MEGA Flashcards
Myositis ossificans end feel
hard
Muscle spasm end feels
rubbery
Springy end feel
meniscus
Mal union of fracture end feel
bony hard
Acute bursitis end feel
empty
Lateral winging of scapula
CN XI palsy
damage to upper trap or rhomboids causes lateral translation of scap
Scapular winging findings
prominent medial border and upward translation/elevation d/t unopposed trapezius
30-90 degrees elevation most active muscle
deltoid
0-30 degrees elevation most active muscle
supraspinatus
above 90 degrees elevation most active muscle
serratus and upper trap
Medial winging - serratus is most commonly seen in
90 degrees+ flexion
Lateral winging - is most commonly seen in
ranges of 90+ abduction
C2 dermatome coverage
temple forehead occiput
C4 dermatome coverage =
above clavicles
C5 dermatome coverage =
lateral shoulder anterior arm
Nipple level
T4
Superfical sensation
via skin and subcutaneous tissues
Pain temp and light touch are what kind of sensation
superficial sensation
Deep sensation
muscle tendon fascia
Kinestheisia and proprioception are examples of what kind of sensation
deep sensation
Cortical sensation
combination of superficial and deep sensation
Examples of cortical sensation
sterognosis
2 point discrimination
barognosis
Localization of tactile touch
Combined cortical sensations are carried by
DCML
Lateral spinothalamic tract cxarries
pain and temp (superficial sensations)
FIne vs crude touch
fine - localized (anterior spinothalamic)
crude - non localized (lateral spinothalamic)
GCS - Eyes - 4
ESPN- Eye Opening
E eye opening spontaneously -4
S eye opening to sound -3
P eye opening to pain -2
N No response -1
GCS - Motor - 6
Can’t Live without FrENDs - Motor Response
Obeys Commands- 6
Localizes pain - 5
Withdraws from Pain - 4
Flexion to pain (decorticate)- 3
Extension to pain (decerebrate) - 2
None- 1
GCS - Verbal - 5
Our Country Wins
Oriented - 5
Confused - 4
Inappropriate words - 3
Incomprehensible sounds - 2
No response -1
Less than 8 on GCS
severe
13-15 GCS
mild
9-12 GCS
mod
mod GCS
9-12
mild GCS
13-15
severe GCS
less than 8
Best auscultation site for S3 heart sounds
mitral valve - L 5th mid clavicular space
Best auscultation site for S2 heart sounds
pulmonary sound
RPE scale way to remember
start at 9 and 50% then add 5 for every increase
9= 50%
10=55%
11=60%
12=65%
13=70%
14=75%
15=80%
16=85%
17=90%
18=95%
19=100%
Denervated heart = increased or decreased resting HR
increased
Denervated heart effects on exercise
delayed HR increase
slower decrease in HR - return to resting
increased resting HR
decreased maximum HR
Stages of lipedema
Stage I: skin surface smooth, subcutaneous fat thickened, fat structure fine-
knotted
Stage II: Skin surface uneven, fat structure coarsely knotted
Stage III: Tissue additionally coarser and harder, large lobed deforming fat lobes
Stage IV: Additional severe lipolymphedema
Cellulitis is more common with lymphedema or lipedema
lymphedema
Pain on pressure: lymphedema or lipedema
lipedema
CE MI PONS MEDU
CE = 1,2
MI = 3,4
PONS = 5,6,7,8
MEDU = 9,10,11,12
Causes of short step length
FLOP - hip flexor tightness results in shorter step on opposite side
glute max contracture on same side
FLOP
Flexor tightness opposite side - step length reduced
High ankle sprain - tibiofibular sprain
syndesmosis squeeze test (Hopkins test)
pain distal tib fib joint
Anteiror drawer in 0 DF
posterior TFL
Anterior drawer in 20 PF
ATFL
Blumbergs sign
rebound tenderness
Appendicitis sympotms
RLQ epigastric pain
colicky to contant pain as progresses
rebound tenderness (Blumbergs sign)
Mcburneys point location
1/3 between ASIS and umbilicus
closer to ASIS
Obturator sign
RLQ pain with IR of hip in 90/90
Rovsing sign
Press into LLQ - pain in RLQ
Pinch and inch test
Pinch 1 in of tissue in RLQ
Murphys sign - gallbadder
deeply inhale, palpate under ribs, exhale
if gallbladder presses into hand = pain
Murphys sign - kidney
closed fist - thrust with other hand to kidney (12th rib)
Murphys sign - hand
lunate dislocation
make a fist - if all knuckles are in line = positive
Referred pain patterns - to testes
ureter
Referred pain patterns - to shoulderblade
gallbladder
Referred pain patterns - to umbilicus
pancreas
Referred pain patterns - to L shoulder
diaphragm
heart
Referred pain patterns - to R shoulder
liver
gallbladder
R lung
peptic ulcer
head of pancreas
Head of pancreas pain
R shoulder
Cullen sign
periumbilical ecchymosis
acute pancreatitis
Kehrs sign
pain referred to the left shoulder on gentle palpation of the abdomen when the patient is lying down with legs elevated
Hiatial hernia pain
L shoulder
Thorax wrapping anteirorly pain is called
flank pain
RLQ pneumonic
AC
appendix
chrons
LUQ pneumonic
Don’t banana split
(diaphragm, body and tail of pancreas, spleen)
RUQ pneumonic
good luck hot pack
(gallbladder, liver, head of pancreas, peptic ulcer)
FIM scale
1-7
1= dependent (patient participates less than 25%)
