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Final Frontier General NPTE Prep > NPTE Final Frontier Study Tips > Flashcards

NPTE Final Frontier Study Tips Flashcards

1
Q
  1. A PT examines a patient with chief concerns of tingling into the 4th and 5th digits along the muscle wasting over the hypothenar eminence. The PT suspects ulnar neuropathy and decides to examine the integrity of the nerve. Which of the following testing procedure would be the BEST?
    A. Have the patient flex both wrists while holding them for one minute
    B. Have the patient make a fist around the thumb and perform ulnar deviation
    C. Have the patient grasp a piece of paper between their first and second finger while the examiner pulls the paper and monitors the first finger
    D. Have the patient perform extension of the third digit of the hand against examiner resistance
A

Correct Answer: C
o Answer A is incorrect because it is the Phalen’s special test for Median nerve
o Answer B is incorrect because it is Finkelstein’s special test for Dequervain’s Tenosynovitis
o Answer D is incorrect because it is Maudsley’s test for lateral epicondylitis
o Froment’s sign occurs as the result of a weak adductor pollicis which is innervated by the ulnar nerve. In an attempt to hold the paper, the patient will compensate for weak thumb adduction by flexing the IP joint of the thumb (FPL innervated by the median nerve)

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2
Q
A

Correct Answer: D
-The most amount of hip extension will be needed is during terminal stance. Tight hip flexors will limit hip extension

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3
Q
A

Correct Answer: A

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4
Q

List the mnemonic for remember the auscultation of the heart

A

All PTs make 2245
A for Aortic in the 2nd ICS
P for Pulmonary in the 2nd ICS
T for Tricuspid in the 4th ICS
M for Mitral in the 5th ICS

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5
Q
A
  • Initially wrist & shoulder ROM maintain
  • Joint mobilization to improve elbow flexion and extension
  • Stretching & soft tissue to biceps & brachioradialis
  • Stretching & soft tissue to flexors & extensors
  • Contract relax technique to biceps to help with elbow ROM and then strengthen within that new ROM
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6
Q

Which of the following would be the MOST likely diagnosis?
A. Smith’s fracture
B. Colles fracture
C. Scaphoid fracture
D. Dinner fork deformity

A

Correct Answer: A
o Reason why: the radius dislocated volar which is called a Smith’s fracture. Also known as a garden spade deformity

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7
Q

Which of the following would be the MOST likely presentation in this patient?
A. Wasting of thenar eminence
B. Wasting of hypothenar eminence
C. Unable to perform little finger adduction
D. Unable to perform index finger extension

A

Correct Answer: A
o Reason why: lateral 3 and ½ fingers have loss of sensation which is innervated by the median nerve provided sensation to the thenar eminence
o Incorrect Answer B: hypothenar eminence is supplied by ulnar nerve
o Incorrect Answer C: little finger adduction (interossei) is performed by ulnar nerve
o Incorrect Answer D: index finger extension is performed by radial nerve

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8
Q

The patient has been coming to PT for 4 weeks and has significant improvement in wrist ROM but continues to experience limitation in end range wrist extension. Which of the following is the MOST appropriate intervention?
A. Dorsal glide of carpal bones
B. Volar glide of carpal bones
C. Medial glide of carpal bones
D. Lateral glide of carpal bones

A

Correct Answer: B
o Reason why: in the wrist joint the role and glide are in the opposite direction. To improve wrist extension volar glide would be appropriate.
o Incorrect answer A: would improve wrist flexion
o Incorrect answer C: would improve radial deviation
o Incorrect answer D: would improve ulnar deviation

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9
Q
A

Correct Answer: D
o Reason why: any motion of performing hip flexion will be fine so loading response and initial contact both require hip flexion, but when hip extension is performed the hip flexors are lengthened and do not tolerate that well.

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10
Q
A

Correct Answer: B
o Reason why: sensation to anterior 2/3 of tongue is trigeminal nerve
o Incorrect Answer A: the collapsed tolerance to normal environmental sounds; the facial nerve controls the excessive movements of the stapedius bone & dampens the sound and its injury can cause hyperacusis.
o Incorrect Answer C: the facial nerve innervates the corneal reflex
o Incorrect Answer D: this is controlled by the facial nerve

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11
Q

What do we know that hypomobility at one joint can cause?

A

hypermobility at another joint (i.e.
(i.e. limited in cervical flexion motion or looking down so the thoracic spine will assist in performing cervical flexion)

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12
Q

Describe how someone with excessive PF at the ankle might compensate up the chain

A

leads to knee hyperextension then leading to increased lordosis and an anterior pelvic tilt (THINK OF SOMEONE WEARING HIGH HEELS)

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13
Q

What is the convex-concave rule & concave-convex rule and give a good example

A

convex-concave: roll & glide are opposite (i.e. shoulder abduction the roll occurs in the superior direction while the glide occurs in the inferior direction)

concave-convex: roll & glide are the same

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14
Q
A

Correct Answer: A
o Reason why: Posterior roll is performed with the talus an anterior glide will improve PF
o Reason not B & C: stick to that plane so you can rule those two glides out because they are for inversion & eversion
o Reason not D: to improve DF you would then need a posterior glide of the talus

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15
Q

Describe the convex-concave rule for the ankle with both PF & DF

A

-roll & glide occur opposite

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16
Q

List the joints of the body and how the convex & concave rules affect them (VERY IMPORTANT SLIDE)

A

-Shoulder: opposite
-Elbow: same
-Proximal radioulnar: opposite
-Distal radioulnar: same
-Wrist: opposite
-Fingers: same
-Hip: opposite
-Knee: same
-Ankle: opposite
-Foot: same

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17
Q

What is the best pneumonic to remember about what happens during pronation of the ankle for open chain exercise?

A

DEE
dorsiflexion
eversion
external rotation

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18
Q

What is the best pneumonic to remember about what happens during supination of the ankle for open chain exercise?

A

PII
plantarflexion
inversion
internal rotation

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19
Q
A

Correct Answer: D Posteriorly

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20
Q

List all of the motions of the shoulder and what directional glides occur

A

Flexion & ABD: inferior glide
External rotation: anterior glide
Internal rotation: posterior glide
Adduction: superior glide

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21
Q

What is the capsular pattern of adhesive capsulitis of the shoulder?

A

ER>ABD>IR

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22
Q

According to the NPTE, what would be the best glide to perform if a pt has adhesive capsulitis? (IMPORTANT TO REMEMBER

A

posterior-inferior glide

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23
Q

PRACTICE QUESTION KEY THING TO REMEMBER FOR NPTE

A

THE QUESTION HIGHLIGHTS BOTH ACTIVE AND PASSIVE MOTION AS WELL AS PAIN TWICE. THEREFORE, THE INITIAL INTERVENTION SHOULD FOCUS ON PAIN FIRST

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24
Q

If a patient is in pain and you are going to perform a joint mobilization, what mobilizations would be most appropriate?

A

only grades 1 & 2 for pain

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25
Q

PRACTICE QUESTION KEY THINGS TO REMEMBER FOR NPTE
A patient presents with limitations in shoulder active and passive ROM that are pain free. The best intervention is what?

