Physical Therapy Tests and Measures

Question 1

Angina Pain Scale

Answer 1

1 - Mild, barely noticeable
2 - Moderate, bothersome
3 - Moderately severe, very uncomfortable
4 - Most severe or intense pain ever experienced

Question 2

Ankle-Brachial Index (ABI)

Answer 2

Compares systolic BP at ankle and arm to check for peripheral artery disease.
BP taken at both brachial and posterior tibial arteries while Doppler ultrasound is used.
Higher BP in ankle divided by higher BP in arm.

> 1.30 Indicates rigid arteries and need for an ultrasound test to check for PAD
1.0-1.30 Normal; no blockage
0.8-0.99 Mild blockage; beginnings of PAD
0.4-0.79 Moderate blockage; may be associated with intermittent claudication during exercise
<0.4 Severe blockage suggesting severe peripheral artery disease; may have claudication pain at rest

Question 3

Blood Pressure

Answer 3

Bladder should encircle 80% of arm in adults and 100% of children <13 y.o. If bladder too small, false high readings will result.

Normal BP: <120/80
Elevated 120-129 and <80
Stage 1: 130-139 or 80-89
Stage 2: at least 140 or at least 90
Hypertensive Crisis: >180 and/or > 120

Question 4

Heart Sounds - Aortic area

Answer 4

2nd intercostal space at the R sternal border

Question 5

Heart Sounds - Pulmonic area

Answer 5

2nd intercostal space at the L sternal border

Question 6

Heart Sounds - Mitral area

Answer 6

5th intercostal space, medial to the L midclavicular line

Question 7

Heart Sounds - Tricuspid area

Answer 7

4th intercostal space at the L sternal border

Question 8

S1

Answer 8

Lub
Closure of the mitral and tricuspid (AV) valves at the onset of ventricular systole.
High frequency sound with lower pitch and longer duration than S2

Question 9

S2

Answer 9

Dub
Closure of aortic and pulmonic (semilunar) valves at onset of ventricular diastole.
High frequency sound with higher pitch and shorter duration than S1

Question 10

S3

Answer 10

Vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole.
Normal in healthy young children.
Abnormal in adults; may be associated with heart failure; called ventricular gallop.

Question 11

S4

Answer 11

Vibration of the ventricular wall with ventricular filling and atrial contraction.
May be associated with hypertension, stenosis, hypertensive heart disease, or MI. Called atrial gallop.

Question 12

Heart Murmurs

Answer 12

Vibrations of longer duration than the heart sounds.
Often due to disruption of blood flow past a stenotic or regurgitant valve.
Sounds can be soft, blowing, or swishing.

Question 13

Tracheal and bronchial sounds

Answer 13

Loud, tubular sounds normally heard over the trachea.

Inspiratory phase is shorter than expiratory phase with a slight pause between them

Question 14

Vesicular breath sounds

Answer 14

High pitched, breezy sounds normally heard over the distal airways
Inspiratory phase longer than expiratory phase with no pause between them

Question 15

Adventitious breath sounds

Answer 15

Abnormal sounds heard with inspiration and/or expiration that can be continuous or discontinuous.

Question 16

Crackle (rales)

Answer 16

Abnormal, discontinuous, high-pitched popping sound heard more often during inspiration (wet crackles) or from sudden opening of closed airways (dry crackles).

Question 17

Pleural friction rub

Answer 17

Dry, crackling sound heard during both inspiration and expiration
Occurs with inflamed visceral and parietal pleural rub together
Heard over spot where patient feels pleuritic pain

Question 18

Rhonchi

Answer 18

Continuous low-pitched sounds with a “snoring” or “gurgling” quality that may be heard during both inspiration and expiration
Caused by air passing through obstructed airway due to inflammatory secretions or liquid, bronchial spasm or neoplasms in smaller or larger airways.

Question 19

Stridor

Answer 19

Continuous high-pitched wheeze heard with inspiration or expiration
Upper bronchial obstruction

Question 20

Wheeze

Answer 20

Continuous “musical” or whistling sound composed of a variety of pitches.
Heard during inspiration and/or expiration but variable from minute to minute and area to area
Turbulent airflow and vibrations of walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm, or foreign body.

