterior disc reduction with TMJ?
CLICKING with mouth opening If TMJ without reduction then no clicking should be heard
What kind of exercises for ACL?
CLOSED CHAIN EXERCISES AVOIDING 0-30 degrees work from 90-40 degrees to avoid stress of ACL
If you see medial stabismus, what cranial nerve is damaged?
CN VI (abducens) This nerve innervates the lateral rectus causing medial strabismus (one eye is inward one is forward)
What is the formula for cardiac output?
CO = HR x SV Cardiac output INCREASES proportionally with with HR, stroke volume, preload Cardiac output DECREASES with an INCREASE in afterload (resistance)
What happens to the COG for a person with bilateral transfemoral amputations?
COM is more posterior Want to set the back wheels more posteriorly
What is the form of electrical current for iontophoresis?
CONTINUOUS DIRECT CURRENT *
How can you tell if it's canalithiasis or cupulo?
Canalisthesis is less than a minute Cupulolisthesis is greater than a minute Treatment for cupulo is liberatory (sermont) - start facing the UNINVOLVED SIDE
What. aresome symptoms of multiple myeloma?
Cancer caused by uncontrolled plasma cells in bone marrow usually affects musculoskeletal system first (osteoporosis), kidney stones, anemia, weakness and fatigue, skeletal bone pain
How should a patient descend the staircase after RIGHT total hip arthroplasty?
Cane/crutch and affected extremity should lead (right leg and cane) then good leg CANE/CRUTCHES AND AFFECTED TOGETHER To go up with cane/crutch 1. Good leg 2. Crutch and affected up together Cane and crutch without handrail 1. Hold onto railing with one hand and place cane/crutch on OPPOSITE side of injured leg 2. Lift stronger leg onto step ("up with the good") Walker 1. Turn walker sideways and put on opposite side of handrai 2. Place 2 front legs of walker on the 1st step 3. Up with the good
What is a training effect?
Cardiac output = SV X HR Training effect is an increase in stroke volume. There is a resultant ecrease in heart rate to maintain the same cardiac output at rest
An individual has motor and sensory loss in the right upper extremity in the areas innervated by C5 and C5. Which activity would be MOST difficult?
Carrying bear in crook of arm (this requires elbow flexion which is innervated by C5-C6) This myotome includes biceps, brachii, brachialis, brachioradialis and deltoid, supinator Pushing wagon - triceps Holding raison - wrist flexors Grasping cup - requires finger, thumb and wrist muscles
If a PT is using E stim over a stage II ulcer with lots of exudate, what polarity should the PT use and where it should be placed?
Cathode placed in the wound
What is predictive validity?
measure of future performance
What is dermatome for C8?
medial arm & index, long and ring finger *dorsal little finger* *ulnar nerve*
What is most common area for osteochondritis dissecans?
medial femoral condyle
what is motified plantigrade
standing with hand supporting on the table good to facilitate UE/LE WB for pt with hemi
What is face validity?
Degree to which a measurement appears to test what it is supposed to
What are nerves for knee flexors?
L5,S1
What nerve roots does a straight leg raise stress?
L5-S1
What does FIM assess?
Level of burden 18 specific activities what the patient ACTUALLY does in real time
What are 2 symptoms associated with hypothyroidism?
Myalgia Proximal muscle weakness
How should electrodes be placed for biofeedback muscle strengthening?
Wide spaced electrodes + high sensitivity
What spinal conditions do you WANT to do extension exercises?
1. Ankylosing spondylosis 2. DDD All other benefit from flexion to centralize
What muscles are involved with mouth opening?
1. Anterior digastric muscle 2. Suprahyoid 3. Lateral pterygoid
What is normal gestation?
40 weeks
What percentage of gait cycle is swing?
40%
What is function of L hemisphere? (list 5)
1. Aphasia (brocas, wernickes) 2. Language 3. Analytical, logical and rational 4. Positive emotions 5. Sequencing
What is the screwhome mechanism?
1. Knee extension --> tibia ER --> femur IR 2. Knee flexion --> tibia IR --> femur ER
How do you improve long-term retention and task transfer to novel conditions?
1. Knowledge of results 2. Random practice
What is klumpke's paralysis?
(C8-T1) lower brachial plexus injury, results from sudden upward pull of shoulder leads to paralysis of the intrinsic muscle of the hand (small muscles) which leads to claw hand and often, a sympathetic palsy (Horners Syndrome) if the T1 root is involved Impaired wrist flexion and instrinsic muscles of the hand
What degree should hinged brace be set to with ACL?
20-70 degrees initially
What are crackles (rales)
"popping, crackling" sound associated with fluid in the alveoli and airways NOT continuous and are heard on inspiration*
How much does blood volume and oxygen consumption increase during pregnancy?
- Blood volume increases 35-50%- Oxygen consumption increases 15-20%
If a patient presents with excessive foot pronation during midstance through toe off, what is the most likely cause of their gait deviation?
- Compensated forefoot varus *Forefoot varus results in the pinky side being lower than the big toe side so have to pronate in order to get the big toe in contact with the ground (either pronate or can PF the first ray)
A 6 year old patient presents with the following symptoms. What is his diagnosis?- No history of trauma or pain- Decreased stance time on the L LE- PROM IR and Abd limited 50%- AROM IR and
- Legg-Calve-Perthes Disease- This is very characteristic of the condition where IR and abduction are limited, it is more prevalent in males, and it is most common in pre-pubescent children*SCFE occurs in older children and they commonly report groin pain
What is seen with a left scoliosis?
-spinous processes of the thoracic spine rotate to the right body of vertebrae goes to side of scoliosis but the spinous process rotates to the opposite side* LEFT SCOLIOSIS -LEFT vertebral body rotation -RIGHT spinous process rotation -LEFT elevated shoulder -LEFT prominent scapula
What ABI would result in an ulcer?
.36 Those with ABI would have weak calf muscles since activity level is diminished
What is pulsed ultrasound intensity normally set to?
.5-.75 W/cm^2
What is continuous ultrasound intensity normally set to?
.5-2.0 W/cm^2 for thermal effects
What should the distance between the transducer and the ultrasound area be?
.5-3cm (usually 2 cm) NEVER in direct contact
What are symptoms of pulmonary embolism?
1) Tachycardia 2) Chest pain 3) Dyspnea 4) Hemoptysis (coughing blood) Unilateral leg pain, edema, history of DVT
How is Ranchos Los Amigos scored?
1-8 1=worst 8=best
Hoehn and Yahr Scale
1-Unilateral disease with minimal dysfunction 2-Bilateral or midline impairment without balance dysfunction 3-Bilateral, mild to moderate postural dysfunction 4-Severely disabled but still able to stand and walk 5-Confined to bed and wheelchair Hoen and Yahr has to do with postural stability
What are the 2 types of frequencies for ultrasound?
1. 1 MHz (deep tissues up to 5 cm deep) 2. 3 MHx (superficial 1-2 cm deep)
What is there to know about wheelchair ramps?
1. 12 inches of horizontal run for each inch of vertical rise (8.3% grade) 2. Determined by rise/run x 100 3. Ramp should be a minimum of 36 inches wide 4. Should have handrails if ramp has a rise >6 inches or a horizontal run >72 inches 5. Ramps should have a level landing at the top and bottom 6. If the ramp changes direction, the landing area must be a minimum of 5ft x 5 ft (60 inches x 60 inches)
How long does stable angina occurs v. unstable angina?
1. 5-15 min = stable 2. >15 min = unstable
What are the Ottwawa knee rules?
1. 55 or older 2. Tenderness at the fibular head or patella 3. Inability to flex the knee greater than 90 degrees 4. Inability to weight bear for 4 steps
A physical therapist prepares to perform volumetric measurements as a means of quantifying edema. Which patient would appear to be the MOST appropriate candidate for this type of objective measure? (969) 1. A 38-year-old female with a Colles' fracture 2. A 27-year-old male with bicipital tendonitis 3. A 48-year-old male with a rotator cuff tear 4. A 57-year-old male with pulmonary edema
1. A 38-year-old female with a Colles' fracture
A patient has a resting blood pressure of 120/80 mm Hg. During an activity with a metabolic equivalent level of 4, which of the following blood pressure responses is MOST likely associated with poor left ventricular function?1. 108/78 mm Hg2. 129/76 mm Hg3. 138/83 mm Hg4. 164/84 mm Hg
1. A drop in systolic blood pressure greater than or equal to 10 mm Hg with an increase in workload is considered an abnormal response and correlates with left ventricular dysfunction It is normal for diastolic blood pressure to remain the same or increase or drop by 10 mmHg
What is best intervention for spondylolisthesis?
1. Abdominal muscle strengthening 2. Stabilization
What are symptoms of metabolic syndrome?
1. Abdominal obesity (>40 inch waist size for men; >35 for women) 2. Elevated triglycerides (>150) 3. Low HDL (<40) 4. Fasting plasma glucose of >110
What exercise intervention should be used for someone with increased lumbar lordosis (anterior pelvic tilt)?
1. Abdominal strengthening 2. Iliopsoas (hip flexor) stretching
What muscles are associated with de quervains tenosynovitis?
1. Abductor pollicis longus 2. Extensor pollicis brevis
What tendons are tested with the Finkelstein test?
1. Abductor pollicis longus 2. Extensor pollicis brevis
What shoe modifications are used for
1. Achilles tendonitis = heel lift to reduce pressure 2. Plantar fasciitis = heel cup, longitudinal arch taping 3. Posterior tibial tendonitis - tendon support 4. Hallux rigidus = rocker bottom to reduce extension of hallux in gait (this decreases paina nd increases activity level)
A young, otherwise healthy, adult is recovering from a complete spinal cord injury (ASIA A) at the level of L4. What are the functional expectations for this individual? 1. Ambulation using bilateral AFOs and canes. 2. Ambulation using bilateral KAFOs, crutches, and a swing-through gait .3. Ambulation using reciprocating gait orthoses and a reciprocating walker. 4. Ambulation using bilateral KAFOs and a reciprocating walker.
1. Ambulation using bilateral AFOs and canes. Since it is L4 this is ankle dorsiflexors involved. L3 which is knee extensors is innervated so no need for KAFO.
What is seen in the ankle/toes with a LE flexor synergy?
1. Ankle DF, supination, inversion 2. Toe EXTENSION
What is seen in the ankle/toes with a LE extensor synergy?
1. Ankle PF 2. Toe FLEXION
A patient had a total hip arthroplasty with a constrained (cemented) prosthesis using a posterolateral approach. Which of the following recreational activities has the LEAST risk of causing prosthetic loosening or dislocation for this patient? 1. Distance freestyle swimming 2. Water skiing 3. Stationary rowing 4. Playing racquetball
1. Distance freestyle swimming Least likely to dislocate hip with this kind of swimming cause its not breaking the hip precautions for posterolateral approach High-impact sports are contraindicated for this patient. Hip positioning into end-range flexion, adduction, and medial (internal) rotation is also contraindicated.
What are signs of left sided heart failure?
1. Dry cough 2. Wheeze 3. Tachy 4. Cyanosis 5. Pallor There is a backup of blood in the pulmonary system 3
What are common indications for aquatic therapy?
1. Edema 2. Strain 3. Sprain 4. Arthritis
What are signs of right sided heart failure?
1. Edema systemically (ascites) 2. Vein distension 3. Bilateral pedal edema there is a backup of blood in venous circulation
What are symptoms of digitalis toxicity?
1. Electrolyte imbalances (hypokalemia, hypomagnesia) 2. Rhythm disturbances (ventricular arrythmias, bradycardia, heart block) 3. GI symptoms (vomiting, nausea, diarhea, loss of appetite) 4. Neurological symptoms (lethargy, disorientation, weakness, delirium) Renal dysfunction is commonly encountered in the setting of chronic digoxin toxicity Most common precipitating cause of digitalis intoxication is HYPOkalemia which occurs often in patients with heart failure as a result of diuretics
What conditions lead to diminished breath sounds and decreased fremitus?
1. Emphysema 2. Pleural effusion
What are some conditions with decreased fremitus?
1. Emphysema 2. Pleural effusion (fluid is on OUTSIDE of lungs) 3. Pneumothorax All of these conditions don't have fluid
What is the most likely position that a patient with a reverse total shoulder will dislocate?
1. Extension 2. Adduction 3. IR
What position allows for the best palpation of the supraspinatus?
1. Extension 2. Medial (internal) rotation Can apply US in this position
Which of the following activities should be the PRIMARY emphasis of a physical therapy treatment program for a child who has athetoid cerebral palsy? 1. Facilitating cocontraction patterns and encouraging control in voluntary movement gradation 2. Increasing muscle strength using progressive resistive exercises 3. Facilitating use of primitive reflexes to perform gross motor tasks 4. Preventing development of contractures and ensuring full voluntary range of motion
1. Facilitating cocontraction patterns and encouraging control in voluntary movement gradation Athetoid CP is affected by basal ganglia Characterized by involuntary movements that are slow and writhing In therapy, the emphasis should be on facilitating cocontraction and encouraging control in voluntary movement
Which of the following patient factors would MOST increase the risk for an adverse drug reaction?
1. Female gender 2. Over 75 3. Use of herbal compoundss 4. Hepatic or renal insufficiency
What is opening restriction?
1. Flexion 2. Contralateral side bending
What does ulnar nerve innervate?
1. Flexor carpi ulnaris 2. % 1/2 of the flexor digitorum profundus 3. 3rd and 4th lumbricals 4. Muscles of hypothenar eminence 5. Interossei 6. Intrinsic muscles of hand Injury = weakness with wrist flexion and flexion of ulnar half of digits (CLAW HAND DEFORMITY) as well as weakness of finger abductors and thumb adductors (adductor pollicis)
A therapist attempts to locate the ulnar artery at the wrist. Which two tendons should the therapist utilize to locate the ulnar artery?
1. Flexor digitorum superficialis 2. Flexor carpi ulnaris
What muscles does the anterior interosseous nerve innervate?
1. Flexor pollicis longus 2. Flexor digitorum profundus 3. Pronator quadratus PURELY MOTOR, no sensory impairments OK sign is impaired - weakness of flexor pollicis longus
What are some examples of diseases requiring droplet precautions?
1. Flu 2. Meningitis 3. Pneumonia 4. Mumps/rubella
What does median nerve innervate?
1. Forearm pronators (pronator teres) 2. Most of wrist flexors (flexor carpi radialis, palmaris longus, flexor digitorum superficialis) 3. 1st and 2nd lumbricals 4. Muscular of thenar eminence Injury = weakness of wrist flexion & forearm pronation Injury 2 = APE HAND deformity, sign of benedicition, inability to oppose thumb ANTERIOR FOREARM
What movement is there in forearm, wrist and fingers with a UE flexor synergy?
1. Forearm supination 2. Wrist, finger, thumb flexion
What are signs of ketoacidosis?
1. Fruity breath 2. Weak and rapid pulse 3. Kussmaul breathing 4. Dehydratin
What movements reproduces pain with lateral epicondylitis?
1. Full passive wrist flexion 2. Ulnar deviation 3. Forearm pronation 4. Elbow extension Wrist extension or gripping will make the pain sharp
What is SIJ cluster?
1. Gaenslen's Test - supine, hip joint maximally flexed on one side and opposite hip extended off table . Presssure is applied to flexed extremity and to extened leg. Positive if pain is felt in SIJ. 2. FABER 3. Thigh Thrust - examiner flexes hip to 90 degrees, then applies pressure to femur posteriorly at various angles of abduction and adduction 4. Distraction - therapist applies pressure directed posterolaterally at both anterior and superior iliac spine 5. Sacral Thrust 6. Compression - patient side lying and compression is applied over iliac crest toward opposite SIJ 7. Yeoman - patient prone, examiner passively extends the hip being tested with the knee flexed to 90 degrees while stablizing the pelvis
Which of the following gait parameters are MOST important for independence in community mobility for an individual who had a cerebrovascular accident?
1. Gait velocity/speed 2. Knee extension control/strength Important for community mobility
An apparently healthy individual has several risk factors for coronary artery disease. The client is interested in improving overall fitness and cardiac health. After a graded exercise test, which was asymptomatic, the client is referred for an exercise class. Which is the BEST measure of exercise intensity in a newly tested and exercising individual? 1. Heart rate (HR). 2. Rating of perceived exertion (RPE). 3. MET level. 4. Respiratory rate.
1. Heart rate (HR). since healthy you do not need to use RPE. Can simply use heart rate to monitor intensity
What are examples of ratio data?
1. Height 2. Weight 3. ROM GONI 4. Force
What are the stages of healing?
1. Hematoma - forms in the fracture site soon after injury (inflammatory stage) 2. Callus formation - one of the first indications that healing has occurred (presence of callus on imaging allows the patient to progress from PROM to AAROM) 3. Remodeling - last stage of bone healing where the fracture has solidly united with woven bone
What is difference between Hills sachs fracture and REVERSE hills sachs fracture?
1. Hills sach - anterior glenohumeral dislocation (95% of dislocations occur in the anterior direction) 2. Reverse Hills Sachs - posterior glenohumeral dislocation (typically present holding their arm medially rotated and adductedand may exhibit flattening of the anterior shoulder and a prominent coracoid process)
What 3 dressings are used for hydration and moisture retention?
1. Hydrogel 2. Hydrocolloid (protects wound from infection) 3. Transparent film
A therapist suspects lower brain stem involvement in a patient with amyotrophic lateral sclerosis (ALS). Examination findings reveal motor impairments of the tongue with ipsilateral wasting and deviation on protrusion. These findings confirm involvement of which cranial nerve? 1. Hypoglossal. 2. Glossopharyngeal. 3. Vagus. 4. Spinal accessory.
1. Hypoglossal. Ipsilateral tongue deviation when sticking it out is hypoglossal
What electrolyte imbalances are seen with Addison's disease (adrenal insufficiency)
1. Hyponatremia (from loss of sodium) 2. Hyperkalemic 3. Hypoglycemic 4. Acidosis Loss of cortosol
What are main symptoms of a right sided stroke?
1. Impulsiveness 2. Poor safety awareness 3. Difficulty with spatial relationships
An adult patient is referred to physical therapy with knee pain after falling from a ladder. The patient is seen the day after the injury and is unable to articulate the exact mechanism of injury. The knee is swollen and the patient's gait is antalgic. The therapist is concerned about an undiagnosed fracture. What physical examination finding would indicate a need for knee radiographs? 1. Inability to flex the knee to 90°. 2. Joint line tenderness. 3. Inability to fully extend the knee. 4. Positive anterior drawer test. 1. Inability to flex the knee to 90°.
1. Inability to flex the knee to 90°. Ottawa knee rules 1. Inability to flex to 90 2. Inability to bear weight immediately 3. Isolated tenderness of patella 4. Tenderness at the head of fibula 5. 55 or older
What are symptoms of dehydration in younger?
1. Increase in HR 2. Increase in RR 3. Lack of crying 4. Sunken fontanelle 5. Cold hands and feet
How can you decrease the likelihood of a burn?
1. Increase space between electrodes 2. Increase size of cathode (neg) relative to anode (positve) 3. Decrease current density
What are the non-thermal effects of ultrasound?
1. Increased cell and skin permeability 2. Facilitation of tissue repair 3. Promotion of normal cell functione
What are common signs of spondylolisthesis?
1. Increased lumbar lordosis 2. Stiff, waddling gait 3. Hamstring tightness with knee flexion 4. Pelvic rotation 5. Mostly occurs at L4-L5 6. Step down deformity
What physiological thing occurs from acute burns?
1. Increased oxygen consumption 2. Increased minute ventilation 3. Increased core tempertature 4. Diminished intravascular, interstitial and intracellular fluids
What are symptoms of diabetes (decreased insulin)?
1. Increased thirst 2. Increased urination
What muscles are external rotators?
1. Infraspinatus 2. Teres minor 3. Posterior deltoid
What are 2 muscles of external rotation?
1. Infraspinatus 2. Teres minor
What is considered early stance phase?
1. Initial contact 2. Loading response
What is function of cranial nerve III (oculomotor)?
1. Innervates medial rectus which if weak could cause lateral strabismus 2. Mediating pupillary constriction. A lesion would lead to pupillary DILATION 3. Ptosis - loss of innervation to levator palpebrae suepriosis muscle (inability to open eye) 4. Double vision due to inability to move eye since 4 and 6 ocular muscles are controls by this nerve 5. Mediates pupillary light reflex
What is order of evaluation?
1. Inspection 2. AROM 3. PROM
What is sequence of sensory responses to cryotherapy?
1. Intense cold 2. Burning 3. Aching 4. Analgesia/numbness
What are symptoms of peripheral vestibular lesion?
1. Intermittent nystagmus 2. Normal smooth pursuit 3. Normal saccades
A patient presents with decreased motion at the occipitoatlantal joint (OA). The PT wants to use the principles of coupled motions that occur in that area of the spine during manual therapy techniques. In order to improve OA mobility, when the occiput is side bent to the right, how should the therapist mobilize C1? 1. Into rotation to the left. 2. Into rotation to the right. 3. Back into extension. 4. Forward into flexion.
1. Into rotation to the left.
What are common symptoms of medial meniscus tear?
1. JOINT LINE pain and tenderness 2. Clicking and catching 3. Springy end feel or rubbery end feel 4. Use bounce home, thessaly, apley and mcmurray 5. Loss of ROM
A male patient is referred to outpatient physical therapy for lower back pain. During the patient interview, he describes a recent increased difficulty with urinating that does not affect his lower back pain symptoms. Neurological screening examination is normal and Murphy's sign is negative. Based on this clinical scenario, what may this patient's low back pain be associated with? 1. Lower urinary tract. 2. First lumbar nerve root. 3. Kidney. 4. Sacro-iliac joint.
1. Lower urinary tract. UT can lead to low back pain
In a patient with breast cancer, which of the following sites are the MOST common sites of metastasis?
1. Lungs 2. Bones 3. Liver
What are arterial lines (a-lines) used for?
1. Measuring BP 2. Obtaining blood samples
What is the action of the lumbricals?
1. Metacarpophalangeal flexion 2. Interphalangeal extension
What are PTAs allowed to do?
