Physical Therapy Tests And Measures Flashcards
Describe the Ankle-Brachial Index (ABI)
- known as the ankle arm index
- Compares the SYSTOLIC BP at the ankle and arm to check for PERIPHERAL ARTERY DISEASE (PAD)
What arteries are used to measure the ankle brachial index (ABI)?
- Brachial arteries
- tibialis posterior arteries
How is the ABI calculated?
Divide the higher of the two BP measurements in the ankles by the higher of the two systolic BP measurements in the arm.
[Ankle Systolic/ Arm Systolic]
What is the normal ABI?
1.0-1.3 = Normal, no blockage
What is an abnormal ABI?
> /= 1.30
Indicates rigid arteries and the need for an ultrasound test to check for PAD
What is number is considered a mild blockage?
0.8-0.99
Mild blockage; beginnings of PAD
What number indicates a moderate blockage?
0.4-0.79
Moderate blockage; may be associated with intermittent claudication during exercises
What number indicates a Severe blockage?
<0.4
Severe blockage; suggesting severe PAD; may have claudication present at rest
When taking BP what percentage of the bladder inside the cuff should encircle an adults arm? And child’s arm (<13yo)?
Adults-80%
Child-100%
What happens to the BP reading if the cuff is too small?
False high readings will occur
At what interval should you deflate the BP cuff?
No more than 2-3mmHg/sec
Describe Phase 1 of the Korotkoff sounds
1st appearance of clear tapping sounds corresponding to the appearance of a palpable pulse
This phase corresponds with systolic blood pressure (SBP)
Describe Phase II of the Korotkoff sounds
Sounds become softer and longer
Describe phase III of the Korotkoff sounds?
Sound becomes crisper and louder
Describe Phase IV of the Korotkoff sounds?
Sounds become muffled and softer
Describe Phase V of the Korotkoff sounds.
Sounds disappear completely
The diastolic pressure (DBP) is the pressure at the last audible sound
How is BP classified in children ages 3-17 years old?
Classified by SBP and DBP percentiles for age, sex and height
What is normal BP for children (3-17yo)?
SBP and DBP <90th percentile
What is Prehypertensive for children (3-17)?
SBP or DBP >/= 90th percentile to < 95th percentile
What is Stage 1 hypertension for children (3-17 yo)?
SBP and/or DBP >/= 95th percentile to =99th percentile plus 5 mmHg
What is Stage II hypertension in children (3-17 yo)?
SBP and/or DBP > 99th percentile plus 5 mmHg
In adults what is considered normal BP?
<120 mmHg SBP;and <80 mmHg DBP
In adults what is considered prehypertension?
120-139 mmHg SBP or 80-89 mmHg DBP
In adults what is considered Stage 1 Hypertension?
140-159 mmHg SBP and 90-99 mmHg DBP
In adults what is considered stage 2 hypertension?
> /= 160 mmHg SBP; and >/= 100 mmHg
When is BP considered a medical emergency?
> /= 210 mmHg; and >/= 110 mmHg
What are the designated auscultatory areas of heart sounds?
- Aortic area- 2nd intercostal space a the right sternal border
- Pulmonic area-2nd intercostal space @ left sternal border
- Mitral area- 5th intercostal space; medial to the left midclavicular line
- Tricuspid area- 4th intercostal space at the left sternal border
Describe the first S1 (lub)?
- 1st heart sound
- closure of the mitral and tricuspid (AV) valves at the onset of ventricular SYSTOLE
- High frequency sound w/ lower pitch and longer duration than S2 (dub)
Describe S2 (dub)
- 2nd heart sound
- closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole
- High frequency sound with HIGHER pitch and SHORTER duration than S1 (lub)
Describe S3.
- 3rd heart sound
- vibration of the distending ventricle walls due to passive flow of blood form the atria during the rapid filling phase of diastole
- normal in healthy young children; termed “physiologic” 3rd heart sound
- Abnormal in adults may be associated with heart failure; often called “ventricular gallop
Describe S4
- 4th heart sound
- pathological vibration of the ventricular wall with the ventricular filling and atrial contraction
- may be associated with hypertension, stenosis, hypertensive heart disease or MI; often called “atrial gallop”
Describe normal tracheal and bronchial breath sounds
- loud, tubular sounds normally heard over trachea
- inspiratory phase is SHORTER than the expiratory phase and there is a slight pause b/t them
Where is it abnormal to hear bronchial sounds?
Over the distal airways
Represent consolidation or compression of lung tissue that facilitates transmission of sound
Describe normal vesicular breath sounds.
- high pitched, breezy sounds normally heard over the distal airways in healthy lung tissue
- inspiratory phase is LONGER than expiratory phase and there is no pause b/t them
Describe crackles (rales) sounds.
