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NPTE > Final Frontier readings > Flashcards

Final Frontier readings Flashcards

1
Q

What nerve provides the afferent input for the corneal reflex?

A

CN V: Opthalmic branch

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2
Q

What nerve provides the efferent response of the corneal reflex?

A

CN VII

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3
Q

Describe the abdominal reflex and its findings.

(T7-T12)

A

Contraction of the superficial abdominal muscles when stroking the abdomen lightly (Lateral –> medial)

(+) if asymmetric = indicates UMN lesion on the absent side

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4
Q

Describe the cremasteric reflex and its findings.

(L1, L2)

A

Contraction of the cremaster muscle (pulls up the scrotum) after stroking the same side of the superior/medial thigh

(+) Absent = SCI and corticospinal lesions

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5
Q

What is another name for the babinski reflex? What does it indicate?

(S1, S2, tibial nerve)

A

Plantar reflex

(+) Great toe DF and fanning of the toes = UMN lesion and corticospinal lesion

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6
Q

What facilitates the anal reflex? What nerve(s) provide the afferent and efferent input of the reflex?

A

Contraction of the external anal sphincter upon stroking the skin around the anus

afferent: Pudenal nerve
efferent: S2-S4

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7
Q

Describe the bulbocanvernosus reflex and its findings.

(S2-S4)

A

Anal spincter contraction in reponse to squeezing the glans penis or tugging on an indwelling foley catheter

First reflex to emerge after SCI (indicates that the body is out of spinal shock)

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8
Q

Is muscle wasting/atrophy more prominent with nerve root damage or peripheral nerve damage?

A

Peripheral nerve damage

The damaged peripheral nerve is supplied by more than one nerve root = more muscle fibers being affected

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9
Q

Capsular pattern of shoulder?

A

ER > ABD > FLX > IR

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10
Q

Mobilization/Manual therapy

humeroradial FLX

A

anterior

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11
Q

Mobilization/Manual therapy

humeroradial EXT

A

posterior

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12
Q

Mobilization/Manual therapy

Proximal RU joint PRON

A

Posterior

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13
Q

Mobilization/Manual therapy

Proximal RU joint SUP

A

anterior

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14
Q

Mobilization/Manual therapy

Distal RU joint PRON

A

Anterior

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15
Q

Mobilization/Manual therapy

Distal RU joint SUP

A

Posterior

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16
Q

Mobilization/Manual therapy

knee FLX

A

posterior

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17
Q

Mobilization/Manual therapy

knee EXT

A

anterior

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18
Q

hip capsular pattern?

A

FLX > IR > ABD

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19
Q

How long are precautions for a THR implemented?

A

3-6 months

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20
Q

When can a person start to perform FWB s/p uncemented THR/TKR?

A

6 weeks

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21
Q

When can resisted exercises start for those s/p THR?

A

week 4

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22
Q

How long is a pt NWB s/p meniscus repair?

A

3-6 wks

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23
Q

At what degree is a knee brace locked at s/p ACL repair?

A

0 degrees EXT

wean off around wks 2-4

  • recent clinical practice allows for ROM as tolerated after 1 week
  • pt is able to unlock brace with ROM exercises
  • remains locked with ambulation
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24
Q

(true/false) Lack of skeletal maturity can be considered as a contraindication to ACL surgery

A

true

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25
Q

When can exercises begin after ACL repair?

A

POD 1

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26
Q

An ACL tendon graft goes through _______ for 2-3 weeks prior to revascularization

A

necrotizing process

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27
Q

(true/false) bone to bone healing is faster than soft-tissue to bone healing

A

true

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28
Q

What exercise precautions are in place for those s/p ACL repair?

A
  1. avoid shear forces and stress on graft –> no OKC knee EXT in short sitting
  2. avoid CKC quad strengthening between 60-90 degrees of FLX
  3. use caution with knee FLX strengthening for HS tendon and knee EXT strengthening for quadriceps tendon
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29
Q

When can a functional brace be used during ACL rehab?

A

Starting wk 12

reduces anteriro translation especially at low external loads

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30
Q

What muscles are inhibited with upper crossed syndrome?

