General Board Review

Question 1

TIPS ON TAKING TEST *****

• BE CONFIDENT. You’ve passed 6 of these exams. You can do it. 1/2 the battle is in your mind. Be confident.
• Begin every new question with fresh re-start. Carry nothing from the previous question(s) forward. Don’t get discouraged, or cocky. Take 1 question at a time, and give full effort to that question.
• Read the question thoroughly. Don’t skip over small little details and words that could change things. Pay attention. Each word in the question is important. Don’t just gloss over details in the question. The details are in there for a specific reason.
• After reading the question, try to think of the answer in your mind BEFORE looking at the answer choices.
• From point above, if you know it, still verify it is right by eliminating the other choices.
• If you don’t know it, at least narrow it down to 2 choices (there will usually be 2 very wrong distractor answers).
• Trust your gut - 90% of the time it is right. And don’t second guess or dwell over or doubt yourself. Be confident with the most logical choice and move on.
• Sometimes you just don’t know - it’s fine, move on and don’t worry! Or just come back to it with a fresh look (mark it).
• *** NEVER insert more info into the question that is not there. Just take the info there and only base your reasoning/answer off just that info. Don’t assume, add info, etc.
• ** Always default to SAFETY on board questions. Make sure you as PT are keeping pt safe. ** Remember what Dr. Furze said about the board. She said in general, the board is making sure you are SAFE as a practitioner. So not that every ? is about patient safety, but in general they want to make sure you are safe. So just keep that in the back of your mind.
• *** THESE WERE THE TIPS FROM TAKING PEAT AND THEIR ADVICE:
• Perhaps MOST MOST MOST importantly, when reviewing the answers, almost NEVER was there a trick question. Just go with your gut on the one that seems most logical and that you know best.
• You will feel that you are failing throughout the test - that is normal. Don’t worry about that.
• EVERY QUESTION - give 100% mental effort, and reset for every ?
• It is a mental endurance game. Stay sharp and focussed.
• Trust your gut, don’t second guess.
• The test is NOT about memory recall of stats, diagnosis’s, etc. - it is about APPLICATION of knowledge into a real life case/patient.
• Almost 90% of questions ask you to choose the BEST answer. There may be multiple right answers, just like in the clinic there are multiple right approaches - but what they are looking for is what would be BEST. It’s ok if all of them are good answers.
• Read the entire ?. Don’t jump to conclusions while reading ?
• They don’t give you all the info. But they give you enough to answer the ?. Do NOT insert more info in - just work with what the ? is.
• Try to answer it in your head BEFORE looking at the answer choices.
• Sometimes it seems like you don’t know, or it is confusing but there is one answer that seems right and logical - go with it every time. Trust your gut.
• After going through all the answers - most seem like the logical choice. So don’t over think it, don’t think they are trying to trick you, RARELY go with the answer choice you don’t know. If you think it is right and most logical - trust your gut.
• Don’t worry too much about the details in the stem - just know what is the CONCEPT they are asking. The concept behind the question - answer that.
• Remember that you will go through periods where you get 10-15 right and it feels easy and you are cruising and doing well/confident. Then you’ll go through periods where it feels like the last 10 you got all of them wrong. That is ok. That is normal. Stay positive. You may have just got a bunch of hard one’s in a row. It’s fine. Keep head up and keep going - you’ll get to a batch of really easy ones.
• Just because there is are 2 answer choices with one being opposite than the other does NOT mean one of them is right. Sometimes that is true, sometimes it is a distractor. Don’t worry about stuff like that - just choose the BEST answer and don’t do that game.
• Don’t over think it. Go with the most logical answer.

2)
- Do 2 PEAT Exams (and write FC’s on them)
- Do the final Score builders exam (and write FC’s on them)
- Review all PT 356 app ?s
- Review the master doc of board FC’s you made

3) Go look into these links:
* PEAT provided by The Federation of State Boards of Physical Therapy https://pt.fsbpt.net/PEAT/

• International Educational Resources https://therapyexamprep.com/
• Team Educational Resources
  http: //therapyteam.com/ (this is a paid course)

I have a link saved in my favorites - check that out.

Answer 1

OK

Question 2

1) Will your facet joints open or close when you do lumbar flexion?
2) During right sidebending, will left facet joint open or close
3) When doing right lumbar rotation, will left facet joint open or close?

4) Forward flexion and backward extension of lumbar spine is in what plane
- And that motion is around what axis

5) Sidebending the trunk is in what plane
- Around what axis

6) Rotation of the trunk is in what plane
- Around what axis

7) What motions of the trunk are “coupled” together
- In lumbar spine, what is the coupling motions
- T or F: in lumbar spine, if you side bend to the left, the spinous process goes to the left?
- T or F: It is opposite in the c-spine

8) What does “coupling” of the spine movements mean?
9) What are the 2 principles of spine coupling:

Answer 2

1) Open
2) Open
3) Open

4) Sagittal
- medial-lateral

5) Coronal (Frontal)
- Anterior-posterior

6) Transverse (Axial)
- Verticle

7) Rotation and Sidebending are coupled together in the spine.
- Opposite (side bending to the left will cause the VERTEBRAL BODY to rotate to the right)
- True (because the vertebral body rotates right, thus spinous process goes left … same direction as the side bend)
- True (sidebending to the left in c-spine causes VERTEBRAL BODY to rotate to the left … but the spinous process will thus go right)

8) This means when a segment is rotated, then side-bending (to the same side or the opposite side) will also occur. The converse is also true: if a segment side-bends, rotation (to the same side or the opposite side) will also occur.

9)
Principle I: When the spine is in neutral, side-bending to one side will be accompanied by rotation to the opposite side in the lumbar spine (same side in c-spine).

Principle II: When the spine is in a flexed or extended position (non-neutral), side-bending to one side will be accompanied by rotation to the same side.

Question 3

1) Explain concave vs. convex
2) Give some reasons why you might NOT want to do joint mobs

3) If you did this movement below, how would you grade that joint mobilization:
- Small amplitude/movement at beginning of range
- Small amplitude at end of range
- Large amplitude up to the limit of their range
- Large amplitude/mvmt performed within their range, but not to end of range and not returning to beginning of range
- Small amplitude high velocity thrust to snap adhesions at the limit of range

Answer 3

1) Concave forms the caved in portion, convex is the bulging out portion
2) Disease or infection, New Joint Replacement, Fracture, Osteoporosis, Tumor, Joint Hypermobility, fusion

3)

• Grade 1
• Grade 4
• Grade 3
• Grade 2
• Grade 5

Question 4

1) C1 is called the:
2) C2 is called the:

3) Tip of C2 is called:
- Ligaments that prevent too much rotation (and attach to point above?

4) T or F: there is a disc between C1 and C2?
- Are there discs in sacrum and coccyx?

5) How many vertebrae are there?

6) Primary curvatures of the spine are:
- How to remember this:

7) Secondary curvatures of the spine are:
8) What areas of the spine move the most
9) What is unique anatomically about the cervical vertebrae

10) What joint is the “yes” joint in the cervical spine?
- What joint is the “no” joint in the cervical spine?

11) How do you differentiate between a pedicle and a lamina on a vertebrae?
12) How many joints on a thoracic vertebrae (and explain them):
13) Why doesn’t the thoracic spine move much?
14) T or F: Remember the “giraffe” shape of thoracic vertebra, and how spinous process points down to next vertebrae below, so touching spinous process in thoracic region is thus 1 level below actual vertebral body.

Answer 4

1) Atlas
2) Axis

3) Dens (Odontoid process)
- Alar lig’s

4) False
- No - those vertebrae are fuzed

5) C7T12L5S5C4 = 33

6) Thoracic and sacral
- Think of us in utero as a little bud, we are in a flexed (kyphotic) fetal position

7) Cervical and Lumbar
8) Cervical and Lumbar
9) They have a transverse foramen for the vertebral artery

10) Atlantooccipital (Occiput and C1)
- Atlantoaxial (C1-C2)

11) Think of a laminectomy … they come in from posterior back and cut out lamina. Thus, the pedicles are above/below intervetebral foramina
12) 12 (2 right sided facets for head of rib, 2 left sided facets for head of rib, the 4 facet joints for articulation of vertebrae, one above and below body, and one on each transverse process for tubercle of rib)
13) Ribs articulate with thoracic vertebrae and thus don’t allow movement
14) True

Question 5

1) Outer portion of intervertebral disc is called:
2) Inner portion of intervertebral disc is called:
3) Intervertebral discs are what type of joints:
4) Facet joints are what type of joints:

5) What ligament connects the lamina together?
- This ligament (from above) restricts what motion
- What other ligaments limit flexion of the spine
- The anterior longitudinal lig restricts what motion

6) is the base of the sacrum the superior or inferior portion
- The base of a lobe of the lung is the superior or inferior portion

7) The sacral hiatus is what
- A hiatus is a ________

8) What are the extrinsic m’s of the back
- What are the intrinsic m’s of the back

9) The splenius capitus and cervicis muscles of the neck do what actions

10) What 2 muscles are innervated by the Accessory n
- This is what CN
- Axillary nerve innervates what m’s
- Teres Major muscle is primarily innervated by what n.

11) What are the upward rotators (muscles) of the scapula
- What are the downward rotators (muscles) of the scapula
- What m’s elevate the scapula

12) Rhomboid m’s are innervated by what nerve
- What nerve roots does dorsal scapular nerve come from
- Long thoracic nerve innervates what m.
- Long thoracic nerve has nerve roots from:

13) Erector spinae m’s (spinalis, longissimus, and iliocostalis) are innervated by what nerve:
- Their action is to do what:
- Iliocostalis attach where
- Longissimus muscle attaches where
- Spinalis m’s attach where:

14) The really really deep intrinsic m’s of the back are:
- These m’s attachments are:

15) What nerve roots innervate the diaphragm?
- How to remember?
- What nerve is it?

16) What does the vagus nerve do
- What Cranial Nerve is the Vagus Nerve:

17) Would sympathetic or parasympathetic innervation speed up the Heart Rate (HR) and contractile force
18) Pain sensation from myocardial ischemia is called:

Answer 5

1) Annulus fibrosis
2) Nucleus pulposus
3) Cartilaginous
4) Synovial

5) Ligamentus flavum
- spinal flexion
- posterior longitudinal lig, interspinous lig’s
- spinal extension

6) Superior (top)
- For the lobe of lung, apical is top and base is bottom

7) Where lower sacral and coccyx nerves run through /exit
- Hole

8) Extrinsic: traps, levator, rhomboids, lats, serratus posterior
- Erector spinae (spinalis, longissimus, iliocostalis), multifidi, QL

9) Extend head (when working bilaterally), or side bend and rotate head to side of contraction (when working unilaterally)

10) Traps and SCM
- CN XI
- Deltoid and Teres Minor
- Lower Subscapular

11) Upper trap, serratus anterior, lower trap
- Levator scapula, rhomboids, peck minor
- Levator and upper traps

12) Dorsal scapular n
- C4/C5
- Serratus ant
- C5/6/7 (remember brachial plexus drawing)

13) Dorsal rami of spinal nerves at that segment
- Extend the spine (bilaterally), side bend to ipsilateral side (unilaterally)
- On the ribs (angle of ribs)
- Transverse processes
- Spinous processes

14) Rotatores, Levatores, Multifidi - even the QL
- From transverse processes up to spinous processes above to stabilize spine

15) C3/4/5
- 3/4/5 Keeps you alive
- Phrenic nerve

16) Parasympathetic supply to heart and lungs and other structures. The most important function of the vagus nerve is afferent, bringing sensory information of the inner organs (such as gut, liver, heart, and lungs) to the brain. This suggests that the inner organs are major sources of sensory information to the brain. Motor - it provides innervation to pharynx and layrnx for speaking for those m’s.
- CN X

17) Sympathetic
18) Angina pectoris

Question 6

1) How many spinal nerves are there

2) The spinal cord, like the brain is covered in what meningeal layers (from deep to superficial)
- Which one is the tough outer meningeal layer

3) Spinal cord ends where (what level)
- What is this section called where the spinal cord ends?
- What are the “horses tail” nerve fibers distal to the ending of the spinal cord

4) ** Which spinal nerve carries SENSORY fibers … dorsal or ventral?
- Which spinal nerve carries MOTOR fibers … dorsal or ventral?
- Is afferent sensory or motor, and is efferent sensory or motor?
- How to remember (from last point)
- Is ventral anterior or posterior

5) Which is singular and which is plural of these 2: ramus and rami

6) Where do the dorsal and ventral roots combine to form a spinal nerve
- The dorsal root ganglion is just lateral (outside) this area from point above, and what is the dorsal root ganglion

7) What are denticulate ligaments

8) Fluid is found in these meningeal layers. What is this fluid called:
- Where is this fluid found?
- What space / area is it found in?

9) Dorsal rami nerves innervate what things:
- Why only those m’s

10) Looking at a transverse slice of a spinal cord, the “wings” of the gray mater - is that the dorsal or ventral side
- How to remember?

11) The spinal cord gets its blood supply from what artery:

12) What is the difference between gray matter and white matter:
- Why is white matter white:
- Does the white matter have ascending or descending tracts

Answer 6

1) 31 (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)

2) 3 (pia is deep, arachnoid is middle, dura is outer)
- Dura

3) L1 / L2
- Conus medularis
- Cauda equina

4) Dorsal
- Ventral
- Afferent is SENSORY, efferent is MOTOR
- Efferent = effort = motor
- Ventral is anterior, dorsal is posterior

5) Ramus is singular, rami is plural

6) Intervertabral foramen
- Bulge in the spinal nerve where the dorsal (SENSORY) cell bodies are

7) Extensions of the pia mater that anchor the spinal cord to the dura

8) Cerebrospinal fluid (CSF)
- Between arachnoid and pia mater
- Subarachnoid space

9) Skin and intrinsic back m’s
- The dorsal root exits RIGHT BY the posterior intrinsic m’s of the back

10) Dorsal
- Your wings are on your back

11) Vertebral artery

12) Grey matter is distinguished from white matter in that it contains numerous CELL BODIES and relatively few myelinated axons, while white matter contains relatively few cell bodies and is composed chiefly of long-range myelinated AXONS.
- The color difference arises mainly from the whiteness of myelin sheaths covering the axons.
- BOTH

Question 7

1) What is the difference between Anaerobic Metabolism and Aerobic Metabolism:

2) From question above, which is for high intensity, short duration exercise:
- Which one requires Oxygen to convert carbs into ATP

3) What are the 3 energy systems to create ATP

3A) Which energy system is 1st used and for fast bursts of energy

• How does this energy system from the point above work?
• How long will the 1st energy system last
• 2nd energy system used that gets energy from breaking down carbs/sugar is _________
• How long will the 2nd phase last
• Do the first two energy systems use O2
• 3rd energy system used is:
• The 3rd energy system uses O2 in reaction to convert substrates into ATP, but how long does it last

4) What is ATP (Adenisine Triphosphate)
- 3 primary substrates that are converted into ATP

5) Which energy system results in the formation of Lactic Acid
- How and why does lactic acid build up
- Build up of Lactic Acid causes what symptoms?

6) Which of the 3 energy systems is for low intensity but long duration exercise (aerobic)
- From point above, is this energy system aerobic or anaerobic
- T or F: This system produces the most ATP
- T or F: This system takes longer as there are more complex reactions in order to produce ATP (Krebs Cycle)

Answer 7

1)

• Anaerobic: Anaerobic metabolism is the creation of energy (ATP) through the combustion/conversion of carbohydrates in the ABSCENSE of oxygen (does NOT use O2 to create ATP). This occurs when your lungs cannot put enough oxygen into the bloodstream to keep up with the demands of your muscles for energy (or can’t break it down as fast to keep up with demands of energy), so it uses other quicker sources for conversion into energy. It is for quick bursts of energy (1-40 seconds and includes phosphogen and glycolytic energy systems).
• Aerobic: Aerobic is the way your body creates energy through the combustion/conversion of carbohydrates, amino acids, and fats in the presence of oxygen (requires O2 to convert these things into ATP). Combustion means burning, which is why this is called burning sugars, fats, and proteins for energy. It requires O2, and thus is not used in short distances, but long endurance sports. Because it takes longer to break down O2, your body slows down and can’t go as fast / high pace.

2) Anaerobic
- Aerobic

3)

• Phosphagen System
• Glycolytic System
• Oxidative System

3A) Phosphagen

• Creatine phosphate (CrP), which is stored in skeletal muscles, donates a phosphate to ADP to produce ATP. During rest the ATP will help to restore CrP.
• 1-10 seconds
• Glycolytic
• 10-40 seconds
• NO. The reaction to convert substrates into energy does not require O2 (but they still have O2 in their body of course)
• Oxidative
• Lasts as long as you have O2 and nutrients to convert into ATP

4) Energy source for ALL cellular functions
- Glucose (Carbs), protiens (amino acids), fats

5) Glycolytic
- During the processes of glycolysis, hydrogen ions (H+) are released into the muscle cell. … During high intensity exercise the products of anaerobic glycolysis namely pyruvate and H+ accumulate rapidly. Lactate is formed when one molecule of pyruvate attaches to two H+ ions.
- The build up of this acid causes muscle fatigue, pain, burning, nausea, weakness.

6) Oxidative
- Aerobic
- TRUE
- TRUE

Question 8

MUST MUST know difference between Muscle Spindles and Golgi Tendon Organs

1) What is a muscle spindle and it’s purpose
2) What is a Golgi Tendon Organ

2A) Are these two nerve receptors from above fast and highly myelinated?

3) Which of these two are located in the tendon or the myotendinous junction?
- Which ones are stretch receptors
- Which one conveys muscle tension info to the CNS

4) What are Joint Receptors
- What types are there:
- T or F: ALL joints have free nerve endings receptors
- What do golgi ligament endings do
- Which one detects stretching of joint capsule
- Which one detects vibration, acceleration, or high velocity changes in joint position
- Which ones detect pressure
- What are free nerve endings

Answer 8

1) They are receptors (sensory and motor) throughout the muscle belly and they detect the LENGTH of a muscle being STRETCHED and send a signal to the brain about the length of a muscle. They’ll initiate a reflex to resist too much stretch.
2) Sensory receptor in the muscle tendon to detect TENSION or LOAD or severe contractions muscles go through, and will sense when too high / too much to shut muscle off to protect it (so lifting or muscle contraction stops).

2A) YES

3) Golgi tendon organs
- Muscle Spindles
- Golgi Tendon Organs

4) Receptors in the joints
- Free nerve endings, golgi ligament endings, golgi-mazzoni, pacinian, ruffini, merkle
- True
- Like golgi tendon organs, but these detect tension or stretch in ligaments to protect them
- Ruffini endings
- Pacinian
- Merkel (Angela Merkel puts pressure on us)
- Afferent nerves that can detect temperature, mechanical stimuli (touch, pressure, stretch) or danger (nociception). Thus, different free nerve endings work as thermoreceptors, cutaneous mechanoreceptors and nociceptors. In other words, they express polymodality.

Question 9

1) Explain main difference between Type I and Type II muscle fiber types

1A) How to remember Type I

2) So which one is FAST twitch
- Which one uses oxidative system
- Which one fatigues quicker
- Which one is anaerobic
- Which one has LARGER fibers
- Which one has less blood supply
- Which one has large amounts of mitochondria
- Which one would you use in a marathon
- Which one’s are slow twitch
- Which one’s would you use in a sprint or power lift
- WHich one’s are wider
- Which one’s are redder (more blood)

3) Which of the 2 have a breakdown of 2 subtypes
- What are the 2 subtypes
- Explain each
- T or F: Type I are also called slow oxidative
- Which of Type II is fast oxidative
- Which of the 2 subtypes would fatigue faster

Answer 9

1) Skeletal muscle fibers can be categorized into two types: slow-twitch (Type I) and fast-twitch (Type II). Type II muscle fibers use anaerobic respiration and are better for short bursts of speed than Type I fibers, although Type II fatigue more quickly. Type I are slow twitch and use oxidative system, last longer (don’t fatigue as easily) and work at slower pace.

1A) Type I are recruited first, and are the SLOW fibers

2) Type II
- Type I
- Type II
- Type II
- Type II
- Type II
- Type I (remember oxidative takes place in mitochonria)
- Type I
- Type I
- Type II
- Type II
- Type I

3) Type II
- Type IIa and Type IIb
- Type IIa is fast twitch oxidative, and Type IIb is fast twitch glycolytic
- True
- Type IIa
- Type IIb (glycolytic)

Question 10

1) There are 3 main categories of joints in the body. What are they:
- Of these 3, what one is most common

2) Another name for synovial joints is:

3) Synovial joint examples would be:
- All synovial joints have 5 distinguishing characteristics, what are they:
- T or F: These joints are most prone to injury

4) What are the subtypes of synovial joints:
- Explain each (from point above):
- Examples of uniaxial joints:
- Examples of biaxial joints:
- Examples of multiaxial joints

5) Explain what fibrous joints are:
- Is movement more or less in these joints
- Examples of fibrous joints:

6) Explain cartilaginous joints:
- Examples:

Answer 10

1) Synovial, Cartilaginous, Fibrous
- Synovial

2) Diarthroses

3) Hip, knee, shoulder, elbow, etc.
- Joint cavity, articular cartilage over bony ends, synovial membrane, synovial fluid, and fibrous capsule.
- True

4) Uniaxial, biaxial, multi-axial
- Uniaxial is movement in one plane at that joint, biaxial is in 2 planes, multi is multiple planes
- Hinge joint like the elbow, or pivot like atlantoaxial
- Condyloid (metacarpalphalangeal of a finger), saddle like the thumb
- Shoulder and hip (ball and socket)

5) Where bones are united or connected by fibrous tissue (NON-synovial, so none of the synovial joint components listed above).
- LESS
- Sutures (bones of cranium), syndesmosis (like in forearm and leg’s interosseous membranes), tooth (gomphosis)

6) Joints with hyaline cartilage or fibrocartilage that connects one bone to another
- IV Discs, Sternum to lower ribs (costal cartilaginous joints), pubic symphysis

Question 11

1) The shoulder complex or girdle consists of how many articulations (joints):
- What are those articulations

2) With the G/H joint, what is the concave portion

3) What is the difference between osteokinematics and arthrokinematics
- How to remember
- Give examples of each for the G/H joint

4) So, rolling, gliding, and spinning is osteokinematics or arthrokinematics
5) Explain the rules of concavity and convexity

5A) Let’s give some examples of concave vs. convex movements.

• For the G/H joint, is the arthrokinematic motion (roll and glide) in the same or opposite directions?
• What about for the ulnohumeral (arthrokinematic mvmt of rolling and gliding during a joint mob)?
• What about radiohumeral?
• Radiocarpal:
• Hip:
• Tibiofemoral:
• Patellofemoral:
• Talocrural:

6) Loose pack position of G/H joint
- Closed pack position of G/H joint

7) *** WHAT IS THE CAPSULAR PATTERN OF THE G/H JOINT

8) The S/C joint is where the clavicle inserts into the sternum, but what specific part of the sternum
- What motions (osteokinematic) are allowed at the S/C joint

9) Loose pack and closed pack positions of both A/C and S/C joints are:

10) Muscles that contribute to shoulder flex:
- “ for ext
- “ for abd
- “ for add
- “ for hor abd
- “ for hor add
- “ for ER
- “ for IR
- “ Scapula elevation
- “ scapula depression
- “ scapula protraction
- “ scapula retraction
- ** “ scapular upward rotation
- ** “ scapular downward rotation

Answer 11

1) 4
- Glenohumeral (G/H), Acromioclavicular (A/C), Sternoclavicular (S/C), and Scapulothoracic joints.

2) The concave portion is the glenoid cavity, and the convex portion is the head of the humerus

3) Osteokinematics are normal ROM movements of bones at the joints, whereas arthrokinematics are small movements of bones at the actual joint surfaces (during joint mobs)
- Arthro means joint, so what is happening at the joint
- Osteokinematics would be shoulder flex, abd, ext, IR, etc. (normal ROM), and Arthrokinematics would be an inferior glide and P-A joint mob.

4) Arthrokinematics

5) Always use the G/H joint as the example. When the concave surface is fixed (like glenoid cavity) and the convex surface moves on it (like humeral head), the convex surface rolls and glides in OPPOSITE directions.
- When the convex surface is fixed (like humerus with radial head/olecranon or femur with tibia) and the concave surface moves on it (like radial head/olecranon or tibia), the concave surface rolls and glides in the SAME direction.

5A)

• G/H: Opposite
• Ulnohumeral: Same
• Radiohumeral: Same
• Radiocarpal: Opposite (because the moving part is the carpal bone, which is convex, and the radius which is concave is fixed)
• Hip: Opposite
• Tibiofemoral: Same
• Patellofemoral: Opposite
• Talocrural: Opposite

6) 55 deg’s of abd, and 30 deg’s of hor add (scaption plane)
- Full Abduction and ER

7) ER, ABD, than IR

8) Manubrium
- Elevation, depression, protraction, retraction

9) Loose: arm resting at side; CLosed: arm elevation

10) Long head of biceps brachii, anterior portion of deltoid, coracobrachialis, and partially the pec major
- Triceps, post deltoid, lats, teres major
- deltoid, supraspinatus
- gravity, coracobrachialis, peck major, lats, teres major
- post delt, triceps, infraspinatus, teres minor
- peck major, ant delt
- infraspinatus, teres minor, post delt
- subscap, lats, teres major, peck major, ant delt
- Levator scapulae, upper traps
- Gravity, lower traps, lats, teres major, pec minor
- Serratus ant, pec minor
- Rhomboids, middle traps
- upper trap, serratus ant, lower traps
- levator scapula, middle traps, rhomboids, pec minor

Question 12

Define each of these terms below:

Concentric:

Eccentric:

Isometric:

Isokinetic:

Isotonic:

Active Insufficiency:

Passive Insufficiency:

Answer 12

Concentric: 
o	Shortening (contracting) of a muscle

Eccentric:
o	Lengthening (elongating) of a muscle. Opposite motion of the muscle opposite doing a controlled elongation of muscle as opposite side does shortening contraction.
o	Example: As biceps contracts, triceps will eccentrically contract / elongate in a controlled way.

Isometric:
o Both concentric and eccentric muscles hold firm in place equally. So you generate a force without changing the length of the muscle or joint angle.

Isokinetic:
o Consistent movements at a constant speed. So muscles (concentric and eccentric) move through ROM at a constant speed.

Isotonic: Muscle contraction is generated with the muscle exerting a constant tension. Muscle movement with constant load (lifting a weight).

Active Insufficiency:
o When concentric muscles can’t contract any more (ex: wrist flexors can’t flex any more).

Passive Insufficiency:
o Opposite of active insufficiency, where the opposite eccentric muscles can’t elongate any more (as wrist flexors reach active insufficiency, the wrist extensors will be stretched fully = passive insufficiency).

Question 13

1) The elbow joint consists of how many smaller joints (and name them):
2) Does the radiohumeral or the ulnohumeral joint participate in pro/supination

3) What muscles contribute to elbow flexion:
- “ elbow ext
- “ forearm supination
- “ forearm pronation

4) Palpate your biceps muscle belly and do pronation and supination - what motion (pro or supination) does the biceps participate in

Answer 13

1) 3 (radioulnar, radiohumeral, ulnohumeral)
2) Radiohumeral (and the radioulnar obviously)

3) Biceps brachii, brachiallis, brachioradialis, and partly the wrist flexors (common flexor tendon - CFT), partly deltoid
- Triceps, anconeus (and common extensor tendon - CET), partly deltoid
- Supinator, biceps brachii
- Pronator teres, pronator quadratus

4) Supination

Question 14

1) What is the accronym to remember the bones of the wrist (carpal bones)
- That stands for:
- How do you remember trapezius and trapezium placement?
- T or F: following the thumb down (proximal) it goes the trapezium bone then the schaphoid bone under that?

Answer 14

1) So long the pinky, here comes the thumb
- Schaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapizius, trapezium
- Trapezium is Thumb
- True (this is important because radiographically the scaphoid and lunate are diplaced more medially than you think).

Question 15

1) Another name for the hip joint
- What portion of this joint is the concave portion

2) *** The acetabulum is oriented in what directions

3) Loose pack of the hip joint is:
- Closed pack position of hip is:
- Capsular pattern of hip is:
- So open pack and closed pack position of hip both have what motion:

4) Muscle actions for the hip:
- Flexion:
- Extension:
- Abd:
- Add:
- IR:
- ER:
- Hip Stabilization

5) Normal angle of the shaft of the femur to the head of the femur is:
- If that angle is 110 deg’s it is called:
- If that angle is 140 deg’s it is called:

6) Would coxa vara cause genu varum or genu valgum
- Would coxa valga cause genu varum or genu valgum

6A) How is femoral ant/retroversion different than coxa valga/vara

• Normal femoral anteversion is about how many deg’s:
• Femoral retroversion would be how many degree’s:
• Abnormal femoral anteversion would be how many deg’s:
• Femoral anteversion would do what to the feet
• Femoral retroversion would do what to the feet
• People with femoral anteversion would compensate by walking in a toe in or toe out position to make the femur more secure in the acetabulum?
• People with femoral retroveversion would compensate by walking in a toe in or toe out position to make the femur more secure in the acetabulum?

6B) In anatomy, the word “version” refers to:

7) Average Q angle for men and women at the hip
- How is Q angle measured
- Large Q angles typically contribute to what condition

Answer 15

1) Iliofemoral (or coxa)
- Acetabulum

2) Inferior, lateral, and anterior

3) 30 deg’s flex, 30 deg’s abd, slight ER
- Full extension, IR, and ABduction
- Flexion, abd, IR (sometimes IR is most limited)
- Abduction

4)
- Flexion: iliopsoas, rectus femoris, sartorius, pectinius, ant portion of adductor magnus
- Extension: Glute max, hamstrings, part of glute med, post portion of add magnus
- Abd: Glute min/med (part of max), piriformis (when hip is flexed), TFL
- Add: Gravity, Adductor longus, add magnus, add brevis, pectineus, gracilis
- IR: Iliopsoas, piriformis, TFL, part of glute med and min, pectineus, add longus
- ER: Glute max, obturator externus, piriformis, gemelli, sartorius
- Stabilization: Glute med/min

5) 130 deg’s
- Coxa vara
- Coxa valga

6) Genu valgum (knocked knees)
- Genu varum (bowed legged)

6A) Coxa valga/vara has to do with the superior/inferior orientation or angle of the femoral head in relation to the shaft of the femur in the coronal/frontal plane. Ant/retroversion is how femoral head comes anterior/posterior in relation to the femoral shaft.

• 15 deg’s
• Less than 8 deg’s
• More than 20-25 deg’s
• toe out (ER)
• toe in
• Toe in
• Toe out

6B) the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. Anteversion refers to an abnormal forward rotation of the head of the femur in relation to the shaft of the femur.

7) Normal for men is 14 degrees and for women is 17 degrees
- From ASIS down quad to MIDDLE of patella, then another line from middle of patella to tibial tubercle where patellar tendon inserts. Angle is straight line perpendicular to the floor to the angle of the quad
- PFPS - Patellofemoral pain syndrome or lateral tracking of patella in femoral groove (quad tendon is more lateral pulling patella into lateral femoral groove)

Question 16

1) The talocrural joint is the _______ joint:
- What motions happen at this joint:
- Loose and closed pack position of this joint is:
- Capsular pattern of this joint is most limited in what motion:

2) The subtalar joint is between what 2 bones
- What osteokinematic motions happen here

3) Supination of the foot is the same as inversion or eversion
- Inversion is when the foot/toes go medial or lateral

4) What joints are at the midtarsal joint (mid foot)
- What motions happen here

4A) Is the cuboid in front of the talus on the medial side, or in front of the calcaneus on the lateral side?
- How to remember this?

5) Muscle actions of the ankle/foot:
- DF:
- PF:
- Inv:
- Ever:

Answer 16

1) Ankle
- DF and PF
- Loose: 10 deg’s of PF and neutral between inv and ever. Closed: full DF
- PF more than DF

2) Talus and calcaneus
- Inversion and Eversion

3) Inversion
- Medial

4) Talocalcaneonavicular, calcaneocuboid
- Inversion and eversion

4A) In front of calcaneus on lateral side
- C = C (Calcaneus and cuboid)

5)
- DF: Ant tib, ext hallucis long, fibularis (peroneous) tertius, ext digitorum longus
- PF: gastroc, soleus, plantaris, post tib, flexor digitorum and hallucis, part of peroneus longus and brevis
- Inv: Post tib, ant tib, flexor digitorum longus
- Ever: fibularis (peroneus) longus and brevis and tertius

Question 17

1) How many vertebrae make up the c-spine?
- How many cervical spinal nerves?
- What is the formula to remember how many vertebrae there are:
- How many IV discs are there, and why?
- How many spinal nerves are there
- Do spinal nerves exit above or below their corresponding vertebrae
- IV Disc L4/L5 will cause compression of what nerve if it gets a herniated disc

2) C1 is called:
- C2 is called:
- How to remember the difference between these 2
- The atlanto-occipital joint is between what 2 bones:
- Joint between C1 and C2 is called:
- What motion happens at the Atlanto-occipital joint
- What motion happens at the Atlanto-axial joint
- T or F: majority of the rotation of the skull happens at atlanto-axial joint

3) Another name for a facet joint is:
- Loose pack of c-spine is:
- Closed pack position of spine is:

4) Muscle action of c-spine is:
- Flex:
- Ext:
- Lateral Side bend:
- Rotation:

Answer 17

1) 7
- 8
- C7T12L5S5C4 = 33
- 23: not one between C1/C2, and sacrum and coccyx are fuzed.
- 31: 8 in c-spine, 12 in t-spine, 5 in l-spine, 5 in sacrum, 1 in coccyx
- In c-spine they exit ABOVE, below C8 they are all exiting BELOW
- L5

2) Atlas
- Axis
- An axis spins, so that has to be C2, so C2 has the Dens
- Between Occiput and C1
- Atlantoaxial
- “Yes” so flex and ext of cranium
- “No” so cervical rotation mainly, but does have some flex and ext, lat flex / sidebend
- True

3) Zygapophyseal joint
- Midway between flex and ext
- Full ext

4)
- Flex: SCM, longus capitus/colli, scalenes
- Ext: traps, erector spinae / paraspinals, spleneus capitus and cervicis
- Lateral Side bend and rotation: scalenes, SCM, trap, splenius cervicis, paraspinals, levator scapulae

Question 18

1) What are the 3 cardinal planes
2) What are the 3 corresponding axes

3) Starting with the Sagittal plane, describe it’s motion
- It divides the body into what sections
- Occurs around what axis?

4) Describe motion of Frontal plane
- Another name for frontal plane
- Divides body into what sections
- Occur around what axis

5) Describe motion of Transverse plane
- Divides body into what sections
- Occur around what axis

Answer 18

1) Sagittal, Frontal (Coronal), Transverse
2) Anterior-posterior, Medial-Lateral, Vertical

3) Forward and back
- Right and left
- Medial-Lateral

4) Side to side
- Coronal
- Anterior and posterior
- Anterior and posterior

5) Rotation
- Top and bottom (sup and inf)
- Vertical

Question 19

1) Define both of these:
- Open Chain
- Closed Chain

1A) Give an example of the quads as an explanation of how muscle work in open vs. closed chain

2) Give an example(s) of an open chain activity:
- Give an example(s) of a closed chain activity:

Answer 19

1)
- Open Chain: Distal segment is free (not fixed) and able to move.
- Closed Chain: Distal segment is fixed (can’t move). So body moves over a fixed position.

1A) Quads in open chain extend knee (LAQ). But in closed chain with foot fixed, it will still extend knee by bringing thighs up (ascending from a squat)

2) LAQ, kicking a soccer ball
- Squat, stance foot during gait

Question 20

They will ask a ? about body composition testing:

1) What is Hydrostatic Weighing:
- What is it called when you just measure a distal limb
- Would you do volumetric displacement of the knee or shoulder?

2) What is skinfold measurement
- What are the 9 sites

2A) They will ask this … do they do skin fold measure on lateral or medial calf

3) What is BMI
- How is it calcuated?
- T or F: Increase in BMI is associated with a risk in co-morbidities and death
- You want your BMI to be less than what amount:
- “Obese” BMI is over what amount:
- “Overweight” BMI is what:

Answer 20

1) Calculates body density by immersing a person in water (remember water = hydro). Measure water that gets displaced (knowing lungs full of air isn’t really factored in).
- Volumetric displacement (doing water displacement of a DISTAL limb like a wrist or ankle)
- NO

2) Method of determining body fat through measuring 9 sites. Theory is that the subcutaneous fat measured in these areas will help you know total body fat composition.
- Triceps - The back of the upper arm
- Biceps: Front middle arm
- Subscapular - Beneath the edge of the shoulder blade
- Pectoral - The mid-chest, just forward of the armpit
- Midaxilla - Midline of the side of the torso
- Abdomen - Next to the belly button
- Suprailiac - Just above the iliac crest of the hip bone
- Quadriceps - Middle of the upper thigh
- Calf: medial calf

2A) MEDIAL

3) BMI = Body Mass Index
- Taking the body weight (in Kg’s) and dividing by height (in meters) … so it is kg/m^2.
- True
- 18.5 kg/m^2 (normal is 18-24)
- 30
- 24-29 ish

Question 21

1) What is a plumb line:
- Plumb line should run through what landmarks:

2) Know that capsular pattern / restrictions of major joints:
- Shoulder:
- Hip:
- Knee:
- Ankle:

3) For the things below, what is the NAME of this grade of MMT, and what movement the person makes at this grade:
- 0/5:
- 1/5:
- 2-/5
- 2/5
- 2+/5
- 3-/5
- 3/5
- 3+/5
- 4-/5
- 4/5
- 4+/5
- 5/5:

6) What is an end-feel:
- Is it felt on AROM or PROM
- Types of NORMAL end-feels:
- When/where is it felt

7) What is a hard end feel and give examples:
- What is a firm end feel and give examples:
- What is a soft end feel and give examples:

8) What are the abnormal end feels:
- Give examples of each:

Answer 21

1) A string that is suspended to measure proper posture (or “verticality”). It is to help the PT and pt know ideal positioning based on selected body parts.
- Ear (acoustic meatus), odontoid process (dens), acromion, lumbar vertebrae, hip (slightly posterior), knee (slightly anterior), malleoli (slightly anterior), and calcaneocuboid joint

2)
- Shoulder: ER, Abd, IR
- Hip: Flex, Abd, IR
- Knee: Flex, Ext
- Ankle: PF, DF

3)

• 0/5: Zero (no palpable contraction)
• 1/5: Trace (can palpate a muscle contraction)
• 2-/5 Poor minus (can’t do full ROM w/ gravity eliminated)
• 2/5: Poor (can complete ROM with gravity eliminated)
• 2+/5: Poor Plus (can initiate some ROM movement against gravity)
• 3-/5: Fair minus (can do more than 1/2 of ROM against gravity)
• 3/5: Fair (can complete ROM against gravity, but w/o resistance)
• 3+/5: Fair plus (can complete ROM against gravity with min resistance)
• 4-/5: Good minus (completes ROM with min-mod resistance)
• 4/5: Good (completes ROM with moderate resistance)
• 4+/5: Good plus (completes ROM with mod-max resistance)
• 5/5: Normal (completes ROM against max resistance)

6) The feeling of resistance at the end of ROM
- PROM
- Hard, firm, soft
- At the end of ROM with overpressure (to feel what is restricting or stopping the movement)

7) Hard: Bone on bone (elbow, knee ext)
- Firm: Ligament, capsule, or muscle stretch (almost all joints)
- Soft: muscle or tissue on tissue (biceps, gastrocs)

8) Empty, muscle spasm, springy block, boggy, Firm, Hard, Soft
- Empty: When PT does PROM and they guard and stop you (won’t let you continue). You don’t feel anything except the pt stops the ROM movement due to pain.
- Muscle spasm: involuntary contraction or spasticity
- Firm: like in frozen shoulder when it’s firm before it should be firm, thus pathological
- Hard: bone on bone when there should not be bone on bone (like an osteophyte or fracture)
- Springy Block: Springy Block: when you try to move a joint through ROM and mid-range you feel a block and it stops you. Best example is: meniscus tear in knee
- Boggy: end feel is stopped due to edema or effusion/fluid in a joint

Question 22

1) When describing the gait cycle, there are 2 ways to describe the steps / phases of the gait cycle. What are those 2 ways:

2) Regardless of which system you use to describe it, the gait cycle has 2 main steps - what are they:
- What % of gait cycle is stance phase, and what % is swing:

3) Name the phases of STANCE phase in standard terminology:
- Name the phases of SWING phase in standard terminology

3A) How to remember standard
- What one has all the swings in swing phase terminology

4) Name the phases of STANCE phase in Ranchos terminology:
- Name the phases of SWING phase in Ranchos terminology

5) Now go back through terminology of standard vs. Ranchos above and just compare

6) Peak muscle activity for the anterior tib during gait cycle is when:
- What about peak activity for gastrocs
- Quads:
- HS’s:

7) What is the range (least to most) degrees of ROM required for these motions below during gait cycle:
- Hip flexion:
- Hip Ext:
- Knee Flex:
- Knee Ext:
- Ankle DF:
- Ankle PF:

8) What is the ‘base of support’ in relation to the gait cycle
- Will BOS increase or decrease as cadence increases?
- Average BOS for adult during gait is:

9) What is ‘cadence’ in relation to gait
- How many steps per min is avg for adult in a minute

10) T or F: Most adults have some mild ‘toe out’ or ER of foot
- What is average degrees of toe out
- How many toes in toe out is normal

11) What is the double support phase during gait
- Does this phase exist when running?
- Will this phase (time in this phase) increase or decrease as you walk slower?

12) Does the pelvis rotate during gait cycle
- How many degrees
- Does the pelvis rotate with the trunk, or opposite of it

13) How many times during gait cycle is there a single support phase
- How many times is there a double support phase

14) How to measure step length
- About how far is it for an adult

15) What is a stride compared to a step
- On average how far is it?

16) Below are some abnormal gait patterns. Explain them:
- Antalgic:
- Ataxic:
- Cerebellar:
- Circumduction:
- Double Step:
- Equine
- Festinating:
- Hemiplegic:
- Parkinsonian:
- Scissor:
- Spastic:
- Steppage:
- Trendelenberg:
- Vaulting:

17) Now, from point above, match the description with the proper gait abnormality name:
- One sided LE weakness and disuse
- Toe walking, short gastrocs
- Big steps (exaggerated hip and knee flexion so toes don’t drag). Foot slap due to DF weakness
- Hip abductor weakness and thus lateral trunk flexion, so hip drops and trunk leans on stance leg
- Leg swings out during swing phase due to hip, knee, or ankle ROM deficits / pain / injury
- Alternate steps are different length and rate
- Hip hiking and excessive PF, so leg can advance.
- Walks on toes fast and almost will fall over, has to grasp an object to stop
- A protective gait pattern where involved step length is decreased to avoid weight bearing due to pain.
- Forward flexion, shuffling gait, small steps, and even festinating
- Staggering and uncoordinated due to cerebellar damage
- Stiff movement, toes catch or drag, legs held together, hip and knee joints flexed.
- Staggering, uncoordinated, and unsteadiness. Wide BOS and movements are exaggerated.
- Legs cross midline when advanced

Answer 22

1) Standard terminology and Rancho Los Amigos Terminology

2) Stance phase, swing phase
- Stance is 60%, and Swing is 40%

3) STANCE: Heel strike, foot flat, midstance, heel off, toe off
- SWING: Acceleration, Midswing, Deceleration

3A) S = S (standard is heel Strike)
- Rancho

4) STANCE: Initial contact, Loading Response, Midstance, Terminal Stance, Pre-swing
- SWING: Initial Swing, Midswing, Terminal Swing

5) ok

6) Ant Tib: Just after heel strike to eccentrically lower foot to ground (during loading response).
- Gastrocs: Late stance and toe off
- Quads: Midstance and initiate swing phase
- HS’s: Late swing to decelerate swing limb

7)
- Hip Flex: 0-30 deg’s
- Hip Ext: 0-10 deg’s
- Knee Flex: 0-60 deg’s
- Knee Ext: 0 deg’s
- Ankle DF: 0-10 deg’s
- Ankle PF: 0-20 deg’s

8) Distance between R and L foot
- Decrease
- 2-4 inches

9) # of steps an individual will walk over some period of time (p/min)
- 110-120 steps per min

10) True
- 7 deg’s
- 2 to 2.5 ish

11) When both feet touch the ground
- NO
- Increase

12) YES
- 8 deg’s (4 when leg goes forward during swing, and 4 deg’s when leg goes backwards)
- Opposite

13) Twice
- Twice

14) Right heel (at heel strike) to Left heel (at heel strike)
- 28 inches

15) A stride is only dealing with one foot - so from R heel strike to R heel strike (2 steps).
- 56 inches

16)
- Antalgic: A protective gait pattern where involved step length is decreased to avoid weight bearing due to PAIN. Abnormal gait due to pain in LE’s (algia = pain).
- Ataxic: Staggering and unsteadiness. Wide BOS and movements are exaggerated. Uncoordinated
- Cerebellar: Staggering and uncoordinated due to cerebellar damage
- Circumduction: Leg swings out during swing phase due to hip, knee, or ankle ROM deficits / pain / injury / poor prosthetic fit
- Double Step: Alternate steps are different length and rate
- Equine: High steps, toe walking, short gastrocs
- Festinating: Quick short steps like in Parkinson’s pt’s
- Hemiplegic: One sided LE weakness and disuse
- Parkinsonian: Forward flexion, shuffling gait, small steps, and even festinating, freeze on gait
- Scissor: Legs cross midline when advanced due to tight hip adductors or adductor spasticity
- Spastic: Stiff movement, toes catch or drag, legs held together, hip and knee joints flexed.
- Steppage: Big steps (exaggerated hip and knee flexion so toes don’t drag). Foot slap due to DF weakness
- Trendelenberg: Hip abductor weakness and thus lateral trunk flexion, so hip drops and trunk leans on stance leg
- Vaulting: Hip hiking and excessive PF, so leg can advance.

17)

• Hemiplegic
• Equine
• Steppage
• Trendelenberg
• Circumduction
• Double Step
• Vaulting
• Festinating
• Antalgic
• Parkinsonian
• Cerebellar
• Spastic
• Ataxic
• Scissor

Question 23

1) Alopecia =
- How to remember

2) In a “scottie dog” view, what is the eye of the dog
- What is the nose
- What is the ear
- What is the front lower paw/leg
- What is the neck
- Body of dog
- Tail
- Back lower paw/leg

3) What is the pars articularis
- How does it get fractured most often?

Answer 23

1) Hair Loss
- Al, please, do something with your balding hair

2) Pedicle
- Transverse process
- Superior articular process
- Inferior articular process
- Pars articularis
- Vertebral body, lamina, and spinous process
- Opposite sup. articular process
- Opposite inf. articular process

3) Portion between the inf. and sup. articular process portion and the lamina
- Hyper extension

Question 24

1) Explain the Oswestry what it is for and how to score.
- A higher score on this test means a better function or more disability?

2) Explain the DASH what it is for and how to score.
- A higher score on this test means a better function or more disability?

3) Explain the LEFS what it is for and how to score.
- A higher score on this test means a better function or more disability?

4) Explain the NDI what it is for and how to score.
- A higher score on this test means a better function or more disability?

5) T or F: NDI and Oswestry and both related to the back or spine, and are scored the exact same way (just diff. ?s)?

6) What is the only one of these main assessments where a lower score means more disability? **
- How to remember

Answer 24

1) For low back pain pt’s. 50 points total (10 sections, 1 score is no pain and 5 score is can’t move). Calculate by taking total score / 50 x 100% = Disability Score.
- More disability

2) Disabilities of Arm, Shoulder, and Hand (UE). 30 items, 1 score is no pain and 5 is can’t move ….
- More disability

3) Lower Extremity Functional Scale. 20 items. Score of 0 is no pain, score of 4 is extreme difficulty.
- Better function

4) Neck Disability Index. 50 points total (10 sections, and add up score and divide by 50 points possible … just like Oswestry).
- More disability

5) True

6) LEFS
- L = Lower in LEFS = and lower score on LEFS is “lower” function (or bad).

Question 25

1) What is sacral nutation - Sacral nutation would appear as an anterior or posterior pelvic tilt? 2) What is sacral counternutation 3) How could you assess this? 4) T or F: Could one side be nutated and another not? - What would that be called? 5) How would you fix a sacral torsion

Answer 25

1) Base (top) of sacrum goes anterior and inferior - Posterior 2) Base (top) of sacrum goes posterior and superior 3) Sacral torsion: find PSIS's and go up and medial and palpate. Is one side higher/lower than another 4) Yes. - It would be called L on R (or R on L) backwards sacral torsion for whatever side is more posterior 5) Let's say the L side is up/high, then place pt on right side (sidelying) and do a resisted MET to L piriformis to have the piriformis pull anterior sacrum back down into position.

Question 26

1) Berg Balance Scale is out of how many points? - What is the cut off for ROF (risk of falls) 2) How is Berg and Tinetti different? 3) Tinetti is out of how many points? - What is the cut off for ROF 4) What % of help does this level of assistance require: - Minimum Assist (Min A) - Moderate Assist (Mod A) - Maximum Assist (Max A) - Total Assist (Tot A) 5) What is the time frame or amount of minutes where you can NOT bill for any units? - List time amounts and how many units for those time amounts: 6) So from the question above, how much time is for 1 unit 7) The CPT Code below is for what: - 97161: - 97162: - 97163: - 97164: - 97110: - 97530: - 97140: - 97116: - 97112: - 97113:

Answer 26

1) 56 - 41 (higher score = lower risk of falling, and lower than 41 is ROF ... down in 20 range is huge risk of falling) 2) Berg is just balance, Tinetti has a gait element + balance 3) 28 (16 on balance, and 12 on Gait) - 19 or less 4) - Min A: 0-25% is what PT does to help - Mod A: 25-50% (what PT does) - Max A: 50-75% (what PT does) - Tot A: 75-100% (what PT does) 5) 0-8mins - 8-22 mins (1 unit) - 23-37 mins (2 units) - 38-52 mins (3 units) - 53-67 mins (4 units) - 68-82 mins (5 units) - Etc. 6) After the first 8 mins, it goes in 14-15 minute increments, up to 22 mins 7) - 97161: Low Eval - 97162: Mod Eval - 97163: High Eval - 97164: Re-Eval - 97110: Theraputic Proceedure / Ex - 97530: Theraputic Activities - 97140: Manual Therapy - 97116: Gait Training - 97112: Neuromuscular Re-Ed - 97113: Aquatic

Question 27

1) For the average adult, how much ROM do they have at these joints: - Shoulder Flex: - Shoulder Ext: - Shoulder Abd: - Shoulder ER: - Shoulder IR: - Elbow Flex: - Elbow Ext: - Forearm Pronation: - Forearm Supination: - Wrist Flex: - Wrist Ext: - Wrist Rad Dev: - Wrist Uln Dev: - Hip Flex: - Hip Ext: - Hip Abd: - Hip Add: - Hip ER: - Hip IR: - Knee Flex: - Knee Ext: - Ankle DF: - Ankle PF: - Ankle Ever: - Ankle Inv: - Subtalor: - Cervical Flex: - Cervical Ext: - Cervical Sidebend: - Cervical Rotation: - ThoracoLumbar Flex: - ThoracoLumbar Ext: - ThoracoLumbar Sidebend: - ThoracoLumbar Rotation:

Answer 27

1) - Shoulder Flex: 180 - Shoulder Ext: 60 - Shoulder Abd: 180 - Shoulder ER: 90 - Shoulder IR: 70 - Elbow Flex: 150 - Elbow Ext: 0 - Forearm Pronation: 80 - Forearm Supination: 80 - Wrist Flex: 80 - Wrist Ext: 70 - Wrist Rad Dev: 20 - Wrist Uln Dev: 30 - Hip Flex: 120 - Hip Ext: 30 - Hip Abd: 45 - Hip Add: 30 - Hip ER: 45 - Hip IR: 45 - Knee Flex: 135 - Knee Ext: 0 - Ankle DF: 20 - Ankle PF: 50 - Ankle Ever: 15 - Ankle Inv: 35 - Subtalor: 5 - Cervical Flex: 45 - Cervical Ext: 45 - Cervical Sidebend: 45 - Cervical Rotation: 70 - ThoracoLumbar Flex: 80 - ThoracoLumbar Ext: 25 - ThoracoLumbar Sidebend: 35 - ThoracoLumbar Rotation: 45

Question 28

1) What is the process for doing a Goni measurement properly: 2) Why did I put this as a question / process to review? 3) For most joints, I know where the axis, stationary arm, and moveable arm of the goni goes; however, for the motions below, name where you put the axis, stationary arm, and moveable arm: - Pronation - Supination - Wrist Flex and Ext: - Ankle Inv and Ever: - Thoracolumbar Flex and Ext: - Thoracolumbar Sidebend: 4) **** How is the best way to remember the difference in ROM for wrist flex and ext - Of those 2, which one moves more (larger ROM)

Answer 28

1) - Place subject in proper testing position - Stabilize the proximal joint segment (at distal portion) - Move distal joint segment through the ROM and make an estimate of what ROM is and determine end-feel (estimate ROM by eyeball) - Return distal segment to starting position - Palpate the bony landmarks - Align the goni - Read and record the starting position and then remove the goni - Stabilize the proximal joint segment - Move the distal segment through ROM - Replace and realign goni - Record ROM 2) Cause I've seen a question on it and I'm positive there will be some question on it :) 3) - Pronation: axis is lateral aspect of ulnar styloid process; stationary arm is parallel to midline of humerus; moveable arm is dorsal wrist - Supination: axis is medial aspect of ulnar styloid process; stationary same as pronation; moveable is now ventral part of wrist - Wrist Ext: axis is lateral aspect of wrist by triquetrum (or ulnar styloid process); moveable is 5th metacarpal - Ankle Inv and Ever: axis is posterior aspect of the ankle midway between malleoli (where subtalor joint would be); stationary is posterior midline of leg; moveable is posterior calcaneus - Thoracolumbar Flex and Ext: Usually uses a tape measure vs. goni, or inclinometers - Thoracolumbar sidebend: Axis is Spinous process of S2; stationary is perpendicular to spine; moveable is between acromial processes 4) Look at ulnar styloid process during wrist flex and ext and watch where 5th metacarpal goes ... much easier to see - Wrist FLEXion (flexion is 80 vs. 70 of ext)

Question 29

1) What is the apprehension test of the shoulder for (to help rule in / diagnose): - How is the test performed - What is a positive test 2) What is the Speed's test of the shoulder for (to help rule in / diagnose): - How is the test performed: - What is a positive test 3) What is the Drop Arm test of the shoulder for (to help rule in / diagnose): - How is the test performed: - What is a positive test 4) What is the Supraspinatus test of the shoulder for (to help rule in / diagnose): - How is the test performed: - What is a positive test 5) What is the Adson Maneuver test for (to help rule in / diagnose): - How is the test performed: - What is a positive test 6) What is the Roos test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 7) The valgus stress test of the elbow is testing for what 8) When a pt's hand is pronated and flexed at the elbow and you do a Resisted RSC of the middle digit into extension, what are you testing for? - What is this called - What is test when you tap middle finger multiple times quickly - Positive sign for the test from above 9) What is Tinel's sign (how to do it), and what is it for? - Name some common nerves you'd do this on? 10) How would you do a capillary refill test - Above what amount of time for refill indicates concern/pathology - If it takes that long to refill, it indicates what? 11) What is the Phalen's test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: - How long must it be held? - How long must ROOS be held? 12) What is the Ely's test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: - What other test is in this position and what is it for: 12A) So Roos you have to hold for how long? - Phalens you have to hold for how long? - Capillary refilling time is concerning when it exceeds how long? 13) What is the Ober's test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 14) What is the Thomas test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: - What is Modified Thomas test for: 15) What is the Craigs test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 16) What is the Trendelenberg test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 17) What is the trendelenberg position - What is reverse trendelenberg position 18) What is the Lachman test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 19) If you did a valgus stress test of the knee, would you apply a force on lateral or medial knee 20) What is the Apley's test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 21) What is the McMurray's test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 22) Is there an anterior drawer test for the knee and the ankle? - What is the Anterior Drawer test of the ANKLE for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 23) What is the Talor Tilt test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 23A) What is the Kleiger's test: 24) What is the Homan's Sign for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 25) What is the Thompson test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: 26) What is the True Leg Length Discrepancy test for (to help rule in / diagnose): - How is the test performed: - What is a positive test: - With the supine-sit test, what result needs to happen to help rule in a true LLD

Answer 29

1) Shoulder instability / capsular laxity / labral tear / Dislocation - Pt is laying supine with arm in 90/90 (to the square) and PT ER's it. - Apprehension during ER 2) Biceps tendinopathy / pathology - Pt is sitting and it basically is a RSC of biceps / shoulder flexion resisted, and PT palpates bicepital groove - Pain during that resistance 3) RC tear / tendinopathy (or impingement) - Patient abducts arm out and is supposed to slowly lower arm down to the ground - If they can't (it drops) or is very very painful 4) To detect a supraspinatus tear - Patient abducts arm to 90 deg's and about 30 deg's of hor adduction, then PT does a RSC test pushing down (basically the harmonica position, but push down) - If the pt can't or is very painful = supraspinatus tear 5) Thoracic Outlet Syndrome - Pt is sitting and PT monitors the radial pulse. PT then extends and ER's the shoulder and patient slightly extends and rotates head to compress neurovascular bundle - Weakness, sensory loss, ischemic pain, etc. down arm and DIMINISHED PULSE during test. 6) Thoracic Outlet Syndrome - This is the chicken dance. Pt abducts arm, ER's arm, and does elbow flexion, then opens and closes their hands for 3 minutes - Weakness, sensory loss, ischemic pain, etc. - can't hold arm up that long (3 mins) 7) Tear or strain to MCL of the elbow 8) Lateral epicondylitis - Maudley's - Hoffman's - Curling/flexing of the index and thumb during the tapping 9) Tapping on a nerve repetitively to see if there is any tingling sensation which indicates some compression or pathology of the nerve - Medial (tap wrist), Ulnar (cubital tunnel), Tibial (tarsal tunnel) 10) Compress a nailbed and push/squeeze for a few seconds and then release it. PT will note the time it takes for nailbed to regain color. - 2+ seconds for adults (4+ for elderly) - Arterial insufficiency 11) Carpal Tunnel Syndrome (median nerve compression) - Do the prayer and reverse prayer position and hold it for 60 ish seconds. - Tingling into thumb, index finger, middle finger, or lateral half of ring finger - 60 sec's - 3 mins 12) Rectus femoris tightness or contracture (short quads) - Pt in prone and PT passively does knee flexion stretching quads - Tightness so you can't get knee past 90, or hip flexion occurs due to tight quads - Phelp's - for Gracilis tightness 12A) 3 mins - 60 seconds - 2+ seconds for adults (4+ for elderly) 13) Tight IT band / TFL - Pt lies sidelying in 90/90 position at knee. PT grabs leg and does passive extension and abduction and then slowly lowers. - If pt's leg can't adduct down and touch the table. 14) Tight hip flexors (Psoas or Rectus) - Pt in supine and edge of bed and brings one leg to chest and the other he lowers off table. - If pt's angle from hip is high = tight psoas / hip flexor. If knee angle is less than 90, could be tight rectus femoris. If straightening the knee causes hip to lower it is tight rectus; if straightening the knee does nothing to the hip (it's still high) = tight psoas - IT band tightness 15) Femoral Anteversion / Retroversion - Pt lies prone and flexes knees up to 90 deg's. PT rotates hip until greater trochanter is parallel with table, and then PT measures angle of tibia and perpendicular axis from table. THIS IS important because in anteversion the femur head is more forward causing leg / ankle in prone to go in medially, but when you make the greater trochanter parallel to the table it brings in lower leg/ankle out much more. And visa versa for retroversion. - Angle less than 8 degrees is femoral retroversion, and more than 15 degrees is femoral anteversion 16) Glute med weakness - Pt stands and either walks or is asked to stand on one leg for 10 seconds - If a drop of the pelvis happens on contralateral side = glute med weakness on ipsilateral side since it can't hold trunk up 17) That is when you lay supine and tilt the table at an angle so the head is down (lower than legs) - Lay supine, tilt the table, and now the head is higher than the feet. 18) ACL injury - Pt lies supine with slight (20-30 degrees) of knee flex, and PT grabs superior tibia and does quick pull - Anterior translation of tibia = ACL tear 19) Lateral 20) Meniscus tear - Patient is prone with knee flexed to 90 deg's. PT applies compressive force down tibia and medially and laterally rotates tibia - Pain, clicking 21) Meniscus tear - Patient is supine with knee flexed, and PT will medially rotate tibia and bring knee into full extension passively while palpating joint line. Repeat and now laterally rotate tibia and extend leg again. - Pain, clicking, popping, crepitus heard or felt at joint line palpation 22) YES - ATFL ligament sprain - Pt is supine with ankle about 20 deg's of PF. PT stabilizes or holds heel and pulls talus and calcaneus forward. - Excessive forward translation with pain = ATFL tear 23) Calcaneofibular ligament or Deltoid ligament sprain (primarily CFL) - Grab heel and move into inv/ever or ab/adduction at subtalor joint - If pain or laxity on lateral side, it is calcaneofibular lig sprain; if on medial side it is deltoid sprain. And remember eversion normally gets 15 ish degrees, and inversion gets about 30 deg's, so if you get more than that it could indicate lig tear/laxity. 23A) ER of ankle/foot to help rule in a deltoid lig or high ankle syndesmosis lig sprain. 24) Deep Vein Thrombosis - DF foot then squeeze calf - Pain during this 25) Ruptured Achilles tendon rupture - Pt is prone with feet over edge of table and PT squeeze calf m's - If the foot does NOT PF, then ruptured achilles 26) Leg Length Discrepancy - Patient is supine with feet about 6-8 inches apart. PT measures with a tape measure from ASIS to medial malleolus on both sides. - More than 2 cm comparably between legs will indicate LLD - Leg is long in supine and sitting up

Question 30

Know these terms below: Bursitis: - It is ruled in through what imaging device: - The end feel would be what Contusion: Edema: Effusion: Genu Valgum: - With genu valgum, will it place stress on medial or lateral condyle/meniscus - Will it stress MCL or LCL - Would genu valgum be because of coxa vara or valgus Genu Varum: - With genu varum, will it place stress on medial or lateral condyle/meniscus - Will it stress MCL or LCL Kyphosis: - What causes this Lordosis: - What causes this Q Angle: - Normal Q Angle is: - Abnormal Q angle leads to: Sprain: Strain: Tendonitis: - Symptoms include:

Answer 30

Bursitis: A condition caused by acute or chronic inflammation of the bursae. Symptoms may include a limitation in active range of motion secondary to pain and swelling. - X-ray - Empty (pain) Contusion: A sudden blow to a part of the body that can result in mild to severe damage to superficial and deep structures. Could be a contusion to a bone or muscle. Treatment includes AROM, ice, compression, strengthening, modalities. Edema: Swelling. An increased volume of fluid in the soft tissue OUTSIDE a joint capsule. Effusion: An increased volume of fluid INSIDE a joint capsule. Genu Valgum: Knees touch so medial knee touches and ankles go out from each other. Called knocked-knee - Lateral - MCL - Varum Genu Varum: Bow legged, so knees are out and ankles are closer together. - Medial - LCL - Valgus Kyphosis: Excessive curvature of thoracic spine. - Osteoporosis, compression fracture, arthritis, posture / weight, paralysis, age, sheuremann's Lordosis: Excessive curvature of l-spine or c-spine - Weak muscles, pregnancy, weight, hip flexion contracture, spasms, disc issues Q Angle: Degree of angulation from ASIS to mid-patella. - 13 deg's in males, and 18 deg's for female - Poor patellar tracking, PFPS Sprain: Acute injury involving a LIGAMENT Strain: Acute injury involving MUSCLE/tendon Tendonitis: Condition caused by acute or chronic inflammation of a tendon. - Gradual onset, tenderness, swelling, pain

Question 31

1) What does Prophylactic mean 2) The medication Lipitor is for what - How to remember 3) Metformin medication is for what 4) Oxicodone medication is for what 5) What is the medication valium (diazepam) for:

Answer 31

1) Preventative measure / therapy / meds. You do something in hopes to prevent a future disease / condition. PROactive measure 2) High cholesterol - Lipids are fats 3) DM II 4) Pain killer / narcotic 5) Seizures and anxiety and even sleep apnea (even muscle spasms) ... calm system down.

Question 32

Below are common types of fractures - KNOW THEM: Avulsion Fracture: Closed Fracture: Comminuted Fracture: Compound Fracture: Displaced Fracture: Greenstick Fracture: - This fracture more commonly happens to who Linear Fracture: Nonunion Fracture: Oblique Fracture Spiral Fracture: Stress Fracture: Transverse Fracture: *** Best imaging device to see a stress fracture

Answer 32

Avulsion Fracture: Portion of bone becomes fragmented at the site of the tendon insertion due to sudden stretch of tendon. Closed Fracture: A break in a bone where the skin over fracture remains intact. Comminuted Fracture: A bone that breaks into fragments at site of injury. Compound Fracture: A break of a bone that protrudes out through the skin. Displaced Fracture: A break in a bone where the fragments are out of place. Greenstick Fracture: Break on one side of the bone that does not damage the periosteum on opposite side. - USUALLY SEEN IN CHILDREN. Linear Fracture: A break that is parallel to the long axis of the bone Nonunion Fracture: A break in a bone that has failed to unite and heal after 9-12 months. It didn't UNITE. Oblique Fracture: A break that is diagonol Spiral Fracture: A break in the shape of an "S" due to TORSION or TWISTING Stress Fracture: Break in a bone due to repeated forces to a particular portion of a bone Transverse Fracture: A break in a bone that is at a 90 deg angle to the bone's long axis Bone Scan

Question 33

1) From least assistive to MOST assistive, name all the orthotic options: 2) What motions does a solid AFO control - What does a posterior leaf spring AFO do - A floor reaction AFO controls what motion 3) Which one is often only worn by children 4) What is unique about the RGO: - Who would use these? 5) What is a parapodium - Can you ambulate in/with it - What population / patient type usually uses this? - Why would they use it - ** Is this the better option, or is it better to manually stretch patient 6) What are the orthoses options for the spine 7) Which one of those from point above is used for scoliosis pt's? - What scoliotic braces are worn all day / all the time - What scoliotic brace is worn just at night (nocturnal) - How to remember above

Answer 33

1) - Foot orthoses - SMO: Malleolar Orthoses - AFO: Ankle Foot Orthoses (posterior leaf --> Solid) - KAFO: Knee Ankle Foot Orthoses - HKAFO: Hip Knee Ankle Foot Orthoses - RGO: Reciprocating Gait Orthoses - Parapodium (standing frame) 2) SOlid AFO's control DF/PF and Inv/Ever - Helps someone with DF (from Drop Foot) - Knee extension (forces knee ext during stance phase due to weak quads) 3) SMO 4) When pt shifts weight into one side, the mechanism will advance the other LE. - Paraplegia pt's 5) Standing frame - Yes. Pt can shift weight and rock the base across the floor. - Pediatrics - Prevent contractures, prevent pressure injuries/ulcers, offload, ambulate - Parapodium is much better 6) - General back brace - Corset - Milwaukee / Boston Orthosis (or Charleston) for Scoliosis) - Halo for C-spine - TLSO: Thoracolumbosacral orthosis 7) Milwaukee - Milwaukee and Boston - Charleston - Charleston is in the south and warm, so you dance during the day and you can't wear a brace doing that dance; but Milwaukee and Boston are in the north and cold places so you need to wear the brace all the time to stay warm :)

Question 34

1) From lowest / farthest level to most severe, name the upper extremity amputation types: 2) From lowest / farthest level to most severe, name the lower extremity amputation types: 3) There are really 3 types of dressings. What are they: 4) From point above, which category would these fall in: - Air cast: - Ace wrap: - Plaster 5) Main disadvantage of the rigid dressing: - What is a disadvantage of a semi-rigid dressing: - Disadvantage of soft dressing: 6) There are some specific gait deviations for those amputee's who wear a prosthetic. - Why might someone walk with a lateral bend - Why might someone walk with a circumducted gait - Why might someone walk with a vaulted gait - Why might someone walk with a medial whip - Why might someone walk with a lateral whip - Why might someone walk with a abducted gait - Why might someone walk with a drop off gait 7) With amputees, these terms mean: - Stump: - Residual: - Sound: - Salvage: - Transosseous vs. Transarticular - AKA - BKA - AEA and BEA 8) Main reasons why people get an amputation / prosthetic: - Congenital amputees have more LE or UE prosthetics - Younger amputees are more likely to get an amputation from vascular disease or trauma 9) So below is an amputation type - where is this amputation: - Symes - Chopart's: - Rotationplasty: - Forequarter: - Boyd: - Pirigoff: 10) T or F: The higher the amputation, the more energy expenditure / demand?

Answer 34

1) - Digit amputation (either at metacarpalphalangeal, or PIP, DIP) - Partial hand (portion of the hand at trans carpal, trans metacarpal, transphalangeal) - Wrist Disarticulation - Transradial (distal to elbow joint) - Elbow disarticulation (through elbow joint) - Transhumeral (distal to shoulder) - Shoulder disarticulation - Forequarter / Scapulothoracic (entire shoulder girdle) - Below elbow (transradial) and Above Elbow (transhumeral) 2) - Partial toe - Toe disarticulation - Transmetatarsal - Lisfranc - Transverse Tarsal (Chopart's) - Syme's (at ankle removing malleoli) - Boyd (horizontal line cutting off bottom of calcaneus) - Pirigoff (vertical line cutting off back of calcaneus) - Transtibial (distal to knee) - Knee disarticulation (at knee joint) - Transfemoral - Hip disarticulation - Hemipelvectomy (removal of one half of pelvis) - Hemicorporectomy (1/2 of the CORPSE / body - removal of both LE's and entire pelvis) 3) - Rigid - Semi-rigid - Soft 4) - Semi-rigid - Soft - Rigid 5) Can't monitor / inspect wound, can't change dressing easily / quickly, and requires a professional for placement - Doesn't protect as well as a rigid dressing, and may loosen and thus cause more edema - Less protection, have to change dressing a lot (which could impact wound, risk of tourniquet effect 6) - Lateral Bending: prosthetic is too short, prosthetic doesn't fit well, or weak hip abd's on prosthetic side - Circumducted gait: prosthetic is too long, or abduction contracture, weak hip flexors - Vaulted gait: prosthetic is too long, excessive PF at ankle, short residual limb - Medial whip: Tight/short abductors bring leg out so they whip leg in to correct - Lateral whip: Tight/short adductors bring leg in, so they whip leg out - Abducted gait: Gives you a wider BOS - Drop off: Weak quads, so knee gives out 7) - Stump: prosthetic - Residual: Prosthetic / Amputated side (residual = what is left after amputation) - Sound: Good side (non-amputated side) - Salvage: Try to save the leg - Tranosseous is amputation through bone (like transfemoral), and transarticular is through the joint (disarticulation) - AKA: Above knee amputation - BKA: Below knee amputation - Above and Below Elbow 8) Vascular disease (like DM II) is about 45%, then trauma is another 45%, then cancer, congenital, etc. - UE - Trauma (older people are more from DM II) 9) - Symes: ankle joint (ankle disarticulation) - Chopart: Tarsal (midtarsal joint) - Rotationplasty: Upsidedown tibia approach so ankle becomes knee. - Forequarter: entire shoulder girdle - Boyd: horizontal line cutting off bottom of calcaneus - Pirigoff: vertical line cutting off back of calcaneus (where achilles attaches) 10) True

Question 35

1) MUST MUST MUST know wound staging. How many stages are there in wound staging: 2) What are the stages: 3) What is the Wagnar / Wagner grading for ulcers: ***** 4) List examples of: - High absorption dressings: - Moderate/Medium absoprtion dressings: - Low absorption dressings:

Answer 35

1) 4 2) - Stage I - redness, heat and edema involving the epidermis (NON-blanchable erythema of INTACT skin), reversible with decreased pressure, dermis is not involved - Stage II - partial thickness skin loss with tear in epidermis, blanchable, both epidermis/dermis are involved, infection and/or necrosis may be present - Stage III - full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia, infection and/or necrosis may be present - Stage IV - full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone and supporting structures 3) For Diabetic / Neuropathic wounds: Grade 0 = Intact skin Grade 1 = Superficial ulcer (not into subcutaneous layer) Grade 2 = Deep ulcer into subcutaneous layer (possible bone/muscle exposure .... no infection yet) Grade 3 = Deep, infected ulcer (osteitis/abscess/osteomyelitis) Grade 4 = Partial foot / digit gangrene Grade 5 = Full foot gangrene 4) - HIGH Absorption Dressings: Alginate, Hydrofibers, …. Foam, Gauze (For more FULL thickness, high exudate wounds) - Medium Absorbers: Foam, Gauze, Hydrocolloids (just depends on thickness and how much you put on). For secondary dressings primarily for excess exudate - LOW Absorbers: Collagens, Hydrocolloids, Hydrogels, Transparent films. (For LOW exudate, more shallow, Stage I and II type wounds)

Question 36

1) What is MAIN drug used for Rheumatic disease - What do they do? 2) What are Glucocorticoids / Cortisosteroids - Main drug that is a corticosteroid

Answer 36

1) DMAA or DMARDS (Disease Modifying Antirheumatic Agent) - Halts the progression of rheumatic disease by modifying the pathology of the immune response 2) Reduce inflammation in chronic conditions through vasoconstriction - Prednisone is a corticosteroid. An anti-inflammatory agent. It prevents the release of substances in the body that cause inflammation

Question 37

1) If I did a Thompson test, what injury am I testing for 2) If I did an arthrogram, what am I typically looking into - What is an angiogram: 3) Capsular pattern of shoulder is (in what order): - T or F: Adhesive capsulitis will present with this capsular pattern 4) If I did a speed's or Yergason test, what am I testing for - How do you perform each of these tests 5) What is a Colles fracture - What is it's opposite? - How to remember? 6) Involuntary contraction to the SCM muscle is what diagnosis: - If not caused by congenital, what else could cause it 7) Fracture or Degeneration at L4/L5 level is called: 8) A few conditions where there is pain at anatomical snuffbox 8A) How to remember what tendons are involved in a De Quervan's Tenosynovitis: 9) What is the special test for De Quervain's Tenosynovitis 10) What is this: X-linked recessive trait manifesting in only male offspring (females become carriers). Clinical presentation includes: waddling gait, PROXIMAL muscle weakness, toe walking, hypertrophy of CALF, difficulty climbing stairs. Rapid progression of disease with inability to ambulate by 10-12 yrs of age and death often in age 20's. 11) XX chromosomes are what gender - XY chromosomes are what gender - X-linked recessive trait means:

Answer 37

1) Achilles tendon rupture 2) An arthrogram is an X-ray image or picture of the inside of a joint (e.g. shoulder, knee, wrist, ankle) after a contrast medium (sometimes referred to as a contrast agent or “dye”) is injected into the joint. For example, in the shoulder, for adhesive capsulitis (by detecting decreased volume of fluid in joint capsule) - An angiogram is a diagnostic test that uses x-rays to take pictures of your blood vessels. A long flexible catheter is inserted through the blood stream to deliver dye (contrast agent) into the arteries making them visible on the x-ray to see if / where occlusion is. 3) ER, Abd, IR - True 4) Biceps tendinitis - Speeds: is a RSC of biceps with elbow extended and supinated - Yergason's: elbow bent and pronated and pt supinates while you resist, but you feel bicepital groove 5) Fracture to distal radius, where bone is displaced POSTERIORLY or dorsally - Smith's fracture (distal radius fracture with anterior displacement) - In church History, the Smith's were out in front (ventral), thus the Colles were in the back (dorsal) 6) Torticollis - Ocular torticollis - CN IV damage 7) Spondylolisthesis 8) - De Quervain's Tenosynovitis (entrapment or inflammation / tendinitis of the abductor pollicis longus and extensor pollicis brevis tendons). - Schaphoid fracture 8A) Both are for the thumb (so pollicis), one is abductor, one is extensor, one is longus, one is a brevis ... AL (abductor longus) 9) Finkelstein's 10) Duchenne Muscular Dystrophy 11) Female - Male - Girls carry it, but boys get it

Question 38

1) Define how to differentiate the differences between a SPRAIN: - Grade 1: - Grade 2: - Grade 3: 2) Are these same grades (from point above) the same for muscles - Is a muscle injury called a sprain? 3) Injury in growing kids (going through growth spurts) where there is pain on anterior knee at patellar tendon: insertion (tibial tuberosity) - What is it 4) An infection that occurs within the bone - Most common ways people get this? 5) Condition where there is general knee pain, articular cartilage damage to patella, and more common in younger females 6) Condition where there is sharp pain first steps in the morning in heel 7) If a drop arm test or empty can test is positive, the pt has what condition: 8) Positive painful arc indicates what condition: - Pain at top of shoulder ROM (170 ish deg's) usually indicates what 9) A Cobb angle is measured for what diagnosis - Angle from 25-40 deg's requires what intervention: - Angle of 40 deg's or more requires what intervention: - WHen should someone be assessed 10) Tinnitus is: - 2 special tests of the ear to detect hearing deficits 11) Osteosarcoma is: - What type of bones does an osteosarcoma effect - A pt that gets this will most likely end up getting a what: 12) An amputee pt will have what complications post surgery 13) Besides war and trauma, most common reason someone gets an amputation is:

Answer 38

1) - Grade 1: Small microscopic tears. Swelling / inflammation / pain, but no signficant damage. MILD tear. - Grade 2: Partial tear - Grade 3: Full rupture 2) YES - No, muscle is STRAIN. Strain a muscle, sprain a ligament 3) Osgood-Schlatter's - A childhood repetitive use injury that causes inflammation and a painful lump below the kneecap where patellar lig inserts at tibial tuberosity. Osgood-Schlatter disease affects children experiencing growth spurts. Children who play sports in which they regularly run and jump are most at risk. The disease causes a painful lump below the kneecap. The condition usually resolves on its own, once the child's bones stop growing. 4) Osteomyelitis - Could be from a fracture or injury, but usually from STAPH infection (bacteria) 5) PFPS (Patellofemoral pain syndrome) 6) Plantar fasciitis 7) Rotator cuff tear 8) Either rotator cuff tendinitis (slight tear) or shoulder impingement (bone spurs) - A/C degeneration/arthritis 9) Scoliosis - Spinal brace/orthosis - Surgery - When moderate scoliosis is detected 10) Ringing in ear - Rinne and Weber 11) Bone tumor - LONG bones - Amputation (transfemoral or transtibial) 12) - Gait and balance impairments - Prosthetic management and AD training - Fatigue easily - Wounds and residual limb management/care - Phantom pain - Hypersensitivity on residual limb - Psychological issues (cosmetic, self-esteem, purpose) - Contractures **** 13) DM II or some vascular disease.

Question 39

1) 3 parts of the sternum are called (from top to bottom) - At the top of the sternum is a little notch. It is called: 2) How many "true ribs" are there - and what are they - How many false ribs are there - How many floating ribs are there 3) What connects the ribs to the sternum 4) ANother name for these ribs is: - True ribs - False Ribs - Floating ribs 5) What connects the false ribs to the sternum 6) The top hole of the rib cage is called: - The bottom hole of the rib cage is called: - The bottom hole is covered by what: - Excursion of the diaphragm means diaphragm goes up (exhale) or down (inspire) - Normal excursion amount is what: 7) Is the clavicle and scapula part of the thoracic axial skeleton or the shoulder girdle 8) What type of joints are these: - Sternoclavicular (S/C) - Sternocostal - Costochondral 9) What articulates at the costotransverse joint 10) ANother name for a facet joint is: - DO these facet joints have a capsule - Are costovertebral and costotransverse joints synovial joints: 11) T or F: You can get OA at a facet joint - This arthritis is best seen on what imaging

Answer 39

1) Manubrium, body, and xiphoid process - Jugular notch 2) 7 (first 7 ribs bilaterally) - 5 - 2 (last two) 3) Costal cartilage 4) - True: Vertebrocostal - False: Vertebrochondral - Floating: Vertebral 5) Costal arch 6) Superior thoracic aperture (inlet) - Inferior thoracic aperture (outlet) - Diaphragm - Up (exhale) - 3-5 cm 7) Shoulder girdle 8) - S/C: Synovial (with a disc) - Syndchondroses - Cartilaginous 9) Tubercle of the rib 10) Zygapophysial joint - Yes. They are a synovial joint - YES 11) YES. It is a synovial joint, so there is articular cartilage over sup and inf articular processes, so they get arthritis - MRI

Question 40

1) What are the 3 intercostal m's - Which of these m's is oriented / angled in (towards midline) - How can you remember this (from point above) - Which of the two work during INSPIRATION to elevate the rib - How to remember this - If looking from inside the body and you see intercostal m's oriented out pointing lateral, which one's are those 2) What structure passes through the anterior and posterior scalene m's 3) What is main vein that drains blood from the head/brain - What is main artery that ascends up from heart through neck to supply brain to head/neck 4) What muscle protracts the scapula - This muscle is innervated by what nerve: - What is another action of this muscle - DOes this muscle elevate the ribs? - If you injure this muscle (or nerve) you get what pathology:

Answer 40

1) Internal and external intercostal m's, then the innermost intercostal m's - External - Ex to Sex (external m's point in to sex organs) - External - What happens to a guy during sex ... raise (inspiration) - Internal 2) Brachial plexus 3) Jugular vein - Carotid artery 4) Serratus Anterior - Long thoracic nerve (C5/6/7) - Help upwardly rotate the scapula (with arm abduction motion), and elevate ribs - Yes - Scapular winging

Question 41

**** 1) List the order (from superior to inferior, or largest to smallest) the bronchial tree of the trachea: 2) What is the difference between ventilation and respiration - What is it called where gas exchange happens in blood vessels 3) Your abdominal wall has layers of m's. Name them from outermost to innermost: 4) Is the trachea or the esophogus more anterior (in front) 5) The subclavian vein empties into ________ vein which empties into ________ 6) Two major trunks coming off heart are: 7) Sack covering over the heart is called: 8) What is cardiac tamponade

Answer 41

``` 1) - Trachea - L and R Main Bronchus (bronchi) - Lobar bronchi - Segmental bronchi - Bronchopulmonary segments - Terminal bronchioles - Respiratory bronchioles - Alveolar ducts - Alveolar sacs (This is where the gas exchange / respiration happens between O2 and CO2). ``` 2) Ventilation is the movement of air into and out of the lungs. - Respiration is the exchange of gases (oxygen and carbon dioxide) across a membrane either in the lungs or at the cellular level. - Diffusion 3) Rectus abdominus is outermost in anterior portion. Then external oblique, then internal oblique. Then transverse abdominus. 4) Trachea 5) Brachiocephalic vein --> Superior Vena Cava 6) Aortic trunk and pulmonary trunk 7) Pericardium 8) When fluid accumulates in pericardial cavity, which compromises heart's ability to contract and work properly thus impacting cardiac output

Question 42

1) What 2 main arteries come off the aorta to supply blood to the heart itself: - The L side (main one from point above) then becomes what artery (that wraps around the left backside of heart): - From main point above, the L Coronary Artery then goes down the front part of the heart. What is that artery's name - The R coronary artery then has a branch that goes down in the front on the right side (R ventricle). This artery is called: 1A) The R coronary artery runs through what? - From point above, what is that - So the coronary sinus is what - Is the coronary sinus sitting in the coronary sulcus 2) The big huge vein on the back of the heart (that drains blood of the heart) is called: - The word sulcus means: - It drains into where? 4) Main artery on the back of the heart is: - Does the artery from the point above come off the R or L coronary artery? 5) What is Heart Dominance - What % are R heart dominant? 6) R Coronary a supplies blood to what structure: 7) Most occlusions to heart (leading to MI) occurs in what artery: 8) What is a hiatus - What 4 things go through a hiatus in the diaphragm 9) What is the covering over the lungs called: - It has 2 layers. Explain both: - There is fluid between these 2 layers. Why? - What if air or fluid gets into this space? - WOuld fluid in this space be consolidation in lung or pleural effusion - What is the proceedure to remove fluid in those spaces: - What is the proceedure to remove fluid if it gets into the pericardial cavity: 10) Which lung has 3 lobes, which has 2: - Why only 2 on that side - What are the lines called that seperate each lobe of the lung - The superior lobe of the L lung has a unique anatomical feature. What is it: 11) The root of the lung where all a's, v's, and bronchial tree enter lung is called: 12) 3 surfaces of the lung: - 3 borders of lung

Answer 42

1) R and L coronary artery - L Circumflex artery - Anterior interventricular branch (left anterior descending branch of L coronary artery) - R marginal branch (or R Coronary artery) 1A) Coronary sulcus - The groove (coronary groove) that runs under each atria where the coronary a's and v's run) - The great vein (on posterior heart) where blood of the heart drains back into the R. atrium - Yes 2) Coronary Sinus (that runs in the Coronary sulcus) - Groove - R atrium (like sup and inf. vena cava) 4) Posterior interventricular branch (posterior descending artery) - R Coronary artery 5) The artery that supplies the posterior third of the interventricular septum – the posterior descending artery (PDA) determines the coronary dominance. If the posterior descending artery is supplied by the right coronary artery (RCA), then the coronary circulation can be classified as "right-dominant". - 2/3'rds 6) R atrium, most of R ventricle, SA node (usually) and AV node (usually) 7) Left anterior descending branch of L coronary artery 8) Hole or gap - Descending aorta - Inf. Vena Cava - Esophogus - And thoracic duct 9) Parietal Pleura - The parietal pleura lines the thoracic cavities, and then there is an inner layer called the visceral pleura that lines the actual lung (visceral = organ) - Reduces friction during respiration. - BAD - compress or collapse lung. Needs to be taken out. - Pleural effusion (consolidation is IN the lung itself, pleural effusion is fluid in parietal space) - Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier. - Pericardiocentesis is a procedure done to remove fluid that has built up in the sac around the heart (pericardium). It's done using a needle and small catheter to drain excess fluid. 10) R lung has 3 lobes, L has 2 - The heart (mediastinum) - Both lungs have an Oblique fissure (oriented in a diagonol between middle and inferior lobs), and the R lung also has a horizontal fissure (horizontal line between middle and superior lobe or R lung) - Lingula (near where the middle lobe would be) 11) Hilum 12) Surfaces: Costal, mediastinal, diaphragmatic - Borders: Anterior, inferior, posterior

Question 43

1) What is the difference between the Thymus and Thyroid gland 2) Main function of thymus gland is: - Main function of thyroid gland is: - Which gland goes away (for most) after puberty - Where is the Thymus gland located: - Where is the Thyroid gland located:

Answer 43

1) The thyroid and thymus glands are both endocrine glands, but they are different, and their functions differ. The thyroid is located in the NECK. It produces two primary hormones - thyroxine (T4) and triiodothyronine (T3) (and Calcitonin). These govern metabolism. The thymus is located in the upper chest (mediastinum area) and is much larger in children than in adults (and typically goes away after puberty). It's involved in IMMUNE function. White blood cells pass through the thymus. They are then called T-cells (for thymus). They assist in the immune response by what we call cell-mediated immunity (as opposed to humoral immunity, which has to do with antibodies produced by bone marrow). 2) Immune function (t-cells or t-lymphocytes) - Produce T3 and T4 which help with metabolism - Thymus - Chest, behind sternum - Neck (goiter)

Question 44

1) What is the sac covering over the heart - The heart and great vessels area is called: - Are there also 2 layers of the pericardium (like the pleura around the lungs) - Purpose of the 2 layers? - If fluid gets into this space, what is it called: - The proceedure to remove that fluid in pericardial cavity is called: - That space where fluid gets is called: - So what is pericarditis 2) What is the name of the valve between the R atrium and the R ventricle 3) *** Think of the flow of blood of the heart. From start to finish, name the VALVES the blood will go through, in order: - Which of those 4 valves only has 2 cusps (all others have 3): - The valve (from question above) is between what two chambers of the heart? 4) What is the name of the little tendinous structures that hold valves in place as blood tries to push them out/up - THe muscle that holds the tendinous chords (from point above) tied to the valves 5) What is a septum (in relation to the heart) 6) Muscle of the heart is called: - Has 3 layers - name them 7) Pectinate m's are in the atrium wall or ventricular walls? 8) Purpose of the papillary m's 9) ***** Name in order from outer most to innermost the layers of the heart from mediastinal space all the way down to blood in a chamber: 10) The inner chamber walls look similar in the atrium and ventricles, but have different names. What are those names for atrium vs. ventricles: - How to remember 11) Hole between the two atria is called: - Atrial septal defect would be what: - Can a child (or adult) get ventricular septal defect 11A) Explain difference between foramen ovale and fossa ovalis 12) Which ventricle has thicker myocardium? - Why - How many papillary m's does the L ventricle have? 13) What are the heart sounds - what do they represent? - 1st heart sound (lub) is what? - 2nd heart sound (dub) is what? - T or F: the lub is beginning of systole, and dub is end of systole? 14) Which valve is MOST associated with heart disease? - Why? - This pathology is called: - What does it lead to (from point above) - Mitral regurgitation is what, and how is it caused: - What might be the next valve to get these conditions? Why? 15) Two phases of the cardiac cycle are: - Systole is: - Diastole is: - Would the tricuspid valve and mitral valve be open or closed during diastole? - Would the aortic and pulmonary valve be open or closed during systole 16) Does the heart have a fibrous skeleton for support?

Answer 44

1) Pericardium - Mediastinum - Yes - fibrous and visceral layer of the pericardium - Reduce friction of the beating heart - Cardiac tamponade - Pericardiocentesis - Pericardial cavity - Inflammation / infection of the pericardium surrounding the heart 2) Tricuspid valve 3) Tricuspid valve --> Pulmonary Valve --> Mitral (or Bicuspid) Valve --> Aortic Valve - Mitral (bicuspid) - L atrium to L ventricle 4) Choardae Tendineaa - Papillary muscle 5) Wall between the atrium, or ventricles 6) Myocardium - Epicardium (outer layer), myocardium (middle layer), endocardium (inner layer) 7) Atrium 8) They hold the chordae tendinaea so when blood from ventricles push up to aortic or pulmonary trunks, these m's hold the tricuspid and mitral valves down so blood doesn't regurgitate backwards into atria (so when blood goes from R ventricle up to pulmonary valve, the papillary muscle holds chordae tendinea taut so tricuspid valve isn't pushed up into R atrium holding valve closed so no blood goes up into R atrium). 9) Fibrous pericardium --> Parietal pericardium --> Pericardial cavity --> Visceral pericardium --> Epicardium --> Myocardium --> Endocardium --> Chamber with blood 10) Atrium is the pectinate muscle - Ventricles is the trabeculae carneae - Pecks are higher, so pectinate is in higher chambers 11) Oval foramen (foreamen ovale) ... but it closes up after childhood - Blood flows from L to R atrium (high pressure to low) - Yes of course. This again takes blood from L to R ventricle (due to high to low pressure), and could lead to CHF 11A) Foreaman is a hole, fossa is a hollow depression. Foreaman ovale is hole shunting blood from R atrium to L atrium in fetus. It closes at birth once lungs start working to become the closed/fuzed fossa ovalis. 12) Left - Hypertrophy from working hard being it is the L ventricle - 2 (only two cusps on mitral valve) 13) Lub / Dub. They are the sounds of the valves closing. - Tricuspid and Mitral valve closing - Aortic and Pulmonary Valve closing (semi-lunar valves) - True 14) Mitral valve - Because of the continuous high pressure it is under - Mitral stenosis (or narrowing / calcification) - Narrowing of valve, so less blood getting through, so higher BP - Caused by abnormalities of the valves (leaflets), rupture or fibrosis of a papillary muscles, or rupture of the chordae tenineae - Aortic valve ... again due to higher pressure / more blood volume 15) Systole and Diastole - Systole: heart during contraction/pumping - Diastole: heart at rest Systole occurs when the heart contracts to pump blood out, and diastole occurs when the heart relaxes after contraction - OPEN - OPEN 16) YES

Question 45

1) The pacemaker of the heart is the: 2) From start to finish, go through the conduction system of the heart (as the impulse would flow): 3) If I wanted to listen specifically to the aortic valve, where on the body would I listen? - If I wanted to listen to the pulmonary valve, where would I listen? - The tricuspid valve? - Mitral valve? 4) The posterior mediastinum contains what structures:

Answer 45

1) SA Node 2) SA Node --> AV Node --> Internodal bundle --> Interatrial Bundle (to L atrium) --> Atrioventricular Bundle of HIS --> L and R Bundle Branch --> Purkinjie fibers --> Septomarginal trabecula 2) 2nd intercostal space R of the manubrium - 2nd intercostal space L of the manubrium - 5th intercostal space just L of sternum - 5th intercostal space a few inches L of sternum (midclavicular line) 4) Esophogus, thoracic aorta, thoracic duct, nerves

Question 46

1) The CNS contains what: - T or F: Brainstem is included as part of brain? 2) In the spinal cord, is "afferent" sensory or motor? - Is dorsal or ventral have efferent fibers - How to remember that dorsal is sensory - Does the wing of the gray part have efferent or afferent fibers - Is the butterfly portion of the spinal cord gray mater or white mater? - Does anterior or ventral spinal roots carry information to or away from the brain - Dorsal or posterior nerve roots carry info to or from brain (CNS) 3) Is the gray mater or white mater where cell bodies / neurons reside? - So what does the white mater consist of? 4) There are 2 hemispheres of the brain. Which side controls RIGHT sided structures / actions? 5) What are the lobes of the brain? 6) Are cranial nerves part of the CNS or PNS 7) How many spinal nerves are there 8) What is the ANS (Autonomic nervous system) - Fight or flight is what division? - Main neurotransmitter for sympathetic n.s. - Main neurotransmitter for parasympathetic n.s. - The entire purpose of the ANS (symp and parasymp) is to do what? - Is the ANS voluntary or involuntary? 8A) Is the pre-ganglionic neuron for sympathetic system short or long? - What is neurotransmitter for BOTH sympathetic and para at preganglionic synapse - What is post ganglionic synapse neurotransmitter for sympathetic - Are pre-ganglionic fibers short or long in para - T or F: neurotransmitter for both pre and post for para is AcH - How to remember if sympathetic is short or long pre-ganglionic fibers 9) What is the somatic nervous system - Is this voluntary or involuntary? 10) What system is responsible for mood, emotion, aggression, fear, sexual behavior, motivation, memory, etc. - Structures of this system include:

Answer 46

1) Brain and spinal cord - True 2) Afferent is sensory, efferent is motor (e = effort/motor) - Ventral - DRG = dorsal root ganglion which contain the sensory fibers / nerve cells - Afferent (wing = dorsal) - Gray - Away - Towards 3) Gray - Axons (from above) ... myelinated axons / nerve fibers carrying signals up and down (ascending and descending tracts of axons) 4) Left hemisphere of the brain 5) Frontal lobe, parietal lobe, occipital lobe, temporal lobe 6) PNS 7) 31 (8 cerv, 12 thor, 5 lumb, 5 sac, 1 coccy) 8) Sympathetic and Parasympathetic - Sympathetic - Norepinephrine - AcH (acetylcholine) - MAINTAIN HOMEOSTASIS - Involuntary 8A) Short - AcH - Norepinephrone - Long - True - S = S (Sympathetic = Short for pre) 9) Sensory and motor nerves of the PNS that controls our muscles and movement - Voluntary 10) Limbic system - Fornix, amygdala, hippocampus, thalmus / hypothalamus

Question 47

*** MUST KNOW 1) What are the functions of the FRONTAL lobe of the brain: - An injury to this lobe would manifest how? - Is Broca's area in frontal lobe? - Is Wernecke's area in the frontal lobe? - From the last 2 points, which is responsible for production of speech, which is for comprehension of speech 2) What are the functions of the PARIETAL lobe of the brain: - An injury to this lobe would manifest how? 3) What are the functions of the OCCIPITAL lobe of the brain: - An injury to this lobe would manifest how? 4) What are the functions of the TEMPORAL lobe of the brain: - An injury to this lobe would manifest how? 5) Broca's area is what: - What lobe is it found in: 6) Wernicke's is what? - What hemisphere is it typically in? - What lobe is it in? 7) What is Homonymous Hemianopsia - It would result from damage (ie: CVA) to which artery - R side of brain damage results in what sided homonymous hemianopsia

Answer 47

1) Frontal: Movement, intellect, personality, judgement / reasoning, speech, logic, math - Weakness, motor changes, personality changes, speech deficits, cognition deficits - Yes (Left Frontal Lobe ... or in the dominant hemisphere, so usually left side of brain). - No - it's in the temporal lobe - Broca's is for production, Wernecke's is for comprehension 2) Parietal: Sensation, touch, kinesthesia, vibration, temperature, hearing, language - Sensory deficits, impaired language 3) Occipital: Vision, process visual info (colors, lights, shapes) - Visual deficits, impaired ocular muscle movement, reading and writing impairment, blindness 4) Temporal: Hearing, memory, Wernicke's area - Wernicke's aphasia (receptive deficits), hearing deficits, learning deficits, difficulty with memory 5) Area responsible for speech production. Responsible for controlling the movement of the muscles of the speaking apparatus and related movements of lips, tongue, larynx, and pharynx - Frontal 6) Area in brain responsible to understand / comprehend and produce meaningful speech (understanding language) - Left Hemisphere - Temporal lobe 7) Homonymous is same side. Hemi is half. Hemianopsia, or hemianopia, is a visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes. Homonymous hemianopsia (or homonymous hemianopia) is hemianopic visual field loss on the same side of both eyes. - MCA - Left

Question 48

1) What are the meninges - Which layer is impermeable - How many layers ... and what are they? - What is inner most layer - What is outer most layer - T or F: Dura mater lines the periosteum of bone (skull) - Which layers forms around the contours of the brain and spinal cord? 2) What is the fluid found in meninges - Where is this fluid (from last point) found (what meningeal layers)? 3) What is the epidural space - In the brain, is the epidural space real (actual space) or potential? - In the spinal cord, is the epidural space real or potential? - How to remember this (from the last 2 points) 4) How many ventricles are there in the brain? - What are they (name them)? - What are they? - What connects the 3rd and 4th ventricle? - T or F: It is in the ventricles where CSF is made? - What is CSF made by (in what anatomical structure)? - What pathology can happen in these ventricles? - T or F: CSF gives cushion or buoyancy for brain? 4A) How to remember syringomyelia? 5) What is the Blood Brain Barrier (BBB)?

Answer 48

1) Connective tissue layers / coverings around the CNS (brain and spinal cord). They protect the brain and spinal cord from infections and foreign particles - The arachnoid layer is impermeable - 3 (Dura, arachnoid, pia) - Pia - Dura - True - Pia 2) Cerebrospinal fluid (CSF) - Subarachnoid space 3) Epi - above/outer. So, place between outer dura and periosteum of skull or vertebrae. - Potential - Real - Well fluid getting into the epidural space of the brain is a pathology (ie: hematoma). Whereas Dr's place anesthesia into epidural space in spinal cord for pain control. 4) 4 - L and R lateral ventricle, 3rd ventricle, 4th ventricle - Fluid filled cavities (filled with CSF) to protect and nourish the brain. CSF passes through them to cushion / protect brain and provide antibodies to protect brain. - Cerebral aqueduct - True - Choroid plexus - Excess fluid (CSF) causing hydrocephaly (enlargement of ventricles of brain) or syringomyelia (excess CSF in spinal cord) - True 4A) You need a syringe to get liquid out, and mye is prefix for spinal cord 5) Responsible for the exchange of nutrients between the CNS and the vascular system. It protects the CNS (brain and spinal cord) by restricting certain molecules / toxins from crossing the barrier, while letting others in.

Question 49

***** THERE WILL BE A ? ON THIS STUFF **** 1) Which hemisphere (right or left) is responsible for: ``` 1A) Language 1B) Logic, rational, analytical, mathematic, reasoning 1C) Musical, artistic, spatial relationships, imagination, creativity 1D) Hand-eye coordination 1E) Movements 1F) Nonverbal 1G) Left hand control 1H) Science and math and numbers 1I) Impulsive ```

Answer 49

``` 1A) Left (usually ... whatever is dominant) 1B) Left 1C) Right 1D) Right 1E) Left 1F) Right 1G) Right 1H) Left 1I) Right ```

Question 50

***** THERE WILL BE A ? ON THIS STUFF **** 1) Below is a certain tract in the brain/spinal cord. You need to identify whether it is an ascending or descending tract: a) Corticospinal: b) Spinocerebellar: c) Spino-olivary: d) Vestibulospinal: e) Spinothalamic: f) Fasciculus cuneatus: g) Fasciculus gracilis: 2) Now explain the function of each of these tracts: a) Corticospinal: b) Spinocerebellar: c) Spino-olivary: d) Vestibulospinal: e) Spinothalamic: f) Fasciculus cuneatus: g) Fasciculus gracilis: 3) Ascending tracts (spino-cortical) are for motor or sensory? - Descending tracts (cortico-spinal) are for motor or sensory? 4) In a cross section of the spinal cord, is the gray mater or white mater where the tracts are?

Answer 50

1) a) Corticospinal: descending b) Spinocerebellar: ascending c) Spino-olivary: ascending d) Vestibulospinal: descending e) Spinothalamic: ascending f) Fasciculus cuneatus: ascending g) Fasciculus gracilis: ascending 2) a) Corticospinal: motor tract responsible for ipsilateral voluntary movement b) Spinocerebellar: Sensory tract that ascends to cerebellum for ipsilateral proprioception, tension in m's, joint sense, posture c) Spino-olivary: ascends to cerebellum and relays info from proprioceptive organs d) Vestibulospinal: motor tract responsible for ipsilateral gross postural adjustements e) Spinothalamic: Sensory tract for pain, and temp f) Fasciculus cuneatus: sensory tract for trunk, neck, and UE sensation g) Fasciculus gracilis: sensory tract for trunk and LE sensation 3) Sensory - Motor 4) White

Question 51

Know these terms: 1) Axon: 2) Dendrite: 2A) Terminal Branches: 2B) Synapse: 2C) Action potential: 3) Endoneurium: 3A) Perineurium: 4) Epineurium: 5) Motor unit: 6) Myelin: - Demyelination results in what: - Demyelination in the CNS is: - Demyelination in the PNS is: 7) Nerve Conduction Velocity (NCV): 8) Neurons: 9) Nodes of Ranvier: 11) Saltatory Conduction: 12) Schwaan Cell: - What is a Schwaan's cells counterpart in the CNS 13) What are the types of cells the myelinate axons in the: - CNS: - PNS:

Answer 51

1) Axon: Part of the neuron going AWAY from the cell body (conducting impulse away from cell body) 2) Dendrite: An extension of the cell body that receives signals from other neurons (these are the projecting arms of the cell body ... axon is portion going away from cell body to pass signal) 2A) Terminal Branches: These are the ends of the axon where the signal passes over to a dendrite 2B) Synapse: Junction between 2 nerve cells where signal passes 2C) The impulse or signal 3) Endoneurium: Innermost covering of a peripheral nerve that covers individual axon 3A) Perineurium: Middle layer of covering surrounding a group of axons 4) Epineurium: Outermost covering of a peripheral nerve that covers entire nerve 5) Motor unit: A single motor neuron and all the muscle fibers it innervates 6) Myelin: Coverings over axons to help propogate / speed up the conduction speed and signal. They are protiens and lipids that form to create a sheath around nerves to increase conductivity of the nerve impulse. - Slower conduction of signal - MS (Multiple Sclerosis) - GBS (Guillain-Barre Syndrome) 7) Nerve Conduction Velocity (NCV): Measures speed of a nerve impulse along an axon of a nerve 8) Neurons: Nerve cells of the CNS - contain cell body, axon, dendrite 9) Nodes of Ranvier: Brief gaps in myelination of an axon; helps facilitate rapid conduction of nerve impulses so signal can jump from gap to gap 11) Saltatory Conduction: An action potential moving along an axon in a jumping fashion from node to node 12) Schwaan Cell: Myelinating cell in PNS - Oligodendrocytes 13) - CNS: Oligodendrocyte - PNS: Schwann cell

Question 52

MUST KNOW DIFFERENCE BETWEEN NERVE FIBERS: 1) Of all the nerve fibers, which are the noxious fibers - What does noxious mean 2) Which are the smallest fibers? - Are these fibers fast or slow noxious 3) Which ones are poorly myelinated, so they are slow - Are A-delta fibers noxious - Are A-delta fibers myelinated 4) Which fibers are largest and fastest - Are A fibers highly myelinated? - Are A-alpha or A-beta fibers faster 5) What are the sub-types of A fibers (list them and their function): 6) What is the purpose/function of muscle spindles? - What is the purpose/function of golgi tendon organs 7) What is a baroreceptor - What is the ability to evaluate weight of objects?

Answer 52

1) C fibers (and D, but D are faster and larger) - PAIN 2) C fibers - Slow 3) C fibers - Yes (fast noxious) - Yes 4) A fibers - YES - A-alpha 5) - Alpha: muscle spindle (Ia) and golgi tendon (Ib) - Beta: touch, pressure, vibration, kinesthesia, position - Delta: pain, temp, fast noxious 6) Senses muscle stretch / length - Senses muscle load 7) Senses changes in pressure - Barognosis, or baresthesia, (to differentiate objects of different weights by holding or lifting them. It is the opposite of abaragnosis, the inability of evaluating the weight of objects).

Question 53

1) What are the main UE reflexes to test, and what muscle and dermatome level does it test 2) What are the main LE reflexes to test, and what muscle and dermatome level does it test 3) Dermatome area for these: - C1: - C2: - C3: - C4: - C5: - C6: - C7: - C8: - T1: - L1: - L2: - L3: - L4: - L5: - S1: - S2: - S3-5: 4) If there was MOTOR impairment to these areas, what m's would be effected: - C1: - C2: - C3: - C4: - C5: - C6: - C7: - C8: - T1: - L1: - L2: - L3: - L4: - L5: - S1: - S2: - S3-5:

Answer 53

1) - Biceps: C5 (C5/6) - Brachioradialis: C6 (C5/6) - Triceps: C7 2) - Quads/Patellar: L3/4 - Achilles: S1/2 3) - C1: Vertex of skull (upper surface of head) - C2: Temple, forehead, occiput - C3: Neck - C4: Top of shoulder - C5: Lateral arm - C6: Radial side of forearm down into thumb - C7: Middle of forearm to middle finger(s) - C8: Medial arm down to medial 5th digit - T1: Inner arm - L1: Anterior groin - L2: Middle of thigh - L3: Anterior thigh down to medial knee - L4: Medial lower leg down to medial malleolus - L5: Lateral lower leg down to dorsum of foot / big toe - S1: Lateral and plantar side of foot - S2: Back of lower leg / thigh - S3-5: Saddle area 4) - C1: None - C2: Longus colli, SCM, rectus capitus (NOT facial m's since those are from CN's) - C3: Splenius capitus - C4: Traps, levator, scalenes (4/5/6) - C5: Deltoid, supraspinatus, infraspinatus, biceps, rhomboids - C6: biceps, brachioradialis, supinator, wrist extensors - C7: Tricpes, wrist flexors, serratus, lats, pecs - C8: Ulnar deviators, thumb extensors, - T1: N/A - L1: None - L2: Psoas, hip adductors - L3: Quads, Psoas - L4: Quads, tib anterior, extensor hallucis, ext digitorum longus - L5: tib ant, ext hallucis longus, perenials, glute med - S1: calf and hamstrings - S2: calf and hamstrings - S3-5: bladder, rectum, pelvic floor

Question 54

MUST KNOW CRANIAL NERVE's: 1) True or False: CN's must be in roman numerals? 2) The key is to remember the mneumonic. So, what is the mneumonic to remember what each CN is? 3) From point above, what are the CN's 4) Now, what does each CN do (it's function): - Olfactory (1) - Optic (2) - Occulomotor (3) - Trochlear (4) - Trigeminal (5) - Abducens (6) - Facial (7) - Acoustic / Vestibulocochlear (8) - Glossopharyngeal (9) - Vagus (10) - Spinal Accessory (11) - Hypoglossal (12) 5) For a CN screen, how would you test: - CN V: - CN VII: - CN XII: 5A) Must know which CN's are for sensory and which are for motor. What is the numonic to remember: - What does that code mean: - So now list each cranial nerve and what fibers it carries 5B) What is the motor aspect of the Vagus nerve (CN X) 6) What is the CN for: - Parasympathetic to visceral organs - SCM and Trap muscles - Vision - Smelling - Facial Sensation - Facial movements / expression - Posterior 1/3rds of tongue taste - Anterior 2/3rds of tongue taste - Tongue muscle movement - Salivation and Swallowing - Hearing / Vestibular - Eye movement for Lateral Rectus - Eye Movement for 4 eye m's - Eye movement for sup oblique m 7) What CN will test reaction to light? - What CN will test blink reflex - What CN tests visual fields (ability to see) - What CN tests downward and inward gaze - What CN tests clenching jaw down - What CN tests face sensation - What CN tests tongue protrusion - If one side of CN XII gets injured will tongue deviate towards that side or opposite? - Balance and coordination tests what CN - Resisting a shoulder shrug tests what CN - Closing your eyes tight, smiling, whistling, puffing cheekcs tests what CN - Taste on posterior 1/3rd of tongue tests what CN - Taste on anterior 2/3rds of tongue tests what CN - Testing gag reflex or ability to swallow tests what CN - A lateral gaze look with eyes tests what CN - Face sensation and clenching teeth tests what CN 8) List what each of these eye m's do: - Lateral rectus: - Medial rectus: - Superior rectus: - Inferior rectus: - Superior Oblique: - Inferior Oblique: - which one's are innervated by Occulomotor nerve: - which one is innervated by trochlear nerve: - which one is innervated by abducens nerve

Answer 54

1) TRUE 2) On Old Olympus Towering Top A Finn And German Viewed Some Hippos 3) - Olfactory (1) - Optic (2) - Occulomotor (3) - Trochlear (4) - Trigeminal (5) - Abducens (6) - Facial (7) - Acoustic / Vestibulocochlear (8) - Glossopharyngeal (9) - Vagus (10) - Spinal Accessory (11) - Hypoglossal (12) 4) - Olfactory (1): Smell - Optic (2): Vision - Occulomotor (3): Eye movement (4 occular m's) - Trochlear (4): Eye movement (sup. oblique m) - Trigeminal (5): Facial sensation, and m's of mastication - Abducens (6): Eye movement (lateral rectus m) - Facial (7): Facial movement/expression, anterior 2/3'rds of taste - Acoustic / Vestibulocochlear (8): Hearing / Vestibular - Glossopharyngeal (9): Tounge sensation (post 1/3rd of taste, salivation, swallowing) - Vagus (10): Parasympathetic to visceral organs - Spinal Accessory (11): SCM and Traps - Hypoglossal (12): Tongue Movement (tongue m's) 5) - CN V: Open and close jaw - CN VII: Facial expressions - CN XII: Stick tongue out 5A) - Some say marry money but my brother says big brains matter more - S = sensory, M = motor, B = both - Olfactory (1) - sensory - Optic (2) - sensory - Occulomotor (3) - motor - Trochlear (4) - motor - Trigeminal (5) - both - Abducens (6) - motor - Facial (7) - both - Acoustic / Vestibulocochlear (8) - sensory - Glossopharyngeal (9) - both - Vagus (10) - both - Spinal Accessory (11) - motor - Hypoglossal (12) - motor 5B) pharyngeal and laryngeal branches transmit motor impulses to the pharynx and larynx 6) - Vagus (X) - Spinal Accessory (XI) - Optic (CN II) - Olfactory (CN I) - Trigeminal (CN V) - Facial (CN VII) - Glossopharyngeal (CN IX) - Facial (CN VII) - Hypoglossal (CN XII) - Glossopharyngeal (CN IX) - Acoustic / Vestibulocochlear (CN VIII) - Abducens (CN VI) - Oculomotor (CN III) - Trochlear (CN IV) 7) CN III (Oculomotor) - Sensory portion of V, motor portion of VII (not II or III) - CN II (Optic) - CN IV (Trochlear ... sup oblique) - CN V (Trigeminal) - CN V (Trigeminal) - CN XII (hypoglossal) - Towards the injured side - CN VIII (Vestibulocochlear) - CN XI (spinal accessory) - Facial (CN VII) - Glossopharyngeal (CN IX) - Facial (VII) - Glossopharyngeal (CN IX) - Abducens (CN VI ... lateral rectus) - Trigeminal (CN V) 8) - Lateral deviation of eye - Medial deviation of eye - upward and outward - downward and outward - downward and inward - upward and inward - All others - Trochlear: sup oblique - Abducens: lateral rectus

Question 55

1) What m's does this nerve innervate: - Axillary: - Long Thoracic: - Dorsal Scapular: - Suprascapular: - Subclavius: - Musculocutaneous: - Median: - Ulnar: - Radial: - Thoracodorsal: - Subscapular: 2) What m's will these nerve's innervate: - Lumbar Plexus: - Sacral Plexus: - Inf. Gluteal Nerve: - Superior Gluteal Nerve: - Sciatic Nerve - Tibial Division: - Sciatic Nerve - Fibular Division: - Deep Peroneal / Fibular Nerve: - Superficial Fibular Nerve: - Femoral nerve: - Obturator nerve: - Tibial nerve:

Answer 55

1) - Axillary: Deltoid and Teres minor - Long Thoracic: Serratus Anterior - Dorsal Scapular: Rhomboids, levator scapulae - Suprascapular: Supraspinatus, infraspinatus - Subclavius: Subclavian muscle - Musculocutaneous: Biceps, brachiallis, and corachobrachialis - Median: Wrist flexors, lateral part of hand m's - Ulnar: Flexor carpi ulnaris, extensor carpi ulnaris, hand intrinsics, 1/2 of flexor digitorum profundus - Radial: Triceps, brachioradialis, supinator, anconeus, wrist extensors - Thoracodorsal: Lats - Subscapular: Subscapularis, and part of teres major 2) - Lumbar Plexus: Psoas major/minor, QL - Sacral Plexus: Piriformis, Gemelli, Obturator internus, quadratus femoris - Inf. Gluteal Nerve: Glute max - Superior Gluteal Nerve: glute med and min, TFL, and glute max - Sciatic Nerve - Tibial Division: Semitendinosous, semimembranosus, biceps femoris long head - Sciatic Nerve - Fibular Division: biceps femoris short head - Deep Peroneal / Fibular Nerve: ant tib, extensor digitorum longus, extensor hallucis longus, fibularis tertious, extensor digitorum brevis - Superficial Fibular Nerve: peroneal / fibular longus, and brevis - Femoral nerve: quads, sartorius, iliacus, pectineus - Obturator nerve: adductors longus/brevis/magnus, gracillis, obturator externis - Tibial nerve: Gastroc, soleus, plantaris, flexor digitorum longus, flexor hallucis longus, post tib, popliteus, foot intrinsics on plantar foot (from medial and lateral plantar n. coming off of tibial n).

