Comp Exam Flashcards
Na/K Pump
3 Na OUT; 2 K IN
Local Potential - Temporal
STEPWISE Fashion
Local Potential - Spatial
SEVERAL at SAME TIME
End of Cord
L2
Cauda Equina
L2-S5
Lateral Horns
T1-L2
Posterior Intermediate Sulcus
C1-T2
Rexed Laminae 2
PAIN;
substanita gelatinosa
Rexed Laminae 3 & 4
DISCRIMINATIVE touch; CONSCIOUS proprioception;
nucleus proprius
Rexed Laminae 7
UNCONSCIOUS proprioception,
nucleus dorsalis/Clark’s column
Dorsal Column
Discriminative touch, conscious proprioception
Spinothalamic
Conscious pain/temp
Spinoreticular
Arousal, unconscious pain
Spinocerebellar
Unconscious proprioception
Lateral Corticospinal
Voluntary movement; fine motor
Rubrospinal
Gross motor
Reticulospinal
Trunk and posture
Vestibulospinal
Trunk and posture
Tectospinal
Reflexive turning of head
Quadraplegic
C1-T1
Paraplegic
T1/2 Down
Anterior Cord Injury
Ventral lost, dorsal intact
NO pain/motor/light touch/proprioception/deep pressure
Central Cord Injury
Medial lost;
UE > LE weakness
Brown Sequard Injury
Half lost
NO ipsi light touch/vibration; contral temp
Autonomic Dysreflexia Risk
T6 and above
SNS output
thoracolumbar
PNS output
cervicosacral
Thalamus nuclei: anterior
emotional tone
Thalamus nuclei: dorsomedial
judgement/reasoning
Thalamus nuclei: ventral anterior
motor planning/regulation
Thalamus nuclei: ventral lateral
motor output regulation
Thalamus nuclei: ventral posterior
somatosensory and vestibular information
Thalamus nuclei: LGN
relay to primary visual [17]
Thalamus nuclei: MGN
relay to primary auditory [41]
BG Loop: striato-pallido-thalamic
motor
BG Loop: dorsolateral prefrontal
executive function
BG Loop: lateral orbitofrontal
empathy/social appropriateness
BG Loop: Anterior cingulate
procedural learning
BG Loop: Direct
facilitates movement via internal GP, + feedback
BG Loop: Indirect
inhibit movement via external GP, - feedback
Climbing Fibers
Teach purkinje cells how to response to particular patterns of movement from mossy/parallel fiber input
Broca’s Area
L = motor program of speech R = nonverbal, gestures, tone
Wernicke’s Area
L = comprehension of speech R = nonverbal, spatial relationship
Semicircular canal
ANGULAR movement
Otolith
LINEAR movement [utricle = horizon; saccule = vert]
M1
primary simple movement of hand/face
PMA
complex multi-joint movement that is coordinated
PMCd
large proximal mm
PMCv
hand shape
SMA
sequential movement and bilat coordination
Stroke: face droop, dead arm, dysarthria, dysphagia
MCA
Stroke: LE weakness, difficulty standing
ACA
Stroke: impaired judgement, impulsivity, neglect, visual deficits, hemiparesis
Right
Stroke: language deficits, aphasia, apraxia, processing delay, perseveration, hemiparesis
Left
CT
good contrast resolution
specific and sensitive
Xray
specific, not sensitive
MRI
sensitive, no specific
T1 MRI
parallel, bone, anatomical
T2 MRI
perpendicular, water, pathology
ABCs of radiology
Alignment, Bone density, Cartilage, Soft tissue
Therapeutic Index
LD50/ED50; HIGHER # = SAFER
Absorption
best with small, lipid soluble, polar molecules
Pharmokinetics
absorption, distribution, biotransformation, excretion
Pharmacodynamics
effect at target site
HTN meds [5]
beta blocker, alpha blocker, Ca blocker, diuretics, ACE inhibitor
Anti-arrhythmia meds [4]
Na blocker, beta blocker, K blocker, Ca blocker
MAOI
prevent dopamine breakdown
Mm relaxors
Baclofen [bind to GABA]; Botox [inhibit Ach]
Cancer drug that causes foot drop
