NPTE Final Frontier Study Tips Flashcards
1
Q
- 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)
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
3
Q
A
Correct Answer: A
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
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
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
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
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
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.
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
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)
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)
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
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
15
Q
Describe the convex-concave rule for the ankle with both PF & DF
A
-roll & glide occur opposite
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
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
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
19
Q
A
Correct Answer: D Posteriorly
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
21
Q
What is the capsular pattern of adhesive capsulitis of the shoulder?
A
ER>ABD>IR
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
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
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
25
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?
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
26
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
27
Describe why they are termed "upper cross" and "lower cross" syndromes
THEY FORM AN "X" PATTERN
28
List the characteristics that make up the "Lower Cross Syndrome" (2)
THEY FORM AN "X"
1. Tight iliopsoas (facilitated) & thoracolumbar extensors (facilitated)
2. Weak abdominals (inhibited) & glutes (inhibited)
29
List the characteristics that make up the "Upper Cross Syndrome" (2)
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)
30
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
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
31
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
32
Describe a really good hand signal to remember how the pelvis is rotating and where the ASIS & PSIS are during pelvic rotations
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
33
WHAT SHOULD YOU ALWAYS REMEMBER WHEN IT COMES TO STRETCHING VS STRENGTHENING
ALWAYS ALWAYS ALWAYS STRETCH BEFORE YOU STRENGTHEN
34
What does it mean if one side of the pelvis has rotated compared to if both sides are rotated?
if one side is affected it is a rotation vs if both sides are affected it is a pelvic tilt
35
Correct Answer: B
Reason why: Gluteus medius muscle is innervated with the superior gluteal nerve
36
Which nerve innervates the gluteus maximus and gluteus medius?
gluteus maximus=R inferior gluteal nerve
gluteus medius=R superior gluteal nerve
37
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
38
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
39
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
40
What is a good rule of thumb for concentric vs eccentric muscle action?
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)
41
What PROM A Technique can help facilitate more supination movement at the proximal radioulnar joint?
Anterior glide
42
Describe the rule of 6 that applies for ANY major surgeries (i.e. RTC)
1st six weeks: protective (PROM, no resistance)
2nd six weeks: moderate protection (AROM, start putting weight on it)
6 months: back to ADLs
43
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
44
Describe the relationship between FHP and the lower cervical spine and upper cervical spine
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
45
OPEN CHAIN
Describe the screw home mechanism of the tibiofemoral joint and why this happens anatomically
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
46
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
-tibia goes into lateral rotation with terminal knee extension
-tibia goes into medial rotation when coming from TKE back into flexion
47
Correct Answer: C
48
CLOSED CHAIN
Describe the "screw home mechanism" when it comes to performing a sit to stand
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
49
Give the overall summary for the screw home mechanism for locking & unlocking in both open & closed chain
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
50
What are the upward rotators of the scapula?
upper trap, lower trap, and serratus anterior
51
What are the downward rotators of the scapula?
pec minor, levator scap, rhomboids, lats
52
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
53
What should always be priority 1 & 2 regarding any training for ADLs on the NPTE?
IMPORTANT TO REMEMBER
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
54
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
55
What is the conventional weight bearing approach for an Achilles tendon repair?
6 weeks immobilization & NWB
56
What is our focus in Phase 1 of an Achilles Tendon repair? (3)
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)
57
Suspicion of an Achilles injury
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
58
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
59
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
60
What are the definitions of active and passive insufficiency?
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
61
What is a simple way to remember passive insufficiency and active insufficiency, and give an example for each
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)
62
Correct Answer: C
-Reason why: Active insufficiency is performing the muscle's actions which is hip flexion & R lateral flexion of the trunk
63
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
64
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
65
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
EXCESSIVE HIP ANTEVERSION
-Toes pointed in
-Medial femoral rotated
-Coxa valga
-Lateral patellar subluxation
-Medial tibial rotated
-Subtalar pronation
66
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
EXCESSIVE HIP RETROVERSION
-Toes pointed out
-Femur externally roated
-Coxa vara
-Tibia externally rotated
-Subtalar supination
67
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?
