Final Frontier - everything

Question 1

Convex/concave rule: Convex = what arthrokinematics

Answer 1

Convex = Roll and Glide in OPPOSITE directions

Question 2

Convex/concave rule: Concave = what arthrokinematics

Answer 2

Concave = Roll and Glide in SAME direction

Question 3

what are the 3 mvmts needed for ankle supination?

Answer 3

“Sup IPAD”
SUPination = Inversion, Plantar flexion, ADDuction

Question 4

what are the 3 mvmts needed for ankle pronation?

Answer 4

Pronation = Eversion, DF, ABDuction
(opposite of SUP IPAD)

Question 5

What mobilization will you use with Adhesive Capsulitis/Frozen Shoulder?

Answer 5

mobilizations in directions that improve mvmts in CAPSULAR pattern as it will have limitations in a capsular pattern of the shoulder –> ER > flex/ABD> IR = shoulder mobilization towards Posterior - inferior

Question 6

What mobilization grades should you use to address PAIN?

Answer 6

grade I and II, out of resistance; ANY AMPLITUDE (Large or small)

Question 7

What mobilizations should you use to improve ROM?

Answer 7

Grade III and IV, INto resistance; ANY amplitude

Question 8

What is weak and tight in lower cross syndrome?

Answer 8

weak glutes and abdominals, tight lumbar extensors and hip flexors

Question 9

What should you do if you see trendelenburg gait? (intervention)
What other gait deviation will they have?

Answer 9

Trendelenburg = opposite hip affected; Lt hip trendelenburg = Rt hip ABD weakness –> Tx: Rt hip ABD strengthening

ipsilateral trunk lean in stance

Question 10

What are general post surgical procedures?

Answer 10

Rule of 6’s:
-first 6 weeks = protective phase
-next 6 weeks = moderate (resistance)
-next 6 months = back to ADLs

Question 11

What is weak and tight in upper cross syndrome?

Answer 11

weak deep cervical flexors and scap stabilizers (lowe trap + serratus ant);

tight upper trap, levator, SCM, pecs and upper cervical extensors

Question 12

How do you lock the knee during a sit-to-stand? (screw-home mech in CKC)
what happens when sitting back down (flex in CKC)?

Answer 12

CLOSED kinetic chain
K. extension: femur -> IR
K. flexion: femur -> ER

Question 13

How do you lock the knee during a LAQ? (screw-home mech in OKC)
what happens when flexing the knee back down?

Answer 13

OPEN kinetic chain
K. extension: tibia -> ER
K. flexion: tibia -> IR

Question 14

what muscles do you have to strengthen to complete full upward scapular rotation?

what mvmts require upward scapular rotation?

Answer 14

upward rotation:
-upper/llower trap and serratus anterior

mvmts: shoulder Flex/ABD

Question 15

what muscles do you have to strengthen to complete full downward scapular rotation?

what mvmts require downward scapular rotation?

Answer 15

Downward rotation:
-Pec minor, rhomboids, levator scap, latissimus dorsi

Mvmts: shoulder Ext/ADD/IR

Question 16

What is active insufficiency?

Answer 16

active = SHORTEN, inability for 2-JOINT muscle to SHORTEN simultaneously at BOTH joints

Question 17

What is Passive insufficiency?

Answer 17

Passive = LENGTHEN, inability for 2-JOINT muscle to LENGTHEN simultanously at both joints

Question 18

What is a normal response to exercise? (Vitals)

Answer 18

HR increases
SBP increases
DBP goes up/down by 10
SpO2 = same
RR increases

Question 19

what is an ABNORMAL response to exercise? (vitals)

Answer 19

HR: abnormal increase/decrease

any changes in heart rhythm

SBP: >200 OR decrease >15 mmHg

DBP: > 110

SPO2: decrease

RR: decreases

Question 20

What are the stages of hypertension?

Answer 20

Normal: <120/80
Elevated: 120-129/80-89
Stage I: 130-139/80-89
Stage II: 140+/90+
hypertensive crisis: >180/>120 (emergency!)

Question 21

What does the sympathetic nervous system do to the heart?

Answer 21

increase HR through SA node

Question 22

What does the parasympathetic nervous system do to the heart?

Answer 22

decreases HR through SA node

Question 23

What are the by products of anaerobic exercise?

Answer 23

Lactic acid

Question 24

What changes occur INITIALLY during high altitudes to vitals?

Answer 24

HR increases
BP increases
Cardiac Output increases
Stroke Volume No change

Initially = acute hypoxia = ↑ CO -> ↑ HR, so that SV can stay the same

Question 25

What changes occur after a period in high altitudes with vitals?

Answer 25

HR increases BP drops down back to normal cardiac output drops down to normal stroke volume decreases Acclimatization = X acute hypoxia = ↑HR  ↓ CO , SV ↓

Question 26

What happens to your vitals once you're used to training at high altitudes when coing back to lower altitudes?

Answer 26

HR decreases RR decreases BP decreases CO increase SV increase CO ↑, SV ↑ (because now they have a lot of oxygen available)

Question 27

What happens to vitals underwater/aquatic therapy?

Answer 27

HR decreases BP decreases vital capacity decreases (less lung expansion from pressure) work of breathing increases stroke volume increases cardiac output increases SV increases bc CO increases which means it’s pumping out more blood per pump

Question 28

where do you auscultate for heart valves?

Answer 28

All - Aortic, Rt 2nd IC space P - pulmonary, Lt 2nd IC T's - Tricuspid - 4th IC Move - Mitral - 5th IC lateral to mid clavicular line Erbs point - 3rd IC space, can hear both

Question 29

What is S1 heart sound, which valves are closed, and what is happening in the heart?

Answer 29

"Lub" Ventricles contract (systole)- AV valves close (tricuspid and mitral valves)

Question 30

What is S2 heart sound, which valves are closed, and what is happening in the heart?

Answer 30

"Dub" Ventricles relax (diastole) - aortic and pulmonary valves close

Question 31

What is an S3 heart sound and what is it indicative of?

Answer 31

S3 is after S1, S2 "SLOSH-ing IN" IN = S3 indicative of CHF

Question 32

What is an S4 heart sound and what is it indicative of?

Answer 32

S4 is before S1, S2 " A-STIFF wall" indicative of MI

Question 33

What happens during heart valve stenosis? What happens during systolic and diastolic stenosis?

Answer 33

stenosis = valve that is closed, should be open systolic stenosis: systolic = ventricles contract = aortic and pulm valves should be open but are not diastolic stenosis: diastole = ventricles relax/fill = mitral and tricuspid should be open but are not

Question 34

What happens during heart valve regurgitation? What happens during systolic and diastolic regurgitation?

Answer 34

regurgitation = valves are open when they should be closed systolic regurgitation: ventricles contract = aortic and pulm are open; mitral and tricuspid SHOULD be closed diastolic regurgitation: diastole = ventricle relaxation/ filling = mitral and tricuspid are open; aortic and pulmonary SHOULD be closed

Question 35

What does the frontal lobe do?

Answer 35

Frontal lobe = in the front "A CEO" Apraxia/Aphasia w/ injury Controls, plans, programs Emotional/behavior, personality Olfaction

Question 36

What does the temporal lobe do?

Answer 36

temporal lobes = touch temporal lobes -> ears hearing language and comprehension injury = Aphasia: Wernicke's

Question 37

What does the Parietal lobe do?

Answer 37

Parietal = Perception, sensory perception graphesthesia, tactile, sharp injury= sensory loss, unilateral neglect (unable to perceive sensation)

Question 38

What does the Occipital lobe do?

Answer 38

Occipital = O-SEE-pital See = vision injury = visual field deficits visual agnosia = can't ID what thing is Prosopagnosia = can't name/ID people's faces

Question 39

What is Broca's aphasia? Where is it located? Describe impairment? Treatment?

Answer 39

BROca's --> BROken speech slow, hesitant speech have trouble EXPRESSING themselves with words --> EXpressive aphasia or NON-fluent aphasia "BEAN" = Broca’s Expressive Aphasia Non-fluent located in Frontal lobe - Left tx: have trouble speaking --> NO open ended questions, yes/no/simple questions only.

Question 40

What is Wernicke's aphasia? Where is it located? Describe impairment? Treatment?

Answer 40

Wernickes = lang comprehension Wernicke aphasia = not understanding what was said/asked RECEPTIVE aphasia -> have trouble RECEIVING information said Can speak in sentences --> fluent aphasia WORD SALAD - wowsome Tx: have trouble understanding words --> use demonstrations, gestures, visual cues Temporal lobe - Left

Question 41

What is conduction/disconnection aphasia?

Answer 41

can understand language but has difficulty with language output. impaired association b/w Wenicke's and Broca's

Question 42

What is global aphasia?

Answer 42

"total aphasia" cannot speak fluently or understand language Affects Wernicke’s, Broca’s, Cortical and subcortical areas

Question 43

What is the location of all 12 CN pairs?

Answer 43

CE MI PONS MEDU 1,2 3,4 5,6,7,8 9,10,11,12 cerebrum midbrain pons medulla

Question 44

what is CN 1? located? type? Lesion?

Answer 44

CN 1: olfactory N. Location: frontal lobe of cerebrum Type: sensory Lesion: anosmia, loss of sense of smell

Question 45

what is CN 2? function? located? type? Lesion?

Answer 45

CN 2: optic N function: vision - - visual acuity (clarity), color, peripheral vision - pupillary reflex (afferent) location: occipital lobe of cerebrum type: sensory Lesion: blindness, myopia/presbyopia, hemianopsia

Question 46

what is CN 3? function? located? type? Lesion?

Answer 46

CN 3: oculomotor function: moves eye, opens eyelids, constric pupil -pupillary reflex (Efferent) Location: midbrain type: motor Lesion: ptosis (eyelid drooping) -dilated pupils -lateral strabismus (nothing can pull eye IN --> ABDucens pulls it laterally)

Question 47

what is CN 4? function? located? type?

Answer 47

CN 4: Trochlear N. Fx: moves eye down + in -"SO4" superior oblique innervated by CN 4 Located: midbrain type: motor

Question 48

what is CN 5? function? located? type? Lesion?

Answer 48

CN 5: trigeminal N. Fx: - sensation of face through opthalmic and maxillary branch -> corneal reflex (afferent - touched eyeball) -sensation to 2/3 Ant Tongue -close jaw/M. of mastication --> temporalis, masseter, and Med/Lat pterygoids located: pons type: mixed Lesion: -paresthesia/numbness in face -inability to chew

Question 49

what is CN 6? function? located? type? Lesion?

Answer 49

CN 6: Abducens Fx: ABDuces eye ball -"LR6" -> lateral rectus supplied by CN 6 location: pons (CE MB PONS MEDU) type: motor lesion: medial strabismus

Question 50

what is CN 7? function? located? type? Lesion?