1. Modify specific treatments in accordance with changes in patient's status NOT allowed to do re-evals, determine need for continued therapy or talk about prognosis with patient
What is hickman catheter?
1. Monitors central venous pressure 2. Withdrawal of blood for analysis 3. Chemotherapy Inserted in jugular vein and advanced to superior vena cava
When to call EMS for PVC
1. More than 6 per minute 2. Present in triplets or more (v tach) : rapid progression to v fib 3. If it lands on a "T" wave : no ventricular filling PVC has no P wave followed by a large QRS complex that is premature, followed by a compensatory pauseWide and bizarre looking Ischemia, caffeine, CHF(a fib and flutter too), cardiomyopathy, digoxin therapy
What findings would you see with fibromyalgia?
1. Multiple generalized local TENDER POINTS in the muscle WITHOUT referred pain patterns 2. Chronic fatigue, decreased exercise intolerance, headaches, IBS, sleep disturbances
What are the 2 hallmark signs of a PVC?
1. NO p wave 2. Wide and bizzare QRS complex
What are examples of peripheral vestibular lesion?
1. Neuritis (dizziness, vertigo but NO change in hearing) - occurs from infection 2. Labyrinthitis (dizziness, vertigo AND change in hearing) - occurs from infection 3. Bilateral vestibular loss/hypofunction (diff walking in dark or uneven surfaces) 4. Menieres (lots of endolymph within the inner ear - vertigo, tinnitus, fullness or pressure in the ear, fluctuating hearing) - 20 min BUT NOT more than 24 hours 5. BPPV - only lasts a few seconds with a change in position
What drugs are used for angina?
1. Nitrates 2. beta blockers 3. calcium channel blockers
What are conditions that have stridor?
1. Obstruction in throat 2. Anaphylatic shock
What are tests for diabetes?
1. Oral glucose random tolerance test -positive if blood glucose level >200 -normal if <140 (tested 2 hrs after sugary drink) 2. Fasting glucose test -positive if >126 -normal if <100 (tested 8 hours after last intake of food/drink) 3. A1C test -positive: >6.5% -normal: <5.7% POSITIVE VALUES MEAN PATIENT HAS DIABETES (based on attachment of hemoglobin that measures blood glucose over last 2-3 months)
Describe pacinian corpuscles, golgi tendons and free nerve endings?
1. Pacinian corpusule --> responsible for pressure and vibration sense 2. Golgi tendon --> sensitive to muscle contraction force 3. Free nerve endings --> sensitive to pain and itch
If a patient demonstrates a shorter step length with the right LE, what does this indicate?
1. Painful left knee 2. Left hip flexor contracture (spend less time on LLE in stance phase) 3. Right hamstring contracture
What are some alternative causes of incontinence?
1. Parkinson's 2. Diabetes 3. Medications
What type of intervention would someone with patellofemoral syndrome benefit from?
1. Patellar mobs to stretch out the lateral surfaces 2. Closed chain quad strengthening NO QUAD SETS
What are the most common grafts for ACL?
1. Patellar tendon 2. Tendons of semitendinosus and gracilis i
What are treatment parameters for muscle re-education?
1. Patient begins by performing maximal muscle contraction 2. Set to low sensitivity 3. Adjust so that the patient can perform the reps at a ratio of 2/3 of maximal muscle contraction 4. Isometric contractions should continue for 6-10 seconds with relaxation in between
What is bounce home test?
1. Patient in supine 2. Therapist grabs patient's heel and maximally flexes the knee 3. Patient's knee is then extended passively 4. POSITIVE = incomplete extension or rubbery end-feel which indicates meniscal lesion
A patient seen in a PT clinic exhibits a forward head posture, excessive thoracic kyphosis, and rounded shoulders. which muscles should be the focus of a therapeutic stretching plan for this patient?
1. Pec minor 2. Rectus capitis posterior major 3. Upper traps
What conditions have a pleural friction rub?
1. Pleural effusion 2. Pleuritis 3. Pneumonia
What conditions have crackles (rales)?
1. Pneumonia 2. Pulmonary edema 3. L sided CHF 4. Chronic Bronchitis 5. Atelectasis
What are symptoms of cerebral palsy?
1. Poor postural control 2. Excessive lumbar lordosis 3. Hip dislocation possibility 4. Neuromuscular scoliosis 5. Intellectual disability 6. Epilepsy/seizures 7. Scissoring, toe walking, crouch gait hypertonia, hyperreflexia, both feet pointing downward and inward (equinovarus deformity), resistance to passive muscle movement
What does damage to corticospinal tract cause?
1. Positive babinski 2. Absent superficial abdominal and cremasteric reflexes 3. Loss of fine motor or skilled voluntary movements HEEL WALKING IS commonly utilized functional test to identify if the corticospinal tract is involved
Where should electrodes be placed in order to reduce shoulder subluxation?
1. Posterior deltoid 2. Supraspinatus Should use biphasic current Ramp up and ramp down times should be approximately 3 seconds each
What is seen gait wise with duchenne muscular dystrophy?
1. Shortened hip flexors (from overuse) 2. Limited hip extension ROM due to above 3. Scapular winging 4. Lordotic posture (anterior tilt) 5. Hamstring contractures 6. TFL contractures By 8 the deficits are clearly present. Rarely see anything before 5. Thoracic spine moves into relative extension to compensate for pelvic tilt and the scapulae wing in an attempt to keep the center of mass behind the hip joint
A patient with a complete tetraplegia (ASIA A) at the C6 level is initially instructed to transfer using a transfer board. with the shoulders externally roatted, how should the remaining UE joints be positioned?
1. Shoulder ER 2. Forearm supination 3. Elbow and wrist extension 4. Finger flexion (fingers should always be flexed to preserve tenodesis grasp)
What is upper limb tension test for radial nerve bias?
1. Shoulder girdle depression 2. Elbow extension 3. Medial rotation of whole arm 4. Wrist, finger, and thumb flexion
What is procedure for TUG?
1. Sit in chair 2. Transfer to standing 3. WALK 10 FEET 4. turn around WITHOUT EXTERNAL SUPPORT 5. Walk back and sit Scored based on amount of postural sway, excessive movements, reaching for support, side stepping or any indication of LOB Scored on 5 point scale (1=normal, 5=impaired)
What motions make up the power grip?
1. Slight extension 2. Ulnar deviation Use volar (palmar) glide to improve extension Use radial glide to improve ulnar ROM These result in a power grip
What is optimal functional position of the wrist and hand?
1. Slight wrist extension 2. Slight ulnar deviation 3. Fingers flexed at MCP, PIP and DIP joints 4. Thumb slightly abducted
What causes excessive extension with a prosthesis?
1. Soft heel 2. Posterior displacement of socket relative to foot
What is function of R hemisphere? (list 5)
1. Spatial relationships 2. Music/art 3. Hand eye coordination 4. Negative emotions 5. Emotional lability 6. Judgement/awareness 7. Impulsive behavior
What are examples of cortical sensation?
1. Stereognosis 2. Bilateral simultaneous stimulation 3. 2 point discrimination
How do you test for medial epi?
1. Supination of forearm 2. Wrist extension 3. Elbow extension These movements place the flexor carpi radialis on stretch
What is procedure for Nobles compression test?
1. Supine 2. Flex knee to 90 degrees 3. Add compression to lateral femoral condyle 4. Extend knee 5. Symptoms approx 30 degrees
What are 3 muscles of INTERNAL ROTATION?
1. Suscapularis 2. Teres major 3. Lats
What are clinical prediction rules for lumbar manipulation?
1. Symptom duration <16 days 2. No symptoms distal to the knee 3. FABQ score <19 4. At least 1 hypomobile lumbar segment
What symptoms are common with dehydration?
1. TACYcardia 2. Orthostatic hypotension 3. Low blood pressure
What is example of interval data?
1. Temperature
What are examples of superficial sensation?
1. Temperature 2. Pain 3. Crude touch 4. Pressure
What are the muscles that CLOSE the mouth?
1. Temporalis 2. Masseter 3. Lateral pterygoid
What is NMES parameters?
1. The larger the muscle, the longer then pulse duration 2. Frequency = 35-50 pulses/sec 3. Higher frequencies will promote more fatigue (NOT stronger contraction) 4. On time should be 6-10 seconds with off time should be 5x longer (1:5) 5. Ramp time of 1-4 seconds would be recommended 6. Treatment time should be a minimum of 10 contraction and maximum of 20 contractions 7. Do treatment 3x per week
What is alignment of tibia and femur with W-sitting?
1. Tibia external rotation 2. Femoral internal rotation
What does radial nerve innervate?
1. Triceps/anconeus 2. Wrist extensors 3. Brachioradialis 4. Finger extensors Injury = weakness with wrist and finger extension, resulting in wrist drop deformity
What are symptoms of central cord syndrome?
1. UE involvement 2. Motor > sensory 3. Distal > proximal 4. NO bladder impairments
What is an absolute contraindication to aquatic therapy?
1. UTI (urinary tract infection) 2. Hep A
What are chronic adaptations to exercise?
1. VO2 increases at maximal exercise 2. resting HR decreases 3. No change in SBP or DBP at submaximal exercise 4. Blood lactate increased 5. Plasma volume increases
If there is a flaccid bladder (LMN) what bladder training techniques do you want to use?
1. Valsalva maneuver 2. Crede maneuver 3. Time voiding program
Which of the following types of practice is MOST appropriate for long-term motor learning for a patient with a cerebrovascular accident? 1. Varied task practice with variable time intervals 2. Task practice of one activity for 15 minutes with 10-minute rest 3. Practice of a variety of related skills in blocks of 5 minutes 4. Partial task practice with patient-preferred time intervals
1. Varied task practice with variable time intervals Key word here is long term so you want to change it up
When an individual experiences an increase in blood pressure, which of the following reflexes responses should occur?
1. Vasodilation 2. Decrease in cardiac output
What gait deviations are seen with increased limb length?
1. Vaulting over longer leg 2. Circumduction of longer leg during swing phase 3. Hiking of hip of the longer leg to clear it during swing phase
A patient is referred for physical therapy with a diagnosis of degenerative joint disease (DJD) affecting C2 and C3. The patient complains of pain and stiffness in the cervical region and transient dizziness with some cervical motions. What is the BEST initial examination procedure? 1. Vertebral artery test. 2. Adson's maneuver. 3. Lhermitte's test. 4. Oppenheim's test.
1. Vertebral artery test.
A therapist is examining a patient's balance using posturography testing with the Clinical Test for Sensory Integration in Balance (CTSIB). The patient's sway increases with loss of balance under conditions with the eyes closed and platform moving (condition 5). During condition 6, with both the visual surround and platform moving, loss of balance is more immediate. Which of the following BEST identifies the source of the patient's problems? 1. Vestibular deficiency. 2. Visual dependency. 3. Problems with sensory selection. 4. Somatosensory dependency.
1. Vestibular deficiency.
What are examples of deep sensation?
1. Vibration 2. Kinesthesia
What positions worsen pancreatitis?
1. Walking 2. Lying supine
What are some methods to inhibit tone?
1. Warmth and icing 2. Deep pressure
What is correct sequence for PPE donning?
1. Wash hands 2. Gown 3. Mask 4. Goggles 5. Gloves END WITH GLOVES
What is circumduction due to?
1. Weak hip flexors 3. Weak dorsiflexors
What is myotome for C7?
1. Wrist flexors 2. Elbow extensors (triceps)
What are common anxiety medications?
1. Xanax 2. Valium/diazapam 3. Lorazepam (ativan)
What are the zones of injury?
1. Zone of coagulation = irreversible cell damage 2. Zone of stasis = reversible damage 3. Zone of hyperemia = inflammation
What are types of selective debridement?
1. autolytic --> use of bodys own mechanisms to remove NON-VIABLE tissue. Commonly use hydrocolloids, hydrogels (moisture retentive dressing) want to establish a moist wound envionment that rehydrates necrotic tissue NOT for infected wounds 2. Sharps - use scalpel to selectively remove devitalized tissue Most expedient form of removing adherent necrotic tissue (if non adherent then pulsed lavage is best option) 3. Enzymatic - use of topical agents. Used on wounds that have not responded to autolytic debridement . Can be slow to help it heal
What effects does a hip flexion contracture have on gait? (ex: R hip contracture)
1. decreased contralateral step length - decreased L side step length 2. excessive knee flexion 3. decreased hip extension. 4. increased anterior pelvic tilt. 5. increased lumbar lordosis
What are hip precautions? (posterolateral approach)
1. do not flex beyond 90° 2. do not adduct or cross legs 3. do not internally rotate 4. do not pivot at hip 5. sit only on raised chair and raised toilet seats 6. transfer sit to stand by keeping operated hip in slight abduction and extended out in front
What is Murphy's sign?
1. gallbladder 2. dislocated lunate in the wrist
What are symptoms of hypoglycemia?
1. headache 2. Blurred vision 3. Slurred speech
What are physiological changes to immersion?
1. need to urinate 2. hydrate 3. decrease in edema
When applying mechanical lumbar traction, which positions for the pelvic and thoracic belts would be BEST?
1. pelvic belt just above the iliac crest 2. thoracic belt over the lower rib cage.
A patient with a hypertonic piriformis will also MOST likely have: 1. sacroiliac joint dysfunction. 2. limited hip extension. 3. anterior thigh paresthesia. 4. gluteus maximus weakness.
1. sacroiliac joint dysfunction gluteal atrophy also likely
What are symptoms of lyme disease?
1. skin rash on UE 2. flu-like symptoms 3. foggy thinking 4. Neck stiffness
What should amplitude be for iontophoresis?
1.0-4.0 mA
When fitting a patient with forearm crutches, the top of the crutch cuffs should be placed how far below the patient's elbows?
1.5 inches (lofstrand crutches)
A physical therapist inspects a wound that has large quantities of exudate requiring frequent dressing changes. If the therapist applies a dressing that cannot handle the amount of exudate present, which of the following outcomes is the MOST likely? (1144) 1.Maceration 2.Granulation 3.Epithelialization 4.Infection
1.Maceration Masceration - softening of CT fibers due to excessive moisture. Result of loss of pigmentation & wound that is highly susceptible to breakdown or enlargement
1 cm equals ____ mm
10
What is the maximal aerobic capcity in METs for a healthy person with no past medical history?
10 METS maximal aerobic capacity is typically 8-12 METS If they are highly trained athletes then it might be 15-20 METS If older individual then might be at 5-8 METS
What is the minimal recommended work interval duration for a non-deconditioned adult performing aerobic interval training?
10 minutes (guidelines for interval training call for performance of intermittent exercise of at least 10 minutes)
How much should systolic BP increase per MET?
10 mmHg Rise of SBP of 50 is normal during graded exercise testing
A patient with a 10-year history of scleroderma is referred for physical therapy to improve functional status and endurance. The patient was recently treated with corticosteroids for a bout of myositis. Examination findings reveal limited ROM and fibrotic soft tissue along with hyperesthesia. What is the BEST choice for initial intervention? 1. Treadmill walking using body weight support at an intensity of 40% HRmax 2. Active range of motion (AROM) exercises and walking in a therapeutic pool 3. Closed-chain and modified aerobic step exercises 4. Soft tissue mobilization and stretching.
2. Active range of motion (AROM) exercises and walking in a therapeutic pool Warmth and buoyancy will enhance movements and decrease pain. Other options are too aggressive
A middle-aged patient complains of "throbbing pain" in the lumbar region with activities upon exertion, such as walking up a flight of steps or playing tennis. The patient expresses no complaints of pain with bending, twisting, sitting, standing, or walking any distance. Active movements of the lumbar spine are full and pain free. Provocation testing is negative. Neurological signs are unremarkable. There is no significant tenderness to palpation. What is the MOST likely diagnosis for this patient? 1. Lumbar disc herniation. 2. Aortic aneurysm. 3. Quadratus lumborum muscle strain. 4. Sacroiliac joint sprain.
2. Aortic aneurysm. Throbbing low back pain that occurs only with activities that increase the HR is a red flag for aortic aneurysm. Medical referral is indicated.
An older adult at risk for falls has undergone a structured home-based exercise program that consisted of standing balance training and strengthening exercises. Which measure is the BEST choice to document improvements? 1. Timed Up & Go Test. 2. Berg Balance Test. 3. 6-Minute Walk Test. 4. Performance-Oriented Mobility Assessment (Tinetti).
2. Berg Balance Test. Berg balance looks at not only balance but also strength assessments with sit to stand
A patient who had a myocardial infarction 5 days ago is referred for a low-level treadmill test. The patient reports having had several episodes of mild angina at rest, after meals, and during the night since being hospitalized. Which of the following actions is MOST appropriate for the physical therapist? 1. Proceed with the usual low-level protocol, because mild angina is common this soon after a myocardial infarction. 2. Defer testing the patient, because the symptoms suggest unstable angina after a myocardial infarction. 3. Perform the test at a lower-than-usual workload, because the symptoms suggest unstable angina after a myocardial infarction. 4. Defer testing the patient, because 5 days after a myocardial infarction is too soon to begin physical exertion.
2. Defer testing the patient, because the symptoms suggest unstable angina after a myocardial infarction.
Postural screening of a patient reveals that the greater trochanters are not level in the standing position. The pelvis is not rotated or tilted, and the knee and ankle landmarks are level in the standing position. The findings indicate which of the following impairments? 1. Tibial length disparity 2. Femoral length disparity 3. Nutation of the sacroiliac joint 4. Hemivertebrae in the lumbar spine
2. Femoral length disparity Because of level knee and ankle landmarks and normal pelvic symmetry, the leg length discrepancy is due to femoral length disparity.
A patient reports recent onset of unilateral pain in the temporalis region and upper neck area and a sensation of fullness in the ear. The patient's range of mouth opening is 4 fingers' width. Pain increases when the patient bites down on a cotton roll with the back molars and during palpation over the area of the masseter muscle. There is no clicking joint noise during repeated mouth opening. Which of the following interventions is MOST appropriate? 1. Heat and masticatory muscle strengthening 2. Heat and masticatory muscle relaxation technique 3. Joint mobilization with anterior translation followed by ice 4. Joint mobilization with vertical distraction and long-axis distraction
2. Heat and masticatory muscle relaxation technique Absence of joint clicks, normal range of motion, and increased pain during the biting down test indicate muscular or ligament involvement (most likely excessive muscle tension). This intervention would address the soft tissues involved. The recent onset indicates this may be in the acute phase of healing. There is no indication that weakness is present, so relaxation techniques may be more appropriate in this stage of healing. This patient has normal mouth opening. Joint mobilization to increase mouth opening is not indicated
A therapist is examining a patient with chronic obstructive pulmonary disease (COPD) GOLD stage III. What would be a clinical finding that the therapist would expect for this patient? 1. Decreased subcostal angle. 2. Increased anteroposterior-to-lateral chest ratio 3. Use of supplemental oxygen 4. Weight gain
2. Increased anteroposterior-to-lateral chest ratio (aka barrel chested) -it would be emphysema Only in stage 4 do you see supplemental oxygen
After an uncomplicated acute myocardial infarction (MI), which graded exercise test (GXT) should be administered to the patient before hospital discharge?
2. Low level GXT at 4 to 6 days post MI.
A patient has shoulder pain and decreased shoulder active range of motion. The patient's past medical history is unremarkable. Which of the following information would be MOST helpful in determining the source of the patient's symptoms? 1. Date of onset of the problems 2. Passive shoulder range of motion measures 3. Upper extremity deep tendon reflex measures 4. Manual muscle testing scores for the rotator cuff
2. Passive shoulder range of motion measures With just the information listed in the stem, it is impossible to determine whether the problem is adhesive capsulitis or rotator cuff tendinitis/tear, etc. Passive range of motion measures are needed to make this determination, i.e., full passive range of motion points to tendinitis, whereas limited passive range of motion points to adhesive capsulitis.
A therapist is applying a symmetrical biphasic pulsed current to the vastus medialis to improve patellar tracking during knee extension. The patient complains that the current is uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, what should the therapist adjust? 1. Current polarity. 2. Pulse duration. 3. Current intensity. 4. Pulse rate.
2. Pulse duration. Decreasing the pulse duration reduces the electrical charge of each pulse, making the current more comfortable by decreasing the total current applied while maintaining the full therapeutic effect
A physical therapist administers the Mini-Mental State Examination to a patient recently admitted to an acute care medical facility. The MINIMUM patient score necessary in order to avoid being classified as possessing a cognitive impairment would be:
24 <20 = dementia, schizo 24 = diminished but OK 30 = PERFECT SCORE; cognitively intact
during ausculation, the therapist hears S1 and S2 heart sounds. during early diastole the therapist hears a low frequency sound of turbulence. what suspected sound should the therapist record this as? 1. S4 sound 2. S3 sound 3. heart murmur 4. pericardial friction rub
2. S3 sound- S3 is an abnormal third heart sound due to poor ventricular compliance and turbulence. It is heard as a low frequency sound during early diastole S4 is due to exaggerated atrial contraction and subsequent turbulence, low frequency, heard during late diastole Heart murmur: swishing sound during systole, diastole, or both systole or diastole caused by turbulent blood flow through the heart valves Pericardial friction rub: leathery sound during systole
A patient exhibits heel rise in the midstance phase of gait. Which of the following impairments is MOST likely associated with this finding? 1. Shortening of the hamstrings 2. Shortening of the gastrocnemius 3. Weakness of the tibialis anterior 4. Weakness of the flexor digitorum longus
2. Shortening of the gastrocnemius A common cause of decreased dorsiflexion is a tight Achilles tendon or shortening of the gastrocnemius.
Patient with Parkinsons with diminished movement, A PT employed Rhythmic initiation to help improve which of the following? 1. Trunk stability and proximal tone 2. Trunk rotation 3. UE function 4. Active and Passive ROM
2. Trunk rotation RI is a PNF technique designed to improve mobility. Trunk rotation is lacking in pts with PD and is a good activity to focus on to improve bed mobility.