COXA VARA
-short ipsilateral leg
-anterior pelvic tilt
COXA VALGA
-long ipsilateral leg
-posterior pelvic til
68
How do we calculate Rate Product Pressure?
HR x SBP
-Good identification of the metabolic demands of the heart
69
How do we calculate cardiac output?
HR X SV
70
What two things should we know about the relationship between "incremental exercise" and "heart rate & cardiac output"?
1. Increases linearly with increasing work rate
2. Reaches plateau at 100% VO2 max (volume of oxygen you are consuming)
71
What two things should we know about the relationship between "incremental exercise" and "blood pressure"?
Mean arterial BP increases linearly as well
-Systolic BP increases
-Diastolic remains fairly constant
72
What three things can increase during working out, and 1 one thing stays the same?
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
73
What two things should we know about the relationship between "incremental exercise" and "blood pressure"?
Mean arterial BP increases linearly as well
-Systolic BP increases
-Diastolic remains fairly constant
74
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
75
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
76
VERY IMPORTANT TO REMEMBER
What are our areas of concern regarding SBP & DBP with exercise?
How about RR?
SBP=change>20mmHg
DBP=change >10mmHg
>20 breaths/min
77
Give a good analogy of SBP not increasing with exercise
think of it as a tire where if you are filling it, the pressure continues to decrease, which means there is a leak somewhere
78
Resting BP-133/88mmHg
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
79
What are the New Blood Pressure Guidelines for this year's NPTE?
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
80
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
81
After steady state in exercising, what does this mean?
ATP is produced aerobically
82
What is the main idea behind training at altitude?
lower amounts of oxygen at high altitudes, athletes' bodies work to produce more RBCs when they train high above sea level
83
What is the main idea behind training at altitude?
lower amounts of oxygen at high altitudes, athletes' bodies work to produce more RBCs when they train high above sea level
84
Correct Answer: A
85
With Altitude Changes, list what occurs with the following both with the initial encounter and then once acclimatization occurs
-HR
-BP
-CO
-SV
-HR: increases & increases
-BP: increases & normal
-CO: increases & normal
-SV: no change & decreases
86
NOT ASKED ON THE EXAM, BUT GOOD TO KNOW
Once you come back down to normal altitude what occurs?
CO & SV with both increase because they are use to the demand of the higher altitude while HR & BP stabilize
87
What impact does aquatic therapy have on the following:
-HR
-BP
-SV
-CO
HR: decreases
BP: decreases
SV: increases
CO: increases
88
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
89
How does aquatic therapy impact vital capacity & work of breathing?
vital capacity=decreases
work of breathing=increases
90
What is the relationship between beta-blockers and HR?
Who typically takes beta blockers?
What impact do beta blockers have during submax & maximal exercise?
-reduce HR & contractility (lower the myocardial oxygen demand)
-coronary artery disease & HTN
-lower HR
91
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
92
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?
If they are a cardiac transplant
93
What is a good pneumonic to remember 13-20 on the RPE scale?
SHVEM
13-Somewhat hard
15-Hard
17-Very Hard
19-Extremely Hard
20-Maximal Exertion
11 is light
9 is very light
94
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
Finish the sentence: The more unfit an individual is, the _____ the recovery after exercise with CO, SV, AND HR
longer
96
Correct Answer: B
-Reason why: All PTs make 2245
Aortic->2nd ICS
Pulmonary->2nd ICS
Tricuspid->4th ICS
Mitral->5th ICS
97
Where are the heart sounds S1 & S2 heard best?
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
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
Describe what the S1 sound is
Describe what the S2 sound is
"lub"
-closure of mitral & triscupid valves, onset of systole
"dub"
-closure of aortic & pulmonary valves, onset of diastole
100
What does S3 & S4 heart sounds indicate?