Answer 50

CN 7: facial fx: motor muscles of face and closing eyelids (EXCEPT M. of mastication -> CN 5) "restaurant opens at 3' and closes at 7' " --> eyelids open w/ CN 3 and close w/ CN 7 -Corneal reflex (Efferent) - touched eyeball --> closes eyelids Sensory: taste to ANT tongue type: mixed location: pons Lesion: Bell's Palsy

Question 51

What supplies innervation to the tongue?

Answer 51

Anterior 2/3 = 2 CN's -S5 = sensation by CN5 -T7 = taste by CN7 Posterior 1/3 = 1 CN backwards P = 9 (P for POSTerior tongue) -sensation and taste by CN 9 motor fx: CN 12 - hypoglossal

Question 52

what is CN 9? function? located? type? Lesion?

Answer 52

CN 9: glossopharyngeal Fx: -sensory: "P = 9" post 1/3rd of tongue - gag reflex - uvula sensation (Afferent) -motor: swallowing location: medulla type: mixed lesion: dysphagia -diff tasting post 1/3 of tongue -NO gag reflex (if you don't have sensation, cannot have motor output CN10) uvula = CN 9 sen + CN 10 motor

Question 53

what is CN 10? function? located? type? Lesion?

Answer 53

CN 10: Vagus N. Fx: - sensation of pharynx and larynx motor: gag reflex (efferent) type: mixed location: medulla Lesion: - no gag reflex -uvula deviation to OPPOSITE SIDE --> uvula deviation Rt = Lt CN 10 lesion uvula = CN 9 sen + CN 10 motor

Question 54

what is CN 11? function? located? type? Lesion?

Answer 54

CN 11: acessory N. Fx: innervation to upper trap and SCM type: motor Location: medulla Lesion: atrophy and weakness to upper trap and SCM

Question 55

what is CN 12? function? located? type? Lesion?

Answer 55

CN 12: hypoglossal function: tongue mvmt location: medulla type: motor lesion: tongue will not move "lick your lesion" -> Rt CN 12 lesion = tongue STAYS Rt

Question 56

what is CN 8? function? located? type? Lesion?

Answer 56

CN 8: vestibulocochlear fx: vestibulo = balance cochlear = hearing type: sensory location: medulla lesion: hearing loss either conductive: plugging your ears (outer passage) OR sensorineural: inner ear

Question 57

how can you tell when you have conductive hearing loss using Rinne and Weber test for CN 8?

Answer 57

Rinne test: "Rinne behind Pinna" (mastoid process) conductive hearing loss = can hear bone conduction LONGER than ear/air conduction conductive = BC > AC, ex. 10 sec > 5 sec Weber's test to test for SIDE: "CANS" -Conductive HL -> Louder in Affected ear -Sensorineural -> louder in Normal Ear

Question 58

how can you tell when you have sensorineural hearing loss using Rinne and Weber test for CN 8?

Answer 58

Rinne test: "Rinne behind Pinna" (mastoid process) Sensorineural hearing loss = can hear air conduction LONGER than bone conduction (can be normal or SN) AC > BC = -normal OR -Sensorineural HL ex. bone = 5 sec, air 10 sec Weber's test to test for SIDE: "CANS" -Conductive HL -> Louder in Affected ear -Sensorineural -> louder in Normal Ear IF can hear equally on both sides during Webers = Normal hearing, NO HL

Question 59

If shine was lit on LEFT eye, which CN is damaged if BOTH eyes constrict (#1)?

Answer 59

None, both pupils constricting = Normal response

Question 60

If shine was lit on LEFT eye, which CN is damaged if RIGHT eye does NOT constricts (#2)?

Answer 60

1 eye constricts - Lt = normal Lt CN 2 (shine lit on Lt) and Lt CN 3 Right eye = CN 2 intact (because other eye constricted = it got the message) -> Rt CN 3 affected

Question 61

If shine was lit on LEFT eye, which CN is damaged if LEFT eye does NOT constricts (#3)?

Answer 61

1 eye constricts - Rt = intact Lt CN 2 (shine lit on Lt) and Rt CN 3 since one eye constricted = Lt CN 2 is intact (side light is shining on) -> Lt CN 3 affected

Question 62

If shine was lit on LEFT eye, which CN is damaged if Neither eye constricts (#4)?

Answer 62

No response = CN 3 could not respond because it did not receive the message/sensation Affected/lesion = Lt CN 2 -> couldn’t sense the light (and light is shining on Lt eye)

Question 63

What is inspiratory reserve volume?

Answer 63

Max air in (voluntary)

Question 64

What is expiratory reserve volume?

Answer 64

max air out (voluntary)

Question 65

What is residual volume?

Answer 65

air stuck in lungs (after max expiration)

Question 66

What is tidal volume?

Answer 66

avg air in/out, relaxed breathing

Question 67

What is functional residual capacity?

Answer 67

"residual" = amt of air in lungs after you breathe out FRC = ERV + RV = expiratory reserve volume + residual volume

Question 68

What is inspiratory capacity?

Answer 68

inspiratory = max air you can breathe IN IC = IRV + TV = inspiratory reserve volume + tidal volume

Question 69

What is vital capacity?

Answer 69

max amt of air exhaled after max inhale VC = tidal vol. + IRV + ERV (≈ 80% total lung capacity)

Question 70

What is total lung capacity?

Answer 70

Max air that can fill lungs TLC = TV + IRV + ERV + RV (all values added)

Question 71

What happens in the lungs with COPD or any other obstructive lung disease? (to lung volumes)

Answer 71

COPD = can't get air out -residual volume increases -functional residual capacity increases -total lung capacity increases

Question 72

What happens to lung volumes with restrictive lung diseases?

Answer 72

restrictive = difficulty getting air IN -everything goes down/decreases

Question 73

List different diagnoses that are classified as obstructive lung diseases?

Answer 73

(anything affecting the lungs) asthma COPD Emphysema Pneumonia Cystic fibrosis Respiratory distress syndrome (infants) ...

Question 74

List different diagnoses that are classified as restrictive lung diseases?

Answer 74

(anything affecting other systems that impair the lungs getting air in) Sarcoidosis idiopathic pulm fibrosis pneumothorax atelactasis MSK alterations: arthritis, AS, scoliosis, arthrogryposis, burns, scleroderma Neuro alterations: CVA, SCI, MS, Parkinsons, M. dystrophy

Question 75

What is FEV1?

Answer 75

Forced expiratory volume 1 = max expiration in 1 sec

Question 76

how do you position a patient for postural drainage?

Answer 76

Bad lung UP

Question 77

What is Stage I from the GOLD standard classification system for COPD ? FEV %? FEV/FVC? s/s?

Answer 77

Stage I (mild COPD): FEV >80% FEV/FVC: <70% or 0.7 s/s: chronic cough + sputum

Question 78

What is Stage II from the GOLD standard classification system for COPD ? FEV %? FEV/FVC? s/s?

Answer 78

Stage II (moderate COPD): FEV 50-80% (-30 from previous stage) FEV/FVC: <70% or 0.7 s/s: chronic cough + sputum + DOE (dyspnea on exertion)

Question 79

What is Stage III from the GOLD standard classification system for COPD ? FEV %? FEV/FVC? s/s?

Answer 79

Stage III (severe COPD): FEV 30-50% (-30 from previous stage) FEV/FVC: <70% or 0.7 s/s: chronic cough + sputum + DOE (dyspnea on exertion) increased fatigue and exacerbations

Question 80

What is Stage IV from the GOLD standard classification system for COPD ? FEV %? FEV/FVC? s/s?

Answer 80

Stage IV (very severe COPD): FEV <30% (-30 from previous stage) FEV/FVC: <70% or 0.7 s/s: chronic cough + sputum + DOE (dyspnea on exertion) + RESPI failure or Rt CHF

Question 81

What are some interventions for COPD or obstructive lung diseases?

Answer 81

Pursed-lip breathing Huffing (stacked huffing) Paced breathing strengthen inspiratory/expiratory M.s

Question 82

Describe the abnormal breath sound wheezing?

Answer 82

high pitched, musical quality mostly during expiration heard in: asthma, COPD

Question 83

Describe the abnormal breath sound stridor?

Answer 83

sounds like a whistle - peanut stuck in airway during both inspiration and exhalation indicative of aspiration/obstruction to airway

Question 84

Describe the abnormal breath sound Crackles/rales?

Answer 84

bubbles/popping sounds during both inhalation/exhalation indicative of fluid in lung like COPD and CHF

Question 85

Describe the abnormal breath sound in pleural rub?

Answer 85

sounds like velcro or sand paper rubbing both inspiration/expiration indicative of pleural inflammation

Question 86

What is bronchophony?

Answer 86

when voice sounds loud and clear during lung auscultation Ex. "99" = abnormal, normal lungs should not sound super clear, it means there is fluid in the lungs (increases vocal resonance)

Question 87

What is Egophony?

Answer 87

EEEEEgophony for hearing an "A" instead of "E" Ask pt to say “E” ->you hear “A” = abnormal, indicative of secretions/fluid

Question 88

What is whispered pectoriloquy?

Answer 88

Pt whispers “1,2,3” and it sounds loud and clear = abnormal, fluid in lungs/infection (increases vocal resonance)

Question 89

What happens during respiratory acidosis? How do you calculate ABG?

Answer 89

Respiratory = something abnormal w/ CO2 respiratory ACIDosis = ↑ in CO2 pH ↓ HCO3 stays the same Calculate: write norms in # line and add given values to that number line Ex. COPD = air stuck, can’t get air out = ↑ CO2 ↑ CO2 = respiratory + ↑ acidic pH = ↓

Question 90

How do you calculate ABG? What happens if pH is NORMAL? What happens if all 3 are ABNORMAL?

Answer 90

Calculate: write norms in # line and add given values to that number line pH normal = compensated NONE normal = partially compensated

Question 91

What happens during respiratory alkalosis? How do you calculate ABG?

Answer 91

Respiratory = CO2 abnormal Alkalosis = decreased CO2 pH = increases (more basic) HCO3 = normal Calculate: write norms in # line and add given values to that number line

Question 92

What happens during metabolic alkalosis? How do you calculate ABG?

Answer 92

metabolic = HCO3 abnormal alkalosis = HCO3 increases pH = increases (more basic) PaCO2 = normal Calculate: write norms in # line and add given values to that number line

Question 93

What happens during metabolic acidosis? How do you calculate ABG?

Answer 93

metabolic = HCO3 abnormal acidosis = HCO3 decreases pH = decreases (more acidic) PaCO2 = normal Calculate: write norms in # line and add given values to that number line

Question 94

What lymph duct does the RUE and face drain to?

Answer 94

RULE = RUE drains to Lymphatic duct everything else drains through THORACIC duct

Question 95

What is the difference b/w primary and secondary lymphedema?

Answer 95

primary = congenital/hereditary Secondary = acquired ex. infection, chronic venus insufficiency, etc.