A
  • deep cervical flexors
  • lower trap
  • serratus anterior
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31
Q

What muscles are tight with upper crossed syndrome?

A
  • SCM
  • pectoralis
  • upper trap
  • lev scap
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32
Q

What muscles are inhibited with lower crossed syndrome?

A
  • abdominals
  • gluteal muscles
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33
Q

What muscles are tight with lower crossed syndrome?

A
  • rectus femoris
  • iliopsoas
  • back extensors
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34
Q

What are the 5 D’s and 3 N’s?

A
  • dysphagia
  • diplopia
  • dysarthria
  • drop attacks
  • dizziness
  • ataxia of gait
  • nystagmus
  • nausea/vomiting
  • N/T
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35
Q

What motions of the neck test both vertebral arteries?

A

FLX and ROT tests

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36
Q

What motions of the neck test the contralateral vertebral artery?

A
  • EXT + ROT tests
  • cervical ROT tests
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37
Q

What motions of the neck test the ipsilateral vertebral artery?

A

SB tests

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38
Q

What type of onset does adhesive capsulitis have?

A

insidious

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39
Q

what is another name for periarthritis?

A

adhesive capsulitis

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40
Q

Describe the initial onset stage of adhesive capsulitis.

A
  • pain that increases with movement and is present at night
  • loss of ER with intact RTC strength
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41
Q

Describe the freezing stage of adhesive capsulitis.

A
  • persistent and intense pain at rest
  • motion is limited in all directions
  • lasts for 3-9 months

cannot be fixed by injections

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42
Q

Describe the frozen stage of adhesive capsulitis.

A
  • pain only with movement
  • significant adhesions
  • limited motions in all directions
  • deltoid, RTC, biceps, and triceps atrophy
  • lasts 9-15 months
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43
Q

Describe the thawing stage of adhesive capsulitis.

A
  • minimal pain
  • no synovitis but gas capsular restrictions from adhesions
  • motion may improve
  • stage lasts for 15+ months
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44
Q

For adhesive capsulitis, what direction mobilization would you use to improve ER and IR?

A

posterior glide

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45
Q

(true/false) RA can present with systemic symptoms

A

true

fatigue, malaise, fever, weight loss, multi-system dysfunction

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46
Q

How long does stiffness last in the morning when RA is present?

A

> 45 minutes

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47
Q

How long does stiffness last in the morning when OA is present?

A

< 30 minutes

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48
Q

What capsular pattern is present with legg-calve-perthes disease?

A

absent capsular pattern

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49
Q

What gait deviations are present in those with legg-calve-perthes disease?

A

psoatic limp or trendelenburg

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50
Q

What gait deviations are present with SCFE?

A

lurch gait or trendelenburg

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51
Q

What 5 chracteristics rule-in lumbar manipulation?

A

4/5 must be present:
- pain < 16 days
- no symptoms below the knee
- FABQ < 19
- IR > 35 degrees in at least one hip
- hypomobility of 1+ level of lumbar spine

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52
Q

What percent of body weight is needed to overcome friction when performing lumbar mechanical traction?

A

> 25%

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53
Q

What percent of body weight is needed to achieve separation of the joint spaces when performing lumbar mechanical traction?

A

> 50%

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54
Q

When performing lumbar traction for the first time, a maximum of ___ pounds should be used to to determine patient response

A

30 pounds

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55
Q

What is the maximum duration allowed for lumbar traction?

A

Acute intermittent lumbar traction: < 15 minutes
Acute sustained lumbar traction: < 10 minutes
Chronic: 30 minutes

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56
Q

what is the purpose of a posterior stop on an AFO?

A

stops excessive PF

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57
Q

What is a posterior leaf spring AFO used for?

A
  • allows for stored energy potential
  • assists with DF
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58
Q

What is a GR-AFO used for?

A
  • control at the ankle and knee
  • prevents the knee from collapsing into FLX during the stance phase by restricting DF
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59
Q

What is another name for shin splints?

A

medial tibial stress syndrome

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60
Q

How do you differentiate between medial tibial stress sydrome and a stress fx?

