Practice Exam Flashcards
Extra-articular complications of RA
vasculitis
Extra-articular complications of psoriatic arthritis
Psoriatic skin and nail changes
Conjuctivitis
Iritis
Extra-articular complications of degenerative disc disease
disc degerneration
Changes in skin composition associated with aging
decrease sensitivity to touch decreased perception of pain/temp increased risk of injury decreased elasticity inflammatory responses are weakened
Breathing pattern of ASIA A C5
rising of abdomen due to no abdominal m tone on the abdominal viscera
m weakness is symmetric
diaphragm - innervated by C3-5 (so it still fxns)
m weakness will cause a restrictive disorder not obstructive
Criteria for dx of metabolic syndrome
abdominal obesity (>40in men, >35in women) elevated triglycerides (>150) low HDL (<40 M; <50 F) fasting plasma glucose >110
Limitations of US
difficulty penetrating bone
US usually used for tendon tears, bleeding/fluid in mm/bursae/joints; soft tissue tumors; early RA; masses/lumps
Disorders associated with obesity
HTN; dyslipidemia; hyperinsulinemia (type 2), hyperglycemia
Normal composite motion of of shoulder ABD to 150 degrees
100 deg GH; 50 deg scapulothoracic motion
2:1 ratio (So 150 = 100+50)
Mm to strengthen for crutch use
Lower traps, Lats, pect major
Mm : shoulder depressors and extensors and elbow extensors
Scoliosis: breathing abnormalities
increased lateral costal expansion on side of curve
ribs would elevate normally more on curved side
shortened side would have shortened m length and decreased aeration
Anterior glide of shoulder
increase ER and late flexion
Inferior glide of shouler
inreases shoulder ABD
Tx: break up LE synergey patterns in hemiplegic pt
high kneeling, ball throwing
What’s carried in dorsal column-medial lemniscus tracts
light touch, 2-point discrimination; stereognosis (3D touch recognition); barognosis (discern weight)
Where is pain/temp carried?
anterolateral spinothalamic pathways`
Most important factor in amputation treatment
wound healing
also: hip flexor contracture, residual limb shape, m atrophy
Tx: address tightness of lumbricals in hand
exercise: MCP EXT; IP FLX (lumbrical do opposite)
Adhesive capsulitits: capsular pattern; Dx characteristics
shouler ER > FLX > IR
- thickening of synovial capsule
- adhesions within the subacromial/subdeltoid bursa
- adhesions to the biceps tendon
- and/or obliteration of the axillary fold secondary to adhesions
*commonly associated with other systemic and nonsystemic conditions
Most common comorbid condition of DM?
adhesive capsulitis
PTA: pt records
pt has right to see notes; no need for PT permission
Chest tube: what happens if dislodged and not fixed?
pneumothorax (+ pressure on lung tissue - lung can’t inflate - collapses)
Pulmonary edema: cause
increased hydrostatic pressure within pulmonary vascular system
OR
changes in vascular membrane
Atelectasis: tx
facilitate deep breathing
- by reducing pain, segmental breathing (prolonged inspiration with breath hold), incentive spirometry
Post-op flexor tendon repair (hand)
wait 48-72 hrs prior to ROM
wait 1-3 weeks before active flexion
passive extension after adequate strength of repair
Phantom limb pain
result of nn being cut
Iontophoreis: current used
direct current with negative pole (acetate ion is negative)
PCL: mechanism of injury
MVA - dashboard injury
ACL: mechanism of injury
noncontact deceleration producing valgus twist injury
eg: athlete pivoting in opp direction
hyperEXT with severe medial tib ROT
patella dislocation: mechanism of injury
powerful quad contraction with sudden FLX and ER of tibia on femur
rupture of popliteal a: mechanism of injury
severe trama resulting in dislocation of tibia on femur
most common: force on tibia while knee is FLXed (dashboard)
Patellofemoral syndrome
runners knee
most common overuse injury in runners
cause: mistracking of patella within intercondylar groove
Sx:
- knee pain, especially sitting with knee FLX
- occasional buckling of knee possible
Primary reason a compression garment reduced edema?