Question 96

What is stage 0 (latency stage) of lymphedema?

Answer 96

no edema, occasional heaviness tissue = normal

Question 97

What is stage I (reversible stage) of lymphedema?

Answer 97

edema: soft/pitting edema increases in dependent positions (standing, walking) reduces w/ elevation = REVERSIBLE

Question 98

What is stage II (Spontaneously Irreversible) of lymphedema?

Answer 98

Brawny edema (hard, fibrotic changes) Irreversible w/ elevation Stemmers sign positive tissue appears fibrotic, proliferation of adipose tissue

Question 99

What is stage III (lymphostatic elephantiasis) of lymphedema?

Answer 99

brawny, non-pitting edema (hard, fibrotic edema) Stemmers sign positive skin changes: papillomas, hyperkeratosis, deep skin folds infections common

Question 100

What is the pitting edema grade scale?

Answer 100

grade 1: barely visible, immediate rebound grade 2: slight indentation 3-4 mm, lasts < 15 sec grade 3: indentation 5-6mm, lasts <30 sec grade 4: indentation of 8mm+, lasts >30sec

Question 101

What are the characteristics of lymphedema?

Answer 101

-usually unilateral, may be bilateral -infections such as cellulitis are common -no pain -Stemmer's sign = present (positive)

Question 102

What are the characteristics of lipedema?

Answer 102

-bilateral LE's -pain -hands and feet usually spared

Question 103

What is a normal and an abnormal lymph node palpation?

Answer 103

normal: soft, non-tender abnormal: tender, hard/immobile

Question 104

What do you do in rhythmic initiation?

Answer 104

1. guide mvmt 2. active participation of guided mvmt

Question 105

What do you do in rhythmic stabilization/stabilizing reversals?

Answer 105

stabilizing = pertubations

Question 106

What do you do in slow reversals/isotonic reversals/dynamic reversals?

Answer 106

Concentric all the way! (of both agonist and antagonist)

Question 107

What do you do in combination of isotonics?

Answer 107

combination = combination of concentric and eccentric M. action (of ONE M. group)

Question 108

What is Medial scapular winging?

Answer 108

AKA "open book" put hands in front of you and "open a book" indicative of serratus anterior weakness -> long thoracic N. palsy (C5,C6, C7)

Question 109

What is lateral scapular winging?

Answer 109

AKA "sliding door palsy" put hands in front of you and "slide door laterally" indicative of trapezius weakness -> accesory CN 11 palsy

Question 110

What are the norms for ABG values? pH? PaCO2? HCO3?

Answer 110

pH: 7.35-7.45 CO2: 35-45 HCO3: 22-26

Question 111

What are the 3 parts in a Glascow Coma Scale and how is it graded?

Answer 111

Eyes = 4 letters, = 4 pts Verbal = V = 5, 5 pts Motor = 6 pts

Question 112

How do you grade the Eyes portion of the Glascow coma scale?

Answer 112

Eyes = 4 letters, = 4 pts Ben's life: Eyes = Ben as an adult can married Ben wake up? 4 = spontaneous - wakes himself up 3= speech - you tell him to wake up 2= pain stimuli - you throw cold water at him to wake up 1= no response

Question 113

How do you grade the Verbal portion of the Glascow coma scale?

Answer 113

Verbal - V = 5 pts Ben's life = Ben as a baby learning how to talk 1 - no response 2 - babbling, incoprehensible sounds 3 - inappropriate words 4 - sentences, confused conversation 5 - oriented, normal sentences

Question 114

How do you grade the Motor portion of the Glascow coma scale?

Answer 114

Motor = last, 6 pts Ben's life = OLD BEN 6 - Obeys commands 5 - Localizes (pain) 4 - withDraws 3 - Bends, abnormal flexion 2 - Extends, abnormal extension 1 - No response

Question 115

What is spondylosis? age? pain? agg? Ease? SLR? imaging?

Answer 115

spondylosis = OA/DJD age: >50 LBP: unilateral Agg: extension/stand Ease: flexion/sitting SLR: NEGATIVE imaging: X-ray involvement in spine ONLY!

Question 116

What is spinal stenosis? age? pain? agg? Ease? SLR? imaging?

Answer 116

Spinal stenosis --> progression of spondylosis (OA/DJD) age: >60 y/o pain: LBP - bilateral + legs Agg: extension/stand/walk Ease: flexion - sitting, bending SLR: POSITIVE imaging: X-ray = bone -MRI + CT = N. involvement

Question 117

What is spondylolysis (LYSIS)? age? pain? agg? Ease? SLR? imaging?

Answer 117

Spondylolysis = unilateral Fx of pars articularis age: 15-20 y/o pain: LBP - local Agg: extension/stand/walk & flexion during standing or lifting wt Ease: bend -> seated (off loaded, X wt bearing) SLR: negative imaging: X-ray, OBLIQUE view --> scotty dog = +

Question 118

What is spondylolisthesis? age? pain? agg? Ease? SLR? imaging?

Answer 118

Sponylolisthesis = bilat Fx of pars articularis -> Ant dislocation of VB (UNSTABLE) age: 20, can worsen w/ age pain: LBP - local Agg: extension/stand & flexing during standing or lifting wt Ease: bend -> seated (off loaded, X wt bearing) SLR: negative ( no N. ) imaging: X-ray - LATERAL view

Question 119

What is disc herniation? age? pain? agg? Ease? SLR? imaging?

Answer 119

disc herniation = nucleus pulposus age: 30-50 pain: LBP unilateral + leg (N. involvement) Agg: flexion, sitting, bending, ASCENDING stairs Ease: extension, stand, DESCENDING stairs SLR: POSITIVE imaging: MRI + CT

Question 120

What is anterior cord syndrome in SCI?

Answer 120

Anterior cord injury MOI: hyper-FLEXION injury s/s: loss of pain + temp s/s: loss of motor bilaterally ( lateral spinothalamic tract)

Question 121

What is Central cord syndrome in SCI?

Answer 121

Central cord syndrome MOI: hyper-EXTENSION s/s: loss of motor in neck and UE's bilat (both ascending and descending tracts medially = neck and UE)

Question 122

What is posterior cord syndrome in SCI?

Answer 122

posterior cord syndrome = posterior cord injury MOI: compression injury ex. tumors, OA/DJD of C spine s/s: loss of propioception (dorsal columns) = ataxia MOTOR fx preserved!

Question 123

What is Brown-Sequard syndrome in SCI?

Answer 123

brown-sequard = injury to half of SCI MOI: hemisection injury - bullet, stab-wound, etc. s/s: - IPSILAT: loss of motor and propioception -CONTRALAT: loss of pain and temp

Question 124

What are the norms for ABI? (ankle-brachial index)

Answer 124

ABI = ankle BP/brachial BP = claudication or PAD severity abnormal high = >1.4, false elevation, noncompliant arteries, vessel calcification normal = 1.0 mild = 0.7-0.9 mod = 0.5 - 0.7 severe = < 0.5 = MEDICAL EMERGENCY!! severe arterial disease, risk for limb ischemia, gangrene, ulcers, pain at REST

Question 125

What are the 3 categories for the Rancho Los Amigos levels of consciousness and what are the levels of each category?

Answer 125

RLA -> Response, L -> Confused, Appropriate Lvls 1-3 = response Lvls 4-6 = confused Lvls 7-8 = appropriate

Question 126

List all 8 of Rancho los amigos levels of consiousness.

Answer 126

RLA -> Response, L -> Confused, Appropriate Lvls 1-3 = response 1 = No response 2 = generalized response 3 = localized response Lvls 4-6 = confused 4 = confused + agitated 5 = confused + inappropriate 6 = confused appropriate Lvls 7-8 = appropriate 7 = automatic appropriate 8 = purposeful appropriate

Question 127

how to facilitate muscle tone? (how to increase M. tone, ex. flaccid)

Answer 127

-approximation -manual resistance -quick icing -light touch -tapping -high frequency vibration -quick stretch -fast spinning

Question 128

how to inhibit muscle tone? (how to decrease M. tone, ex. spasticity)

Answer 128

-deep pressure -prolonged stretch -neutral warm or prolonged cold -maintained touch -low frequency vibration -slow stroking -slow rocking

Question 129

What does the modicied Ashworth scale measure and what are the values?

Answer 129

Modified Ashworths = spasticity ONLY (CANNOT measure riggidity or flaccidity or synnergies) 0 = normal 1 = resistance at END-range 1+ = resistance at last 1/2 of end-range 2 = resistance through MOST range 3 = passive mvmt difficult 4 = RIGID

Question 130

What is the norms for the peripheral pulse grading scale and when is it used for?

Answer 130

used for severity of PAD and claudication 0 = absent pulse 1+ = barely perceptible 2+ = easily palpable/NORMAL 3+ = full pulse/ increased strength 4+ = bounding pulse

Question 131

What are the 5 P's s/s for intermittent claudication?

Answer 131

Pain (at rest, worse at night) pallor pulselessness paresthesia: n/t paralysis usually in thigh, but can be in hip and glutes

Question 132

what are the cardinal sx of heart disease?

Answer 132

-pain: chest, neck, jaw, arm, --indigestion -palpitations -dyspnes/SOB -dizziness -cardiac syncope (fainting/OH) -fatigue -cough -diaphoresis (sweating) -cyanosis -edema

Question 133

what is the difference b/w primary and secondary HTN?

Answer 133

primary HTN = idiopathic; obesity, family hx, diet, etc secondary HTN = acquired as a result from other medical condition - "secondary" to medical cond. ; thyroid, kidney dx, pregnancy, etc.

Question 134

what are the s/s of orthostatic hypothension (OH)?

Answer 134

-BP drop upon changing positions -HR increases (to compensate) -lt headed, dizziness, fainting -pallor + diaphoresis -weakness action: "if head is pale -> LIFT the tail" = return to supine

Question 135

What are improtant labs for myocardial infarction or cardiac disease?

Answer 135

-Troponin = GOLD standard -Cratine Kinase -Total cholesterol -LDL -HDL -triglycerides -high sensitivity C-reactive protein (CRP)

Question 136

What is the norm for troponin levels for heart disease?

Answer 136

troponin is: Heart M. protein, heart death(infarct -> heart releases proteins (and potassium in cell = high potassium/hyperkalemia) Normal = 0.0-0.5 MI = > 0.5

Question 137

What is the norm for creatine kinase (CK-MB) for MI?

Answer 137

Creatine kinase is also a protein in muscle cells, can be released with injury to skeletal or cardiac muscle important in rhabdomyolysis and MI CK-MB: >3 = MI CK-MB: < 3 = skeletal M. damage

Question 138

what are the lab values for total cholesterol?

Answer 138

Normal = < 200 mg/dL High = > 200 = higher risk for heart dx

Question 139

What are the lab values for LDL and what does it mean?

