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PT Examination > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is an iterative process?

A

a process for calculating a desired result by means of a repeated cycle of operations

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2
Q

As the number of “iterations” increases, what should you be doing?

A

you should become closer to the desired result (convergent)

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3
Q

What are the six elements of the patient/client management model?

A

examination
evaluation
diagnoses
prognosis
intervention
outcomes

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4
Q

What are the three portions of a physical therapy examination?

A

history
systems review
tests and measures

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5
Q

What kinds of things will you be examining while conducting a patient history?

A

(coming from graphic on slide 6)
activities/participation
current condition
family history
general demographics
general health status
growth and development
living environment
medical/surgical history
medications
review of systems
social/health habits
social history

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6
Q

What systems are being covered during the Systems Review of a PT Examination?

A

musculoskeletal
neuromuscular
cardiovascular/pulmonary
integumentary
communication

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7
Q

What is the difference between conducting a Systems Review and the Review of Systems during Patient History?

A

Review of Systems covers any and all medical or health conditions (endocrine, ear/nose/throat, gastro, hematologic/lymphatic, etc.) while the Systems Review is a limited set of hands-on tests to determine further instruction and test for conditions treatable with physical therapy.

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8
Q

What is tested during the Systems Review to assess the Cardiovascular/Pulmonary system?

A

heart rate
respiratory rate
blood pressure
edema

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9
Q

What is tested during the Systems Review to assess the Integumentary System?

A

pliability (texture)
presence of scar formation
skin color
skin integrity

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10
Q

What is tested during the Systems Review to assess the Musculoskeletal System?

A

gross symmetry
gross ROM
gross strength
height/weight

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11
Q

What is tested during the Systems Review to assess the Neuromuscular System?

A

gross coordinated movement (balance, gait, locomotion, transfer, transitions)
motor function (motor control and motor learning)

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12
Q

What is tested during the Systems Review to assess Communication?

A

ability to make needs known
consciousness
orientation (person, place, time)
expected emotional/behavioral responses
learning preference (barriers, education needs)

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13
Q

What occurs during the tests and measures portion of the PT Examination?

A

gathering of data
ruling in and out

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14
Q

In the tests and measures portion of the PT examination, you should perform what is necessary to:

A

confirm or reject your hypothesis
support PT clinical judgements about diagnosis, prognosis, and plan of care

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15
Q

What are the four branches of the “Physical Therapist Decision Making” graphic?

A

retain
consult
refer
co-manage

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16
Q

In the PT decision-making process, what should a physical therapist do if they plan to retain the patient?

A

develop POC
retain accountability for POC
define boundaries within which others assisting with service delivery operate
always have the option to perform all elements or direct and supervise

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17
Q

Who does a PT direct and supervise if they plan to retain the patient?

A

physical therapy assistants
physical therapy aides/technicians

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18
Q

In the PT decision-making process, who should a PT consult with in regard to a patient?

A

others PTs
other disciplines
MD/DO/DDS (etc)
NPs/PAs
psychology
social work
nursing

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19
Q

In the PT decision-making process, who could a PT refer a patient to?

A

other PTs
other disciplines
MD/DO/DDS (etc)
NPs/PAs
psychology
social work
nursing

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20
Q

In the PT decision-making process, who could a PT co-manage a patient with?

A

other disciplines
MD/DO/DDS (etc)
NPs/PAs
psychology
social work
nursing

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21
Q

What are the four portions of a SOAP note?

A

subjective
objective
assessment
plan

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22
Q

What all is involved in the subjective content portion of an evaluation? (SOAP)

A

general demographics (age, gender, race)
chief complaint
history of present illness
pain rating/description
past medical history
past surgical history

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23
Q

how can the subjective content portion of an evaluation be obtained?