A patient has significant shortening of tissues around a joint after immobilization. Patient instruction in which of the following interventions would BEST produce rapid, lasting changes in tissue length? 1. Stretching exercises of short duration performed multiple times throughout the day 2. Use of a dynamic splint worn multiple hours throughout the day 3. Stretching exercises of ballistic quality performed multiple times throughout the day 4. Multiple repetitions of range of motion exercises performed to end range
2. Use of a dynamic splint worn multiple hours throughout the day This option uses the concept of creep. Creep is permanent deformation of tissue through the application of a low magnitude load over a long period of time (p. 84). The use of a dynamic splint will allow the application of such a load and induce rapid changes over an extended period with minimal tissue damage and inflammation
What is the MOST appropriate intervention to correct for the problem of a forward festinating gait in a patient with Parkinson's disease? 1. Use of a heel wedge. 2. Use of a toe wedge. 3. Increase stride length using floor markers. 4. Increase cadence using a metronome.
2. Use of a toe wedge. festinating gait is an abnormal and involuntary increase in the speed of walking in an attempt to catch up with a displaced center of gravity others would help with freezing
During scoliosis screening, the forward bend evaluation is conducted to determine the presence of which of the following clinical features? 1. Excessive thoracic kyphosis 2. Vertebral rotation 3. Lateral spinal deviation 4. Lumbar lordosis
2. Vertebral rotation With scoliosis, a rib hump is caused by rotation of the vertebral bodies
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 the situation, what would be the BEST approach to incorporate in the intervention? 1. LE splinting and light touch down hand support 2. rhythmic stabilization during holding kneeling 3. peturbed balance activities while standing on carpet 4. stabilizing reversals during holding in side-lying
2. rhythmic stabilization during holding kneeling rhythmic stabilization is a PNF technique designed to improve stability. the high kneeling position is a good choice to begin with for the patient with pronounced ataxia. the posture is upright while center of mass is lowered, degrees of freedom are reduced by kneeling (foot and ankle control not required), and base of support is increased over standing.
What does a 20 degree knee flexion contracture mean and what can you do about it?
20 degree knee flexion contracture means that the knee is unable to complete the last 20 degrees of extension This is caused by: 1. Tightness of hamstrings 2. Restriction in posterior capsule of the knee 3. Weakness of quads
What degree of flexion does knee need to be in for Lachman test?
20-30 degrees of knee flexion (apply anterior directed force to the tibia on the femur)
What is the ideal amount of time for therapeutic heating effects with minimal risk of burns?
20-30 min
What is recommended exercise duration?
20-60 min of continuous or intermittent activity MINIMUM of 10 bouts of accumulated exercise throughout the day
What is the percentage of body weight to use for reduction in muscle spasms?
25%
What should metronome (rhythmic auditory stimulation) be set to for a patient with Parkinson's?
25% faster than patients current gait speed
What is average step length?
28 inches
A patient with coronary artery disease received inpatient cardiac rehabilitation after a mild myocardial infarction (MI). The patient is now enrolled in an outpatient exercise class that utilizes intermittent training. What is the BEST initial spacing of exercise/rest intervals to safely stress the aerobic system?
2:1
what ACL grade warrants surgery?
3 Common tendons are patella tendon, hamstring and ITB graft ACL has poor blood supply Tears most often happen at the midsubstance of the ligament MRI is preferred imaging
What is ANOVA?
3 or more variables compared
In the second phase of ACL rehab (5-8 weeks) what should your patients strength grade be?
3+-4/5 (fair plus to good)
What age group is leg calves perthes disease?
3-12
How is glascow coma scale rated?
3-15 (3= worse, 15=best) Rated on motor, verbal response and eye opening
A PT is prescribing a wheelchair for a patient with left hemiplegia who is of average height (5 feet 7 inches). Which of the following is the BEST choice to improve the patient's function? 1. Desk armrests. 2. A 20-inch seat height. 3. A 17.5-inch seat height. 4. Elevating leg rests.
3. A 17.5-inch seat height. A hemi or low-seat wheelchair has a seat height of 17.5 inches. The lower seat height permits the patient to propel and steer the wheelchair using the sound right upper and lower extremities
A patient with advanced liver disease has developed severe ascites. This condition will MOST likely have which of the following effects on the patient's respiratory system? 1. Increased residual volume 2. Increased functional residual capacity 3. Decreased inspiratory reserve volume 4. Decreased forced expiratory volume in 1 second (FEV1)
3. Decreased inspiratory reserve volume Ascites causes restrictive lung cause it is not allowing you to inspire (restrictive has to do with difficulty inhaling)
A patient with advanced liver disease has developed severe ascites. This condition will MOST likely have which of the following effects on the patient's respiratory system? 1. Increased residual volume 2. Increased functional residual capacity 3. Decreased inspiratory reserve volume 4. Decreased forced expiratory volume in 1 second (FEV1)
3. Decreased inspiratory reserve volume Decreased inspiratory reserve volume Ascites is a condition where there is increased fluid in the peritoneal cavity, causing distention. This distention puts increased pressure upon the diaphragm and thoracic cavity, which may lead to a restrictive lung pattern. Decreased inspiratory reserve volume is a component of restrictive lung disease
A patient has a 10-year history of peripheral vascular disease (PVD) affecting the right lower extremity. During auscultation in a peripheral vascular examination, the therapist should examine for: 1. Cool temperature of the LE. 2. Pitting edema of the dorsum of foot. 3. Femoral and popliteal artery bruits. 4. Capillary refill greater then 5 seconds.
3. Femoral and popliteal artery bruits. Bruits help identify peripheral arterial disease with auscultation
The physical therapy plan for a patient who underwent a medial meniscectomy includes exercising the quadriceps femoris against accommodating resistance. Which of the following exercises should be recommended? 1. Knee bends through half of the range 2. Knee extension with an ankle weight 3. Knee extension on an isokinetic exercise device 4. Straight-leg raising with a sling suspension
3. Knee extension on an isokinetic exercise device key word in question was ACCOMODATING Resistance. this means isokinetic which has set speed
A patient has a very large right-sided bacterial pneumonia. Oxygen level is dangerously low. Which of the following body positions is the MOST likely to improve this patient's arterial oxygen pressure (PaO2)? 1. Prone-lying with the head of the bed in the Trendelenburg position. 2. Right side-lying with the head of the bed in the flat position. 3. Left side-lying with the head of the bed in the flat position. 4. Supine-lying with the head of the bed in the Trendelenburg position.
3. Left side-lying with the head of the bed in the flat position.
A patient with a complete spinal cord injury at the level of T1 (ASIA A) is in the community phase of mobility training. In order for the patient to navigate a 4-inch-height curb with the wheelchair, what should the therapist tell the patient to do? 1. Ascend backward with the large wheels first. 2. Descend backward with the trunk upright and arms hooked around the push handles. 3. Lift the front casters and ascend in a wheelie position. 4. Place the front casters down first during descent.
3. Lift the front casters and ascend in a wheelie position.
A therapist decides to use biofeedback to decrease the muscle tension associated with a suboccipital tension headache. What is the proper initial biofeedback protocol? 1. Low-detection sensitivity with recording electrodes placed far apart. 2. High-detection sensitivity with recording electrodes placed closely together. 3. Low-detection sensitivity with recording electrodes placed closely together. 4. High-detection sensitivity with recording electrodes placed far apart.
3. Low-detection sensitivity with recording electrodes placed closely together. Relaxation is LOW SENSITIVITY, CLOSE ELECTRODES
Patient presents with burning and tingling on the left lateral thigh that has manifested recently in her third trimester of pregnancy. The patient states that symptoms occur more in standing than sitting, and that light touch is more aggravating than applied pressure. Patient was negative for the neurological findings involving reflexes, dermatomes, and myotomes. Based upon this information, what is the MOST LIKELY cause of these symptoms? 1. Disc derangement L2/3 segment. 2. Nerve root L3 compression. 3. Meralgia paresthetica. 4. Referred pain from the sacroiliac joint due to instability post-relaxin release.
3. Meralgia paresthetica. Characterized
Excessive anterior tilting of the scapula is MOST likely to result from tightness of which of the following muscles? 1. Anterior deltoid 2. Pectoralis major 3. Pectoralis minor 4. Rhomboids
3. Pectoralis minor
A patient is asked to perform a previously demonstrated hamstring stretch for a physical therapist. The patient, referring to pictures of the stretch in the home exercise program, comfortably performs the stretch at end range for 60 seconds, while maintaining a posterior pelvic tilt. To ensure the most effective stretch during future performance, the therapist should make which of the following changes? 1. Decrease the intensity of the stretch. 2. Instruct the patient in proper stretch duration. 3. Provide re-direction on proper body alignment. 4. Provide visual aids to cue the patient to perform the exercise regularly.
3. Provide re-direction on proper body alignment. Should AVOID posterior pelvic tilt while stretching hamstring cause this assists in stretching rectus femoris
An elderly male patient recovering from a fractured hip repaired with ORIF has recently been discharged home. During a home visit, his wife tells the therapist that he woke up yesterday morning and told her he couldn't remember much. Upon examination, the therapist finds some mild motor loss in his right hand and anomia. The therapist affirms the presence of short-term memory loss. What is the therapist's BEST course of action? 1. Advise the family to document and record any new problems that they notice over the next week and then report back to the therapist. 2. Ignore the findings because they are expected after surgical anesthesia. 3. Refer him to his physician immediately because the therapist suspects a stroke. 4. Refer him to his physician because the therapist suspects Alzheimer's type dementia.
3. Refer him to his physician immediately because the therapist suspects a stroke. Anomia (language disturbance - inability to retrieve known words) memory loss motor loss
Examination of a patient with balance dysfunction reveals the following:Romberg test: positiveGait: wide-based, slow, with decreased trunk rotationLoss of balance when asked to turn head while walkingNo sign of ataxiaBased on these findings, which of the following diagnoses is MOST likely correct? 1. Benign paroxysmal positional vertigo 2. Cerebellar lesion 3. Unilateral vestibular lesion 4. Mononeuropathy of the sural nerve
3. Unilateral vestibular lesion Those with unilateral vestibular lesion have vertigo, postural instability, oscillopsia, and disequibrium The wide BOS is an attempt to minimize trunk rotation and movement of the head, which can increase sensory conflict and vertigo
Which of the following interventions is MOST appropriate to assist with maintaining bone density for a patient with a history of osteoporosis and previous vertebral fractures? 1. Use of a rowing machine 2. Water aerobics 3. Walking on a treadmill 4. Performing sit-ups on a mat
3. Walking on a treadmill Swimming is great but not as good as surface walking which is weight bearing Weight bearing is very important in those with osteoporosis
Patients with advanced emphysema experience difficulty in breathing during exercise because of: 1. hypocapnia. 2. atrophy of secondary breathing muscles. 3. alveolar dilation. 4. damage to the phrenic nerve.
3. alveolar dilation Emphysema is characterized by abnormal and permanent enlargement of the air spaces distal to the terminal nonrespiratory bronchioles accompanied by destructive changes of the alveolar walls.
When planning a physical therapy program for a patient who has early stage Alzheimer disease, it is MOST important that the daily activities: 1. promote involvement and interest through maximum stimulation. 2. are changed each day to meet the need for variety. 3. are highly structured to reduce anxiety and confusion. 4. provide frequent opportunities for decision making.
3. are highly structured to reduce anxiety and confusion. Want highly structured and soothing for someone with Alzheimer's They would NOT respond well to highly stimulating environments, changes or vaiety or situations where they have to use greater cognitive skills than they possess such as frequent decision making
A patient with coronary artery disease has been doing regular aerobic exercise on treadmill. if the patient fails to comply with in taking prescribed beta-blocker medication and continues to exercise what potential rebound effect could result? 1. increased in BP and decrease in HR during exercise 2. decrease in BP and HR during exercise 3. increase in BP and HR during exercise 4. decrease in BP and increase in HR during exercise
3. increase in BP and HR during exercise Beta-blockers affect the beta-1 adrenergic receptors. blocking these inhibits the sympathetic response. however if abruptly terminated they cause a reflexive opposite response. this patient will demonstrated increased contractility, BP, and HR as a result
A physical therapist is evaluating a 25-year-old volleyball player who reports knee tenderness, which began after playing in a tournament 2 days ago. The patient has had no previous knee pain or recent trauma. The therapist has identified the patient's point of tenderness as indicated in the photograph. This is MOST indicative of: - pointing below patella 1. Osgood-Schlatter disease. 2. bipartite patella. 3. infrapatellar tendinitis. 4. a stress fracture of the patella.
3. infrapatellar tendinitis. Infrapatellar tendinitis is associated with eccentric overloading during deceleration activities and repeated jumping and landing NOT osgood schaltter cause here there is pain at tibial tubercle and seen in younger than 25 Patellar stress fractures would have point tenderness at PATELLA and would not be able to extend knee
A therapist wishes to examine the balance of an elderly patient with a history of falls. the Berg balance test is selected. which area is NOT examined during this test? 1. sit to stand transitions 2. functional reach in standing 3. turning while walking 4. tandem standing
3. turning while walking BERG is ONLY BALANCE (static and dynamic) No walking or gait is assessed here so 3 is wrong cause it says walking. The tinneti and DGI assess gait in a patient
A patient is seen by a physical therapist after being diagnosed with patellofemoral pain syndrome. As part of the session, the patient describes a number of exercises that they were instructed to perform by their personal trainer. Which of the following exercises would be the MOST likely to exacerbate the patient's symptoms? (1114) 1.Terminal knee extension in standing 2.Mini-squats from 0-30 degrees of knee flexion 3.Long arc quads from 0-45 degrees of knee flexion 4.Quadriceps setting in terminal knee extension in supine
3.Long arc quads from 0-45 degrees of knee flexion patellofemoral has pain greater than 30 degrees
A patient is two days post surgical insertion of a urinary catheter. This procedure is MOST commonly performed with which of the following types of catheters?(1138) 1.Condom 2.Foley 3.Suprapubic 4.Swan-Ganz
3.Suprapubic (SURGICAL WAS KEY WORD) Suprapubic - indwelling urinary catheter, surgically inserted directly into bladder. performed under anesthesia Foley - indwelling urinary tract catheter that has a balloon attachment at 1 end. Balloon filled w/ air or sterile water must be deflated before catheter can be removed. Does not require surgical insertion..
How long does menieres episode last?
30 min-24 hours
What pressure should be used to control edema for upper extremity?
30-40 mmHg (>45 is CONTRAINDICATED)
how to determine heart rate on EKG
300/#of big boxes bw peaks (R waves) 3 boxes = 100 bpm 4 boxes = 75 bpm5 boxes = 60 bpm More than 5 = Brady Less than 3 = Tachy
The therapist is instructing a patient with traumatic brain injury (TBI) how to lock the brakes on a wheelchair. The patient is right-handed, and the right upper extremity is more affected than the left. What is the BEST motor learning strategy to use with this patient? 1. Have the patient practice brake locking using the left hand to assist the right 2. Guide the patient's right hand through the locking motions, then the left. 3. Verbally talk the patient through the locking motions, practicing with both hands simultaneously 4. Have the patient practice locking the brakes first with the left hand and then with the right.
4. Have the patient practice locking the brakes first with the left hand and then with the right. Using the motor learning strategy of transfer training is best to use with this patient. Practice is performed with the less affected extremity first and then progressed to use of the more affected extremity
A patient is exercising in a phase 3 outpatient cardiac rehabilitation program that utilizes circuit training. One of the stations utilizes weights. The patient lifts a 5-lb weight, holds it for 20 seconds, and then lowers it slowly. The therapist corrects the activity and tells the patient to reduce the length of the static hold. Which of the following BEST describes the expected effects of isometric exercise? 1. Reduced normal venous return to the heart and elevated BP. 2. Abnormal oxygen uptake. 3. Lower heart rate (HR) and arterial blood pressure (BP). 4. Higher HR and arterial BP.
4. Higher HR and arterial BP.
An elderly patient with a left transfemoral amputation complains that when sitting, the left foot feels cramped and twisted. What is the therapist's BEST choice of intervention? 1. Appropriate bed positioning with the residual limb in extension. 2. Iontophoresis to the distal residual limb using hyaluronidase. 3. Hot packs and continuous US to the residual limb. 4. Icing and massage to the residual limb.
4. Icing and massage to the residual limb. Icing and massage for phantom limb pain
Examination of a patient recovering from stroke reveals a loss of pain and temperature sensation on the left side of the face along with loss of pain and temperature sensation on the right side of the body. All other sensations are normal. What is the likely location of the lesion? 1. Right cerebral cortex or internal capsule. 2. Midbrain. 3. Left cerebral cortex or internal capsule. 4. Left posterolateral medulla.
4. Left posterolateral medulla. Ipsilateral face
A patient with possible ligamentous injury of the knee presents with excessive tibial external rotation. Which ligament is MOST LIKELY to be injured? 1. Posterior cruciate. 2. Medial patello-femoral. 3. Anterior cruciate. 4. Medial collateral.
4. Medial collateral. do external rotation on yourself and feel which ligament is strained
A physical therapist is developing a treatment plan for a patient with fibromyalgia (FM). Which factor must the therapist consider when planning an exercise regimen for this patient? 1. Patients with FM have difficulty with water-based (aquatic) exercises. 2. Supervision or group exercise sessions may decrease compliance with the regimen. 3. Morning sessions work best for patients with FM. 4. Patients with FM have difficulty with sustained overhead activities.
4. Patients with FM have difficulty with sustained overhead activities. Sustained overhead activities means they will fatigue which is no good for those with fibromyalgia
Which of the following strategies for intervention would be MOST appropriate for a patient with moderate Alzheimer disease and urinary incontinence? 1. Continuous catheterization 2. Functional exercises 3. Biofeedback 4. Prompted voiding
4. Prompted voiding Prompted voiding is used for patients who may have cognitive deficits and require reminders of regular intervals for voiding. Continuous catheterization is usually used for patients who have a neurological deficit that directly affects urinary function, such as a spinal cord injury, and places the patient at risk for developing a urinary tract infection.
A frail, elderly wheelchair-dependent resident of a community nursing home has a diagnosis of organic brain syndrome, moderate Alzheimer's type dementia, During the therapist's initial interview, the patient demonstrates limited interaction and mild agitation and keeps trying to wheel the chair down the hall. Because it is late in the day, the therapist decides to resume the examination the next morning. How should the therapist document this in the medical record? 1. Disorientation to time and date. 2. Inattention as a result of short-term memory loss. 3. Frustration because of an inability to communicate. 4. Sundowning behavior.
4. Sundowning behavior. late in the day is the key word here
A patient has limited right rotation caused by left thoracic facet joint capsular tightness at T6-7. What arthrokinematic glide would MOST effectively improve right rotation in sitting? 1. Superior and anterior glide on the right T7 transverse process. 2. Superior and anterior glide on the left T7 transverse process. 3. Superior and anterior glide on the right T6 transverse process. 4. Superior and anterior glide on the left T6 transverse process.
4. Superior and anterior glide on the left T6 transverse process. Do glide of top one affected left tightness do glide of LEFT transverse process to improve right rotation **
A patient in the 8th month of pregnancy has numbness and tingling of the left hand, except for the little finger (5th digit). She demonstrates edema of the hand and fingers, a positive Tinel sign at the wrist, and a Good (4/5) muscle test grade of the wrist and finger flexors. The MOST appropriate intervention is: 1. a wrist splint to position the wrist in full extension. 2. a hot pack followed by tendon gliding exercises. 3. resistive exercises for the wrist and finger flexors. 4. frequent rest and elevation of the left upper extremity.
4. frequent rest and elevation of the left upper extremity. Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling associated with the individual being in the 8th month of pregnancy. In this case, rest and elevation would do the most to decrease the edema and relieve the symptoms. The wrist should not be positioned in full extension. Initial conservative treatment sometimes includes cock-up splinting to hold the wrist in neutral to 10° of extension, but not full extension.
To prevent contractures in a newly admitted patient with anterior neck burns, it would be best to position the neck in which of the following? 1. hyperflexion 2. slight flexion 3. neutral 4. slight extension
4. slight extension
What is hypermobile and hypomobile with TMJ?
A deviation during opening is associated with hypomobility toward the temporomandibular joint deviation and hypermobility contralaterally
Paradoxical breathing
A form of abnormal breathing that is common in tetraplegia where the abdomen rises and the chest is pulled inward during inspiration. On expiration the abdomen falls and the chest expands. Decreased chest wall expansion.Inefficient, requires more energy, fast fatigue Upward and outward motion of upper chest and inward motion of abdomen indicates abdominal paradoxical breathing Patients who are paralyzed or have weak intercostal can develop this compensatory pattern. With this pattern they counterbalance the strength of the diaphragmatic inferior pull by usin their SCM muscles and possibly their scalenes, traps and pec muscles THis also minimizes the collapse of the upper chest that is observed in paradoxical breathing
A physical therapist is taking the history of a patient with low back pain. Which of the following questions is BEST for the therapist to ask, if the therapist suspects the pain is caused by an inflammatory reaction? A. "Is your pain constant or intermittent?" B. "What activity bothers you the most?" C. "Is it difficult to stand up straight after you've been sitting?" D. "Does your pain radiate down into the leg?"
A. "Is your pain constant or intermittent?" Constant pain = hallmark of an inflammatory reaction (aka systemic) Mechanical pain would change iwth positions or activities (aka gets better when standing)
A patient with Addison's disease is referred for physical therapy following a hip fracture. The therapist recognizes the cardinal symptom of Addison's disease which is:
A. Asthenia (extreme lack of energy)
While working in a private practice clinic, a physical therapist observes a patient fall in the parking lot outside the office. The patient sustains a severe laceration to the forearm. The physical therapist secures a pressure dressing to the wound site, but notes that blood is soaking through the dressing and the bandage. Which of the following actions should the therapist perform NEXT? A. Elevate the limb and apply pressure to the wound. B. Remove the dressing and bandage and start over with a tighter bandage. C. Apply additional dressings and bandages and apply pressure to the brachial artery. D. Call the patient's physician and arrange transportation for medical care.
A. Elevate the limb and apply pressure to the wound. This should be done first before adding more dressings and applying pressure at brachial artery
A physical therapist is treating a patient who sustained a complete spinal cord injury. The patient currently walks with bilateral knee-ankle-foot orthoses and forearm crutches. The patient asks the therapist about how to correctly descend 1 step. Which of the following actions is MOST appropriate for the therapist to take? A. Instruct the patient to approach the step facing forward, lower the legs to the next step, and then place the crutches on that step. B. Instruct the patient to approach the step facing forward, place the crutches on the lower step, and then lower the legs to that step. C. Explain to the patient that descending stairs is not an appropriate goal at this time. D. Instruct the patient to approach the step facing forward, place one crutch on the lower step, lower the legs to that step, and then place the other crutch on that step.