Answer 139

Normal = < 130 higher = high plaque buildup IF high risk for MI, desired = < 70 LDL = LOW is BETTER for heart

Question 140

What are the lab values for HDL and what does it mean?

Answer 140

HDL = High quality!! = good for heart high = better, keeps arteries open Desirable = > 50

Question 141

What are the lab values for triglycerides and what does it mean?

Answer 141

high = high risk of heart dx Normal = < 150

Question 142

What are the lab values for High sensitivity C-reactive protein (CRP) and what does it mean?

Answer 142

Identifies risk for heart dx before s/s High risk = > 2.0

Question 143

What are the norms for HR?

Answer 143

Normal: 60-110 bpm High: > 130 bpm Low: < 60bpm

Question 144

What are the norms for BP?

Answer 144

Normal: < 120/80 Too High: >180/110 Too low: <90/60

Question 145

What are the norms for SPO2?

Answer 145

Normal: 95-100% too low: < 90%

Question 146

What are the norms for RR?

Answer 146

Normal: 12-20 breaths/min too high: > 25 too low: < 12

Question 147

What are the lab value norms for RBCs?

Answer 147

Normal RBC (mill/uL): 4-6

Question 148

What are the lab value norms for WBCs?

Answer 148

WBCs in (Th/uL): Normal: 5-10 OR 5,000-10,000 Too high: > 11 or 11,000 = leukocytosis (infection, chronic inflamm., surgery/trauma, allergy) Too low: < 4 or 4,000 Leukopenia: viral, chemo, anemia, autoimmune Lower: < 1.5 or 1,500 Neutropenia: stem cell dx, bacterial, radiation = NEUTROPENIC PRECAUTIONS!

Question 149

What are the lab value norms for platelets?

Answer 149

Platelets = (Th/uL) Normal = 140-400 OR 140,000 - 400,000 too high: > 450 or 450,000 thrombocytosis: inflammation, stress, cancer, iron deficiency, hemorrhage meds = HIGH CLOT RISK, DVT/PE too low: < 150 or 150,000 thrombocytopenia: infection, leukemia radiation, liver dx, anemia = HIGH RICK FOR BLEEDING, FALL RISK!

Question 150

What are the lab value norms for Hematocrit (Hct)?

Answer 150

Hct: % of RBCs in blood, fluid balance normal: 40-50% too high: > 60% CAD, dehydration, burns = HIGH CLOT RISK, DVT/PE too low: < 15% anemia, bld loss, bone marrow suppression = CHECK SPO2, low perfusion, cardiac failure!

Question 151

What are the lab value norms for Hemoglobin (Hgb)?

Answer 151

Hgb: (gm/dL) O2 carrying capacity, fl balance normal: 12-17 too high: > 20 CAD, dehydration, hypoxia, COPD, burns = HIGH RISK OF CLOTTING/CLOGGING --> ischemia, MI, CVA too low: < 8 anemia, bld loss, bone marrow suppression = PT CUTOFF, NO pt, monitor SPO2 <7 = TRANSFUSION! --> CHF or death

Question 152

what is the medical tx for confirmed acute coronary syndrome?

Answer 152

-anticoagulants: antiplatelets -> aspirin -beta-blocker: -lol's -Ace inhibitor: -pril's -Statins

Question 153

How do beta-blockers work?

Answer 153

block B1 receptor in SA node (sympathetic NS) to reduce HR AE: also reduce heart conduction -> heart blocks meds: atenolol, metropolol, nadolol, propanolol PT: cannot use HR to measure exercise vigor --> RPE

Question 154

How do calcium-channel blockers work?

Answer 154

block Ca+ channel in heart = no action potential = decreased HR -reduces M. contractility -vasodilation meds: verapamil, nifedipine, amlodipine

Question 155

How do organic nitrates work?

Answer 155

release nitric oxide (NO) = powerful vasodilator = reduced heart workload sublingual = immediate, short duration oral meds = slow speed, long duration; prevent angina meds: nitroglycerin, nitrostatin, isosorbides

Question 156

how do Statin's meds work?

Answer 156

Lipid lowering drugs: lower fats to ↓ heart dx risk -↓ cholesterol production in liver -↑ LDL-cholesterol absorption in liver AE: myalgias, weakness, inflammation -> Rhabdomyolysis

Question 157

What are the levels of cardiac rehab and MET lvls for each?

Answer 157

Inpatient cardiac rehab program: lvl 1 = bedrest, 1-1.5 METs lvl 2 = limited room amb., 1.5-2 METs (max 5 mins) lvl 3 = limited hall amb, 2-2.5 (>5 mins) lvl 4 = progressibe hall amb., 2.5 - 4 (5-7 min walk) lvl 5 = progressive hall amb., 3-4 (8-10 mins) lvl 6 = stairs and amb as tolerated, 4-5

Question 158

What are the phases of cardiac rehab?

Answer 158

Phase I = acute/inpatient must be medically stable for 24 hrs (after cardiac procedure or MI) Phase II: post-acute/OPPT Phase III: maintenance phase (don't need MD supervision) Phase IV: disease prevention program

Question 159

What are the levels of dyspnea scale and what is your stop value?

Answer 159

0 = no dyspnea 1 = mild, noticeable 2 = mild, some difficulty 3 = moderate difficulty, can continue 4 = severe difficulty, cannot continue

Question 160

What are the levels of angina scale and what is your stop value?

Answer 160

0 = no angina 1 = light, barely noticeable 2 = moderate, bothersome 3 = severe, uncomfortable, preinfarction 4 = most pain, infarction pain

Question 161

What are the 3 different types of angina?

Answer 161

-Classic/stable angina: predictable w/ activity decreases w/ rest of nitroglycerin -Unstable angina: unpredictable, not activity depealndent, does not change with rest or nitroglycerin -Prinzmetal (variant angina): not activity dependent, usually ossurs in early AM, not relieved by meds or rest -> STEMI

Question 162

What does the 6MWT test for and what are norm values?

Answer 162

tests for endurance < 300 m = predictive of mortality > 750 m = shorter hospital stay

Question 163

What does the TUG test for and what are norm values/cutoffs?

Answer 163

tests for fall risk >13.5 sec = high risk for falling Dual TUG: >30sec = high fall risk

Question 164

What does the 10MWT test for and what are norm values/cutoffs?

Answer 164

tests for gait speed >0.8 mph = community ambulator, stairs + crowds 0.40-0.80 mph = limited community walker, stairs <0.40 mph = household ambulator

Question 165

What does Berg Balance Scale test for and what is it's cutoff?

Answer 165

BBS = measures static and dynamic balance using functional activities 0 = unable 4 = independent cutoff: < 45 = high fall risk

Question 166

What does Tinetti test for and what is it's cutoff?

Answer 166

tests for balance cutoff: < 18 = high fall risk

Question 167

What does Functional reach test for and what is it's cutoff?

Answer 167

tests for balance, postural stability, LOS cutoff: <7 inches = high fall risk

Question 168

What are the different types of scoliosis and the screening criteria?

Answer 168

infantile scoliosis: < 3 y/o Juvenile: 3-10 y/o Adolescent: 10-18 y/o Adam's forward bend test: >10 degrees = +, refer to MD 20-35 degrees = bracing, postural training, breathing exercises >35 = SURGICAL INTERVENTION

Question 169

What are the 6 stages of ALS?

Answer 169

Stage I: early LMN -mild weakness -asymmetrical Stage II: Mod I w/ AD -mod. atrophy in groups of M.s -use of AD Stage III: amb w/i functional limits -severe weakness, fatigue mild/mod functional limitations -ambulatory Stage IV: WC -severe weakness and wasting of LEs -Mod A + AD's required -WC user Stage V: (UMN) -progressive weakness of limbs and trunk -spasticity, hyperreflexia, loss of head control -Max assist Stage IV: bedridden -dependent in all ADLs -respi distress

Question 170

What are the cardinal signs of Parkinson's disease?

Answer 170

-Rigidity -Bradykinesia -tremor -postural instability

Question 171

What are the Hoehn and Yahr classification of disability for parkinson's?

Answer 171

Stage I: minimal/absent, unilateral Stage II: bilateral Stage III: balance deficits, activities restricted Stage IV: all sx present and severe, standing and walking w/ assistance Stage V: confined to WC or bed

Question 172

What are the subtypes of MS presentation?

Answer 172

Relapsing-remitting: discrete attacks + full/partial remission Primary progressive: disease progression from onset, no discrete relapses Secondary-progressive: initially relapse-remitting, changes to -> steady decline of fx Progressive-relapsing: steady deterioration from onset w/ occassional acute attackts Clinically isolated syndrome (CIS): first episode lasting > 24 HOURS, CAN develop into MS

Question 173

What are the characteristics of Mild, Moderate, and Severe TBI?

Answer 173

Mild: -LOC: 0-30 mins -GCS: 13-15 Mod: -LOC: > 30 mins-24hr -GCS: 9-12 Severe: -LOC: > 24hr -GCS: <9

Question 174

What are the differences b/w Right vs Left sided stroke?

Answer 174

Right: -memory loss -facial weakness -impulsive -quick emotional outburst (pseudobulbar effect) -neglect Left: -aphasia (Broca's/Wernicke's) -swallowing diff. -slow, cautious behavior

Question 175

What are the Brunnstrom stages of stroke recovery?

Answer 175

Stage I: flaccid paralysis Stage II: emergence of spasticity, hyperreflexia, synergies (mass patterns of mvmt) Stage III: Peak spasticity, voluntary mvmt IN synergies ONLY Stage IV: emerging isolated jt mvmt Stage V: increased control OUT of synergies Stage VI: control and coordination NORMAL

Question 176

What is agnosia and what types are there?

Answer 176

agnosia = cannot ID/recognize object, sensation intact =lesion in secondary sensory areas -astereognosis/tactile agnosia: X ID object w/ touch -visual agnosia: can't ID object seen -prosopagnosia: can't ID faces -Auditory agnosia: can hear sounds but not recognize them --Lt 2nd aud cortex = X understand speech --Rt = X understand environmental sounds

Question 177

what is apraxia and what are different types?

Answer 177

Apraxia = being unable to make voluntary movements or gestures even though you have the physical ability and understanding -motor apraxia: knowledge of task, cannot perform -ideational apraxia: does not know how to use item at all - misuse of item ex. use toothbrush to comb hair -ideomotor apraxia: can use item but not when asked motor plans (in relation to object manipulation) is not available voluntarily

Question 178

What is chorea?

Answer 178

brief, purposeless and quick mvmts, random like a CHOREography --> dance-like injury from: overactivity in basal ganglia seen in: -Dyskinetic/athetoid CP -Huntington's dx -stroke/brain tumor

Question 178

What is Athetosis:

Answer 178

slow writhing mvmts or postures, sustained injury from: basal ganglia seen in: -Dyskinetic/athetoid CP

Question 178

What are the 3 types of CP and where are their lesions and presentation?