A

EMPHASIS HERE IS ON PAIN-FREE ROM. DUE TO THE LIMITATION IN PASSIVE & ACTIVE ROM, IT IS LIKELY A JOINT RESTRICTION, AND A GRADE 3-4 MOB WOULD BE THE BEST SELECTION

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26
Q
A

Correct Answer: C
-Reason why: an inferior glide will help with shoulder abduction and then you must make the choice that allows for a grade 1 or 2 joint mobilization because pain is the main focus. Due to pain being the main issue you must select answer choice C compared to choice D

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27
Q

Describe why they are termed “upper cross” and “lower cross” syndromes

A

THEY FORM AN “X” PATTERN

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28
Q

List the characteristics that make up the “Lower Cross Syndrome” (2)

A

THEY FORM AN “X”
1. Tight iliopsoas (facilitated) & thoracolumbar extensors (facilitated)
2. Weak abdominals (inhibited) & glutes (inhibited)

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29
Q

List the characteristics that make up the “Upper Cross Syndrome” (2)

A

THEY FORM AN “X”
1. Tight upper trap/levator scap (facilitated) and SCOM/pectoralis (facilitated)
2. Weak deep cervical flexors (inhibited) and lower trap/serratus anterior (inhibited)

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30
Q

Describe the long sitting (supine to sit) test when attempting SI joint dysfunction that may be the cause of leg length discrepancy. Specifically discuss findings when in supine compared to long sitting

A

Supine:
-If one leg is shorter than the other than posterior rotation is present
-If one leg is longer than the other than anterior rotation is present
Long sitting:
-If one leg is longer than the other than posterior rotation is present
-If one leg is shorter than the other than anterior rotation is present

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31
Q
A

Correct Answer: C
It is easier to stretch compared to strengthening
-Reason it is not A or D: it is not an anteriorly rotated innominate
-Reason it is not B: strengthening is not easier than stretching

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32
Q

Describe a really good hand signal to remember how the pelvis is rotating and where the ASIS & PSIS are during pelvic rotations

A

make finger guns with both fingers and your thumbs are the PSIS and your index finger is the ASIS

-if your fingers point down then PSIS is high and ASIS is low
-if your fingers point up then the PSIS is low and ASIS is high

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33
Q

WHAT SHOULD YOU ALWAYS REMEMBER WHEN IT COMES TO STRETCHING VS STRENGTHENING

A

ALWAYS ALWAYS ALWAYS STRETCH BEFORE YOU STRENGTHEN

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34
Q

What does it mean if one side of the pelvis has rotated compared to if both sides are rotated?

A

if one side is affected it is a rotation vs if both sides are affected it is a pelvic tilt

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35
Q
A

Correct Answer: B
Reason why: Gluteus medius muscle is innervated with the superior gluteal nerve

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36
Q

Which nerve innervates the gluteus maximus and gluteus medius?

A

gluteus maximus=R inferior gluteal nerve
gluteus medius=R superior gluteal nerve

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37
Q
A

Correct Answer: A
Reason why: Answer choice A directly targets the gluteus medius
Reason not B: that target L side gluteus medius & R side hip extensors
Reason not C: that target R hip extensors
Reason not D: targets L side gluteus medius & R side hip flexors

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38
Q
A

Correct Answer: D
Reason why: Answer choice D targets gluteus maximus more than the medius
Reason not A, B, or C: they all target the gluteus medius directly

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39
Q
A

Correct Answer: B
-Reason why: in terminal swing the hamstring is having to eccentrically contract to prepare for the stance phase
-Reason not A: your knee must flex which is concentric
-Reason not C: your hamstring is neutral so there is not contraction
-Reason not D: pushing off the ground causing a concentric contraction

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40
Q

What is a good rule of thumb for concentric vs eccentric muscle action?

A

if you are moving away from the ground it is going to be concentric vs if you are going towards the ground it is eccentric (i.e. running uphill is concentric lifting away from the ground while running down hill is eccentric because you are running towards the ground)

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41
Q

What PROM A Technique can help facilitate more supination movement at the proximal radioulnar joint?

A

Anterior glide

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42
Q

Describe the rule of 6 that applies for ANY major surgeries (i.e. RTC)

A

1st six weeks: protective (PROM, no resistance)
2nd six weeks: moderate protection (AROM, start putting weight on it)
6 months: back to ADLs

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43
Q
A

Correct Answer: A
Reason not B: you would stretch the SCOM
Reason not C: need to strengthen deep cervical flexors
Reason not D: need to strengthen deep cervical flexors

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44
Q

Describe the relationship between FHP and the lower cervical spine and upper cervical spine

A

lower cervical spine will go into excessive flexion lengthening the cervical flexors while the upper cervical spine will go into excessive extension to keep the eyes on the horizon causing tightness of the upper cervical extensors

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45
Q

OPEN CHAIN
Describe the screw home mechanism of the tibiofemoral joint and why this happens anatomically

A

lateral femoral condyle is flatter and does not extend as far distally compared to the medial condyle; these structural differences cause the tibia to rotate laterally on femur at full knee extension (Screw-home mechanism)

REMEMBER THAT THIS OCCURS AT TKE AND TERMINAL KNEE FLEXION

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46
Q

OPEN CHAIN
To sum up biomechanically the “screw home mechanism”, what occurs with the tibia in terminal knee extension and then what happen when the knee has to be unlocked to go into flexion

A

-tibia goes into lateral rotation with terminal knee extension

-tibia goes into medial rotation when coming from TKE back into flexion

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47
Q
A

Correct Answer: C

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48
Q

CLOSED CHAIN
Describe the “screw home mechanism” when it comes to performing a sit to stand

A

IT IS THE OPPOSITE OF OPEN CHAIN
-Reminder that in order to achieve TKE the tibia has to perform lateral rotation on the femur so in order to perform a STS where it is closed chain, the femur has to perform internal rotation on the tibia in order to unscrew that screw home mechanism

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49
Q

Give the overall summary for the screw home mechanism for locking & unlocking in both open & closed chain

A

OPEN CHAIN
-Lateral rotation of tibia for locking
-Medial rotation of tibia for unlocking
CLOSED CHAIN
-Medial rotation of femur for locking
-Lateral rotation of femur for unlocking

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50
Q

What are the upward rotators of the scapula?

A

upper trap, lower trap, and serratus anterior

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51
Q

What are the downward rotators of the scapula?

A

pec minor, levator scap, rhomboids, lats

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52
Q
A

Correct Answer: C
-Reason it is C: rhomboid major & minor work as downward rotators so if they are weak then excessive upward rotation would occur
-Reason not A: it is an upward rotator so if weakness was present it wouldn’t cause excessive upward rotation
-Reason not B: it is an upward rotator so if weakness was present it wouldn’t cause excessive upward rotation
-Reason not D: pec major doesn’t play a role in rotation of the scapula

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53
Q

What should always be priority 1 & 2 regarding any training for ADLs on the NPTE?
IMPORTANT TO REMEMBER

A

IMPORTANT TO REMEMBER
1st priority=safety
2nd priority=obeying safety while choosing the most relevant exercise to the desired task and choose the most relevant exercise

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54
Q
A

Correct Answer: B
-Reason why: B this is the best position for the pt and 45 degrees is an appropriate ROM this early on
-Reason not A or C: pt is a safer position for this pt
-Reason not D: the pt shouldn’t be going into 90 degrees in the first 6 weeks

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55
Q

What is the conventional weight bearing approach for an Achilles tendon repair?

A

6 weeks immobilization & NWB

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56
Q

What is our focus in Phase 1 of an Achilles Tendon repair? (3)

A

4-6 weeks
-Active ROM of non-immobilized joints
-Muscle setting of DFs, investors, evertors, and PFs (PFs @ 2 weeks)
-Weight shifting activities in bilateral stance while wearing the orthosis (when PWB is allowed)

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57
Q

Suspicion of an Achilles injury

A

Correct Answer: C
-Reason why: we are assessing the Achilles and this is the only special test that does that
-Reason not A: assesses ACL
-Reason not B: assesses ACL
-Reason not D: assesses meniscus

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58
Q
A

Correct Answer: C
-Reason why: heel raises shouldn’t be performed only 2 weeks post-op
-Reason not A, B, or D: all of those would be appropriate interventions to perform 2 weeks post-op

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59
Q
A

Correct Answer: B
-Reason why: we are still protecting the Achilles tendon which is why we need the minimal shoe lift to take some stress off the tendon

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60
Q

What are the definitions of active and passive insufficiency?