Vincristine
Transcription
DNA > RNA
Translation
RNA > protein
Anaerobic vs. Aerobic Respiration
An = 2 ATP, A = 34 ATP
B cells
humoral immunity
bone marrow
antibodies
T cells
cell mediated immunity
thymus
NK cells
Hypersensitivity Types
ABCD 1 = allergic 2 = antibody [blood] 3 = immune complex [clumps] 4 = cell mediated [delay]
Hashimoto’s
HYPOthyroidism, goiter, weight gain, cold intolerance
Grave’s
HYPERthyroidism, exopthalamus, weight loss, heat intolerance
OCD
obsessive = repeated behavior compulsive = MUST react immediately
ADHD
hyperactive, inattentive, impulsive
Cancer warning signs
Night pain Can't alleviate pain Deep ache Diffuse Weakness Fatigue
Cushing’s
HYPER-ACTH, moon face, obese
Addison’s
HYPO-ACTH, hyperpigmentation
Na
142 [135=low, 145=high], ECF Aldosterone = direct relationship ADH = indirect relationship Hypo = hypovolemia, dec AP Hper = edema, HTN
K
3.5-5 [3.5=low, 5=high] ICF
Aldostersone = indirect relationship
Hypo/Hyper = arrhythmia, N/T
Ca
ECF
PTH = direct relationship
Hypo = inc AP, weak heart
Hyper = dec AP, strong heart
Spinal Fx Stability
1 column = stable
3 column = unstable
2 column = follow middle column classification
[I = stable, II, III = unstable]
Knee Trauma Rule: Hx of trauma or fall AND 50 yo, AND/OR can’t WB 4 steps
Pittsburg Rule
Knee Trauma Rule: >55 yo, tender @ fibular head/patella, can’t flex knee to 90, can’t WB 4 steps
Ottawa Rule
Anterior and Posterior Hip Precautions
A: ext, ABD, ER
P: flex, ADD, IR
Bone Health T-score
-1 = norm
-1 to -2.5 = osteopenia
> -2.5 = osteoporosis
ABI Scale
0.5-0.8 = intermittent claudication
ACE wrapping for AKA
into extension and ADD
Extensor Excursion
extensor ligaments prone to shortening
splint in extrinsic + [MCP flex, PIP/DIP ext]
Functional Hand Splint
Wrist 20-30 ext, thumb ABD, MCP 15-20 flex, PIP slight flex
DF Stop and PF Stop
DF = extension moment at knee PF = flexion moment at knee [aid push off/foot drop]
DF assist
increase toe clearance and prevent foot slap
ex. gillette, posterior leaf spring
Ground Reaction AFO
force knee extension and aid push off
Pressure intolerant areas for prosthetic sockets
distal patella tibial crest fibular head distal fibula HS tendons
Lever arm [long, short]
Long = flexion moment, buckle Short = fall over front, buckle
Prosthetic [long, short, medial whip]
Long = vault, uphill, LBP
Short = step in hole
Medial Whip = ER of knee
Disease: systemic, autoimmune, proximal, bouchard’s nodes at PIP
RA
Disease: local, degeneration, distal, herberden’s nodes at DIP
OA
OA nodes
Herberden’s at DIP
RA nodes
Bouchard’s at PIP
Stages of Cancer Intervention
Preventative, restorative, supportive, palliative
Bone Malignancy: LE, 60 yo, distal femur/proximal tibia
osteosarcoma
Bone Malignancy: > 40 yo, M>W, central skeleton and pelvis
chondrosarcoma
Bone Malignancy: >3
Ewing’s Sarcoma
Common metastasis sites
Pituitary Thyroid Breast Lung Kidney
Type of Research: record, analyze, and interpret what exists naturally
Descriptive
Nominal Data
Classification scale, data assigned to a category
Ordinal Data
Ranking scale
Interval
Equal intervals with NO true zero [ex. temp]
Ratio
Equal intervals WITH true zero [ex. ROM]
Intra-rater
between ONE person
Inter-rater
between 2+ people
Standard Deviation Break Down
1 SD = 68% [34.1x2]
2 SD = 95% [13.6x2]
3 SD = 99% [2.1x2]
Error: concluding there is a difference when there is not
Type 1