A

Medial tibial stress syndrome:
- non-focal pain on the posteromedial tibial border
- pain improves with exercise and returns during cool-down
- limited mobility within the posterior compartment of the leg

Stress Fx:
- deep focal pain
- pain is present at rest and with activity
- no change in ROM

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61
Q

What are the 3 conditions that make up the female-athlete triad?

A
  • osteoporosis
  • amenorrhea
  • eating disorder
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62
Q

What is another name for reactive arthritis?

A

reiter’s syndrome

joint inflammation secondary to infection within the body

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63
Q

Describe OKC foot supination.

A

INV + PF + ADD
(“IPAD”)

OKC foot pronation is opposite (EV + DF + ABD)

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64
Q

Describe CKC foot supination.

A

INV + DF + ABD
(“I DAB”)

CKC pronation is opposite (EV + PF + ADD)

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65
Q

What is RPP used for? What is the formula?

A
  • used to estimate myocardial workload and O2 consumption

RPP = HR x SBP

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66
Q

What happens to the following values during incremental exercise?

HR
CO
MAP (SBP and DBP)

A

all increase EXCEPT for DBP which remains constant

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67
Q

What happens to the following values during initial training above altitude?

HR
CO
BP
RR
SV

A

All values increase EXCEPT for SV which has no change due to an increase in HR promoting oxygenation

Above sea level has decreased O2 = hypoxia = increased RBC production

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68
Q

What happens to the following values during acclimatization above altitude?

HR
BP
CO
SV

A
  • HR increases
  • BP is normal
  • CO is normal
  • SV is decreased
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69
Q

What happens to the following values once a person returns to sea level after altitude training?

HR
BP
CO
SV
VO2 and O2 production

A
  • HR and BP are normal/stable
  • increased CO
  • increased SV
  • increased VO2 and O2 production
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70
Q

What happens to the following values during aquatic therapy?

swelling
circulation/venous return
HR
BP
CO
VO2
SV
work of breathing
Vital capacity

A
  • swelling decreases
  • venous return increases
  • HR decreases
  • BP decreases
  • CO increases
  • VO2 decreases
  • SV increases
  • work of breathing increases
  • vital capacity decreases

swelling decreases and circulation improves due to hydrostatic pressure

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71
Q

What do beta blockers do?

A
  • decreases HR and contractility
  • decreases myocardial O2 demand

(-lol)

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72
Q

What will beta blockers do to HR during exercise?

A

will lower HR

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73
Q

What is afterload?

A

pressure required to pump blood out of the ventricles

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74
Q

(true/false) Those with severe pulmonary impairment will reach their cardiovascular maximum before their ventilatory maximum

A

False (opposite)

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75
Q

What is glossopharyngeal breathing used for?

A

assist with coughing

76
Q

what is stacked breathing used for?

A
  • improving inspiration
  • ex: hypoventilation, atelectasis, ineffective cough, and uncoordinated breathing patterns during ADLs
77
Q

What does pursed-lip breathing help improve?

A
  • increases TV
  • reduces RR and dyspnea
  • facilitates relaxation of airways for better air exchange
  • decreases resistance

used for patients with obstructive disease and those who experience dyspnea at rest or with minimal exertion

78
Q

What does sustained maximal inspiration (SMI) / inspiratory hold help improve?

A
  • increase inhaled volume
  • restore FRC
  • prevents alveolar collapse

common in acute cases (sx, ineffective cough, etc)

79
Q

what is segmental breathing used for?

A
  • improve ventilation to a hypoventilated segment
  • alter regional distribution of gas
  • maintain or restore FRC

used with pleuritic, incisional, or post-traumatic pain that causes decreased movement within a portion of the thorax and for those at risk of developing atelectasis

80
Q

What happens to HR when temperature increases?

A

HR increases

81
Q

What spinal cord segments contain the sympathetic nerves?

A

T1-T4

control is in medulla (cardioacceleratory center)

82
Q

What does sympathetic stimulation do to the diameter of blood vessels?