Question 56

1) You can grade a DEEP TENDON reflex. List the various grades you can give a deep tendon reflex response: 2) If you wanted to test superficial sensations, what would you be testing for: - If you wanted to test deep sensations, what would you be testing for: 3) Define or explain how you'd test/assess these sensation terms below: - Barognosis: - How to remember point above - Deep Pain: - Graphesthesia: - How to remember point above - Kinesthesia: - Light Touch: - Localization: - Proprioception: - Stereognosis: - How to remember point above - Superficial Pain: - Temperature: - Two-Point Discrimination: - Vibration: 4) So if I could not do these things below, what would it be called (what term defines this sensation deficit): - Can't identify an object without sight? - Can't identify where a limb is in space - Can't identify a letter or number drawn on the hand with eyes closed - Don't feel anything with a squeeze to forearm or calf - Can't perceive different weight of objects

Answer 56

1) - 0: No reflex / response - 1+: Diminished reflexed - 2+: Active normal reflex response - 3+: Exaggerated response - 4+: Hyperactive (not normal) 2) Superficial: temp, light touch, pain - Deep: proprioception, kinesthesia, vibration 3) - Barognosis: Perceive the weight of different objects in your hand - BAR of weights to weight things out - Deep Pain: Squeeze the forearm or calf - Graphesthesia: Identify a number or letter drawn on the hand without visual input - Draw a graph on your skin/arm - Kinesthesia: identify direction / extent of a movement of a joint - Light Touch: Perceive touch through light pressure (ie: cotton ball or feather) - Localization: ability to identify the exact location of touch - Proprioception: identify where a body part is in space (static position of an extremity in space) - Stereognosis: identify an object without sight - Bryan did this in class - Superficial Pain: Perceive noxious stimulus with a pin, paper clip, toothed popsicle stick - Temperature: Perceive warm vs. cold - Two-Point Discrimination: Using a 2 point caliper on the skin, identify one or two points without visual input - Vibration: Perceive vibration from a tuning fork 4) - astereognosis - Proprioception - agraphesthesia - Deep pain - Abarognosis (NOT baresthesia, which is ability to differentiate weights)

Question 57

1) What does ALS stand for: - Other name for this condition is: - What is ALS: - Where does the injury/pathology take place? - Is this demyelination or axon degeneration? - Is there motor weakness, sensory loss, or both? - Will there be UMN or LMN signs, or both? - What is prognosis - How do they eventually die 2) What does MS stand for: - What is MS: - Where does the injury/pathology take place? - Is this demyelination or axon degeneration? - Will there be UMN or LMN signs, or both? 3) What does GBS stand for: - What is GBS: - Where does the injury/pathology take place? - Is this demyelination or axon degeneration? - Will there be UMN or LMN signs, or both? 4) What is Myasthenia Gravis: - How does it happen? - Main s/s 5) What is Muscular Dystrophy - Will you see this more in males or females - Clinical presentation of MD is: 6) So, if I had LMN signs and disease process only effected PNS or peripheral nerves, I'd have which of these conditions: - If I had UMN and LMN signs, I'd have: - If I only had UMN signs, I'd have: - If the signs start more distal first, I'd have: - T or F: ALL these conditions are progressive? - Why does GBS have a better prognosis than MS or ALS? - What has the worst prognosis - Will you get sensory s/s with ALS? - Will you get sensory s/s with MS or GBS? - How do people usually die from these conditions? - Patients will get Paresthesias - what is that? - Will someone with muscular dystrophy or MG lose sensory component? 7) UMN Signs are: 8) LMN Signs are: 9) So how to remember what type of atrophy belongs to UMN vs. LMN 10) Why might someone get a neuropathy: 11) What pathologies or conditions would present with UMN signs

Answer 57

1) ALS: Amyotrophic Lateral Sclerosis - Lou Gehrig’s - Upper and Lower motor neurons axon degeneration (axon gradually breaks down and dies). - Anterior horn cell - This is NOT demyelination (like MS or GBS where myelin sheath breaks down), ALS is just axon degeneration in CNS and in the PNS. - Just motor (it is in anterior horn cells - so just motor) - thus sensory stays in tact. - UMN and LMN signs since it is in CNS and PNS - Very bad - 2-5 yrs - Respiratory failure 2) Multiple Sclerosis (MS): - Demyelinating disease of the CNS. So nerves loose demyelination causing slowed signal and slowed movements, processing, etc. - In the brain and spinal cord (central nervous system). - Demyelination. In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. - UMN signs 3) Guillain Barre Syndrome (GBS): - Just like MS, but now in Peripheral Nerves (so demyelination of peripheral nerves). - Peripheral nerves in PNS - Both (like stated above in MS) - LMN signs 4) Myasthenia Gravis: A nervous condition down at the Motor end plate (or NMJ). So AcH can’t get released normally at NMJ, so a contraction can’t happen. - Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs. The name myasthenia gravis, which is Latin and Greek in origin, means "grave, or serious, muscle weakness." - Muscle weakness, fatigue 5) Muscular Dystrophy: Disease or wasting to the actual Muscle itself. A genetic disorder where there is an absence of dystrophin, a protein needed to build and maintain muscle mass. Without dystrophin, muscles eventually waste away. Results in muscle weakness, and eventually respiratory failure. - X-linked recessive trait manifesting in only male offspring (females become carriers). - Clinical presentation includes: waddling gait, proximal muscle weakness, toe walking, hypertrophy of CALF, difficulty climbing stairs. Rapid progression of disease with inability to ambulate by 10-12 yrs of age and death often in age 20's. 6) GBS - ALS - MS - GBS - True - Because GBS is in PNS, and those nerves can grow back. Most pt's with GBS can't recover and get better (where CNS pathologies pt's can't). - ALS (2-5 yrs) - NO (anterior horn cell) - Yes - It impacts diaphragm and they have respiratory issues - Abnormal sensation = Numbness, tingling, can't feel - No (those are just in the muscle) 7) - Spastic - Hyperreflexia - Hypertonic - Disuse atrophy - Positive Babinski's and clonus 8) - Flaccid - Hyporeflexia - Hypotonic - Wasting atrophy - No Babinski or clonus - Fasciculations (Brief, spontaneous contraction or twitch in a muscle) 9) Alphabetical .... disuse atrophy vs. wasting atrophy. D is higher in alphabet so UMN, and Wasting is lower so LMN 10) Trauma, DM II, Idiopathic, Genetics, infection, inflammation, post-surgical, compression, etc. 11) Cerebral Palsy (CP), Stroke (CVA), ALS, MS, Hydrocephalus, Brain tumor

Question 58

1) Define these terms: - Akinesia: - Dyskinesia: - Asthenia: - How to remember asthenia: - Ataxia: - Athetosis: - Bradykinesia: - Chorea: - Clasp-Knife Response/RIgidity: - This clasp knife rigidity would be graded how on modified ashworth scale - Clonus: - Cogwheel Rigidity: - Dysdiadochokinesia: - Dysmetria: - Dystonia: - Fasciculation: - Hemiballism: - Kinesthesia: - Lead Pipe Rigidity: - Rigidity: - Tremor: 2) Explain difference between ballismus vs. chorea vs. athetosis 3) How are athetosis and dystonia related? 4) Difference between clasp-knife and cogwheel rigidity - On Modified Ashworth Scale, Clasp Knife is rated a: - On ", Cogwheel is rated a: - On ", lead pipe rigidity is rated a: 5) What is difference between cogwheel and lead pipe rigidity: 6) What is Dysmetria

Answer 58

1) - Akinesia: Inability to initiate movement / lack of movement (like in Parkinson's disease) - Dyskinesia: abnormal movements, uncontrolled involuntary movements - Asthenia: Generalized weakness or lack of energy, body fatigue or tiredness - Has NOTHING to do with asthma, but asthma can make you tired, weak, fatigued, etc. - Ataxia: Inability to perform coordinated movements (cerebellar deficit) - Athestosis: Involuntary slow writhing movements of limbs (not trunk). Abnormal flinging uncordinated movements caused by damage to BASAL GANGLIA. Low and high tone - Bradykinesia: Slow movements - Chorea: Movements that are QUICK / SUDDEN, random, and involuntary. Dance like. Think of chorea like choreograph, dance like quick sudden mvmts. From basal ganglia damage - Clasp-Knife Response/Rigidity: Form of resistance seen during ROM of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement through the ROM (just releases). - 1 (1+ is cogwheel, lead pipe is more 3+ or rigid) - Clonus: UMN lesion sign where pt involuntarily has spasm contraction of a muscle (done with DF at ankle) - Cogwheel Rigidity: Rigidity where there is jerky resistance throughout entire ROM. - Dysdiadochokinesia: Inability to perform rapidly alternating movements (hands doing pro/supination). It's a coordination issue, so cerebellar damage. - Dysmetria: OVERSHOOTING/UNDERSHOOTING - Dystonia: Closely related to athetosis; however, there is a larger AXIAL muscle involvement rather than appendicular muscles/limbs - Fasciculation: Muscular twitch. Seen in LMN - Hemiballism: Involuntary and VIOLENT movement of a large body part (from damage to basal ganglia) - Kinesthesia: Ability or awareness to perceive the direction and extent of movement of a joint or body part - Lead Pipe Rigidity: Form of stiffness/rigidity or constant resistance throughout ROM - Rigidity: State of sever hypertonicity where a sustained muscle contraction does not allow for any movement - Tremor: Involuntary rhythmic oscillatory movements secondary to a basal ganglia lesion. 2) They are all abnormal uncontrolled movements, but: - Ballismus: violent (ballismic missile) - Chorea: sudden / quick / dance-like (choreograph dance) - Athetosis: slow writhing 3) Both are involuntary uncontrolled writhing movements, but athetosis involves limbs more where dystonia is more trunk. 4) When doing PROM, clasp knife will be jerky and then just release (like pocket knife going in). Clasp knife will be hard/rigid at start of ROM but then release at end of ROM. Cogwheel Rigidity is jerky and stiff throughout whole ROM. - 1 - 1+ - 3+ 5) Cogwheel rigidity and leadpipe rigidity are two types identified with Parkinson's disease: Cogwheel rigidity is JERKY resistance to passive movement as muscles tense and relax. Leadpipe rigidity is SUSTAINED resistance to passive movement throughout the whole range of motion, with no fluctuations. 6) Overshooting and undershooting

Question 59

1) What is the balance reflex? - What does this reflex do? 2) What are the postural strategies (how many) 3) From point above, which is the first posture / balance strategy we use (if it is a little balance issue or perterbation, on solid ground)? - Do m's in this strategy fire proximal to distal or distal to proximal? - If we sway slightly backwards, and using this 1st strategy, what m's kick in first, then what muscle, then what muscle - If we sway slightly forward, and using this 1st strategy, what m's kick in first, then what muscle, then what muscle 4) If I used hip strategy (2nd one), do m's kick on or fire proximal to distal or distal to proximal - If I sway forward to catch myself, what is happening to my head and hips/buttocks - If I sway forward (head goes forward, hips back), what m's fire first, then what m's? - If I sway backward (head goes back, hips forward), what m's fire first, then what m's? - T or F: The hips will move the same direction as the head? 5) If the perturbation or loss of balance is very small, what strategy would we use - T or F: The greater force, loss of balance, perturbation, etc. the higher up we go in what postural strategy we use to correct or catch ourselves? 6) Another method or postural sway / balance strategy they didn't teach in school is the suspensory strategy. What is that? - Examples of when we use this? 7) When would we employ the stepping strategy? 8) What things factor into our balance?

Answer 59

1) VOR: Vestibulo-ocular reflex - Allows for head/eye movement coordination. It allows for gaze stabilization during body movements so eyes can maintain a steady image while your head/body moves. 2) There are 5: ankle, hip, stepping, reaching, and suspensatory 3) Ankle - Distal to proximal - Ant tib, quads, abs - Gastrocs, HS's, paraspinals 4) Proximal to distal - They go opposite to "balance" each other. Essentially we lower our COG down and have head go opposite direction of hips so as to make our COG even/balanced over our legs. If you fall back, hips go back and head goes forward (and visa versa) - abs, quads - paraspinals, HS's - False 5) Ankle - True 6) Crouch down, do knee and hip flexion, and get COG low to the ground to avoid falling - Skateboarding, surfing, snowboarding 7) If our COG gets way outside our BOS? 8) Vision, Vestibular, and muscles (somatosensory component)

Question 60

1) What is aphasia? - What causes it? - What determines what type of aphasia it is? 2) What are the main 2 types of aphasia? - Is Broca's fluent or non-fluent aphasia? - Another term for Broca's aphasia? - Why (from point above) - T or F: With Broca's (or non-fluent) you can comprehend just fine, just can't produce speech - What lobe is it found in? - What hemisphere is it found in 3) Other term for Fluent aphasia? - Yet another term - Explain this aphasia - Where is Wernicke's area 4) So Non-Fluent aphasia is called: - Another term for Wernicke's aphasia - Another term for fluent aphasia - Another term for Broca's aphasia - If you can comprehend everything but can't produce speech, you have what aphasia - If you can't comprehend anything but can produce speech, you have what aphasia - Which one will you see someone get really frustrated when trying to speak? 5) What is it called if you have both Broca's and Wernicke's? - Explain this aphasia: 6) What is abulic aphasia - What artery is damaged (from CVA) in Broca's and Wernecke's aphasia - What artery is damaged (from CVA) in Abulic aphasia?

Answer 60

1) A neurological impairment of speech. - It is the result of some brain injury / head trauma / CVA / tumor / infection. - The severity of the injury, location of injury, blood vessels involved or effected. 2) Fluent and Non-Fluent - Non-fluent - Non fluent, or expressive aphasia - Broca's area is responsible for production of speech (actual movement of m's and through to create speech sound). So when this area can't work, you are NOT fluent. - True - Frontal Lobe - Left (in the dominant hemisphere, so usually left side of brain). 3) Wernicke's Aphasia - Receptive aphasia - Word output and speech production is fine, but not able to comprehend. Just rambling jargon non-sense. Speech lacks substance - L side of brain in temporal lobe (usually L side ... dominant side) 4) Broca's - Receptive aphasia - Wernicke's - Expressive aphasia - Broca's (or expressive aphasia) - Wernicke's (receptive aphasia) - Broca's ... because they can comprehend everything, just can't talk right so it is frustrating. 5) Global aphasia - It impacts receptive and expressive abilities (so Broca's and Wernicke's) 6) Mutism, social issues - MCA - ACA

Question 61

1) What is the official term for a stroke - What is a stroke 2) What are primary risk factors for getting a stroke 3) What are secondary risk factors for getting a stroke 4) What is a TIA - How is this different from a stroke - Do both have F.A.S.T. symptoms? - Do both have vision and speech problems - What medication would be given to treat TIA's 4A) What is a complete stroke: - A right brained stroke presents with symptoms on what side of the body? - What is a "stroke in evolution" 5) Define these terms: - Embolus: - Thrombus: - Hemmorage: - Infarction: - Occlusion: 6) Difference between infarction and occlusion: 7) Difference between embolus and thrombus:

Answer 61

1) CVA: Cerebrovascular Accident - An ischemic event where not enough blood (Oxygen) gets to a portion of the brain as a result of ischemia or hemmorrhage. 2) - HTN - Cardiac disease (Atherosclerosis, arrythmias) - DM II - SMoking - MI 3) - Obesity - Surgery - High cholesterol - Stress - Lack of exercises - Alcohol consumption 4) Transient Ischemic Attack. A TIA is a mini-stroke, without (sometimes) any major effects. A TIA is a small clot that lead to interruption of blood flow to brain. TIA's don't cause permanent damage, but indicates future risk of a stroke. - Symptoms resolve quickly (within 24-48 hours) - Yes - Both have vision and speech problems, but again, if they resolve quickly = TIA - Blood thinners / thrombolytics 4A) A CVA that presents with total neurological deficits at the onset. - Opposite side (left) - A CVA caused by a thrombus that gradually progresses. Neurological deficits are not seen for one or two days after onset. 5) - Embolus: A solid, liquid, or gaseous blood formation that travels throughout bloodstream to cerebral arteries causing an occlusion of a blood vessel (and then infarction). - Thrombus: Atherosclerotic plaque or blood clot that blocks an artery causing occlusion or eventually an infarct (tissue death). - Hemmorage: Abnormal bleeding in the brain due to rupture of a blood vessel. No Oxygen gets to brain tissue distal to hemmorage, and excess blood pooling causing pressure / damage to brain tissue. - Infarction: obstruction of the blood supply to an organ or region of tissue, typically by a thrombus or embolus, causing local death of the tissue. - Occlusion: the blockage or closing of a blood vessel or hollow organ. 6) Infarction is tissue death (necrosis) due to inadequate blood supply to the affected area. It may be caused by artery blockages, rupture, mechanical compression. Occlusion is just a vessel that is being blocked somehow. 7) An embolus is a thrombus (blood clot) that travels to distant site.

Question 62

1) What is a synergy pattern 2) Generally - flexion synergy pattern is the limb / joint / body part moving into flexion. The extension synergy pattern is the limb / joint / body part moving into extension. BUT ... list the flexion synergy pattern for: - Toes: - Ankle: - Hip: - Forearm: - Shoulder: What is the Extension synergy pattern for: - Toes: - Ankle: - Hip: - Forearm: - Shoulder: 3) T or F: Synergy patterns happen after someone has a stroke/CVA - The strange movement in both flexion and extension synergy patterns happens where (and why)

Answer 62

1) After someone has a CVA, the higher centers of their brain are damaged. These higher centers are responsible for complex motor patterns - so when those higher centers are damaged, the brain can't control gross motor patterns. Some patients lose independent control of selected muscle groups, resulting in coupled joint movements that are often inappropriate for the desired task 2) - Toes: Extension - Ankle: DF and Inversion - Hip: Flex, Abd and ER - Forearm: Supination (remember cause bicep flexes and does supination) - Shoulder: Flex, Abd and ER (If other joint isn't listed, assume it is in flex) - Toes: Toes flex - Ankle: PF and inversion - Hip: Ext, IR, Add - Forearm: Pronation - Shoulder: Ext, IR and Add (If other joint isn't listed, assume it is in ext) 3) TRUE - Toes (flexion synergy pattern has toes extend, and extension synergy pattern has toes flex)

Question 63

1) Explain difference between Motor Control and Motor Learning: 2) Briefly explain the history and development of thought for motor control: 3) What is the 3 stage model of motor learning: 3A) Feedback is needed more when you are learning a new motor task, so what stage(s) is feedback needed more? - If learning a really hard task, how frequently should feedback of performance be: - If learning a simple task, how frequently should feedback of performance be: 4) Feedback is imperative for motor learning. Feedback allows for motor learning. Define these forms of feedback (for motor learning): - Intrinsic feedback: - Extrinsic feedback: - Knowledge of Results: - Knowledge of Performance: - Inherent feedback is intrinsic or extrinsic feedback? 5) Practice refers to the repeated performance of a movement/task in order to learn and improve and acquire a skill. Define these terms related to practice: - Mental Practice: - Massed Practice: - Distributed Practice: - Constant Practice: - Variable Practice: - Random Practice: - Blocked Practice: 6) Define these motor learning terms: - NDT: - Fascilitation: - Inhibition:

Answer 63

1) - Motor Control: Study of movement or ability to regulate movement - Motor Learning: Study of the acquisition or modification of movement. It utilizes different forms of feedback, practice strategies, and transfer of learning to different environments to learn (or re-learn) motor movement. 2) It used to be thought that motor control was a reflex or heiarchachal where the cortex was perceived as the highest functioning system, and the spinal cord was just reflexive / responsive. New models were then developed to challenge these theories and now we know the cortex is not solely responsible for all motor movement. 3) - Cognitive Stage: Initial stage. Conscious processing. Acquire info. A controlled environment is best for this stage. Needs external feedback for correction / improvement. - Associative Stage: Intermediate stage. Moves from conscious thought to trial and error action. This is where one practices. Relies less on feedback, and more on practice (trial and error), and intrinsic learning/feedback. - Autonomous Stage: Final stage of transitioning to a SKILLED movement. Person makes movement AUTOMATIC and is SKILLED, and no real need to conscious / cognitive processing to perform action. It becomes an automatic response. - Expert stage: 3A) More in cognitive stage, and then some (but less) in associative - Every 5 or so repetitions - Every 15-20 repetitions 4) - Intrinsic feedback: Your own internal feedback. Visual, vestibular, sensory, proprioceptive, somatosensory, self talk, etc. - Extrinsic feedback: Feedback from others or environment (verbal feedback from others) - Knowledge of Results: Feedback on the overall outcome / result. Result is at the END - Knowledge of Performance: Feedback regarding the specific actual movement / task (not the entire thing) - Intrinsic 5) - Mental Practice: Cognitive rehearsal of a task or experience without any physical movement - Massed Practice: The practice time in a trial is greater than the amount of rest between trials. LITTLE REST BREAKS - Distributed Practice: The amount of rest time between trials is equal to or is greater than the amount of practice time for each trial. LARGER REST BREAKS - Constant Practice: Practice of a task under a uniform condition - Variable Practice: Practice of a task under differing conditions - Random Practice: Varying practice amongst different tasks - Blocked Practice: Consistent practice of a single task. 6) - NDT: Neuromuscular developmental treatment. This is a hands-on treatment approach where experience in movement ensures that a particular pattern is readily accessible for motor performance. It is a form of motor learning to help someone develop motor control. - Facilitation: A technique used to elicit voluntary muscular contraction. - Inhibition: A technique utilized to decrease excessive tone or abnormal movement patterns. A therapist can use an NDT approach / technique of manual contacts to decrease abnormal tonal movements, or facilitate certain movements to accomplish therapeutic goals.

Question 64

1) What is the Brunnstrom stages of motor recovery (what is it for): - How to remember that: - How many stages? - What are the stages? 1A) Spasticity starts at what stage? - Spasticity ends at what stage? - HEIGHT of spasticity is what stage? 2) What does PNF stand for - What is PNF 3) What is the Developmental Sequence - What are the example stages - What are the main stages of the developmental sequence 4) There are certain keys to ensuring you do PNF right. What are they: 5) For UE, what motions is D1: - For UE, what motions is D2: 6) - For D1 UE, what are the specific shoulder, elbow, wrist motions performed? - For D2 UE, what are the specific shoulder, elbow, wrist motions performed? 6A) T or F: With D1, for UE and LE, your extremity starts OUT (abduction). With D2, extremity starts IN (adduction)? - T or F: with UE D1 and D2 you start UP 7) - For D1 LE, what are the specific hip, knee, ankle motions performed? - For D2 LE, what are the specific hip, knee, ankle motions performed? 8) Besides the UE and LE, what other PNF patterns are there?

Answer 64

1) These are stages of progression following a CVA - BrUNden couldn't say name right, like stroke pt's struggle speaking - 7 - Stage 1: Flaccid, no volitional movement - Stage 2: Limb synergies (flexion or extension pattern). A little spasticity. - Stage 3: Spasticity increases (height of spasticity) - Stage 4: Spasticity begins to decrease, movement is not as much synergies - Stage 5: More control of movement, less spasticity (or digression/disappearance of spasticity) - Stage 6: Joint movements with some coordination (selective control). NO SPASTICITY! - Stage 7: NORMAL motor function / coordinated movement 1A) Stage 2 - Stage 6 it is gone - Stage 3 2) Proprioceptive Neuromuscular Fascilitation - Therapists uses specific hand holds to help restore normal function / movement. Either used as a stretch technique to get greater flexibility (contract relax), or for neuro pt's to help strengthen weaker muscle groups 3) A progression of motor skill acquisition - progressing through more advanced movements as you develop (as a child, or in motor re-learning after brain damage, or after an amputation or neuro injury) - Fetal, prone on elbows, roll over, quadruped, sitting, crawl, tall kneel, half kneel, pull to stand, cruise, stand, walk, run, jump - Immobility, Mobility, Stability, Controlled mobility, Skill ... (Initial random uncontrolled movements (mobility) are followed by maintenance of a posture (stability), then movement within a posture (controlled mobility), and finally, movement from one posture to another posture (skill). 4) - Work in diagonal movements - Give quick stretch to initiate mvmt - Resistance given during movement pattern - Follow developmental sequence (progress through stages of motor control) 5) D1: NOT draw the sword ... hand down to same side and goes up to opposite side. - D2: Draw the sword (hand down at opposite hip and goes up to same side) 6) - D1: START: - Shoulder: IR, Ext, Abd - Elbow: Ext, Pronation - Wrist: Ext - Fingers: Ext END: - Shoulder: ER, Flex, Add - Elbow: Flex, Supination - Wrist: Flex - Fingers: Flex - D2: START: - Shoulder: IR, Ext, Add - Elbow: Flex, Pronation - Wrist: Flex - Fingers: Flex END: - Shoulder: ER, Flex, Abd - Elbow: Ext, Supination - Wrist: Ext - Fingers: Ext 6A) TRUE - False, you start D1 and D2 DOWN 7) - D1: START: - Hip: IR, Abd, Ext - Knee: Ext - Ankle: PF END: - Hip: ER, Add, Flex - Knee: Flex - Ankle: DF ``` - D2: START: - Hip: ER, Ext, Add - Knee: Ext - Ankle: PF END: - Hip: IR, Flex, Abd - Knee: Flex - Ankle: DF ``` 8) Pelvis and Scapula

Question 65

*** KEY NEURO TERMINOLOGY ... KNOW THESE TERMS: 1) - Agnosia: - Agraphesthesia: - Agraphia: - So "graph" must mean: - Anosognosia: - Aphasia: - Apraxia: - Ataxia: - Astereognosis: - Body Schema: - Decerebrate Rigidity: - Decorticate Rigidity: - Diplopia: - Dysarthria: - Dysphagia: - Dysprosody: - Dys vs. A prefix - Emotional Lability: - Hemiparesis: - Hemiplegia: - Homonymous Hemianopsia: - Neologism: - Perseveration: - Synergy: - Unilateral Neglect: 2) **** These are the one's you need to review over and over: - Neologism: - Dysprosody: - Anosognosia: - Agnosia: - What artery is impacted if someone has Homonymous Hemianopsia:

Answer 65

- Agnosia: The inability to interpret information or identify things/objects (even people) (it's GONE) - Agraphesthesia: The inability to recognize symbols, letters, shapes, or numbers traced on the skin. - Agraphia: The inability to write due to a lesion in the brain. Usually this deficit is found in people with aphasia - Graph: write - Anosognosia: The denial or unawareness of one's illness (usually in someone with unilateral neglect - could be physical or mental ilness) - Aphasia: Speech impairment - loss of ability to understand or express speech, caused by brain damage. - Apraxia: Inability to carry out a familiar purposeful movement (can't do the movement) due to brain damage. You can't even process or try to do movement. - Ataxia they can carry out the movement with little coordination. So you try to do the movement, but it's uncoordinated. - Astereognosis: Inability to recognize objects by the sense of touch when vision occluded (Brian reaching hand in bag for a COMB). - Body Schema: Having an understanding of the body as a whole and the relationship of its parts to the whole. - Decerebrate Rigidity: A characteristic of a corticospinal lesion at the level of the brainstem that results in EXTENSION of the trunk and ALL extremities (dEcErEbratE). - Decorticate Rigidity: A characteristic of a corticospinal lesion at the level of the diencephalon where the trunk and LE's are in extension, but UE's are positioned in flexion. LOOKS LIKE kangaroo or T-rex arms with straight body and legs. - Diplopia: Double vision - Dysarthria: Slurred and impaired speech due to motor deficit of the tongue or other facial m's necessary for speech - Dysphagia: Inability to swallow properly - Dysprosody: Impairment in the rhythm and inflection of speech - Dys is dysfunctional whereas A is CAN'T - Emotional Lability: A characteristic of a right hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation - Hemiparesis: A condition of weakness of one side of the body - Hemiplegia: A condition of paralysis on one side of the body - Homonymous Hemianopsia: The loss of the right or left half of the field of vision in both eyes. From damage to MCA - Neologism: a newly coined word or expression. (loggoria) - Perseveration: The state of repeatedly performing the same segment of a task or repeatedly saying the same word/phrase without purpose. - Synergy: Mass movement patterns that are primitive in nature and coupled with spasticity due to brain damage - Unilateral Neglect: The inability to interpret stimuli and events on the contralateral side of a hemispheric lesion. Left-sided neglect is most common with a lesion to the right inferior parietal or superior temporal lobes. 2) - Neologism: a newly coined word or expression. (loggoria) - Dysprosody: Impairment in the rhythm and inflection of speech - Anosognosia: The denial or unawareness of one's illness (usually in someone with unilateral neglect - could be physical or mental ilness) - Agnosia: The inability to interpret information or identify things/objects (even people) (it's GONE) - MCA

Question 66

1) What is a "complete" spinal cord injury - What is an "incomplete" spinal cord injury 1A) Do the ascending tracts in the spinal cord do motor or sensory? - Do descending tracts do motor or sensory? 1B) Now, imagine an axial cutout of a spinal cord so you can see all the tracts ... what is the main big tract in the posterior section of the spinal cord: - Does this tract (from above) do pain and temp? - Where are pain and temp running through? - There are 2 main sections in the DCML ... what are they - What do these 2 main sections do: - So spinothalamic tract is mainly for what: 1C) What are the main tracts on the very outside/lateral part of the spinal cord - Is this an ascending or descending tract? - What is it's purpose? 1D) What is the main motor tract? - Is this an ascending or descending tract? - Where is it located? - What is it's purpose? 1E) The spinothalamic tract - is it sensory or motor? - Ascending or descending? - How can you know if it is ascending or descending - What is the function of this tract? 1F) What is purpose of vestibulospinal tract - What is purpose of tectospinal tract? 2) Know and define these specific spinal cord lesion types: - Anterior Cord Syndrome: - What part/section is damaged: - How does this injury usually happen: - What are s/s: - Are these complete or incomplete: - Brown-Sequard's Syndrome: - What part/section is damaged: - How does this injury usually happen: - What are s/s: - Are these complete or incomplete: - Cauda Equina Injury: - What part/section is damaged: - What are s/s: - Are these complete or incomplete: - Is this a CNS or PNS injury? - Central Cord Syndrome: - What part/section is damaged: - How does this injury usually happen: - What are s/s: - Are these complete or incomplete: - Posterior Cord Syndrome: - What part/section is damaged: - How does this injury usually happen: - What are s/s: - Will they lose motor function? 3) What is the ASIA impairment scale - What are the levels / grades you can get from this test? - From point above, what do each mean: 4) What is "neurologic level" in this ASIA scale: - What is motor level: - What is sensory level: - What is motor index scoring: 5) When performing the ASIA, are there specific spots you have to test sensation? - When testing muscle strength, what would you test for the ASIA to determine C5 level - What would you test (for m's) for C6 - " C7 - " C8 - " T1 - " L1/2 - " L3 - " L4 - " L5 - " S1/2

Answer 66

1) A lesion to the spinal cord where there is no preserved motor or sensory function below the level of the lesion. And no sacral sparing. - A lesion to the spinal cord with incomplete damage to the cord. There may be scattered motor function, sensory function, or both below the level of the lesion. Sacral sparing. 1A) Ascending: Sensory - Descending: Motor 1B) DCML (Dorsal column medial lemniscus). The dorsal column–medial lemniscus pathway (DCML) (also known as the posterior column-medial lemniscus pathway (PCML)) is a sensory pathway of the central nervous system that conveys sensations of fine touch, vibration, two-point discrimination, and proprioception (position) from the skin and joints. - No - Anterolateral spinothalamic tract - Fasciculus Gracilis and Fasciculus Cuneatus - Gracilis: tactile and proprioceptive info from the LOWER half of the body (lower trunk and LE's) - Cuneatus: tactile and proprioceptive info from UE's and torso - Pain and Temp 1C) Spinocerebellar - Ascending - Carries information from Golgi tendon organs and muscle spindles UP to the cerebellum for the coordination, posture of movements. 1D) Corticospinal tract - Descending - One area is in the mid lateral section, another is anterior middle section. - Carry motor signals from brain to m's to control movement of ipsilateral limbs and trunk 1E) Sensory - Ascending - If it is spino-thalamic, it starts in spine and goes up to thalamus. If it is cortico-spinal, starts in cortex and goes down to spinal cord. - Transmit pain, temp, touch up to somatosensory portion of the thalamus 1F) Vestibulospinal: A reflex or response to maintain balance/equilibratory as a result of input of the vestibular apparatus. - Tectospinal: Coordinates head and eye movements. 2) - Anterior Cord Syndrome: - Compression/Damage to anterior part of cord and anterior spinal artery. - Typically from cervical flexion - Loss of motor function, pain, temp - Incomplete - Brown-Sequard's Syndrome: - What part/section is damaged: One half (either side) - How does this injury usually happen: Stab wound - What are s/s: Loss of vibration and position on same side, loss of pain/temp on contralateral side. - Incomplete - Cauda Equina Injury: - What part/section is damaged: Injury BELOW L1 - What are s/s: flaccid, areflexia, impaired bowel and bladder function, LE's, LMN - Are these complete or incomplete: Could be complete, but usually incomplete - PNS, after L1/2 these are spinal nerves so peripheral nerves - Central Cord Syndrome: - What part/section is damaged: Central part of spinal cord damaged / compressed - How does this injury usually happen: Cervical Hyperextension - What are s/s: UE's effected more than LE's and motor deficits more than sensory - Incomplete - Posterior Cord Syndrome: - What part/section is damaged: Posterior section of spinal cord is damaged / compressed and posterior spinal artery. - How does this injury usually happen: - What are s/s: Loss of pain, proprioception, 2 point discrimination, and stereognosis. - No 3) ASIA: American Spinal Injury Association. It is a specific objective test to determine if someone has a complete or incomplete spinal cord injury, and what level of SCI. - A, B, C, D, E - A: Complete - no sensory or motor function preserved below level, and sacral S4-5 has no feeling (no sacral sparing). - B: Sensory Incomplete - Sensory is preserved partially below level of lesion, but no motor function below neurologic level - C: Motor Incomplete - Some motor function below neurologic level, most key muscle groups have a muscle grade of 3 or less - D: Motor Incomplete - Some motor function below neurologic level, most key muscle groups have a muscle grade of 3 or more. - E: Normal - Sensory and motor functions are normal 4) The lowest level where both sensory and motor function is preserved - Motor level: Most caudal segment/level where m's have a MMT of 3 or greater, and the level above is a 5/5 - Sensory level: Most caudal dermatome with a normal score (2/2) for pinprick and light touch. - Motor index scoring: Testing each key muscle using the 0-5 MMT scoring, with a total of 25 per extremity and a total possible score of 100 5) yes. They are called "key sensory points." And there is a specific spot for each dermatome level. - C5: Biceps flexion - C6: Wrist extensors - C7: Triceps (elbow extensors) - C8: Finger flexion - T1: Finger abduction - L1/2: Hip Flexors - L3: Quads - L4: Ankle DF's - L5: Big Toe Ext - S1/2: Calf

Question 67

1) If someone had a COMPLETE C4 spinal cord injury, determine what level of assistance they would need for the activity below: - Bed mobility: - Transfers: - Weight Shift: - Wheelchair Management: - Wheelchair Mobility: - ROM / Positioning: C5: - Bed mobility: - Transfers: - Weight Shift: - Wheelchair Management: - Wheelchair Mobility: - ROM / Positioning: C6: - Bed mobility: - Transfers: - Weight Shift: - Wheelchair Management: - Wheelchair Mobility: - ROM / Positioning: C7-8: - Bed mobility: - Transfers: - Weight Shift: - Wheelchair Management: - Wheelchair Mobility: - ROM / Positioning: Paraplegia: - Bed mobility: - Transfers: - Weight Shift: - Wheelchair Management: - Wheelchair Mobility: - ROM / Positioning:

Answer 67

``` 1) C4: - Bed mobility: Dependent - Transfers: Dependent - Weight Shift: Can use a power recliner wheelchair - tilt chair - (otherwise dependent) - Wheelchair Management: Dependent - Wheelchair Mobility: Supervision to mod ind - ROM / Positioning: Dependent ``` C5: - Bed mobility: Mod to max assist - Transfers: max assist w/ slide board - Weight Shift: Can use a power recliner wheelchair - tilt chair - (otherwise dependent) - Wheelchair Management: Dependent - Wheelchair Mobility: mod ind - ROM / Positioning: Dependent C6: - Bed mobility: Min assist - Transfers: Min assist w/ slide board - Weight Shift: Mod ind - Wheelchair Management: Min assist - Wheelchair Mobility: Mod ind - ROM / Positioning: Mod assist C7-8: - Bed mobility: Independent - Transfers: Mod ind - Weight Shift: Mod ind - Wheelchair Management: Some asst req'd - Wheelchair Mobility: Mod ind - ROM / Positioning: Min assist Paraplegia: - Bed mobility: Ind - Transfers: Ind - Weight Shift: Mod ind - Wheelchair Management: Ind - Wheelchair Mobility: Ind (unless uneven surface or uphill) - ROM / Positioning: Ind

Question 68

1) What are some potential complications that can come from a spinal cord injury: 2) From the point above, answer the questions below about these conditions: - Autonomic Dysreflexia: - What is it: - Above/Below what level of SCI: - s/s: - Causes: - Fixes: - With autonomic dysreflexia, you'd obviously check their BP, but FIRST thing you'd do is: - Then after you have done that (from point above), more often than not the noxious stimulus is what: - Orthostatic hypotension: - What is it: - s/s: - Causes: - Fixes: - Pressure Ulcers: - What is it: - s/s: - Causes: - Fixes: - Spasticity: - What is it: - s/s: - Causes: - Fixes: - DVT - Deep Vein Thrombosis: - What is it: - s/s: - Causes: - Fixes: - Special test to rule in: - Diagnostic tool to rule in: - Ectopic Bone: - Other name for this: - What is it: - s/s: - Causes: - Fixes:

Answer 68

1) - Autonomic Dysreflexia - Spinal Shock - Orthostatic Hypotension - Pressure Ulcers - Spasticity - Contractures - Incontinence - DVT: Deep Vein Thrombosis - Ectopic Bone - Psychological, emotional, sexual, social 2) - Autonomic Dysreflexia: - What is it: Common complication for a SCI pt where some noxious stimulus below SCI level creates pain (which pt can't feel), it triggers the ANS to set off. If not treated, pt can go into convulsions, hemmorage, death. - Above/Below what level of SCI: Above T6 - s/s: so blood pressure spikes, sweating, HR DEcreases, HA's, blurry vision, goose bumps / cold below and warm/flush above level, etc. - Causes: kink in catheter, sitting on something, full bladder or UTI, tight clothing, ingrown toenail, ulcer, extreme temp. change, etc. - Fixes: Fix whatever it is setting it off (quickly, it is a medical emergency) - SIT THEM UP! *** - Some issue with their catheter, so check that. - Orthostatic hypotension: - What is it: Decrease in Blood Pressure as a result of changing positions (more than 20mmHg in systolic, or 10mmHg in diastolic) - s/s: dizzy, lightheaded, nausea, blacking out - Causes: Changes in position (too quickly) - Fixes: Monitor vitals (especially BP). Use elastic stockings (ACE wrap or abdominal binding), move positions slower - Pressure Ulcers: - What is it: Because SCI pt's lose sensation and motor control, they can't feel wounds, and can't reposition themselves to offload and weight shift. This develops pressure ulcer, or skin breakdown. - s/s: skin breakdown, blanching, open wound - Causes: Sustained pressure of a bony prominence on skin over time. Friction or shearing force on skin. - Fixes: Change positions, tilt table, prop w/ pillows/cushion, nutrition and hydration, surgery if necessary, wound mngmt - Spasticity: - What is it: Hypertonic m's - s/s: - Causes: SCI, brain injury, stress, UTI, bladder / catheter obstruction, touch - Fixes: Meds, stretch, pool therapy, weight bearing, estim, splints/casting/orthodic, standing frame, surgery - DVT - Deep Vein Thrombosis: - What is it: Formation of blood clot in lower leg and becomes an embolus. Pt's with SCI's are at a greater risk since they don't move LE's to pump blood back to heart. - s/s: Leg pain, edema in LE's, positive Homan's sign, warmth in area - Causes: Inability to move due to SCI - Fixes: Anticoagulant meds, PROM muscle contraction, ankle pumps - Homan's - Doppler - Ectopic Bone: - Other name: Heterotopic ossification - What is it: Spontaneous formation of bone in the soft tissue. Usually happens by a joint (like the knees or hips) . - s/s: Pain, edema, decreased ROM - Causes: Abnormal calcium buildup - Fixes: Meds, PT to restore ROM and function

Question 69

IMPORTANT SCI terminology: - Cauda Equina Injury: - Dermatome: - Myelotomy: - Myotome: - Neurectomy: - Neurogenic Reflexive Bladder: - Neurologic Level: - Paraplegia: - Sacral Sparing: - Spinal Shock: - Tenodesis: - Tenotomy: - Tetraplegia (Quadraplegia): - Zone of Preservation: 2) A cauda equina injury happens below what level? - Will this injury present with UMN or LMN signs? - Is Sacral sparing complete or incomplete SCI - What is Spinal Shock: - Tenodesis grasp is important to teach people with what level of SCI - Explain difference of a neuroectomy, tenotomy, and myelotomy

Answer 69

- Cauda Equina Injury: Term to describe injuries below L1, so LMN signs or LMN lesion - Dermatome: Area of skin innervated by a spinal level - Myelotomy: Surgical procedure that severes (cuts) certain spinal tracts within the spinal cord in order to decrease spasticity (to improve function) - Myotome: Area of muscle innervation by a spinal level - Neurectomy: Surgical removal of a segment of a nerve in order to decrease spasticity (to improve function) - Neurogenic Reflexive Bladder: The bladder empties reflexively for a pt with an injury above the T12 area. So the sacral arc remains intact. - Neurologic Level: Lowest segment of the spinal cord with intact strength and sensation. Muscle groups must receive a "fair" grade (or 3/5 with a 5/5 at level above). - Paraplegia: A term used to describe injuries that occur at the level of the thoracic region or below (so only LE's impacted) - Sacral Sparing: An INCOMPLETE SCI/lesion where some of the innermost tracts remain innervated. If you have sacral sparing, you still have saddle region sensation, and pelvic floor / sphincter muscle control. - Spinal Shock: A physiologic response that occurs 30-60 mins after trauma to the spinal cord and can last up to several weeks. It presents with total flaccidity and areflexia below level of lesion. - Tenodesis: Pt's with tetraplegia that have no motor control of for grasping objects with UE can develop a tenodesis grip. They have tight finger flexors (which they can't move) and can extend wrist to form a grasp (since they have C6). You want them in elbow ext, wrist ext, and finger flexion (so they can grip things via finger flexion). If you have C6 you can do it - Tenotomy: Surgical release of a tendon in order to decrease spasticity - Tetraplegia (Quadraplegia): Term used by ASIA to describe injuries that occur at the level of the c-spine - Zone of Preservation: A term used to describe poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury 2) L1 (where spinal cord ends) - LMN ... peripheral nerves - Incomplete - Shock spinal cord goes into following trauma, where inflammation causes paralysis and areflexia below lesion. - C6/7 - All are surgical proceedures to reduce spasticity. Teno is release of a tendon, neuro is severe a nerve, and myelo is getting rid of a spinal tract.

Question 70

**** WILL BE A ? ON GLASGOW COMA SCALE and RANCHO LEVELS*** 1) What is the Glasgow Coma Scale - What is range of scores for this scale - A higher score is better or worse 2) So what are the ranges for the Glasgow Coma Scale, and what do they mean: 3) What is tested / assessed during a Glasgow Coma Scale assessment 4) What is the Rancho Los Amigos Levels of Cognitive Functioning: - How many Rancho levels are there? 5) Explain each of the Rancho Levels:

Answer 70

1) Way to quantify the extent of a TBI (traumatic brain injury) based on s/s - 3-15 - Better 2) - 8 or less = coma - 9-12: moderate brain injury - 13-15: mild brain injury 3) - Eye Opening ability (spontaneous = 4, to speech = 3, to pain = 2, no eye opening = 1) - Motor Response (obeys commands = 6, localized pain = 5, withdraws = 4, abnormal flexion = 3, extensor response = 2, nothing = 1) - Verbal Response (oriented = 5, confused conversation = 4, inappropriate words = 3, incomprehensible sounds = 2, nothing = 1) 4) Tool used to rate how people with brain injury are recovering. ... Each level describes a general pattern of recovery, with a focus on cognition and behavior. - 8 5) - Level I: No response (deep sleep and totally unresponsive to stimuli) - Level 2: Generalized Response (pt reacts inconsistently and non-purposefully to stimuli. Regardless of stimuli, response is same ... response could be abnormal mvmt or vocalization or physiologic response) - Level 3: Localized Response (pt reacts specifically to local stimuli, and relate to stimulus provided. They will follow simple commands, but delayed). - Level 4: Confused-Agitated (pt is in a heightened state of anxiousness, frustration, confusion. Has bizarre behavior, lacks attention abilities, no memory, easily agitated) - Level 5: Confused -INAppropriate (pt is still confused, but not as hostile or agitated now. Has better attention, but easily distracted. Needs to focus on specific task. Can somewhat converse/socialize for short period. Learning is still hard. Very little carry over of info learned. VERY INAPPROPRIATE CONVERSATION / COMMENTS) - Level 6: Confused - Appropriate (Pt has better behavior, but still needs some direction. Shows some carryover from previously learned info. Still has memory issues, but are appropriate. - Level 7: Automatic-Appropriate (Pt appears appropriate and oriented and not confused. Goes through daily routine normally but robotically. Starting to recall and carryover learning. More social, but judgement a little impaired). - Level 8: Purposeful - Appropriate (Pt is normal again. Abel to remember/recall, responsive to environment, doesn't need supervision)

Question 71

KNOW DEVELOPMENTAL MILESTONES: Explain what child can do at these stages and in these positions: 1) For Newborn - 1 month: - Prone: - Supine: - Sitting: - Fine Motor: 2) 2 - 3 months: - Prone: - Supine: - Sitting: - Fine Motor: 3) 4-5 months: - Prone: - Supine: - Sitting: - Standing: - Fine Motor: 4) 6-7 months: - Prone: - Supine: - Sitting: - Standing: - Fine Motor: 5) 8-9 months: - Prone: - Supine: - Sitting: - Standing: - Fine Motor: 6) 10-12 months: - Standing: - Mobility: - Fine Motor: 7) 12-15 months: - Standing: - Mobility: - Fine Motor: 8) 16-24 months: - Gross Motor: - Fine Motor: 9) 2 years: - Gross Motor: - Fine Motor: 10) 3-5 yrs (Preschool): - Gross Motor: - Fine Motor: 11) 5-8 yrs (Early School Age): - Gross Motor: - Fine Motor: 12) 9-12 yrs (Later School Age): - Gross Motor: - Fine Motor:

Answer 71

1) For Newborn - 1 month: - Prone: fetal / flexed position (may lift head occassionally) - Supine: Lays, mostly flexion - Sitting: Can't sit, head bobs - Fine Motor: Only closed fist, objects in direct line of sight 2) 2 - 3 months: - Prone: Prone on Elbows, rolls to supine - Supine: Legs kick - Sitting: Can't sit, but head control better - Fine Motor: Uses palmar grasp 3) 4-5 months: - Prone: Bears weight through arms extended, pivots, reaches for toys - Supine: Rolls from supine to prone, plays with feet in mouth - Sitting: Can sit for second or two, good head control - Standing: Can't stand, but will bear with through LE's when supported - Fine Motor: Grasps and releases toys 4) 6-7 months: - Prone: Rolls (everything same from above) - Supine: Rolls and lifts head (everything same from above) - Sitting: Can sit independently - Mobility: Starts crawling - Standing: Can't stand yet - Fine Motor: Rakes with fingers to pick up toys 5) 8-9 months: - Prone: Gets to hands and knees / quadruped - Supine: Doesn't like supine - Sitting: Can sit and transition to other positions - Standing: Starts to stand against furniture - Mobility: Cruising along furniture, crawls - Fine Motor: 6) 10-12 months: - Standing: Stand briefly without support, pulls to stand using half-kneel transition - Mobility: Walks with 2 hands holding their hands. Bear crawls on hands/feet - Fine Motor: Can put objects in container 7) 12-15 months: - Standing: Stands ind. - Mobility: Walks without support - Fine Motor: Builds tower, turns over objects 8) 16-24 months: - Gross Motor: Squats, walks backward, goes up/down stairs, kicks and throws balls, pick up toy from floor without falling - Fine Motor: Stacks 6 cubes, does vertical/horizontal strokes with crayon on paper 9) 2 years: - Gross Motor: Rides tricycle, walks downstairs using alternating feet, runs on toes - Fine Motor: Turns knob, opens and closes jar, button a button 10) 3-5 yrs (Preschool): - Gross Motor: Throws ball 10 feet, hops 2-10 times, catches ball - Fine Motor: Copies a circcle or cross, cuts with scissors, starts to demonstrate hand preference 11) 5-8 yrs (Early School Age): - Gross Motor: Skips, gallops, jumps - Fine Motor: Hand preference is evident, can button small buttons 12) 9-12 yrs (Later School Age): - Gross Motor: Mature patterns of movement, jumps, runs - Fine Motor: Draw, handwriting developed

Question 72

MUST KNOW THE PRIMITIVE REFLEXES: 1) What is a primitive reflex: 2) What does the word "integrate" mean with regards to primitive reflexes? - Does the primitive reflex go away? 3) ATNR - What does ATNR stand for: - When does it appear (onset): - When does it integrate: - What is the stimulus: - What is the response: **** ATNR is the __________ pose 4) STNR - What does STNR stand for: - When does it appear (onset): - When does it integrate: - What is the stimulus: - What is the response: - Purpose of reflex: 5) TLR - What does TLR stand for (or Symmetrical Tonic Labyrinthine reflex): - When does it appear (onset): - When does it integrate: - What is the stimulus: - What is the response: - Big picture - this reflex does what? 6) What is the Landau reflex: - When does this appear: - When will this reflex integrate *** 7) Palmar Grasp Reflex - What is it / purpose: - When does it appear (onset): - When does it integrate: - What is the stimulus: - What is the response: 8) T or F: The plantar reflex is the same as palmar, but it is the toes curling / flexing around your finger of pressure 9) Rooting - What is it / purpose: - When does it appear (onset): - When does it integrate: - What is the stimulus: - What is the response: 10) Moro - What is it / purpose: - When does it appear (onset): - When does it integrate: - What is the stimulus: - What is the response: *** How to remember MORO 11) What is the startle reflex - What is the Positive support reflex: - What is the walking (stepping) reflex: 11A) What is the Galant Reflex 11B) What is the positive support reflex 12) ***** SO WHAT REFLEX INTEGRATES LATEST (LAST) - What reflex integrates fastest

Answer 72

1) Response to some stimulus, and these "primitive" reflexes are seen in infants / young children 2) Basically it means it doesn't present any more as a reflex (Integration refers to the inhibition by higher centers of neurological control which modify the reflex in such a way that the pattern of response is no longer stereotypical). - The reflex does not disappear; it may reactivate under stress, after injury, or during activities requiring great strength. 3) ATNR - What does ATNR stand for: Asymmetrical Tonic Neck Reflex - When does it appear (onset): Birth - When does it integrate: 4-6 months - What is the stimulus: Rotation of the head - What is the response: Arm and leg on face side will extend, and then arm and leg on other side (or back of head) will flex *** ATNR is the HERCULES / DAB pose 4) STNR - What does STNR stand for: Symmetrical Tonic Neck Reflex - When does it appear (onset): 4-6 months - When does it integrate: 6-8 months - What is the stimulus: Flex and Ext the neck - What is the response: With neck flex ... the UE's flex and LE's extend. With neck Ext ... the UE's will extend and LE's will flex - Purpose: prepare baby for crawling 5) TLR - What does TLR stand for: Tonic Labyrinthine Reflex (so labyrinth in inner ear ... so related to head position) - When does it appear (onset): Birth - When does it integrate: 6 months - What is the stimulus: Hold baby in hand in prone, then supine - What is the response: In prone, baby's extremities FLEX, and in supine, baby's extremities EXTEND - This reflex serves to limit the child's ability to flex the neck in a supine position. You can decrease impact of reflex by lying in sidelying or supine with hip flexion. If in prone they will flex head, in supine they will extend head 6) Suspend baby out in the air in prone and their head and LE's will all extend - Starts 6ish months (after STNR and TLR integrate) - 12 months - 2 ish yrs old 7) Palmar Grasp Reflex - What is it: A reflex to help child to grasp and do fine motor skills - When does it appear (onset): Birth - When does it integrate: 6 months - What is the stimulus: Pressure in palm on ulnar side of hand - What is the response: Flexion of fingers to grip your fingers 8) True 9) Rooting - What is it / purpose: Baby turns head toward mother's breast / food to survive. - When does it appear (onset): Birth - When does it integrate: 3 months - What is the stimulus: Touch on the cheeck - What is the response: Turn head to same side with mouth open 10) Moro - What is it / purpose: Fight or Flight response - you hold baby and just barely let them fall and go, and they will extend arms/legs since they are scared. - When does it appear (onset): Birth - When does it integrate: 6 months - What is the stimulus: Dropping - What is the response: Arms abduct, fingers extend, legs extend, cry *** MORO: You Moron, why would drop a baby? 11) Startle: like the Moro, when you do a sudden noise, it startles them (but elbows are flexed) - Positive Support: Weight placed on balls of feet and the legs will stiffen/straighten and trunk goes into extension - Walking: when supported and feet placed flat on ground, baby will reciprocally walk 11A) Stimulated by touching the skin along the spine from the shoulder to the hip on one side. Response / reflex is lateral flexion of trunk towards side stimulated. It will go away at about 2 months 11B) Stimulated by bearing weight through feet. The response is for LE's to extend so an infant can bear weight to walk 12) Landau (2 years) - Galant (2 months)

Question 73

KNOW these MAJOR neuro conditions: Explain each condition below: 1) ALS: - What is it 2) MS: 3) GBS: 4) MG: 5) MD: 6) Alzheimer's Disease 7) Carpal Tunnel Syndrome 8) Cauda Equina Syndrome: 9) Cerebral Palsy (CP): 10) If you see synergy patterns, it means the person had what injury accident: - If you see spasticity, it could be the person had what injury - Brunnston's stages of recovery is for what injury - Gross Motor Function Classification System is for what - DMD will present with proximal or distal manifestations - GBS will present with proximal or distal manifestation - Clinical prediction rule for carpal tunnel is: - Major s/s of MD - Major s/s of MS - MOST strokes happen in what artery - WHO will get Alzheimers

Answer 73

1) ALS: Amyotrophic Lateral Sclerosis (Lou Gherigs) - Upper and Lower motor neurons AXON DEGENERATION (axon gradually breaks down and dies). This is NOT demyelination (like MS or GBS where myelin sheath breaks down), ALS is just axon degeneration in CNS and PNS. - UMN and LMN signs since it is in CNS and PNS - Only motor weakness (not sensory loss) since it is injury to the anterior horn cell of spinal cord. Presentation starts distal and moves proximal. - Average life expectancy is 2-5 yrs (and typically this effects males more than females, age 40-70 yrs old). 2) MS: Multiple Sclerosis - Demyelinating disease of the CNS … brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. This will result in vision loss, cognitive processing slowing, motor weakness, balance and coordination issues, fatigue, etc. - UMN signs - Main s/s = OPTIC NEURITIS 3) Guillain Barre Syndrome (GBS): - Just like MS, but now in Peripheral Nerves (so demyelination of peripheral nerves, showing as LMN signs). Much better prognosis, as peripheral nerves can regenerate. - Distal manifestations first 4) Myasthenia Gravis (MG): - A nervous condition down at the Motor end plate (or NMJ). So AcH can’t get released normally at NMJ, so a contraction of the m's can’t happen properly. Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs. The name myasthenia gravis, which is Latin and Greek in origin, means "grave, or serious, muscle weakness." 5) Muscular Dystrophy (MD): - Disease or wasting to the actual Muscle itself. A genetic disorder where there is an absence of dystrophin, a protein needed to build and maintain muscle mass. Without dystrophin, muscles eventually waste away. Results in muscle weakness, and eventually respiratory failure. X-linked recessive trait manifesting in only male offspring (females become carriers). Clinical presentation includes: waddling gait, proximal muscle weakness, toe walking, hypertrophy of calf, difficulty climbing stairs. Rapid progression of disease with inability to ambulate by 10-12 yrs of age and death often in age 20's. 6) Alzheimer's Disease: - Alzheimer's disease is a progressive neurological disorder that destroys memory and other important mental functions. Brain cell connections in the cerebral cortex and subcortical areas, and the cells themselves, degenerate and die, eventually destroying memory and other important mental functions. The brain cell damage and loss is irreversible, and progresses (gets worse) with time. Memory loss and confusion are the main symptoms. It is made manifest in those who are older once cells and neuron connections die; and it is more common in women than in men. - OLDER WOMEN is the answer; and it is progressive; and exercise helps delay progression 7) - CTS Clinical Prediction Guide: > Age greater than 45 > Decreased sensation to thumb, index, and middle fingers > Shaking hand to relieve symptoms - Phalen’s and Reverse Phalen's Test (Phalen’s is only relevant if combined with muscle weakness and sensation impairments. By itself with no other exam findings, it is irrelevant). MUST do phalen's for 60 seconds - Tinel’s sign - EMG study - More likely in women, usually in 40-60 age range - Pins and needles, numbness, and m's weakness in median nerve innervation / distribution 8) Cauda Equina: - Cauda equina syndrome (CES) is a condition that occurs when the bundle of spinal nerves below the end of the spinal cord (L1) known as the cauda equina is damaged. Could be caused by compression of the nerve roots, trauma, infection, tumor, injury, etc. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Since it is below where the spinal cord ends, it is a peripheral nerve injury, so you'd see LMN signs. 9) Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It's caused by damage that occurs to the immature brain as it develops, most often before birth (like a fetal stroke, gene mutation, maternal infection, lack of O2 in utero, etc.). Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with abnormal reflexes, flacid/floppiness, muscle tone or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking, or some combination of these. Main s/s is SPASTICITY. Some even have trouble eating, swallowing, eye movement, or breathing (any muscle can be impaired). It could effect the entire body, or just a part. Cerebral palsy's effect on function varies greatly. Some affected people can walk; others need assistance. Some people show normal or near-normal intellect, but others have intellectual disabilities. Epilepsy, blindness or deafness also might be present. 10) Stroke - CP, SCI, Stroke, etc. - Stroke - CP - Proximal - Distal - Over 45, paresthesia in median nerve distribution, shaking hands to relieve symptoms - Big calf, waddling gait, x-linked, fast digression - Optic neuritis - MCA - OLDER women

Question 74

1) What is a stroke: - Other name for a stroke: 2) Signs of a Stroke: 3) How to quickly assess for a stroke: 4) Types of a stroke: - Ischemic: - Hemmorrhagic: - TIA: - Lacunar - How to remember Lacunar 5) People who recover from stroke may experience: 6) Risk factors that lead to increased risk of stroke: 7) For the arteries below, how would a stroke to this artery present / effect: - MCA: - T or F: These are most common strokes? - Presentation / symptoms for MCA stroke: - ACA: - Presentation / symptoms for ACA stroke: - PCA: - Presentation / symptoms for PCA stroke: - VBA: 8) Right vs. Left Stroke: 9) T or F: A Left CVA means left brained, so right sided impairments? 10) What is the homonculus - Where on the homonculus is the LE? - Where is UE and face? - So a MCA stroke would manifest in more UE or LE deficits - ACA stroke would manifest in more UE or LE deficits 11) What is "locked in syndrome" - What causes it? - Where in the brain would the blood occlusion happen - Do they recover 12) How do you remember Lacunar stroke? - Most strokes happen at what artery?

Answer 74

1) A stroke is a sudden interruption in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke). Other strokes are caused by bleeding into brain tissue when a blood vessel bursts (hemorrhagic stroke). - CVA: Cerebrovascular accident 2) - FAST: Face droops, arm weakness, slurred speech, time counts - call 911 - One sided weakness - Face droops - Difficulty speaking / smiling (slurred speech) - Fatigue, nausea, vomit, lightheaded 3) FAST (see point above) ... ask them to smile, speak, and raise arms 4) - Ischemic Stroke: A blockage / blood clot in the artery. Could be from a thrombus, embolus, or lacunar - Hemorrhagic Stroke: Caused by a blood vessel rupture, so excess bleeding. - Ministroke / Transient Ischemic Attack (TIA): A temporary blockage in the artery. Ministrokes don’t cause permanent damage but they do increase your risk for stroke. And symptoms disappear much quicker. - Lacunar: stroke to DEEPER parts of brain (thalamus, basal ganglia, etc.) - Hakuna Matata - simba went DEEP into the forest 5) - One sided Weakness / paresis, paralysis, spasticity - Changes in sensation - Memory, cognitive, attention, or perception problems - Depression - Fatigue - Vision problems - Communication / speech problems - Behavior changes - Synergy patterns or spasticity - Cosmetic / psychological / emotional 6) - HTN (high blood pressure) - Smoking and Alcohol use - Diabetes, high cholesterol, being overweight, atherosclerosis, etc. - Previous history of stroke - Age - Family history of strokes - Sometimes its just a fluke accident 7) - MCA: Middle Cerebral Artery. MOST strokes occur at the MCA. The MCA supplies the OUTER portions of the brain (frontal, temporal, and parietal lobes), and will result primarily in FACE and UE paralysis (even though lower extremities and trunk also can be involved), contralateral motor and sensory deficits. - True - Face and UE > LE impairments - ACA: Anterior Cerebral Artery. Supplies blood to interior brain (portions of frontal, temporal, and parietal lobes), and will result in more LE and saddle/genital issues (remember the homunculus … the inner/medial areas are legs, saddle region). People with a ACA stroke will experience contralateral motor and sensory deficits more in lower extremities, and experience bowel/bladder issues. - LE > UE impairments - PCA: Posterior Cerebral Artery. Supplies primarily posterior brain (occipital lobe). These patients will primarily have their VISION impacted (hemianopsia). - VBA: Vertebral Basilar Artery. This artery supplies blood to brainstem, posterior brain, and cerebellum. If a stroke happens here, you would see cerebellar impacts (gait deviations, coordination, and balance issues), but they also get “locked in syndrome” (or tetraplegia) which is they are conscious but lose all their motor and sensory and communication abilities during the stoke. 8) - Right: weakness or paralysis to Left side, poor attention, impaired judgement, spatial deficits, memory deficits, emotional lability, impulsive behavior, difficulty processing visual cues - Left: weakness or paralysis to Right side, impaired processing, more frustrated, aphasia (speech and language), dysphagia, motor apraxia, difficulty processing verbal cues 9) True 10) A cortical homunculus is a distorted representation of the human body, based on a neurological "map" of the areas and proportions of the human brain dedicated to processing motor functions, or sensory functions, for different parts of the body. - LE is inner / medial - UE and Face is more outer/lateral - UE - LE 11) Also known as pseudocoma, is a condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking. - Stroke, Traumatic brain injury, tumor - Brain stem (the pons is impacted, which relays other communication to diff. parts of the brain) - Rarely do these people recover and "come out" of it 12) Akuna Matata - they went deep into forest (so deep stroke in deep structures of brain like thalamus and basal ganglia) - MCA

Question 75

1) Down Syndrome (what is it ... s/s ... explain it) 2) What is the official name for a 'Waiter's Tip' hand position (condition) - What is it - explain it (how it happens, and how it presents): 3) GBS 3A) So does Muscular Dystrophy (DMD) present with more proximal or distal involvment? - Does GBS present with more proximal or distal involvement at first? - What is a main s/s that shows someone has MS - AFP (alpha-fetoprotien) test is done to help rule in what condition - 2 main types of spina bifida 4) Parkinson's: 5) Huntington's: 6) MS: 7) Spina Bifida 8) Glasgow coma scale is used for what injuries: - You must must know Glasgow Scale levels. List the LOC (loss of consciousness), PTA (post-traumatic amnesia), GCS (glasgow coma scale) for mild, moderate, and severe cases: 9) Trigeminal Neuralgia: 10) Will a C7 SCI (spinal cord injury) have any respiration / breathing impairments - Someone with C7 SCI can do what, and can't do what? 11) Will someone with L3 spinal cord injury have any sexual impairment - Will they have bladder issues? - Are they more prone to UTI's

Answer 75

1) A congenital disorder arising from a chromosome defect, causing intellectual impairment and physical abnormalities including short stature and a broad facial profile. It arises from a defect involving chromosome 21, usually an extra copy (trisomy-21). s/s include: hypotonia, ligament laxity, flattened nasal bridge, enlarged tongue, developmental delay, cognitive deficits. Exercise is essential for children with Down Syndrome, to prevent obesity. 2) Erb's Palsy - “Waiter’s Tip” position from a legion of C5-C6 nerve An injury to the arm from a fall on neck/shoulder region (or being pulled out of the womb incorrectly). It is a brachial plexus injury to C5-C6 nerves, which results in the “Waiters Tip” hand position. Anything innervated by C5-C6 is lost. So: suprispinatus, deltoid, infraspinatus, teres minor, biceps brachii, brachialis, supinator, brachioradialis, and extensor carpi ra/dialis longus. You thus can’t flex shoulder, can’t abduct shoulder, can’t laterally rotate shoulder, or flex elbow. You can, however, flex wrist since this is C7. 3) GBS: Guillain-Barre Syndrome - This is the demyelinating disease of the PNS (or lower motor neurons). It manifests as distal symmetrical motor weakness and mild distal sensory impairments due to the myelin sheath over nerves degenerating. Complications from GBS include muscle weakness, respiratory impairments/paralysis (due to diaphragm becoming weak), dysphagia, bladder weakness, even arrythmia's. The prognosis for GBS is much better than Multiple Sclerosis (which is the demyelinating disease of the CNS) due to the fact that peripheral nerves can regenerate over time (most will recover). Etiology of disease is unknown, however, it is considered to be an autoimmune response to a previous respiratory infection, influenza, immunization, or surgery. Guillain-Barre Syndrome (GBS) is a temporary inflammation and demyelination of the myelin sheaths of peripheral nerves. A physical and neurological examination, strength testing, and review of medical history are all important to help diagnose GBS. It can be diagnosed through a cerebralspinal fluid (CSF) test where you'd find elevated levels of protein without an increase in leukocytes. Additionally, electromyography tests will result in abnormal or slowed nerve conduction. 3A) DMD: Proximal - GBS: Distal - Optic neuritis - Spina Bifida - Occulta (hidden and closed), and myelomeningocele (open and dangerous) 4) Parkinson's: - Parkinson's disease (PD) is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. So, dopamine levels drop which leads to movement disorders (tremors, shuffled gait, gait and balance deficits, LE weakness, rigidity, brady/hypokinesia, poor posture, motor planning and initiation dysfunction, etc.). Once disease is diagnosed and shows up on imaging, about 60% of the damage to substantia nigra has been done (thus symptoms show up years before, but won't show on imaging until about 60% of this area of the brain has degenerated). It is a progressive disorder. Medications like Levodopa and Carbidopa can help decrease the speed of progression (minimizing bradykinesia, rigidity, and tremors). There is also an option of dopamine replacement therapy. PT can help with LE strengthening, gait improvements, and balance. Symptoms: tremors, freeze on gait, shuffled gait, impaired movement, forward flexed posture, impaired initiation of movement, lack of dissociation of limbs, gait and balance impairments. Resting tremors in hands or feet will increase with stress and disappear with movement or rest. 5) Huntington's: - Huntington's disease is an inherited/genetic disease, and it is a progressive disorder. It causes the progressive breakdown (degeneration) of nerve cells in the brain (the basal ganglia). Huntington's disease has a broad impact on a person's functional abilities and usually results in movement, thinking (cognitive) and psychiatric disorders. Most people with Huntington's disease develop signs and symptoms in their 30s or 40s. But the disease may emerge earlier or later in life. It is fatal (progressive), and typically pt's have 15-20 yrs prognosis after diagnosis. Signs of the disease are mental deterioration, speech disturbances, ataxic gait, and enlarged ventricles in the brain. Medications are available to help manage the symptoms of Huntington's disease, but treatments can't prevent the physical, mental and behavioral decline associated with the condition. 6) MS: Multiple Sclerosis - Demyelinating disease of the CNS … brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body (plaque buildup on nerve axons, which slows and disrupts or even stops nerve conduction). Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. This will result in vision loss, cognitive processing slowing, motor weakness, balance and coordination issues, fatigue, etc. - UMN signs with MS. MS is the demyelinating disease of the CNS (or upper motor neurons). - It manifests as ataxia, balance dysfunctions, fatigue, visual problems, sensory changes, clumsiness, muscle weakness, paresthesias, and optic neuritis. Optic neuritis, inflammation of the CN II is usually the first symptom seen due to CN II becoming demyelinated from the upper motor neurons in the cerebral cortex degenerating/demyelinating. - Interventions include regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance activities, gait training, and core stabilization. 7) Spina Bifida is a birth defect that occurs when the spine and spinal cord don't form properly in utero. It's a type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the baby's brain, spinal cord and the tissues that enclose them. Normally, the neural tube forms early in pregnancy and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube doesn't close or develop properly, causing defects in the spinal cord and in the bones of the spine. It typically happens in the lumbar/sacral region. To detect whether a baby has spina bifida, a AFP (alpha-fetoprotien) test is done to see if there are elevated levels of this protein in the blood. You can usually see a buldge with hair in that area. Spina bifida can range from mild to severe, depending on the type of defect, size, location and complications. When necessary, early treatment for spina bifida involves surgery — although such treatment doesn't always completely resolve the problem. There are 3 forms of spina bifida: 1) Occulta, which means hidden. This is the mildest and most common type. There is a small gap between vertebrae and some protrusion posterior of spinal cord, but skin covers. 2) Myelomeningocele, which is also known as open spina bifida. It is most severe type. The spinal canal is open, thus highly prone to infections, so surgery is needed. A sac is formed on baby's back, and since it is below L1, if there is any damage, it would be LMN signs, LE muscles/sensory weakness, and even sacral bowel or bladder issues. 8) TBI (Traumatic Brain Injury) - > Mild > LOC: 0-30 min > PTA: Less than a day > GCS: 13-15 > Moderate > LOC: 30 min – 24 hours > PTA: 1-7 days > GCS: 9-12 > Severe > LOC: 24+ hours > PTA: 7+ days > GCS: Less than 9 9) Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It is usually the result of abnormal pressure on or irritation of the trigeminal nerve. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. Symptoms are typically unilateral and may be either episodic or constant. You will have sudden pain described as sharp, jolting, stabbing, or shock-like or persistent burning or aching sensations on one side of the face. 10) Remember that the diaphragm is innervated by the Phrenic Nerve (C3/4/5 keeps you alive), so diaphragm will be fine. However, all thoracic musculature (abd, intercostals) below C7 will not be innervated, so accessory breathing will most certainly be impaired. - They will be able to move UE's, so feeding, grooming, dressing, etc. will be in tact. They can even do slide board type transfers and propel a manual wheelchair. But gross motor like sitting up or walking won't happen. 11) YES - Yes - Yes

Question 76

1) Name the m's of the anterior - lateral abdomen from superficial to deep 2) Name the m's of the posterior - lateral low back from superficial to deep 3) Which way does the fibers of the ex. oblique run compared to the internal oblique 4) Ext. Oblique muscle has what action - It is innervated by what nerve 5) Weakness of the abdominal m's can lead to a: 6) Attachments of the rectus abdominus m. are: - Innervated by: - What separates the two bellies of this muscle

Answer 76

1) Rectus abdonimus is most superficial directly anterior, but then external oblique, then internal oblique, then transverse abdominis. Psoas and QL are deep. 2) Lats, then midline is erector spinae (spinalis, longissimus, iliocostalis), and lateral to erector spinae is obliques. (Serratus posterior is superficial to erector spinae). Then you have deep paraspinals (multifidi, rotatores), and then even deeper is QL and Psoas are very deep. 3) Ex oblique runs down and anterior to sex organs (EX = SEX), and internal run more in a transverse / side to side orientation. 4) Bilateral contraction does flexion of trunk. Unilateral will side bend to that side, and rotate that side's shoulder to contralateral side. - Intercostal nerves T7-T11 and subcostal nerve (T12) 5) Herniation of visceral contents (inguinal, umbilical, or linea alba hernias) 6) Originates from pubic crest and symphysis, and goes up and inserts into costal cartilage of lower ribs, and xiphoid process. - Intercostal nerves T7-T11 and subcostal nerve (T12) - Linea alba

Question 77

1) What is referred visceral pain 2) So if you had a pt come in and present with a certain pain, but could not reproduce it through muscle testing or special testing, then what organ refers pain to the: - Right shoulder: - Left Shoulder (Jaw and Radiating down L Arm): - Mid back and mid stomach: - L Low Back down around to groin: - L mid back and L mid stomach: - Lower mid abdomen - R lower quadrant

Answer 77

1) When the abdominal viscera is inflammed, injured/damaged, compressed, or some ischemic event - it sends pain along certain paths which manifests as superficial somatic pain. 2) - Right shoulder: Liver, gallbladder, duodenum - Left Shoulder/Jaw/UE: Heart, spleen - Mid Back/Stomach: Stomach - L Low back / groin: Kidney - L mid back/stomach: spleen - Lower mid abdomen: colon - R lower quadrant: appendix

Question 78

1) A network or connection of veins or arteries linked together providing multiple paths of blood flow is called: 2) T or F: Veins throughout the body are oriented with large deep veins, and a network of superficial veins with many connecting veins between 3) The small intestine's parts are called: - Which of those (from point above) connects the small intestine to the large - Portion between the stomach emptying contents into small intestine is called: - From point above, that dumps stuff into what part of the intestine? - What is tube called that releases bile into small intestine - That bile comes from where - The organ from point above sits under what organ 4) The Greater Omentum is what: 5) Large Intestine is called: - Left colic flexure is what 6) Appendix is on the R side or L side of Abdomen 7) Descending colon turns into what: - THe answer to point above then turns into what: - What condition is often associated in this area: 8) A hiatus is what - What are some of the hiatus' in the abdomen 9) What are the attachments for the QL muscle - What does this muscle do - QL is innervated by what nerve(s) - The muscle just anterior to the QL that also acts as a low back stabilizer is the _________ muscle 10) The top of the abdominal cavity is enclosed by what: - What nerve innervates this muscle 11) Nephron is the term for what - Function of the kidneys is: - The tube that leaves the kidneys is what - From point above, this leads to what/where - Tube that leaves the structure from the last point above - What is a kidney stone 12) Other names for a kidney stone:

Answer 78

1) Anastamosis 2) True 3) Jejunum and ileum - Ileum - Duodenum - Jejunum - Bile duct - Gallbladder (stores and releases, liver produces it) - Liver 4) Yellow fatty portion of abdominal wall that holds all abdominal contents in place (ligament of visceral organs so gravity doesn't pull them down - they stay in place) 5) Colon - Curved/rounded portion of colon where colon changes directions 6) R 7) Sigmoid colon - Rectum - Diverticulis 8) A hole - YOu have a hiatus for the esophogus to pass through diapragm to stomach, you have a hiatus for inf. vena cava and descending abominal aorta to pass through diaphragm, you have hiatus' through adominal m's for iliac artery and vein to descend into LE's, etc. Hiatus for inguinal lig's 9) It attaches to iliac crest, up to 12 rib, and then on transverse processes of lumbar vertebrae - With pelvis fixed, it will laterally flex trunk/lumbar spine; with pelvis in open chain it will hip hike. Working bilaterally it helps with extension of back. - T12 (subcostal) and L1-5 nerves - Psoas 10) Diaphragm - Phrenic Nerve (C3/4/5 keeps you alive) 11) Kidneys - The kidneys perform many crucial functions, including: maintaining overall fluid balance. regulating and filtering minerals from blood. filtering waste materials from food, medications, and toxic substances - Ureter - Bladder - Urethra - Kidney Stones: Kidney stones, or renal calculi, are solid masses made of crystals. Kidney stones usually originate in your kidneys. However, they can develop anywhere along your urinary tract. 12) Renal calculi, Nephrolithiasis, renal stone

Question 79

1) What is the main muscle of the pelvic floor - From point above, it has 3 parts, what are they - These m's are innervated by what nerve - Purpose of these m's - The hole of the pelvic floor m's where we deficate, what is that called? - What goes through that hole? - The hole of the m's where the vagina exits is called: 2) Other 2 muscles that form the posterior part of the pelvic floor - Which of those is superior / on top

Answer 79

1) Levator ani muscle - Puborectalis, pubococcygeus, iliococcygeus - S3/4 ventral rami / Perineal branch of Pudendal nerve - They are the pelvic diapragm, giving support to pelvic viscera and complete the enclosure of the abdomen to maintain pressures. It supports uterus/vagina/rectum - Rectal hiatus - Rectum --> Anus - Urogenital hiatus 2) Coccygeus and Piriformis - Piriformis

Question 80

1) All the veins of the UE's and Head/Neck dump blood back into the heart through the: - All the veins of the LE's and Trunk dump blood back into the heart through the: 2) 4 Chambers of the heart are: - Flow of blood through the heart goes through what chambers in what order - T or F: Veins dump blood into heart into the L atrium - What vein dumps heart blood back into heart 3) What valve does blood flow through to get into the R ventricle, and then what valve when it leaves R ventricle - What valve does blood flow through to get into the L ventricle, and then what valve when it leaves R ventricle 4) The semilunar valves are what - So the other two valves together are called what - Why are aorta and pulmonary called "lunar" 5) When blood leaves the R ventricle and goes through the pulmonary trunk, does it flow through the pulmonary veins or pulmonary arteries to get to the lungs? - How do you remember that? 6) Main difference between all veins in the body compared to pulmonary veins - Pulmonary veins dump blood into what chamber 7) What are the little strands that hold the cusps of the valves? - What m's hold the things from point above - What is the point of the chordae tendinae and papillary m's 8) The muscular wall between the two ventricles is called: 9) 3 layers of muscle for wall of heart is (from outside to inside): - WHich one is the thick muscular portion - WHich layer has arteries, nerves, lymphatics 9A) Besides the 3 layers mentioned above, what is another layer around the heart - What is it (from point above) - How many layers is the pericardium 10) How many different arteries branch off the aortic arch to supply blood to the body (and what are they) - How many different arteries branch off the aortic arch to supply blood to the heart (and what are they) - T or F: There really is not brachiocephalic a on the L side - The R brachiocephalic a branches to become what a's

Answer 80

1) Superior Vena Cava - Inferior Vena Cava 2) R Atrium, L Atrium, R Ventricle, L Ventricle - R atrium, R ventricle, L atrium, L ventricle - False (into R atrium) - Coronary sinus 3) Tricuspid, Pulmonary - Mitral (bicuspid), Aortic 4) Pulmonary and Aortic - Atrioventricular valves - Cause blood goes UP to the moon 5) Pulmonary arteries - Vessels that leave heart are arteries, vessels coming into heart are veins 6) The pulmonary veins are oxygenated blood, whereas all other veins are de-oxygenated blood - L atrium 7) Chordae Tendinae - Papillary m's - Hold valve closed so when blood pumps out through semilunar valves, it doesn't backflow into atrium through atrioventricular valves 8) Interventricular septum 9) Epicardium, myocardium, endocardium - Myocardium - Epicardium 9A) Pericardium - Double walled connective tissue covering / protection over the heart - 2 10) 3 (R Brachiocephalic a, L common carotid a, L subclavian a) - 2 (R and L coronary a's) - True - R subclavian a, and R common carotid a

Question 81

1) Where is the apex of the heart - What is the base of the heart - Apex of lung / apical part of a lobe? - Base of lung lobs? - Apex of sacrum? - Base of sacrum? *** What to remember about base vs. apex 2) Does the heart have it's own blood supply? - What are these arteries called? - Where do these a's (from point above) start? 3) What are the main 2 arteries coming out of aorta to supply blood to the heart? - What is main branch off the R coronary artery in the front of the heart - The L coronary artery branches into what a's - What is the main artery on the back of the heart - Does the Post. Interventricular a. come off the R or L coronary a? 4) Tricuspid valve prevents blood from what chamber entering into what chamber - Pulmonary valve prevents blood from entering back into what chamber - Mitral / Bicuspid valve prevents blood from what chamber entering into what chamber 5) What is systole - What is diastole - What is atrial systole - What is atrial diastole - What is preload - Is preload the same thing as EDV? - What is afterload - Is afterload ESV? - What is stroke volume - Each beat of the heart typically ejects what % of blood w/n the ventricle? - Normal SV is what amount: - If you increase preload, what will that do to SV - If you increase afterload, what will that do to stroke volume - If CO decreases, what would that do to afterload - What is cardiac output - Normal CO p/min is: - Intense exercise CO is:

Answer 81

1) The bottom pointed part (more of the left ventricle point by 5th intercostal space) - Upper border of the heart involving the L atrium, part of R atrium and greater vessels - Apex/apical is top part of lobe - Base is bottom of lobe of lung - Apex is tip on bottom of sacrum - Base is top portion of sacrum *** It is less about WHERE, and more about how it looks / shape that determines it. Apex is the pointed portion 2) YES - Coronary arteries - Coming out the aorta 3) R and L Coronary a's - Marginal a. - L Circumflex a, and anterior interventricular a. - Posterior Interventricular artery - 2/3rds of the time it is the R coronary a (R heart dominant) 4) Prevents blood from R ventricle going into R atrium - R Ventricle - L Ventricle blood from going into L Atrium 5) Systole: when heart is pumping / contracting - Diastole: When heart is relaxed - Atrial Systole: When atria contract and push blood into ventricles - Atrial Diastole: When atria relax and are repolarizing - Preload: Preload is the initial stretching of the cardiac myocytes (muscle cells) prior to contraction. It is tension in the ventricular (both) walls at the end of diastole when blood is filled up in ventricles before contraction. It reflects the venous filling pressure that fills the L ventricle during diastole. - NO. Preload is pressure vs. EDV is actual volume of or amount of blood - Afterload: Afterload is the RESISTANCE the L ventricle must overcome to push blood out during contraction. Or, pressure the heart must work against to eject blood during systole (ventricular contraction). Refers to the forces that impede the flow of blood out of the heart, primarily the pressure in the peripheral vasculature, the compliance of the aorta, and the mass and viscocity of blood. - No (same as above) - SV: SV = EDV - ESV. Volume of blood ejected by each contraction/beat of the L ventricle. - 60% - Normal SV is 60-80 mL - Increase it - Decrease it - Increase it - CO / Q: SV x HR. Amount of blood pumped from the L or R Ventricle per minute (total blood in circulation) - Normal CO is 4.5-5.0 L/min at rest (increases with exercise) - Can get up to 25 L /min with intense exercise (5x higher)

Question 82

1) What are baroreceptors - If the sympathetic n.s. gets turned on, what will baroreceptors do 2) What nerve innervates parasympathetic activity of heart - Does the vagus nerve only innervate the heart? - When the vagus nerves overreacts, what happens 3) What is a Chemoreceptor - Give an example of how it works 4) What is the Valsalva Maneuver? - When doing this, what will it do to blood pressure?

Answer 82

1) Baroreceptors are mechanoreceptors that detect changes in PRESSURE (in joints or vessels). In vessels, they maintain blood pressure. They are located in the carotid sinus and in the aortic arch. Their function is to sense pressure changes by responding to change in the tension of the arterial wall. The baroreflex mechanism is a fast response to changes in blood pressure. They are part of the ANS (sympathetic and parasympathetic n.s.) - Increased blood pressure due to increased contractility, increased HR, venoconstriction. 2) Vagus nerve - No, it does parasympathetic activity for all visceral organs - Vasovagal syncope (HR slows way down to dangerous level). 3) A sensory cell or organ responsive to chemical stimuli. - When the lungs are low on O2, it sense low O2 levels to increases respiration, or the opposite. 4) Forced expiration against a closed epiglottis and rectum produces increased intrathoracic pressure. Forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while expelling air. - It decreases cardiac output and thus blood pressure

Question 83

1) The trachea bifurcates at what - Bifurcates means what - What does the trachea bifurcate into / become - From there, how does it keep branching? 2) The lungs are covered by what connective tissue layer? - Then the space between lungs and _________ is what: **** MUST KNOW LUNG VOLUME TERMS **** 3) Describe each term below: - Tidal Volume (TV): - Inspiratory Reserve Volume (IRV): - Expiratory Reserve Volume (ERV): - Residual Volume (RV): - Vital Capacity (VC): - Functional Reserve Capacity (FRC): - Inspiratory Capacity (IC): - Total Lung Capacity (TLC): - Anatomic Dead Space: 4) Tidal volume makes up about what % of total lung capacity? - What % is IRV: - What is % of ERV: - T or F: You can never forcefully exhale all air out of lungs? - Related to the point above, this is called: - What % is Vital Capacity? Thus what is % of RV: 4A) Total lung volume (amount ... in normal healthy lung): - " Tidal volume: - " Vital Capacity: - " RV and ERV: - IRV: 5) What is ventilation / inhalation vs. respiration 6) What is Forced Expiratory Volume (FEV) - FEV1 should be about how much: - What is Peak Expiratory Flow (PEF)

Answer 83

1) Sternal angle (about T2) - Split / divide - R and L main / primary bronchus - Becomes lobar bronchi --> segmental bronchi --> secondary then tertiary bronchus --> Bronchioles --> Terminal Bronchial --> Respiratory Bronchial --> Alveolar sac --> Alveoli 2) Visceral Pleura - Pleural cavity is space, and outer connective tissue layer is the parietal pleura 3) - Tidal Volume (TV): Normal breathing. Inspired and expired air with each breath during normal breathing. - Inspiratory Reserve Volume (IRV): Max volume of air you can breathe in after normal tidal volume. - Expiratory Reserve Volume (ERV): Max volume you can exhale after normal tidal volume - Residual Volume (RV): Volume of air remaining in lungs at the end of max exhalation. - Vital Capacity (VC): VC = TV + IRV + ERV. So it is tidal volume plus IRV and ERV (max exhale, then max inhale) - Functional Residual Capacity (FRC): ERV + RV (so volume of air in lungs after normal TV exhalation. - Inspiratory Capacity (IC): TV + IRV. Max air you can inhale - Total Lung Capacity (TLC): ALL volumes added together. - Anatomic Dead Space: Volume of air that occupies the non-respiratory airways 4) 10% - 50% - 15% - True - Residual volume - 75% is VC, 25% is RV 4A) 6000mL - 500 mL - 4,800mL (need to get at least 2,500 in hospital) - Both are 1,200 mL each - 3,100 mL 5) Inhalation is breathing air in and out; respiration is exchange of gas (O2/CO2) 6) Measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath - 80% in 1st second - PEF: Max flow of air during the beginning of a forced expiratory maneuver

Question 84

1) When you hear Arterial Blood Gas (ABG) - what do you think? - What is PaCO2: - What is PaO2: - What is SaO2: - HCO3 is: 2) The partial pressure of O2 in arterial blood (PaO2) and the percent oxygen saturation of hemoglobin (SaO2) provide information about how well the lungs are functioning to oxygenate the blood. The partial pressure of carbon dioxide in arterial blood (PaCO2) provides information on how well the lungs are able to remove carbon dioxide. Changes in PaCO2 directly affect the balance of pH in the body. Blood pH is tightly regulated, as an imbalance in either direction can affect the nervous system and cause convulsions or coma. Bicarbonate (HCO3) is an important component of the chemical buffering system that keeps the blood from becoming too acidic or basic and is often part of an ABG test. 3) What is the normal pH range - Below what level is acidic: - Above what level is alkalinic: - Skin's pH is what 4) Normal ranges for PaO2: - Normal ranges for PaCO2: - Normal ranges for HCO3: - Normal ranges of SaO2: 5) So what is main difference between respiratory acidosis and respiratory alkalosis: * ** 5A) How to remember this? - So if PaCO2 goes to 29 and pH is at 7.68, what is this? - If HCO3 goes to 18 and pH goes to 7.24, what is this - If PaCO2 goes to 58 and pH is 7.10, what is this - If HCO3 is 44 and pH is 7.55 - So normal ranges/values for: PaO2: - " for PaCO2: - " for HCO3: - " for O2 saturation (SaO2): 6) Is hyperventilating going to cause respiratory acidosis or respiratory alkalosis? - Hypoventilating causes what: 7) So in respiratory alkalosis, what happens to pH levels? - What happens to PaCO2 levels in respiratory alkalosis - Is Bicarbonate (HCO3) levels affected in respiratory alkalosis - What causes respiratory alkalosis - What are the symptoms of respiratory alkalosis 8) So in respiratory acidosis, what happens to pH levels? - What happens to PaCO2 levels in respiratory acidosis - Is Bicarbonate (HCO3) levels affected in respiratory acidosis - What causes respiratory acidosis - What are the symptoms of respiratory acidosis

Answer 84

1) It is a lab test to collect blood to determine / evaluate acid-base (pH), ventilation (PaCO2), and Oxygenation (PaO2) of blood. HOMEOSTASIS - PaCO2: Partial pressure of CO2 in blood - PaO2: Partial pressure of O2 in blood - SaO2: Percent Oxygen Saturation of Hemoglobin - HCO3: Bicarbonate 2) Ok 3) 7.4 (7.35-7.45) - Below 7.35 is acidic - Above 7.45 is alkalitic - 3-4 4) Normal ranges for PaO2: 97 mmHg (80-100) - Normal ranges for PaCO2: 40mmHg (35-45) - Normal ranges for HCO3: 24 (22-26) - Normal ranges of SaO2: 95-98% 5) Respiratory acidosis or alkalosis occurs when the levels of carbon dioxide and oxygen in the blood are not balanced. First, your body needs oxygen to function properly. When you inhale, you introduce oxygen into the lungs. When you exhale, you release carbon dioxide, which is a waste product. Normally, the respiratory system keeps these two gases in balance. Respiratory alkalosis occurs when you breathe too fast or too deep so you get excess O2 and then carbon dioxide levels drop too low. This causes the pH of the blood to RISE and become too alkaline. Respiratory acidosis is a condition that occurs when there isn't enough O2 or lungs can't remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 in lungs causes the pH of blood and other bodily fluids to DEcrease (pH is LOW), making them too acidic. 5A) C = C (aCidosis = excess CO2 in lungs. Acidosis is pH going down, which means CO2 must be going up) - Respiratory Alkalosis - Metabolic acidosis - Respiratory acidosis - Metabolic alkalosis ``` - 80-100mmHg 60-80 is mild hypoxia 40-60 is moderate " <40 is severe " - 35-45 mmHg (around 40) - 22-26 mEq/L - 97% ``` 6) Respiratory alkalosis - Respiratory acidosis (not enough O2, so CO2 goes up, which means pH must go down) 7) Because you get excess O2 (less CO2), pH levels go UP - Go DOWN - NO (HCO3 is only a factor in metabolic acidosis/alkalosis) - Hyperventilation (too much O2, falling levels of CO2) - Dizziness, syncope, confusion 8) Since it is acidic, pH would naturally go down (below 7.35) - Go UP - NO (HCO3 is only a factor in metabolic acidosis/alkalosis) - Hypoventilation (not enough O2) - Anxiety, restless, dyspnea, HA (late symptoms = confusion and coma).

Question 85

1) What is the "cardiac biomarker" - or enzyme that is found in the blood following a MI 2) What is a Cholesterol test - What are the main 2 types of cholesterol - From point above, which of these two is the good one, which is the bad one - Why is the good one from the point above, actually good - Why is the bad one from the point above, actually bad - When someone has high cholesterol, what does that actually mean 3) What is a Complete Blood Count (CBC) - What is a hematocrit - A low hematocrit leads to: - A high hematocrit is from: - What is polycythemia vera: - What is normal route to get more RBC's 4) What are PTT and PT tests: 5) What is the medical term for RBC's - What is the medical term for WBC's

Answer 85

1) Troponin (these enzymes leak out of heart cells following heart attack, and will show up hours after the MI in the blood). 2) Also called a lipid panel or lipid profile, a cholesterol test measures the amount of cholesterol and triglycerides in the blood in order to determine the risk of atherosclerosis. - HDL and LDL - HDL is GOOD, LDL is bad - HDL carries away LDL from the blood - LDL builds up in arteries and causes atherosclerosis - Well it means their diet is such that they are consuming too much fat from fatty/sugary foods. The body will convert certain amounts of fat into energy, but anything in excess of what the body needs is stored as fat (LDL in blood, and triglycerides in adipose tissue). This leads to obesity, high blood pressure, cardiac pathologies, diabetes, atherosclerosis, etc. 3) A CBC measures red blood cell count, total white blood cell count, platelets, hemoglobin, and hematocrit, - Percent of RBC's in your total overall blood volume. - Low: anemic - High: dehydration or polycythemia vera - Condition that causes an overproduction of RBC's. It is a type of blood cancer. It causes your bone marrow to make too many red blood cells. These excess cells thicken your blood, slowing its flow, which may cause serious problems, such as blood clots - EPO (erythropotein in kidney) released to signal bone marrow to produce more RBC's 4) Tests to see how fast your blood clots. PTT stands for Partial Thromboplastin time, and PT stands for Prothrombin time. It measures how quickly the blood clots. It can screen for bleeding disorders or monitor oral anticoagulant therapy. PTT is more often used. 5) Erythrocytes - Leukocytes

Question 86

**** LAB VALUES ***** 1) What is the NORMAL amount of RBC's in human body - Normal amount of WBC's: - Hematocrit: - Hemoglobin: - Platelets: 2) What is the amount of RBC's that is scary / too low or high - WBC's: - Hematocrit: - Hemoglobin: - Platelets: 3) Question 1 and 2 above, what test will give you those figures: 4) What are normal values for blood glucose levels - What are abnormal blood glucose levels - Low levels of glucose in blood leads to: - High levels of glucose in blood leads to: - HbA1C is: - Good and bad levels on HbA1C test are: 5) Normal potassium levels are: 6) Serum Cholesterol Test ... what are normal values - Does this test monitor HDL and LDL? - So a score less than 200 means what - What is a good amount of HDL you want - Do you want to get a really low HDL count? - What is a desirable amount of LDL?

Answer 86

1) 4.5 (ish) x 10^6/ml - 4,500-11,000 /mm^3 - Males - 39-45%; Females - 33-45% - Males - 14-18; Females - 12-16 - 150,000-450,000 2) RBC's: - WBC's: Less than 5,000 - Hematocrit: Less than 25% - Hemoglobin: Less than 8 - Platelets: Less than 20,000 is bleeding 3) Complete blood count (CBC) 4) 60-120 mg/dL - When not fasting, you don't want it above 140. 140-200 is pre-diabetes, and over 200 is diabetic. When fasting, you want it under 100, between 100-125 is prediabetic, and over 125 is diabetic - Low: Low energy - High: Diabetes, atherosclerosis - HbA1C: Test to measure blood glucose levels to help diagnose diabetes (DM II). Measures blood sugar levels over 3 months. - 5.7% and below is normal (good). 5.7-6.4% is pre-diabetic. Above 6.4 is diabetic. 5) 3.5-5.0 6) 200-240 mg/dL (ideally less) - Yes, both - That is good. Means you have less LDL - 40-60 mg/dL - No. You need HDL to get rid of LDL - Well 200 is about as high as you want to go for total cholesterol, and you need 40-60 of it being HDL, so really you don't want any more than 120-140 in LDL. More than 160 ish is too much LDL.

Question 87

1) Is there a difference between an ECG and EKG - So what is an ECG / EKG? - This is also known as: 2) What is an angiogram (or angiography) - What is a coronary angioplasty - More often than not, an MI is in what a. of the heart 3) What is a bronchoscopy - What does 'scopy' mean in medical terms - What does 'plasty' mean in medical terms - How to remember last 2 points - What does "centesis" mean in medical terms 4) What is a cardiac catheterization 5) Carotid Ultrasound 6) Chest Radiograph 7) Computed Tomography (CT Scan) 8) Echocardiography 9) Fluoroscopy 10) Invasive Hemodynamic Monitoring 10A) Swan-Ganz catherter is synonymous with what: 11) MRI 12) Pharmacologic Stress Test 13) Pleuroscopy 14) Positron Emission Tomography (PET) - How to remember 15) Thoracentesis 16) Venography

Answer 87

1) No. There is no difference between an ECG and an EKG. ECG stands for electrocardiogram, and EKG is the German spelling for elektrokardiographie, which is the word electrocardiogram translated into the German language. An ECG (EKG) is a test that measures the electrical activity of the heart. - Diagnositic test to monitor the electrical and other activity of the heart. Electrodes are placed on chest to monitor cardiac rhythm, effect of cardiac medications, pacemaker function, etc. - Holter monitoring (except a holter monitor is an EKG you can wear ambulating around) 2) Radiologic exam that injects a contrast medium (dye) into blood vessels to detect any occlusion or pathology. Coronary angiograms, for example, can show where plaque build up is on heart and extent of occlusion. - A coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries. The term "angioplasty" means using a balloon to stretch open a narrowed or blocked artery. - Anterior descending a. by L ventricle 3) Procedure for direct visualization of the bronchial tree, so you can see on camera any tumors, bronchitis, foreign bodies, bleeding, etc. in bronchioles. You can also get a tissue sample (biopsy) to study. - Study or examination (look around, fix something, get biopsy, take an image) - Surgical repair - Scope like telescope is to look, plasty like plaster or plastic surgery is to fix - To puncture to remove fluid 4) A thin catheter inserted into an artery in the leg or arm and advanced to the coronary arteries where a contrast dye is injected. This helps them see any plaque or occlusions, measures blood pressure, and perform a coronary angioplasty procedure. 5) Carotid Ultrasound: A procedure that uses sound waves (ultrasound) to examine and visualize the structure and function of the carotid arteries. It is to screen for risk of stroke and evaluate placement of a stent. 6) These are used to visualize the location, size, and shape of the heart, lungs, blood vessels, ribs, and bones of the spine. Chest radiographs can also reveal fluid in the lungs or pleural space, pneumonia, emphysema, cancer, and other conditions. 7) A CT Scan is a diagnostic test that uses x-ray machine that rotates around a pt lying on a table. A computer processes the info from the scanner and creates a pic. of the organ and surrounding structures. The pictures are slices of the body called tomograms and each pic is called a computed tomograph. 8) An echocardiogram uses high frequency SOUND (U.S.) waves non-invasively to evaluate the functioning of the heart in real time images. It can provide info on the size and function of the ventricles, thickness of the septum(s), function of valves, and look into chambers of the heart. 9) A real-time x-ray procedure that shows the heart and lungs - or any joint - used in surgery to see anatomy in REAL TIME. Because fluoroscopy involves a relatively high dose of radiation, it has been largely replaced by echocardiograms and other tests. 10) Continuous monitoring of cardiovascular status is performed by intra-arterial catheters and intravenous lines that measure pressure, volume, and temperature. A balloon catheter (known as a Swan-Ganz catherter) is placed in the pulmonary artery to obtain the pulmonary artery wedge pressure and L atrial pressure. 10A) Pulmonary artery catherter 11) MRI = Magnetic Resonance Imaging. MRI uses a magnetic field and radio waves to create 3-D images of the heart and blood vessels. Can look at size of heart, vessels, valves, chambers, damage from MI, aneurysms, plaque buildup, blockages, etc. Mainly used for SOFT TISSUES imaging. 12) A diagnostic proceedure in which cardiovascular stress is induced by pharmacologic agents when contraindications to a routine exercise stress test exist, or when a pt is unable to exercise due to injury or another debilitating condition. It is used in combination with imaging modalities such as radionuclide imaging and echocardiogram. So rather than doing exercise test to stress the heart (which the pt has contraindication), you do a stress test through meds. 13) A procedure that includes examination of the lung surfaces, pleura, and pleural space using a small video camera inserted between the ribs into the pleural space. A tissue sample may be taken to biopsy. 14) A PET scan is an imaging test in which a small amount of radioactive material is injested / inhaled / SWALLOWED. The radioactive material will concentrate in areas of high levels of chemical activity (which corresponds to the disease location). This will present as a different color on the scan. - I'd like to kill my pet, so make them drink/injest some radioactive "die" into them 15) A procedure that includes removal of fluid from the pleural space with a needle 16) A radiopaque dye is injected into a vein while an x-ray procedure creates an image of the vein to detect a clot or blockage.

Question 88

*** MUST KNOW PHARMACOLOGY for heart and lungs *** 1) What are ACE Inhibitors - Who (what type of pt's) would this be used on: - Side effects: - ACE inhibitors end with: - How to remember that from above? 2) Antiarrhythmic Agents 3) Anticoagulant Agents - Who are they used for - Side effects - MAIN anticoagulant meds 4) Antihyperlipidemia Agents - Main antihyperlipidemia drug - Who are they used for - Side effects 5) Beta Blocker - Who are they used for: - Side effects: - Beta blocker drugs end in: 6) Calcium Channel Blockers - Who are they used for - Side effects 7) Diuretic Agent - Who are they used for - Side effects - So what are anti-diuretics 7A) MOST times a cardiac med will have what as a side effect: 8) Nitrate agents - Who are they used for 9) What is Myalgia - What is polyuria 10) *** - Inotrophic: - Chronotropic: - Dromotropic: 10A) How to remember from above: 11) Thrombolytic Agent - Who are they used for - Side effects 12) Antihistamine - Who are they used for 13) Anti-inflammatory agents - Who are they used for - Main anti-inflammatory med - Are corticosteroids for anti-inflammation? 14) Bronchodilators - Who are they used for - Most common drug: 15) What are Mucolytic Agents - Who are they used for:

Answer 88

1) Angiotensin-Converting Enzyme: DECREASE BLOOD PRESSURE by suppressing the enzyme that converts angiotensin I to angiotensin II. - Those with HTN / High BP, or Congestive Heart Failure (CHF) - Hypotension, dizzy - "pril" - pr = pressure; il = nill ... so pressure become nill 2) Control arrhythmias 3) Inhibit platelet aggregation and thrombus formation (prevents clotting) - Stroke or MI pt's, pt's who've just had a cardiac proceedure, or Leg surgery to prevent DVT's, etc. - Hemorrhage, risk of bleeding - Warfarin, Heparin 4) Statins - so they inhibit the enzyme in cholesterol synthesis, break down LDL (low density lipoprotiens), decrease triglyceride levels, and increase HDL's - LIPITOR - Pt's with hyperlipidemia, atherosclerosis, vascular disease, DM II - HA 5) Decrease myocardial oxygen demand by decreasing HR and contractility by blocking beta-adrenergic receptors. - Pt's with HTN, angina, arrhythmia's, heart failure (even asthma and need for bronchodilation) - Bradycardia, arrhythmias, fatigue, depression, dizzy, weak, blurred vision - LOL (Propanolol, Albuterol for lungs/asthma) 6) Decrease the entry of calcium into vascular smooth muscle cells (heart), resulting in diminished myocardial contraction, vasodilation, and decreased O2 demand of the heart. - HTN, angina, arrythmia's, CHF - HA, Dizzy, hypotension 7) Diuretics get rid of fluids, so you pee out fluids more. It will help decrease blood pressure and edema by excreting out more urine. - HTN, edema, CHF, pulmonary edema - Dehydration, hypotension, electrolyte imbalances, polyuria - Helps retain fluid 7A) HYPOtension 8) These are vasodilators (like nitroglycerine for angina symptoms). They decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels. - Angina 9) Muscle pain (myo = muscle, algia = pain) - Excessive peeing 10) - Inotropic are medicines that alter the FORCE or energy of heart’s muscular contraction. - Chronotropic are drugs or medicines that change the HEART RATE and RHYTHM by affecting the electrical conduction system of the heart and the nerves that influence it. - Dromotropic are drugs that affect the CONDUCTION of electric impulses through the heart. 10A) Chron is like chronologic, so timing / rhythm / rate. INO = I know I'm strong, so inotropic is force. Other is conduction of impulse. 11) Disolves clots through conversion of plasminogen to plasmin - MI, Pulmonary embolism, stroke, thrombosis, DVT - Bleeding, hemorrhage 12) Blocks the effects of histamine, so less allergy symptoms (anti-allergenic). So it helps stop/clear up nasal congestion, mucus build up, symptoms of a common cold, etc. - People with seasonal allergies, people sneezing or coughing from common cold 13) Prevent inflammatory bronchoconstriction by prohibiting production of inflammatory cells / inflammatory mediators - Bronchospasms, asthma - Prednisone - Yes 14) Relieve bronchospasms by stimulating receptors responsible for bronchial smooth muscle relaxation or blocking receptors responsible for bronchoconstriction (open airways) - Asthma, Bronchospasms, wheezing, SOB, COPD - Albuterol 15) Decrease the viscosity of mucous secretions by altering their composition and consistency - Those with mucous secretions, like in pneumonia, asthma, bronchitis, cystic fibrosis

Question 89

Below are several different cardiac or pulmonary proceedures performed to be aware of: 1) What is an Atherectomy 2) Balloon Angioplasty 3) Balloon Valvuloplasty 4) The medical term "plasty" means: 5) Cardiac Ablation 6) Cardiac Pacemaker 7) CABG (What does it stand for) - What is a CABG 8) Heart Transplant 9) Valve Replacement 10) Ventricular Assistive Device 11) What are airway adjuncts - What are some examples: 12) What is an oral pharyngeal airway: - What is a nasal pharyngeal airway: - What is a endotracheal tube: - What is a tracheostomy tube: 13) What is airway suctioning 14) What is a Bullectomy 15) What is a lobectomy 16) Who might qualify for a lung transplant 17) What is a lung volume reduction surgery 18) What is mechanical ventilation 19) What is a thoracotomy - What does 'otomy' mean 20) What is a tracheostomy - What does 'ostomy' mean - What does ectomy mean - Otomy means

Answer 89

1) Ather is like in atherosclerosis. Ectomy is cut away. So this is a procedure to cut away the plaque inside an artery. Like an angioplasty proceedure (catheter going into vessel to place a stent to widen vessel, except this catheter will try to cut away plaque to increase blood flow. 2) Angioplasty involves inserting a small balloon-tipped catheter into a stenotic artery and expanding the balloon at the site of the blockage to help widen the narrowed artery to improve blood flow. Usually a stent is placed to help keep the vessel wide (prop it open, if you will). 3) This surgical procedure uses cardiac catheterization to treat stenotic heart valves. A balloon-tipped catheter is threaded through the veins to the faulty heart valve, then inflated to open the narrowed valve to increase blood flow. 4) plasty: a combining form with the meanings “molding, formation” “surgical repair, plastic surgery,” used in the formation of compound words: angioplasty 5) A surgical proceedure that uses radio frequencies or chemicals to destroy areas of the myocardium that have been identified by electrophysiologic testing to be causing cardiac arrhythmia. Ablation is an option for pt's with tachyarrythmias that cannot be controlled by medication or who have arrythmia's that respond well to ablation. In other words, there are abnormal electrical current going through heart, and ablation destroys the muscle tissue to ensure not abnormal electrical signals go throughout heart. 6) A pacemaker is a surgically implanted battery powered device placed under the skin. If a pt has a poor electrical conduction system and SA node (or AV node) is having issues, and resulting in arrythmia's, a pacemaker is implanted. 7) CABG = Coronary Artery Bypass Graft Surgery - Surgery to treat coronary arteries that are narrowed, occluded, or even damaged from a MI (infarcted). It is an attempt to revascularize the heart muscle. Blood is rerouted around the effected artery joining the same or another artery to ensure continued blood flow. 8) A surgical procedure where a failing heart / diseased heart is replaced with a healthy donor heart. These procedures are reserved for end-stage CHF or Renal Failure, and when other treatments have been unsuccessful. 9) A surgical procedure in which a prosthetic valve is implanted in the heart to replace a leaky (regurgitating), narrowed, or stenotic heart valve. Prosthetic valves can either be mechanical or a tissue / cadaver graft from the same pt, donor, cadavar, or often from a pig. 10) VAD is a miniature pump that is implanted in the chest to provide mechanical support to the failing ventricle(s). A right ventricular device (RVAD) attaches to the right atrium and pulmonary artery, bypassing the right ventricle. Some get a BiVAD (bilateral ventricular assistive device) where both ventricles are bypassed. LVAD's are most commonly used as a temporary treatment for people waiting for a heart transplant, or even a permanent treatment for someone with heart failure. 11) An adjunct is an added supplementary feature (adjunct professor). These include various devices used to access and maintain a patent's airway. They provide ventilation to pt, or promote airway clearance. - Oral pharyngeal airway, Nasal pharyngeal airway, endotracheal tube, tracheostomy tube 12) A plastic tube shaped to fit the curvature of the soft palate and tongue that holds tongue away from back of throat to maintain pt's airway - A latex or rubber tube inserted through the nose to allow for nasotracheal suctioning - A plastic tube inserted in the trachea from the mouth or nose to provide an airway and to allow for ventilation (short term emergency) - A trache - an artificial airway inserted into the trachea from an incision in the neck below the vocal cords used in pt's needing prolonged mechanical ventilation. (Long term ventilation option) 13) Suctioning is the mechanical aspiration of secretions from the nasopharynx, oropharynx, and trachea using a suction catheter. It removes pulmonary secretions from airways 14) You know ectomy is removal, and the "bullae" are large air spaces that form when alveoli are destroyed, like in emphysema. This improves breathing. 15) Removal of a lobe of the lung 16) Someone with end-stage COPD, pulmonary fibrosis, cystic fibrosis, or other serious lung diseases. 17) A surgical procedure in which a portion of lung tissue damaged by emphysema is removed. THis creates extra space in the chest so that the remaining lung tissue and the diaphragm work more efficiently, so pt can breathe easier. 18) Pt's with severe pulmonary dysfunction may need assistance to breathe from a positive pressure mechanical ventilator or breathing machine. The positive pressure from the ventilator provides the force that delivers air into the lungs by increasing intrathoracic pressure. Could be used with a trache. 19) A surgical incision cutting the chest wall to access the heart, lungs, great vessels, etc. It could be under the arm (axillary thoracotomy), through sternum (median sterotomy) or from the back (posterolateral thoracotomy) or under the breast (anterolateral thoracotomy) - Cutting 20) A surgical hole created in the neck to access trachea to help a pt breathe. - Create an opening - Cutting away - Surgical incision

Question 90

1) Another term for "normal" breathe sounds - Normal breathe sounds over the trachea or main bronchi would sound like what: - Lower bronchial tree breathe sounds (that are normal) would sound like what 2) Another term for abnormal breathe sounds is: - What are some examples of abnormal breathe sounds: 3) Difference between restrictive and obstructive lung diseases: - Both restrictive and obstructive lung conditions share a similar symptom. What is it: - Examples of obstructive lung conditions: - Examples of restrictive lung conditions: - So if you struggle to get air OUT, you have restrictive or obstructive 3) Explain the term Crackles: - Another synonymous term is: - When / why would you hear crackles, what pathology is it 3A) What is the high pitched sound heard in airways: - What causes these 4) What is pleural friction rub - This would sound like dry crackling, but would you hear it during inspiration or expiration 5) What is Rhonchi - What is stridor - Which one of these is high pitched - Which one is from upper airway obstruction 6) What are the 3 different ABNORMAL voice sounds you'll hear in lung conditions: - How do you test / hear for them? - In normal healthy lung tissue, will the sound be clear or muffled? - If it is a louder than normal sound, that indicates what: - Consolidation of the lung means what: - What is atelectasis? - So the 3 abnormal voice sounds (from first point) are not heard in normal lungs? True or False - So Explain each of the 3 abnormal voice sounds 6A) What is fremitus - Will fremitus be more pronounced or less with atelectasis - WOuld it be more or less pronounded with pleural effusion? - WOuld it be more or less pronounded with consolidation? 7) True or False: the 3 abnormal voice sounds from point above are basically 3 tests to determine if there is consolidation of the lung? 8) Review again the 4 main adventitious breathe sounds: 9) Abnormal Breath sounds are indicators of what: 10) What again is the "99" test:

Answer 90

1) Vesicular - Loud - High pitched, breezy 2) Adventitious - Crackles (rales), wheezing, rhonchi, stridor, pleural friction rub 3) Obstructive lung diseases include conditions that make it hard to exhale all the air in the lungs. People with restrictive lung disease have difficulty fully expanding their lungs with air and getting air in. - SOB: Obstructive and restrictive lung disease share the same main symptom: shortness of breath with exertion. - Obstructive: COPD, Asthma, Cystic Fibrosis, Bronchiectasis (within the lungs usually) - Restrictive: Obesity, Scoliosis, Pulmonary Fibrosis, MS, ALS, Rib fracture, SCI (something external usually) - Obstructive 3) Crackles : Abnormal clicking / popping / rattling sound in lungs - Rales (Crackles was formerly rales) - Typically from some edema (consolidation) where fluid or air bubbles move through airways 3A) Wheezes - Something obstructing air getting out - COPD, mucus, asthma, bronchospasms 4) When visceral (over lung) and parietal (surrounding rib cage) pleurae rub together - BOTH 5) Continuous deep / low pitched sounds .... like SNORING or gurgling, from air trying to pass through secretions in airways. - Stridor: High pitched sound during ins/expiration - Stridor - Stridor 6) Bronchophony, Egophony, Whispered Pectoriloguy - Put stethoscope over lungs and have the pt say words or numbers or letters, and you listen to quality. - Muffled and NOT distinct - Consolidation or atelectasis - Consolidation refers to increased density of the lung tissue, due to it being filled with fluid and/or blood or mucus. - Collapsed lung - True - Bronchophony: Pt will say "99" and it should sound muffled, but with this it is louder and clearer due to consolidation in lungs - Egophony: Pt will say "ee" and normally it should sound like a muffled "ee" sound, but with egophony it will sound like "ay" - suggesting consolidation (REMEMBER - E=E, Egophony says EE) - Whispered Pectoriloguy: Pt will whisper "1,2,3" and instead of it sounding muffled, it will be louder and clearer - suggesting consolidation 6A) Putting hands on lungs when you don't have stethescope - LESS - Less (since lung is smaller - MORE cause of consolidation 7) True 8) Rhonchi: Low pitched breathe sound. Air trying to pass through airways, but there is fluid or mucus blocking. Crackles/Rales: High pitched breathe sound sounding like little pops / crackles. When someone has pneumonia or CHF, or alveoli aren’t working properly. Wheezing: High pitch whistling sound. Caused by narrowing of airways due to inflammation of airways. Musical Stridor: higher pitched harsh vibratory sound. Caused by narrowing of upper airways (specifically the upper airways – some obstruction in trachea or larynx). 9) Asthma, pneumonia, consolidation, bronchitis, inflammation, COPD, emphezema, foreign body / aspiration, and even CHF. 10) As you auscultate pt’s lungs, have them say “99” as you listen to each lobe. PT should hear a muffled ‘99’ = healthy lung. If the ‘99’ sound is more clear, this indicates consolidation and fluid build up in lungs (asthma, bronchitis, pneumonia). Same thing with an “E” – have pt say “E.” It sound sound muffled = normal. A clear “E” or it sounding like an “A” sound is concerning. If you hear an absent / empty sound when doing ‘99’ this could indicate a collapsed lung (atelectasis).

Question 91

1) What is an ECG? - What is the standard (hospitals use) amount of leads used? - What can an EKG tell you? 2) What is the P Wave in an EKG? - What is the difference between depolarization and repolarization? - So depolarization is an actual heart beat? - Is depolarization associated with systole or diastole 3) What is the PR Interval - How long does it last (and how far is that on an EKG strip) 3A) One little tiny box on an EKG strip is how much time? - 1 big box has how many little boxes? - So how many seconds in a big box - how many big boxes does it take to get to 1 second? - A typical EKG strip will look at how many seconds - How many tally marks up above the strip is in 6 seconds - So how many seconds between each tick mark up above - So how many big boxes in a 6 second strip 4) What is the QRS complex - What is happening in the background behind the QRS complex that you can't see on an EKG strip? - Normal duration of a QRS complex is? - Normally QRS complexes are narrow, so a wide QRS complex means what? 5) What is the QT interval - What is the ST segment - What is the T Wave 6) What is the Pace Maker of the heart? - What is the pace of the pace maker (from point above) - If the pace maker fails, what takes over 7) What is NSR (Normal Sinus Rhythm) - What are the numbers / rates you'll see in a NSR? 8) SO what is the process / steps to determine the actual NSR or rhythm of the heart? 9) What do these terms mean: - Bradycardia: - Tachycardia: - Sinus Block: - Sinus Arrest: - PAC's: - Bigeminy: - Trigeminy: - Quadreminy: - A-Fib: - A-Flutter: - Pacer Rhythm: - 1st Degree Heart Block: - 2nd Degree Heart Block: - 3rd Degree Heart block: - Supraventricular Tachycardia: - PVC: - Unifocal: - Multifocal: - Couplet: - Triplet: - Asystole: - Agonal: - Artifact: - ST Segment Elevation: - ST Segment Depression: - Bundle Branch Block: - Ventricular Tachycardia (V-tach) 10) So is A-Fib or A-Flutter the nice synchroniced flowing P waves? - What is happening in A-fib - What is a solution - Rate if AV node takes over, or junctional rhythm - Indication there is a ventricular problem - Will a ventricular problem have a P wave - Indicator it is a junctional rhythm - What is sinus arrythmia - What are more concerning - PAC's or PVC's - So a PAC is what (what is happening) - What could cause a PAC - Which heart degree (1st, 2nd, or 3rd) is a medical emergency? - Is one or two PVC's here and there normal - Is ST Segment elevation from ischemia or infarction 11) Go and review the most basic / common EKG strips in case you have to recognize the pathological arrhythmia

Answer 91

1) An EKG - Electrocardiogram. It shows the electrical activity of the heart (recorded from electrodes on the body) and whether physiologic, pharmacologic, or pathologic changes are taking place. - 12 lead - Electrical activity of the heart (rhythm), impact of medications, diagnose location and extent of MI (ischemia or infarction), arrythmia's, SA node issues, heart health, etc. 2) Represents atrial DEpolarization (contraction) - Think of DEpolarizing as the contraction so it is losing signal as it depolarizes. REpolarizing is the heart resting and revving up for the next contraction (reboot). Depoloarization is systole, and repolarization is diastole. - True - Systole 3) The PR interval is the time from the onset of the P wave to the start of the QRS complex. It reflects conduction through the AV node. - The normal PR interval is between 0.12-0.20sec's in duration (three to five small squares) 3A) 0.04 seconds - 5 little boxes - 0.20 seconds - 5 big boxes - 6 seconds - 3 (one at beginning and end, and one in middle) - 3 seconds - 30 big boxes (5 big boxes in a second x 6 seconds = 30) 4) Ventricular DEpolarizaiton - Atrial repolarization - 0.04-0.12 seconds (1-3 boxes) - PVC or some ventricular problem (slower spread of ventricular depolarization) 5) QT interval: time for both ventricular depolarization and repolarization. - Isoelectric time between when ventricles depolarize to when they repolarize - Ventricular repolarization 6) SA Node - 60-100 bpm - AV node 7) When everything is right with the heart and heart rate. - 60-100 HR - Regularity of HR: regular - P Waves: Normal - PR Interval: 0.12-0.20 sec's (or 3-5 boxes) - QRS Complexes: Narrow (0.04-0.12 sec's ... no more than 3 boxes) 8) - Step 1: Determine regularity. Is the distance between the p-p, and QRS-QRS waves regular and normal? - Step 2: Calculate the rate: Count how many QRS complexes in 6 seconds (2 big hash marks - technically 3) and multiply by 10 - Step 3: Assess P Waves - Step 4: Look at PR INterval (is there a 1st, 2nd, or 3rd degree block) - Step 5: Determine QRS width. Wide QRS is ventricular issue 9) - Bradycardia: Slow HR (less than 60 bpm) - Tachycardia: Fast HR (more than 100 bpm) - Sinus Block: Missing a beat (SA node doesn't fire, so no p wave, QRS complex, nothing), but space or time missed is EXACTLY one normal rhythm missing. - Sinus Arrest: Missing a beat (SA node doesn't fire, so no p wave, QRS complex, nothing), but it lasts more than 3 seconds. Sinus Block is miss a beat, sinus arrest is more than a beat. There is a big long gap of no heart activity at all. - PAC's: Premature Atrial Complexes. Early P wave, everything else normal. - Bigeminy: Every other beat is premature - Trigeminy: Abnormal every 3rd beat - Quadreminy: Abnormal every 4th beat - A-Fib: Action potential chaos/disarray in Atria, crazy quick atrial contractions. Both Atria are not contracting at same rate as ventricles (way more often and chaotic). ** BUT QRS complex is normal width but IRRegular - A-Flutter: Action potential circling around in atria, nice quick flutter (3:1 or 4:1). But if there are only 2 humps, that is P and T wave = Sinus Tachycardia. If 3-4 waves, and they are nice = flutter. And QRS complex is typically REGular - Pacer Rhythm: Straight Line going down at the start of the P wave (or R wave). This pacer line / strike indicates a pace maker is providing the atria or ventricles with an impulse to start the conduction (not the SA node). - 1st Degree Heart Block: Longer than normal P-R Intervals (more than the 0.20 secs / 5 boxes … usually it is 0.12-0.20 or 3-5 boxes), but in 1st degree heart block, all the P-R intervals are consistently longer than 0.20 secs (but each the same length) AND you have QRS complexes for each. - 2nd Degree Heart Block: - Mobitz I / Wenckeback: P-R intervals get progressively longer until a QRS complex drops off (then this repeats) - Mobitz II: P-R intervals are constant, but missing QRS complex occassionally with a P wave there - 3rd Degree Heart block: Impulse between atria and ventricles is disrupted. So, P-P intervals are normal (regular), QRS-QRS (or R) intervals are normal, but they both are off / getting 2 different pace makers and rhythms between ventricles and atria. - Supraventricular Tachycardia: Fast Fast - 150-250 bpm (can't even see P wave). REMEMBER Supraventricular tachycardia and atrial tachycardia are same basically. - PVC: PVC's (Premature Ventricular Complex). Early electrical impulse, so QRS is early, no P wave, and a WIDE QRS - Unifocal: Up or down, just same direction. ^ ^ or v v - Multifocal: Up, down - multiple directions. ^v v ^^ - Couplet: 2 PVC's together - Triplet: 3 PVC's together - Asystole: 0 (dead - flat line) … P wave maybe present, but nothing else - ventricles just not firing - Agonal: No P wave, Wide QRS complex, HR is 0-20 bpm (scary … agonal is right before Asystole) - Artifact: When the machine messes up and there are squiggly lines all over. Has nothing to do with abnormal heart rhythm, just a machine mistake :) - ST Segment Elevation: ST segment is elevated, which means myocardial Infarction (MI) - ST Segment Depression: ST segment is depressed, which means ischemia - Bundle Branch Block: When both ventricles are firing at different rates. One ventricle is dilated or hypertrophied, so they fire at different rates. It looks like a notched QRS complex (or bunny ears at top of QRS complex). Can't diagnose/classify a BBB for sure unless you have a 12 lead. - V-tach: 3 or more PVC's at a ventricular rate of 150+ bpm. Long amounts of V-tach is very scary and dangerous 10) A-Flutter (a-fib is atrial chaos) - A-fib: atria are depolarized between 350-600 x/min. Atrial electrical chaos - Meds, or ablation - 40-60 bpm - Wide QRS - Usually NO, will be missing P wave - Inverted P wave with normal QRS - Some abnormal heart rate/rhythm - PVC's are very concerning if there are a lot, but usually a PAC every heart and there is normal - Premature atrial contraction, so atrium initiates an impulse before SA node fires - Caffine, stress, smoking, alcohol - 3rd - Yes - Infarction (ischemia is ST segment depression) 11) ok

Question 92

1) What is exercise stress testing? - Is this the same as VO2 Max testing? Why or why not? 2) When would a Dr. or PT stop a exercise stress test: 3) You can get someone's HR by sticking a stethescope on their chest, or you can do what? - Difference between HR and pulse is - Can you detect arrythmia's when feeling a pulse? - Can you detect peripheral artery disease when feeling for a pulse? - How (from point above) 4) What does RPE stand for: - What is RPE 5) They recently revised the scale and did it between 0-10. So 1 is weak or nothing, and 10 is max HR - T or F: On the old scale, the score x 10 = HR

Answer 92

1) An exercise stress test is used to determine how well your heart responds during times when it's working its hardest. During the test, you'll be asked to exercise — on a treadmill or bike — while you're hooked up to an electrocardiogram (EKG) machine, BP cuff, HR monitor, oximeter, etc.. This allows your doctor to monitor your vitals and heart's response to exercise. - No. VO2 is commonly used to test the aerobic endurance or cardiovascular fitness of athletes before and at the end of a training cycle. VO2 max tests maximal oxygen consumption, refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise. Whereas an exercise stress test is typically for a cardiac patient. 2) Drop of Diastolic BP more than 10mmHg or increase in systolic BP over 180+ or diastolic over 120mmHg, moderate angina, ataxia/dizziness, cyanosis, v-tach, ST elevation, above 80% max HR, RPE over 15 ish, at pt's request, SOB, etc. 3) Palpate their pulse on a distal artery (brachial, radial, carotid) - HR is the actual beats of the heart, where pulse is feeling blood pulsating through DISTAL arteries as a result of the heart beating. - Yes, of course - Yes - It would be very faint (normal pulses are strong and regular) 4) Rate of Perceived Exertion - It is a scale to essentially determine someone's HR. Someone at a 6 exertion level (which is very light) for example means their HR is 60. Someone at a 13 on the scale suggests their HR is 130 bpm which is somewhat hard. A 19 on RPE is very very very hard, suggesting they can't do it any more it is too hard. 5) Ok - True

Question 93

1) What is a normal adult respiratory rate - What is RR for a 10+ child: - What about a 1 yr old child: - What about a newborn: 2) What is a normal ratio of inspiration compared to expiration (time it takes): - How is this different than IRV and ERV with lung volumes - With COPD, how does that ratio (from point above) change: 3) What is the FITT-VP principle, and what is it for - FITT-VP stands for what 4) When doing exercise (cardiovascular training / endurance tests), you don't want to go over heart rate max. What is that (and how do you calculate it) 5) How much should one exercise each week 6) We know Systolic BP will go up in correlation to how hard the heart works, but what should happen to Diastolic blood pressure? 7) What are airway clearance techniques 7A) - Why would you use airway clearance techniques - When might you want to be cautious about airway clearance techniques 8) How does posture and positioning relate to airway clearance: 9) Some ideas to help improve posture for airway clearance: 10) What is diapragmatic breathing: - What is upper chest breathing: - So of these 2, which is more efficient and which is used when someone is struggling to get air in? - Which one uses accessory breathing m's - What are the accessory breathing m's 11) What is an incentive spirometer, and what is it used for: - So do you do big breathe in or out when determining vital capacity using an incentive spirometer? 12) You can measure chest wall expansion. What is a normal value: 13) What are the 4 phases of a cough: 14) What is a peak flow meter, and what is it used for: - What is a good number to get, what is a concerning number when using this device: - How would you document their cough: - A weak cough can lead to what: 15) What are cough assist devices: 16) What is Chest PT - 2 examples are: 17) What is Postural Drainage: 18) What is Percussion: 19) What is: - Autogenic Drainage: - Directed Cough: - Active Cycle of Breathing: - Huffing: 20) With postural drainage, how long should the pt stay in that position - If you hear consolidation in upper lobes, how should you position the pt for postural drainage - Lateral middle lobe? - Lower lobes 21) What is the Semi-Fowler's Position - Fowlers position is - What is the Trendelenburg position (not for gait) - What is reverse trendelenburg position - What is semi-fowler's position used for: - What is Trendelenburg position used for: - T or F: Semi-Fowler's position is used in hospitals to help people accomplish efficient diaphragmatic breathing? - Why (from point above) - What is a good way to teach and accomplish diaphragmatic breathing: 22) What is cyanosis: - What is syncope: - What is dyspnea: - What is pursed lipped breathing: - What is atelectasis: - What is anemic: - What is hypoxic:

Answer 93

1) 12-20 breaths p/min - 15-20 bpm - 15-25 bpm - 30-45 bpm 2) 1:2 (expiration is double the time) - You can inspire 2x as much than expire; however, it takes 2x as long to expire air normally - 1:3 or 1:4 (longer expiration since there is obstruction) 3) This is how you create an exercise prescription to know what to dose as far as exercise for a pt. - Frequency, Intensity, Type, Time (how frequent you should exercise, how much, what type, and how long), total Volume, and Progression. 4) Means you want to calculate the max HR you will NOT take your pt over, for safety. You take 220 - their age x 80%ish. 5) 5 times, 30 mins per time for 150 mins per week. 6) Stay the same or slightly lower (should not increase more than 10mmHg) 7) Ways to help clear the airways to manage or prevent impaired mucociliary transport, cough, clearance. The techniques include breathing strategies, manual and mechanical techniques, and postural drainage. Many pulmonary conditions will result in a patient struggling to clear their airways due to some obstruction, mucus / secretion build up, etc. Several of these conditions where coughing is difficult include: COPD, Chronic Bronchitis, Emphysema, Pneumonia, Asthma, Cystic Fibrosis, etc. Physiologically, the ciliary cells in our airways (trachea and lungs) capture foreign particles during breathing so they don’t enter lungs, then produce a secretion to help move those foreign particles up and out (cough). Sometimes that mucociliary escalator that gets mucus up and out gets injured, or accessory muscles are weak, or a rib fracture, or some pulmonary condition (from above) makes coughing ineffective. Below are interventions on how to help these patient’s improve airway clearance and coughing: 7A) - Mucus build up in airways, difficulty clearing secretions, difficulty coughing, difficulty breathing - Intercranial pressure >20mmHg, Head or Neck injury, hemmorage, spinal injury, CHF, rib fracture, etc. 8) Posture is critical to open up lungs to improve breathing and coughing ability. So, assess a pt's posture. Get them into an upright posture, head up, shoulders back, arms ER’d, open up airways. Use towels to prop up pt’s if seated posture is poor and they need help breathing. Give them posture exercises. Sometimes it is necessary to position a patient manually for them to help them improve posture to improve breathing. 9) Some ideas: Place a towel roll between their scapula to open up chest, and a pillow at lumbar region to promote anterior pelvic tilt. 10) Diapragmatic: Diaphragmatic breathing is the ‘natural’ and most efficient way to breathe. It doesn’t require using upper accessory muscles, so it is much more efficient. - Upper Chest: Upper chest breathing is NOT efficient. It requires so much more energy since accessory muscles (SCM, scalenes, pecs, traps, etc.) are being used. But, if pt can not speak well, cough, breath well, they should kick in upper chest breathing to get accessory m’s to help improve RR. It is not used long term, but using upper chest breathing will kick in the accessory muscles to help with breathing. - Diaphragmatic is more efficient, upper chest is helpful for secondary breathing help - Upper chest - SCM, Scalenes, pecks, serratus, lats, abs 11) An incentive spirometer measures a pt’s vital capacity. Have the pt exhale all their air out, and then place mouth over device and inhale as much and as fast as they can. This will move the large dial, which will show the vital capacity of the lungs. Goal is to get this above 2,500 mL (normal VC is around 4,800). If the pt does not hit that amount, work on it as an exercise. Also, an incentive spirometer can be used to train pt’s (therapeutically) how to breathe properly. Exhale all the air out, then slowly inhale trying to keep the dial between the notches in between the ideal position. This trains lungs to breathe better. Thus, it is an assessment and intervention tool. - You do big breathe in (after you've exhaled air out) 12) Normal expansion: 2-3 inches (or 3-7.5 cm) 13) 1 - Inhale (most important step. The more air you get in, the more you can expel out) 2 - Hold your breathe 3 - Build up pressure while holding breathe (air moves from high pressure to low pressure, so the more pressure you build up, the more forceful and productive the cough). 4 - Cough out 14) A peak flow meter is a device that measures the effectiveness of a cough. Follow the 4 phases of a cough (above) and cough into the device. - If someone can get over 250, they have a productive cough. If they are below 162, that is the cut-off and very concerning due to weak non-functional cough. - Document what level they got, and whether it is a functional, weak functional, or non-functional cough. - A weak or unproductive cough can lead to obstruction of airways, pneumonia, and further deterioration of their pulmonary condition. 15) There are lots of devices out there that are designed to help improve a pt’s ability to do airway clearance. They are called ‘Positive Expiratory Pressure Device.’ Some examples include: acapella, quake, flutter, etc. These devices have a built up pressure within them which will help mobilize secretions. In order to get them to work, one has to really do a forceful expiration, which helps improve one’s ability to do a productive cough. 16) Using hands on chest to help with airway clearance. - Examples are postural drainage and percussion or vibration 17) Many pulmonary/respiratory patients will get fluid build up in their lungs, and it is necessary at times to help move that fluid / secretions up and out of airways. Postural drainage is when you auscultate each lobe of the lung, and listen for consolidation or areas where there is fluid build up (review how to do that with the “99” test a few slides back). When you hear areas of fluid build up, place the patient in a position where gravity will help fluid flow out of the lung. So, for example, if there is fluid in the upper lungs, sit the patient up. If in the lower lung lobes, lay them down with their feet and chest above their head so gravity will pull fluid down (or up and out of airways to be coughed out). If you hear it more in the front than the back, lay them supine. If more in the back than the front, lay them prone. If more of the middle lobe, lay them sidelying. Just get gravity to pull fluid down and out. See picture to the right. 18) Percussion is when you use your hands to manually percuss or lightly hit the patient in the chest. The goal is to mobilize and loosen secretions in the airways, so the patient can cough up and out those secretions. The percussion, or vibrating / hitting the chest will cause secretions to become loose and mobilize so they can be coughed up and out. Obviously the goal is not to hit hard and hurt the patient, but use a cupped hand position and percuss over the lungs, specifically the lobes where you auscultated and heard consolidation, abnormal breathe sounds, wheezes, crackles, etc. See pictures to the right. 19) - Autogenic Drainage: Controlled breathing to mobilize secretions - Directed Cough: Manually assisted cough or strong "huff" to help elicit a cough when a pt has physical limitations. - Active Cycle of Breathing: A technique developed under the name "forced expiratory technique" to assist secretion clearance in pt's with asthma. Basically breathing exercise with a huff cough - Huffing: Forced expiratory manuever performed with the glottis open. Helps with coughing up secretions 20) 3-5 minutes - Sitting up - Sidelying on the opposite side (so gravity pulls it down) - Head down with trunk above head (trendelenberg position) 21) The Semi-Fowler's position is an inclined medical position where the patient is on their back at a bed angle between 30°-45°. - Fowlers is sitting up slightly reclined (semi-fowler's is MORE RECLINED back at greater angle) - Trendelenberg: On their back, titlted with head down lower than trunk (feet elevated above head). - Reverse Trendelenburg: On back, tilted with head higher than feet. - Breathing, feeding, medically complex - Surgery (help with blood pressure, cardiac function) - True - Because if they were supine the abdominal contents would weigh down on diaphragm. - Smell the roses, blow out the candles. Sniffing. Place hand on ribs and abdomen and get abdomen to move. 22) cyanosis: a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood. - syncope: is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out." It most often occurs when blood pressure is too low (hypotension) and the heart doesn't pump enough oxygen to the brain - dyspnea: Difficult or labored breathing - Pursed Lipped Breathing: Pucker lips and breathe in through nose and out through pursed lips - Atelectasis: collapsed lung - Anemic: A condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anemia can make you feel tired and weak - Hypoxic: A condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level.

Question 94

1) What does MET stand for - What is a MET 2) So sitting at rest, how many MET's is that - Vacuuming the carpet - Moving furniture - Playing Soccer - Walking - Running - Playing with Dog - Hiking mountain: 3) So "light" MET's are what range: - Medium/Moderate MET's are what range: - Vigorous MET's are what range: 3A) So which of these 2 would be 3-4 MET's: level walking at 1mph, or walking on treadmill at 3mph 4) If you had to do CPR, you need to give how many compressions to how many breathes? - How do you create an ideal airway when giving CPR - How deep should your compressions be if doing CPR to an adult - How deep should your compressions be if doing CPR to little child - Roughly, how many compressions per / min should you give - How do you tell if you need to do CPR - If they have a pulse but not breathing, how often do you provide breathes 5) What does AED stand for - What does CPR stand for - What is an AED

Answer 94

1) Metabolic Equivalent - One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg body weight x min 2) Sitting: 1 - Vacuuming: 3 - Moving: 6 - Soccer: 10 - Walking: 4 - Running: 9 - Dog: 4-5 - Hiking: 7-8 3) <3 - 3-6 - > 6 3A) Walking on treadmill at 3mph 4) 30:2 (30 compressions, 2 breaths) - Head tilt, chin lift - 2 inches deep - 1.5 inches - 100-120 - See if they are conscious, are they breathing, do they have a pulse? - 6-8 sec's 5) AED = Automated External Defibrillator - Cario-pulmonary resuscitation - AED: A medical device that can analyze the heart's rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm.

Question 95

1) What is Angina Pectoris 2) What are the 2 types of Angina: 3) Another term for Angina: 4) What do you take to quickly relieve symptoms of angina (which thus helps diagnose what is happening): - Why is this medication (from point above) good - why does it work? 5) If a MI does result from this, what is typical medical procedure: 6) Can you reverse atherosclerosis? - SO what can you do about atherosclerosis 7) What is Chronic Venous Insufficiency - What are the symptoms for CVI - What is treatment for CVI - How to remember the term "stasis" 8) What is CHF 8A) What are the 4 stages of CHF: 9) Signs of pulmonary venous congestions indicates right or left sided heart failure - Systemic venous congestion indicates right or left sided heart failure 10) What does CAD stand for: - What is it:

Answer 95

1) Chest pain resulting from heart problems (CAD, atherosclerosis, CVD, cardiomyopathies). Results from diminished myocardial perfusion (so ischemia to heart muscle), most commonly caused by narrowing of one or more of the coronary arteries due to an embolism, atherosclerosis, or even inflammation. You feel this pain in chest area, but it also radiates and becomes referred pain in left upper extremity, radiates down left arm, neck and jaw, and chest area (front and back). Mainly chest and left shoulder/arm. *** Think of it as lactic acid build up when tissue doesn't get enough O2 2) - Chronic stable angina: Comes from over-exertion from exercise, it is PREDICTABLE. - Unstable angina: Can happen during rest, or exercise, or anytime. It is UNPREDICTABLE, and usually happens in the MORNING. 3) Another term for angina = Acute Coronary Syndrome 4) Nitroglycerin - Nitroglycerin is a VASODILATER, a medicine that opens blood vessels to improve blood flow (from a stenosis/atherosclerosis). It is used to treat and help prevent angina symptoms, such as chest pain or pressure, that happens when there is not enough blood flowing to the heart. 5) CABG 6) NO. - Exercise and diet (lose weight) Change lifestyle Stop smoking CABG = Bypass surgery (graft) Stent surgery (widen vessel) Medications 7) CVI is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis. Usually this condition effects the distal LE's and is characterized by venous incompetence and results in venous hypertension. - Symptoms include: edema, feeling of heaviness, dull/aching pain in LE's, skin color changes, ulcers form (mostly by medial malleolus), etc. - Treatment includes compression stockings, elevating the legs, movement/exercise, wound care, and moisturizing the skin to prevent cracks. In some cases, surgery may be needed to improve blood flow. - STAY ... it pools (blood pools ... stasis) 8) CHF = Congestive Heart Failure. This is a progressive condition where the heart begins to fail and cannot maintain a normal cardiac output due to a weakening heart. Basically the heart muscle fails and so fluid builds up. Because of this, the heart can't keep up with the O2 and energy demands of the body. The ventricles weaken and dilate to the point that the heart can't pump efficiently. Diminished cardiac output causes compensatory changes including increases in blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass. The etiology of CHF may include arrhythmia, pulmonary embolism, hypertension, valvular heart disease, myocarditis, angina, renal failure, and severe anemia. A pt with CHF will initially show signs of tachycardia since the heart tries to speed up the HR to improve cardiac output (CO). As the severity of CHF increases, signs of venous congestion become apparent too. 8A) > Stage 1: You don’t experience any symptoms during typical physical activity. People usually don't know they are in this stage. > Stage 2: You’re likely comfortable at rest, but normal physical activity may cause fatigue, palpitations, and shortness of breath. At this stage, lifestyle changes can help reduce symptoms. Medication can also be given in this stage. > Stage 3: You’re likely comfortable at rest, but there’s a noticeable limitation of physical activity. Even mild exercise may cause fatigue, palpitations, or shortness of breath. Lifestyle changes are necessary, but more medical interventions at this stage are necessary. > Stage 4: You’re likely unable to carry on any amount of physical activity without symptoms, which are present even at rest. No cure for this stage except complete heart transplant. 9) Left - Right 10) Coronary Artery Disease - It is atherosclerosis of the actual heart's blood vessels where plaque builds up in coronary arteries. This build up causes an aneurism (weak vessel) and stenosis (narrowing of vessel), which could lead to a thrombus and embolism, and thus a MI (Myocardial Infarction, or heart attack). If your coronary arteries get an aneurism by buldging and weakening (or narrowed = stenosis from plaque build up) then blood supply is limited to myocardial muscle of heart. If a thrombus (blood clot) clogs it and blood and O2 can't get though to myocardial muscle ... over time the coronary artery hardens or weakens and ruptures or gets a block/clot, and you get MI or stroke (cardiac muscle dies). - CAD takes years and years to develop, but will eventually lead to a MI (heart attack) or a CVA (stroke). Risk factors include DM II, Obesity, Kidney disease, elevated cholesterol, family history, etc.

Question 96

1) What is Cor Pulmonale: - What are the symptoms: 2) What is Cystic Fibrosis: - Normal life span for pt's with this condition is: 3) What is Emphysema: - Symptoms include: - Two types of emphysema pt's: 4) What is Hypertension: - For HTN to be diagnosed, systolic and diastolic need to be at what: - Symptoms include: 5) What does MI stand for: - What is it - What is a widow maker? - What causes an MI - Where is pain felt from an MI? 6) s/s of a MI: 7) Elevated levels of _______ will be found in blood following an MI 8) What are the types of MI: 8A) What does "transmural" mean 9) What is a STEMI or ST-Elevation: - What is a NON-STEMI: - T or F: A ST segment elevated on EKG suggests ischemia, and an ST Segment depressed on EKG suggests infarction? 10) What is Peripheral Vascular Disease (PVD)

Answer 96

1) This is known as right sided heart failure or pulmonary heart disease. It is hypertrophy or enlarging of the right ventricle caused by altered structure or function of the lung. It occurs when the right ventricle is unable to effectively pump blood due to the prolonged presence of pulmonary hypertension and increased right ventricular afterload. - Symptoms: The cardinal symptoms is SOB, fatigue, chest pain, jugular vein distension, swelling/edema in LE's, dizziness, and syncope. 2) This is a genetic condition usually seen in CHILDREN, but can effect LUNGS or digestive system. Cystic fibrosis affects the EXOCRINE cells that produce mucus. This condition causes the exocrine glands to OVERPRODUCE THICK MUCUS which causes airway obstruction. So lots of mucous collects in the lungs. These secreted fluids are normally thin and slippery. But in people with cystic fibrosis, a defective GENE causes the secretions to become STICKY and THICK. Instead of acting as a lubricant, the secretions plugs the airways, ducts and passageways, especially in the lungs and pancreas. This mucus clogs the airways and traps bacteria leading to infections, extensive lung damage, and eventually, respiratory failure. Ultimately it can lead to death due to respiratory failure. - 35 yrs old 3) Emphysema: a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. It is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed. It usually is from smoking. Alveoli get bigger. The alveoli lose their elastic recoil and air gets trapped ... eventually the alveoli get damaged and destroyed. - Symptoms include SOB, persistent cough, wheezing, increased RR - The main two types of emphysema pt's: - Pink Puffers: Emphysema (from puffing / smoking) - Blue Bloaters: Bronchitis (B=B=B ... Bloater = Bronchitis = Barrel Chest) 4) What is hypertension (HTN): A condition in which blood pressure is persistently elevated - Measured as systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg. - Symptoms may not be recognized until blood pressure becomes dangerously high producing HA's, confusion, visual changes, fatigue, arrhythmia's, or tinnitus. Interventions are lifestyle changes as well as medical intervention (medications). 5) Myocardial Infarction: - Heart attack. MI = ischemia of heart muscle which results in muscle tissue death (necrosis) from coronary artery getting blocked and heart muscle thus not getting blood / O2 and dying. When MI happens, necrosis of the tissue happens and heart muscle doesn't regenerate (it dies). A CABG is thus needed to reroute blood past necrotic artery/tissue. - Widow Maker: A full occlusion of the left coronary artery is called ... or MI to LCA (left coronary artery) or LDA (left anterior descending artery) is: WIDOW MAKER - Thrombus, atherosclerosis, HTN, elevated cholesterol, inactivity, smoking, DM II, obesity, family history, etc. - Chest pain, L shoulder and arm pain, jaw pain 6) - CHEST PAIN (heavy chest) ... Angina - Referred pain in chest and upper left extremity (Angina) - Jaw pain - Dyspnea - Nausea / vomiting - "impending doom" - Pale (cyanosis) - HTN - Pain, weak, fatigued 7) Troponin - These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood 8) - Transmural Infarction: FULL thickness necrosis (cell death) through the entire ventricular wall from endocardium (deep) to epicardium (superficial). So, all of the layers of the heart muscle are impacted / dead. - Subendocardial Infarction- PARTIAL thickness on the subendocardial portion of ventricular wall – (epicardial aspect of muscle tissue is spared and doesn't die so there is LESS tissue damage). 8A) Transmural: existing or occurring across the entire wall of an organ or blood vessel. All the way through. 9) - STEMI or ST-elevation myocardial infarction is caused by a sudden complete (100%) blockage of a heart artery (coronary artery). (=INFARCTION) - Non-STEMI (NSTEMI) is usually caused by a severely narrowed artery but the artery is usually not completely blocked (=ISCHEMIA). - False. It is opposite / other way around. ST segment elevation indicates infarction 10) Peripheral vascular disease (PVD) is a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm. This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise. Essentially the lumen (or inside of the vessel) narrows typically due to atheroscleorsis. Most pt's develop this condition secondary to DM II, Obesity, Inactivity, HTN, high cholesterol, smoking, or even family history. It is important to help pt's change lifestyle, stop smoking, exercise, lose weight, change diet, check limbs for wound / wound management, and medical intervention as necessary.

Question 97

1) What is a pneumothorax: - What is a tension pneumothorax: 2) What is an embolism: - What is a pulmonary embolism: - s/s of a pulmonary embolism - What is best way to diagnose a pulmonary embolism? 3) What is a Restrictive Lung Disease - Examples include: 4) What is tuberculosis (TB): - s/s include:

Answer 97

1) A pneumothorax occurs when air (blood, puss, object, fluid) gets in the pleural cavity of the lungs (or pleural cavity gets ruptured). So air from lungs leaks, or air from outside seeps in. THIS CAUSES THE LUNG TO COLLAPSE. Pt's will experience significant chest pain, SOB, hypoxemia, cyanosis, and hypotension. - A tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function 2) Embolism: When an artery gets clotted and the clot dislodges and travels elsewhere w/in a blood vessel to lodge at a distant site from origin. - Pulmonary Embolism: Occurs due to some venous thrombus that gets detached and travels from somewhere else in the body but gets lodged in a pulmonary artery. - s/s: dyspnea/ SOB, coughing, coughing up blood, hypoxia, chest pain - Angiogram 3) Refers to a group of lung diseases that prevent the lungs from fully expanding with air. This restriction makes breathing difficult. Many forms of restrictive lung disease are progressive, getting worse over time. However, some causes of restrictive lung disease can be reversed. Examples of restrictive lung disases are: chest wall stiffness, scoliosis, tumor, respiratory muscle weakness, pulmonary fibrosis, pleural effusion, rib fracture, SCI, etc. Obviously something is blocking lungs from being able to fully expand, thus causing SOB and dyspnea. 4) A disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. It is highly contagious / infectious spread through airborne transmission. s/s will include: fever, chills, fatigue, COUGH UP BLOOD, weight loss, decreased appetite, night sweats, etc. Left untreated, it can be fatal. It is diagnosed based on a skin test with a small amount of tuberculin injected in the forearm and you watch for the skin's reaction over next 48 hours.

Question 98

1) What is the integumentary system - T or F: It is the body's largest organ - What does integumentary system include - What is the most superficial layer of skin called? - Is the epidermis vascularized? - From point above, how do you know - True skin layer is called: - Is that layer (from point above) vascularized? 2) So layers from outside down to bone are what: 3) What are the phases of normal wound healing (just name each phase): - Explain each of those 3 phases - what happens, how long they last, etc. 4) What are the various "healing by Intention" options: 5) What are the various things that impact wound healing:

Answer 98

1) Skin - True - Epidermis layer, dermis, hair follicles, glands (sweat), nails - Epidermis - No - Dry flaking skin (epidermis) doesn't bleed when it comes off - Dermis - Yes 2) Epidermis, dermis, subcutaneous tissue, fascia, muscle / ligament / tendon (with nerves and vessels all throughout), then bone 3) Bleeding, then Inflammatory phase, proliferative phase, maturation phase/remodeling - Inflammatory Phase (1-10 days): When you get a wound, it will immediately start to swell - this is inflammation. Clotting (platelets) form, WBC's come to area to kill foriegn bodies, RBC's come to heal damaged tissue, etc. Re-epithilialization occurs where new skin is put down. - Proliferative Phase (3-21 days): Granulation tissue forms and begins to fill wound bed full of epithilial cells. Wound closes, granulation / epithilialization and wound contraction. - Maturation Phase (7 days to 2 years): This is the REMODELING phase. Once granulation tissue and epithilial tissue appear in wound bed, remodeling phase has started. Scar forms and appear red and fibers contract and regain tensile strength. 4) - Primary Intention Healing – This occurs where the tissue surfaces have been approximated (closed). This can be with stitches, or staples, or skin glue (like Derma bond), or even with tapes (like steri-strips). This kind of closure is used when there has been very little tissue loss. It is also called “primary union” or “first intention healing.” An example of wound healing by primary intention is a surgical incision. - Second Intention Healing – A wound that is extensive and involves considerable tissue loss, and in which the edges cannot be brought together heals in this manner. This is how pressure ulcers heal. Secondary intention healing differs from primary intention healing in three ways: The repair time is longer. The scarring is greater. The chances of infection are far greater. - Tertiary Intention Healing – This type of wound healing is also known as “delayed” or “secondary closure” and is indicated where there is a reason to delay suturing or closing a wound some other way, for example when there is poor circulation to the injured area. These wounds are closed later. Wounds that heal by tertiary intention require more connective tissue (scar tissue) than wounds that heal by secondary intention. An example of a wound healing by tertiary intention is an abdominal wound that is initially left open to allow for drainage but is later closed. 5) - Nutrition: proper nutrition - Moisture: balance between mascerated and descicated (using proper dressings) - Age: Epidermis thins as you age, making it more fragile and suseptible to injury. Plus the older you get, the worse metabolism you have, so wound healing is worse. - Co-morbidities: DMII or other vascular diseases can delay or inhibit proper healing. - Edema: Inflammation is normal, but excessive edema or lymphedema delays wound healing. - Wound Care: Failure to care for / protect a wound can delay wound healing. - Infection: Infectious bacteria delay wound healing. - Lifestyle: The more you exercise and the better your nutrition, helps wound healing. - Medication: Meds can help or negatively effect wound healing. - EXERCISE

Question 99

*** 1) Where would you typically find/see an arterial insufficiency wound? - Where would you typically find/see an venous insufficiency wound? - Where would you typically find/see a neuropathic (DM II) wound? 2) How would arterial insufficiency ulcers appear/look? - How would venous insufficiency ulcers appear/look? - How would neuropathic / DM II ulcers appear/look? 3) What would exudate be like with arterial insufficiency ulcers? - What would exudate be like with venous insufficiency ulcers? - What would exudate be like with neuropathic ulcers? 4) What pain would someone feel with an arterial insufficiency wound? - What pain would someone feel with an venous insufficiency wound? - What pain would someone feel with an neuropathic wound? 5) What pedal pulses would someone feel with an arterial insufficiency wound? - What pedal pulses would someone feel with an venous insufficiency wound? - What pedal pulses would someone feel with an neuropathic wound? 6) Of the 3 wound types from ?s above, which one would have the most edema? - Which of the 3 would have a diminished skin temperature? - Which of the 3 would have an increased skin temperature? - Which one would have hair loss: - Which one would be dry and flaking: - Which one would be shiny: - If you elevate your leg, this wound type will get better: - If you elevate your leg, this wound type will get worse:

Answer 99

1) Lower leg and foot/toes on dorsum of foot and lateral malleolus. - Medial malleolus - Plantar foot (due to weight bearing / shearing) 2) Small, round, dry, smooth edge, well defined, lack granulation tissue, deep, shiny, dorsum of foot/lateral - Irregular shape/edges, larger, wet, shallow - Well defined oval, little wound bed, some necrosis, plantar foot 3) Minimal (dry) ... scant - Lots (moderate/heavy) ... copious - Low (moderate) 4) Severe - Mild to moderate - None (neuropathy) 5) Faint / diminished / absent - Normal - Diminished / absent 6) Venous insuff. - Arterial and neuropathic - Venous - Hair loss: arterial - Dry/Flaking: Venous - Shiny: Arterial - Venous - Aterial

Question 100

* *** 1) What is the difference between Braden Scale and Wagnar / Wagner Scale 2) What are the stages for the Braden Scale: 2A) Scores (cut off) for Braden scale: 2B) Another name for a pressure ulcer 3) What is a pressure injury/ulcer: - How often should you move a pt that is laying on their back? - How often should you move a pt that is sitting? - What areas of the body do people typically get a pressure injury/ulcer? 4) Terminology: - What does rubor mean? - Turgor: - Epithelial: - Granulation: - Slough/necrotic fibrous tissue: - Eschar: - Undermining: - Tunneling: - Sinus Tract: - Fistula: - Scant: - Copious: - Serous: - Sanguineous - Sero-sanguineous: - Purulent: - Chylous: - Periwound: - Debridement: - Dessication vs. Maceration: - Viable vs. non-viable: 5) So again, what is Braden Scale for: - With the Braden scale, is a high score or a low score better? - What is the Wagnar Scale? - Grade 5 on the Wagnar scale is what: 6) List the different types of wounds one can get: 7) Depth of wounds are classified into 3 categories: - Again, what are the 3 phases of healing: 8) What are: - Primary Dressings: - Secondary Dressings: - Tertiary Dressings: 9) For dressing types, what are: - High absorbers: - Medium Absorbers: - Low Absorbers: 10) So which one is the HIGH absorber ... a hydrofiber or hydrogel? 10A) Can you use a hydrogel dressing on a wound with significant drainage? - Can you use a Foam dressing on a wound with significant drainage? - Can you use a Transparent film dressing on a wound with significant drainage? - Why is Gauze so commonly used on wounds? - Is an alginate used on wounds with a lot of exudate or a little exudate? - And why is alginate specifically used for 11) Can you use a silver based dressing when using e-stim? - Most common topical used 12) How many Grades are there for the Wagnar scale: - What is this scale used for? - What are the grades for this scale (describe each): 13) In a sentance describe the difference between a venous and an arterial insuff. wound: 14) Describe the flow of lymph through the lymph system: - What is one way during an exam to know if someone has lymphedema - What is that (from point above) 15) How are pulses rated: 15A) What is difference between rating system for pulses vs. deep tendon reflexes? 16) What is Rubor of dependency 17) Sometimes wounds can be classified as: Red, Yellow, or Black. Explain each: 17A) Related to point 17 above, what would you do for each of these types of wounds 18) Would you debride viable or non-viable tissue? 19) Explain each type of debridement below: - Sharp Debridement: - Enzymatic Debridement: - Autolytic Debridement: 20) What are some other mechanical forms of debridement:

Answer 100

1) Braden: The Braden Scale is to help rate or predict a pressure injury/ulcer. It uses a scores from less than or equal to 9 to as high as 23. The lower the number, the higher the risk for developing an acquired ulcer/injury. There are six categories within the Braden Scale: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. You get a 4 if you are good in the area, and a 1 if you are bad. LOWER SCORES mean you are more prone to get a pressure injury. There are 6 categories, 4 is the most you can get in all but 1, for a total of 23 points. - Wagnar: THis is the scale to determine the extent of a neuropathic / DM II wound 2) - Stage 1: Intact skin, non-blanchable. No real visible changes, if so, superficial layer - Stage 2: Partial-thickness wound with skin loss (dermis exposed). Wound bed is viable and red. - Stage 3: Full thickness, deep wound, but bone/muscle/tendon/lig are NOT exposed. - Stage 4: Full thickiness, deep wound, but bone/muscle/tendon/lig are exposed. - Unstageable: Full thickness but tissue damage is so much or eschar/slough make it impossible to grade. ``` 2A) 23: Perfect score 15-18: Mild risk to get a Pressure Injury (PI) 13-14: Mod risk " 10-12: High risk " <9: Severe risk " ``` 2B) Decubitus ulcers = pressure ulcers. 3) A pressure ulcer is where skin breaks down due to pressure in a certain area. Typically these develop in patients who are bed-ridden or immobile. The areas of concern are the bony prominences because you do NOT have as much tissue covering the bony prominences (calcaneus, knees, hips, sacrum, elbows, shoulders, occiput). - 2 hours laying on back or side is the limit - 15 mins is the limit in sitting position - Over a bony prominence (occiput, elbow, hips, sacrum, calcaneus, spine, scapula, ischial tuberosities) 4) - Rubor: Red - Turgor: how flexible the skin is (older people have worse/less turgor as they age) - Epithelial: outer cell layer - Granulation: pink/red, granular-looking (this is GOOD, means healing) - Slough/necrotic fibrous tissue: soft, moist, dead fibrous tissue, white/yellow/tan/brown/green - Eschar: brown or black necrotic tissue (dead) - Undermining: undermining occurs when the tissue under the wound edges becomes eroded, resulting in a pocket beneath the skin at the wound's edge - Tunneling: wounds that reach through layers of tissue, often including deeper skin layers and muscle, forming tracts, or tunnels. They are among the most difficult types of wounds to heal - Sinus Tract: A tunneling wound or sinus tract is a narrow opening or passageway extending from a wound underneath the skin in any direction through soft tissue and results in dead space with potential for abscess formation - Fistula: Passage between 2 wounds or structures - Scant: Minimal - Copious: A lot - Serous: Clear, thin, watery plasma. It's normal during the inflammatory stage of wound healing and smaller amounts is considered normal wound drainage - Sanguineous: red (bloody) - Sero-sanguineous: Pink (mix of blood and clear serous) - Purulent: yellow / puss / infected - Chylous: drainage is milky, white drainage that occurs after abdominal surgeries where there is trauma to the cisterna chyli or adjacent lymphatic trunks. - Periwound: 4cm around edge of wound - Debridement: Removal of damaged tissue - Dessication vs. Maceration: Dry vs. wet (macerated = wet) - A NON-viable wound is necrotic, whereas viable means it has granulation tissue and can/will heal. 5) Rating or predicting a pressure injury - High score is better, low score is more prone to a Pressure Injury - For DM II ulcers, grading the extent of the neuropathic ulcer - Extensive/full gangrene (4 is partial gangrene, 3 is infectious) 6) - Pressure injury - Diabetic Ulcer (Neuropathic) - Thermal / Burn - Surgical incision - Vascular (arterial or venous insufficiency) - Traumatic - Infectious 7) Superficial, partial thickness, or full thickness - Inflammation, proliferative, remodeling 8) - Primary Dressings: First layer of dressing to fill or cover wound (fill, NOT stuff. And primary is NOT for compression) - Secondary Dressings: Covers a primary dressing, provides a closed or protective environment. Used for compression, keep primary dressing down, get excess exudate. You need a secondary if wound is a bit deeper or has more exudate (or both) - Tertiary Dressings: May further secure, absorb, and/or provide compression 9) - High absorbers: Alginate, Hydrofibers, …. Foam, Gauz (For more FULL thickness, high exudate wounds) - Medium Absorbers: Foam, Gauz (just depends on thickness and how much you put on). For secondary dressings primarily for excess exudate - Low Absorbers: Collagens, Hydrocolloids, Hydrogels, Transparent films. (For LOW exudate, more shallow, Stage I and II type wounds) 10) Hydrofibers (alphabetical … F is HIGHer than G … f for fiber, g for gel) 10) NO (they are for low exudate wounds, more for protective covering over wound to keep it moist) - Yes - No (these are more to protect and cover wound, more for superficial wounds with minimal drainage) - It absorbs drainage, it also acts as debridement tool since it adheres to wound bed, can be used on infected or non infected wounds, wet or dry wounds, etc. - A lot of exudate - Infected wounds 11) NO - Lidocain 12) 6 - DM II or neuropathic ulcers typically - Grade 0: No open lesion - Grade 1: Superficial ulcer (no involvement of subcutaneous tissue) - Grade 2: Full thickness w/o infection, exposing bone/tendon/muscle/lig - Grade 3: Full thickness/deep with infection (osteitis, abscess, osteomyelitis) - Grade 4: Partial gangrene (ie: one digit) - Grade 5: Full/extensive gangrene (ie: entire foot) 13) Arterial: pale, hairless, cool to the touch, edema is usually not present, pulses usually absent. - Venous: weepy, wet…often in LE, color may be cyanotic, pulses may be present, pitting edema is likely, stasis dermatitis at periwound (staining of skin), shallow ulccers. 14) - Lymph capillaries > collecting lymph vessels > lymph nodes > lymphatic vessels of LE > thoracic duct > subclavian vein. - Stemmer's Sign - Stemmer’s sign: thickening of the skin over the proximal toes and phalanges-> inability to tent the skin ``` 15) • 0 = absence • +1 = barely perceptible • +2 = diminished • +3 = normal • +4 = stronger, pounding…common in Charcot neuropathy. ``` 15A) Deep tendon reflexes is normal at 2+, whereas with pulses, normal is 3+ 16) Pt is supine, the extremity is then passively elevated to 45 degrees and held for one min. The foot blanches w/arterial insufficiency. Normally foot color should return to pink WITHIN 15 SECONDS of being returned back down to the table. Arterial disease the color returns in greater than 30 seconds and returns dark red (rubor) = positive test. 17) Red: Granulation healing tissue - Yellow: Slough or infected - Black: Necrotic / eschar or dead tissue 17A) Red: let is heal, maintain moist environment, protect wound. - Yellow: remove slough, absorb drainage, remove exudate - Black: Debride necrotic tissue 18) Non-viable 19) - Sharp Debridement: Use scalpel or scissors to remove non-viable tissue or debris from a wound. - Enzymatic Debridement: Using some topical application of enzymes on the surface of necrotic tissue. - Autolytic Debridement: This is the body's own mechanisms to remove non-viable tissue. Basically you get a dressing (transparent films, hydrocolloids, hydrogels, alginates, etc.) and place over wound to allow it to soften and liquidify to fall off in time. 20) - Wet-to-Dry Dressings: Applying a moistened guaze dressing on necrotic tissue. Wet dressing is allowed to dry and is removed later with necrotic tissue adhered to dressing. - Wound Irrigation: This is like Pulsatile Lavage - where you use pressure of a liquid to remove non-viable tissue from wound bed. - Hydrotherapy: This is like whirlpool where tissue is softened so dead tissue can fall off.

Question 101

1) They used to classify burns as 1st degree, 2nd degree, 3rd degree - but not any more. Now it is based on depth of the burn. How many levels / classifications are there: - What are they: 2) From point above, explain each: 2A) So if the burn did the superficial epidermis layer and a top portion of the dermis, it would be classified as: - " deep into subcutaneous layer - " only epidermis - " deep into bone / muscle 3) What is the Rule of Nines 4) Related to rule of 9's, what % of the body would be burned for the section below: - Head and Neck: - Anterior Trunk: - Posterior Trunk: - Entire arm, forearm, hand: - Entire leg and foot: - Genital region: 5) Define these terms: - Autograft: - Allograft: - Xenograft: - Heterograft: 6) T or F: Heterograft and Xenograft are the same thing (synonymous)

Answer 101

1) 5 - Superficial burn, superficial partial thickness burn, Deep partial thickness burn, full thickness burn, and Subdermal burn. 2) - Superficial burn: Burn involving only the outer epidermis layer. The area may be red with some edema. Heels in 2-5 days without scarring. - Superficial Partial Thickness Burn: Involes the epidermis and upper portion of the dermis. BLISTERS may show up. Healing occurs with no scarring in 5-21 days. - Deep Partial Thickness Burn: Complete destruction of epidermis and majority of the dermis. It will blister and swell, nerve endings will be damaged, it will be painful. If not infected, it will heal in 21-35 days with some scarring. - Full Thickness Burn: Complete destruction of epidermis and dermis layers and even subcutaneous fat layer. This burn requires a GRAFT and is suseptible to infection. - Subdermal Burn: This is the worst as it penetrates deep down into bone / muscle / tendon / lig, and surgical intervention is required. 2A) Superficial partial thickness (it would have blisters) - Full thickness - Superficial - Subdermal 3) The rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate the body surface area on an adult that has been burned by using multiples of 9 4) - Head and Neck: 9% - Anterior Trunk: 18% - Posterior Trunk: 18% - Entire arm, forearm, hand: 9% ... for each - Entire leg and foot: 18% ... for each - Genital region: 1% 5) - Autograft: skin graft from their own body. - Allograft: skin graft from a donor. - Xenograft: graft from an animal (pig or cow) - Heterograft: Skin graft from another species 6) TRUE

Question 102

1) What is your endocrine system - What happens with pathology to some part of the endocrine system: 2) Name the glands for each region of the body: - BRAIN: - NECK: - CHEST: - KIDNEYS: - PANCREAS: - PELVIC: 3) What hormone(s) does this gland produce: - Pineal: - Hypothalamus: - Pituitary: - Thyroid: - Parathyroid: - Adrenal Glands: - Pancreas: - Reproductive: 4) Posterior pituitary gland releases 2 hormones (the rest are from anterior). What are those 2: 5) Which of all the glands is the MASTER GLAND 6) Which gland maintains and monitors for homeostasis, or is the COMMAND CENTER 7) What is a Diuretic 8) If you had a ADH deficiency, it would lead to what condition? - What is this condition: 9) What is Hyperthyroidism - Hyperthyroidism disease 10) What is hypothyroidism 11) When you think of parathyroid, think of: - What does parathyroid hormone do: 12) What does cortisol do: - When cortisol is overproduced, it is called: 13) Does the cortex or medulla produce epinephrine and norepinephrine? 14) Function of insulin:

Answer 102

1) The endocrine system is the collection of glands that make and secrete hormones directly into the circulatory system to be carried towards distant target organs/glands/cells. Like neurons carrying electrical action potentials to create change/movement in body, hormones do the same. - If your endocrine system isn't healthy, then each hormone needed for homeostasis could become hyper or hypo active (or not work at all). You also might have problems developing during puberty, growing properly, getting pregnant, producing milk, giving birth, sexual arousal, insulin management, weak metabolism, or managing stress. You also might gain weight easily, have weak bones, or lack energy because too much sugar stays in your blood instead of moving into your cells where it's needed for energy. 2) - BRAIN: pineal gland, hypothalamus, and pituitary gland - NECK: Thyroid and parathyroid glands - CHEST: Thymus is between your lungs (goes away with time) - KIDNEYS: Adrenals are on top of your kidneys - PANCREAS: behind your stomach. - PELVIC: ovaries in a women, testes in a man. 3) - Pineal: Melatonin (regulates sleep cycle) - Hypothalamus: Monitors hormone levels in body and then sends signals / controls the release of the 2 hormones to posterior pituitary gland, and the 6 in anterior pituitary gland. - Pituitary: - Posterior pituitary gland releases 2 hormones (the rest are from anterior). What are those 2: Oxytocin and ADH (antidiuretic hormone ... or vasopressin) - Anterior pit gland releases 6 hormones - 2 Anterior pituitary lobe conditions Hyperpituitarism (oversecretion of GH leading to acromegaly and giantism) Hypopituitarism (decreased secretion of GH leading to dwarfism or Panhypopituitarism) Giantism is overgrowth of long bones, acromegaly is thickness of bones - Thyroid: - Hormones: T3 (tri) and T4 (thyroxine), Calcitonin - Target Organ: liver - Function of each: METABOLISM - Parathyroid: - Hormones: PTH - Target Organ: Bone, kidney, GI - Function of each: Calcification of bone (CALCIUM) - Adrenal Glands (Kidney): Cortex - Hormones: cortisol, aldosterone - Target Organ: many - Function of each: metabolism, inflammation, electrolyte balance, stress balance Medulla: - Hormones: adrenaline (epinephrine, NE, dopamine) - Target Organ: widespread - Function of each: fight or flight - Pancreas: - Hormones: insulin, glucagon - Target Organ: liver - Function of each: glucose homeostasis - Reproductive: OVARIES: Women - Hormones: estrogen, progesterone (and testosterone) - Target Organ: many (mainly uterus and breast) - Function of each: female characteristics / menstrual Cycle TESTES: Men - Hormones: testosterone - Target Organ: many - Function of each: male characteristics 4) Oxytocin and ADH (antidiuretic hormone ... or vasopressin) 5) Pituitary 6) Hypothalamus 7) Drug to help pass urine or remove fluid from body 8) Diabetes insipidus - An uncommon disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty even if you've had something to drink. It also leads you to produce large amounts of urine 9) If you have hyperthyroidism, it means your thyroid is overactive and produces too much thyroid hormone which increases metabolism. - Grave’s disease 10) Not producing enough Thyroid hormone = slow down metabolism 11) Calcium - Will sense if blood calcium levels are too low, and signal to create more 12) Reduces stress (also metabolism, and anti-inflammatory) - Cushings syndrome 13) Medulla 14) Remember that Insulin transports glucose out of blood and into cells for use as energy (and excess goes to the liver for storage as glycogen).

Question 103

1) What is metabolism: - What is Catabolism: - What is anabolism: 2) What is a metabolic disorder - A metabolic bone disease is: - Acid-base metabolic disorders 2A) What is metabolic syndrome: - What causes it: 3) What is the endocrine system - Give examples of what the endorcrine system regulates in the body 4) What does this hormone do: - Prolactin - Oxytocin - Antidiueretic hormone: 5) What is hypopituitarism: - So what is hyperpituitarism: 6) Where is the Thyroid gland located - What hormones does the Thyroid produce - What does T3 and T4 do? - What does Calcitonin do? 7) What is Hypothyroidism: - WHat does it result in - s/s are what: 8) What is hyperthyroidism: - WHat is the common condition associated with hyperthyroidism - s/s are what: - The most evident s/s of hyperthyroidism is exophthalmos. What is that: 9) Where is the parathyroid gland - WHat hormone does this gland produce - What's the function of that hormone (from point above) - What is the difference in function of Calcitonin vs. Parathyroid hormone 10) Hypoparathyroidism results in what - Hyperparathyroidism results in what - Increased bone reabsorption would happen from which one (from points above) - Hypocalcemia would happen from which one (from points above) 11) What is the adrenal gland: - T or F: when you think of adrenal gland, think kidney, thus function of kidney 12) The adrenal cortex (outer portion) produces what hormones, and what are the function of those hormones 13) What hormones does the adrenal medulla produce - DIfference between those 2 hormones (from point above) 14) What are the 2 main pathologies from an adrenal pathology: - Explain both pathologies (from point above): - Which one of those 2 is overproduction of hormones from adrenal gland - Which one would you see abdominal fat build up 15) What are 2 main hormones produced by pancreas - Is pancreas an exocrine or endocrine gland - Hormone producing cells of pancreas are called: - Alpha cells produce ________ hormone, beta cells produce _______ hormone 16) What does insulin do: - What does glucagon do: 17) Difference between Type I and Type II Diabetes: 18) DM II is typically in adults or children - DM I or DM II is more common - WHich one has a solution / cure / treatable - T or F: In DM II, the pancreas does not produce insulin - What is an A1C test - What is good and what is bad A1C reading 19) What is an A1C test? 20) What are blood glucose levels (few hours after eating) for normal, pre-diabetic, and diabetic - The 'after eating' glucose tests (for data above) is called: 21) What are blood glucose levels (when fasting) for normal, pre-diabetic, and diabetic - The 'fasting' glucose tests (for data above) is called:

Answer 103

1) Metabolism: Breakdown of complex organic compounds (through chemical reactions) in order to generate energy for all bodily processess. It also generates energy from the synthesis of substrates (carbs, fats, protiens) - Catabolism - the breakdown of molecules to obtain energy (like break down of carbs/sugars, protiens/amino acids, and fats) to create ATP - Anabolism - the synthesis of all compounds needed by the cells 2) When some metabolic process (chemical reaction, too much hormone/enzyme, or not enough hormone/enzyme, injury to gland) etc. - Osteoporosis - Metabolic acidosis or alkalosis 2A) A cluster of conditions that increase the risk of heart disease, stroke, and diabetes. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, insulin resistance, and abnormal cholesterol levels. The syndrome increases a person's risk for heart attack and stroke. - Obesity (high BMI) 3) System in the body of several glands that produce hormones that travel through bloodstream to target cells to regulate homeostasis to ensure chemical reactions are happening in body. Certain hormones only have receptor sites on certain organs / cells. - Growth, blood pressure, glucose control, stress levels, metabolism sexual reproduction, fluid balance (water and salt), etc. 4) - Prolactin: causes lactation in women (lactin = lactate) - Oxytocin: causes uterus contraction during labor (ox giving birth) - Antidiueretic: causes water retention (retain fluids) 5) When there is a decreased or absent hormonal secretion from the ant. pituitary gland. This could result in dwarfism, delayed growth or puberty, sexual/reproduction disorders, diabetes insipidus. - When there is excess secretion of ant. pituitary gland so you get conditions like giantism, acromegaly, infertility, impotence, etc. 6) Anterior neck (goiter) - Thyroxine (T4), Triiodothyronine (T3), and calcitonin (and ant pit. gland releases the thyroid-stimulating hormone to trigger these to work). - Increases cellular metabolism - Increases calcium storage in bone and decreases blood calcium levels. 7) Decreased levels of T3 and T4 - Decreased metabolism - Fatigue, weight gain, delayed puberty, developmental delay, depression, lethargic 8) Excess levels of T3 and T4 - Grave's Disease - Nervous, sweating, weight loss, enlarged thyroid gland (goiter) - Big buldging eyes 9) Four parathyroid glands are found on the thyroid gland (lateral side of the gland) on the neck - Parathyroid hormone (PTH) - Counteract Calcitonin (which takes Ca+ out of blood into bone for bone reabsorption) and it will increase blood calcium levels - Parathyroid hormone acts to increase blood calcium levels, while calcitonin acts to decrease blood calcium levels. This interaction between parathyroid hormone and calcitonin is also an important part of bone remodeling 10) Low blood calcium levels, resulting in hypocalcemia, muscle cramps, muscle pain, seizures - Excessive calcium, so excessive bone metabolism. You'll get kidney stones, kidney damage, depression, memory loss, bone deformity, myopathy - Hyperparathyroidism - Hypoparathyroidism 11) Gland at top of each kidney (outer portion called the cortex, inner portion the medulla). Produces corticosteroids that will regulate water and sodium balance, body's response to stress, and metabolism. - True (fluid / ion balance) 12) Aldosterone: Increases reabsorption of sodium ions by the kidneys, and increases excretion of potassium ions in urine. Ion / Mineral balance. - Cortisol (glucocorticoid): metabolism of food, stress 13) Epinephrine and Norepinephrine - Epinephrine and norepinephrine are very similar neurotransmitters and hormones. While epinephrine has slightly more of an effect on your heart (increase HR and contraction), norepinephrine has more of an effect on your blood vessels (vasoconstriction). Both play a role in your body's natural fight-or-flight response to stress 14) Addison's disease and Cushings Syndrome - Addison's: Hypofunction of the adrenal cortex, so decreased production of cortisol and aldosterone. - Cushing's: Hyperfunction of adrenal gland, so excessive cortisol production - Cushing's - Cushing's 15) Insulin and Glucagon - Both - Islets of Langerhans - Alpha produce glucagon, beta cells produce insulin 16) Insulin: Decreases blood glucose levels by taking surgar to body's cells and stores excess glucose in liver as glycogen - Glucagon: Increases blood glucose levels in blood by stimulating stored glycogen in liver into glucose in blood for energy 17) Type I: Inherited, mainly in children, from pancreas not producing beta cells to produce insulin. Will need exogenous insulin injections. NO CURE. - Type II: Developed, mainly in adults (and some obese kids), mainly from diet and lifestyle choices. Could be due to excess sugar intake, or inappropriate cellular response to insulin. Typically one has hyperglycemia (high blood sugar) and pancreas can't produce enough insulin or receptors become resistant. Treat through diet, exercise, meds, insulin injections. 18) Adults - DM II - DM II - False - Monitor of blood sugar levels over 3 months - 5.7 and below is good, 5.7-6.4 is pre-diabetic, and 6.5+ is diabetic 19) HbA1C Test: measures blood sugar levels over 3 months. Hb (Hemoglobin) is a protein that blood sugar binds to (like O2 does). With diabetic patients, they either do not produce insulin (Type I) or they don’t produce enough insulin or cell receptor sites won’t accept insulin. So, sugar stays bound to Hemoglobin, and thus in the blood. This HbA1C test detects how much sugar is bound to hemoglobin. You want this result to be less than 5.7% (or around 100 mg/dL of blood sugar). Higher than this number indicates diabetes. 20) Normal: 140 and below - Pre-diabetic: 140-200 - Diabetic: 200+ - IGT (Impaired Glucose Tolerance Test): 21) Normal: 100 and below - Pre-diabetic: 100-125 - Diabetic: 125+ - IFG (Impaired Fasting Glucose Test):

Question 104

1) What is the GI system (what does GI stand for): - What is the function of the GI system 2) What is the upper portion of the GI tract (the anatomy) - Lower GI tract includes what anatomy - What is the jejunum and ileum - What is function of duodenum - Is the jejunum or ileum first part of small intestine - Is stomach part of upper or lower GI tract 3) Main difference in function between small and large intestine - Which one is longer? 4) Once food leaves small intestine it enters large intestine. Name the anatomical parts of the large intestine in order of how food travels 5) What is the function of the gallbladder - What is function of the liver - What is function of pancreas - How to remember which portion is the endocrine funciton 6) What are some pathologies you'd see with the esophogus: - What are some pathologies you'd see with the stomach: - What are some pathologies you'd see with the intestines: - What are some pathologies you'd see with the rectum or anus: - What are some pathologies you'd see with the Gallbladder: - What are some pathologies you'd see with the liver: - What are some pathologies you'd see with the pancreas: 7) What is Crohn's Disease 8) What is the medical term for: - Gallbladder: - Kidney: - Liver: - Stomach: - Spleen: - Intestine: 9) What do these medical terms mean: - ectomy - Acou - Adip - Hema - aesthesi - Algia - arthr - articul - cyte - lithiasis 10) You should know what abdominal structures are in each of the 4 quadrants of the abdomen. List below what structures are in each quadrant: - Left upper: - Right upper: - Left lower: - Right lower:

Answer 104

1) Gastrointestinal - Responsible for the digestion of food. Breaks down food, absorbs nutrients, discards waste 2) Mouth, esophogus, stomach - Duodenum, jejunum, ileum, colon, rectum - Small intestine portions - It is section between stomach and small intestine that starts chemical digestion (mixes in bile from gallbladder/pancreas) - Jejunum - Upper 3) The small intestine (small bowel) is about 20 feet long and about an inch in diameter. Its job is to absorb most of the nutrients from what we eat and drink. ... The large intestine (colon or large bowel) is about 5 feet long and about 3 inches in diameter. The colon absorbs water from wastes, creating stool - SMALL 4) Cecum (portion at junction), ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus 5) Stores and releases bile into duodenum to help with digestion - Produces bile, helps create RBC's, regulates carbs / protiens / fats, stores glycogin, filters blood - Exocrine: secretes enzymes to help with digestion (secretes into duodenum); Endocrine: secretes insulin and glucagon into blood. - Endocrine is hormones, so the inulin/glucogon portion is endorcrine (releasing enzymes for digestion is exocrine) 6) Esophogus: hiatial hernia, GERD (gastro-esophogeal reflux disorder), esophageal cancer, dysphagia. - Stomach: Gastritis, peptic ulcer, gastric cancer, motility disorder - Intestines: Malabsorption syndrome, appendicitis, irritible bowel syndrome, Crohn's disease, ulcerative colitis, colon cancer, intestinal hernia, diverticulis - Rectum/Anus: Rectal or anal cancer, hemorrhoids, anorectal fistula, rectal fissure - Gallbladder: Gallstones (cholelithiasis), Cholecystitis, gallbladder cancer - Liver: Cirrhosis, jaundice, hepatitis, ascites, liver cancer, heptamegaly - Pancreas: pancreatic cancer, DM II, pancreatitis 7) Crohn's: Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people. 8) - Gallbladder: Chole - Kidney: Nephron - Liver: Hepatic - Stomach: Gastro - Spleen: Spleno - Intestine: Entero 9) - ectomy: removal / excise (surgical removal of) - Acou: hearing - Adip: fat - Hema: Blood - aesthesi: sensation - Algia: pain - arthr: joint - articul: joint - cyte: cell - lithiasis: the formation of stony concretions (calculi) in the body, most often in the gallbladder or urinary system. 10) - Left upper: Stomach, part of transverse and descending colon, most of pancreas, spleen - Right upper: liver, gallbladder, head of pancreas, duodenum, part of small intestine, part of transverse and ascending colon - Left lower: descending and sigmoid colon, part of small intestine - Right lower: appendix, cecum and start of ascending colon, part of small intestine

Question 105

1) What anatomical structures are found in the genitourinary system - What are anatomical structures in the male genital system: - What are anatomical structures in the FEmale genital system: 1A) What does endometrium mean 2) What is renal failure - What is acute renal failure - What is chronic renal failure - What would be main medication to give pt in renal failure - Renal failure often requires this medical intervention 3) What is urinary incontinence: - What can a PT do to treat this 4) What is difference between these: - SUI: Stress Urinary Incontinence - UUI: Urge Urinary Incontinence - OUI: Overflow Urinary Incontinence - FUI: Functional Urinary Incontinence

Answer 105

1) Kidney's, ureter's, bladder, urethra - Penis, testes, scrotum, epididymis, prostate - Ovaries, uterine tubes, uterus, cervix, vagina 1A) This is the inner layer of the uterus 2) A condition of the kidneys where kidneys are failing - kidney's experience a decrease in glomerular filtration rate and fail to adequately filter toxins and waste from the blood. - Acute: sudden decline in kidney function, increased BUN and creatine levels, sodium retention, could be to hemmorrage or kidney stone or embolism or neoplasm - Chronic: progressive decline in renal function due to DM II, HTN, cyst, nephritis - Diuretic - Hemodialysis (or transfusions) 3) Involuntary loss of urine, but enough that it is a problem for the pt. When bladder pressure exceeds sphincter resistance. - Pelvic floor muscle training / kegals (bladder retraining) 4) - SUI: Loss of urine due to activities that increase intra-abdominal pressure (like: sneezing, coughing, running, jumping) - UUI: Loss of urine after a sudden intense urge to void due to detrusor muscle of the bladder involuntarily contracting during bladder filling - OUI: Loss of urine when the intra-bladder pressure exceeds the urethra's capacity to remain closed due to urinary retention - FUI: Loss of urine due to the inability or unwillingness of a person to use the bathroom facilities prior to involuntary bladder release

Question 106

1) What happens to rib cage of a pregnant woman - Would oxygen consumption, blood volume, and cardiac output increase or decrease during pregnancy? - In a supine position, what would happen to blood pressure to a pregnant woman? - T or F: Pregnant women do not experience ligament laxity? - How to remember this - Condition pregnant women get where abdominal m's are stretched: - From point above, how would you test to see if a woman has this? - The seperation must be greater than _______ (what distance) to actually be diagnosed (from 2 points above) 2) Should pregnant women exercise during pregnancy? - What position should women avoid when exercising? - T or F: balance is thrown off during pregnancy - T or F: Appetite increases during pregnancy to ensure baby gets calories? 3) What are some contraindications for exercise during pregnancy:

Answer 106

1) It expands due to uterus expansion - Increase - Hypotension (pressure on inferior vena cava) - False - During pregnancy women release the Relaxin hormone which causes lig laxity - diastasis recti (seperation of the R and L sides of the rectus abdominis at linea alba) - Have them lay supine and do a crunch - 2 fingers width 2) YES (mild to mod exercise - nothing vigorous). About 3-5 times p/wk. - Supine - Yes of course - weight of abdomen throws center of gravity off - True ``` 3) ABSOLUTE: - Heart disease - Lung disease - Bleeding RELATIVE: - Severe anemia - Chronic bronchitis - Type I DM - Obesity - HTN - Smoker ```

Question 107

1) What is the study of oncology? - What is cancer? - Is a neoplasm caner? - These are also called? - What does Benign and Malignant mean? - Are neoplasms benign or malignant? - What does metastasize or metastasis mean? 2) What is the accronym to detect cancer? - What does this accronym stand for? 3) For cancer (or any co-morbidity), what is primary prevention, secondary prevention, and tertiary prevention: 4) Examples of primary prevention: - Secondary prevention examples: - Tertiary examples include: 5) What are the suffix's you'll see associated with cancer? - What are the different types of skin cancer: 6) What are the connective tissues in our body? - Cancer of the connective tissues is called - Examples of these (from point above) - Is a sarcoma malignant or benign - Review again the difference between malignant and benign - What is the benign bone tumor called - Malignant bone tumor is: 7) Based on the prefix and suffix, what cancer type would these be: - Neuroblastoma: - Lymphoma: - Leukemia: - Myelodysplasia or Multiple Myeloma: **** 8) What is staging of cancer: *** 9) HOW DO YOU STAGE CANCER: 10) What is grading vs. staging of cancer: 11) What is the TNM system: 12) "In situ" or carcinoma in situ means what:

Answer 107

1) Cancer - Abnormal uncontrolled cell growth within the body - A neoplasm is an abnormal mass of tissue that results when cells divide more than they should or do not die when they should. - Tumor - Benign = not cancer. Malignant = cancer. Malignant cancer cells grow uncontrollably, invade other tissues, can go to distant sites (which is metastacize), destroy body's immune system. - Neoplasms may be benign (not cancer), or malignant (cancer). - It has travelled/spread to other parts of the body (not just the tissues involved) 2) C.A.U.T.I.O.N - C: Change in bowel or bladder - A: A sore that will not heal - U: Unusual bleeding/discharge - T: Thickening / Lump develops - I: Indigestion or difficulty swallowing - O: Obvious change in wart / mole - N: Nagging cough / hoarseness 3) - Primary Prevention - trying to prevent yourself from getting a disease. - Secondary Prevention - Treating it early on and prevent it from getting worse. - Tertiary Prevention - trying to improve your quality of life and reduce the symptoms of a disease you already have (you won't get better, so just improve QOL). 4) Primary: screening or Dr. visit before you ever have a condition; or lifestyle (diet and exercise) choices to prevent getting condition. - Secondary: Take meds or make lifestyle changes now so condition can be reversed (or not progress) - Tertiary: Manage symptoms and limit complications. Make pt comfortable, just improve QOL, pain meds 5) Oma, Sarcoma, oncology - There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the epidermis (the outer layer of the skin) is called basal cell carcinoma. 6) Bone, cartilage, ligaments, muscle, vessels, fat - Sarcoma - Fibrosarcoma, Liposarcoma, chondrosarcoma, osteosarcoma - Malignant - Malignant is cancerous, benign is NOT cancerous (yet) - Osteochondroma - Osteosarcoma 7) - Neuroblastoma: Nerve cancer - Lymphoma: cancer of lymph system (vessels, nodes, sleen, tonsils, etc.) - Leukemia: cancer of WBC's - Myelodysplasia: cancer of bone marrow (from plasma cells) 8) Staging is telling you the extent of the cancer (benign vs. malignant and if it has metastasized to other areas). Staging helps determine extent, to know what treatment is necessary to determine prognosis. * *** 9) - Stage 1: "Early Stage" - A small mass/tumor or abnormal cells have been found. Malignancy is limited to the tissue of origin with no lymph node involvement, no metastasis. - Stage 2: "Localized" - Malignancy is spreading into adjacent tissues, lymph nodes may show early/slight signs - Stage 3: "Regional Spread" - Malignancy that has spread to adjacent surrounding tissues and deeper structures. Other distant lymph nodes may be effected. - Stage 4: "Distant Spread/Metastacized" - Malignancy that has metastasized beyond primary site (from one organ to another) and spread to other parts of the body. 10) - GRADING is a way of classifying cancer CELLS. Grade I – cancer cells that resemble normal cells and aren't growing rapidly. Grade II – cancer cells that don't look like normal cells and are growing faster than normal cells. Grade III – cancer cells that look abnormal and may grow or spread more aggressively. - STAGING is a way of classifying the TUMOR. 11) - T: Tumor - N: Nodes - M: Metastasis TUMOR: - TX means the tumor can’t be measured. - T0 means there is no evidence of a primary tumor (it cannot be found). - T1: (each number represents description of stages above) - T2: " - T3: - T4: so this would be metastasis NODES: - NX means the nearby lymph nodes cannot be evaluated. - N0 means nearby lymph nodes do not contain cancer. - N1- N4 (same as above) METASTASIS: - MO: No metastasis - M1: Distant metastasis Ex: T1N0MX or T3N1M0 or T4N3M1 (last one being the worst) 12) Carcinoma "in situ" refers to cancer in which abnormal cells have NOT spread beyond where they first formed. The words “in situ” mean “in its original place.” These in situ cells are not malignant, or cancerous. However, they can sometimes become cancerous and spread to other nearby locations.

Question 108

1) For psychological disorders, there are different types. Define each below: - Affective disorders: - Neuroses disorders: - Dissociative disorders: - Somatoform disorders: - Schizophrenia disorders: 2) Examples of psychological conditions / disorders in each category: - Affective disorders: - Neuroses disorders: - Dissociative disorders: - Somatoform disorders: - Schizophrenia disorders: 3) What is a hypochondriac? - What is it called when you are sick (physically or mentally) and you fail to recognize, admit it 4) What is bariatrics

Answer 108

1) - Affective disorders: Disorders where there are disturbances of mood, attitude, emotion. States of extreme happiness or sadness occur and mood can alternate without cause. - Neuroses disorders: Disorders where individuals exhibit fear, irrational anxiety, extreme worry (phobia/OCD)and obsessive maladaptive strategies in dealing with stress or everyday life. - Dissociative disorders: When a person unconsciously dissociates (separates) one part of the mind from the rest. - Somatoform disorders: These are classified based on the physical symptoms present. A mental condition manifesting in blindness, paralysis, or other nervous system (neurologic) symptoms - Schizophrenia disorders: Psychotic in nature and present with disorganization of thought, hallucinations, emotional dysfunction, anxiety, etc. 2) - Affective disorders: depression, mania, bipolar (MOOD) - Neuroses disorders: OCD, Anxiety, Phobia (ANXIETY) - Dissociative disorders: Multiple personality - Somatoform disorders: Somatization disorder, conversion disorder, hypochondriasis disorder - Schizophrenia disorders: Paranoid, Schizophrenia 3) Someone who is very worried / fearful about their health or getting sick (believes minor illness is life threatening) - anosognosia 4) The branch of medicine that deals with the study and treatment of obesity

Question 109

1) What is Addison's Disease - What are glucocorticoids and their function? - What are minerocorticoids and their function? - How to remember where the adrenal gland is? 2) The adrenal gland secretes what hormones ... and what do those hormones do? 3) What is Ankylosing Spondylitis: - What are the s/s: - What causes it: 4) What is Appendicitis: - What is the test for ruling in Appendicitis? - How do you do that test (from above) 5) What is arterial insufficiency - How do you treat / help someone with this condition? - s/s of an arterial insuff. wound? 6) Why is Breast Cancer so dangerous? - T or F: It is leading killer of women in the U.S. - What is diagnostic tool to rule in breast cancer? - What is procedure to remove breast cancer: 7) What is Cellulitis: - Is it contagious? 8) What is Chronic Fatigue Syndrome: 9) What is complex regional pain syndrome - How does it happen / develop? - s/s of CRPS? - Examples of how this would happen/develop? - What is cause / etiology? 10) What is Crohn's Disease 11) What is Cushing's Syndrome - Typical s/s - What causes it: 12) What is fibromyalgia: - What are s/s of fibromyalgia: - What causes fibromyalgia: 13) What is a full thickness burn: 14) What does GERD stand for: - What is GERD: 15) What is GOUT - s/s of Gout 16) What is Grave's Disease - What are s/s - How do you treat it - Main symptom indicating someone has this? 17) The more common name for Herpes Zoster? - What is this condition? 18) What does HIV stand for: - What is HIV - HIV leads to what? 19) Is HIV / AIDS contagious? Meaning as a PT working with them, is it contagious? - Primary risk of contracting HIV is: 20) What is Juvenile Rheumatoid Arthritis (or Juvenile Idiopathic Arthritis) - Do boys or girls have a higher incidence? - What causes it: - s/s of this condition: 21) What is multiple myeloma - What is malignant melanoma: - How to remember: 22) A neuropathic ulcer would occur in a pt with what condition - It is also called: 23) What is osteoporosis: 24) What is a partial thickness burn 25) What is a Peptic Ulcer 26) Lupus is also known as: - What is it: - What is the classic s/s for lupus: - What other s/s are common to LUPUS 27) What is Urinary Stress Incontinence: - Types of urinary stress incontinence are: 28) What is a Urinary Tract Infection - Common s/s of a UTI is:

Answer 109

1) Addison's disease, also called "Adrenal insufficiency," is an uncommon disorder that occurs when your body doesn't produce enough of certain hormones. In Addison's disease, your adrenal glands, located just above your kidneys, produce too little cortisol and, often, too little aldosterone. - Glucocorticoids: Glucocorticoids are a class of corticosteroids ... are powerful medicines that fight inflammation, help with metabolism, and stress (cortisol). - Minerocorticoids: Also a corticosteroid, but this is aldosterone, which influences salt, electrolyte, and water balances in the body. - ad"renal" ... so above kidney 2) - Cortisol: A steroid hormone that regulates a wide range of vital processes throughout the body, including metabolism, anti-inflammation, stress, and the immune response. It has a very important role in helping the body respond to stress. - Aldosterone: affects the body's ability to regulate blood pressure. It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine. It causes an increase in salt and water reabsorption into the bloodstream from the kidney thereby increasing the blood volume, restoring salt levels and blood pressure. - Epinephrine and Norepinephrine: helps with sympathetic response in body. 3) An inflammatory arthritis affecting the spine and large joints. Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the small bones in your spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply. It is a "spondy" so a class of arthritis of the back. - s/s: pain, stiffness, low back pain, men 2x more likely to get it than women (age 20-40), kyphotic posture - Idiopathic, genetics 4) Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. It is inflammation to the inner lining of the appendix, and the pain spreads and hurts extremely bad (main pain in right lower quadrant of abdomen). Typically it is ruled in through pain with percussion of area, rebound tenderness, guarding. - McBurney's Point. - How to do McBurney's Point: Find umbilicus (belly button) and draw a line down to ASIS. About 2/3rd's of the way down from umbilicus on that line is the appendix. Apply pinpointed pressure at that point with your finger. If pt is in a lot of pain with this, typically indicates appendicitis. 5) Any condition that slows or stops the flow of blood through your arteries due to arteries getting clogged. This causes a lack of oxygen to get to cells (and if an ulcer forms, it won't heal quickly or correctly). It could be from DM II, obesity, atherosclerosis, smoking, etc. Another name is Peripheral Artery Disease (PAD), and it is when there is insufficient blood flow to your extremities — usually your legs — and they don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication). Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs. - Treat: You often can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet. - s/s: You will know if someone has arterial insufficiency due to small dry whitish wounds on the feet due to poor blood supply. Wound will be shiny, lack hair in the area, be dry, long capillary refill, wound on dorsum and lateral foot, long rubor of dependency, claudication pain, etc. Whereas venous insufficiency wounds are wet, larger, edema, wound on medial foot, etc. 6) Breast cancer can spread easily due to cancer being right by axillary lymph nodes, so it metastasizes to lungs, liver, bones, even brain. - True. Breast cancer is leading cause of death in females in the U.S. - Mammogram - Massectomy: Removing part or all of a breast with breast cancer. 7) Cellulitis is a common, but sometimes painful bacterial skin infection. It may first appear as a red, swollen area that feels hot and tender to the touch. The redness and swelling can spread quickly. It most often affects the skin of the lower legs, although the infection can occur anywhere on a person's body or face. - No. Non-contagious 8) Chronic fatigue syndrome (CFS) is a disorder characterized by extreme fatigue or tiredness that doesn't go away with rest and can't be explained by an underlying medical condition. It essentially is extreme and constant exhaustion. The etiology is unknown, but could be from immune response or lifestyle factors (diet, exercise, sleep habits). This is typically managed through education, sleep changes, diet changes, therapy, exercise, and meds if necessary. There is no cure, and how it resolves is variable depending on the person. 9) Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) following an injury. - It usually after an injury, stroke, surgery, or even heart attack. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. - s/s/: It is evidenced by an increase in sympathetic nervous system activity: changes in skin color, temperature changes, sweating, burning. The effected part becomes hypersensitive, so the pt stops using the limb and then atrophy starts to occur in m's. - Examples: a stubbed toe causes extreme ankle and LE pain, sweating or color changes to entire foot. Following an injury or surgery there is extreme pain and burning of an entire limb. - The exact cause of complex regional pain syndrome isn't well understood but may involve abnormal inflammation or nerve dysfunction. Complex regional pain is characterized by pain that is greater than would be expected from the injury that causes it. 10) An inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition, cramping, blood in the stool, GI tract ulcers, diminished appetite, etc. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people. 11) A disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. It is hypercortisolism. Cortisol is sometimes called the “stress hormone” because it helps your body respond to stress. Simply put - it is overproduction of cortisol so you have abnormally high amounts of cortisol in your body. - Most typical s/s is the abdomen will be larger (FAT deposits) with LEGS being SKINNY. So fat loss in arms and legs, but abdomen and neck and face have fat gain. - Causes: Some people get it from excessive steroid use (corticosteroids, glucocorticoids), or some malfunction in the endocrine hormone system. 12) This is a condition not fully understood, but is essentially characterized by multiple pain points throughout entire body (need to have 11+ of 18 specific points experiencing pain to be properly diagnosed). Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals For example, someone could come in with pain points in the back, shoulders, neck, UE's, and down in bilateral ankles. Pain may have started in one area, but spread over time, and then led to sleep pattern changes, fatigue increasing, irritable bowel symptoms, etc. It could have been from an injury, emotional stress, or repetitive injuries. - Hypersensitive (all over) > Pain all over body (multiple areas / joints) > Constant pain > Cognitive changes ... fogginess, forgetfulness > ADL's impacted due to pain or hypersensitivity > Pain for months that didn't come on by some MOI / trauma > Pain starts in one area that spreads to diff. body parts > Sleep patterns change (less sleep) > Fatigue > Irritable Bowel Syndrome > Numerous myofascial tender points (trigger points) all over body in multiple areas > Depression - Stress from job / family / finances / peer pressure / etc. > Trauma that leads to neurological and psychological chronic pain > Overuse injury > Degeneration of joints 13) Remember they don't classify burns now as 1st degree, 2nd degree, and 3rd degree. But a 3rd degree burn would be a full thickness burn. Essentially epidermis, dermis, subcutaneous and deeper layers like bone / muscle / tendon / ligament all effected. Nerve endings are burned and thus don't provide sensation, but pain in surrounding partial thickness areas send pain signals. Graft is needed over burn area. 14) Gastroesophageal Reflux Disease - This is when stomach acid, or digested food/water frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of your esophagus and cause "heart burn" or chest pain. It feels like the food is trapped in the esophagus. 15) Gout is a kind of arthritis caused by a buildup of URIC ACID crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. A form of arthritis characterized by severe pain, redness, and tenderness in joints > URIC ACID in joints > Severe pain > Redness > Swelling in joints which causes intense pain > Often swelling of the BIG TOE. > Attacks can come suddenly, often at night. > Sensation that the BIG TOE is on fire > Affected joint is hot, swollen, tender (so with big toe, even the sheet on it is irritating) > Can get it in the knee and ankle (and other joints) as well > You'd find uric acid in synovial fluid to help diagnose it 16) This is hyperthyroidism (hyperactive thyroid). Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. - Symptoms include: anxiety, hand tremor, heat sensitivity, weight loss, wide puffy eyes and enlarged thyroid, heat intolerance, increased appetite, sweating, insomnia. - Treatment: medicaitons, removal of thyroid - Big wide eyes (scary eyes) ... exophthalmos 17) Shingles - Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area (usually the trunk), with itching, and burning. It basically is a reactivation of the chickenpox virus (varicella zoster virus VZV) in the body, causing a painful rash. The disease chickenpox is caused by the initial infection with VZV. Anyone who's had chickenpox may develop shingles. It isn't known what reactivates the virus. Shingles causes a painful rash that may appear as a stripe of blisters on the trunk of the body. Pain can persist even after the rash is gone (this is called postherpetic neuralgia). 18) Human Immunodeficiency Virus - A virus that attacks a human's immune system, so immune system won't work properly. Spread by sexual contact. And it can't be cured (person has it for life). HIV attacks certain cells in the immune system and prevents them from carrying out their proper immunity functions against microbes. When the immune system is sufficiently weakened, infected people catch atypical and severe infections. This is then called the Acquired Immunodeficiency Syndrome, or AIDS. - AIDS = acquired immunodeficiency syndrome - If not treated, HIV can lead to AIDS. You can't ever get rid of AIDS, but can manage through ANTIRETROVIRAL drugs to help boost immune system. 19) NO - Unsafe sex 20) JRA is often referred to by doctors today as juvenile idiopathic arthritis (JIA), is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. An autoimmune disorder when immune cells mistakenly begin to attack the joints and organs causing local and systemic effects throughout body. - Girls usually have a higher incidence than boys. - Idiopathic, genetics - s/s: > Persistent joint pain > Joint swelling and stiffness > Some children may experience symptoms for only a few months, while others have symptoms for the rest of their lives. > Fever, swollen lymph nodes and rash 21) Cancer of the plasma cells. The plasma cells are a type of white blood cell in the bone marrow. With this condition, a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys, and red blood cell count. - Skin cancer. Melanoma occurs when the pigment-producing cells that give color to the skin become cancerous. Very serious due to the high likelihood of metastasis that develops in melanin-producing cells responsible for giving skin its color. First sign is a suspicious change in the appearance of a freckle or mole through asymmetry, irregular borders, uneven coloration or increased diameter. - Multiple is the CDC - complete blood count, but this is of plasma cells 22) Diabetes - Diabetic ulcer 23) A condition the rate of bone resorption accelerates while the rate of bone formation slows down. It essentially is where bones become weak and brittle, so can't hold weight as well. As you age, you can develop compression fractures (or any fracture) resulting in more thoracic kyphosis. Because of this posture, there is a greater moment arm (spine will bend out more) … so more torque with head pulling down, and that creates more pressure or wedge fractures on spinal column. Anterior vertebral body gets thinner as weight of body bears down on it over time. Weakened bone over time. Bones get old, people don't exercise and strengthen them (put pressure and resistance on them), etc. So bone becomes weak and wears down over time. 24) Unlike full thickness that gets down past subcutaneous layers to bone / muscle / tendon, a partial thickness burn involves the epidermis and upper portion of the dermis layers. You can have a partial thickness or a deep thickness (deep obviously being deeper, but not a full thickness burn). These burns will appear red, blanch when touched, and heal with time. 25) These are sores that develop in the lining of the stomach, lower esophagus, or small intestine (GI tract). They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem. Pt's experience a burning pain after eating, heartburn, fatty food intolerance, hematemesis. 26) Systemic Lupus Erythematosus - Systemic Lupus Erythematosus is a long-term autoimmune disease in which the body's immune system becomes hyperactive and attacks normal, healthy tissue. Symptoms include inflammation, swelling, and damage to the joints, skin, kidneys, blood, heart, and lungs. It is a connective tissue disorder caused by an autoimmune reaction in the body, and females are at greater risk than males (typically age 15-40 yrs old). - Red butterfly rash across cheek and nose - Skin rashes, fever, fatigue, malaise, PHOTOSENSITIVITY (she wore glasses), dyspnea, cough, and peripheral neuropathies are all common findings in patients who have systemic lupus erythematosus 27) This occurs when there is an increase in abdominal pressure - an activity such as coughing, sneezing, lifting, or exercising causes a small amount of urine to leak from the urethra, which is the tube urine passes through. It is involuntary loss of urine with any form of exertion. Stress incontinence (SI) is the most common type of incontinence suffered by women, especially older women. - SUI: Stress Urinary Incontinence - UUI: Urge Urinary Incontinence - OUI: Overflow Urinary Incontinence - FUI: Functional Urinary Incontinence - SUI: Loss of urine due to activities that increase intra-abdominal pressure (like: sneezing, coughing, running, jumping) - UUI: Loss of urine after a sudden intense urge to void due to detrusor muscle of the bladder involuntarily contracting during bladder filling - OUI: Loss of urine when the intra-bladder pressure exceeds the urethra's capacity to remain closed due to urinary retention - FUI: Loss of urine due to the inability or unwillingness of a person to use the bathroom facilities prior to involuntary bladder release. 28) A UTI is an infection in any part of your urinary system — your kidneys, ureters, bladder and/or urethra. When some infectious organism enters the urinary system, a UTI develops. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than are men. - A strong and persistent urge to urinate, as well as a burning sensation with urination. Also, commonly people can experience low back pain when they have a UTI.

Question 110

1) What is an arthrogram 2) What is doppler ultrasound used for? 3) What is a bone scan for? 4) If you used iontophoresis (applying a med over skin), how often should you check skin for burns? 5) If you used the Braden scale, how is scoring done? - The scoring factors in what? 6) What is the difference between planes of motion and axis of movement? - So sagittal motion is around what axis of movement? - Frontal motion is around what axis of movement - Axial (rotation/transverse) motion is around what axis of movement 7) What is the relationship of speed / velocity of a concentric contraction to the force generated? 7A) Related to the point above, the faster the speed, the less force needed. However, let's imagine someone doing a bicep curl ... if the person had a 2lb weight and a 4lb weight and lifted each at 1 second each, which one would produce more power? - If you had a 4 lb weight that did a bicep curl in 1 second, and a 4 lb weight that did a bicep curl in 4 seconds, which one would produce more power? - So what is the point with regards to question 7 and 7A 8) When doing e-stim, the standard unit of measure when recording alternating current frequency is: 9) A diastasis recti must be how large to be diagnosed? 10) Males and females obviously have differences in the size of their lungs. What lung value would be MORE in men? 11) What is the difference between obstructive and restrictive lung conditions? - What are examples of each? 12) Blood pH levels are what normally - Skin has a pH level of what? *** - True or false: an acidic skin reaction would cause pH to be low (1-2) 13) If someone has chronic pain, should you use modalities? 14) The BERG balance scale is out of how many points? - What is cut off for ROF? 15) What is syncope? - What is example of how it would be caused? 16) Respiratory acidosis is when pH is ______ (high or low) due to hypoventilation - Respiratory alkalosis is when pH is ______ (high or low) - If someone is taking oral potassium chloride, they would have a respiratory or metabolic acidocis/alkalosis? 17) Difference between muscle hypertrophy and hyperplasia? - Which one is NOT possible? 18) Hematocrit is what? - So a high hematocrit number is usually a result of what? - Low hematocrit condition is what? - Normal hematocrit is what amount? 19) People with right homonymous hemianopsia would have difficulty seeing on what side? - This happens from a CVA to what artery? 20) Blood is produced where? - Blood cancer of WBC's is called: - Blood cancer of plasma cells is called: - Cancer of lymph system is: 21) A blood test would reveal what to differentiate DM I vs. DM II 22) Occlusion to the ACA would manifest with more UE or LE manifestations (weakness and sensation)? - How to remember point above? - Occlusion to MCA would manifest how - PCA would manifest how - An occlusion to what artery would manifest in aphasia? - Why (from point above) 23) If you don't have taste on posterior 1/3'rd of tongue, what CN is impacted? - Anterior tongue taste is innervated by what CN? - So what does Hypoglossal CN (XII) do? 24) Ultrasound MUST have a coupling agent. What are some examples? - Will ultrasound work on direct skin? - Ultrasound to see blood flow movement is called: - If you have a hard / strange / irregular body surface, what coupling agent would you use? 25) Pulmonary angiography is used for what - This is the diagnostic test of choice to rule in what condition? 26) A "communication board" in a hospital setting is used for what? - Would it be used for someone who couldn't speak English (spoke Spanish for example) - Who would they be used for 27) Would a pulmonary embolism typically happen as a result of a blood clot forming in UE or LE's - *** What is time frame for when these typically happen? - So remember the ? of who would be most suseptible for a PE ... a sedentary woman who is obese, or a middle age man who had surgery 3 weeks ago? 28) What is a D-Dimer blood test for? - SO what is an example condition the test would rule in /out - How to remember? 29) *** If you did a RSC to a Grade III muscle strain, would it be weak? - If you did a RSC to a Grade III muscle strain, would it be painful? - If you did a RSC to a Grade I muscle strain, would it be weak? - If you did a RSC to a Grade I muscle strain, would it be painful? 30) If a pt can't reach forward and grasp steering wheel, what could it be because of: 31) What is abulic aphasia - How to remember? For the one's below, what type of aphasia is this: - Impaired/difficulty speaking (or producing language) = - Inability to understand/comprehend, but can speak fine = - Inability to produce or comprehend language = 32) What is Addison's Disease - From point above, how to remember? - What is the opposite of Addison's - So what is Grave's Disease - Which of the 3 above causes HYPERreflexia? - Adrenal glands are located where, and produce what? - Aldosterone is hormone for what - Too much aldosterone causes what? 33) What type of wound is this: ulcers are typically shallow, irregular in shape, have a lot of exudate / macerated, and are usually in lower limb proximal to medial malleolus. - What type of wound is this: small, round, partial thickness wound on the lateral malleolus with distinct wound edges - What type of wound is this: wounds are commonly on plantar side of foot where shear of weight bearing cause ulcer where pt can't see or feel. - What type of wound is this: from sustained/prolonged pressure on tissues with no movement. Around bony prominences - Another name for a pressure ulcer? 34) If a pt is uncordinated and clumsy with balance issues, what part of brain is most likely damaged? - If a pt is just slow - slow to initiate movement, what part of brain is most likely damaged? - Slow movements is called: - Often you see this slow movement pattern in what condition? - Medulla Oblangota damage wound manifest how? - Hippocampus damage wound manifest how? 35) A halo vest cervicothoracic orthosis is worn for what / when 36) Coughing up blood is a common s/s for what condition? 37) Which heating agent would require the GREATEST temperature .... whirlpool, ultrasound, paraffin, or diathermy - What is diathermy: 38) Common med prescribed for neuropathic pain 39) Alternative medicine examples include: 40) Nociceptive means what:

Answer 110

1) It is an xray that uses an injected dye to visualize joint structures. Dye is injected into the joint for images to be taken. You can see fluid leakage if there is a tear in any part of joint cavity. This is used in most major joints. 2) This ultrasound is typically used to view blood flow in major veins, arteries, and cerebrovascular system. 3) Bone scan uses radioactive isotopes to identify areas of bone that have high bone mineral turnover (stress fracture). Bone scans view for bone diseases and see if bone is metastasizing 4) Every 3-5 mins 5) This is for pressure injuries, so the higher the BETTER. 23 is perfect (no risk for pressure sore). 15-18 is mild, 13-14 mod, 10-12 is high risk, and below 9 is severe risk to get a pressure injury - Sensation, movement, activity, friction/shear, age, nutrition, etc. 6) Planes are sagittal, frontal/coronal, and axial/transverse. But an axis of movement is the orientation of the axis. - med-lat - ant-post - Vertical 7) The velocity of muscle shortening during concentric exercise is inversely proportional to the force exerted by the muscle. So the faster the speed, the less force needed (and visa versa). 7A) The 4lb weight would produce more power - Since they are both the same weight, the one that goes fastest produces MORE POWER. - That power generated is different than force of a muscle, and more power requires more speed; whereas the faster speed/velocity requires less force 8) HERTZ (frequency = Hz) 9) 2 finger width apart between muscle belly's of rectus abdominus 10) Inspiratory Reserve Volume 11) Lung conditions are either obstructive or restrictive. Obstructive is when things obstruct air getting in/out. Restrictive is when your lungs just can't move. - Obstructive: COPD or emphasema or bronchitis. - Restrictive: pregnancy, fibrosis, broken rib, accessory muscle weakness, etc. 12) pH can be from 1-14 (lower being acidic, higher being alkalitic). Normal pH of blood is between 7.35-7.45 - 3-4 - True 13) NO 14) 56 - 41 15) Syncope refers to a loss of consciousness often resulting from insufficient blood flow to the brain. The condition comes on fast, like orthostatic hypotension. - Going from supine to sitting would bring on syncope as blood flow is decreased in brain. Me getting up fast and running into oven :) 16) Low - High - metabolic alkalosis 17) Hypertrophy is larger muscle mass, hyperplasia is more muscle fibers - The actual number of muscle fibers does NOT change (hyperplasia does not happen, but hypertrophy can). 18) % of RBC's in blood - Dehydration (less plasma / liquid in blood, so higher RBC count) - Anemia - 38-45% 19) Right - MCA 20) Bone marrow - Leukemia - Multiple Myeloma - Lymphphoma (Hodgkin's or Non-Hodgkins) 21) High level of keytones in blood. In type I, not enough insulin can get glucose to cells, so it breaks down fat as a result to get energy, leading to high levels of keytones. 22) LE - Homonculus has LE in middle, so ACA - MCA is UE and face - Vision - MCA - Because MCA supplies blood to Broca's and Wernicke's area 23) CN IX (9) - Glossopharyngeal - CN VII (7) - Facial - Tongue movement (tongue m's) 24) Gel, water, lotion, oil, etc. - No - Doppler ultrasound - Normally direct contact with a coupling gel would work, but irregular body surfaces are hard with ultrasound, so you can use water (but don't need gel + water). Just water immersion. 25) Pulmonary angiography looks at blood flow in vessels specifically in/through the lungs. - Pulmonary embolism 26) Used for pt's having difficulty communicating? - NO. They'd use an interpreter typically - Someone with an aphasia having difficulty speaking (Broca's aphasia) 27) LE's - 2-10 days post surgery - Sedentary woman who is obese since the guy is past the 2-10 day window 28) A D-dimer blood test helps determine if there is a blood clot. It helps rule in/out a thrombos - DVT - D = D, D Dimer for Dvt 29) YES - NO (it is grade 3, so no pain) - Slightly, but much stronger - YES (much more pain than a grade III) 30) Nerve entrapment (not RC since flexion isn't effected, not adhesive capsulitis either since flexion isn't part of capsular pattern) 31) delayed response time to questions, mutism, reduced social interactions and reduced interest are common. - U = U (mutism = abulism) - Broca's or expressive - Werneke's or receptive - Global aphasia 32) Addison's is from adrenal dysfunction where adrenal cortex is in HYPOfunction. So there is a decrease in cortisol and aldosterone produced, so weakness and fatigue - Ad = Ad (Addisons = Adrenal Glands) - Cushing's - overproduction or hyperfunction of adrenal glands hormones - Hyperfunction of Thyroid gland - Graves - On kidney, and produce cortisol and aldosterone - Regulator of the salt and water balances of the body - High blood pressure 33) Venous insuff. - Arterial - Neuropathic / Diabetic - Pressure ulcer/injury/wound - Decubitus ulcers = pressure ulcers. 34) Cerebellum - Basal Ganglia - Bradykinesia - Parkinson's - It controls nervous activity like: respiration, HR, vomitting, coughing, sneezing - Hippocampus: In temporal lobe, responsible for memory 35) Spinal fracture (most likely in cervical or upper thoracic region) 36) PE (Pulmonary embolism) ... TB 37) Paraffin - A medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot. 38) Gabapentin 39) homeopathy, acupuncture, dry needling, tai chi 40) Pain

Question 111

1) Would cryotherapy cause vasoconstriction or vasodilation? - Would heat cause vasoconstriction or vasodilation? 2) They will ask a question about carpal bones. How to remember them? - Most fractured carpal bone? - T or F: bone from above has poor blood supply? - How do you palpate it? 3) If the shoulder does dislocate, will it dislocate posteriorly or anteriorly - Is the shoulder the most dislocated joint in the body? - Anterior shoulder dislocation of shoulder places what nerves in jeapordy of injury - What injury is (often) caused by an anterior shoulder dislocation 4) What are bursa - How is bursitis diagnosed 5) What is a Colles' fracture - What is another fracture of the distal radius - How are they different? - How to remember that? 6) Most commonly fractured metacarpal bone is: - What is that fracture called: 7) What are the collateral lig's of the fingers - Are these collateral lig's of the finger tight/taut during flexion or extension? - So are these lig's loose during flexion or extension? 8) On the finger, does the flexor digitorum superficialis or profundus tendon go father (more distal) in it's distal attachment 9) A fracture of the metacarpals is called a: 10) What m's does the accessory nerve innervate? - What m's does the axillary n innervate 11) Upper trap fibers do what action 12) The lat muscle is innervated by what nerve: - Where does it originate and insert? - What are it's actions 13) The levator scapulae muscle is innervated by what nerve: 14) Explain difference in actions of deltoid and supraspinatus in abducting the arm 15) All 4 of the rotator cuff m's essentially all insert at common tendon at what bony landmark? - The RC m's obviously provide movment to G/H joint, but they also provide what: - Supraspinatus and Infraspinatus m's are innervated by what nerve 16) Teres Major muscle is innervated by what nerve - Biceps muscle is innervated by what nerve - What other muscle(s) is innervated by the nerve supplying the biceps - Biceps reflex test is for what nerve roots 17) Pollicis and Hallucis - which one is for the thumb? 18) After the brachioradialis muscle ... list the m's in order going down the forearm: 19) How to remember intrinsic hand m's (what is neumonic) - What does it stand for (what m's) - What nerve innervates these intrinsic m's of the hand? - What is condition when extrinsic hand m's/tendons take over - Special test for ulnar nerve grasp / adductor pollicis (grasping and holding a peice of paper when pulled) 20) Lumbrical m's of the hand do what action - Origin of these m's is where - They insert / attach where - Innervation of these m's is what 21) The interosseous m's have PAD and DAB. Explain - How many ABductor interossei m's are there? - How many ADDuctor interossei m's are there? - Are the thumb and little finger involved in these PAD and DAB m's? WHy or why not 22) *** Power grip of hand primarily comes from ______ nerve muscles. - Pinching grip comes from _____ nerve muscles. - So holding a ball or can is mainly using _____ nerve 23) ALL THINGS BRACHIAL PLEXUS: - What is mneumonic to remember big divisions for brachial plexus 24) For the roots (R) of the brachial plexus, what are they - What are the trunks (T) of the brachial plexus - What are the cords (C) of the brachial plexus - What are the branches (B) of the brachial plexus - Axillary and radial n's come off what cord? - Median nerve comes from what cords? - Ulnar nerve comes from what cords - Musculocutaneous n comes from what cord 25) Would the brachial plexus be of ventral or dorsal rami of cervical nerve roots? - How do you know that (from point above) or how to remember? 26) Brachial plexus injury to C5-C6 is called what - How does this happen 27) Main vein on lateral upper arm / forearm - Main vein on medial upper arm / forearm - Are these deep or superficial v's - Main superficial vein of anterior leg: - Main superficial vein of posterior leg: - Deep v's or arm and leg are what:

Answer 111

1) Cold creates vasoconstriction - Heat creates vasodilation 2) So long the pinky, here comes the thumb - Schaphoid - True - Within the anatomical snuffbox 3) Anteriorly - Yes - Axillary and musculocutaneos - Bankart lesion 4) Synovial lined fluid filled sacs that act as cushions that protect tendons and ligaments, protecting them, and allowing movement with less friction - X-ray 5) Fracture of the distal radius - Smith's fracture - Colles is when radius fragment goes posterior/dorsal; Smith's is when fracture portion goes anterior/ventral - The Smiths are out in front with church history 6) 5th - Boxer 7) Like all collateral lig's, they are on the side providing medial and lateral support to DIP and PIP jt's - Flexion - Extension 8) Profundus 9) Boxer fracture 10) SCM and Traps - Deltoid and Teres Minor 11) Elevate shoulder (shrug) and help with UE elevation (or upward rotation of scapula). They also laterally flex head and bilaterally they work together to extend head 12) Thoracodorsal nerve - Spinous processes of lower t-spine and thoracolumbar fascia, lower ribs, and iliac crest. It inserts up into intertubercular groove of humerus - Elevate lower trunk (with arms fixed), extension of UE, IR of UE, adducts UE 13) Dorsal scapular nerve (C4/5) 14) They both contribute to UE elevation, but the supraspinatus only up to about 90 deg's. And remember what Steve taught you - supraspinatus also does humeral head depression, which is important to prevent impingement 15) Greater tubercle of humerus - Stability. They are dynamic stabilizers of that joint - Suprascapular n 16) Lower subscapular nerve - Musculocutaneous n - Coracobrachialis and brachialis - C5-C6 (mainly C5) 17) Pollicis 18) Extensor carpi radialis longus, extensor carpi radialis brevis, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus 19) All for one and one for all - Abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, adductor pollicis, opponens digiti minimi, flexor digiti minimi, abductor digiti minimi - Recurrent branch of median does thumb m's, Ulnar nerve does all others - Claw hand (intrinsic minus hand) - Froment's 20) Alligator hand (flex MCP jt, and extend PIP and DIP jts) - Tendons of the flexor digitorum profundus - Lateral sides of digits 2-5 extensor hood's - Median nerve does medial 2, and ulnar does lateral 2 21) AB = abduction, and AD = adduction. P = palmer. D = dorsal - 4 - 3 - NO - they have the little abductor, flexor, and opponens m's for each 22) Ulnar nerve - Median - Ulnar ``` 23) R: roots (RUGBY) T: trunks (TEAMS) D: divisions (DRINK) C: cords (COLD) B: branches (BEER) ``` 24) C5-T1 - Superior, Middle, Inferior - Lateral, Posterior, medial - Musculocutaneous, median, ulnar, axillary, radial - Posterior cord - Lateral and medial **** - Medial - Lateral 25) Ventral - Because these n's supply m's (so an action or efferent), so ventral is motor 26) Erb's palsy (Waiter's Tip) - Injury or birthing process tears C5-C6 nerve roots to UE becomes paralyzed/weak essentially 27) Cephalic v - Basilic v - Superficial - Great saphenous v. - Small saphenous v. - Arm is brachial, leg is tibial

Question 112

1) If a pt is dependent and needs assistance of a care giver, how frequently should they be repositioned in bed to prevent pressure injuries? - Should care givers inspect skin of this dependent person when they go in and rotate? 2) From least supervision / assistance to most supervision / assistance, name the levels (in order) and what each level requires of the PT 3) It is important to communicate effectively with other therapists and the pt when doing a transfer. If there are more than 1 therapists, who takes command? 4) What are examples of dependent transfers - What are examples of assisted transfers - Would you ever use a slide board for a toilet transfer? - What is a "Stand Step Transfer" 5) Measurements for a w/c for a pt are important. Below - what are the measurement amounts for these aspects of tailoring a w/c to a pt: - How high should seat be from floor - Seat Depth - Seat Width - Back height - Armrest height - From point above, how might that be effected? 6) What is a commode chair 7) What are the different levels of weight bearing. List them and describe them from MOST weight bearing to LEAST weight bearing 8) From MOST support to LEAST support, what are the assistive devices a person could use: 9) For all AD's above, about how much elbow flexion do you want (be it parallel bars, crutches, cane, etc.) - If someone is NWB'ing - what AD can they use? 10) What gait pattern would you use with a walker - Top of crutches should be measured at what body landmark? - Crutch, walker, or cane handle height is positioned at what bony landmark - What gait patterns can be used with crutches - Can lofstrand crutches be used with NWB'ing pt's - From point above, why or why not? - Cuff of a lofstrand crutch should be positioned where - Can you use a cane for someone with PWB'ing restrictions? 11) What are the gait pattern options? - What is a "point" - What is 2 point: - What is 3 point: - What is 4 point: - Which of these is only used with crutches - Which of these is MOST secure/safe - Which is fastest and least secure - 3 point can be used with what AD's - T or F: 3 point is used when someone is PWB'ing or even NWB'ing 12) What is an NG Tube - What is a G Tube - Why might a G tube be better? - What is a J Tube - What is another way, and more common way, to get food / liquids / electrolytes / meds into one's system 13) Would food / liquids / meds be inserted into an artery or a vein? - So what is an arterial line for? 14) What is a central venous pressure catheter for: - Another term for a pulmonary artery catheter 15) What do you NOT want your intracranial pressure to go above? 16) What is an Oximeter used for - What is oximetry 17) What are the 3 different types of urinary catheters - Explain each of them - how/where they are applied and why 18) What is an ostomy device - What is a stoma? 19) What is a chest tube 20) What is an arteriography - Is this the same thing as an angiogram? - So what is arthography - So what is electroencephalography - So what is electromyography - What is myelography - What might myelography imaging try to detect / diagnose? - What is venography

Answer 112

1) Every 2 hours - Yes 2) - Independent (pt doesn't require assistance) - Modified Independent (AD or grab bar) - Supervision (PT observes) - Stand By Assist (SBA - PT just stands by) - Contact Guard Assist or CGA (PT has hands on) - Min Asst (PT helps 0-25%) - Mod Asst (PT helps 25-50%) - Max Asst (PT helps 50-75%) - Total Assist or Dependent (PT helps 75-100% or does it all for pt since they can't) 3) PT at the head of the pt 4) Dependent: 3 person lift, 2 person lift, hydraulic lift, and a squat pivot transfer - Assisted: Stand pivot, slide board - NO (too dangerous) - Stand Step transfer is used when a pt has strength and balance ability but just requires supervision or guarding from the PT (and pt steps vs. pivots) 5) - Seat: From feet flat on ground to popliteal fossa, go up 2 inches so feet can set on footrest - From popliteal fossa to back of buttocks, minus 2 inches (so not too much pressure at knee) - As wide as their hips PLUS 2 inches - Up to inferior angle of scapula - With arms at 90 deg's elbow flexion down at side, add an inch - If pt has a seat cushion which adds height 6) Chair with cut out seat for bathroom use (with removable pan), but you can transport the chair 7) - NWB (Non-Weight Bearing): pt can't place any weight through involved extremity - TTWB (Toe Touch Weight Bearing): Just places toes on floor for balance, but doesnt do WB'ing - PWB (Partial Weight Bearing): Put a certain amount of weight through involved extremity. Usually a protocol from a Dr. - WBAT (Weight Bearing as Tolerated): Pt determines how much they can do - FWB (Full Weight Bearing): Can place full weight 8) Wheelchair --> Parallel Bars --> Walker --> Axillary Crutches --> Lofstrand Crutches --> Quad Cane --> Single Point Cane 9) 20-25 deg's - Walker or crutches 10) 3-point - 3 finger width's from axilla - Ulnar styloid process - 2 point, 3 point, 4 point - Yes - You can, but it is harder - 1 inch below olecranon process - NO (cane's are just for balance) 11) 2 point, 3 point, 4 point, swing to, swing through - How many points hit the ground. It can be a foot, a crutch, a cane, or the walker - 2 point: Pt uses 2 crutches or 2 canes and one foot always touches when one cane or crutch touches. - 3 point: One foot and then 2 crutches; or 2 feet and one walker - 4 point: one foot, one crutch/cane, other foot, other crutch/cane - 3 point - 4 point - 2 point - Crutches and walker - True 12) Naso-Gastric Tube, used for feeding pt's who are uncounscious or can't feed themselves (short term liquid feeding or medication administration) - Gastric-Tube: feeding right into the stomach, more for long term feeding / medication administration - No aspiration, those who can't swallow benefit from this - Jejunum tube - straight into small intestine - IV (intra-venous administration - through a vein) 13) Vein - Monitor blood pressure, or obtain blood samples, arterial blood gases measure 14) Measure blood pressure / function in the R atrium or superior vena cava through a catheter inserted down a vein into heart - Swan-Ganz catheter 15) 20 mmHG. Keep it between 10-15 ideally 16) To monitor the oxygen saturation in blood - A device placed on finger typically to monitor O2 levels 17) External, Foley, and Suprapubic - External: On the outside (usually only in males over penis) - Foley: Up into/through urethra to base of bladder - Suprapubic: Surgically inserted right into bladder 18) Bag on outside of body to collect waste/drainage from a surgery. An opening in the abdomen to remove waiste. - A hole or opening in the body 19) Plastic tube inserted into side of chest and uses suction to remove air or fluid or pus from intrathoracic space. 20) Radiograph of a vessel with some dye injected into artery - Yes - This is injecting a die into a JOINT to determine pathology (leakage from a joint capsule/cavity) - Recording electrical activity in the brain - Recording electrical activity in muscle - Imaging of the subarachnoid space in spinal cord (with contrast medium put into epidural space) - Disc herniation, spinal cord compression, tumor - Imaging for the veins (putting contrast medium in to detect clog/block or tumor).

Question 113

1) List all the modalities you can think of: 2) Does heat or cold transfer heat away from the body? 3) What are the different ways heat is transferred: 4) What is conduction: - What is convection: - What is conversion: - What is evaporation: - What is radiation: 5) Examples of things that transfer heat via conduction: - Examples of things that transfer heat via convection: - Examples of things that transfer heat via conversion: - Examples of things that transfer heat via evaporation: - Examples of things that transfer heat via radiation: 6) What is diathermy: 7) What does cryotherapy do (what are the theraputic effects) - T or F: Cryotherapy slows down metabolism and NCV 8) Explain why / when you'd use these cryotherapy methods: - Ice massage: - Cold Pack: - Cold Bath 9) How long should you do ice massage: - How long should you do cold pack: - Should you put a towel between skin and cold pack? 10) What is a cryo cuff and what are benefits of using this? - What form of energy transfer is it? 11) Is Vapocoolant spray a cryotherapy agent? - What form of energy transfer is it? - Proper technique to apply coolant spray is: 12) Which cryotherapy option has the possibility of creating frostbite? 13) Cryotherapy is cold agents, what is term for hot / heating agents? 14) Purpose of or theraputic effects from thermotherapy 15) Would thermotherapy increase or decrease metabolic rate and NCV 16) When would you NEVER use thermotherapy - absolute contraindication - When would you NEVER use cryotherapy - absolute contraindication 17) Examples of SUPERFICIAL thermotherapy - Examples of DEEP thermotherapy 18) **** HOW MANY LAYERS are to be applied using a hot pack **** - Someone should have a hot pack for how long to get theraputic effect?' - Do you need to check skin throughout (if so, how often) 19) What is Fluidotherapy? - How does it work? - What form of energy transfer is it? 20) Infrared lamp is another form of heating up superficial tissue. What form of energy transfer is it? - Do you have to wear goggles for using this device? - How far should the limb / treatment area be from device? 21) Deep heating agents can go how deep? - How many cm in an inch - What is major deep heating agent? - What form of energy transfer is the modality from point above? 22) Most modalities are used for gait control theory. What is that? - What are the noxious / painful nerve fibers - What are the nerve fibers stimulated with a modality that override the fibers from point above 23) You can use ultrasound for imaging soft tissues, but PT's mainly use US for what 24) What are 2 main frequencies used with US: - Which one from point above goes DEEPER into tissues for theraputic effect - T or F: Low frequency gets deeper into tissues 25) *** MUST REMEMBER THESE TIPS WHEN USING US TO BE SAFE: 26) When would you not use US (absolute contraindications) 27) Attenuate means what: - What things do NOT attenuate US waves well - What attenuates US waves well 28) With US, is 1MHz or 3MHz low frequency - Which of those 2 does more superficial tissues 29) T or F: With US, lower frequency needs higher intensity (and visa versa) - Will intensity or frequency determine sound wave depth? - Would you use 1MHz or 3MHz for deeper tissues 30) What does the gel (liquid medium) do: 31) When would you use continuous waves vs. Pulsed waves? - So if it is a 20% pulsed setting - what does that mean - What is a Duty Cycle and how is it calculated? - Is pulsed used for thermal or non-thermal effects? 32) So thermal effects / or thermal mode is used for what? - Non-thermal effects / or non-thermal mode is used for what? 33) For duration of US, an area of 2-3x the size of the probe/head/transducer requires how long?

Answer 113

1) Heat, cryotherapy (cold), US, E-stim (TENS, NMES), Laser, Paraffin, Whirlpool (hydrotherapy), traction, Ionto, Massage, Phonophoresis 2) Cold transfers heat from the body to the cooling agent (and with heat it's opposite where heat transfers from heat pack to body). 3) Conduction, convection, conversion, evaportation, radiation 4) What is conduction: Gain or loss of heat from direct contact between two materials of different temp's. Heat goes from object of higher temp to the object of lower temp. - What is convection: Gain or loss of heat by moving air or water across the body - What is conversion: When some electrical source converts energy into heat within the body - What is evaporation: Transfer of heat as a liquid absorbs energy and changes form into a vapor - What is radiation: Transfer of heat from a radiation energy source of higher temp to a cooler object 5) Conduction: Heat pack, ice pack, paraffin, body heat - Convection: whirlpool, fluidotherapy - Conversion: diathermy, ultrasound - Evaporation: vapocoolant spray - Radiation: Infrared lamp, laser, ultraviolet light 6) A medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot. 7) Pain relief (increases pain threshold), vasoconstriction, reduces inflammation/swelling - True 8) - Ice Massage: Smaller areas, or hard to get areas around some bony prominence or contoured area - Cold Pack: Can conform to any body part or joint - Cold Bath: to immerse an entire limb 9) Ice massage: 5-10 mins over 10cm-15cm area - 20 mins - Yes 10) Cuff with cold water circulating cold water through cuff. Benefit is cold and compression - Conduction and convection 11) YES - Evaporation - 3-4 swipes one way (not back and forth), at 30 deg angle to body, and 12-18 inches from body 12) Vasocoolant spray 13) Thermotherapy 14) Increase blood flow (vasodilation), soften/loosen tissues, pain relief (increase pain tolerance), heal heal damaged tissues (blood flow to area) 15) Increase (speed it up) 16) Tumor/cancer, skin anesthesia - Area of compromised circulation, Raynaud's, Skin anesthesia 17) Superficial: hot pack, paraffin, fluidotherapy, infrared lamp - Deep: US 18) 6-8 layers - 15-20 mins - Yes, every 5 or so mins 19) A container that circulates warm air and small cellulose particles - Place extremity into device and warm air and these small particles will circulate creating friction and heat up extremity - Convection 20) Radiation - YES - 20 inch's 21) 3-5cm - 2.54 - Ultrasound - Conversion (converts sound wave into heat) 22) To override pain (noxious) signals by stimulating other sensory nerve fibers - C fibers - Use of modality to stimulate Aβ nerve fibers to overcome C fibers 23) Theraputic effects (heat deep tissue, gait control pain relief, promote blood flow, heal damaged tissue, heal wounds, etc.) - UltraSound waves create the effect of deep HEAT in your muscles and joints because the high frequency creates so much friction at the tissue level it heats up the tissue. The ultrasound sends acoustic waves much deeper than a heat pack goes, and the frequency of the acoustic waves vibrates the tissue so much that it creates friction, which produces heat. Heat increases vasodilation, which brings blood to the area to help it heal. 24) 1MHz and 3MHz - 1MHz - True (Low frequency = 1MHz) 25) - Have to have a medium (gel or water or lotion or oil) - Keep moving probe so you don't burn skin - Designed for small targeted areas 26) Pt can't communicate / cognition, skin sensation issues, pacemaker, on kids over epiphyseal growth plates, major nerves, over organs or face, pregnant women abdomen, stent in an artery, malignancy 27) Absorb - Bone (then cartilage next, then ligament, then tendon) - Muscle, fat, blood 28) 1MHz - 3MHz 29) TRUE - Frequency - 1MHz 30) It converts sound waves energy to thermal energy 31) Continuous wave (100%) so constant ultrasound wave delivered. - Pulsed is on/off where ultrasound waves go on and off - Means 20% of the time an ultrasound wave is delivered. - Duty Cycle = (On Time / On Time + Off Time) * 100 - Non-thermal 32) Thermal: Increase soft tissue extensibility, modulate pain, reduce muscle spasm or joint stiffness, increase circulation (ie: pain, tendinopathy, contracture) - Non-Thermal: Wound healing / tissue healing, promote normal cell function, reduce edema, improve blood flow 33) 5 mins

Question 114

1) For the modality of traction, when would you NOT use it (absolute contraindications) 2) A force of 25% of body weight will accomplish what purpose in lumbar spine? - A force of 50% of body weight will accomplish what purpose in l-spine? - What % of body weight is needed to stretch soft tissues in c-spine traction? - What % of body weight is needed to create vertebrae joint distraction in c-spine traction? - Never give traction over ____ lbs of force in c-spine - When should you stop traction? 3) Hydrotherapy is what: - Electrotherapy is what: - Cryotherapy is what: - Thermotherapy is what: 32) What would you use electrotherapy for: - When would you NEVER use electrotherapy (absolute contraindications) 33) Difference in theraputic effects of TENS vs. NMES 34) TENS does gait control theory, but what else does it do? - Explain point above: 35) High frequency TENS will do what: - Low frequency TENS will do what: - How does TENS help chronic pain pt's: - What things diminish effects of TENS effects? 36) If you want to use TENS to target sensory nerves to diminish pain (gait control) what frequency do you use? - If you use NMES to get a muscle contraction, what frequency do you use? - If you use TENS for endogenous opioid release, what frequency do you use? 37) High frequency TENS is for sensory (gait control) or motor - So high frequency TENS does what physiologically: - True or False: with high frequency you want low duration (and visa versa) - Low frequency TENS is for sensory (gait control) or motor? - What does low frequency TENS do physiologially 38) You will have 2 electrodes when doing e-stim. If the electrodes are closer together, will you get a more superficial or deep tissue effect - T or F: The closer the electrodes are together, the better it will feel to the pt - The two individual electrodes are called what - Which one is the positive electrode (from point above) - How do you remember that? - Does electrons flow from anode to cathode or cathode to anode? 39) Difference between Direct Current and Alternating Current - *** Which of these currents can burn you? 40) What is a pulsatile current 41) So will current density be larger or smaller with smaller electrodes - Will current flow be greater in small or large electrodes 42) Monopoloar electrode placement technique is used for what situations/conditions: - Bipolar electrode placement technique is used for what situations/conditions?

Answer 114

1) Osteoporosis, fracture, fusion/surgery, peripheralization of symptoms, pregnancy, TMJ, tumor, infections, meningitis, spondylolithesis, HTN or VBI issues, lig laxity 2) 25%: stretch soft tissue - 50%: separate vertebrae - 7-10% - 13-20% - 30 lbs - If it peripheralizes pt's symptoms, is painful, etc. 3) Using water as a modality for pain relief - Using electricity as a modality for pain relief - Using cool / water / ice " - Using heat " 32) Pain relief (gait control), re-innervate a nerve or muscle (NMES or Re-builder during neuropathy), help re-train m's (neuro re-ed), strengthen m's - Pt's with seizures, cardiac arrythmia's, pacemaker, malignancy, osteomyelitis, pregnant uterus, paresthesias 33) TENS: targets sensory nerves, which are responsible for sending pain signals to the brain. So TENS is used for Gate Control Theory to override C fibers pain, to control pain, after injury or surgery, traumatic pain, chronic or acute pain, etc. NMES: targets the muscle itself, specifically through activating the motor unit. NMES will create a muscle contraction, wake up / activate the muscle, recruit more muscle fibers and motor units, etc. This will improve strength, activity, function, and endurance for muscle purposes. 34) Stimulates endogenous opioids of body - It will cause body to release serotonin and other endogenous / organic opioids for pain relief 35) TENS High frequency / rate (90-130Hz) will stimulate A-beta fibers and reduce transmission of C fibers (Gate Control). - TENS Low frequency / rate (2Hz-10Hz) releases endogenous opioids. Activates endogenous opioid mechanism, so reduces transmission of noxious stimulus. - So chronic pain pt's essentially suffer from loss of endogenous opioids released, and increased central excitability. What TENS does to help these chronic pt’s is increases endogenous opioid release and reduces central excitability. - Caffeine or narcotics makes TENS not work as well. 36) High frequency (60-150 Hz) - Low frequency <20Hz - Low frequency 2-10Hz 37) High is for sensory / gait control. Low is for motor or endogenous opioid release (endogenous being really low) - Stimulate A-beta fibers and reduce transmission of C fibers (Gate Control) - which will override the painful C fibers. It helps alleviate pain. - True - Motor and endogenous opioid release - Stimulates A-delta fibers to release endogenous opioids (to help alleviate pain). So it activates the internal endogenous opioid mechanism, which reduces transmission of noxious stimulus. It may also produce a muscle contraction if the intensity is high enough. 38) Superficial (farther apart = deeper effect or deeper the current will go) - False. Farther apart the electrodes are the more comfortable to pt - Anode and Cathode - Anode - Anna is positive - Anode to cathode 39) Direct Current (DC) is a constant flow of electrons from anode to cathode - Alternating Current (AC) is a continuous bidirectional flow of current. Polarity changes from positive to negative with the change of electron flow. Alternating current is biphasic - DC (Direct current) 40) Where the current alternates on/off. Could be monophasic of biphasic 41) Larger / increased - Large 42) Wounds - Muscle weakness, neuro re-ed, spasms, ROM

Question 115

1) What are the parameters of e-stim 2) From point above, explain what each are: 3) What is the difference between NMES and FES - Give an example of both above using the anterior tib muscle 4) How should electrodes be places over a muscle when doing NMES - T or F: The farther apart the electrodes are placed, the weaker the density of the current will be? - T or F: The farther apart the electrodes are placed, the more superficial the current will be? - Why is Duty Cycle important when doing NMES 5) For TENS, if you want to get a sensory gait control pain relieving effect, do you want high or low frequency? - For point above, with that frequency, do you want long or short pulse duration? - To get small muscle twitch / contraction, do you want high or low frequency? - If you want to use TENS for noxious effect, do you want high or low frequency - If you want natural opioids released, do you want high or low frequency 6) What is Iontophoresis - When / why / who would you use ionto on - When would you never use ionto (absolute contraindications) - **** A PT must monitor the skin of a pt with ionto how often? 7) A pt can have an acidic or alkaline reaction to ionto. If it is an acidic reaction, it would happen under which electrode? - If it is an alkaline reaction, it would happen under which electrode? - How to remember? 8) Common medications / ions used during ionto - Does Lidocaine have a positive or negative polarity? - Does Dexamethasone have a positive or negative polarity? - How to remember: - Lidocaine is used / indicated when pt has what condition - Dexamethasone is used / indicated when pt has what condition 9) Is Massage considered a Modality? - When would you NOT do massage (absolute contraindications) 10) What are the types / techniques of massage: 11) From point above, explain each:

Answer 115

1) Amplitude, frequency, rise time, phase duration, current modulation 2) Amplitude: Magnitude or height of the current. Peak amplitude is at the top of the arch (or bottom) - the maximum point from zero where the pulse is maintained. - Frequency: The number of pulses delivered per second (in Hz). It is going to effect the number of action potentials elicited during the stimulation. A higher frequency causes more AP's to fire. - Rise Time: Time it takes for the current to move from zero to peak intensity in each phase. - Phase Duration: How long it takes for one phase of a pulse. It begins when current departs from zero and then ends when it gets back to zero. Pulse duration in a biphasic current is time it takes to do 2 phases. - Current Modulation: Any alteration in the amplitude, duration, or frequency of the current. You could do a burst or a ramp. 3) NMES: Stimmulated a peripheral nerve to get a muscle contraction of a muscle. - FES: Functional electrical stimulation is used to enhance the performance of a functional activity. - Anterior Tib: NMES will stimulate deep fib nerve to cause DF. For FES, you'd use it during gait to improve DF to prevent foot drop during swing phase of gait. 4) One electrode ideally is over the motor end point where nerve stimulates muscle. The other electrode is parallel to it, at least 2 inches away. - True - False (farther = deeper) - Duty Cycle is the on/off time. A muscle will fatigue if it is constantly contracted, so duty cycle turns off stimulation and allows muscle to rest so as to not fatigue. 5) High - Short - Low - Either - Low 6) Using e-stim to drive a medication (ions) into tissue through skin layers. - Pain, inflammation, fungal infection, ischemia, scar tissue, warts - Skin sensitivity, skin parasthesia, drug allergy to medication applied - Every 3-5 min's 7) Anode - Cathode - A=A (acidic for anode), K=K (alKalitic for Kathode) 8) Lidocain, Dexamethasone, Copper sulfate, Iodine, Magnesium sulfate, zinc oxide - Positive - Negative - Dex - make an x for negative. Lidocaine is POS - Pain - Inflammation 9) YES - Acute injury, cancer, cellulitis, embolus or thrombus, infection 10) Effleurage, Friction, Petrissage, Tapotement, Vibration 11) Effleurage: Light stroke that produces relaxing response. It is what you do at the start of massage and end to allow pt to relax. Strokes should go directly towards the heart. - Friction: Technique used over a scar or a trigger point. It is a deep technique to loosen adhesions. - Petrissage: Kneading, or squeezing the muscle and rolling it under the therapists hands. Goal is to loosen adhesions, improve lymph flow, remove metabolic waste. Could use entire hand(s) or a few fingers. - Tapotement: Rapid alternating movements like cupping or slapping. It enhances circulation and stimulates peripheral nerve endings. - Vibration: Rapid shaking movement. Primarily for relaxation.

Question 116

1) The hip bone is also called: - The hip bone is made up of ___ different bones - What are those bones from above - They all come together where 2) The head of the femur articulates with what (or in what) 3) If you bruise or get a contusion to the iliac crest, this is called: 4) How many ligaments form the hip joint capsule: - From point above, what are they - Which one of these from above is the "Y Lig" - Which of these lig's is most important, and why - What does the pubofemoral lig do / restrain - Which of these 3 lig's is the weakest? - Which one is in the back of the hip 5) What muscle attaches to the lesser trochanter of the femur 6) Whether a young person from trauma, or older person from osteoporosis, where on the femur is a fracture most common? 7) Which ligament of the knee is stronger - the ACL or PCL? - How do you know that, or how will you remember that? 8) Does the ACL prevent anterior or posterior translation of the TIBIA? - *** Where does the ACL attach, and what motion does it prevent? 9) What are the coronary lig's 10) Would the ACL be tight/taut when the knee is flexed or extended - The PCL tightens most in knee flexion or extension - What does the PCL do? - How do you know / remember the above point? - Are the ACL and PCL intracapsular or extracapsular lig's - What are the extracapsular lig's 11) Are the MCL and LCL of the knee taut in knee flex or ext - So what lig's of the knee are taut during knee ext? 12) Why are the MCL and medial meniscus often damaged together? 13) Where is the cuboid bone, where is the navicular bone - Which one articulates with the talus? - Which one articulates with the calcaneus? - How to remember which bone the cuboid is in front of: 14) The extra bone in the foot is called a: - Where is this located? - Most fractured bone / part of the bone in the foot - What is this called? - How many tarsal bones are there, and what are they 15) How many phalanges does the hallux (and pollicis) bones have compared to other digits

Answer 116

1) Coxa - 3 - Ilium, ischium, pubic - Acetabulum 2) Acetabulum 3) Hip pointer 4) 3 - The 3 bones of the coxa/pelvis (ilium, ischium, pubic) ... so ilialfemoral lig, ischialfemoral lig, pubofemoral lig - Iliofemoral - Iliofemoral (or Y lig) - because it reinforces the hip joint and limits hyperextensionn and lateral rotation - Limits ext and IR - Ischiofemoral lig - Ischiofemoral lig 5) Iliopsoas 6) Neck of the femur 7) PCL - The PCL rarely gets torn, it is the ACL that is torn more 8) Anterior - The ACL attaches from the lateral femoral condyle (thigh bone) to the medial tibial plateau (shin bone) and prevents excessive anterior translation of the tibia on the femur (keeping the shin bone from moving too far forward) 9) They secure the meniscus down to the tibial plateau 10) Extended (because it prevents hyperextension) - Flexion - Prevents anterior displacement of the femur, or posterior displacement of the tibia - THink of doing an anterior and posterior drawer test for ACL and PCL. And remember the ACL attaches on the back of femoral condyle so extension is taut / flexion is loose. With PCL, it attaches to front of tibial condyle so it is taught in flexion / loose in ext. - Intra (within the joint capsule) - MCL, LCL, Patellar Lig 11) Ext - ACL, MCL, LCL 12) Cause the MCL attaches to the medial meniscus, so they are often damaged together 13) Cuboid is on the lateral, navicular is on the medial - both are in front of the calcaneus - Navicular - Cuboid - C = C (Calcaneus is with cuboid on the right, and talus and navicular are on the left) 14) Sesamoid bone - Base / plantar side of 1st metatarsal - Tuberosity of the 5th metatarsal - Jones fracture - 7: talus, calcaneus, cuboid, navicular, 3 cuneiform b's 15) 2 (all other digits have 3)

Question 117

1) If you looked at a lateral view of the ankle, the fibularis m's come down around the lateral malleolus. First, what is the more common name for these m's - Just below the lateral malleolus, which tendon is higher or on top? 2) The lateral collateral lig of the ankle consists of how many lig's - What are those lig's (from ? above) - What is the lig on the medial side (medial collateral lig of ankle) - Lateral lig's of ankle resist what motion - When these lateral lig's tear, do they usually tear from anterior to posterior or posterior to anterior - What special test will assess if Deltoid lig is torn - What special test assesses if calcaneal fib lig is torn - What special test assesses if ATFL is torn - WHich lig is rarely torn at ankle 3) Ankle joint is also called: - What motions does this joint (from above) allow: - Capsular pattern of this joint is what: 4) What joint allows inversion and eversion of the foot - Which joint is a partial ball and socket joint - Joint between navicular and cuboid and the calcaneus and talus is: - The joint from above is supported by what lig - Another name for the lig from point above - Function of the lig from 2 points above 5) What is the important ligament on the dorsum of the foot? - It connects what bones 6) The psoas major muscle attaches where (origin) proximally - It attaches where distally - It's actions in open chain is - It's actions in closed chain is - It joins what muscle to attach distally - If one psoas acts alone, what motion would it do - What nerve innervates the psoas - What innervates the iliacus m. 7) Lumbosacral plexus has a helpful mneumonic to remember n's. What is the mneumonic 8) What does the mneumonic stand for - the names of the nerves descending from top to bottom of lumbosacral plexus 9) Which of these n's passes through the belly of the psoas m. 10) The TFL m does what action - TFL is innervated by what nerve 11) Action of the sartorius m - What nerve innervates sartorius m - *** What motion helps you remember what the sartorius actions are - T or F: Sartorius is the longest m. in the human body? 12) What is unique about the vastus medialis (or VMO portion of vastus medialis) of the quadriceps 13) Anterior compartment of the thigh m's are innervated by what nerve? - Medial compartment of the thigh m's are innervated by what nerve? - What muscle doesn't fit pattern of the 2 above points, and why? 14) Of the adductor m's, which is the most anterior, and which is the largest/longest 15) Pes Anserine insertion includes tendons of what m's 16) Gluteus Max m is innervated by what nerve - Action of glute max is: 17) Is Glut med an IR or ER of the hip - Is the glute med or glute min more superficial - They are innervated by what n's 18) You know the piriformis ER's the hip, but what does it do to a flexed hip - Piriformis is innervated by what nerves - What nerve runs either through or just under the piriformis muscle 19) Does the semitendinosus or semimembranosus form part of the Pes Anserine insertion - Both these m's are innervated by what nerve 20) Where does biceps femoris m (long and short head) insert distally? - The short head is innervated by what n: 21) What is the nerve that curves around from sciatic n. around lateral portion of knee 22) The lateral compartment of the lower leg - these m's are innervated by what nerve - Anterior compartment of leg is innervated by what nerve - Posterior compartment of leg is innervated by what nerve 23) The fibularis longus m. inserts where distally - What is the action of this m. - Fibularis brevis m. inserts where distally? 24) At the medial malleolus, there are several structures that course just below it. What is mneumonic to remember these structures: - What do these stand for 25) *** What muscle "unlocks" the knee joint - So what is the action of the m. from point above in open chain and closed chain 26) The deep m's of the posterior compartment of the leg are: - Which one has a tendon that is most posterior down at medial malleolus 27) Posterior tib m. inserts where distally

Answer 117

1) Peroneus m's - Fibularis brevis m 2) 3 - ATFL, PTFL, Calcaneofibular lig - Deltoid lig - Inversion - Anterior to posterior - Klieger's (and sort of the talor tilt) - Talor tilt - Anterior drawer of ankle - PTFL 3) Talocrural - DF and PF - PF then DF 4) Subtalor jt (or talocalcaneal) - Talocalcaneonavicular - Transverse tarsal joint - Spring - Plantar Calcaneonavicular - Provides strong support for talus and maintains arch of the foot 5) Lisfranc lig - Medial cuneiform and 2nd metatarsal to secure cuneiform b's to metatarsal's 6) Transverse processes and sides of vertebral bodies/discs of lumbar vertebrae - Lesser trochanter - Flex hip - Flex trunk (and lateral flex of trunk) - Iliacus - Sidebend trunk - Ventral rami L1-L3 - Femoral nerve (L2-L4) ``` 7) S: Some I: Idiots I: In G: Georgia L: Love F: Fighting O: Over L: Ladies ``` ``` 8) S: Subcostal I: Iliohypogastric I: Ilioinguinal G: Genitofemoral L: Lateral femoral cutaneous F: Femoral O: Obturator L: Lumbosacral trunk ``` 9) Genitofemoral n. 10) Flexes, abd, and IR femur - Sup. Gluteal n (L4/L5) 11) Flex hip, abd, and ER hip (and slight flexor of knee) - Femoral nerve (L2/3) - Sitting indian style (flexes, abd's, and ER's hip) - TRUE 12) It mainly attaches with other quad m's and inserts in patellar tendon; but portions of the VMO actually attach to the patella on medial side (and some fibers help form the joint capsule) 13) Femoral - Obturator - Pectineus m is both an adductor and flexor, is really in medial compartment, but is innervated by femoral nerve 14) Anterior is the adductor longus, and the largest/longest is the adductor magnus 15) SGT: Sartorius, Gracilis, Semi-tendinosus 16) Inf. Gluteal n (L5-S2) - Extend and ER hip 17) IR - Glute med is superficial, and Glute min is deep - Superior Gluteal n (L5-S1) 18) Abducts hip - Ventral rami S1-S2 - Sciatic nere 19) Tendinosus (remember SGT) - Sciatic n (L5-S2) 20) Head of fibula - Fibular division of sciatic nerve 21) Common fibular nerve 22) Superficial fibular - Deep fibular - Tibial nerve 23) Wraps around plantar side of foot to insert at base of 1st metatarsal and plantar side of medial cuneifrom bone - Evert the foot (and weak PF) - Tuberosity of 5th metatarsal on lateral side of foot 24) Tom, Dick, And, Very, Nervous, Harry - Tib Post, Flexor Digitorum Longus, Tibial Artery, Tibial Vein, Tibial Nerve, Flexor Hallucis longus 25) Popliteus - Open chain: flexes and IR's knee - Closed chain: Unlocks / slightly ER's knee (femur ER's on tibia) 26) Posterior Tib, Flexor digitorum longus, flexor hallucis longus - Harry (Flexor hallucis longus) 27) Tuberosity of navicular bone, plantar surface of cuboid and cuneifrom b's, and bases of 2/3/4th metatarsals

Question 118

1) Major superficial vein of anterior lower leg - Major superficial vein of posterior lower leg - Deep vein of the thigh and then the lower leg - Main cutaneous nerve of the lower leg 2) Small saphenous v. would dump blood into what v. 3) The common iliac artery becomes the femoral artery, but it breaks off and goes deep. What is that deep a.

Answer 118

1) Great saphenous v - Small saphenous v. - Deep is femoral v., then ant and post tibial v. - Sural n. 2) Popliteal v. (remember vein's blood goes up, and from superficial to deep) 3) Deep artery of the thigh

Question 119

1) Standard precautions are: - PPE means: - You should wash hands at least how long? 2) The term Asepsis means - Opposite term from Asepsis 3) The Americans with Disabilities Act (ADA) is what: - With the ADA, employers or builders would have to make what accommodations: - Do employers have to make all accommodation requests? - How wide does a hall or doorway need to be 4) ** For a ramp to be proper dimensions, it must be ____ inches of horizontal run for every ____ inches up vertically - A ramp should be how wide - A "landing area" needs to be every _____ feet on a long ramp 5) Must know what these terms mean: - Beneficence: - Duty: - Fidelity: - Justice: - Nonmaleficence: - Paternalism: - Veracity: 6) What are the elements of the ICF Model 7) Who is the only person in a PT clinic environment that can assist with PT interventions? - Does the PT have ultimate responsibility to oversee and supervise a PTA 8) What are responsibilities that ONLY a PT can perform in a PT clinic setting: - Can an aide help a PT provide interventions? 9) Are clinical judgements / clinical reasoning done during the examination or evaluation portion of the Patient Model 10) If you don't have Medicare or Gov't health insurance, you obviously have private. These private health ins. plans are called "managed care." What does that mean: - The two examples / options of managed care are: 11) What is an PPO: - What is a HMO: 12) What is the ACA (what does it stand for) - Why was it passed 12A) So how do you qualify for medicare? 13) The lower your monthly premium cost amount, the lower or higher your deductible will be? - What is a deductible: - After deductible is met, what then do you have to pay - But to ensure you don't have to pay outrageous amount, what puts a cap on how much you'll have to pay 14) ** Explain the difference between Medicare Part A, and Medicare Part B 15) Is part A or B "free" or part of automatic benefits of Medicare - T or F: For part B, you have to enroll and pay a premium 16) So Medicaid is different from Medicare in what way 17) Worker's Compensation is what: - What are the benefits people recieve on worker's comp - Are employers req'd by law to provide this 18) If you work (at least 10 yrs) and pay into system paying social security taxes, you qualify automatically (at age 65) for part A or part B of Medicare - If you didn't pay into system for 10 yrs, can you still get Medicare Part A - Does Part A have a deductible for anyone who uses benefit? - T or F: Anyone on Part B of Medicare pays a monthly premium and deductible amount - Under Part B, pt's are allowed how much PT per/year 19) What is Medicare Part C: - What is Medicare Part D: 20) ***** IMPORTANT ?'s: - Hospital uses what type of payment method - SNF's use what type of payment method - Outpatient uses what type of payment method - Intake form Home Health uses - Intake form outpatient uses - Intake form Inpatient / Rehab hospital uses - Which settings get payment from Medicare on a per episode bases - Which settings get payment from Medicare on a per service bases 21) Other very important gov't program to know about is IDEA. What is this?

Answer 119

1) Washing hands, wearing gloves, wearing mask and gown, etc. - PPE: Personal protective equipment (like those listed above) - 30 seconds 2) Absense of bacteria and viruses. So, the elimination of microorganisms that cause infection - so a sterile environment. - Contamination (sepsis - infected / virus / bacteria) 3) Act to prevent/eliminate discrimination against those with a disability (for employment, housing, public accommodations, etc.). Employers, Govt, Schools, and Builders must make appropriate accommodations - Certain hall and doorway width, ramps, higher/lower sings, parking available, etc. - Employers must accommodate those employees with a need as long as it is reasonable and doesn't place an undue burden on employer financially or alter course of business. - 32 at least for doorway, 36 inches for hallway 4) 12 inches horizontal for every 1 inch up vertically - 36 inches - 30 feet 5) - Beneficence: Do good (act for benefit of others) - Duty: Obligation to others - Fidelity: Faithfulness / keep committments - Justice: Fair - Nonmaleficence: Do no harm - Paternalism: When someone fails to recognize another individual's rights and autonomy - Veracity: Truth (tell the truth) 6) - Body Functions: physiological functions, pain, ROM, strength, coordination - Body Structures: Anatomy / structures - Impairments - Activity: Task (walking, standing, sit-stand, balance) - Participation: Participation in a situation (recreation, hobby, relationships) - Activity limitations - Participation limitations - Environmental Factors (work env., house, others) - Personal Factors (hygiene, age, gender, fam hx) 7) PTA - Yes 8) Initial eval, interpretation of referrals, creating and modifying POC (which includes goals), Re-exam's, D/C plan, Documentation - NO (only a PTA) 9) Evaluation 10) A Managed Care Organization (MCO) is an insurance company. Managed care is where a big insurance company manages the health care for payees on its plan. Managed Care is a PPO or HMO health insurance plan. These insurance companies have contracts with health care facilities and clinican/provider groups to provide health care for members. These Dr's or hospitals/facilities/clinics make up the plan's "network of providers." How much of your health care costs the plan will pay for depends on the plan and the PPO/HMO network's rules. Examples are below, like a PPO or HMO. - HMO's and PPO's 11) PPO - Preferred Provider Organization: More expensive, more options, no gatekeeper. PPO plans cost more, but provide many more options when picking a doctor or hospital. They do have an "in-network" list of providers, but there are fewer restrictions on seeing non-network or out-of-network providers. In addition, your PPO insurance will pay the bills if you see a non-network provider, although it may be at a lower rate. PPO's have NO gatekeeper (which basically is a PCP or Dr. you have to go see first in order to get a referral or to see other specialties). PREMIUMS are HIGHER with a PPO, but you have more coverage/options/providers/out of network choices (because more options = higher cost). PPO's are most popular managed care type option of a health insurance plan in the U.S. (about 50% of all private insurance provided by companies are a PPO) because it gives people more options and choice amongst providers. A PPO is typically used by those with higher incomes, or who want more access to more providers/options, or who know they will need a lot of medical care and/or see many specialits. HMO - Health Maitenence Organization: HMO's are not as popular as a PPO because an HMO gives you access to only a certain amount of doctors and hospitals within its network, so fewer options/choices. But, HMO's are cheaper. A HMO network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO’s network (in-network). There are few opportunities to see a non-network provider (or it will cost much more). There are also typically more restrictions for coverage than other plans, such as allowing only a certain number of visits, tests or treatments. HMO's require you to have a "gatekeeper" which is a PCP who coordinates your overall health care. You have to go see this gatekeeper / PCP first before getting other health care or seeing other specialists (the gatekeeper makes the referral for you to see the other Dr, and if you don't get this referral from the gatekeeper, you can't see other specialists). The idea behind the gatekeeper is to be a filter to minimize visits, costs, etc. PREMIUMS ARE LOWER with an HMO, which means you have less options/coverage and can NOT go out of your network for care! Those who choose an HMO would be someone who wants lower monthly premiums, or who already has a PCP they like and use, and/or don't need other medical options or providers. 12) Affordable Care Act - Because health care costs kept going up, employers were paying less (or not offering) insurance, and salaries weren't going up - so people were left w/o ins, and this was a way to ensure everyone had access to insurance. So the ACA was enacted to try and address and bring about these changes: expanded Medicare and Medicaid programs, mandate that all Americans have insurance (because if healthy people backed out of insurance, costs would go up even more), provided gov't subsidaries to small businesses and individual payers through the "exchange," opened up exchanges to get affordable insurance for individuals and small businesses, ensured insurance plans didn't stop paying after a certain amount of money was paid out (no beneficiary cost limits), gauranteed that pre-existing conditions would be covered, ensured that insurance companies could not deny or discriminate against certain risky/expensive demographics of patients, and allowed kids to stay on their parents health insurance until age 26. 12A) Be age 65, be a US citizen, and have paid into the system for at least 10 years (or are a spouse of someone who paid in qualifies you). OR be disabled. 13) Higher - A deductible is a set amount you have to pay every year toward your medical bills BEFORE your insurance company will start paying for any health care costs - Co-insurance (80/20) - Out of pocket max 14) - Part A: Provides benefits for care provided in hospitals, SNF's, hospice ... hospitalizations. - Part B: Outpatient care, physician services, imaging 15) Part A - True 16) Medicare is for older pt's, and Medicaid is for those who are economically disadvantaged and can't afford insurance (qualify for welfare / public assistance). This is a "safety net" program for low in come people. 17) Benefits / protection / compensation for workers who are hurt at work on the job. - Continued wages and costs of health care covered for the injury - YES 18) Part A - Yes, but you pay a monthly premium ($407 p/month) - Yes ($1,364 p/episode) - True - $2,090 p/yr 19) This is the "Medicare Advantage" program (or Managed Care). In Part C, people get both Part A and Part B Medicare benefits, but it is managed by an insurance company. Most HMO's are part of this program. - Part D: This is prescription drug coverage for Medicare participants so they can get medications at a reasonable cost. It is optional, and provided by a private insurance company, and participants have to pay a co-pay and a % of drug cost, but Medicare pays for a significant portion of the cost. 20) - Hospital: DRG (they know a hip surgery, for example, will cost xyz so Medicare pays hospital that amount for all hip surgeries and then hospital has to manage pt / episode to try and make money). - RUGS - FFS (Fee for service) - Oasis - FOTO - FIM / CARE - Hospital, Home Health, Inpatient - Outpatient 21) IDEA - Individuals with Disabilities Education Act: Law passed to ensure those with disabilities had access to education, and specific services provided in the education setting to help students with disabilities access that education. IDEA is a gov't program that pays for PT, OT, and SLP ("skilled" or "related services") in an education setting (school), specifically to help kids access and gain education. Kids age 21 and younger qualify. Kids from Kindergarten to 12th grade fall under the Individualized Education Plan (IEP), and kids age 0-3 (or pre-kindergarten) fall under the Individualized Family Service Plan (IFSP). These plans ensure kids get the PT, OT, and SLP services they need if they have a disability that limits them from getting/accessing education. The gov't pays for this program by paying for PT's, OT's, and SLP's to come into the school setting and work with these kids specifically on tasks that will help them get an education.

Question 120

1) What are CPT codes - Most CPT codes used by PT's start with what numbers? - Most common CPT codes used are below - what are they for? - 97161: - 97110: - 97530: - 97112: - 97116: - 97140: 2) ICD Codes are what - An example ICD code is 755.12 ... what do those numbers mean - Who makes a medical diagnosis though? 3) What is Maslow's Hierarchy of Needs - First most basic level is: - Highest level is: - What are the levels in order from least/basic to highest/most 4) Explain each level of Maslow's hierarchy of needs 5) Explain difference between Classical Conditioning and Operant Conditioning 6) From question above, pavlov's dog is example of: - Positive or neg. reinforcement after a behavior is which one: 7) ** What is the Trans-Theoretical Model - What is each stage, and explain each 8) There are various team models to providing patient care. What is: - Unidisciplinary: - Multidisciplinary: - Interdisciplinary: - Transdisciplinary: 9) 3 domains of learning are: - Explain each: 10) There are 5 stages of dying, what are they (and explain them):

Answer 120

1) CPT = Current Procedural Terminology Codes - Proceedure codes used by PT's and other health care professionals to describe the interventions that were provided to a pt. - 97000 (or something else in the 000 part ... 97161, 97530, etc.) - 97161: Initial Eval - Low - 97110: Ther Ex / Ther Proceedure - 97530: Ther Activities (gait, functional activities) - 97112: Neuro-reed (balance) - 97116: Gait training - 97140: Manual therapy 2) Codes to identify a specific diagnosis (ICD = International Classification of Diseases). - First 3 numbers identify the diagnosis / disease, and the numbers after the period help differentiate similar diagnosis'. - Medical Dr's 3) States that there is a hierarchy of biogenic and psychogenic needs all individuals must possess and progress through (and can't move to a higher level until they've achieved the last level). - Physiological - Self-Actualization - Physiological, Affiliative, Esteem, Self-Actualization 4) - Physiological: Need for basic things to survive: food, water, shelter - Affiliative: Need for security, stability, and safe environment - Esteem: Need to feel good about oneself and one's capabilities, to be respected, receive recognition - Self-Actualization: Need to realize one's full potential as a human being. 5) Classical: A learned/conditioned response to some stimulus - Operant: reinforcing or punishing stimulus is given after a behavior 6) Classical - Operant 7) Theory/model for explaining the "why" people change (or don't change). Stages of Behavior - Precontemplation: Not thinking about / intending to change - Contemplation: Intending to change soon - Preparation: making plan to change - Action: Taking action to change - Maintenance: continuing new behavior 8) - Unidisciplinary: One discipline provides care (PT) - Multidisciplinary: A few disciplines provide care, but seperately at diff times (don't work together) - Interdisciplinary: A few discplines provide care, and mostly function independently but routinely coordinate pt care. - Transdisciplinary: Many disciplines participate in providing care together 9) Cognitive, Psychomotor, Affective - Cognitive: Knowledge, comprehension, understanding, synthesis, evaluation - Psychomotor: Physical action and skill, motor part - Affective: attitude, values, emotions 10) - Denial: Refuse to believe it's happening (as a therapist don't try to force them to accept it - let them work through the stages) - Anger: Frustration and negativity (ie: "why me") ... therapists shouldn't take anger personally - Bargaining: Pt tries to negotiate with fate / God and make a deal - Depression: Pt gets very depressed and show very little interest in various things - Acceptance: Pt comes to terms with their fate, and they try to maximize time they have, settle old grievances / repent, want to spend meaningful time w/ family, etc.

Question 121

1) What are the steps to practicing evidenced based practice (EBP): 2) What is a PICO question - P.I.C.O. stands for 3) Explain each aspect of P.I.C.O 4) ** Very important to know the levels or hierarchy of evidence for research articles. List them in order from LEAST valid to most valid. 5A) How to remember above: 5) What is a Systematic Review: - T or F: Systematic reviews are highest or best level of evidence? 6) What is a Meta-Analysis: 7) What is a RCT (Randomized Control Trial) 8) The Gold Standard for Clinical Trials is what type of study: 9) What are: - Case Report: - Case Series: - Case Control Studies: - Cohort Study: 9A) So from above, which one: - Only looks at 1 pt and the intervention for that pt. - Is a retrospective study and compares those with a disease to those without - but just observational - Looks at many different pt with similar disease 10) Explain the difference between Descriptive research, Experimental research, and Exploratory research: 11) Examples of descriptive research: - Examples of experimental research: - Examples of exploratory research: 12) What is difference between qualitative and quantitative research 13) From question above, which one would have a LARGE sample size: - Which one has an active participant in the study - Which one is statistical 14) There are 4 categories of scales of measurement. What are they: - Of those 4, which are qualitative and which are quantitative 15) Explain each of the 4 from point above: 15A) Related to the scales above, what scale does this describe: The pain scale consists of a 10cm line with each end anchored by one extreme of perceived pain intensity. The pt is asked to mark the line at the point that best describes their present pain level 15B) So explain each of these rating scales: - Descriptor Differential Scale: - Verbal Rating Scale: - Visual Analog Scale: - Numerical Rating Scale: 16) Examples of the 4 categories from point above: 17) Difference between interrater and intrarater reliability - What is test-retest reliability

Answer 121

1) - Identify a problem - Formulate a focused clinical question about pt problem - Search literature - Critically appraise articles for validity, impact (effect size), and applicability - Integrate findings into practice - Assess outcomes 2) A very focused well-defined question for pt problem or topic to research - P: Patient or Problem - I: Intervention - C: Comparison - O: Outcome 3) - P: What is the target population/patient or problem - I: What intervention or form of therapy needs to be evaluated? - C: What is the Comparison treatment / intervention - O: What changes or outcomes would suggest the intervention is effective 4) - Ideas and Opinions (Expert Opinion) - Case Reports - Case Series - Cross-Sectional Studies - Case Control Studies - Cohort Studies - RCT's: Randomized Control Studies - Systematic Reviews and Meta-Analysis 5A) First one is expert opinion - Then alphabetical for the C's: case report, case series, case control-studies, cohort studies - RCT's - Systematic Reviews & Meta Analysis 5) Systematic Review: Systematic Reviews are the best studies as they summarize multiple similar RCT's studies on a topic into one paper. Instead of having to read 50 articles on the same general topic, a systematic review will bring all that research, data, and conclusions from all 50 into one succinct paper to not only save the clinician time, but to also provide evidence from multiple RCT’s on outcomes and interventions (and clinical practices) that are best for the patient based on research / evidence. - TRUE 6) These will thoroughly examine a number of valid studies (systematic reviews) on a topic and mathematically combine the results (data) using accepted statistical methodology to report the results as if it were one large study. They only work if all the studies have similar parameters (participants are same demographic, had similar interventions, measurements were similar, etc.). Then data is combined. 7) These are carefully planned experiments that introduce a treatment, intervention, or exposure and study its effect on real patients going forward. It assesses the relative effect of a specific intervention compared to a controlled condition. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between an experiment group (gets intervention / IV) and a control group (who doesn’t get intervention / DV) to see if the IV introduced will impact the DV being studied. A RCT is a planned experiment and can provide sound evidence of cause and effect.   8) RCT's 9) - Case Report: Studies of a single patient. It follows the ICF model, but has no control group, no experimental factor (doesn't introduce an IV), etc. Just studies that one person's specific case / intervention / outcomes. It doesn’t suggest cause and effect, but it does typically lead to further research studies. Can be retrospective or prospective. These studies don’t have many controls so they aren’t rigorous. But they are very good about being truest to replicating real patient care, and helping spur further research. - Case Series: Case reports are defined here as singular reports on one individual patient, while case series are collections of information on more than one patient. The subjects in a series usually share one or more common characteristics, such as disease, treatment, or side effect. - Case-Control Studies (or ‘Retrospective Studies’): Studies in which patients who already have a specific condition (the ‘cases’) are compared with people who do not have the condition (the ‘controls’). It is ALWAYS retrospective, and only observational (no intervention is introduced). The researcher looks back to identify factors or exposures that might be associated with the illness. They often rely on medical records and patient recall or surveys for data collection. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean than one factor necessarily caused the other. Researchers could gather certain data, or manipulate it, to prove hypothesis. These can’t determine cause and effect. - Cohort Study: Identify a group of patients who are already taking a particular treatment, have an exposure, or have the condition, follow them forward over time (prospective), or looking back in time (retrospective), and then compare their outcomes with a similar group that has not been affected by the treatment, isn’t exposed, or doesn’t have the injury. Cohort studies are observational and not as reliable as randomized controlled studies, since the two groups may differ in ways other than in the variable under study.   9A) - Case report - Case-control study - Case series 10) - Descriptive: Recording, analyzing, and interpreting conditions that exist to understand a clinical phenomenon. - Experimental: Comparing two or more conditions for the purpose of determining cause and effect between an ind and dependent variable - Exploratory: Examines the dimensions of a phenomenon of interest and it's relationship to other factors. 11) Descriptive: case report, case series - Experimental: RCT's - Exploratory: Cohort 12) QuaNtitative: These studies focus on DATA, statistics, OBJECTIVITY. You quantify (numbers) people's results, surveys, or interventions. It seeks to know the what, when, where (quantitative). Typically larger sample sizes. It generates data to prove (or disprove) the already formed hypothesis. - QuaLitative: These studies are more exploratory research to gain understanding of the WHY and the HOW ... the opinions and attitudes of participants. It includes focus groups, interviews, surveys, observation, etc. It tries to form a hypothesis. It has smaller sample sizes. It EXPLORES and discovers subjects in their natural environment to discover the ‘why’ and form a hypothesis. These do not take data to generalize to everyone (like QuaNtitative studies), but seeks to understand behaviors within the context or situation / environment. These studies are also called ”interpretivism.” These studies are used more in social studies or psychology, where as medicine and science use QuaNtitative. 13) Quantitative - Qualitative - Quantitative 14) Nominal, Ordinal, Interval, Ratio - Qualitative are nominal and ordinal; quantitative are interval and ratio 15) - Nominal: categories (no ordering) - Ordinal: categories (but ordered or ranked) - Interval: differences between measurements but no true zero - Ratio: difference between measurements with a true zero 15A) Visual Analog Scale 15B) - Descriptor Differential Scale: consists of 12 descriptor items each centered over 21 horizontal dashes. At the extreme left dash is a minus sign, and at extreme right is a plus sign. Pt's are asked to rate the magnitude of their pain in terms of each descriptor. Like subjective assessment tool/survey. - Verbal Rating Scale: People are to describe their pain (ie: sharp, agonizing, burning) - Visual Analog Scale: uses a 10-15cm line with the left saying NO pain, and right saying "worst pain." You mark on line where you are at. - Numerical rating scale: asks pt's to rate their pain level on an intensity of 0-10 or 0-100. 10 being horrible pain 16) - Nominal: marriage status, type of car owned, blood type, type of arthritis, cities - Ordinal: letter grades, service quality rating, levels of assistance, joint laxity grades (NON-NUMERICAL) - Interval: temp in Fahrenheit - Ratio: height, age, weight 17) Inter: Between 2 people (consistency of measures by more than one person over time) - Intra: Between yourself at different times/measures (consistency of measures by same person over time) - Consistency of repeated measurements made on the same individual on separate occasions

Question 122

1) Explain difference between Chopart and Syme's amptuation 2) If a pt with CHF had cycles of deep breathing followed by shallow breathing with periods of apnea, this breathing is called: - What is Kussmaul's respiration: - What is Eupnea: - What is Apnea: - What is Orthopenia: - What is Cheyne-Stokes: - What is typical pt who experiences Cheyne-Stokes respiration: 3) The validity of a research project is important. Explain these types of validity: - Face validity: - Content Validity: - Construct Validity: - Criterion-Related Validity: - Concurrent Validity: - Predictive Validity: - Prescriptive Validity: 4) When can you really trust the evidence: 5) What is the difference between the independent variable and the dependent variable: 6) *** Difference between Sensitivity and Specificity: 7) Someone who has the condition and tested positive for it is: - Someone who does not have the condition and tested negative for it is: - Someone who does not have the condition and tested positive for it is: - Someone who does have the condition and tested negative for it is: 8) SPin and SNout stands for what: 9) A test with a high sensitivity is good at ruling ______ (in or out) condition when test is negative, but if test is positive you can NOT confidently rule IN the condition since that test (with a high sensitivity) is only good at ruling OUT (thus SNout). - A test with a high specificity is good at ruling _____ (in or out) condition when test is positive, but if test is negative you can NOT confidently rule OUT the condition since that test (with a high specificity) is only good at ruling IN (thus SPin). 10) What is a Type I and Type II error: 11) A larger sample size in a study is obviously better because it means there is more ___________ in the study 12) Difference between statistical significance and clinical significance: 13) What type of validity is it when both the researcher and the participant are blinded in the study - What is the validity when the research findings are relevant and applicable to the population 14) What is the "k" or "K" in a study: - So a 0.24 is a good or a bad k in a study 15) What is the ceiling and floor effect in a study: 16) What is the Null Hypothesis vs. the Research Hypothesis: 17) Internal vs. External validity: 18) What is "r" or Pearson's r in a study - What is a high or good "r" 19) What is ICC: - ICC of 0.75-1.0 = - ICC of 0.5-0.75 = - ICC < 0.5 = 20) What is "d" in research - What is it: - What is a small effect size? - What is a large effect size? 21) What is a "p" value 22) What does "RR" stand for: - What is it: - A RR of 1 means what: - RR > 1 means what: - RR < 1 means what: 23) What does RRR stand for: - What is it: 24) What does NNT stand for: - What is it: - NNT is the inverse of what: 25) What does ARR stand for - What is it: - ARR is the inverse of what: 26) What does OR stand for - What is it: - OR = 1: - OR > 1: - OR < 1: 27) What does LR stand for: - What is it 28) A positive LR is: 29) A negative LR is: 30) A test with a LR of 1 or close to 1 means what: - LR more than 1 and less than 1 means what: 31) SEM stands for: - What is it: 32) MDC stands for: - What is it: 33) MCID stands for: - What is it: - Give a few examples: 34) Explain difference between these terms: Mean: Median: Mode: 35) What is positive predictive value and negative predictive value 36) Confidence Intervals are what: 37) Incidence vs. Prevelance: 38) Prospective vs. Retrospective: 39) What is a T-Test: 40) Effectiveness vs. Efficacy: 41) Clinical Practice Guidelines vs. Clinical Prediction Guides/Rules 42) What is the difference between: - Single Blind: - Double Blind: - Triple Blind: 43) The Research hypothesis is also known as: - The Null hypothesis is also known as: 44) 1 standard deviation means ____ % of all values fall within one standard deviation above and below the mean - 2 standard deviations is ____ % - 3 standard deviations is ____ %

Answer 122

1) Syme's is through ankle, and Chopart is through transtarsal or midtarsal (between tarsal's) 2) Cheyne-Stokes - Kussmaul's respiration includes deep and fast breathing that is associated with metabolic acidosis. This is panting labored breathing - Eupnea: normal breathing, normal rate, etc. - Apnea: temporary cessation of breathing - Orthopnea: dyspnea when laying, relieved by sitting up - Cheyne-Stokes: respiration that includes cycles of increasing and decreasing rate and depth of breathing with periods of apnea. - CHF 3) - Face validity: The degree to which a measurement appears to test what it is supposed to test. - Content Validity: Is the assessment content relevant and appropriate - Construct Validity: Is the measurement actually measuring the right construct (skill, knowledge) - Criterion-Related Validity: - Concurrent Validity: when a test score correlates well with a different measure that has been validated (compare the FIM to the BERG) - Predictive Validity: Does the measurement predict future behavior - Prescriptive Validity: 4) *** Most research is fabricated by researchers / professors / students / employees to try and get published, write a dissertation, prove their hypothesis, etc. But, if I find a study that has a HIGH sensitivity with a HIGH specificity, and the sample size in the study was statistically significantly large, there has to be a high correlation between independent and dependent variables (validity), high reliability (ICC) between different tests and testers, effect size is high (meaning intervention had an effect), agreement (k) between professionals is high, etc. There has to be NO bias, random sampling and allocation done, participants and researchers / therapists were blinded, and the study was replicated in multiple times in multiple settings. IF ALL OF THIS IS TRUE ... then I have confidence that it is a valid study with enough data to implement in my clinical practice with patients. Otherwise … clinical experience > EBP. 5) IV: The outside intervention introduced in the study to impact/change the DV. What the researchers introduces to manipulate or impact the DV. DV: The main thing being tested or measured … what the IV impacts. 6) Sensitivity: Ability of a test / intervention to CORRECTLY identify those WITH the condition - or those who test POSITIVE who actually have the condition. The test results will be POSITIVE in patients WITH the disease. HAVING THE CONDITION (True +). Vales closer to 1 (like 0.87) indicate a test that is good at ruling IN those with the condition. - Specificity: Ability of the test / intervention to CORRECTLY identify those WITHOUT the condition - or those who test NEGATIVE who do NOT have the condition. The test results will be NEGATIVE in patients WITHOUT the disease. NOT HAVING THE CONDITION (True -). Vales closer to 1 (like 0.87) indicate a test that is good at ruling OUT those without the condition. 7) True positive - True negative - False positive - False negative 8) SPIN stands for SPecific tests rule IN the condition when the test is POSITIVE. - SNOUT stands for SeNsitive tests rule OUT the condition when they're NEGATIVE. 9) OUT - IN 10) Type I errors: FALSE POSITIVE ('you are pregnant' to a man). You REJECT null hypothesis when it was true. (These are less common) - Type II errors: FALSE NEGATIVE ('you are not pregnant' to a pregnant woman). You do NOT reject null hypothesis when it was false. (These are more common) 11) Statistical Significance 12) Just cause you have statistical significance does NOT mean it is clinically relevant and applicable to practice/patients (and visa versa). 13) Internal validity (since they are double blinded) - External validity 14) K is the Kappa statistic which is INTER-RATER AGREEMENT (two PT's agree). It says that if two different PT's AGREE on a test/intervention at a 0.70, that is high. If they agree at 0.17 for the test/intervention, that is low. The higher to 1 the better or more agreement, closer to 0 is more chance and less agreement between testers. - Bad. That means there is less agreement between the 2 testers. You want it closer to 1 15) Ceiling effect: instrument does not register a further increase in score for high scoring individuals. UNABLE TO DETECT HIGH PERFORMERS. High bar (standard) is set too low. - Floor effect: instrument does not register a further decrease in score for low scoring individuals. UNABLE TO DETECT LOW PERFORMERS. Low bar (standard) is set too high. If outcome measure has a low ceiling effect or measure, then you don’t have a way to improve. If most people are getting high scores then I can't really find way to see high performers. 16) Research Hypothesis (or alternative hypothesis) is Ha = independent variable will cause a change in the dependent variable. - Null Hypothesis is Ho = independent variable will NOT cause a change in dependent variable (have NO effect or NO correlation). 17) Internal validity is how well the study was done (bias, randomized, blinding, methods, etc.). - External validity is how applicable the results are to the general population (other patients outside of the study participants). 18) Correlation. If Independent Variable (IV) does impact or create a change in the Dependent Variable (DV) then there is a high correlation (= high validity). If IV does not impact DV (or other factors do) then it is a low correlation. - A high correlation / validity is closer to 1, a low correlation / validity is closer to 0 (so a r = 0.1 is low correlation between IV and DV). 19) Reliability. When you do multiple tests / studies / measurements / interventions over time, you want them to be reliable and produce CONSISTENT repeated measures. Taking a test or measurement multiple times and getting very similar result means consistency, or high reliability. Whether two tests are done over the same day, or over multiple days, or whether tests are performed by an intra-rater (same person doing multiple tests) or inter-rater (different testers testing multiple times) … Reliability is CONSISTENCY in test measurements between testers over multiple tests. - ICC of 0.75-1.0 = high reliability - ICC of 0.5-0.75 = moderate reliability - ICC < 0.5 = poor reliability 20) Effect size: - Effect size is the size or effect of an intervention, or size of the difference between the two groups or interventions (experimental vs. the control group). Basically the effect of the intervention. You want a large effect size to show the intervention/treatment did make a difference in experimental group. - Small effect size is d = 0.2 - Large effect size is d = 0.8+. 21) A small p-value (typically ≤ 0.05) indicates strong evidence AGAINST the null hypothesis, so you REJECT the null hypothesis (it means the IV is impacting DV, so there is correlation). A large p-value (> 0.05) indicates WEAK evidence against the null hypothesis, so you do NOT reject the null hypothesis (low correlation between IV and DV). Usually it is less than 0.05, and while that might provide some statistical significance, it tells us NOTHING about clinical significance. 22) Relative Risk - The ratio of ... risk in the exposed group (cases) to the risk in the non-exposed group (controls). Exposed group risk / non-exposed group risk. Or … risk in the experiment (E) group / risk in the control (C) group. So: EER/CER - A RR = 1 means risk is equal in both groups. - If RR > 1, the risk in the exposed group is greater than the non-exposed group (positive association) - If RR < 1, the risk more in the non-exposed (negative association) Ex: Smokers (exposed group) have a RR of 1.61 to developing CVD to non-smokers (non-exposed group) ... or smokers are 1.61 times more likely to get CVD than non-smokers. 23) Relative Risk Reduction: - Percentage that the treatment reduces risk compared to control. RRR = (1-RR) * 100 (goal is to get it to 100%). 75% RRR means 75% less likely to have an ACL tear if they do this program, or you’ve reduced the risk by 75% 24) Numbers Needed to Treat - Number of patients that must be treated in order to achieve one additional favorable outcome / prevent a bad outcome. NNTB = Numbers needed to treat to get a Benefit. NNTH = Numbers needed to treat to cause Harm - It's the inverse of ARR (so NNT = 1/ARR) 25) Absolute Risk Reduction - The absolute arithmetic difference in event rates between control and experimental groups. Decrease in risk of treatment in relation to a control treatment. ARR= CER−EER (control group event rate minus experiment group event rate … or risk of control group minus risk of experiment group). - It is the inverse of NNT … so 1/NNT 26) Odds Ratio - A measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. OR = (odds of developing disease in exposed patients) / (odds of developing disease in unexposed patients) - OR = 1 implies that the event is equally likely in both groups - OR > 1 implies that the event is more likely in the exposed group - OR < 1 implies that the event is less likely in the exposed group, and more likely in the unexposed group 27) Likelihood Ratio - LR’s are used for assessing the value of performing a diagnostic test. They use the sensitivity and specificity of the test to determine whether a test result usefully changes the probability that a condition (such as a disease) exists. It provides a direct estimate of how much a test result will change the odds of having a condition. IT HELPS PREDICT THE POST-TEST ODDS. So if sensitivity and specificity are high, then you'll get a high +LR, which will give you a high post-test probability which tells you the intervention will most likely help you know what condition/diagnosis is (rule it in). 28) +LR = sensitivity / (1-specificity) +LR > 10 is a test result with a LARGE effect on increasing the probability of disease/condition +LR between 5-10 is a test that has moderate effect on increasing the probability of the disease/condition +LR < 5 indicates a small effect on increasing the probability of the disease/condition 29) - LR = (1-sensitivity) / specificity - LR < 0.1 indicates that the result has a large effect on decreasing the probability of the disease/condition - LR between 0.1-0.5 indicates that the test has a moderate effect on decreasing the probability of the disease/condition - LR > 0.5 indicates a small effect on decreasing the probability of the disease/condition 30) A likelihood Ratio of 1 (or close to 1) means that THIS TEST HAS VERY LITTLE INFLUENCE ON THE FACT THAT THE PATIENT DOES / DOES NOT have the condition. It means the test has a bad sensitivity and specificity. In other words, the test was USELESS. - A likelihood ratio of greater than 1 indicates the test result is associated with the disease. A likelihood ratio less than 1 indicates that the result is associated with absence of the disease. 31) Standard Error of Measurement - Standard error of measurement. Nobody and no instrument is perfect at measuring each time. So SEM estimates how repeated measures of a person on the same instrument tend to deviate slightly around the “true” score. 32) Minimal detectable change - Smallest amount of change an INSTRUMENT can accurately measure that corresponds with a noticeable CHANGE in patient's ability. It is NOT just SEM or measurement error of the clinician, but enough of a change (minimal detectable change) recorded to indicate some progress. MDC may NOT yet be MCID or important enough change to Dr. and patient to suggest improvement, but it at least is MDC enough that it is NOT DUE TO MEASUREMENT ERROR /SEM. MDC = SEM * 1.96 *√2 33) Minimally Clinically Important Difference - Smallest difference in a measurement that CLINICIANS and PATIENTS would care about to show actual IMPROVEMENT/progress/healing. So it is what amount of improvement (measure) that is actually significant to the patient for progress. - Pain (VAS) = 2+ point difference for a MCID - ROM = 5+ degrees improvement for a MCID - MMT = Improvement of 1 grade (from a Grade 2 to a Grade 4) 34) Mean: Average Median: # in the middle (50% of values above, 50% below) Mode: # that occurs the most 35) PPV: Probability a patient with a positive test actually has the disease/condition. NPV: Probability a patient with a negative test actually does NOT have disease/condition 36) An estimate of dispersion, or variability, around a point or estimate (usually the mean). So a 95% CI means: We are 95% confident that the true population mean lies within this certain confidence interval (about the mean). Wider CI's come from LARGER standard deviations and SMALLER sample sizes. (Opposite is true). So the MORE people you get in the study, the smaller the standard deviation will be and thus smaller the CI will be. 37) Incidence: How many new cases in a period of time - Prevalence: What % of the total population has the condition 38) Prospective: follow the study group(s) forward in time. The now and into the future. Who NOW has or will become injured / get the condition / get cured. - Retrospective: look at study group(s) retrospectively, or from the past to gather data about a condition. These studies don’t study the now or into the future, just looks and studies the past to try and discover the ‘why’). Who had the condition / injury in the past. 39) T-tests are handy hypothesis tests in statistics when you want to compare means. You can compare a sample mean to a hypothesized or target value using a one-sample t-test. You can compare the means of two groups with a two-sample t-test. If you have two groups with paired observations (e.g., before and after measurements), use the paired t-test. 40) Effectiveness relates to how well a treatment works in practice in the real world with real patients, as opposed to efficacy, which measures how well the treatment / intervention works in clinical trials or laboratory settings with study participants. 41) Clinical Practice Guidelines: These are general recommendations by a team of expert clinician-scholars in the field to provide the most useful recommendations for the patient care. They are derived from the best and latest evidence (usually from many RCT’s and systematic reviews). - Clinical Prediction Guides/Rules: Guides that are formed from a cluster of exam findings and may HELP with FORMING A DIAGNOSIS or the treatment of a pt. They can be used to help determine the need for referral for radiographic examination and other diagnostic work-up. An example is the Ottawa Ankle Rules, which help determine if a pt has an ankle injury or not and needs an x-ray or not. 42) - Single Blind: the participants are blinded of hypothesis / DV (but researchers and data analyzers are not blinded) - Double Blind: the participants and researchers are blinded of hypothesis / DV (but data analyzers are not blinded) - Triple Blind: the participants, rearchers, and data analyzers are all blinded of hypothesis / DV 43) Alternative hypothesis - Statistical hypothesis 44) 68% - 95% - 99%

Question 123

1) What are the elements of the patient management model 2) Do PT's make a diagnosis - Difference between medical diagnosis and PT diagnosis 3) Generally, most injuries or MS pathologies will take 8-12 weeks to fully heal; however, what parts of the body don't really heal or take much longer: - We know CNS injuries don't regenerate, but PNS injuries do. When a nerve grows back - this is called: 4) S.M.A.R.T. goals stands for what: 5) ABCDEF goals stand for what: - Give an example of an ABCDEF goal 6) What is a PAR-Q screen: - What is a PHQ Screen: 7) Normal or ideal BP (Blood Pressure) for an adult is: - Would children/infants have a higher or lower BP: - s/s of high BP: - Systolic and Diastolic mean what - New standard for HIGH BP classification 8) If blood pressure gets above _____ (ish) during exercise, stop exercise - If BP is too low, why is that bad: - s/s of low BP: 9) Normal heart rate (HR) for an adult is: - Difference between HR and pulse - Why is a really low HR bad: 10) What meds slow down the HR - An example of the med from above 11) HR for children: - HR for infants (1-12 months) 12) Normal RR for adults is - Fast RR is called: - Fast HR is called: 13) RR for children: - RR for infants (1-12 months) 14) Normal SpO2 amounts are: - Would SpO2 be higher or lower in someone with COPD: - What is it called if you can't get enough O2 through breathing - A severe hypoxic SpO2 rating would be: 15) Difference between SpO2 and SaO2 16) Normal body temperature is: - Would oral or rectal temp be higher? - Would oral or axillary temp be higher - What is tympanic membrane temp reading - Out of all the ways to assess temp, what is warmest and what is coolest

Answer 123

1) - Examination - Evaluation - Diagnosis - Prognosis - Interventions - Outcomes 2) PT's don't make a medical diagnosis, but can make a PT diagnosis - Medical Dr's give a medical diagnosis (but even them, and their imaging, is not always right). A PT / movement diagnosis is what you'll do. Focus on their functional deficits and address improving ROM / Strength / Function / ADL’s. Main goal is to help pt achieve THEIR goals, and improve function, reduce pain, increase ROM and Strength, and improve movement to improve life. 3) Areas with poor blood supply, like: cartilage, meniscus, IV discs, labrum, etc. (and CNS injuries don't really ever regenerate, and PNS nerves are 1mm p/day) - Neuroplasticity 4) - S: Specific - M: Measurable - A: Attainable/Achievable - R: Realistic - T: Timely ``` 5) Actor/Audience Behavior Context or Conditions Degree Expected time Functional purpose - Mr. McCarthy (A) will walk (B) in hospital corridor (C) for 100 ft in less than 2 min (D) within 1 wk (E) in order to get home and back to work (F). ``` 6) PAR-Q: See if someone is safe for exercise (PAR-Q = physical activity readiness questionaire. Screen to see if their health and condition allows them to safely exercise, often given to cardiac condition pt's). - Screen for depression 7) 120/80 - Lower - Dizzy, lightheaded, fatigued, headaches, vertigo, orthostatic hypotension, blurred vision - Systolic is pressure of blood during heart beat/contraction (the top number - 120). Diastolic is blood pressure during heart relaxation (bottom number - 80) - Over 140 systolic or over 90 diastolic 8) Above 180 systolic, and above 120 diastolic - Means body tissues are not getting O2, leading to fatigue - Light headed, fatigue, faint, dehydrated, blurry vision, dizzy 9) 60-100 bpm - HR is the actual heart beat, Pulse is felt distal in arteries - Usually low HR is good, a sign of being fit. But, it could be a sign of a weak heart, or problems with electrical conducting system of heart. 10) Beta Blockers - propranolol (anything ending in lol) 11) 80-100 - 100-120 12) 12-20 - Tachypnea - Tachycardia 13) 15-30 - 25-50 14) 95%+ - Lower (88-92%) - Hypoxic - Less than 85% 15) - SpO2: Measures O2 peripherally (p = peripheral). This is more convenient/accessible to get this figure, but maybe not exactly accurate (but very close). - SaO2: Measures O2 in the actual artery (a= artery). This is much more accurate/exact, but obviously more invasive since you have to get it from within an artery. 16) 98.6 ish deg's - Rectal - Oral (oral is about 1-2 deg's higher than armit) - Ear canal through infrared - Warmest is rectal; coolest is axillary

Question 124

1) When auscultating the heart, where would you listen to hear the aortic valve? - Where would you listen to hear the mitral valve? 2) S1, S2, S3, and S4 are the heart sounds. Which of these are the normal heart sounds - From point above, explain both of those: - What is S3 sound: - What is S4 sound: - Is S1 the "lub" or the "dub" - Where is it best to hear "lub" - Where is it best to hear "dub" 3) Which side of the body has 3 lobes in the lung - What is the name of the space between the actual lung and down below where there is pleural lining where lung can expand: 4) Air that moves through the lung during normal quiet breathing is called (normal inspiration and expiration): - How much (amount) is the amount of air from point above - It accounts for what % of total lung volume: 5) Air that can still be breathed in above normal inspiration is called: - Air that can still be breathed out below normal expiration is called: - Air that remains in lung even after maximal expiration (the air always remaining in lung): - Formula for inspiratory capacity (IC): - Formula for Functional Residual Capacity (FRC): - Formula for Vital Capacity (VC): - Formula for Total Lung Capacity (TLC): - So define Vital Capacity: - So define Total Lung Capacity: 6) A normal lung sound when auscultated is also called a ________ breathe or sound - An ABnormal lung sound when auscultated is also called a ________ breathe or sound - When auscultating, would a normal "99" sound be clear or muffled? - If it sounds clear, what does that mean - Abnormal breathe sounds are indicators of what: 7) - Rhonchi: - Crackles / Rales: - Wheezing: - Stridor - Which abnormal breathe sound is LOW, which sound is HIGH 8) The most efficient way to breathe is: 9) What does an incentive spirometer measure - How do you use an incentive spirometer to measure (what was asked in point above): - Goal is to get above _____ mL on the incentive spirometer for their vital capacity - Normal VC is how much 10) If you were to get a tape measure and measure chest expansion, what would you get in a normal pt (in inches and cm) 11) Explain the mucociliary escalator in relation to a cough: 12) What are the 4 phases of a cough: 13) What is a Peak Flow Meter - Getting over a _____ shows one has an effective cough using a Peak Flow Meter - Below _____ on a Peak Flow Meter shows concern for a non-functional cough - How would you document someone's cough - A weak cough can lead to: 14) What is a costophrenic cough assist: 15) What are some cough assist devices / Positive expiratory pressure device 16) Two common examples of Chest PT are: - Explain both: 17) If someone has an unproductive cough or mucus build up, what is the BEST thing they can do to help this: 18) What is the medication to help open up airways: - THe med from point above is a bronchodilator or bronchoconstrictor - What type of agonist is it

Answer 124

1) Aortic: R side of sternum (L side if looking at someone's chest), 2nd intercostal space - Mitral: L side of sternum (R side if looking at someone's chest), 5th intercostal space mid-clavicular line 2) S1 and S2 - S1 is when atrioventricular valves (tricuspid and mitral) close at start of systole. S2 is when semilunar valves (aortic and pulmonary) close at end of systole - S3: Abnormal heart sound right after ‘dub’ or beginning of diastole … ventricular gallop. Often indication of CHF. It is ventricular failure and refilling. Heard at apex. Can be normal in children. - S4: Extremely abnormal heart sound at end of diastole. Pressure in ventricle is so high that atria have to contract harder to get blood into ventricle. Heard in HTN, MI, CAD, angina. Heard at apex - S1 is Lub - At mitral valve (5th intercostal space) - At Aortic valve 3) R side has 3 lobes, left side has 2 lobes - Costodiaphragmatic recess 4) Tidal volume - 500mL - 10% 5) Inspiratory reserve volume (IRV) ... 3,100mL and 50% - Expiratory reserve volume (ERV) ...1,200 of 6,000mL - Residual volume (RV) ... 1,200 of 6,000mL - IC = TV + IRV - FRC = ERV + RV - VC = TV + IRV + ERV - TLC = TV + IRV + ERV + RV - VC = Max volume of air that can be inspired after max expiration - TLC = Amount of air in lungs after max inspiration 6) Vesicular - Adventitious - Muffled - There is consolidation or more fluid build up in lungs - Abnormal breath sounds are indicators of: asthma, pneumonia, consolidation, bronchitis, inflammation, COPD, emphezema, foreign body / aspiration, and even CHF. 7) - Rhonchi: Low pitched breathe sound. Air trying to pass through airways, but there is fluid or mucus blocking. Deep snoring sound. - Crackles/Rales: High pitched breathe sound sounding like little pops / crackles. When someone has pneumonia or CHF, or alveoli aren’t working properly. NON-musical. - Wheezing: High pitch whistling sound. Caused by narrowing of airways due to inflammation of airways. MUSICAL SOUNDS. - Stridor: Harsh vibratory sound. Caused by narrowing of UPPER airways (specifically the upper airways – some obstruction in trachea or larynx). - Rhonchi is low, Crackles/Rales and Wheezes is High 8) Diaphragmatic breathing 9) Vital Capacity - Breathe all air out, then breathe in through incentive spirometer as much air as you can inspire. - 2,500 mL - 4,800 mL 10) Normal expansion: 2-3 inches (or 3-7.5 cm) 11) Many pulmonary conditions will result in a patient struggling to clear their airways due to some obstruction, mucus / secretion build up, etc. Several of these conditions where coughing is difficult include: COPD, Chronic Bronchitis, Emphysema, Pneumonia, Asthma, Cystic Fibrosis, etc. Physiologically, the ciliary cells in our airways (trachea and lungs) capture foreign particles during breathing so they don’t enter lungs, then produce a secretion to help move those foreign particles up and out (cough). Sometimes that mucociliary escalator that gets mucus up and out gets injured, or accessory muscles are weak, or a rib fracture, or some pulmonary condition (from above) makes coughing ineffective. Below are interventions on how to help these patient’s improve airway clearance and coughing: 12) - Inhale (most important step. The more air you get in, the more you can expel out) - Hold your breathe - Build up pressure while holding breathe (air moves from high pressure to low pressure, so the more pressure you build up, the more forceful and productive the cough). - Cough out 13) A peak flow meter is a device that measures the effectiveness of a cough. Follow the 4 phases of a cough (above) and cough into the device. - If someone can get over 250, they have a productive cough (or functional cough). - If they are below 162, that is the cut-off and very concerning due to weak non-functional cough. - Document what level they got, and whether it is a functional, weak functional, or non-functional cough - A weak or unproductive cough can lead to obstruction of airways, pneumonia, and further deterioration of their pulmonary condition. 14) A manual way for a PT to help assist a pt with a cough. Place the pt in supine. Teach them the 4 phases of a cough. You as PT place your hands on the patient’s lower ribs / chest wall cavity and as the pt gets to the 4th step of coughing out, you squeeze chest cavity to help compress lungs to help with expulsion of cough. 15) Acapella, quake, flutter, etc. 16) Postural drainage, percussion - Postural Drainage: Many pulmonary/respiratory patients will get fluid build up in their lungs, and it is necessary at times to help move that fluid / secretions up and out of airways. Postural drainage is when you auscultate each lobe of the lung, and listen for consolidation or areas where there is fluid build up (review how to do that with the “99” test a few slides back). When you hear areas of fluid build up, place the patient in a position where gravity will help fluid flow out of the lung. So, for example, if there is fluid in the upper lungs, sit the patient up. If in the lower lung lobes, lay them down with their feet and chest above their head so gravity will pull fluid down (or up and out of airways to be coughed out). If you hear it more in the front than the back, lay them supine. If more in the back than the front, lay them prone. If more of the middle lobe, lay them sidelying. Just get gravity to pull fluid down and out. See picture to the right. - Percussion: Percussion is when you use your hands to manually percuss or lightly hit the patient in the chest. The goal is to mobilize and loosen secretions in the airways, so the patient can cough up and out those secretions. The percussion, or vibrating / hitting the chest will cause secretions to become loose and mobilize so they can be coughed up and out. Obviously the goal is not to hit hard and hurt the patient, but use a cupped hand position and percuss over the lungs, specifically the lobes where you auscultated and heard consolidation, abnormal breathe sounds, wheezes, crackles, etc. See pictures to the right. 17) MOVE. EXERCISE. Movement opens up the airways, improves posture, mobilizes secretions, improves breathing, helps coughing become more productive. It can be as simple as sitting up from in bed to a sitting position, to walking around the house, to going outside for a walk, go for a run, etc. Just get up and move. - Also, teach them how to cough, posture and positioning, quake/flutter/a-cappella, assistive cough technique, mucolytic meds, etc. 18) Albuterol - Bronchodilator - Beta 2 agonist

Question 125

1) Describe the grading system for PULSES 2) **** What are the values for an ABI 3) If you were doing the ASIA or doing a sensory assessment, what does the value below mean: - 0: - 1: - 2: - NT: 4) What device would you use to assess sensation on the bottom of the foot for someone with DM II 5) When doing a capillary refill test, how long (roughly) should it take for nail bed to refill? - Over _____ sec's is concerning for a normal adult, and over ____ sec's for an elderly adult is concerning 6) You assess arterial and venous compromise the same way. How? - For venous refilling time, what is a normal and abnormal amount of time - What is Rubor of Dependency - Normal and abnormal filling time for Rubor of Dependency: 7) What is the special test to assess for DVT - How do you perform it? - A diagnositic test to confirm a DVT is 8) What is intermittent claudication - Will you see this manifest more in UE's or LE's - It is pain from what? 9) What is pitting edema - How do you rate pitting edema: 10) Calculating BMI factors in what two variables - Below _____ is a very good BMI - Above ____ is considered obese - Normal BMI range is ______ 11) The VAS is what: - RPE is what - RPE of 13 equates to what 12) If a CBC test was done on me, what would be tested: - WBC's are responsible for what - Normal WBC count range - Low WBC count could mean - High WBC count means - Do NOT exercise a pt when their WBC count is less than - WBC's are often called: 13) Function of RBC's: - Other name for RBC's - How long do RBC's last in your body - Where in the body are RBC's created - Too few RBC's leads to what - If RBC count is too low, it could be from what - If RBC is too high, it could be from 14) What is a hematocrit - Normal hematocrit is: - No exercise if hematocrit is below: 15) Hemoglobin is what: - Normal hemoglobin ranges - No exercise if hemoglobin is below 16) Platelets do what - Normal amounts of platelets: - Below _______ means excessive bleeding - Above ______ means excessive clotting - No exercise if platelets are below - What is test to see how well your blood clots 17) An INR above _____ means your blood is not clotting enough and you are at risk of bleeding - Tests to see how fast your blood clots - A typical aPTT time for blood to clot is 18) Pt's would take what 2 main med's to help prevent a DVT or PE - Another name for warfarin 19) Normal blood glucose levels are what: - Too low of blood sugar levels means what - Too high blood glucose levels means what: 20 HbA1C is what: - Why would this be high? - Normal and abnormal HbA1C levels are what 21) IGT test is what - Normal and abnormal results of this test are what - IFG test is what - Normal and abnormal results of this test are what 22) Normal potassium (k) levels are: - Too little or too much potassium can lead to what 23) Goal for pH levels in body is: - Below 7.35 is what: - Above 7.45 is what: 24) What is the GOOD cholesterol, and what is the BAD cholesterol - The good cholesterol - why do you want that in your body? - How to remember which one is the bad: - Bad cholesterol leads to what 25) A Normal TOTAL (both HDL and LDL) cholesterol level is what amount: - More than 240 means you have too much ____ cholesterol - Normal range for HDL - Less than 40 HDL means what - Normal LDL levels - Above what LDL amount is bad

Answer 125

1) 0: Absent pulse 1+: Very weak pulse, but barely palpable 2+: Normal (average) easily palpated pulse 3+: Increased / large / bounding pulse ``` 2) **** > 1.2: Atherosclerosis (calcification) 0.95-1.2: Normal 0.75-0.95: Mild arterial disease 0.5-0.75: Moderate arterial disease < 0.5: Severe arterial disease ``` 3) - 0: No sensation / absent - 1: Diminished sensation - 2: Normal sensation - NT: Not testable 4) Monofilament 5) 1 second (Child: 0.7 sec; Adult 1.1 sec; elderly: 1.7 sec) - 2 sec's, 4.5 sec's 6) Elevate LE being tested for 60 sec's. Then lower leg and time how long it takes for blood flow to return and normalize - ~15 sec Normal (< 15 sec = venous reflux, incompetent valves; > 15 sec = arterial compromise) - Same test but for arteries - Normal: < 15 seconds (Abnormal: 20-30 seconds = mild arterial insufficiency; 30-45 seconds = moderate arterial insufficiency; 45+ seconds = severe arterial insufficiency) 7) Homan's sign - DF ankle and squeeze calf (pain = positive for DVT) - Doppler 8) Claudication is pain from a lack of blood flow to tissues. It is usually manifest during activity / walking / exercise. - Typically manifest in the LE’s, but can manifest in UE’s. - This is NOT a disease – it is a symptom of a disease (atherosclerosis is the disease). Intermittent Claudication of the LE’s equates to Angina of the heart (not enough O2 getting to tissue due to arterial flow blocked, thus lactic acid builds up and burns/painful). 9) Refers to visible swelling caused by a buildup of fluid within tissues. When an indentation remains after the swollen skin is pressed, this is called pitting edema. 0: No pitting edema 1+: Mild pitting edema (2mm deep) 2+: Mod pitting edema (4mm deep) 3+: Mod-Severe (6mm deep) 4+: Severe (8mm deep) 10) Height and weight (in kg's) - 18.5 - 30 - 19-24 11) Visual Analog Scale - way to rate someone's pain - Rate of Perceived Exertion - a way to put a pain number that relates to Heart Rate, to monitor HR during exercise. - HR of 130 bpm 12) Count for WBC's, RBC's, Platelet's, Hemoglobin, and Hematocrit - Immune system defense - 4,500-11,000 - Cancer or some infection body is fighting, autoimmune - Body is trying to fight some sickness/infection - 5,000 - Leukocytes 13) Carry O2 to body's cells - Erythrocytes - 120 days - Bone marrow - Anemia (anemic) - less O2, so fatigue - Bleeding, overhydrated, pregnant, etc. - Dehydrated, vomit, diarreah, 14) % of RBC's in total blood - 38-45% - 25% 15) Protein that carries RBC's to cells. O2 binds to hemoglobin to be taken to cells in body - Females is 12-15; Males is 14-18 - 8 16) Blood clotting - 150,000-450,000 - 150,000 - 450,000 - 20,000 - INR 17) 3.5+ - aPTT and PT (activated partial thromboplastin time) - 30-40 sec's 18) Heparin or Warfarin - Coumadin 19) 60-120 - Body doesn't have enough substrates to break down to convert to energy, lacking energy - Leads to atherosclerosis, DM II, CAD 20) Test of blood glucose levels over 3 month time - Someone who is diabetic, for example, and doesn't produce enough insulin or eats too much sugar - you'll see more sugar bound to hemoglobin in the blood, causing HbA1C levels to be high. - Less than 5.7 is normal; 5.7-6.4 is pre-diabetic, 6.4+ is diabetic 21) Impaired Glucose Tolerance test - to measure blood glucose levels - Normal is 140 or below; 140-200 is pre-diabetic; 200+ is diabetic - Impaired Fasting Glucose test (glucose levels after fasting) - Less than 100 is normal; 100-125 is pre-diabetic; 125+ is diabetic 22) 3.5-5.1 - Heart arrhythmia's 23) 7.35 - 7.45 - Acidic - Alkalinic 24) HDL is good; LDL is bad - It removes the bad (LDL) cholesterol from bloodstream - L = L (Lazy people get LDL build up) - Fatty build up in arterial walls, leading to atherosclerosis, MI, CAD, etc. 25) 200-240 - LDL - 40-60 - This is bad - you want more HDL - Take 200-40 ish and that is 160 (normal range is 100-180) - 180

Question 126

1) What is a BMP test: - What is tested in this test 1A) What is a Comprehensive Metabolic Panel (CMP) 2) A contractile lesion / issue is what: - A non-contractile lesion / issue is what - What will AROM and PROM be like with a contractile issue 3) When would you NOT do a joint mob (grade 1-5) 4) PAM and PPM stand for: - Explain each - What is osteokinematic motion vs. arthrokinematic - Which one is osteokinematic - PAM or PPM 5) What motions happen in PAM or Arthrokinematic motion 6) Arthrokinematics = - Osteokinematics = 7) When doing PAM, describe each grade of movement: 8) From point above, which movements (grades) decrease pain, and which increase ROM 9) For concave-convex rule: - If concave end is fixed, will the glide happen in the same direction or opposite direction? - -If convex end is fixed, will the glide happen in the same direction or opposite direction? 10) If someone did a Mulligan joint mob, what would it be for - What test rules in the condition from point above 11) If you did an anterior drawer on the knee, is that an A-P or P-A force - Doing this as a joint mob would help with knee flex or ext - Doing a posterior drawer (or A-P) motion will help with flex or ext 12) Doing an anterior drawer joint mob at the ankle would be an A-P or P-A force? - This (from point above) will help with DF or PF ROM - Doing an posterior drawer joint mob at the ankle would be an A-P or P-A force? - Doing a posterior drawer (from point above) will help with DF or PF ROM 13) What are normal end feels (describe each) 14) From point above, give an example of each: 15) What are abnormal end-feels, and explain each: 16) If you measure ROM of popliteal angle - how do you perform it: - What is it assessing? 17) Muscle length measurements are the same as taking ROM, except when (or in what circumstance): 18) What is the purpose of doing a RSC: - Can you apply a MMT grade to a RSC? 19) *** What are the grades for a RSC: 20) For the items below, explain what each grade for a MMT grade means: - 0: - 1: - 2: - 3: - 4: - 5: 21) A Make test is grade: - A break test is grade: - Wording for a break test: - Wording for a make test: 22) MMT'ing also goes by good/fair/poor grading. Name the grade and then the wording grade associated with the number grade: 23) T or F: Some will do MMT grades as 3+, 4+, 3-, etc. - So what wording grade would you give this number grade: 3+/5 - " (from point above) for 4-/5

Answer 126

1) Basic Metabolic Panel: A BMP is a blood test that measures your sugar (glucose) levels, electrolyte and fluid balance, and kidney function. All of these relate to a person’s metabolism. - Na, K, Cl, Bun, Glucose, CO2, HCO3, CR 1A) CMP: All the BMP tests, but with other tests to determine LIVER and other functions. So it tests to see how the LIVER is doing. Main test included in CMP that is not in the BMP is the bilirubin test. 2) Something with muscle or tendon - Something in joint (capsule, ligament, bone, meniscus/labrum, cartilage, bursa, skin, nerve) .... NOT muscle - AROM will be weak and painful, PROM will be just fine (if they are relaxed) 3) Fracture, osteoporosis, infection, tumor, hemmorage, pregnant, vascular issue, fusion 4) PAM = Passive Accessory Motion; PPM = Passive Physiologic Motion - PAM is a joint mob (joint motion); PPM is normal AROM - Osteokinematic is normal AROM joint motion; Arthrokinematic is motion in/at joint - PPM 5) Roll, Glide, Spin 6) Arthrokinematics: Intra-articular movements that occur at joints. This Passive Accessory Movement (PAM), it is what we ourselves can NOT do / reproduce (joint movement produced by others). - Osteokinematics: Natural movements that occur at joints. How the bone moves around a joint. This Passive Physiologic Movement (PPM), it is what we ourselves can do / reproduce (normal movement … elbow flexion). 7) - Grade I: Small oscillation movement at beginning of ROM - Grade II: Big oscillation movement at beginning of ROM (from start to mid ROM, first 1/2) - Grade III: Big oscillation movement from mid-end ROM (2nd 1/2) - Grade IV: Small oscillation movement at end of ROM - Grade V: Small amplitude, quick thrust (a manipulation, or adjustment / pop … not a mobilization). 8) Grade 1 and 2: Decrease Pain - Grade 3 and 4: Increase ROM 9) - Opposite - Same 10) Lateral epicondyalgia/itis - Maudley's 11) P-A - Flexion - Ext 12) P-A (P-A if pulling talus, but A-P if pushing tibia) - PF - A-P (A-P if pushing talus, P-A if pulling tibia) - DF 13) - Soft: Soft tissue / muscle / fat - Firm: Ligaments, tendons, capsules being stretched - Hard: Bone on bone 14) Soft: elbow and knee flex - Firm: Almost every joint - Hard: Elbow extension 15) - Springy Block: Less stretchy then firm end feel - Muscle Spasm: Guarding or muscle spasms - Empty: Pain 16) Pt lies prone and puts leg in 90/90 position and extends knee up to ceiling until HS's restrict motion - HS tightness 17) When it is a 2 joint muscle (like quads, biceps, etc.) 18) RSC's help us know whether injury/pain is a contractile vs non-contractile issue. We’re trying to figure out if they have pain or weakness, a tear in a muscle or not. - NO! You can not apply a MMT grade to a RSC. It is just to help you rule in / rule out a contractile vs. non-contractile lesion. 19) *** - Strong and Painful = Slight muscle tear - Weak and Painful = Partial muscle tear - Strong and Painless = No muscle tear, or no issue at all - Weak and Painless = Complete muscle tear 20) - 0: No visible or palpable contraction - 1: Palpable contraction - 2: Slight / part ROM against gravity, or full ROM w/o gravity - 3: AROM against gravity (but no resistance) - 4: Moderate muscle strength (can't hold position against max resistance) - 5: Full muscle strength (able to hold strength/position on full resistance) 21) 4 - 5 - Hold, don't let me move you - Push, Push, Push 22) 5: Normal 4: Good 3: Fair 2: Poor 1: Trace 0: No/Zero 23) True - Fair + - Good -

Question 127

1) What is the difference between MMT'ing Capital flexion and cervical flexion 2) Scapular adduction is the same motion as what: - Scapular abduction is the same motion as what: 3) When MMT trunk flexion (or abs), what is a - Grade 5: - Grade 4: - Grade 3: - Grade 2: - Grade 1: - Grade 0: 4) Below are PNF patterns. Explain each: - Rhythmic initiation: - Dynamic Reversals / Slow Reversals: - Stabilizing Reversals: - Rhythmic Stabilization: - How to remember these? - What are Agonist reversals: 5) Nervous system injuries / pathologies can happen anywhere along the chain of the nerve. Starting in the CNS and going down to the muscle, list what/where an injury can happen in order: 6) Basically 3 types of injuries can happen in the nervous system. What are they: 7) List the main most common neuro conditions adults get vs. kids: 8) What are neurological conditions that are genetic: - What are neurological conditions that are ischemic - Is CP inherited (genetic) 9) What is myelin? - What are the myelin cells in CNS - What are the myelin cells in PNS - What happens when myelin is destroyed/damaged - What causes demyelination 10) *** The demyelinating condition of the CNS is: - The demyelinating condition of the PNS is: - What is MS - What is GBS - Is CNS or PNS conditions progressive (irreversible)? - Will MS have UMN or LMN signs? - Is GBS progressive? 11) Besides demyelination, you can damage nerves. Give examples of how nerves get damaged - When you damage a nerve, will you get demyelination (slow conduction), sensory, or motor impairments? 12) What does ALS stand for: - What is ALS - Is ALS a demyelination condition - Will you get UMN or LMN signs with ALS? 13) T or F: Nerves in PNS can regenerate? - This is called what: 14) So what is Anterior Horn Cell Damage: 15) What is Radiculopathy? - Where does this damage occur? 16) What is a neuropathy - Explain difference between mono and polyneuropathy 17) So what is the difference between radiculopathy and neuropathy 18) Must know difference between these terms: - Neuropraxia: - Axonotmesis: - Neurotmesis: 19) What is a plexopathy: 20) What is the Neuromuscular Junction: - What neuropathology happens here: 21) What is it called when the pathology is at the muscle itself - What causes a myopathy: - Main pathology or condition of myopathys:

Answer 127

1) Capital is motion at C1, so chin tuck. Cervical is all cervical flexion motions. 2) Scapular retraction - Cross arm adduction 3) 5: Does a sit up and clears inf. angle of scapula off table with arms behind head 4: Does a sit up and clears inf. angle of scapula off table with arms across chest 3: Does a sit up and clears inf. angle of scapula off table with arms down to side of pt 2: Pt can lift head off table, but not scapulae 1: Palpable contraction, but can't move 0: No contraction visible or palpable 4) - Rhythmic initiation: Take patient through the motion passively. Then progress them from PROM -> AAROM -> AROM - Dynamic Reversals / Slow Reversals: Now add resistance in those functional/impaired motions (bed mobility, trunk rotation, STS, throwing arm, etc.) back and forth (resistance both ways). Patient does the motion, and you just provide resistance. Make it harder by adding more resistance, or doing larger ROM’s. - Stabilizing Reversals: Now the patient holds their body/trunk/limb in place so their body is stable / not moving. Then you add a lot of resistance to try to move them. Say: “Don’t let me move you” … and pt needs to resist your pressure. - Rhythmic Stabilization: Now you try to twist them. You say: “Don’t let me twist you” - Rhythmic's are first and last, then alphabetical - Agonist reversals include resisted concentric, isometric, and eccentric contraction tasks 5) - Demyelination of CNS (MS) - SCI - Anterior horn cell (ALS) - Demyelination of PNS (GBS) - nerve root = radiculopathy - plexus = plexopathy - peripheral nerve (neuropathy ... mono or poly) - neuromuscular junction (MG) - muscle (MD) - Could also get a Double Crush Syndrome which is an injury to the nerve at 2 locations 6) - First: Degeneration / Demyelination - Second: Injury / Trauma / Lesion to axons - Third: Vascular (ischemia, CVA) 7) - Adults: Stroke SCI Parkinson’s MS ALS MG TBI Etc. ``` - Kids: Cerebral Palsy Muscular Dystrophy Autism Down Syndrome Gross Motor Development Delay Etc. ``` 8) down syndrome, MD, Autism - Stroke, TIA, ischemia to nerve causing neuropathy - NO 9) Our nerves have a protective covering around them (much like insulating cover over an electrical cord). This covering is a myelin sheath. This myelin allows the speed of the action potential (the electrical impulse) to move faster. Without myelin, the nerve conduction will go slower, thus we would move, and sense, and respond slower. - Oligodendrite Cells - Schwann cells - There are various disease processes that destroy the myelin covering around nerves. When the myelin is destroyed / damaged, the nerve is damaged, and scar tissue forms (which blocks the conduction or speed of the signal). - Demyelinating diseases could be from an auto-immune diseases, infection/virus, genetics, inflammation, damage to the nerve, or some lack of blood supply that causes this myelin to become destroyed. 10) MS: multiple sclerosis - GBS: Guillain-Barre Syndrome - MS: Demyelinating disease of the CNS … brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. - GBS: Muscle weakness starts in the legs, moves to arms and upper body, and eventually to the diaphragm. Multiple Sclerosis is demyelinating disease of the CNS, and GBS is demyelinating disease of the PNS. - In the CNS, nerves do NOT regenerate, thus the reason why MS is progressive and worsens with time. But in PNS, people can recover from GBS - UMN - NO. Thankfully, unlike the CNS, PNS nerves can regenerate. There is no guarantee that they will, but damage to PNS nerves can be reversed and improved (that is why GBS has a good prognosis. Some infection may cause the GBS, but symptoms can improve and the condition reverse). 11) From an Injury. Examples include: Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), Concussion, Head Trauma, MVA, Laceration accident, etc. Nerves can become compressed, cut / severed, or crushed in any number of accidents (ie: war, sports, MVA, laceration, etc.). - Such an injury can damage the nerve itself (which depending on the type of nerve, will impact motor control, sensation, or both), it can damage the myelin sheath covering (see explanation above), slow or halt neural conduction flow (action potential / signal not getting through … like in ‘Drop Foot’), or damage blood vessels that essentially result in the nerve not getting blood supply and getting damaged (when blood supply is cut off to the nerve, eventually the nerve does not work … nor anything that nerve innervates). It could be an entire nerve, a portion, only effect the motor fibers, only effect the sensory fibers, or both fibers could be impacted – just depends on an injury. 12) ALS (Amyotrophic Lateral Sclerosis) / Lou Gehrig’s: - Upper and Lower motor neurons axon degeneration (axon gradually breaks down and dies). - This is NOT demyelination (like MS or GBS where myelin sheath breaks down), ALS is just axon degeneration in CNS and PNS. - UMN and LMN signs since it is in CNS and PNS 13) TRUE - Neurogenesis (or neuroplasticity) 14) Best example is ALS. ALS is an upper and lower motor neuron condition (but axon degeneration, not demyelination) where anterior horn cells are damaged. 15) Radiculopathy is commonly referred to as “pinched nerve.” This is a pinched spinal nerve, where it becomes a peripheral nerve. Damage at the nerve root level. Radiculopathy refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). This can result in pain (radicular pain), weakness, numbness, paresthesia, or difficulty controlling specific muscles. Remember that the spinal nerve exits the intervertebral foreamen, so if there is stenosis or OA or bone spurs in/around that intervertebral foreaman, it will pinch the nerve. It could pinch, compress, or severe all or part of it. That is why no one radiculopathy presents the same. One injury might only impact the motor nerves, another might only impact sensory, one might impact both, and one might be severe while the other is mild. It just depends - Nerve roots 16) A neuropathy is a result of damage to the actual peripheral nerve (outside the spinal cord, distally). It causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body. Mononeuropathy is one nerve in one extremity, and Polyneuropathy is many nerves (and potentially many peripheral n’s in multiple extremities). - MONOneuropathy: carpal tunnel syndrome (Median Nerve), ulnar nerve palsy, drop wrist (Radial Nerve), drop foot (Deep Fibular Nerve) - POLYneuropathy: or multiple n’s in multiple extremities/areas. These are always caused by disease (genetic, metabolic, toxin/infection, inflammation), not by injury/trauma. #1 cause is DM II 17) Peripheral neuropathy is the damage to the actual peripheral nerve, such as carpal tunnel syndrome or drop foot (but only to that nerve). Radiculopathy is the pinching of the nerve at the ROOT (up at intervertebral foreaman where it exits spinal cord), which can produce pain, weakness, and numbness distally along the dermatome path, myotome path, and any peripheral nerves that derive from that nerve root (for example, L5 nerve root sends fibers to Sciatic Nerve and then to Deep Fibular Nerve, and C8 goes deep in anterior forearm (Median Nerve) and to distal thumb (recurrent median nerve). 18) - Neuropraxia: A type of peripheral nerve injury, and is known as the mildest form of nerve injury. It is classified as a transient conduction block of motor or sensory function without nerve degeneration, although loss of motor function is the most common finding. VERY MILD, CAN RECOVER. **** Neurapraxia is a class 1 nerve injury that involves some local compression or blockage of the nerve. It could happen from trauma and result in entrapment of the nerve. So a neurapraxia injury to a nerve will cause the NCV to be diminished or altered or even absent. Conduction above the site of injury will be normal. And it won't impact areas that nerve doesn't innervate. - Axonotmesis: is an injury to the peripheral nerve of one of the extremities of the body. The axons and their myelin sheath are damaged in this kind of injury, but the endoneurium, perineurium and epineurium remain intact. So more severe, but can regenerate. - Neurotmesis: It is the most serious nerve injury in the scheme. In this type of injury, both the nerve and the nerve sheath are disrupted. While partial recovery may occur, complete recovery is impossible. 19) This is when there is some pathology or damage to a nerve within a plexus (like the Brachial Plexus or the Lumbosacral Plexus). These are so complicated because a nerve within a plexus typically has many spinal root levels involved. For example, the Sciatic Nerve has fibers from L5-S2, the Median Nerve has fibers from C6-C8, etc. Thus, sometimes it is hard to differentiate between whether it is a Median Nerve issue, or a C6 vs. C7 issue. That is why you need to assess dermatomes, myotomes, and peripheral nerves to try to be specific. 20) Neuromuscular Junction (motor end plate) - where nerve and muscle meet. - Myasthenia Gravis: This is a neurological condition down at the Motor End Plate or Neuro Muscular Junction (NMJ) where the axon connects and passes signal to the muscle fibers. It is characterized by AcH not properly (or at all) being released normally at NMJ, so a contraction can’t happen with the muscle. The disorder can happen at the pre-synaptic cleft, or the post-synaptic cleft. 21) Myopathy - Genetics (like Muscular Dystrophy), endocrine (parathryroid), inflammatory - Muscular Dystrophy: Disease or wasting to the actual Muscle itself. A genetic disorder where there is an absence of dystrophin, a protein needed to build and maintain muscle mass. Without dystrophin, muscles eventually waste away. Results in muscle weakness, and eventually respiratory failure.

Question 128

1) How would you rate reflexes: 2) Biceps tests what spinal level: - Brachioradialis tests what spinal level: - Triceps ": 3) ** If you are not getting a reflex, have pt do what? 4) Babinski's reflex suggests what: - How do you perform: - What is a positive test: 5) CLonus is a test for what: - How do you perform it: - A positive test is what: 6) What is Hoffman's sign: - How do you perform Hoffman's: - What is Homan's sign for:

Answer 128