A

active insufficiency: the inability of a two-joint muscle to shorten simultaneously at both joints

passive insufficiency: the inability of a two-joint muscle to lengthen simultaneously at both joints

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61
Q

What is a simple way to remember passive insufficiency and active insufficiency, and give an example for each

A

STRETCHING THE MUSCLE
-Passive insufficiency is essentially stretching that muscle (i.e the actions of the hamstrings are knee flexion & hip extension; when you perform knee extension & hip flexion at the same time that is passive insufficiency)

PERFORMING THE MUSCLE’S ACTIONS
-Active insufficiency is performing the actions of that muscle (i.e. the actions of biceps is both elbow flexion & shoulder flexion; however, if you perform elbow flexion prior to should flexion you can only get so much shoulder ROM compared to full ROM when performing normal shoulder ROM)

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62
Q
A

Correct Answer: C
-Reason why: Active insufficiency is performing the muscle’s actions which is hip flexion & R lateral flexion of the trunk

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63
Q
A

Correct Answer: A
-Reason why: passive insufficiency of the hamstrings is hip flexion & knee extension
-Reason not B: hip flexion and knee extension would be active insufficiency of quadriceps
-Reason not C: it only performs hip flexion
-Reason not D: active insufficiency of the hamstrings would be knee flexion & hip extension

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64
Q
A

Correct Answer: A
-Reason why: you are trying to provide an orthotic that relieves pain, and they already have a structural deficit that causes the foot to go into pronation, so the orthotic that could provide cushion is the medial post under the 1st metatarsal head
-Reason not B: it doesn’t directly impact pain relief for foot pronation
-Reason not C: this would force them into more pronation
-Reason not D: this would address the lack of PF, and the pt is not lacking that

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65
Q

If we suspect a pt has excessive hip anteversion, describe the following effects it will have on the rest of the kinetic chain down the lower extremity

A

EXCESSIVE HIP ANTEVERSION
-Toes pointed in
-Medial femoral rotated
-Coxa valga
-Lateral patellar subluxation
-Medial tibial rotated
-Subtalar pronation

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66
Q

If we suspect a pt has excessive hip retroversion, describe the following effects it will have on the rest of the kinetic chain down the lower extremity

A

EXCESSIVE HIP RETROVERSION
-Toes pointed out
-Femur externally roated
-Coxa vara
-Tibia externally rotated
-Subtalar supination

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67
Q

NEW CONCEPT & IMPORTANT TO REMEMBER
If we suspect a pt has coxa vara at the knee, what will happen to that leg & pelvic rotation?

How about if we suspect coxa valga?

A

COXA VARA
-short ipsilateral leg
-anterior pelvic tilt

COXA VALGA
-long ipsilateral leg
-posterior pelvic til

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68
Q

How do we calculate Rate Product Pressure?

A

HR x SBP
-Good identification of the metabolic demands of the heart

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69
Q

How do we calculate cardiac output?

A

HR X SV

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70
Q

What two things should we know about the relationship between “incremental exercise” and “heart rate & cardiac output”?

A
  1. Increases linearly with increasing work rate
  2. Reaches plateau at 100% VO2 max (volume of oxygen you are consuming)
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71
Q

What two things should we know about the relationship between “incremental exercise” and “blood pressure”?

A

Mean arterial BP increases linearly as well
-Systolic BP increases
-Diastolic remains fairly constant

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72
Q

What three things can increase during working out, and 1 one thing stays the same?

A

Increase
-Systolic BP (if it does not increase that means there is a leak in the heart b/c it is not increasing)
-HR
-Cardiac output (VO2 max)

Constant
-Diastolic BP

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73
Q

What two things should we know about the relationship between “incremental exercise” and “blood pressure”?

A

Mean arterial BP increases linearly as well
-Systolic BP increases
-Diastolic remains fairly constant

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74
Q
A

Correct Answer: B
Reason why: Rate product pressure calculates the SBP x HR, which is a true representation of the metabolic demand of the heart
Reason why not A: to find the true metabolic demand of the heart you have to have both HR & SBP; this answer choice only has SBP
Reason why not B: diastolic blood pressure cannot determine the metabolic demand on the heart since it is the rest BP
Reason why not D: HR is unreliable because they are on beta blockers

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75
Q
A

Correct Answer: D
Reason why: We are performing a stress test which should increase the systolic BP. Here, the SBP decreases by 33mHg

-Reason not A: Diastolic only dropped 2mmHg, which is not significant

-Reason not B: Diastolic only decreased by 7mmHg

-Reason not C: RR is expected to increase with exercise, and it did here by 10 breaths/min

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76
Q

VERY IMPORTANT TO REMEMBER
What are our areas of concern regarding SBP & DBP with exercise?

How about RR?

A

SBP=change>20mmHg

DBP=change >10mmHg

> 20 breaths/min

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77
Q

Give a good analogy of SBP not increasing with exercise

A

think of it as a tire where if you are filling it, the pressure continues to decrease, which means there is a leak somewhere

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78
Q

Resting BP-133/88mmHg

A

Correct Answer: D
-Reason why: Stage 1 range is 130-139 systolic & 80-89 diastolic

-Reason not A: Normal is <120/<80

-Reason not B: Elevated would be above 120/80 but <130/80

-Reason not C: Not used as a specific category

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79
Q

What are the New Blood Pressure Guidelines for this year’s NPTE?

A

Normal: <120/80
Elevated: 120-129 SBP & DBP <80
Stage 1: 130-139 SBP & DBP 80-89
Stage 2: >140 SBP & DBP >90
Hypertensive crisis: >180 SBP & DBP >120

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80
Q
A

Correct Answer: B

-Reason why: Initially, ATP is produced by anaerobic pathways initially (30s-1min) & after steady state is reached, ATP is produced aerobically. The volume of oxygen needs to be sufficient to meet ATP demands

-Reason not A: Lactic acid is associated with anaerobic exercise

-Reason not C: There is no need for the exercise to be discontinued

-Reason not D: We won’t be able to achieve steady state if the RR is insufficient to meet the ATP demand

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81
Q

After steady state in exercising, what does this mean?

A

ATP is produced aerobically

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82
Q

What is the main idea behind training at altitude?

A

lower amounts of oxygen at high altitudes, athletes’ bodies work to produce more RBCs when they train high above sea level

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83
Q

What is the main idea behind training at altitude?

A

lower amounts of oxygen at high altitudes, athletes’ bodies work to produce more RBCs when they train high above sea level

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84
Q
A

Correct Answer: A

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85
Q

With Altitude Changes, list what occurs with the following both with the initial encounter and then once acclimatization occurs

-HR
-BP
-CO
-SV

A

-HR: increases & increases
-BP: increases & normal
-CO: increases & normal
-SV: no change & decreases

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86
Q

NOT ASKED ON THE EXAM, BUT GOOD TO KNOW
Once you come back down to normal altitude what occurs?

A

CO & SV with both increase because they are use to the demand of the higher altitude while HR & BP stabilize

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87
Q

What impact does aquatic therapy have on the following:
-HR
-BP
-SV
-CO

A

HR: decreases
BP: decreases
SV: increases
CO: increases

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88
Q
A

Correct Answer: B
-Reason why: Aquatic therapy has been shown to decrease BP

-Reason not A: it increases cardiac output

-Reason not C: it decreases heart rate

-Reason not D: ability to take in more oxygen will decrease

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89
Q

How does aquatic therapy impact vital capacity & work of breathing?

