Exam 1

Question 1

Whats on a chart review?

Answer 1

onset (date/reason)
current condition
comorbitites
home/living status
why patient needs pt
precuations
medications
overall tolerance to activity

Question 2

Vital signs: normal values, what they mean, abnormal vitals

Answer 2

Normal:
Pulse= 60-100 bpm
respiratory rate= 12-20 breaths per minute
Blood presure= 120/80 mmhg
temp= 98.6 or 37 C
Pain and pulse oximetry

Abormal:
brachycardia= less than 60 bpm
tachycardia= greater than 100 bpm
bradynpnea= less than 12 breaths per minute
tachypnea= greater than 20 breaths per minute
hypertension= 140/90 mm or higher
hypotension= lesser than 90/60 mmhg

Question 3

Pain medications
include examples, indication,

Answer 3

Opioids (Narcotics)

Examples: Oxycodone, Percocet, Dilaudid, Fentanyl, Morphine, Codeine
Indication: Severe pain management, often used post-surgery.

Non-Opioids (Over-the-Counter Medications)
Examples: Acetaminophen (Tylenol), NSAIDs (Aspirin, Naproxen, Ibuprofen, Celecoxib)
Indication: Pain relief, fever reduction, anti-inflammatory.

Question 4

High blood pressure medication
include examples, indication,

Answer 4

ACE Inhibitors

Examples: Benazepril, Lisinopril
Indication: Prevents blood vessel constriction by inhibiting angiotensin II, used to lower blood pressure.

Diuretics
Examples: Lasix, Bumex, Lozol
Indication: Reduces blood volume, helping to lower blood pressure.

Beta-Blockers
Examples: Atenolol, Nadolol, Propranolol
Indication: Lowers blood pressure by reducing heart rate and force of contraction.

Question 5

Anti-inflammatory medications
include examples, indications,

Answer 5

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Examples: Aspirin, Ibuprofen, Naproxen Sodium, Diclofenac, Celecoxib
Indication: Treats pain, fever, and inflammation.
.

Corticosteroids
Examples: Prednisone, Cortisone, Triamcinolone, Dexamethasone
Indication: Strong anti-inflammatory agents used for conditions like arthritis, lupus, and certain cancers.

Question 6

Cholestrol-lowering medications
examples and indications

Answer 6

Examples: Lipitor, Crestor, Zocor
Indication: Reduce cholesterol levels to lower the risk of heart attack or stroke.

Question 7

Blood thinners
Examples and indications

Answer 7

Anticoagulants

Examples: Eliquis, Heparin, Warfarin (Coumadin)
Indication: Purpose is to reduce
coagulation of blood and
reduce clotting. Prevents blood clots in patients at risk of stroke or heart attack.

Antiplatelet Medications
Examples: Aspirin, Plavix
Purpose is to keep
platelets from sticking to
each other and to walls of
blood vessels
often prescribed to
decrease risk of future
blood clots. Not as strong
as anti-coagulants

Question 8

Psychotropic drugs
examples and indications

Answer 8

Examples: Antidepressants, anti-anxiety meds, mood stabilizers, antipsychotics, ADHD meds
Indication: Alters mood, behavior, or perception, used in various mental health conditions.

Question 9

Reflexes their spinal levels and how to document

Answer 9

Spinal Levels:
Achilles Reflex: S1
Patellar Reflex: L2-L4
Biceps Reflex: C5-C6
Triceps Reflex: C6-c7
brachioradialis-c5,c6

How to Document:
0: No response
1+: Diminished
2+: Normal
3+: Brisker than average
4+: Hyperactive with clonus

Question 10

Primitive Reflexes (babinski and hoffman)

Answer 10

Babinski Reflex: Stroke the plantar surface of the foot. A positive test indicates upper motor neuron involvement and is signified by the extension of the big toe and fanning of the other toes.

Hoffman’s Reflex: Flick the nail of the middle finger, and a positive response is the flexion of the thumb and index finger, indicating upper motor neuron dysfunction (e.g., cervical myelopathy).

Question 11

Goniometry: How to Do It, Landmarks for Shoulder Motions, Normal Ranges

Answer 11

Shoulder Flexion:

Normal Range: 0° to 180°
Landmarks:
Fulcrum: Lateral aspect of the greater tubercle of the humerus.
Stationary Arm: Parallel to the midaxillary line of the thorax.
Moving Arm: Aligned with the lateral midline of the humerus, using the lateral epicondyle as a reference.

Shoulder Extension:
Normal Range: 0° to 60°
Landmarks:
Fulcrum: Lateral aspect of the greater tubercle of the humerus.
Stationary Arm: Parallel to the midaxillary line of the thorax.
Moving Arm: Aligned with the lateral midline of the humerus, using the lateral epicondyle as a reference.

Shoulder Abduction:
Normal Range: 0° to 180°
Landmarks:
Fulcrum: Anterior aspect of the acromion process.
Stationary Arm: Parallel to the midline of the sternum.
Moving Arm: Aligned with the anterior midline of the humerus, using the medial epicondyle as a reference.

