Level 1 Flashcards
Surgical protocol for Achilles’ tendon rupture
Cast or brace for 6-8 weeks
Prognosis to returning to plof after Achilles’ tendon rupture
6-7 months
A pt with surgical repair of Achilles’ tendon has A decreased brisk for route injury and a higher rate of return to athletic activities t/f
True
What test can assist in diagnosing adhesive capsulitis?
Arthrogram by detecting a decreased volume of fluid within the joint capsule
What part of the joint capsule is the tightest with adhesive capsulitis
Anteroinferior
What was two interventions for chronic adhesive cap?
US and grade iii and iv mobs
Acute bursitis difference from adhesive capsulitis
Acute bursitis only a few weeks, severe pain c a and p rom in ALL directions especially flexion greater than 90 and abduction greater than 60, arises secondary to calcific tendonitis
Leading cause of death in a person with Alzheimer’s is infection and ?
Dehydration.
How is Alzheimer’s different from multi infarct dementia
Multi infarct dementia produces symptoms in a step like manner secondary to ongoing cerebral infarcts.
What are some diagnostic tests for als
EMG for fibrillation and muscle fasciculations
Muscle biopsy verifies LMN involvement
Spinal tap may reveal a high protein content
Ct scan will appear normal until late
Primary indicator of als
Motor involvement without sensory .. Also eye movement , bowel and bladder remain intact
LBP, lim spinal ext,morning stiffness, fatigue, weight loss, kyphosis, X-ray reveal ossification
Ankylosing spondylitis
X-ray showing bamboo appearance of the spine
Late stage ankylosing spondylitis - accompanied with multiple cardiopulmonary complications
Best exercise for pt with AS
Swimming is highly recommended ** Low impact aerobic training emphasizing extension and rotation - high impact and flexion are contraindicated
PCL rehab typically emphasizes strengthening of the
Quads
T/f rarely to surgeons do PCL reconstruction due to lack of functional limitations
T- but there are long term djd changes due to alternation of arthrokinematics
Non surgical procedure for Achilles’ tendon rupture
Includes serial casting for approximately 10 weeks followed by the use of a heel lift to ensure maximum healing without stress on the tendon for 3 to 6 months
Common sites for arterial insufficiency ulcers
Dorsum of the foot, the lateral malleolus, and toes
Around with shallow , irregular edges?
Venous- min pain, heavy exudate
Plain film radiography diagnose bicipital tendinitis?
No, but can show calcification in the groove in the groove or subacromial spurring
Initial PT for bicipital tendinitis
Avoidance of overhead motions, possible short term immobilization, pendulum exercises, use of tens, no active PT initially
Anterior joint instability could likely cause
A bankart lesion which is a avulsion of the labral ligamentous complex from the Anteroinferior aspect of the glenoid - CT scan needed to diagnoses and surgery to repair
Five common sites of breast cancer meta
Brain, lungs, bone, adrenals, liver
Post surgical carpal tunnel pts should avoid
Wrist flexion and a forceful grasp- SHOULD include tendon gliding, massage, desensitization techniques, modalities, etc- after four weeks a pt can progress with active wrist flexion, gentle stretching, putty exercises, light PRE, and continued modifications of body mechanics
What is the location of the guyon tunnel
Between hook of the hamate and the pisiform- will cause atrophy of hypothenar musculature
Hyper extension injury to the spinal column will cause Injury to which ligament?
Ligamentum flavum
Cor pulmonale is normally seen as a consequence of
Copd due to sustained hypoxia which produces an inc in pulmonary artery pressure
High concentration of sodium and chloride in sweat is a consistent finding for?
Cf- parents will notice a salty taste when kissing child- greater than 60mEq/l
90% of pts with cf have pancreatic enzyme deficiency which eventually leads to fibrosis of the pancreas. This process interferes with?
Digestion and absorption of nutrients
Cf is obstructive disease common pulm function test findings?
Decreased fev1 and fvc, increased frc and rv
Williams flexion exercises are performed with which condition
Spondylolisthesis- strengthen abdominals and reduce lumbar lordosis
Degenerative spondylolisthesis causes ?