external pressure caused by compression garment increases amt of pressure on the tissue –> causes relative increase in hydrostatic pressure in extravascular spaced compared with the intravascular space
classic TMJ unilateral capsular restriction: Tx
chin deviated to R in terminal opening
right TMJ, inferior glide manip
Akinesia: tx
(freezing of gait)
identification of triggers
Adrenal insufficiency: associated metabolic abnormalities
- hyponatremia (2ary to renal loss of Na+ )
- inability to regulate potassium and sodium (2ary to decrease in cortisol)
pts will be hyperkalemic, hypoglycemic, may have acidosis
HepB precautions
transmitted in blood, body fluid, body tissues
- avoid direct contact with blood
Scoliosis: screening test
Adam’s forward bend (Standing)
Continuous ultrasound: use?
thermal effects
higher intensity = greater chance of tissue temp rise
results in increased metabolic rate of tissue
- would decrease stiffness of collagen
contraindicated for acute inflammation
Lyme disease: stage III
late or chronic Lyme disease
characterized by intermittent arthritis with marked pain/swelling
large joint primarily affected, esp knee
permanent joint damage can occur
Heart sound: S3
abnormal
cause: poor ventricular compliance and turbulence
sound: low-freq sound during early diastole
Heart sound: S4
abnormal
cause: exagerated atrial contraction and subsequent turbulence
sound: low-freq sound in late diastole
Heart sound: murmur
sound: swishing sound in systole, diastole, or both
Heart sound: pericardial rub
sound: leathery sound during systole
Full-term infant in NICU: reasons
low Apgar scores
resp distress
specific diagnoses (many)
Normal tone of full-term infant
initial tone and posturing: some FLX of limbs
decreased FLX at 1 month
Osteoporosis: tx
goal: bone stimulus
WBing exercises
standing > high load, short duration (running, jumping, weights)
Stemmer’s sign
tests for lymphedema
pull up on base of 2nd toe/finger
+: unable to opull skin up
Anterior walker
enhances forward lean posture
McBurney’s point
pain/tenderness with palpation = acute appendicitis
location: btwn ASIS and umbilicus (R lower quadrant)
Murphy’s sign
+ : associated with acute cholecystitis or acute pyelonephritis
Hiatal hernia Sx
sharp pain localized to lower esophagus/upper stomach area
Beta blocker: exercise response
decrease sympathetic response to activity = decrease HR, blunt HR response to activity
Apgar scores
- HR over 100bpm
- good respiration and crying
- cough or sneeze
- pink color
- active movements
(2 points each)
1 minute after birth: 8-10 points normal
Vertebral artery test
Position: passively move head/neck into EXT and side FLX, rotation to same side
Hold 30 seconds
+ : dizziness/nystagmus occur, indicating the opposite side artery is being compressed
Opisthotonos
extreme hyperEXT of neck
LE FLXed
heels touching buttocks
Semi-Fowler position
supine, head and torso elevated 30 deg
Berg Balance Test: what does it include?
sit<>stand
functional reach
tandem standing
*does not include gait
Clubfoot: stretching
Plantar flexion and eversion
Pursed lip breathing
increases resistance to airways on exhalation
–> increase pressure –> prevents airway collaspe
What does the HS do during gait?
Controls forward swing of leg during terminal swing
Loss of strength = abrupt knee extension and increased hip flexion
Loose pack position: humeroulnar jt / humeroradial jt
ulnar: 70 deg flexion
radial: 70 deg flexion, 35 deg supination
ASIA A C6: transfers
no triceps
arms anterior to hips; shoulder ER, elbow/wrist EXT; forearm SUP, finger FLX
requires: ant deltoid, shoulder ERs, clavicular portion of pec major –> flexes and adducts humers –> elbow EXT
Compartment syndrome
occurs when pressure within the mm builds to dangerous levels; pressure can decrease blood flow
can be acute or chronic
ACUTE = MEDICAL EMERGENCY
chronic aka exertional compartment syndrome; usually not emergency; often caused by athletic exertion
complaint = bursting type of pressure and pain
Shin splints
aka medial tibial stress syndrome
nonfocal tenderness (diffuse along mid-distal, posteromedial tibia)
no edema
Reliability coefficients
>.75 = good reliability .5-.75 = mod reliability
hemosiderin changes and increased LE edema Sx consistent with ____.