A

Coronary arteries: vasodilate

peripheral arteries: vasoconstriction

83
Q

Those with a cerebellar lesion have what kind of reflex?

A

normal or diminished

84
Q

Those with a lesion of the basal ganglia have what kind reflex?

A

normal or decreased

85
Q

Describe the clasp-knife effect.

A

an increase in resistance to PROM that suddenly gives away

86
Q

What type of atrophy does a UMN lesion have?

A

disuse atrophy

Widespread loss of mobility that develops within weeks to months

87
Q

What type of atrophy does a LMN lesion have?

A

neurogenic atrophy

rapid focal, significant muscle wasting consistent with degree of damage

88
Q

With myopathy, you will see (proximal/distal) muscle weakness

89
Q

With neuropathy, you will see (proximal/distal) muscle weakness

90
Q

(true/false) strength is impaired ipsilaterally if the corticospinal tract is damaged above the medulla

A

False (strength will be impaired contralaterally if damage is above the medulla – strength will be impaired ipsilaterally if damage is below the medulla)

91
Q

(true/false) Variant angina responds to nitroglycerin

A

true (most of the time)

92
Q

What medication class is used as a long term treatment of variant angina?

A

calcium channel blockers

93
Q

What is the apical pulse?

A

The point of maximal impulse

–> used when peripheral pulses are weak or other palpation sites are not able to be palpated

–> pt is supine - palpate at 5th ICS at the midclavicular line (location of the mitral valve)

94
Q

Why must you only test one side at a time when taking a carotid pulse?

A

It reduces the risk of reflexive drop in pulse rate and/or BP due to stimulation of baroreceptors

95
Q

Where in the heart will you hear the S3 sound if it is present?

A

mitral valve (apical pulse point)

96
Q

Which heart sound is decreased if aortic stenosis is present?

97
Q

Which heart sound is decreased if 1st degree heart block is present?

98
Q

Ventricular gallop

99
Q

Atrial gallop

100
Q

What is a systolic murmur and what does it indicate?

A

Turbulance between S1 and S2

  • indicates possible valve disease and/or aortic stenosis if not classified as normal for the patient
101
Q

What is a diastolic murmur and what does it indicate?

A

turbulence between S2 and S1

  • indicates possible aortic and pulmonary regurgitation
102
Q

What abnormal heart sound would you hear if a patient has atherosclerosis or a partially blocked artery?

A

bruit

commonly heard in the carotid and/or femoral arteries

103
Q

What is Dressler syndrome?

A

Post-MI pericarditis

will have a pericardial friction rub when auscultating

104
Q

When taking BP, if the cuff is too small, what will happen to the reading?

A

it will read higher than the actual BP

If the cuff is too large, the reading will be lower than actual P

105
Q

What BP is considered as hypotension?

A

SBP < 90 mmHg

OR

DBP < 60 mmHg

106
Q

If a patient has a mediastinal shift, what position is not recommended?

A

S/L on the affected side due to the risk of increasing the mediastinal shift

107
Q

A tracheal shift is an indicator of what?

A

upper mediastinal shift

  • shifts contralaterally when pressure is increased on the affected side (hemothorax, pneumothorax, etc.)
  • shifts ipsilaterally when lung volume and intrathoracic pressure are decreased on the affected side (atelectasis, lobectomy, pleural fibrosis, etc)
108
Q

Cyanosis is a sign of _____.
Digital clubbing is a sign of ____.

A

cyanosis –> acute hypoxia
digital clubbing –> chronic hypoxemia

109
Q

what is fremitus?

A

vibrations produced by the voice or by the presence of secretions within the airways

110
Q

What caues yellow sputum?

111
Q

What caues green sputum?

A

bacterial infection

112
Q

What caues pink frothy sputum?

A

pulmonary edema due to CHF

113
Q

What caues brown sputum?

A

blood or dirt

blood can also cause red sputum

114
Q

What caues black sputum?