Error: concluding there is NO difference when there is
Type 2
Pearson’s Correlation Interpretations [R value]
1 = perfect 0.7 = strong 0.5 = moderate 0 = no relationship
Sensitivity
SNOUT Tests for True + If you're - you DON't have it RULE OUT ex. MRI
Specificity
SPIN Tests for True - If you're + you HAVE it RULE IN ex. pregnancy test
Term: self-determination; wishes of competent individuals are honored
Autonomy
Term: moral obligation to act for benefit of others
beneficience
Term: obligation individuals have to others in society
duty
Term: obligation to do no harm
non-maleficence
Term: obligation to tell the truth
veracity
Consequentialism
Focus on consequences, ends justify means
Actions that bring most good
Deontological
Focus on action, strict moral obligation
Global vs. Local muscles
Global = mobility, pain = over-activation Local = stability, pain = inhibition
PLL becomes the
tectorial membrane
supraspinous ligament becomes the
nuchal ligament
ligamentum flavum becomes the
posterior atlanto-occipital membrane/ligament
Collagen type in the nucleus pulposus vs. annulus fibrosus
nucleus = type 2 annulus = type 1
optimal stimulus for regneration of nucleus vs. annulus
nucleus = compress/distract annulus = rotation
Cloward Sign
anterior/lateral disc = mid back/scapular boarder
posterior/lateral disc = over scapula/upper arm
Facet orientation
CS = 45 to horizontal TS = coronal [60-90-0] LS = sagittal
Fryette’s Law
LS in neutral = OPPOSITE coupling
LS in flex/ext = SAME coupling
SI motion
nutation = flexion; counternutation = extension
Neutral and Elastic Zone
Neutral = 1st few degrees; movement w/little R Elastic = neutral to end ROM; movement w/high R
Condition: B&B dysfunction, saddle paresthesia, severe back pain, B leg pain, motor weakness
CE
Condition: motor/sensory changes, hyper-reflexive, +/- B&B dysfunction, +/- pain
cord compression
5 D’s for VA screen
Drop attack Dizzy Diplopia Dysarthria Dysphagia
MMT vs. Myotome
MMT = consistent weakness; Myotome = fatiguing weakness
Traction parameters
CS = 5-10# of F, Upper = 10-20 flex, Lower = 25-30 flex LS = 25-50% BW
Neurodynamic tender points
C6, T6, L4, post knee, ant elbow
Slider vs. Tensioner
Slider: both ends move, irritable
Tensioner: one end moves, chronic
McKenzie Classification: abnormal stress on normal tissue, no pain w/movement; re-edu
Postural
McKenzie Classification: normal stress on abnormal tissue, pain at end ROM, remodel tissue
Dysfunctional
McKenzie Classification: abnormal stress on abnormal tissue, direction pain; recover function
Derangement
MSI: Flexion vs Extension Category
Flex: tight ext, weak paraspinals, flat back
Ext: tight flex, weak abs, lordosis
How short and long muscles test
short test strong
long test weak
think L/T relationship
Type 1 and 2 fibers prone to…
1 = weakness, 2 = tightness
ROM testing for single and multi-joint muscles
single = end ROM; multi = mid ROM
Forefoot varus NWB and WB [FF, STJ, C]
NWB: FF inverted, STJ neutral, C vertical
WB: FF flat, STJ pronated, C everted
Forefot valgus NWB and WB {FF, STJ, C]
NWB: FF everted, STJ neutral, C vertical
WB: FF flat, STJ supinated, C inverted
Rearfoot varus NWB and WB [FF, STJ, C]
NWB: FF inverted, STJ neutral, C inverted
WB: FF flat, STJ pronated, C vertical
Soft end feel [6]
hip flex, knee flex, elbow flex, PIP flex, CMC flex, CMC opposition
Hard end feel [8]
elbow ext, pronation, RD, PIP flex, Thumb MCP flex, Thumb IP flex, PIP flex, ankle eversion