A. Instruct the patient to approach the step facing forward, lower the legs to the next step, and then place the crutches on that step. The legs need to be lowered first then the crutches cause if otherwise the hips would buckle when the patient leans forward to bring crutches to next step If someone has an SCI and is using KAFO, they will not have sufficient hip control
A physical therapist is planning to use electromyographic biofeedback to evaluate muscle activity in a patient who had a cerebrovascular accident. The therapist is monitoring activity in the patient's triceps brachii muscle. Which method of electromyographic biofeedback signal processing would give the BEST measure of the quantity of muscle activity during a planned activity? A. Integrated B. Full-wave rectified C. Amplified raw D. Low-pass filtered
A. Integrated best method for quantifying EMG biofeedback is to use an integrated form of the data. This provides a summation of the data over a period of time
Knee capsular tightness has limited a patient's ability to attain full flexion. An INITIAL intervention a physical therapist can employ to restore joint motion should emphasize sustained mobilization in the loose-packed position using:
A. Posterior glide and internal rotation of the tibia. posterior glide improves knee flexion and internal rotation goes with knee flexion according to screw home mechanism
The parents of a 1 month-old child with myelomeningocele report that the child has been increasingly irritable and has changed sleeping patterns over the past 3 days. The child has also been vomiting. Which of the following actions is MOST appropriate for the therapist to take? A. Refer for immediate medical follow-up. B. Instruct the parents to monitor head circumference daily C. Advise the parents to watch the child for worsening symptoms. D. Take head circumference measurements to compare at subsequent visits
A. Refer for immediate medical follow-up. (may be indicative of hydrocephalus) Sixty percent of children with myelomeningocele develop hydrocephalus after surgical closure of their lesion. Early warning signs of hydrocephalus include irritability; changes in sleep patterns, and changes in appetite and weight. Eighty to ninety percent of children who acquire hydrocephalus will require a cerebrospinal fluid shunt. These children require ongoing follow-up by a physician. Given the seriousness of this child's symptoms, the child should be immediately referred for medical follow-up.
A patient sustained a severe brain stem injury 1 week ago and has demonstrated minimal change since the incident. The patient's cognitive status is MOST likely to include: A. a decreased level of arousal B. a decreased level of intelligence C. an increased level of agitation D. an increased level of impulsivity
A. a decreased level of arousal
A clean well-granulating Stage II pressure ulcer with minimal serous drainage is MOST appropriately dressed with: A. a nonadherent dressing. B. a packed dressing. C. topical medication only. D. dry-to-dry gauze.
A. a nonadherent dressing. Best choice cause any adherence of the dressing to the fragile granulating tissue could cause additional trauma Since its a superficial wound you do not pack
A physical therapist is planning a patient education program for a group of patients with chronic low back pain. To increase the likelihood that the patients will utilize the proper body mechanics at the work site, the therapist should: A. ask the patients to demonstrate use of proper body mechanics. B. provide a reference list of articles describing body mechanics C. ask the patients to describe actions they do that increase their back pain. D. provide information on the frequency of low back injuries due to improper body mechanics
A. ask the patients to demonstrate use of proper body mechanics. Evaluation of the patient's retention of the information presented in the program can be enhanced by asking the patients questions about the program information, having the patients ask questions about the program, having the patients demonstrate what they have learned and testing the patient about the program material.
A 3 month-old infant presents to physical therapy with poor midline head control. Upon evaluation, the physical therapist notes facial asymmetry and observes limitation of cervical rotation to the left and cervical lateral flexion to the right in the infant. A radiology report indicates premature fusion of the infant's cranial sutures. This infant has: A. right congenital muscular torticollis. B. left congenital muscular torticollis. C. right cervical facet hypomobility. D. left cervical facet hypomobility.
A. right congenital muscular torticollis. Cause they have limitations in right lateral flexion (named by side with limited lateral flexion)
A physical therapist is designing a rehabilitation program for a patient recently diagnosed with ankylosing spondylitis. The physical therapist should anticipate that as the disease progresses, the patient is MOST likely to require: A. special precautions for osteoporosis. B. a wheelchair for community mobility. C. assisted ventilation. D. bilateral ankle-foot orthoses.
A. special precautions for osteoporosis. Osteoporosis is a skeletal complication associated with longstanding ankylosing spondylitis. While lung expansion is generally decreased, assisted ventilation would not be required, because the muscles of respiration remain functional.
What is considered a concussion evaluation?
ABC's 1. Airway 2. Breathing 3. Circulation IMMEDIATELY CHECK THESE before anything else
A physical therapist is examining a patient who is complaining of pain in the left shoulder region. the examination of the shoulder elicits pain in the last 30 degrees of shoulder abduction ROM. this finding is most congruent with which diagnosis?
AC sprain AC sprains will have pain at extremes of ROM, especially horizontal adduction and full elevation and pain on passive horizontal adduction and elevation Both supraspinatus tendinitis and subacromial impingement have a painful arc between 60-120 degrees elevation, NOT end range
What is BEST intervention for myostitis ossificans?
ACTIVE RANGE OF MOTION not passive
What conditions have abnormal EMG's?
ALS, Guillain barre, Myasthenia Gravis, Peripheral neuropathy
Muscle common for median nerve velocity testing?
APB
How long do you need to wait to start active-assist and active ROM exercises with a patient who underwent a surgical repair of a 5 cm RC tear?
AROM start at 6-8 weeks (same with isotonic strenghtening) Can do PROM immediately and supine AAROM when they can tolerate it
What do you see with anterior inominate?
ASIS lower PSIS higher on affected side "ALS" - long to short (PSIS higher if it is long to start with)
How do you measure leg length?
ASIS to medial malleolus
Which of the following exercises should be AVOIDED for a patient who has a hiatal hernia?
Abdominal bracing in supine position For hernias want to avoid valsalva, abdominal bracing, and groin stretch as well as being in supine position
What would a tight inferior joint capsule limit?
Abduction
What is action of TFL?
Abduction, medial rotation, and flexion of the hip
A patient with a recent onset of steroid-induced myopathy would have the MOST difficulty performing which of the following activities? 1. Writing with a pen 2. Dressing 3. Climbing stairs 4. Rising from a supine position
Answer: 3. Climbing stairs. Prolonged use of corticosteroids can lead to corticosteroid-induced catabolism, resulting in inhibition of muscle protein synthesis and muscle weakness. The proximal muscles of the lower and upper extremities are affected first. Patients first report difficulty in climbing stairs.
What are the different parts of RTC?
Anterior = subscapularis Posterior = supraspinatus, infraspinatus, teres minor
What ligament does the anterior drawer of the ankle test?
Anterior TALOfibular ligament tibiofibular ligament is different (high ankle sprain and would be tested with a DF and rotation maneuver - dorsiflexion is most likely cause of mechanism of injury
What special test is used for slipped capital femoral epiphysis?
Anterior impingement test (hip to 90, internally rotate and adduct) Those with slipped capital femoral epiphysis have leg shortness, knee pain and pain when hip is internally (medially) rotated + sign with groin pain with anterior impingement test
What innervates flexor pollicis longus?
Anterior interosseous
What does Adson's thoracic outlet syndrome test specifically?
Anterior scalene involvement in thoracic outlet symptoms Interventions 1. Stretching of the scapulothoracic muscles 2. Stretching anterior scalenes
What is schuermann's disease?
Anterior wedging of the vertebral bodies Presents with an abnormal degree of kyphosis due to anterior vertebral wedging
Which of the following wheelchair features would make it easiest to perform a wheelie?
Anteriorly placed axle the more anterior the axle is in relation to patient's center of mass, the easier it will be to perform a wheelie However also increases the relative risk of tippign backward ***
Where should electrodes be placed to target anterior tibialis?
Anterolateral
Where would electrodes be placed for deep peroneal nerve (tib anterior)?
Anterolateral
A therapist is reviewing x-rays from a patient with a trimalleolar fracture. What are the BEST radiographic views to visualize this bony fracture?
Anteroposterior and lateral.
What is atropine?
Antichonolinergic blocking parasympathetic system causing increased HR and contractility to counteract bradycardia and bronchospasm caused by CAD
What is contraindicated in patients with stage 0 lymphedema?
Any activities that could result in skin damage (ie running barefoot)
What is apraxia, anosognosia, and somatoagnosia?
Apraxia = inability to perform purposeful learned movement or activities. They have difficulty following written and verbal instructions. When teaching them a new task it should be broken down into its component parts with one being taught at a time. Benefit from repetition Anosognosia = severe denial or awareness of the presence or severity of one's neurologic defect (paralysis. They may deny that an extremity belongs to them or lie as to the reasons for why an extremity does not move as it should***** Somatognosia = impairment in body schema where there is a lack of awareness of a body structure and its relationship to other body parts, to onself or to others (EXAMPLE: patient is attempting to brush their hair hwoever does not realize that the mirror image is not actually a true part of their body)
A patient presents to physical therapy with the signs and symptoms of adhesive capsulitis of the shoulder. Which of the following imaging studies would be the MOST appropriate to confirm the diagnosis?
Arhrograpy = best imaging for adhesive capsulitis
What are signs and symptoms of rotator cuff tear?
Arm positioned in internal rotation and adduction Point tenderness at greater tubercle and acromion Marked limitation in shoulder flexion and abduction Marked upper trap recruitment evident Increased anterior shoulder structure tone
What is the main reason a wound healing is delayed?
Arterial perfusion to the wound area (if vascular flow is absent or severely diminished - ABI .5) then prognosis is very bad ABI of .5-.8 = high risk for non-healing Nutrition and wound environment also affect
Which of the following is not a piece of criteria needed to move on to the second phase of ACL rehab? a. ROM 0-120, min 110 b. Full passive extension c. Ascend 8 stairs with no pain d. FWB and independent with gait
Ascend 8 stairs with no pain YOU DO NEED: 1. ROM 0-120 with minimum being 110 2. Full passive knee extension 3. FWB and independent with own gait (no crutches or cane) 4. Good quad control
What is egophony?
Ask PT to pronounce 'ee-ee-ee--ee" sound. If the noise changes to "aaaaaa" it is abnormal THINK CONSOLIDATION IF ABNORMAL = cystic fibrosis, pneumonia, pulmonary edema Emphysema
What should you ask the patient to differentiate between systemic and mechanical pain?
Ask if the pain is constant or intermittent Intermittent (changes with positions or activities) = mechanical Constant pain = systemic
How do you test attention?
Ask patient to count from 1 to 25 by increments of 3 Task requires the person to exert a sustained and consistent effort Attention deficits are common with brain injury, stroke and dementia
What is Tinnetti?
Assesses balance and gait
What is a cross sectional study?
Assesses exposure and outcomes at a SINGLE point in time If question says anything about over time this is not the answer
What is the importance of rotator cuff muscles?
Assist in positioning the humeral head in the glenoid fossa
what is function of posterior delotid?
Assists lats with shoulder extension Are a horizontal abductor
What is healing for a grade II ligament sprain?
At 3 weeks it would be disorganized and not able to withstand high tensile forces At 3 weeks it is beginning to organize
RTC repair timeine?
At 8-12 weeks, patient can actively elevate the arm to functional heights >4 weeks for someone to sleep on involved side
How long should you wait after taking proton pump inhibitor for GERD before doing therapy?
At least 90 min
A patient suddenly falls and lands on a piece of equipment left on the floor. a severe laceration with spurting blood is noted in the area of the lateral distal right thigh. to help control bleeding, where should the PT apply pressure in addition to directly over the wound?
At the femoral triangle WANT TO CHOOSE AN ANSWER THAT OCCLUDES THE MOST PROXIMALLY (think turniquet)
What is someone with RA subject to?
Atlantoaxial subluxation or instability
What is the difference between atraumatic instability vs. labral tear?
Atraumatic instability - has a sudden onset, is not traumatic, can be provoked by apprehension test (ABD, ER of shoulder). Insidious onset (meaning gradual very slow) Labral tear - clunk test, traumatic, suddenn onset BOTH SUDDEN ONSET BUT one is traumatic and one is not
When there is an irregular heart beat, what is the best way to measure HR?
Auscultation at apical for 60 seconds Rates faster than 100 bpm or slower than 60 should be measured for a full minute
What must come first when treating a patient with abdominal pain -- auscultation or palpation?
Auscultation of abdomen --> superficial palpation --> deep palpation
A patient had a split-thickness skin graft for a superficial partial-thickness burn injury to the upper extremity. The surgeon has requested range of motion exercises for the patient. Currently, the patient is able to actively move the upper extremity through one-third of range of motion for shoulder flexion. Based on this finding, what is the MOST appropriate action for the physical therapist to take at this time? A. Defer any range of motion exercises until the patient is able to participate more actively. B. Begin active assistive range-of-motion exercises. C. Begin bed mobility training to facilitate increased use of the upper extremity. D. Continue with active range-of-motion exercises.
B. Begin active assistive range-of-motion exercises. Since this patient cannot achieve full range of motion by himself, then active assistive range of motion is indicated to prevent contract Continuing with only active range of motion would not facilitate adequate increases in range of motion and would not prevent contractures.
Which of the following subjective reports from a patient with rheumatoid arthritis indicates the need for further medical examination by a physician? A. Morning pain in both lower extremities B. Numbness in both lower extremities C. Increased pain during activities of daily living D. Inability to sleep at night
B. Numbness in both lower extremities Symmetrical numbness could be indicative of myelopathy from either infection
A patient received a gunshot wound to the distal posterior thigh that resulted in complete severance of the common fibular (peroneal) nerve. Which of the following exercises is necessary in the early rehabilitation period to prevent contracture formation? A. Active plantarflexion, inversion, and toe extension B. Passive dorsiflexion, eversion, and toe extension C. Active dorsiflexion, eversion, and toe flexion D. Passive plantarflexion, eversion, and toe flexion
B. Passive dorsiflexion, eversion, and toe extension Common peroneal nerve (otherwise known as deep fibular/tibial or peroneal nerve) innervates tibialis anterior, extensor digitorum longus, peroneus tertius and peroneus longus and brevis Because of the complete nerve severance, all of those muscles would be affected and would not be able to actively contract until regeneration has taken place. Therefore, the patient would completely lose ankle dorsiflexion, eversion, and toe extension. Those motions would have to be performed passively in order to maintain range of motion.
When considering special tests for orthopedic assessment of a client, the validity of a test is important because the: A. results of the test can be standardized. B. test measures what it is supposed to measure. C. results of the test are reproducible D. test can be accurately performed by someone else.
B. test measures what it is supposed to measure. This is the definition of validity. Validity measures what it is supposed to measure.
A patient presents to physical therapy with low back and leg pain, with symptoms extending to the bottom of the foot. During the physical therapy examination, the patient does not report leg pain in the first test position (photograph #1), but reports a severe increase in symptoms in the second test position (photograph #2). These findings support which of the following conclusions? A. The pain is the result of a herniated disc. B. The patient may be displaying nonorganic symptoms. C. The symptoms are the result of an inflamed sciatic nerve. D. The hamstrings are in a facilitated state of contraction.
B. The patient may be displaying nonorganic symptoms. Since sitting knee extension and the straight-leg raise culminate in essentially identical positions, symptomatic responses to the 2 types of maneuvers should be similar. If the patient had a symptomatic herniated disc, both positions would result in a similar symptom increase. Symptomatic responses to the 2 types of maneuvers should be similar. If the patient had an irritated sciatic nerve, both positions would result in a similar symptom increase. If the patient had a facilitated hamstring, both positions would result in a similar
During inspiration, a patient demonstrates increased upper chest expansion with retraction of the epigastric area. The physical therapist should suspect weakness of the: A. scalene muscles. B. diaphragm. C. rectus abdominis. D. intercostal muscles.
B. diaphragm. Normally, as the diaphragm descends with inspiration, it places increased pressure on the abdominal contents with a resultant distension of the epigastric area. Weakness of the diaphragm would decrease the distension and may result in a compensatory increase in upper chest expansion to improve ventilation.
A patient is being examined for medial epicondylitis. With this diagnosis, the physical therapist should expect to MOST likely find pain over the: A. origin of the flexor digitorum profundus with resisted finger flexion. B. origin of the pronator teres muscle with active pronation. C. medial epicondyle with passive wrist flexion. D. insertion of the triceps brachii with passive elbow extension.
B. origin of the pronator teres muscle with active pronation. The pronator teres, palmaris longus, flexor carpi radialis and ulnaris as well as flexor digitorum SUPERFICIALIS all originate from medial epicondyle of the humerus Pain would be elicited with active contraction of involved muscle (flexor carpi radialis) or when muscles are passively stretched (into passive extension) In this case with medial epicondylitis resisted wrist flexion and pronation would cause pain over origin of pronator teres
An elderly patient presents with a sacral pressure ulcer measuring 6 in x 6 in (15 cm x 15 cm). The wound has moderate serous fluid drainage and is loosely covered with necrotic and fibrotic tissue, although there are no indications of infection present. The BEST method of debridement is: A. daily vigorous scrubbing of the wound. B. wet-to-dry dressings with normal saline 2 times/day. C. daily wet-to-dry dressings with 1:1 diluted povidone-iodine (Betadine). D. whirlpool jet agitation 2 times/day.
B. wet-to-dry dressings with normal saline 2 times/day. Wet to dry dressings are used for necrotic tissue that needs debridement Whirlpool is NOT effective in removing necrotic tissue
When should you use habituation exercises?
BILATERAL VESTIBULAR HYPOFUNCTION
Pt presents w/ significant pain secondary to first and second degree burns across his anterior shins. Before debridement of the dead skin, which of the following is the MOST appropriate?
BRIEF INTENSE TENS (this provides rapid-onset, short term pain relief during painful procedures such as wound debridement, deep friction massage, joint mobs or passive stretching) Conventional TENS = most common; used for acute injuries such as ankle sprain. relief is relatively short, and they have a short and comfortable tingling sensation with NO MOTOR response Acupuncture like TENS = used for CHRONIC pain, uses body's own endogenous opiates. Duration may be long lasting meaning >1 hr. Amplitude is strong, but comfortable rhythmic muscle twictches.
When an individual experiences an increase in blood pressure, what reflexive response should occur?
Baroreceptor reflex This includes vascular dilation (decreases BP) and a decrease in cardiac ouput
The intervention for a patient who has right sciatic pain caused by piriformis compression should NOT include: A. instruction in mild self-stretching in sitting with the right hip and knee flexed and pressure applied in the medial direction to the distal thigh with the left upper extremity. B. contract-relax exercises to the hip external rotators performed with the patient sidelying on the left and the right hip and knee positioned in 90° of flexion C. active resistive strengthening exercises to the piriformis with the patient prone and the knee flexed. D. application of cold to the area of sciatic nerve irritability.
C The piriformis muscle functions as an external rotator of the hip, and it is thought that a tight piriformis muscle may compress the sciatic nerve causing pain. Passive internal rotation and resisted external rotation may be painful. Intervention would call for stretching of the piriformis muscle, not strengthening it. Modalities such as ice may also be helpful to decrease the inflammation.
What is basic life support sequence?
C-A-B Chest compressions Assess airway Give breaths 1. Check responsiveness 2. Activate emergency response 3. Check pulse 4. Begin chest compressions 5. Airway 6. Breathing
What diseases require contact precautions?
C-diff E-coli Skin infection Scabies i
A patient had knee surgery 4 weeks ago. Which of the following descriptions represents the correct neuromuscular electrical stimulation parameters to use for strengthening the quadriceps muscle of this patient? A. 1 to 4 pps, 100 microseconds B. 1 to 4 pps, 350 microseconds C. 40 to 50 pps, 350 microseconds D. 100 pps, 100 microseconds
C. 40 to 50 pps, 350 microseconds Tetany is needed for strengthening Correct answer requires a frequency that will lead to tetany (something above 30 hz) and a long enough pulse width to recuit motor fibers (usually something greater than 200 microseconds) D which is 100 pps/Hz and 100 microseconds is used for conventional TENS for acute pain management (a pulse width of 100 microseconds makes it hard to achieve a motor response and the higher frequency of 100 pps leads to rapid fatigue)
For a patient with insulin-dependent diabetes who is completing a cardiovascular fitness program, what change in diabetic management is MOST likely to be instituted as fitness increases? A. Switching to oral rather than injected medication B. Decreasing caloric intake for 2 to 3 hours following exercise sessions C. Decreasing the amount of insulin taken daily D. Increasing the amount of insulin taken daily
C. Decreasing the amount of insulin taken daily Exercise increases sensitivity of insulin receptors therefore leading to a decrease in the amount required to be injected Important to increase caloric intake and carbs before exercise
Which of the following pulmonary function tests measures the average total amount of air moved during inspiration of normal breathing? A. Vital capacity B. Inspiratory capacity C. Tidal volume D. Inspiratory reserve volume
C. Tidal volume Tidal volume = total volume of air moved during either inhalation or exhalation over a specific period of time (1 min) and then divided by the ventilatory rate VC = maximum inhalation to maximum exhalation Inspiratory Capacity = volume with MAXIMAL inhalation Inspiratory reserve volume = measures inspiratory volume beyond normal inspiration
A physical therapist has been working with a patient who has a spinal cord injury. To document that the patient has been educated about skin care, the therapist should record that the patient: A. is unable to tolerate more than 1 hour in a wheelchair. B. is unable to tolerate more than 1 hour in a wheelchair. C. is able to state 3 causes of skin breakdown. D. is able to perform 10 push-ups in the wheelchair.
C. able to state 3 causes of skin breakdown This is only one listed in educational terms
A physical therapist is developing a gait training program for a patient following a total hip arthroplasty of the right hip done via an anterolateral approach 2 weeks ago. The proper instructions and rationale for crutch training utilizing 1 crutch include holding the crutch in the: A. right hand to decrease activity in the right hip abductors. B. right hand to facilitate activity in the right hip abductors. C. left hand to decrease activity in the right hip abductors D. left hand to facilitate activity in the right hip abductors
C. left hand to decrease activity in the right hip abductors With an anterolateral approach, the gluteus medius is cut Abductors should NOT be exercised Want crutch on opposite side
What nerves innervate the volar (anterior) surface of the arm?