Shoulder Adduction:
Normal Range: 0° (return to neutral after abduction; typically not measured beyond neutral).
Landmarks:
Same as abduction.

Shoulder Internal Rotation:
Normal Range: 0° to 70°
Landmarks:
Fulcrum: Olecranon process of the ulna.
Stationary Arm: Perpendicular to the floor.
Moving Arm: Aligned with the ulna, using the ulnar styloid process as a reference.

Shoulder External Rotation:
Normal Range: 0° to 90°
Landmarks:
Fulcrum: Olecranon process of the ulna.
Stationary Arm: Perpendicular to the floor.
Moving Arm: Aligned with the ulna, using the ulnar styloid process as a refere

Question 12

Capsular Pattern of Shoulder – What Does It Mean?

Answer 12

Capsular Pattern: A specific, predictable pattern of motion loss that indicates a problem with the joint capsule.
For the Shoulder:
The capsular pattern is loss of external rotation > abduction > internal rotation.
What it means: The presence of this pattern indicates that the joint capsule is the source of limitation, often seen in conditions such as arthritis, capsular inflammation, capsular tightness, intra-articular surface.

Anterior portion (limits external rotation)
Posterior portion (limits internal rotation)
Inferior portion (limits abduction)

Question 13

Reliability – Inter-rater and Intra-rater

Answer 13

Inter-rater Reliability: Refers to the consistency between different examiners.

Margin of Error: Generally 5-6 degrees, due to variability in technique and examiner skill.
Intra-rater Reliability: Refers to the consistency of measurements when taken by the same examiner.

Margin of Error: Typically smaller (3-4 degrees), since the same examiner is repeating the measurement.

Question 14

MMT: Grading Scales, How to Do It, Limitations of It

Answer 14

5 (Normal): Full ROM against gravity with maximum resistance.
4+: Holds position against
moderate to strong pressure
4 (Go Full ROM against gravity with moderate resistance.
4- Holds position
against slight to moderate pressure
3+: Holds test position against slight pressure
3 (Fair): Full ROM against gravity with no resistance.
3-: Gradual release from test position in against-gravity position. (In
against-gravity position, moves through more than 50% ROM)
2+: Moves through partial ROM
against gravity (first 50%). In gravity
eliminated position, moves to end range and
holds against pressure
2 (Poor): Full ROM in gravity-eliminated position.
2-: Moves through partial ROM
in gravity minimized position
1 (Trace): Palpable contraction, no movement.
0 (Zero): No contraction observed.

Limitations of MMT:
Subjective: The amount of resistance applied can vary between testers, making it somewhat subjective.
Not Sensitive to Small Changes: MMT detects gross changes in muscle strength but is not sensitive enough to detect subtle differences.
Not Suitable for CNS Disorders: In patients with central nervous system disorders, MMT may not be able to accurately reflect functional strength.

Question 15

Other Types of Muscle Testing

Answer 15

Isokinetic Muscle Testing

Measures muscle strength at different velocities. Provides a detailed analysis of muscle strength throughout a joint’s full range of motion

Handheld Dynamometry
A portable device used to measure muscle force output.

Question 16

Norms for Isokinetic Tests (Quad/Hamstring Ratio)

Answer 16

Quad/Hamstring Ratio:
The quadriceps to hamstring strength ratio should generally be 3:2 (or 60% hamstring strength to quadriceps strength).
Clinical Significance: This ratio is used to assess muscle balance around the knee, which is important for injury prevention (e.g., ACL injuries).

Question 17

Advantages and Disadvantages of Isokinetic Testing

Answer 17

Advantages:

Allows us to test at different velocities
Provides quantifiable measures of force
output (to the nearest foot/lb)
Provides graphic display of force output
during entire contraction
Allows us to measure force of concentric,
eccentric and isometric muscle contractions
Can also test power and endurance

Disadvantages:
expensive
Time consuming
Not all joints can be tested
Testers need to be trained
Does not always relate to function

Question 18

Primary Impairments vs Secondary Impairments

Answer 18

Primary Impairments: Direct result of pathology (e.g., muscle weakness due to stroke).
Secondary Impairments: Develop as a consequence of the primary impairment (e.g., decreased endurance or joint contracture due to immobility from weakness).

Question 19

Convex/Concave Rule

Answer 19

If a concave surface moves on a convex surface, the roll and glide occur in the same direction.
If a convex surface moves on a concave surface, the roll occurs in the same direction as the bone movement, but the glide occurs in the opposite direction

Question 20

Nagi & ICF Models

Answer 20

Nagi Model:

Pathology → Impairment(consequence of pathology, like reduced rom, decreases balance, strength endurance. → Functional Limitation (ability to perform a task )→ Disability.
Describes the progression from a medical condition (pathology) to a disability affecting daily life.
ICF Model:

The International Classification of Functioning, Disability, and Health (ICF) emphasizes functioning rather than just disability.
It includes:
Health Condition: The disease or disorder.
Body Function/Structure: Impairments such as limited ROM or strength.
Activity: Limitations in performing tasks (e.g., walking, dressing).
Participation: Restrictions in societal roles (e.g., work, community participation)

Question 21

Passive and Active insuffiency?