Answer 178

-Spastic CP = lesion to motor cortex, s/s: scissor gait -Athetoid/dyskinetic CP = lesion to BG, s/s: dyskinesia -Ataxic CP = lesion to cerebellum, ataxic gait, balance and coordination -mixed CP

Question 179

Describe the 3 types of memory?

Answer 179

-immediate recall: repeat w/i 5 mins -recent/short-term memory: recent events (breakfeast, etc. ) -remote/long-term memory: past events (where did you grow up)

Question 180

Describe the 3 types of attention?

Answer 180

sustained attention = how long can they sustain attention on something divided attention = dual task/shifting attention to diff tasks focused attention = sustained attention in spite of distractors (internal vs external)

Question 181

How do you calculate burn percentage using the rule of 9's on an ADULT?

Answer 181

-entire head = 9% (front = 4.5, back = 4.5) -entire arm = 9% each (front = 4.5, back = 4.5) -entire leg = 18% each (front = 9%, back = 9%) -entire trunk front = 18% (9% thoracic, 9% abdominal) -entire trunk back = 18% (9% thoracic, 9% abdominal)

Question 182

How do you calculate burn percentage using the rule of 9's on an CHILD?

Answer 182

-Head + neck = 18% (front = 9%, back = 9%) -Trunk front = 18% (thoracic = 9%, abdominal = 9%) -Trunk back = 18% (thoracic = 9%, abdominal = 9%) -Whole arm = 9% (front = 4.5, back = 4.5) -Whole leg = 14% (front = 7%, back = 7%)

Question 183

What is involved in an epidermal burn?

Answer 183

just epidermis = pink/red "erythamous" -1st degree sunburn -DRY EPIdermal = EPIdermis Burn = layer of SKIN pressure ulcer = layer of TISSUE

Question 184

What is involved in a superficial-partial thickness burn?

Answer 184

-epidermis + papillary part of dermis = RED/PINK + WET "mottled red" -BLISTER -WET -edema -BLANCHING of skin brisk capillary refill epidermis: free N. endings + merkel = X pain/itch + soft touch Papillary: Meissner + Krause + Rufini = X cold/hot temp sensation Burn = layer of SKIN pressure ulcer = layer of TISSUE

Question 185

What is involved in a deep-partial thickness burn?

Answer 185

Epidermis + papillary + reticular = mixed red/waxy white -2nd degree burn -BROKEN BLISTER -WET -excessive scarring -> keloid/hypertrophic Burn = layer of SKIN pressure ulcer = layer of TISSUE

Question 186

What is involved in a full thickness burn?

Answer 186

complete burn of epidermis + dermis layers = only hypodermis left = WHITE ISCHEMIC/CHARRED (black) color -NO blanching -poor distal circulation -leathery, rigid-dry skin -Anesthetic = loss of all nerves (NO pain) -requires skin graft Burn = layer of SKIN pressure ulcer = layer of TISSUE

Question 187

What is involved in a subdermal burn?

Answer 187

epidermis + dermis + hypo + tissues (M.) = CHARRED (black/burnt) -no pain -> anesthetic, no nerves left -tissue defects -requires skin graft/flap Burn = layer of SKIN pressure ulcer = layer of TISSUE

Question 188

contraindications for exercise after a burn injury?

Answer 188

NO PT IF: -exposed joints -exposed tendons -thrombophlebitis -DVT -compartment syndrome -Skin grafts - MD dependent Burn = layer of SKIN pressure ulcer = layer of TISSUE

Question 189

What is the difference b/w a diabetic ulcer?

Answer 189

it involves both arterial insufficiency (arterial compromise) AND neuropathic (loss of protective sensation)

Question 190

Describe a stage I pressure ulcer?

Answer 190

-just red (nonblanchable) -skin intact Stage I = amt of tissue 1 = 1 skin layer

Question 191

Describe a stage II pressure ulcer?

Answer 191

-Red + blanchable (turns white to pressure) -closed OR open wound -partial thickness ulcer = epidermis + dermis = WET blister + fluid (serosanguineous or serum) -may have slough (cheese) Stage II = amt of tissue 2 = 2 skin layers (epi + dermis)

Question 192

Describe a stage III pressure ulcer?

Answer 192

-OPEN -full thickness = epidermis + dermis + hypodermis -up to connective tissue (full skin loss) -can have necrosis Stage III = amt of tissue 3 = 3 tissues (epi + dermis + fat)

Question 193

Describe a stage IV pressure ulcer?

Answer 193

-full thickness skin loss + tissue damage (skin + muscle/tendon/bone) -underminint and tracts present -mat have slough and eschar but does not obscure tissue depth Stage IV = amt of tissue 4 = 4 tissue layers (epi + dermis + fat + bone)

Question 194

Describe an unstageable pressure ulcer?

Answer 194

-depth of damaged tissue involved is obscured by necrosis/eschar/slough

Question 195

Describe a deep pressure injury stage in pressure ulcers?

Answer 195

-discolored area (bruise/purple) where damage to tissue underneath is not reversible -will progress to full-thickness injury (epidermis + dermis)

Question 196

Describe the wound from an arterial insufficiency?

Answer 196

-"punched out" -calloused, dry skin around wound -cold skin -SYMMETRICAL wound shape -diminished pulse -PAINful -Reddish-pink in dependent positions -in LATERAL MALLEOLUS -ABI < 0.4 = NO PT!

Question 197

Describe the wound from an venous stasis or venus insufficiency?

Answer 197

-weepy, wet -hemosiderin staining (reddish-dark staining) -ASYMMETRICAL wound -edema -painless -in MEDIAL MALLEOLUS

Question 198

What organs are in the Right Upper Quadrant?

Answer 198

-liver -gallbladder

Question 199

What organs are in the Left Upper Quadrant?

Answer 199

-spleen -pancreas -stomach

Question 200

What organs are in the Right Lower Quadrant?

Answer 200

-large/small intestine -appendix

Question 201

What organs are in the Left Lower Quadrant?

Answer 201

-Pancreas -colon

Question 202

What are the values for a DEXA bone scan?

Answer 202

for bone density normal: > -1 osteopenia: -1-2.5 standard deviations osteoporosis: < -2.5 standard deviations

Question 203

What is part of the cervical radiculopathy cluster?

Answer 203

-cervical rotation AROM < 60 - (+) ULTT -(+) distraction -(+) spurlings >3+/4

Question 204

What are the C-spine rules?

Answer 204

imaging IF: -Age > 65 -dangerous MOI -paresthesia in UE's -able to rotate neck >45 degrees bilat and None of: -simple rear end MVC -sitting in ED -ambulatory -delayed (not immediate) neck pain -absence of midline C-spine tenderness

Question 205

What is the CPR (clinical prediction rules) for Carpal tunnel syndrome?

Answer 205

-Age > 45 -ease: shaking hands -wrist ration: >0.67 -sx severity scale: > 1.9 -decreased sensation in median N. distribution -2 pt discrimination > 6mm

Question 206

What are the ottawa knee rules?

Answer 206

Need X-ray IF: (high indication for fracture) -Age > 55 -isolated patellar tenderness -tenderness at head of fibula -inability to flex knee to 90 degrees -inability to bear weight for 4 steps immediately after injury

Question 207

What are the ottawa ankle rules?

Answer 207

NEED X-ray IF: (high indication for fracture) PAIN IN MALLEOLAR + ANY: -TTP @ posterior medial or lateral malleoulus to 6cm up from malleoulus -inability to bear weight for 4 steps after injury

Question 208

What are the Ottawa FOOT rules?

Answer 208

NEED X-ray IF: (high indication for fracture) PAIN IN MIDFOOT + ANY: -bone tenderness at navicular bone (medial) -bone tenderness at base of 5th met (lateral) -inability to bear weight for 4 steps after injury

Question 209

What is the open-packed, closed-packed, capsular pattern, and normal end-feel for the Lumbar spine?

Answer 209

Open-packed: b/w flex and extension closed-packed: max extension Capsular pattern: SB/rot > extension > flexion normal end-feel: firm capsular/ligamentous

Question 210

What are the TBC for and against manipulation interventions in LBP?

Answer 210

factors for: -hypomobility w/ spring test -low FABQ < 19 -hip IR > 35 -pain onset < 16 days ago Factors against: -sx below knee -increasing frequency -peripheralization w/ motion testing -no pain w/ spring testing

Question 211

What are the clinical findings for Hip OA CPG diagnosis?

Answer 211

-Antetior or lateral hip pain w/ wt bearing -morning stiffness lasting < 1hr -hip IR < 24 degrees -hip flex and IR < 15 degrees from other side --pain w/ hip IR -no MOI

Question 212

Special tests for intra-articular pathology in hip?

Answer 212

-hip scour: + if sx reproduced and/or crepitus -hip quadrant: + if sx reproduced and/or crepitus -FABER/Patrick test: + if hip sx reproduced

Question 213

Special test for hip femoroacetabular impingement/labral tests?

Answer 213

FADDIR + = hip pain reproduction

Question 214

What does the prone knee bend test?

Answer 214

femoral nerve tension or quad muscle length: +: reproduction of unilateral pain in lumbar/buttock/posterior thigh or combination

Question 215

What does the Thomas test do?

Answer 215

Test for hip flexor length: rectus femoris and iliopsoas + = one thigh higher than the other IF knee straight = rectus femoris shortening IF knee bent = iliopsoas shortening

Question 216

What does the modified Ober's test?

Answer 216

test tensor fascia latae length + = leg can't lower to table

Question 217

What does the supine 90/90 or popliteal angle test?

Answer 217

test hamstring length + = cannot extend up to 20 degrees of full extension

Question 218

What is the CPR for hip OA?

Answer 218

-pain w/ squatting -lateral hip pain w/ active hip flexion -scour (+) w/ ADD -> lateral hip or groin pain -pain w/ active hip extension -PROM IR < 25 4+/5

Question 219

What is the open-, closed- packed positions of the hip? Capsular pattern? Normal end-feel?

Answer 219

Open-packed: 30 flex + 30 ABD + slight ER (figure 4) Close-packed: full ext + ABD + IR Capsular pattern: Flex > IR > ABD Normal end feels: flex: soft Ext: firm-ligamentous ABD/ADD: firm - ligamentous ER/IR: firm ligamentous

Question 220

What are the total hip arthroplasty precautions for an Anterior approach?

Answer 220

-X flex > 90 -X ADD (cross legs) -X ER -X prone lying -extend operated leg when sitting or standing

Question 221

What are the total hip arthroplasty precautions for an Posterior approach?

Answer 221

-X flex > 90 -X ADD (cross legs) -X IR

Question 222

List in order the weight bearing precautions from least WB to most WB.