C5-6; T1
During the examination of a patient with carpal tunnel syndrome, the physical therapist is MOST likely to find: A. paresthesia of the medial palmar surface of the hand B. weakness of finger extension of the lateral 3 digits. C. paresthesia of the lateral 3 digits. D. weakness in wrist flexion and ulnar deviation
C. paresthesia of the lateral 3 digits (in carpal tunnel syndrome there is pain and paresthesias in the median nerve distribution of the hand, which includes the lateral three digits) There is an ape hand deformity which is weakness of the abductor pollicis brevis meaning loss of opposition and abduction of the thumb but not of the wrist flexors or finger extensors.
An athlete sustained a severe inversion sprain of the right ankle while playing basketball. To provide strapping support for the ankle, pressure and support should be applied over the tendons of the: A. flexor digitorum longus and tibialis posterior B. gastrocnemius and flexor hallucis longus C. peroneus longus and peroneus brevis. D. tibialis anterior and tibialis posterior.
C. peroneus longus and peroneus brevis. With an inversion injury, the tendons of the peroneus longus and brevis can become strained. Swelling with an inversion strain usually occurs over the anterolateral part of the ankle. Compression and support is most beneficial by placing tape stirrups on the lateral side of the ankle, over the tendons of the peroneus longus and brevis and pulling the ankle into slight eversion
A patient with chest pain from myocardial ischemia will MOST likely exhibit: A. increased pain upon chest-wall palpation. B. increased pain with deep breathing. C. relief with nitroglycerin (Nitrostat) ingestion. D. relief with antacid ingestion
C. relief with nitroglycerin (Nitrostat) ingestion. chest pain from myocardial ischemia = angina With angina, there is relief of chest pain with rest and nitroglycerin If not relieved with rest or nitroglycerin THINK heart attack (MI) Increased pain with palpation = think MSK Increased pain with breathing = think PULMONARY Relief of pain with antacids = think PEPTIC ULCER
A physical therapist evaluates a patient who has lateral epicondylitis. The patient reports a subjective pain rating of 8/10. The patient also reports pain and shows weakness with resisted wrist extension. The therapist decides to use ice massage as an intervention. The MOST appropriate length of time for the ice massage is: A. 10 minutes. B. until the area turns red, and the patient reports a burning sensation C. until the patient reports that the area feels numb D. no longer than 5 minutes.
C. until the patient reports that the area feels numb Ice massage is applied to control pain, edema or inflammation Dosage for ice massage is determined by patients response and applied until patient experiences analgesia or reported numbness over the area of massage Usually 5-10 min but look for feeling of numbness first over the time Ice 1. Cold 2. Burning 3. Aching 4. Numbness (this is the desired end effect)
A physical therapist is applying electrical stimulation to a patient with a neurapraxia. To minimize accommodation, the physical therapist should: A. decrease the size of the stimulating electrode. B. increase the pulse duration. C. utilize a rapid rate of rise. D. select a biphasic waveform.
C. utilize a rapid rate of rise. (rise time must be rapid enough to avoid accomodation) For A, if you decrease the size of the electrode it will increase current density Neurapraxia means that the muscle is innervated
What do you stabilize during sharp purser?
C2 (axis)
UE Dermatomes
C2 = from one ear to the other behind the head C3 = ring around the top of the neck C4 = upper trap, lower neck. From medial clavicle to AC joint C5 = deltoid. Lateral arm. 1/3 down the arm to 1/3 top of forearm C6 = radial border of hand C7 = index, middle and ring finger C8 = ulnar border of hand T1 = medial arm. 2/3 down the arm to 2/3 of the forearm to ulnar styloid
at what SCI level injuries can you start to drive and become dependent with dressing?
C5
Which is the BEST choice of manual therapy technique to correct a closing restriction of T5 on T6?
Central PA pressure at a 60° angle on the spinous process of T6 while stabilizing T5.
What is cogwheel rigidity a sign of?
Central nervous system dysfunction
What are Frenkel's exercises used for?
Cerebellar ataxia
What condition do you think of when you hear hip adduction and internal rotation of hip during gait?
Cerebral palsy Hip adduction, internal rotation consistent with their gait pattern
What is the hoffman sign indicative of?
Cervical myelopathy or UMN disease
During which of the following scenarios are gloves required to comply with standard precautions? A. During all patient care in the hospital setting B. Performing ROM on a patient with AIDS C. Massaging neck of patient with hepatitis D. Changing diaper
Changing diaper Gloves are only required in contact with blood or body fluids3 Gloves are required with diapers since this is a body fluid
Which of the following associated conditions places children with Down syndrome at GREATER risk for frequent respiratory infections?
Chest muscle hypotonicity Respiratory tract infections are very common secondary to hypotonicity of the chest and abdominal muscles and contribute significantly to morbidity and mortality. Decreased muscle tone compromises respiratory expansion. Cardiopulmonary manifestations include poor ability to clear secretions from both upper and lower airways, resulting in greater susceptibility to pulmonary infections, and postural abnormalities that may lead to restrictive lung dysfunction in older children.
What does damage to basal ganglia cause?
Choreoathetosis rigidity bradykinesia
What gait deviation do you see with weak hip flexors?
Circumduction
A patient recovering from stroke walks with limited tibial advancement during stance on the more affected LE. the therapist next examines the patient for a compensatory gait deviation. what is the MOST likely deviation?
Circumduction (circumduction is the most likely gait deviation when tibial advancement is limited - spasticity of plantar flexors)
A physicalt herapist examines a patient who has limited cervical ROM. The therapist attempts to screen for vertebral artery involvement but is unable to position the patient's head and neck in the recommended test position. Which action is most appropriate?
Complete vertebral artery test as far into the available cervical ROM as possible Vertebral artery test extension, lateral flexion, and rotation to ipsilateral side Positive = dizziness, nystagmus, slurred speech or loss of consciousness Should still perform the test and clear the patient's vertebral artery for their available ROM. As the patient gains additional ROM the test can be readministered
What is ris management program?
Comprehensive risk management program that monitors occurrence related to pt and staff for intention of preventing further safety risk (wet floors)
How do you test TIBIOfibular ligament?
Compress the shaft of the tibia and fibula at the mid calf This stretches the syndesmosis
What should you use for scar management?
Compression garments that aid in the formation of smooth, flat scars
What is costoclavicular test for TOS?
Compression of clavicle and 1st rib 1. Military posture pull shoulders back Positive - loss of radal pulse or symptoms from compression between clavicle and 1st rib
What is genu varum associated with?
Coxa valga (>135) rickets
What is genu valgum associated with?
Coxa vara (<120)
A patient with insulin dependent diabetes is participating in an aerobic exercise class. the therapist recognizes that important dietary recommendations to prevent delayed onset hypoglycemia after exercise include intake of which of the following:
Crackers or bread Slowly absorbed carbohydrates (crackers, bread, or pasta) can help prevent delayed onset hypoglycemia- Rapidly absorbed carbohydrates (fruit juice, candy) are given DURING exercise to prevent hypoglycemia-saturated fats (steaks) should be limited, salads and vegetables do not have major effects in preventing hypoglycemia
What cranial nerve is ptosis associated with?
Cranial nerve III (oculomotor) Difficulty opening the eye Horners would be difficulty closing eye
A physical therapist is working with a child who recently learned to sit independently. Which of the following gross motor skills should be the focus of intervention NEXT? 1. Cruising 2. Walking 3. Creeping on hands and knees 4. Rolling from prone to supine position
Creeping on hands and knees rolling --> sitting --> creeping --> cruising --> walking
What is cardiac rehab guidelines for terminating exercise?
Criteria for reducing exercise intensity or termination(1) onset of angina and other symptoms of exertional intolerance(2) systolic BP ~ 240 mmHg, diastolic BP ~ 110 mmHg(3) > 1-mm ST segment depression, horizontal or downsloping ( 4) increased frequency of ventricular arrhythmias; ( 5) second-degree or third-degree AV block
What is liberatory sermont maneuver used for?
Cupulolisthiasis (type of BPPV)
What wheelchair seat is indicated for patients with pelvic obliquity?
Custom molded seat
To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients into 2 groups. One group is treated with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the: A. continuous variable. B. dependent variable C. discrete variable D. independent variable.
D The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the effect or response. In this case the TENS is the treatment or independent variable. Continuous and discrete variables are methods of quantifying variables INDEpDNET IS WHAT IS BEING EXPERIMENTED / CHANGED DEPENDENT IS THE OUTCOME
A physical therapist is treating a patient with iontophoresis. If the current is set at 4 mA, the duration at 15 minutes, and the dexamethasone (Decadron) solution at 0.04%, with an electrode area of 4 cm2, how should the therapist record the current dosage in the patient's chart? A. 0.16 mA-mg B. 16 mA/cm2 C. 0.60 mg/min D. 60 mA-min
D. 60 mA-min The current dosage for iontophoresis is calculated by multiplying the current (4 mA) by the duration (15 minutes). dosage = current x duration Ex: dosage = 4 x 15 dosage =60 In this case the calculation would yield a value of 60 mA-min.
A physical therapist is working on progressive functional mobility with a patient who had a transverse colectomy 2 days ago. The patient has developed a low grade fever. What is the MOST appropriate examination for the physical therapist to perform, prior to continuation of the patient's intervention? A. Heart rate B. Blood pressure C. Respiratory rate D. Auscultation
D. Auscultation Common causes of post-operative fevers are atelectasis or pneumonia Auscultation of the lungs would help the therapist in delineating this as a cause of fever
A patient who is re-learning the task of moving from sit to stand following traumatic brain injury is frustrated because of repeated failed attempts. To facilitate the patient's success, the physical therapist should FIRST do which of the following? A. Permit the patient to rest until the next physical therapy session and re-attempt the activity. B. Encourage the patient to visualize success with the task, before resuming attempts. C. Provide incentive by holding a desired object for the patient to reach toward. D. Decrease the challenge of the task, so that the patient experiences success
D. Decrease the challenge of the task, so that the patient experiences success It is most important for the patient to experience some form of success in order to provide motivation.
When conducting a bicycle ergometer test on a patient with a history of myocardial infarction and diabetes, it is MOST important to monitor: A. Anginal level via angina scale B. Exertional level on the Borg scale C. Percent of age predicted heart rate D. Rhythm on 12-lead EKG
D. Rhythm on 12-lead EKG
A right-handed woman is being examined by a physical therapist for right-sided weakness in her upper and lower extremities. Her muscle tone is hypotonic and she is ataxic during walking. She has a history of hypertension and alcoholism. Passive range of motion is normal with deep tendon reflexes showing hyporeflexia. She has an intention tremor when she tries to pick up an object from a table and exhibits difficulty in performing the finger to nose test. What is the location of the MOST probable area of the lesion? A. Right side, cervical spinal cord B. Left side, cerebral hemisphere C. Left side, substantia nigra D. Right side, cerebellar hemisphere
D. Right side, cerebellar hemisphere Her symptoms are reflective of cerebellar lesion which produces hypotonia, hyporeflexia , ataxia and INTENTION TREMOR cerebellar lesions produce ipsilateral signs and symptoms in the extremities A lesion in substantia nigra would produce symptoms seen in Parkinson's such as rigidity and resting tremor
A patient with metabolic syndrome is participating in a circuit-training program involving both aerobics and strength training. The therapist notes the patient is sweating and having difficulty concentrating on an activity and coordinating movements. When asked if there's a problem, the patient is confused and has difficulty speaking. The therapist should: A. Discontinue the exercises and have the patient rest B. Reschedule the patient for another time C. Discontinue the exercises and refer the patient back to the physician D. Sit the patient down and administer fruit juice immediately
D. Sit the patient down and administer fruit juice immediately Probably has diabetes and is experiencing hypoglycemia
A patient who has recently and successfully completed a 12-week program of Phase III cardiac rehabilitation will MOST likely demonstrate a decrease in: A. carbon dioxide elimination in maximal work B. cardiac output in maximal work. C. stroke volume at a given level of submaximal work. D. heart rate at a given level of submaximal work.
D. decrease in heart rate at a given level of submaximal work. aerobic conditioning will result in a decrease in HR both at rest and with exercise
During an evaluation, a patient lacks 10° of passive ankle dorsiflexion. The same degree of limitation is present whether the knee is flexed or extended. The muscle MOST likely contributing to this restriction is the A. gastrocnemius. B. tibialis anterior. C. plantaris. D. soleus.
D. soleus. (soleus is not a 2 joint one so it is not affected if extended or bent) *The tibialis anterior is a dorsiflexor of the ankle and while weakness in this muscle may limit active dorsiflexion, it would not affect passive dorsiflexion* weakness limits active not passive Limiting passive is usually due to tightness
A physical therapist is examining a patient who has difficulty making a fist. Results of the patient's muscle tests show the following: Flexors of the index, middle, ring, and little fingers (2nd to 5th digits) at the proximal interphalangeal joint are Normal (5/5). Flexors of the index finger (2nd) and middle finger (3rd digit) at the distal interphalangeal joint are Normal (5/5). Flexors of the ring finger (4th digit) and little finger (5th digit) at the distal interphalangeal joint are Poor (2/5).These findings are consistent with a lesion of the: A. median nerve C8-T1. B. median nerve C5-C6. C. ulnar nerve C5-C6. D. ulnar nerve C8-T1.
D. ulnar nerve C8-T1. The weakness is in the flexors of the fourth and fifth digits at the distal interphalangeal joint (2/5). The other fingers show normal strength (5/5). This weakness would indicate a problem with the flexor digitorum profundus, since the distal joints are involved. The flexor digitorum profundus is innervated by both the median and ulnar nerves. The flexor digitorum profundus muscles flexing the index and middle fingers are innervated by the median nerve. The flexor digitorum profundus muscles flexing the ring and little fingers are innervated by the ulnar nerve. Therefore, since the ring and little fingers are involved, the lesion would have to be involving the ulnar nerve. The flexor digitorum profundus to the fourth and fifth fingers is innervated by the ulnar nerve roots C8 and T1.
What happens to blood glucose levels if you increase insulin?
DECREASES (its the opposite)
What is contraindicated with thrombolytic agents?
DO NOT USE WITH HEMORRHAGIC STROKE
What is Alzheimer's?
Damage in cerebral cortex and subcortical areas of the brain
Which of the following integumentary system observations is consistent with skin cancer?
Dark raised spot that bleeds with minimal contact
When do you have peak hamstring activity in the gait cycle?
Deceleration
When performing manual lymphatic drainage, which of the following techniques is MOST appropriate to use?
Decongest the involved trunk quadrant before decongesting the involved limb. (the goal of manual lymphatic drainage is to direct the lymphatics centrally. The progression is trunk quadrant first, followed by proximal to distal segments) When performing manual lymphatic drainage, the therapist must decongest the involved trunk quadrant before decongesting the involved limb from proximal to distal locations. This is done to direct the flow of the lymphatics centrally toward the lymphatic ducts.
What is cognitive behavioral therapy for?
Decrease anxiety This is within our scope of practice to provide CBT for anxiety Help them recognize signs (fidgeting, nail biting) and journal their feelings
An important change in gastrointestinal function that occurs with aging is?
Decrease in nutrient absorption
What can exercise do to blood glucose?
Decrease it
What is an initial sign of peripheral lymphedema?
Decreased finger flexibility
If you have a posterior pelvic tilt what kind of lumbar sacral angle do you have?
Decreased lumbar sacral angle
A patient has completed an aerobic training program. Which of the following cardiopulmonary outcomes is MOST likely to result from the training program?
Decreased resting heart rate
What do beta blockers do to HR and BP?
Decreases both Also decreases oxygen demand and angina
What is Kussmaul breathing?
Deep and labored breathing HYPERVENTILATING metabolic acidosis associated with decreased blood pH Diabetic ketoacidosis can cause this (ketones released)
What is huffing?
Deep inspiration followed by a forceful exhalation with an open mouth
For poor posture what should you strengthen?
Deep neck flexors and rhomboids Stretch sub occipitals and pecs
Which burn classification produces the MOST scarring? (ex: keloids)
Deep partial thickness burn
What is function of digitalis?
Depresses sympathetic activity thus slowing the heart rate and depressing electrical conductivity Increases contractility of the heart
What is the most diagnostic movement for TMJ?
Depression (mouth opening)
What is mneumonic for negative ions?
Dexter CC Always Ignores Sally D= dextamethasone C= calcium chloride A=Acetic acid I= Iodine S=salicylates
When to use diaphragm vs. bell with auscultation?
Diaphragm with firm pressure = S1 and S2 Bell = S3 because pitch is deeper Diaphragm for high pitched Bell for deep sounds (aka S3)
What is a sign of Parkinson's?
Difficulty shifting attention/selective attention due to deficit in frontal lobe
What happens if you have insult to vagus nerve (CN X)?
Difficulty swallowing (dysphagia)
A patient is lacking forearm supination due to associated joint restriction. Which of the following glides at the distal radioulnar joint will MOST likely be limited with testing?
Dorsal glide of the radius on the head of the ulna At the distal radioulnar joint the concave ulnar notch of the radius articulates with the convex head of the ulna. A dorsal glide of the radius on the head of the ulna would test for supination. If there were associated joint restrictions here, testing of this glide would be restricted
What would be main mechanism of injury for anterior tibiofibular ligament (high ankle sprain)?
Dorsiflexion
What does posterior glide of talus improve?
Dorsiflexion Exercise = staircliming
What ankle position will bias the tibial nerve?
Dorsiflexion and eversion
what is action of fibularis tertius?
Dorsiflexion and eversion
The physical therapist is instructing a mother to perform ROM and stretching for her newborn who has clubfoot. in what directions should the therapist advise her to carefully stretch?
Dorsiflexion and eversion stretches it Club foot = plantarflexion and inversion Want to stretch in opposite direction
What ankle position will bias the sural nerve?
Dorsiflexion and inversion
What are sensory deficits associated with L5?
Dorsolateral foot with also weakness of extensor hallicus longus
During pregnancy, which exercise is CONTRAINDICATED?
Double leg lifts
What AFO for someone with diabetic neuropathy who has mediolateral instability as well as fluctuating edema and glove-and-stocking sensory loss in both LE's?
Double upright metal ankle foot orthosis
What kind of bone deformity is seen with osteoporosis?
Dowager's hump
What is considered orthostatic hypotension?
Drop in systolic >20 Drop in diastolic >10
What is the cause of the high percentage of aging pop hospitalizations with GI complaints?
Due to effects of non-steroidal anti inflammatory drugs May be taking these for pain and inflammation in the knees If pain changes with food intake then think gastric region is source of complication
Why would an athlete have a low blood pressure?
Due to increased stroke volume At rest they would have a lower BP
How do you determine end feel?
During passive range of motion, PT should apply overpressure at the end of ROM to determine end feel
When is pain present with achilles tendinosis?
During running and weight bearing activities Treatment: ice therapy, activity modification and eccentric exercises
What is cardiac difference between dynamic exercise and isometric exercise?
Dynamic = facilitates circulation Isometric = hinders blood flow, producing higher HR and BP
What should you work on with someone with fetal alcohol syndrome?
Dynamic balance
What type of stretching (rapid, long lasting) will someone with significant tissue shortening after immobilization benefit from?
Dynamic splint
What is a nerve conduction velocity test most useful for?
Evaluation of peripheral nerve or LMN status Ex: carpal tunnel
What would be main mechanism of injury for deltoid ligament?
Eversion
Wht is psoatic gait seen with legg calve?
Exagerrated toe out and swing the leg forward
Common gait deviations: Swing phase--> abnormal synergistic activity (stroke)
Excessive hip and knee flexion with abduction
A patient has normal quadriceps strength but unilateral weakness (3/5) of the hamstring muscles on the right. what might the therapist observe during swing phase of gait?
Excessive hip flexion followed by abrupt knee extension on weak side
What is keloid scarring?
Excessive scar tissue grows OUTSIDE of the original margins of the wound
What exercise prescription should someone with dyslipedemia follow?
Exercise at a moderate intensity of 40-80% of the HR reserve 5x per week
Regular aerobic exercise lasting at least 30 minutes per session should be MOST beneficial in decreasing the symptoms associated with which of the following conditions? 1. Type 1 diabetes 2. Type 2 diabetes 3. Multiple sclerosis 4. Amyotrophic lateral sclerosis
Exercise is a major contributor in controlling hyperglycemia in type 2 diabetes by improving skeletal muscle glucose transport and whole-body glucose homeostasis. Regular exercise can help the body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication needed to treat diabetes or even eliminate the need for medication.
A physical therapist assistant in an outpatient cardiac rehabilitation program is instructing a patient in proper lifting technique. What should the physical therapist assistant recommend to help the patient avoid the Valsalva maneuver during weight lifting?
Exhale during the lifting (concentric phase) and inhale during the lowering (eccentric phase)
What is difference between control group and experimental group?
Experimental = gets treatment Control = no treatment or a standard treatment
Twenty-four hours after application of postoperative transcutaneous electrical nerve stimulation (TENS), the patient no longer feels the electrical stimulation. What is the BESTcourse of action for a physical therapist assistant to take?
Explain to the patient that sensory accommodation occurs with TENS and readjust the intensity
What is STNR reflex?
Flex head = flexed UE and LE extended (like looking up position) Extend head = extend UE and flex LE Interferes with crawing Also known as the crawling reflex, symmetrical tonic neck reflex (STNR) is present briefly after birth and then reappears around six to nine months. This reflex helps the body divide in half at the midline to assist in crawling - as the head is brought towards chest, the arms bend and legs extend. It should disappear by 11 months. Developmental delays related to poor muscle tone, tendency to slump while sitting, and inability to sit still and concentrate can result if th STNR is retained.
What is the function of the sartorius?
Flexes the thigh and rotates it laterally, and abducts the hip joint With resisted hip flexion, the sartorius will be recruited which produces that external rotation and abduction of the hip to subsitute for weakness
What is hip capsular pattern?