A

via patient interview and/or information gathered from questionnaires or surveys

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24
Q

What all is involved in the objective content portion of an evaluation? (SOAP)

A

observation (posture, gait)
range of motion (PROM, AROM)
strength (MMT, resisted)
joint mobility
palpation
special tests
neurological testing
muscle length testing
systems review (neuromuscular, cardiopulm, integ, MSK)

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25
Q

What all is involved in the assessment portion of an evaluation? (SOAP)

A

clinical decision making based on subjective and objective content
problem list/areas of deficit
establish a clinical diagnosis
is this patient appropriate for PT?
are additional referrals needed?
establish patient goals (SMART goals)

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26
Q

What are some components to developing an appropriate plan of care?

A

therapist recommendations
agreement and consent from the patient
specific correlation to diagnosis, prognosis, and established goals
anticipated number of visits
clear plan of progression
flexible but specific

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27
Q

What is the definition of goniometry?

A

the measurement of angles

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28
Q

what are goniometers used for in physical therapy?

A

measure the joint angles created by the bones in the body

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29
Q

What is inclinometry?

A

measuring angles of slope, elevation, or depression of an object with respect to gravity’s direction

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30
Q

Is goniometry objective or subjective?

A

objective

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31
Q

What two things does goniometry help us get a comprehensive exam of?

A

joints and surrounding tissues

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32
Q

What are some common applications of goniometry to physical therapy?

A

describing specific positions used for splinting/immobilization or exercises
fabrication or fitting orthosis or adaptive devices
documenting changes and progression in the patient’s condition in response to treatment
determining impairment present
research tool

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33
Q

What are some skills necessary to adequately perform goniometric measurements?

A

knowledge of normal joint structure and function
skill in palpation of body and soft tissue landmarks
skill in positioning and stabilizing body parts
information about best positions for instrument alignment
skill in accuracy of reading and recording measurements

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34
Q

what are the three parts of a goniometer?

A

body
stationary arm
moving arm

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35
Q

where should the body of the goniometer be in regard to the body?

A

placed directly in the center of the landmark (joint axis/joint line) that is used to measure that specific joint angle
creates a fulcrum

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36
Q

where should the stationary arm of the goniometer be placed in regard to the body?

A

attached to the body, cannot be moved independently of the body
aligned parallel to long bones of proximal segment

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37
Q

where should the moving arm of the goniometer be in regard to the position of the body?

A

attached to the center of the body and freely moves on the body to record measurement
aligned parallel to long bones of distal segment

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38
Q

What are some keys to reading the scale on a goniometer?

A

be sure to read the correct increments/scale for measurement
be at eye level with the goniometer when reading the scale

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39
Q

what is inclinometry primarily used to assess?

A

spinal ROM

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40
Q

what does the display of the inclinometer indicate?

A

the angle at which the inclinometer is situated relative to the line of gravity

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41
Q

how does using two inclinometers benefit?

A

improve accuracy of measurement by assisting in identifying extraneous joint movements

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42
Q

what are kinematics?

A

study of motion without regard to forces (motion of body segments, type/direction/magnitude)

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43
Q

What are the three types of movement that bony segments can undergo?

A

translation (linear displacement)
rotation (angular displacement)
combination of both

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44
Q

what does arthrokinematics refer to?

A

the movement of the joint surfaces in relation to one another

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45
Q

what are arthrokinematics measured with?

A

joint play

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46
Q

what does osteokinematics refer to?

A

the gross movement of the shaft of the bones (rather than the joint surfaces)
usually described in angular/rotatory motion produced around fixed axis

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47
Q

what are osteokinematics measured with?

A

goniometer

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48
Q

osteokinematics occur in one of three ____________ and around three corresponding ______________.

A

cardinal planes, axes

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49
Q

where does the sagittal plane go through the body?

A

anterior to posterior aspect of the body

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50
Q

what are the motions occurring in the sagittal plane?

A

flex/extend

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51
Q

all motions in the sagittal plane take place around what kind of axis?

A

medial-lateral axis

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52
Q

where does the frontal plane go through the body?

A

from one side of to the other (split into front and back halves)

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53
Q

what motions are occurring in the frontal plane?