Answer 222

Non-weight bearing (NWB): X touch Toe-touch WB (TTWB): can rest toes on ground for balance, X WB Partial WB (PWB): limited amt of WB especified by MD Weight bearing as tolerated (WBAT): from 0-full WB, pt dependent Full Weight bearing (FWB): full WB, no AD needed

Question 223

implications of patella alta?

Answer 223

nothing there to give it horizontal/lateral stability can partially/fully dislocate with knee flexion

Question 224

implications of patella baja?

Answer 224

-limited knee ROM -Ant knee pain -Quad weakness w/ extensor lag

Question 225

What is the open-, closed- packed position of the knee? Capsular pattern? Normal end-feel?

Answer 225

Capsular pattern: Flex > Ext Normal end feel: Flex: soft Extension:

Question 226

What are the MMT grades for the Gastroc or PF?

Answer 226

5 = 25 at full ROM 4 = 2-24 reps w/ full ROM 3 = 1 heel raise rep 2 = unable to lift heel in standing

Question 227

What are the clinical findings (s/s) for a knee miniscus injury according to the CPG?

Answer 227

MOI: twisting injury -tearing sensation at time of injury -DELAYED EFFUSSION (6-24 hrs pos injury) -sx of catching or locking -p! w/ passive hyper-extension -pain w/ max knee flex -pain or audible click w/ McMurrays -jt line tenderness -pain/ locking/catching w/ thessaly's

Question 228

What are the clinical findings (s/s) for a knee articular cartilage injury according to the CPG?

Answer 228

-acute trauma w/ hemarthrosis (IMMEDIATE SWELLING 0-2 hrs) -> indicative of Fx -insidious onset aggravated w/ REPETITIVE impact -intermittent pain and swelling -hx of catching/locking -jt line tenderness

Question 229

What are the clinical findings (s/s) for patellofemoral pain syndrome (PFPS) according to the CPG?

Answer 229

-diagnosis of exclusion including referred from hip of back -retropatellar or peripatellar pain -reproduction of retro/peri patellar pain w/ -squatting -stair climbing -prolonged sitting -other activities loading PFJ in flexed position -positive patella tilt test

Question 230

What are the clinical findings (s/s) for a knee ligament sprain according to the CPG?

Answer 230

-sx onset linked to precipitating trauma -MOI: decelerating, cutting, or valgus motion -"pop" heard/felt at time of injury -HEMARTHROSIS w/i 0-12 hrs post injury (bld inside jt) -knee EFFUSSION present (swelling + blood INSIDE jt capsule) -sense of knee instability -excessive laxity w/ tibiofemoral ligament testing (cruciate/collateral ligament integrity testing) -p! + sx w/ ligament integrity testing -LE strength and coordination deficits -impaired SL balance -abnormal compensatory strategies when decelerating/cutting

Question 231

What are 3 tests for a torn meniscus?

Answer 231

-McMurrays: + = click/pops audible or palpable -Thessaly's: + = pain, w/ or w/o click/pop -Jt line tenderness

Question 232

What does the Lachman test do?

Answer 232

Test for ACL injury knee in 10 and 20 degrees of knee flexion + = anterior translation of tibia

Question 233

What are wheals?

Answer 233

Wheals are HIVES!! -irregular borders -not raised (slightly) -sign of allergic rxn skin is mad, but doesn't know what it's mad about -> irregular

Question 234

What are Vesicles?

Answer 234

Vesicles are BLISTERS!! -dome shaped -small -thin walled sac filled w/ CLEAR fluid

Question 235

What are pustules?

Answer 235

PUStule = PUS filled Ex. zit/cystic acne (bigger)

Question 236

What is Herpes SIMPLEX and what are its characteristics?

Answer 236

Herpes simplex = herpes virus = cold sores Type 1 = above the waist Ex. lips, face, UE Type 2 = below the waist Ex. STD

Question 237

What is herpes ZOSTER and how does it appear on the skin?

Answer 237

Zoster = Shingles sx: pain and paresthesia (n/t) -rash -unilateral -raised to palpation -pink w/ silvery white appearance -spread in DERMATOMAL pattern

Question 238

Herpes ZOSTER: precautions? modalities? contraindications? what CN are affected?

Answer 238

Zoster = Shingles precaution: airborne modalities: TENS, in dermatomal pattern contraindications: NO HEAT, cold ok CN?: CN 3 and CN 5

Question 239

What kind of dressing should you use for VERY MILD exudate?

Answer 239

transparent films

Question 240

What kind of dressing should you use for MINIMAL exudate?

Answer 240

-hydrogel -hydrocolloid

Question 241

What kind of dressing should you use for MODERATE exudate?

Answer 241

Foams

Question 242

What kind of dressing should you use for HEAVY exudate?

Answer 242

-calcium alginate -hydrofiber

Question 243

What are the goals for wound healing?

Answer 243

-keep center MOIST (appropriate bld supply and wound healing) -keep surroundings DRY (moisture = infection)

Question 244

What are the 3 types of selective debridement?

Answer 244

-Sharps debridement: use of sharps (scalpel, forceps, etc) -Enzymatic debridement: use of topicals -Autolytic debridement: use of body's mechanism

Question 245

What are the 3 types of nonselective debridement?

Answer 245

-Wet-to-dry dressings: use gauze to rip bad part out -Wound irrigation: using water hose w/ pressure (Ex. power washing deck) -Hydrotherapy: whirlpool (Ex. hand washing clothes - dipping it in/out of water and agitating it to remove dirty parts) ONLY USE NONSELECTIVE DEBRIDEMENT IF > 50% OF TISSUE IS NONVIABLE!!

Question 246

Describe a hyperthrophic scar?

Answer 246

hypertrophic = hypertrophy (Ex. muscles) = thicker skin -stays WITHIN margins of original scar

Question 247

Describe a keloid scar?

Answer 247

Keloid = confused skin -goes outside of original scar borders -irregular in shape -may be raised

Question 248

What's the difference between dementia and delirium?

Answer 248

Dementia = progressive, non-reversible Delirium = abrupt, fluctuates, reversible, includes hallucinations

Question 249

What are the settings for thermal modalities, aka hot packs or heat? Temp? Tx time? layers? Peak time?

Answer 249

temp: 160-170 F time: 20-30mins layers: 6-8 towel layers peak time: 5 mins --> check skin

Question 250

What are contraindications for thermal modalities, aka hot packs?

Answer 250

Contraindications: -compromised circulation -arterial disease -bleeding/hemorrhaging -over tumor -bld clot (DVT/thrombophlebitis) -impaired sensation (ex. diabetes) -impaired mentation -over eyes

Question 251

What are the settings for cryo modalities, aka ice packs? Temp? Tx time? layers?

Answer 251

Temp: 0-10 F, 25F Tx time: 10-20 mins can be applied every 1-2hrs have layers covering

Question 252

What are contraindications for cryotherapy?

Answer 252

-Cold hypersensitivity (Ex. cold induced urticatia, etc. ) -Cold intolerance -Cryoglobulinemia (bld clots forming from cold) -paroxysmal cold hemoblobinuria (causes hemolysis of RBCs, autoimmune) -Raynaud's -over regenerating peripheral N.s -Circulatory compromise

Question 253

What are the parameters for continuous ultrasound? Duty cycle? Tissue depth? frequency? intensity? duration of tx?

Answer 253

Continous US = Thermal (NOT for inflammation or acute injury) Duty cycle = 100% Depth of tissue? -superficial = 1-2 -frequency = 3 MHz -intensity = 0.5 W/cm3 -deep = 2-5cm -frequency = 1 MHz -intensity = 1.5-2.0 W/cm3 tx time: 5-10 min

Question 254

What are the parameters for pulsed ultrasound? Duty cycle? Tissue depth? frequency? intensity? duration of tx?

Answer 254

Pulsed US = nonthermal = indicated for acute injury/inflammation Duty cycle = 20% Tissue Depth: -superficial = 1-2cm -frequency = 3 MHz -intensity = 0.5 -1.0 W/cm3 -deep = 2-5cm -frequency = 1 MHz -intensity = 0.5 -1.0 W/cm3 Tx time: 5-10 mins

Question 255

What are the contraindications for ultrasound?

Answer 255

-impaired circulation -impaired sensation -impaired mentation -over tumors -over/near bld clot (DVT/thrombophlebitis) -over joint CEMENT -over PLASTIC -over pacemaker -carotid sinuses -over epiphyseal plates/growth plates

Question 256

Describe the different patient positioning in bed for the list below: Fowlers? Semi-Fowlers? Trendelenburg? Reverse trendelenburg?

Answer 256

Fowlers: HOB at 45 degrees up (half-sitting up in bed) Semi-Fowlers: HOB at 15-30 degrees up (head up slightly) Trendelenburg: flat back, entire bed angled, feet raised higher than head by 15-30 degrees Reverse Trendelenburg: flat back, entire bed angled, head raised higher than feet by 15-30 degrees ****Important incase they ask you for postural drainage or contraindicated positions for CHF, PVD/PAD, etc. ***

Question 257

What is the formula for age predicted HR max?

Answer 257

HR max = 220 - age

Question 258

How do you calculate the APGAR scale?

Answer 258

APGAR = score 0-2pts ea. Appearance: blue, blue extremities, pink Pulse: No pulse, < 100bpm, 100-140 Grimace/Cry: (from painful stimuli) No response, grimace, cry/withdrawl Activity: (muscle tone) No activity/flaccid, some flexion, active extremities Respiration: no respi. , weak cry, strong cry -check 5 mins after birth -check 10 mins after birth ONLY if score LESS THAN 7!!

Question 259

What is considered "Bowstringing" in the hand and fingers?

Answer 259

Bowstringing is a rupture of pulley Ex. Flexor digitorum Profundus tendon (on image)

Question 260

What is trigger finger and what are different treatments?

Answer 260

Trigger finger = tenosynovitis of flexor tendon swollen tendon cannot pass through annulus pulley -conservative treatment = finger splint in neutral to allow tendon inflammation to reduce -cortisone injection -severe = surgery cut tendon sheath

Question 261

What is mallet finger?

Answer 261

DIP looks like a mallet MOI: forced hyper-flexion in sports from catching a ball -ruptures Extensor Digitorum tendon at DIP jt --> DIP can no longer exten, stuck in flexion -Central slip is preserved -CAN PROGRESS to swan neck deformities if not treated (central slip injured) -Tx = splint of DIP in extension for 4-8wks for tendon to heal

Question 262

What is swan neck deformity?

Answer 262

Swan neck deformity = -distal interphalangeal FLEXion and --proximal IP EXTension structures injured: -extensor tendon rupture (mallet finger) + -lax volar plate common in RA

Question 263

What is a Boutonniere deformity?

Answer 263

Boutonniere Deformity = central slip is torn The interphalangeal (IP) jt pops through the lateral bands (like a button) --> causing hyperextension of proximal interphalangeal jt

Question 264

what is Jersey finger?