A

vital capacity=decreases

work of breathing=increases

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90
Q

What is the relationship between beta-blockers and HR?

Who typically takes beta blockers?

What impact do beta blockers have during submax & maximal exercise?

A

-reduce HR & contractility (lower the myocardial oxygen demand)

-coronary artery disease & HTN

-lower HR

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91
Q
A

Correct Answer: B
-Reason why:

-Reason not A: SBP levels will increase with exercise

-Reason not C: HR will increase with exercise

-Reason not D: there is no need for this just because of beta blocker

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92
Q

In regards to cardiac patients, when is it most appropriate to educate a patient on a longer warm-up period & cool-down period during exercise sessions?

A

If they are a cardiac transplant

93
Q

What is a good pneumonic to remember 13-20 on the RPE scale?

A

SHVEM
13-Somewhat hard
15-Hard
17-Very Hard
19-Extremely Hard
20-Maximal Exertion

11 is light
9 is very light

94
Q
A

Correct Answer: A
-Reason why: Unfit individuals when they start working out will have a higher HR which this is a good measure to asses if their fitness changed over 6 weeks

-Reason not B: pre training information doesn’t give you a comparison without post-training

-Reason not C: used for assessing pain so not relevant

-Reason not D: we want to be able to compare pre and post this just states knowing what the increase in BP during exercise

95
Q

Finish the sentence: The more unfit an individual is, the _____ the recovery after exercise with CO, SV, AND HR

A

longer

96
Q
A

Correct Answer: B
-Reason why: All PTs make 2245
Aortic->2nd ICS
Pulmonary->2nd ICS
Tricuspid->4th ICS
Mitral->5th ICS

97
Q

Where are the heart sounds S1 & S2 heard best?

A

S1=apex of the heart (mitral valve)

S2=base of the heart (aortic or pulmonary)

S1 & S2 sound equally loud at Erb’s point

98
Q
A

Correct Answer: C
-Reason why: lub is the closing of the mitral/tricuspid valves & getting ready for systole then “dub” is closing of the aortic & pulmonary valves & getting ready for diastole

99
Q

Describe what the S1 sound is

Describe what the S2 sound is

A

“lub”
-closure of mitral & triscupid valves, onset of systole

“dub”
-closure of aortic & pulmonary valves, onset of diastole

100
Q

What does S3 & S4 heart sounds indicate?

A

S3-> ventricular gallop or ventricular filling “associated with heart failure”

S4->atrial gallop or ventricular filling with atrial contraction “associated with HTN, MI”

101
Q

What 3 structures make up the brainstem from proximal to distal?

A

midbrain
pons
medulla

102
Q

Give a general overview of how many hemispheres and lobes the brain is composed of

A

2 Hemispheres
-Right & Left

4 lobes on each hemisphere
-Frontal
-Temporal
-Parietal
-Occipital

103
Q

If we suspect a Frontal Lobe lesion, what would we suspect would be impacted? (4)

A

-Apraxia & Aphasia: Broca’s

-Controls plan, programming, movement

-Emotional, behavioral control, and personality affected

-Olfaction affected

104
Q

If we suspect a Temporal Lobe lesion, what 3 things would we suspect could occur?

What is a good way to remember what this lobe is responsible for?

A

-Hearing
-Language comprehension
-Aphasia: Wernicke’s

-think about where the temporal lobe is located (right above your ears & think about temple area)

105
Q

What is a good pneumonic to remember what the frontal lobe is responsible for?

A

“A CEO”

A->Aphasia & Apraxia: Broca’s
C->Controls plan, coordinate movement, programming
E->emotional control, personality change
O->olfaction control

106
Q

What is apraxia?

What is aphasia?

A

-inability to perform previously known skilled tasks (i.e. driving or dressing up)

-speech-related issue

107
Q

Name again which lobe Broca’s aphasia (expressive aphasia) and Wernicke’s aphasia (receptive aphasia) occurs in then differentiate between the two

A

Broca’s->occurs in frontal lobe and they have broken speech; they can understand, but cannot articulate themselves completely

Wernicke’s->occurs in temporal lobe and they cannot comprehend what is going on, but they will fully express themselves in speech, but it will be about a completely different topic

108
Q

If we are working with someone who has Broca’s aphasia, how can we best work with them?

How about with Wernicke’s aphasia?

A

-Yes/No questions rather than them having to explain themselves

-Gestures & demonstration

109
Q

Match up the following with its corresponding aphasia

-Receptive aphasia
-Expressive aphasia

A

Receptive aphasia: Wernicke’s
Expressive aphasia: Broca’s

110
Q
A

Correct Answer: A
-Reason why: The patient is able to expressive themselves, but they say a “word salad” or they speak on something else that isn’t relevant to the topic

-Reason not B: Broca’s aphasia would be inability to express yourself

-Reason not C: same thing as non-fluent aphasia

-Reason not D: facial nerve does not affect speech

111
Q

If we suspect a lesion to the parietal lobe, what would we expect to see? (2)

A

-Perceptual disorders (unilateral neglect)

-Sensory loss

112
Q

If we suspect a lesion to the occipital lobe, what would we expect to see? (2)

A

-Visual loss

-Inability to identify previously known objects (visual agnosia or prosopagnosia->difficulty naming people)

113
Q

If we suspect a lesion to the occipital lobe, what would we expect to see? (2)

A

-Visual loss

-Inability to identify previously known objects (visual agnosia or prosopagnosia->difficulty naming people)

114
Q

What is the pneumonic to remember where the cranial nerves are located?

A

CE MI PONS MEDU
CErebrum
MI->midbrain
PONS
MEDUlla

CE (Cerebrum)->CN 1 & 2
MI (Midbrain)-> CN 3 & 4
PONS->CN 5, 6, 7, & 8
MEDU (Medulla)-> CN 9, 10, 11, & 12

115
Q

Differentiate between presbyopia & myopia both that would happen due to impact of CN II

A

Presbyopia: far sightedness (short distance vision loss)

Myopia: short sightedness (long distance vision loss)

116
Q

What cranial nerves are responsible for your pupillary light reflex?

What does the pupillary light reflex even do?

Describe the impact of CN II & II with the pupillary light reflex

A

CN II & III

-when the eyes are exposed to too much light they will constrict

if either eye constricts that means that CN II is intact and not impaired, so if neither eye constricts with a light held to it that means that CN II is affected

if you shine a light in the L eye and the L eye constricts, but the R eye doesn’t then R eye CN III is impacted and if you shine a light in the L eye and the L eye doesn’t constrict, then the L eye CN III is impacted

117
Q

Examples
-If you shine the light in the L eye and the R eye stays dilated, which CN is impacted?

-If you shine the light in the L eye and only the R eye constricts, which CN is impacted?

-If you shine the light in the L eye and neither of the pupils responds, which CN is impacted?

A

-R CN III

-L CN III

-L CN II

118
Q
A

Correct Answer: C
-Reason why: Since neither of the pupils constricted on the R eye that means the R optic nerve is affected

-Reason not A: it would have to be the same scenario except the L eye

-Reason not B: neither pupil constricted which means optic nerve. If only the R eye didn’t constrict then it would be oculomotor

-Reason not D: the R pupil would have had to constrict and the L eye would have had to not constrict for this to be appropriate

119
Q

If CN III is affected, what can occur?

A

-strabismus: abnormal positioning of the eyeball (specifically laterally)
-ptosis: drooping of eyelids
-dilation of pupils

120
Q

What are CN IV & VI responsible for?

A

Trochlear->looking down & in towards nose

Abducens->looking out

121
Q

When cranial nerve VI is affected, what might we suspect could occur?