- abnormal, discontinuous, high pitched POPPING sound heard more often during INSPIRATION
- May be associated with restrictive or obstructive respiratory disorders
Describe wet crackles
Represents the movement of fluid or secretions during inspiration
Describe dry crackles
Occur from the sudden opening of closed airways
What do crackles that occur during the latter half of inspiration typically represent?
- Atelectasis
- Fibrosis
- Pulmonary edema
- Pleural effusion
What do crackles due to movement of secretions sound like?
Usually low-pitched and can be heard during inspiration/expiration like the sound of hairs being rubbed together b/t the thumb and forefinger
What may pulmonary edema produce in regards to lung sounds?
May produce fine crackles as air bubbles through fluid in the distal airways
Where are crackles typically heard?
Bases of the lungs with interstitial lung disease, atelectasis, pneumonia, bronchietasis, and pulmonary edema
Describe Rhonchi
-Continuous low-pitched sounds described as having a “snoring or “gurgling” quality that may be heard during booth inspiration and expiration
What are Rhonchi caucused by?
Caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller (sibilant rhonchi) or larger (sonorous Rhonchi) airways
Describe a strider (lung sound).
Continuous high-pitched wheeze with inspiration or expiration
Indicates UPPER airways obstruction
Describe a wheeze (lung sound)
- continuous “musical” or whistling sound composed of a variety of pitches
- heard both during inspiration and expiration, but variable from minute to minute and area to area
What causes wheezing?
Arises from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm or foreign body
Describe bronchial breath sounds
Abnormal breath sounds when heard in locations (distal airways) where vesicular sounds are normally present
Pneumonia may produce these sounds
What does a decreased or diminished sound indicate?
A less audible sound may indicate severe congestion, emphysema, or hypoventilation
What do absent breath sounds indicate?
Absent lung sounds may indicate pneumothorax or lung collapse
In Normal lungs what do voice sounds present as?
- Transmission of spoken sounds is usually muffled
- Whispered words are faint and the syllables are not distinct except over the main bronchi
What does increase in loudness and distinctness in voice sounds indicate?
Indicates consolidation, atelectasis or fibrosis, all of which improve transmission of vibrations through lung tissue
T of F: whispered and spoken voice sounds are somewhat more valuable than breath sounds in detecting pulmonary consolidation, infarction, and atelectasis
True
Describe bronchophony.
Increased vocal resonance with greater clarity and loudness of spoken words
(E.g.- “99”)
Describe Egophony.
A form of bronchophony in which the spoken long “E” sound changes to a long, nasal-sound “A”
Describe Whispered pectoriloquy
Recognition of whispered words, “1,2,3”
What is the equation for BMI?
BMI = weight [kg] / height [m2]
OR
BMI = weight (lb)/ height (in2) x 703
BMI of <18.5 is classified as?
Underweight
BMI of 18.5-24.9 is classified as what?
Normal
BMI of 25-29.9 is classified as what?
Overweight
BMI of 30-34.9 is classified as?
Obesity (class 1)
BMI of 35.0-39.9 is classified as?
Obesity (class 2)
BMI of >/= 40.0 is classified as what?
Extreme obesity
What population is the BMI appropriate to use for?
General population
Overestimates body fat for athletes; underestimates body fat for elders
BMI classifications do not apply to what population?
Children and adolescents. Instead the following is used:
BMI b/t 85-95th percentile for age and sex is considered at risk for becoming overweight
BMI >/= the 95th percentile is considered overweight or obese
What is normal capillary refill time? Abnormal?
Normal: Full color returns < 2 seconds
Abnormal: Refill time is >2 seconds; BF is compromised (arterial occlusion, hypovolemic shock; hypothermia)
For claudication symptoms; if pt has pain in the buttock, hip or thigh what arteries may be obstructed?
Aorta and iliac (always the most proximal stenosis)
For claudication symptoms; pt with pain in the calf occurs with stenosis of what arteries?
Femoral and popliteal arteries
For claudication symptoms; Pain in the ankle or foot occurs with disease in what arteries?
Tibial or peroneal arteries
What is the procedure for the claudication test?
Patient walks on a flat track at maximum speed or on a treadmill a 2.0 mph at a constant grade b/t 0-12%
Score: initial claudication distance (ICD): pain-free walking distance AND
Absolute claudication distance: maximum distance walked when test is terminated due to pain AND speed of walking
List the anatomic locations when applying ECG electrodes to the limb.
- Right arm (RA)- infraclavicular fossa medial to R deltoid muscle
- Left arm (LA)- infraclavicular fossa medial to L deltoid muscle
- Left leg (LL)- Left side of abdomen below the rib cage
- Right Leg (RL)- Right side of abdomen below the rib cage (GROUND ELECTRODE)
List the anatomic locations of the chest electrodes for percordial leads
V1: 4th Intercostal space at R sternal border
V2: 4th intercostal space at L sternal border
V3: Midway b/t V2 and V4
V4: 5th intercostal space at left midclavicular line
V5: Left anterior axillary line at V4 level
V6: Left midaxillary line at V4 and V5 Levels