Question 21

Abnormal Bronchial breath sounds

Answer 21

Abnormal when heard where vesicular sounds are normally present. Possibly due to pneumonia.

Question 22

Absent breath sounds

Answer 22

May indicate pneumothorax or lung collapse.

Question 23

Bronchophony

Answer 23

Increased vocal resonance with greater clarity and loudness of spoken words
May indicate consolidation, atelectasis, or fibrosis.

Question 24

Egophony

Answer 24

Form of bronchophony in which the spoken long “E” sound changes to a long, nasal-sounding “A”

Question 25

Whispered pectoriloquy

Answer 25

Recognition of whispered words, like “1, 2, 3”

Question 26

Body Mass Index (BMI)

Answer 26

Weight (kg) / height (m^2) or weight (lb) / height (in^2) x 703.

<18.5 Underweight
18.5-24.9 Normal
25-29.9 Overweight
30-34.9 Obesity class 1
35-39.9 Obesity class 2
40 or more Obesity class 3

Question 27

Capillary Refill Time

Answer 27

Full color returns in < 2 seconds = normal refill time
> 2 seconds = abnormal refill time and capillary blood flow compromise (arterial occlusion, hypovolemic shock, hypothermia)

Question 28

Claudication Test

Answer 28

Pt walks on flat track at max speed or treadmill at 2.0 mph at a constant grade between 0-12%.

Scoring:
Initial claudication distance (ICD) = pain-free walking distance
Absolute claudication distance (ACD) = maximum distance walked when test is terminated due to pain
Speed of walking

Grading scale for claudication pain:
Grade 1 - Definite discomfort or pain but only of initial or modest levels
Grade 2 - Moderate discomfort or pain from which pt’s attention can be diverted
Grade 3 - Intense pain from which pt’s attention cannot be diverted
Grade 4 - Excruciating and unbearable pain

Location of obstruction
Pain in buttock, hip, or thighs = aorta and iliac arteries
Pain in calf = femoral and popliteal arteries
Pain in ankle or foot = pain in tibial or peroneal arteries

Question 29

Borg Dyspnea Scale

Answer 29

0-10 from No breathlessness to maximal

3 is moderate and 5 is severe breathlessness

Question 30

Sinus arrythmia

Answer 30

Sinus rhythm but with quickening and slowing of impulse formation in the SA node resulting in slight beat-to-beat variation of rate.

Question 31

Sinus arrest

Answer 31

A sinus rhythm but with intermittent failure of either SA node impulse formation or AV node conduction that results in occasional complete absence of P or QRS waves.

Question 32

Premature atrial contractions (PAC)

Answer 32

When an ectopic focus (abnormal pacemaker site) in the atrium initiates an impulse before the SA node.
P wave is premature with abnormal configuration.
Very common and generally benign but may progress to atrial flutter, tachycardia, or fibrillation.
May occur from caffeine, stress, smoking, alcohol, and any type of heart disease.

Question 33

Atrial flutter

Answer 33

Atrial tachycardia, atrial rate of 250-350 bpm. Ventricle rate depends on AV node conduction.
Saw tooth shaped P waves.
Occurs with valvular disease (especially mitral), ischemic heart disease, cardiomyopathy, hypertension, acute MI, chronic obstructive lung disease, and pulmonary emboli.
Signs & symptoms include palpitations, lightheadedness, and angina.
Stagnation of blood can predispose to thrombi in the atria.

Question 34

Atrial fibrillation

Answer 34

Common arrhythmia where atria are depolarized between 350-600 bpm.
Irregular undulations of ECG baseline without discrete P waves.
Occurs in healthy hearts and those with coronary artery disease, hypertension, and valvular disease.
Symptoms include palpitations, fatigue, dyspnea, lightheadedness, syncope, and chest pain.
Stagnation of blood can predispose to thrombi in the atria.

Question 35

1st degree atrioventricular block

Answer 35

PR interval longer than 0.2 seconds but relatively constant from beat to beat.
No symptoms or significant changes in cardiac function.
May be caused by medications that suppress AV conduction.