2 = maxA (patient participates 25-50%)
3 = modA (patient participates 50-75%)
4 = minA (patient participates 75% or greater)
5 = supervision (cuing, setup, guarding = CGA)
6 = modI - IND w/ AD
7 = IND
Qs can be asked both ways - pt participation or PT assist
SLR sural bias
ankle DF IV
SLR tibial bais
ankle DF EV
toe extension
TED SID PIP
Tibial - Eversion - DF
Sural - Inversion - DF
Peroneal - Inversion - PF
XRAY view needed for spondy
oblique view
Low TSH =
hyperthyroidsim
High T3/T4
hyperthyroidsim
Hyperthyroidsim signs
increased HR causes decrease BP
Muscle weakness and atrophy
heat intolerance
high metabolic rate
increased glucose absorption
restlessness
insomnia
increased appetite and weight loss
increased perspiration
hyperreflexia
exopthalomos
Hypothyroidsim signs
decreased HR
increased BP
low BMR weight gain
cold intolereance
decreased glucose absorption
sleepiness, prox muscle weak
constipation
brittle hair nails
prolonged DTR - they move slow and prolonged
myxedema
Cardiovascular changes with aquatic therapy
you pass your exam and go on vacation =
decreased HR and BP
but you’re happy so your happy heart = increased stroke volume and CO
hydrostatic pressure makes heart more efficient
Pulm changes with aquatic therapy
hydrostatic pressure =
decreased lung expansion
increased work of breathing
decreased VC IRV
% WB thorax exposed
33%
% WB head exposed
10%
% WB at ASIS
50
MS is categorized as UMN/LMS
UMN
MS vs ALS
MS pain - UMN
ALS no pain, UMN+LMN, pure motor
disuse atrophy =
UM
Primary progressive MS
steadily worsening from the onset no periods of relapse or remission
Relapsing remitting MS
periods of attacks and remission
Secondary progressive
initially relapsing remitting and transitions to primary progressive
Progressive relapsing
most dangerous
steadily worsening from start with periods of attacks
COPD gold stage 1
mild
FEV1 80%+
FEV1/FVC ratio less than 70%
obstructive disease
COPD gold stage 2
moderate
FEV1 50-79%
SOA with exerction
COPD gold stage 3
severe
FEV1 30-49%
COPD gold stage 4
very severe
FEV1 less than 30%
MAM R U
ULTT 1 Median - AIN
ULTT 2 Median - Musculocutanoeus
ULTT 3 - Radial
ULTT 4 - Ulnar
Independent sliding board transfers
C6 - wrist extension creates tenodesis grasp
Independent pressure relief
C6 - lat dorsi innervated can compensate for lack of triceps
BROWN - POT
Brown sequard
Pain OPP side Temp Opp side
Motor pain and temp loss below level - bilateral
anterior cord syndrome
DCML spared - proprioception , vibration, 2 point discrimination, fine touch
Posteiror cord syndrome
bilateral loss of DCML
MUD - E
Central cord
motor more than sensory
UE>LE
hyperExtension
Pressure ulcer stages
Stage 1 - non blanchable redness - when you press it doesnt go away
Stage 2 - superfical partial thickness wound
Stage 3 - full thickness wound involving subcu tissue (3 - FAT)
Stage 4 - full thickness with bone or tendon exposed 4- BONE)
Pressure relief in wheelchair
once every 15-20 mins
Waxy white burn
deep partial thickness
Burn classificaiton: no pain or pressure
Full thickness burn - third degree
charred or tan leathery apperance
Sensitive to pressure but not to light or pinprick touch
deep partial thickness - 2nd degree
Protocol THA Phase 1
max protection
WBAT
precautions
ankle pumps
UE strengthening
Avoid hip flex contracture
3 things needed to use parametric test
normal distribution
ratio or interval data
sample size 30+
Anterior hip precautions
adduction extension ER
Chi square used with
nominal data
Thomas test - psoas tightness
hip flexion only
Thomas test - rectus femoris tightness
extended knee
Thomas test - biceps femoris tightness
lateral rot of tibia
Elys test
prone knee flexion tests rectus
Increase in PR interval only
normal PR interval is .12-.20 so prolonged would likely be higher than .20
Hypocalcemia EKG
prolonged QT interval
Baby is a QT - baby cries prolonged without calcium
Hypercalcemia EKG
QT interval shortned because baby (the QT) has lots of milk
Hypokalemia
decrease T wave
ST depression
Interventions are what kinds of variable
I for an I
Independent for Intervention
Outcome measures are … variables
dependent variables
Contact precautions
MRSA Cdiff VRE Lice Scabies
Gram negative bacterias are what precaution
contact
HEP A and B precautions
Contact
Strep A precaution
droplet
Pertussis precaution
droplet
uhthoff phenomenon
MS worse in hot weather
Precautions postural drainage
pulm edema
hemoptysis
ascites
pleural effusion
massive obestiy
Contraindications postural drainage
increased intracranial pressure
hemodynamically unstable
spinal fusion
head trauma
Ranchos Level 4 interventions
they do not have carryover from previous sessions so orient them and consistent schedule
used closed ended questions
prepare multiple activites and give options - impulsive
be calm
New Girl Looks Cute in a CO-IN and CAP-APP
No response
Generalized
Localized