Spinal stenosis
Polyuria, polydipsia (inc thirst), polyphasia, along with nausea, weight loss, fatigue, blurred vision and dehydration. Signs of?
Type I dm
Diagnoses of DM- fasting and random blood glucose levels?
Fasting greater than 125 mg/Dl
Random of 200 mg/dl
Hypotonia, developmental delay, lax ligs, and poor strength are key areas of focus for what disorder?
Down’s syndrome
Duchenne muscular dystrophy is initially identified by
Child having difficulty getting off the floor, needing to use the gower’s maneuver to compensate for the proximal muscle weakness
What disease causes pockets of air to for, between the alveolar spaces, increasing the dead space and impairing gas exchange
Emphysema - caused by destruction of elastin protein within the alveolar walls
X-ray showing an increased sub costal angle is indicative of!
Copd- emphysema
Which cervical root is affected with Erb’s palsy?
C5-c6: loss of rotator cuff, deltoid, brachial is, coracobrachialis, and biceps brachis function
Diagnosis of fibromyalgia
Widespread history of pain that exists in all four quadrants, axial pain, and pain in at least 11 of 18 standardized “tender point” sites. On TOP of fatigue, IBS, depression
Initial exercise session duration for a fibromyalgia pt
3-5 min initially due to low tolerance for excursion and should not be worked through pain. Weight lifting should be avoided
Disease progression of GBS
Symptoms peak at 4 weeks, plateau for 2-4 weeks, followed by gradual recovery that can last up to 2 years
Three phases of HIV disease process
Asymptomatic hiv, symptomatic HIV, aids
During which phase do T cell counts begin with p drop
Asymptomatic phase - 1-2 years post infection
Normal range for T cell count
650-1200 cells
Onset of aids occurs when T cell count drop below
200 cells per mm3
Medical management will institute antiretroviral therapy HAART when T cells drop below
500 mm3
Leading cause of death from aids
Kidney failure due to extended drug therapies
With what disease The ventricles become enlarged secondary to atrophy of basal ganglia
Huntingtons disease - the pt will initially present with involuntary choreic movements and mild alterations in personality - late stage is characterized by a decrease in IQ, dementia, incontinence, inability to ambulate, progression from choreiform movements to rigidity.
What causes inflammation and stiffness to multiple joints for a period of greater than 6 weeks
JRA
Visual problems, paresthesias, clumsiness, weakness, ataxia, balance dysfunction, and fatigue are initial symptoms of?
MS- frequent rest breaks,break up task into smaller steps to avoid fatigue. On going ambulation and mobility activities are important to maintain endurance and prevent disuse atrophy
What does an elevated st segment indicate
Acute infraction
What does depressed ST segment indicate
A pending subendocardial or transmural infarction
An inverted t wave indicates
Myocardial ischemia
Exercise testing is performed within ____ days of the MI in order to establish baseline guidelines for a pt that has been cleared to exercise
3 days
Ulcer with a well defined oval or round shape surrounded by a rim of hypertrophic callus. Usually occurs on the plantar surface of foot by the met heads
Neuropathic ulcer
Primary vs secondary OA
Primary is related to aging vs secondary to trauma in younger age
A genetic defect affecting collagen producing genes and reduces production of collagen
Osteogenesis imperfecta
Blue schelra, easy bruising, triangular face, bowing of long bones, brittle teeth are signs and symptoms of?
Osteogenesis imperfecta
Strengthening exercises for OI should avoid?
Rotational forces, placing weights/resistance near a joint, and using long lever arms. Child needs to exercise and weight bear in a safe fashion in order to optimize strength and bone mass
What should a pt with op avoid
Excessive flexion durin exercise or adls, heavy resistance exercise, use of ballistic movements
Disease cussing bone deformities, brittle bone, bone pain, and abnormal thickened spongy bone
Pagets also cause fatigue stiffness hearing loss headache
Progression of Parkinson’s disease includes?