A

-Strabismus in the medial direction because it normally causes lateral movement of the eye

122
Q

Knowing that cranial nerves III, IV, and VI are responsible for eye movement, list each of their specific actions below

A

CN III- up, down, in, and up & in
CN IV-down & in (towards the nose)
CN VI-outward

123
Q

List which cranial nerves all of the eye muscles are responsible for

A

CN III-superior rectus, inferior rectus, medial rectus, inferior oblique

JUST REMEMBER THESE TWO
CN IV-superior oblique
CN VI-lateral rectus

124
Q

What are the two different types of hearing deficits?

A
  1. Conductive hearing loss
    -Outer ear is involved
  2. Sensorineural hearing loss
    -Inner ear is involved
125
Q

If you put earplugs in, what type of hearing loss are you creating?

A

conductive hearing loss (it involves external ear canal)

126
Q

Describe the Rinne test and how it can help determine what type of hearing loss a patient might have.

How will you know if your pt has a conductive hearing loss?

A

REMEMBER THAT AIR CONDUCTION IS GREATER THAN BONE CONDUCTION

If you find that air conduction is greater than bone conduction it is either normal or sensorineural

Rinne test
-Use a tuning fork and place it on the mastoid process

-After you do the tuning fork, place it in front of their ear canal. If it is conductive hearing loss, the bone conduction will be longer than the time with the tuning fork than it is conductive

127
Q

Describe the Weber test

A

-Take the tuning fork and put it on the vertex of the head, and if you hear the sound equally in both ears, that is a normal finding; If abnormal, it can be either conductive or sensorineural

-If the sound is louder on the affected ear, it is conductive
-If the sound is louder on the nonaffected ear, it is sensorineural

128
Q

What are the steps to diagnose hearing loss? (2)

A
  1. Rinne’s test
    -Bone conduction >Air conduction=Conductive
    -Air conduction>Bone conduction=Sensorineural
  2. Weber’s test
    -Conductive if louder in the affected ear
    -Sensorineural if louder in unaffected ear
129
Q
A

Correct Answer: B
-Reason why: Rinne’s test reveals it has to be conduction hearing loss which rules out A & D. Weber’s test shows that it was louder on the L ear which means the L ear is affected ruling out C

130
Q

Which cranial nerves are responsible for opening & closing the eyelids?

A

opening eyelids->CN 3
closing eyelids->CN 7

131
Q

Breakdown the functions of the tongue via sensory & motor

A

Sensory
-Sensation
Anterior 2/3: CN 5
Posterior 1/3: CN 9
-Taste
Anterior 2/3: CN 7
Posterior 1/3: CN 9

Motor: CN VII (Hypoglossal)

132
Q

If CN VII is affected, how can you tell which side is affected?

A

“Lick your lesion”
-Whichever side is affected it will stay on that side; if R CN VII is affected the tongue will stay on the R side

133
Q
A

Correct Answer: B
-Reason why: asking the pt to say “ahh” is a motor request and when the pt performs it, there is a deviation to the left. We know that the vagus nerve performs motor and with deviation to the pt’s left it would be the L vagus nerve

UVULA AND TONGUE DEVIATION ARE OPPOSITE

134
Q

In terms of gag reflex, describe the role of the two cranial nerves that impact it

A

CN IX (glossopharyngelal) does afferent or sensory of the gag reflex while CN X (vagus) performs efferent or motor of the gag reflex

135
Q
A

Correct Answer: B
-Reason why: Cerebellum is responsible for coordination, balance, and ataxia

136
Q
A

Correct Answer: A
-Reason why: Trigeminal does sensation to anterior 2/3 while facial does taste to anterior 2/3 and glossopharyngeal does sensation & taste to posterior 1/3

137
Q
A

Correct Answer: A
-Reason why: CN VIII is not impacted in this case scenario which is vestibulocochlear

-Reason not B: Trigeminal nerve CN 5 is the ability to chew and that is impacted

-Reason not C: CN II & III perform pupillary light reflex and they are impacted

-Reason not D: CN IX & X perform the gag reflex & CN IX is impacted

138
Q

On examination of a 45-year-old male patient, the therapist observes that the patient is able
to clench his teeth but is unable to smile, whistle or close his eyes. The patient reports that
most of the sounds around him are unpleasant and too loud. Which nerve is affected and what
other findings can help the therapist confirm the diagnosis?

A. Oculomotor nerve; Absence of corneal reflex
B. Trigeminal nerve; Absence of sensation on the face
C. Facial nerve; Absence of taste on anterior 2/3rd of the tongue
D. Vestibulocochlear nerve; loss of balance and equilibrium

A

C. Facial nerve; Absence of taste on anterior 2/3rd of the tongue

139
Q

A patient is able to read the Snellen chart, but he is unable to follow the therapist’s finger,
with the right eye, from center to the right. The rest of the movements seem to be normal.
Which cranial nerve could be affected?
A. Right oculomotor nerve
B. Right abducens nerve
C. Right trochlear nerve
D. Right optic nerve

A

B. Right abducens nerve

140
Q

On sensory examination, the PT finds that a patient does not recognize light touch with a cotton ball on the left side of his face. He reports being unable to chew his food though there is no problem swallowing. On further testing, corneal reflex is also affected. What could be the cause of this presentation?
A. Facial nerve palsy
B. Oculomotor nerve palsy
C. Trigeminal nerve palsy
D. Glossopharyngeal nerve palsy

A

C. Trigeminal nerve palsy

141
Q

Which of the following Is LEAST LIKELY an expected sign in a patient with facial nerve palsy?

A. Hyperacusis
B. Absence of sensation in the anterior 2/3 of the tongue
C. Absence of corneal reflex
D. Decreased lacrimation

A

B. Absence of sensation in the anterior 2/3 of the tongue

142
Q

A 60-year-old male patient reports a shock-like and stabbing sensation running through his
jawline which has become frequent and excruciating lately. He says that the episodes occur
usually when he goes out in cold weather or when shaving or brushing his teeth. The therapist
suspects a possible cranial nerve inflammation. What is the suspected condition and the cranial
nerve affected?

A. Bell’s palsy; CN 7
B. Trigeminal neuralgia; CN7
C. Bell’s palsy ; CN 5
D. Trigeminal neuralgia; CN 5

A

D. Trigeminal neuralgia; CN 5

143
Q

A patient reports missing sensation on the anterior 2/3rd of his tongue. On examination what
other findings can be used to confirm diagnosis of a cranial nerve involvement?

A. Loss of sensation on face
B. Loss of ability to smile and frown
C. Loss of lacrimation
D. Loss of Gag reflex

A

A. Loss of sensation on face

144
Q

Which of the following cranial nerves is tested by placing a vibrating tuning fork on the mid
position of the head?

A. Vestibulocochlear nerve, Rinne test
B. Glossopharyngeal nerve
C. Vestibulocochlear nerve, Weber test
D. Trigeminal nerve

A

C. Vestibulocochlear nerve, Weber test

145
Q

On asking a patient to protrude her tongue, the therapist notices that her tongue deviates
towards the left side. Which cranial nerve is affected and what other sign can the therapist look
out for?

A. Left CN 9; Atrophy of the left side of the tongue
B. Right CN 9; Atrophy of the right side of the tongue
C. Left CN 12; Atrophy of the left side of the tongue
D. Right CN 12; Atrophy of the right side of the tongue

A

C. Left CN 12; Atrophy of the left side of the tongue

146
Q

What finding can be seen in a patient with a CN 11 palsy?

A. Absent gag reflex
B. Deviation of the tongue to the affected side
C. Hyperacusis
D. Inability to shrug shoulders

A

D. Inability to shrug shoulders

147
Q

During an eye examination of a patient with reports of double vision, the therapist finds that
he is able to follow the therapists fingers vertically up and down, but his left eye is unable to
look down and in. Which cranial nerve is affected in this patient?