Confused - Agitates
Confused - inappropriate
Appropriate
Confused
Automatic
Purposeful
Forward sway muscles active with hip strategy
concentric abdominals and quads
Forward sway ankle strategy
eccentric contraction of posteirior muscles - gastroc, paraspinals and hamstrings
Backward sway ankle strategy
eccentric tibA quads abdominals
Backward sway muscles active with hip strategy
concentric paraspinals and hamstrings
When to use distributed practice
strok, SCI, MS, post polio
anytime that fatigue is an issue
Procedural learning
tasks performed without thinking
Declarative learning
concious recall of information such as names states facts dates etc
Performing exercises w/ lymphedema
proximal joints to distal
Ionto for hyperhydrosis
use water - neutral
Ionto for pain
options
salicylate - negative
lidocaine - positive
xylocaine - positive
Ionto for calcification
acetate/acetic acid
negative
Ionto for inflamm
dexamethasone
negative
Ionto for scars
iodine
negative
Ionto for dermal ulcers
zinc oxide
positive
Ionto for fungal infection
think green penny
copper - positive
Ionto for muscle spasm
calcium - positive
magnesium - positive
Burns with ionto most commonly occur with
negative polarity
Opening restriction =
pop top -
Closing restriction
bottoms up
work on bottom segment
Hip contracture position
flexion and adduction
Intrinsic plus position
resting hand splint
Class 1 compression garment
20-30 mmHg
used for mild lymphedema
UE
fragile skin or elderly
Class 2 compression garments
30-40 mmhG
stage 2 lymph
min compression neeeded for LE
min compression neeeded for LE
30-40 mmHg
40-50 mmHg would be used for
LE
Low anterior thigh wall
acts like weak quad
Low lateral wall
weak abductors
Low walls vs high walls prosthetics
low walls = weak muscles
high walls = tight muscles
How to assess diastasis recti
lift head progress toward shoulders and scapula
if split is greater than 2cm - protect abdominal musculature and progress head lifts
Disk protrusion % lumbar traction
25% body weight
Paroxysmal nocturnal dyspnea involves which sided heasrt failure
L
Naming torticollis
side of muscle tightness
Oblique - ipsilateral rotators
internal = Ipsilatearl
Oblique contralateral rotators
external
C is close to E
Ex. rolling to supine from R sidelying - oblique action
left IO right EO
Difference in axle bariatric WC
Difficulty propelling WC solution
Move front casters back =
closer to patient COM
Person in bariatric WC has more weight placed
anterior
solution is to displace rear axle forward
OLD FEN
Motor response GCS
Obeys command
Localized pain - moves
Draws away (flex) from pain
Flexion
Extension
None
Medial epicondylitis most commonly affects
FCR and pronator teres
R optic nerve lesion
blindness of R eye
R optic tract lesion
Homonymous hemianopsia with blindless on L sides
Cannot do the task with cueing but can without being watched
ideomotor
APGAR Slow and irregular
1
APGAR Cry
2
APGAR Active movement
2
APGAR Flexed arms and legs
1
Bouchard nodules
OA nodules at PIP
PIP in GB
Fall risk on POMS
less than 19
Fall risk on FGA
less than 22
Fall risk on TUG
30+
most can finish less than 10
11-20 normal for elderlyNOr
Normal TUG for elderly
11-20
In ABG question if no values are within normal it is
partially compensated
axial load + IR/ER in 160 degrees elevation
crank test
Crank test is perfomred in … elvevation
160
AC Shear test positive
abnormal movemenet or pain
Rhabdo signs
dark brown urine
CK
decreased bone desity = increase or decreased bouyancy in water
increased
Renal dysfunction = increased or decreased urine output
decreased
S1 vs tibial nerve pathology
S1 sensation supplies lateral foot, tibial supplies sole of foot
Color of deep partial thickness burns
mixed red/waxy white
US depth for shoulder capsule
deep 1 mHz
Diagnostic studies =
cross sectional
Suprapubic tapping is best for
spastic bladder
this will not work for flaccid bladder as there is no reflex arc available
Platelet count less than 10000
no exercise
10-20 bike no resistance
20000 bike + therex
Pain with food or within 30 mins-1 hour after=
gastric ulcer
Gastric=Food
Pain inbetween meals 2-3 hours after
duodenal ulcers
Empty=Duodenal
IRs of the shoulder
subscapularis, lat, pec minor
concentric phase of throwing
fall risk functional reach test
less than 10 in
Supine development peds
2-3
3-5 months touch knees
5-7 months touch toes to mouth
Cancer stages
0 - in situ
1 - at tissue
2 adjacent tissue + lymph
3 deep tissue + lymph
4 beyond origin + lymph
How to remember HCt values
Hemoglobin x3
Males 13-18 x3 = 39-54%
Females 12-16 x3 = 36-48%
Angry folks have HF - wound absorption
alginate
foam
hydrocolloid
hydrogel
film
Angry folks have HF - wound absorption
Signs of supraspinatus tendonitis
pec minor tightness = anterior tilt of scap
upward migration of HH
painful arc
Gaenslen test
positive for a SIJ lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion.