Question 36

2nd degree atrioventricular block

Answer 36

Impulse between atria and ventricles fail intermittently.
2 major types: Mobitz type I block (Wenckebach block) and Mobitz type II block.
Mobitz I - progressive prolongation of PR interval until one impulse is not conducted (generally benign)
Mobitz II - consecutive PR intervals are the same and normal followed by nonconduction of one or more impulses (more serious condition)

Question 37

3rd degree atrioventricular block

Answer 37

Complete heart block, all impulses blocked at AV node and none transmitted to ventricles.
Atria and ventricles paced independently; atrial rate > ventricular rate.
Medical emergency requiring pacemaker.
May faint if ventricular rate too slow.
Causes include degenerative changes of the conduction systems, digitalis, heart surgery, and acute MI.

Question 38

Premature ventricular complex (PVC)

Answer 38

Premature ventricular depolarization due to an ectopic focus.
P wave usually absent and QRS complex has a wide and aberrant shape.
Bigeminy - Normal sinus impulse followed by a PVC.
Trigeminy - PVC occurs after every two normal sinus impulses.
Common arrhythmia that occurs in healthy and diseased hearts.
Pt may be asymptomatic or have palpitations.
Causes include anxiety, caffeine, stress, smoking, and all forms of heart disease.

Question 39

Ventricular tachycardia (v-tach)

Answer 39

3 or more consecutive PVCs at a ventricular rate of > 150 bpm
P waves absent and QRS complexes are wide and aberrant
V-tach longer than 30 seconds is life-threatening and requires immediate medical interventions
Pt unable to maintain adequate blood pressure and eventually become hypotensive
May progress to ventricular fibrillation, causing cardiac arrest
Causes include MI, cardiomyopathy, and valvular disease

Question 40

Ventricular fibrillation (v-fib)

Answer 40

Ventricles do not beat in coordinated fashion but fibrillate or quiver asynchonously and ineffectively
No cardiac output; patient becomes unconscious
ECG shows fibrillatory waves with irregular pattern
May require immediate defibrillation
Medications to support circulation and intravenous antiarrhythmic agents
Causes include heart disease of any type, MI, and cocaine use

Question 41

Ventricular asystole

Answer 41

Ventricular standstill with no rhythm
ECG records a straight-line pattern
Requires immediate CPR and medications to stimulate cardiac activity
Causes incline MI, ventricular rupture, cocaine use, lightning strikes, and electrical shock

Question 42

ST segment depression

Answer 42

Subendocardial ischemia, digitalis toxicity, or hypokalemia

Segment is evaluated as a deviation from baseline in mm.

Question 43

ST segment elevation

Answer 43

Earliest sign of acute transmural infarction
Can also indicate benign early repolarization pattern in a normal heart
Deviations from isoelectric baseline expressed in mm.

Question 44

Abnormal Q wave

Answer 44

Marker of infarction; signifies loss of positive electrical voltages due to necrosis.
Significant or abnormal Q wave is longer than 0.04 msec and larger than 1/3 the amplitude of the R wave.

Question 45

T wave inversion

Answer 45

Occurs hours or days after an MI as a result of a delay in repolarization produced by the injury.
May also occur with R and L bundle branch blocks, after a CVA, and normal juvenile T wave pattern in children and some adults.

Question 46

Exercise Stress Test

Answer 46

ECG, BP, HR, and symptoms are monitored while exercise intensity is increased to monitor tolerance. Negative test indicates low probability of coronary artery disease. Positive test indicates high probability of coronary artery disease. Can determine aerobic exercise prescription.

Question 47

Homan’s sign for DVT

Answer 47

Passively DF the ankle with knee straight. Positive if pain in the calf or popliteal space.

Question 48

Mediate Percussion

Answer 48

Act of tapping surface of body to identify areas of altered density. Use middle finger to strike intercostal spaces anteriorly and posteriorly, comparing sounds from each space from left to right.