S3-> ventricular gallop or ventricular filling "associated with heart failure"
S4->atrial gallop or ventricular filling with atrial contraction "associated with HTN, MI"
101
What 3 structures make up the brainstem from proximal to distal?
midbrain
pons
medulla
102
Give a general overview of how many hemispheres and lobes the brain is composed of
2 Hemispheres
-Right & Left
4 lobes on each hemisphere
-Frontal
-Temporal
-Parietal
-Occipital
103
If we suspect a Frontal Lobe lesion, what would we suspect would be impacted? (4)
-Apraxia & Aphasia: Broca's
-Controls plan, programming, movement
-Emotional, behavioral control, and personality affected
-Olfaction affected
104
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?
-Hearing
-Language comprehension
-Aphasia: Wernicke's
-think about where the temporal lobe is located (right above your ears & think about temple area)
105
What is a good pneumonic to remember what the frontal lobe is responsible for?
"A CEO"
A->Aphasia & Apraxia: Broca's
C->Controls plan, coordinate movement, programming
E->emotional control, personality change
O->olfaction control
106
What is apraxia?
What is aphasia?
-inability to perform previously known skilled tasks (i.e. driving or dressing up)
-speech-related issue
107
Name again which lobe Broca's aphasia (expressive aphasia) and Wernicke's aphasia (receptive aphasia) occurs in then differentiate between the two
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
If we are working with someone who has Broca's aphasia, how can we best work with them?
How about with Wernicke's aphasia?
-Yes/No questions rather than them having to explain themselves
-Gestures & demonstration
109
Match up the following with its corresponding aphasia
-Receptive aphasia
-Expressive aphasia
Receptive aphasia: Wernicke's
Expressive aphasia: Broca's
110
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
If we suspect a lesion to the parietal lobe, what would we expect to see? (2)
-Perceptual disorders (unilateral neglect)
-Sensory loss
112
If we suspect a lesion to the occipital lobe, what would we expect to see? (2)
-Visual loss
-Inability to identify previously known objects (visual agnosia or prosopagnosia->difficulty naming people)
113
If we suspect a lesion to the occipital lobe, what would we expect to see? (2)
-Visual loss
-Inability to identify previously known objects (visual agnosia or prosopagnosia->difficulty naming people)
114
What is the pneumonic to remember where the cranial nerves are located?
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
Differentiate between presbyopia & myopia both that would happen due to impact of CN II
Presbyopia: far sightedness (short distance vision loss)
Myopia: short sightedness (long distance vision loss)
116
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
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
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?
-R CN III
-L CN III
-L CN II
118
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
If CN III is affected, what can occur?
-strabismus: abnormal positioning of the eyeball (specifically laterally)
-ptosis: drooping of eyelids
-dilation of pupils
120
What are CN IV & VI responsible for?
Trochlear->looking down & in towards nose
Abducens->looking out
121
When cranial nerve VI is affected, what might we suspect could occur?
-Strabismus in the medial direction because it normally causes lateral movement of the eye
122
Knowing that cranial nerves III, IV, and VI are responsible for eye movement, list each of their specific actions below
CN III- up, down, in, and up & in
CN IV-down & in (towards the nose)
CN VI-outward
123
List which cranial nerves all of the eye muscles are responsible for
CN III-superior rectus, inferior rectus, medial rectus, inferior oblique
JUST REMEMBER THESE TWO
CN IV-superior oblique
CN VI-lateral rectus
124
What are the two different types of hearing deficits?
1. Conductive hearing loss
-Outer ear is involved
2. Sensorineural hearing loss
-Inner ear is involved
125
If you put earplugs in, what type of hearing loss are you creating?
conductive hearing loss (it involves external ear canal)
126
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?
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
Describe the Weber test
-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
What are the steps to diagnose hearing loss? (2)
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
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
Which cranial nerves are responsible for opening & closing the eyelids?
opening eyelids->CN 3
closing eyelids->CN 7
131
Breakdown the functions of the tongue via sensory & motor
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
If CN VII is affected, how can you tell which side is affected?