Laceration to back of hand =
sensory loss only in distribution of radial nerve (dorsum of thumb)
motor is done by everything proximal to wrist
child collapses = first action
30:2 CPR followed by activating EMS if alone
Complications of NSAIDs
vasoconstrictors = increased BP and peripheral edema
abdominal pain, melena (dark stool)
Dilated pupils biltaerally =
CN 2
CN 3 if ipsilaterally
Cyanosis, confusion, diaphoresis, restlessness, hypoventilation
resp acidosis
hyperventilation, lightheaded, dizzy, syncope, muscle cramps
resp alkalosis
metabolic alkalosis results in compensatory
hypoventilation
metabolic acidosis results in compensatory
hyperventilation, cardaic arrythmias, hyperkalemia
Weak PF gait deviations
decreased pushoff and shortened contralateral step length
Conversion disorder
person actually thinks theyre sick and weakn blind etc
treat with CBT
Malingering
made up symptoms
for secondary gain
Mandatory reporter
must report cases to CPS
Modify exercises in this progression
intensity
duration
frequency
Pressure tolerant areas
Patellar tendon
Medial lateral tibia
Fibulae shaft or neck
Intolerant
Fib head
Tibial crest and condyles
Distal tibia
softer heel cushion =
increased loading response
Normal GFR
90-120
kidney filure is below 15
Damage to peduendal nerve -
stress incontinence
pudendal nerve
carries motor and sensory from S2-4 sacral spianl nerve
Functional incontinence
impaired cognition or physical functioning - cannot get to toilet but bladder works fine
Overflow bladder
non contractile overflow due to prostate enlargement or areflexive bladder
When you are resting and holding pee your detrusor muscle is and pelvic floor is
relaxed
contracted
BPH pain or no pain
no pain
Motor function is preserved below the neurologic level, but …. of the key muscles below the neurologic level have a muscle grade
more than half
less than 3
Crede method
manial pressure to lower abdomen to empty bladder
NLOI
most caudal segment with both normal light touch and pinprick
+
at least 3/5 motor on both sides of body
Lower GI stool
black coffee color
COlon stool
blood
Better with lean forward and sitting up; worse laying down
pancreatic cancer
Pancreatitis
Makes sense because they are both pancreatic conditions
Signs of increased hemoglobin
dehydration and shock
Signs of decreased hemoglobin
tachycardia, decreased exercise tolerance, fatigue
INR 2.5
be cautious
INR 2.5-4
risk for hemoarthosis - bleeding into joint
INR 4-6
no therapy - maybe bed rest
Less than 10,000 platelet
no go
10-20,000 platelet
basic ADLs only
20-30,000 platelet
light exercises
30-50,000 platelets
submax, AROM, avoid resistance
Normal potassium
3.5-5
low potassium creates heart arrythmias and cramping
ESR normal values
less than 15 male
less than 20 female
prothrombin time
12-15
high prothrombin time = liver damage because liver makes clotting proteins
Psoatic limp
flexion ER adduction
AROM limitations LCP vs SCFE
extension and abduction - LCP
abduction, flexion, IR - SCFE
Normal sodium values
135-145
Normal calcium
8.4-10.4
Normal magnesium
1.8-2.4
Hyperkalemia is associated with metabolic
acidosis
Symptoms of hypercalcemia
fatigue confusion increased urination cardiac arrhythmia
Goldthwaits test
lumbar spine vs SIJ
place hand under interspinous space and perform SLR
if pain occurs before interspace movement = SIJ
Gillets test
Palpate S2 and PSIS on side the knee is flexed
normally should move inferior to S2
if moves minimally joint is hypomobile
Transient osteoporosis can be associated with pregnancy
third trimester
How many minutes of ice for spasticity
30 mins
Trunk curl ups are contraindicated for rectus diastisis ….