chronic venous insufficiency
Chronic arterial insufficiency: Sx
- pain
- decreased/absent pulses
- dependent rubor
- trophic changes (nail changes/loss of hair, pale/shiny skin)
Percussion and shaking: precautions
platelet count of 30,000 (where’s the exact cut off??) = increased risk for bleeding
Hip: Capular patterns
2 classical capsular patterns: FAME and MEAL
FAME: FLX, ABD, IR, EXT
MEAL: IR, EXT, ABD
Hip OA practice guildelines
- pt report of hip pain
- present with either one of the following:
- hip IR <15 AND hip FLX <115 AND age >50
- hip IR >=15 AND pain with IR, am stiffness <=60min AND age >50
Spondylolisthesis
= forward translation of vertebral body
Spondylolysis
break in the vertebra typically in the region of pars interarticularis
may or may not be associated with spondylolithesis
Bamboo appearance of the spine on radiograph is an indicator of what?
Ankylosing spondylitis
PTA: what to do if PT not in room
okay to continue tx plan
Boutonniere deformity
MCP EXT
DIP EXT
PIP FLX
central extensor tendon rupture
Most likely prosthetic cause for circumduction during swing
- long prosthesis
- locked knee jt
- loose knee friction
- inadequate suspention
- small or loose socket
- plantar flexed foot
Lhermitte’s sign
= sudden, transient, electric-like shocks speading down body when head is FLXed forward
occurs mostly in MS patients, can also be seen in compression disorders of c-spine
Head jolt test
turn head at freq of 2-3x/second
+ : worsening of baseline HA
indicadive of meningeal irritation
Kernig’s sign
for: meningeal irritation
supine, LE flexed at hip/knee; straighten knee
+ : resistance to knee straightening
Tinel’s test
percussion of nerve at sit of compression
+ : distal tingling sensation
Airway clearance technique frequency in CF pt with acute respiratory failure
as often as possible
- clear secretions
- assist with gas exchange
Arterial ulcer: typical location
- distal lower leg (toes, foot)
- lateral malleolus
- anterior tibial area
Venous ulcer: typical location
- medial malleolus
- distal lower leg
Sublingual nitroglycerin: primary effects
- increases coronary blood flow by dilating coronary aa and improving flow to ischemic areas
- in low doses - produces vasodilation (venous > arterial) and is used in acute and long-term prophylactic mgmt of angina pectoris
- decreases L ventricular end-diastolic pressure
- reduces myocardial O2 consumption
Arm positioning for pt s/p CVA
= opposite to expected posturing and spastic patterns shoulder protraction, ABD, ER elbow EXT writst neutral fingers EXT
Statin: possible side effect
statins: atorvastatin, LIpitor…
<5% experience myalgia, cramps, stiffness, spasm, weakness affecting exercise tolerance
send to PCP
Spastic bladder
UMN problem
contracts and reflexively empties in response to a certain level of filling pressure
reflex emptying can be triggered by manual stim techniques (stroking, kneading, tapping suprapubic area)
stage I pressure ulcer
nonblanchable erythema of intact skin
stage II pressure ulcer
partial-thickness skin loss involving the epidermis or dermis
superficial, presents clinically as an abrasion, blister or shallow crater
stage III pressure ulcer
full-thickness skin loss with damage to or necrosis of subcutaneous tissue
presents clinically as a crater
stage IV pressure ulcer
full-thickness skin loss with extensive destruction, tissue necrosis, damage to m/bone/supporting structures
undermining or sinus tracts may be present
Duchenne’s MD
rapidly progressive disorder
muscle wasting/atrophy
common: contracture hip/knee/PF/ITB
scoliosis at age 11/12
main focus: prevent contractures, maintain ADLs / energy conservation, family ed, positioning
neoprene sleeve
for warmth, maybe good for arthritis
rhythmic stabilization
proprioceptive neuromuscular facilitation (PNF) technique used to improve postural stability
Quad / HS torque relationship
65% at 60deg/sec
69% at 180
71% at 300
Supracondylar fx
most common pediatric elbow fx; 3-10 yrs of age
extension fx = 95% of supracondylar fxs
mech of injury: fall, hand outstretched / elbow hyper EXT
Thoracic outlet Sx
- wasting in the thenar area
- numbness or tingling in the fingers
- pain in the shoulder/neck
- ache in the arm/hand
- weakening grip
vertebral a occlusion: Sx