"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
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
In terms of gag reflex, describe the role of the two cranial nerves that impact it
CN IX (glossopharyngelal) does afferent or sensory of the gag reflex while CN X (vagus) performs efferent or motor of the gag reflex
135
Correct Answer: B
-Reason why: Cerebellum is responsible for coordination, balance, and ataxia
136
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
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
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
C. Facial nerve; Absence of taste on anterior 2/3rd of the tongue
139
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
B. Right abducens nerve
140
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
C. Trigeminal nerve palsy
141
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
B. Absence of sensation in the anterior 2/3 of the tongue
142
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
D. Trigeminal neuralgia; CN 5
143
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. Loss of sensation on face
144
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
C. Vestibulocochlear nerve, Weber test
145
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
C. Left CN 12; Atrophy of the left side of the tongue
146
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
D. Inability to shrug shoulders
147
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
B. Cranial nerve IV
148
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
REALLY GOOD TO REMEMBER
What is a good rule of thumb to remember for a short leg vs a long leg and its compensation?
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
Differentiate between stride & step for the gait cycle
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
List what type of questions we could expect to see for the stance (2) and swing phase of gait (2) on the NPTE
Stance
-Muscle actions
-Step length
Swing
-FES
-ROM needed
152
Give just a brief overview of the three rockers of the foot
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
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
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
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
What are the 3 reasons someone would perform a hip hike when walking?
lacking ROM at the hip, knee, or ankle DF
157
List the ROM needed at each joint of the LE during normal gait
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
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
List the muscle activity involving the ankle during the entire gait cycle
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
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
List the muscle activity involving the knee during the gait cycle
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
Correct Answer: A
163
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
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
List the muscle activity that occurs at the hip during the gait cycle
Abductors (medius, minimus, TFL)
-Stance: ECCENTRIC to stablize pelvis
Adductors (longus/brevis, gracilis, adductor magnus)
-Early & late stance: CONCENTRIC to stabilize pelvis
166
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
List the 4 volumes
List the 4 capacities
Volumes
-Inspiratory reserve volume
-Tidal volume
-Expiratory reserve volume
-Residual volume
Capacities
-Functional residual capacity
-Inspiratory capacity
-Vital capacity
-Total lung capacity
168
What is tidal volume?
What is inspiratory reserve volume?
What is the expiratory reserve volume?
What is residual volume?
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
DEFINITELY WILL BE ASKED ON NPTE
Now that you have this foundation explain how COPD patients are impacted
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
What is total lung capacity and what is the expected amount?
maximum amount of air that can fill the lungs (TV + IRV + ERV + RV)=6,000mL
171
What is vital capacity and what is the expected amount?
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
What is inspiratory capacity and what is the expected amount?
maximum amount of air that can be fully inspired (TV + IRV)=3,600mL
173
What is functional residual capacity and what is the expected amount?
amount of air remaining in the lungs after a normal inspiration (RV + ERV)=2,400mL
174
How does aquatic therapy affect TLC, VC, IC, & FRC?
it decreases all of them because you cannot take the full amount of air in or out when you are in water
175
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
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)
NEED TO REMEMBER THIS
-Normal or increase
-Decrease
-Decrease
-Decrease
-Increase
-Increase
-Increase
177
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)
VERY VERY KEY THING TO REMEMBER TO GET EASY POINTS ON EXAM
ALL WILL DECREASE
178
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?
*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
Give a few examples of restrictive lung disease (8)
1. Sarcoidosis
2. Lung fibrosis
3. Ankylosing spondylitis
4. Obesity
5. Burns
6. Pneumonia
7. Pneumothorax or hemothorax
8. Pulmonary effusion
180
What will most neuro conditions be in terms of pulmonary disease? Restrictive or obstructive?
Restrictive
181
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
What is FEV1 AND FVC in a pulmonary examination?
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
List the levels of severity of COPD GOLD Classification
Stage 1 (mild) >80
Stage 2 (moderate) 50-80
Stage 3 (severe) 30-50
Stage 4 (very severe) <30
184
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
Correct Answer:C
-80%=mild
-50-80%=moderate
-30-50%=severe
<30%=very severe
186
What is a good mnemonic for the symptoms experienced with GOLD's classification for COPD?
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
-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
What are the 4 normal breath sounds?
1. vesicular
2. broncho-vesicular
3. bronchial
4. tracheal
189
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?