more than 2 finger widths
First degree flat foot
Second degree
third degree
navicular drop 1/3 to floor
2/3
on floor
Burn scale for scattered burns
hand method
Primary repair
first 12-24 hours,
delayed primary surgery
within the first 10 days
Functional capacity of a C8 spinal cord injury
able to transfer from floor into wheelchair
SCI level independent with driving a car with adaptive controls.;
C5
Closed packed posotion hip
extension abductoin IR
Meds that give OP with long term use
corticosteriods
coumadin/aspirin/heparin
On off time traction
60 on 20 off
On off time for muscle spasms
10 on 10 off - fatigues muscle
On off time russian
10 on 30 off
Blanching with. brisk refill
superficial
ex sunburn
2-7 day heal
Redness and blistering, appears wet and weeping
no scarring
extremely painful
blanching with brisk refill
mod edema
superficial partial thickness
Blanching with slow refill
red waxy white
sensitive to pressue but not light touch or pinprick
lots of edema
will result in extensive scarring
deep partial thickness
No blanching
white or charred brown leathery appearance
no pain or pressure
full thickness
High risk on Braden
12 or less
Mod risk on Braden
13-14
Low risk on Braden
15-18
Rubor of dependency test
seen with
arterial wounds
elevate leg to 60 degrees for 1 min, hang off bed
color should return within 15 seconds
if takes longer or foot turn bright red = arterial insufficiency
Normal capillary refill
less than 3 seconds
Options for ABI of ankle
dorsalis pedis or posterior tib artery
ABI with venous insufficiency
high
Compression pumps for venous ulcer pressure
45-60 mmHg
Interventions for Arterial insufficiency
walk until symptoms arise
manage BP cholesterol risk factors etc
Wound dressing for little to no drainage
transparent film
Wounds with mild exudate or partial thickness
hydrocolloid
Wounds with necrosis and sliugh
partial and full thickness
dry wounds
hydrogel
Induration
very hard and swollen
Subscapular nerve innervates
teres major
Axillary nerve innervates what 2 muscles
deltoid and teres minor
Subscap innervation
upper and lower subscapular nerve
Suprascapular nerve innervates
supra and infraspinatus
There’s major
Weakness or insufficient recruitment of pelvic muscles results in sustained posture of SI joint
counternutation
Anterior pelvic tilt results in what motion of sacrum
counternutation
The ideal amount of time for therapeutic heating effects heat
20-30 mins
What does laying supine while preganant lead to?
Increase in inferior vena cava pressure = decrease in venous return and cardiac output
Increased IR rotation during swing
caused by weakness of hip ER
tight IT band
Normal RR rate adult
12-20
Normal RR rate elementary kid (8-12 yr)
20-30
Normal RR rate toddler (1-3 yr)
25-40
Normal RR infant (less than 1 yr)
30-60
Why does hypothyroidism present with …
decreased cerebral blood flow = slowed neurologic functions, reduced peristaltic activity leading to constipation and decreased appetite, decreased circulation = cold intolerance
TibA innervation
L4-5
Can PTs recommend med changes if its OTC
No
Aspirin vs Tylenol
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Tylenol is an analgesic NOT an NSAID
Jugular vein distension
R sided HF
think flow backs up
Excessive hip adduction IR upon landing =
ACL - quad action in flexed valgus position put inordinate load
MOI PCL
hyperflexion or extension
Oblique popliteal ligament
prevents hyperextension
anteromedial tibia rotation
10 meter walk test
measures gait speed
mark 2 meters 6 meters 2 meters
have patient start walking and start timer at the 2 meter point stop at 8 - only measures gait speed through middle 6 meters
can use AD
Positive venous filling time
less than 15 seconds
due to venous reflux
Positive rubor dependency test
greater than 15 seconds
Stage 1 lymphedema is better in
morning
What type of compression garment for lymphedema
phase 2 - flat knit
L5 nerve root DTR
hamstrings
Trigger foods GERD
acidic (coffee)
chocolate alcohol
fatty
Slipping of the iliopsoas tendon
snapping at lesser trochanter or anterior acetabulum
45° of flexion to extension w hip abducted and ER
Large muscle group NMES
35-80 pps
200-350 microseconds large
For small 150-200
Difficulty with initiation of movement
basal ganglia
hip/groin pain, limited IR, flexion, and abduction
hip dysplasia
Smaller in stature and may have limb length discrepancies, hip abductor weakness, antalgic gait
LCP
adolescent, antalgic gait and a laterally (externally) rotated lower extremity, obese
SCFE
Efficacy
extent to which an intervention produces a desired outcome under ideal conditions
extent to which an intervention produces a desired outcome under ideal conditions
Efficacy
extent to which an intervention produces a desired outcome under usual clinical conditions.