A

ab/adduction

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54
Q

all motions of the frontal plane take place around what kind of axis?

A

anterior/posterior axis

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55
Q

where does the transverse plane go through the body?

A

goes through the body horizontally (same way cross-sections are made)

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56
Q

what kind of motion occurs in the transverse plane?

A

rotation

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57
Q

all motions in the transverse plane take place around what kind of axis?

A

vertical or longitudinal axis

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58
Q

what does one degree of freedom of motion refer to?

A

joints that allow motion in only one plane around a single axis

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59
Q

what does three degrees of freedom of motion refer to?

A

joints that allow motion in all three planes

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60
Q

what is used to measure motions occurring in a single plane?

A

goniometer

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61
Q

what is the definition of range of motion?

A

the arc of motion (in degrees) between the beginning and the end of a motion in a specific plane

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62
Q

what is the starting position for measuring all ROM (except rotation in transverse plane)?

A

anatomical position

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63
Q

where is the starting position of ROM for measuring rotations in the transverse plane?

A

half way between full medial rotation and full lateral rotation (neutral positon)

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64
Q

what is the definition of active range of motion?

A

voluntary unassisted muscle contraction resulting in joint motion

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65
Q

which should be assessed first in the exam process, active or passive ROM?

A

active ROM

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66
Q

what does active range of motion provide information about?

A

willingness to move
coordination
muscle strength
joint ROM

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67
Q

what is the definition of passive range of motion?

A

motion attained by the examiner, without assistance from the subject

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68
Q

which is usually greater, AROM or PROM?

A

PROM

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69
Q

what does passive range of motion provide information about?

A

integrity of articular surfaces
extensibility of the joint capsule and associated ligaments, muscles, fascia, and skin surround the joint

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70
Q

what are some common causes of pain with active range of motion?

A

contracting/stretching of “contractile” tissues and attachments to bone (muscles/tendons)
stretching or pinching of non-contractile tissues (ligaments, joint capsules, bursa, fascia, skin, nerve)

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71
Q

what are some common causes of pain with passive range of motion?

A

non-contractile tissue (pain due to moving, stretching, pinching)
pain at end range PROM (could be result of stretching either contractile or non-contractile)

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72
Q

What does comparing motion with pain (PROM and/or AROM) and location do?

A

helps to begin your guide to examination and treatment

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73
Q

what are the four main range of motion reasonings?

A

mobility deficit (non-contractile)
movement coordination (control)
muscle power deficit (contractile)
radiating pain (neurological)

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74
Q

what is the definition of an end feel?

A

the barrier to further motion at the end of PROM

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75
Q

how are you able to characterize the type of end feel you assess in terms of pressure application?

A

slight overpressure to joint (ex: joint capsule vs soft tissue)

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76
Q

what is a normal soft end feel?

A

typically due to soft tissue approximation
yielding compression that stops further movement
(ex: knee flexion)

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77
Q

what is a normal firm end feel?

A

due to tissue stretch (muscle, capsule, ligament)
has a firm, springy type of movement with slight give
(ex: hip flex w/ knee straight, shoulder external rotation, forearm supination)

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78
Q

what is a normal hard end feel?

A

due to bone contacting bone
a hard, unyielding sensation that is painless
(ex: elbow extension)

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79
Q

what are some examples of abnormal end feels?

A

any normal end feels that are found in an unexpected point in ROM or in a joint that should display a different end feel
muscle spasms (rebound, stop, may have pain)
empty (no mech restriction, pain)
boggy (soft, mushy with effusion)
springy block (firm, elastic resistance at unexpected point - usually indicates internal derangement)

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80
Q

what are some precautions to consider when measuring joint ROM?

A

joint dislocation
joint subluxation
unstable bone fracture
tendon/ligament rupture
infectious or acute inflammatory response
severe osteoporosis

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81
Q

how do you document ROM?