``` 1) 0=absent 1+=trace 2+=normal 3+=strong 4+=clonus ``` 2) C5 - C6 - C7 3) Clench fists (if testing LE), or tighten LE m’s (if testing UE reflexes). 4) UMN lesion - Run stick up lateral foot and across metatarsal heads quickly - Toes flare vs. curl or tickleish 5) Clonus is a test for an UMN lesion. - You place your hands across the metatarsals of patient’s foot. Then you RAPIDLY (very quickly) force the foot into DF. - If there is an UMN lesion, the foot will have excessive tone / spacticity and will have rapid sustained beats. 5) Hoffman’s sign is basically same as Babinski’s, but with upper extremity. - So you flick the middle finger (nail of 3rd digit). If the thumb and index finger curl or twitch while you flick the 3rd digit = UMN lesion. - Testing for a DVT in LE's

Question 129

1) Numonic for the Cranial Nerves (CN) ``` 2) List what each CN is: CN I: CN II: CN III: CN IV: CN V: CN VI: CN VII: CN VIII: CN IX: CN X: CN XI: CN XII: ``` ``` 3) For the CN's, which are sensory, which are motor (do it by the numonic) CN I: CN II: CN III: CN IV: CN V: CN VI: CN VII: CN VIII: CN IX: CN X: CN XI: CN XII: ``` ``` 4) What is the function of each CN CN I: CN II: CN III: CN IV: CN V: CN VI: CN VII: CN VIII: CN IX: CN X: CN XI: CN XII: ``` 5) What would you do to do a CN screen:

Answer 129

1) On Old Olympus Towering Top A Finn and German Viewed Some Hawks ``` 2) CN I: Olfactory CN II: Optic CN III: Occulomotor CN IV: Trochlear CN V: Trigeminal CN VI: Abducens CN VII: Facial CN VIII: Vesibulocochlear CN IX: Glossopharyngeal CN X: Vagus CN XI: Spinal Accessory CN XII: Hypoglossal ``` ``` 3) CN I: Some CN II: Say CN III: Marry CN IV: Money CN V: But CN VI: My CN VII: Brother CN VIII: Says CN IX: Big CN X: Brains CN XI: Matter CN XII: More ``` S = Sensory, M = Motor, B = Both 4) CN I: Smell CN II: Vision CN III: Eye mvmt (4 occular m's) CN IV: Eye mvmt (sup oblique) CN V: Jaw / Chewing and sensation of face and jaw CN VI: Eye mvmt (lateral rectus) CN VII: Facial m's mvmt, front 2/3'rds of tongue CN VIII: hearing and vestibular CN IX: Swallowing and back 1/3rd of tongue sense, salivate CN X: Vagus - innervation to organs, bowel, respiration, parasympathetic CN XI: Muscle mvmt of SCM and Traps CN XII: Tongue mvmt ``` 5) - CN 1: Olfactory n. Smell something - CN 2: Optic n. Vision – can they read a line on a paper - CN 3, 4, 6: Ocular Muscle n’s Eye movement (visual field tracking ability) - CN 5: Trigeminal n. Jaw movement – open and close jaw - CN 7: Facial n. Facial expressions. Smile and move facial m’s. - CN 8: Vestibulocochlear n. Hearing. Can they hear? - CN 9: Glossopharyngeal n. Can they swallow? - CN 10: Vagus n. Can’t really test - CN 11: Accessory n. Move or do a MMT to SCM and Traps - CN 12: Hypoglossal n. Stick tongue out ```

Question 130

1) What is the difference between tone and spasticity: 2) What is the scale used to assess spasticity: - What is the rating for this scale: 3) Pt's will be given a compression garment to wear following a surgery (on LE's following a TKA, for example). Why? What is the purpose - What is the best way to prevent edema, DVT's, and lack of ROM progress following a surgery? 4) What are a few ways to assess coordination: 5) What is the assessment tool to assess coordination - It stands for what: - Score range is what: - A 0 score means what: - The highest score you can get is a: - The test will measure things like: 6) What is neglect? - Damage (CVA) to R side of brain is most common, meaning which side is neglected? 7) Why would someone become hypersensitive - Why would you do desensitization techniques for these pt's: - What is the common analogy for desensitization: 8) What is neuroplasticity: - *** What are the principles of neuroplasticity: 9) *** What are the UMN signs: 10) *** What are the LMN signs: 11) T or F: An EMG and NCV test can help rule in the diagnosis of Multiple Sclerosis - Why (from point above) - EMG tests measure what: - In an EMG, you should hear what when muscle is at rest? - From point above, if you do hear activity, what does that mean 12) A NCV test measures what: - There are norms for the speed of each nerve, so when the speed is less, what does that mean? - Will hot or cold temp's impact NCV speed - Are C fibers myelinated or not 13) Can these tests get specific about identifying where the lesion is? - Why would we do these tests? 14) If the lesion is at the anterior horn cell level, what condition would this be: - If it is at the nerve root level, it would be: - If at a plexus (brachial or lumbosacral): - At a peripheral nerve(s) - At neuromuscular junction - At muscle belly 15) What is the Clinical Practice Guidelines for ruling in an ankle fracture - What is the Clinical Practice Guidelines for ruling in a cervical fracture - What are the s/s to determine to get imaging for a c-spine fracture 16) What is the scale used for determining if someone has ligament laxity? - How do you score it? - What is a good score, what is a bad score 17) What are the actions performed on the Beighton test

Answer 130

1) Tone: Checking for tone is just doing PROM on patient. Feeling for any abnormal / excessive tone during PROM movements. - Spasticity: Spasticity is simply checking for tone (doing PROM), but now adding SPEED during that movement. 2) Modified Ashworth Scale - 0: No increase in muscle tone - 1: Slight increase in muscle tone, manifested by a catch and release or min resistance at end range (clasp-knife) - 1+: Slight increase in muscle tone, manifested by a catch, and then min resistance through 1/2 of ROM (cogwheel) - 2: More recognizable increase in tone through most of the ROM - 3: Lots of tone - difficult to move through ROM (lead-pipe) - 4: Rigid 3) Help with edema and prevent swelling. Helps with preventing a DVT so it helps blood flow move back up to the heart. - MOVE IT (activity / exercise) - helps with blood and fluid flow 4) - Finger to nose / Finger chase (dymetria) - Heel to shin test - Incy wincy spider - Alternating pro/supination with hands (Dysdiadochokinesia) - Jumping Jacks - Hand eye coordination with ball 5) SARA - Scale for assessment and rating of ataxia - 0-40 - No coordination deficits - 40 = severe ataxia - Heel to shin, alternating hands, finger-nose, jumping jacks, fast alternating hand mvmts, gait 6) Following brain damage/injury in which patients fail to be aware of items to one side of space. - L (side opposite the brain damage) 7) Injury to an area and becomes chronic, which impacts pain processing and brain becomes hypersensitive. - Desensitization works by showering the brain with sensory input until the body becomes acclimated, eventually increasing the threshold to that sensation. - Think of the shower analogy. When first stepping into a really warm shower, skin is not used to it and hypersensitive. But if you slowly ‘desensitize’ it, the brain will turn off the ‘warning’ signal and allow you to get in (at the same heat) and it feels ok instead of painful. 8) The ability of the brain (CNS) to form and reorganize synaptic connections, especially in response to learning or experience or following injury. - Timing: sooner the better - Recent: the more recent the better - Repetition: the more you practice the better - Variability: the more variability in practice the better - Intensity: the more intense the practice the better - Age: the younger you are the better - USE IT OR LOSE IT 9) - Spacticity - Hyperreflexia - Hypertonic - Babinski's or clonus - Atrophy (from disuse) 10) - Flaccidity - Hyporeflexia - Hypotonic - Muscle wasting - Absent babinski's and clonus 11) False - MS is an UMN or CNS pathology, and EMG and NCV only deals with PNS issues of nervous system - Evaluating and recording the electrical activity within / produced by skeletal muscles. - Nothing - Abnormal electrical signal = pathology 12) Measures how fast an electrical impulse moves through your nerve - Either demyelination or axon loss/lesion - Cold (makes it slower) - NO they are not - they are the slow noxious nerve fibers 13) yes. That is the point of doing them - to determine where the lesion is specifically (is it happening at the wrist, or more proximal at the elbow on Median Nerve. If the ulnar nerve, is it at the wrist, elbow, or more proximal? Etc.) - Determine if it is just median nerve (any peripheral nerve), or is it actually C6/C7/C8 nerve root involvement / radiculopathy. It can detect slower NCV - be it from compression at carpal tunnel, or along entire nerve path to rule in something like GBS or ALS 14) ALS - Radiculopathy - Plexopathy - Mononeuropathy or polyneuropathy - Myasthenia Gravis - Myopathy / Muscular Dystrophy 15) Ottawa Ankle Rules - Canadian C-Spine Rules - MOI (dangerous MVA, for example), Age, ROM (can't go past 45 deg's), limitations, pain level, paresthesia down UE 16) Beighton's Score - 1 point for each hypermobile joint/action - Score of 0-3 is normal; and a score of 4-9 represents ligamentous laxity 17) - Bend thumb to touch forearm - Bend pinky back past 90 deg's to back of hand - Elbow goes past 0 deg's (hyperextends) - Knee goes past 0 deg's (hyperextends) - Bend forward and place palms on ground with knees straight

Question 131

1) ULNT stands for - What is it 2) What is Adson's special test for: - It assesses if the condition (from point above) is happening where 3) What are the other special tests for TOS (explain them) 4) VBI special test stands for: - Always check what before performing this test - What are you looking for during this test - From point above, these stand for: 5) What is the difference between the alar and transverse ligament's of the neck - Side bending and rotation (coupling) is what in c-spine - So feeling spinous process of C2 during alar lig test ... if you sidebend left, the spinous process should go which direction? - So what is a positive finding of an alar lig test: - What is a positive finding of a transverse lig test: 6) How do you perform a transverse lig special test: - What is a positive on this transverse lig special test: 7) Goal of the cervical flexion-rotation and the AA rotation tests is to do what: - A positive finding is what: 8) What's the difference between the IR lag sign and the ER lag sign special tests: - The subscapularis lift off test is called: 9) Anterior apprehension special test is to assess for what: - What diagnosis might you test this on with someone? - What is the relocation test 10) Sulcus sign or sulcus test is for what - How is test performed 11) Anterior slide test is to assess for what: - How is it done? 12) Jerk slide test is to assess for what: - How is it done? 13) O'Brien's tests if to help rule in what: - Is this test performed in the same position as empty can / full can? - What do results mean: 14) What is the Acromioclavicular Shear Test / Paxinos Sign 15) What is Speed's test for 16) Yergason's test is for what: 17) Maudsley’s Test is for what: - How would you perform this? - This is somewhat similar to what other test? 18) What test is this describing ... PT grasp pt’s hand and moves wrist into ulnar deviation. Then once in ulnar deviation, move wrist back and forth between flexion and extension (while maintaining ulnar deviation). 19) What test is this describing: PT grasps triquetrum between the thumb and the 2nd finger of one hand, and the lunate bone with the thumb and 2nd finger of the other hand. PT moves the lunate palmer and dorsally with respect to the triquetrum. 20) What test is this describing: PT grasps wrist from the radial side with the thumb over the scaphoid tubercle. PT will use other hand to grasp metacarpals and move wrist into ulnar deviation and slight extension. Then move wrist into radial deviation and slight flexion. During this motion, PT presses scaphoid back and out of normal alignment as pt flexes. Then PT releases scaphoid, and you’ll get a “thunk” as the scaphoid moves back into place (if positive, or lig laxity). 21) What test does this describe: Thumb tendons (abductor pollicis longus, extensor pollicis brevis) get enflamed which leads to a compartment issue. Pt puts thumb into fist with thumb tucked into/inside fingers, and PT puts wrist into ulnar deviation to stretch thumb tendons. It is positive if pain is produces, suggesting tendinitis. 22) What test does this describe: Pt makes fist. If 3rd metacarpal head is not longer (which it should be) then positive for LUNATE bone necrosis / laxity / dislocation 23) What test does this describe: Test to see how/if radial and ulnar arteries are functioning properly. PT occludes radial then ulnar artery to see refilling time 24) Adam's test is for what - How do you perform this test: - If hump goes away bending forward than it means what: 25) Gillet's test is what: 26) When a pt is sitting and bends forward while PT palpates both PSIS’s and has pt bend forward. PSIS’s should be symmetrical as pt bends forward. This is what test? 27) What is Gaenslen’s Test 28) What is Faber's or Patrick's Test for: - How to perform 29) What is Craig's test for 30) When you bring leg up into passive hip flexion and then IR, what is this test? - It is to assess what 31) McMurray's special test is for what - How do you perform this 32) Thessaley's special test is for what: - How do you perform this - MUST ensure you do what with this test 33) Apley's special test is for what - How do you perform this 34) Nobel's test is for what 35) Fairbank's apprehension test is for what 36) Windless mechanism is special test for what 37) Thompson test is for what - What are you looking for 38) Homan's test is for what - How do you do it 39) Interdigital squeeze test is for what 40) Test to see if there is arterial insufficiency in LE's

Answer 131

1) Upper limb neural tension test - Nerve glide assessment of median, ulnar, or radial nerve neural tension 2) Thoracic Outlet Syndrome - At scalenes (exit point of brachial plexus) 3) - Costoclavicular: arm extended to stretch pecks to see if compression is at pecks - Roos: chicken dance to compress at 1st rib and clavicle 4) Vertebral Artery Insufficency - neck ligament integrity - 5 D's, and 3 N's - D's: diplopia (double vision), dysarthria (speaking issues), drowsy, drop attack, dysphagia (difficulty swallowing) - N's: numbness, nystagmus, nausea 5) Alar connects dens to C1 to prevent too much rotation. Transverse prevents forward translation of C1 from C2 - SAME (side bending and rotation is same in neutral) - RIGHT (the rotation goes left, so spinous process goes right) - Positive: If C2 spinous process is not moving at all, or goes to the SAME side of lateral flexion, or there is hypermobility. This indicates a positive finding for alar lig issue. - Do a C1 joint mob and they get a lump in their throat 6) PT palpates the space between the occiput and C2 spinous process (where posterior arch of C1 is). Then PT pulls pt’s head up (protraction) repeatedly. - Positive: If the pt reports a “lump in the throat” or significant spinal cord compression type symptoms, or lots of lig laxity = positive finding 7) The goal with neck flexion is to lock out all lower c-spine jts so that rotation is only happening at C1/C2 (thus no rotation happens in lower c-spine, so you know what is happening at C1-C2. - Rotation should be about 45 degrees. Anything significantly less or more (or imbalance bilaterally) suggests joint impairments. 8) IR: Put hand behind back (like tucking in shirt) and lift arm off backside. If they can't, possible subscapularis tear - ER: PT brings hand back to full ER and asks pt to hold it. If they can't and it moves forward into IR, possible Infraspinatus tear. - Gerber's 9) Shoulder capsule instability (anterior G/H lig instability/laxity) - Anterior shoulder dislocation - Same as above, but then provide a stabilizing A-P force at shoulder. If this helps it feel better, it confirms anterior lig laxity / dislocation 10) Superior G/H capsule / lig laxity (and coracohumeral lig) - Either you see G/H or shoulder sag; otherwise, pull down at elbow and you'll see G/H joint gap significantly 11) Shoulder labral tear - Pt stands with hand on hip like "I'm a little tea pot" and PT applies force up long axis of humerus into labrum 12) Posterior labral tear - Arm in 90/90 horizontal abd position and you apply force up long axis of humerus into posterior labrum 13) Labral tear or A/C joint pathology - No. Empty/full can is for RC and in a scaption plane. O'Brien's is in 90 deg's of flexion and only 10 deg's of ADDuction). - IR Position: Pt will report if pain is at top of shoulder (A/C jt) or “inside” shoulder (SLAP lesion). Then repeat firm press down in an ER Position Positive: If there’s pain on both IR/ER at top of shoulder = A/C jt pathology. But, if there’s pain on IR and then less/no pain on ER = SLAP tear. 14) Compress A/C joint to detect an A/C joint sprain 15) Biceps strain / tendinitis 16) It is a resisted supination test to detect a biceps pathology 17) Lateral epicondylitis - Resistance of 3rd digit extension - Hoffman's for UMN signs (flicking 3rd digit) 18) TFCC load test 19) Ballottement Test / Reagan’s Test 20) Watson’s Shift Test 21) Finkelstein test 22) Murphy’s Sign: 23) Allen's test 24) Scoliosis - Bend forward and look at back for hump on one side - It is a functional not a structural scoliosis 25) "J" test - palpate PSIS's to detect SI joint abnormality. It should form a J during one leg stance; if not = SI jt dysfunction 26) Piedallus Test 27) Patient lays supine with painful leg resting off end of treatment table, or off side of table. And test both sides if pain on both sides / or general pain. PT: Brings pt’s other (good) leg up to a 90/90 position and places a downward force to lower leg while forcing good leg into more flexion (so legs going in opposite directions). - It is the pectineus fix 28) Sacroiliac / SI Joint Dysfunction or Pain (and can be positive in FAI as well). It also helps rule in very tight hip capsule if it won’t go down, or low back pain. - Figure 4 position (flex, abd, er) and push down on knee 29) Hip anteversion or retroversion 30) Fadir - For FAI and/or abdominal issue. This could be painful for anyone really, but if someone has FAI the head of the femur will catch and this will be painful. If however doing this test and pain is felt in the ABDOMEN, then could either mean a psoas abscess or some abdominal pathology … refer). 31) Meniscus - Pt lies supine and you passively IR/ER them and do knee flex and ext to grind mensicus 32) Meniscus - The "dance" on one leg to grind meniscus - 20 to 30 deg's of knee flexion to grind meniscus 33) Meniscus - Laying prone and push knee into table to grind meniscus 34) IT band 35) Patellar mob to see for patellofemoral pain syndrome 36) Plantar fasciitis 37) Torn achilles - When you squeeze calf, if it does NOT PF, it is torn achilles 38) DVT - DF ankle and squeeze calf (pain = positive) 39) Morton's neuroma / metatarsalgia 40) Rubor of Dependency

Question 132

1) What is the progression of resistance by color with therabands: 1A) What are the stages of Motor Control: - Explain each: 2) ***** What are the stages of motor function (just list them with brief description): 3) If the disc of the TMJ is stuck anteriorly of the joint, would that cause someone to not be able to open their jaw, or not be able to close their jaw - If the disc of the TMJ is stuck posteriorly of the joint, would that cause someone to not be able to open their jaw, or not be able to close their jaw 4) What is the muscle MOST commonly involved in TMD of the TMJ 5) What are the m's of mastication: - TMD is what: 6) What causes TMD: 7) Normal depression or opening ROM for the TMJ is what: - Lateral excursion of the jaw is about what ROM normally - What do you use to measure ROM of TMJ 8) What is circuit training: ``` 9) These landmarks are where on body: ANTERIOR: First rib: T1: T2: T3: T4: T7: T10: L1: ``` ``` Posterior: C7: T3: T7: L4: S1/2: ``` 10) What is Bruxism

Answer 132

1) Yellow = lightest/easiest - Red: harder - Green: even harder - Blue: really hard - Black: impossibly hard 1A) Mobility --> Stability --> Controlled Mobility --> Skill - Mobility: ability to initiate movement through a functional ROM. - Stability: ability to maintain a position or posture - Controlled Mobility: ability to move in a weight bearing position or rotate around an axis - Skill: ability to consistently perform a functional task (ADL's) 2) - Inhibitory: Can't move - Initial Mobility: Postural control being learned - Stability: Posture and maintain position is good - Controlled Mobility: Dynamic movements - Skill: Skilled 3) Open - Close 4) Lateral Pterygoid (since it attaches to the disc and condyle) 5) Temporalis, masseter, lateral pterygoid, and medial pterygoid muscles. THe buccinator also, but that is more of an internal m's to help with food in side of mouth. - Temporomandibular dysfunction: Where articular disc gets mis-aligned and stays anteriorly or posteriorly and doesn’t go back into place between the mandibular fossa of temporal bone and condyloid process of mandible. This causes pain and difficult / abnormal jaw motions. 6) Trauma, blow to head, whiplash - Bruxism: Grinding your teeth - Muscles of mastication issue: - Tightness / Tonic muscle contractions of m’s of mastication - Weak m’s - Nerve issue - OA, RA - Malalignment of teeth/jaw (may need to see dentist/oral surgeon) - Poor posture 7) 35-50 mm - 10-15 mm - Boley Gauge 8) Non-stop high intensity exercises, rotating between each exercise to strengthen, but because you take no rest break, you get the cardio / aerobic exercise benefits. It targets strength building and muscular cardiovascular endurance. An exercise "circuit" is one completion of all prescribed exercises in the program. You do leg strengthening, then chest, then arms, then back, etc. but keep going so you get aerobic exercise benefits too. ``` 9) ANTERIOR: First rib right under clavicle (Apex of lung goes 2-3 cm above 1st rib) T1: Jugular Notch T2: Sternal Angle T3: Rib felt in/below axilla T4: Nipple Line T7: Xiphoid T10: Umbilicus L1: Inguinal ``` ``` Posterior: C7: Vertebra Prominens T3: Spine of Scapula T7: Inf. Angle of Scapula L4: Iliac Crest (top portion) S1/2: PSIS ``` 10) Grinding your teeth

Question 133

1) The 10m walk test can be done how many times (taking average) - A community safe ambulator who is not a fall risk and can cross the street in normal speed will get a score of what? - The cut off score for a ROF, someone who is not safe, could be hospitalized, can't walk in public, and can only do household ambulation is what: - So if you are a limited community ambulator, you'd get a score of what: 2) Walk through every phase of the gait cycle - in order: 3) What is Trendelenberg gait: - So if R hip abd's (glute med) is weak, you'd lean which way - What is a compensated trendelenberg gait: 4) Spacticity in hip adductors would cause what gait pattern - Ataxic gait means what - Antalgic gait means what - WHat is a shuffled gait - Shuffled gait is seen in what diagnosis - Lateral vs. Medial whip gait pattern 5) Cut off score for the TUG balance test to determine ROF - 5STS cut off score for ROF - Tandem stance " - Single Leg Stance " - Functional reach " - 4 square step test " 6) Berg Balance Scale is out of how many points? - Below what point value is ROF on Berg - ***** T or F: Berg is only test they can NOT use an AD on - Tinnetti Balance tool is out of how many points - Cut off score for Tinnetti for ROF is: - How are Tinnetti and Berg different 7) CTSIB test is for what - You are timing them for 30 sec's in each of 6 positions (first 3 on firm ground, last 3 on foam pad. 2nd one on each is eyes closed, 3rd one on each is cover over eyes) - Total time to do test is: - Cut off score for ROF is: - What determines stopping time 8) What does DGI stand for: - What is it - Highest score you can get on the DGI is: - Cut off for ROF is: 9) What does FGA stand for: - What is it - How is it different than the DGI - Highest score you can get on the DGI is: - Cut off for ROF is: 10) What is the HiMAT test: - Who is this test for - What's in the test - It is out of how many points - What is cut off score 11) What is phonophoresis: 12) What is a nociceptor - What is a proprioceptor: - " baroreceptor: - " mechanoreceptor: - What does Noxious mean? 13) What nerve fibers are for noxious / pain - Are these larger or smaller nerve fibers - Are C fibers myelinated - Would NCV be faster or slower in these fibers? - So what are the fast noxious nerve fibers 14) Afferent fibers go down to the body or up to the brain 15) Nerve fibers that are for muscle spindles (muscle stretch) - Nerve fibers for golgi tendon organs (muscle load) - Nerve fibers for free nerve endings - Touch, vibration, pressure, position - are from what nerve fibers 16) Gate control theory is activating ____ nerve fibers to overtake ____ nerve fibers 17) What medication is taken for spasticity

Answer 133

1) 3 times - > 0.8 m/s - < 0.4 m/s - 0.4 - 0.8 m/s 2) initial contact / heel strike, heel rocker, ankle rocker, mid stance, forefoot rocker, terminal stance, toe rocker, toe off, pre-swing, initial swing, mid swing, terminal swing (knee extending and ankle PF’ing), heel strike, repeat. 3) Trendelenburg gait is when weak hip abductors cause you to fall / lean AWAY from side of weak hip. - Left because the R glute med is weak and can't keep you upd - A “compensated Trendelenburg gait” is when you compensate and lean over the “bad” side to correct COM back over stance leg 4) Scissors gait - Ataxic: not coordinated - Antalgic: gait pattern to avoid some pain, so abnormal gait - Short steps - Parkinson's - Medial Whip = Tight / short abductors bring leg out, so they whip leg in (medial) to correct. Lateral Whip = Tight / short adductors bring leg in, so they whip leg out (lateral) to correct. 5) 15 sec's - 15 sec's - < 10 sec's - < 5 sec's - < 7 inches (~18 cm's) - > 15 sec's 6) 56 - 41 - TRUE - 28 - 19 - Tinnetti has a gait element 7) Balance - to see if balance impairment is from vision, vestibular, or LE weakness (somatosensory) - 6 x 30 = 180 ... then you do 3 trials, so 540 - Less than 260 - Moving arms, stepping, opening eyes 8) Dynamic Gait Index - A gait assessment tool (assesses gait, head turns, over obstacles, steps) - 24 - 19 9) Functional Gait Assessment - A gait assessment tool (assesses gait, head turns, over obstacles, steps) - Adds a few more difficult elements - 30 - 22 10) High Level Mobility Assessment Tool - High level athletes and functional pt's - run, skip, stairs, - 54 - There is NO cut off score. Just normative values: Males: 50-54 points; Females: 44-54 points 11) Use of ultrasound to drive in topical medications through the skin 12) A sensory receptor for pain signals - Receptor to detect where you are in space - " pressure changes - " movement - Painful 13) C fibers and A delta - Smaller - NO - Slower - A delta 14) Up to brain 15) A alpha Ia - A alpha Ib - A delta - A beta 16) A beta, C 17) Baclofen **

Question 134

1) An incredible (very good) VO2 Max score for men and women would be: - A really poor VO2 max score for men and women would be: 2) A VO2 Max of 50 for men would equate to about what MET level 3) Deficits in vitamin B's (B1, B2, B12) leads to what side effects - Deficiency of Vitamin A leads to - Vitamin D is important for what - Deficiency of Vitamin D does what: 4) What are the contraindications of pool therapy - not allowing someone to get into water 5) There are some principles of aquatic therapy to know. Explain each below: - Hydrostatic Pressure: - Buoyancy: - Resistance: - Thermodynamics: 6) Which one is genetic - Type I or Type II diabetes? - Which one is more common - Type I or II - Explain what Type I is - what is happening? 7) What is Type II Diabetes 8) What is Type III diabetes: - What is Type IV diabetes: 9) What is the difference between insulin and glucagon 10) We know why exercise is so important for someone with DM II (helps people lose weight, prevent more atherosclerosis, decreases blood sugar levels, etc.) - but main reason why exercise is SO important for someone with Type II DM is: 11) There are two major complications that can result from having diabetes. What are they (just list them): 12) From point above, explain each: 13) From point above, those with Type I are more prone to get which one? - From point above, those with Type II are more prone to get which one? 14) Can someone with DM II (type I or II) get low blood sugar levels? - How (from point above) - What would blood sugar have to get below to start seeing hypoglycemia symptoms - Symptoms of hypoglycemia are: - As a PT, you must always have what on hand

Answer 134

1) Men above a 50, Women above 40 - Men below 35 ish, Women below 25 ish 2) 8-9 3) Lethargy, irritable - Suseptible of infections - Calcium absorption for bones - Soft bones 4) Open wound (not covered properly), infection or sickness, incontinence, hx of siezures (within 1 year), allergies to chlorine, ostomy or catheter line into body risks infection, vital capacity less than 1L, end stage renal disease/CHF 5) - Hydrostatic Pressure: This is compression, so helps with edema or lymphodema (the lower you go, the more the hydrostatic pressure) - Buoyancy: Helps pt float. So less WB'ing, can move more. The more your body is under water, the more buoyancy effect. - Resistance: Resistance of water helps with strengthening (especially if there are jets) - Thermodynamics: Warmth. Heat helps with pain relief, blood flow, soften tissues 6) Type I - Type II - Typically this is a GENETIC defect, seen in early age, and is NOT COMMON. It is an autoimmune disease where the body's immune system attacks BETA cells that produce insulin in the pancreas, and so a person doesn't have insulin to clear out blood sugar levels, so they need insulin injections for life. Hyperglycemia would be detected by a HbA1c, IGT, or IFG test, resulting in high blood sugar levels since insulin isn’t produced. 7) This is when either the pancreas is not producing enough insulin (typically from an unhealthy diet and consumption of too much sugar), or the pancreas is producing enough insulin but the tissues (cell receptors) are not allowing insulin in because they are resistant for a variety of reasons. When the insulin receptors on cell walls become RESISTANT to the effects of insulin, or a person’s diet is high in sugar and the pancreas can’t produce enough insulin to keep up, this is when Type II develops. When the insulin receptors on cell walls malfunction, they do not let insulin in to release the glucose to metabolize. This results in high blood glucose levels (hyperglycemia) and leads to Type II diabetes. If, on the other hand, a person’s diet is unhealthy and high in sugary foods, the pancreas (which produces insulin) can’t keep up and so there is a heightened level of blood glucose amounts. Diabetic symptoms may take years to appear, and people can often use medications, diet, and exercise in the early stages to reduce the risk or slow the disease. However, if necessary, people may need to inject insulin to help manage diabetes and clear out high blood sugar levels. Consistent exercise and low fat/calorie diet has proven to reduce Type II diabetes by 58% over 3 years. 8) Type III: Non-pancreatic causes of elevated blood sugar (e.g. drug therapy). - Gestational diabetes – abnormality in blood glucose during pregnancy. 9) - Insulin: A hormone produced in the pancreas by the islets of Langerhans that regulates the amount of glucose in the blood. All cells in your body need sugar for energy. However, sugar cannot go into most of our cells directly. After you eat food and your blood sugar level rises, cells in your pancreas (known as beta cells) are signaled to release insulin into your bloodstream. Insulin then attaches to and signals cells to absorb sugar from the bloodstream. Insulin is often described as a “key,” which unlocks the cell to allow sugar to enter the cell and be used for energy. The lack of insulin causes a form of diabetes. - Glucagon: Glucagon is a hormone the pancreas produces to help regulate blood sugar levels in the body. In contrast to insulin, glucagon helps raise blood sugar levels when they get too low. Glucagon will be released and go to the liver to stimulated stored sugar (glycogen) that is stored there as a reserve. Like when you fast and are starving, the body has a resivoir of sugars to break down for energy, and glucagon is responsible for this process and keeping blood sugar levels from falling too low. 10) *** Exercise increases the cells receptivity to insulin. 11) DKA (Diabetic Ketoacidosis), and HHS (Hyperosmolar Hyperglycemic State) 12) - DKA (Diabetic Ketoacidosis): If sugar can’t be removed from blood and get into cells for creation of energy, the body will turn to other sources to get energy. It will thus break down fat, which could release dangerously high levels of keytones into the blood. Ketones can make your blood ACIDIC. Acidic blood can cause DKA. The most serious effects of DKA include: Swelling in your brain A loss of consciousness Diabetic coma Death - HHS (Hyperosmolar Hyperglycemic State): IT IS EXTREME HYPERGLYCEMIA (high blood sugar amounts), it is a complication of diabetes mellitus in which high blood sugar results in high osmolarity WITHOUT significant ketoacidosis (not having keytone acidosis in blood). More common in those with Type II diabetes 13) DKA - HHS 14) Yes - Taking too much insulin, not eating, fasting too long, exercising way too much, etc. The pancreas can even create abnormally large amounts of insulin (like a tumor) - 70mg - Tired, lethargic, weak, shaky - Sugary drink or candy bar

Question 135

1) What is the task oriented approach 2) For a concussion, in order to move to next stage, they must have NO symptoms for how long 3) What are the stages for a concussion 4) What does VOMS stand for - What is VOMS - What are the things you do in a VOMS - Why do you do these things: 5) *** What are the grades for an ASIA spinal cord injury 6) What again are the stages for wound healing: 7) Describe Parkinson's disease - what is happening physiologically: - Main s/s of Parkinson's - Main intervention to use on Parkinson's pt's is: 8) **** The Hoehn and Yahr Scale is for what: - What are the ratings: 9) What assessment tool would you give to someone who is a Worker's Comp pt: - What does this test (from above) measure: 10) T or F: Heating a limb with lymphedema is an effective intervention? - Why (from point above) - Should pt's with lymphedema fly. Why or why not? 11) With manual lymph drainage (MLD) do you start proximal or distal and move fluid back up? - T or F: MLD (manual lymph drainage) is effective for pt's with CHF 12) Is lymph fluid blood or plasma 13) What are the 2 main lymph ducts in the body - What is primary vs. secondary lymphedema 14) How do you tell lymphedema apart from lipedema 15) Besides damage to lymph system or chemo, how else might someone get lymphedema - Besides large LE's, lymph nodes removed, or diagnostic tests to rule it in, what is a common diagnostic s/s that someone has lymphedema 16) **** What are the stages of lymphedema 17) What is the cancer of the lymph system - What is this (from point above) - How do you tell these 2 cancer's apart? 18) How do you stage lymph cancer: 19) What is an axillary vs. a sentinel lymph node dissection

Answer 135

1) - 1st step: Analyze the task or movement - 2nd: Identify impairments needing to be worked on Do some tests and measures to really determine what impairment is Do an objective test to get objective baseline #’s to be able to track progress (if possible) - 3rd: What can you do to modify task, set up environment differently, educate/correct - 4th: Allow patient to now practice given new education and modifications. Repetition and practice are KEY! 2) 24 hours 3) - Stage 1: No activity. Rest. Limit head movement. - Stage 2: Head movement, position changes, ROM, stretching neck/shoulder/scapula, light aerobics - Stage 3: Strengthening of neck/shoulder/scapula, neck coordination activities. Increase intensity, strengthen, condition, sport specific activities. - Stage 4: Sport specific activities (but NO contact) - Stage 5: Full sport participation / full contact 4) Vestibular-Ocular Motor Screen - Screening tool to detect a concussion. It assesses systems for balance: vision, vestibular, and somatosensory - Smooth pursuits, saccades, Convergence, VOR - Doing these assessments will re-create symptoms, suggesting a concussion (symptom provocation), with VOR being most indicative of a concussion. So, performing VOMS was consistent with helping rule in someone with a concussion. 5) - Grade A: Complete loss of neurologic function (motor and sensory) below level of injury - Grade B: Some sensation below level of injury (including anal sensation) - Grade C: Some muscle movement below level of injury, but less than 50% - Grade D: More than 50% of muscle strength preserved below level of lesion - Grade E: All neurologic function has returned 6) Bleeding, Inflammatory, Proliferative, Remodeling 7) A disorder of the CNS that impacts movement and motor planning. Neurons in the substantia nigra portion of the brain degenerates over time. It is a progressive disease, meaning neurons continue to degenerate overtime, and symptoms get worse. By the time signs and symptoms manifest (see below), 30-60% of those neurons have already degenerated. - Tremor, rigidity, short shuffled steps, bradykinesia, forward posture, impaired balance, FREEZE ON GAIT - BIG movements (LSVT Big Training) 8) Parkinson's - 1: Unilateral involvement - 2: Bilateral involvement, no balance deficits - 3: Bilateral involvement, but some righting reaction deficits - 4: Severe disability, can still walk- but very impaired - 5: Confined to a bed or w/c 9) FCE: Functional Capacity Examination - Measures strength, endurance, coordination, lifting capacity, physical demand work level and positional tolerance. The data gathered through this evaluation objectively defines the injured employee's physical capabilities. 10) False - That brings blood flow to the area, which makes things (edema) worse - No. It increases pressure in LE's 11) Proximal. Clear out proximal vessels first before moving distal. - FALSE *** that makes CHF pt's condition worse 12) Plasma. Lymph fluid is excess plasma from the bloodstream that gets filtered out at capillaries to then enter the lymph system. 13) Thoracic Duct and Right Lymphatic Duct. - Primary: congenital, genetic. Secondary: cancer treatment, surgery, injury/damage to lymph vessels or nodes, node removal, infection / toxins / parasites 14) Lipedema pt's do NOT have swelling around ankles, and lipedema pt's have pain in LE's where lymphedema pt's do not have pain in LE's. Lymphedema is diagnosed through Stemmer's sign 15) Filariasis: A leading cause of Lymphedema world-wide, this disease is caused by a mosquito bite that causes parasites that live in the human lymph system. - "Stemmers Sign" which is a thickened fold of skin at the base of the 2nd toe that can be gently pinched and lifted. 16) - Stage 0: Latent, early phase, lymph transport is impaired slightly, no evidence of swelling/edema, but fatigue and pain. NO edema present yet. No tightness. - Stage I: It is reversible, Pitting edema, reverses with elevation, increases with activity or heat, Inflammatory response to eating protein, subcutaneous tissues begin to fibrosis (harden). - Stage II: Nonpitting, can't reverse it, and doesn't reduce with elevation, fibrosis present, and skin now changes. Start feeling tight. Can't use manual lymph drainage to help reduce edema - Stage III: This is ELEPHANTITIS, severe nonpitting, leathery keratotic skin, skin folds with tissue flaps, nonpitting fibrotic edema, atrophy, connective and scar tissue, management includes trying to maintain as much function and QOL as possible 17) Hodgkin's Lymphoma - Cancer of the lymph system. Both Hodgkin and Non-Hodgkin lymphoma are malignancies of the WBC's called lymphocytes, which help the body fight off infections and other diseases. This cancer progress from the lymphocytes, then to lymph nodes, then to lymph vessels, etc. - The only way to tell these two cancers apart is a biopsy for Hodgkins has the presence of Reed-Sternberg cells. Other names: Hodgkin's lymphoma, Malignant lymphoma 18) - Stage 1: single node, or group of nodes - Stage 2: 2 or more nodes, on one side of diaphragm (meaning above or below) - Stage 3: Nodes on BOTH sides of diaphragm (meaning above and below) - Stage 4: Widespread extralymphatic involvement 19) - Axillary Lymph Node Dissection: An axillary lymph node dissection (ALND) is surgery to remove lymph nodes from the armpit (underarm or axilla) due to cancer. The lymph nodes in the armpit are called axillary lymph nodes. An ALND is also called axillary dissection, axillary node dissection, or axillary lymphadenectomy. - Sentinel Lymph Node Dissection: The sentinel lymph node is the hypothetical FIRST lymph node or group of nodes draining a cancer. Sentinel lymph node dissection is an alternative to traditional axillary lymph node dissection, and many women believe that it can spare them more invasive surgery and side effects. ... Likewise, the sentinel lymph node is the first node "standing guard" for your breast. A Dr. will do an imaging technique using dye and first impacted lymph nodes will get dye first.

Question 136

1) What is Bruxism: 2) What is trigeminal neuralgia 3) What is a Jefferson's Fracture: - What is a Hangman's Fracture: - Clay Shoveler fracture: 4) What is a Bankart lesion: - What is CRPS: - What is atraumatic osteolysis of distal clavicle 5) Is little leaguers elbow a strain of the MCL or LCL of the elbow? - What is the special test to rule in Lateral Epicondylitis - What is the joint mob at the elbow for lateral epicondylitis 6) Radial nerve palsy would result in what deformation - What is Volkmann's Ischemic Contracture 7) What is RA - Rheumatoid Arthritis 8) What is Osteochondritis Dissecans (OCD) 9) What is Kienbock's Disease - What is carpal coalition - What is a Colles' fracture - What is a Smith's fracture 10) What carpal bone fracture is most dangerous - and why 11) Boxer's fracture happens where - Bennett's fracture happens where 12) What is DeQuervain's Tenosynovitis - What is Dupuytren's Contracture 13) Swan Neck and Boutonnière Deformities are a result of what: - Swan neck appears how: - Boutonniere appears how 14) Mallet finger is from what, and appears how - What is trigger finger or trigger thumb 15) Double Crush syndrome is: 16) Another name for Intrinsic Minus Hand - What is it 17) ANother name for Erb's Palsy - What is it / what is damage from 18) What is Bells Palsy:

Answer 136

1) Bruxism: Grinding your teeth 2) Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It is usually the result of abnormal pressure on or irritation of the trigeminal nerve. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. Symptoms are typically unilateral and may be either episodic or constant. You will have sudden pain described as sharp, jolting, stabbing, or shock-like or persistent burning or aching sensations on one side of the face. 3) Jefferson Fracture (C1): A burst fracture of C1. Could happen from axial pressure from head, or diving into a pool, etc. This fracture can disrupt the transverse ligament. Many die from this fracture. - Hangman's Fracture (C2): Severe hyperextionsion, so C1 fractures C2. It is fatal (this how people die from hanging). - An avulsion fracture where m's attached to spinous process break tip of spinous process off during severe muscle contraction 4) A Bankart Lesion is a labral tear from an anterior dislocation of shoulder (so the anterior part of the labrum, and the G/H ligs or capule are torn). It will create anterior instability of G/H joint. - Complex regional pain syndrome (CRPS) is a condition of intense burning pain, stiffness, swelling, and discoloration that most often affects the hand. Is is an autonomic nervous system dysfunction - hyperactivity of sympathetic nervous system in the periphery that follows some other injury. - This is a condition most commonly found In athletes who play contact sports (or do weight lifting, or it can happen after a motor vehicle accident). It is pain around the A/C joint due to increased stress/force on the A/C joint. Typically it is related to intolerable exercise doses / weight training (too much lifting). 5) MCL - Maudley's test … RSC of 3rd digit (will be painful) - Mulligan's / Lateral Epicondyle mobilization while gripping (should increase strength) 6) Drop wrist - If an injury happens in the arm or forearm, there is potential to get damage to blood vessels (especially the brachial artery). This can lead to "compartment syndrome" where the compartments in the forearm either don't get enough blood, or get hemmoraging 7) RA is a chronic autoimmune disease, which means your own body's immune system attacks its own synovial joints resulting in inflammation and pain in joints (espeically in your hands and feet). Unlike OA, which typically effects specific or a few joints, RA effects many joints (bilaterally). RA has a distal to proximal progression mostly affecting the upper extremities (hands and fingers). The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint. RA can also effect your eyes, skin, lungs, heart, blood vessels, etc. RA will eat away at cartilage lining bones, and result in bone deformity. 8) OCD is when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. The condition typically affects just one joint, however, some children can develop OCD in several joints. In most cases, OCD is in children. 9) Avascular necrosis of the lunate bone. - Refers to fusion of two or more carpal bones, and the most commonly involved bones are the lunate and triquetrum. - Complete fracture of distal radius with posterior displacement of distal fragment. - Fracture of the distal radius in which the distal segment displaces anterior (towards the palm) 10) Schaphoid bone fracture, due to poor blood supply to schaphoid bone 11) 5th metacarpal bone - Fracture of the base of the first (thumb) metacarpal bone which extends into the carpometacarpal (CMC) joint. 12) Entrapment of the tendons (tendinitis) contained within the first dorsal compartment at the wrist (abductor pollicis longus and extensor pollicis brevis). So tendons are restricted / compressed / inflammed, so they don’t glide through tendon sheath properly. - Hypertrophy or contracture of the palmar fascia (you'll see 4th and 5th digits slightly flexed 13) RA - Flexion of MCP and DIP joints with extension of PIP joints. Typically in digits 2-5. - flexion at the PIP joint and extension at the DIP joint. 14) Damage to the extensor tendon leading to the inability to extend the DIP - A condition of the fingers or thumb that occurs when inflammation of the tendon leads to narrowing of the tendon sheath and expansion of the tendon in the finger, so the tendon gets caught and thus doesn't move properly. It looks like a "trigger" finger since it will be pulled into flexion like pulling a trigger. Prolonged inflammation can lead to scarring, thickening, and formation of nodules in the tendon. 15) Distinct compression (or lesion) occurring at two or more locations of a nerve along the course of the peripheral nerve. The effect can be to synergistically increase symptom intensity. One example would be the compression of the median nerve both in the pronator teres muscle (median nerve palsy) and distally in the carpal tunnel (carpal tunnel syndrome). So injury at 2 locations of a nerve. 16) Claw hand - Imbalance of strength between strong extrinsic and weak intrinsic m’s of hand. Extrinsic will overtake weak intrinsic m’s. A combined medial and ulnar nerve pathology. 17) Waiter's Tip - “Waiter’s Tip” position from a legion of C5-C6 nerve An injury to the arm from a fall on neck/shoulder region (or being pulled out of the womb incorrectly). It is a brachial plexus injury to C5-C6 nerves, which results in the “Waiters Tip” hand position. Anything innervated by C5-C6 is lost. So: suprispinatus, deltoid, infraspinatus, teres minor, biceps brachii, brachialis, supinator, brachioradialis, and extensor carpi ra/dialis longus. You thus can’t flex shoulder, can’t abduct shoulder, can’t laterally rotate shoulder, or flex elbow 18) Bell's palsy causes sudden, temporary weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing. Bell's palsy, also known as facial palsy. Cause is unknown - but it's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. Or it might be a reaction that occurs after a viral infection. For most people, Bell's palsy is temporary. Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy can recur.

Question 137

1) Secondary Sequela means 2) What is ankylosing spondylitis 3) Difference between Pectus Carinatum and Pectus Excavatum 4) People get Barrel Chest from what conditions 5) Another name for Herpes Zoster - What is it: 6) What is T4 syndrome: 7) What is Scheuermann's Disease 8) What is Autonomic Dysreflexia 9) Explain difference between nutation and contra-nutation (or counter-nutation) - So would nutation appear as an anterior or posterior pelvic tilt?

Answer 137

1) Sequela means a condition that is caused secondary to another condition. So, some patients experience a CVA (stroke), SCI, Scoliosis, OA, or other injuries that thus cause a movement dysfunction (lack of innervation, weak muscles, hemiparesis, etc.). 2) A disease which causes inflammation and pain in the spine and SI joints (and other joints such as the shoulder, hips, knees, ankles, etc.). The word spondylitis refers to inflammation of the spine; ankylosis means fusion or the melding of two bones into one. If ankylosing spondylitis is not managed well, it can lead to permanent stiffening of the spine and kyphotic posture. New bone can grow around the spine, which results in the bones fusing together and limits movement. It also results in a characteristic stooped posture. 3) Pectus Carinatum: where AP dimension of chest is abnormal as the sternum sticks out further. It is not from an injury, it is just a developmental growth deformity. It is a problem because the chest won't expand properly during breathing. Pectus Excavatum: caved in chest or sternum projects interior or posterior. Now you have a decreased dimension of the chest, so in severe cases it will certainly impact respiration. 4) COPD or Emphezema 5) Shingles - Shingles (or herpes zoster) is an infection that impacts the dorsal root ganglion of the spinal cord/nerves in the thorax area. So someone who had herpes earlier will get a flair up from the virus and the nerve root effected will be impacted. - They won’t come in to you with breakout, and you think it is some t-spine MS issue. But it will later break out and manifest as a rash in a dermatomal pattern. This rash in a dermatome areas is evidence they have shingles. Refer! 6) T4 syndrome is a sympathetic reaction from hypomobility where the patient gets parathesia into the hands. You have sympathetic ganglia in T2-T7 area, so if there is hypomobility, the sympathetic response triggers these other side effects. So doing mobilizations and manual therapy in that area clear up the symptoms. 7) Adolescent kyphosis from a growth disorder of the spine. It is a congenital condition where spine's vertebrae grow into a wedge shaped position, resulting in extreme kyphosis posture in kids (and hyperlordosis as a compensation). Usually seen in adolescent males, which begins around puberty age. 8) Typically seen in SCI pt's with an injury T6 and below. But essentially if you are working with a SCI pt with an injury at or above T6, they could experience this. Typically what happens is the SCI pt gets some stimulus below the injury that they can't feel, but signals are sent to the brain which causes sympathetic nervous system to be activated. So, for example, a pt could have a kink in their catheter, be sitting on some sharp object, have a UTI, overfilled catheter bag, constipation, hemmoroids, a cut or bruise, tight restrictive clothing, menstrual cramps, etc. Anything can trigger it, but if it is below T6 level, the patient won't feel it. But the nervous system feels the pain and sends signal to sympathetic nervous system to activate due to the pain. So patient will get High Blood Pressure, Sweat, Increased Heart Rate, etc. But below level of injury the blood pressure might be less. These signs should signify caregivers and family that something is wrong, and find and remove the stimulus that is causing the pain. First thing to do is sit the patient UP (get head up) and lower legs. Then look for stimulus (remove object being sat on, remove tight clothing, drain cath bag or undue kink, etc). Also, take the pt's blood pressure and monitor. 9) Nutation: Top of sacrum goes anterior, while inominate (hip) bones go posterior. If sacrum goes forward on ilium (or Innominate), or if innominate goes back while sacrum goes forward = It is nutation. - Contranutation is when the top of the sacrum goes posterior, and inominate bones go anterior. - So, nutation appears as POSTERIOR PELVIC TILT. It can happen bilaterally or unilaterally. With unilateral, ASIS will be HIGHER on side of nutation (thus PSIS lower on effected side). With bilateral, both ASIS will be higher than PSIS. - Contranutation looks like Anterior Pelvic tilt. This will appear as increased lumbar lordosis. Can also be unilateral or bilateral. Bilateral will appear as both ASIS lower than PSIS's.

Question 138

1) Another name for Athletica Pubalgia - What is it 2) ANother name for a hip pointer - What is it 3) What is Intermittent Claudication 4) What is SCFE 5) Avascular Necrosis of the Hip is also called: - What is it - About what age range 6) FAI at the hip is what: - Abnormal bony growth in acetabulum is called: - Abnormal bony growth in femoral head is called: - What does this result in: 7) What is chondromalacia 8) What is Genu Recurvatum 9) What is Hoffa's Syndrome 10) What is Osgood-Schlatter's 11) Jumper's Knee is also known as: - What is it 12) A "corked thigh" is a what: 13) What is restless leg syndrome - When does it happen most: 14) What is Haglund's Deformity: 15) Hallux Valgus would also be known as a: - What is a Jones Fracture - What is Metatarsalgia - What is Morton's Neuroma 16) Difference between pes cavus and pes planus 17) What is Charcot Foot Deformity 18) What is Charcot-Marie-Tooth disease - How to remember this 19) Of the 2 conditions above, which is hereditary: - Which one is from DM II - Which one effects the foot - What does the other one do

Answer 138

1) Sports Hernia - This is a strain of the muscles attaching to the pubic bone (anterior on the hip). It could be any of the muscles that attach to the pubic bone (adductor longus, adductor brevis, rectus abdominus, pectinius, or all of them most likely. Even the inguinal ligament can be pulled). So a 'sports hernia' is just a pull/strain of those muscles attaching to the pubic bone. The pulled weak muscles could then lead to an actual abdominal hernia as well. And remember the spermatic cord (leading down to the testicles) is right in this area, so males will often feel pain in and around scrotum, and females around genitals. 2) Iliac crest contusion - When someone gets a direct blow to the iliac crest, it causes pain, bruising, swelling, pain during walking, etc. Often happens during a sports injury (like a helmit to the hip), or during some fall or trauma. 3) This is blood circulation problems in the leg. When the muscles do not get enough blood (O2), they can cramp, get painful, numb, tingling, or weak. Typially this happens as a result of poor blood flow due to diabetes, high blood pressure, high cholesterol, atherosclerosis, being overweight and lack of activity. It typically is a result of atherosclerosis (plaque build up in arteries) that cause blood flow impairment and blood clots in arteries. Thus, blood can't get through, causing muscles to not get enough oxygen. Angina pain to the heart is intermittent claudication pain to legs (same reason). 4) Slipped Capital Femoral Epiphysis: When the head of the femur and the neck of the femur slip off each other at the epiphyseal growth plate section (the head staying within the acetabulum). Could be from trauma, obesity, or congenital hip dysplasia, and often leads to FAI or Labral tear within the hip joint. Typically in younger aged kids (age 10-16 ish). 5) Legg-Calve Perth - Avascular necrosis in hip joint at femur head near/in acetabulum. It is lack of blood supply to the bone leading to bone cell death. If not fixed, it can lead to OA later in life, and even other conditions like FAI. - 6 ish 6) Femoral Acetabular Impingement: Extra bone grows along either the acetabulum or femoral head/neck (which form the hip joint). - This bony overgrowth in the acetabulum is a PINCER morphology, and the femoral head/neck is a CAM morphology. - Because the bones do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity. Often there is "impingment" of the capsule/ligaments and muscles in and around hip, which become limited due to the excess bone growth. 7) This is where the cartilage under the kneecap starts to get damaged / worn down. From "Runners Knee" - could even be from Relaxin hormone in pregnancy. From PFPS 8) Genu recurvatum is also referred to as back knee or knee hyperextension 9) Your Hoffa's Pad is your infrapatellar fat pad which sits below the patella and behind the infra-patellar tendon. Typically this area is injured by a direct blow to the lower knee. 10) Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). Most often seen in children (growing adolescents). Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. Because physical activity puts additional stress on bones and muscles, children who participate in athletics — especially running and jumping sports - are at an increased risk for this condition. However, less active adolescents may also experience this problem. 11) Patellar tendinitis - Jumper's knee, also known as patellar tendonitis, is a condition characterized by inflammation of your patellar tendon. This connects your kneecap (patella) to your shin bone (tibia). Jumper's knee weakens your tendon, and, if untreated, can lead to tears in your tendon. 12) Quad contusion 13) Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. - It typically happens in the evening or nighttime hours when you're sitting or lying down. 14) Haglund's deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes or women’s pumps, can cause this irritation. 15) Bunion - This is when the 5th metatarsal bone on the lateral side of the foot gets fractured. - Pain on sole of foot near MTP joints due to repetitive loading / pressure on metatarsal heads (on plantar side). Pain and inflammation on ball of foot. Pressure moves from heel to ball of foot during gait (primarily in the 2nd-3rd metatarsal heads area). Often results from repetitive overuse during running or sports. Or from improper shoes fit. - It is called a "neuroma" suggesting a tumor or growth, when in fact, it is an entrapment of a digital nerve(s) in the forefoot and toes. Interdigital nerves get compressed between metatarsals. Injury or overuse or pressure causes fibrosis or thickening around a digital nerve in the toes, which leads to inflammation of the nerve and connective tissue covering the nerve. Not really a neuropathy but more an impingement of the digital nerves of the toe(s). 16) Cavus: A condition where the foot has a very high arch (on the medial side). Too much of an arch places excessive weight on the heel, balls of the foot, and lateral side of the foot during walking and standing. This creates pain, instability, calluses, as well as causes gait abnormalities which can cause pain and issues up the chain. - Planus: This is a condition where the medial longitudinal arch of the foot gets weak/damaged and results in a flat foot. Arches of the feet are critical to help with shock absorption, distribute weight, adjust to uneven surfaces, etc. Weak muscles or ligaments can result in the arch losing support. This causes significant gait deviations, which results in creating other pain and deformities up the chain. 17) Most often seen in Diabetic patients at their FEET, but Charcot Foot is when nerve damage causes one to not have SENSATION, and then lack of nerve and blood supply causes bones, muscles, and ligaments to slowly DEFORM and this leads to JOINT INSTABILITY and COLLAPSE. The arch of the foot then naturally decays and gets deformed, so not only does it result in flat foot (lose your arch), but bone decay. Bones in the foot will get sores and lose stability and get deformed. 18) *** Charcot–Marie–Tooth disease (CMT) is different. This is one of the HEREDITARY MOTOR and SENSORY neuropathies of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. Charcot-Marie-Tooth is a genetically inherited condition characterized by motor and sensory neuropathy, progressive muscle wasting, and diminished reflexes. You'll see distal muscle weakness and a steppage gait pattern. - It is NOT in the foot (Charcot foot is in foot) ... and the foot one is from DM II 19) Charcot-Marie-Tooth - Charcot Foot Deformity - Charcot Foot Deformity - motor and sensory neuropathy where you lose muscle and sensation across various parts of the body (muscle atrophy, diminished reflexes, lacking sensation)

Question 139

1) What is JRA and/or JIA - Explain it - Do boys or girls get this more? 2) What is Ehlers-Danlos Syndrome - What scale helps rule this in 3) Ergogenic aids are what - What are legal and illegal one's 4) What is Fibromyalgia 5) What is Heterotrophic Ossification 6) What is Gout - Most often this is seen where - Defining characteristic of Gout is: 7) What is Osteomyelitis - Often caused by: 8) What is fibrosis 9) Difference between Type I and Type II muscle fibers 10) So from point above: - Which fibers do you utilize first - Which fibers atrophy or fatigue fastest - Higher intensity activities use what type of fibers 11) Review the muscle contraction process: 12) What is active insufficiency vs. passive insufficiency: 13) Open chain vs. closed chain: 14) From point above, why does this matter with regards to muscle attachments 15) What is DOMS 16) 3 main electrolytes in the body are: - Na main responsibility: - K main responsibility: - Ca main responsibility: 17) Edema vs. Effusion 18) Sprain vs. Strain

Answer 139

1) Juvenile Rheumatoid / idiopathic arthritis - JRA is often referred to by doctors today as juvenile idiopathic arthritis (JIA), is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. An autoimmune disorder when immune cells mistakenly begin to attack the joints and organs causing local and systemic effects throughout body. - Girls usually have a higher incidence than boys. 2) Joint hypermobility and ligament laxity. These are "elastic" people and make very good gymnists, circus performers, dancers, etc. They are hypermobile in fingers, thumbs, elbows, knees, spine movements, etc. This hypermobility is manifested in joint instability. - Beighton scale 3) Performance enhancers or supplements - > Legal: caffeine, creatine supplements, protein supplement, carbo drinks > Illegal: steroids, blood doping, mushrooms, stimulants, testosterone patches, Chondroitin, Glucosamine 4) This is a condition not fully understood, but is essentially characterized by multiple pain points throughout entire body (need to have 11+ of 18 specific points experiencing pain to be properly diagnosed). Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. It essentially belongs to the rheumatic disease conditions, although pain is not in the joints, but in the muscles, but results from some immunology body response that become pathological. 5) Heterotopic Ossification (HO) is the abnormal growth of bone in the non-skeletal tissues including muscle, tendons or other soft tissue. When HO develops, new bone grows at three times the normal rate, resulting in jagged, painful joints. 6) Gout is a kind of arthritis caused by a buildup of URIC acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. A form of arthritis characterized by severe pain, redness, and tenderness in joints - Big Toe - Uric acid 7) An infection that occurs within the bone - Staph infection 8) Fibrosis: The thickening and SCARRING OF CONNECTIVE TISSUE, usually as a result of injury. 9) > Type I fibers are SLOW twitch oxidative muscle fibers (little force, long endurance … good for aerobic exercise). Good for long endurance aerobic exercise. These are the first fibers to turn on / activate. > Type IIa are fast oxidative > Type IIb are fast glycolytic (lot's of force, low endurance, good for strengthening). Fatigue easily (due to reliance on glycolytic system for energy). 10) Type I - Type II - Type II 11) We need an action potential to travel down the axon to the synaptic terminal (axon terminal). It stimulates the release of AcH neurotransmitter. Then AcH will land on receptors of post synaptic membrane. When AcH binds to receptor, this changes membrane permeability, and allows sodium ions to enter into muscle fiber. When AcH is on receptor, sodium can RUSH into the cell. AcH is the key, and unlocks the gate so sodium can go INTO muscle cell. This creates ANOTHER action potential and travels along the sarcolemma or plasma membrane of muscle fiber. As this happens, AcHase breaks down AcH and then AcH no longer binds to receptor, releases to be used again later. As action potential goes down sarcolemma, it goes down the t-tubule (which is at the triad or zone of overlap) and goes down and releases Calcium from the terminal cisterna (called exitation contraction coupling). When Calcium binds to troponin, it causes tropomyosin to move away from the active sites of actin, and reveals sites where myosin can bind to actin. Now myosin head binds to actin … this is the CROSS BRIDGE FORMATION. Myosin heads bend (cock and recock) to grab onto actin and pull, grab onto actin and pull, etc. Myosin doesn’t move, it grabs actin and moves actin. In order for this movement to happen, we NEED ADP. For the head of myosin to flex or move (push actin) we need to get rid of ADP + P. When ADP LEAVES myosin head, that is when we get a POWER STROKE. The hydrolysis of ATP causes myosin head to then cock again and it all repeats. It ends when action potential ends, and when calcium no longer is sent into muscle. 12) Active Insufficiency: When concentric muscles can’t contract any more due to there is no more room to contract more (ex: wrist flexors can’t flex any more). Passive Insufficiency: Opposite of active insufficiency, where the opposite eccentric muscles can’t elongate any more (as wrist flexors reach active insufficiency, the wrist extensors will be stretched fully = passive insufficiency). 13) Open chain: the segment furthest away from the body — the distal part, usually the hand or foot — is free and not fixed to an object. Movement at any one joint in the chain does NOT demand movement at any other joint in the chain. Think of leg dangling of plinth and you raise it up / extend. Closed chain: A kinematic chain in which segments at both ends of the chain are fixed to a surface. Movement at any one joint will demand movement of AT LEAST one other joint in the chain. Think of leg pushing a weight machine and knee in the middle of the two closed chain ends produces movement. 14) *** So important to remember that muscles' "origins" and "insertions" are more like "attachments" because in closed chain (foot fixed to the ground, the quads rather than pulling the tibia up, will pull the femur up. Remember that about ALL muscles. 15) Delayed Onset of Muscle Soreness: When you work out and really stretch/work your muscles, and then 24 hours later you experience severe soreness in your muscles that were stretched and worked. This occurs days following strenuous unaccustomed physical activity, and will restore within 1 week. Why/How does this happen: Ischemic Response - heavy lifting tears the muscle (trauma, so blood rushes to area). Metabolic waste products accumulate during inflammation process and this is painful. 16) Na, Ca, K - Fluid balance - K+ is important for function of MUSCLE cells, heart cells, and nerve cells. Especially cardiac cells - arrythmias. - Bone strength 17) Edema: Swelling. An increased volume of fluid in the soft tissue outside a joint capsule. Effusion: An increased volume of fluid INSIDE a joint capsule. 18) Sprain: Acute injury involving a LIGAMENT Strain: Acute injury involving muscle/tendon

Question 140

1) Types of Fractures: Avulsion Fracture: Closed Fracture: Comminuted Fracture: Compound Fracture: Displaced Fracture: Greenstick Fracture: Linear Fracture: Nonunion Fracture: Oblique Fracture: Spiral Fracture: Stress Fracture: Transverse Fracture:

Answer 140

1) Avulsion Fracture: Portion of bone become fragmented at the site of the tendon insertion due to sudden stretch of tendon. Closed Fracture: A break in a bone where the skin over fracture remains intact. Comminuted Fracture: A bone that breaks into fragments at site of injury. Compound Fracture: A break of a bone that protrudes out through the skin. Displaced Fracture: A break in a bone where the fragments are out of place. Greenstick Fracture: Break on one side of the bone that does not damage the periosteum on opposite side. USUALLY SEEN IN CHILDREN. Impacted Fracture: Linear Fracture: A break that is parallel to the long axis of the bone Nonunion Fracture: A break in a bone that has failed to unite and heal after 9-12 months Oblique Fracture: A break that is diagonol Spiral Fracture: A break in the shape of an "S" due to TORSION or TWISTING Stress Fracture: Break in a bone due to repeated forces to a particular portion of a bone Transverse Fracture: A break in a bone that is at a 90 deg angle to the bone's long axis

Question 141

1) Define these terms: - Apraxia: - Ataxia: - Asterixis: 2) Difference between Phrenic and Vagus nerve 3) What are Glial Cells 4) What is Orthostatic Hypotension 5) Define these terms: - Anemia/Anemic: - Hypoxic / Hypoxia: - Ischemia / Ischemic: - Hemolytic / Hemolysis: 6) Thrombopenia 7) Hemochromatosis means - How to remember 8) What are BBP, and give examples 9) Sickle Cell Disease: 10) Hemophilia is: - Hemostasis is: 11) What are INR or pT or aPTT 12) An anti-diuretic will do what 13) Define these: - Anyuerism: - Stenosis: - Sclerosis: 14) What is diffusion in the blood - What is this in the lungs: 15) What is Hematopoiesis - What is EPO: - Too much hematopoiesis or EPO can lead to what: 16) What is angiogenesis - What is in the mediastinum 17) What is Cardiac Tamponade - What is the fix for this (from point above) 18) What is Cor Pulmunale - How would it be seen/characteristics 19) What is difference between depolarization and repolarization of heart

Answer 141

1) - Apraxia: inability to perform particular purposive actions, as a result of brain damage. Can't even do it. Could be movement apraxia or speech apraxia. Result of brain damage from liver not removing all toxins (and the toxins get into brain). - Ataxia: Lack of coordination due to cerebellum damage. The loss of FULL control of BODILY MOVEMENTS. (one will get it as same reason noted above) - Asterixis: is a flapping TREMOR of the HAND when the WRIST is extended, sometimes said to resemble a bird flapping its wings. "Flapping tremor" (one will get it as same reason noted above) 2) Phrenic Nerve: C3,4,5 keeps you alive. Phrenic nerve innervates the diaphragm to keep you breathing. - Vagus Nerve: CN X and is primarily for parasympathetic innervation of heart, lungs, and visceral organs. 3) Glial cells: SUPPORT cells, protect neurons (both oligodendrocytes. and schwaan cells) 4) Clinical OH is a decrease in systolic blood pressure (BP) of 20 mmHg or more or a decrease in diastolic BP of at least 10 mm Hg, within 3 minutes of changing from a supine to an upright position. When you “black out” getting up quickly (syncope), that is normal, but when it is prolonged, that is a worry. OH is when your BP drops and stays low when changing from supine to upright position. 5) - Anemia / Anemic: Low RBC count. So, if a pt doesn't have enough RBC's, they will not be able to get enough O2 to body's tissues (muscles, organs, etc.) and thus be very weak, pale, tackycardia, etc. - Hypoxia / Hypoxic: Hypoxia is low amounts oxygen being perfused to and delivered to body tissues ... either from a low RBC count, RBC's getting destroyed, excessive bleeding, EPO isn't being produced by Kidney, pulmonary disfunction from low ventilation or perfusion, etc. - Ischemia / Ischemic: lack of blood and thus O2 to tissues. Ischemia is the decrease of blood supply to a tissue. It can be local, caused locally by a thrombus or embolus, or global due to a low perfusion pressure. Hypoxia is lack of oxygen to a tissue from any cause. - Hemolytic / Hemolysis: RBC's destroyed 6) Low blood platelet count. Normal platelet ranges are anywhere from 150,000 to 450,000 units / uL of blood. Anywhere below about 60,000 indicates pt has very limited platelets in blood. 7) Too much IRON in the body (typically from diet or drinking alcohol). The human body canNOT rid itself of extra iron. Over time, this excess iron builds up in major organs such as the heart, LIVER (most effected), pancreas, joints, and pituitary. If the extra iron is not removed, these organs can become diseased. Untreated hemochromatosis can be fatal. It can lead to: Diabetes, Arthritis, Some cancers, Parkinsons, Alzheimers, Depression, Infertility, Impotence (erectile dysfunction), darkened skin, etc. - Think of chrome ... metal ... iron 8) Bloodborne pathogens are infectious microorganisms in human blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). Needlesticks and other sharps-related injuries may expose workers to bloodborne pathogens. 9) RBC's become misshapen and lose their biconcave shape and become sickle cell shaped. This means the RBC's lose surface area, which causes them to not allow as much O2 to bind, which results in anemia. Because of their misshape, they also clog in vessels more easily, also resulting in anemic conditions. 10) A medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury. Patient will probably need some type of medication that helps the blood clot. - The stopping of the flow of blood … or how to keep one from bleeding. It is the first phase of wound healing (clotting), and one manually through guaze or bandaging. 11) Tests to determine how fast blood will clot. Coagulation tests used to evaluate hemostasis 12) ADH's reabsorb water. It is for water retention (or water homeostasis). Remember: you take diuretics for CVD or CHF to flush excess fluid out to relieve pressure on heart. So anti-diuretic will help keep fluid in body. 13) - Anyuerism: A weakened or ballooned blood vessel from atherosclerosis or injury. - Stenosis: is a NARROWING of a vessel (or lumen) so it impacts blood flow, which limits O2 delivery to tissues / cells. - Sclerosis: hardening 14) Diffusion: Gas exchange happens from diffusion (high pressure to low pressure). - Like respiration in the lungs 15) Hematopoiesis: Formation of new blood cells (triggered by EPO hormone produced and sent from the kidney to bone marrow to produce new/more blood cells. - EPO: Erythropoietin is a protein secreted by the kidney in response to cellular hypoxia; it stimulates red blood cell production in the bone marrow (a process called Hematopoiesis). EPO is produced naturally in the body by the kidneys. It stimulates the bone marrow to produce red blood cells. If the body does not produce enough EPO, severe anemia can occur. They replace the need for many blood transfusions ... the drugs stimulate production of erythropoiesis and thus elevates RBCs production (vs. doing a transfusion and having more RBC's from some donor injected into you). You need RBC's :) - polycythemia vera (too many RBC's) 16) Angiogenisis: formation of new blood vessels - Heart, Great vessels (aorta, pulmonary trunk, SVC), Trachea / Esophogus 17) When fluid gets into pericardial space. More fluid will compress heart and vessels and be life threatening - Pericardiocentesis 18) Right sided heart failure. Most commonly arises out of complications from high blood pressure in the pulmonary arteries (pulmonary hypertension). It's also known as right-sided heart failure because it occurs within the right ventricle of your heart. Abnormal enlargement of the right side of the heart - Jugular vein distension, LE edema 19) Depolarization is CONTRACTION ... the state which the cell changes from a negative to a positive charge inside the cell (and thus a positive to negative charge outside the cell) as ions flow in and out. CAUSING A CONTRACTION - Repolarization then would be contraction stops and the cell returns to a NEGATIVE charge as ions flow out of cell and go back to resting potential of a negative charge. IT IS RELAXATION

Question 142

1) Explain each below: - Atrial Kick - EDV (End Diastolic Volume) - ESV (End Systolic Volume) - SV (Stroke Volume) - How much is normal - CO (Cardiac Output) - How much is normal - Ejection Fraction (EF) - You want it to be about what - How to calculate EF - What do you want this to be: - Preload - Afterload - Frank Starling Law

Answer 142

1) - Atrial Kick: Extra little squeeze of blood from atria to ventricles (as AV node slightly delays) to give ventricles just a bit more blood - End Diastolic Volume is how much (mL) of blood in ventricles before ventricular contraction - End Systolic Volume is how much (mL) of blood after ventricular contraction - Stroke Volume is the amount of blood pumped out of the venricles during a beat. SV = EDV - ESV - 60-80mL (about 60% of EDV) - Cardiac Output is the amount of blood pumped out of the heart in a minute. CO = HR x SV - 4.5-5.0 L - Ejection Fraction is the % of blood ejected out of ventricles during systole (not amount - that is SV) - 60% - Calculate: EDV-ESV. Take that amount and divide by EDV = a %. - You want 60% or higher (below 50% and less is scary, means not enough blood is pumped out) - Preload: amount ventricles are STRETCHED (by EDV amount) by contained blood (left ventricular length before systolic ejection) - Afterload: ventricular PRESSURE on aorta at the end of systole (or resistance to ejection during systole) - Frank Starling Law: The greater the preload (EDV) the more blood the heart will pump (SV and thus CO)

Question 143

1) What is digital clubbing: - What can cause it 2) What is Raynaud's: 3) Jugular Venous Distension (JVD) probably is from a back up from what side of the heart 4) What is CAD 5) 4 types of an M.I. 6) What is Cardiovascular Disease (CVD) 7) From point above, what are the classifications of CVC 8) What heart conditions would you NEVER exercise a pt 9) What is the difference between these: - IV: - PICC line: - Central Catheter: 10) What is Enteral Nutrition - What is parenteral nutrition

Answer 143

1) Digital Clubbing: Enlargement of tips of fingers / toes. Nails emerge. This is from prolonged cyanosis. Lack of O2 (POOR CIRCULATION) over long time means nail will deteriorate. - Anorexia, Pulmonary fibrosis ... basically any cardiac or pulmonary condition that causes lack of O2 perfusion to tissues 2) Raynaud's: In Raynaud's phenomenon, smaller arteries that supply blood to the skin constrict excessively in response to cold, limiting blood supply to the affected area. The fingers, toes, ears, and tip of the nose are commonly involved and feel numb and cool in response to cold temperatures or stress. It's often accompanied by changes in the color of the skin. 3) R side 4) Coronary Artery Disease. It is atherosclerosis of the actual heart's blood vessels where plaque builds up in coronary arteries. This build up causes an aneurism (weak vessel) and stenosis (narrowing of vessel), which could lead to a thrombus and embolism, and thus a MI (Myocardial Infarction, or heart attack). If your coronary arteries get an aneurism by buldging and weakening (or narrowed = stenosis from plaque build up) then blood supply is limited to myocardial muscle of heart. If a thrombus (blood clot) clogs it and blood and O2 can't get though to myocardial muscle ... over time the coronary artery hardens or weakens and ruptures or gets a block/clot, and you get MI or stroke (cardiac muscle dies). 5) - Transmural Infarction: FULL thickness necrosis (cell death) through the entire ventricular wall from endocardium (deep) to epicardium (superficial). So, all of the layers of the heart muscle are impacted / dead. - Subendocardial Infarction- PARTIAL thickness on the subendocardial portion of ventricular wall – (epicardial aspect of muscle tissue is spared and doesn't die so there is LESS tissue damage). - STEMI or ST-elevation myocardial infarction is caused by a sudden complete (100%) blockage of a heart artery (coronary artery). (=INFARCTION) - Non-STEMI (NSTEMI) is usually caused by a severely narrowed artery but the artery is usually not completely blocked (=ISCHEMIA). 6) Overarching term of any heart conditions that include diseased vessels, structural problems, and blood clots. Caused by: HTN, CAD, dysrhythmias, heart valve abnormalities, effusions, PE, cardiomyopathies, pulmonary HTN, Spinal Cord Injury, trauma, multisystem failure. 7) - Class I: patients with cardiac disease Without limitations to Physical Activity (PA) - Class II: Slight limitations to PA - Class III: Marked limitation in PA and Uncomfortable at rest - Class IV: can’t do PA without Discomfort. ``` 8) A-Flutter A-Fib (unless it's a chronic issue) 3rd Degree AV Block SEVERAL PAC's, PJC's, PVC's in a row SVT V-Fib (very dangerous) V-Tach Agonale Asystole ``` 9) - Intravenous therapy (IV): are lines inserted into a peripheral blood vessel in the FOREARM for: delivers liquid substances, drugs, electrolytes, nutrients, blood transfusion, blood draw, etc. Line is directly inserted into a vein to distribute this substance to heart to circulate through blood. The intravenous route of administration can be used for injections or infusions. Intravenous infusions are commonly referred to as drips. Typically done for SHORT-TERM reasons. - Peripherally Inserted/Indwelling Central Catheter: It is a form of intravenous access that can be used for a PROLONGED period of time (e.g., for long chemotherapy regimens, extended antibiotic therapy, or nutrition intake) or for administration of substances that should not be done peripherally typically in brachial artery of ARM. It is inserted into a peripheral vessel, but then a tube/catheter is pushed up to the superior vena cava and it stays in place (dwells within the veins) for days or weeks. - Central Catheter: Basically same thing as a PICC and IV, but now this is done more centrally into a larger vein because perhaps there is MORE substances to be delivered that won't fit in a smaller peripheral vein. Central venous line, or central line, is a catheter placed into a large vein (internal jugular, subclavian, femoral) to also administer medication or fluids, draw blood, etc. that are unable to be taken by mouth or would harm a smaller peripheral vein. - IV is in forearm or dorsal hand vein, PICC line is upper arm (still peripheral), and Central Line would be in Jugular vein or Subclavian or even Femoral (larger central vein). IV is short term (few days), PICC is long time (many days, weeks, months). 10) Enteral Nutrition: Through GI tract. Like, A FEEDING TUBE. Feeding a pt via a feeding tube so pt's can get their nutrition. - Parenteral nutrition (PN): So right into bloodstream, not through GI tract. It is intravenous administration of nutrition, which may include protein, carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements for patients who cannot eat or absorb enough food through tube feeding formula or by mouth to maintain good nutrition status.

Question 144

1) What is Status Asthmaticus 2) What is Cystic Fibrosis 3) If someone has a pleural effusion, what is the proceedure to remove fluid 4) What is a pneumothorax - What is atelectasis 5) Closed vs. open vs. tension pneumothorax 6) What are example conditions of COPD - What is it 7) What is intubation vs. extubation 8) What is syncope vs. dyspnea - What is apnic 9) Must know difference between these: - Chronic Bronchitis - Asthma - Emphezema - Bronchiectasis 10) What is pneumonia 11) What is restrictive lung disease - Examples include: 12) What is tuberculosis

Answer 144

1) Individuals with asthma get so deprived of air that it is a medical emergency, panic, get blue/cyanotic, and can die. It is scary cause it can lead to cardiac or respiratory failure. 2) This is a GENETIC condition usually seen in CHILDREN, but can effect LUNGS or digestive system. Cystic fibrosis affects the EXOCRINE cells that produce mucus. This condition causes the exocrine glands to overproduce thick mucus which causes airway obstruction. So lots of mucous collects in the lungs. These secreted fluids are normally thin and slippery. But in people with cystic fibrosis, a defective gene causes the secretions to become sticky and thick. Instead of acting as a lubricant, the secretions PLUG the airways, ducts and passageways, especially in the lungs and pancreas. This mucus clogs the airways and traps bacteria leading to infections, extensive lung damage, and eventually, respiratory failure. Ultimately it can lead to death due to respiratory failure. 3) Thoracentesis 4) A pneumothorax occurs when air (blood, puss, object, fluid) gets in the pleural cavity of the lungs (or pleural cavity gets ruptured). So air from lungs leaks, or air from outside seeps in. THIS CAUSES THE LUNG TO COLLAPSE. Pt's will experience significant chest pain, SOB, hypoxemia, cyanosis, and hypotension. Atelectasis: Collapsed lung 5) Closed Pneumothorax: Chest is still in tact Open Pneumothorax: open is from a gun shot wound or knife puncturing through thoracic wall into lung ... so air gets into pleural space. THIS CAUSES THE LUNG TO COLLAPSE. Tension Pneumothroax: When you don't have an open wound, but maybe fractured rib punctures one lung, and air escapes into pleural cavity but then can't get air out. So pressure and air keep building and building until it collapses lung, shifts the mediastinum over or causes heart valves to be pinched which effects entire cardiac cycle. 6) pneumonia, asthma, bronchitis, emphazima - where an object/mucus/inflammation gets lodged in airway, or more commonly the airways get inflammed, mucous buildup, or airway / alveoli get damaged. 7) Intubation vs Extubation: Intubation is putting a tube IN throat. Extubation is the process of REMOVING the tube (oral endotracheal tube ... ETT ... or trach from a pt). 8) Syncope: Dizziness that leads to blacking out (Loss of consciousness due to decrease in BP) Dyspnea: Difficulty breathing - Apnic/Apnea: Breathless 9) Chronic Bronchitis: Inflammation / Irritation of airways that causes hypersecretion of mucus in airways leading to a cough. It can lead to fibrosis (scaring of respiratory tract), and kills the ciliary columnar epithelial cells (and thus mucociliary escalator) that helps get mucous up and out. Bronchioles get narrowed, goblet cells get hyperplasia (produce more mucous) and ciliary cells get damaged / decrease and don't work to get stuff out. It is diagnosed by patient having a cough producing sputum for at least three months for two consecutive years. Often comes from SMOKING Asthma: The trachea or bronchioles (airway) reacts to some allergen that causes it to inflame and become hyper-irritated ... so a hyper response and airway narrows (inflammed). It causes an overproduction of mucous. An Asthma attack is an extreme SOB, cough, wheezing, dyspnea, use of accessory m’s to help breathe, hyper-inflated lungs and air gets trapped. HR and RR increase. Sputum (mucous) increases significantly. Emphysema: is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). So you get hyperinflation of lungs / more air in lungs - so a barrell chest or bigger chest. In people with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed. It usually is from smoking. Alveoli get bigger. The alveoli lose their elastic recoil and air gets trapped ... eventually the alveoli get damaged and destroyed. Symptoms include SOB, persistent cough, wheezing, increased RR. Bronchiectasis is PERMANENT dilation of bronchi caused by DESTRUCTION of elastic and muscular components of airways. They will get chronic cough, overproduction of sputum. Bronchiectasis may result from an infection or medical condition, such as pneumonia or cystic fibrosis. Mucus builds up and breeds bacteria, causing frequent infections. Symptoms include a daily cough that occurs over months or years and daily production of large amounts of phlegm 10) FLUID getting into the lung (maybe from aspiration), and it causes an INFECTION. Often a result of STREP. It results in decreased lung volumes/compliance; decreased gas exchange, increase RR, increase inspiratory pressure, increase work of breathing. Can be treated with antibiotics. 11) Refers to a group of lung diseases that prevent the lungs from fully expanding with air. This restriction makes breathing difficult. Many forms of restrictive lung disease are progressive, getting worse over time. However, some causes of restrictive lung disease can be reversed. Examples of restrictive lung disases are: chest wall stiffness, scoliosis, tumor, respiratory muscle weakness, pulmonary fibrosis, pleural effusion, etc. Obviously something is blocking lungs from being able to fully expand, thus causing SOB and dyspnea. 12) A disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. It is highly contagious / infectious spread through airborne transmission. s/s will include: fever, chills, fatigue, weight loss, decreased appetite, night sweats, etc. Left untreated, it can be fatal. It is diagnosed based on a skin test with a small amount of tuberculin injected in the forearm and you watch for the skin's reaction over next 48 hours.

Question 145

1) Rubor = - Pallor = 2) Cellulitis is: 3) What is Rheumatic Fever 4) With cancer, explain each: - Benign: - Malignant: - Metasticize: 5) What is the grading vs. staging and TNM system with cancer 6) Is chemo or radiation a medication to treat cancer 7) What is debulking with regards to cancer 8) Carcinoma vs. Sacrcoma 9) What is alcoholic hepatitis 10) Explain each: - BUN (Blood Urea Nitrogen) test: - Urea: - Uremia: 11) What are keytones 12) T-lymphocytes vs. B-lymphocytes 13) What is creatine 14) Idiopathic vs. Iatrogenic 15) Nosocomial means - Examples: 16) What are the 3 lines of defense of the body 17) What are antigens vs. antibodies 18) What does c-diff stand for: - What is it: 19) What is staph infection: - What is MRSA: - Is cellulitis contagious? - What to remember about MRSA 20) Difference between Hep A, Hep B, Hep C - Which one does not have a vaccine

Answer 145

1) Redness - Pale 2) Cellulitis is a common, NON-contagious, but sometimes painful bacterial skin infection. It may first appear as a red, swollen area that feels hot and tender to the touch. The redness and swelling can spread quickly. It most often affects the skin of the lower legs, although the infection can occur anywhere on a person's body or face. 3) An autoimmune disease that can result from inadequately treated strep throat or scarlet fever. Rheumatic fever causes inflammation, especially of the heart, blood vessels, and joints. When a child gets strep, they get the fever. This Rheumatic fever causes inflammation, especially of the heart (valves), blood vessels, and joints. If untreated, it can permanently damage the heart. Typically results in a heart valve getting stenosis (typically the mitral valve) 4) - Benign: Abnormal cell growth, but Non-cancerous, remote or little or not cancerous yet. Can be removed, won't grow back. But can lead to cancer. - Malignant: Cancerous. Bad and growing cells. Threat to life. Malignant cells can invade and destroy nearby tissue and spread/grow. - Metasticize: For the cancer to spread and grow to other areas of the body (outside the original tumor spot). 5) - GRADING is a way of classifying cancer CELLS. - STAGING is a way of classifying the TUMOR. - TNM = Tumor, Nodes, Metasticized (how big is the tumor, how many nodes effected, has it metasticized) Ex: T1N0MX or T3N1M0 6) Chemo 7) Debulking: Debulking is the reduction of as much of the bulk of a tumour as possible. It is usually achieved by surgical removal. To remove fibrosclerotic connective tissue. 8) - Carcinoma: derived from EPITHILIAL/OUTER tissues. These tumors are fast growing. Examples include SKIN, large intestine, stomach, BREAST and lung cancer. - Sarcoma: derived from connective tissues. Tumors involve bone, cartilage, muscle, fibrous tissue, fat and synovium. 9) Alcoholic hepatitis: Liver inflammation caused by drinking too much alcohol. With this condition, the liver becomes swollen and tender. This interferes with the liver’s ability to perform essential functions (get rid of toxins), and with time may develop into a more serious condition known as CIRRHOSIS of the liver. 10) - BUN: A test to measure the health and functioning of kidneys. Urea is waste produced by kidneys that exits body in urine. - Urea: WASTE product in URINE. As body breaks down (metabolizes) PROTEINS and AA's, this is the waste product. Urea SHOULD be in urine, but NOT in the blood. - Uremia: When urea (see above) gets into the blood, a result of kidneys not filtering and functioning properly. 11) Keytones are byproducts of the body breaking down fat for energy that occurs when carbohydrate intake is low. If sugar is low (like in fasting or DM II), the body looks for other source for energy - and turns to excess stored fat. When we fast or are starving, the body naturally pulls from fat reserves if it is low on glucose to create energy. Fat gets released into bloodstream and broken down in liver to be used as fuel. But in a person with diabetes who isn't producing insulin, fat keeps getting released at high levels and circulating through body's system and the liver produces keytones, which decrease blood pH 12) T-cells recognize and kill virus-infected cells directly (helpers and suppressors). Some help B-cells to make antibodies, which circulate and bind to antigens. B lymphocytes (B cells) are ANTIBODY-producing cells that are essential for acquired, antigen-specific immune responses. Produce antibodies to fight foreign antigens (cells, bacteria, viruses, etc.). Plasma cells are fully differentiated B-cells that produce antibodies, immune proteins that target and destroy bacteria, viruses and other "non-self" foreign antigens. 13) Source of limited quick energy for metabolism in phosphagen system. It basically is a Waste product of muscle metabolism 14) Idiopathic is unknown how you got disease/condition - Iatrogenic: Illness (infection) resulting from a medical exam or treatment (Dr or surgery or exam). It's a side-affect the individual gets from the treatment they are receiving. 15) Hospital acquired infection. Originating or taking place in a hospital, acquired in a hospital. - Examples: urinary tract infections, respiratory pneumonia, catheter, trach, surgical site wound infections, gastrointestinal and skin infections. 16) First-line: Skin, hair, mucous membranes, cilia, coughing/gag reflex, gloves, tears, safe sex, saliva (these stop the invasion into the body) - Second-line: The inflammatory process (WBC's that phagocytize foreign invader) - Third-line: The immune response (lymphocytes that produce ANTIBODIES) 17) Antigens: Any substance foreign to the body that stimulates the immune system to produce antibodies to fight the antigen/intruder. Antigens can be bacteria, viruses, or fungi that cause infection and disease. Antibodies are protiens created by the body to fight bacteria, viruses, antigens. Anitbodies are created to kill the antigens. 18) Clostridium difficile - Infection of colon ... diaharreah and inflammation of colon. You take an antibiotic to stop inflammation ... but it causes inflammation of the colon by the bacteria called Clostridium difficile and is very life threatening. From nosocomial or community diarrhea. (Remember: difficulty in the colon). Transmitted through fecal-oral route. 19) Staph Infection: on the SKIN (often in the nose) from skin to skin direct contact with other person close to you, or from recent hospital visit (nosocomial), catheter. Bacteria can't go through intact skin, but can through weak/damaged skin. - MRSA: A bacteria that is resistent to many different kinds of antibiotics. It is usually passed via touch/contact. MRSA is VERY CONTAGIOUS and can be spread through direct contact with an infected person. It can also be contracted by coming into contact with an object or surface that an infected person has touched. MRSA is resistant to most antibiotics. - NO - It is contagious and resistant to antibiotics 20) Hepatitis A: Infection from a contaminated person (same as B and C below), but typically passed via contaminated food or water. Hepatitis B: A virus that infects/attacks the liver, easily overcome with a vaccine, but can damage the liver. Passed when you contact another person's blood or through anus/sex. Hepatitis C: A virus that also infects the liver, passed through unclean needles/swabs .. passed from blood of infected person to you, and you may not even know (NO s/s). - HEP C has no vaccine

Question 146

1) Difference between HIV and AIDS 2) Lyme Disease: - What is Lupus: - What is Celiac's 3) What is Lipedema 4) What is RSV 5) What is Encephalopathy: - What is Hepatic Encephalopathy: 6) What is Metabolism 7) PTH vs. Calcitonin: 8) Function of the prostate gland 9) What does Cachectic mean - What is Sepsis 10) What is Crohn's disease

Answer 146

1) Human Immunodeficiency Virus. HIV is a virus that attacks a human's immune system, so immune system won't work properly. Spread by sexual contact. And it can't be cured (person has it for life). HIV attacks certain cells in the immune system and prevents them from carrying out their proper immunity functions against microbes. When the immune system is sufficiently weakened, infected people catch atypical and severe infections. This is then called the Acquired Immunodeficiency Syndrome, or AIDS. AIDS = acquired immunodeficiency syndrome If not treated, HIV can lead to AIDS. You can't ever get rid of AIDS, but can manage through ANTIRETROVIRAL drugs to help boost immune system. 2) BULLS EYE RASH is the big s/s that tells you it is Lyme disease. It happens typically from a TICK BITE. Caused by a bacteria, Borrelia burgdorferi, that’s transmitted to humans through a bite from an infected black-legged or deer TICK. ... Early signs and symptoms of Lyme disease include fever, chills, headache, fatigue, muscle weakness. (remember: Lyme is Amanda Nelson = tick). Erythema Migrans = Redness Migrating ... or rash spreading. Seen in early LYME disease, or from tick bite. Typically goes away. - LUPUS: BUTTERFLY RASH. An inflammatory disease caused when the immune system attacks its own tissues. Lupus (SLE) can affect the joints, skin, KIDNEYS, blood cells, brain, heart, and lungs. Symptoms vary but can include fatigue, joint pain, rash, photosensitivity, and fever. These can periodically get worse (flare-up) and then improve. Etiology: Not known. Genetic and hormone factors, stress, exposure to UV light, drugs. There is no cure for lupus - Celiac's: An immune reaction to eating gluten, a protein found in wheat, barley, and rye. (how to remember: you are SILLY for just eating gluten) 3) A disorder that looks like Lymphedema (swelling due to lymphatic drainage issue), but this is a adipose tissue (fat) issue. It is irregular distribution of fat beneath the skin resulting in bilateral LE enlargement, usually of the legs and buttocks from fat. Seen from hip to ankle (but NOT past the ankle into the feet. If feet are swollen as well = lymphedema). And Lipedema occurs primarily in women. Lipedema pt’s report pain in legs, where lymphedema pt’s typically don’t feel much pain from the swelling. 4) Respiratory syncytial virus infection, usually called RSV, is a lot like a bad cold. Its an infection in the lungs and respiratory tract. It causes respiratory tract infections. And like a cold, it is very common and very contagious. Most children have had it at least once by age 2. 5) Encephalopathy: A broad term for any brain disease that alters brain function or structure. Typically from liver or kidney not filtering out toxins and wastes, and those enter the blood-brain barrier and effect the brain. Cephalon = brain - Hepatic encephalopathy: The LOSS of BRAIN FUNCTION when a DAMAGED LIVER DOESN'T REMOVE TOXINS from the blood and those toxins pass through blood-brain barrier and effect the brain. 6) Metabolism is ALL the chemical processes to break down nutrients / food (the lipids, carbs, sugar molecules) into broken-down chemicals and then convert them into energy. Metabolism converts the fuel in the food we eat into the energy needed to power everything we do, from moving to thinking to growing. Catabolism breaks molecules down, Anabolism builds molecules up needed to produce/convert energy. Nutrition is the key to metabolism. The pathways of metabolism rely upon nutrients that they breakdown in order to produce energy. This energy in turn is required by the body to synthesize new proteins, nucleic acids (DNA, RNA) etc. 7) Calcitonin lowers blood calcium levels by taking/storing calcium in bones. It will take too much calcium in the blood to the bones. Reduces calcium levels in blood. When the calcium in our blood goes too low, the parathyroid glands make more PTH. Increased PTH causes the body to put more calcium into the blood. Increased PTH causes the bones to release their calcium into the blood. PTH will sense if blood calcium levels are too low, and signal to create more ... which will signal that the body needs more calcium. BUT, calcitonin only kicks in when blood calcium levels are too high, and it takes calcium TO the bones. They are opposites. 8) Stores and secretes fluid with semen and seminal vesicle fluid during ejaculation 9) A general state of ill health involving marked weight loss and muscle loss. WASTING AWAY. - Sepsis is a potentially life-threatening complication caused by the body's response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body's response to these chemicals is out of balance, triggering changes that can damage multiple organ systems 10) An inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition, cramping, blood in the stool, GI tract ulcers, diminished appetite, etc. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

Question 147

1) Explain each medical terminology (prefix or suffix): - Paresis: - lysis / lytic: - plegia: - itis: - itis / osis / algia / opathy - Oma: - Sarcoma: - Algia / algesia - Cyte: - emesis: - philia / cytosis: - penia: - tropic: - lithiasis: - Tmesis: - plasty: - pnea: - scopy: - otomy: - ostomy: - ectomy: - retro: - megally / mega: - sclerosis: - stenosis: - oid: - centisis: - phasia: - phagia: - stasis: - entero: - rhino: - pneumo: - peri: - cephal: - caudal: - meningo: - myel: - cele: - plasia: - plasty: - chondro: - arthro: - malacia:

Answer 147

1) - Paresis: Weakness - lysis / lytic: cut off or breakdown or tear off - plegia: loss of mvmt / paralysis - itis: inflammation - Tendinitis: inflammation; Tendinosis: diseased or abnormal state/condition; Tendinopathy: pathy is like pathology, so disease; Tendinalgia: Pain - Oma: tumor - Sarcoma: cancer (of connective tissues - bone, m, lig) - Algia / Algesia: pain - Cyte: cell - emesis: vomit - philia / cytosis: increase - penia: decrease - tropic: stimulating - lithiasis: formation of (gallstones, kidney stones) - Tmesis: cut out - plasty: surgical reformation/reconstruction - pnea: breathing - scopy: look at / examine - otomy: cutting - ostomy: surgical opening - ectomy: cut out / surgical removal - retro: going back - megally / mega: big - sclerosis: hardening - stenosis: narrowing - oid: similar - centisis: puncture to remove fluid - phasia: speech disorder - phagia: swallowing disorder - stasis: stop - entero: intestine - rhino: nose - pneumo: lungs - peri: around - cephal: head - caudal: tail - meningo: meninges - myel: bone marrow - cele: hernia - plasia: development / growth - plasty: reconstruction - chondro: cartilage - arthro: joint - malacia: softening

Question 148

1) Below are myotomes. Name the myotome level for these m's: - Traps - SCM: - Deltoid and supraspinatus: - Infraspinatus, teres minor/major, subscapularis - Biceps: - Triceps: - Forearm flexors: - Forearm extensors: - Hand: - Rhomboids and Middle Traps: - Paraspinals: - Lats: - Serratus: - Pecs: - QL: - Abs / Obliques: - Iliopsoas: - Glute Med/Min - TFL/IT Band: - Glute Max: - Piriformis: - Adductors - Quads: - Hamstrings: - Ant. Compartment of Lower Leg: - Fibularis m's: - Extensor Hallucis Longus: - Gastroc / Post: - Levator Scapula - Saddle area:

Answer 148

1) - Traps: C3-4 - SCM: C2-3 - Deltoid: C5 - 3: C6 - Biceps: C6 - Triceps: C7 - Forearm flexors: C7-8 - Forearm extensors: C6-8 - Hand: C8-T1 - Rhomboids / Mid Traps: C5 - Paraspinals: Dorsal rami - Lats: C6-7 - Serratus: C5-7 - Pecs: C6-8 - QL: T12-L4 - Abs / Obliques: T7-T12 - Iliopsoas: L1-L4 - Glute Med/Min: L5-S1 - TFL/IT Band: L5-S1 - Glute Max: L5-S2 - Piriformis: S1-S2 - Adductors: L1-L3 - Quads: L2-L4 - Hamstrings: L5-S2 - Ant. Comp: L4-5 - Fibularis m's: L4-S1 - Extensor Hallucis Longus: L5 - Gastroc / Post: S1-2 - Levator: C3-5 - Saddle: S3-5

Question 149

1) Explain each: - Aphasia: - Dysphagia: - Dysarthria: 2) Some pt's you may need to assess their orientation. What is orientation x1, x2, x3, x4 - Is an orientation x1 or x4 better? 3) What is the mini-mental 4) How do you document sensation 5) Spasticity is different than tone how? 6) The 3 abnormal reflexes you'd check with a neuro screen 7) *** What are the 6 standardized tests you'd do with all neuro pt's. This is the "CORE SET" - How to remember? - You are supposed to assess the core domains for every neuro pt. What does that mean? 8) Where are the options of where you can d/c a neuro pt to: - Explain qualifications of what qualifies to d/c someone to each spot above: 9) Standardized test performed in hospitals or rehab facilities for PT's for their neuro pt's - What does it assess: - How many items: 10) What is Athetosis - What is the intervention for this condition above 11) What is Graded Motor Imagery (GMI) - What do you do with GMI - What is motor imagery - L vs. R discrimination is called: - Why do mirror therapy 12) CIMT stands for: - What is it: - When or for whom would you use this technique on?

Answer 149

1) - Aphasia: communication impairments (Broca's, Wenicke's) - Dysphagia: difficulty swallowing - Dysarthria: facial mvmts impaired (speech impaired due to facial m's) 2) Orientation x1, x2, x3 or x4 (person, DOB, time/date/season, place/event) - x4 - means they know all 4 of the points above (vs. x1 means they only knew 1 so are disoriented) 3) Mini-Mental is a screening tool (if needed, to objectify cognition). 4) 2 = Intact, 1 = Impaired, or 0 = Absent. 5) You add speed or high velocity movement when checking PROM to assess spasticity 6) Babinski's, clonus, Hoffman's 7) 5STS, 6 min WT, 10 meter WT, ABC, Berg, FGA - 5,6,10,A,B,F - Assess core domains: walking, transfers, and patient goals 8) Home, Inpatient Rehab, Home Health, SNF, Hospice, Outpatient - Home • Have family support, can do basic ADL’s, doesn’t have transportation to go to OP - Inpatient Rehab • Must tolerate 3 hours of rehab daily, and qualify for 2 of 3 services (PT, OT, SLP) - Outpatient • Can drive themselves or has a ride to/from OP appts, and are medically stable - Home Health • Needs a skilled service (PT, OT, SLP), is medically stable but is still dependent on nursing or PT - SNF • Needs a skilled service (PT, OT, SLP) • Not medically stable (needs nursing) - Hospice: End of life 9) FIM / Care - Eating, grooming, bathing, dressing, toileting, mobility, communication, social interaction, memory - 18 10) A condition in which abnormal muscle contractions cause involuntary writhing movements. It affects some people with cerebral palsy, impairing speech and use of the hands. From basal ganglia damage, mix of high and low tone. - Get them to midline 11) An exercise of the brain for chronic pain pt's to help get neuron connections fixed in brain - L vs. R discrimination, mirror therapy, and motor imagery - THINKING about / imagining a movement - Laterality - It helps neural connections reshape brain to think the impaired side is actually good 12) Constraint induced manual therapy: - Immobilize the GOOD limb to force the bad limb to improve and strengthen - Stroke (CVA) pt's, SCI's, recovering orthopedic condition

Question 150

``` 1) Below is the developmental sequence. List when each gross motor mvmt happens: o Head control o Prone on elbows o Rolling o Grasping o Sitting up w/o support o Crawling o Standing up (but not walking) o Cruising o Walking / Gait o Running o Skipping o Stairs:  Ascend creeping:  Creeps down:  Walks up:  Walks down:  Walks up alternating feet: ``` 2) What is normal BP, HR, and RR for kids: 3) Explain these standardized tests / screening tools for pediatric pt's: • TIMP: • AIMS: • Denver scale: 4) What are the NORM tests: 5) For the tests from the last point, explain each briefly: 6) What are the Criterion Tests (explain them each) 7) What are the major primitive reflexes: - Rooting: - Sucking: - Palmer Grasp: - Moro: - STNR: - ATNR: - Landaeu: - Righting reactions: 8) Explain these pediatric special tests: - Ortalani's and Barlow's: - Craig's Tests: - Galeazzi: 1 9) How to remember difference between Ortalani's and Barlow's

Answer 150

``` 1) o Head control (1-3 months) o Prone on elbows (3-4 months) o Rolling (3-4 months) o Grasping (1-5 months) o Sitting up w/o support (6 ish months) o Crawling (6-8 months) o Standing up (but not walking) (9-12 months) o Cruising (9-12 months) o Walking / Gait (12-18 months) o Running (2 yrs) o Skipping (5 yrs) o Stairs:  Ascend creeping: 9-14 months  Creeps down: 14-23  Walks up: 16-18 months  Walks down: 18 months  Walks up alternating feet: 3 ish ``` 2) • BP: 95/65 ish • HR: 1-12 months is 100-120, kids age 1-8 yrs 80-100 • RR: 1-12 months is 25-50 bpm, kids age 1-8 yrs 15-30 bpm 3) • TIMP: NICU infants • AIMS (for 0-18 months of developing infants, gross motor) • Denver scale (for developmental milestones of children) ages 0-6 4) AIMS, Peabody, PEDI, BOT-2 5) • AIMS (0-18 months – gross motor skills) • Peabody PDMS-II (0-6 yrs, Gross and Fine Motor Skills) • PEDI (6 mon-7.5 yrs, Functional Self-care, social function) • BOT-2 (4-21, Gross/Fine Motor in HIGH developing kids) 6) • GMFM (5 mon-16 yrs, Gross Motor for CP pts) • PBS (Any age, Berg Balance Scale for kids) • SFA (K-6th grade, School Function) • Wee-FIM (Any age, Inpatient Rehab facility for kids) 7) - Rooting (breast feeding, when it develops/starts and when it integrates/goes away is: 28w/3m) - Sucking (28w/5m) - Palmer (28w/6m) - Moro (28w/5m), It is a response to a sudden loss of support and involves three distinct components: spreading out the arms (abduction) pulling the arms in (adduction) crying (usually) - STNR (UE flex and LE extend when neck is flexed 4m/12m), - ATNR (When the child's head is turned to the side, the arm on that side will straighten and the opposite arm will bend (sometimes the motion will be very subtle or slight. A DAB when neck rotated. 20w/5m). - Landaeu (hold baby horizontal 3m/12m to test hypotonia), - Righting reactions (6m/Never) 8) - Ortalani’s and Barlow’s Test (for: Hip Dysplasia) o Barlow’s to dislocate (posterior force) and Ortalani’s to relocate (abduction to pop back in). - Craig’s Test: o Test for femoral anteversion - Galeazzi’s o Leg length discrepancy (viewing top of knees while supine) 9) B = B (Barlow's is break or dislocate), Ortalani's is put back in (abduction)

Question 151

1) Can deep somatic (bone or muscle) pain refer to other areas? - Can superficial cutaneous pain refer? 2) If you heat an area, how long typically do you do it: - How deep does a heat pack go into tissues - How many towel layers do you need when applying heat 3) Tidal volume is normally what amount - Less than what amount of tidal volume would be concerning 4) Whole body vibration as a treatment has been found to decrease _______ in Parkinson's pt's. 5) How is a hemiplegic w/c different than others - Why is a sit-stand or stand transfer harder in a hemiplegic chair 6) Genu recurvatum is: - Genu valgus will increase compression of the medial or lateral tibial condyle - Will genu valgus cause strain/stress on MCL or LCL - Genu varum would compress medial or lateral tibial condyle 7) The most reliable way to check a pt's identity in a hospital setting is: 8) What is Osteogenesis Imperfecta: - Best way to diagnose or determine which type of OI you have is: 9) What degree of elbow flexion do you want when someone uses a cane, walker, crutch, etc. 10) What is Crohn's disease - What is Diverticulitis - What do you need to eat more of if you have Diverticulitis 11) Macerated means: - Desiccated means: - Indurated means: 12) Best way to diagnose RA (Rheumatoid Arthritis) is: 13) Is the RPE scale an objective or subjective measure - Is RR or HR an objective measure 14) When auscultating lungs, how many breaths do you need to listen to in each segment to get a good picture of breath sounds - Adventitious vs. vesicular means - Tubular quality sounds are found/heard where - Vesicular breath sounds are found/heard where - Wheezes and crackles are abnormal sounds from what 15) What med would you give someone who has CHF - Inhaled corticosteroids are for what - Mucolytics are for what 16) What is the most accurate way to measure weight, girth, swelling, etc. - Girth measurements are the same as what measurements: - What are anthropometric measurements: - If you had to measure a reduction of edema in the wrist, what method would you use to be most accurate? - If you had to measure a reduction of edema in the knee, what method would you use to be most accurate? 16A) So, we know volumetric displacement of water is most accurate way to measure girth/swelling, but when or what situations would you use it? - So what is hydrostatic weighing vs. volumetric displacement 17) What is the Rinne test: - So if it takes 15 sec's for sound to disappear when placed on skull, how long will sound last when tuning fork is a few cm's away from skull? - What is a "positive" on this test - If Mastoid process portion of test is louder or longer than air, is that positive or negative - What is the Weber test: 18) A concentric or eccentric contraction lengthen's a muscle - A concentric or eccentric contraction slows down a muscle 19) If you measured skin folds to get accurate body fat %, what areas do you measure: - What area do you NOT measure 20) What is the difference of these subjective pain scales: - Verbal pain scale: - VAS: - Numerical Rating Scale: - Descriptor Differential Scale:

Answer 151

1) YES - NO (it is localized) 2) 20 mins - 2 cm (less than 1 inch) - 6-8 layers 3) 500 mL - Less than about 325 mL 4) tremors and rigidity 5) Lower seat so LE can propel w/c. Foot rest removed on uninvolved side so they can propel w/c. - Lower seat makes it harder to do those actions. 6) Hyperextension of the knee - Valgus will increase compression of LATERAL tibial condyle - MCL - Medial 7) Check the pt's wristband 8) Osteogenesis Imperfecta, also known as brittle bone disease, is a group of genetic disorders that mainly affect the bones. It results in bones that break easily. - Genetics 9) 20-25 deg's 10) Crohn's Disease: is a specific form of inflammatory bowel disease in which the lining of the GI tract becomes abnormally inflammed. - Diverticulitis refers to possessing inflammed or infected diverticula. Treatment for diverticulitis includes diet modification, controlling infection, and lowering colonic pressure - Increase fiber intake. 20-35 grams of fiber is recommended per day. **** 11) Wet - Dry - Hard / firm 12) Finding rheumatoid factors in the blood 13) Subjective - Yes 14) 1 - Adventitious = abnormal; Vesicular = normal - Auscultating over trachea - Vesicular breath sounds are normally found over the distal portions of the lung in a person withOUT lung disease. - Wheezes and crackles often mean secretions/consolidation in the airways. 15) Diuretic - Inhaled corticosteroids are to reduce inflammation in airways - Mucolytics are used to improve the expectoration of bronchopulmonary secretions in pt's with chronic bronchopulmonary diseases 16) Volume displacement in water - Circumferential - Anthropometric measures how much subcutaneous fat in proportion to total body fat. It is through height, weight, BMI, waste to hip ratio, % of body fat. These measurements are then referenced against norms for that person's age. - Volumetric displacement of water - Circumferential (the book said the knee is not practical to dump into water ? - so use tape measure) 16A) For DISTAL extremity injuries/conditions. For example, the wrist or ankle. But you wouldn't do the hip or shoulder or even the knee. Mainly distal extremities. - Volumetric displacement is to measure edema of a distal extremity. Hydrostatic weighing is the gold standard to get actual body weight (of entire body) most accurately. Hydrostatic weighing deals with the entire body, volumetric displacement is for edema in a distal limb 17) Rinne test is for detecting hearing loss ... it is when a PT holds a tuning fork against the mastoid process until the sound is no longer heard by the pt. Then the PT holds tuning fork 1-2 cm away from auditory canal until they can't hear the sound. The duration of time it takes until pt can't hear sound is recorded in each position. Normal ratio is 2:1 (conduction of air being 2x longer than bone conduction). It is a test to compare bone conduction to air conduction of sound waves to assess hearing. - 2:1 ratio says it will last 30 seconds - Unlike other tests, positive on Rinne test is GOOD (normal). - Negative (abnormal) - The doctor strikes a tuning fork and places it on the middle of your head. You note where the sound is best heard: the left ear, the right ear, or both equally. 18) Eccentric - Eccentric 19) Abdomen near belly button, mid-axillary (side of torso), pectoral mid chest, Suprailiac site, triceps, and below inf. border/angle of scapula, MEDIAL calf, quads / mid thigh .... these are all sites used - Lateral calf site is not used, but medial calf is used 20) - Verbal pain scale asks pt to use certain words like: agonizing, fair, unpleasant, etc. - VAS is a 10 cm line with NO PAIN at left and WORSE PAIN on right. - Numerical Rating Scale asks the pt to rate their pain on a scale of 0-10 (or 0-100) - The Descriptor Differential Scale consists of 12 descriptor items each centered over 21 horizontal dashes. At the extreme left dash, a minus sign and at the extreme right is a plus sign. Patients are asked to describe their pain based on each descriptor.

Question 152

1) Explain each breath sound: - Wheezes: - Crackles: - Rales: - Rhonchi: 2) What is the Kernig's sign - What is Brudzinski's sign - These special tests are for ruling in what: - How to remember Kernig's vs. Brudzinski's 3) What position is best to assess the L scapula? 4) Following a TKA, usually about how long after are pt's allowed to drive again - Can you drive while taking narcotics? - WHat is the only reason why someone could drive sooner if they had a TKA - Is tylenol a opioid - Is tramadol an opioid - Is meloxicam an opioid - Is Demerol an opioid? - How to remember opioid drug names 5) If you were measuring elbow ROM with a goni, would you stabilize the proximal end of the humerus, or the distal end of the humerus? 6) If you suspect someone has GBS, you would do a diagnostic test how? - From point above, what would you find - Would you also find elevated leukocyte levels - SO what would you find in the CSF if it was Multiple Sclerosis - *** How to remember? 7) A vertebroplasty is a medical proceedure for what type of injury/pathology? - What is a kyphoplasty - If someone had a ruptured disc, what would that proceedure (surgery) be called: 8) What is the STM technique used at the beginning and end of STM to get pt to relax - What is the STM technique where you are kneading where the muscle is squeezed and rolled under the PT's hand. - What is the SMT technique that is rapid movements like tapping, hacking, cupping, slapping, etc. 9) Where is most likely location you'd find an osteochondroma in a child - Where is most common site 10) What is stereognosis - How is vibration sensation assessed? - What is Barognosis 11) The median age for someone to live with cystic fibrosis is: - What is Cystic Fibrosis 12) What is Ludington's special test 13) A child with Down Syndrome would be more likely to have seizures or have congenital heart defects? 14) Levadopa is what - About how long after taking medications does main effect happen 15) An "Empty" end feel means what: 16) Someone in an abnormal state of consciousness can be termed many things: delirium, stupor, dementia, vegetative state, coma, locked-in syndrome, brain dead, etc. But each are different. Explain each below: - Brain Dead: - Coma: - Locked-in-Syndrome: 17) Hypoparathyroidism would result in what in the body 18) What is a MET: - So what does 5 MET's mean: 19) What do these medications do: - Mucolytic's: - Antihistamines: - Beta Adrenergic Agonist: - Antihussives: 20) What is the Phelp's special test: 21) A few ways to treat ulcers are below. Explain each: - Pulsed Lavage: - Total Contact Casting: - Oral Antibiotics: 22) *** What is polycythemia vera

Answer 152

1) - Wheezes are HIGH pitched adventitious (abnormal) breath sounds as air moves through airway (weeeeee is HIGH pitched). Wheezes are often heard with asthma and bronchitis. MUSICAL - Crackles are adventitious (abnormal) sounds due to fluid accumulation in airways - Rales are synonymous with crackles - Rhonchi are LOWER pitched adventitious sounds during breathing 2) A positive Kernig's sign is when pt is in supine and can NOT tolerate hip flexion and knee extension (basically a SLR) which puts spinal meninges on stretch. This is positive for meningitis. Refer immediately. - A positive Brudzinski's sign occurs when a pt placed in supine experiences pain with passive flexion of the neck. Passive neck flexion will also produce hip and knee flexion since the pt will try to decrease neural tension of the meninges. Brudzinski's is also another special test to help rule in meningitis. - Meningitis (inflammation of the meninges) - B = B (Brud is closer to Brain, so neck flexion; and K is for KICK like in the SLR) 3) Right sidelying 4) ~ 4 weeks - NO - If it was the Left side done (and it is an automatic transmission) - No, it's a non-opioid analgesic - YES (helps with severe pain) - No (it's an NSAID) - YES - ends with ol? 5) Distal. It said stabilize proximal joint segement at distal end. Stabilizing proximal end of humerus was too far away to adequately stabilize the joint, so you go closer (Distal) to the joint being measured to stabilize. 6) CSF tap of lumbar spine - Elevated PROTIEN levels (albumin, NOT globulin) - No (unless they are fighting some infection too) - gamma globulin - A vs. B. A (like gAmmA is for 1st condition in CNS, so MS. B is in alBumin in gBs and B condition down further in PNS, so GBS) 7) Vertebral compression fracture. Vertebroplasty is a minimally invasive proceedure used to stabilize vertebral compression fractures (usually in osteoporosis pt's). The surgeon uses fluoroscopy to locate the fractured vertebrae and injects some bone cement into the fracture site. - Kyphoplasty is a proceedure to place a balloon type object in between vertebrae that have lost height due to osteoporosis to get pt out of kyphotic posture. - Microdiscectomy 8) Effleurage - Petrissage - Tapotement 9) Osteochondromas (bone tumors) usually appear near the GROWTH PLATE (epiphysis), which is located at the END of long bones (such as the femur, humerus, or tibia). - Distal femur 10) Brian - refers to ability of a pt to identify objects placed in the hand without visual assistance (your ability to feel what something is without seeing it). It could be a pen, comb, pin, anything. - A tuning fork - Refers to the recognition of weight. The patient is asked to identify the comparative weights of similar sized objects. 11) 35 yrs old - Cystic fibrosis is an inherited disease of the exocrine glands of the lungs. Pt's can get anit-inflammatory meds, do chest PT, nutrition, etc. to help improve life expectancy, but it has low age mortality. 12) This test is performed having the pt positioned in sitting and asking pt to clasp both hands behind the head. The pt is then asked to alternately contract and relax the biceps muscles. A positive test is indicated by the absense of movement in the biceps muscle and may indicate a biceps tendon rupture. 13) Congenital heart defects 14) Medication given to Parkinson's pts to help decrease symptoms of tremors and rigidity. - 1 hour 15) Empty: this is when pain prevents getting to end range so resistance is not even felt 16) - Brain dead: loss of function of entire cerebrum, brain stem, etc. Pt is in a coma, can't breathe independently. Only reflexes that remain are deep tendon, withdrawl, plantar flexion. Recovery doesn't happen. - Coma: unresponsive so pt can not be aroused and does not respond to stimulation. Recovery can happen, but depends on extent of injury to brain. - Locked-in syndrome: lesion in brainstem. Pt is conscious and aware of surroundings (can move and communicate w/ their eyes), but voice and physical function is lost. 17) Less Ca+ being released, so hypocalcemia ... and that can lead to tetany in muscles. 18) A MET is the amount of O2 consumed while sitting at rest (3.5mL O2/kg/min). METs are critically useful since they tell you how much energy is expended (or energy cost) for particular activities. - five times the energy expended at rest in order to perform the activity 19) - Mucolytic drugs are used to treat secretion build up in airways. These can be used for CHRONIC asthma pt's to reduce mucus buildup, though they would not be effective in treating symptoms of an ACUTE asthma attack. - Antihistamines are used to treat allergic attacks/reactions. Antihistamines block the binding of histamines to receptor sites in airways, to reduce symptoms of an allergic reaction. - Beta adrenergic agonists are used to reduce bronchospasm that you'd get in an ACUTE asthma attack. They create smooth muscle relaxation to bronchodilate airways. - Antitussives are used to suppress coughing associated with common cold (they are cough suppresants) 20) Phelp's: is when pt is prone with knees extended. The hips are first abducted maximally, then the knees are flexed. If there is further hip abduction after flexing the knees, the test is positive for shortening of the gracilis muscle. 21) - Pulsed lavage: more used for necrotic tissue that requires debridement. - Total contact casting is casting designed to relieve pressure to plantar portion of foot. Used for superficial ulcers (grade 1) or pre-ulcerative lesions to allow better healing. Not used for gangrene. - Oral antibiotics may help fight infection, and typically used when it is grade 3 where bone has become infected, or grade 2 where skin is exposed. 22) Where the body produces too many new RBC's.