Effectiveness
Efficacy vs effectiveness
Efficacy = ideal conditions
Effectiveness = actual conditions
OPP shoulder =
… flexion
… abduction
30
60
Too much friction at prosthetic knee = gait deviation
circumducted
Afib that is contraindicated vs ok to treat
new onset 100+ bpm = no go
managed chronic under 100 bpm = ok
Orthotic management scoliosis cobb angle
25° to 45°
cobb angle for spinal fusion
40 degrees
Rocker bottom shoe
takes weight off toes and more weight through heel
CHF and aquatic therapy
must be monitored closely due to immersion and increase in volume overload that could happen
PEDI
limitations in participation
has a section for caregiver assistance
SFA
assess performance w school tasks
Signs of spinal shock
inability to sweat
areflexia
hypotension
Signs of PE
tachycardia
tachypnea
decreased O2sat
What is a hiatal hernia
stomach protrudes through diapragm
Glossopharyngeal breathing
C3-4 partial diaphragm
Pusher syndrome treatment
ask them to find midline then reward them with success
physically pushing them back is only going to make them push harder
remember, pusher syndrome is a postural/perceptual issue, not muscular
Hypoproteinemia less than 2 g/dL
ABI less than .6
contraindication for compression pump
MG affects women when
20-30
men 50+
MG affects men when
50+
women 20-30
Molymyalgia rheumatica common age
80+
Central slip vs distal slip/tendon of extensor digitorum
central = PIP
distal -DIP
Compensations w measuring forearm pronation
shoulder abduction and IR
Compensations w measuring forearm supination
shoulder adduction and ER
Anemia is associated with what comorbidity
CKD - decreased RBC lifespan and erythropoetin production
Babinski sign tests what tract
corticospinal tract
Tetraplegia - you want them to have … hamstrings and … lower trunk
flexible hamstrings to 100 for long sitting
tight trunk for sitting stability
How to increase neural tension with SLR
adduct and IR hip
flex cervical spine
obviously DF
Glute med innercation
L4-S1
Weak hip flexors (L2) results in what gait deviation
ER of hip to use adductors as flexors
Glute max innervation
L5-S2
Aortic aneurysm pain referral
lower abdomen and back
Pancreatic pain
epigastric and LUQ
FDS paralyisis results in
swan neck
3 muscles innervated by AIN
FDP
FPL
pronator quad
Cardiac tamponade
fluid collection within pericardium
Cardiovascular changes with elevation
initially everything increases
Head ball coach Colorado
increase HR
BP
CO
except SV normal
Valsalva CV effects
increased ab pressure
increases BP and venous pressure - due to decreased blood flow to heart
decreased HR
Dangers of Valsalva
on relaxation, blood rushes to cardiac system and overloads
Infant normal BP
75/50
Infant normal HR
120
Child normal HR
80-140
large diameter or small diameter fibers are activated first during estim
LARGE
Hydrocolloids can be used with what stage wound
Stage 2 and 3 - minimal drainage
Transparent films only used with stage
1 and 2
Shunt dysfunction vs tethered cord
Shunt - lethargy irritability vomiting headache seizures
cord - spasticity buttock pain weak leg muscles
Back pain with SLR =
central lesion
Leg pain with SLR =
lateral disc herniation
Insidious vs acute
insidious =comes on gradually with maybe no symptoms at first
Obturator nerve innervates
adductors
-longus
-brevis
-gracilis
+ obturator externus (adductor/ER)
Sitting in chair knee flexion needed
80 degrees
Knee flexion needed to tie shoes in sitting
105
Limited MTP mobility orthotic
Metatarsal bar to transfer stress to shaft and off joint
PF MMT
1 rep
3/5
PF MMT
2-24 reps
4/5 good
PF MMT
4/5 good
2-24 reps
PF MMT
25 reps
5/5
Safe and effective strengthening for osteoporosis
back extensor
Why do OA knee pain shift weight to same side
to decrease load on medial compartment of knee e]
Loose packed superior/prox radioulnar joint
35° of supination and 70° elbow flexion
Shoulder exercises below 90 should be used for
acute phase shoulder impringement
Picking object from the floor w/ prosthetic
unaffected extremity forward, WB through unaffected extremity while bending and reaching for the object on the floor
Cryo can cause
increase in systolic and diastolic blood pressure.