Flexion Abduction Internal rotation
Which condition would MOST liekly be associated with an increased risk for cardiac arrest if left untreated?
HYPERKALEMIA - this is an excessive amount of potassium in the blood (>8.5) when normal levels should be 3.5-5.0. THis can lead to respiratory paralysis and cardiac arrest Hypercalcemia is too much calicum in blood and is associated with hyperparathyroidism (symptoms: constipation, pain, nausea, vomitting) Hypermagnesia is associated with renal failure Hypernatremia is excessive sodium in blood Occurs when there is a net WATER LOSS or a sodium gain. Caused by impaired dthirst or restricted access to water. Main symptom is THIRST
What kind of tone is seen with ataxia?
HYPOTONIA
What intervention BEST illustrates selective stretching when working with a patient with SCI (C6 complete)?
Hamstrings ranged to 110 degrees in supine tenodesis grip is wrist extension and finger flexion
What is Bakody sign?
Hand on top of head relieves nerve pain
What are droplet precautions?
Hand wash, gown, gloves, mask Spread by coughing, sneezing, or talking Can invade the the hosts nasal mucosa, conjunctiva, or mouth Requires close contact (3-6 feet or less) DOES NOT STAY IN AIR (this would be airborne)
What do hydrocolloids do?
Handle minmal to moderate exudate in NON-INFECTED wounds
How to perform anterior drawer test?
Hands underneath and pull in direction of YOU THE THERAPIST exercises should be closed chain avoiding further anterior tibial translation knee flexed to 90 Grab proximal tibia anterior force of tibia on the femur If there is excessive anterior translation of tibia on femur it is positive
What should you do when someone has a suspected apendicitis?
Have patient lie down and be as still as possible DO not give them food, apply heat, or continue exercising them even if its gently
How do you perform whispered pectoriloquy?
Have patient whisper "1,2,3" Normal: only hear faint sounds Abnormal: loud and clear sound
What is the rule of 9's?
Head and neck - 9% (4 1/2 in front, 4 1/2 in back) Each arm - 9% (4.5 anterior, 4.5 posterior) Each leg - 18% (9 in front, 9 in back) Anterior trunk - 18% Posterior trunk - 18% Perineum - 1% Baby has 18% big head (0 in front, 9 in back) their legs are also only 7 in front and 7 in the back Rule of 9 is only for superifical partial thickness - full thickness NOT SUPERFICIAL BURNS
What exercise should be given initially for diastis recti of 3 cm?
Head lift - abdominal bracing OR posterior pelvic tilt with bracing You want to minimize the action of the obliques, and control intraabdominal pressure Wait until separation is 2 cm or less to progress to other exercises
Principles for E-stim for wound care
If the wound is clean then you want to place the positive electrode in the wound bed (attracts macrophages and epidermal cells)- If the wound is infected, want to place the negative electrode in the wound bed to attract cells that promote healing (neutroohils)- Want to use high volt because this is the only waveform that creates polarity- Want the frequiency to be high ~100 pps to provide continuous and comfortable current
When to use saline versus an antiseptic?
If wound has no signs of infection use saline If there is signs of infection use irrigation with antiseptic or antimicrobial
What is the MOST likely cause of edema of the arm following a modified mastectomy?
Impaired lymph drainage
What would happen if you had insult to hypoglossal nerve (CN XII)?
Impaired tongue movement Tongue deviates to weak side Originates in medulla
What is impaired in someone with pulmonary fibrosis?
Impaired ventilatory pump - respiratory rate and desaturation may occur
A patient has a cerebellar dysfunction that affects both the trunk and the limbs. During examination, which of the following findings will MOST likely be observed?
Impairments in the timing of muscle activation (cerebellar dysfunction is characterized by delays in initiating and timing of movements) Ataxia Speed, amplitude of displacement, directional accuracy and force of movement Ataxic movements are thought to occur due to impairments in the timing and duration of muscle activation
For patients who have chronic obstructive pulmonary disease, a forward-bent posture produces which of the following physiological effects to help relieve dyspnea?
Improved length-tension relationship of the diaphragm
what is relationship between ER and flexion?
Improving ER helps increase flexion ROM Anterior glide improves ER ROM
What is joint approximation good for?
Improving low postural tone
What is Roos test?
In baseball throwing position and open and close hand for 3 min Positive = inability to maintain position or weakness of arms and sensory loss Indicative of thoracic outlet syndrome
How is hep b transmitted?
In blood, body fluids and body tissues Precautions --> avoid direct contact with blood or blood contaminated equipment
Knowledge of results and knowledge of performance. When to provide in stages of learning?
In cognitive stage (early on), you want to give knowledge of results cause its less in depth As you progress to associative then you can switch to knowledge of performance (quality of movement)
When does spastic bowel dysfunction occur?
In patients who have a SCI above S2 If below S2, it would be flaccid bowel
Cardiac output
Is the amount of blood ejected by each ventricle in one minute Is is calculated by HR x SV Stroke volume is volume of blood pumped by each ventricle with each heartbeat Normal cardiac output is 5L/min 4 determinents of cardiac output 1. Heart rate Positive chronotropes = increase HR (ex: sympathetic stimulation - epinephrine) and drugs like atropine Negative chronotopes (parasympathetic such as acetyecholine decrease HR) 2. Preload -preload is amount of blood entering ventricles during diastole (end diastolic blood volume) influence by venous return, fluid volume and atrial contraction / volume of blood at the end of diastole 3. Afterload (during systole) Resistance the ventricles must overcome to circulate blood Factors that increase afterload = hypertension, atherosclerosis, vasoconstriction 4. Contractility How hard the myocardium must contraction for a given preload Positive ionotropes = increase contractility (epinephrine) Negative iontropes = decrease contractility through parasympathetic (acetylcholine) / beta blockers and calcium channel blockers Preload = volume Afterload = pressure. Looks at systemic and pulmonary vascular resistance Main functon of heart is to squeeze blood out to the body. Decrease afterload = vasodilators left ventricle must overcome in order to get aortic valve open Increase afterload = vasocontrictors Decrease preload = diuretics, ACE inhibitors Wanto decrease preload when someone has CHF or has fluid overload, kidney failure
What would have if a tendon were completely torn?
Isometrics would be weak and pain free since there are no nerve endings
If someone with a fracture 2 months ago presents to you with heat, swelling, erythema, and tenderness at the fracture site. What does it indicate and what should you do?
It could possibly be a non-union fracture. You should call their physician.
Why do you ice an acute ankle sprain?
It decreases metabolic activity in the cells around the primary injury
What is something many people get wrong about sympathetic nervous system?
It doesnt actually lead to an increase in HR initially (that is parasympathetic contrary to belief) SNS increases heart rate but the initial increase in HR is due to parasympathetic system withdrawal SNS DOES however increase rate of breathing
What is passive insufficiency?
It occurs when a muscle cannot elongated any farther without damage to its fibers (this is done passively). THINK STRETCHING AND OPPOSITE MUSCLE ACTION Ex: diminished knee flexion ROM then this is due to passive insufficiency of quads (opposite muscle)
What is impaired in someone with pontine infarct?
Jaw movement Observed jaw deviation during mastication results from an insult to the trigeminal nerve (CN V) which originates in the pons Other issues with trigemal is impaired facial sensation, difficulty with jaw opening and impaired corneal reflex
LE dermatomes
L2 = Lateral thigh L3 = medial lower thigh to right under the medial tibial condyle (medial knee - 3) L4 = medial lower leg/calf, ankle, arch, big toe L5 = lateral leg, anterior shin, and DORSAL foot except big toe S1 = The "Sh1t that L5 missed" lateral ankle, plantar surface of the 4 toes, and dorsal 5th toe S2 = medial posterior thigh
What nerve roots are innervated by femoral nerve?
L2, L3, L4 (L2-4)
What nerve roots does a prone passive knee flexion stress?
L2-L3
The hip adductor muscles are innervated by what nerve root?
L4 - also the dermatome for tibialis anterior (DF) Innervated by obturator nerve
When would you have a diminished knee relfex?
L4 level
What are nerves for hip extensors?
L4-5
What are the nerves used for SLR?
L4-S1
If there is a posterolateral disc bulge at L4-L5 which nerve root is most likely affected?
L5 It should be the nerve root below L5 dermatome includes dorsal aspect of the great toe
A 48 year old male patient presents to an amputee clinic with a right above knee prosthetic limb. During gait evaluation, the PT diagnosis right lateral trunk bending and tendency to toe out. Which of the following would be the MOST likely cause of this gait abnormality?
Lateral trunk bending = medial wall is too high A high wall in a prosthetic limb is similar to a tight muscle in a person with an intact lim (too high medial wall = tight hip adductors) Another reason would be low lateral wall, small prosthetic limb
What muscle other than triceps should be strenghthened to assist with push ups transfer from wheelchair for someone with C6 SCI?
Latissimus dorsi Push ups are performed to strengthen muscles that hike the pelvis or lift from the mat In C6, only lats are innervated
What side is weak if you have a pelvic drop on the right?
Left glute med
A physical therapist is examining a patient and finds that when the patient's feet are together in standing position, the left iliac crest appears lower than the right. However, when the feet are spread apart, the iliac crests are level. This discrepancy is MOST likely caused by tightness of which of the following muscle groups?
Left hip abductors (tightness in the abductors on the side that DROPS) The tight hip abductors would be pulling the left hip downward
A 31-year-old pregnant obese female, in her third trimester, is diagnosed with damage of pudendal nerve. The patient is referred to physical therapy clinic for pelvic floor strengthening. What is the BEST initial physical therapy intervention for involved muscles? A. Supine and perform a maximum of 5 contractions held for 3 seconds each B. Left side lying and perform a maximum of 10 contractions held for 5 seconds each C. Right side lying and perform a maximum of 10 contractions held for 5 seconds each D. Sitting and perform a maximum of 10 contractions held for 10 seconds each
Left side lying and perform a maximum of 10 contractions held for 5 seconds each The best initial position for muscle strengthening can be supine or side-lying. However, as the patient is pregnant, and in the third trimester, supine position should be avoided. Sitting will help strengthen the muscles against gravity and can be used in a more advanced phase.
What position is appropriate with GERD?
Left sidelying
What is the pain referral pattern for the spleen?
Left upper quadrant to left shouler
What EKG change can digitalis lead to?
Lengthened PR interval,shortenedQT
What is adductor longus tendon lengthening surgery for?
Lengthening of gracilis and iliopsoas Reduces hip subluxation in those with CP Leads to a reduction in scissoring gait
What would lead to lateral stabismus?
Lesion of oculomotor nerve (since it innervates medial rectus) Not able to go medially means it is going to go laterally
What SCI level is autonomic dysreflexia common?
Lesions above T6 put them in upright position to lower BP and examinate urianry drainage system Flushing or vasodilation above the level of the lesion
A patient has sustained a traumatic brain injury and is slow to respond to all stimuli. The patient currently verbalizes and moves away from noxious stimuli and is able to close the eyes 3 of 5 times when asked. What level on the Rancho Los Amigos levels of cognitive functioning scale BEST describes this patient's current status?
Localized response Localized response is defined as a patient having a localized response and reacting specifically but inconsistently to stimuli. Responses are delayed and directly related to the type of stimulus present.
For patients with T-spine SCIs wanting to be able to maintain a proper long sit, what do you need to ensure?
Long sit especially in patients with SCI, its important that their hamstrings are an appropriate length. If they are too short, it will pull the patient in to a posterior pelvic tilt and add excess strain on their back- Proper hamstring length is equivalent to being able to complete a SLR to 100 to 110 degrees
A 41-year-old female lawyer presents to an outpatient clinic with history of low back pain. The physical therapist measures the arch index as 0.38. Which of the following orthotic interventions is MOST appropriate for the patient?
Longitudinal arch support This helps flat feet and supination The foot support can be supplemented by foot intrinsic muscle strengthening exercises
What are symptoms of ALS?
Loss of ability to speak, swallow, and breathe Oral motor paralysis UMN&LMN symptoms
What is involvement of glossopharyngeal CN nerve?
Loss of posterior 1/3 of tongue Loss of gag reflex
When is S3 heart sound heard?
Low frequency sound of turbulence heard during early diastole It is an abnormal heart sound due to poor ventricular compliance
What are biofeedback settings for muscle re-education?
Low sensitivity 1. Ask patient to perform maximal muscle contraction 2. Set to low sensitivity 3. Perform reps at a ratio of 2/3 of the maximal contraction
What would be seen with inflammation?
Low white blood cells Increased neutrophils when there is inflammation
With a stroke what artery is affected with aphasia?
MCA
What nail issues are seen with renal failure?
MEES lines short transverse lines across the nail
How do you differentiate myositis ossificans vs. a bone tumor on an x-ray?
MO calcify in the periphery, go toward the center a bone tumor calcifies in the center and goes out into the periphery
What is superficial partial thickness burn?
MOST PAINFUL TYPE Involves epidermis and upper portion of the dermis Has abrasions and intact blisters Healing occurs with minimal to no scarring in 5-21 days (3 weeks) Brisk capillary refill PT intervention is assisting wound with prep for primary intention
What imaging is gold standard for labral tears?
MRI
What is a resting splint?
Maintain a joint in an appropriate position during an acute exacerbation, allowing the joint to rest while limiting the risk of contracture development
A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago. The patient is currently unable to independently clear secretions, despite receiving instruction in the bronchopulmonary hygiene techniques of positioning, percussion, shaking, and vibration. Which of the following interventions is MOST appropriate to help this patient clear the secretions?
Manual costophrenic assist Any patient who has been receiving mechanical ventilation will likely have some respiratory muscle deconditioning. Providing manual assist at the lower ribs during cough will assist the patient in successfully clearing secretions NG suctioning is a viable option to clear secretions but IS USUALLY LAST RESORT when a patient does not have an artificial airway If artifical airway then you can use NG suctioning If no artificial airway use manual costophrenic assist
What is null hypothesis?
NO relationship exists between the variables (any relationship that is found is due to chance or sampling error)
A patient with diabetes mellitus has had a stage III decubitus ulcer over the right ischial tuberosity for the past 5 months. the ulcer is infected with staphlococcus aureus, and necrotic tissue covers much of the wound. what therapeutic modality is contraindicated in this situation?
Moist hot packs are contraindicated because they accelerate bacterial growth High voltage monophasic pulsed current, pulsed monophasic curent and low voltage constant microamperage direct current CAN be used
What are side effects of methylprednisone?
Mood and visual changes, rapid weight gain
What happens if you have anterior scalene or pec minor tightness?
More at risk for developing thoracic outlet syndrome
If you have pain that decreases with rest. What does this indicate?
More of a mechanical cause of pain
A patient with chronic asthma as been admitted to the hospital with an acute exacerbation. what is the MOST important information the therapist needs to determine patient's prognosis with PT?
Most recent pulmonary function test results This will give information regarding the severity of the lung disease and will assist in determining how much the patient will progress
What is function of canaith repositioning maneuvers?
Move the canalith debris out of the affected shoulder and back to the otolith
Positive sharp waves at rest on EMG are most indicative of which condition?
Muscular dystrophy Positive sharp waves = denervated muscle disorders
What part of skin does musculocutaneous, median, radial and ulnar nerve innervate?
Musculocutaneous - lateral sie of forearm and elbow flexors Median nerve - anterior surface of hand an posterior tips of lateral 3 fingers and wrist flexors Radial nerve - posterior surface of arm, forearm, and hand including elbow and wrist extensors Ulnar nerve - skin of medial two fingers and wrist flexors
What are the requirements for data to be considered ratio?
Must provide known equal distances between scores HAS AN ABSOLUTE ZERO IS FOR RATIO DATA
A 2-year-old child has spastic quadriplegic cerebral palsy, with persistence of primitive reflexes, no selective control of movement, and frequent respiratory infections. Which of the following elements is MOST critical to include in the physical therapist's examination?
Oral-motor control could be a factor in respiratory infections because poor feeding is associated with weak sucking, poor coordination of the swallowing mechanism, and a hypoactive gag reflex
What is a complication associated with long-standing ankylosing spondylitis?
Osteoporosis
What are primary and secondary risk factors for atherosclerosis?
PRIMARY - high blood pressure, increased lipids, cigarette smoking SECONDARY - obesity, stress, sedentary lifestyle
How are PSIS and ASIS positioned in posterior inominate rotation?
PSIS is lower ASIS higher on involved side Isometric contraction should focus on hip flexors to correct inominate
How to perform alar ligament test?
PT grasps C2 spinous process and performs cervical side flexion
A physical therapist assistant was treating a patient who is 3 weeks post-ACL surgery. The PTA asked the patient to do open chain knee extension exercises that were not in the original plan of care. The patient got injured during the exercise and damaged the newly reconstructed ACL. According to delegation duties, who is responsible for the injury?
PTA They are responsible for themselves unless the PT designed the wrong POC If it were a PT aide then the PT would be responsible
"ECG shows early wide QRS not preceded by P wave followed by a compensatory pause."
PVC
What are signs of SI joint derangement?
Pain directly over the region of the joint Pain in low back Pain that increases with walking
Which of the following is consistent with pain of musculoskeletal origin?
Pain that decreases with rest
What is the pain distribution pattern for angina?
Pain that radiates down the left arm into the ulnar border of the hand to the 4th and 5th digits
What is clinical sign of slipped capital?
Pain that worsens with weight bearing Groin pain Painful hip internal rotation and abduction Weak hip abductors
What is allodynia?
Pain to a stimulus that should NOT be painful
What is cardinal sign of labral tear?
Painful passive internal rotation with limitations in ROM
What dermatome does C6 root supply?
Palmar surface of thumb and distal radial forearm
A physical therapist assistant reads in the medical record that a patient has an indurated ulcer on their lower leg. Which method was MOST likely used to identify the induration?
Palpation
What kind of gait training for those with impaired coordination?
Parallel bars Use closed environment if they are agitated
A 24 year old student is admitted to the hospital on early Saturday morning following a night of partying with friends. The physical therapist is reviewing the lab reports and sees the following values:HCO3 (Bicarbonate ion) = 28.9 mEq/L, PaC02 (Arterial carbon dioxide pressure) = 48.9 mm Hg and pH = 7.49. The BEST diagnosis for this patient would be:
Partially compensated metabolic alkalosis Another way to solve these questions is to remember that whenever all three values (PaCO2, HCO3 and pH) are not within normal range, the answer is partially compensated whereas when the pH is normal it becomes compensated.
What is the best intervention to address diploplia?
Patch over the eye or prisim glasses
What kind of brace is used to help someone with Q angle of 30 degrees and abnormal patellofemoral tracking?
Patellar stabilizing brace with a lateral buttress An increased valgus deformity can result in lateral displacement force on the patella The lateral buttress brace provides support to help prevent subluxation
During evaluation of the lumbar spine, the patient is sitting and the therapists asks the patient to lean forward. While the patient is leaning forward the therapists palpates the lumbar spine and notices that the left transverse process of L4 is more prominent than the right transverse process of L4. Given this information the therapist concludes that
Patient has opening restriction on the left left transverse more prominent than right transverse process of right
What does an anterior glide of talus on distal tibia look like?
Patient prone and therapist performing glide down towards table (p-a) is an anterior glide
What is soques phenomenon?
Patient raises involved UE above 100 degrees with elbow extended which will cause extension and abduction of the involved fingers
After a recent cesarean, a patient tells the therapist that she is anxious to return to her prepregnancy level of physical activity (working out at the gym three days/wk and running 5 miles every other day). What is the BEST choice of activities for this patient at this time? 1. Pelvic floor and gentle abdominal exercises for the first 4-6 weeks. 2. A walking program progressing to running after 4 weeks. 3. Pelvic floor exercises and refrain from all other exercise and running for at least 12 weeks .4. Abdominal crunches with return to running after 5 weeks.
Pelvic floor and gentle abdominal exercises for the first 4-6 weeks. Can also do TENS, assisted breathing, racing abdominal crunches and running contrandicated
What exercises should be given to those with stress incontinence?
Pelvic floor strengthening specifically functional exercises that incorporate approrpriate actvation of pelvic floor muscles
What is swayback posture?
Pelvis is posteriorly tilted and thoracic spine is in relative flexion
In what condition do you see coffee-ground emesis?
Peptic ulcer or upper GI bleed Heparin given for this
What is hematocrit?
Percentage of red blood cells in a volume of blood
A therapist sees a patient in the ICU with multiple traumas and severe TBI. a chest tube is in place and exits from the right thorax. the patient is in need of airway clearance. what action should be taken in this case?
Percussion and shaking can be done in the areas surrounding the chest tube the area around the chest tube is often the area in most need of airway clearance.-percussion and shaking are not contraindicated just be careful not to agitate the patient
In order to ascend and descend a curb, an individual in a wheelchair must first learn how to?
Perform a wheelie
If a patient presents with a Type II SLAP post op from 1 week ago, what is the PT's best choice of intervention during early rehabilitation?
Perform careful ROM of the shoulder internal rotators avoid extension and ER
What is procedural learning?
Performed without attention Learned through repetition
In the INITIAL management of a patient with a partial peripheral nerve injury, the goal of the physical therapy intervention will MOST likely be to prevent which of the following problems?
Peripheral nerve injuries cause weakness of muscles and flaccidity (LMN) Primary goal would be joint protection and prevention of contrractures through splinting
Iontophoresis should be used with precaution for a patient who has which of the following conditions?
Peripheral neuropathy Iontophoresis should be used with precaution in patients who have conditions involving decreased sensation Can be used for edema, joint pain and inflammation from degenerative joint disease
What kind of foot abnormality is seen in Charcot-Marie-Tooth Disease?
Pes cavus (high arch)
What kind of foot deformity is seen with Charot Marie Tooth Disease?
Pes cavus which is abnormally high arch foot
Which phase of ACL rehab is the graft the weakest?
Phase 2 (weeks 4-8) The patient will feel good even if the graft is weak so be careful
Which phase of ACL rehab can you begin plyometric training in an aquatic environment?
Phase 3 In phase 4 you can do plyometrics on land
If you have weak gastrocs, which phase of gait is most affected?
Pre-swing (gastrocs work hardest here - peak gastroc activity)
What is grading for superficial reflexes?
Present or absent Different than regular reflexes where it is 2+ is normal and more
What is cogwheel rigidity?