A
  1. joint
  2. movement
  3. side of body
  4. degrees of motion
  5. AROM/PROM
  6. position (if different than standard)
  7. abnormalities (if found)
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82
Q

what is the best way to document hypermobility?

A

best if you further clarify that the patient has ____ degrees of hyperextension and ____ amount of flexion to limit confusion, rather than some of the other ways you may see it.
BE CLEAR

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83
Q

what is hypermobility?

A

denotes ROM that is beyond normal values for the tested joint

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84
Q

what is hypomobility?

A

refers to a decrease in the PROM that is substantially less than normal values for age matches norms

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85
Q

what are some key points to ROM education and set up for the patient?

A

providing description of procedure
having necessary tools ready (towel, goni, etc) PREP/PLAN ENVIRONMENT
discuss what patient should expect
provide a rationale for why you need to perform the procedure
always finish with obtaining patient consent

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86
Q

what is the common procedure methodology and administration steps to performing ROM on your patient?

A
  1. place the subject in proper testing position
  2. stabilize the proximal joint
  3. position distal joint segment so that the patient is in a zero starting position
  4. slowly take the joint through PROM (assess end feels, quality, visual estimate)
  5. return to starting position
  6. palpate bony anatomical landmarks
  7. align the goniometer
  8. read/record starting position
  9. remove goniometer
  10. stabilize the proximal segment
  11. move distal segment through available ROM
  12. realign/reread goniometer as needed
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87
Q

what is the definition of reliability?

A

amount of consistency between successive measurements of the same variable, same individual, same conditions
extent to which the measurements are repeatable

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88
Q

what is poor reliability indicative of?

A

the measurement is not dependable

89
Q

should you use a measurement with poor reliability in a clinical decision-making process?

A

no

90
Q

does goniometry have good/excellent relability?

A

yes

91
Q

which kind of reliability is greater, intratester or intertester?

A

intratester

92
Q

when can intertester reliability be higher?

A

when using the same positions/landmarks/procedures

93
Q

what is a normal variation of ROM difference between testers?

A

4-5 degrees

94
Q

what is the definition of validity?

A

the degree to which an instrument measures what it is purported to measurement
“how well does a measurement represent the true value?”

95
Q

what is face validity?

A

“does the test appear to measure what it is supposed to measure?”

96
Q

what is criterion validity?

A

comparing to a well-established gold standard

97
Q

what is true biological variation?

A

differences noted between individuals caused by factors of age, gender, race, medical history, etc.

98
Q

what is temporal variation?

A

variation in measurement on the same individual at different times, caused by activity level, health status, emotional status, etc.

99
Q

what is measurement error?

A

variation (difference in measurement) due to testers, measurement instruments, procedural methods, etc.

100
Q

what is the definition of muscle strength? (multiple)

A

the ability of muscle to develop tension or torque
force generated over a single, unlimited episode against an immovable resistance
the maximal force a muscle or muscle group can generate at a specified or determined velocity

101
Q

why is muscle strength tested?

A

to determine the capability of muscles to function in movement and their ability to provide stability and support

102
Q

what is the purpose of performing muscle strength assessment in someone with a spinal cord injury?

A

it can be used to determine the level of the lesion and degree of damage to the cord

103
Q

what can help differentiate between two possible diagnoses in muscle strength assessment?

A

the pattern of the muscle strength loss

104
Q

what is the testing of strength with use of a constant external resistance?

A

isotonic muscle strength testing

105
Q

what is isotonic muscle strength testing

A

the testing of strength with use of a constant external resistance

106
Q

what is the subject’s ability to provide resistance through the range of motion at a constant velocity referred to as?

A

isokinetic

107
Q

why is isokinetic muscle strength testing rarely used?

A

necessary equipment is very costly

108
Q

what is generating force against an immovable resistance with muscle length remaining at the same throughout the test referred to as?

A

isometric muscle strength testing

109
Q

what are some common ways/equipment used to assess isometric muscle strength?