A

fungal infection or smoking

115
Q

What caues mucoid sputum?

thick, clear, white, or grey

A
  • COPD
  • asthma
  • acute viral infections
116
Q

Consolidation (ex: PNA) increases/decreases fremitus

A

increases

most conditions will have decreased fremitus

117
Q

Fremitus (increases/decreases) with atelectasis

A

Fremitus will be absent

118
Q

Central cord syndrome has more (motor/sensory) involvement

A

motor > sensory

119
Q

Central cord syndrome has more (UE/LE) involvement

120
Q

Brown sequard syndrome has (ipsilateral/contralateral) loss of pain and temperature

A

contralateral loss

121
Q

Brown sequard syndrome has (ipsilateral/contralateral) loss of vibration, position sense, and motor control

A

ipsilateral loss

122
Q

What is preserved with posterior cord syndrome?

A

motor function

123
Q

What occurs to blood vessels above and below the level of lesion when autonomic dysreflexia is present?

A

Above level: vasodilation
Below level: vasoconstriction

124
Q

What reflex presents itself first when the body comes out of spinal shock?

A

bulbocavernosus

125
Q

(true/false) glossopharyngeal breathing helps with breathing and clearing secretions

A

false - only helps with breathing

126
Q

Orthostatic hypotension is commonly seen with SCIs above what spinal level?

127
Q

Neurogenic shock occurs at what spinal level of SCI?

A

ABOVE T6

autonomic dysreflexia occurs AT or ABOVE T6

128
Q

With an SCI, what spinal levels present with a spastic bladder and bowel (neurogenic bladder)?

129
Q

With an SCI, what spinal levels present with a flaccid bladder and bowel (autonomous)?

A

AT or below S2

130
Q

What is a marcus gunn pupil?

A

An afferent pupillary defect with limited pupil constriction to light

131
Q

Symptoms of MS are commonly (unilateral/bilateral)

A

unilateral

132
Q

MS is a (UMN/LMN) disease

A

UMN

hyperreflexia and spasticity

133
Q

What is a dyssynergic bladder?

A

decreased coordination between contraction and relaxation of the bladder

134
Q

What are the most common cerebellar symptoms?

A
  • ataxic gait
  • dysdiadokinesia
  • intention tremor
  • dysmetria
135
Q

(true/false) Lhermitte sign can be used for dx of MS

136
Q

What is uhthoff phenomenon?

A

increased neuro s/s due to heat

pseudoexacerbation / pseudoattack

137
Q

What is pseudobulbar affect?

A

involuntary emotional expression disorder

sudden and unpredictable episodes of crying, laughing, etc

138
Q

What is the most common bowel complaint of MS?

A

constipation

< 3 bowel movements/wk

139
Q

With MS, the goal is to increase (intensity/duration) first.

140
Q

For spasticity management, PT treatment time should be based on what factor?

A

The time of baclofen administration

PT session should try to be in the middle of the dose cycle

141
Q

GBS is a (UMN/LMN) condition

A

LMN

flaccidity and hyporeflexia

142
Q

(true/false) GBS is asymmetrical

A

false (symmetrical)

143
Q

With GBS, are proximal or distal muscles more affected?

A

distal > proximal

144
Q

With Myasthenia gravis, are proximal or distal muscles more affected?

A

proximal > distal

145
Q

(true/false) myasthenia gravis has motor and sensory involvement

A

false (pure motor involvement)

146
Q

(true/false) PD does not affect the sensory system

147
Q

Is ALS symmetrical or asymmetrical?

A

asymmetrical

148
Q

What involuntary movements are present with ALS?

A

fasciculations

149
Q

What involuntary movements are present with MS?

A
  • intention and postural tremors
  • muscle spasms
150
Q

When are symptoms of myasthenia gravis more severe?

A
  • Later in the day
  • after prolonged activity
  • fluctuation in intensity of activity
151
Q

What are hallmark problems of myasthenia gravis?

A
  • fatigue
  • fluctuating ASYMMETRIC ptosis
152
Q

(true/false) unilateral neglect is due to sensory loss

A

False

caused by lesion(s) to the the inferior and posterior portions of the parietal lobe

153
Q

What side is unilateral neglect on in most cases?

A

left side of the body

154
Q

What is unilateral visual inattention?