Presents similar to ratchet type movement with more jerkiness Throughout ROM
After gait training a patient with a transtibial prosthesis, a therapists notices redness along the patellar tendon and medial tibial flare. what would this finding indicate? 1. the socket is too small and the residual limb is not seated properly 2. the socket is too large and pistoning is occurring 3. there is inproper weight distribution during stance 4. pressure tolerant weight bearing is occurring
Pressure tolerant weight bearing is occurring pressure tolerant areas of the typical transtibial residual limb include the patellar tendon, medial tibial plateau, the tibial shafts, and the distal end. redness is expected in these areas
A 6 year old boy has been diagnosed with Duchenne muscular dystrophy, the MOST appropriate physical therapy goal is:
Prevention of contractures and determine the best method of mobility We are responsible for choosing best mobility device and preventing contractures in their body preservation of strength and muscle tone is not approrpiate because its very hard to prevent as it is a progressive disease
What condition is a standing frame helpful with?
Prevention of osteoporosis and bone density loss Helps improve respiratory function
How do superficial and partial thickness wounds usually heal by?
Primary intention (smooth clean edges are reapproximated and closed with sutures, staples or adhesives
If it says right thoracic, left lumbar structural scoliosis, what side scoliosis is it?
RIGHT SIDE SCOLIOSIS
Lesion to oculomotor nerve (CN III) would lead to what?
Ptosis (impaired eyelid elevation)
Difference between ptsosis and bells palsy?
Ptosis = inability to open eye Bells palsy = difficulty closing eye (affected by facial nerve CN VII - also has anterior 2/3 of tongue)
How to perform posterior drawer test?
Push towards patient knee flexed to 90-90 Do posterior translation of tibia on femur Make sure hamstring is relaxed Look for tibia to sag posteriorly W
What muscle generates energy to go up the stairs?
Quadriceps
What is the prone instability test?
REDUCTION IN PALPABLE TENDERNESS. NOT a reduction in pain is a positive sign Positive = pain upon prone segmental palpation of the lumbar spine demonstrates a reduction of tenderness when asked to stabilize the upper body and lift the legs off the ground A positive test implies that the tenderness initially encountered in prone position can be reduced upon activation of the segmental stabilizers of the spine, which contract when the lower extremities are raised off the ground in the second part of the examination PT's can use this information to determine whether pain can be addressed mainly through lumbar spine stabilization Those who have negative results have been found to respond poorly to lumbar stabilization techniques
A physical therapist notices that a patient is experiencing early toe-off during terminal stance in gait. Which of the following identifies a likely cause, AND an appropriate intervention to address that cause?
Rationale: Hip flexion contracture will lead to lack of hip extension in terminal stance and will result in early toe off. An appropriate intervention to address this is to provide prolonged stretching to the hip flexor musculature to improve ROM. Soleus is a plantarflexor and its tightness will not cause an early toe off. Early toe off caused by hip flexor contracture (what to do prolonged stretching to increase hip extension in terminal stance
If a patient complaints of heaviness of prosthesis what should you do?
Re-evaluate hip strength A complaint of heaviness likely reflects weakness
What is Milwaukee brace?
Realignment of the spine due to scoliosis
A patient presents with a stage III pressure ulcer with moist, necrotic wound. a HYDROCOLLOID dressing is being used. during the dressing change, the therapist detects a strong odor, and the wound drainage has a yellow color. what is the therapists BEST course of action?
Reapply a new hydrocolloid dressing and record findings in chart *with hydrocolloid dressing, it is normal to have an odor and yellowish color as the dressing material melts. It is not always indicative of infection* Hydrocolloid dressings are typically changed every 3-5 days
What compensation is used for forefoot varus?
Rearfoot valgus * (calcaneus assuming a position of eversion with the subtalar joint in a neutral position)
What is a retrospective cohort study?
Received exposure (intervention) and experience an outcome They are followed over time
A patient with type 1 diabetes is beginning an aerobic cycling exercise program. Insulin should be injected into which area?
Rectus abdominis muscle
What is the FLAG system?
Red Flag = signs related to serious pathology (cauda equina, unremitting night pain, unexplained weight loss) Blue Flag = false perceptions of the work-health relationship (unsupportive work supervisor) Yellow Flag = beliefs, coping mechanisms, pain behavior and emotional response to pain or injury Orange Flag = psychiatric (personality disorder, signs of depression) Black Flag = system or contextual obstacles (little ability to modify workplace to reduce strain on body)
What is urge incontinence related to?
Reduced bladder capacity or detrusor instability Is the sudden unexpected urge to urinate and the uncontrolled loss of urine
Which of the following is considered a benefit of administering a medication using iontophoresis instead of through oral administration?
Reduced gastrointestinal impact
What effect does exercise has on diabetes?
Reduction of blood glucose level
What is the sural nerve?
S1 nerve root -sensory nerve in the calf region -the medial cutaneous branch arises from the tibial nerve -the lateral cutaneous branch arises from the common fibular nerve -these 2 join together to form the sural nerve
At what level are foot intrinsics innervated?
S1-S2
When are S3 and S4 heart sounds heard?
S3 = CHF (indicates insufficient left ventricle - occurs when blood continuously fills a relaxed left ventricle during early diastole) S4 = hypertension , pulmonary hypertension, pulmonary stenosis
What is action of teres major?
SAME AS LATS extends, adducts and medially rotates
What is associated with hypotensive response with regards to SBP?
SBP that fails to rise or fall (>10 mmHg) with an increasing workload
What is pulse pressure?
SBP-DBP Pulse pressure increases in direct proportion to the intensity of exercise SBP increases with exercise and DBP tends to stay the same or change slightly In a healthy adult it is common to see a 40-50
What is dizziness handicap inventory?
SELF REPORT questionare that quantifies the impact of dizziness on daily life
What muscles are shortened in anterior pelvic tilt?
SHORTENED/NEED TO BE STRETCHED 1. lliopsoas (hip flexors) 2. Erector spinae LENGTHENED/NEED TO BE STRENGTHED 1. Rectus abdominis 2. Gluteus maximus
During pregnancy, the presence of the hormone relaxin can lead to abnormal movement and pain. Which joints are typically affected?
SI joints* commonly affected during pregnancy resulting in pain
A patient reports burning medial knee pain that occurs during knee flexion greater than 60°. Resisted knee extension is strong and pain free. The patient denies any popping or instability and there is no history of trauma. There is tenderness to palpation over the anteromedial distal thigh. Which of the following conditions is MOST likely causing the patient's knee pain?
Saphenous nerve impingement Burning pain = neurological in origin Saphenous nerve has a distribution over the distal anteromedial knee and can be compressed as it exits the adductor canal Flexion of knee past 60 degrees can reproduce symptoms associated with this impingement
The left phrenic nerve was accidentally severed during a thoracic surgery. which muscles should the physical therapist strengthen to provide substitute function?
Scalenes (with paralysis of the diaphragm, the scales which are the accessory muscles should be strengthened in order to help)
What carpal bone is typically fractured with a fall on an outstretched hand?
Scaphoid
What is scapulohumeral rhythm?
Scapula and humerus move in 1:2 ratio or 2:1 GH to ST ratio When the arm is abducted 180 degrees, 60 degrees occurs from rotation of the scapula and 120 degrees by rotation of the humerus at the GH joint Upward rotation - upper and lower trap, serratus anterior
What role does scapula play with impingement?
Scapular abnormalities can be a cause of impingement
Which of the following diagnoses is BEST defined as a chronic condition of thickening and loss of elasticity of skin with fibrosis of multiple organ systems?
Scleroderma
What splint should be used for legg calve perthes?
Scottish rite orthosis - this is an abduction splint They are limited in internal rotation and abduction
What adjustment should be made for someone with hemiplegia?
Seat lowered approximately 2 inches to allow better use of the LE''s to propel the chair
When to use non selective vs selective debridment?
Selective debridement (enzymatic, sharp, autolytic) - used when you want to avoid disrupting nearby skin. Only removes NON-VIABLE tissue (necrotic or devitalized) Non-selective (wet to dry, wound irrigation, whirpool) - removal of BOTH viable and non-viable tissue from a wound
What is restless leg syndrome?
Sensation of unpleasant paresthesias that compels the patient to have voluntary, spontaneous, continuous leg movements that temporarily relieve the sensations Discomfort worsens at rest, in the evening, and/or during sleep Sensation of "spiders or ants" on/in feet/calf muscles Causes sleep disturbances, paresthesia, and uncomfortable sensations If it were vascular or neurological claudication pain would increase with activity and NOT at night
What is trigeminal nerve responsible for?
Sensation to ipsilateral face Motor function of ipsilateral muscles of mastication
How to best stretch the biceps?
Shoulder extension and forearm pronation
What is L'hermitte's sign?
Sign of posterior column damage Flexion of neck produces an electrical shock like painful sensation running down the spine and into the LE's
Diastasis Recti intervention
Significant when >2cmTest for DR prior to prescribing abdo exercises (place hand horizontally over umbilicus with pt in hooklying. >2 finger widths separation when pt lifts head & shoulders off bed plinth)More than 2 - avoid aggressive ab work. Head lift with braceMore than 4 - avoid any exercise. Splinting
A physical therapist is examining a patient who reports decreased walking endurance. The therapist notes that the muscles of the L4 myotome weaken after the patient holds the muscle contraction for 4 seconds. These findings are MOST likely due to:
Single nerve root lesion (these types of lesions may not be apparent on testing immediately but may emergence after a few seconds)
What kind of transfer should someone with T10 SCI be able to do?
Sit pivot transfer this level SCI have partial to full innervation of trunk musculature and fully innervated upper extremities
When cervical traction is applied in the sitting position, the force required for an effective stretch is:
Sitting requires a greater force than when in a supine position
During an outpatient evaluation the PT checks the active and passive ankle range of motion. The patient lacks 8 degree of passive ankle dorsiflexion. The same limitation in range of motion is present whether the knee is extended or flexed. The muscle MOST likely contributing to the restriction in passive range of motion is?
Soleus Both soleus and gastroc are stretched with passive ankle DF however the soleus does not cross at the knee so the position of the knee does not have any affect on the passive range of motion
What is Jobe's test?
Special test for rotator cuff tears (supraspinatus tears) Neers and hawkins are for impingement Clunk test is for labral tears
If you have a lesion in peripheral nerve what would it look like?
Specific myotomes and dermatomes would not be a hemiparesis
Where does SPASTIC or reflex bowel occur?
Spinal cord lesion ABOVE S2. UMN lesionThe parasympathetic connections at S2-4 are intact so "reflex defecation" can occur when the rectum fills with stool
Where does a FLACCID or areflexive bowel occur?
Spinal cord lesion at S2-S4 or cauda equina. LMN/peripheral nervesThe parasympathetic connection at S2-4 are no longer intact so when the bowel is full it does not reflexively empty. This cause impacted feces as well as incontinenece
If bilateral symptoms present what spinal condition should you think?
Spinal stenosis
What end feel does a meniscal tear result in?
Springy block
If you have difficulty turning a door knob what muscles are weak?
Supinator and biceps
What is gravity eliminated position for deltoid/supraspinatus?
Supine - slide arm on the table
What is MMT for pec major - sternal border?
Supine with 120 degrees of shoulder abduction apply downward force diagonally down and in towards the patient's opposite hip
What is the saphenous nerve?
Supplies skin on medial aspect of leg and foot Entrapment of this nerve can cause pain at the medial side of the knee
Where does pain generated from the bladder typically manifest?
Suprapubic area and lower back
If spastic or reflexive (UMN) bladder, what type of bladder training should be performed?
Suprapubic stroking or tapping A spastic UMN bladder contracts and reflexively empties in response to a certain level of filling pressure
What nerve innervates the infraspinatus?
Suprascapular (C5-6)
What leads to right sided heart (ventricular) failure?
Sustained elevation in pulmonary arterial hypertension
Incentive spirometry is used to assist a patient in achieving:
Sustained maximal inspiration (this is a modification of deep breathing exercises in which the patient inspires through an open glottis) Incentive spirometry encourages slow, deep breathing to improve lung volumes and reduce atelectasis Provides visual feedback regarding their performance during deep breathing exercises
What is the BEST way to monitor intensity of exercise for a patient limited mostly by claudication?
Sustaining pain levels of at least 2/4 on the claudication scale during exercise The rule states that in order to generate collateral circulation in patients with ischemia (claudication) patients need to exercise with at least moderate claudication pain. This level of blood and oxygen deprivation initiates the generation of collateral circulation.
What lobe is wernicke's in?
Temporal Memory loss and facial recognition also part of temporal
A physical therapist assistant works with a patient diagnosed with carpal tunnel syndrome. As part of the physical therapy session, the physical therapist assistant classifies the end-feel associated with wrist extension as firm. What is the MOST logical explanation?
Tension in the palmar radiocarpal ligament and the palmar joint capsule (think what is limiting it)
If you have tight hip flexors what phase of gait will most likely show limitation in hip ROM?
Terminal stance (if hip flexors are tight then hip extension will be limited. Terminal stance requires full hip extension so therefore this phase would be the most affected)
What is terminal stance equivalent to in standard terminology?
Terminal stance = heel off
What is two step exercise test?
Test for coronary insufficiency 1. Ascend and descend 2, 9" high steps 2. ECG records cardiac activity during the exercise
A patient recovering from a stroke reports lack of feeling in the more affected hand. light touch testing reveals lack of ability to tell when stimulus is being apply (only 1 correct response out of 10 tests). what additional sensory tests should the therapist perform?
Test for pain and temperature Light touch, barognosis, 2 point discrimination and sterognosis are all part of dorsal column pathway so cannot be the answer Dorsal column = proprioception, vibration and monofilament, ligh touch
What are symptoms of tethered cord syndrome?
Tethered cord occurs when adhesions anchor the SC at the site of the lesion as individuals with spina bifida grow 1. Progressive scoliosis 2. Hypertonicity 3. Gait changes 4. Bladder dysfunction
CTSIB?
The CTSIB is positive for vestibular deficiency with loss of balance on conditions 5 and 6. Patients who are surface dependent (somatosensory) have difficulties with conditions 4, 5 and 6. Patients who are visually dependent have difficulties with conditions 2, 3 and 6. Sensory selection problems are evident with loss of balance on conditions 3-6.
What is the brachialis?
The brachialis causes flexion and functions regardless of the degree of pronation/supination. POWERFUL FLEXOR WHEN FOREARM IS PRONATED** opposite of biceps where it is strongest when it is supinated brachioradialis would be with forearm in neutral position
How does a compression garment work with lymphedema to reduce edema?
The compression garment exceeds the internal hydrostatic pressure
Which of the following muscular responses would be expected during normal micturition?
The contraction of the detrusor acts to empty the bladder, while the relaxation of pelvic floor allows the urine to pass 1. Detrustor contraction 2. Pelvic floor relaxation
What are AHA guildelines for CPR and help when alone or when in a group setting?
The correct answer is B: Establish unresponsiveness by shaking the person's shoulder while asking in a loud voice,"Are you all right? AHA guidelines - Immediate recognition of unresponsiveness, activation of the emergency response system, and initiation of CPR if the lay rescuer finds an unresponsive victim is not breathing or not breathing normally for adults when alone. When In a group, first check responsiveness then start CPR while other person in the group call 911. A 68-year-old man is playing golf with five other people and suddenly collapses while getting ready for his next swing. You are in the group and are the first person to reach him. He is not breathing, and you are unable to palpate a pulse. What is the next BEST action to take?A. Activate the emergency response system by calling 911 or a similar emergency service and obtain an automated external defibrillatorB. Establish unresponsiveness by shaking the person's shoulder while asking in a loud voice,"Are you all right?"C. Begin and continue chest compressions at a rate of 100 per minute and a depth of at least 2 inchesD. Begin with 30 chest compressions and then open the airway by using the head-tilt, chin-lift maneuver
A patient who sits with a severely slumped forward posture may experience respiratory compromise due to which of the following factors?
The diaphragm descends (moves caudally) during inspiration. The severely slumped forward sitting position would lower the diaphragm and cause it to be compressed by the abdominal contents, thereby resulting in respiratory compromise
While using electromyographic biofeedback, an increase in the amount of auditory feedback since the beginning of the treatment session would be considered a positive change if:
The goal of using biofeedback is to increase muscle recruitment
A physical therapist observes a patient from behind during bilateral shoulder abduction and notes that the patient's right scapula is more abducted than the left scapula at the end range of movement. Which of the following conditions is the MOST likely cause of the altered scapula position on the right?1. Tightness of the rhomboid major and minor2. Weakness of the serratus anterior3. Restricted motion of the glenohumeral joint4. Weakness of the upper trapezius
The most likely reason for the increase in scapular motion is restriction of the glenohumeral joint. To fully abduct the shoulder, the scapula and glenohumeral joint both have to contribute to produce the motion. If the glenohumeral joint is restricted, the scapula has to increase its motion to accomplish the task.
A patient who is participating in a weight-loss program has been walking 3 days/week for 15 minutes for the past 3 weeks. When progressing the exercise program, which of the following modifications will MOST likely accomplish the weight-loss goal?
The optimal exercise duration for achieving weight loss with a walking program is 30 to 60 minutes of continuous aerobic activity. Therefore once a patient is safely tolerating 15 minutes, the best progression is to increase the duration while maintaining the same intensity or walking speed.
While examining a patient with left-sided low back pain, a physical therapist notes that the left sacral sulcus is deeper and the left anterior superior iliac spine is more superior than the right. Which of the following is the MOST likely explanation for this finding?
The patient's left innominate has rotated posteriorly (with a left innominate posterior rotation, the left sulcus becomes deeper and the left anterior superior iliac spine is more superior) Posterior = left sulcus deeper, superior L ASIS Anterior = left shallow, lower and posterior position of ASIS
What is active insufficiency?
The point at which a muscle cannot shorten any farther due to contracting THINK MUSCLE ACTION AND STRENGTH If diminished knee flexion strength then this is due to active insufficiency of the hamstrings
The resting heart rate of a 32-year-old runner is measured at 46 bpm. Which of the following explanations for this heart rate is MOST likely?
The rate (bradycardia) is secondary to an increased stroke volume Cardiac output is the product of stroke volume x heart rate A training effect is an increase in stroke volume which leads to a resultant decrease in heart rate to maintain the same cardiac output at rest
A patient has severe chronic obstructive pulmonary disease and bilateral knee osteoarthritis. During aquatic therapy involving slow walking, which of the following water levels is MOST appropriate for this patient?
To the navel Patients who have knee arthritis often have difficulty and pain when walking on land. Due to buoyancy, ground reaction forces and knee joint forces are less during walking in the water, compared to these same forces while walking on land. The greater the amount of water displaced by the body, the less the ground reaction forces experienced, and the less force transmitted up the body through the ankles, knees, hips, and trunk. Therefore, as water depth increases and more of the body is immersed in water, knee compressive force decreases. This allows a patient who has knee arthritis to be able to walk in water with minimal difficulty and pain, even though the patient may be unable to walk without pain and difficulty on land. *DONT go to the shoulder cause this can impair breathing*
If iliopsoas is affected what part of gait would be the most affected?
Toe off (pre-swing) and acceleration (initial swing) Here the hip flexors are firing
What kind of muscle fiber recruitment is best for maintaining posture?
Tonic, slow twitch fibers (type 1 fibers)
What heel cushion results in excessive knee flexion?
Too hard of a cushion (does not allow for adequate PF during loading response) "HF" - "heart failure" Also an anteriorly displaced socket
What heel cushion results in excessive knee extension?
Too soft of a cushion "SE" - "Scary Elephant" (causes foot to plantarflex too quickly)
What are parameters / contraindication for cervical traction?
Traction force applied to cervical spine should NOT exceed 30 pounds Muscle spasms/Stretch soft tissue: 7-10% (11-15 pounds) Joint Distraction: 13-20% (20-30 pounds)
What is a prominent, pathological Q wave indicative of? (if ECG shows presence of significant Q waves)
Transmural myocardial infarction
What dressing for stage I pressure ulcer?
Transparant film and foam
What are the most effective modes of exercise to reduce claudication and when are the symptoms elicited?
Treadmill and track walking Initial workloads are set to elicit claudication symptoms within 3-5 min Use excercise-rest-exercise method
How do PVC's look at EKG?
Wide QRS with absent P wave
What is there to know about ankylosing spondylitis?
Want to do extension exercises More in males with onset of 20-40 Systemic rheumatid arthritis that is associated with 1. Increase in thoracic kyphosis 2. Loss of lumbar curve* 3. Recurrent and insidious back pain 4. Morning stiffness 5. Impaired spinal extension Chronic inflammation results in destruction of ligamentous osseus junction with subsequent fibrosis and ossification Patient may exhibit flexion at the hips, spinal kyphosis, fatigue, peripheral joint involvement If costovertebral joints are affected there will be impaired chest mobility, compromised breathing and decreased vital capacity. this would be restrictive lung condition
Which of the following recommendations regarding foot care is BEST for a physical therapist assistant to give to a patient who has type 2 diabetes?
Wear well fitting socks and shoes
Which of the following treatment interventions can be used for either facilitation or inhibition of muscle tone?
Weight bearing
What type of exercises are best for osteoporosis?
Weight bearing - these provide the best stimulus to bone Aquatic and high load (jumping, running and weights) not the best
What type of aphasia is fluent aphasia?
Wernickes aphasia Impaired auditory comprehension and fluent speech that is of normal rate and melody
What can a PT change without a physicians orders?
Wheelchair tray
Which abnormal breath sound is continous?
Wheezing COPD, asthma, emphysema (THINK OBSTRUCTIVE HAS WHEEZING)
What is baroreceptor reflex?
When BP increases, there is vascular dilation (reduces BP) and a decrease in cardiac output OR When BP falls, HR increases and arterioles constrict
In an older adult patient, impaired proprioception may be a result of malabsorption of which of the following nutrients?
When stomach secretions do not have enough intrinsic factor, vitamin B12 is not absorbed well. This results in pernicious anemia and other problems related to low levels of vitamin B12. Inadequate vitamin B12 gradually affects sensory and motor nerves, causing impaired proprioception to develop over time.
When should nystagmus occur with Dix-Hallpike?