A

MMT
hand-held dynamometer

110
Q

what are the advantages of isometric muscle strength testing?

A

structure, reproducibility

111
Q

what are the disadvantages of isometric muscle strength testing?

A

provides information about strength at only one point in ROM

112
Q

what phase in the lifespan do you see a gradual increase in muscle strength?

A

during childhood and into young adulthood

113
Q

what phase in the lifespan do you see a gradual decline in muscle strength?

A

from young adulthood (age 20-30) throughout the remainder of the patient’s life

114
Q

what happens within the muscle as you begin to see a decline in muscle strength?

A

decrease in total muscle mass
loss of motor neurons
reduction in the number and size of muscle fibers

115
Q

at what age do you begin to see greater muscle strength in males over females?

A

9-10 years old

116
Q

do males or females see an earlier decline in muscle strength in the lifespan?

A

males

117
Q

how did manual muscle testing begin (what condition did the patients have)?

A

Wilhelmine Wright in 1912 assessed patients with polio, built classifications to distinguish the extent of the condition

118
Q

who introduced the concept of percentages in grading MMT?

A

henry and florence kendall

119
Q

who published the first comprehensive text on MMT in regard to gravity and gravity-eliminated positions?

A

lucille daniels and catherine worthingham

120
Q

what are some important things to explain/tell the patient during the education/consent portion of muscle testing?

A

describe what is being done, tell why it is important
discuss what the patient should expect
show them the tools being used and explain them
explain the importance of exerting maximum effort
use layman/understandable terminiology
ALWAYS FINISH BY ASKING CONSENT

121
Q

what kinds of things should you consider during the preparation and set-up portion of muscle testing?

A

non-distracting environment
understand that the testing may cause patient discomfort/pain
firm mat/table, small amount of friction of the surface material
ensure table height gives you proper leverage/body mechanics
organize testing to limit patient position changes throughout the assessment
ensure all needed materials are at hand

122
Q

what is the common administration/procedure for manual muscle testing (after prep/consent/etc)?

A
  1. place patient in gravity-resisted position
  2. take patient through PROM and return to starting position
  3. ask patient to move through their available AROM while proximal joint is stabilized
  4. identify correct muscles and palpate appropriately
  5. if patient is able to complete ROM against gravity, resistance is applied at designated location
    5a if patient is not able to complete ROM against gravity, the patient is repositioned in a gravity-eliminated/gravity-limited position, patient is asked to move through AROM in this position (no resistance applied)
  6. appropriate muscle grade is given
123
Q

which segment of the joint should be fixed and which should be moveable during MMT?

A

proximal segment is fixed, distal is moveable

124
Q

what are some ways to stabilize the proximal segment of the joint during MMT?

A

patient position
use of firm testing surface
muscle activity by patient
manual fixation by examiner

125
Q

what is resistance in MMT?

A

the force acting in opposition to a contradicting muscle

126
Q

where is resistance typically applied/strongest in a one-joint muscle?

A

applied at end of ROM

127
Q

where is resistance typically applied in a two-joint muscle?

A

applied at mid-range

128
Q

resistance must be applied in MMT/strongest in order to give what MMT grade?

A

> 3

129
Q

what is the break test?

A

increasing force is applied until the patient’s muscle contraction is overcome by the examiner

130
Q

what kind of force should you apply during resisted MMT and how long should you hold?

A

maximal force, 4-5 seconds

131
Q

in what direction should you apply resistance in MMT?

A

perpendicular to the primary axis of the body part being tested

132
Q

what does a 0 (zero) represent on the MMT grading scale?

A

no evidence of visible or palpable contraction
muscle is not connected, no attachment/contraction

133
Q

what does a 1 (trace) represent on the MMT grading scale?

A

slight contraction, but no motion
can palpate muscle activation

134
Q

what does a 2 (poor) represent on the MMT grading scale?

A

movement through complete test range in a gravity-eliminated position
can move through ROM

135
Q

what does a 3 (fair) represent on the MMT grading scale?