-Inspiratory longer than expiratory
-soft
-low
-over most of the lungs
190
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?
-inspiratory & expiratory sounds are equal
-intermediate
-intermediate
-between 1st & 2nd interspace anteriorly & between scapulaes
191
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?
-Expiratory sounds longer than inspiratory
-Loud
-High
-Over manubrium
192
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?
-Inspritaory & expiratory are equal
-very loud
-relatively high
-over trachea of neck
193
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
Abnormal respiratory sounds
-What is rhonci?
-Who do we typically see it in?
-continuous, low-pitched, rattling lung sounds that often resemble snoring
-COPD, bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis
195
Abnormal respiratory sounds
-What is wheeze?
-Who do we typically see it in?
-continuous whistling, caused by airway obstruction
-asthma, COPD, aspiration of any foreign body
196
Abnormal respiratory sounds
-What is crackles?
-Who do we typically see it in?
-brief, discontinuous, popping lung sounds that are high pitched
-can be heard in both phases of respiration (previously called rales)
-associated with CHF
197
Abnormal respiratory sounds
-What is a pleural rub?
-Who do we typically see it in?
-ausculatation in the lower lateral chest area that occurs with inspiration & expiration (sounds like sandpaper or velcro)
-indication of pleural inflammation
198
Correct Answer: B
-Reason why: wheeze is high pitched and is commonly heard with obstructive disorders such as COPD
199
Lung voice sounds
What is bronchophony and give an example
-increase vocal resonance, w/greater clarity & loudness of spoken words (i.e. 99)
YOU SHOULD NOT HEAR "99" NORMALLY WHEN STETHOSCOPE IS USED
200
Lung voice sounds
What is egophony and give an example
it is a form of bronchophony in which "long E" sound turns into "nasal A" sound
201
What is whispered pectoriloquy and give an example
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
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
What are the normal ABG values?
pH 7.35-7.45
PaCO2 35-45 mmHg
HCO3 22-26 mEq/L
204
Now that we know the normal ABG values, list when each value is considered acidic & alkaline
pH
<7.35=acidic
>7.45=alkaline
PaCO2
<35=alkaline
>45=acidic
HCO3
<22=acidic
>26=alkaline
205
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?
CO2 or carbon dioxide is associated with respiratory
HCO3 or bicarbonate is associated with metabolic
206
To summarize everything mentioned in the previous flashcards list what makes up each of the following
-Respiratory acidosis
-Respiratory alkalosis
-Metabolic acidosis
-Metabolic alkalosis
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
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
the second part of each answer should say O2
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
the second part of each answer should say O2
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
GOOD THING TO KEEP IN MIND
How does a contracture/tightness impact range of motion?
How does weakness impact range of motion?
-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
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
TWO KEY WORDS IN GAIT CYCLE QUESTIONS
What does it mean when you see that something is early or delayed?
early=tightness/contracture
delay=weakness
213
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
What role does gluteus maximus play in the gait cycle?
How about the erector spinae?
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
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
During the stance phase of gait, if we see a forward trunk lean, what should we suspect?
Backward trunk lean?
Lateral trunk lean?
-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
In the swing phase, what might we suspect is the culprit if backward trunk lean was present?
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
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
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?
-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
Describe what happens to the muscles of the foot during gait
Peroneus Longus & Brevis
-Stance phase: concentric to maintain medial & lateral stability
Foot Intrinsics
-Stance phase: concentric to support plantar fascia
221
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
Correct Answer: D
Ankle PF and anterior pelvic tilt are directly correlated with knee hyperextension (genu recurvatum
223
What two things are medial tibial torsion directly associated with?
metatarsal adductus
subtalar pronation
224
What two impairments should we suspect to be the culprit with early heel off?
tight gastrocnemius in midstance & tight hip flexors in terminal stance
225
What would be the main culprit with for delayed heel contact?
How about with toe drag?
weak dorsiflexors
weak dorsiflexors or PF contracture/tightness
226
Correct Answer: D
The first 3 options would all directly cause knee hyperextension
Pes equinus is excessive PF
227
Correct Answer: D
228
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
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.