When the affected ear is towards the floor and should fatigue within 60 seconds
Why is cooldown important?
Without it blood will pool Helps with muscle pumping to return blood back to the heart Prevents blood pooling With aerobic exercise there is vascular dilation
A patient recently suffered a level IV Traumatic Brain Injury (TBI), and is currently admitted in the hospital. The PT wants participation from the patient during treatment. Which of the following is the MOST appropriate question that the PT should ask the patient to engage them in the treatment session?
Would you like to work on ball or go for a walk? During the treatment of RLA level IV patient, some control can be given to the patient when it is safe and appropriate. The physical therapist can give options and let them choose rather than asking what they want. Give them control of activities within the limit of therapeutic intervention, so that the patient feels that he has some control over the situation.
What is duchenne muscular dystorphy?
X linked recessive trait **** ONLY MALES * Proximal muscle weakness (like myasthenia gravis) Toe walking, waddling gait, anterior lordosis, pelvic instability, pseudohypertrophy of calf muscle, gower's maneuever Scoliosis is very common Have high creatine kinase levels
Can biofeedback be used for urinary and bowel incontinence?
YES
Do those with Parkinson's have a loss of postural reflexes?
YES can do platform balance training - improves limits of staility and center of pressure alignment (not so much anterior displacement)
Can a patient participate in aquatic therapy with an open wound?
YES (as long as it is covered with an occlusive dressing)
Can you procede with exercise if someone has sinus bradycardia?
YES. There are no restrictions with sinus rhythm -
A physical therapist assistant works with a patient that sustained a torn anterior cruciate ligament (ACL) and a medial meniscus tear. Which scenario would result in the GREATEST likelihood of a successful meniscus repair?
a tear involving the outer third of the meniscus with reconstruction of the ACL good blood supply in outer 1/3 of meniscus
An elderly adult patient presents with a history of and subjective complaints consistent with lumbar central spinal stenosis. The most appropriate clinical test used to differentiate spinal stenosis from intermittent vascular claudication would be: a. Bicycle (van Gelderen's) test b. Lumbar quadrant test c. Femoral nerve traction test d. Valsalva's maneuver
a. Bicycle (van Gelderen's) test The bicycle (van Gelderen's) test is designed to differentiate between spinal stenosis and intermittent vascular claudication. Van Gelderen's bicycle test is designed to stress the LE vascular system without causing any central canal or foraminal stenosis that could be misinterpreted as intermittent neurogenic claudication.
Counternutation goes with...
anterior pelvic tilt
positive test of Adson demonstrate what structure is involved in TOS
anterior scalene (extension, contralateral side bending, ipslatera rotation)
A patient presents with limitation with wrist flexion. the joint manipulation technique that would BEST improve the patient's ROM is which of the following grade IV descriptions?
anterior to posterior glide of the proximal carpal row on the distal radius and ulna (during wrist flexion, the proximal row moves dorsally on the radius and ulna)
What is dermatome for L3 (knee extensors)?
anteromedial thigh medial fem condyle
What condition is NOT approrpirate to use parafin?
anytime you have edema, swelling, complex regional pain syndrome DO NOT use it cause it can make it worse DO use on aching fingers if you have OA
What is arterial line used to measure?
arterial blood pressure Radial and brachial arteries are the most common sites
Figure 8's and cutting/ plyometric drills are appropriate to incorporate into rehab when: a. the patient has achieved walking without crutches b. the patient can descend 8 steps without pain c. the patient squats with less dynamic valgus d. after the patient has return to sports at PLOF
b. the patient can descend 8 steps without pain figure 8s would happen around week 17 (end of 3rd beginning of 4th rehab phase) incorporating sports specific drills prior to going back to sport full time.... need to accomplish this in clinic first
What part of brain is damaged with athetoid CP?
basal ganglia vs. UMN if spastic CP
A physical therapist assistant performing lower extremity range of motion on a patient identifies increased resistance to elongation on both sides of the hip, knee, and ankle joints. The assistant determines that the resistance DOES NOT seem to be influenced by speed. Damage to which structure would be MOST consistent with the described
basal ganglia not affected by speed *
How do you perform Allen's test and what region is being tested?
baseball thrower position, rotate head AWAY, positive would be diminished or absent pulse Tests axillary region
What information do you need to know for METS?
body weight
A physical therapist assistant works with a four-month-old infant. During mat activities the infant suddenly becomes unconscious. The MOST appropriate artery to assess the infant's pulse is the:
brachial artery different from adults where you would typically use radial or carotid artery
What is function of osteoblasts?
build bone THINK OSTEOBLAST BUILD BONE
An elderly pt w/ back pain is referred to PT. The pt has pancreatic cancer and moderate senile dementia and is unaware of the dx or prognosis, at the family's request. The pt asks the PT's BEST response is: a. "I will tell the doctor to answer all of your questions" b. "Ask the nurse practitioner for this information" c. "I'll treat the sxs and see how well you do" d. "To discuss the dx and prognosis w/ the pt"
c. "I'll treat the sxs and see how well you do"
A pt presents to PT with a primary complaint of low back pain and right lower extremity radicular symptoms extending distally to the calf of 2 weeks duration. Current pain intensity is rated as 2/10 with rest and 5/10 during lumbar extension movements. What us the strongest prognostic indicator that would affect the clinical outcome? a. 2/10 pain intensity with rest b. 5/10 pain intensity during lumbar extension c. Lower extremity radicular symptoms d. Current symptoms duration (2weeks)
c. Lower extremity radicular symptoms The presence of lower extremity radicular symptoms in patients experiencing low back pain is strong negative prognostic indicator for achieving good clinical outcomes.
An adult pt is dx w/ TOS. The pt presents w/ guarding in the upper trap and scalene mm. Given this situation, which technique would be the MOST EFFECTIVE way to decrease the m guarding and provide pain relief? a. Maitland grade I mobilization of the atlanto-axial joint b. Maitland grade I mobilization of the C6-7 joint c. Maitland grade V manipulation of the 1st rib d. Maitland grade V manipulation of the C6-C7 joint
c. Maitland grade V manipulation of the 1st rib
Which of the following wound dressings is MOST appropriate for a wound with moderate to copious amounts of exudate?
calcium alginate
Parasympathetic influence on the heart
caused by acetylcholine released by cholinergic sympathetic neurons 1. bradycarida 2. decrease myocardial contraction force 3. constrict coronary blood vessels 4. dilate pulmonary blood vessels 5. constrict muscle blood vessels.
If you have pendular/vertical nystagmus what does it mean?
central vestibular pathology
What is T-test?
compares means of 2 different groups Variance is NOT known
what is intact in ALS
congition, eye muscles, sensation, sphincter (bowel, bladder control)
What is overflow incontinence?
constant leaking of urine from a bladder that is full but unable to empty
What is lead pipe rigidity?
constant resistance throughout the ROM
A patient with a complete spinal cord lesion at T9 has difficulty with:
coughing
What are correct parameters for SCI wheelchair pressure relief?
current recommendations to prevent pressure ulcers with patients with SCI who are wheelchair users include 10-15 seconds of pressure relier (push ups) every 15-20 minutes of sitting
A female patient complains of intermittent pain in the right SI region. There was insidious onset approx. 4 months ago. Pain has gradually worsened and is now fairly constant and does not vary much with activity or movement. Active motion assessment of the lumbar spine reveals no change in symptoms with movement. SI provocation tests are negative. The patient is mildly tender over the right SI region. The MOST likely diagnosis for the patient would be: a. SI joint sprain b. Multifidus muscle strain c. Right L5/S1 facet joint arthrosis d. Ovarian cyst
d. Ovarian cyst An ovarian cyst can refer pain to the SI region and is more likely to cause constant pain that does not vary much with activity. Symptoms are not likely to be reproduced with musculoskeletal examination.
A patient diagnosed with multiple sclerosis uses extensor tone to assist them to successfully complete a sit to stand transfer. Which pharmacological agent would MOST limit the patient's ability to complete the transfer?
dantrolene sodium - this reduces tone
What is one of the most common early signs of right ventricular failure?
dependent edema (if the right ventricle fails, the increased fluid will back up. traveling backward from the right ventricle the edema goes into the right atrium and then the periphery causing dependent edema)
What is PAR-Q?
designed to determine if medically suited to begin an exercise program
What does an EMG do?
detects and records action potentials from skeletal muscle fibers
how will weak quadriceps effect ambulation on stairs or ramps?
difficulty going down stairs or ramps
How will weak glute max effect ambulation on stairs and ramps?
difficulty going up stairs or ramps (think that they will ahve a backwards lean and will be more likely to fall backwards)
A patient's plan of care includes use of iontophoresis for management of calcific bursitis of the shoulder. to administer treatment using the acetate ion, what characteristics and polarity should be used?
direct current using the negative pole Acetic acid is negative so it needs to be paired with a negative pole
A patient discusses a number of recommended dietary changes following a physician visit. Which medical condition would MOST warrant an increase in the amount of dietary fiber?
diverticulitis = increase fiber intake
During examination of the a patient with degenerative osteoarthritic changes in the CMC joint of right thumb, the PT notes a 20 degree loss of thumb palmar abduction. what translatory joint play motion (based on traditional concave/convex rules of motion) is associated with thumb palmar abduction and should be examined?
dorsal translation of the metacarpal on the trapezium For abduction of thumb it is a volar roll, dorsal glide
What are side effects of baclofen?
drowsiness and muscle weakness
What should foam NOT be used on?
dry wound This is because it has high absorptive properties. Should be used rather on something with a lot of exudate Charcol is for a fetid odor
What is antalgic gait?
due to pain on the stance limb, the stance phase will be shorter. The opposite leg swing phase (step length) will be shorter.
Full passive knee extension is primary initial goal of phase 1.... which of the following exercises would not help to accomplish that goal?
e. active knee extension 30-0 degrees you actually want to AVOID active extension between 30-0 degrees
PT concludes that there is insufficient deceleration of the shoulder during throwing. Which strengthening technique would be most effective in improving control of deceleration of shoulder?
eccentric of LATERAL(External rotators) Think its muscle opposite of the direction you are going
What is a premature atrial contraction (PAC)?
ectopic focus in the atrium initiates an impulse before the SA node (think before p wave since that is the SA node) Is benign Heart rate is normal here. Not affected.
A patient suffers a chemical burn on the cubital area of the elbow. Which position would be the MOST appropriate for splinting of the involved upper extremity?
elbow extension and forearm supination
Which is a typical early clinical manifestation of cystic fibrosis (CF)?
excessive appetite and weight loss
describe abnormal synergistic activity during stance phase of gait seen in CVA?
excessive hip adduction + hip and knee extension + plantarflexion (scissoring or adductor gait)
A patient with a grade III diabetic ulcer is being treated with a calcium alginate wound dressing. What are the primary indications for this type of wound dressing?
facilitate autolytic debridement and absorb exudate
What are symptoms of cellulitis?
fever, elevated temperature, erythema, inflammation, tenderness, no lesions and UNILATERAL
What is a clear sign of brainstem dysfunction?
ipsilateral facial problem Contralateral body problem
During an outpatient evaluation the therapist checks the active and passive hip range of motion. The patient lacks 20 degrees of passive hip flexion. The same limitation in range of motion is present whether the knee is extended or flexed. The muscle MOST likely contributing to the restriction in hip passive range of motion is:
glute max If someone lacks passive hip flexion ROM then there must be a limitation in hip extensor muscle The hamstrings are 2 joint muscle which cross the knee so if knee were extended or flexed it would be affected Glute max is the only answer that is 1 joint
What is crepitus?
grating sound made by movement of bone ends rubbing together indicating a fracture or joint destruction
What is Charcot Marie Tooth disease?
hereditary disorder with motor and sesnory neuropathy Has progressive muscle wasting and diminished DTR"s Initially affects the ankle dorsiflexors and evertors*** causing drop foot and a compensatory steppage gait As it progresses, it involves the intrinsic muscles of the hand leading to difficulty with fine motor taks s
What activity would help break up obligatory LE synergy patterns in a patient with hemiplegia?
high kneeling position, ball throwing
A patient is immersed up to the neck in a therapeutic pool, while exercising this patient, the therapist should take into consideration the physiological effects of immersion. what significant result may occur?
increased work of breathing (this is a result of increased hydrostatic pressure)
What happens to pulse with increased stroke volume?
increases to 3+ or 4+
According to the clinical commentary regarding Whiplash associated disorders, which of the following statements is correct.
individuals with chronic whiplash typically present with measurable differences in motor, sensory, and psychological dysfunction
Which of the following interventions would be CONTRAINDICATED for a patient who has heart failure?
manual lymphatic drainage
What is concurrent validity?
interpretation is justified by comparing the measurement to GOLD STANDARD at approximately the same time Ex: HR measurement made by palpation of peripheral pulses will have concurrent validity if HR measurements by palpation are assosicated with HR measured simultaneously from an ECG
A patient is being treated with anticoagulant therapy following surgery. Which of the following conditions is a potential complication with excessive blood levels of this medication?
intracranial hemorrhage anti-coagulants contraindicated in those with hemorrhage
What should you closely monitor in someone with a TBI?
intracranial pressure because they are at a very high risk for developing a hemmorrhage Normal ICP: 5-15 mmHg Abnormal: >20 mmHg is dangerous
What part of LE should be tender if you have ITB syndrome?
lateral femoral condyle
To avoid impingement of the greater tubercle on the acromion process in attaining full abduction of the shoulder during passive range of motion, the physical therapist assistant should:
laterally (externally) rotate the humerus
When is pericardial friction rub heard?
leathery sound during systole
What is the digitalis effect?
lengthened PR interval and shortening of QT interval *** Scooped or sagging ST depressions J point depression Flattened T waves (does not rise above the baseline)
Which finding could be most related to the use of silver sulfadiazine?
leukopenia Use of silver sulfadiazine can produce a decrease in WBC's below 5,000
What are indwelling right atrial catheters used for?
long term administration of substances such as chemo and anti-biotics
What is a cohort study?
longitudinal, observational study in which individuals with a risk factor or exposure are followed over time to compare the occurrence of a disease in the exposed group to that of an unexposed individual group Relative risk
What is thrombocytopenia related to?
low PLATELET count
What is a dynamic splint?
low load, continuous load Facilitates passive or assisted movement of a joint or to resist movement in the direction opposite the line of pull NOT given during acute exacerbations Uses spring or elastic component
What do hydrogels do?
maintain moisture in wound bed, soften necrotic tissue and support autolytic debridement
A patient who has a complete lesion of the median nerve at the elbow will NOT be able to:
make a fist
What does a peripheral nerve injury present with?
motor and sensory loss
Hydrocephalus is associated with which of the following diagnoses?
myelomeningocele
Should you take care of exudate or necrosis first?
necrosis
What does weakness without pain mean?
nerve injury
A physical therapist assistant treats a patient with superficial partial-thickness burns on the anterior surface of his lower legs. In an attempt to assist the patient to control the pain associated with the burns, the physical therapist assistant rewards the patient with a lengthy rest period after successfully completing an exercise sequence. This type of psychological approach is MOST representative of:
operant conditioning (employs punishment and rewards for behavior)
A negative scour test probably rules out what condition at the hip?
osteoarthritis DJD Acetabular labral tear Procedure 1. Flex and adduct hip with knee in full flexion 2. Apply downward force along shaft of femur while passively adducting and ER the hip Positive = any pain or clicking
What breathing technique would NOT be appropriate for atelectasis?
paced breathing Paced breathing helps with rate of breathing NOT depth. For atelectasis you need interventions that help with depth of breathing such as pain reduction techniques, segmental breathing and incentive spirometry
A patient presents with c/o neck pain on the right. During AROM examination the PT observes Flexion, Side-Bending, and rotation normal on the with extension being painful and limited. Limited and painful right side-bending, and rotation. Based on this pattern what is the arthrokinematic restriction?
pain on right indicates restriction is on the right Want to do a downglide of a facet on the right side
Which of the following modalities is MOST appropriate for decreasing pain and increasing tissue extensibility prior to active hand exercises in a patient who has rheumatoid arthritis?
paraffin wax bath Paraffin wax baths are used to decrease pain and increase tissue extensibility in patients who have rheumatoid arthritis. The increase in collagen extensibility associated with heating may decrease pain perception and increase tolerance for participation in active exercise. Paraffin allows for even distribution of heat to fingers (all joints)
What heating agent requires the GREATEST temperature?
parafin
A human bite injury result in laceration of the extensor tendons over the MCP joints. following surgical repair, the patient was placed in a dorsal dynamic extension splint (as pictured on page 640). therapy was initiated in the first 24-48 hours, with the therapist instructing the patient to move in which way
passively extend the wrist and actively flex the MCP joints one would not want any active extension as it could disrupt the repair. passively extending the wrist and MCP joints would be safe but would not help with preventing contractures of the repaired extensors tendons
An elderly patient with degenerative joint disease is seen by a PT 3 days following a total knee replacement. which of these findings would be an indication for the therapist to contact the surgeon?
patient fails to recognize the therapist on the 3rd consecutive post op visit They are exhibiting signs of post operative delirium which is a safety concern
A patient utilizing a prosthesis following a right transfemoral amputation demonstrates a right lateral bend with gait. Which testing procedure would be MOST anticipated based on the observed finding?
patient is positioned in left sidelying; downward pressure is applied to the distal aspect of the right limb (right hip abductor weakness)
Positive test result of Wright test (hyperabduction) demonstrates what involvement in TOS
pec minor and upper ribs procedure: 1. palpate radial pulse while abducting arms to 180 degrees Positive = diminished or absent radial pulse or a reproducton of symptoms as the neurovascular bundle is compressed between pec minor and upper ribs
What is a contraindication for cryotherapy?
peripheral vascular disease
Which Korotkoff's sound is most closely associated with diastolic pressure?
phase IV - 4
What is cause of vaulting?
plantarflexion spasticity DF limitation (NOT DF weakness cause that would lead to steppage gait)
To prevent maximal compressive forced being placed on the patella, the therapist should minimize placing the patient in which position? 1. prone and flexing the knee to 30 degrees 2. in sitting position with knee flexed to 90 3. supine and flexing both the hip and knee to 110 degrees 4. prone and flexing the knee to 110 degrees with the hip extended
prone and flexing the knee to 110 degrees with the hip extended (extending the hip while flexing the knee will lengthen the rectus femoris and TFL, resulting in increased compressive forces at the patellofemoral joint)
A therapist has decided to use mechanical lumbar traction on a patient with posterior herniated nucleus pulposus at L2-3. if tolerated by the patient, what is the best positioning for the treatment?
prone with no pillow under hips or abdomen (want neutral or extended spine position in order to allow for separation of the vertebral bodies)
An adult patient is referred to PT with a diagnosis of central spinal stenosis. the patient's chief complaint is LBP that radiates to the posterior aspect of both leg. prolonged walking is a an aggravating factor. the therapist identifies several hypomobile lumbar segments and plans to treat the patient with graded posterior to anterior mobilizations. how should the therapist position the patient in order to avoid exacerbating the LE symptoms?
prone with the pillow under the patient's hips and lumbar spine (this allows for some flexion which relieves symptoms in those with spinal stenosis)
Visual cues are super important in the cognitive stage of learning. What's important for the associative stage?
proprioceptive cues
What direction should lymph be drained?
proximal to distal
A patient with a severe cerebellar lesion can sit independently, can stand with minimal assistance, and requires moderate assistance of one person to walk safely. The patient wants to transfer independently from a wheelchair to a bed. Which of the following transfer techniques is MOST appropriate for the patient?
sliding board transfer (this they can do independently) Not stand pivot cause they can't stand independenty without help
To prevent contractures in a newly admitted patient with anterior neck burns, it would be best to position the neck in which of the following?
slight extension Typically contracture for anterior neck burns is in flexion
What leads to toe first initial contact?
spastic plantarflexions weak dorsiflexors
What is galant reflex?
stroking along one side of the spine while newborn is in ventral suspension causes lateral flexion of lower body toward the stimulated side
What is murphys sign?
sudden stop in inspiratory effort that is indicative of acute cholecystitis
What does trochlear nerve innervate?
superior oblique musclein the eye
What nerve is involved in power grip?
ulnar nerve (ulnar nerve controls flexion of ulnar digits) `
What is T10 dermatome?
umbilicus
What is stridor?
upper airway obstruction Inspiratory, high pitched wheezing due to tracheal narrowing and disruption of airflow (gasping)
Which of the following is true regarding the use of knee braces following ACL surgery?
use of functional brace is more beneficial than not using brace with ACL deficiency
A physical therapist examining a patient's joint play finds restriction in the direction indicated by the arrow in the photograph. To address the restriction, the therapist should include an intervention to increase which motion of the index finger (2nd digit)?
volar glide used for finger flexion If there is limitations in volar glide this would indicate limited ability to perform finger flexion Flexion= volar roll, volar glide Extension = dorsal roll, dorsal glide Proximal phalanx on metacarpal This is for carpometacarpal joints of digits 2-5: motion of proximal phalange
What is GMFCS level 3?
walks with an assistive device **** in most settings
While observing a football player's ability to perform a bilateral leg-lowering activity, a physical therapist assistant notices an increase in lumbar lordosis as the legs approach the horizontal position. Which of the following conditions is the MOST likely cause of the lordosis?
weak abdominal muscles
What results in hip hiking?
weak hip and knee flexors extensor spasticity quadratus lumborum performs hip hip
A patient fell while rock climbing 2 days ago. The fall resulted in a fracture of the right ankle, requiring an open reduction internal fixation. The patient also sustained a brachial plexus injury which resulted in significant weakness in the muscles in the right C6-C7 myotome. The patient is to remain non-weight-bearing on the right. Which of the following assistive devices is MOST appropriate for this patient? A. Axillary crutches B. Wheelchair C. Standard walker D. Forearm crutches
wheelchair
If a patient is in the hospital and the MD ordered a Doppler study of the leg, what is the appropriate next step for the PT (assuming this patient has PT orders)?
withhold PT until results are in DO NOT want to mobilize a patient with a potential DVT because it could make it break loose and cause a PE or CVA
What muscles would be weak with radial nerve dysfunction?
wrist extensors and triceps (can use platform attachment)