Dysphasia, difficulty with speech, and pulmonary impairment
Less pain with superficial or deep partial thickness burn?
Deep
Which burn will blanch, superficial or deep partial thickness burn?
Superficial partial thickness burn will blanch when touched and the return to red color indicating capillary refill is intact
A pt with a deep partial thickness burn will benefit from PT interventions to address ?
Wound and edema management and prevent the for,action of hyperthrophic or keloid scarring
What burn involves the epidermis, dermis, subcutaneous tissue, and larger blood vessels
Sub dermal
Pain location differentiation for patellofemoral syndrome vs patellar tendinitis
Retropatellar pain for patellofemoral vs point tenderness at the superior pole of the patella tendon for patellar tendinitis
Exercise prescription for patellofemoral syndrome
Strengthening of the vastus medialis, flexibility of lateral fascia, medial patellar glides, taping, and avoidance of deep squats
What Is the goal of a walking program for PVD
Have the pt achieve longer walking periods with less rest, eventually walking for 30 mins continuously. Initially have the pt walk until near maximal pain and then rest until the pain is relieved in order to promote collateral circulation
What should a pt do if they have pain at night due to PVD
Head of bed elevated 4-6 inches
How is a stage one pressure ulcer classified
As an area of nonblanchable erythema of intact skin
Stage iii pressure ulcer
Through the epidermis, dermis, and into the subcutaneous tissue, but not through fascia
Condition where there is an increase in sympathetic activity which causes a release of norepinephrine in the periphery and subsequent vasoconstriction of blood vessels. Results in pain and an increase in sensitivity to peripheral stimulation
reflex sympathetic dystrophy RDS
Symptoms of RDS
A pt with RDS will experience intense, burning, and chronic pain in the affected extremity that will eventually spread proximally. May progressive to bone demineralization, edema, joint ankylosis, atrophy– initiate treatment ASAP
Poor lung expansion causing inability to deep inspire
Restrictive lung disease
As restrictive lung disease progresses, respiratory muscle fatigue will lead to ?
Respiratory muscle fatigue will lead to Impaired alveolar ventilation and carbon dioxide retention. Pt first will have exertion all dyspnea and then progress to dyspnea at rest
An infectious and inflammatory systemic disease that can result in restrictive lung disease
Tuberculosis- droplet precautions
80% of individuals diagnosed c RA possess a positive
RF - rheumatic factor in addition to elevated wbc, erythrocyte sedimentation rate, hemoglobin, and hematocrit values
Extraarticular manifestations of RA
Perry carditis anemia tearing of tendons and muscular true osteoporosis swan neck and boutonniere deformity’s compression neuropathy’s peripheral neuropathy’s depression pleurisy skin changes and anorexia
Systemic effects of RA
Insomnia, fatigue, and organ involvement including the heart and lungs
RA exercise guidelines
Gentle isometrics for strengthening…. Aggressive strengthening always contraindicated. In the acute phase should avoid resistive training, deep heating modalities, and any form of active stretching since it will further exacerbate RA
Which two muscles depress the humeral head with elevation
Supraspinatus and subscapularis
Rehab of rotator cuff tendinitis
Stretching and strengthening exercises must remain pain free; strengthening exercises are initiated with the arm at the pt side to avoid impingement, it is important for the entire cuff to be strong prior to initiating overhead activities
Following a rotator cuff tear the shoulder is usually protected by a sling and small amount of abduction for how long?
First 6 weeks sp repair
Sciatic nerve distribution
L5,l5, s1-3
A patient with scoliosis less than 25 degrees should be monitored every
Three months
If scoliosis ranges between 25-40 degrees it requires a
Spinal orthosis and PT intervention for posture, flexibility, strengthening, respiratory function, and proper utilization of the spinal orthosis
A scoliosis with greater than 40 degree curve requires
Surgical spinal stabilization
What is the most effective way to prevent neural tube defects?