A

movement through complete test range against gravity
can move through ROM, gravity applied

136
Q

what does a 4 (good) represent on the MMT grading scale?

A

movement through complete test range against gravity and able to hold against moderate resistance
can move through ROM, can withstand some resistance

137
Q

what does a 5 (normal) represent on the MMT grading scale?

A

movement through complete test range against gravity and able to hold against maximum resistance

138
Q

what does a 2- represent on the MMT grading scale?

A

movement through partial test range in a gravity eliminated position

139
Q

what does a 2+ represent on the MMT grading scale?

A

movement through complete test range in a gravity eliminated position, through up to 1/2 of test range against gravity

140
Q

what does a 3- represent on the MMT grading scale?

A

movement through complete test range in gravity eliminated position and through >1/2 test range against gravity

141
Q

what does a 3+ represent on the MMT grading scale?

A

movement through complete test range against gravity and able to hold minimal resistance

142
Q

can you give someone with a hard block 160 degrees of shoulder flexion a grade above a 3?

A

clinically, yes. you just need to be sure that you document that they fulfilled their full capable ROM to 160 degrees

143
Q

in diagnosing, what is the most important MMT grading difference?

A

between 0 to 1, because 0 means there is no muscle activation at all, and 1 means it is at least present and can be strengthened

144
Q

what is the definition of a substitution in MMT?

A

results from one or more muscles attempting to compensate for the lack of strength in another muscle of group of muscles

145
Q

what is the presence of a substitution a good indicator of?

A

muscle weakness in target muscle
may indicate inadequate stabilization
may even occur as a result of poor instruction given to patient

146
Q

how are fusiform muscle fibers arranged?

A

parallel to the line from origin to insertion

147
Q

why is tendonitis so common in full muscle groups of fusiform muscles?

A

during overuse, it affects the entire muscle since fibers extend from origin to insertion

148
Q

how are pennate muscle fibers arranged?

A

obliquely into the tendon/tendons that extend the length of the muscle on one side (unipennate) of through the belly of the muscle (bipennate)

149
Q

how are fan-shaped muscle fibers arranged?

A

side by side to form a fan-shaped unit

150
Q

what is active muscle insufficiency?

A

when a prime mover (agonist) becomes shortened to the point it cannot generate or maintain active tension
occurs in two joint muscles

151
Q

what is passive muscle insufficiency?

A

not enough length from the opposing side for the muscle to go through the full ROM

152
Q

muscles with fewer fasciculi have greater _______ but less ______

A

ROM, power

153
Q

muscles with a larger number of fasciculi have less _______ but greater _________

A

ROM, power

154
Q

what questions do you ask to determine the selection of appropriate testing tools?

A

is it appropriate for the patient’s strength? (MMT/functional best if weakness is present, HHD/isokinetic best is strength is good or above)
is it age appropriate? (assess functional ability/strength in patients younger than 3-4 years)
what is available?
when more than one option is available, which provides the most quantifiable data?

155
Q

when would you want to use a functional muscle testing (isotonic)?

A

good strength or above
inability to follow commands
tests multiple muscles and joints at once

156
Q

when would you want to use manual muscle testing (isometric)?

A

when able to provide a pain free contraction
gravity eliminated - lack of full ROM against gravity
gravity dependent - full ROM against gravity

157
Q

when would you want to use resisted muscle testing (isometric)?

A

done when muscle is painful to contract (not graded)
strong/weak
pain free/painful
muscle screening vs manual muscle testing

158
Q

what is the main difference between strength screening and testing?

A

no grade is assigned for screening due to lack of positioning and adherence of grading criteria, positioning is much more specific in test (gravity eliminated/gravity dependent)

159
Q

what kinds of patient influences can be presented during testing?

A

patient effort
pain threshold, reaction to discomfort
comprehension of instruction
available motor skills
attitude and depression
cultural, social, gender influences

160
Q

what is the definition of palpation per the medical encyclopedia?