Answer 264

Jersey finger = due to holding on to jersey and hyperextends the PIP (MOI) Flexor digitorum profundus tendon avulsion -Pt unable to flex DIP jt

Question 265

What is Gamekeepers thumb? MOI? sx? special tests? Tx?

Answer 265

Gamekeeper's thumb = rupture of ulnar collateral ligament of the thumb -causes laxity of medial side of IP jt of thumb MOI: FOOSH w/ thumb in hyper-ABD at IP jt -has weak pincer grasp -valgus stress test at thumb -instability/laxity tx = thumb spica splint

Question 266

What is the difference b/w Rheumatoid arthritis and Osteoarthritis at the hands?

Answer 266

OA = nodes at the 2 most distal jts -Bouchard = IP jt -Heberden's nodes = at DIP jt RA = nodes at MCP jt (metacarpal phalangeal, aka knuckles, most proximal jt) WITH ULNAR DRIFT

Question 267

What are the mvmts of the thumb? Do it with your hand

Answer 267

thumb flexion = in the hand (E) thumb ext = away from hand (F) thumb ABD = hamburger (G) thumb ADD = back with fingers (H) thumb oposition = touching each finger

Question 268

What is the arthrokinematics of the thumb in ABD and ADD?

Answer 268

saddle jt = ABD + ADD = convEX ABD = hamburger = cowboy slumps FWD on saddle = -anterior roll + post glide head rolls fwd, butt slides back ADD = thumb together to hand = cowboy slumps BACK on saddle = -POST roll + ANT glide head rolls backwards/post, butt slides fwd

Question 269

What is the arthrokinematics of the thumb in flexion and extension?

Answer 269

saddle jt = flex + ext = conCAVE -extension = cowboy sliding off the SIDE (lat) = -lateral roll + lateral slide -flexion = cowboy sliding back to MIDDLE = -medial roll + medial slide

Question 270

What is the arthrokinematics of the thumb in opposition?

Answer 270

thumb opposition = 2 phase mvmt 1. ABD of thumb 2. flexion w/ medial rotation of thumb

Question 271

What does it mean when you loose the angle/slope of the 4th and 5th knuckles?

Answer 271

i think it's lunate dislocation or AVN of lunate ...... fact check it!!

Question 272

What is spoon nails significant for? (medical diagnosis)

Answer 272

spoon nail = koilonychia -anemia -DM -protein deficiency Always refer back to MD if not already documented or known by MD, especially w/ multiple sx

Question 273

What is a central nail ridge significant for? (medical diagnosis)

Answer 273

central nail ridge = middle line of nail is raised indicative of: -Fe deficiency -folic acid deficiency -protein deficiency Always refer back to MD if not already documented or known by MD, especially w/ multiple sx

Question 274

What is nail beading significant for? (medical diagnosis)

Answer 274

nail beading = several raised ridges along the nail significant for: -endocrine conditions such as: -DM -thyroid -Addison's Always refer back to MD if not already documented or known by MD, especially w/ multiple sx

Question 275

What is sandpaper nails significant for? (medical diagnosis)

Answer 275

Rough/sandpaper nails, dull appearance seen in: -chemical exposures (work related?) -psoriasis -autoimmune Dx -lichen planus Always refer back to MD if not already documented or known by MD, especially w/ multiple sx

Question 276

What is pitting nails significant for? (medical diagnosis)

Answer 276

pitting nail = indicative of: -autoimmune dx -psoriasis -eczema -lichen planus Always refer back to MD if not already documented or known by MD, especially w/ multiple sx

Question 277

What is onycholysis significant for? (medical diagnosis)

Answer 277

onycholysis = splitting of the nail from skin underneath associated w/: -thyrotoxicosis -trauma -contact dermatitis -chemicals exposure -porphyria cutanea tarda need to see medical provider --> not-emergency but requires medical tx

Question 278

What is digital clubbing significant for? (medical diagnosis)

Answer 278

digital clubbing = distal finger and nail is bulbous indicative of: -pulmonary dx Shamroths sign = no window b/w fingers Always refer back to MD if not already documented or known by MD, especially w/ multiple sx

Question 279

What is a sign for Melanoma on the fingernail?

Answer 279

straight black line down the middle, especially if you can see it in more than one finger

Question 280

What are some of the primary and secondary interventions for Carpal Tunnel Syndrome according to the CPG?

Answer 280

Primary interventions: -night splints w/ wrist in NEUTRAL position -risk ID -sx self management -posture/activities that Agg sx -can increase duration to daytime wear (splint) and metacarpalphalangeal jts may be included in splint Secondary interventions: -assistive tech: Ex. different mouse, and keyboard that limits key-strike force -superficial heat (pt dependent as it can have negative effects on sensory-impaired tissue and acute inflammation) -interferential current -phonophoresis -manual therapy -stretching: general stretching and lumbricals

Question 281

What is De Quervain's Tenosynovitis? what muscles? MOI? special tests? tx?

Answer 281

inflammation of the tendon sheaths of the Extensor Pollicis Brevis and ABDuctor Pollicis Longus MOI: overuse/repetitive gripping, grasping or wringing -golfing -typing -playing piano -fishing -carpentry Special tests: Finkelsteins tx: -splinting -US -ice/heat -strengthening

Question 282

List all the special tests for Scaphoid fracture?

Answer 282

-Axial loading of the thumb -pain in anatomical snuff box

Question 283

What is the Watson Scaphoid test?

Answer 283

Tests for Scaphoid instability 1. grip scaphoid b/w fingers 2. passively move wrist into radial deviation and slight flexion 3. press scaphoid down (out of normal alignment) 4. Let go - (+) = loud "Thunk" when scaphoid moves back into place or subluxation

Question 284

What is the TFCC Load test? TFCC = triangular fibrocartilage complex

Answer 284

Tests for TFCC tear --> laxity/instability TFCC = ulnar side, cartilage at ulnar side b/w ulna and carpals 1. grab space b/w ulna and carpals b/w two fingers 2. provide dorsal glide (+) = reproduction of pain or laxity

Question 285

What is the open-packed, closed-packed and capsular pattern for the distal radioulnar jt?

Answer 285

-open-packed: 10 degrees supination -closed-packed: 5 degrees supination -capsular pattern: pain at extremes of pronation/supination

Question 286

What is the open-packed, closed-packed and capsular pattern for the distal radio-carpal jt?

Answer 286

-open-packed: neutral w/ slifht ulnar deviation -closed-packed: full extension w/ radial deviation -capsular pattern: flexion and extension equally limited

Question 287

What is the open-packed, closed-packed and capsular pattern for the mid-carpal jt (proximal carpals and distal carpals)?

Answer 287

-open-packed: neutral or slight flexion w/ ulnar deviation -closed-packed: full extension and ulnar deviation -capsular pattern: flexion and extension equally limited

Question 288

List special tests for hip intra-articular pathology, aka capsular?

Answer 288

-hip SCOUR -hip quadrant -FABER or Patricks test (+) if sx reproduced or crepitus in jt

Question 289

What is a test for hip or femur fracture?

Answer 289

patellar-pubic percussion test (+) one side sounds dimmer or muffled than the other

Question 290

What is a test for hip impingement?

Answer 290

FADDIR --> tests for Femoroacetabular impingement (FAI) and labral tears (+) = reproduction of pain/sx 3 types of FAI: -CAM (@ neck of femur) --> pinches labrum and damages cartilage -Pincer (@ acetabulum) --> pinches labrum -Mixed pt profile: -growing children, growth spurts -involved in athletics -OA, middle aged woman https://www.youtube.com/watch?v=CNgQpbZPflU

Question 291

What are the hallmark signs and MOI for heterotrophic ossificans (myositis ossificans)?

Answer 291

myositis ossificans/heterotrophic ossifican = muscle starts calcifying MOI: -complication post surgery (involving bone/jt, example ORIF or THA) -trauma -blast injuries Hallmark: -progressive loss of ROM when postratumatic inflammation should be resolving -pain on palpation -firm mass palpable

Question 292

What are some pain descriptors for bony tissue involvement?

Answer 292

Deep ache, boring

Question 293

What are some pain descriptors for muscle/fascia tissue involvement?

Answer 293

dull achy sore burning cramping

Question 294

What are some pain descriptors for nerve tissue involvement?

Answer 294

sharp shooting lancinating tingling burning numbness weakness

Question 295

What are some pain descriptors for vascular tissue involvement?

Answer 295

burning stabbing throbbing tingling cold

Question 296

What are some pain descriptors for visceral tissue involvement?

Answer 296

deep pain cramping stabbing visceral = usually lean towards injury MSK = usually lean away

Question 297

What are the stages for the Wagner pressure ulcer scale?

Answer 297

Scale for diabetic foot ulcers grade 0 = skin intact, possible bone deformation/ hyperkeratosis grade 1 = superficial ulcer (skin tissues only) grade 2 = deep ulcer, into tendon/bone/jt capsule grade 3 = tissue abcess, presence of tendonitis, osteomyelitis, cellulitis grade 4 = wet/dry localized gangrene grade 5 = extensive gangrene w/ necrosis (indicative for amputation)

Question 298

What is the cervical myelopathy cluster?

Answer 298

-age >45 -ataxic gait -+ Hoffman's -+ inverted supinator sign -+ Babinski

Question 299

What is the CPR for ankle impingement?

Answer 299

must have 5+/6 -anterolateral ankle jt tenderness -anterolateral jt swelling -pain w/ forced DF -pain w/ SL squat on affected side -pain w/ activities -absence of ankle instability

Question 300

What is the Well's CPR for DVT?

Answer 300

Major criteria: -active cancer w/i past 6 mo. -paralysis -recently bedridden or major surgery -localized tenderness -thigh and calf are swollen -family Hx of DVT Minor criteria: -hx of recent trauma -pitting edema -dilated superficial veins -hospitalized w/i last 6 mo -erythema positive = > 3 major criteria + >2 minor criteria

Question 301

What are the key clinical findings for Plantar Fasciitis according to the CPG?

Answer 301

-plantar medial heel pain w/ initial steps & worsening w/ prolonged WB -heel pain from increase in WB activity -reproduction of heel pain w/ palpation or provocation of plantar fascia (WINDLASS) -Positive windlass test -negative tarsal tunnel tests as well as other LE peripheral N. entrapment -negative findings suggesting referral from lumbar, pelvis, lower limb tension, or other neurological exam

Question 302

What are some interventions for plantar fasciitis according to the CPG?

Answer 302

Therapeutic exercises: -plantar fascia stretching -gastroc/soleus stretching Manual: -jt mobes for talocrural DF -soft tissue mob of plantar fascia -soft tissue mob of gastroc/soleus trigger pts Taping: -antipronation taping Foot orthoses: -IF pt has excessive pronation --> foot orthoses w/ support for medial arch and/or heel cushion -IF excessive supination --> foot orthoses w/ heel cushion (due to decreased shock-absorption capacity) Night splints: -for 1-3 month period

Question 303

What are some other interventions for plantar fasciitis to improve walking and running gait abnormalities according to the CPG?