Blood borne pathogens and precautions
pathogens = HIV, Hep B, Hep C
gown and glove to tx open wound
Feces pathogens
Hep A, Hep E
Airborne pathogens and precautions
TB, SARS, Measles, Chicken Pox
PAPR, neg airflow room
Droplet pathogens and precautions
Influenza, mumps, whooping cough
Mask and gloves
Contact pathogens and precautions
VRE, MRSA
gown and gloves
Contraindications to ICU Tx
HR >100, 200, 110
O2
Positioning for AKA, BKA, Burns
AKA = extension and ADD BKA = hip and knee extension Burn = elongation across joints
Gait Trianing
4 and 2 point = FWB
3 point = NWB
3 point mod = PWB
4 and 2 point mod = balance
Gait Speed
Norm = 1.4 m/s
Fall risk =
Burn Classification
Superifical: epidermis, red, painful
Superifical partial: dermis, edema, blister, painful
Deep partial: little dermis remains, white, painless
Full: subcutaneous, painless
Pressure Ulcer Classification
Stage 1: skin intact, non blanchble redness
Stage 2: partial thickness, red w/slough
Stage 3: full thickness, to FASCIA
Stage 4: full thickness, THROUGH fascia
Unstageable: full thickness covered with eschar
Arterial vs. Venous wound
Arterial = punched out, red halo, pain with elevation Venous = irregular, hemosiderin staining pain with dependent position
Wound Dressing = TIME
tissue management
infection
moisture
edge advancement
US
Thermal = continuous, non thermal = DC 50%
1 MHz = deep; 3 MHz = superifical
subacute = 1 deg change, chronic = 2, stretch = 4
Venous Wound Tx
CORE: compression, optimize wound environment, review risk factors, estable maintenance plan
Wound modalities
- HVPC 2. US [acute nonthermal; chronic thermal]
Pain modalities
- TENS 2. IFC
Edema modalities
- IFC 2. NMES
Weakness modalities
- Russian 2. NMES 3, IFC
Carotid Sheath
Carotid a, Vagus n, Internal Jugular v.
Cubital Fossa
Brachial a, Median and Radial n, Biceps tendon
Pes Anserinus
SGT FOS
sartorius, gracilis, semitentindosus
femoral, obturator, sciatic
Posterior Neck Triangle
Trapezius, posterior SCM, Clavical
Accessory n. BP, phrenic n. subclavian a/v
Brainstem
Midbrain = III, IV Pons = V, VI, VII, VIII Medulla = IX, X, XI, XII
CN
Olfactory Optic Oculomotor Tochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharyngeal Vagus Acessory Hypoglossal
Term: movement related to displacement, velocity, and acceleration
kinematics
Term: movement in terms of forces
kinetics
Newton’s Laws
1st = intertia 2nd = F=m*a 3rd = action/reaction
Levers
1st = FAR; 2nd = ARF, 3rd = AFR
Convex-Concave Rule
Convex moving = OPPOSITE
Concave moving = SAME
Term: inability of a 2 joint mm to perform concentric contraction over 1 joint when shortened over another
active insufficiency
Term: inability of a 2 joint mm to lengthen over 1 joint when it is lengthened over another
passive insufficiency
Phases in Healing
Acute = 0-10 day, at rest/with motion Subacute = 10d-6wk, with motion Chronic = 6w-1yr, after activity
Hip Angle of Incline
Norm = 125
Valgum > 125, longer limb w/increase joint reaction force
Varus
Hip Angle of Torsion
Norm = 8-15
Anteversion >15, IR, Toe IN
Retroversion
ACL
NWB resists ANT translation
WB resists POST translation
PCL
Resists FLEX
NWB resists POST translation
WB resists ANT translation
Hand Deformity: PIP hyperext; DIP flex
swan neck
Hand Deformity: PIP flex, DIP hyperext
Boutonniere
Hand Deformity: PIP ext, DIP flex
Mallet finger
Spine Coupling
CS = Opposite LS = Same TS = follows what it's closest to