A

unilateral neglect

“hemi-inattention, hemineglect, and unilateral spatial neglect”

155
Q

What is anosognosia?

A

lack of awareness and/or denial, of a paretic extremity as belonging to the person and/or lack of insight concerning disability

common for patients to claim that the limb has a mind of its own

156
Q

What is somatoagnosia?

A

lack of awareness of the body structure and relationship of body parts to oneself or others

157
Q

What is the common name for autopagnosia?

A

somatoagnosia

also called simply body agnosia

158
Q

Where is the lesion found that causes somatoagnosia?

A

dominant parietal lobe (left)

159
Q

What is right-left discrimination?

A

inability to identify the left and right side of the body

160
Q

(true/false) those with right-left discrimination are able to imitate movements of the examiner.

A

false (unable)

161
Q

body scheme impairment

characterized by difficulty in naming the fingers on command, identifying which finger was touched, and/or unable to mimick finger movements

A

finger agnosia

162
Q

What is figure-ground discrimination?

A

inability to distinguish a figure from the background in which it is embedded

163
Q

what is form discrimination?

A

inability to perceive or attend to subtle differences in form and shape

Often confuses objects of similar shape or does not recognize the object when placed in an unusual position
(ex: mistaking a pen as a toothbrush)

164
Q

What is topographical disorientation?

A

difficulty understanding and remembering the relationship of one location to another

regardless of utilizing a map or not

165
Q

What is the most common form of agnosia?

A

visual agnosia

inability to recognize familiar objects despite normal function of the eyes and optic tracts

166
Q

What is prospagnosia?

A

inability to recognize familiar faces

167
Q

(true/false) another name for color blindness is color agnosia

A

false

color agnosia is when the pt is unable to identify and/or name colors on command but they can correctly match colored chips

168
Q

What is simultanagnosia?

A

The inability to perceive a visual stimulus as a whole

punched out visual picture

169
Q

What is astereognosis?

A

inability to recognize an item by handling them

note: tactile, proprioception, and thermal sensations may be intact

170
Q

What is ideomotor apraxia?

A

disconnection between the idea of a movement and its motor execution

–> pt is able to carry out the task automatically and describe how the task is done… HOWEVER, the pt is unable to imitate gestures or perform the task on command

171
Q

What is ideational apraxia?

A

Inability to perform a purposeful motor act with/without a command.

  • The pt no longer understands the overall concept of the task and/or cannot retain the idea of the task.
  • pt may not be able to formulate the motor patterns required for a task
172
Q

What descending spinal tract will result in a positive babinski sign, absent abdominal and cremasteric reflex, and the loss of fine motor/skilled voluntary movement if damaged?

A

corticospinal (pyramidal) tracts

173
Q

What type of hematoma is chronic in nature and is often mistaken as dementia?

A

epidural hematoma (hemorrhagic stroke type)

174
Q

What type of hemorrhagic stroke results in a midline shift of the brain?

A

subdural hematoma

175
Q

What type of hemorrhagic stroke reults in the inability to identify the lateral ventricles?

A

subarachnoid

worst prognosis and often leads to death

176
Q

(true/false) cardiac arrythmias are common in those with PD

177
Q

What mnemonic is used to identify the primary signs of PD?

A

“TRAPP”

  • Tremor (resting)
  • Rigidity
  • Akinesia and bradykinesia
  • Postural instability
  • Pill rolling
178
Q

What is akinesia?

A

inability to initiate movement

179
Q

What is sialorrhea?

A

excessive saliva production (drooling)

180
Q

What is bradyphrenia?

A

slowing of the thought process

181
Q

What is one orthotic option for treatment of festinating gait?

A

Toe wedge to displace the pt’s COG backward and improve stability

182
Q

What drugs are used to treat tremor in those with PD?

A

anticholinergic drugs

183
Q

What drug is commonly used to enhance dopamine release?

A

amantadine

184
Q

What medication is commonly used in early stages of PD to slow down progression of the disease?

A

Selegiline

185
Q

Huntington’s disease results in degeneration of what structures?

A

Basal ganglia and cerebral cortex

NPTE (21 decks)

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