A. Cranial nerve II
B. Cranial nerve IV
C. Cranial nerve III
D. Cranial nerve VI

A

B. Cranial nerve IV

148
Q
A

Correct Answer: C
-Reason why: Draw out a picture of the impairment that is stated in the question and then solve the impairment in order to have normal walking ensue.
The pt must PF the shorter limb in order to make contact with the ground for walking and all of the other options are incorrect based off this

IN ORDER TO FULLY COMPENSATE THE LONGER LEG WILL HAVE TO GO INTO DF AND THE SHORTER LEG WILL HAVE TO GO INTO PF in order for the normal walking to ensue

149
Q

REALLY GOOD TO REMEMBER
What is a good rule of thumb to remember for a short leg vs a long leg and its compensation?

A

in order for a short leg to compensate to achieving walking=PF
in order for a long leg to compensate to achieving walk=DF

150
Q

Differentiate between stride & step for the gait cycle

A

stride=heel strike on the R then the stride ends when heel strike happens again on the R side; one complete gait cycle

step=heel strike on the R + heel strike on the L

2 steps=1 stride (or 1 gait cycle)

151
Q

List what type of questions we could expect to see for the stance (2) and swing phase of gait (2) on the NPTE

A

Stance
-Muscle actions
-Step length

Swing
-FES
-ROM needed

152
Q

Give just a brief overview of the three rockers of the foot

A
  1. heel rocker: when you are on your heels
  2. ankle rocker: when you are on your midfoot
  3. forefoot rocker: when you are on your toes
153
Q
A

Correct Answer: B
-Reason why: R hip abductors are weak, causing the Trendelenburg sign. These R hip abductors help to stabilize the pelvis during the stance phase of the gait cycle

154
Q
A

Correct Answer: D
-Reason why: The goal of FES is to prevent toe drag and produce appropriate ground clearance, which happens in the initial swing to mid-swing phases

-Reason not B: FES will work on contraction, not eccentric control of the DF to prevent foot slap

155
Q
A

Correct Answer: D
-Answer D is the only answer choice that doesn’t cause hip hike while the other 3 answer choices do

PF weakness will also cause DF which will not cause a gait deviation in the clearance phase

156
Q

What are the 3 reasons someone would perform a hip hike when walking?

A

lacking ROM at the hip, knee, or ankle DF

157
Q

List the ROM needed at each joint of the LE during normal gait

A

Hip
-Stance: 0-30 degrees of flexion & 0-20 degrees of hyperextension
-Swing: 20-30 degrees of flexion

Knee
-Stance: 0-40 degrees of flexion
-Swing: 0-60 degrees of flexion

Ankle:
-Stance: 0-10 degrees DF & 0-20 degrees PF
-Swing: 0-10 degrees PF

158
Q
A

Correct Answer: A
-Reason why: they are limited in knee flexion because you knee up to 60 degrees of knee flexion for the swing phase; thus the phase of gait that compensation would be seen in is initial swing

Values:
Hip
-Stance: 0-30 degrees of flexion & 0-20 degrees of hyperextension
-Swing: 20-30 degrees of flexion

Knee:
-Stance: 0-40 degrees of flex
-Swing: 0-60 degrees of flex

Ankle:
-Stance: 0-10 degrees of DF & 0-20 degrees of PF
-Swing: 0-10 degrees of PF

159
Q

List the muscle activity involving the ankle during the entire gait cycle

A

Dorsiflexors (EHL, EDL, anterior tibialis)
-Prior to and during heel strike: ECCENTRIC (lowers foot to ground)
-Prior to and during swing:
CONCENTRIC (foot clearance)

Plantarflxors (gastroc, soleus, FHL, FDL, posterior tibialis)
-Midstance: ECCENTRIC (controls tibia over foot)
-Heel off: CONCENTRIC (performs PF for pushing off ground)

160
Q
A

Correct answer: B
-Reason why: Gastrocnemius will perform concentric contraction during heel off and if they are tight the PF will come early and cause early heel off

-Reason not A or D: they are not involved with the ankle

-Reason not C: weakness of tibialis anterior would cause foot slap or inability to clear foot in swing

161
Q

List the muscle activity involving the knee during the gait cycle

A

Quadriceps (vastus medius/lateralis/intermedius/rec fem)
-Prior to heel strike:
ECCENTRIC to prevent knee flexion/prevent buckling
-Pre swing:
ECCENTRIC to slow down tibia

Hamstrings (biceps femoris, semimembranosus, semitendinosus)
-Prior to heel strike:
ECCENTRIC protects knee from hyperextension
-Swing phase:
CONCENTRIC performs knee flexion & hip extension

162
Q
A

Correct Answer: A

163
Q
A

Correct Answer: D
-Reason why: the pt is limited in hip flexion and terminal stance will require the most amount of hip extension which will show the most limitation

164
Q
A

Correct Answer: B
-Reason why: tightness of the L hip flexors will restrict hip extension on the L so a decreased step length will occur on the R side

-Reason not C: backward lean in stance phase is due to weak gluteus Maximus (hip ext)

-Reason not D: lateral lean during swing would be due to needing L leg clearance

165
Q

List the muscle activity that occurs at the hip during the gait cycle

A

Abductors (medius, minimus, TFL)
-Stance: ECCENTRIC to stablize pelvis

Adductors (longus/brevis, gracilis, adductor magnus)
-Early & late stance: CONCENTRIC to stabilize pelvis

166
Q
A

Correct Answer: C
-Reason why: When anterior muscles are weak there will be in a leaning direction towards that muscle that is weak so a forward trunk lean is due to weakness of quadriceps

-Reason not A: would cause a backward trunk lean

-Reason not B: would cause a trunk lean to the R

167
Q

List the 4 volumes

List the 4 capacities

A

Volumes
-Inspiratory reserve volume
-Tidal volume
-Expiratory reserve volume
-Residual volume

Capacities
-Functional residual capacity
-Inspiratory capacity
-Vital capacity
-Total lung capacity

168
Q

What is tidal volume?

What is inspiratory reserve volume?

What is the expiratory reserve volume?

What is residual volume?

A

The amount of air you are regularly breathing in (500ml)

The maximum amount of air you can breathe in (typically 5-6x more than tidal volume)

The maximum amount of air you can breathe out (2-3x more than tidal volume)

Both IRV & ERV are what is breathed OVER tidal volume, so if you are trying to calculate how much residual volume is leftover you must subtract the IRV/ERV-tidal volume

Air that is stuck in the lungs and does not come out (ALWAYS PRESENT IN THE LUNGS)

169
Q

DEFINITELY WILL BE ASKED ON NPTE

Now that you have this foundation explain how COPD patients are impacted

A

they have a difficult time getting air out since it is an obstructive disorder; this leads to an increase in residual volume because the air they cannot get out

170
Q

What is total lung capacity and what is the expected amount?

A

maximum amount of air that can fill the lungs (TV + IRV + ERV + RV)=6,000mL

171
Q

What is vital capacity and what is the expected amount?

A

total amount of air that can be expired after fully inhaling (TV+IRV+ERV)=4,000ml or 80% TLC

JUST THINK TO STAY VITAL OR ALIVE YOU MUST HAVE NORMAL BREATHING (TV) & MAX AMOUNT AIR IN (IRV) & MAX AMOUNT AIR OUT (ERV)

172
Q

What is inspiratory capacity and what is the expected amount?

A

maximum amount of air that can be fully inspired (TV + IRV)=3,600mL

173
Q

What is functional residual capacity and what is the expected amount?