varies with area of ischemia and cause of occlusion
most common: vertigo, dizziness, nausea, vomiting head/neck pain
other signs: weakness, hemiparesis, ataxia, diplopia, pupillary abnormalities, speech difficulties, altered metnal status
complex regional pain syndrome
chronic pain condition
believed to be the result of dyxfxn in CNS or PNS
Sx: dramatic changes in color/temp of skin with intense burning pain, skin sensitivity, sweating, swelling
key Sx = continuous, intense pain out of propportion to the severity of the injury; get worse vs better with time
Mm involved in mouth opening
lateral pterygoid
anterior head of the digastric m
suprahyoid mm
Mm involved in mouth closing
masseter
temporalis
medial pterygoid
lateral pterygoid
Mm involed in mouth retrusion
temporalis
suprahyoid
Pancreatitis pain
midline or L of epigastrium, just below xiphoid process
pain referred to mid/lower back, rarely to upper back
Small intestine pain
midabdominal (umbilicus level)
pain referred to back if intense
Large intestine / colon pain
poorly localized to midabdominal area
pain can be reffered to sacrum
appendicial pain
R lower quadrant
pain can be referred to periumbilical area or R hip
Rolling walker contraindication
forward flexed posture (typical in PD)
Appearance: pallor
indicative of anemia, internal hemorrhage, lack of sunlight exposure
Appearance: yellowish
indicative of jaundice (liver disease)
Appearance: cherry-red
indicative of carbon monoxide poisoning
Appearance: bluish, slate colored
indicative of hypoxia
Put fibular/peroneal n on stretch
SLR with ankle PF and inversion
Put tibial n on stretch
SLR with DF and eversion
Put sural n on stretch
SLR with DF and inversion
MS: diagnostic imaging
MRI: detects MS plaques in white matter of brain/spinal cord
UTI: Sx
lethargic
nausea
painful urination
feverish
Accessory mm of respiration
scalenes
sternocleidomastoid
Stutter test
for: plica condition
pt seated, extend knee
+: patella jump/stutters btween 60-45 deg flexion
Diff Dx: Myositis ossificans vs tumor
Myositis ossificans:
happens 2-4 weeks after injury
lesions begin to calcify at periphery and work towards center
at <3 weeks post trauma, bone scan demonstrates increased uptake in the area
Osteosarcoma:
calcifies at center, continues to periphery
Stress Rxn: radiographic signs
Osteal bone: endosteal or periosteal callus formatin wtihout fx line. circumferential periosteal rxn with fracture line through one cortex. Frank fx
Cancellous bone: flake-like patches of new bone formation (2-3 weeks)
Cloudlike area of mineralized bone. Focal linear area of sclerosis, perpendicular to the trabeculae.
Effects of Valsalva maneuver
initial increase in BP followed by a drop, slowing of HR, decreased return of blood to heart, increased venous pressure
General exercise guidelines
10 min: min recommended work interaval duration for non deconditioned adult performing aerobic activity
20min: lowest end of the acceptable amt of exercise time per day
30 min: total recommended daily exercise time; can be broken to 3x10min
Prevent delayed hypoglycemia with ___.
Crackers/bread = slowly absorbed carbs
Acromioclavicular sprain
pain at extremes of AROM, esp horizontal ADD and full elevation, pain on passive horzontal ADD and elevation
special tests
- AC shear test: + if abnormal mvmt of AC joint or pain
- passive cross-chest ADD
- OBrien test
Calcific tendonitis
found on imaging
no Sx
if symptomatic: may present as :
- chronic, relatively mild pain similar to shoulder impingement syndrome
- large calcific deposit that may interfere with elevation of the arm
- more severe acute pain attributed to the inflammatory process
Peabody Developmental Motor Scale
norm-referenced standardized for: gross motor / fine motor skills 6 sutests age: 1-72 months
WeeFIM
comprehenvisve criterion-referenced for: fxnal performance 18 items, 6 subscales age: 6mo-8yr
Denver II
norm-referenced
standardized test of development
for: fxnal performance (self-care, sphincter control transfers, locomotion, cogn fxn)
age: 1 week to 6.5 yrs
Movement Assessment of Infants (MAI)
criterion referenced
for: m tone, reflexes, automatic rxns, volitional vmmt
age: birth to 12 mo
Flat foot deformity can result from injury to _____ tendon.