Prenatal care including recommended amount of folic acid, especially in the first 6 weeks of pregnancy
90% of the myelomeningocele cases a _____ is required
Shunt is required for hydrocephalus - 1/3 of all cases have mild retardation - all have attention problem solving perceptual difficulty
Ongoing additional findings with myelomeningocele include
Hydrocephalus, club foot, neuropathic fracture, visual problems, osteoporosis, kyphosis, hip dislocation, and latex allergy
Drug often given to sci pts to control the amount of secondary damage and improve the neurological outcome
Intravenous methylprednisolone
A connective tissue disorder caused by an autoimmune reaction in the body
Systemic lupus erythematosus
Initial presentation SLE of causing pt to go see physician
Fever, malaise, rash, arthralgias, headache, and weight loss
Common presentation throughout the course of SLE
Red butterfly rash, arthralgias, alopecia, pleurisy, kidney involvement, seizures, depression, fibromyalgia, and cardiac involvement
PT goals should focus on with pts c SLE
Relaxation and energy conservation, stress reduction, therapeutic ex as tolerated, and pain management
Thoracic outlet syndrome symptoms
Difficulty sleeping due to excessive pillows or malpositioning of the arm, difficulty with carrying shit on the affected side, or difficulty driving car
TOS PT intervention
Stretching scalenes, pain management, strengthening traps, lavatory scap, and rhomboids, postural awareness, activity modification
Anterolateral THA approach precautions
Avoid hip flexion and ER
What THA approach is used for pts that might be noncomplaint with post surgical precautions
Direct lateral approach
A cemented hip replacement allows for what kind of weight bearing initially
Partial
Noncemented THA require what type of WB and for how long?
TTWB for up to 6 weeks
Hip precautions should be adhered to for
Min of 3 months
Neers shoulder protocol for advocates for initiating isometric exercises shoulder exercises ____ weeks after TSA and AROM after ____ weeks
3, 6
PROM and AAROM are indicated for the first phase of rehab following a TSA but ____ is contraindicated
AROM
Pt should avoid IR and ER rom 35 degrees during the first 2-3 weeks post surgery
T- initial phase should focus on PROM, AAROM, and pendulum and wand exercises
A hemiarthroplasty is indicated over a TSA when ?
Humeral head/neck fracture beyond repair, pt doesn’t have enough to bone density to support the glenoid component or when there is significant rotator cuff deficiencies
Nightly malignant cancer that begins in the medullary cavity of a bone
Osteosarcoma
Pain, swelling that is worse at night or with exercise are symptoms of
Osteosarcoma -
Where does osteosarcoma metastasize to
Lungs in 90 % of the cases
PT interventions for pelvic floor muscle weakness that is tested as 0-2/5 includes
Biofeedback, estim, bladder retraining, therapeutic exercise. Pelvic floor muscle strengthening at this level includes facilitation and tapping of the pelvic floor muscles, overflow exercises using the Buttocks, adductors, and lower abdominals, and the implementation of kegal exercises
PT intervention for pelvic floor muscle weakness or 3-5/5 include
Continued biofeedback and bladder retraining, weighted vaginal cones for resisted training, and implementation of pelvic floor muscle exercise during activities
Polyarticular JRA involves how many joint
More than 4 joints
What stage- pitting edema that reduces with elevation over night and does not exhibit any fibrotic changes
Stage I
Stage II edema
Fibrotic changes begin to occur and increase in non-pitting edema that does not reduce with elevation
Stage III edema is characterized by
Skin changes, frequent infections, and severe edema that is non pitting and fibrotic.
In addition to ROM, strengthening, etc the PT should do transverse friction massage to the healing MCL ligament so that it does not adhere to surrounding structures. Care must be taken to avoid massaging what part?
The proximal attachment of the MCL due to potential bony periosteal disruption .. Use of crutches should Continue until the pt can adequately extend the knee
Erb’s palsy waiters tip deformity
Loss of elbow flexion and wrist supination, and the hand positioned in a pinch grip manner
During The recovery of Erb’s palsy nerve regeneration remains at a constant speed however
PT intervention can assist with overall strength and function during recovery