Question 153

1) What are the different levels of evidence in research: 2) What are grades of recommendation for research studies 3) An infant with a rough, slightly protruding reddish-purple lesion on the right lower side of their face - what would this be called: - What is dermatitis - What is a nevus - What is a Rosacea 4) Bursitis is often diagnosed with what type of imaging study 5) According to those who write this test, at what level of Diastolic BP would you stop exercise? - Same question as the one above - but for systolic BP - Would you have to stop exercise if someone threw a few PVC's - Would you stop exercise if someone went into v-tach? 6) What is the FIM - What are the levels / grades given for the FIM in terms of levels of assistance needed? 7) Will NCV increase or decrease when a cryotheraputic agent is used? - Will metabolic rate " (same as above)? - Will pain threshold " 8) What ion / electrolyte is associated with cardiac arrythmia's - What ion is associated with fluid imbalances - What ion is associated with bone absorption and muscle function 9) What is allodynia - what is hyperalgesia - what is hypothesia - what is analgesia 10) T or F: Oral temperature is usually always higher than a rectal temperature 11) What do you need to ensure you do when performing the Thessaley's special test? 12) T or F: when performing a special test, you should first test the "good" side to get a baseline 13) What is the Red-Yellow-Black wound staging system 13A) From point above, if a wound is classified as black, what do you do? 14) What is dysmetria - Give examples - It is from damage to what area of the brain 15) If you were doing a cardiac exercise test and had a pt who was asymptomatic but had 2 known risk factors for CAD, and another pt who was symptomatic but no known risk factors for CAD, which one would you be more worried about and monitor much more closely? 16) There are different kinds of whirlpool tanks. Explain each: - Hubbard tank: - Highboy tank: - Lowboy tank: - Walk tank: 17) If you had a pt that needed to work on kegal exercises, what position would be best to start to eliminate gravity? - From point above, how would you progress the pt to make the exercises harder 18) A low hematocrit could be from what: - Low hematocrit leads to what condition - A high hematocrit could be from what 19) If you had an A/C joint strain or degeneration or injury, pain would be primarily located where on the shoulder? - If you had posterior shoulder pain and you rule out bone and muscle, what could cause pain on posterior shoulder?

Answer 153

1) - Level I: RCT's, Systematic review - Level II: RCT's, Systematic Review (but poorer quality) - Level III: Case control study, retrospective cohort study - Level IV: Case series - Level V: Expert opinion 2) - Grade A: GOOD evidence for or against intervention (like Level I study) - Grade B: FAIR evidence for or against intervention (Level II or III) - Grade C: Conflicting or POOR-quality evidence (Level IV or V) - Grade I: Insufficient Evidence to make a recommendation 3) Hemangioma (is a benign tumor that appears like a red-purple birthmark. Often found in newborns) - Dermatitis: is a rash (accompanyed by pruritus and erythema) - Nevus: is a mole. Small dark skin growth - Rosacea: is an inflammatory skin disorder that causes facial erythema. You'll see flushing and erythema. 4) X-ray (but can be seen on an ultrasound) 5) Diastolic BP would have to be 120+ - It said it needed to be 250 mmHg for you to stop exercise for systolic (I'd do 200, but it says 250) - PVC's are not good, but may still do light exercise constantly monitoring EKG's - V-tach you STOP exercise ``` 6) FIM is 18 item assessment to assess person in acute setting to assess physical, psychological, social function. - 7 is totally independent, and 1 is totally dependent. 7 - Independent 6 - Modified Ind (use AD) 5 - Supervision 4 - Min A 3 - Mod A 2 - Max A 1 - Total A 0 - Couldn't complete ``` 7) Decrease - Decrease - Increase (due to gait control) 8) Potassium (K+) is a major ion responsible to generate action potential in the heart. Hypokalemia (low K+ levles) and hyperkalemia (high K+ levels) can result in arrythmias. - Na - Ca 9) Pain produced by a stimulus that does NOT usually provoke pain. Pt's with fibromyalgia, migraine HA's, and neuropathies are at greater risk to experience allodynia. It is pain from a NON-noxious stimulus. - Hypersensitivity to painful stimulus (that's normally not painful) - Hypothesia: is a decreased sensitivity to sensory stimuli. The pt has a diminished capacity for physical sensation. - Analgesia: inability to feel pain 10) FALSE. Rectal is higher than oral 11) This is for a meniscus, so you need about 20 deg's of knee flexion to grind the meniscus (like a mini-squat) 12) TRUE 13) Use wound's surface color, and indicates how well wound is healing. A red wound is most desirable (means granulation or healing), followed be yellow (= infected), and then black (= necrosis / dead). Black = eschar or necrosis. - Red = granulation tissue (healing tissue) - Yellow = infected tissue - Black = eschar or necrotic (dead tissue) 13A) Debride it 14) Dysmetria refers to an inability to modulate movement where patient's will either overestimate or underestimate their targets. Overshoot/undershoot - Nose to finger (will overshoot); Draw a circle (will miss the end line - overshoot); draw a figure 8; Step on markers on the floor during gait (will miss - overshoot) - Cerebellum (since this is a coordination issue) 15) The one who is symptomatic. 16) - Hubbard: is full body immersion. These are big - Highboy: immerse larger body parts, but can't fully extend leg. It is high, just not wide. - Lowboy: is for immersing larger body parts, but pt can extend LE's in these. - Walk tank: allows near full body immersion in an upright posture to do functional activities. 17) Supine - Move from supine --> sitting --> tall kneeling --> standing --> walking --> running 18) Not producing enough RBC's, too much water/fluids, bleeding, etc. - Anemic - A high hematocrit means more RBC's and less plasma in blood. It could be from being dehydrated, vomitting, or diahreah. A high hematocrit could also be from polycythemia vera where the body produces too many new RBC's. 19) Superior - Cervical Radiculopathy

Question 154

There WILL be a question on the boards about respiratory acidosis/alkalosis or metabolic acidosis/alkalosis. MUST understand this concept and how to interpret numbers.  PaCO2 - partial pressure of dissolved CO2 in plasma  pH - degree of acidity or alkalinity in blood  HCO3- level of bicarbonate in the blood  % of SaO2 - % of the amount of hemoglobin sites that are filled (saturated) with O2 molecules ``` PaO2 80-100 mm Hg • below 80 mm Hg = hypoxemia. • 60-80 = mild hypoxemia • 40-60 moderate hypoxemia • <40 severe hypoxemia • *** Hyperventilation takes PaO2 over 100, and hypoxic event takes it below 80. ``` pH 7.35-7.45 PCO2 / PaCO2 35-45 mm Hg (remember 35 and 45 like in the pH values) HCO3 22-28 mEq/liter **** What is solution to metabolic alkalosis? Oral Potassium Chloride

Answer 154

Arterial Blood Gases PROCESS: 1) First, look at the pH. Is it between 7.35-7.45? Is it below or above (acidotic or alkalotic). - If it is between 7.35-7.45 and all other values are in a normal range, body is in homeostasis. - If it is below 7.35, then determine if it is respiratory acidosis (the PaCO2 will be going UP since pH is going down), or is it respiratory alkalosis (PaCO2 going DOWN and pH going up); or metabolic acidosis (pH going down AND HCO3 will go down); or metabolic alkalosis (pH going up and HCO3 going UP). So, for respiratory: pH and PaCO2 move in OPPOSITE directions. For metabolic, HCO3 and pH move in the SAME direction. SO - respiratory acidosis is when pH goes down and PaCO2 goes up; metabolic acidosis is when pH goes down and HCO3 goes down. In order to know what is happening, MUST know norm values of each (see other side of this flashcard). Examples: - If pH is 7.21 and PaCO2 is 63, this is respiratory acidosis since 7.21 is low pH and 63 is a high PaCO2 (moving in opposite directions). - If pH is 7.21 and HCO3 is 12, they both are low, so must be metabolic acidosis. High pH and high HCO3 is metabolic alkalosis. - If pH is above 7.45, then determine if it is respiratory alkalosis (PaCO2 will be going DOWN since pH is going UP), or is it metabolic alkalosis (HCO3 will go UP since pH is going up). - *** HOWEVER, if the pH is in a normal range, but other values are off – this is compensated. If pH is off and other values are off, this is uncompensated. - How to know if it is compensated? - To determine if the patient’s primary respiratory process has been compensated for by the renal system, look at HCO3. - To determine if the patient’s primary metabolic process has been compensated for by the respiratory system, look at PCO2 - A high HCO3 in respiratory acidosis indicates compensated respiratory acidosis. - A low HCO3 in respiratory alkalosis indicates compensated respiratory alkalosis. GO REVIEW PRACTICE DOCUMENT

Question 155

1) For paraplegic pt's, is having a slide board in the bathroom for toilet transfers ok? 2) If you had a pt that had dentures and you wanted to do c-spine traction, would you take the dentures out or leave them in? 3) Does the wrist have more ROM in flex or ext? - Does the wrist have more ROM in rad dev or uln dev? 4) Briefly explain each: - Neuropraxia: - Axonotmesis: - Neurotmesis: 5) When traction to the lumbar spine is performed, there is some friction between pt's body and surface of table. What % of pt's body weight needs to be applied to overcome the friction element? - 25% of pt's body weight during lumbar traction accomplishes what: - 50% of pt's body weight during lumbar traction accomplishes what: - What % is needed in c-spine to get muscle stretch - What % is needed in c-spine to get seperation of vertebrae - NEVER go over what amount (%) of force in c-spine 6) Let's say you were going to MMT the right Hip Adductors. What position would the pt be in? - Now, let's say the pt had lost 80% of their strength, what position would you test this same pt in? - Now, let's say the pt had lost 20% of their strength, what position would you test this same pt in? 7) Common s/s of Parkinson's is: - Would Parkinson's pt's have Ballistic movements 8) What is the cathode and anode? - If a pt got ionto and had an alkaline reaction, what ion would accumulate at what electrode? - If a pt got ionto and had an acidic reaction, what ion would accumulate at what electrode? - How to remember 9) What do diuretics do? - What happens to blood plasma volume when taking diuretics? - What is the side effect of taking diuretics? 10) What is Alzheimer's - **** is it more common in men or women - Is it more common in younger or older pt's 11) What is Warfarin and Coumadin - Often pt's are given these meds when? - So what is an INR test - Normal INR vales are: - A high INR means what, and a low INR means what - A PT would avoid therapy/exercise with an INR value of 12) If someone was prescribed a Charleston scoliosis brace, when and how long should they wear it - What is the angle for accessing how progressed scoliosis is - From above, that angle must be what to get a brace - From above, that angle must be what to consider surgery - What are the braces that must be worn all day / all the time 13) Would optic neuritis be seen as an effect of GBS or MS - What protien would you find in CSF if it was MS 14) What is the difference between inter and intra-tester reliability 15) Difference between a strain and a sprain - Grade I, II, and III sprains and strains mean what 16) With spinal cord injury pt's, explain each below and describe why each would happen with a SCI pt: - Spinal Shock: - Autonomic Dysreflexia: - Orthostatic Hypotension: 17) Vacuum or suction devices used in wound therapy create what in the wound bed: 18) Best imaging device to detect a stress fracture - Explain telethermography imaging method: 19) Posterolateral approach THA restrictions are: - Are the glute med and min m's impacted in a THA posterolateral approach? - What muscle is impacted with this approach - If someone post-THA has hip instability, would it be due to posterior capsule or weak hip abductors? - Is the piriformis m impacted in a posterolateral approach? - What m's are impacted in an anterolateral approach 20) What exercise should you probably avoid with someone with Grave's disease 21) Review - what will ? ask about alzheimers

Answer 155

1) NO. That is not safe and adds unnecessary risk. 2) If you remove the dentures, the alignment of the TMJ may be altered causing pressure through the mandible. Leave dentures in to help forces travel properly through c-spine, not TMJ 3) It said that extension can go up to 70 deg, and flexion up to about 80 deg - Radial dev about 20, and ulnar dev about 30 4) - Neuropraxia: Temporary nerve injury that can recover (praxia: inability to perform function) - Axonotmesis: Severed an axon, but not entire nerve (tmesis: seperate) - Neurotmesis: Entire nerve seperated 5) 25% - Stretching m's - Actual seperation of spine - 7% (7-10%) - 13% (13-20%) - 30% 6) Right sidelying - Supine - Right sidelying 7) Parkinson's include: Hypokinesia, rigidity, tremors, shuffled gait, freeze on gait, bradykinesia, poor posture, cogwheel rigidity - NO. But that is what you want them to work on (big movements) 8) Cathode: black or negative electrode (what provides the charge/shock). Anode: red or positive electrode - Alkaline reaction happens with accumulation of sodium hydroxide at cathode. - Acidic reaction is hydrochloric acid accumulating at the anode - A = A (acidic at anode) 9) Diuretics help REDUCE blood pressure by getting rid of excess fluids. - Blood plasma volume will decrease. - Orthostatic HYPOtension (not hypertension) is thus a side effect of a diuretic. 10) Alzheimer's disease is a progressive neurological disorder that results in deterioration and irreversible damage within the cerebral cortex and subcortical areas of the brain. The loss of neurons results from the breakdown of several processes that would normally sustain brain cells. - Women - Older - To remember for the boards with Alzheimers ... females are more prone to than males, and 83 is older than 81 (seriously, they said you look for the OLDEST age for a female ... that is the answer). 11) Blood thinner meds (anticoagulant) - Following some surgery to prevent DVT's (and thus PE's). Or after an MI, DVT, PE, Stroke, etc. - An INR was developed to see how fast clotting factors form, to see how fast a blood clot forms. - Normal range is 2.0-3.0 - High means it takes longer for blood to clot (excess bleeding); and a low means blood clots quickly and easily - PT would NOT be done if INR is around 4.0 or higher. An INR of 1.2 is low, so blood is clotting too fast, so at risk of DVT. 12) At night, 8-10 hours. Charleston brace is a nocturnal (night time) brace, so forces are applied to the spine during sleep, so the effects of gravity are minimized. Thus, pt's can do normal activities without restrictions of a brace during the day. - Cobb angle - 25-40% - 40%+ - Milwaukee and Boston braces are DAY time braces worn during the day (typically by kids). These braces are worn all day (even part of the night, and removed when getting wet). 13) MS. Optic neuritis is inflammation that damages to optic nerve (CN II), and since CN II is an extension of the cerebral cortex, it is susceptible to demyelination in the CNS .. thus MS. - gAmmA globulin 14) INTRA is within yourself (or same tester), INTER is between people (more than one person recording). 15) *** SPRAIN is for ligament (sprain your ankle). STRAIN is for muscle/tendon tear (strained a muscle) *** - Grade I: Slight minimal stretch - Grade II: Partial tear - Grade III: Complete tear/rupture 16) - Spinal shock is the response at 30-60 mins after injury and can last a few weeks. It is flaccid paralysis and loss of reflexes below injury. - Autonomic dysreflexia: some noxious stimulus below level of injury triggers autonomic nervous system response (sympathetic n.s. response) so blood pressure rises. It is serious, so if not treated, can lead to convulsions, hemmorage, and even death. It usually happens with pt's who have a SCI at T6 or above. IF THIS PT JUST HAD A DROP IN BLOOD PRESSURE, it is probably not autonomic dysreflexia. - Orthostatic hypotension (or postural hypotension) is a reduction in blood pressure when moving positions ... going from supine to sitting. 17) Vacuum-assisted closure devices creates negative pressure (called NWPT: negative wound pressure therapy). The negative pressure helps facilitate growth and granulation tissue in wound bed. 18) Bone scan - Telethermography shows thermal / heat alterations in body 19) posterolateral precautions for THA are hip flexion greater than 90, IR, and adduction. - NO (the posterolateral approach does NOT cut through glute min and med) - Glute max - Posterior capsule given they had to cut through it, but remember they don't have to tear through glute min and med. - Yes, it is detached and then later attached back on - Glute med and min, and vastus lateralis 20) Aquatic therapy ... because someone with Grave's will have an accelerated metabolic rate and are often intolerant to warm environments. 21) OLDEST FEMALE will be the one with Alzheimers

Question 156

1) What would be the impact (if any) of a NCV on a condition with LMN symptoms - What is a Fasciculation? - Are fasciculations found in UMN or LMN lesions? - Do UMN or LMN pathologies get MORE atrophy (they both do get atrophy, but what one gets more) - Which one (UMN or LMN) gets WASTING atrophy 2) What is Thrombocytopenia? - So what are thrombocytes? 3) An older patient with thoracic vertebral pain during spinal flexion, without any pain during coughing or difficulty breathing, is probably a sign of what condition? - What two other conditions can increase the risk of developing osteoporosis 4) What is Costochondritis - Would you feel this pain more in the front or the back of the thoracic spine 5) What is Alzheimers - What intervention is the best for this condition 6) Stretching as an intervention is especially critical for pt's with this condition - Coordination training would be important for pt's with what condition 7) To read or determine a diagnosis on an EKG strip, usually a _____ seconds strip is looked at: - If there are 8 QRS complexes in a ______ (from above) second strip, what would the heart rate be? 8) What is the unit of measurement for frequency in an estim unit - What is a voltage - What is a coulomb - What is a pulse 9) If exudate is very pink and damp, you'd call it what - So what do these below mean: - sanguineous: - serosanguineous: - serous: - seropurulent: 10) If you performed the Kleiger's lateral rotation special test, what are you assessing? 11) What is negative pressure wound therapy (NPWT), and why is it used: - If a wound has ______ you would NOT use NPWT - If a pt had a skin graft, would you use NPWT? - If bone or tendons were exposed, would you use NPWT? - But never place the NPWT vacuum over these things: 12) Berg Balance Scale is out of how many points - Lower than ____ on the Berg is a ROF 13) An overweight deconditioned pt would experience an increase in HR and systolic BP if they were to exercise. But what would you see more of, an increase in HR or increase in systolic BP? 14) Knowing the differences of the CN's for the eyes is important. - First, what are the CN's involved with the eye - Explain each of the CN's involved with the eye - How to remember CN VI 15) What is syncope: - What causes syncope: 16) A PT observes a pt complete hip abduction and adduction exercises in standing. What axis of movement is utilized with these particular motions? - What are the PLANES of movement - Movement occurs around what axis' 17) Normal ABI is what: - A value of ____ is very low and dangerous - If someone had an ABI of 0.36, would they get intermittent claudication upon exercise or would they get claudication at rest - What is intermittent claudication - Is claudication venous or arterial - What are s/s of arterial vs. venous claudication? - What imaging would you do to asssess blood flow problems 18) How do you treat: - Respiratory acidosis - Respiratory alkalosis - Metabolic acidosis - Metabolic alkalosis 19) MRSA is basically called what: - Is it contagious? - How is it spread? - Thus what protective equiptment should you wear when working with such a pt - What would you be sure to wear with a condition that can be passed via airborn 20) Some R sided stroke pt's will get Figure-ground discrimination dysfunction. What is this? - What is an example of this dysfunction

Answer 156

1) LMN's would have impairments with NCV studies (slower) - Fasciculation is a term for a weak and involuntary contraction or twitching of a group of fibers - LMN pathology. They are NOT found with UMN lesions. - LMN - LMN (UMN gets disuse atrophy) 2) Thrombocytopenia is a condition in which you have a low blood platelet count. - Platelets (thrombocytes) are blood cells that help blood clot. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries. 3) Vertebral fracture due to osteoporosis - Diabetes or hyperparathyroidism can increase the risk of developing osteoporosis 4) This is an inflammation of the cartilage in the rib cage. It is pain in ribs where ribs meet costal cartilage - This would be pain in the FRONT of the thorax 5) Alzheimer's is a progressive neurodegenerative disease in the brain. Plaques form in / on the nerves, and thus impact memory and difficulty learning new things. - There is compelling evidence that physical activity (exercise) can improve memory and delay decline. 6) Spacticity or hypertonicity. Pt's with contractures or pain due to inflexibility. - Coordination training is appropriate for pt's with ataxia, cerebellum impairments, balance impairments, etc. 7) 6 - 80 bpm 8) Hertz (Hz) - Voltage is electrical force - Hertz is unit of measure which describes the number of cycles p/sec when using an alternating current - A coulomb is the amount of electrical charge transported in one second by a steady current of one ampere - Pulses p/sec is utilized to describe the frequency of pulsed current 9) serosanguineous - Sanguineous exudate is red with thin watery consistency. It is fragile granular tissue (good) - Serosanguineous exudate is light red or pink with thin watery consistency. It is present during inflammatory phase of healing - Serous exudate is clear and light in color with thin watery consistency - Seropurulent exudate is yellow to tan with cloudy appearance. This is sign of infection. 10) If the pt had a medial ankle sprain (Deltoid Lig) and/or high ankle syndesmosis sprain. 11) Negative Pressure Wound Therapy (NPWT) is the process of applying negative pressure to a wound through the use of a vacuum device. NPWT is used on diabetic ulcers, venous statis ulcers, surgical wounds, traumatic wounds, burns, and even skin grafts. The negative pressure helps reduce edema, promote formation of granulation tissue, and remove exudate and infectious material. - Eschar. Presense of eschar or necrotic tissue is CONTRAINDICATION for NPWT. Before doing NPWT, you need to debride any eschar or necrotic tissue. - Skin grafts are NOT a contraindication for NPWT. It is often used for burns and wounds with a skin graft. - If muscle and tendon are exposed, NPWT can still be used (remember lady in Iowa where you could see ribs). - *** Do NOT place NPWT dressings on nerves, or blood vessels, or organs though. 12) 56 - 41 13) HR 14) - CN II, CN III, CN IV, CN VI - CN II is optic nerve, and is just sensory, so sensation of sight and visual fields - CN III is oculomotor nerve and is motor, so it innervates eyelid levator muscle, sup/inf/medial recti muscles, and inf. oblique muscle of eye. So it elevates eye, moves eye up, down, and medially - CN IV is trochlear nerve and innervates sup oblique muscle, so damage means difficulty with downward and inward gaze - CN VI is abducens and does LATERAL RECTUS muscle movement. - CN VI is the last CN for the eye, and lateral rectus is the last or most outside muscle of the eye (last = last ... or lateral rectus for CN VI) 15) Passing out or fainting / temporary loss of consciousness usually related to insufficient blood flow to the brain. It most often occurs when blood pressure is too low (hypotension) and the heart doesn't pump enough oxygen to the brain. - abrupt changes in posture (such as standing up too quickly, standing for long periods of time, fear, pain, stress 16) Anterior-posterior - planes: frontal, sagittal, and transverse. - Movements occur around axes: anterior-posterior, medial-lateral, and vertical. 17) 1.0 - 0.5 or lower - Claudication at rest - Claudication refers to leg pain from vascular disease. It comes on with walking/activity, and subsides with rest (when it is bad, it happens at rest). It is from muscle ischemia (not enough blood getting to working muscle tissue). - Could be arterial or venous. - Arterial is immediate pain (no blood getting to tissues) and immediate relief upon resting, whereas venous pain would occur hours after exercise and relief would not be immediate. - Doppler ultrasound 18) - Respiratory acidosis is characterized by elevated PaCO2 and low pH due to hypoventilation. Patient's with respiratory acidosis are treated by managing the underlying cause, supporting ventilation (getting more O2), and correcting any electrolyte imbalance. GET MORE O2 - Respiratory alkalosis refers to a state in which the pH is abnormally high and PaCO2 is low indicating alkalemia. Pt's with respiratory alkalosis are treated by managing the underlying cause and increasing carbon dioxide retention (getting more CO2). RETAIN MORE CO2 - Metabolic acidosis is a condition that occurs when there is an accumulation of acids due to an acid gain or biocarbonate loss. Pt's with metabolic acidosis are treating by managing the underlying cause, correcting any coexisting electrolyte imbalances, and administering sodium biocarbonate. - Metabolic alkalosis is a condition that occurs when there is an increase in pH and biocarbonate accumulation or an abnormal loss of acids. Patients with metabolic alkalosis often experience hypokalemia and may therefore be treated with ORAL POTASSIUM CHLORIDE. 19) Staph infection - a bacteria that is hard to treat because it is resistant to most anti-biotics - Yes - Contact (not through airborn, but through touch) - Gloves and gown (no mask necessary) - Mask 20) Figure-ground discrimination dysfunction involves difficulty distinguishing the foreground from the background in a complex visual array. - Have the pt pick forks out of a drawer of disorganized silverware. Or white button on white shirt example.

Question 157

1) Apical segment of a lobe of the lung is where 2) Trendelenberg position (not gait) means what - Reverse trendelenberg position is what - Fowler's position is what - Semi-fowler's position is what - So what angle is high fowler, semi-fowler, and low fowler 3) If you had to do postural drainage to the posterior segment of a lower lobe, what position would you place the pt in - If you had to do postural drainage to the anterior segment of an upper lobe, what position would you place pt in - If a pt had hypertension, would you put them in Trendelenberg position 4) If a child has spastic diplegia CP, and they had excessive spasticity in PF's, what would pt do at the knee to help get a flat foot on the ground 5) T or F: Someone with MS can present with different symptoms depending on what spinal tract was demyelinated? - If corticospinal tract was impacted, what would be symptoms: - If cerebellar tract was impacted, what would be symptoms: - If frontal lobe tracts were impacted, what would be symptoms: - If spinothalamic tract was impacted, what would be symptoms: 6) Why or why would you not do passive stretching of cervical spine to a child with down syndrome 7) At what angle of knee flexion is the patella in full contact with femoral groove - At 0 deg's (full extension) patella is where: - At 30 deg's " - At 60 deg's " - At 120 deg's " - At 135 deg's " 8) Let's say a pt had both arterial and venous insufficiency. Would you want to elevate leg or do compression for this pt? - Would you walk on a treadmill with this pt - What is a good exercise you can do 9) If a pt had a posterior cord syndrome SCI, how would it manifest - Would they lose any motor function 10) What is a Brown-Sequard SCI - What is Cauda Equina SCI 11) anthropometric measurements are what: - What is gold standard or best way to measure % of body fat: - Where are common places to take anthropometric measurements - Would you do a measurement at the lateral or medial calf 12) 3 main types of blood cancer are: - One of the most curable cancers is: 13) Formula for Cardiac Output (CO): - Formula for Stroke Volume (SV): - Will adults or children have a larger SV? - Will adults or children have a higher HR - Average CO for an adult is: 14) Is there a cure for Lymphedema - For lymphedema pt's, do you use short stretch or long stretch bandages - Why (from point above) - What have more compression - short stretch or compression bandages 15) What are the stages of Lymphedema 16) From point above, which stage/phase is the treatment phase? - Which phase/stage is the maitenence phase? - What bandage do you use (and when) in Stage I - What bandage do you use (and when) in stage II 17) What breathing exercise should you teach a lymphedema pt? - Why (from point above) 18) As a review, what are the grades for the modified ashworth scale to measure spasticity 19) Spasticity in LE's in a child is usually a sign of what condition - It is when what spinal tract gets injured in development - Will kids with Down Syndrome have spasticity - Will kids with spina bifida have spasticity - If someone has a SCI, would they demonstrate spasticity 20) From last point above, SCI's and CP both can manifest with spasticity, but what are main differences in how that spasticity presents in CP vs. SCI pt's 21) Medicare is going to require some outcome measure subjective assessment to track progress. What are the common one's they'd accept 22) From point above, explain briefly what each one's scores are and what those scores mean 23) A Tinetti is out of how many points - Below what is a ROF 24) From the options below of on:off times for e-stim, which one will create the most muscle fatigue quickest: - 1:3 - 3:1 - 1:6 - 5:1

Answer 157

1) Top (apex) 2) Tilted with head down - Tilted with head up - Head/Back propped up ... or reclined. Sitting up in slightly reclined position. - Head/Back propped up ... but MORE reclined (45 deg's ish). May even have legs propped/elevated (in a V position) - High fowler is 90 deg's (ish) sitting up; semi is 45-60 deg's reclined; and low fowler is closer to flat/supine 3) Posterior segments of the lower lobes require the Trendelenberg position - Treating the anterior segment of upper lobe requires pt to be supine - NO 4) Do excessive knee hyperextension 5) True - Corticospinal tract s/s present with paresis, spasticity, excessive tendon reflexes, spasms, clonus, babinski - Cerebellar tract s/s present with ataxia, postural and intention tremors, hypotonia, and truncal weakness - Frontal lobe s/s would show as cognitive impairments, difficulty concentrating or attention, memory, personality, processing - Spinothalamic tract s/s result in sensory deficits and neuropathic pain 6) Down syndrome (trisomy 21) is an extra 21st chromosome and these kids have atlantoaxial instability or ligament laxity, thus passive stretching is dangerous. 7) 90 deg's - at 0 deg's it is above groove - at 30 deg's it just starts to enter groove - at 60 deg's it is almost fully in - at 90 it is fully in - at 120 it is exiting groove - at 135 is is below groove 8) NO, neither. It may help with the venous, but not the arterial - Probably not given that would make venous insuff worse - Ankle pumps in supine 9) Posterior Cord Syndrome: a lesion on posterior part of spinal cord (usually spinal artery severed). You'd lose proprioception, two point discrimination, stereognosis. - NO. Motor function is preserved. 10) Brown-Sequard's: incomplete lesion by a stab wound (or something) that hemisects the spinal cord. So one side is injured. You'd lose vibratory and position sense on the same side, and loss of pain and temp on opposite side. But one sided motor is preserved - Cauda Equina: this is below level of L1/L2 where spinal cord ends. Usually these injuries are not complete since there are so many cords that would have to be severed, so you'd lose bowel/bladder function, become flaccid distal, some motor or sensory loss. 11) The principle is you measure how much subcutaneous fat in proportion to total body fat. - Hydrostatic weighting is gold standard for entire body weight (volume measurement of a distal limb by displacement of water) - Iliac crest, inf angle of scapula, tricpes, pecks, quads - Medial (they will trick you and put lateral calf ... NOT AT LATERAL CALF) 12) leukemia (WBC's), lymphoma (lymph cells), and myeloma (plasma). - Hodgkins disease (type of lymphoma of the lymphatic system) 13) CO = HR x SV - EDV - ESV = SV (ie: 140mL - 50mL = 90 mL) - Adults - Kids - 4-8 Lg 14) No - Short - Long stretch do NOT give enough compression - Compression garments have higher pressure (more compression) than short stretch bandages 15) Stage 0: the Latency Stage. A subclinical state where swelling is not evident despite impaired lymph transport. No visible edema, but pt reports heaviness. Stage 1: Mild Stage. Edema present/visible. No pitting edema or starting to get pitting edema. This is reversible. Wear short stretch bandage at night. Stage 2: Moderate Stage. Lots of edema. Pitting edema. Not reversible. Wear compression garment during day and short stretch at night. Stage 3: Lymphostatic Elephatiasis (Severe Stage) 16) Stage I - Stage II - Phase 1 uses short stretch bandages, at night - Phase II uses compression garments during day and short stretch bandage at night. 17) Diaphragmatic breathing - It will act as a pump to help move lymph fluid up thoracic duct 18) - Grade 0: absense of spasticity - Grade 1: slight increase in tone (catch and release) - Grade 1+: slight increase in tone (catch, but then resistance after throughout rest of ROM) - Grade 2: Increase in tone throughout entire ROM, but extremity can still move fine - Grade 3: Considerable increase in tone, and not easily moved throughout ROM - Grade 4: Rigidity 19) CP - Corticospinal - No - No - spina bifida manifests with LMN signs (so more flaccid) - Yes they could 20) SCI - their spasticity will manifest in flexor or extensor patterns. - CP: their spasticity is often seen in specific muscle groups (HS's, adductors, and PF's) 21) FOTO, LEFS, DASH, NDI, Oswestry 22) - FOTO: A low score is good / high score = more disability - LEFS: A low score means more disability. - DASH: A low score is good / high score = more disability - NDI: A low score is good / high score = more disability - Oswestry: A low score is good / high score = more disability 23) 28 pts - <19 24) 5:1. The greater the on time in relation to the off time, the more the muscle will fatigue.

Question 158

1) Which one is a high arch - pes planus or pes cavus 2) What is Charcot's foot - It is seen in pt's with what condition - Main s/s associated with Charcot's is: - WOuld you see more pes cavus or pes planus in Charcot's 3) **** If a patient has full PASSIVE knee extension ROM, and then does a SLR and the knee is slightly bent during the SLR, what is this because of - Explain that concept from the point above 4) What is polio: - What is post-polio syndrome - Is sensation effected with polio? 5) Explain each of these breathe sounds: - Wheezes: - Crackles: - Rales: - Rhonchi: 6) What is Metabolic Syndrome - What causes it ... or what is the most important risk factor for getting this condition - From this list, what would a person with metabolic syndrome NOT have: elevated triglyceride levels, high cholesterol, abnormal blood pH, high glucose levels, insulin resistance, high BMI, high blood pressure, low blood pressure 7) What is Klinefelter syndrome - How to remember? 8) What would the internal oblique m's do during accessory breathing 9) What is Prednisone - Pt's taking glucocorticoids (corticosteroids ... which prednisone is) are at risk of developing _________ (this condition) 10) Explain what each of these meds do: - Amlodipine (Norvasc) - Cyclobenzaprine (Flexeril) - Pseudoephedrine (Sudafed) - Nitroglycerine (Nitrostat) 11) What is a bankart repair or lesion - Shoulder dislocations most often happen posterior or anterior - Most important exercises / interventions to give a pt like this are: 12) Of these epilepsy (anticonvulsant) meds below, which one has a cardiac arrythmia side effect - Dilantin, Tegretol, Klonopin, Neurontin 13) What is orthostatic hypotension - Who does it occur in? - What are a few interventions that would help someone with orthostatic hypotension - Would a standing frame help a pt with this 14) Heat packs generally should be applied for how long to get desired physiological effect - How many towel layers must you apply when doing a heat pack 15) A pt presents with marked weakness during resisted testing of right shoulder extension and medial (internal) rotation. Which of the following nerve lesions would MOST likely produce the described impairments? a) Thoracodorsal nerve b) Suprascapular nerve c) Spinal accessory nerve d) Axillary nerve 16) *** What are the major steps for goni measurement 17) A PT assesses a pt with a TBI using the Glasgow Coma Scale. If the PT documents the eye opening score as a 3 (E3) - what does that mean? 18) A high ankle sprain is called: - What are the ligaments involved in this type of ankle sprain (from point above) - If it is a signifiant tear, surgery is needed. If someone doesn't surgically repair the lig's, they run the risk to develop what: 19) What is Myositis Ossificans 20) Explain the orientation or direction the acetabulum faces - Explain the orientation or direction the head of the femur faces - What is the normal femoral anterversion angle - Do kids or adults have more stable hip joints? - Normal/average hip anteversion angle as an infant is: 21) Sundown syndrome or sundowning is often seen in what pt's / conditions - What is sundowning? - Thus, what are some interventions to try with these pt's 22) What balance righting reaction is utilized first? Then what? Then what? - Ankle strategy utilizes what muscle group first, then what - Hip strategy utilizes what muscle group first, then what - What strategy goes proximal to distal in muscle group firing - If your DF's fire first, would you be swaying forwards or backwards 23) What is the suspensory strategy used following some perturbation that affects posture/balance:

Answer 158

1) Pes cavus 2) Charcot's foot is a form of neuropathic arthropathy that involves bone destruction and absorption leading to an unstable joint. Sublaxation of the joints commonly results in a rocker-bottom foot deformity, which can cause ulcers due to the pressure. - *** Charcot's foot is usually seen in pt's with DM II - They have neuropathy and loss of SENSATION (from DM II). You'll see foot trauma and joint destruction. Charcot's is MOST closely related to altered sensation in the foot *** Charcot's is NOT caused due to ulcers in the foot, but from sensation issues. - Charcot would cause pes planus 3) Extension lag - Joint swelling (effusion) of the knee following a TKA inhibits the function of the quad muscle. If the pt has full passive knee ext ROM but is unable to fully extend knee during active ROM ... this is the EXTENSION LAG. It could be from effusion, muscle weakness, pain, or combo of all 3 4) Polio is a virus that is contracted through food, water, or contaminated person that causes paralysis of m's - Post-polio syndrome is a term used to describe symptoms that occur years after the onset of poliomyelitis. The condition is characterized by a weakening of the muscles that were originally affected by poliomyelitis. Symptoms include progressive muscle weakness, fatigue, and muscle atrophy. - Sensation is not typically affected. 5) - Wheezes are HIGH pitched (weeeee) heard on exhalation - Crackles are discontinuous adventitious (abnormal) breathe sounds due to fluid accumulation in airways - Rales are synonymous with crackles ** - Rhonchi are low pitched adventitious breathe sounds due to secretions in airways. 6) A cluster of conditions that increase the risk of heart disease, stroke, and diabetes. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, insulin resistance, and abnormal cholesterol levels. The syndrome increases a person's risk for heart attack and stroke. - Obesity (high BMI) - Abnormal blood pH wouldn't apply, and they'd have high BP 7) Klinefelter syndrome is a genetic condition that results when a male is born with at least 1 extra copy of the X sex chromosome. Klinefelter syndrome is a common genetic condition affecting males, and is not diagnosed until adulthood. SO - it is a Sex chromosome disorder *** - Models for Calvin Klien are femmy (smaller gonads, larger breasts, less hair) 8) Compress the abdomen (due a crunch), so they'd help with expiration by decreasing the chest volume / cavity 9) Steroid shot that helps with ANTI-INFLAMATION - Osteoporosis. 10) - Amlodipine (Norvasc) is a calcium channel blocker, so they slow conduction to SA node to decrease myocardial contraction. - Cyclobenzaprine (Flexeril) is a muscle relaxor to relieve muscle spasms to decrease CNS excitability to relax muscles. - Pseudoephedrine (Sudafed) is an alpha 1 agonist used to relieve cold symptoms. It is a vasoconstrictor so it reduces blood flow to an area. - Nitroglycerine (Nitrostat) is a nitrate used to decrease ischemia to heart and smooth muscle. It vasodilates, which is opposite of what question says (enhance heating effects) 11) A bankart lesion involves detachment of the anterior labrum due to a shoulder dislocation. A bankart repair is a surgical procedure to reattach and repair the torn labrum and joint capsule. - Usually it always dislocates anteriorly. - Scapular and glenohumeral dynamic stabilization exercises 12) Tegretol 13) Orthostatic hypotension is a sudden decrease in blood pressure that occurs with movement (ie: sitting or standing). Change in position causes pooling of blood in LE veins and reduces cardiac output. - Those who have been immobile for a while. - Exercise/Move, compression stockings, abdominal binder, even a tilt table - NO (that is for a pt who can't stand and needs help) 14) 15-20 mins - 6-8 15) Thoracodorsal, because lats extend and IR. While Axillary does do deltoid, and deltoid does a little ext and IR, the Teres Minor (also innervated by Axillary) does ER. 16) - Put pt in testing position - Stabilize proximal joint segment (at distal end) - Palpate bony landmarks - Move through ROM and determine end-feel - Measure with goni 17) Glasgow scale is used to determine extent of a TBI to determine level of consciousness and severity. GSC is scaled based on verbal response, motor response, and ability to open eyes. A total score of 8 or less correlates to severe brain injury and coma. Scores of 9-12 indicate moderate TBI, and scores from 13-15 indicate mild brain injuries. - Eyes opening part is scored from 1-4. So a score of 4 is spontaneous eye opening. A 3 is in response to speech. A 2 is in response to pain. A 1 is someone who doesn't open eyes. 18) Syndesmosis sprain - The syndesmotic ligaments are the interosseous lig, and ant and post tibiofibular ligs. - If lig's are not repaired, it can cause damage to articular cartilage surfaces (leading to arthritis). 19) Myositis ossificans is a condition of calcification of the muscle. This is caused by neglecting to properly treat a muscle strain or contusion. An x-ray is the primary imaging study to diagnosis this. 20) Acetabulum faces inferior, lateral, and slightly anterior. - The head of femur also faces anterior, but superior. - Normal anterversion means the angle straight out laterally to a line straight through femoral head. Should be about 8-15 degrees anteriorly angled. If it is more or less than that, it creates hip instability. - Adults - At birth, normal anteversion is 30 deg's and then gradually diminishes through skeletal maturity. A child with 20 degrees is thus typical, however would be unlikely to represent the most stable hip. A child with 30 deg's is thus not as stable. 21) Those with Alzheimers or dimentia - Sundowning is a term used to describe disorientation, agitation, or general worsening of mental symptoms that occur specifically at dusk or nightfall. Sundowning is extremely common among individuals with dementia. It is thought to be associated with impaired circadian rhythm, environmental factors, stress, and impaired cognition. - THUS, try to do interventions earlier on in the day with these pt's. Or help put on lights later in the day so the dusk effects aren't as strong. 22) Ankle is first, then hip, then stepping, then reaching. - Ankle: PF's, HS's, paraspinals if falling forward; DF's, quads, abs if falling backwards - Hip: Abs, hip flexors, quads, DF's if falling back; paraspinals, HS's, PF's if falling forward - Hip (ankle does distal to proximal) - Backwards 23) This is when you crouch or lower down to the ground to get your center of gravity lower to prevent falling. You crouch, squat, or bend knees. Used in surfing or snowboarding or skateboarding.

Question 159

1) ACE inhibitor med's are used for what (what type of pt, what do they do) - Bradycardia is a side effect for people taking what type of med - Dehydration is a side effect of those taking what type of med 2) Hypokalemia leads to - HYPERkalemia is a side effect of what med's 3) Tonic labyrinthine reflex is - If a baby's head is flexed, they'll do what with their extremities? - If a baby's head is extended, they'll do what with their extremities? 4) A PT positions a pt in supine and places the head and neck in maximal flexion, and then laterally flexes the head to the left and rotates the head to the right. While stabilizing the head in this position, the PT then depresses the right shoulder girdle. Which right-sided muscle would be fully assessed for adequate length using this testing 5) What would be an extrapulmonary cause for dyspnea and decreased lung volumes 6) Do girls or boys get scoliosis more? - What is the angle scoliosis is measured by - A pt with scoliosis range of _____ deg's requires some orthosis like a Boston brace. - A curve greater than ___ deg's requires spinal surgery (fusion with a rod) 7) What is a halo vest orthosis used for 8) Damage to the heart in these areas is from occlusion of which coronary artery: - R side of heart - This artery supplies blood to the posterior portion of the interventricular septum and inferior walls of both ventricles - L anterior ventricle - posterolateral wall of the left ventricle 9) In the capsular pattern of the shoulder, what is the most limited motion? - So what joint mob would you want to perform to help increase that restricted motion from point above - Posterior glide helps with what motions - Inferior glide helps with what motions - Anterior glide helps with what motions - Superior glide is not normally done, but if it was, what would it help with 10) What is emphezema - What are the 3 classifications of emphezema - Explain each 11) What is pneumonia 12) What is Pulmonary Fibrosis 13) What is Abulic Aphasia - What is Broca's aphasia - What is Wernicke's aphasia - What is global aphasia - Which one is Expressive aphasia - Which one is receptive aphasia - Damage to Broca's and Wenecke's area is from what artery - Abulic is from what artery 14) What is the difference between a sliding transfer and a slide board transfer: - Which one from above is a dependent transfer 15) If you took some CSF (cerebrospinal fluid) and found these findings below, what would it diagnose: - High levels of RBC's - High levels of protein (called albumin) - High levels of gamma globulin 16) The mildest form of a peripheral nerve injury is called: - Most severe form of a peripheral nerve injury is called: 17) What is neuropraxia - Neuropraxia will obviously slow NCV at site of lesion, but will it impact NCV distal to the lesion - A complete loss of electrical conduction at all points distal is the most severe degree is called: 18) What is the Haines-Zancolli test - We know that joint capsules and muscle tendons can limit ROM at these joints, but remember the extensor hood. What are the oblique and transverse retinacular lig's 19) Ionotophoresis uses which type of current from list below: a) direct b) alternating c) pulsatile d) interferential 20) From point above, explain each current 21) What does an echocardiogram, or EKG tell you? - What is a heart block - Explain each type of heart block 22) If someone is experiencing dyspnea, what is the best and quickest position to put them in to help improve breathing - Why is this position (from above) helpful

Answer 159

1) ACE inhibitors decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II. Dr's use ACE inhibitors to treat pt's with HTN and CHF. Common side effects thus are hypotension. - Beta blockers - Diuretic 2) Hypokalemia refers to low levels of potassium (and that leads to muscle cramps, weakness, fatigue, arrythmias). - ACE inhibitors. 3) Put baby in prone and their extremities will flex, and put baby in supine and extremities will extend. Prone positioning increases flexor tone, while supine positioning increases extensor tone. - flexion of arms and extension of legs - extend arms and flex legs 4) While you would stretch the R sided SCM, because they depressed the shoulder girdle, it would be the R TRAP that they are elongating. 5) Scoliosis (in other words, extrapulmonary is something outside the lungs causing lung issues). Some restrictive lung (extra-pulmonary reason) 6) Girls - Cobb angle - 25-40 deg's - 40+ deg's 7) Halo vest is an invasive cervical-thoracic orthosis that restricts cervical motion (metal ring with 4 posts with pins through skull) 8) - R coronary artery - Posterior descending a. - L anterior descending artery - Circumflex artery 9) ER - Anterior glide or P-A force - Post: flexion, IR, and hor add - Inf: abduction, flexion - Ant: ER and extension, and hor abd - Adduction 10) Emphysema is when air accumulates in lungs (in COPD) and elastin in alveoli are destroyed so the air sacs are enlarged and damaged. - centrilobular, panlobular, and paraseptal - Centrilobular: MOST COMMON type of emphysema and typically destroys upper lobes of lungs while alveolar sacs remain in tact. Smoking is main cause of this type of emphysema. - Paraseptal: this is in the lower lobes of the lungs, and destroys alveolar sacs (air pockets). It is LEAST common form of emphysema. 11) Pneumonia is inflammation of air sacs in one or both lungs - and the air sacs fill with fluid. Caused by bacteria, virus, fungus, parasite, infection. Children are most prone to get pneumonia. 12) Pulmonary fibrosis is a RESTRICTIVE lung disease where damage to alveoli creates scarring on tissues (scar tissue). Cause is idopathic, but could be from dust, asbestos, animal droppings, etc. 13) Abulic aphasia is reduces spontaneous speech and delayed response time to ?s. Mutism, delayed response, social deficits. People with this will also struggle socially or avoid social circumstances. - Broca's would manifest in limited speech production and jumbled words (can understand, just can't speak clearly). CAN NOT PRODUCE language. Broca's is expressive aphasia (and most common type of aphasia). Broca's is in the front portion of the brain and gets blood from middle cerebral artery. - Inability to understand ?s being asked is usually Wernicke's aphasia (can't comprehend/understand, but can speak fine). Can NOT UNDERSTAND language. - GLobal is both broca's and wernicke's (or both receptive and expressive). Can't produce or comprehend language. - Broca's is "expressive aphasia" - Wernicke's is "receptive aphasia" - MCA - ACA 14) Sliding transfer is transfering a pt from supine position from one bed/table to another. You put a sheet under pt to slide them to new table. - Slide board transfer is using board to slide on between w/c and bed, or chair to chair - Sliding transfer 15) - High RBC's means a SCI (usually there are not high RBC counts in CSF) - GBS - MS 16) Neuropraxia - Neurotmesis 17) Neurapraxia is the mildest form of nerve injury that involves some local compression or blockage of the nerve. Nerve fibers are not damaged and there is no evidence of nerve degeneration. These injuries can be caused by trauma to or entrapment of the nerve. - NO (It does NOT impact nerve conduction distal to lesion. If it effects distal, it is a higher degree of injury (like axonotmesis). - Neurotmesis. ALL motor and sensory distal is gone and permanent due to complete lesion. 18) The Haines-Zancolli test can be used to determine which structure is affecting ROM at the DIP jt of the hand. - The oblique and transverse retinacular ligaments cross the volar aspect of the PIP joint, but cross the dorsal aspect of the DIP joint as they insert into the common extensor mechanism. Because of this unique orientation, the structure most limiting when the PIP joint is extended and the DIP joint is flexed. If the PIP joint is flexed, the structure will be put on slack and there will be more available ROM at the DIP joint. 19) DIRECT 20) - Direct current is characterized by an uninterrupted flow of electrons toward the positive pole. This is necessary to move the ions to the dermal barrier. Polarity remains constant - Alternating current is characterized by the bidirectional (constantly changing) continuous flow of electrons. Electrons flowing in an alternating current move from the negative to positive pole, reversing direction when the polarity is reversed. - Pulsatile current is characterized by three or more pulses grouped together and may be unidirectional or bidirectional. A series of unidirectional pulses is known as monophasic pulsed current and a series of bidirectional pulses is known as biphasic pulsed current. - INterferential current combines two high frequency alternating waveforms that are biphasic. The two waveforms are delivered through two sets of electrodes through seperate channels in the same stimulator. 21) EKG's are used to determine presence of ischemia or infarction in the heart, though it is also used to detect disturbances in heart rate and rhythm. - A heart block occurs when there is a blockage in the electrical conduction system of the heart (commonly at the AV junction between atria and ventricles). - First degree (prolonged PR interval) - Second degree type I (mobitz I). PR intervals get progressively longer and then QRS complex drops off - Second degree type II (mobitz II). PR intervals are constant but a missing QRS complex occassionally. - 3rd degree: impulse of atria and ventricles are off, so P-P intervals are normal, and R-R are normal, but they are oof getting 2 different pace makers/rhythms between ventricls and atria 22) Leaning forward in sitting with UE support - Leaning forward allows pecks to elevate rib cage so diaphragm doesn't have to work as hard, so helps with dyspnea.

Question 160

1) Do the external or internal intercostals help with expiration - How to remember this? 2) Explain when during gait cycle the Terminal Swing happens - If someone had issues / limitations in PF, what phase of gait cycle would it be most manifest - How many deg's of knee flexion during terminal stance - How many deg's of DF at end of terminal stance - How many deg's of metatarsaophalangeal joints at end of terminal stance 3) What happens to our heart muscle as we age? - What does this do to cardiac output - What is arterial patency - What would decrease arterial patency 4) BIG movements are the prescribed exercises for which disease: 5) Explain each of these sensations: a) graphesthesia b) vibration c) stereognosis d) barognosis - T or F: adding an "a" in front of any of these makes it the INABILITY to do these things 6) Increased or decreased amounts of this ion / electrolyte could cause cardiac arrythmia's 7) What is 1 MET - So what is 5 MET's 8) Ataxic gait is from damage to the ________ - Ataxic gait is defined as: - Legs crossing midline is called ______ gait pattern. - From point above, you'd see this gait pattern in what condition - This condition you'd see this gait pattern: shows signs of small shuffling, forward flexed trunk, quick small steps, and festinating. - A _______ gait pattern is high steps due to dorsiflexor weakness (from foot slap) 9) If an x-ray showed an osteochondroma on a child, where would it most likely be - What is an osteochondroma 10) A grade of "fair" for MMT indicates what? - A grade of "good" is: - A grade of "normal" is: - A grade of "poor" is: - A grade of "trace" is: - A grade of "zero" is: 11) A Glasgow coma scale score of 4 or 14 suggests more serious TBI? - What are grades for Glasgow Coma Scale 12) Other name for Levels of Cognitive Functioning Scale - What is this scale: - What are the levels of this scale: ******** Carryover starts happening at stage 6 - confused appropriate

Answer 160

1) Internal (they especially help with forced expiration to bring ribs down) - Ex = Externals point to sex organs, and during inspiration they help ribs go up just like erection 2) Terminal swing begins when the tibia is perpendicular to the floor and ends when foot touches the ground. - Loading response is time between initial contact and beginning of swing phase for other leg. The ankle needs to do at least 15 degrees of PF during this phase. - 0 deg's - 0 Deg's - 30 deg's of ext 3) As we age, we get a reduction in cardiac pacemaker cells, increased cardiac afterload, and diminished arterial elasticity. - This results in reduced cardiac output (SV x HR) and increase in SYSTOLIC blood pressure. With increased age, cardiac output decreases making older adults less tolerant to exercise activity and fatigue easy. - How open and free flowing your vessel is - Atherosclerosis 4) Parkinson's 5) - Graphesthesia is the ability to identify a number or letter drawn on the skin without visual input. Use a pen cap or tip of reflex hammer. - Vibration is a DEEP sensation done with a tuning fork over a bony prominence. - Stereognosis refers to the ability of a pt to identify objects placed in the hand without visual assistance (like Brian did in class). Objects like a coin, comb, paper clip, pen, leaf, etc. - Barognosis refers to recognition of weight. Pt is asked to compare objects of different sizes / weights. Combs would thus not be used in this test. - TRUE 6) Potassium 7) One MET (metabolic equivalent) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2/kg/min. - An increase in Oxygen uptake five times greater than resting value (15 ish mL O2/kg/min) 8) Cerebellum - Ataxia is defined as the presence of abnormal, uncoordinated movements. An ataxic gait pattern is characterized by staggering and unsteadiness. Usually it has a wide BOS and mvmts that are exaggerated. - Scissoring - Spastic cerebral palsy - Parkinson's - Steppage 9) Distal femur - An osteochondroma is most common type of BENIGN bone tumor. It can occur in any bone, but usually is around the knee (distal femur). It essentially is a growth plate that separates and continues growing independently. 10) That the muscle can hold the test position against gravity but can't hold if even a little pressure is added. AROM, no resistance Grade 3 - Grade 4 - Grade 5 - Grade 2 - Grade 1 - Grade 0 11) Grade of 4 - Glasgow coma scale score of 14 or more is no real trauma/injury, score of 13-15 is mild, score of 9-12 is moderate brain injury, a score of 8 or less on the Glasgow is severe brain injury. A score of 4 is bad. 12) The Rancho Los Amigos Level of Cognitive Functioning Scale - Used to determine the cognitive and behavioral recovery / progression of the individual following a TBI as they emerge from a coma. - Level I: No response (deep sleep and totally unresponsive to stimuli) - Level 2: Generalized Response (pt reacts inconsistently and non-purposefully to stimuli. Regardless of stimuli, response is same ... response could be abnormal mvmt or vocalization or physiologic response) - Level 3: Localized Response (pt reacts specifically to local stimuli, and relate to stimulus provided. They will follow simple commands, but delayed). - Level 4: Confused-Agitated (pt is in a heightened state of anxiousness, frustration, confusion. Has bizarre behavior, lacks attention abilities, no memory, easily agitated) - Level 5: Confused -INAppropriate (pt is still confused, but not as hostile or agitated now. Has better attention, but easily distracted. Needs to focus on specific task. Can somewhat converse/socialize for short period. Learning is still hard. Very little carry over of info learned. VERY INAPPROPRIATE CONVERSATION / COMMENTS) - Level 6: Confused - Appropriate (Pt has better behavior, but still needs some direction. Shows some carryover from previously learned info. Still has memory issues, but are appropriate. - Level 7: Automatic-Appropriate (Pt appears appropriate and oriented and not confused. Goes through daily routine normally but robotically. Starting to recall and carryover learning. More social, but judgement a little impaired). - Level 8: Purposeful - Appropriate (Pt is normal again. Abel to remember/recall, responsive to environment, doesn't need supervision)

Question 161

1) A physician informs a pt that recent testing reveals that her breast cancer has spread to tissues adjacent to the primary tumor. THe cancer cells have fully infiltrated the lymph nodes in this area, however, have not spread to other areas of the body. This description is MOST consistent with which stage of cancer: - What are the stages of cancer 2) Calcium channel blocker medications treat what - What is major side effect 3) What is Cerebral Palsy - What are 3 ways CP can be classified 4) From point above, explain each of the 3 classifications of CP 5) So if someone got spastic CP, it would be from damage to what area of brain: - So if someone got dyskinetic / athetoid CP, it would be from damage to what area of brain: - So if someone got ataxic CP, it would be from damage to what area of brain: - What if someone got damage to the brainstem, how would that present 6) Would GBS present with more proximal or distal weakness - Which condition also presents with more distal weakness first - Main s/s of Charcot foot is 7) What type of w/c would someone with a C4 SCI need 8) If you are very concerned about something with a pt in an acute setting, should you report your concern to the pt's physician or the nurse? 9) What is the median age for survival rate with a person who has cystic fibrosis 10) A pt rehabing from cardiac surgery receives orders for patient-controlled analgesia. Which of the following meds would most likely be administered with this method: a) Hydromorphone (Dilaudid) b) Prednisone (Deltasone) c) Digoxin (lanoxin) d) Haloperidol (Haldol) 11) Explain each of these spinal cord injury / syndromes - Central Cord - Anterior cord - Posterior Cord - Conus Medularis - Anterior Spinal Artery - Cauda Equina - Brown Sequard 12) A pt in a hospital setting who is at risk of getting pressure ulcers should be moved/rotated how often to avoid an ulcer: - In sitting: - In laying: 13) Can a cane be used when a pt has a PWB order - A cane, or crutch, or walker should be measured to what bony landmark for the right height - You should allow about how many degree's of elbow flexion to ensure it is fit right? - You can also measure a cane to be as high as what bony landmark? 14) Another name of the perceived exertion scale is: 15) What is the lateral pivot shift test 16) Pt's with Polymyalgia Rheumatic (PMR) may also have __________ that can cause blindness or stroke. - Main s/s of the condition from the point above is: 17) Let's say you have a child with CP (spasticity) or DMD (Duchenne Muscular Dystrophy) ... what would be better to do as an intervention to help stretch muscles that are short / contracture: stretch the short m's, or daily standing program 18) How frequently should you check/assess electrical equiptment to ensure it is safe

Answer 161

1) Stage III - Stage I: cancer that is limited to the tissue origin withOUT lymph node involvement or metastasis. - Stage II: cancer that has spread into adjacent tissues. Lymph nodes only have minimal involvement. - Stage III: cancer that has spread to adjacent tissues, but marked involvement of lymph nodes. - Stage IV: cancer that has spread beyond the primary site to other areas of the body. Metasticized 2) These meds can be used to treat hypertension, angina, arrhythmias, and CHF to slow down workload of heart. - Hypotension 3) Cerebral Palsy (CP) is a permanent neurologic condition that occurs as a result of a defect or lesion to the immature brain. This insult to the developing brain can occur in utero, during birth, or even shortly after birth. CP is characterized by movement abnormalities, with the specific abnormality being based on the brain structure effected. - Spastic, Dyskinetic, Ataxic 3) - Spastic CP: is caused by damage to the motor cortex and corticospinal tract (and results in spasticity) - Dyskinetic CP: is caused by damage to basal ganglia, and can be athetoid or dystonic. Athetoid is slow, writhing, continuous movements. Dystonic is involuntary sustained or intermittent muscle contractions. - Ataxic CP: is from damage to cerebellum. They will have difficulty coordinating movement. 5) Spastic - motor cortex - Dyskinetic / Athetoid - basal ganglia - Ataxic - Cerebellum - Damage to the brainstem is not associated with CP. Brainstem is where all cranial nerves exit, thus damage here results in brain death or whatever CN was impacted. 6) Distal - Charcot-Marie-Tooth - Altered sensation (from DM II) 7) Power Tilt-in-space 8) Nurse. The physician does need to know yes, but the physician is typically NOT the first health care provider that would be involved in addressing this, the nurse would. 9) 35 yrs old (mid 30's) 10) A - Hydromorphone (Prednisone is an anti-inflammatory) ... lol is a beta blocker 11) - Central Cord: Happens with hyper ext and presents with greater involvement in LE's and more motor deficits (not sensory) - Anterior Cord: loss of motor - Posterior Cord: Loss of pain, proprioception, 2 point discrimination, and stereognosis. - Conus Medularis: Injury around L1 results in LE weakness and sensory loss bilaterally - Anterior Spinal Artery: Damage to artery from severe flexion. Lose temp and motor function (corticospinal and spinothalamic damage) - Cauda Equina: Below L1 level - damage to nerve roots. This is where you get saddle area sensation loss and bowel and bladder dysfunction - Brown Sequard: hemi or 1/2 of spinal cord injury 12) - Sitting: 15 ish mins - 2 hours 13) NO. Canes are only used to help with balance, not when a pt is PWB'ing - Ulnar styloid process - 20-25 deg's - Greater trochanter 14) "Borg's Scale" 15) The lateral pivot shift test is a commonly utilized special test designed to assess the integrity of the ACL. A positive test is indicated by a palpable shift or clunk occuring between 20 and 40 deg's of flexion, and suggests anterolateral rotatry instability. 16) Temporal arteritis (giant cell arteritis). Polymyalgia Rheumatic (PMR) is characterized by joint pain and stiffness that is progressive. This condition is typically treated with systemic corticosteroids. Some pt's with PMR may also have temporal arteritis (giant cell arteritis), that can cause blindness or stroke. - headache and visual disturbances. 17) Manual stretching is good, but NOT enough. The hold times of a few min's of stretching short m's isn't enough. A daily standing program where the child stands in a standing frame for 30-40 mins is much better to stretch m's and prevent contractures. 18) At least every 12 months

Question 162

1) What is the ratio of the G/H joint in terms of how much motion comes from G/H jt, and how much comes from scapular movement 2) If you used a pediatric BP cuff to take BP on an adult, would you expect the BP to be higher or lower? 3) What scale would I use to assess risk of developing pressure ulcer - What scale would I use to assess neuropathic ulcer - What scale would I use to determine an arterial wound/ulcer 4) From point above, the Braden scale factors in what things to determine a score - Highest score you can get is a: - Is a high score or a low score good 4A) What other scale has similar SCORING to the Braden scale 5) A side effect of epilepsy meds is: 6) If you think of the capsular pattern of the talocrural joint, what is MORE limited .... DF or PF - So if you needed to do a joint mob to address this capsular pattern, what joint mob would you do? 7) With the lungs especially, Apical means ______, basal means _______ - Base of sacrum is top or bottom 8) If someone had a CVA to the ACA, what intervention can you expect you'll most need to work on - If MCA is involved in CVA, what will be effected most - If PCA is involved in CVA, what will be effected most - If cerebellum is effected most in CVA, what would you need to work on - If someone gets Aphasia's, what artery probably was involved in CVA - If you get nystagmus, CVA probably happened where - Abulic aphasia is from damage to what artery 9) Enteral administration means: - Parenteral administration means: - Intrathecal method is what: - Subcutaneous method is: - Sublingual method is: - Transdermal method is: 9A) T or F: Entereal is anywhere in G.I tract? - Is rectal an entereal or parentereal method? 10) A 68-year old female pt diagnosed with polymyalgia rheumatica reports recently experiencing headaches of increasing intensity along with visual disturbances. Based on this clinical presentation, which of the following conditions is the MOST likely cause of this pt's symptoms: - Most common s/s of this condition from above are: 11) Probably best intervention to use with pt's with CRPS is: - Probably one of the best interventions to use with a pt with fibromyalgia is: 12) A pt with a stage III pressure injury over the ischial tuberosity presents with copious amounts of seropurulent drainage from the wound bed. The PT is concerned about maceration of the periwound tissue. Based on this info, which of the following wound dressings would be the MOST appropriate choice for this pt: a) transparent film b) impregnated gauze c) hydrocolloid d) calcium agent 13) Does wrist flexion or extension have more ROM 14) How often a week does someone get dialysis if they are in stage III renal failure 15) A pt without a cardiac history describes the sudden onset of substernal pain that has radiated to the subclavicular area over the last 5 hours. The pt indicates that the knifelike pain increases with inspiration and movement and decreases when seated and leaning forward. The therapist identifies a pericardial friction rub through auscultation. The MOST likely diagnosis is: - From point above, there are patterns of chest pain to help rule in what is happening ... so for points below, what cardiac condition is this describing: - Crushing / squeezing / heavy chest pain - Sternal, L shoulder, L UE pain - Chest pain that increases with inspiration and decreases with forward leaning, and you can hear it when auscultating the heart 16) What is the difference between dementia and delirium 17) Which condition below is from a vitamin B12 deficiency, and which is from a Vitamin D deficiency - Atrophic Gastritis and Osteomalacia 18) A group of PT's attempt to determine the relationship between 2 variables . Which of the following correlation coefficients would indicate the strongest relationship: - +0.86 - +0.45 - -0.34 - -0.89 19) What is the normal ratio of quad strength to HS strength - So if a quad could generate 140 ft/lbs of force, what could HS's do 20) Using rule of 9's, how much % of body are these areas: - Anterior thorax - Anterior UE - Entire Leg (only 1) - Head and Neck - Front side of one leg - Genitals: - Entire Arm: 21) Systolic BP typically increases how much with each additional MET - Will systolic BP increase if an activity level / MET is sustained 22) If diastolic BP gets above ______ mmHg, stop exercise - Is BP higher in the LE's or UE's 23) Even though an X-ray is better for bone, and MRI is better for soft tissues, why are x-rays ordered first (and MRI's usually not ordered)

Answer 162

1) 2:1. Remember the abduction motion is partly G/H joint, and partly scapular movement. It is a 2:1 pattern. The G/H joint does the 2, the scapula does the 1. So it does (should) get 180 deg's of passive abduction, but 120 of that is G/H, and 60 is scapula (or scapulothoracic). *** 2) Higher 3) Braden - Wagnar - ABI 4) Braden Scale is a scoring system used to assess a pt's RISK for developing a pressure injury. It factors in 6 elements: sensory perception, level of mobility, exposure to moisture, activity level, nutrition status, and exposure to friction and shear. All risk factors are scored 1-4 (friction and shear category is only 1-3) - 23 points. - The lower the score the higher the risk of developing a pressure injury. 4A) Glasgow Coma Scale 5) Cardiac arrythmias 6) PF - Do an anterior glide/drawer of the talus from tibia to promote more PF. 7) tip or top; base/bottom - Top 8) LE strength, gait, etc. since LE's are effected more with ACA stroke - UE and face m's - Vision - Coordination and balance deficits is more injury in cerebellum - MCA - Cerebellum - ACA 9) Administration of drugs involves the mouth, esophogus, stomach, and intestines (GI Tract). Most common enteral routes are oral, sublingual, and rectal. - Parenteral are all administration methods that do not involve the GI tract, get meds/fluid/food straight into bloodstream - Intrathecal is into the spine ... a parenteral method - it's injecting drug into spinal canal / a sheath or meningeal layer (drug into CNS w/o having to pass blood-brain barrier) - Subcutaneous is a parenteral form of drug administration of injecting drug under skin into subcutaneous tissue to get into bloodstream - Sublingual is an enteral form of drug administration (done under the tongue, or in cheecks). Then drugs dissolves into blood stream. - Transdermal is a parenteral form of medication applied to surface of the skin to allow absorption of drug into skin into bloodstream 9A) True - Entereal 10) Temporal arteritis - HA's and visual disturbances 11) Desensitization techniques - Pacing so they don't fatigue easily 12) Answer: D (calcium agent) Explain: stage III pressure injury is full thickness. Seropurulent drainage is yellow/tan and early sign of infection. - Transparent film dressings are thin and water resistant but allows you to see in / see the wound. These are for superficial wounds with minimal drainage. - Impregnated gauze is a guaze with silver impregnated into it, but used for minimally exuding wounds. - Hydrocolloid dressings consist of gel-forming polymers (gelatin). These are used for partial or full thickness wounds, but are less absorptive than alginate dressings. - Alginate dressings, like calcium agents, are for highly permeable wounds (like venous insuff. ulcers) with excessive drainage. 13) Flexion (~80 deg's, compared to ~70 deg's of ext) 14) 3x p/wk for a few hours for each treatment 15) Pericarditis - MI - Angina - Pericarditis 16) Delirium is when a pt is disoriented and irritable, but not associated with vitamin deficiency. Could happen from an infection - Dementia is a permanent condition related to cognitive impairment. These symptoms mimic dementia, but not caused by vitamin deficiency 17) - Atrophic gastritis is found in older adults that have decreased acid production. The acid is needed to produce Vitamin B12 - Osteomalacia is a malabsorption condition where vitamin D is deficient (not Vitamin B12). Remember vitamin D deficiencies lead to bone conditions (softening of bones, and malacia means softening) 18) You should know that closer to 1 is the strongest correlation. However, the question didn't say whether positive or negative - that is why -0.89 is the right answer vs. +0.86 19) 3:2 - About 85 ft/lbs 20) - Ant Thorax: 18% - Ant UE: 4.5% - Entire Leg: 18% - Head and Neck 9% - Front of Leg: 9% - Genitals: 1 - Entire Arm: 9% 21) 8-12 mmHg - No 22) 110 - LE's 23) They are cheaper and can tell you a lot. They are the conservative first approach.

Question 163

1) Where is the best place to try and elicit the brachioradialis reflex - Why (from above) - What spinal nerve root level are you testing when you test for brachioradialis reflex - What spinal nerve root level are you testing when you test for biceps 2) If you had a pleural effusion, would you have increased or decreased fremitus - If you had pulmonary edema or consolidation, would you have increased or decreased fremitus - If you had an atelectasis, would you have increased or decreased fremitus - What is atelectasis 2A) **** What is difference between consolidation in lung and pleural effusion - WHich one from above will fremitus be DECREASED: - WHich one from above will fremitus be INCREASED: 3) What condition is this describing: extra chromosome, hypotonia, lig laxity, flattened nasal bridge, palmar crease, enlarged tongue, and developmental delay, very flexible - What is Legg-Calve- Perth 4) Would a child with spina bifida or cerebral palsy be more prone to walk with a reciprocating gait orthosis 5) 4 stages of an effective cough 6) What is the best position to be in to get the most effective cough 7) If a pt is post surgery and doing exercise and starts to leak clear drainage from fixation site (ORIF), do you contact nursing or their physician? - Do you need to stop exercise - When would you stop exercise 8) If someone had droplet precautions, what PPE would you have to wear - Example of droplet transmission (and what is the difference between droplet and airborne) - What is contact transmission and examples - Vector born examples of transmission are: 9) So if someone has droplet precautions, you especially want to wear what PPE 10) In research, a simple random sample means what: 11) An atrial gallop is associated with what heart sound - What is ventricular gallop 12) What is the scale (grades) to assess someone's balance - Explain each 13) Let's say a PT needs to assess a body part that requires pt to get into a gown, but pt is noticably uncomfortable with that but finally agrees. What is the better option - bring a female into the room as a witness, or transfer the pt to a female PT 14) A physical therapist treats a patient status post CVA. Which action would be MOST likely to facilitate elbow extension in a patient with hemiplegia? 1. turn the head to the affected side 2. turn the head to the unaffected side 3. extend the lower extremities 4. flex the lower extremities 15) PT's should be aware of common s/s of infection following a surgery. What would you look for: - What should you do if you suspect infection 16) What is Malaise 17) When dealing with ADA specifications or requirements for w/c's - how wide (at min) does a doorway need to be: - How wide does a hall need to be to allow a w/c to do a 180 deg turn - Ramp should be how wide - Hallway should be how wide 18) What is pleural effusion - Is pulmonary fibrosis an obstructive or restrictive lung disease - Crackles (or rales) are from what 19) The components of a clinical question posed in order to search the literature for information about the effectiveness of a therapy include: 20) Let's say you do a VBI test on a pt but they can't get their head into the exact head positions. What do you do? 21) *** Which one below is the assessment tool, and which one is the correction manuever? - Dix Hallpike and Eppley Manuever 22) Another name for Eppley Manuever

Answer 163

1) Styloid process of radius. - Think about all reflexes you check, you go to distal tendon ... so go to distal tendon of brachioradialis - C6 - C5 2) Decreased (because the lung is smaller, so less fremitus) - Increased (consolidation or fluid IN lung increases fremitus) - Decreased - Collapsed lung 2A) Consolidation is liquid in the lung (but lung is still same size). Pleural effusion is liquid in pleural space, which thus compresses lung. - Pleural effusion - Consolidation 3) Down syndrome - Osteonecrosis (avascular necrosis) of femoral epiphysis of femoral head (so short limb, hip pain). In kids age-ish 6 4) Spina bifida 5) - Big inhale - Close glottis (hold) - Build up pressure - Forceful expiration 6) Sitting 7) No, leaking clear drainage from a surgical site post-op is very common - No - Perhaps if it looks infected or drainage was more yellow/green 8) Mask - Droplet transmission is the usual way that cold and flu viruses and some bacteria are spread from person to person. You send droplets into the environment via your saliva and mucus when you cough, sneeze, or talk. Others can get sick when they come in contact with those infected droplets, either in the air or on surfaces where they land. Airborne also get distributed via a cough or sneeze, but these are much smaller and stay in air longer - Germs (bacteria, virus) spread through contact like touching / skin contact, touching infected surfaces, sex, blood - Mosquitoes, ticks, rats, dogs, and other animals 9) Mask 10) that every member of the population has an equal opportunity of being chosen 11) S4. This happens in late diastole and usually is from resistance to ventricular refilling - S3 12) Normal --> Good --> Fair --> Poor - Normal = person able to sit unsupported, move in and out of BOS, and accept max challenges w/o loss of balance - Good = able to sit unsupported, move in and out of BOS, and accept some challenge w/o loss of balance - Fair = able to sit unsupported, but can not accept any challenge or go outside BOS - Poor = Needs external support to maintain balance 13) Bring a female in with you as a witness is the better choice. This will protect the PT; whereas it is impractical to transfer the pt to another PT and the pt still might have similar concerns with a female PT. 14) 1. turn the head to the affected side. Why: pt's status post CVA exhibit abnormal tonic reflexes. The asymmetrical tonic reflex (ATNR) produces extension of UE when pt's head is turned toward affected side (flexion of UE on unaffected side) 15) Yellowish exudate from surgical site, warm to the touch and reddish, edema, higher Blood Pressure, malaise - Notify referring physician 16) A general sense of being unwell, often accompanied by fatigue, diffuse pain, or lack of interest in activities. 17) 32 inches - 60 inches - 36 inches - 36 inches 18) Accumulation of fluid in pleural space. You can usually hear and auscultate a pleural friction rub. - Restrictive (scarring and fibrosis restrict alveoli and lung mvmt) - Sounds from fluid / secretion accumulation in airways, usually heard during inspiration and expiration 19) patient or problem, intervention, comparison, outcome (P-I-C-O) 20) Complete the VBI test as far into the available cervical range of motion as tolerated 21) Dix-Hallpike is the assessment, and Eppley is the correction manuever 22) Canalith repositioning manuever

Question 164

1) Someone with RA in the hands/fingers will present how? How will wrist and fingers appear? 2) Another name for the Faber's test - How do you perform this test - What is it assessing? 3) How would you typically assess these things below: - Attention - Constructional ability - Abstract ability - Orientation 4) What are the 3 phases of wound healing: - Below, list what cells arrive during this stage of wound healing - Fibroblasts - Platelets - Endothelial cells - Leukocytes - Macrophages 5) From point above, what are first cells to arrive after injury/wound - Endothelial cells will do what 6) A posterior G/H joint dislocation would create what injury - An anterior G/H joint dislocaiton often creates what injury - What % of shoulder dislocations are anterior 7) Let's say a pt tries to lift a heavy box up to a top shelf and in so doing hyperextends back to accomplish the task. What is more needed - education on proper lifting mechanics, or use an elevated step/platform so pt doesn't have to reach as high 8) If a pt post-op has had 20 visits and is not making great progress, will insurance approve a request to get more visits 9) A patient is referred to physical therapy with a C6 nerve root injury. Which of the following clinical findings would NOT be expected with this type of injury? 1. diminished sensation on the anterior arm and the index finger 2. weakness in the biceps and supinator 3. diminished brachioradialis reflex 4. paresthesias of the long and ring fingers 10) What is diplopia - What is a good therapy / intervention idea for these pt's 11) What is digitalis medication for - What effect would digitalis have on an EKG reading 12) With muscular dystrophy pt's, are the proximal or distal m's involved first - From point above, what is progression of condition - what gets worse in what order 13) Define each term below: - Spondylitis: - Spondylosis: - Spondylolisis: - Spondylothesis: - Spondyloptosis: 14) If you wanted to manually help someone get full expansion of lungs to encourage better breathing - how would you 15) What is a side effect of the use of topical antibiotic silver sulfadiazine 16) If someone is taking Lasix, what condition do they probably have - What type of medication is Lasix? 17) Excess amounts of this electrolyte can lead to cardiac issues - Normal levels of the electrolyte from the point above are: - What is hypernatremia - Main symptom related to hypernatremia would be: 18) What type of test is this (sensitive or specific) when the test is negative in persons who do not have the disease? - How do you remember this 19) What are life threatening arrythmia's that you would for sure use an AED on to help save the person - What are some arrythmias that are just that - an arrythmia - but not life threatening, thus you don't need an AED for 20) If someone had a facet dysfunction, would they prefer lumbar flexion or extension - What is neurogenic claudication - With neurogenic claudication, would they prefer flexion or extension 21) What imaging modality would you use to view calcific tendonitis - What modalitiy is best for calcific tendonitis

Answer 164

1) Radial deviation of the radiocarpal joint and ulnar deviation of the fingers (ulnar drift) 2) Patrick's test - Frog leg / man crossed leg position in supine - Hip capsule tightness or hip IR's stretch, SI dysfunction 3) - Asking a pt to count from 1 to 25 by 3's (it requires attention) *** - Asking a person to copy figures consisting of varying sizes and shapes, or drawn known items like a clock - Ask a person to interpret a proverb or describe similarities between two objects - Ask person to identify name, day, month, place, year, city, state, etc. 4) Bleeding (hemostasis), inflammatory, proliferate, remodeling - End of proliferate -> Remodeling - Bleeding - Proliferate - Inflammatory - Inflammatory 5) Platelets - Create new blood vessels, transport O2 and nutrients to wound 6) Reverse Hill-Sachs fracture/lesion - Bankart - 95% 7) Use step or elevated platform is better. Teaching body mechanics certainly won't hurt, but he still needs a step up so he doesn't have to hyper-extend his back. 8) No, probably not. At that point, you may need to give them a HEP 9) 4. paresthesias of the long and ring fingers - Why: because if it is just a C6 injury, then ulnar nerve C7/8/T1 would be fine. It's not a SCI where everything below injury is damaged/lost ... just C6 10) Double vision - Place a patch over one eye to really work on strengthening that one eye's ocular m's 11) For those pt's with CHF, and it helps increase force of myocontractility - Prolonged PR interval 12) Proximal - Proximal m's --> distal m's --> ADL's impacted --> Respiration impacted --> Death 13) - Spondylitis: Inflammation of vertebrae (spine, spondy = spine) - Spondylosis: Arthritis of back/spine - Spondylolisis: Defect in pars articularis, start of a fracture or arthritis degeneration/seperation of lumbar vertebrae - Spondylothesis: Forward displacement of one vertebrae on another (classified as grade 1-5 depending on severity) - Spondyloptosis: Where vertebral body has shifted completely off adjacent vertebral body. It is a grade V spondylolisthesis 14) Direct pressure of hands over lateral ribs with pt in supine 15) Leukopenia 16) CHF - A diuretic 17) Potassium (hyper/hypokalemia) - 3.5-5.0 - Excess Sodium (Na) - Thirst 18) Specific - Sensitive tests are positive when someone has the disease. Specific tests are negative in those without the disease. SPIN, SNOUT 19) V-fib, V-tach, Agonole - Atrial fib, A-flutter, PAC's, PVC's, 1st Degree heart block, tachycardia, bradycardia, etc. 20) Flexion, as that opens/gaps the joint, and extension causes compression of joint - A side effect of spinal stenosis where spinal nerves become compressed by narrowing of spinal column. A pt would get weakness, cramping, and pain in legs - but gets better with rest. - Both would be painful, rest would help. 21) X-ray, as it is bone within a muscle tendon - Ionto with acetic acid

Question 165

1) If you had a wound that needed to be treated with a foam dressing impregnated with charcoal, you'd be treating what type of wound - Is a foam dressing for dry or heavily exudating wounds? - Is charcoal helpful in treating infected wounds - What would you use to treat an infected wound 2) Is an exoskeletan or an endoskeletan prosthetic better for cosmetic looks? If a pt is more concerned about cosmetic looks, which one should they get - If someone is more concerned with mobility and more functional activity, should they get a SACH foot or a single or multi-axial prosthesis 3) If a pt passes midstance and he slightly vaults and exhibits early toe off, what is he limited with, PF's or DF's 4) Common s/s of Parkinson's include - What medicine helps with these symptoms - What is a side effect of prologed chronic use of that medication from point above 5) What is the high guard sitting position - What m's are very critical to maintain this position 6) In terminal stance phase of gait, how many deg's of flexion is happening at the knee 7) What is a colostomy - T or F: the farther along the intestinal tract that fecal material travels, the more the stool resembles the consistency of normal stool - So what part of the colon would a colostomy bag be placed to have the most normal stool 8) Describe a person who's max MET level is a 6 - " max MET level is a 10 - " max MET level is a 15 9) If you had a shoe insert of a high and wide toe box, it would be for what condition - If you had a transverse metatarsal bar to redistribute pressure of metatarsal heads, it would be for what condiiton 10) A physical therapist inspects the skin of a child recently admitted to the hospital after sustaining a scald burn from hot water on his torso. The burn is moist and red with several areas of blister formation. The burn covers an area approximately four inches by three inches and blanches with direct pressure. The MOST likely burn classification is: 1. superficial 2. superficial partial-thickness 3. deep partial-thickness 4. full-thickness 11) Autonomic dysreflexia is common in pt's with a SCI above what spinal level - What causes autonomic dysreflexia - What are s/s of autonomic dysreflexia - What do you do ? 12) Benzodiazepine meds do what - Side effect would be - Common name for this drug is: 13) What is the TNM classification system - T or F: knowing the stage of cancer someone is in is most important factor to determine their prognosis and POC / interventions to create 14) What causes incontinence - If someone does resistance exercises and leaks a bit of urine, would you provide them pelvic floor exercises immediately - What is better activity / intervention to provide if someone "leaks" 15) If someone had a stroke, and they demonstrated the impairment below, then you'd know where in the brain the stroke happened. So, list where in the brain the stroke happened based on the impairment: - Dysarthria: - Chorea: - Hemiballismus: - Hypertonia: - Nystagmus: 16) What is dyspraxia - If a child had dyspraxia, what piece of equipment would be best for them given this impairment - a swing, bolster, weighted vest, rocking chair, sit and spin 17) If an exercise stress test is done, what are they looking for: - Why is this test done - What is ischemia 18) We know cryotherapy is used on LE injuries to help with vasoconstriction to reduce swelling. But in very acute phase, is doing whirlpool or leg elevation with cryotherapy better (and why) 19) Of the s/s listed below, which one is NOT associated with anorexia: - hypokalemia, osteopenia, hypertension, cardiac arrythmia, hyponatrimia, fatigue 20) If a pt had a C6 complete SCI, can they do an independent transfer? - Can they do a slide board transfer? - From above, why? 21) What is the highest SCI level at which independent transfers with a slide board could be done

Answer 165

1) Heavily exudating wound that has a terrible odor - Heavily exudating - NO - Impregnated silver 2) Endoskeleton is more cosmetically attractive - A SACH is just a basic cosmetic foot; a single or multi axial is much more dynamic and used for higher ADL activities 3) DF's 4) Bradykinesia, shuffled gait, rigidity, forward flexed, freeze on gait, fasciculations - Levodopa - Choreoathetosis (uncontrolled involuntary movements) 5) Like a baby sitting on the floor with legs out (long sitting). - Back paraspinals and Rhobmoids to keep shoulders back from collapsing forward 6) 0 deg's 7) Surgical opening in the colon created for the elimination of feces. - True - Sigmoid colon (since it is farthest along the intestine) 8) A 6 would be someone who is fairly inactive, or older person - A 10 would be a younger person who is fit and active - A 15 is a high level professional athlete 9) Hallux valgus - Metatarsalgia (even for sesamoiditis) 10) 2. superficial partial-thickness - Superficial burn is outer layer or epidermis and will be red with some edema and scarring - Superficial partial-thickness will be epidermis and dermis layers with minimal scarring, but WILL HAVE BLISTERS - Deep partial-thickness destroys epidermis and dermis, damaged nerve endings - Full thickness will get infected and require a graft 11) T6 - Some noxious stimulus below lesion level (that they thus can't feel) triggers an autonomic nervous system response - Elevated BP suddenly, sweating, bradycardia, HA, vasodilation (flushing) - Sit up first, Remove noxious stimulus, take BP, treat as medical emergency 12) Promote sleep and inhibit CNS - Drowsiness - Valium 13) For cancer: t = tumor, n = node, m = metastasis - True 14) Could just be weak pelvic floor m's, but could also be due to enlarged prostate, prostatitis, cancer, neurologic disorders, obstruction, etc. - No. You need a referral from a physician since the cause of incontinence is unknown. - Some education on incontinence, and recommend meeting with their PCP 15) - Dysarthria: Dysarthria is impairment of speech, and this is from stroke to CEREBELLUM - Chorea: Involuntary rapid irregular movements, from stroke to BASAL GANGLIA - Hemiballismus: Large amplitude, sudden, violent motions on one side, from stoke to BASAL GANGLIA - Hypertonia: Increase in muscle tone from damage to UPPER MOTOR NEURONS in CEREBRUM (motor cortex or corticospinal tract) - Cerebellum 16) Difficulty planning a new motor act, and can't interpret or modulate tactile input, and difficulty with proprioception - Weighted vest can give tactile input to a child with an impaired sense of position / proprioception 17) Ischemia on an EKG strip - Exercise stress test is used to determine the ability of the cardiovascular system to accommodate for increasing demand (done on a bike or treadmill, etc.) - Ischemia: an inadequate blood supply to an organ or part of the body, especially the heart muscles. 18) Leg elevation with cold pack is better since you get cryotherapy effect and leg elevation to reduce swelling. 19) Hypertension (they'd get hypotension) 20) No - Yes - They still have lats, part of pecs, part of serratus, part of wrist extensors, shoulder ER's, and tenodesis grip 21) C6

Question 166

1) Excessive w/c seat width would make what functional activity difficult 2) What primitive reflex, if it did NOT integrate, would make getting into quadruped position very difficult for an infant - What is this reflex 3) In research, what is a repeated measures design? 4) Main difference between TENS and NMES using e-stim is what: 5) If a pt has pain during the 60-120 deg's portion of UE abduction, they most likely have what condition: - If a pt has pain during 170-180 deg's portion of UE abduction, they most likely have what condition: - If pt has pain at end range of ER, it could be: - If pt has pain at end range of IR, it could be: - A pt with biceps tendinitis would experience more pain during what motion 6) If an older male had prostatitis, what would they experience - If an older male had benign prostatic hyperplasia (BPH) - enlargment of prostate - they would experience what: 7) Bioavailability of a drug means what: - Would intravenous or oral method result in a higher bioavailability of the drug in the bloodstream 8) If using ionto on a pt, why would you use these specific ions: - Lidocain: - Dexamethosone - Magneseum: - Zinc: - Acetate: - So if a pt had a LE ulcer and PT uses ionto to help with ulcer, what ion would they use? 9) Where is the lingula of the lungs - What lobe is it part of 10) If a PT does a submaximal exercise test to a cardiac pt, in order to predict the pt's max oxygen uptake it is necessary to determine the relationship between what variables: 11) Normal tidal volume is about ____% of total lung capacity - Average amount of tidal volume is: - Total lung volume amount is: - Normal residual volume is: - Functional residual capacity is: 12) If a pt is supine with arm 90 deg's abducted and elbow flexed, and then the PT does passive IR and it is limited at 50 deg's, what ligament is preventing further ROM 13) A physical therapist positions a patient in prone to measure passive knee flexion. Range of motion may be limited in this position due to active or passive insufficiency of knee extensors/quads 14) Would applying a liquid or a gel onto electrodes during e-stim increase or decrease electrode resistance? - Would a small electrode or large electrode increase the resistance 15) What is talipes equinovarus - What motion would be very limited with this condition - How do you remember this? 16) What is Syndactyly - What is metatarsus adductus - Is calcaneovalgus result in the bottom of the calcaneus pointing in or out 17) What are heel loop or toe loops on a w/c used for 18) *** Premorbid means: 19) If a pt required you to provide manually assisted cough, would you place your hand at the epigastric level, or umbilicus level 20) The sinus tarsi is where - What is and where is the sustentaculum tali

Answer 166

1) Propelling the w/c forward (b/c arms have to go wider) 2) symmetrical tonic neck reflex - When head is flexed, UE's flex and LE's extend; when head is extended, the UE's extend and LE's flex 3) controls for differences between subjects 4) TENS uses a higher frequency (TENS for gate control pain relief, NMES is for muscle neuro re-ed) 5) Shoulder impingement - A/C arthritis - Anterior G/H capsule instability - Posterior G/H capsule instability - Pain on anterior shoulder during shoulder and elbow extension 6) Painful urination and ejaculation - urge to urinate frequently, small amounts of urine during voiding, dribbling at end of urination, nocturia 7) Percent of the drug that reaches systemic circulation - IV (orally it gets broken down before entering blood stream) 8) - Lidocain: Pain relief - Dex: inflammation - Magneseum: Muscle relaxor or vasodilator - Zinc: promote wound healing / ulcers - Acetate: calcific deposits - Zinc 9) Mid chest on left side near mediastinum - L Upper lobe 10) HR and workload 11) 10% - 500mL - ~6,000 mL - ~20% or ~1,200 mL - ERV + RV = 40% 12) Posterior joint capsule 13) Passive 14) Decrease - Small 15) Clubfoot (adduction of forefoot, varus of hindfoot, PF at ankle). - Ankle DF - Remember the pt you worked with in Iowa (he had NO DF) 16) Webbed toes / fingers, or 2 fingers/toes fuzed together - Medially curved forefoot - OUT 17) A pt with LE spasticity to try and keep legs from flinging out during spastic moments. 18) Preceding the occurrence of symptoms of disease or disorder. 19) Epigastric (bottom of rib cage where stomach sits) - Upper central abdomen between costal margins and just below sternum 20) Right where the ATFL lig is. The sinus tarsi is a tunnel between the talus and the calcaneus that contains structures that contribute to the stability of the ankle and to its proprioception but can get damaged in the sinus tarsi. The joint between the talus and calcaneus is also known as the subtalar joint. - The shelf of the calcaneus bone where the MEDIAL edge of the talus bone sits

Question 167

1) If a pt at a Rancho Level IV gets increasingly aggitated as the 60 minute session wears on, what should the PT do? Decrease session time to 30 mins or increase rest break times 2) Would pulmonary edema result from right sided or left sided heart failure - So would LE edema be assosicated with right or left sided heart failure 3) What is tardive dyskinisea: - How to remember? 4) *** Can you get anterior compartment syndrome in the UE forearm? - Where do you get anterior or posterior compartment syndrome 5) So what is anterior interosseous syndrome 6) What is phonetics - What type of aphasia would this be necessary for, or is this the primary intervention for: - Is phonetics used for Broca's aphasia 7) Let's say a pt had full PROM, but was limited with AROM ... what form of testing would help clarify the difference in ROM - What is passive joint motion testing: - What is special tests isolating flexibility: 8) Name the condition that the below description describes: - Inflammation of the lining of the digestive tract: - Insufficient insulin produced by pancreas - Hypofunction of the adrenal cortex - Hyperfunction of the Thyroid gland - Hyperfunction of the parathyroid gland - Hypothyroid condition is: 9) Those with RA typically get what drug to help treat condition - What other drugs are given to RA pt's - What other comorbidity (in addition to RA) would prevent you from giving this pt Corticosteroids, and why 10) Explain what type of pain these below describe: - sharp, shooting, burning, numb, tingling - dull, aching, cramping - Deep, intolerable, localized - Throbbing, pulsating, diffuse 11) Lupus is more common in men or women - At what age is Lupus most common 12) If a child throws a tantrum to get attention and you refuse to acknowledge the child's actions (ignore them), what type of behavior therapy is this: - So what is operant conditioning - What is aversive conditioning 13) What is a foot progression angle - A negative foot progression angle is: - A positive foot progression angle is: - So what causes in-toeing - What causes out-toeing - Excessive ER of foot would be femoral anteversion or retroversion - What is retroversion of the hip 14) What bacteria is found in pneumonia - What bacteria is found in MRSA - What bacteria is found with a gastric ulcer - What bacteria is responsible for tetanus 15) If someone had L lower quadrant pain, would it be from a peptic ulcer or from diverticulitis? 16) If you come across a situation where someone is severly injured, what is first step you do, then what is next step 17) Would hyperparathyroidism cause muscle spasms - Would hyperparathyroidism cause obesity or weight loss 18) Posterior tibial tenosynovitis would be more associated with lateral ankle sprains or a flat foot - Would peroneal tenosynovitis be more associated with lateral ankle sprains or a flat foot - Would post tibial tenosynovitis result in more pronation or supination of the foot - Would peroneal tenosynovitis result in more pronation or supination of the foot - Would plantar fasciitis result in more pronation or supination of the foot 19) Which injury will heal better and why - a medial meniscus tear to the inner 1/3rd of the meniscus, or outer 1/3rd 20) If a pt's skin post surgery is warm, red/yellow, oozing puss, tender, etc. - it is a sign of what: - For a mascectomy, what is the common infection that happens following breast surgery - What is mastitis 21) Would an obese pt (BMI >30) experience more heat intolerance or orthostatic hypotension during increased exercise?

Answer 167

1) PT should first increase rest break times to see if that helps limit agitation; if it doesn't work, then decrease amount of each session times. 2) Left - Right 3) A side effect of anti-psychotic drugs. It is involuntary choreoathetoid mvmts, and rhythmic mvmts of tongue, mouth, and jaw - Think of TART (tardive) ... so dyskinisea of mouth 4) NO - Only in LE's (lower leg) 5) Injury to the anterior interosseous nerve (of anterior forearm - median nerve branch), a branch of the median nerve. It leads to dysfunction of m's it innervates like: flexor pollicis longus, lateral half of flexor digitorum profundus, and pronator quadratus muscle. 6) study and practice of how to produce speech sounds (how sound is physically created and recieved). - Dysarthria - No 7) MMT (when there is muscle weakness, MMT detects it and you'll have full PROM and limited AROM) - Helps detect a capsular pattern (AROM and PROM will be limited) - Commonly used with a suspected musculotendinosous limitation (PROM and AROM limited and painful) 8) - Crohn's disease - Type I DM - Addison's disease - Grave's Disease - Osteopenia (because of increase release of PTH hormone so you get loss of bone density) - Hashimoto's 9) Disease-modifying antirheumatic agents - Corticosteriods or nonopiod agents - DM due to corticosteroids elevating blood sugar levels 10) - Nerve - Muscle - Bone - Vascular 11) Women - Age 15-40 ish (child bearing years) 12) Extinction: withholding reinforcement for a behavior which reduces the future probability of the behavior. - Connecting a behavior with a consequence (good or bad) - Create a unpleasant stimulus to create an aversion to the bad behavior 13) The angle between the longitudinal axis of the foot and a straight line progression of the body in walking - In-toeing - Out-toeing - Excessive hip IR - Excessive hip ER - Retroversion (your compensation is thus ER foot) - When neck of the femur is positioned more posteriorly, less than 8 deg's 14) Strep - Staph - Helicobacter pylori - Clostridium 15) Diverticulitis. This is infection/inflammation of colon. Whereas peptic ulcers are more commonly found in esophogus, stomach, or duodenum (upper GI tract) 16) Make sure scene is safe, then check for responsiveness (then do CPR if needed, then call 911 if needed) 17) No, a lack of calcium would, so hypoparathyroidism - Weight loss 18) Flat foot - Lateral ankle sprains - Pronation - Supination - Pronation 19) Outer tears heal better due to more blood supply (inner tears have very little blood supply (avascular) 20) Infection - Cellulitis - Inflammation/infection of breast tissue 21) Heat intolerance. They have so much fat that heat can't escape, so they get very hot. With BP, they would get increased BP (hypertension, not hypotension).