Answer 21

Passive Insufficiency

Passive Insufficiency: Occurs when a muscle cannot stretch enough across two joints to allow for full ROM at both joints.
Example: The hamstrings are stretched when the hip is flexed and the knee is extended, limiting the ROM at the hip or knee.

Active Insufficiency: Occurs when a muscle is shortened across two joints and cannot generate maximal force.
Example: The hamstrings are actively insufficient when attempting to contract while the hip is extended and the knee is flexed.

Question 22

How to Test the Length of a Muscle

Answer 22

Muscle Length Testing: Stretch the muscle across both joints it crosses and measure the length at one of those joints.
Example: For hamstrings, extend the hip and flex the knee to measure the muscle length.

Question 23

Capsular Patterns – What It Means if the Patient Is in One

Answer 23

Capsular Pattern: A pattern of motion restriction that is characteristic of a joint capsule issue (e.g., arthritis or capsulitis).
Shoulder: External rotation is most restricted, followed by abduction, and then internal rotation.

Question 24

AROM vs PROM – What Are the Differences?

Answer 24

Active Range of Motion (AROM): Movement performed by the patient voluntarily.
Significance: AROM provides information about strength, coordination, and willingness to move.

Passive Range of Motion (PROM): Movement performed by the therapist, with no assistance from the patient.
Significance: PROM provides information about joint integrity and flexibility, but not about muscle strength.

Question 25

Documentation for ROM (Plus and Minus)

Answer 25

ROM Documentation: If the joint does not start at 0° or reaches a limitation, this should be documented using “+” or “-“ signs.
Example: If a patient lacks 20° of knee extension, document as -20° extension.

Question 26

End Feels – Normal and Abnormal

Answer 26

Normal End Feels:
Soft: Due to soft tissue approximation (e.g., elbow flexion).
Firm: Muscular stretch, capsular or ligamentous tension (e.g., shoulder abduction).
Hard: Bone contacting bone (e.g., elbow extension).

Abnormal End Feels:
Soft: Occurs when soft tissue edema is present (e.g., in a swollen joint).
Firm: Occurs when there is capsular or ligamentous shortening (e.g., in frozen shoulder).
Hard: Occurs in joints where a bony block is present (e.g., bone spurs).
Empty: Occurs when pain limits the motion, and the end range is not reached

Question 27

Posture – Normal Alignment

Answer 27

Ideal Posture:

Sagittal View:

The plumb line passes through:
The earlobe, shoulder joint, lumbar vertebrae, slightly anterior to the axis of the hip joint, and anterior to the lateral malleolus.
The pelvis should be in a slight anterior tilt.

Posterior View:
The plumb line passes through the midline of the pelvis, trunk, and head.
The scapulae should be 4 inches apart and level.
The calcaneus should be vertical.

Question 28

Upper Cross Syndrome, Lower Cross Syndrome

Answer 28

Upper Cross Syndrome:

Tight: Upper trapezius, levator scapula, pectorals.
Weak: Deep neck flexors, rhomboids, serratus anterior
Posture: Forward head posture, rounded shoulders.

Lower Cross Syndrome:
Tight: Hip flexors, lumbar extensors.
Weak: Glutes, abdominals.
Posture: Anterior pelvic tilt, increased lumbar lordosis.

Question 29

Scapular and Pelvic Muscle Weakness/Tightness and How They Affect Posture

Answer 29

Scapular Weakness/Tightness:

Weak scapular stabilizers (e.g., lower traps, rhomboids) lead to scapular winging and poor shoulder alignment.
Tight upper trapezius can lead to elevated shoulders and tension headaches.

Pelvic Muscle Weakness/Tightness:
Weak glutes and abdominals contribute to an anterior pelvic tilt, causing increased lumbar lordosis and potential low back pain.
Tight hip flexors also contribute to anterior pelvic tilt.

Question 30

Stretch Weakness and Adaptive Shortening

Answer 30

Stretch Weakness: Occurs when muscles are kept in an elongated position over time, leading to weakness.
Example: Abdominals in an individual with anterior pelvic tilt.

Adaptive Shortening: Muscles that remain in a shortened position over time become tight and lose flexibility.
Example: Hip flexors in someone with a sedentary lifestyle.

Question 31

Medial Collapse – What Causes It?

Answer 31

Medial Collapse: A condition where the knee falls inward during weight-bearing activities.
Causes:
Weakness in the hip abductors (gluteus medius) and external rotators.
Over-reliance on the tensor fascia lata (TFL) and iliotibial band to stabilize the hip.

Question 32

Foot Function Index and How It Is Scored

Answer 32

Foot Function Index (FFI): This tool measures the impact of foot pathology on function in terms of pain, disability, and activity restriction.