Distal humerus fx nerve damage
ulnar or median nerve
mid humerus = radial nerve
Superior gluteal nerve
glute med and min
Inferior gluteal nerve
glute max
Genitofemoral nerve
L1-2
sensory only
Contraindications after UCL suregry
no ER
acute, deep, and localized pain in the lower leg
stress fracture
diffuse pain and tightness, relief of pain with rest and increase in pain with activity and stretching
compartment syndrome
ACE inhibitors have an effect on HR T or F
False no effect
ALS exercises
no resistance in patients with less than 3/5 - risk of overuse weakness
AROM, opassice, submax aerobics are all appropriate
Why is aquatic therapy contraindicated with severe CKD
evere kidney disease due to the patient’s inability to adjust to fluid loss during immersion
Presense of rheumatoid factor =
RA
Absence of rheumatoid factor
OA
Tracheal shift occurs to side of
less volume
toward involved side with
fibrosis, atelectasis, lobectomy,
more volume/pressure = deviation away (pleaural effusion, pneumothorax, hemothorax, tumor,
Target INR for patient on warfarin/coumadin
2-3.5
Lat MMT palm up or down
up
Sliding board w/ assist
C5
Manual WC with rim projections
C5
only short distance tho
Muscles that can be weak with crutch use
radial nerve - elbow and wrist extensors
Fibular translation test
high ankle sprain
capsular pattern hip
IR>flex>abd
Best way of increasing muscle length
US + stretching same time
US + stretching after
Heat + stretching
US goes depper than heat
Coracoclavicular injury =
AC joint
Post MI HR cap
70% HR max
Restance training post MI
5 weeks
remain under 70% maxHR till 6 weeks
Hyperresonant to percussion
more air
Hyporesonent to percussion =
more fluid
More fremitus (vibration)
more fluid
less fremitus = more air
Brochiectasis =
obstructive
standing or slow walk MET
1.5-2
normal walk speed
1.2-1.4 m/s
3 mph
normal walk MET
3-4 METS
brisk walk MET
5-6
jogging MET
7-8
Normal BMI
18-25
Overweight BMI
25-30
Underweight BMI
18 or les
Flexor hallicus longus and flexor digitorum longus innervation
tibial
Gastroc short =
decreased ROM in extension
increased in flexion
Pleural effusion results in … fremitus and … resonance
decreased
dull
Return to sport quad to hamstring ratio
3:2
Phase 3 cardiac rehab should inclusde restistance of
1-3 lbs or 30-50% 1 rep max
FITT - obesity
greater than 5 days a week to max caloric expenditure
40-60 %VO2max
Atelectasis vs pneumothorax
atelectasis = ALVEOLI collapse causing decreased lung volume , tracheal deviation toward
pneumothorax - collapse of lung - tracheal deviation away because of pressure buildup
RA vs OA
OA - morning stiffness less than 1 hour, unilateral, large joints
RA - morning stiffness more than 1 hou, bilateral, small joints
Adverse effects of diuretic
hypovolemia - decreased fluid = increased CO = excessive demand on heart
Orthostatics
Fewer, better beats
digoxin - inhibits SNS
decreased HR, increased force of contraction
Urokinase
clot buster
Side effects statins
muscle weakness, pain, inflammation, tendon degeneration
V1 EKG placement
4th IC space R of sternum
V2 EKG placement
4th IC space L of sternum
V4 EKG placement
5th IC space mid clavicular line
V5 EKG placement
5th IC space axillary line
V6 EKG placement
directly under armpit
EKG one small box =
.04 sec
this means one large box is .2 sec
Bigeminy and trigeminy
no exercise = 6 or more PVC in minute
Heimlich for pregnant or obese
above stomach
With CPR you want chest to rise but not
abdomen
When do you change positions with CPR
every 5 cycles - taking no longer than 10 secs
If ped has pulse (normal) but no breaths =
perform rescue breaths every 3-5 seconds (12-20 breaths/min)
if pulse is low less than 60 then give compressions
If adult has pulse (normal) but no breaths =
perform rescue breaths every 6-8 seconds (10 breaths/min)
if pulse is low less than 60 then give compressions
DGI fall risk
8 items scored 0-3
max sore 24
11+-4
Meausrement point for FRT
closed fist - third metacarpal head
TUG distance
3 meters
POMA/Tinneti has
balance and gait components
max score 28
High validity and reliability to determine exercise tolerance
6MWT
Fugyl meyer
14 highest score
patients with hemiplegia
If pt has DVT when can they early ambulate and compression
after starting blood thinners
Pt on coumadin and has DVT =
ambulate amd compress
Pt has DVT and no meds =
no ambulate or compression
CHF class: marked limitation of physical activity
class 3
CHF class: SLIGHT limitation of physical activity
class 2
CHF class: inabiliy to carry out PA without discomfort limitation of physical activity
Class 4
barely perceptible indentation on pitting edema scale
1+
slight indentation less than 15 sec on pitting edema scale
2+
deep indentation less than 30 sec on pitting edema scale
3+
greater than 30 sec pitting edemax
4+
Lower lobe lateral basal
20 in elevated
prone 1/4 turn
lower ribs percussion
Lower lobe superior segment
bed flat pillow under stomach
percussion to tip of scapq
Lower lobe posterior basal segment
20 in elevated
prone
lower ribs
Horner syndrome sings
ptosis - eyelid drooping
miosis - pupil constriction
Normal breathing patternxs
epigastric and chest wall expansion
SCI ASIA A C8 breathing pattern
abdominal protrusion and chest wall retraction
Myasthenia gravis
repeated contractions = fatigue
can demonstrate normal MMT
NO SENSORY or REFLEX changes
Concurrent validity
comparsion of scores test A and B - do they measure the same thing?