Question 168

1) Serous exudate is what color - What is pink exudate called - From point above, is this exudate healthy or not - What is red exudate called - From point above, is this exudate healthy or not - Yellow exudate is called - From point above, is this exudate healthy or not 2) What is the difference between selective debridement of a wound, and non-selective - Is Whirlpool a selective or non-selective form of debridement - Is wet-to-dry dressings selective or non-selective - Is enzymatic debridement selective or non-selective - What is wound irrigation - Is wound irrigation selective or non-selective 3) Is osteoporosis more prevelant in males or females - Is osteoporosis more prevelant in caucasian or african-americans - Is it more prevelant in younger or older pt's - What exactly is it? - MOST common sites for bones to break with osteoporosis 4) With advancing age, does bladder capacity increase or decrease - Is the detrusser muscle spasming a common reason for incontinence? - Is decreased urge sensation a common reason for incontinence? 5) If you did a neural tension test for the radial nerve passively on a pt, what is the first thing you'd do - When doing any of the upper limb neural tension tests, what is a sensitizer 6) Common side effect of someone taking a corticosteroid or glucocorticoid is: 7) What potential complication of a MI is a pt MOST susceptible to: 8) What % of total blood volume filters through the lymphatic system - What does the lymph system transport back to heart that the venous system does not 9) Which tests below are used for thoracic outlet syndrome? Which are NOT - Adson's, Halstead, Froment's, Wright 10) What is the general rule for how long you do an ultrasound treatment session 11) A physical therapist works with a child with Legg-Calve-Perthes disease. Which medical condition is MOST often associated with this condition? - What is Legg-Calve-Perth - Another bone that commonly doesn't heal due to lack of blood supply 12) Would you use a compression device for someone with pulmonary edema (why or why not)? - Would you use a compression device for someone with intermittent claudication (why or why not)? 13) What is the device most commonly (and effectively) used to help with proper breathing following a thoracic surgery - What are flutter valves 14) If you want to assess facial sensation, what nerve are you testing - What is the sensory component of CN VII: - What is efferent component of CN VII: - What is efferent component of CN V: - Afferent component of CN V is: 15) What is serial casting - *** How many degrees do you get / improve with 1 round of serial casting - So how many rounds of serial casting would it take to get an increase of 25 deg's of ROM 16) How could you assess or test someone's abstract ability when doing cognitive function testing - Copying drawn figures of varying shape and sizes is assessing what - Being able to identify letters or numbers traced on the skin is assessing what - Counting to 100 by 3's is assessing what: 17) What is a Pavlik harness used for - How are hips dislocated in hip displasia - So the Pavlik harness keeps a childs hips in what position - How long do they wear it 18) If an athlete gets median nerve entrapment, more likely than not, what muscle is where the median nerve is getting entraped 19) What is Waddell's signs - What are some of the signs 20) What is a: - T-Test: - Z-Test: - Chi-Square Test: - Analysis of Variance (ANOVA) Test:

Answer 168

1) Clear (light / watery) - Serosanguineous - Yes, it shows healthy healing wound (granulation) - Sanguineous - It means excessive bleeding - Purulent - Not healthy - means it is infected 2) Selective = removing only nonviable tissue; Non-selective = removing both viable and non-viable tissue from a wound - Non-selective (it will soften and debride everything) - Non-selective - Selective - Using a pressurized fluid to irrigate wound bed - Non-selective 3) Females - Caucasians - Older - Metabolic bone disorder where rate of bone resorption accelerates while rate of bone formation slows down. Bones become brittle and porous and easily fracture. - Neck of femur, compression fx of vertebrae, distal radius/ulna 4) Decrease - NO - Yes, bladder becomes full but pt has decreased bladder sensitivity so they get more incontinence 5) Depress the shoulder girdle - Once you go through sequence of limb movements, if no symptoms are brought on in the step-by-step sequence, then you do a sensitizer .... lateral cervical flexion to put more neural tension on nerves to try to provoke symptoms. 6) HYPERTENSION *** 7) Arrythmia's 8) 15% ish (10-20%, but no more ... the rest goes through venous system) - larger proteins 9) Froment is a special test for the Ulnar nerve; all other special tests are for TOS. Froment is for adductor pollicis - grab and hold onto peice of paper when pulled 10) Five minutes for an area that is two times the size of the transducer face 11) Avascular necrosis - Degeneration of femoral head due to avascular necrosis (lack of blood supply) - Schaphoid 12) NO. This just pushes fluid to an already failing heart, making things worse - The book said you could use compression with intermittent claudication (it's not a contraindication) 13) Incentive spirometer - Used for mucus secretion clearance (flutter, quake, a-capella) 14) Trigeminal - Taste to anterior 2/3rds of tongue - Facial expressions - Chewing - Facial sensation 15) A casting method to improve muscle flexibility when someone develops a contracture (so elongate a muscle). You put cast on to stretch muscle a little, then remove cast and expand ROM and cast again and keep inching your way to full ROM - 5-7 degrees (so each time you remove cast and add a new cast to get a bit more ROM, you should get about 5-7 more deg's) - 4-5 rounds 16) Ask how 2 items are similar/related; or ask them to interpret a saying or proverb - Constructional ability - Graphesthesia - Attention/concentration ability 17) Kids with hip dysplagia - Extension and adduction - Hip flexion and abduction (frog leg / faber) - 18-23 hours p/day 18) Pronator teres 19) 5 tests to help differentiate between physical (organic) and behavioral (nonorganic) causes of back pain. Waddell signs are used to detect psychogenic, sometimes inappropriately labeled “non-organic,” manifestations of low back pain in patients. - *** When you ER the shoulder and pelvis the pt will report LBP at around 30 deg's of ER to both extremities - SLR is painful in supine, but not in sitting (or visa versa) - Rather than pinpointed localized pain, pain is all over low back - Normally sensation loss is in a dermatome pattern, where as with psychogenic LBP it is a "stocking" fit or all over Lower leg 20) - T-Test: when a study compares the means of 2 different groups (only 2) - Z-Test: Also compares means of 2 different groups - Chi-Square Test: Test to compare nominal data (non-numerical like yes-no responses or gender) - Analysis of Variance (ANOVA) Test: When 3 or more variables are being compared (3 or more)

Question 169

1) What are cataracts: - What is macular degeneration: - What is presbyopia: - What is glaucoma: 2) Is inhalation a form of enteral administration of a drug - Examples of enteral forms of administration - What is the name for the other way of doing non-enteral administration - From point above, how is that administered 3) When creating a HEP for a pt, it would be smart and important to not make it long, or have 20 exercises etc. - that would just lead to non-compliance. But the most important factor to ensure pt compliance in a HEP is: 4) An infant is in a propper sitting position. What is this: - Ring sitting is what: - So if ring sitting doesn't require UE's for support, to maintain this position, would the infant need strong trunk flexors or trunk extensors 5) What is an equinus gait pattern - What is a good gait intervention to help with this gait pattern 6) A physical therapist reviews the medical record of a patient with a suspected head injury. During testing using the Glasgow Coma Scale, the patient exhibited spontaneous eye opening, was able to follow selected motor commands, and was considered to be “oriented” based on verbal responses. The MOST likely score assigned to the patient would be: 7) Will 1MHz or 3MHz go deeper into tissue with Ultrasound modality - If you were worried about creating more inflammation due to using US, what parameter would you adjust when doing treatment 8) A PT employed in a home health setting treats a pt following a total knee arthroplasty. Which of the following physical therapy goals would be the MOST essential to avoid long-term complications: a) decrease inflammation b) improve range of motion c) prevent deep venous thrombosis d) improve strength 9) Is a handrail or an assistive device more sturdy/safe when asc/descending stairs - Is ascending stairs or descending stairs harder (let's say for a post-op TKA pt) 10) When doing an EMG / electromyography test, how would a normal muscle at rest sound - The display screen where the muscle activity of an EMG is displayed is called a: - If a muscle is slightly denervated, how will it sound 11) If someone had posterior tibial tendon dysfunction, would they display hindfoot valgus or varus 12) What bones could be involved in a Lisfranc injury (sprain, fracture, etc.) - What bones are NOT involved in a lisfranc injury 13) Deep sensory receptors include: - Mechanoreceptors include: - Nociceptors are what - Thermoreceptors are what 14) Nociceptors will send their signal up through what spinal tract - Thermoreceptors will send their signal up through what spinal tract - Mechanoreceptors will send their signal up through waht spinal tract 15) What is Ape Hand Deformity - Major s/s of this deformity 16) What hand deformity does this describe: - Fixed flexion of the metacarpophalangeal joints - Fixed hyperextension of the metcarpophalangeal joints - Wasting of the hypothenar eminence 17) A physical therapist reviews a research study that examines knee flexion range of motion two weeks following arthroscopic surgery. Assuming knee flexion range of motion is a normally distributed variable, what percentage of patients in the population would achieve a goniometric measurement value between the mean and one standard deviation above the mean? - What % of people fall into 1 standard deviation above/below the mean - What % fall within 2 stand dev's above/below mean - What % fall within 3 stand dev's above/below mean - So, what % of people fall between 1 and 2 standard deviations above OR below the mean - What % of people fall into 2 standard deviations above OR below the mean - What % of people fall between 2 and 3 standard deviations above OR below the mean

Answer 169

1) Opacity (foggy) vision - Loss of central vision (looking forward) - they can't see in front, but CAN see the periphery - Farsightedness (managed with eye glasses). They can't see close up objects/reading. Older people suffer from this. - Increased ocular pressure in the eye that causes damage to the optic nerve, which leads to loss of vision 2) NO (that does NOT go through GI tract) - Oral, sublingual, gastric, g-tube, j-tube - Parenteral - Through bloodstream via an IV (intramuscular, subcutaneous, intrathecal) 3) That it aligns with / accomplishes the pt's goals 4) Forward trunk position where the infant uses their UE's for support. - Ring: Independent sitting position where legs are in a ring position w/o use of UE's for support - Extensors (allowing infant to sit more upright rather than flop forward 5) Exaggerated plantar flexion during swing phase and decreased heel strike due to shortened achilles tendon - Backwards walking since it forces plantar flexors to lengthen 6) 15 - The tool ranges from 3-15 with higher score representing a greater level of consciousness. The scale examines eye opening, motor response, and verbal response. - Score of 8 or less is severe head injury - Score of 9-12 is mod head injury - Score of 12-15 is mild (15 being highest possible) 7) 1MHz goes deeper - Pulse (do a lower / less frequent pulse) 8) Answer: B (ROM) Explain: all of these are important, but preventing a DVT and reducing inflammation are not really the main priorities of a PT, those are priorities of nursing and medical staff. And, ROM must come before strength, and not getting ROM causes long-term issues. 9) Handrail (it is sturdier and more supportive) - Descending is harder since it requires more quad strength (ascending is easier) 10) Electrical silence - Oscilloscope - Spontaneous electrical potentials, like fibrillations 11) Hindfoot valgus 12) All the midtarsal bones ... navicular, cuboid, 3 cuneform, and base of metatarsals. - Talus, calcaneus, and phalanges (it is a mid foot injury) 13) Muscle spindles and golgi tendon organs (evalute posture, muscle tone/position/mvmt) - Discriminative sensations like touch, pressure, itch, tickle, vibration, discriminative touch - Receptors to detect pain (noxious stimuli) - Receptors that respond to changes in temp 14) Lateral spinothalamic tract - Lateral spinothalamic tract - DCML 15) Ape hand deformity, is a deformity in humans who cannot move the thumb away from the rest of the hand. It is an inability to abduct the thumb. Abduction of the thumb refers to the specific capacity to orient the thumb perpendicularly to the ventral (palmar) surface of the hand. - They can't move thumb away from hand - can't do thumb opposition or abduction away from other fingers (thumb is stuck next to hand/other fingers). You'll see wasting of thenar eminence, can't do thumb opposition 16) - Dupuytren's contracture - Claw finger - Bishop's hand (or benediction hand) where there is an ulnar nerve pathology 17) 34% - 68% - 95% - 99.7% - 14% - 48% (that is where you get the 14% from last point) - About 2.5%

Question 170

1) What is clonus test - Is it an UMN or LMN test - How do you perform it - What must you remember to do when performing this test? 2) The most important factor to consider when determining a schedule for calibration and maintenence of an ultrasound unit is: 3) With ultrasound, what is duty cycle - So for example, if on time is 2 seconds and off time is 8 seconds, what is duty cycle 4) *** Explain each below: - D1 Flexion for UE: - D1 Extension for UE: - D2 Flexion for UE: - D2 Extension for UE: 5) From point above, the extensions will end with hand up or down - Flexions will end with hand up or down - D1 extension is what: - D2 extension is what: 6) The Rhomberg balance test is an assessment of a pt's balance. What are you observing during test to determine their balance abilities - Is this a timed test? - How are feet positioned during this test 7) If someone is choking, when would you use a finger sweep vs. an abdominal thrust - You should combine abdominal thrusts with what else to help dislodge object they are choking on - With an infant, what should you do 8) A rating of a 16 on the Borg rating of perceived exertion equates to what % of max heart rate - 16 means what 9) A normal toe-out degree angle is 10) The 3 areas that surgeons graft from to do an autograft ACL reconstruction are: 11) Children with CP have spasticity, and sometimes will undergo a surgery to lengthen m's to reduce spasticity and help with joint alignment. If a child had excessive lumbar lordosis, what muscle would they need to lengthen? - If they released the hamstrings, that would help with what - If a CP pt had a scissoring gait pattern, you'd need to lengthen what m's 12) A laminectomy is a surgical proceedure to help with what condition 13) If you did resistive movements on a pt and they didn't feel pain at first, but pain got worse with more movement, what could that be from: - What is emotional hypersensitivity 14) What is the main drawback of doing a max exercise test - If you did this on a person suspected of having CAD (which you wouldn't do by the way), if the pt did have CAD would this test be highly sensitive or specific 15) In a burn pt, what is the best predictor of whether the pt will have altered sensation - Explain type of sensation and pain pt would have with a superficial partial thickness burn - Explain type of sensation and pain pt would have with a full thickness burn 16) For the items below, would this increase risk of burn or descrease risk of burn when using ionto: - decrease distance between electrodes - increase current intensity - increase size of cathode relative to the anode - decrease the amount of moisture on the electrodes 17) If you set the parameters of an ultrasound, what is each parameter below: 1. 5 W/cm2, pulsed 20%, 1 MHz, 6 minutes. 18) So in relation to the point above, if I wanted to increase the tissue temperature, what parameter(s) would I need to change: 19) With regards to using PPE, when would you use gloves vs. using sterile gloves 20) If someone appears to have ataxic, coordination, balance, posture issues - then the lesion is where in the brain - If a pt has athetoid, ballistic, ballismus mvmts, that is from damage to what - If someone had issues with dysdiadochokinesia, it is from damage to: - What is dysdiadochokinesia - If someone had rigidity or bradykinesia, it is from damage to: - If someone had paralysis, behavior issues, or apraxia, it is from damage to: - If someone had issues with swallowing, respiration, HR, it is from damage to: - If someone had issues with dysarthria, it is damage from: - If someone had issues with nystagmus, it is issues from: - If someone had hemiballismus, it is issues from: - If someone had choreoathetosis, it is issues from: - If someone was apathetic or lacked judgement, it is issues from: - If someone had athetosis, it is issues from: - If someone had dysmetria, it is issues from:

Answer 170

1) To assess abnormal reflex - UMN (won't be seen in a LMN lesion) - *** Place knee in slight flexion (do NOT extend knee) and provide quick stretch to PF's (force ankle into DF). If positive, you'll see quick oscillations 2) How frequently the machine is used 3) The amount of on time / total time - 2 / 10 = 20% 4) - D1 Flexion: close your hand and pull up and across body (throw trash over shoulder) - D1 Extension: open your hand and push down and away from your body (throw trash down) - D2 Flexion: Open your hand and pull up and away from body (pull sword out and up to fight) - D2 Extension: close your hand and pull down and across your body (grab your sword) 5) DOWN - UP - Throw trash down and out/away - grab your sword 6) Amount of sway during eyes open compared to amount of sway during eyes closed - No. Just observing sway during eyes open vs. eyes closed - Feet together 7) Finger sweeps only if you can see the object and pt is unconscious (so you don't push it down further). Otherwise, do abdominal thrusts (aka: heimlich) - Back blows - Position head down and do back blows 8) 85%. It is 16 out of a 20 point scale (but scale starts at 6), so about 85% - 160 bpm 9) 7 degrees 10) Patellar tendon, semiTENdinosus, and gracillis (membranosus is NOT used) 11) Iliopsoas (tight iliopsoas causes excessive anterior pelvic tilt and then you'd compensate with increased lordosis) - Reduce knee flexion contracture (improving knee extension during gait) - Adductors (adductor longus) 12) Spinal stenosis 13) Intermittent claudication - insufficient blood supply / ischemia to active m's where pain gets worse with increased activity - Exaggerated pain response with any form of movement 14) It requires participant to exercise to the point of volitional fatigue (thus, is dangerous) - Sensitive (it will be positive in someone with the disease ... a true positive) 15) DEPTH of the burn - Superficial: extreme pain and significant sensitivity - Full: Absence of pain and inability to feel sensations 16) - Increase risk of burn - Increase " - Decrease " (it decreases current density and reduces risk of burn) - Decrease " 17) - 1.5 = intensity - pulsed 20% = duty cycle - 1MHz = frequency - 6 min = duration/time 18) Increasing Duty cycle will improve heating up tissue. Frequency of 1MHz is already at right setting for heating up tissue. Maybe you could do a bit higher intensity. 19) Gloves when it is intact skin; sterile gloves when there is exposed skin / wound / bodily fluids 20) Cerebellum - Basal ganglia - Cerebellum - Inability to perform rapid, alternating movements - Basal ganglia - Frontal lobe - Brainstem - Cerebellum - Cerebellum - Basal ganglia - Basal ganglia - Frontal lobe - Basal ganglia - Cerebellum (this is overshooting/undershooting - so a coordination issue)

Question 171

1) Is Addison's from hyperfunction or hypofunction of the adrenal gland - What is the condition called that results from hyperfunction of the adrenal gland 2) Adrenal glands produce what hormones - What do those hormones (from point above) do: - Reduced amounts of these hormones results in: 3) Hyperfunction of the thyroid is a condition called: - Would you get weight gain or loss with this condition? - Would you get weight loss or weight gain with Cushing's syndrome - Hypofunction of thyroid is condition called: 4) A physical therapist examines a patient with a suspected injury to the thoracodorsal nerve. Which objective finding would be consistent with this injury? 1. shoulder medial rotation weakness 2. shoulder extension weakness 3. paralysis of the rhomboids 4. paralysis of the diaphragm 5) Hydrostatic pressure increases as the depth of immersion ___________ (increases or decreases) - So if a pt is in the aquatic pool positioned vertically with a flotation device around torso, what area of the body would feel most hydrostatic pressure 6) There was a question that described how a pt with Parkinson's had hip flexor contractures and forward leaning posture, and it asked the BEST intervention for this pt. What is it? 7) elevated arterial blood pH, low PaCO2 describes what condition: - The condition from point above is caused by what: - low arterial blood pH, high PaCO2 describes what condition: - The condition from point above is caused by what: - Elevated blood pH and elevated PaCO2 is what: - Low blood pH and low PaCO2 is what: 8) A yellow discoloration of the skin is called: - Usually this yellowish skin color suggests pathology of what organ - So what are some other conditions that could produce yellowish skin: - Would ulcerative colitis produce jaundice 9) What is dyspraxia 10) Kids with down syndrome have hypertonia or hypotonia? - What is the best technique to try and get a child with downs to activate a muscle 11) Does osteonecrosis happen more on the medial or lateral femoral condyle - Does it happen more in women or men 12) What is a bivalved cast - Why would you do this? - If a PT notices fingers/toes losing circulation, can a PT remove a bivalved cast? 13) What is the positive support reflex - What does this reflex do to the pt's trunk - So, often a PT will get a pt to do trunk flexion in standing leaning on a theraball. Why? 14) When someone has a stroke, they can develop "pusher's syndrome." What is that - So if a pt had a right CVA with left hemiplegia, what side would they push towards - Will they turn their head while doing this? - What are interventions to help with pushers syndrome 15) Kids in a school system receiving therapy via the Individualized Educational Plan (IEP) typically have goals written for what length of time? - What is the Individualized Educational Plan - *** What is the key to remember about goals in an IEP - IEP is part B or C - IFSP is part B or C 16) Related to the point above, what is the difference between IEP and IFSP 17) What is a parapodium walker - If a child required use of a parapodium walker, would they first practice gait using a HKAFO or parallel bars 18) If a pt is sitting on a table and the PT does an anterior pelvic tilt to the pt, will the pt do a concentric or eccentric contraction of the spinal extensors to maintain an upright position? 19) Would fats or carbs be used more to convert to energy / ATP with long periods of time slow exercising? - If someone had been exercising for 5 mins at 75% max effort, what will they use to produce ATP - What is it called when you switch from burning fats (long distance / slow) to more quick high energy carbs - Would proteins (amino acids) be utilized more during short-term exercise or prolonged activity 20) What is Hoffman's reflex - An abnormal response to Hoffman's is: - What is the Cremasteric reflex - Abnormal response of Cremasteric reflex is: 21) If you suspect a pt needs to meet with their PCP, would it be better to advice the pt to contact the physician or the physician's office? 22) T or F: Nystagmus is an indication of cerebellar dysfunction

Answer 171

1) HYPO - Cushing's 2) Cortisol and aldosterone (and epinephrine) - Cortisol: Because most bodily cells have cortisol receptors, it affects many different functions in the body. Cortisol can help control blood sugar levels, regulate METABOLISM, help reduce inflammation, and assist with memory formulation. - Aldosterone: Aldosterone affects the body's ability to regulate blood pressure. It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine. It has a controlling effect on salt and water balance and helps control blood pressure - Fatigue and weight loss 3) Grave's disease - Weight loss - Weight gain - Hashimoto's 4) - The medial rotators include: subscap, teres major, lats, pecs, and ant deltoid. Lats help do IR, but so many others help do IR if lats are effected. - Lats are innervated by thoracodorsal nerve (C6-C8). Weakness of lats will impact shoulder ext and IR (but many other m's also impact shoulder extension) - Rhomboids are innervated by dorsal scapular nerve (C4-5) - Diaphragm is phrenic nerve (C3-5) 5) Increases - Feet 6) Prone lying (to stretch hip flexors to improve posture). Then start working on posture and gait and strengthening, etc. 7) Respiratory alkalosis - hyperventilation - Respiratory acidosis - Hypoventilation - Metabolic alkalosis (PaCO2 follows what HCO3 does in compensated) - Metabolic acidosis (PaCO2 follows what HCO3 does in compensated) 8) Jaundice - Liver (hepatic) - Cholecystitis (gall bladder infection); Pancreatitis; Hepatitis - NO - it would produce bloody stools, rectal bleeding, diarrhea, fever, etc. 9) Motor incordination (like developmental coordination disorders). They'll have slow mvmt times, poor motor sequencing, perceptual problems. So they'll struggle with balance, changing surfaces, manuevering around obstacles 10) Hypotonia - Quick stretch 11) MEDIAL - Women 12) Bivalved cast means the cast cut into two halves. - To check on skin, wound, healing - inspect the limb frequently. - YES 13) When weight bearing through balls of feet, the muscles of their legs contract in a straight standing position when the balls of their feet make contact with a solid surface. - Extends trunk - So as the pt does weight bearing through LE's, the forward lean on theraball will help prevent that extensor tone to kick in 14) A significant lateral deviation toward the hemiplegic or effected side - LEFT side - No ... just lean left, weight bear left, and yet be more unresponsive to stimuli on the left. - Use a mirror, a small wedge, practice weight shifting across midline, and facilitation techniques, reorient them to midline, and have them clasp hands so they can't push with good arm. 15) 12 months / 1 year - Program for school aged kids that require services (PT, OT, or SP). Services are provided through federal money because of the IDEA (individuals with disabilities education act). Feds mandate review of an IEP on a one year basis. - Goals must focus on improving child's educational / school experience - B - C 16) IDEA law allows for services (PT, OT, SP) to be provided for children in need using gov't funds. IEP (part B) is for school-aged kids (3-21) and goals must focus on improving educational experience. IFSP (part C) is early intervention for kids age 0-3, not school based. 17) Basically a standing frame that can move. - Parallel bars are more sturdy and safe. They are the first step of gait training 18) Concentric 19) Fats - Carbs - "Crossover" - Prolonged activity 20) Tapping the nail of the middle finger. - Flexion of the index finger and thumb - Stroking the skin of the upper middle thigh of males - Stroking of the skin causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal. 21) Their office 22) TRUE

Question 172

1) A patient experiences a proximal humerus fracture that is non-displaced. Which clinical finding would provide the BEST support for the patient being cleared to perform active-assisted exercise? 1. hematoma formation 2. diminished pain 3. callus formation 4. remodeling 2) Explain what these lines are used for: - Intravenous (IV): - Arterial Line: - Central Venous Line: - Pulmonary Artery Line: 3) How will you remember the difference between abduction and extension of the thumb - Flexion and extension of the thumb occur in what plane - Ab/Adduction of the thumb occur in what plane - *** So if you wanted to improve thumb ABduction ROM, what joint mob would you do? 4) Normal platelet counts are: - Below what level is scary and you need to be very cautious 5) *** What is the Gross Motor Function Classification System: - How many levels are there - Explain each level 6) What is the difference between deep tendon reflexes and superficial reflexes: - Examples of deep tendon reflexes - Examples of superficial reflexes - How do you score / grade a deep tendon reflex - How do you score / grade a superficial reflex 7) Main s/s of someone with myasthenia gravis would be - Would someone with MG have coordination deficits - Would someone with MG have deep tendon reflexes 8) Below, what is the right answer to this question: A physical therapist completes a family training session with a patient rehabilitating from a spinal cord injury. During the training the patient asks a question regarding their functional ability following rehabilitation. The MOST appropriate therapist response is to: 1. explain that it is difficult to predict since all patients progress differently 2. provide information on the expected prognosis based on the nature and severity of the injury 9) What is Roos test for - How to perform it - A positive finding is: 10) What is a platform attachment on crutches - Why would someone get / need one of these - Would someone with a transhumeral amputation use one of these - What if someone had a proximal humerus fracture, could they use one of these - If someone had a radial nerve injury, would they use one of these 11) Would cerebellar lesions result more in hypertonia or hypotonia 12) Sputum is what - If sputum is purulent, what does that mean - Would asthma have purulent sputum? - Would pulmonary edema have purulent sputum? - What would pulmonary edema sputum look like - Would tuberculosis have purulent sputum? - What is tuberculosis - Would a lung abscess have purulent sputum? 13) In research, the variable introduced to influence the outcome is the ________ variable; the variable that is constant that and what the introduced variable is to effect is the _______ variable 14) Would the normal aged adult or an older adult be more suseptible to toxicity when taking meds, and why - So if a Dr. is concerned about toxicity with a pt taking a med, will he prescribe a med with a shorter or longer half life - With medications, what does biotransformation mean: - With medications, what does clearance mean: 15) If I did this action below, what reflex would I be testing: - brushing the skin with a light, feathery object - passive joint range of motion - stroking the skin with a non-cutting but pointed object - tapping the muscle tendon 16) Arthritic condition where there are urate crystals (uric acid) found in the joint: - Arthritic condition often in older adults who have pain in pelvic and shoulder regions plus higher than normal erythrocyte sedimentation - An autoimmune condition that has multiple joint pain, but has a butterfly rash 17) When is it considered acceptable for a clinical trial to include a non-treatment control group as a basis for comparison with a new experimental therapy? 18) If you apply a heat pack on a pt, you should check on them regularly (every 3-5 mins), but what else should you do to help ensure pt safety 19) Normal radial deviation ROM is: - Normal ulnar deviation ROM is: 20) The talor tilt test really is a test to assess what ligament 21) If a PT treats a pt for weeks with no progress (subjectively or objectively) and the PT has altered interventions and POC many times, then what is the next best course of action to take: 22) Explain each: - Dysphonia: - Dysarthria: - Dysphasia: - Dysphagia: - Diplopia: - Dysmetria: - Dyspraxia: 23) Gout is found more often than not in what joint - Are the ankle or knee effected by gout - Main identifier it is Gout 24) What is the most important measure to assess and practice to ensure an older pt can cross the street safely 25) How much oxygen is in room air - For every liter of O2 a pt needs through a nasal canula, what amount of extra O2 do you give - So someone on 3 liters of O2 through nasal canula has how much O2 being delivered

Answer 172

1) Answer is C - Callus Why: hematoma is early right after injury. Pain could diminish on day 2 but doesn't mean they are ready for exercise. A callus formation (confirmed on x-ray) means bone is healing, so they can start exercise. Remodeling is end-stage healing and they should have started exercising before then. 2) - Intravenous (IV): administer meds and fluids into a vein - Arterial Line: line into artery to monitor BP and get sample arterial blood gas analysis (usually radial and brachial a's are used) - Central Venous Line: catheter into a large vein (sup vena cava) to measure R arterial pressure, apply thicker fluids, meds, blood sampling - Pulmonary Artery Line: balloon-tipped catheter introduced through jugular vein or subclavian vein to go through R atrium and through heart to R pulmonary a. Used to monitor cardiovascular pressures. 3) A=A ... alligator hand is abduction. Extension is high five position - Frontal - Sagittal - POSTERIOR glide of caropmetacarpal joint *** 4) 150,000-400,000 - <20,000 5) A classification system for children with CP - motor impairment disabilities - 5 - Level I: Children walk at home, school, outdoors and in the community. They can climb stairs without the use of a railing. Children perform gross motor skills such as running and jumping, but speed, balance and coordination are limited. - Level II: Children walk in most settings and climb stairs holding onto a railing. They may experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas or confined spaces. Children may walk with physical assistance, a handheld mobility device or used wheeled mobility over long distances. Children have only minimal ability to perform gross motor skills such as running and jumping. - Level III: Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances. - Level IV: Children use methods of mobility that require physical assistance or powered mobility in most settings. They may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned. At school, outdoors and in the community children are transported in a manual wheelchair or use powered mobility. - Level V: Children are transported in a manual wheelchair in ALL settings. Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements. 6) Deep tendon are just that - deep tendon. Superficial are more cutaneous and don't involve muscles, but are done by stroking skin - patellar, achilles, biceps, triceps, etc. - cremasteric, abdominal reflex, corneal, plantar - Ordinal scale from 0-4+ (0=no response, 1+ = diminished, 2+ = normal, 3+ exaggerated, 4+ hyperactive) - Present, Diminished, Absent 7) Muscle weakness and fatigue's quickly - NO, those come from damage to cerebellum (it's at the NMJ) - Yes 8) Correct answer is 2. You want to be honest and not just beat around the bush and not answer the question. 9) Thoracic Outlet Syndrome - Hold hands up in 90/90 elevated position and do chicken dance for 3 minutes - Unable to hold arms up for the 3 minutes 10) A little platform addition to rest arm on to bear weight through vs. holding onto the handle (so arm is in 90/90 resting on platform to side of crutch) - Pt's who can't bear weight through wrist/hand due to some fracture or deformity, or even an amputation of UE, or even those who can't extend their elbow (radial nerve injury) - No, they can't bear weight through arm anyway - NO - YES (because you can't extend elbow) 11) Hypotonia 12) Mucus from lungs/airways - It is more yellow (ish) suggesting infection - NO - NO - "Frothy" - No, it would be Blood-tinged - highly contagious infectious disease spread through airborne transmission - YES 13) Independent; Dependent 14) Older adults because they don't metabolize things as fast - Shorter: half-life is the amount of time required for 50% of the drug remaining in the body to be eliminated - Biotransformation: series of chemical changes that take place due to enzymatic activity (reduction of drug) - Clearance: Rate at which an active drug is removed from the body 15) - Light touch - Tone (or spasticity) - Superficial reflex (like babinski) - Deep tendon 16) GOUT - Polymyalgia rheumatica - Lupus 17) when there is no known effective form of therapy to treat the patient’s condition. Rules of Helsinki research stipulations state that a placebo control may be used in clinical conditions for which no treatments have been effective or when the purpose of the research is to determine if a particular treatment is not effective. 18) Give them a bell to ring if they need help 19) Rad: 0-20 deg's - Uln: 0-30 deg's 20) Calcaneofibular 21) Alert the referring physician to notify him of the lack of progress. 22) - Dyphonia: abnormal sounds - Dysarthria: slurred or slow speech due to facial m's weakness - Dysphasia: difficulty with speech (spoken, comprehended) - Dysphagia: difficulty swallowing - Diplopia: Double vision - Dymetria: over / undershooting coordination deficit - Dyspraxia: This is Developmental co-ordination disorder (DCD) 23) Toes / feet - NOT often - URIC ACID 24) Velocity (how fast) 25) 21% - 4% - 33%

Question 173

1) If a PT was going to monitor exercise on a cardiac pt post-surgery, what would be better to monitor (and why) - their target HR or RPE scale? 2) Why would you need to aspirate someone's elbow 3) Explain the difference: - Hemorrage: - Hemolysis: - Hematopoiesis: - Anemia: - Hypoxic: - Dyspnea: - Ischemic: - Cyanosis: - Pallor: 4) What is Ascites: - Main s/s of cor pulmonale - What is diaphoresis: - What is osteogenesis imperfecta: - Best interventions for those with osteogenesis imperfecta are: 5) What condition does this describe: chronic history of widespread muscular pain, multiple tender points, and excess fatigue - Why is the condition described above NOT myofascial pain syndrome - Why is the condition described above NOT chronic regional pain syndrome 6) Below are reactions of whether a pt is in a hypoglycemic state or a hyperglycemic state. Explain which state they'd be in and why: - polyuria - hyperventilation - excessive thirst - headache 7) If cardiac output suddenly decreases, would cardiac afterload have increased or decreased 8) What is the general rule in ultrasound for how large the probe / transducer head should be for the area being treated - So if an area being treated is 12cm, how big of a transducer head should you use 9) If a PT assesses upper, middle, and lower chest wall motion during a respiratory assessment - which of those 3 would the PT perform from behind the pt 10) If a child is screened in school for scoliosis and is found to have moderate scoliosis - what is the best course of action from the list below: 1. refer the adolescent for further orthopedic assessment 2. educate the adolescent as to the cause of the scoliosis 3. devise an exercise program for the adolescent 4. instruct the adolescent in the importance of proper posture 11) If a pt in a wheelchair is very young and active, would they do better in a folding frame or rigid wheelchair frame 12) Lachman's test is for what: - It is done with knee in flexion, but how many deg's of flexion 13) Will an older person have increased or decreased skin turgor with age: - What is turgor 14) How much pressure from compression garments would typically be necessary to control lower extremity edema in an ambulatory pt - Off the shelf compression garments typically have how much pressure 15) What is a graded exercise test 16) If a pt post-stroke had Left sided neglect, would you provide manual assistance on the L side or R side during interventions like gait training (manual assistance meaning cues, weight bearing, correction) 17) What is the multi-directional reach test 18) ACE inhibitors are meds to treat what: - MAIN side effect of these drugs is: - Main side effect of anticoagulant meds is: - Main side effect of antispasticity meds is: - Main side effect of antiepileptic meds is: 19) If a pt had flaking skin and brownish discoloration, is this more an indication there is venous or arterial insufficiency - If a pt had severe pain in the legs at rest, is this more an indication there is venous or arterial insufficiency - If a pt had shiny smooth dry skin on legs, is this more an indication there is venous or arterial insufficiency - If a pt feels relief getting up and walking around or hanging feet over their bed to reduce pain, is this more an indication there is venous or arterial insufficiency - If a pt had a significant decrease in skin temp, is this more an indication there is venous or arterial insufficiency 20) If you applied a hot pack and next visit the pt had blisters and burns, would you modify or change the documentation from the previous visit? - From point above, would you complete an incident report 21) If you calculated the Karvonen formula, what are you calculating? - How would you calculate it: - Give an example 22) If a pt had 2/5 MMT grade at the hip, would they need a HKAFO - If a pt had a 3+/5 MMT grade at the hip, would they need a HKAFO? 22A) How do you calculate the age-predicted max HR 23) *** MUST MUST KNOW what the major side effect is of cortizone shots, especially prolonged use: - Would someone with HIV / AIDS have a weakened immune system - Would someone with malabsorption syndrome have a weakened immune system - Would someone with iron-deficient anemia have a weakened immune system

Answer 173

1) RPE scale only because following a surgery, they may be on meds that diminish HR response, so a RPE is better indicator (even though it is subjective) 2) Olecranon bursitis 3) - Hemorrage: bleeding - Hemolysis: RBC destruction - Hematopoiesis/Hemopoiesis: formation of RBC's in bone marrow - Anemia: reduced RBC's - Hypoxic: a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level - Dyspnea: difficulty breathing - Ischemic: a restriction in blood supply to tissues, causing a shortage of oxygen that is needed - Cyanosis: bluish color due to poor circulation - Pallor: Pale 4) Accumulation of fluid in peritoneal cavity - This is R sided heart failure so edema and swelling in LE's - Extreme sweating / perspriation (from shock or reaction to drug) - Disorder of collagen synthesis that affects bone metabolism - they can fracture so easily and hypermobility of joints - Things that ensure protection of bones/joints - no risk of fractures. 5) Fibromyalgia - Myofascial pain syndrome has multiple trigger points but not fatigue - CRPS is not body widespread and doesn't get fatigue, it is an abnormal nervous system response to pain that makes things hypersensitive in one extremity following an injury 6) - Polyuria is a result of HYPERglycemia as the body tries to remove excess glucose - Hyperventilation is a s/s of diabetic ketoacidosis (hyperglycemia) and is very dangerous - Excessive thirst is due to polyuria and getting dehydrated, so hyperglycemia - Headaches are from low blood sugar levels (<70 mg/dL). The brain needs glucose as a source of energy 7) Increased 8) The area should be 2-3x bigger than transducer head - ~5cm 9) Lower chest wall motion 10) Since it is moderate, they should go get further screening as EARLY detection and treatment is best for scoliosis. Education is important, so is posture, and exercise - but if it is moderate, should get further screened. 11) Rigid 12) ACL - 20-30 degrees flexion 13) Decreased - Skin turgor refers to the elasticity of your skin. When you pinch the skin on your arm, for example, it should spring back into place with a second or two. Having poor skin turgor means it takes longer for your skin to return to its usual position. It's often used as a way to check for dehydration 14) 35mmHg - 16-18 mmHg 15) A graded exercise test (GXT) is a screening tool to track an individual's fitness level. The test evaluates the participant's exercise capacity by measuring cardiovascular response to physical activity 16) L side 17) Test to measure the distance a pt can reach in forward, backward, and lateral direction to see how they can balance when going outside their BOS 18) High blood pressure - Hypotension - Bleeding - Drowsy, confused, dizzy - ataxia, confusion, cognitive impairments 19) Venous - Arterial - Arterial - Arterial - Arterial 20) NO - that is fraudulent - YES 21) HR max - (HRmax-HRrest * .60-.80) + HRrest - (180-60 *.60-.80) + 60 = 132-156 22) Yes - No 22A) 220 - age x 70-85% 23) Immunosuppression ***** - Yes, of course - Yes - this is when someone has difficulty digesting or absorbing nutrients (poor nutritional status weakens immune system) - Anemia is not associated with a weakened immune system

Question 174

1) A prophylactic measure means what - Of the wound dressing options below, which one would be used as a prophylactic measure: calcium agent, hydrocolloid, hydrogel, and transparent film 2) The best way to instruct a pt to strengthen pelvic floor m's is to say: 3) If a pt exercising says he is having chest pain, and then after 20 min's of rest is still having chest pain - would you call the referring physician or call an ambulance? 4) What is an excellent (good health) waist-hip ratio: - What is a bad (obese) waist-hip ratio: 5) If someone got mallet finger, would you want to splint them in 5 degrees of flexion at the DIP joint, or 5 degrees of hyperextension at the DIP joint? - Why 6) If someone had a peroneal or fibular sublaxation of the peroneal tendons, if you wanted to recreate the sublaxation, would you actively or passively move the ankle in various directions - What ankle motions will cause these tendons to sublax 7) What is filariasis: - Is filariasis primary or secondary lymphedema - Would a mastectomy cause primary or secondary lymphedema - What is Milroy's disease - Is Milroy's primary or secondary lymphedema - What is lymphadenitis - Is lymphadenitis lymphedema 8) Are opioids CNS stimulants or depressants - Would opioids increase or decrease a pt's RR 9) Explain the differences between these types of shock: - septic shock: - neurogenic shock: - cardiogenic shock: - hypovolemic shock: 10) Related to the point above, if someone got in a MVA and has a partially severed leg, what type of shock will they go into - What is sepsis 11) ADA requirements for a ramp slope for w/c use is: - If the percent grade of a ramp is 50%, would it meet the rise/run rule - If a ramp needs 2 seperate sections with a landing area, why would it require that - Landing areas should be about every ____ feet - ADA requirements for the width of the ramp are: 12) The ADA requires employers to make reasonable accommodations for those with disabilities. Which item below is NOT a reasonable accommodation: 1. the accommodation would cost hundreds of dollars 2. the accommodation would require an expansion of the employee’s present workstation 3. the accommodation would fundamentally alter the operation of the business 4. the accommodation would not address the needs of other employees 13) At what rate (in mmHg) should you deflate the BP after inflating it 20mmHg above estimated systolic BP: 14) If you did a graded exercise test with an arm ergometer rather than a treadmill because a pt had a LE injury, would you expect their max oxygen consumption to be more or less than if you did the test on the treadmill? - Would the work level be larger or smaller on the arm ergometer vs. treadmill 15) What is thrombocytosis - What is polycythemia - Would thrombocytosis cause higher blood pressure - Would polycythemia cause higher blood pressure - Will someone with anemia have BP impacted - Will someone with leukopenia have BP impacted 16) A physical therapist prepares to assess the blink reflex in a patient with suspected neurological involvement. Which cranial nerve components are assessed with this reflex? 17) Why would someone get the diagnostic test below: - Electroencephalography (EEG): - Lumbar Puncture: - Cerebral Angiogram: - Echocardiogram (ECG): 18) Tegretol (carbamazepine) is a drug for what 19) If an older pt is a fall risk due to vision problems going from low light to bright light and their eyes can't adjust, what is a helpful solution 20) What is the difference between role playing and modeling behavior 21) A physical therapist reviews a laboratory report for a patient recently admitted to the hospital. The patient sustained burns over 25 percent of her body in a fire. Assuming the patient exhibits hypovolemia, which of the following laboratory values would be the MOST significantly affected? 22) Define: hypervolemia: - Define: hypovolemia: - What is erythrocyte sedimentation rate: 23) A physical therapist performs autolytic debridement in an attempt to remove nonviable tissue from a stage IV pressure ulcer. Autolytic debridement removes necrotic tissue by using: 1. a sharp instrument 2. an externally applied force 3. the body’s own mechanisms 4. a commercially prepared enzyme 24) What is an example of wound debridement from an externally applied force - What is an example of enzymatic debridement 25) For babies during development, what is the modified plantigrade position - About what age does this develop or start - When does a baby start getting in to quadruped position - When does a baby start ring sitting - When can a baby do a bridge 26) How long usually does it take a surgical scar to fully heal and become "mature" - If someone is 4 weeks out from surgery and are going to a tropical location for a vacation, what should they do to protect their scar 27) Sunscreen at 15 SPF means what - Usually with a scar, you'd want at least what level of sunscreen 28) What are anabolic steroids - Why do young men use these - Would a male get a deeper voice using these? - What is MAJOR concern for young men taking these steroids - Can steroids damage the liver and lead to testicular atrophy for anyone (no matter the age) who takes steroids 29) Explain RA - If someone was in the active acute inflammatory phase, what intervention(s) would be best

Answer 174

1) Something you do to prevent a disease (PROactive measure) - Transparent film 2) pull your muscles upward and inward as if attempting to stop the flow of urine 3) Call an ambulance 4) < 0.8-0.9 - > 1.0 (1.15 waist to hip ratio is really obese) 5) 5 deg's of hyperextension - This puts the extensor hood on slack to heel properly without too much tension 6) Actively since they will sublax during a muscle contraction - The motions they do: eversion and DF 7) Disease causes by mosquito that then causes lymphedema - Secondary - Secondary - Inherited disease that presents in infancy with lymphedema - Primary - infection or inflammation of a lymph node - NO 8) Depressants (I take opioids to slow down/relax) - Decrease (this is a side effect) 9) - septic shock: shock from system wide infection - neurogenic shock: from a neuro injury (like SCI) - cardiogenic shock: cardiac problems leading to poor perfusion to organs / MI - hypovolemic shock: severe blood loss (injury, trauma, amputation) 10) Hypovolemic - Sepsis: systemic infection 11) For every 1 inch in height, it needs 12 inches of run - No, the slope grade % of 12 inches to 1 is a very low angle (100% being verticle) - The ramp is very long and there needs to be a rest period / section for the w/c user - 30 feet (and a 5x5 section) - 36 inches 12) - An employer would be required to spend a few hundred dollars for this accommodation - Workstation accommodations are common and essential to perform job - It is "undue hardship" if the accommodation alters the operation of the business, so an employer is not required to do this - ADA only applies to those employees with a disability 13) 2-3 mmHg per / second 14) Less (smaller muscles requiring less O2) - Smaller 15) Excessive number of platelets in the blood - When the hematocrit (the volume percentage of red blood cells in the blood) is elevated, so more RBC's - The book said NO - Yes (there are more RBC's in blood) - No - No 16) afferent cranial nerve V; efferent cranial nerve VII - Remember CN III does it actively, but this reflex (which is a passive assessment) assesses those CN's above 17) - Electroencephalography (EEG): View electrical activity in brain, record seizure activity, cerebellar lesions, or metabolic disorders - Lumbar Puncture: Needle below L1/2 for CSF fluid sample to detect hemmorage, inflammation, infection, MS, meningitis, or tumor - Cerebral Angiogram: Determine the narrowing or blockage of a artery in the brain to diagnose a CVA, brain tumor, aneurysm, etc. - Echocardiogram (ECG): evaluate heart function, rhythm, valves, chambers, etc. 18) Antiepileptic to prevent seizures 19) Use diffuse lighting (changing bulbs to red bulbs won't help) 20) Role playing requires participants to take the place of someone else by acting the part of that person/situation. It is acting. Modeling however is demonstrating proper behavior and others watching it and learning from it. 21) Hypovolemia is blood volume loss, so the lab value effected most would be hematocrit or # of RBC's 22) Hypervolemia, also known as fluid overload, is the medical condition where there is too much fluid in the blood. - The opposite condition is hypovolemia, which is too little fluid volume in the blood. - An erythrocyte sedimentation rate (ESR) is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly 23) - Body's own mechanisms. - Autolytic debridement is performed using a moisture dressing that promotes rehydration of viable tissue and allows the body's enzymes to digest necrotic tissue. You could use transparent films, hydrocolloids, hydrogels, and alginates - (AUTOLYTIC means YOUR OWN break down) 24) Pulsatile lavage - Apply some external enzyme (not the body's own created enzyme's) to the surface of the wound for the enzyme to degrade non-viable tissue 25) Standing up against a table leaning for partial weightbearing ... position a baby would cruise in - 10 ish months - 8 ish months (7-9) - 6-7 months - 5 ish months 26) 12-18 months - COVER IT (don't expose it to the sun) 27) 15 means with that sunscreen you can stay in the sun 15 x longer than they would be able to without protection - 30 SPF 28) A synthetic or man-made testosterone - To build muscle, increase body weight, etc. - No, but a female would (taking these masculinizes women) - Steroids will trigger a growth spurt and then the body responds and it triggers cessation of bone growth prematurely - YES 29) RA has flare ups of inflammation in synovial tissues of a joint that result in erosion of cartilage and supporting structures within the capsule. Signs and symptoms include pain and tenderness of affected joints, morning stiffness, warm joints, malaise, and increased fatigue. RA has periods of exacerbation and remission. - Splinting for joint protection, protect joint, energy conservation, etc.

Question 175

1) During the initial screening of a patient, the physical therapist notes contusions in various states of healing on the chest, back, and face, as well as multiple scars. The patient reports falling often. Which of the following courses of action should the therapist take FIRST? 2) If someone has hammer toes, get them what shoe modification - If someone had achilles tendon issues, get them " - If someone had plantar fasciitis, get them " - If someone had morton's neuroma or metatarsalgia - If someone had difficulty with terminal stance of gait due to mobility issues of the foot (like the great toe), get them " 3) A patient reports significant hypersensitivity to light touch in the left foot and ankle region following minor trauma. A physical therapist notes warmth, swelling, and redness over the entire foot and ankle. - What is probable diagnosis - What interventions should you do for this pt 4) How would you position the humerus for application of an ultrasound treatment to the supraspinatus tendon insertion? - Capsular pattern of shoulder - How will shoulder dislocate after anterior dislocation - How will it dislocate after a RTSA 5) A patient reports an insidious onset of swelling of 1 month's duration on the dorsum of the left foot. What would be the MOST likely cause? - Why wouldn't it be heart failure - Why isn't it lipidema - Why do you know it is lymphedema 6) For the BEST motor learning to occur, what needs to happen: 7) IF someone was doing aquatic therapy, would the increased hydrostatic pressure increase or decrease their blood pressure 8) If someone had a c-section (cesarian), where would their scar be? - If someone was doing soft tissue mobilization in circuluar motions clockwise around abdomen in big circles, what are they probably doing/helping with 9) Changes in the level of which hormone are MOST likely to contribute to development of chondromalacia patella in a pregnant woman? 1. Calcitonin 2. Progesterone 3. Relaxin 4. Insulin 10) From point above, what is chondromalacia patella - WHat does Calcitonin do: - What does progesterone do - Why is Relaxin the right answer 11) A physical therapist is reviewing the laboratory report of a patient who received a diagnosis of pneumonia 2 weeks ago. The patient's white blood cell count is currently 9,000 cells/mm3. Which of the following conditions does this value indicate for the patient? 1. Anemia 2. Development of leukocytosis 3. Immunosuppression 4. Resolution of the pneumonia infection 12) From point above, how would anemia be diagnosed: - Why is leukocytosis the wrong answer - Why is immunosuppresion the wrong answer - Why is resolution of pneumonia infection the right answer 13) Would the Liver refer pain to R or L shoulder - Would pancreas refer pain to R or L shoulder - Where would kidney pain be felt 14) What is an abdominal aneurysm - Main s/s - How would you test for it 15) What is Murphy's percussion test for - How do you perform it - T or F: Pt will report presence of back or flank pain to rule in doing this test to confirm 16) Distention on the costal margin is from: 17) When using electrical stimulation to treat a patient's nonhealing, infected wound, which of the following waveforms and parameters will be MOST helpful in facilitating wound closure? 1. Symmetrical biphasic waveform, 35 pps 2. Interferential current waveform, 100 beats/second 3. High-voltage pulsed current waveform, positive electrode in wound, 4 pps 4. High-voltage pulsed current waveform, negative electrode in wound, 100 pps 18) The patient in the photograph sustained a twisting injury to the knee 1 week ago. The physical therapist notes laxity when performing the (ACL ant drawer) test demonstrated in the photograph. The patient wants to resume athletic activity as soon as possible. Which of the following criteria MUST be met before the patient returns to athletic activity? 1. The patient can demonstrate ability to jump and land with stability. 2. The patient's gait is nonantalgic. 3. Knee functional range of motion is restored, and pain is rated less than 5/10. 4. Knee effusion is abolished, quadriceps strength is Fair (4/5), and pain is rated 0/10. 19) Which of the following fall prevention strategies is MOST appropriate for a resident of a nursing home who has dementia, poor balance, and often wanders? 1. Place the patient in bed, with the side-rails up and secured. 2. Place the patient in a wheelchair with a seat belt that the patient is unable to remove independently. 3. Seat the patient in a geriatric recliner to reduce the likelihood of wandering. 4. Use an electronic monitor that will remotely alert staff when the patient gets out of bed. 20) One day after lumbar laminectomy surgery, a patient refuses to wear a thoracolumbosacral orthosis because of a painful and itching rash that extends in a narrow path from the central low back along the iliac crest to the right lateral trunk. Which of the following conditions is MOST likely present?

Answer 175

1) - Answer: Ask the patient if bruising was caused by being hit, kicked, or abused. - Reason: Multiple lesions in various stages of healing in a broad number of areas is a sign of possible abuse. In the interest of patient protection, the issue should be pursued, because the patient may not be forthcoming with an admission that abuse has taken place. 2) High Toe Box - Heel lift - Arch support, or heel cushion, or even a heel cup - Metatarsal bar or pad (same thing) - Rocker bar 3) - CRPS - Desensitization and weight bearing gradual exercises to get pt used to using foot again 4) Extension and IR - ER, Abd, IR - Abd and ER - Ext, IR, and Add 5) Lymphedema - Then BOTH feet would have swollen - Doesn't go past ankles (lipidema is NOT fatty in ankles or feet) - It is unilateral and lipidema the feet aren't involved 6) Motor learning principles suggest that psychomotor skills are best learned when practice conditions allow errors to occur, involves varying the task, varying the environment in which the task occurs, and providing minimal feedback of results. 7) Increase 8) Really really low on the abdomen, in a straight cut line - Intestinal gas pain (circular motions following the asc/trans/desc colon) 9) Answer: Relaxin 10) Chondromalacia patellae, also known as “runner's knee,” is a condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. This condition is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee - The role of calcitonin is to decrease plasma calcium concentration (doesn't impact cartilage) - The hormone progesterone is secreted by the placenta during pregnancy (doesn't impact cartilage) - Chondromalacia is a roughening of the cartilage behind the kneecap, and relaxin causes an increase in tendon and ligament laxity, exacerbating any friction between the patella and the femur 11) Resolution of the pneumonia infection 12) A CBC test, iron levels, or hematocrit or hemoglobin levels - An increase of WBC's due to some infection (but above 11,000 WBC's) - Immunosuppression causes leukopenia, which is a white blood cell count less than 4000/mm3. - The patient's white blood cell count is within the normal range of 4500-11,000/mm3, so the infection has resolved. 13) R - L - Low back areas 14) When descending aorta gets weakened and buldges - Pulsing or pounding sensation in the abdomen during increased activity or when lying in supine position - Palpate middle of abdomen deep to feel pulsating mass 15) Kidney - Tap lower back and there will be costovertebral tenderness in that region with renal involement - True 16) Distention on the costal margin is descriptive of an abnormal finding for the spleen, which is palpated typically below the left costal margin. A positive finding occurs in conditions such as mononucleosis and trauma. This warrants immediate medical attention. 17) High-voltage pulsed current waveform, negative electrode in wound, 100 pps 18) The patient can demonstrate ability to jump and land with stability. - Nonantalgic gait, ROM, and controlling joint effusion and pain and strengthening the quadriceps are part of the program of rehabilitation after anterior cruciate ligament injury, but these criteria are not functionally sufficient for the patient to resume athletic activity. 19) Use an electronic monitor that will remotely alert staff when the patient gets out of bed. - The use of restraints (which every other answer is a restraint, including recliner) has become a concern for nursing home caregivers, who must comply with Medicare guidelines and foster prevention of elder abuse. An electronic monitoring device is not a restraint. This option would facilitate safety through improved supervision and would allow the patient to maintain functional mobility. 20) Herpes Zoster - Herpes zoster (shingles) is a painful, blistering skin rash caused by the varicella-zoster virus. The first symptom is usually one-sided pain, tingling, or burning followed by development of a rash that usually involves a narrow area from the spine around to the front of the chest or abdomen. A typical location for occurrence of shingles rash is the T11–T12 dermatome along the iliac crest. The location of the rash, postsurgical onset, and symptoms of pain all suggest herpes zoster.

Question 176

1) If you had an infected wound that had a lot of exudate, which dressing would you use out of foam and alginate 2) Which of the following tests or measurements is BEST to assess risk for skin ulceration in a patient who has diabetes? 1. Rate pressure product 2. Pulse pressure 3. Capillary refill 4. Light touch 3) From point above: - What is rate pressure product - What is pulse pressure - Why is capillary refill the wrong answer 4) What is the lift-off sign test for: - What is another name for this test: 5) Would arterial calcification cause ABI to be higher or lower than a 1.1? - Would arterial occlusion cause ABI to be higher or lower than a 1.1? 6) A 13-year-old patient reports moderate knee pain persisting more than 3 weeks, with no trauma noted. The patient exhibits an out-toeing gait pattern, leg length discrepancy, and restriction in medial (internal) rotation of the involved leg. Which of the following test findings would MOST likely be present? 1. Pain with palpation of the trochanteric region 2. Pain and instability during the application of valgus stress to the knee in full extension 3. Pain in the groin region with hips flexed 80° to 90° and then medially (internally) rotated with adduction 4. Pain in the gluteal region with combined movements of hip flexion to 45° to 60°, abduction, and lateral (external) rotation 7) Related to the point above, what is the likely diagnosis of that child: - s/s of this condition include: - A flexion, abduction, ER test at the hip is called: - This test above is to test for what: - T or F: FAI test is same procedure as point above - Legg-calve perth is what: - What age does legg-Calve show up 8) What is ascitis - L ventricular failure would manifest how: - R ventricular failure would manifest how: 9) A patient has a left brain injury resulting from a cerebrovascular accident. Which of the following impairments are MOST likely to be observed? 1. Spatial impairments, difficulty planning movements, and slow, cautious behavior 2. Spatial impairments, difficulty sustaining movements, and quick, impulsive behavior 3. Speech impairments, difficulty planning movements, and slow, cautious behavior 4. Speech impairments, difficulty sustaining movements, and quick, impulsive behavior 10) From point above, why is that the right answer, and the others are wrong 11) A patient has medial ankle pain, a pronated foot with a calcaneal valgus deformity, pain with passive ankle eversion, and weakness of the great toe flexors. The patient MOST likely has which of the following conditions? 1. Common fibular (peroneal) nerve injury 2. Deltoid ligament strain 3. Tarsal tunnel syndrome 4. Tibialis posterior tendinitis 12) Why is the answer from above the right one 13) *** What do you learn from the last question 14) Do pt's get bilateral carpal tunnel syndrome? - Main s/s of RA - Where does RA manifest first, typically - What is Reiter syndrome - What is another condition commonly found in pt's with Reiter's 15) The right positions for postural drainage to these lobes is: - Lower lobes: - Upper lobes: - Right Middle Lobe: - Anterior segments of lower lobes: - Right Lateral segment: - Posterior segment of upper lobe: - Anterior segments of upper lobeS: - Apical segment of upper lobe 16) Spinal stenosis would show up best on what imaging: - Spondylolithesis " - Disc herniation " - How would a spondylolysis show up on imaging - What is a Spondylolithesis: 17) We know a speed's test is for biceps pathology, but what else can it help rule in - Subacromial bursitis would be identified during what special tests - Supraspinatus tendinitis would be identified in what special tests 19) You have been treating a pt for weeks and now all the sudden their skin looks different and nail beds have changed, etc. Why is this a concern that you need to bring up with the pt's PCP: 20) If you had a wound that is deep, regularly shaped, and dry is most likely an ______ wound - Would you use compression garments for this wound - What if this pt also had lymphedema and LE swelling, would you use compression garments 21) If a quad, paraplegic, or TBI pt had pressure injuries on the ischial tuberosities, would they be better off in a manual recline w/c or a power tilt-in-space?

Answer 176

1) Both can be used for high exudate and hemostasis purposes, but Alginates are for infected wounds 2) Light touch 3) - Rate pressure product reflects myocardial oxygen demand, not skin integrity - Pulse pressure (difference between systolic and diastolic pressures) reflects the pressure responsible for perfusion of organs and tissue but not skin integrity - Capillary refilling time reflects adequacy of arterial skin perfusion but not necessarily risk of developing a skin ulceration 4) Subscapularis muscle - Gerber sign 5) HIGHER - LOWER 6) Pain in the groin region with hips flexed 80° to 90° and then medially (internally) rotated with adduction 7) SCFE - Signs and symptoms are typically found in adolescent patients (10-16 years old) and include leg shortness, knee pain, and pain when the hip is medially (internally) rotated. Groin pain will be triggered with the anterior impingement test (hips flexed to 80° to 90° and medially [internally] rotated with adduction) - FABER (patrick) - To indicate lumbar, sacroiliac joint, or posterior hip dysfunction associated with the hip capsule. Although it is a femoroacetabular impingement test, it is a better indicator of posterior hip dysfunction than anterior hip dysfunction. - False, FAI is IR, add, flex - Avascular necrosis of femoral head - 6 yrs old 8) The accumulation of fluid in the peritoneal cavity, causing abdominal swelling. - Left ventricular failure results in backup of blood into the PULMONARY system and decreased cardiac output. Clinical manifestations include dry cough or wheezing, tachycardia, light-headedness, pallor, or cyanosis. - Right ventricular failure results in backup of blood into the systemic venous circulation (LE's), manifested by EDEMA systemically, including jugular venous distention, ascites, and bilateral pedal edema. 9) Speech impairments, difficulty planning movements, and slow, cautious behavior 10) Spatial impairments and difficulty sustaining movements and impulsive behavior are more likely to be associated with RIGHT brain injuries. 11) Tarsal tunnel syndrome 12) - Pain only with passive ankle eversion, a pronated foot, valgus deformity, and weak toe flexion strength are associated with tarsal tunnel syndrome - Although many of the signs and symptoms described in the stem are consistent with tibialis posterior tendinitis, the weakness of the toe flexors would not be associated with this condition and is why tarsal tunnel syndrome is the right answer. - And if someone had tarsal tunnel, they'd get more paresthesia symptoms where post tib wouldn't 13) If there is a string of s/s and all of them fit a diagnosis except one, probably safe to rule out that diagnosis since 1 of the s/s wasn't consistent with that diagnosis. ** 14) NO, not usually - Rheumatoid arthritis often presents with general fatigue, weakness, and bilateral symptomatic joints (and multiple joints whereas OA is one joint) - Most often presenting first in the hands and wrists (ulnar drift of fingers) - Reiter syndrome is reactive arthritis due to an infection in some other area of the body. Symptoms include joint pain and stiffness, most commonly in the knees, ankles, and feet. In a type of reactive arthritis called Reiter's syndrome, there may be discomfort during urination as well as eye inflammation. However, it is usually asymmetric, occurs after an infection, and presents over several weeks. - Urethritis is commonly found in patients who have Reiter syndrome 15) - Lower: Prone with the lower extremities raised 18 inches - Upper: Sitting up - Supine position with the lower extremities raised 12 inches - Supine with the lower extremities raised 18 inches - Left sidelying with the legs raised 18 inches - Sitting in a chair, leaning forward over a pillow - Lying in a supine position with the bed flat - Sitting back, semi-fowler position about 60 deg's with head flexed 16) Stenosis: MRI - Spondylolithesis: X-ray - Disc: MRI - A line would be seen across the pars interarticularis. - Spondylolisthesis is the forward displacement of one vertebra upon the stationary vertebra beneath it 17) Labral tear - Hawkins kennedy or neers - RC tests - empty can, RSC of abd, etc. 19) Any changes in the integumentary system maybe the precursor to infection, inflammation, and systemic disease 20) Arterial - NO (it would make things worse) - NO ... just do manual lymph drainage 21) Power tilt-in-space as the manual one is much more shearing forces on ischial tuberosities

Question 177

1) Best definition of a systematic review is: - Best definition of a meta-analysis is: 2) Increase in Adrenocorticotropic hormone would cause weight gain or weight loss - Increase in Thyroid-stimulating hormone would cause weight gain or weight loss 3) Why might a physician order a Doppler study - So if a pt had a fractured femur and you were supposed to go in and do an eval and move the pt, but noticed the PCP ordered a Doppler - what do you do 4) If a pt has new onset / symptoms of night pain, urinary incontinence, and abdominal pain - what do you do as PT treating this pt. 5) A patient who fell while running 3 days ago reports diffuse lateral ankle pain with active movement. The patient exhibits localized swelling distal and anterior to the lateral malleolus. Minimal laxity is noted with an anterior drawer test. Which of the following interventions would be MOST appropriate for the patient at this time? 1. Gastrocnemius-soleus stretching 2. Posterior talocrural joint mobilizations 3. Stationary cycling for up to 30 minutes 4. Active range of motion to end-range 6) Picture a pt laying PRONE and the PT is doing passive IR of hip. If it is limited, what joint mob will help with this: - An anterior glide would be limited (and thus needed) if ________ hip rotation was limited - An inferior glide would be limited (and thus needed) if ________ hip rotation was limited - An superior glide would be limited (and thus needed) if ________ hip rotation was limited 7) A physical therapist is evaluating an infant who has bilateral ankle equinus, hindfoot varus, and forefoot adductus. The infant MOST likely has which of the following deformities? - BUT - what is the other name for this condition - What is Metatarsus adductus 8) If someone with DM II is exercising: - Should they exercise during peak insulin times: - Should they exercise at the SAME time every day - Should they avoid exercise if the blood glucose level is less than 150 mg/dL - Avoid exercise if the blood glucose level is greater than 200 mg/dL 9) What is loss of sensation in a stocking glove distribution - Will DM II pt's have sensation loss in a dermatome or peripheral nerve pattern 10) Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot (or forefoot) varus or valgus deformity. 11) A patient underwent a C2–C4 fusion procedure and is ventilator dependent. In what position should the physical therapist position the patient to avoid skin breakdown of the sacrum, ischial tuberosity, scapula, posterior calcaneus, and occipital tuberosity? 1. Prone 2. Sidelying 3. Sitting 4. Supine 12) If a pt was holding a heavy box out in front with arms extended, would this cause a flexion or extension moment on the back - WOuld it increase compressive forces on the low back doing this 13) What is Pneumococcal pneumonia - Will Asthma produce sputum - Will bronchodilators help with Asthma - What is best bronchodilator medication - Will Chronic Bronchitis produce sputum - Will bronchodilators help with Chronic Bronchitis - Will Emphezema produce sputum - Will bronchodilators help with Emphezema - What happens to Residual Volume with Emphezema 14) What is a cross sectional research study - What is a correlational research study 15) Figure 8 wrapping of the ankle is more for edema or support - Compression wrapping of the ankle is more for edema or support - If you did a compression wrap, would you want more pressure applied proximally or distally - When applying a wrap for joint support (like in figure 8), do you want more pressure proximally or distally 16) What is Diverticulosis - MAIN cause of this condition - How to remember this 17) Will irritible bowel syndrome refer pain up to the shoulders - What are peptic ulcers - Some s/s of peptic ulcers - Patients who have a history of long-term nonsteroidal antiinflammatory drug (NSAID) use should be monitored for signs and symptoms of ________ - An example of a NSAID - Would you get coffee-ground vomitus with gastritis 18) Following a surgery if you are treating a pt and see new/different symptoms of redness, swelling, and increasing warmth following a surgical procedure, this could indicate - What should be done - Should you put a heat pack on a suspected area of infection 19) Which of the following parameters of electrical stimulation control the recruitment of peripheral axons during therapeutic electrical stimulation? 1. Current density 2. Symmetry of waveform 3. Duration of stimulus 4. Duty cycle 20) If you want to teach someone a new motor skill, what is the BEST thing to do first 21) With age, what can you expect with the following: - Hepatic blood flow - Metabolic activity - Body fat - Total body water - From the last point, why is this important

Answer 177

1) A systematic review of literature entails a secondary analysis of individual studies with similar characteristics in order to generate a combined conclusion - A meta-analysis is an aggregation of raw data from multiple studies to increase the sample size and generate a conclusion based on a larger subject population 2) Weight gain (Cushing's) - Weight loss (Grave's) - A hyperactive thyroid will elevate the body's metabolism, causing an elevated heart rate, fatigue, weight loss, heat intolerance, and muscle atrophy, among other symptoms 3) Suspected DVT - Do NOT move the pt. Wait for result of Doppler as you don't want to dislodge DVT and cause a PE. 4) Get them to the ED or physician ASAP. These new onset of symptoms may indicate the presence of cauda equina syndrome and require medical assessment. 5) Posterior talocrural joint mobilizations - Why: because joint mobs will help with motion, swelling, and pain. AROM to end range causes pain, they should do AROM within a pain-free range. 6) Posterior glide - ER - Abduction - Adduction 7) Clubfoot - Talipes equinovarus - Hindfoot valgus, forefoot varus 8) - NO (Exercise should be avoided during peak insulin times) - YES (Patients who have diabetes should exercise regularly and consistently) - No (Below 100 mg/dL (5.6 mmol/L) is the cautionary range for exercise) - No (Above 250 mg/dL (13.9 mmol/L) is the cautionary range for exercise) 9) Patients with peripheral neuropathy may have tingling, numbness, unusual sensations, weakness, or burning pain in the affected area. ... Because the symptoms are often present in the areas covered by gloves or stockings, peripheral neuropathy is often described as having a "glove and stocking" distribution of symptoms. - No, it would be generic bilaterally and distally in 'stocking glove' distribution ... and start manifesting in muscle loss (through MMT) with progression of condition. 10) Compensated varus 11) Sidelying - Don't ask me why - makes no sense 12) Flexion - Yes 13) Pneumococcal pneumonia is associated with sputum that is most often pinkish, blood-flecked, or rusty and will show evidence of bacteria when cultured. Treatment is centered on antibiotics. Oxygen can be administered, but bronchodilators are not a treatment of choice. - Yes - Yes - Albuterol - Yes - Yes - No - No - It will increase 14) Cross-sectional research involves studying a group at one point in time and generalizing the results to a population - Correlational research is conducted for the purpose of determining the interrelationships among variables 15) Support (following an ankle sprain or something and there is pain/laxity). - Edema - Distally - Evenly - even pressure distally and proximally 16) Diverticula are small pouches that bulge outward through the colon, or large intestine. If you have these pouches, you have a condition called diverticulosis. It becomes more common as people age. About half of all people over age 60 have it. - Doctors believe the main cause is a low-fiber diet - Diver = Fiber 17) NO - Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine - Melena (dark, tarry stools) and coffee-ground vomitus are indicative of bleeding - bleeding - Meloxicam - NO 18) Indicators of a possible infection. - The surgeon should be notified - NO 19) Duration of stimulus 20) It is best to identify and use the patient's preferred learning style 21) - Decrease - Decrease - Increase - Decrease - Water-soluble drugs have a lower volume of distribution, which speeds up onset of action and raises peak concentration.

Question 178

1) What is Phlebitis: 2) Would you do estim over anterolateral neck - Would you do e-stim on people with arrythmia's - Would you do estim on a someone with atherosclerosis - Would you do estim on someone with phlebitis - Would you do estim on someone with occassional PAC's 3) What is "breakthrough pain' - Is Meloxicam a narcotic for pain relief - What is a med for severe pain releif (breakthrough pain) - What is another narcotic pain med 4) In a patient who has weak oblique, rectus abdominis, and transversus abdominis muscles, which of the following interventions is MOST likely to improve the mechanical efficiency of the diaphragm? 1. Use of a rigid trunk support 2. Use of an abdominal binder 3. Assuming an erect sitting position 4. Assuming a forward leaning sitting position 5) Rapid, jerky motions are characteristic of - Sustained limb posturing is characteristic of - Slow writhing involuntary movements (wormlike) of limbs is characteristic of - Tremors are a characteristic of - T or F: People with athetosis have a mix of high and low muscle tone 6) A 12-year-old patient who has spastic diplegic cerebral palsy has full passive range of motion of the lower extremities, but demonstrates crouching with hip and knee flexion angles of 20° each in standing position. Which of the following interventions is BEST to achieve sustained improvements in lower extremity alignment during walking? 1. Stretching of the iliopsoas 2. Strengthening of the quadriceps and gluteals 3. Stretching of the hamstrings and gastrocnemius 4. Strengthening of the hamstrings and gastrocnemius 7) If you auscultated a pt with atelectasis, how would breathe sounds or egophony sound - Would the same be true in a pt with a pneumothorax 8) What is the cremasteric reflex test - If you lightly stroke someone's low back, what reflex will happen - What is this reflex called - Contraction of the anal sphincter muscles is due to the _______ reflex - Movement of the umbilicus down and toward the area being stroked is due to the _____ reflex 9) A patient who had an atrial septal defect repair continues to have mild pulmonary hypertension. Which of the following activity-level recommendations is MOST appropriate? 1. Participation in all sports is restricted. 2. Participation in sports is not restricted. 3. Participation is limited to low-intensity sports. 4. Participation is limited to basic activities of daily living. 10) A patient who had a cerebrovascular accident exhibits a flexion synergy of the left upper extremity. To promote good upper extremity movement, a physical therapist should mobilize the patient's scapula toward which of the following directions? 1. Upward rotation and retraction 2. Upward rotation and protraction 3. Downward rotation and retraction 4. Downward rotation and protraction 11) Imagine a PT placing a tongue depressor stick in a pt's mouth, and the pt bites down, and then whacking it with their reflex hammer. What reflex is the PT assessing for 12) You can see fractures on radiographs (x-rays) but what is best way to see a stress fracture - Best imaging to see osteophyte growth 13) What is Sever's disease - How to remember? - Of the options below, what is the BEST option for someone with Sever's 1. Stretch the gastrocnemius and soleus, and use a heel wedge. 2. Stretch the plantar fascia, and use an arch support. 3. Stretch the quadriceps, and use a patellar tendon band 4. Stretch the tibialis posterior, and use a medial heel wedge. 14) A patient had a central line peripherally inserted via the cephalic vein. Proper placement has been confirmed. Which of the following activities of the ipsilateral arm should be AVOIDED? 1. Blood pressure measurement 2. Weight-bearing through the hand 3. Active upper extremity range of motion 4. Positioning the hand below the level of the chest 15) A patient has diplopia, dysphagia, and bilateral weakness of the lower extremities. The patient also has loss of vibratory sense, two-point discrimination, and position sense. There are no signs of personality changes or aphasia. Which of the following arteries is MOST likely affected? 1. Basilar 2. Anterior cerebral 3. Middle cerebral 4. Posterior cerebral 16) Vertebro basilar arteries supply what area - Occlusion or CVA to this artery presents how: - ACA lesions of a stroke will mainly impact what: - MCA lesions of a stroke will mainly impact what: - PCA lesions of a stroke will mainly impact what: 17) A patient has non-traumatic neck and shoulder pain, decreased hand dexterity, paresthesia in the right upper extremity, hyperreflexia, and urinary retention with overflow incontinence. The patient MOST likely has which of the following conditions? 1. Central cord syndrome 2. Cervical transverse ligament tear 3. Cervical disc herniation 4. Cervical myelopathy 18) From point above, central cord syndrome happens because of what injury - A transverse lig tear would have what s/s 19) When someone has RA, they will have what ligaments impacted - Why is this important to know - What do you do if you have a pt with RA to help with this - Hallmark s/s of RA - Should you do c-spine traction with these pt's - So what is the point? 20) We know when writing documentation you want to be clear, objective, and measurable, but is it ok to give accronyms or abbreviations

Answer 178

1) Phlebitis (fle-BYE-tis) means inflammation of a vein. Thrombophlebitis is due to one or more blood clots in a vein that cause inflammation. Thrombophlebitis usually occurs in leg veins, but it may occur in an arm. The thrombus in the vein causes pain and irritation and may block blood flow in the veins 2) NEVER (absolute contraindication due to carotid sinus) - NO - A precaution, but no absolute contraindication - NO - Precaution, but not absolute contraindication 3) Sudden brief flare-up of pain that becomes severe - No, it is a NSAID - Oxycodone - Tramadol 4) Use of an abdominal binder - Use of an abdominal corset in patients who have weak abdominal muscles can compensate for laxity and can improve respiratory function - In sitting position, the abdominal contents shift inferiorly and anteriorly in patients who have weak abdominals. This causes the diaphragm to be pulled into a more horizontal position, where its mechanical function is at an extreme disadvantage 5) Chorea - Dystonia - Athetosis - Parkinsons - True. Some muscles demonstrate tone that is too high, and others demonstrate tone that is too low. 6) Strengthening of the quadriceps and gluteals - It said the pt has full ROM in PROM, so iliopsoas tightness is not main concern. You'd need to strengthen glutes and quads - this is probably a strength issue given the context of the question. 7) A patient who has atelectasis, voice sounds will DECREASE since the lung tissue is deflated and will not transmit sounds. - Yes 8) Ipsilateral scrotum elevation - Gluteal tensing - Gluteal reflex - superficial anal reflex - superficial abdominal reflex 9) Participation is limited to low-intensity sports. - The patient should be encouraged to participate in low-intensity sports. Limiting the patient to only basic activities of daily living is too restrictive. 10) Upward rotation and protraction - WHY: Flexion synergy of the upper extremity includes scapular retraction/elevation or hyperextension. In the upper extremity, correct passive range of motion techniques require careful attention to lateral (external) rotation and distraction of the humerus, especially as ranges approach 90° of flexion or more. The scapula should be mobilized on the thoracic wall with an emphasis on upward rotation and protraction to prevent soft tissue impingement in the subacromial space during overhead movements of the arm. 11) The jaw reflex test, which tests the integrity of the trigeminal nerve (CN V), m's of mastication, which is a cranial nerve 12) MRI's - X-ray 13) Sever's Disease, otherwise known as apophysitis of the calcaneus, is an inflammation of the growth plate in the heel of growing children. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. Sever disease is a calcaneal apophysitis and will benefit from stretching to improve flexibility of the gastrocnemius and soleus and use of a heel wedge to decrease the stress and traction of the Achilles insertion. - Sever = Achilles heel - Stretch the gastrocnemius and soleus, and use a heel wedge. 14) Blood pressure measurement - Weight bearing and AROM are precautions and should probably not be done with central line inserted, but most certainly do NOT take blood pressure on that arm 15) Basilar - The fact that it is BILATERAL weakness almost instantly rules out the others too 16) Brainstem and cerebellum - Lesions of these arteries usually manifest as unilateral or bilateral weakness of extremities and loss of vibratory sense, two-point discrimination, and position sense. Diplopia, homonymous hemianopsia, dysphagia, dysarthria, nausea, and confusion may also occur. - LE's, verbal, mvmt, sensation, hemiparesis - UE's and face, verbal (communication and cognition), mvmt, sensation, hemiparesis - Ataxia, homonymous hemianopsia, blindness 17) Cervical myelopathy 18) Hyperextension - Lump in throat, nausea, HA, etc. 19) Cervical spine lig's - This places the patient at high risk for subluxation and significant complications from cervical mobilization - C-spine stabilization exercises - Ulnar drift of fingers at MCP jts - NO - Don't do joint mobs of c-spine in pt's with RA, do cervical stabilization exercises 20) TRY to avoid this and spell out everything clearly so anyone reading it will know.

Question 179

1) A patient who has a spinal cord injury reports having spastic (reflex) bowel function. Which of the following descriptions BEST characterizes the patient's neurologic injury? 1. Injury above spinal segments S2–S4, leaving spinal defecation reflexes intact 2. Injury at or below spinal segments S2–S4, leaving spinal defecation reflexes intact 3. Injury above spinal segments S2–S4, abolishing spinal defecation reflexes 4. Injury at or below spinal segments S2–S4, abolishing spinal defecation reflexes 2) Which orthoses would be MOST appropriate for a child who has a history of myelomeningocele at the S1 level and has Poor (2/5) gastrocnemius strength? - Why not an SMO 3) What is dystonia: 4) What is the MAIN protocol for someone following a meniscus repair - Can these pt's do bridges in the first few weeks as long as the knee doesn't go past 90 deg's 5) When donning personal protective equipment prior to working with a patient who has tuberculosis, which of the following items should be applied LAST? 1. Gown 2. Gloves 3. Goggles 4. N-95 respirator 6) Related to the point above, what is the order of donning PPE 7) Now, what is the order of doffing PPE 8) Should the PPE items from above be taken off in the pt's room before you leave, or after when in the hall - Should the respirator (from point above) be taken off in the room or in the hall after you leave 9) What are some common s/s of adhesive capsulitis 10) What are the stages of progression of ALS: 11) Will someone post-THA need a hydraulic lift to move them if they also suffered a femoral nerve injury? - If doing a stand pivot transfer, would you do it towards side of surgery or away from - Which knee might buckle that you'd need to stabilize 12) If a pt has complete loss of skin and intact underlying fascia, what stage wound is this: - So what would stage 1 be classified as: - Stage 2: - Stage 3: - Stage 4: 13) You know for every inch up of a ramp, ADA requires how far out: - A landing area mid-ramp or end of ramp (platform size) is required to be how big - Ramp width should be - A lip or threshold must not exceed how high - Doorway width 14) Family involvement is important in a pt's recovery, but is there any evidence it helps or makes improvement in pt rehab? - What does research evidence say will result in improved upper extremity functional outcomes after a cerebrovascular accident. 15) Would you use a hot pack or U.S. for pt's with diminshed sensation? 16) When someone has a muscle or ligament strain, what is one of the best early interventions to help ensure collagen fibers get laid down in the right orientation 17) If the temporal lobe and memory is impacted in a CVA, most likely where was the stroke (what artery) 18) A 74-year-old patient who is obese underwent a total hip arthroplasty 5 days ago. Currently, the patient exhibits dyspnea, tachycardia, and light-headedness. When a physical therapist squeezes the patient's calf muscle while positioning the ankle in dorsiflexion, no pain is reported and no swelling or warmth is seen. These findings are MOST indicative of which of the following conditions? 1. Deep vein thrombosis 2. Pulmonary embolism 3. Poor conditioning 4. Infection 19) Pain associated with urinary calculi MOST often occurs because of blockage of which of the following structures? 1. Ureter 2. Urethra 3. Bladder 4. Kidney 20) Probably the most important exercise for a pt who has ankylosing spondylitis is: 21) If a pt exibited drop foot and has a 1/5 (trace) MMT in anterior tib, should you get them a posterior leaf spring AFO or a solid AFO

Answer 179

1) Injury above spinal segments S2–S4, leaving spinal defecation reflexes intact - In spastic bowel dysfunction, the level of cord injury occurs above S2–S4, leaving the spinal defecation reflexes intact. - Spinal cord injuries at or below spinal segments S2–S4 result in flaccid bowel dysfunction, with loss of spinal defecation reflexes. 2) Solid AFO - Supramalleolar orthoses would not provide enough support for an individual who has a history of S1 myelomeningocele, given the poor strength of the gastrocnemius. 3) Dystonia is characterized by co-contraction of the agonist and antagonist muscles and is associated with basal ganglia dysfunction. Segmental dystonia involves two or more adjoining body regions dominated by sustained muscle contractions, causing twisting and repetitive movements and abnormal postures. 4) No knee flexion past 90 deg's for first 4-6 weeks - No, this places too much force and shear on the knee during these first few weeks of healing 5) Gloves 6) The general order for donning personal protective equipment is: - WASH HANDS FIRST - First: gown - Then: Mask or respirator - Next: Goggles - Next: face shield - LAST: Gloves 7) The general order for doffing personal protective equipment is: - First: gloves - Then: goggles and face shield - Next: Gown - LAST: Respirator (in case pt has airborne condition) 8) In the room before you leave - In hall after you leave incase pt has airborne condition 9) Stiffness in AROM and PROM, pain at night, DM II, sleeping difficulties/pain, older than 40, follows capsular pattern (ER, Abd, IR) 10) - Stage 1: Ambulatory, ind. with ADL's, mild weakness - Stage 2: Moderate weakness, some fatigue - Stage 3: Very fatigued, still can ambulate with impairments, AD needed, ADL's impacted - Stage 4: Severe weakness, manual w/c - Stage 5: Power w/c 11) NO - Away from - The surgery knee 12) Stage 3 1. Stage 1 pressure injuries are characterized by nonblanchable erythema of intact skin. 2. Stage 2 pressure injuries are characterized by partial-thickness skin loss involving the epidermis, dermis, or both (e.g., abrasion, blister, or shallow crater). 3. Stage 3 pressure injuries are characterized by full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia (deep crater with or without undermining). 4. Stage 4 pressure injuries are characterized by full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon or joint capsule). 13) 12 inches - 5x5 - 36 inches - 3/4's of an inch - At least 32 inches 14) NO evidence it improve pt's rehab - Research evidence supports that patients who possess active wrist and finger extension 15) NO 16) Gentle stretching 17) PCA 18) Pulmonary embolism - Pulmonary embolism is a common postsurgical condition with symptoms that include dyspnea, chest pain, cough, apprehension, and tachycardia. Individuals undergoing a total hip arthroplasty are at high risk of developing a pulmonary embolus in first 2-10 days. 19) Ureter 20) Aerobic exercise due to the fact that the forward hunched posture would cause respiratory compression 21) Posterior leaf spring - Someone who needs support in all ankle motions would need a solid AFO; but someone with just DF weakness would only need a posterior leaf spring AFO

Question 180

1) Normal intracranial pressures for adults and kids is: - Do NOT go over what amount 2) A patient reports incontinence and a sensation of urgency to urinate with little output. Which of the following interventions is BEST to include in the therapeutic program? 1. Restriction of fluid intake 2. Scheduling an increased frequency of voiding 3. Detrusor contraction exercises 4. Relaxation training 3) What is external validity: 4) Normal bone density t-score is: - Low bone / osteopenia mass t-scores are: - t-scores indicating osteoporosis are: 5) If you notice a pt has a fatty mass and an unusual patch of hair on the low back, it most likely indicates what condition: 6) What is Paget's disease 7) What 2 things MUST be included in the interventions for someone with osteoporosis 8) Which of the following structures provide active compression of the urethra? 1. Pubococcygeus, iliococcygeus, and puborectalis 2. Pubococcygeus, obturator internus, and puborectalis 3. Iliococcygeus, puborectalis, and pubovesical ligament 4. Pubococcygeus, iliococcygeus, and anococcygeus ligament 9) If someone is limited / painful in forearm supination, what compensatory pattern will you see - What is compensatory / substitution pattern for pronation 10) A patient who has a forward head posture reports right-sided headaches and neck pain. Assessment reveals stiffness of the right occipitoatlantal joint segment. The patient's goal is to decrease headache intensity and to improve cervical function. Which of the following muscles would be MOST appropriate to strengthen? 1. Neck extensors 2. Upper trapezius 3. Deep neck flexors 4. Sternocleidomastoid 11) A 43-year-old male patient reports the recent appearance of silver and scaly-appearing plaques on the scalp, elbows, and knees. If left unaddressed, which of the following complications is MOST likely to develop? 1. Bluish digits with cold exposure 2. Dermal reaction to sun exposure 3. Erosive arthritis in the DIP joints of the hands 4. Erosive arthritis in the hip joints - What is Psoriasis 12) Which of the following descriptions BEST depicts the Cheyne-Stokes respiratory pattern? 1. Regular respiration pattern characterized by a rate of less than 10 breaths/minute 2. Regular respiration pattern characterized by a rate of more than 24 breaths/minute 3. Irregular respiration pattern characterized by highly variable respiratory depth and intermittent periods of apnea 4. Irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth of respirations 13) From point above, what is Biot respirations: - What is Cheyne-Strokes respiratory pattern 14) What is the Allen test - What is Froment's test/sign - Piano Key test 15) When treating a patient who has transient upbeating nystagmus and left ocular torsion, canalith repositioning maneuvers should be targeted to which of the following structures? 1. Right posterior semicircular canal 2. Right superior semicircular canal 3. Left posterior semicircular canal 4. Left superior semicircular canal 16) If you remove a chest tube collection device, what could it possibly result in? - And if that happened (from point above), what test would be required before mobilizing the pt: 17) What stage would this be: 1. The physical therapist guides the patient with hand-over-hand cues and demonstrates the propulsion technique. 2. The patient propels the wheelchair with variable speed through an obstacle course with supervision from the physical therapist. 3. The physical therapist allows the patient to problem-solve when steering errors occur and does not provide feedback. 4. The physical therapist allows the patient to independently explore strategies for propulsion and steering during a specific propulsion task. 18) metoprolol is what type of med - If someone taking this med needed to be monitored during exercise, would it be better to monitor HR or RPE - What is the Karvonen formula 19) If treatment time and surface area are kept constant, which of the following ultrasound parameters would MOST likely deliver the GREATEST amount of energy through tissues? 1. 0.5 W/cm2 in continuous mode at 1 MHz 2. 0.8 W/cm2 in continuous mode at 3 MHz 3. 1.0 W/cm2 in 50% pulsed mode at 1 MHz 4. 1.2 W/cm2 in 25% pulsed mode at 3 MHz 20) What is the shoulder clunk test - Best imaging to confirm a labral tear is: - Best imaging to confirm frozen shoulder is

Answer 180

1) The normal range of intracranial pressure is 0 to 10 mm Hg for adults and 0 to 5 mm Hg for children younger than age 6 years - 20mmHg 2) Relaxation training - The patient is describing signs of urge incontinence with possible detrusor contractions. Relaxation training is helpful to decrease bladder contractions. 3) External validity is the degree to which the results of a study can be generalized to a population group externally than those in the study 4) -1.0 or higher (positive numbers) - -1.0 to -2.5 - -2.5 or lower (negative numbers) 5) Spina bifida 6) Paget disease is a chronic bone condition characterized by disorder of the normal bone remodeling process. The bone that is formed is abnormal, enlarged, brittle, and prone to breakage 7) Weight bearing activities (ie: treadmill, walking, balance, etc.) and Resistance strengthening activities 8) Pubococcygeus, iliococcygeus, and puborectalis - The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence. 9) Shoulder lateral (external) rotation and shoulder aDduction past 0° - Shoulder medial (internal) rotation and shoulder abduction 10) Deep neck flexors - You would want to STRETCH extensors and traps to relieve HA symptoms - The presence of cervicogenic headaches is suggested by the patient's posture, pain distribution, and cervical joint hypomobility. Decreased strength in the deep cervical cranioflexors is associated with this condition; therefore, strengthening of the deep neck flexors would be appropriate 11) Erosive arthritis in the DIP joints of the hands - The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands. - Bluish discoloration of the digits with cold exposure is associated with Raynaud disease - Psoriasis is commonly seen in patients who have psoriatic arthritis ``` 12) 1 = bradypnea 2 = tachypnea 3 = Biot respirations 4 = Cheyne-Stokes ``` 13) Biot's respiration is an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea - An irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth and frequency of respirations. This breathing pattern is often observed with depression of the cerebral hemisphere (e.g., coma), in basal ganglia disease, and occasionally with congestive heart failure. 14) Allen: Used to determine the patency of the radial and ulnar arteries and to determine which artery provides a majority of the blood supply to the hand - Froment: A physical examination of the hand to test for palsy of the ulnar nerve which results in reduced functionality and muscle weakness of the pinch grip. It tests the strength of the adductor pollicus of the thumb, which is innervated by the ulnar nerve and is weakened in ulnar nerve palsy. Grab peice of paper and hold it as it is pulled. - Piano: Imagine the ulna head as a piano key. The examiner would press on the ulna head and if painful, would indicate a positive Piano Key Sign. A stable wrist would cause the ulna head to spring back like a piano key without pain 15) Left posterior semicircular canal POSTERIOR CANAL: Debris in the right posterior semicircular canal produces symptoms of transient UPbeating nystagmus and/or right ocular torsion. So left posterior canal would have upbeating nystagmus and left ocular torsion. 93% are posterior canal. ANTERIOR (or Superior) CANAL: Debris in the right superior semicircular canal produces symptoms of persistent DOWNbeating nystagmus and/or right ocular torsion. Opposite for left side. HORIZONTAL CANAL: Side beat indicates HORIZONTAL canal issue. 16) Pneumothorax - Radiograph 17) 1. Cognitive: The cognitive stage is the beginning of the learning process. Cues, instructions, and guidance are provided by the therapist, and demonstration is used. 2. Autonomous: Performing a task with little cognitive attention at variable speeds is characteristic of the autonomous stage of learning. 3. Associative: Problem-solving independent from the therapist's feedback is characteristic of the associative stage of learning. 4. Associative: Exploration of different strategies with little or no input from the therapist is characteristic of the associative stage of learning. 18) Beta Blocker (lol) - RPE since heart rate will be blunted due to the med - The Karvonen formula is a way to determine HR max 19) 0.8 W/cm2 in continuous mode at 3 MHz - Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects, compared to pulsed mode. Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues 20) Pt is supine and you ER and IR arm and shoulder will clunk if there is a labral tear (SLAP) or apprehension / G/H instability - MRI - Arthrogram

Question 181

1) If a small child has torticollis, it could be from damage to what Cranial nerve 2) Stemmer's sign (inability to pinch/fold skin on dorsum of foot) is sign of what stage of lymphedema - If it is reversible lymphedema (meaning elevation can change it) that is stage: - Pitting edema (forming small indentation) - Swelling that feels hard: 3) Someone with sternal precautions (like after an open heart surgery) should NOT do what: - Should these pt's walk for exercise - How should they cough or sneeze 4) If someone had a recent head trauma, should you do postural drainage to the lower lobes? - Why 5) What is Scheuermann disease - What region of the spine does it typically impact 6) If someone had a labral tear 6 months ago, will traction help - Will cryotherapy help someone whose injury was 6 months ago - What is best modality for someone with hip pain 6 months after labral tear 7) The supinator muscle is innervated by what nerve - What nerve root level 8) Which of the following interventions would be MOST appropriate for a patient with a spinal cord lesion to the anterolateral sensory system? 1. Tactile stimulation using tuning forks and vibrators of varying frequencies 2. Active movement using visual feedback for facilitation of position sense 3. Sensory re-education utilizing objects of various sizes, shapes, and textures 4. Patient education concerning protection from hot/cold injuries 9) While performing an assessment of a patient's active shoulder flexion in supine, a physical therapist notices that the patient cannot complete the motion unless the lumbar spine is allowed to extend. Shortness in which of the following muscles is MOST likely the problem? 10) Should a cane be used for PWB - Should cane go on side of impairment, or opposite side 11) A non-English-speaking patient is accompanied to physical therapy by her young English-speaking grandson. The patient does not understand or speak enough English to fully participate in an initial examination. To provide the MOST appropriate services, the therapist should take which of the following actions? 1. Ask the grandson to translate and proceed with the examination. 2. Use a professional translator and proceed with the examination. 3. Ask a same-language-speaking member of the hospital's staff to translate and proceed with the examination. 4. Use gestures, pictures, and simple terms in order to proceed with the examination. 12) At what SaO2 level would supplemental O2 be needed 13) A patient had a biceps femoris tendon repair 3 days ago. After the initial postsurgical assessment, the physical therapist should FIRST initiate which of the following interventions? 1. Gentle isometric strengthening 2. Closed kinetic chain exercises 3. Passive end-range stretching 4. Concentric exercises with gentle resistance 14) What is sepsis - Can a UTI result in sepsis - Main s/s of sepsis 15) Main s/s of gout is: 16) A pregnant patient reports discomfort and dizziness while lying in supine. Which of the following factors is the MOST likely explanation? 17) The degree of hemiparesis initially noted after a cerebrovascular accident is MOST predictive of which of the following? 18) Which of the following bladder management techniques is MOST likely to be used for a patient with bladder dysfunction due to a cauda equina lesion? 1. Sacral nerve modulation 2. Pelvic floor biofeedback 3. Pelvic floor strengthening exercises 4. Intermittent catheterization 19) An enzymatic agent is primarily used for what - Would a hydrocolloid be used for a lot of exudate or little 20) What form of validity is measured by comparing results obtained with a test to results obtained using an already well-established and validated tool? 1. Face 2. Construct 3. Content 4. Criterion-related

Answer 181

1) Trochlear (CN IV) - Ocular torticollis may result from a lesion to the trochlear nerve. Damage to the trochlear nerve results in diplopia. Patients will frequently compensate for the diplopia by tilting the head anteriorly and laterally toward the side of the normal eye. 2) Stage 2 or 3 - Stage 1 - Stage 1 - Stage 2 3) Don't push yourself up from a chair - Yes, slowly build up - With a pillow up into chest 4) NO - it is contraindicated - It will increase intracranial pressure above 20mmHg 5) Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior. - The T7–T10 region 6) NO, it is contraindicated - No, it is effective in early acute stage of swelling - TENS 7) Radial - C6 8) Patient education concerning protection from hot/cold injuries - 1 - this is DCML - 2 - " DCML - 3 - " DCML - 4 - 9) Lats 10) No - Opposite bad leg 11) Use a professional translator and proceed with the examination. 12) When the oxygen saturation falls below 89 percent, or the arterial oxygen pressure falls below 60 mmHg — whether during rest, activity, sleep or at altitude — then supplemental oxygen is needed. 13) Gentle isometric strengthening - Do not do end range PROM right after surgery - wait several weeks 14) Sepsis is a potentially life-threatening condition caused by the body's response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body's response to these chemicals is out of balance, triggering changes that can damage multiple organ systems - YES - Fever and confusion 15) The typical symptom of gout is acute monoarticular arthritis with redness and swelling. More often in BIG TOE 16) Pressure on inferior vena cava 17) Motor recovery 18) Intermittent catheterization 19) Debridement - Little (low to mod) 20) Criterion-related

Question 182

1) Which of the following clinical manifestations MOST indicates the onset of hypoglycemia? 1. Flushed appearance 2. Deep respirations 3. Slow pulse 4. Pallor 2) What type of burn would you see eshcar - What type of burn would you see more edema and red-white coloring - What type of burn would you see intact blisters 3) Normal excursion of the diaphragm is how much - What is excursion - How to remember this? - So would this be more or less with someone with COPD 4) Will pursed lipped breathing cause RR to increase or decrease 5) T or F: The anterior tib assists in inversion at ankle - SO if someone had excessive eversion during stance phase of gait, what 2 m's would you test 6) What is the difference between structural and functional scoliosis - Does the rotational element of scoliosis happen on the convex or concave side of the scoliosis 7) A patient is performing three sets of 15 repetitions at 30% of the one-repetition maximum. To improve power, which of the following modifications would be BEST? 1. Increase the resistance and the number of repetitions per set. 2. Increase the resistance and the speed at which the exercise is performed. 3. Decrease the number of sets and increase the number of repetitions per set. 4. Increase the resistance and decrease the speed at which the exercise is performed. 8) A normal systolic and diastolic response to increased exercise is what: 9) Which of the following interventions would be BEST for a patient who has cervical stenosis and right upper extremity radicular symptoms? 1. Supine cervical traction in 10° of flexion 2. Supine cervical traction in 30° of flexion 10) If you placed your arm above your head like in the Roos chicken dance position and this made symptoms worse, you probably have what: - If you placed your arm above your head like in the Roos chicken dance position and this made symptoms BETTER, you probably have what: - From point above, what is this called 11) What is the MOST accurate way to measure volume reduction from edema 12) Quick refresher on how to stage a wound (pressure injury): 13) If a pt has a chest tube or a recently inserted pace maker put in, should you mobilize them? - If a intraaortic balloon pump via femoral sheath access, should you mobilize them 14) If a pt had hyperbilirubinemia, would they have light or dark colored stools: - Would they have pale (pallor) skin color? 15) What is clubbing of the fingers - Is clubbing a s/s of anorexia - What other condition would cause digital clubbing: - Celiac disease is from an intolerance to 16) What is oscillopsia 17) - What is the Observational Gait Analysis test: - What is the Wolf Motor Function test: - What is the Segmental Assessment of Trunk Control: 18) What abnormal breath sound is considered to be continuous musical sounds - What sound is from upper airway obstruction - What is a grating, creaking, sandpaper sound - What are discontinuous, nonmusical, popping sounds 19) Low-intensity conventional transcutaneous electrical nerve stimulation is being used to control pain. Which of the following physiological responses is MOST likely to occur? 1. Activation of the A (large-diameter) fibers only 2. Activation of the C (small-diameter) fibers only 3. Activation of the A (large-diameter) fibers and substantia gelatinosa 4. Activation of the C (small-diameter) fibers and substantia gelatinosa 20) Someone with lymphedema - should they do LE exercises? - Should they swim in a pool - Should they run barefoot - Can someone in stage 0 lymphedema fly on a plane?

Answer 182

1) Pallor 2) Full thickness - Deep partial thickness - Superficial partial thickness 3) 1.2 to 2 inches (3-5 cm) - How much the diaphragm goes UP when you exhale - Inspiration (IN), expiration (EX = excursion) - LESS (since they can't exhale as much out) 4) Decrease 5) True (so if it is weak, you'd get more eversion during gait) - Posterior tib and Ant tib - they both would be weak, causing more eversion of ankle during stance phase. 6) Structural scoliosis is a fixed deformity that persists during forward bending. Functional scoliosis is a changeable adaptation (posture) that is not present when fully forward flexed. - Convex (remember the concave and convex sides are right by each other, on opposite sides of the spine) 7) Increase the resistance and the speed at which the exercise is performed. - You have to increase the resistance and the SPEED to increase the power 8) A normal blood pressure response to exercise would be an increase in systolic pressure of 20 mm Hg or more with diastolic pressure remaining the same or decreasing slightly. 9) Supine cervical traction in 30° of flexion (because at 30 deg's you get more opening of facets, which helps) 10) Thoracic Outlet Syndrome - C5 disc lesion - Bakody sign **** 11) Water displacement 12) - Stage 1: pressure injury is characterized by intact skin with nonblanchable redness of a localized area, usually over a bony prominence. - Stage 2: A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury. - Stage 3: A Stage 3 pressure injury is characterized by full-thickness skin loss. Subcutaneous fat may be visible, but bone, tendon, and muscle are not exposed. - Stage 4 pressure injury is characterized by full-thickness skin loss with exposed bone, tendon, or muscle 13) Yes - NO 14) Light - No, more yellow or jaundice color 15) An abnormal, rounded shape of the nail bed - Yes. Clubbing is a rare complication of anorexia. In malnourished patients with anorexia nervosa, clubbing seems to be associated with long-term laxative abuse - Pulmonary fibrosis - Gluten 16) Where everything around you seems like it is moving (ocular instability) 17) - Observational Gait Analysis is a functional measure used for the examination of movement patterns during gait. It is used to identify gait deficits. The therapist examines the motion of each major joint during phases of gait. It does not involve scoring of fall risk, nor does it specifically examine postural control. - The Wolf Motor Function Test assesses upper extremity function of patients post stroke. It does not include an examination of gait. - The Segmental Assessment of Trunk Control examines balance and postural control only in the seated position 18) High pitched wheezes - Stridor - Pleural friction rub - Crackles / Rales 19) Activation of the A (large-diameter) fibers and substantia gelatinosa - The gate control theory of pain states that activation of large-diameter fibers will also activate the substantia gelatinosa, which closes the gate. Activation of the A fibers alone would not have this effect. When A fibers get activated, this will cause activation of the substantia gelatinosa, which will close the gate and block pain signals being sent by T-cells. 20) YES - yes, it is exercise and helps with compression - NO - Individuals who have lymphedema in any stage (Stage 0 or risk for other stages) should protect the skin and avoid any activities that could pierce the skin tissue. - Air travel is not contraindicated for individuals who have Stage 0 lymphedema; however, compression garments should be worn during flight to avoid potential swelling due to the decreased air pressure.

Question 183

1) When someone is learning a new task (lets say learning to hit a baseball) and they do 200 repetitions, how often should you give feedback 2) A 6-year-old boy has decreased stance time on the left lower extremity. There is no history of trauma and no pain in the extremity. Passive and active ranges of motion of both hip medial (internal) rotation and hip abduction are limited by 50%. Which of the following conditions is MOST likely present? 1. Femoral retroversion 2. Legg-Calvé-Perthes disease 3. Slipped capital femoral epiphysis 4. Gluteus medius muscle weakness 3) What does supple mean - Would someone with LE ischemia have supple skin - How would their skin appear 4) Where on the forearm should a physical therapist place electrodes for biofeedback therapy in order to facilitate hook grasp? 1. Proximal anteromedial 2. Proximal posterolateral 3. Distal anteromedial 4. Distal posterolateral 5) What is a Pavlik harness for - How often / long should this harness be worn 6) Would you give a back brace to someone in the chronic phase of low back pain? - Would you give a traction unit to someone in the chronic phase of low back pain? - What is best thing for chronic pt with low back pain 7) Is there a cure for lymphedema - How long is someone in each stage of lymphedema - What stages does pitting edema happen 8) Someone can get an injury and then develop CRPS. What is this 9) A physical therapist is treating a patient with bicipital tendonitis. The therapist has determined that iontophoresis with medication for a total treatment dosage of 80 milliampere-minutes is most appropriate. Which of the following current parameters should a physical therapist use when applying the iontophoresis to achieve the BEST results? 1. 3–4 milliamperes, direct current 2. 8–10 milliamperes, direct current 3. 3–4 milliamperes, pulsed current 4. 8–10 milliamperes, pulsed current 9A) What is form discrimination impairment - How could it be tested - What is figure-ground discrimination - How could you test it: - What is Tactile agnosia - Is this the same as astereognosis 10) A patient displays an irregular heart rhythm, increased respiratory rate, and acetone-like breath odor after performing 15 minutes of intense exercise. Which of the following conditions is MOST likely present? 1. Thyroid hypersecretion 2. Pituitary hypersecretion 3. Pancreatic hyposecretion 4. Adrenal hyposecretion 11) Thyroid hypersecretion would present how: - How would Pituitary hypersecretion present - Acetone breath is from what 12) Which of the following communication strategies is MOST appropriate for a physical therapist to use with a patient who has dysarthria following a recent cerebrovascular accident? 1. Provide feedback indicating understanding of the patient's speech. 2. Utilize an increased level of tactile or visual cueing. 3. Use open-ended questions to elicit responses. 4. Speak and interact with the patient's family rather than the patient. 13) A patient with type 1 diabetes is planning to begin an exercise program. Which of the following actions is MOST appropriate for the patient to perform? 1. Inject insulin just prior to starting an exercise session. 2. Avoid food consumption just prior to an exercise session. 3. Complete an exercise session within 1 hour of receiving an insulin injection. 4. Increase food intake prior to an exercise session. 14) Lesions of the skin are the FIRST clinical sign of underlying disease for which of the following diagnoses 15) If someone with hemiparesis laid on their R side all the time, would the R side get shorter (contractures) or longer (stretched) - What is main concern of laying on R side for prolonged time 16) Is aphasia always a result of L sided brain damage 17) History of corticosteroid use is a risk factor for: 18) In which of the following wrist positions would maximal grip strength MOST likely be generated? 1. 0° (neutral) 2. 15° of flexion 3. 30° of extension 4. 60° of extension 19) A patient who had knee arthroscopic surgery 2 weeks ago reports a new onset of calf pain 2 days after an intense exercise session. Which of the following findings should MOST raise suspicion of deep vein thrombosis? 1. Baker cyst, unilateral pitting edema, unilateral varicose veins 2. Bilateral varicose veins, bilaterally equal pitting edema, painful calf raise 3. Knee swelling of 1.2 inches (3 cm) compared to the previous session, painful calf raise, relief with recumbency 4. Calf swelling of 1.4 inches (3.5 cm) compared to the contralateral leg, pitting edema, recent history of cancer 20) If you had a pt with contact precautions, would you wear a gown or a mask? - If you had a pt with droplet precautions, would you wear a gown or a mask? - Which one does Vancomycin-resistant Enterococcus (VRE) require - What is Vancomycin-resistant Enterococcus (VRE)

Answer 183

1) Feedback for very simple movements has been shown to be more beneficial if given every 15 repetitions as a summary. For more complex tasks, such as hitting a ball with a bat, the most effective summary length for learning is every five repetitions. 2) Legg-Calvé-Perthes disease - Legg-Calvé-Perthes disease is associated with limited hip abduction and medial (internal) rotation and higher prevalence in boys than in girls. An age of 6 years is the most common age for the presentation of this condition. - Slipped capital femoral epiphysis includes groin pain, which is not reported by the patient described in the stem. And the pt would be aged 10-16 ish with SCFE 3) Bending and moving gracefully (flexible) - NO - The skin of the lower extremities would become transparent and appear dehydrated. 4) Proximal anteromedial - Proximal because that is where the muscle originates and usually where motor end point is (distally is too far to get reaction). 5) Developmental dysplasia in kids - The harness must be worn 18–23 hours/day. 6) NO - NO - MOVEMENT - exercise 7) No - No set time - Early stages (1, first part of 2) 8) One of the complications after an upper extremity trauma is the advent of complex regional pain syndrome. This complication often presents with burning pain with any movement of the body part, excessive sensitivity to light touch or minor stimulation, temperature changes, localized sweating, localized changes of the skin, or trophic changes of the skin, hair, and nails. Of the four options, this complication would result in longest delay in recovery and return to work 9) 3–4 milliamperes, direct current - Pulsed current is not the correct type of electrical current to use with iontophoresis. Direct current should be used. - Direct current is indicated, but an amplitude of 8–10 milliamperes is too high. - Direct current is indicated with a maximum safe amplitude of 4 milliamperes. 9A) inability to perceive or attend to subtle differences in form and shape. - Have the patient find an object, such as a toothbrush, among similarly shaped objects - inability to visually distinguish a figure from the background in which it is embedded - Have the patient locate a white button on a white shirt. - inability to recognize forms by handling them, although tactile sensation may be intact. - YES 10) Pancreatic hyposecretion 11) Enlarged goiter and sympathetic overactivity (sweating, heightened metabolism, tachycardia, weight loss) - Giantism and acromegaly can result from excessive secretion of growth hormone - Pancreatic hyposecretion 12) Provide feedback indicating understanding of the patient's speech. - When communicating with a person who has difficulty speaking, the physical therapist should use questions that require brief responses rather than open ended that will just frustrate them 13) Increase food intake prior to an exercise session - You do NOT want to avoid eating since that will cause hypoglycemia. You should eat right before you exercise to get blood sugars up. - Exercise should be avoided during the peak activity time of insulin, because insulin is absorbed much faster with exercise, thus altering its effectiveness. - It is important that the person avoid insulin injections within 1 hour of exercise because insulin is absorbed much more quickly in active extremities. This can cause blood glucose levels to drop. 14) Scleroderma 15) Longer (stretched) - Shoulder injury / pain 16) No. Aphasia happens in whatever sided brain is DOMINANT - so for a select few, it would be R sided brain damage causes aphasia 17) osteonecrosis 18) 30° of extension - With the wrist in neutral, the finger flexors are not lengthened to the optimal length for tenodesis action and, as a result, are not as likely to generate the greatest force. - A muscle has maximal ability to generate force (or tension) when the muscle is contracted at its optimal length. Finger flexors involved in grip cross the wrist, so wrist position affects the length of the finger flexors and consequently also affects the ability of the flexors to generate force. The optimal length of the finger flexors is maintained when the wrist is held at approximately 30° of extension. - 60 deg's is too far 19) Calf swelling of 1.4 inches (3.5 cm) compared to the contralateral leg, pitting edema, recent history of cancer - The Wells Clinical Decision Rule for a deep vein thrombosis is a valid and reliable tool in predicting the risk of lower extremity deep vein thrombosis in the orthopedic population. Cancer within 6 months, unilateral swelling greater than 3 cm, and pitting edema are three of the factors in the Wells Clinical Decision Rule, which puts the probability of developing a deep vein thrombosis greater than 75%. 20) Gown - Mask - Gown (contact precautions) - Bacteria that is resistant to anti-biotics

Question 184

1) An aquatic-based rehabilitation program is MOST likely to be contraindicated for a patient who has which of the following conditions or characteristics? 1. History of seizures 2 years previously 2. Human immunodeficiency virus (HIV) 3. Leg ulcer covered in an occlusive dressing 4. Pulmonary fibrosis with a vital capacity of 0.8 liters 2) Are the ulnar tunnel and the cubital tunnel the same thing? 3) What is Lower Crossed Syndrome - With this condition, will you have tight or weak hip flexors - So if hip flexors are tight, what else is - SO what portions are then weak 4) Which of the following characteristics of a skin lesion is MOST likely to require referral to a physician? 1. Smooth and even borders 2. Black and brown coloration 3. Round and symmetrical shape 4. 0.20 inches (5 mm) in diameter 5) Touch pressure threshold is basically what 6) After undergoing a reverse total shoulder arthroplasty, a patient is MOST likely to dislocate the shoulder in which of the following positions? 1. Lateral (external) rotation and abduction with flexion 2. Medial (internal) rotation and abduction with flexion 3. Lateral (external) rotation and adduction with extension 4. Medial (internal) rotation and adduction with extension 7) Which of the following options BEST describes the role of the center coordinator for clinical education? 1. Practices as a physical therapist 2. Reviews daily student documentation 3. Serves as a liaison to the academic institution 4. Acts as a clinical instructor for physical therapy students 8) Which of the following joint mobilization techniques would MOST effectively increase elbow joint flexion? 1. Humeroulnar distraction 2. Humeroradial posterior glide 3. Radioulnar anterior glide 4. Radioulnar posterior glide 9) The purpose of humeroulnar distraction is to increase elbow: - The purpose of humeroradial posterior glide is to increase elbow: - The purpose of radioulnar anterior glide is to increase: - The purpose of radioulnar posterior glide is to increase: - How to remember 2 points above 10) T or F: it is better to exercise MS pt's in the morning 11) It is normal to urinate ______ times in a 24-hour period. 12) What condition does these s/s describe: - transient/temporary pain that radiates down the left arm into the ulnar border of the hand with the ring and little fingers (4th and 5th digits) during activity. It is generally increased with exertion and decreased with rest. 13) These statements below describe which stage of prevention of disease (primary, secondary, tertiary): 1. Stopping the process that leads to the development of disease. 2. Providing education to give people greater control over their own health. 3. Limiting the degree of disability and improving function in patients who have chronic disease. 4. Performing early detection of disease and health conditions through regular screening. 14) Which of the following exercises promotes context-dependent responses in a patient who has Parkinson disease? 1. Lap swimming 2. Walking outdoors 3. Unsupervised treadmill walking 4. Riding a stationary bicycle 15) What is another med often given to people taking oxycodone - Why 16) What is folic acid and who/when is it typically given - What is Glucosamine and who/when is it typically given - What is Niacin and who/when is it typically given 17) If someone had chronic ankle instability and the surgeon wanted to do an autograft to stabilize the lateral ankle, what tendon would he use? - What is this procedure called - When the semitendinosous tendon is used as the autograft, that is for what surgery: - When the gracilis is used " - When the flexor hallucis longus is used " - When the patellar tendon is used: 18) A pt presents to PT for treatment of a non-operative osteoporotic fracture. Which of the following structures would have been LEAST likely affected? - Distal Radius - Vertebral Body - Proximal femur - Tibial Plateau 19) Related to the point above, when someone fractures their distal radius due to osteoporosis, this is called: 20 A pt is evaluated in PT 3 weeks following a lateral ankle reconstruction. Which of the following exercises for the involved LE would be the MOST appropriate to include as part of this pt's home exercise program on the first session? a) supine straight leg raises b) ankle inversion/eversion with a resistance band c) standing calf raise with UE support d) single leg stance with eyes open

Answer 184

1) Pulmonary fibrosis with a vital capacity of 0.8 liters 1. Uncontrolled seizures within the last year are considered a contraindication for aquatic therapy, not a history of seizures in the previous 2 years. 2. Human immunodeficiency virus (HIV) is not a waterborne or airborne transmitted infection. Only waterborne and airborne transmitted infections are contraindications for aquatic therapy. 3. An open wound is not a contraindication as long as it is covered with an occlusive dressing. 4. Aquatic therapy is contraindicated for patients who have a vital capacity of 1 liter or less. 2) NO. Cubital tunnel is at elbow, ulnar tunnel is down by hook of hamate. 3) Lower Cross Syndrome or LCS, is a neuromuscular condition in which there are tight and weak muscles. The involved tight muscles are the thoracolumbar extensors and hip flexors, while the weak muscles are the abdominals and gluteus maximus. ... Some people also experience upper cross syndrome at the same time - Tight - The opposite diagonal - so erector spinae - Abdominals and glutes (diagonal opposite of each other) 4) Black and brown coloration 1. Common moles and other normal skin changes usually have smooth, even borders or edges. Malignant melanomas have uneven, notched borders. 2. A single lesion with more than one shade of black, brown, or blue may be a sign of malignant melanoma. 3. Round, symmetric skin lesions, such as common moles, freckles, and birthmarks, are considered normal. 4. The average mole is less than 0.25 inch (6.3 mm) in diameter. Anything larger than this should be inspected carefully. 5) Monofilament 6) Medial (internal) rotation and adduction with extension 7) Serves as a liaison to the academic institution 8) Humeroulnar distraction 9) Flexion - extension - supination - pronation - Anterior hand facing you is sup, posterior hand is pro 10) TRUE 11) 6 to 8 - A frequency beyond 8 times/day is considered abnormal. 12) Angina ``` 13) 1 = Primary 2 = Promote health and wellness 3 = Tertiary 4 = Secondary ``` 14) Walking outdoors 15) Colace - It is a stool softener since that is a side effect of taking oxycodone 16) Folic acid (or folate) is Vitamin B9 and involved in formation of red blood cells and and is also an important supplement during early pregnancy to reduce risk of birth defects of the brain and spine. - Slow the rate of joint cartilage degeneration, so given to those with OA - Regulate metabolism and help lower cholesterol 17) Peroneous brevis - Brostrom proceedur repairs torn ankle lig's (usually ATFL). Brostrom-Evans procedure uses a tendon graft to support lateral ankle with the peroneus brevis - ACL - ACL - Achilles - ACL 18) Osteoporosis results in bone mineralization problems and causes brittle bones that are more prone to fracture. All bones can be effected, however the bones MOST effected are vertebral bodies, distal radius/ulna, and femoral neck. A fracture rarely happens at tibial plateau 19) Colles' fracture 20) Supine straight leg raises - 3 weeks out they will have weight bearing restrictions, so a SLR is just to keep m's of the LE active without putting weight on ankle.