A

method of feeling with the hands during a physical examination

161
Q

what are the goals of palpation?

A

identify target structure
assess target structure

162
Q

how would a therapist educate their patient prior to palpation?

A

staying professional
providing a description of the procedure
discussing what the patient should expect
providing a rationale behind the procedure
asking permission from the patient

163
Q

how do therapists set up palpation procedures? what are the benefits of this?

A

draping patient appropriately
- preserves patient modesty that allows for proper evaluation while maintaining client-clinician boundaries

164
Q

what surface or fingers of the hands have the greatest discriminatory ability?

A

palmar surface
fingertips of index and middle finger

165
Q

what is important for the clinician to understand when palpating a specific landmark?

A

muscle attachments
actions of the muscles
bony landmarks in the region

166
Q

how does a clinician approach palpation administration?

A

they will go from bony to soft tissue and go superficial to deep

167
Q

what is the grasping technique?

A

either using the entire hand to “cup” an object or using the thumb and index finger to “pinch” an object

168
Q

if one is assessing a gross region or landmark, it would be best to use a ___________ contact surface

A

large contact surface
ie - entire palm

169
Q

what is “rate” in concern to palpation application?

A

the quick assessment of a large area by scanning / stroking of the hands

170
Q

when is a static rate used in palpation?

A

when palpating a moving phenomenon like pulse or respiration

171
Q

how does a clinician balance the duration of necessary palpation?

A

he/she does not want to be hurried or abrupt with contact, while also not prolonging at a location for more than a few seconds

172
Q

if a clinician palpates for a prolonged duration, they run the risk of _________

A

altering client’s tissue

173
Q

in regards to pressure of palpation, how do superficial and deep structures differ?

A

superficial structures require less pressure whereas deep structures require more pressure

174
Q

what is a general rule of thumb when regarding pressure of palpation?

A

use the minimum amount of pressure required

175
Q

what is the benefit of applying firm pressure?

A

expresses knowledge and confidence to the patient

176
Q

if palpation pressure is too hard, the clinician runs the risk of

A

causing patient discomfort and not accurately assessing the condition

177
Q

in what instances would perpendicular application of pressure be necessary

A

pitting edema
palpating pulse
measuring the sensitivity of a trigger point

178
Q

in what instances would parallel application of pressure be necessary

A

to create a drag / shear force
assessment of difference in tissues

179
Q

when documenting palpation, a clinician would want to document the

A

Location/Tissue
texture (abnormal vs normal)
temperature
patient’s response

180
Q

when documenting the patient’s response, the clinician would want to make note of the

A

skin discoloration
any pain
change of muscle tension (twitching, spasm, relaxation)

181
Q

what are the steps of clinical reasoning for palpation?

A

selection
administration
interpretation

182
Q

how does selection and administration of palpation techniques coincide?

A

knowing the structure and appropriate technique for palpation allows for a better understanding of the rate, duration and direction that one should palpate with

183
Q

what body systems is the clinician interpreting during palpation?

A

musculoskeletal
cardiovascular
integumentary
neuromuscular

184
Q

how is/what parts of the musculoskeletal system are assessed in palpation?

A

pain
muscle tension changes
tendon insertions
ligaments

185
Q

how is the cardiovascular system assessed during palpation

A

pulses
edema
capillary refil

186
Q

how does assessment of pulse and edema differ?

A

in pulse assessment never use thumb
in edema assessment always use thumb

187
Q

how is the integumentary system assessed during palpation?

A

temperature (dorsal aspect of hand)
skin turgor (lift/pinch test)

188
Q

how is the neuromuscular system assessed during palpation?

A

sympathetic changes such as sweating, cold or clammy skin
muscle tone (hyper vs hypotonia)

189
Q

what bony landmarks are in the face?

A

temporomandibular joint
angle of jaw

189
Q

what bony landmarks are in the anterior portion of the shoulder/thorax?