Sounds of tissue of high to low density:
Flat or dull - Sound elicited by percussion of thigh muscles; in the upper lung, suggests neoplasm, atelectasis, or consolidation.
Resonance - percussion sound from normal air-filled lung
Hyperresonance - Emphysematic lung, pulmonary emphesema, or pneumothorax
Typany - hollow sound; indicates large pneumothorax

Question 49

Palpation of Peripheral Artery Pulses

Answer 49

Infant 100-130 bpm
Child 80-100 bpm
Adult 60-100 bpm
Bradycardia < 60
Tachycardia > 100

Volume or Amplitude of Pulse 
3+ = Large or bounding pulse
2+ = Normal or average pulse
1 = Small or reduced pulse
0 = Absent

Question 50

Pulmonary Function Testing (PFT)

Answer 50

Measures volume or flow of air during inhalation and exhalation.
Pt exhales into spirometer as hard and as fast as possible for 6 seconds until no more air can be exhaled.

Obstructive ventilatory impairment:

• Decreased expiratory flows
• FEV1/FVC <70%
• Pathologies include asthma, emphysema, and chronic bronchitis

Restrictive ventilatory impairment:

• Reduced lung volumes (TLC, TVC, FEV1) and relatively normal expiratory flow rates
• FVC reduced and FEV1/FVC is normal or >80%
• Pathologies include interstitial lung disease, pleural diseases, chest wall deformities, obesity, pregnancy, neuromuscular disease, and tumor

Question 51

Pulse Oximetry

Answer 51

Estimates percent of arterial oxygen saturation of hemoglobin.
SpO2 is +/-4% of actual arterial O2 saturation.
If SpO2 <90% in acutely ill patients or <85% in patients with chronic lung disease, activity should be stopped.

Question 52

Rate Pressure Product (RPP)

Answer 52

Index of myocardial oxygen consumption and coronary blood flow. Can be compared with onset of angina or development of ECG abnormalities.
RPP = HR X SBP
Usually reported as a 2 digit number x 10^3
May be used to prescribe exercise, keeping intensity below RPP value to reduce risk of angina

Question 53

Rate of Perceived Exertion (RPE)

Answer 53

Original 6-20 scale and revised 0-10 Borg scales.
RPE of 13-14 represents about 70% of maximum heart rate during exercise. RPE of 11-13 represents the upper limit of prescribed training heart rates early in cardiac rehab.

Question 54

Respiratory Rate, Rhythm, and pattern

Answer 54

Assessment of respiration looks at rate, rhythm, depth, and character (effort and sound)

Rate:
Newborn 33-45 breaths/min
1 year 25-35 breaths/min
10 years 15-20 breaths/min
Adult 12-20 breaths/min

Rhythm:
Normal: Inspiration half as long as expiration 1:2
COPD: Longer expiration phase, 1:3 or 1:4

Depth: Deep or shallow than normal tidal volume

Character of respiration:
Normal is quiet and effortless
Labored uses accessory muscles
Wheezes and crackles abnormal

Question 55

Apnea

Answer 55

Absence of spontaneous breathing

Question 56

Biot’s

Answer 56

Irregular breathing, vary in depth and rate with periods of apnea. Often associated with increased intracranial pressure or damage to the medulla.

Question 57

Bradypnea

Answer 57

Slower than normal RR, <12 breaths/min. May be associated with neurologic or electrolyte disturbance, infection or high level or cardiorespiratory fitness.

Question 58

Cheyne-Stokes (periodic)

Answer 58

Decreasing rate and depth of breathing with periods of apnea. Can occur due to CNS damage.

Question 59

Kussmaul’s

Answer 59

Deep and fast breathing; often associated with metabolic acidosis.

Question 60

Paradoxical

Answer 60

Chest wall moves in with inhalation and out with exhalation. Due to chest trauma or paralysis of the diaphragm

Question 61

Six-Minute Walk Test (6MWT)

Answer 61

May use additional O2 and ADs during test. 3 walks with 15 min of rest in between are recommended. Can rest as needed. Provide standard words of encouragement. Record distance walked and number of rest breaks needed.

Question 62

Waist Circumference

Answer 62

Measuring tape placed at level of iliac crest at end of normal exhalation. Increased risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease associated with circumference > 102 cm (40 in) for men and 88 cm (35 in) for women.
Individuals with waist circumferences greater than these values should be considered one risk category above that defined by their BMI.