Question 185

1) When doing scar massage on a patient post-surgery, what is the best method: - With Vitamin E 4x p/day for 5 min's each time - With Vitamin E 2x p/day for 10 min's each time - With Vitamin A 4x p/day for 5 min's each time - With Vitamin A 2x p/day for 10 min's each time 2) For a pt with lateral epicondylitis, how would you put those muscles on max stretch: 3) Most common sites where people with osteoporosis get bone fractures 4) An 85 yr old pt was recently diagnosed with osteoporosis after a fall in which she sustained a femoral neck fx. The pt reports that her lifestyle has become much more sedentary over the past 5 years. Which type of osteoporosis is MOST consistent with the presented scenario: a) Idiopathic b) Senile c) Postmenopausal d) Secondary 5) What is the normal range for diastolic pulmonary arterial pressure: - What would a low amount indicate: 6) If you ask the patient to reach for a bright blue paper located on a white desk, what are you testing? 7) paratenonitis means - Test to rule this in with thumb 8) MUST know the motor, verbal, and eye responses of Glasgow Coma Scale

Answer 185

1) With Vitamin E 2x p/day for 10 min's each time - Should not do this until scar has closed/healed, and should be 10 mins (5 mins is too short) and 4x p/day is too excessive. 2) Elbow extension, forearm pronation, and wrist flexion 3) Neck of femur, compression fx's of vertebrae, distal radius/ulna 4) Answer: B (senile) - Senile osteoporosis is when a pt is 70+ yrs old and pt gets typical age related changes in bone absorption. - Postmenopausal osteoporosis is more hormone related changes in bone absorption (women age 50-60 ish) - Secondary could be due to taking medications, or conditions like malabsoprtion syndrome, alcoholism, malnutrition, drug use, etc. 5) Ranges from 5 to 15 mm Hg - A measure of 3 mm Hg is pathologically low and may indicate unstable hemodynamic status, which is a relative contraindication for percussion 6) A patient who has depth and distance perception problems may have difficulty grasping an object. The impaired patient will overshoot or undershoot the object. 7) PAIR of tendons with inflmammation - Finkelstein 8) Glasgow Coma Scale Eye Opening Response • Spontaneous--open with blinking at baseline 4 points • To verbal stimuli, command, speech 3 points • To pain only (not applied to face) 2 points • No response 1 point ``` Verbal Response • Oriented 5 points • Confused conversation, but able to answer questions 4 points • Inappropriate words 3 points • Incomprehensible speech 2 points • No response 1 point ``` Motor Response • Obeys commands for movement 6 points • Purposeful movement to painful stimulus 5 points • Withdraws in response to pain 4 points • Flexion in response to pain (decorticate posturing) 3 points • Extension response in response to pain (decerebrate posturing) 2 points • No response 1 point

Question 186

1) What is sarcoidosis - Is it an obstructive or restrictive lung disease 2) A pt who had a lateral ankle reconstruction eight weeks ago arrives to a therapy session without their walking boot. They had previously been full weight bearing in a walking boot, but were cleared to ambulate without the walking boot one week ago. The pt reports 6/10 pain over the last week with any ambulation. What would be the MOST appropriate action by the PT? a) Have the pt return to using the walking boot and axillary crutches b) Have the pt use an ankle brace c) Advice the pt that an increase in their pain is expected during the transition d) Refer the pt out for diagnostic imaging 3) A PT presents an in-service on the risk factors associated with developing osteoporosis. Which of the following pt's would be the MOST at risk for developing osteoporosis? a) A 67-year-old female with malabsorption syndrome b) A 70-year-old female with metabolic alkalosis c) A 68-year-old male with fibromyalgia d) A 72-year-old male with cauda equina syndrome 4) A pt diagnosed with postmenopausal osteoporosis is referred to physical therapy to work on general strengthening program. Which pathophysiology is responsible for the development of this condition? a) increased osteoblast and osteoclast activity b) decreased osteoblast and osteoclast activity c) increased osteoblast activity and decreased osteoclast activity d) decreased osteoblast activity and increased osteoclast activity 5) A pt is examined in PT for complaints of R elbow pain. When asked to indicate the location of their pain, the pt points to both the anterior and lateral elbow. The therapist decides to perform a special test to differentiate between lateral epicondylitis and distal biceps tendonitis. Which of the following special tests would be the MOST useful? a) Cozen's test b) Pinch grip test c) Elbow flexion test d) Bunnel-Littler test 6) What is the pinch grip test: - What is the elbow-flexion test: - What is the Bunnel-Littler test: 7) You'd assess the L3/4 nerve root through what deep tendon reflex: - What about L5: - What about S1: - Do deep tendon reflexes assess spinal tracts? 8) A patient has right flank pain after sustaining a blow to the back during a sporting event. The spine is pain free upon palpation. The paraspinal muscles are free of muscle spasms and tenderness. Percussion of the right costovertebral angle reproduces the pain and causes the pain to radiate to the right groin area. Which of the following structures is MOST likely involved? - Where would people feel pain if they had a bladder issue/pain? - What about the spleen? 9) A patient who has a transfemoral amputation reports buckling of the prosthetic knee while walking. This would happen due to the axis being too far anterior or posterior to the trochanteric-knee-ankle line? - What is this called? 10) A prosthesis that is too long is likely to cause what type of gait pattern? - If the medial wall of the socket is too high, this would cause what 11) A patient has polyuria, polydipsia, and a fasting plasma glucose level of 152 mg/dL (8.4 mmol/L). The findings are MOST consistent with which of the following conditions? 1. Primary adrenal insufficiency 2. Impaired glucose tolerance 3. Cushing syndrome 4. Diabetes mellitus 12) Polyuria is what: - Polydipsia - What is impaired glucose tolerance: - Would adrenal insufficiency be associated with weight gain or weight loss 13) How does DM II related to polyuria and polydipsia? - What is Diabetes Insipidus: 14) If someone has a right thoracic rib hump with forward bending of the trunk, would this be structural scoliosis or functional? - How is scoliosis named? 15) What is hemosiderin staining - What condition does this describe - What test will rule this in? - What is a positive test (for test from point above) 16) A woman in the 3rd trimester of pregnancy is performing pelvic floor exercises in supine position. She reports dizziness, nausea, and shortness of breath. Which of the following effects BEST describes the contribution of supine positioning to the patient's symptoms? 1. Increase in inferior vena cava pressure and increase in venous return and cardiac output 2. Decrease in inferior vena cava pressure and increase in venous return and cardiac output 3. Increase in inferior vena cava pressure, leading to a decrease in venous return and cardiac output 4. Decrease in inferior vena cava pressure, leading to a decrease in venous return and cardiac output 17) A patient who has gastroesophageal reflux disease is MOST likely to benefit from education to reduce consumption of which of the following types of food? 1. Coffee, fatty foods 2. Coffee, dairy foods 3. High-sugar foods, fatty foods 4. High-sugar foods, dairy foods 18) A family physician refers a patient to physical therapy for treatment of chronic low back pain. The patient is currently receiving treatment from a massage therapist for the same problem. Which of the following actions is MOST appropriate for the physical therapist? 1. Ask the patient to discontinue the massage therapy. 2. Treat the patient on days the patient is not seen by the massage therapist. 3. Gain permission from the patient to contact the massage therapist to discuss the plan of care. 4. Discontinue the patient's physical therapy. 19) Increased medial rotation of the knee or thigh during gait is primarily a result of what: - When someone does a posterior lean during gait, it usually is due to what 20) What is the question below really asking: Which of the following therapeutic activities is the MOST appropriate for an infant who has a C5–C6 brachial plexus injury? 1. Open-hand batting of an object with finger extension and abduction 2. Reaching with shoulder medial (internal) rotation and forearm pronation 3. Reaching with shoulder lateral (external) rotation and forearm supination 4. Grasping an object with thumb (1st digit) adduction and metacarpophalangeal joint flexion

Answer 186

1) Sarcoidosis is an inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands. In people with sarcoidosis, abnormal masses or nodules (called granulomas) consisting of inflamed tissues form in certain organs of the body - Restrictive 2) Answer: B (ankle brace) - This is common that a pt will have a pain during this transition back to walking - it's normal. But instead of just telling them it is expected, give them a brace to help with the transition. - Remember the surgeon cleared them to get out of the boot, so imaging and going back to the boot is not necessary at this stage. 3) Answer: A. (67-year-old female with malabsorption syndrome) - Risk factors for developing osteoporosis include: older caucasian female; inactive lifestyle; diet inadequacies (Malabsorption syndrome); smoking; drugs; endocrine disorders - Metabolic Alkalosis is NOT associated with an increase in the risk of osteoporosis 4) Answer: D (decreased osteoblast, increased osteoclast) Explain: Osteoporosis is a metabolic bone disorder where the rate of bone resorption accelerates and rate of bone formation slows down. OsteoBlasts are cells that help BUILD NEW BONE. B = B ... blasts build. OsteoClasts are cells that degrade bone material. So osteoClasts work hard and osteoblasts don't, leading to brittle bones. 5) Answer: A (cozen's) Explain: Cozen's test is the pt makes a fist, pronates arm, extends elbow and extends wrist against resistance. PT palpates CET and if their is pain = positive test. 6) - Pinch grip test is for assessment of anterior interosseous nerve. Pt will pinch index and thumb pads together, and if there is weakness and pain = positive - Elbow-Flexion test is when pt flexes both elbows fully and extend wrists and holds this position for 3-5 minutes. It is a positive test if there is tingling, or paresthesia in the ulnar nerve distribution of hand. It assesses cubital tunnel syndrome. - Bunnel-Littler test is a test for intrinsic hand muscle weakness 7) Patellar - Hamstrings - Achilles - NO (the reflex goes to spinal column and back down - not to cerebral cortex) 8) KIDNEY - Low back but especially suprapubic pain - LEFT costovertebral angle (not right), and L upper quadrant and L shoulder 9) Anterior - A flexion moment at the knee (causing knee instability and possibly buckling) 10) An abducted stance or circumduction in swing - Abducted gait or a lateral lean 11) Diabestes Mellitus. - Remember DM is anything above 140 ish. 12) Excess peeing - Excess thirst (intense thirst despite drinking plenty of fluids) - Impaired glucose tolerance is defined as a fasting plasma glucose level greater than or equal to 100 mg/dL (5.6 mmol/L) but less than 125 mg/dL (6.9 mmol/L) (p. 507). - Weight loss 13) Diabetes: Super high blood sugar will make you pee a lot. The more you pee, the more dehydrated and thirstier you get, and the more you drink. - Diabetes insipidus: What most people think of when they hear "diabetes" has to do with your pancreas. Diabetes insipidus happens when there's a problem with your kidneys (or your pituitary gland from releasing too much ADH). Its a disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty even if you've had something to drink. It also leads you to produce large amounts of urine. 14) Structural? If it were functional or postural, the hump would go away when bending forward. - It is named by where the convex side of spine is curving out. So a right thoracic scoliosis is the spine curving OUT to the right in the thorax region (it could be thoraco-lumbar region, or thoraco-cervical region also). 15) A patient's skin distal to the mid-calf is darker than the skin proximal to the mid-calf. - Venous insuff. - Venous filling time - If the venous filling time is less than 15 seconds 16) Increase in inferior vena cava pressure, leading to a decrease in venous return and cardiac output - Pressure in the inferior vena cava rises in late pregnancy, especially in supine position. This causes supine hypotensive syndrome, which presents as dizziness, nausea, and shortness of breath. Supine position causes a decrease in venous return and cardiac output. 17) Coffee, fatty foods - Modifications to help manage symptoms of gastroesophageal reflux disease includes avoiding eating large meals that can distend the stomach and avoiding items such as chocolate, peppermint, alcohol, caffeinated coffee, and fried and/or fatty foods. - Dairy and high-sugar foods do not have an effect on reflux. 18) Gain permission from the patient to contact the massage therapist to discuss the plan of care. - Yes it views a massage therapist as another health care provider for the pt we should communicate with to create a POC for the benefit of the pt. 19) Weak hip abductors / IT band - Weak hip extensors 20) Asking what they need to work on (answer 3) - not what they can do (I put answer 4) - Correct answer: 3

Question 187

1) If a patient has difficulty concentrating, refuses to participate in certain examination procedures, and appears reactive and fearful to touch - should you ask direct or indirect questions about violence and abuse? 2) What things must you consider when prescribing a POC for someone with RA: - Is stretching good for someone with RA? 3) Pulmonary edema is associated with R or L sided heart failure - Dyspnea would be associated with R or L sided heart failure - Jugular vein distension and LE edema is associated with R or L sided heart failure - Muscle weakness / fatigue is associated with R or L sided heart failure 4) Do Parkinson patient's get arrythmia's - Do they get erratic respiration/breathing? - Would parkinson's pt's get more obstructive or restrictive lung issues 5) Sensation comes from precentral gyrus or postcentral gyrus 6) What is Freiberg disease - Symptoms include: 7) What are Brandt-Daroff Exercises 8) From point above, is this a correction if you have a positive Dix-Hallpike? - What is another name for Eppley Manuever 9) For poor posture, what would you do with cervical extensors: - " Cervical flexors - " Pecs - " Rhomboids 10) Should you do PT on someone with: - Dissecting aortic aneurysm - Decompensated chronic heart failure - Third-degree heart block with a rate of 56 bpm - Chronic atrial fibrillation with a rate of 96 bpm 11) Are PT's allowed (within scope of practice) to provide movement advice related to sexual activity following an injury or surgery (ie: THA)? 12) Which of the following mobilizations to the temporomandibular joint would MOST likely improve a limitation in mouth opening? 1. Distraction with anterior glide 2. Distraction with posterior glide 3. Compression with anterior glide 4. Compression with posterior glide 13) RElated to point above, what glide would you do to improve mouth closing - Would you do compression? 14) A patient who has sacroiliac joint dysfunction will MOST likely experience pain during which of the following activities? 1. Sitting 2. Lying in prone position 3. Walking 4. Lying in supine position 15) Why from point above: 16) A patient reports feeling light-headed when moving from sitting to standing position. Which of the following patient instructions would be MOST appropriate? 1. Sit down and perform ankle pumps. 2. Remain standing with the eyes closed. 3. Remain standing with the eyes open. 4. Return to supine position and discontinue the session. 17) If someone has droplet precautions, what is main PPE the therapist needs to wear: - " has airborne precautions, " - So TB (tuberculosis) would require what PPE - So Bacterial pneumonia would require what PPE - What about Varicella zoster and Rubeola 18) With compression garments, is flat knit or circular knit compression stockings more pressure/compression - Remember the ? where someone with lymphedema is RECENTLY diagnosed, but they were in stage 2 when diagnosed ... what stage treatment should they get? - So explain diff. between stage 1 and stage 2 treatment 19) What type of tissue do you do sharp debridement on - Why would you use pulsatile lavage 20) Review the stages of Lymphedema:

Answer 187

1) BE DIRECT (don't beat around the bush) 2) Joint protection, Energy conservation, and especially - consider the stage (acute versus chronic) of rheumatoid arthritis, and the patient must be taught to modify the program to match the stage of the illness - They already have weakened tissues, so better to strengthen joints 3) L - L - R - L (Insufficient cardiac output to working muscles by the left ventricle may result in tissue hypoxia and inability to remove metabolic waste) 4) NO - YES - Restrictive 5) Post (pre is for movement) 6) A form of avascular necrosis in the metatarsal bone of the foot. It generally develops in the second metatarsal, but can occur in any metatarsal. - Pain localized to the metatarsal head and exacerbated with activity, range of motion limitations, joint swelling, and occasional plantar callosity under the second metatarsal head 7) Brandt-Daroff Exercise for Vertigo: - Start in an upright, seated position. - Move into the lying position on one side with your nose pointed up at about a 45-degree angle. - Remain in this position for about 30 seconds (or until the vertigo subsides, whichever is longer). Then move back to the seated position. - Repeat on the other side. 8) No, then you go into Eppley manuever - Canalith repositioning treatment 9) Stretch them - Strengthen (the retractors) - Stretch - Strengthen 10) - NO - NO - NO - Yes, you can (until bpm gets excessively high) 11) YES 12) Distraction with anterior glide 13) Distraction with posterior glide - NO 14) Walking 15) If someone had pain with PROLONGED sitting and standing, it would be SI, but if pt's have SI joint pain it usually is due to pelvic musculature weakness and imbalance, making walking painful (since SI joint's move during walking). 16) Sit down and perform ankle pumps. - Sitting is safe, and pumping ankles will help with blood flow return back to heart to help with blood pressure. 17) Mask - Respirator - Respirator - it is an airborne - Mask (it is droplet) - Airborne, so respirator 18) Flat - Stage 1 - Stage 1 is short stretch bandages at night. Stage 2 is compression bandage during day, short stretch at night. 19) Necrotic - Pulsatile lavage removes wound exudate and loose debris in a wound. It has suction and combines wound irrigation with suction and removes the irrigation fluid, wound exudate, and loose debris. It helps promote granulation of wound bed. 20) - Stage 0 lymphedema there are no clinical signs of edema although reduced lymph transport capacity is present. - Stage 1 lymphedema includes pitting edema, reversible with elevation, and edema that is increased with activity, heat, and humidity and is better in the morning. - Stage 2 lymphedema includes nonpitting edema that is irreversible along with fibrotic skin changes - In Stage 3 lymphedema, there is an increase in severe nonpitting fibrotic edema and atrophic changes in the skin, including hyperkeratosis, papillomas, and warts.

Question 188

1) Can a knee brace help do the job of an ACL and prevent anterior translation of the tibia? - Can a knee brace help provide proprioception to knee? - Can " help with quad contraction - Can " improve patellofemoral tracking 2) What type of incontinence does this describe: - Pt experiences constant leaking of small amounts of urine and has a sensation of the bladder not being fully emptied after voiding. 3) The below descriptions - which describes effectiveness and which describes efficacy: _______ is the extent to which an intervention produces a desired outcome under ideal conditions. _______ is the extent to which an intervention produces a desired outcome under usual clinical conditions. - So what is an effect size: 4) Below is a s/s of either hyperthyroidism or hypthyroidism: - Intolerance to heat: - Lethargy: - Restlessness: - Intolerance to cold: - Diahrrea: - Muscle wasting: - Constipation: - Muscle aches: - Weight loss: - Exophthalmos: - Decreased appetite: - Increased appetite: - Irregular or heavy menses: - Amenorrhea: 4A) What is amenorrhea - How to remember 5) You know that the ideal amount of time to apply a heat pack is 15-20 mins. But what if you have these two options - what do you choose: 5-10 mins or 20-30 mins 6) Would pronator teres and anterior interosseous syndrome present the same way - What is the elbow flexion test - What does elbow flexion test help rule in 7) Loose pack position of elbow is roughly how many deg's of elbow flexion: - " for the knee 8) S3 heart sound is the hallmark of what: - Will someone with S3 get crackles/rales? - Do you have to stop exercise if you hear/suspect this 8A) Which of the following heart sounds heard in a 70-year-old adult MOST likely indicates ventricular failure? 1. S1 2. S2 3. S3 4. S4 8B) Could you hear S3 in children? - So a S4 sound is more indicative of ventricular or atrial failure? 9) Are wet-dry dressings used much in wound care. 10) Main difference between urge and overflow incontinence: 11) During weight bearing, initial compensation for fixed forefoot valgus is provided by - What is forefoot valgus - What is forefoot varus - So fixed forefoot varus (in weight bearing) is compensated how - Functional forefoot valgus is compensated how - Functional forefoot varus is compensated how 12) Which of the following research designs is LEAST valid and generalizable? 1. Small case series 2. Clinical case report 3. Clinical observation 4. Randomized controlled trial 13) What does a Heel rocker shoe do? - T or F: someone with ulcers on toes or metatarsal heads could use a heel rocker shoe - Could these same pt's use a post op shoe? Why or why not - What is a Heat-moldable healing shoe 14) If you had weak calfs (gastroc and soleus) how would that manifest during gait - So if someone had an anterior trunk lean during the foot flat (loading response) phase of gait, what muscle is weak? - Why would they do an anterior trunk lean 15) Will GERD feel like heart burn? - Will you have trouble swallowing with GERD? - Can running flare it up? WHy or why not 16) Cholelithiasis pain would be felt where 17) Exercised-induced asthma ... would it flare up / be worse / get exacerbated in cold or warm environments? - Would it flare up in dry or humid environments? 18) In a hiatal hernia, which structure becomes entrapped - What is it called when intestines are involved in a hernia 19) A 4-year-old child shows no interaction with peers and has increased sensitivity to sound and touch, and poor eye contact - this child probably has what condition - What is best intervention for them 20) If you did a SLR on a pt and wanted to INCREASE neural tension, would you abduct or adduct leg? - Would you ER or IR leg? - Would you DF or PF - Would you do cervical flex or ext

Answer 188

1) YES - Research says no - Research says no - Research says no 2) Overflow incontience 3) - Efficacy - Effectiveness - The effect size is the magnitude of the difference between two mean values. 4) - Intolerance to heat: hyper - Lethargy: hypo - Restlessness: hyper - Intolerance to cold: hypo - Diahrrea: hyper - Muscle wasting: hyper - Constipation: hypo - Muscle aches: hypo - Weight loss: hyper - Exophthalmos: hyper - Decreased appetite: hypo - Increased appetite: hyper - Irregular or heavy menses: Hypo - Amenorrhea: hyper 4A) Absense of menstration - a prefix is lack, so a-men is lacking men (no menstration) 5) It said 15-30 mins is time frame, so 20-30 mins is right answer 6) Similar, but with pronator, you'd get more elbow pain and less hand / median nerve into hand pain. - Max elbow flex with wrist ext to put ulnar nerve on stretch - Cubital tunnel syndrome 7) 70 ish - 25 ish 8) Cardiovascular pump failure - Yes - Yes 8A) S3 8B) Yes - common (and not pathological). In older pt's, it is a sign of ventricular failure. - Atrial 9) Not really. It is often uncomfortable for the patient, causing bleeding and trauma to the wound bed. There is considerable evidence that efficacy of wet-to-dry dressings has not been demonstrated. 10) Overflow is from bladder filling up and just can't contain urine. Urge is from overactivity and muscle spasm leads to leaking. Urge is involuntary leaking due to detrusser muscle activity. 11) Rearfoot supination - Think of the R foot, it is big toe down and pinky up - Think of the R foot, it is big toe up and pinky down - Rearfoot pronation - Tibial medial rotation - Tibial lateral rotation 12) Clinical observation - It goes expert opinion --> case report --> case series ... etc. But a clinical observation is something in preliminary that leads to doing research. 13) Puts weight on heel to take weight off metatarsal heads. - Yes - NO. It won't offload metatarsal heads. - The heat-moldable healing shoe can be molded directly to the shape of the patient's foot and is commonly used after amputation or skin grafting. This type of shoe does not alleviate weight-bearing on the metatarsal heads. 14) Inability / weakness in knee extension (think of muscle function in closed chain) - Quads - Because they are getting line of force in front of the knee to compensate for weak knee extensors 15) Yes - Yes - Yes, acid from stomach going up into esophogus 16) R upper gastric, R shoulder 17) Exercise-induced asthma or bronchospasm is exacerbated in COLD and DRY environments, not warm or humid environments. 18) Stomach bulges up through diaphragm (up into esophogus) - Femoral, inguinal, umbilical, incisional (post-surgery) 19) Autism - They will thrive in a highly structured, predictable environment 20) ADDuct - IR - DF - Flex

Question 189

1) Diaphoresis is what 2) Would palpitations be caused in atria or ventricles (usually) - So where on EKG would palpitations show up 3) If ST segment on EKG is elevated above normal = - If ST segment on EKG is depressed/lower than normal = - So if you see ST segment depression, it probably means what: 4) What is Polycythemia 5) What hematological condition is MOST likely to be found in a patient who has chronic kidney disease? 6) A patient underwent surgical repair of a superior labrum tear in the shoulder 1 week ago. Which of the following resisted motions should be AVOIDED during physical examination of the patient? 1. Forearm pronation 2. Forearm supination 3. Scapular retraction 4. Scapular protraction 7) From point above, why? 8) If you see hip lateral (external) rotation during the swing phase of gait, it indicates what: - Would L2 radiculopathy result in genu valgum? Why or why not? 9) If a pt has GBS, is it true that chances are they recently had an illness or infection? - When someone has MG (myasthenia gravis) what muscles are usually MOST effected? - Main 2 characteristics to remember about Polymyalgia rheumatica: 10) So what condition does this describe: An 82-year-old female patient has a sudden onset of muscle aching and stiffness. The patient reports fatiguing quickly and having difficulty ascending stairs. The patient denies recent illness or significant worsening of symptoms over the last week. The physical therapist notes an oral temperature of 99.9°F (38°C) 11) Damage to the upper trunk of the brachial plexus usually manifests how - Damage to the lateral cord of the brachial plexus would manifest how 12) What type of breathing is best to SLOW down the RR (if it is high, like 30) - Can you use an incentive spirometer to help someone with a HIGH RR 13) What really is this question below asking: Which of the following positions would be MOST appropriate for a patient who sustained burns to the axilla, elbow, and volar (palmar) surface of the hand? 1. Wrist in extension and digits in slight flexion 2. Elbow in slight flexion and forearm in supination 3. Shoulder in abduction and lateral (external) rotation 4. Shoulder in extension and lateral (external) rotation 14) If someone post stroke is demonstrating a pusher syndrome (lets say R brain so L hemipareisis) - do you provide pressure on L side or help them find midline 15) Pt's who are paraplegic will want to stretch or strengthen their trunk m's: - " their hamstring m's: 16) If someone had a positive sulcus sign, what is an intervention to do: 17) Which Pediatric assessment tool has a section for caregiver assistance assessment? - What does BOT stand for in BOT-2 pediatric test: 18) Would lymphedema, arterial insuff, or venous insuff pt's have more firm fibrotic legs/skin 19) Does the central or terminal tendon of the extensor digitorum insert at the PIP joint? 20) Fasciculations and fibrillations are more indicative of UMN or LMN lesions - Severe muscle atrophy " 21) What is Hypoproteinemia - What are normal levels of protiens ? - So if someone had 2g/dL - can you do compression pumps on them 22) A 3-month-old child has asymmetrical thigh folds, uneven knee heights, and asymmetrical hip abduction range of motion - has what condition - SCFE occurs in kids what age? - Legg-Calve Perth " - Hip dysplagia " - Osteochondritis dissecans " 23) Name the stage of the pressure injury described below: - Visibly exposed bone or tendon that is directly palpable - A shallow, open ulcer with a red wound bed without slough - Visible subcutaneous fat, but no visible bone or tendon

Answer 189

1) Excess sweating 2) Atria - Prior to R wave or QRS segment 3) Infarction - Ischemia - Angina 4) Bone marrow stem cells produce excessive red blood cells 5) Anemia 6) Forearm supination 7) Supination is done by biceps muscle and that attaches up in G/H joint on/near labrum. All other muscles don't attach on/near the labrum. 8) Weakness of hip flexors, so either pathology of iliopsoas or some L2 ish radiculopathy - No. Genu valgum is from glute med weakness, and those are innervated by L4-S1 9) TRUE - muscles of eye movement, chewing, swallowing, and facial expression. - HA's and vision issues 10) Polymyalgia rheumatica is a systemic rheumatic inflammatory disorder that is more prevalent in persons over age 80 years and more common in women. Typical clinical presentation includes muscle aching and stiffness, low-grade fever, weakness, fatigue, and malaise, as well as possible headache, weight loss, depression, or vision changes. It is not necessarily associated with a recent illness. (pp. 442-444) Normal oral temperature is 96.8°F to 99.5°F (36°F to 37.5°C). 11) Erb palsy - Effect the musculocutaneous and median nerves and the muscles innervated by them 12) Pursed lipped breathing / diaphragmatic - NO. Those are only used with post-op pt's who need help retraining how to breathe 13) Following a burn, you don't want to have contractures develop, so place extremities / joints in a position to avoid contractures. Thus, answer 3 is best answer cause you want wrist ext and finger ext, elbow ext, and shoulder abd. 14) Better to help them find midline and teach them how to do it and provide feedback when they do it right (if you just push, they learn nothing). 15) Strengthen core - Stretch HS's 16) RC muscle strengthening 17) PEDI - Pediatric Evaluation of Disability Inventory - Bruininks-Oseretsky Test of Motor Proficiency 18) Lymphedema 19) Central (terminal is at the DIP) 20) LMN - LMN 21) Hypoproteinemia is a condition where there is an abnormally low level of protein in the blood - The normal range for protein levels in blood serum is 6 to 8 grams per deciliter (g/dl). Of this, albumin makes up 3.5 to 5.0 g/dl, and the rest is total globulins - NO (contraindicated) 22) Hip dysplasia - 10-15 yrs old - 4 - 8 yrs old - Small infant - 12-20 yrs old 23) - Stage 4 - Stage 2 - Stage 3

Question 190

1) A physical therapist has prescribed an exercise program for a patient with bilateral knee pain and morbid obesity. Which of the following is the LEAST appropriate exercise for this patient? 1. Weight-lifting program 2. Step aerobics 3. Aquatic exercises 4. Stationary bicycling 2) The best way to assess sensation to see if there will be skin breakdown is: - Protective sensation in the foot is considered absent if an individual cannot feel the _____ monofilament 3) What is the orthodic intervention for forefoot valgus - Normal MTP extension of big toe is about how much passively - Why do you need good passive toe extension - If someone had 15 deg's of passive big toe ext, what orthodic should they get - If someone has rearfoot varus, what orthodic should they get? - If someone had rearfoot varus, will they have a pronated or supinated foot in WB'ing 4) Inferior glide of the hip promotes what motion? - Anterior glide " 5) We know functional incontinence could be due to having clutter in the way, or bathroom being locked, or whatever - but could it be due to a walker/crutches or inability to walk? - Developing a voiding schedule would be best for what type of incontience 6) If someone has a unilateral lesion of the semicircular canals on the right side, will they be unable to maintain a gaze on the right or left side? 7) An otherwise healthy patient has advanced osteoarthritis in the medial compartment of the right knee. Which of the following gait deviations is MOST likely to be observed during stance phase on the right lower extremity? 1. Left trunk lean 2. Right trunk lean 8) From question above - why 9) During a Dix-Hallpike, if you see UPbeating and to the right nystagmus, what canal is effected 10) A child who has a myelomeningocele at the T7 level has a new onset of vomiting, lethargy, irritability, headache, and increased seizure frequency. What is the MOST likely cause of these signs and symptoms? 1. Latex allergy 2. Tethered cord 3. Shunt dysfunction 4. Chiari II malformation 11) What is Chiari II malformation - So what is Myelomeningocele - So if it was at the T7 level, would it be Myelomeningocele or Chiari II Malformation? 12) Vertebral artery is most vulnerable / compressed with head in what position - True or false, flexion causes compression of vertebral artery? 13) A patient who had a total knee arthroplasty demonstrates 0° to 85° of active knee range of motion. The patient will likely have the MOST difficulty performing which of the following activities in a normal fashion? 1. Sitting down on a chair seat that is 18 inches (46 cm) high without using the hands 2. Tying shoelaces while sitting and bringing the foot up from the floor 14) What are pulmonary function tests (PFT's) 15) Why do you do an arterial blood gas test: - Would you do a graded or max exercise test for a cardiac or pulmonary patient 16) What does this describe: resting DIP flexion contracture due to a loss of active extension at the DIP joint. - What does this describe: A z-deformity of the hand - ": ulnar drift, swan or boutineere deformity - " : PIP hyperextension and slight flexion of the DIP (swan-neck deformity of the fingers) - A ________ can cause the central slip to be torn and result in a boutonnière deformity, which presents as PIP joint flexion and DIP joint hyperextension 17) During normal muscle contraction or typical physiological processes, what muscle fibers are activated first: - During normal muscle contraction or typical physiological processes, what nerve fibers are activated first: - During e-stim for a muscle contraction, what nerve fibers are activated first: 18) Articular pillars of c-spine are what - A patient has restricted left rotation at the C5–C6 level. When performing a unilateral posterior-anterior joint mobilization, placement of the physical therapist's hand at which of the following locations is MOST likely to increase left rotation? - So hand placement on posterior articular pillar of C6 would mobilize what joint - So hand placement on posterior articular pillar of C5 would mobilize what joint 19) A patient who has Bell palsy would benefit MOST from strengthening of which of the following muscles? 1. Masseter 2. Temporalis 3. Lateral pterygoid 4. Frontalis 20) MUST remember how to MMT and thus grade the gastroc/soleus muscle. - What is a 1/5 (trace): - What is a 2/5 (poor): - What is a 3/5 (fair): - What is a 4/5 (good): - What is a 5/5 (normal):

Answer 190

1) Step aerobics - Obese people are more prone to OA due to weight/stress on joints. Step aerobics is the highest impact activity on that list. 2) Monofilament (touch pressure) - 5.07 3) Lateral forefoot posting - 60-90 deg's - For toe off during gait - Metatarsal bar - Medial rearfoot posting - Pronated 4) Flexion - Extension & ER 5) YES - Urge 6) Right. A patient who has a unilateral lesion or a pathological condition of the central vestibular neurons will not be able to maintain gaze when the head is rotated quickly toward the side of the lesion. 7) Right trunk lean 8) Right will put stress on LATERAL side of the hurt knee, causing a genu valgus at the knee, which OFF-LOADS stress on medial portion of knee. If they leaned left, more weight/stress is on medial comparment. 9) Right Posterior canal 10) Shunt dysfunction - At least 85% of children who have myelomeningocele have hydrocephalus, and 80% to 90% will require a shunt, especially those with high-level lesions. Shunt dysfunction is common, and therapists should be familiar with signs and symptoms for early detection 11) A condition in which brain tissue extends into the spinal canal, present at birth. - A birth defect in which the backbone and spinal canal do not close before birth. The condition is a type of spina bifida - Myelomeningocele 12) The R vertebral artery is MOST compressed with contralateral (left) head rotation and L lateral flexion with extension of head. And traction added makes it even worse. - False. Flexion causes slack 13) 18 inches for chair height is pretty standard. But to get knee up to tie shoes requires over 100 deg's of knee flexion. 14) Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders. - Pulmonary function testing, i.e., spirometry, is used to diagnose and monitor the progression of chronic obstructive lung disease. Pulmonary function testing provides information regarding the volume of air the lung contains and information on the different lung capacities. Two forced spirometry measures that can be followed over time include forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC); the ratio of these values decreases as the severity of lung obstruction increases. 15) assessment of acid-base balance, ventilation, and oxygenation - Cardiac pt's do exercise tests, whereas pulmonary pt's do PFT's 16) Mallet finger - RA - RA - Flexor digitorum superficialis paralysis - middle phalanx dislocation 17) Type I (slow oxidative) - Small A-delta - Large nerve fibers 18) Lateral edges of c-spine - R posterior articular pillar of C5 - C6-C7 - C5-C6 19) Muscles of mastication (temporalis included) are innervated by CN V (trigeminal). Thus strengthening those m's will have NO effect on Bells Palsy, which is paralysis of CN VII (facial nerve muscles) 20) - 1/5 (trace): palpated muscle contraction - 2/5 (poor): In prone / sidelying position (gravity eliminated) and can do AROM / PF - 3/5 (fair): Perform 1 heel raise in standing against gravity - 4/5 (good): Pt can do between 2 and 24 heel raises - 5/5 (normal): Pt can do 25+ heel raises

Question 191

1) Percussion of a patient's kidney elicits a dull or thud-like sound with the absence of pain - what does that mean - If there was pain during this test, it would mean what: 2) If someone had a nasoenteric tube, what position would you avoid - If someone had a PICC or periperal catheter, what position would you avoid - Are IV's sensitive to height? 3) Most pt's with low back pain from spinal stenosis have pain come on from acute injury or insidious onset? - Most pt's with low back pain from disc issue have pain come on from acute injury or insidious onset? - If a SLR recreates pain, would that be from a lateral disc bulge or central disc bulge 4) What stage of lymphedema do you start to see a positive stemmer's sign - When do you start to see tissue hardening / fibrosis / indurated of LE's with lymphedema pt's - Decreased limb swelling with elevation is what stage of lymphedema 5) Compression of the _________ nerve results in the inability to make the 'OK" sign with the thumb and index finger - Would compression of this nerve have any sensory deficits - Compression of the _______ nerve will result in inability to extend the wrist and thumb - _________ will result in a loss of grip power and dexterity 6) If a kyphoplasty surgery is performed, it most likely is performed why? - Why would someone get a spinal fusion - Why is a laminectomy performed 7) What is a prone stander - What population is it usually used for - What must a PT remember about orientation to gravity with these pt's 8) What is alveolar ventilation: - What test will determin alveolar ventilation - What is Inspiratory capacity - How is inspiratory capacity measured: - What is minute ventilation: - What is Total Lung Capacity: - HOw is total lung capacity measured: 9) A 70-year-old patient in a skilled nursing facility is noted to be confused and disoriented. The patient did not exhibit these symptoms a day earlier. Which of the following conditions is the MOST likely cause of these symptoms? 1. Myocardial infarction 2. Irritable bowel syndrome 3. Emphysema 4. Urinary tract infection (UTI) 10) Is Whirpool a form of debridement? - Is it selective or non-selective? - An ABI of 0.4 suggest what - What is the treatment approach for that ABI reading - When do you refer to vascular specialist - What ABI value would you NOT do compression (meaning above this amount you are ok to do compression) 11) Serum bilirubin test is for what - Creatinine clearance is a measure of ______ (what organ) function 12) How would you differentiate between internal and external validity: 13) If someone has severe kidney failure, do NOT do this intervention 14) In the brain the more anterior homonculus or gyrus is for motor or sensory 15) Anterior pelvic tilt could be from what muscles being tight/short - Posterior pelvic tilt " - Are the ASIS or PSIS's higher - From point above, normal pelvic angle is roughly 16) What gland has most effect on metabolism - What gland has most effect on nervous system 17) Alpha 1 agonist meds do what: - Alpha 1 antagonist meds do what: - Beta 1 agonist meds do what: - Beta 1 antagonist meds do what: - Beta 2 agonist meds do what: - Epinephrine and norepinephrine do what - BEST WAY TO REMEMBER WHAT AGONISTs do - Will BP increase or decrease with epinephrine - Beta 2 agonist med is: - Beta 1 antagonist med is - Beta 1 antagonist meds are called: - What do these meds (from point above) do: 18) What do ACE Inhibitors do: - Will they impact the HR 19) If someone had PAIN, what grade mobs would you do? - If someone had limited mobility, what grade mobs would you do? 20) What is open pack position for the radio-humeral jt - What is open pack position for proximal radio-ulnar joint - What is open pack position for the ulno-humeral jt

Answer 191

1) Pt's kidney's are healthy (normal) - Kidneys are inflammed or distended 2) Laying supine or trendelenberg where pt could aspirate - Blood pressure cuff on that side, axillary crutches on that side - YES 3) Insidious - Acute - Lateral 4) Stage 2 - Stage 2 - Stage 1 5) anterior interosseus (NOT median) - NO (but Median has sensory / paresthesia deficits) - posterior interosseous - Cubital tunnel syndrome 6) Pt has a vertebral compression fracture, or scheurmann's or some condition - Unstable spinal segments / arthritis - Disk protrusion or spinal stenosis 7) Stapped into a standing frame but leaned forward (prone) to do homework, art work, tablet, etc. - Pediatrics - It can effect tone or spasticity 8) Refers to the volume of air that participates in gas exchange - Arterial Blood gas test - Insp. Cap: Inspiratory capacity refers to the largest volume of air that can be inspired in one breath from the resting expiratory level - Incentive spirometer - Min Vent: Minute ventilation refers to the total volume of air inspired or expired in 1 minute - The total lung capacity refers to the volume of air contained in the lung at the end of maximal inspiration - Special equiptment (done rarely) 9) UTI - A change in mental status, such as confusion and disorientation, is a potential symptom of a urinary tract infection 10) YES - Non-selective - Severe arterial insuff. - Refer to vascular specialist ASAP - ABI lower than 0.5 - Below a 0.6 11) Test for liver function - Kidney 12) Internal: Internal validity is the degree to which a change in the outcome can be attributed to the experimental intervention rather than extraneous factors - External: External validity (applicability/ generalizability) is the degree to which results can be applied to other individuals and circumstances. 13) Aquatic therapy 14) Front / Anterior is motor, posterior is sensory 15) Hip flexors - Hamstrings - PSIS's are slightly higher - 30 deg's (with PSIS higher) 16) Thyroid - Adrenal (epinephrine) 17) Alpha 1 agonist: arteries constrict - Alpha 1 antagonist: arteries dilate - Beta 1 agonist: Increase HR - Beta 1 antagonist: decrease HR - Beta 2 agonist: Broncho dilate - Activate (act as an agonist) for alpha 1, Beta 1, and Beta 2 receptors - Sympathetic response: constrict arteries, increase HR, open airways - Increase - Albuterol - Propranolol - Beta blockers - They decrease HR , decrease BP, and help you breathe 18) Decrease BP - NO 19) Grade 1 or 2 - Grade 3 or 4 20) Full supination and full elbow extension - 35° of supination and 70° of elbow flexion - 10° of supination and 70° of elbow flexion

Question 192

1) If someone had a 5-10 deg plantarflexor contracture, how would it manifest during gait 2) Muscle cramping, lethargy, and elevated blood glucose levels (300+) are signs of what condition: - What is the action to take as a PT if this happens? 3) A SPRINGY end feel of the knee is most likely from what: - A BOGGY end feel of the knee is most likely from whay: - What end feel would you get from true PFPS 4) Is strength effected in a LE of a pt with lymphedema? - Is sensation " 5) A patient who has been burned has lost the ability to detect light touch, temperature, and sharp/dull sensations. Vibration and pressure sensation are intact. Based on the sensory findings, what is the MOST likely classification of the burn? 1. Epidermal 2. Superficial partial-thickness 3. Deep partial-thickness 4. Full-thickness 6) From point above, how do you differentiate between deep partial thickness and full-thickness burns as far as sensation - So what are the deep receptors - MOST pain from burns are from what degree of burn 7) A MID-shaft fracture of the humerus will impact what nerve (and thus all m's associated with that nerve) - A DISTAL fracture of the humerus " 8) A 78-year-old patient who is being treated for osteoarthritis of the knees reports centralized lower thoracic pain and epigastric pain. The pain is relieved by eating. Which of the following steps would be MOST important in screening for the cause of the new symptoms? 1. Resist the iliopsoas muscle to screen for a psoas abscess. 2. Ask if the patient has been constipated or has had diarrhea. 3. Perform an abdominal examination to screen for an abdominal aortic aneurysm. 4. Ask if the patient is taking a high dose of nonsteroidal antiinflammatory drugs. 9) What nerve innervates the pelvic floor m's 10) A patient's impaired ability to evert and plantar flex the foot at heel off (terminal stance) indicates issues with what nerve: 11) If a pt tests positive on Hawkin's kennedy and painful arc, then interventions need to stay below what: 12) Someone with asthma will have what sound on auscultation - Another description for wheezes - Crackles / rales (bubbling) is often heard in pt's with: 13) What is the progression of treatments for pt's with lymphedema 14) Do you use long stretch bandages with lymphedema pt's - Do you use pneumatic compression pump with lymphedema pt's 15) What is Ménière disease - How to remember? 16) If someone has excessive THIRST, chances are high that they have what condition: - Someone with heat intolerance most likely has what condition - So someone with cold intolerance has what condition - What is excessive thirst called: 17) On a graph how would the line look where 2 variables have a high positive correlation? - On a graph how would the line look where 2 variables have a high negative correlation? 18) What does this describe: A patient has a raised area of skin with black coloration, regular borders, and a diameter of 0.12 inch - What is this? - So skin marks that are larger than 0.25 inches, discolored/dark, or have irregular borders usually indicate what 19) What would cause a Left tracheal deviation: - What would cause a Right tracheal deviation: - So L pulmonary fibrosis would cause trachea to deviate to what side: - So R pleural effusion would " - R atelectasis would " - R pneumoectomy would " 20) On the CTSIB: - If you are VISUALLY DEPENDENT, what conditions would be impacted/impaired: - If you are SOMATOSENSORY INPUT DEPENDENT, what conditions would be impacted/impaired: - If you are VESTIBULAR INPUT DEPENDENT, what conditions would be impacted/impaired:

Answer 192

1) Early heel off, and forced knee extension (think of what would happen in open chain and closed chain) 2) diabetic ketoacidosis - Refer to physician immediately 3) Meniscus pathology - Fluid or blood in joint (joint effusion - hemiarthrosis) - Empty (or pain) 4) No - NO 5) Deep partial-thickness 6) Deep partial-thickness burn would include damage through the epidermis and the papillary layer of the dermis but the deep reticular layer of the dermis that holds the Pacinian corpuscles would be intact. Damage to the epidermis and papillary layer of the dermis would destroy the sensory receptors for pain, itch, superficial touch, warmth, and cold but would spare the sensory receptors for vibration and pressure, which are located deeper in the reticular dermis - Full-thickness burn the epidermis and dermis layers are destroyed, and there is some damage to the subcutaneous fat layer. All nerve endings will be destroyed and the burn will be insensate - Vibration and pressure - Superficial / epidermal or superficial partial thickness 7) Mid: Radial - Distal: ulnar and median 8) Ask if the patient is taking a high dose of nonsteroidal antiinflammatory drugs. - A high percentage of hospitalizations of the aging population who have gastrointestinal problems are due to the effects of nonsteroidal antiinflammatory drugs. This patient may be taking this class of drugs for the pain and inflammation in the knees. Because the pain changes with food intake, the gastric region as a source is implicated. 9) Pudendal 10) superficial fibular (peroneal) nerve 11) Below 90 deg's - don't do arm elevation exercises past 90 deg's at first. 12) Wheezes - Whistling sound - CHF 13) Exercise/Elevation and short-stretch bandages at night - Manual lymph drainage with short stretch compression bandages - Then move to compression garments (35 ish mmHg) during day, and short stretch bandages at night 14) NO - These may have a potential role in the treatment of lymphedema, there is no strong evidence that they are more effective than the use of short-stretch compression bandage 15) Ménière's disease is an inner-ear condition that can cause vertigo, a specific type of dizziness in which you feel as though you're spinning. It also can cause ringing in your ear (tinnitus), hearing loss that comes and goes, and a feeling of fullness or pressure in your ear. Usually, only one ear is affected - MenEAR 16) DM II and are in hyperglycemia - Obesity or hyperthyroidism (Graves) - Hypothyroidism - Polydipsia 17) Line slopes up to right - Line slopes down to right 18) Nevus - A mole - Cancer 19) Tension pneumothorax or R sided pleural effusion, left atelectasis - R atelectasis, L pleural effusion, L tension pneumothorax - Left - Left - Right - Right 20) - 2, 3, 5, 6 - 4,5,6 - 5,6

Question 193

1) When leaning on axillary crutches, you most likely would cause damage to what nerve? - So using crutches for long time would cause what m's to become weak 2) Which of the following types of burns is characterized by visible skin blistering? 1. Superficial 2. Partial-thickness 3. Full-thickness 4. Subdermal 3) From point above, what level of burn is this describing: - sunburn which causes red and inflamed tissue - involve damage to the epidermis, dermis, and subcutaneous tissue. Due to the extensive tissue damage to the dermis and subcutaneous tissue, there is no blister formation, because all of the moisture has been burnt out of the tissue, resulting in eschar formation. - involves complete destruction of all tissue from the epidermis down to and through the subcutaneous tissue down to bone/tendon - involve damage of the epidermis as well as the dermis. Damage to the papillary layer of the dermis creates weeping of the wound, resulting in blister formation. 4) A patient who has peripheral arterial disease has an intact integument in the lower extremities. The patient reports posterior lower leg pain during walking but denies pain at rest. Which of the following ankle-brachial index values is MOST likely to be associated with these findings? 1. 0.3 2. 0.5 3. 0.8 4. 1.2 5) MUST know this info related to point above: 1. An ankle-brachial index (ABI) of 0.3 is considered an indication of severe ischemia in which pain will be present at rest. 2. An ABI of 0.5 indicates the presence of moderate peripheral arterial disease and is typically associated with lower extremity pain with walking and at rest. 3. An ABI of 0.8 is indicative of mild peripheral arterial disease and is typically associated with some form of intermittent claudication with walking but not at rest. 4. An ABI between 1.0 and 1.3 is considered normal, and patients who have an ABI in this range would be expected to be asymptomatic. 6) If someone has HIGH tone, what are some techniques you can do to help decrease high tone: - What could you do to increase tone when someone is flacid and has poor posture / low tone: 7) Can a complete level A SCI pt at C5 help with a slide board transfer? - What will someone with a C4 SCI need help with 8) Reiter syndrome and Psoriatic arthritis are both in the arthritis family. How do you tell them apart? 9) The syndesmosis squeeze test is also called: - It rules in what injury - What other tests will do this - What is fibular translation test 10) This patient most likely has what condition: A 65-year-old sedentary female patient is referred for an aerobic exercise program. She has a thin, small body frame and reports occasional stiffness in her hands that only lasts for a few seconds - BEST interventions for these pt's is: 11) Asterixis is what: - What is it caused by: 12) Would you get nausea and vomitting with Peptic Ulcers? - Would you with GERD? - What meds increase risk of getting peptic ulcers? - What is a common NSAID 13) Would hyperthyroidsim (Graves) be associated with a larger or smaller goiter? - Would " have heat intolerance or cold intolerance - Would " be associated with heavy menstration of abscent menstration - From point above - this is called: 14) If "Huffing" is given as an intervention, why? 15) If you have an acute injury, would you use ice or heat first typically? 16) What is the Liberatory maneuver - What is it for 17) What is joint approximation technique, and what/who is it used for: 18) Papillomas and hyperkeratosis are common dermal abnormalities that occur in the presence of chronic _________ 19) MUST review below the different arteries involved in a stroke/CVA and how they'd manifest: 1. Vertebral (basilar) arteries supply the brainstem and cerebellum. Lesions of these arteries usually manifest as unilateral or BILATERAL weakness of extremities and loss of vibratory sense, two-point discrimination, and position sense. Diplopia, homonymous hemianopsia, dysphagia, dysarthria, nausea, and confusion may also occur. 2. The anterior cerebral artery supplies the superior surfaces of frontal and parietal lobes and the medial surfaces of the cerebral hemispheres, which control the motor and somesthetic cortex serving the legs. The frontal lobe controls the personality; since personality changes are not mentioned, this artery is not likely to be affected. Also, lesions of this artery are most likely to produce hemiparesis or hemiplegia, not bilateral weakness. 3. The middle cerebral artery supplies the frontal lobe, parietal lobe, and cortical surfaces of the temporal lobe and, therefore, affects higher cerebral processes of communication, language interpretation, and interpretation of space, sensation, form, and voluntary movement. Lesions of this artery are most likely to manifest as alterations in communication, cognition, mobility, and sensation. Contralateral hemianopsia and hemiplegia (greater in the face and arm rather than leg) is also likely to be observed. Also, lesions of this artery are most likely to produce hemiparesis or hemiplegia, not bilateral weakness. 4. The posterior cerebral artery supplies the medial and inferior temporal lobes, medial occipital lobe, thalamus, posterior hypothalamus, and visual receptive area. Lesions of this artery are most likely to manifest as contralateral hemiplegia (greater in the face and arm than in the leg), not bilateral weakness, ataxia/tremor, homonymous hemianopsia, cortical blindness, receptive aphasia, and memory deficits. Since ataxia and tremors are not mentioned as the presenting symptoms, this artery is not likely to be affected.

Answer 193

1) Radial - Any innervated by the Radial nerve. 2) Partial-thickness 3) - Superficial / Epidermal - Full thickness - Subdermal - Partial thickness 4) 0.8 5) OK 6) Pressure on skin, vibration, rhythmic rocking - Joint approximation 7) Yes, with assistance. They still have use of: deltoids, biceps, and rhomboids - Basically will be dependent for all movements/transfers 8) They both will NOT have RA factors in the blood. - Reiter: presents with asymmetrical extremity arthritis, conjunctivitis, and urethritis - Psoriatic: characterized by scaly, red patches on the skin 9) Distal tibiofibular compression test - High ankle sprain - Kleiger or Lateral Rotation, and Fibular Translation Test - An ant-post mob of distal fibular to rule in a high ankle / syndesmosis sprain 10) Osteoporosis - Weight bearing and resistance exercise 11) Flapping tremor of hand when wrist is extended - Hepatic / liver issues 12) YES - NO - NSAID's - Ibuprofin/motrin 13) Larger - Heat - Absent - Amenorrhea 14) Huffing is a mechanism used to move mucus into large airways in order to produce an effective cough 15) Ice, to help with inflammation 16) Semont manuever - BPPV, for Posterior canal ... same as Eppley, but done more if there is cupulolithiasis 17) Some techniques used in the treatment of children with hypotonia include joint compression that is graded to approximate the joints without overloading them 18) lymphedema 19) OK

Question 194

1) Central cord syndrome is caused by what type of injury? 2) Normal diastolic pulmonary arterial pressure ranges from ____ to _____ mmHg - What is a low amount: 3) The detrusor muscle should be relaxed or inhibited in patients who have ____ incontinence. - Increased scheduling of voiding will help those with _____ incontinence 4) What is Arthrogryposis 5) Stemmer's sign is the ability or inability to pinch/tent skin on dorsum of foot - What stage of lymphedema would you find a Stemmer's sign 6) It said that Collagen dressings are high or low absorbers 7) Having a foley cathetor can result in what condition developing - Main s/s of this condition above - Would insulin shock cause hunger or lack of appetite 8) Mixed red-white coloring is indicative of what burn - Intact blisters " - Eschar " - Marked edema and broken blisters " 9) History of corticosteroid use is a risk factor for: - FAI of the hip typically happens in people age: 10) A Proximal Tibiofibular posterior glide mobilization will help increase what motion: - A Proximal Tibiofibular anterior glide mobilization will help increase what motion: 11) Jaundice, darkened urine, and ascites are all clinical signs of _____ disease - Does Asterixis relate to the liver? 12) What is a pronator drift 13) When you see ammonia, think of what organ 14) Distal Tibio-Fibular Joint Mobs: - Anterior force helps what motion at ankle - Posterior force helps what motion at ankle 15) Should you get an X-ray or MRI first? 16) Would atelectasis cause increased or decreased fremitus? - WOuld pulmonary effusion " - Would consolidation " - WOuld pulmonary edema " 17) Are gloves required for droplet precautions? 18) If a pt sustained substantial burns, would their oxygen consumption go up or down - Would their core temperature go up or down - WOuld their intravascular fluids go up or down - Would their minute ventilation go up or down 19) Would you hear crackles/rales in impaired secretion clearnace? - Would you " with pleural effusion? 20) "Ulnar Drift" in RA means what ... what is happening in hand joints

Answer 194

1) Hyperextension 2) 5 to 15 mm Hg - A measure of 3 mm Hg is pathologically low and may indicate unstable hemodynamic status, which is a relative contraindication for percussion 3) urge - urge 4) Congenital joint contracture in two or more areas of the body 5) INability to pinch a fold of skin over the dorsum of the foot - Stage 2 or Stage 3 lymphedema 6) High 7) Sepsis - Fever and confusion - Insulin shock would cause hunger, not a decline in appetite 8) Deep partial thickness - Superficial partial thickness - Full thickness - Deep partial thickness 9) osteonecrosis - Middle aged 10) Knee extension - Knee flexion 11) Liver - Asterixis, or liver flap / hand tremor, is also likely to be present as a result of ammonia imbalance, which causes this neurologic symptom 12) A neurological finding ... ask pt to extend and pronate both arms, and they won't be able to on one side. 13) Liver 14) - Ant: PF - Post: DF 15) X-ray 16) Increased - Decreased - Increased - Increased 17) No 18) Up - Up - Down - Up 19) Yes - No (you'd hear friction rub) 20) RADIAL deviation at radio-carpal joint, and ULNAR deviation of fingers

Question 195

1) Would you do circumferential or volumetric measurements on the knee 2) If you have full PROM and limited AROM, what test will help rule in pathology 3) If someone has diminished hip IR and excessive hip ER, they have what: - If someone has diminished ER and excessive IR of the hip, they have what: 4) A physical therapist works with a patient who experiences hyperfunction of the parathyroid glands secondary to a tumor. This condition would MOST likely contribute to the development of: 1. cardiac arrhythmias 2. osteopenia 3. muscle spasms 4. obesity 5) From point above - why? 6) Following Massectomy, would someone get dermatitis or cellulitis more? 7) Is intermittent claudication a contraindication to using compression? - Is pulmonary edema a contraindication to using compression? 8) For a transtibial amputee with a patellar bearing prosthesis, if there is redness around patellar tendon, is that a concern - Where are areas of concern with redness over skin wearing a prosthesis - So would distal anterior tibia or lateral fibula be more concerning to see redness 9) Is supine or reverse trendelenberg position better for diaphragmatic breathing 10) Barbiturate meds help with what 11) If a pt reports buttocks pain and lateral hip pain, would it be more trochanteric bursitis, or piriformis syndrome 12) Is light touch with a feather / cotton ball a SUPERFICIAL reflex? - What is a superficial reflex - Examples include 13) Pallor, cyanosis, and cool skin is probably a sign of what 14) Would you do a 4-point or a 3-point gait pattern with someone following surgery who has PWB restrictions 15) Why would someone get a plastic articulating AFO vs. a metal upright AFO 16) Would someone with malabsorption syndrome be at risk for immunosuppression and risk for infection 17) If someone has trouble or is a fall risk due to lighting at night, is it better to use DIFFUSE or DIM lighting?

Answer 195

1) Circumferential 2) MMT 3) Hip retroversion - Hip anteversion 4) osteopenia 5) Hyperparathyroidism results in DEmineralization of bone due to increased PTH and loss of bone density 6) Cellulitis 7) No, unless really really low ABI below 0.6 - YES - don't push extra fluid back to heart 8) NO, not a huge concern - Bony prominences - Anterior tib due to much less subcutaneous tissue in that area 9) Reverse trendelenberg due to gravity pulling abdominal contents down 10) Reduce seizures and calm nervous system 11) Trochanteric bursitis ... piriformis would have sciatia symptoms down posterior leg 12) NO - Motor response to scraping skin - Abdominal, cremaster, plantar 13) Anemia 14) 3-point (4 point requires more than PWB'ing) 15) Plastic would be for a pt with intact sensation and no tone issues. Metal would be for someone with sensation deficits and tone issues. 16) YES 17) Diffuse

Question 196

1) A nurse caring for a patient who is 2 days post cerebrovascular accident asks the physical therapist for positioning recommendations when the patient lies on the hemiplegic side. The therapist's recommendations should include positioning the: 1. wrist in a flexed position. 2. elbow in a flexed position. 3. scapula in a protracted position. 4. forearm in a pronated position. 2) When evaluating the lower extremity muscle strength of a patient, the physical therapist positions the patient prone with the knee flexed. The therapist asks the patient to point the toes upward toward the ceiling. The patient completes the motion, but inverts the foot slightly. This observation indicates: 1. tightness of the fibularis (peroneal) muscles. 2. substitution by the soleus. 3. substitution by the tibialis posterior. 4. tightness of the tibialis anterior. 3) If a patient has orthostatic hypotension, what can you do to help with this before they move/stand - Would looser clothing or tighter clothing (socks) help with orthostatic hypotension - Will elevating the head help in a hypotensive episode 4) What is heterotopic ossification - What are BEST interventions for this condition: 5) Will someone with intermittent claudication have sensory loss/paresthesia - Would peripheral vascular disease cause sensory changes - Would peripheral vascular disease cause reflex changes - A stocking-and-glove distribution of sensory impairment and distal/peripheral loss of motor function are classic signs of _____________ 6) Is there a difference between a power tilt and a power recline w/c - Which one is better to CONTROL spasticity? 7) BEST way for a cardiac patient to assess their exertion or graded test? 8) What would highest level of ambulation be for someone with a thoracic SCI or child with myelomeningocele? - What would be the highest level of ambulation be for a L1-L2 level " 9) For the question below .... what is the ORDER of what you should do first to last? A physical therapist is preparing to change a dressing on a patient who has a large, draining wound. To prevent infection and contamination, the therapist should FIRST: 1. perform hand washing. 2. don a mask. 3. don a sterile gown. 4. wear sterile gloves. 10) Pain from Crohn's disease is relieved by doing what - Where can Crohn's disease refer pain 11) What is Pyelonephritis 12) You know pulmonary fibrosis and anorexia has been associated with digital clubbing - but what else causes clubbing of fingers? 13) A physical therapist is treating a patient with biofeedback to alter the overactivity of the upper trapezius during shoulder flexion. The patient has improved by 50% but continues to inappropriately recruit the upper trapezius muscle. Which of the following courses of action for biofeedback should the therapist take NEXT? 1. Decrease the sensitivity (gain). 2. Increase the sensitivity (gain). 3. Maintain the same sensitivity (gain). 4. Modify the sensitivity (gain) until visible motor contraction is reached. 14) Percussion over the costovertebral angle is called _________ test - This is a test for what: 15) In a study of changes in muscle strength, several physical therapists performed manual muscle tests on volunteer subjects. The results of the tests are BEST categorized as which of the following types of data? 1. Reliable data 2. Ratio data 3. Interval data 4. Ordinal data 16) We think of Dysdiadochokinesia as rapidly alternating movements - but what is another example of this: 17) If someone had a lesion at the brachial plexus region, will cervical motions provoke pain and symptoms? 18) How do you differentiate whether it is a cervical radiculopathy vs. a cervical myelopathy? 18A) So if cervical extension causes pain along the medial border of the forearm, would this be a C8 nerve root issue or ulnar nerve? 19) We know that MLD (manual lymph drainage) is performed proximal to distal with lymphedema pt's, but does this principle apply to EXERCISES in a lymphedema pt who is doing exercise to remove excess fluid? - Give an example 20) What is an APGAR score: - What does it access: - Best possible score you can get:

Answer 196

1) scapula in a protracted position. - Wrist should be in neutral, elbow extended, and forearm supinated - with scapula protracted 2) substitution by the tibialis posterior. - Normally the gastroc and soleus do the main part of PF, but if there is slight inversion, then the post tib is helping. If ant tib was tight, you'd get less PF 3) Ankle pumps - Tighter helps - No (not elevating head, or head of the bed will NOT help) 4) Abnormal bone growth within muscle - GENTLE STRETCHING! Maintaining available range of motion, avoiding "vigorous" stretching. 5) NO - NO - NO - Peripheral neuropathy 6) Power tilt is entire body tilts. Power recline is your back reclines - Power tilt (with power recline, it puts them in full extension which could trigger spasticity). 7) Rate of perceived exertion 8) A Thoracic level would NOT be able to walk at all - A L1/L2 level would be expected to walk, but may need a KAFO since they have use of their hips. ``` 9) 1 first (wash hands) 2 don mask 3 don gown 4 wear sterile gloves ``` 10) Passing gas - Pelvis and hip 11) Kidney infection (nephr ... itis) 12) Severe clubbing of the nails is an abnormality associated with LUNG CANCER and chronic HYPOXIA. 13) Increase the sensitivity (gain). - The purpose is NOT to get the traps to help with shoulder flexion, so increasing sensitivity on traps is to shut traps off to not help recruit. The same sensitivity would not be as effective. The patient has already learned to decrease recruitment of the upper trapezius by 50%; therefore, to continue toward the goal of "completely training out" this recruitment, the sensitivity should be increased. With increased sensitivity, the patient will work "harder" to not recruit the muscle (inhibition). The patient is attempting to learn how to decrease muscle firing/motor unit activity during voluntary movement. 14) Murphy test - is a sign of a kidney disorder 15) Ordinal data - Manual muscle test scores do not provide known or equal distances between scores, nor do they provide an absolute 0, so cannot be considered ratio data. - Manual muscle tests scores are considered ordinal because they label strength measures in rank order but do not provide known or equal distances between the scores. 16) Increased typing speed, playing piano (hands do alternating unsimilar mvmts) 17) NO 18) Cervical radiculopathy (injury to the nerve root) presents with unilateral motor and sensory symptoms into the upper limb, with muscle weakness in the myotome, sensory alteration in the dermatome, and reflex hypoactivity. AND NECK MOTION will recreate symptoms (especially extension, rotation and lateral flexion to that side) - Cervical myelopathy (injury to the spinal cord itself) presents with spastic weakness, paresthesia, and possible incoordination in one or both lower limbs, and well as SPHINCTER dysfunction. 18A) C8. Cervical motions that reproduce pain mean issues is at nerve root, not at peripheral nerve. 19) YES - You'd do shoulder exercises, then elbow, then wrist, then finger exercises (in that order) help with lymph drainage 20) A score given to brand new infant newborns right after they are born. A test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. The test is usually given twice: once at 1 minute after birth, and again at 5 minutes after birth. - A: Appearance - P: Pulse - G: Grimmace/Reflex - A: Activity/Tone - R: Respiration A newborn's Apgar score is based on these five parameters: heart rate, color, respiration, muscle tone, and reflex irritability. - A 10. You get 2 points if everything is ideal in each of the 5 categories. A 0 for each of the 5 basically means death. Higher the better.

Question 197

1) Which of the following strategies is MOST effective for helping a patient with limited recall learn to do three exercises independently? 1. Allow the patient to perform the exercises through a partial range of motion. 2. Have the patient complete the exercises in a group setting. 3. Decrease the goal to one exercise done with supervision. 4. Gradually reduce the number of verbal cues. 2) What must you think when you see Vitamin D 3) What is easier to aspirate - food or liquids? - So to help prevent aspiration, what can you do: 4) What would be LESS theraputic: pulse mode or continuous mode - So if you are doing ultrasound and someone feels burning, should you reduce pulse mode or intensity? 5) Will anterior or posterior pelvic tilts help strengthen abdominal m's 6) A good intervention (after Eppley manuever) for pt's with vestibular dysfunction is: 7) When a stationary exercise bicycle is used to emphasize strengthening a weak hamstring muscle, which modification to the equipment should be made? 1. Install toe clips on the pedals. 2. Increase the flywheel resistance. 3. Raise the handlebars. 4. Tilt the seat forward. 8) From point above - why? - What would raising the handlebars do? 9) A patient with multiple sclerosis wants to transfer independently. The patient progressed from moderate to minimal assistance for transfers within 3 days; however, no progress has been made in the past 2 weeks. The physical therapist should: 1. discharge the patient without further intervention. 2. provide the patient with a home program and re-evaluate in 1 month 3. increase the patient's treatments to 5 times/week for 2 weeks. 4. decrease the patient's treatments to 1 time/week until the goal is achieved. 10) Why from point above 11) A prosthetic foot that is too far posteriorly set would cause - A prosthetic foot that is too far medially inset would cause 12) Which one from below would result in muscle weakness but NO pain when doing a MMT to the supraspinatus muscle - Deltoid tendinitis - Suprascapular nerve injury - Subacromial bursitis - Supraspinatus tendinits 13) A patient has recurrent lateral patellar subluxations. While testing the patient's patellar mobility, the physical therapist notes that the apex of the patella rotates medially during a passive medial patellar glide. Which of the following structures around the patella are tight? 1. Superolateral 2. Superomedial 3. Inferolateral 4. Inferomedial 14) From point above: why 15) If a patient is using crutches and you are guarding them - where should your hands be: 16) If somone describes their pain as "Agonizing" it probably means more of the pain is from what: 17) A child with myelomeningocele and a history of hydrocephalus begins to exhibit irritability, lethargy, and vomiting. What are they experiencing - s/s of a tethered cord would be: - s/s of a UTI include: - s/s of Arnold Chairi: 18) A patient with relapsing-remitting multiple sclerosis will MOST likely experience which of the following over time? 1. Continuous and steady decline, followed by a plateau 2. Acute worsening, followed by full recovery without additional episodes 3. Acute worsening, followed by improvement and disease stability 4. Continuous and steady decline without improvement 19) From point above - What does point 1 describe: - What does point 4 describe: 20) The PT moving a pt through their available ROM is indicating PROM or stretching?

Answer 197

1) Gradually reduce the number of verbal cues. - Having the patient complete the exercises in a group setting may be distracting to an individual with limited recall. - Gradually reducing the feedback (fading schedule) forces the subject to use internal processes of error detection and results in better delayed retention. 2) Bone disease / issues - Vitamin D is important for calcium absorption, synthesis, and transport, and bone decalcification can result from a deficiency. 3) Liquids (especially thin liquids) - Make liquids thicker, sit pt up / head up, make food warm (colder food is harder), and good posture 4) Pulsed - Intensity 5) Posterior 6) Gaze stability exercises 7) Install toe clips on the pedals. 8) Toe clips limit ankle ROM, so forces more knee ROM and thus more work by HS's - Force more upright posture, less leaning on handlebars, so it requires more core strength to maintain position 9) provide the patient with a home program and re-evaluate in 1 month 10) It is an MS pt, so going 5x per/week will fatigue them. They naturally will be declining, so doing a HEP is necessary anyway at some point 11) early heel rise - Prosthetic foot to lean laterally 12) Suprascapular nerve injury - Everything listed would be weak and painful ... but weakness withOUT pain implicates a NERVE injury 13) Superolateral 14) Medial glide would stress LATERAL structures. The apex (inferior pole) of the patella is moving, however the base / top of the patella is not, causing patellar rotation. Therefore, superolateral structures are tight, holding back this portion of the patella. 15) One hand on gait belt, and one hand on the pt's SHOULDER 16) Emotional / psychological 17) Shunt dysfunction - changes in bowel and bladder function, increased spasticity, back pain - s/s of a UTI include: back pain, urinary frequency, dysuria, and pyuria - s/s of Arnold Chairi: weakness, pain, sensory changes, vertigo, diplopia, and ataxia 18) Acute worsening, followed by improvement and disease stability 19) Primary progressive multiple sclerosis - Primary progressive multiple sclerosis 20) PROM. Stretching is taking them PAST their ROM available

Question 198

1) What is the spray and stretch technique 2) For someone with CRPS, should you do PROM to help ease/calm nervous system, or active ROM as a graded desensitization technque? 3) Ideomotor apraxia is what: 4) Why would you use enzymatic debridement: 5) If a pt has intermittent claudication - would walking be a good exercise? 6) Is using the HR a good indicator for level of physical fitness? - In someone very fit, should HR return to normal resting heart rate faster or slower following exercise 7) polyuria and polydipsia are often reported in what condtion 8) Acute pH balance issues are solved by respiratory or metabolic/renal system? - So if you do quick vigorous exercise, what will build up in your system - - What does that do to pH - So what does that do to O2 or CO2 - So what will body need to do to compensate - So long term acid-base balance is achieved by what 9) Stasis dermatitis is the result of what - Herpes zoster is the result of what - What skin condition has an arthritic component 10) Post Multiparous delivery means what - Pelvic floor m's will obviously be weak following this birth, so what type of incontinence would this woman face 11) Which of the following conditions is an absolute CONTRAINDICATION to a patient's participation in aquatic physical therapy? 1. Advanced peripheral neuropathy 2. Chronic venous insufficiency 3. History of seizure disorder 4. Severe kidney disease 12) Best gel medium for contoured areas like fingers or toes is: 13) Laboratory findings of decreased red blood cell count (anemia) and increased erythrocyte sedimentation rate are MOST indicative of: 14) If someone had an anterior shoulder dislocation, would IR'ing or ER'ing it after surgery be more prone to re-dislocate it? - Would abduction or arm at side be more prone to dislocating it 15) If a pt has hemiplegia and you are working on rolling or bed mobility, what must you ensure 16) 3 or more PVC's would be called 17) Injury to the anterior interosseous nerve would present how? - Would it have sensation impacted? - Test to rule this in/out 18) Does the lower traps help with upward or downward rotation of scapula? - Does lower traps elevate or depress scapula 19) If someone had an increase in BP, would it effect respiration? - Would an increase in BP cause tachycardia or bradycardia? - Would cardiac output increase or decrease with an increase in BP 20) What are the elements of the best fitness / healthy lifestyle changes program:

Answer 198

1) The spray and stretch technique is a modality that can quickly alleviate acute pain and restricted range of motion due to muscle trigger points. The application of a vapocoolant acts as a counterirritant to myofascial pain due to muscle spasm and trigger points. 2) AROM, desensitization, and get pt to gradually start using extremity. If you use a modality - use TENS 3) the inability to perform purposeful movements 4) Eschar/necrotic tissue 5) Yes. It helps with improving blood flow / circulation, which is what this pt needs. 6) Yes - Faster. After training, heart rate returns to resting levels much more quickly after exercise, and time to return to baseline is sometimes used as a measure of physical fitness 7) DM II 8) Respiratory - Lactic acid - Lowers it (you get acidic) - CO2 goes up - Increase RR to get more O2 to even out pH - Renal / metabolic system 9) Venous insuff - Viral infection of a nerve root - Psoriasis 10) Following a birth of multiple babies or after you've had many kids - Stress due to weak pelvic floor m's 11) Severe kidney disease - If someone CURRENTLY has seizures, then be worried, but a history is less worrisome 12) Immersed in water 13) RA 14) ER'ing - Abducting 15) Protect their shoulder 16) V-tach 17) The anterior interosseous nerve is a branch of the median nerve. It innervates the flexor pollicis longus, pronator quadratus, and half of the flexor digitorum profundus. Difficulty would be with pinching and pronation. - No - Make "ok" sign 18) UPward - Depress 19) NO - Brady (the reflexive response is to dilate blood vessels, leading to bradycardia) - Decrease 20) Promotion of a healthy lifestyle is most effectively addressed with appropriate supervision and ACTIVE participation of clients. - *** NO amount of screenings, fairs, brochures will ever be as effective as ACTIVE PARTICIPATION in an exercise class.

Question 199

1) Why would you use a single-subject study design? 2) With trendelenberg gait, let's say the left leg lifts and goes into swing phase and the left hip/pelvis drops .... does this indicate left or right sided glute med weakness? 3) Gamekeeper's thumb is what: - Is this skier's thumb? 4) With learning, is it better to encourage people to ask questions, or to have them write down what they heard 5) ************* - Which type of incontience would benefit MOST from pelvic floor exercises - What causes stress incontience: - What causes functional incontience: - Will pelvic floor exercises help with functional incont? - What is urge incont: - What is overflow incont: - Will pelvic floor exercises help with urge or overflow incont: - Which one is due to an overactive bladder: - Which one is from blockage of the urethra: - What is a treatment for overflow incont: - Which one is from the detrussor muscle not functioning / spasming - Prostate enlargment would cause what type: - Which one is from the bladder spasming - Will you feel an urge to go with overflow incont - Constant leaking is from - Detrussor muscle is what: 6) If you really want to see if someone has learned a new motor task, when should you test them? 7) Which blood from a wound or surgical site is good ... dark red or serosanguineous exudate? - WHat does dark red blood indicate? 8) What is Hypercapnia 9) According to change theory, assessing the patient's ___________ is most important first step to learning a new skill. 10) What type of SCI does this represent: - loss of proprioception, stereognosis, two-point discrimination, and vibration below the level of the lesion - ipsilateral loss of motor function and position sense and contralateral loss of pain sensation several levels below the lesion - loss of motor function and loss of the sense of pain and temperature bilaterally below the level of the lesion - impairment of function in the upper extremities than in the lower extremities - LE involved, but LMN and flaccid 11) Which of the following actions would MOST reduce a physical therapist's risk of being sued for medical malpractice? 1. Consistently obtaining written informed consent before initiating treatment 2. Maintaining accurate medical records 3. Establishing excellent communication and rapport with patients 4. Relying more on objective test findings than on subjective findings 12) If ONE study was performed and 12 of 20 participants saw improvement, can you conclude the IV caused a change? - What if the change was reported 2 months after the study - was it the IV or time healing? 13) Briefly explain difference between these 4: 1. Cellulitis 2. Dermatitis 3. Folliculitis 4. Keratitis 14) Someone with DM II who starts exercising - what will it do to their glucose intolerance - Will exercising reduce cardiovascular risk in pt's with DM II 15) What is: - Hyperhidrosis: - Hyperemia: 16) What is telemetry 17) Subtalor or calcaneal LATERAL joint mob will increase eversion or inversion - How to remember this? 18) Low back pain with coughing and sneezing is most likely a sign of what 19) A counterforce brace for lateral epicondylitis would be applied where - What is benefit of a counterforce brace 20) retropatellar pain is what condition

Answer 199

1) So you can do experimental treatments geared for that specific patient. 2) RIGHT (right side can't hold body/trunk upright) 3) A tear of the ulnar collateral ligament of the first metacarpophalangeal joint (thumb) - Yes (but skier's thumb is acute, whereas gamekeepers thumb is more chronic and a degenerative thinning of the UCL) 4) Obviously both are important, but BEST way is to encourage asking questions. 5) - Stress incont. - Cough, sneeze, jump, laugh, etc. - Functional incontinence is incontinence due to deficits in mobility, dexterity, or cognition - NO - Urge incontinence is characterized by an increased frequency or desire to void (with even little pee) due to detrussor muscle over-activity. - Overflow incontinence is caused by a neurological condition that results in bladder filling and overflowing due to nerve signal not signalling bladder to empty, or something blocking bladder/urethra. - NO - Urge - Overflow - Meds - Urge - Overflow (since it blocks urethra) - Overflow - NO - Overflow - Around bladder and causes a squeeze of the bladder (so in urge incont. it squeezes even when not full) Overflow: Frequent urination or constant dribbling is characteristic of overflow incontinence. It is usually the result of a neurologic problem or obstruction in the bladder. There is a loss of urine with increased bladder distention. Urge: Overwhelming urgency and frequency of voiding describes urge incontinence. Urge incontinence is often caused by involuntary bladder (detrusor) spasms and is associated with both increased frequency of urination and increased urgency to urinate. Stress: Coughing, sneezing, laughing, bending, high-impact physical activity, or exercise cause an increase in intraabdominal pressure. With weakness or loss of tone of the pelvic floor muscles, any increase in intraabdominal pressure can cause leakage of urine. Functional: Difficulty reaching the toilet in time describes functional incontinence. The patient has normal urine control but has difficulty in reaching toileting facilities due to mobility issues or dementia. 6) At BEGINNING of next appt, or after a long break (never do it during or after practicing) 7) Serosanguineous - An inflamed wound 8) excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration 9) Readiness / willingness / motivation to learn new skill 10) - Posterior cord - Brown sequard - Anterior cord and anterior spinal artery - Central cord - Cauda equina 11) Establishing excellent communication and rapport with patients 12) NO - Will never know :) 13) 1. Cellulitis: More often in LE (and one vs. both LE's). Red, swollen, warm, sick, fever, PAIN 2. Dermatitis: Rash (itchy), but both LE's, and from poor circulation (venous insuff = statis dermatitis) 3. Folliculitis: hair follicle inflammation from bacteria infection 4. Keratitis: corneal inflammation 14) Improve it - YES 15) - Hyperhidrosis: excessive sweating (not realted to heat or exercise) - Hyperemia: Increased blood flow to a part of the body. 16) Device to monitor pt's vitals remotely (especially heart activity) 17) Medial glide to increase eversion; lateral glide to increase inversion. - It is what is happening at the JOINT, not at the base of the calcaneus 18) Disc herniation 19) Over wrist extensors / CET insertion - Counterforce braces help keep pressure off of the inflamed muscles by spreading tension to different parts of your arm. Instead of continually stressing the same forearm muscles and tendons when making certain movements, wearing a counterforce brace allows them to rest by re-distributing this pressure 20) chondromalacia patellae

Question 200

1) If a child is sitting with a posterior pelvic tilt and knees flexed, it most likely indicates what 2) These manifestations suggest R or L sided brain impairments - Poor judgement - Poor logic - Aphasia's - Difficulty with spatial relationships - Impulsive - Distorted body image 3) Dyslexia is: - Alexia is: 4) What are the MOST useful for determining changes in status in a patient who has chronic obstructive pulmonary disease and emphysema - Are VC, TLC, and FRC good indicators? 5) For proper ergonomics, where should screen monitor be: - What position should your elbows be in: - How far should your monitor be from your face - What about your shoulders - Hips - Chair in relation to popliteal fossa 6) A physical therapist is evaluating the gait of a patient with sciatic nerve damage. Which of the following gait deviations is the patient MOST likely to exhibit? 1. Extensor lag of the knee 2. Excessive hip extension 3. Decreased ankle dorsiflexion 4. Decreased hip flexion 7) From point above, why? 8) A physical therapist is walking down an isolated hospital staircase. The therapist sees a middle-aged adult lying on the landing and determines that the adult is unresponsive. What should the therapist do NEXT? 1. Initiate chest compressions. 2. Find the nearest defibrillator. 3. Initiate rescue breathing. 4. Activate the emergency response system. 9) Which of the following methods is BEST for a physical therapist to use to determine the impact of pain on the lifestyle and daily functioning of a patient with chronic pain? 1. Observe the patient during simulations of usual daily tasks and note any signs of pain. 2. Have the patient rate changes in pain on a 0-10 scale during exercise in physical therapy. 3. Administer a standardized disability questionnaire. 4. Have trained observers watch the patient perform activities at home. 10) Would you use heat on a pt with edema: - Would you use heat on a pt with cancer: - Would you use e-stim on a pt with cancer: - Would you use cryotherapy on a pt with cancer: - Would you use cryotherapy on a pt with edema: 11) In a transfer, should a pt place arms around therapists neck or upper back 12) What is a dependent pivot transfer 13) For a patient with a complete T10 spinal cord injury to achieve stability while standing with crutches, the patient should maintain which of the following positions? 1. Hips posterior to the ankles 2. Shoulders posterior to the hips 3. Ankles plantar flexed 4. Knees hyperextended 14) Which of the following methods is MOST appropriate to determine maximal oxygen consumption in a patient with multiple sclerosis who has impaired balance? 1. Lower extremity cycle ergometer test 2. Upper extremity ergometer test 3. 6-minute walk test 4. Treadmill stress test 15) A patient with a chronic skin ulcer displays decreased blood pressure and skin turgor, as well as a weak, rapid pulse. A physical therapist should suspect a decreased dietary intake of what: 16) Statis dermatitis is basically what: - You know it is herpes zoster when you see what - Will statis dermatitis itch? - Will cellulitis itch? 17) Push ups are good exercise to strengthen pecs or eccentric biceps, or triceps - but what else? 18) In a patient with a past history of prostate cancer, which of the following laboratory test values is the BEST predictor of a healthy prostate? 1. High prostate specific antigen 2. Low prostate specific antigen 3. High prostatic acid phosphatase 4. Low red blood cell count 19) Developing a voiding schedule is most helpful for a pt with what type of incontience 20) What does complete decongestive therapy (CDT) consist of for lymphedema pt's:

Answer 200

1) Tight HS's and need to stretch HS's 2) - R - L - L (usually, unless they are L handed) - R - R - L 3) Difficulty reading - Can't read 4) Forced EXPIRATORY (not inspiratory) volume in 1 second and the ratio of forced expiratory volume in 1 second to forced vital capacity - NO 5) Aligned with top of forehead - 90 deg's - 16-22 inches - Relaxed down to your side - 90 deg's - 2 inches / finger widths 6) Decreased ankle dorsiflexion 7) Ankle DF's are innervated by deep fibular nerve, which branches off of sciatic nerve. Hip flexion and extensor lag would be from femoral nerve; and sciatic nerve damage would cause weak hip extension not excessive. 8) Activate the emergency response system (then do compressions) 9) Administer a standardized disability questionnaire. - Why: because pain is a subjective thing, so do a questionaire. Recreating the events won't provide you with accurate info since it's not in the same time/setting. 10) No (increases fluid) - No - NO (stimulates cell growth) - Yes - Yes 11) UPPER BACK 12) The patient is only lifted to the point that the buttocks can clear the wheelchair and move to the treatment table or bed 13) Shoulders posterior to the hips 14) Lower extremity cycle ergometer test 15) Water/fluids 16) Venous insuff - A dermatomal skin pattern/reaction - Yes - No, be painful 17) Serratus anterior 18) Low prostate specific antigen 19) Urge 20) Manual lymphatic drainage, compression therapy, and decongestive exercises

Question 201

1) When 2 variables (IV and DV) are highly correlated, does that means one caused the other? - Correlations closer to what value indicate strong relationship - When one variable increases as another decreases, is it a positive or negative correlation 2) Would achilles reflex be present or absent in an L2 SCI 3) A patient reports having had a diagnostic test that showed "increased uptake" in the spine and pelvis. What diagnostic test would they be referring to 4) If a patient is confused or gives the wrong answers, do you agree with them (even if wrong) or help orient them properly 5) Why might a Lachman's test be better than an anterior drawer test to assess the ACL 6) If someone has excessive genu recurvaturm, what AFO would you want 7) If you want to assess a tear of the ATFL, would you do talor abduction or adduction - If you want to assess a tear of the Deltoid lig, would you do talor abduction or adduction 8) Should you do Ultrasound or phonophoresis on a child - Would you do whirlpool modality on a child 9) What is an example of anticipatory postural control - Is a unexpected perturbation an anticipatory balance reaction 10) A hairline fracture to the femur would result more fro a direct blow or from overuse? - So a direct blow to femur area can cause a contusion, but it can also cause Myositis ossificans, which is what: - Is myositis ossificans essentially heterotopic ossification 11) If a pt is demonstrating pusher's syndrome (let's say to the Left), should the therapist provide resistance on the left to correct the patient? - What should the therapist do - One question said have pt's clasp hands together. Why? 12) Would a posterior pelvic tilt make the iliopsoas tighter or looser 13) A patient has a 6-week-old surgical scar that is freely mobile and is completely closed. The scar is soft, is slightly raised to palpation, and is pink with a silvery white appearance .... is this a normally healing scar? - A delayed healing scar will appear how? - An abnormally elevated scar would be called a: 14) If a pt has an impairment with light touch, what else will they have an impairment with in regards to sensation - What does NOT run through that spinal tract and thus would NOT be impacted 15) Would the things below be an absolute contraindication to exercise or exercise tests: - V-tach or V-fib - 3rd degree heart block - Pneumonia (or an ACUTE infection) - PE (pulmonary embolis) - Angina - Chronic condition (DM II, hepatitis, HIV) 16) A pic of someone with TIGHT hip flexors ... what is the question below really asking: A patient displays a positive sign for the test shown in the photograph. After physical therapy intervention, a successful outcome should be assessed by observing what phase of the patient's gait cycle? 1. Foot flat (loading response) 2. Heel strike (initial contact) 3. Midstance 4. Heel off (terminal stance) 17) Analysis of Variance Test (ANOVA) is to assess 2 or 3 groups 18) Is cortisol released more or less in a stressful situation - Is epinephrine released more or less in a stressful situation - Another name for epinephrine - Is growth hormone released more or less in a stressful situation 19) A woman has been walking on a treadmill for 10 minutes at 3.5 miles (5.6 km) per hour and 0° elevation when she reports a new onset of midthoracic back pain, aching in the right biceps muscle, fatigue, weakness, and nausea. Which system is MOST likely implicated? 1. Cardiovascular 2. Gastrointestinal 3. Musculoskeletal 4. Neuromuscular 20) If a pt seriously speaks about committing suicide, what do you do

Answer 201

1) NO. One variable did not necessarily cause the other, even though a positive correlation was found. Correlation indicates a relationship but does not imply causality - 1 (closer to 0 is no relation) - Negative 2) Absent 3) Bone scan shows "uptake" or activity of osteoblasts and osteoclasts in bone. X-rays don't show this. 4) Help orient them properly. 5) In anterior drawer, the HS muscles can help stabilize/protect the knee, and it can give a false positive to meniscus tear pain 6) One that forces slight DF to prevent hyperextension of the knee 7) ADduction - ABduction 8) NEVER over growth plates - No - risk of drowning 9) Reaching for an object far away - No, it's reactive 10) Overuse - is a condition where bone tissue forms inside muscle or other soft tissue after an injury. It tends to develop in young adults and athletes who are more likely to experience traumatic injuries. - Yes 11) NO, it will just make matters worse - Give visual cues to help orient pt to midline - A patient who exhibits ipsilateral pushing (pusher syndrome) associated with left hemiparesis will use the right upper extremity to push over to the left side. Push-off is minimized if the hands are clasped together. It is important to limit pushing with the sound extremity. 12) Tighter 13) Yes - Red, yellow, bloody/drainage, not closed, elevated - keloid scar 14) Light touch is from DCML, so anything else that runs in that posterior column: proprioception, 2 point discrimination, pressure, vibration - Pain and temp (goes through spinothalamic tract) 15) - YES - Yes - Yes - Yes - No 16) Which phase is the leg in MOST hip extension, thus which phase will improve as you stretch hip flexors. 17) 3 18) More - More - Adrenaline - More 19) Cardiovasular - It can impact R arm. Midthoracic pain and upper extremity pain can be signs of angina in women. The undue weakness, fatigue, and nausea are concerning for a systemic origin of pain, particularly the cardiovascular system 20) Get them mental help immediately and do NOT leave them or let them leave till they get help / are safe

Question 202

1) Induration of the skin means what - Indurated skin could be a sign of what: - Ecchymosis means - Hyperkeratosis means 2) Can ice massage cause neuropraxia? - Would ice massage to this area cause neuropraxia below ... - Piriformis insertion points - Piriformis muscle belly - Fibular collateral lig area - Medial epicondyle near CFT - Posterolateral elbow area - Posterior shoulder 3) Can someone get frozen shoulder following a massectomy 4) What color is purulent exudate - Does it have an odor 5) Aspirin is what type of drug - Gold sodium thiomalate (Myochrysine) is what type of drug 6) A pt with hip joint pain is referred to PT for direction in weight bearing strengthening exercises. The physician's referral notes that recent bone density testing revealed the pt has osteopenia. Which of the following comorbidities would MOST likely be part of the pt's medical history? a) Cushing's syndrome b) GBS c) Spinal stenosis d) Hypoparathhyroidism

Answer 202

1) Firm (lost its turgor) - Dehydration - darkish discoloring of the skin - thickening of the skin 2) YES - ...... - NO - Most likely no given how deep it is and glute max is over - Yes, common fib nerve is right there - No (ulnar nerve is below) - Yes (radial nerve is right there) - No (nerves are deeper) 3) YES 4) Yellowish green - Yes 5) NSAID - DMARD 6) Answer: A (Cushing's) Explain: Osteopenia is associated with Cushings and HYPERparathyroidism

Question 203

FINAL PEAT EXAM (4) 1) If you were to do skin protection to prevent a pressure ulcer on the heel with someone with altered sensation, would you place heel on soft cushion, or prop the calf on a soft cushion? 2) Lymphatic drainage should be from proximal to distal or distal to proxima - Do you drain the trunk before doing extremities? 3) To place hand in optimal hand splinting position, what do you do for each: - Wrist: - Fingers: - Thumb: - Do you do slight ulnar or radial deviation? 4) T or F: A pregnant woman with diastis recti will benefit from sit ups / trunk curls? - So what should you do? 5) An exercise program following recent closed reduction of an anterior dislocation of the shoulder should AVOID which of the following motions? 1. Adduction and medial (internal) rotation 2. Hyperextension and lateral (external) rotation 3. Abduction and flexion 4. Extension and medial (internal) rotation 6) Is a SCI an UMN lesion? - So will you see a positive Babinski's with a SCI 7) During a five-position grip strength test, the HIGHEST grip strength measurement is MOST likely to result from use of which handle position of a hand-held dynamometer? 1. 1 2. 2 3. 4 4. 5 8) From point above - the SMALLEST grip is what: - The largest grip is what: - Grip 4 and 5 mainly use what m's - Max grip strength happens at what levels 9) Ptosis of the eyelid is what - It indicates damage to what CN - If you can't close eyelid, it indicates legion to what CN 10) Medial strabismus of the eye means what - It is from damage to what CN 11) A patient has a history of a mild stroke, type 2 diabetes, hypertension, and impaired balance. During examination, the patient performs the Clinical Tests for Sensory Integration and Balance. The patient demonstrates increased sway and difficulty maintaining balance when wearing a dome while standing on a firm surface and when wearing a dome while standing on a foam surface. Based on the findings, which of the following systems or system interactions is the patient MOST dependent upon for balance? 1. Visual 2. Vestibular 3. Somatosensory 4. Sensory selection 12) From point above, why is it NOT a vestibular issue 13) What does LATENCY mean - So if someone has carpal tunnel syndrome, what will test reveal (relative to latency) - Will latency be normal or impaired below the wrist on a pt with carpal tunnel 14) A patient has difficulty palpating the carotid pulse during exercise. The patient should be instructed in alternate methods of self-monitoring, because repeated palpation is likely to result in: 1. an increase in the heart rate. 2. a decrease in the heart rate. 3. an irregular heart rhythm. 4. an increase in blood pressure. 15) If doing the supine-sit test and the R leg is shorter in supine and longer in sitting - this means what: - What if the R leg is longer in supine and sitting, it means what: 16) Main reason for a cool down period following aerobic exercise is for what 17) What is astrocytoma malignancy 18) If someone has a seizure, 1st thing you should probably do - Next thing you should do is: - Should you activate emergency response immediately 19) If someone has scoliosis in standing, but it goes away in sitting, it could be from: 20) A patient recovering from a cervical spine injury is performing stabilization exercises that focus on the lower cervical and upper thoracic extensor muscles. Which of the following exercises would provide the GREATEST cervical spine protection? 1. In prone position, elevate the upper extremities in full flexion. 2. In standing position, reach forward, outward, and upward in functional patterns. 3. In standing position with no support, perform pushing, pulling, and lifting activities. 4. In prone position with the upper extremities abducted and laterally (externally) rotated, horizontally abduct the shoulders and adduct the scapulae.

Answer 203

ok 1) Prop calf. Even the heel resting on a soft cushion the pt won't feel. Just off load any bony prominence ideally. 2) Proximal to distal - Yes 3) - Wrist: Slight extension - Fingers: Slight flexion - Thumb: Abduction - Ulnar 4) False. Do NOT do these with someone with diastis recti - Supine hooklying head lifts emphasize the rectus abdominis muscle and are least likely to increase the separation of the diastasis recti (even a slight post pelvic tilt) 5) Hyperextension and lateral (external) rotation 6) Yes - Yes 7) 2 8) 1 (most flexor m's in shortened position due to active insuff) - 5 - Flexor digitorum profundus - 2 and 3 9) Falling or drooping of upper eyelid - III - VII 10) Strabismus means misalignment - so medial misalignment of the eye - VI (abducens) ... weakness of the lateral rectus muscle would cause medial strabismus / alignment issues 11) Visual 12) Because vestibular issues are only manifested in impairments during #5 and #6 - foam stance when vision is occluded and dome over head. If pt has issues on firm surface with dome, it is a visual issue (in otherwords, issues 2, 3, 5, 6 are all visual issues - so if they had issues on 3 and 6, it is a visual issue. 13) Latency is a time interval between the stimulation and response - INCREASED latency at the wrist - Normal (it is only latent at sight of lesion) 14) a decrease in the heart rate. - Manual pressure on the carotid sinus can cause a reflexive drop in heart rate, blood pressure, or both 15) R ilium is posteriorly rotated - Upslip or LLD 16) To prevent venous pooling 17) Cancer to astro support cells in brain and spinal cord (CNS) 18) Lower them down to the ground - Place them on their side to prevent further injury (mainly prevent aspiration) - Usually no, you don't need to 19) LLD 20) In prone position with the upper extremities abducted and laterally (externally) rotated, horizontally abduct the shoulders and adduct the scapulae. - *** It said prone position is better than standing as it provides more support to neck ???

Question 204

1) A nocturnal cough may be indicative of what condition: 2) A patient who has right hemiplegia is unable to avoid obstacles on the right side of the hallway while walking with a walker. During meals, the patient does not eat foods placed on the right side of the plate. Which of the following tests is MOST appropriate to perform? 1. Patient looks at a fixed target in front while turning the head side to side. 2. Patient detects therapist's fingers from the side while looking straight ahead. 3. Patient shifts gaze from one object to another quickly with the head stationary. 4. Patient tracks therapist's finger moving vertically, horizontally, and diagonally. 3) The ________ test is designed to measure endurance for acutely ill individuals who have cardiovascular and pulmonary dysfunction - Are submax VO2 tests a measure for endurance 4) Blood glucose levels above ____ is dangerous to exercise a pt 5) Would an anterior cord or central cord SCI present with more LE impairments 6) The close-packed position of the radiocarpal joint is: 7) **** Does the S1 nerve root or the L5 nerve root exit BELOW the L5 vertebra - Do cervical nerve roots exit above or below their corresponding vertebrae? - Give example of point above - Is this the same in thorax and lumbar regions - T or F: Everything below C7 (or really C8) exits ABOVE the vertebrae below - A L4/L5 disc bulge will impact what nerve root 8) According to the National Safety Foundation, patient's education is most effective when the patient can respond to each of these questions: 1) What is my main problem? 2) What do I need to do? 3) Why is it important for me to do this? 9) What are the 4 phases of motor learning in order? 10) So, below, what stage of motor learning does this description explain: - feedback is more intrinsic and performance is more routine - requires full attention to the task and extrinsic feedback - the body is capable of reacting to all of the internal and external mechanisms that may act on it and less attention to the task is required - feedback can become more intrinsic and less attention to task is required 11) Would the description below explain hyper or hypoglycemia: - Fruity smelling breath - Thirst, nausea, and vomiting - A common mental state manifestation - Dry, crusty mucous membranes 12) Medial knee sensation is supplied by what nerve root: - The plantar heel is supplied by what nerve root: 13) Do paraplegic pt's sitting in a w/c still need to do pressure relief as often (ie: 15 ish mins) if they have a custom cushion seat? 14) Rhythmic oscillation of the eye is called: 15) A high percentage of hospitalizations of the aging population who have gastrointestinal problems are due to the effects of ____________. - They take these drugs usually because of what 16) The Psoas sign is for what: - How to perform and what you'll find 17) During the shoulder examination of a patient, a physical therapist notes the presence of a capsular pattern without radicular pain. To help establish the cause of the capsular pattern, the therapist should NEXT: 1. perform axial compression on the cervical spine to check for nerve root compression. 2. ask the patient if there has been any prior trauma to the shoulder joint. 3. check for a painful arc during active range of motion. 4. examine the shoulder for a rotator cuff tear. 18) A patient has shoulder joint impairments. The range-of-motion examination reveals restricted lateral (external) rotation and abduction of the shoulder. Based on arthrokinematic principles, which of the following mobilization procedures should be performed for the patient FIRST? 1. Posterior glide 2. Distraction 3. Anterior glide 4. Lateral (external) rotation 19) During walking, a patient demonstrates backward leaning of the trunk at right heel strike (initial contact). The result of manual muscle testing of the weak muscle is Good minus (4-/5). Which of the following exercises BEST addresses this patient's muscular weakness? 1. Bridging activities progressing from double leg to single leg 2. Single-leg stance allowing the opposite side of the pelvis to drop, then return to a level position 3. Prone leg lifts with the leg straight 4. Standing on the uninvolved leg to perform active hip extension of the involved leg 20) Is pain with exercise/walking more indicative of intermittent claudication or DVT

Answer 204

1) Rheumatic fever 2) Patient detects therapist's fingers from the side while looking straight ahead. 1 is VOR 3 is saccades 4 is smooth pursuits 3) 6-minute walk - No, those are more to assess oxygen uptake or aerobic capability, NOT endurance. 4) 250 ish 5) Anterior (central cord has more UE impairments) 6) Wrist extension with radial dev 7) L5 - Above - C7 spinal nerve exits ABOVE C7 vertebrae - NO ... spinal nerves exit BELOW the corresponding level (ie: L5 exits below L5 vetebrae) - False - it is BELOW - L5 8) Ok 9) Cognitive, Associative, Autonomous, Expert 10) - Autonomous - Cognitive - Expert - Associative 11) - Hyper - Hyper - Hypo - Hyper 12) L3 - S1 13) YES 14) Nystagmus 15) nonsteroidal anti-inflammatory drugs (NSIAD's) - OA 16) Psoas abscess - Lay on unaffected sign and do extension of hip to see if it causes psoas and low back pain 17) ask the patient if there has been any prior trauma to the shoulder joint. 18) Distraction - Mobilization into lateral (external) rotation will likely be ineffective without distraction applied to separate the joint surfaces 19) Bridging activities progressing from double leg to single leg - Answers 3 and 4 don't provide enough resistance. A posterior trunk lean is associated with weak hip extensors (especially the gluteus maximus). Double and single leg bridging would specifically target the hip extensors and gluteus maximus. 20) Intermittent claudication (this isn't a sign of DVT - Homan's is sign of DVT)

Question 205

1) Who helps the PT coordinate the pt's discharge 2) How is torticollis named? - So a head rotated left and side bent right is named: 3) A L4/L5 disc bulge will impact the dermatome / myotome of what level 4) Will pursed lipped breathing help a pt with: - CHF - Emphezema or any COPD condition - Peripheral vascular disease - Restrictive lung disease 5) What is the clock method of naming tunneling of a wound 6) If the medial rectus muscle of the eye is weak, what would this cause? 7) After spinal joint mobilization procedures, a patient calls the physical therapist and reports a minor dull ache in the treated area of the back that lasted for 2 to 3 hours. Based on this symptom, the therapist should: 1. consider a possible neurological lesion in the area. 2. refer the patient back to the physician. 3. inform the patient that this response is common. 4. add strengthening exercises to the home program. 8) Which of the following positions is MOST effective to actively stretch the lumbrical muscles? 1. Metacarpophalangeal and interphalangeal flexion 2. Metacarpophalangeal and interphalangeal extension 3. Metacarpophalangeal extension and interphalangeal flexion 4. Metacarpophalangeal flexion and interphalangeal extension 9) If you find a pt UNRESPONSIVE, first thing to do is: 10) Which of the following interventions is MOST appropriate for a patient who has juvenile rheumatoid arthritis and is experiencing painful swelling of both knees? 1. Resistive exercises 2. Stretching to prevent contractures 3. Gentle, active exercises 4. Walking program 11) A patient with cervical radiculopathy reports numbness of the right little finger (5th digit). A physical therapist will MOST likely find a diminished tendon reflex in the: 1. biceps brachii. 2. deltoid. 3. triceps brachii. 4. brachioradialis. 12) From point above --- why 13) An initial physical therapy evaluation is conducted for an older adult patient 1 day after the patient had a left total hip arthroplasty (noncemented) using a posterolateral approach. The patient has no complicating medical history and was active and independent preoperatively. Which of the following activities is LEAST appropriate for the first week of therapy? 1. Active-assistive positioning of the left hip to 60° of flexion 2. Active left hip abduction in right sidelying position 3. Independent bed mobility with the use of a trapeze 4. Walking with moderate assistance with a standard walker to 25 ft (7.6 m) 14) 80% of the conditions that cause digital clubbing are related to what: 15) If someone had HYPOthyroidism, would it impact deep tendon reflexes? - How 16) DM II pts unable to feel what level of monofilament have impaired sensation and are at risk for ulcers 17) Would a radial glide joint mob (at the wrist) improve radial or ulnar deviation - A volar glide improves wrist flexion or extension 18) Will the fingers be flexed or extended in a tenodesis grip with the wrist extended - Then when you flex the wrist, what happens to fingers - So to do a slide board transfer, they will want what one from above: 19) Despite the tenodesis grip being very important to a C6 SCI pt to do a slide board transfer, what is the MOST important thing to teach them to do: 20) How would you splint an elbow after a burn (what position)

Answer 205

1) Medical social worker 2) The SCM muscle effected - Right Torticollis 3) L5 4) - NO - YES - No - No 5) Head is 12 o'clock, and right is 3 o'clock, feet 6 o'clock, etc. 6) Lateral strabismuss 7) inform the patient that this response is common. 8) Metacarpophalangeal extension and interphalangeal flexion 9) Activate the emergency response system 10) Gentle, active exercises 11) triceps brachii. 12) This question they are asking about NERVE root level. So 5th finger is C8 nerve root, and the only reflex that has C8 in it is triceps. 13) Active left hip abduction in right sidelying position - The pt probably can do more than AAROM, but it is not past 90 so they are fine. Active ROM against resitance (gravity) should be avoided for a few weeks. All other functional activities you should do immediately. 14) Lungs / pulmonary 15) Yes - Make them more diminished 16) 10-gram (Semmes-Weinstein 5.07) nylon filament 17) Ulnar - Extension 18) Fingers flexed - Fingers extend - Wrist extended so fingers flexed 19) Rotate head and shoulders in the direction opposite to the desired hip motion. 20) Full ext and supination

Question 206

1) Which of these items below would necessitate ordering a radiograph (according to Ottawa Knee Rules): - Not being able to walk 4 feet - Tenderness to medial femoral condyle - Tenderness to patella - Tenderness to fibular head - Being able to walk 20 feet - Tenderness to tibial tuberosity - Inability to flex knee past 90 deg's 2) What is a primary risk factor for developing atherosclerosis - Is obesity and sedentary lifestyle a primary or secondary risk factor for developing atherosclerosis - Is stress " 3) What are the cells that HIV / AIDS kills that weaken your immune system - What is a normal amount of these cells - Below what number means you now have AIDS and are immunocompromised 4) If someone in sitting had a SLR that was non painful, but in supine a SLR was very painful - it means what 5) If a family is helping with a pt's rehab, will carryover be BEST promoted by teaching the family a transfer skill (for example) at the beginning of rehab, right before discharge, or once home? 6) What are the 3 types of angina - Which one happens at rest - Explain stable angina - Explain unstable angina - Explain variant angina 7) MRSA has what type of precautions 8) If someone had a SCI and 24 hours later has not motor or sensory or reflex ability - they are most likely experiencing what: - So if it is NOT a complete SCI, would spasticity develop after spinal shock wears off? 9) If someone's shoulder girdle / scapula is depressed, it could be from shortness of what muscle 10) Supraclavicular adenopathy and positive iliopsoas sign, are indicative of what conditon: - What is a supraclavicular adenopathy 11) Will pt's with a psychosomatic episode have physical objective s/s 12) Will doing the steps below increase or decrease skin irritation - lower the intensity, use larger interelectrode distance, and use larger electrodes. 13) Would stage 1 pressure injury have blanchable or non-blanchable skin - What does blanchable mean 14) A patient with a mild closed head injury and bilateral femur fractures requires instruction in a lower extremity exercise program. To plan the most effective teaching methods for this patient, what is MOST critical to assess at the INITIAL visit? 1. Comprehension of written, verbal, and demonstrated instructions 2. Short-term memory capacity 15) Which of the following nonsurgical interventions would be MOST appropriate for a patient who had a significant tear of the triangular fibrocartilaginous complex 2 weeks ago? 1. Carpal joint mobilization 2. Splinting for a total of 6 weeks 3. Passive radial and ulnar deviation 4. Resisted supination and pronation 16) Is a pt throwing a PVC concerning? - When would it be concerning - T or F: It is also important to ensure the pt is placed on a stable surface if/when a PVC is detected? 17) If a pt's eye deviates medially, they have an issue with what CN - If their eye deviates down and in, they have an issue with what CN - If they have ptosis, they " - What is ptosis 18) What and where is the saphenous nerve 19) Which of the following recommendations is MOST appropriate for a patient who has a diagnosis of diabetes mellitus and sensory neuropathies in both feet? 1. Perform weekly foot examinations to check for possible skin breakdown. 2. Frequently wash and apply lotion to the entire foot and wear soft slippers. 3. Avoid wearing soft socks with shoes. 4. Ensure comfortable and proper shoe fit and break in new shoes slowly. 20) A 2-year-old child has spastic quadriplegic cerebral palsy, with persistence of primitive reflexes, no selective control of movement, and frequent respiratory infections. Which of the following elements is MOST critical to include in the physical therapist's examination? 1. Modified Ashworth scale 2. Auscultation of heart sounds 3. Assessment of oral-motor control and feeding 4. Assessment of anticipatory postural adjustments

Answer 206

1) - Yes, order x-ray - No - Yes, order - Yes, order - No - No - Yes, order 2) Smoking - Secondary - Secondary 3) CD4 cells (T-cells) - 500-1,000 - Below 200 4) Non-organic symptoms of pain 5) Beginning of rehab 6) Stable, unstable, and variant - Unstable and variant? - Stable angina generally occurs during physical effort and is characterized by substernal, usually NONradiating pain lasting between 5 and 15 minutes. - In unstable angina, the episodes occur during physical exertion or psychological stress and are more frequent, the pain may be severe, and the duration of each event is usually greater than 15 minutes. - Variant angina occurs while the individual is at rest, usually during waking and at the same hour of the day. 7) Contact 8) Spinal shock - YES 9) Lats 10) Testicular cancer - Swollen lymph nodes, suggesting possible cancer 11) NO 12) Decrease 13) Non-Blanchable - Apply light pressure and it goes pale and then recovers 14) If a pt can't comprehend first, they thus won't remember. So comprehension is MORE important. 15) Splinting for a total of 6 weeks - An injury like that you wouldn't do joint mobs, resistance, or AROM - splint and let it heal first. 16) No - More than 3 in a row, or more than 6 p/ min - True 17) VI - IV - III - Droopy eyelid 18) SENSORY nerve of leg 19) Ensure comfortable and proper shoe fit and break in new shoes slowly. - Feet checks should be DAILY. - You NEED proper foot protection (shoes) - Don't put lotion between toes - Need to wear socks as a protection 20) Assessment of oral-motor control and feeding - Be more concerned about respiratory failure than heart failure in these pt

Question 207

1) In the INITIAL management of a patient with a partial peripheral nerve injury, the goal of the physical therapy intervention will MOST likely be to prevent which of the following problems? 1. Nerve degeneration 2. Spasticity and clonus 3. Muscle atrophy 4. Contractures and adhesions 2) Would an abnormal lymph node be firm or soft - Will it be mobile or fixed - Will it be tender or nontender 3) Which of the following nervous system complications would indicate the poorest prognosis for a patient with acquired immunodeficiency syndrome (AIDS)? 1. Toxoplasmosis 2. Leukoencephalopathy 3. Myelopathy 4. Polyneuropathy 4) A patient who has atrophy of the hypothenar eminence of the hand will most likely have the GREATEST difficulty performing which of the following tasks? 1. Holding a cup of water and transferring the contents into another cup 2. Writing two short sentences on a piece of paper using a fine-tipped pen 3. Making a circle with the fingers by touching the tips of the thumb (1st digit) and the index finger (2nd digit) 4. Pulling a piece of paper between the pads of the thumb (1st digit) and the index finger (2nd digit) 5) Pt's with end stage renal failure will have what other condition 6) When held supported in standing position, a 14-month-old child with spastic diplegia is up on tiptoes with the toes curled. This position is characteristic of a: 1. proprioceptive placing reaction. 2. Moro reflex. 3. plantar grasp reflex. 4. traction response. 7) From point above, what is the proprioceptive placing reaction - What is the traction response 8) An ABI takes ankle / brachial blood pressure ... but is it the systolic or diastolic number 9) Decreased perineal reflexes indicates what condition - Would this merit a referral to the PCP 10) Schapoid sublaxation is manifested during what test - A lunotriquetral shear test indicates what - Murphy's sign indicates what - What is Murphy's sign 11) What is a continuous passive motion device for the knee used for 12) A physical therapist examining a patient's joint play finds restriction in the direction indicated by the arrow in the photograph (2nd digit doing a PAM down/volar). To address the restriction, the therapist should include an intervention to increase which motion of the index finger (2nd digit)? 1. Flexion 2. Extension 3. Abduction 4. Rotation 13) A patient is referred to a physical therapist for treatment of left shoulder pain. During examination of the patient's left acromion, the therapist notes an area of skin discoloration that is 1.3 cm in diameter and lopsided in shape with irregular, poorly defined edges. The center is deep red with some shades of brown. The patient reports first noticing the discoloration about 2 months ago. The therapist should recognize these signs as characteristic of: 1. basal cell carcinoma. 2. squamous cell carcinoma. 3. a nevi. 4. a malignant melanoma. 14) When someone gets HIV, an early s/s would be: - A late stage s/s would be: 15) Do NOT use what modality over growth plates of growing children 16) The physical therapy intervention for a patient with dark skin pigmentation includes superficial heat. After 5 minutes of this intervention, the physical therapist removes the heat and observes that the skin over the region being treated is blotchy with both darker and lighter areas. What is the MOST appropriate action for the therapist to take? 1. Discontinue superficial heat and initiate ultrasound. 2. Continue with the use of superficial heat, because this is a normal response. 3. Discontinue superficial heat and initiate ice application. 4. Continue with the use of superficial heat, but add more towel layers. 17) A physical therapist observes a patient from behind during bilateral shoulder abduction and notes that the patient's right scapula is more abducted than the left scapula at the end range of movement. Which of the following conditions is the MOST likely cause of the altered scapula position on the right? 1. Tightness of the rhomboid major and minor 2. Weakness of the serratus anterior 3. Restricted motion of the glenohumeral joint 4. Weakness of the upper trapezius 18) If a pt has frothy sputum, it probably indicates what: 19) Proximal muscle weakness and hypertrophy of calves indicates what condition 20) When someone has lymphedema, do they get arterial compromise? So for point below: - A patient who has a history of receiving radiation therapy reports a sensation of fullness and tightness of the forearm, limited wrist and finger movements, and difficulty wearing a wristwatch and ring. Which of the following tests and measures is MOST appropriate to perform? 1. Check for pulse. 2. Measure limb girth. 3. Obtain blood pressure. 4. Grasp skin on dorsum of hand.

Answer 207

1) Contractures and adhesions 2) FIRM - Either - Either 3) Leukoencephalopathy 4) Pulling a piece of paper between the pads of the thumb (1st digit) and the index finger (2nd digit) - From point one, other extrinsic m's can compensate - For point 4 - that is a test of the adductor pollicis, which is innervated by the ulnar nerve, so if the ulnar nerve is damaged, they won't be able to do that. 5) Anemia 6) plantar grasp reflex. 7) A proprioceptive placing reaction would be exhibited by the lower extremity when the shin is rubbed against a surface resulting in the flexion of the hip and knee - Traction response is exhibited when traction applied to the arm results in upper extremity flexion 8) Systolic 9) Cauda equina syndrome - Yes 10) Watson shift test - Lunotriquetral ligament tear - lunate dislocation - Make a fist and head of 3rd metacarpal is flush with 2nd and 4th 11) To help restore/regain knee FLEXION ROM. 12) Flexion 13) a malignant melanoma. 14) Fatigue - Poor wound healing 15) Ultrasound 16) Continue with the use of superficial heat, but add more towel layers. 17) Restricted motion of the glenohumeral joint 18) The presence of heart failure and resultant pulmonary edema 19) Muscular Dystrophy 20) No - Measure limb girth.

Question 208

1) While working in a private practice clinic, a physical therapist observes a patient fall in the parking lot outside the office. The patient sustains a severe laceration to the forearm. The therapist secures a pressure dressing to the wound site but notes that blood is soaking through the dressing and the bandage. Which of the following actions should the therapist perform NEXT? 1. Elevate the limb and apply pressure to the wound. 2. Remove the dressing and bandage and start over with a tighter bandage. 3. Apply additional dressings and bandages and apply pressure to the radial artery. 4. Call the patient's physician and arrange transportation for medical care. 2) Following ACL reconstruction, you do NOT want to do what: - Is kicking a big ball considered an open chain knee extension exercise? 3) What is the PRIMARY purpose of pursed lip breathing 4) Would medial tibial rotation/torsion cause the patella to go IN or OUT - Would femoral anteversion " - Would genu varum " 5) Boggy end feels are when what is happening - Subacromial or olecranon or any Bursitis condition would have what end feel during PROM - Abnormal hard end feels would be from what: - Abnormal firm end feels would be from what: 6) The "alpha" in a research study is what - You want alpha to be what to indicate statistical sig. or IV impacted DV 7) Most powerful muscle that does elbow flexion is \ - 2 point discrimination is what tract 9) Which of the following descriptions is MOST appropriate for a healed wound with thick fibrous tissue that remains within the original wound border? 1. Epibole 2. Keloid scarring 3. Lichenification 4. Hypertrophic scarring 10) When a pt does strength training, most gains initially are from what - After a few weeks, then the gains are from what 11) For someone with a T12 SCI to be able to walk, they need to be able to do / achieve what 12) A patient is lying supine with hips and knees extended and hands behind the head. The patient is able to raise the head, shoulders, and thorax from the treatment table but is unable to come to a complete long-sitting position. What muscle should the physical therapist target for a strengthening program? 1. Iliopsoas 2. External abdominal oblique 3. Quadratus lumborum 4. Upper rectus abdominis 13) If the left middle cerebral artery was occluded, would you get left or right homonymous hemianopsia 14) As a patient progresses in learning a new motor skill, there should be an increasing reliance on which of the following types of feedback? 1. Tactile cueing 2. Visual knowledge of results 3. Proprioceptive input 4. Verbal information 15) The physical therapy plan for a patient who underwent a medial meniscectomy includes exercising the quadriceps femoris against accommodating resistance. Which of the following exercises should be recommended? 1. Knee bends through half of the range 2. Knee extension with an ankle weight 3. Knee extension on an isokinetic exercise device 4. Straight-leg raising with a sling suspension

Answer 208

1) Elevate the limb and apply pressure to the wound. - First elevate pt's limb. Then apply more dressings - And put pressure on brachial artery not radial (since brachial is proximal) 2) Knee flexion past 90 (for surgeon's designated time period) ... and Open Chain knee extension exercises - YES (don't do it) 3) Help prevent airways from collapsing in COPD pt's. A patient who has chronic obstructive pulmonary disease has premature collapse of the airways upon exhalation, which leads to air trapping and ultimately poor gas exchange. Breathing out through pursed lips slows the airflow and creates a back pressure, which helps to prevent the airways from collapsing while exhaling. 4) Out - IN (causes leg to ER, so you compensate with a toe in) - OUT 5) Swelling / effusion in a joint - Empty due to pain - Hard end-feels are expected due to chondromalacia, osteoarthritis, loose bodies in the joint, myositis ossificans, or displaced fracture. - Firm end-feels would be expected due to increased muscular tone or capsular/muscular/ligamentous shortening. 6) P value - <0.5 7) Brachialis 8) Pain and temp - DCML 9) Hypertrophic 10) Neurogenic / neurologic - Hypertrophy (not hyperplasia) 11) Full hip ext 12) Iliopsoas (rectus got them up part way, psoas has to do the rest) 13) Right 14) Proprioceptive 15) Isokinetic device