Answer 303

Manual: -jt mobilization/manual stretch to restore normal mvmt at - -1st metatarsophalangeal jt -tarsometatarsal jts -talocalcaneal jt -talocrural -knee -hip mobility -soft tissue mob and manual stretching to restore normal M. length to - -calf -thigh -and hip myofascia for terminal stance (DF) Therapeutic ex. and NM-reed: -strenghtening muscles that work eccentrically to control mid-tarsal pronation (tib post + fibularis longus) -" " that control eccentric ankle PF (tib ant) - " " control eccentric knee flexion (quads) - " " control eccentric hip ADD (glute med) - " " control eccentric LE internal rotation (hip ER's) at loading responce goal of therex/NMRE: -reduce pronation during WB -improve and distribute shock absorption during WB

Question 304

According to the CPG, what patient examination findings should there be to diagnose Achilles Tendinopathy?

Answer 304

-gradual onset of pain -pain 2-6 cm to achilles insertion -pain w/ tendon palpation -positive arc sign -+ Royal London Hospital test

Question 305

According to the CPG, what are some ACUTE diagnostic indicators of Achilles Tendinopathy?

Answer 305

-redness, warmth swelling -<3 mo in duration -pain limiting low-lvl activity + examination findings

Question 306

According to the CPG, what are some NON-ACUTE diagnostic indicators of Achilles Tendinopathy?

Answer 306

-No redness, warmth, swelling ->3mo duration -p! during/after high lvl activity -tendon pain w/ palpation w/ or w/o nodules

Question 307

What are the 4 prevention stages for lateral ankle sprains according to the CPG? (look at image)

Answer 307

Question 308

According to the lateral ankle sprain CPG, what are the timelines of return to sport/work for ligament distortion, partial/total ligamen rupture, and surgery? (image)

Answer 308

Question 309

According to the lateral ankle sprain CPG, what are the pt examination findings for ACUTE lateral ankle sprain?

Answer 309

-sudden onset p! w/ ankle inversion-related injury -(-) Ottawa ankle rules -(+) reverse anterolateral drawer test -(+) anterolateral talar palpation test -(+) anterior drawer test

Question 310

According to the lateral ankle sprain CPG, what are the pt examination findings for CHRONIC ANKLE INSTABILITY (CAI)?

Answer 310

-hx of >1 significant ankle sprain -reports of "giving way" -episode of subsequent sprain and/or perception of ankle instability -decreased performance of functional tests -Discriminative instrument scores: -Identification of Ankle Instability: score >11 -Cumberland Ankle Instability Tool: score <25 -4+ "yes" answers to the Ankle Instability Instrument

Question 311

According to the lateral ankle sprain (LAS) CPG, what are interventions for LAS?

Answer 311

-progressively WB w/ external supports -therex and HEP w/ ROM, stretching and NMRE -Manual: (pain-free) -lymphatic drainage -soft tissue/jt mob -A-P talar mobs -improve ankle/foot mobility -normalize gait -Occupational/sports-related training w/ activity and participation restrictions -low lvl laser -US: pulsating short-wave diathermy for edema and gait -NSAIDS

Question 312

According to the lateral ankle sprain CPG, what are interventions for CHRONIC ANKLE INSTABILITY (CAI)?

Answer 312

-Propioceptive/NMRE to improve ankle stability -Manual: -jt mobes/manips in WB and non-WB to improve DF, propioception and WB tolerance -trigger pt dry needling of peroneals (muscles)

Question 313

What is the clinical algorithm to determine SIJ dysfunction?

Answer 313

-pain below L5 -pain unilateral AND NOT central -No centralization/ peripheralation -3/6 (+) SIJ provocation test -(does not go beyond buttocks and thigh)

Question 314

What are the 6 SIJ dysfunction provocation tests?

Answer 314

-Posterior shear/Thigh thrust -SIJ distraction -SIJ compression -Gaenslen's left -Gaenslen's right -sacral thrust

Question 315

What is the thigh thrust provocation test/posterior shear test?

Answer 315

For SIJ (+) = reproduction of pain/sx on the side of the loaded femur

Question 316

What is the SIJ distraction test?

Answer 316

for SIJ (+) = reproduction of pain/sx

Question 317

What is the SIJ Approximation/Compression test?

Answer 317

for SIJ Pt sidelying - AFFECTED side UP! (+) = reproduction of sx (of hip on top)

Question 318

What is the Sacral Thrust Provocation test?

Answer 318

for SIJ pt prone, force on sactum down (+) = reproduction of sx

Question 319

What is the Gaenslen's Provocation test?

Answer 319

for SIJ -pt diagonal w/ one leg hanging off edge of table -other leg to chest -apply pressure to both legs: -downward pressure to leg hanging off -downward pressure to leg on chest (increasing pelvic rotation on SI jt) (+) = reproduction of sx

Question 320

What is the Supine Active Straight Leg Raise test (ASLR)?

Answer 320

for SIJ instability/laxity -pt does SLR --> pain -PT compresses iliac crest --> no pain (+) = pt able to perform active SLR with compression

Question 321

What is the Cervical Radiculopathy Test cluster?

Answer 321

at least 3/4 (+) -upper limb tension test A -Spurlings A -Cervical Distraction -Cervical rotation < 60 degrees

Question 322

What are some indications for traction?

Answer 322

-spinal disc bulge or herniation -spinal N. root impingement -joint hypomobility -SUBacute jt inflammation -muscle spasm

Question 323

What are some contraindications for traction?

Answer 323

-when motion ins contraindicated (Ex. fracture/RTC repair) -ACUTE injury/inflam -jt hypermobility/instability -peripheralizatino of sx w/ traction -uncontrolled HTN

Question 324

What are the dosing parameters for Lumbar traction in the initial/acute phase?

Answer 324

initial/acute phase: Force: 13-20 kg (29-44 lbs) Static hold Total time: 5-10 mins

Question 325

What are the dosing parameters for Lumbar traction for joint distraction?

Answer 325

Joint distraction: Force: 22.5kg (50 lbs) OR 50% body wt Hold/relax time: 15 sec/15 sec Total time: 20-30 mins

Question 326

What are the dosing parameters for Lumbar traction for decreased muscle spasm?

Answer 326

decreased muscle spasm: Force: 25% body wt Hold/relax time: 5 sec/ 5 sec Total time: 20-30 sec

Question 327

What are the dosing parameters for Lumbar traction for stretching of soft tissue/disc?

Answer 327

Force: 25% body wt Hold/relax time: 60 sec/20 sec Total time: 20-30 mins

Question 328

What are the dosing parameters for Cervical traction for inital/acute phase?

Answer 328

initial/acute: Force: 7-9lbs Hold/relax: static hold Total time: 5-10 mins

Question 329

What are the dosing parameters for Cervical traction for joint distraction?

Answer 329

jt distraction: Force: 20-29 lb OR 7% body wt Hold/relax: 15 sec/15 sec Total time: 20-30 mins

Question 330

What are the dosing parameters for Cervical traction for decreased muscle spasm?

Answer 330

M. spasm: Force: 11-15 lb (5-7 kg) Hold/relax: 5 sec/5 sec Total time: 20-30 mins

Question 331

What are the dosing parameters for Cervical traction for soft tissue stretch/Disc?

Answer 331

Tissue stretch/disc: Force: 11-15 lbs (5-7kg) Hold/relax: 60 sec/20sec Total time: 20-30 mins

Question 332

What is the CPR for pts who may benefit from CERVICAL traction?

Answer 332

-Age > 55 -petipheralization w/ spine mobility -(+) shoulder ABD test -(+) ULTT A -(+) Cervical Distraction test

Question 333

What is the CPR for pts who may benefit from LUMBAR traction?

Answer 333

-Age >30 -not manual laboers -low fear avoidance (FABQ) -No neuro deficits

Question 334

According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with mobility deficits?

Answer 334

Common sx: -central/unilateral neck pain -neck motion limitation that reproduces sx -may have referred shoulder girdle/UE pain Expected exam findings: -limited cervical ROM -neck pain reproduced at end-ranges of active and passive mvmt -restricted cervical/thoracic mobility -neck and referred pain reproduced -deficits of scapulothoracic strength

Question 335

According to the Neck pain CPG, what are some interventions for neck pain with mobility deficits?

Answer 335

Question 336

According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with radiating pain/radicular pain?

Answer 336

Question 337

According to the Neck pain CPG, what are some interventions for neck pain with radiating pain/radicular pain?

Answer 337

Question 338

According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with cervicogenic headache?

Answer 338

Common sx: -noncontinous unilateral neck pain w/ associated HA -HA aggravated/precipitated by neck mvmts Expected exam findings: -(+) cervical flexion-rotation test -HA produced w/ cervical segment provocation -strength, endurance, coord deficits of neck M.

Question 339

According to the Neck pain CPG, what are some interventions for neck pain with cervicogenic headache?

Answer 339

Question 340

According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with movement coordination impairments (WAD)?

Answer 340

WAD = Whiplash

Question 341

According to the Neck pain CPG, what are some interventions for neck pain with movement coordination impairments (WAD?

Answer 341

WAD = Whiplash

Question 342

What are the s/sx for Vertebral Artery Insuficiency (VBI)?

Answer 342

5D's And 3N's: Dizziness Drop attacks Diplopia Dysarthria Dysphagia Ataxic gait Nausea Numbness Nystagmus

Question 343

How do you screen for VBI?

Answer 343

pt seated, have pt fully extend neck then cervical rotation maintaining neck extension (+) = nystagmus

Question 344

What do you do if pt shows positive signs for VBI?

Answer 344

Question 345

What is the modified Sharp-Purser test:

Answer 345

tests transverse ligament --> atlanto-axial instability transverse ligament: holds dens back keeps dens from moving anteriorly to SC pt seated 1. grasp spinous process of C2 2. push head towards spinous process (+) = reproduction of myelopathic sx during forward flexion that DECREASE w/ A-P mvmt OR (+) = excess displacement IF (+), CALL 911

Question 346

What is the alar ligament test?

Answer 346

tests Apical ligament of dens --> cervical instability Apical ligament of dens: attaches dens vertically to atlas pt seated 1. grab C2 spinous process 2. either SB or rotate head passively (+) = C2 spinous process does NOT move normal = C2 spinous process moves with mvmt IF (+), CALL 911

Question 347

What is the lateral shear test of the atlanto-axial jt?

Answer 347

tests alar ligament --> cervical instability pt supine 1. grab transverse process of C1 w/ one hand 2. grab transverse process of C2 with other hand 3. apply force b/w 2 grips creating shear force (+) = reproduction of myelopathic sx during translation OR (+) = excess displacement IF (+), CALL 911