A

amount of air remaining in the lungs after a normal inspiration (RV + ERV)=2,400mL

174
Q

How does aquatic therapy affect TLC, VC, IC, & FRC?

A

it decreases all of them because you cannot take the full amount of air in or out when you are in water

175
Q
A

Correct Answer: B
-Reason why: That is the maximum amount they can breathe out (ERV)

-Reason not A: That is the maximum amount of air they can breathe in

-Reason not C: the max amount of air the lungs can have in it; not specific to taking a breathe in

-Reason not D: normal breathe in

176
Q

NEED TO REMEMBER THIS BECAUSE MAJORITY OF Qs WILL COME FROM THIS

What will occur to the following with an obstructive disease?

-Tidal volume

-Inspiratory capacity (IC)

-Expiratory reserve volume (ERV)

-Vital capacity (VC)

-Residual volume (RV)

-Functional residual capacity (FRC)

-Total lung capacity (TLC)

A

NEED TO REMEMBER THIS

-Normal or increase

-Decrease

-Decrease

-Decrease

-Increase

-Increase

-Increase

177
Q

What will occur to the following with a restrictive disease?

-Tidal volume

-Inspiratory capacity (IC)

-Expiratory reserve volume (ERV)

-Vital capacity (VC)

-Residual volume (RV)

-Functional residual capacity (FRC)

-Total lung capacity (TLC)

A

VERY VERY KEY THING TO REMEMBER TO GET EASY POINTS ON EXAM

ALL WILL DECREASE

178
Q

What is a good rule of thumb to remember obstructive diseases?

Give a few examples of obstructive lung diseases(5)

What is a good pneumonic to remember these?

A

Any pathology that decreases the ability to develop a positive intrapleural pressure ANYTHING THAT KEEPS YOU FROM GETTING AIR OUT DUE TO OBSTRUCTIVE PATHWAYS; AIRWAYS CLOSE PREMATURELY AT HIGH LUNG VOLUMES

  1. Emphysema
  2. Chronic bronchitis
  3. Bronchial asthma
  4. Bronchiectasis
  5. Cystic fibrosis

CBABE
-Cystic fibrosis
-Bronchiectasis
-Asthma
-Chronic bronchitis
-Emphysema

179
Q

Give a few examples of restrictive lung disease (8)

A
  1. Sarcoidosis
  2. Lung fibrosis
  3. Ankylosing spondylitis
  4. Obesity
  5. Burns
  6. Pneumonia
  7. Pneumothorax or hemothorax
  8. Pulmonary effusion
180
Q

What will most neuro conditions be in terms of pulmonary disease? Restrictive or obstructive?

A

Restrictive

181
Q
A

Correct Answer: B
-Reason why: pulmonary fibrosis is a restrictive disease in which we know everything decreases leading to answer choice B

-Reason not A: they are having getting air in which wold not increase their normal breathing (TV)

-Reason not C: they are getting less air in which will not increase their air that is always in the lungs (RV)

-Reason not D: Functional residual capacity is residual volume + ERV which is decreased with a restrictive disease

182
Q

What is FEV1 AND FVC in a pulmonary examination?

A

FEV1=how efficiently a pt can get air out in the 1st second of expiration

FVC=how efficiently a pt can get air out in general in expiration

183
Q

List the levels of severity of COPD GOLD Classification

A

Stage 1 (mild) >80
Stage 2 (moderate) 50-80
Stage 3 (severe) 30-50
Stage 4 (very severe) <30

184
Q
A

Correct Answer: B
-Reason why: this pt has COPD, which will decrease their FEV1/FVC ratio

-Reason not A, C, or D: all of these increase with obstructive diseases

185
Q
A

Correct Answer:C

-80%=mild
-50-80%=moderate
-30-50%=severe
<30%=very severe

186
Q

What is a good mnemonic for the symptoms experienced with GOLD’s classification for COPD?

A

80 (stage 1)=mild or dyspnea due to exercise
50-80 (stage 2)=moderate or dyspnea with longer walks
30-50 (stage 3)=severe or dyspnea due to short walks
<30 (stage 4)=very severe or dyspnea at rest

187
Q
A

-Correct Answer: C
-Reason why: this is the most gentle way that a pt can clear secretions without it being forced

-Reason not A: there are only a few conditions in which you need to do supine-assisted coughing (i.e. SCI condition)

-Reason not B: there isn’t enough information to choose this; you need to know the lobe and which side lung is affected

-Reason not D: this is forceful way to clear secretions and this is not appropriate for the pt

188
Q

What are the 4 normal breath sounds?

A
  1. vesicular
  2. broncho-vesicular
  3. bronchial
  4. tracheal
189
Q

Vesicular

-What is the duration of this sound?

-What is the intensity it can be heard at?

-What about the pitch of expiratory?

-Location where it can be heard?

A

-Inspiratory longer than expiratory

-soft

-low

-over most of the lungs

190
Q

Broncho-vesicular

-What is the duration of this sound?

-What is the intensity it can be heard at?

-What about the pitch of expiratory?

-Location where it can be heard?

A

-inspiratory & expiratory sounds are equal

-intermediate

-intermediate

-between 1st & 2nd interspace anteriorly & between scapulaes

191
Q

Bronchial

-What is the duration of this sound?

-What is the intensity it can be heard at?

-What about the pitch of expiratory?

-Location where it can be heard?

A

-Expiratory sounds longer than inspiratory

-Loud

-High

-Over manubrium

192
Q

Tracheal

-What is the duration of this sound?

-What is the intensity it can be heard at?

-What about the pitch of expiratory?

-Location where it can be heard?

A

-Inspritaory & expiratory are equal

-very loud

-relatively high

-over trachea of neck

193
Q
A

Correct Answer: A
-Reason why: vesicular auscultation is low pitch, soft sound and is located over all of the lungs which is described here

-Reason not C: these are intermediate pitch, intermediate sound located over the 1st & 2nd ICS on anterior side

-Reason not B: these are high pitch, loud sound located over the manubrium

-Reason not D: these are very high pitch, very loud and are located over the trachea

194
Q

Abnormal respiratory sounds
-What is rhonci?

-Who do we typically see it in?

A

-continuous, low-pitched, rattling lung sounds that often resemble snoring

-COPD, bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis

195
Q

Abnormal respiratory sounds
-What is wheeze?

-Who do we typically see it in?

A

-continuous whistling, caused by airway obstruction

-asthma, COPD, aspiration of any foreign body

196
Q

Abnormal respiratory sounds
-What is crackles?

-Who do we typically see it in?

A

-brief, discontinuous, popping lung sounds that are high pitched

-can be heard in both phases of respiration (previously called rales)

-associated with CHF

197
Q

Abnormal respiratory sounds
-What is a pleural rub?

-Who do we typically see it in?

A

-ausculatation in the lower lateral chest area that occurs with inspiration & expiration (sounds like sandpaper or velcro)

-indication of pleural inflammation

198
Q
A

Correct Answer: B
-Reason why: wheeze is high pitched and is commonly heard with obstructive disorders such as COPD

199
Q

Lung voice sounds
What is bronchophony and give an example

A

-increase vocal resonance, w/greater clarity & loudness of spoken words (i.e. 99)

YOU SHOULD NOT HEAR “99” NORMALLY WHEN STETHOSCOPE IS USED

200
Q

Lung voice sounds
What is egophony and give an example

A

it is a form of bronchophony in which “long E” sound turns into “nasal A” sound

201
Q

What is whispered pectoriloquy and give an example

A

an increased loudness of whispering
(i.e. pt whispers 1,2,3 and you hear it loud & clear)

YOU SHOULD NORMALLY NOT HEAR IT

202
Q
A

Correct Answer: B
-The reason why: egophony you ask them to pronounce the letter “E” and you would hear a “nasally A”

-Why B is incorrect: you ask the pt to say 99 and you hear it clearly through the stethoscope

-Why C is incorrect: you would ask the pt to whisper 1,2,3 and you could hear it clearly

-Why D is incorrect: it is a lung sound not vocal sounds

203
Q

What are the normal ABG values?