posterior tib
Raynauds Disease
vasospastic disorder
intermittent episodes of small artery constriction of the digits of the fingers/ rarely the toes
temporary pallor and cyanosis
Pressure tolerant areas of WBing of tpical transtibial limb
patellar tendon,
medial tibial plateau
tibial and fibular shafts
distal end
Position for max compressive forces on patella
hip EXT, knee FLX –>max rectus length
Loose pack position of GH joint
30-40 degrees in scapular plane
Closed pack positon of GH joint
full ABD, full ER
Thompson test
for: integrity of Achilles tendon
pt prone, squeeze calf
+ : foot doesn’t move
Congenital muscular torticolis
shortened sternocleidomastoid with weakened contralateral SCM –> lateral FLX of head to involved side and ROT of head to noninvolved side
Osteoporosis risk factors
- postmenopausal
- low body weight
- loss of height
- sedentary lifestyle
- tobacco use
- hyperthyroidism (Grave’s disease)
Osteoporosis: sx
- severe/localized thoracic-lumbar pain
- increased pain with prolonged upright posture
- decreased pain in hook-lying
- loss of height
- kyphosis
R ventricular failure: most common early sign?
increased fluid backs up, travels backwards from R ventricle –> edema goes to R atrium and then the periphery
–>causes dependent edema
Juvenille RA: Sx
swollen, stiff, painful joints usually worse in morning fatigue fever swollen lymph nodes poor weight gain/slow growth
Position of c-spine for traction
C1-2 : 0-5deg FLX
C3-4 : 10-20
C5-7 : 25-30
Glossopharangeal breathing technique
forces air in to lungs; does not assist with coughing/force output
complex regional pain sydrome: sx
stage I : hyperalgesia, allodynia, hyperpathia with edema, increased sweating, and thin/shiny skin
stage II : increased pain with edema and atrophic skin and nail changes
stage III : speading pain, hardening of edema, cool/dry/cyanotic skin, developing osteoporosis and anklyoyls
Pain after thoracic mobs - how to modify?
change to low amp oscillations for pain
Use of heat with MS?
MS pt have heat intolerance
Accessory motions for knee FLX/EXT
FLX: posterior glide and IR
EXT: anterior glide and ER
Exercise modifications post cardiac transplant
Longer warm up/cool down periods bc physiological responses to exercise/recovery will take longer. Can perform low-mod intensity resistance training. Aerobic exercise shoulder be performed 4-6x/week while progressively increasing duration of training from 15-60 min per session
EMG activity
*useful for Dx LMN disease, deficits in transmittion at neuromuscular jxn
needle insertion: insertion activity (bursts of activity)
after insertion: electrical silence (no sound)
Filbrillation potentials: spontaneous activity seen in relaxed denervated muscle
Polyphasic potentials: produced in the contracted m undergoing reorganization
Fasiculation: spontaneous contractions of all/most fibers in a motor unit; m twitches can been seen/felt; present with LMN disorders/denervation
Alterations in MUP size/shape/duration: reinnervation
Complete LMN lesion: only fibrillation
partial LMN lesions: fibrillation and fasciculations
Contraindications for exercise in CA pts
Exercise contraindicated for CA pts with:
platelets <50,000
WBC <3,000
Hg <10
- significant body mets
- severe cachexia,
- severe fatigue
- poor fxnal status
Thoracic outlet syndrome
= compression to neurovascular structures in scalene trirangle (anterior/middle scalenes between clavicle and 1st rib)
compression result of shortened pect minor and scalene mm
clinical manifestations of postpolio syndrome
myalgias
new weakness
atrophy
excessive fatigue with min activity