A

clavicle
glenohumeral joint
manubrium / sternum
coracoid process

190
Q

what bony landmarks are in the anterior portion of the arm?

A

lateral / medial epicondyle of humerus
head of radius

191
Q

what are the bony landmarks of the anterior portion of the wrist?

A

scaphoid bone
pisiform bone

192
Q

what are the bony landmarks of the posterior head and neck?

A

occiput
vertebra prominens (CV7)

193
Q

what are the bony landmarks of the back?

A

scapula - spine, lateral and vertebral border, inferior angle
spinous processes / transverse processes of thoracic vertebra

194
Q

what are the bony landmarks of the posterior arm

A

styloid process of ulna / radius
metacarpal heads

195
Q

what are the bony landmarks of the anterior portion of lower extremities?

A

illiac crest
asis
greater trochanter of femur
medial / lateral femoral epicondyle
patella
tibial tuberosity
medial / lateral malleolus

196
Q

what are the bony landmarks of the posterior lower extremities?

A

PSIS
Sacrum
Ischial tuberosity
fibular head
calcaneus

197
Q

what is the common term for edema?

A

swelling

198
Q

what is vascular permeability?

A

ability of blood vessels to move fluid in and out

199
Q

what is hydrostatic pressure? if it is higher than osmotic pressure what happens?

A

pressure within a blood vessel
higher - fluid travels out into tissue

200
Q

why would having high hydrostatic pressure be good in certain instances?

A

during injury, an increased hydrostatic pressure allows for fluid / cells to cycle in and out for repair

201
Q

what is osmotic pressure? what happens if osmotic pressure is higher than hydrostatic?

A

pressure of fluid in the tissue
fluid travels from tissue into the blood vessel

202
Q

what is a characteristic of normal tissue?

A

osmotic and hydrostatic pressure are equal

203
Q

when there is tissue injury and swelling, there is __________, ___________, and _______________

A

damage to capillary wall
arterial vasodilaton
increased vascular permeability

204
Q

if capillaries are damaged, is there a(n) increase or decrease in permeability factor?

A

a decrease

205
Q

can permeability return to normal levels if the capillaries are damaged?

A

no, capillary wall must heal before permeability can return to normal

206
Q

what is a “pitting” assessment?

A

test to assess the time it takes for an indention in the skin to rebound to original position?

207
Q

what are the grades to the pitting assessment? what depth and time is associated with each?

A

1 - 2 mm - immediate rebound
2 - 3 to 4 mm - <15 seconds
3 - 5 to 6 mm - 10 to 30 seconds
4 - 8 mm - > 20 seconds

(grade - depth - rebound time)

208
Q

if it takes longer to rebound what does that generally mean about the fluid in the interstitial space? what about if you have to press deeper?

A

Longer – thicker fluid
Deeper – more fluid

209
Q

what options are there for measuring edema?

A

circumferential measurement
figure 8 measurement
volumetric displacement

210
Q

what do you want to avoid when doing circumferential / figure 8 measurements?

A

tightening tape measure on the skin, can cause fluid to move from area of measurement resulting in a less accurate measurement

211
Q

what is a pro associated with figure 8 measurements?

A

better for global swelling in larger regions

212
Q

what areas are figure 8 measurements most common in?

A

wrist / hand
foot / ankle

213
Q

what are the landmarks typically used for figure 8 measurements in the foot/ankle?

A

lateral and medial malleolus
navicular bone and 5th metatarsal

214
Q

what are the landmarks typically used for figure 8 measurements in the wrist/hand?

A

ulnar and radial styloid process
2nd and 5th metacarpals

215
Q

what is the average difference between dominant and nondominant sides during volumetric displacement?

A

10 mL

216
Q

what milliliter difference is indicative of swelling?

A

30-50 mL

217
Q

how is edema documented?

A

side of the body
subjective rating (temp,color, size)
objective rating (pitting grade)
measurements (fig 8, circumferential, vol displacement)

218
Q
A

PT Examination (4 decks)

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