A

pH 7.35-7.45
PaCO2 35-45 mmHg
HCO3 22-26 mEq/L

204
Q

Now that we know the normal ABG values, list when each value is considered acidic & alkaline

A

pH
<7.35=acidic
>7.45=alkaline

PaCO2
<35=alkaline
>45=acidic

HCO3
<22=acidic
>26=alkaline

205
Q

VERY IMPORTANT CONCEPT
Remember the concepts of respiratory and metabolic acidosis & alkalosis

Which element is associated with respiratory and which elements is associated with metabolic?

A

CO2 or carbon dioxide is associated with respiratory

HCO3 or bicarbonate is associated with metabolic

206
Q

To summarize everything mentioned in the previous flashcards list what makes up each of the following
-Respiratory acidosis
-Respiratory alkalosis
-Metabolic acidosis
-Metabolic alkalosis

A

Respiratory acidosis
-pH: decreases
-CO2: increases
-HCO3: normal

Respiratory alkalosis
-pH: increases
-CO2: decreases
-HCO3: normal

Metabolic acidosis
-pH: decreases
-CO2: normal
-HCO3: decreases

Metabolic alkalosis
-pH: increases
-CO2: normal
-HCO3: increases

207
Q
A

Correct Answer: A
-Reason why: pH is acidic which means it is acidosis and then HCO3 or bicarbonate values are not normal which means it is metabolic in nature meaning it is metabolic acidosis

208
Q

the second part of each answer should say O2

A

Correct Answer: D
-With COPD there is a buildup of more air than what can be expelled there will be a build-up of CO2 that they cannot expel. So that eliminates A& B. Additionally if there is a buildup of CO2 that will make the ABGs values more acidic

209
Q

the second part of each answer should say O2

A

Correct Answer: D
-With COPD there is a buildup of more air than what can be expelled there will be a build-up of CO2 that they cannot expel. So that eliminates A& B. Additionally if there is a buildup of CO2 that will make the ABGs values more acidic

210
Q

GOOD THING TO KEEP IN MIND
How does a contracture/tightness impact range of motion?

How does weakness impact range of motion?

A

-contracture/tightness will cause decreased ROM opposite (i.e. hip flexion contracture will lead to decreased hip extension and decrease in step length on opposite side)

-weakness will cause decreased ROM in the same motion (i.e. weakness of hip flexors will cause decreased hip flexion and decrease in step length on same side)

CONTRACTURE & TIGHTNESS-LIMITED ROM IN OPPOSITE DIRECTION

WEAKNESS-LIMITED ROM IN THE SAME DIRECTION

211
Q
A

Correct Answer: A
-Early toe-off occurred, which means something is tight. So then you should be searching for an answer choice that has a contracture/tightness present and the only one that this applies to is answer choice A

212
Q

TWO KEY WORDS IN GAIT CYCLE QUESTIONS
What does it mean when you see that something is early or delayed?

A

early=tightness/contracture

delay=weakness

213
Q
A

Correct Answer: A
Weakness of gluteus medius causing loss of proximal stability as the pelvis and the pelvis drops. This then causes genu valgum at the knee causing the R knee pain

214
Q

What role does gluteus maximus play in the gait cycle?

How about the erector spinae?

A

Gluteus maximus
-Stance Phase:
Eccentric to decelerate forward momentum
-Swing Phase:
Concentric for hip extension

Erector Spinae
-Heel strike through toe-off:
Maintain trunk posture

215
Q
A

Correct Answer: A
-Weak muscles are magnets to the trunk so with weak gluteus Maximus there will be a backward trunk lean which eliminates choices B & D. Answer choice C talks about the swing phase which eliminates it but regardless if it said stance phase it would occur on the left side stance phase

216
Q

During the stance phase of gait, if we see a forward trunk lean, what should we suspect?

Backward trunk lean?

Lateral trunk lean?

A

-weakness of hip flexors/quadriceps or hip extensor rigid contracture

-weakness of hip extensors or hip flexor rigid contracture

-weakness of hip abductors or hip adductor rigid contracture

217
Q

In the swing phase, what might we suspect is the culprit if backward trunk lean was present?

A

weakness of hip flexors (think of when you are trying to kick a target up high you have to lean back to reach it if you can’t get it with pure hip flexion)

218
Q
A

Correct Answer: B
-Choice C would cause a lateral trunk lean while D would cause a forward trunk lean.
-Choice A would indeed cause a backward trunk lean, but it occurs in the stance phase
-Choice B causes a backward trunk lean that occurs specifically in the swing phase

219
Q

To summarize the class to this point, finish each sentence

  1. If we have contracture/tightness of a muscle, what will occur to the ROM?
  2. If we have weakness of a muscle, what will occur to the ROM?

STANCE PHASE!!!!!!!!!!!
3. If there is weakness of a trunk muscle (erectors, gluteus Maximus, gluteus medius, hip flexors/quads) what will occur?

SWING PHASE !!!!!!!!!!!!!!
4. If there is weakness of a trunk muscle (erectors, gluteus Maximus, gluteus medius, hip flexors/quads) what will occur to the ROM?

A

-ROM will be limited in the opposite direction (i.e. contracture of hip flexors will limit hip extension)

-ROM will be limited in the same direction (i.e. weakness of gluteus Maximus will cause limited motion in hip extension)

-The trunk becomes a magnet to that muscle and deviates to that weak muscle (i.e. weak gluteus Maximus causes backward trunk lean)

-It switches compared to the stance phase (i.e tightness of hip flexors causes backward trunkk lean)

220
Q

Describe what happens to the muscles of the foot during gait

A

Peroneus Longus & Brevis
-Stance phase: concentric to maintain medial & lateral stability

Foot Intrinsics
-Stance phase: concentric to support plantar fascia

221
Q
A

Correct Answer: C
-The pt lacks 10 degrees of PROM DF
-They lack the 10 degrees of PROM DF with the knee in both extension and flexion
-This means the knee position doesn’t impact the muscle which means it is soleus because gastroc would be affected by the knee being flexed or extended

If it were to be gastroc then DF would be increased with the knee flexed, but limited with the knee in extension since it is a two-joint muscle

222
Q
A

Correct Answer: D
Ankle PF and anterior pelvic tilt are directly correlated with knee hyperextension (genu recurvatum

223
Q

What two things are medial tibial torsion directly associated with?

A

metatarsal adductus
subtalar pronation

224
Q

What two impairments should we suspect to be the culprit with early heel off?

A

tight gastrocnemius in midstance & tight hip flexors in terminal stance

225
Q

What would be the main culprit with for delayed heel contact?

How about with toe drag?

A

weak dorsiflexors

weak dorsiflexors or PF contracture/tightness

226
Q
A

Correct Answer: D
The first 3 options would all directly cause knee hyperextension
Pes equinus is excessive PF

227
Q
A

Correct Answer: D

228
Q
A

Correct Answer: A
-They will lean towards the painful side with the trunk because the muscles are weak on that side so the trunk will lean to that side

*Bring the COM to the L side allows the muscle to not have to work so hard and the trunk will support as well taking the load off of those muscles

229
Q
A

Correct Answer: C
The job of an assistive device is to decrease the load off of a specific area. The assistive device always goes into the opposite hand as well.

Final Frontier General NPTE Prep (3 decks)

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