Content validity
does the single test cover what it’s supposed to measure
Face validity
does the test LOOK valuable
Antacids prolonged =
execes bicarb = alkalosis
Muscle weakness is more common with L/R sided HF
L - decreased BF
Effects corticosteriods on blood sugar and blood pressure
increases
Achy cramping dull pain
muscle
Boring, deep, localized
bone
throbbing, poor localized
vascular
On/off time traction
60 sec and off for 20 seconds
PT should check blood sugar how often during tx session
Every 30 mins
Normal troponin levels
0-.03
Normal levels C reactive protein
normal less than 3
pathology more than 3
Fremitus for pneumonia
Fremitus for PulmEdema
increased
decreased
Icy breath =
women MI
delayed PR interval (greater than .2 sec) 1 big box =
1st degree AV block
1 big EKG box is … sec
.2
Inverted t wave represents left ventricular hypertrophy or ischemia
venous capacitance
degree of active constriction of vessels. (mainly veins) which affects return of blood to the heart
Noble compression test
sitting or supine, palpate lateral epicondyle and ACTIVELY extend knee - pain will be recreated approx 30 degrees knee flexion - point where IT band frictions over lateral epicondyle
Goniometry landmarks cervical rotation
acromian process and nose
red flag for size of mole - melanoma
6 mm
Test for AnkSpondy
Schobers test
Less than … cm increase in length with forward flexion: Schobers test
POsitive
5 cm
Hawthorne effect
change behavior when being watched
CAD/cardiac rehab exercise ratio - inpatient
- outpatinet
1:1
2:1
can work up to 5:1
Jersey finger injury requires
referral to surgoen - necrosis can happen if prolonged unhealed
Normal lymph node palpation
not palpable, to soft to firm
non tender
up to 1 cm diameter
How to test orthostatics
supine sitting (after 2 mins) and standing (after 2 mins)
Tenderness in lymph node
sign of infection inflammation or cancer
Medicare covers people with … regardless of age
ESRD =
Medicare part A vs B
A - hospital
B - outpatient
If pt has Foley in, how should ghey perform hip flexion activities
in sitting - keeps bladder below
Atrophic scar
sunken - acne type scarring
When should brief intense TENS be used
prior to procedures to increase pain tolerance
rapid onset of relief compared to conventional
initial cardiac rehab session patient reports chest pain, appears anxious, and wants to go back to bed to rest. What is the therapist’sBESTinitial course of action?
monitor vitals - not an emergency
Medications that increase falls
antidepressants (Prozac, ZOloft)
Blood thinners (warfarin, aspirin)
BP meds obvi
Mini BEST test
examines STS
compensatory postural control
sensory organization
gait
does not assess sitting balance or med mobility
With patient that is hyperextending, inserting heel lift will
delay forefoot loading and allow the tibia to progress farther forward, thus increasing flexion at the knee by anteriorly tilting the tibia.
Normal 2 point discrimination
less than 6 mm
How to reverse claudicatation -
walking program mod intensity
moderate intensity, 30–60 min/day, 3–5 days/w
CPR order adult
Call 911
Compressions
Airway
Breathing
AED
Canadian C spine rules are highly
sensisiteve
fibromyalgia (FM) typically do not tolerate
sustained overhead activities, vigorous or high-impact activities, and eccentric muscle contractions because they evoke pain
Sessions for FM - time of day
afternoons because they have difficulty with gettign day started
Level 4 Ranchos - agitated and tries to bite the therapist. What is the therapist’sBESTcourse of action?
calm down in this session
do not delay session
Is CHF a medical emergency?
Not really, just call the physician and get them in ASAP
CPR sequencing
R middle and L lingular lobe positioning
supine 1/4 to opposite side
MA
Above T3 SCI maxHR
110-120
Lymphatic system/venous system collection
10-20
80-90
Most likely to increase BP -
isometric exercises
Provocative positions for GERD
supine or jumping
Least accurte form of temp reading
axillary bc its outside the body
Serial casting only gains … degrees
5-7
Used for population studies
z test
Cause of metabolic alkalosis
vomiting
ingestion of antacids
diuretics = loss of volume
Signs of metabolic alkalosis
weakness fasiculations and cramping convulsions
