Readings (1st 20 days) & Lectures 1-5 Flashcards by Danielle Hood

Injury to what nerve can cause the claw hand deformity?

Ulnar n (C8, T1)

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What nerve is vulnerable to injury w/ dislocation of shoulder and fx of surgical neck of humerus?

Axillary n (C5, C6)

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What nerve is vulnerable to injury with shoulder dislocations and midshaft of the humerus?

Radial n (C5- T1)

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“Crutch Palsy” caused by compression of what nerve while leaning on axillary crutches?

Radial n (C5-T1)

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Lateral Epicondylitis (“Tennis Elbow”) is result of what affected n?

Radial n (C5-T1)

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Trauma/fx of upper femur or pelvis during dislocation of hip can cause injury to what n?

Femoral n L2-L4

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Person with who has difficulty crossing their legs may have damage to what n?

Obturator n (L2-L4)

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Piriformis Syndrome caused by compression of what n?

Sciatic n

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What n occupies a groove behind the medial malleolus along T,D & H creating Tarsal Tunnel?

Posterior Tibial n

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What muscles are invovled in Tarsal Tunnel?

Tom, Dick and Harry
-Tibialis posterior
-Flexor Hallucis Longus
-Flexor Digitorum Longus

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Capsular pattern of Shoulder (GH jt)

Max= ER
Mod= ABD
Min= IR

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Capsular pattern of Elbow

Flexion > Ext loss

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Capsular pattern of hip

Max= IR, Flex, ABD
Min= Ext

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Capsular pattern of Knee (Tibiofemoral jt)

flexion> ext loss

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Capsular pattern of ankle (Talocrural jt)

PF> DF loss

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Caudal glide of the GH jt is meant to increase what motion?

Abduction

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Posterior glide of the GH jt is meant to increase what motion(s)?

Flexion, IR

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Anterior glide of the SC jt is meant to increase what motion?

scapular protraction

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Caudal (inferior) glide of the SC jt is meant to increase what motion?

elevation

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Distal glide of the humeroulnar jt is meant to increase what motion?

flexion

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Radial glide of the humeroulnar jt is meant to increase what motion(s)?

varus; flexion

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Ulnar glide of the humeroulnar jt is meant to increase what motion(s)?

valgus; Extension

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Dorsal glides of humeroradial jt increase what motion?

extension

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Volar glides of humeroradial jt increase what motion?

flexion

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Dorsal glides of the proximal radioulnar jt are meant to increase what motion? *****

pronation

Volar glides of the proximal radioulnar jt are meant to increase what motion? ****

supination

Dorsal glides of the distal radioulnar jt are meant to increase what motion?

supination

Volar glides of the distal radioulnar jt are meant to increase what motion?

pronation

Dorsal glides of the Radiocarpal joint are meant to increase what motion?

flexion

Volar glides of the Radiocarpal joint are meant to increase what motion?

Extension

Radial glides of the Radiocarpal joint are meant to increase what motion?

ulnar deviation

Ulnar glides of the Radiocarpal joint are meant to increase what motion?

Radial deviation

Ulnar glides of the CMC jt increases what motion?

radial adduction

Radial glides of the CMC jt increases what motion?

radial abduction

Dorsal glides of the CMC jt increases what motion?

palmar abduction ****

Volar glides of the CMC jt increases what motion?

palmar adduction ****

Volar glides of the MCP and IP jt increase what motion?

flexion

Dorsal glides of the MCP and IP jt increase what motion?

extension

Radial/ulnar glides of the MCP and IP jt increase what motion?

abduction/adduction

Posterior glides of the hip are meant to increase what motion(s)?

Flexion; IR

Anterior glides of the hip are meant to increase what motion(s)?

extension; ER

Posterior glides of the tibiofemoral jt are meant to increase what motion(s)?

flexion

Anterior glides of the tibiofemoral jt are meant to increase what motion(s)?

Extension

Anterior (Ventral) glides of the tibiofibular jt are meant to increase what motion?

reposition post subluxed head

Posterior (dorsal) glides of the talocrural jt are meant to increase what motion?

Anterior (ventral) glides of the talocrural jt are meant to increase what motion?

Medial glides of the subtalar jt are meant to increase what motion?

eversion

Lateral glides of the subtalar jt are meant to increase what motion?

Inversion

Plantar glides of the intertarsal and TMT jts are meant to increase what motion(s)?

PF accessory motions; supination

Dorsal glides of the intertarsal and TMT jts are meant to increase what motion(s)?

pronation

Referred pain in upper trapezius region could be from _____

Diaphragm

Pain in the left axilla and pectoral region may be referred from_____

Heart

Pain at the tip of the shoulder and scapular region may be from

Gallbladder

Three common sites for compression with TOS

Scalene triangle, costoclavicular space, under coracoid process/pectoralis minor m

What disorder is characterize by development of dense adhesions, capsular thickening, capsular restrictions rather than arthritic changes in the cartilage and bone as seen with RA or OA?

Frozen Shoulder (Adhesive Capulitis/ Periarthritis)

Frozen Shoulder has... ______ onset Occurs between___ & ___ years of age Pts with _____ and ____ are at higher risk for developing this

insidious 40 & 65 Thyroid disease, diabetes mellitus

Three phases of GH jt arthritis:

-Acute Phase- Pain and protective muscle guarding -Subacute Phase- capsular tightness w capsular pattern -Chronic Phase- Progressive restriction of the GH jt capsule in capsular pattern; often localized to deltoid region

Four stages of Idiopathic Frozen Shoulder

Stage 1: gradual onset of pain increases w movement, present at night Stage 2 "Freezing Stage": persistent, more intense pain at rest (3-9 months after onset) Stage 3 "Frozen Stage": pain only w movement, 9-15 months after onset Stage 4 "Thawing Stage": minimal pain, significant capsular restrictions from adhesions, 15-24 months after onset

Soft Tissue and Joint Integrity Mobility with Frozen Shoulder

-PROM -Passive jt distraction and glides grade I & II -Pendulums -Gentle Muscle setting

Tension tests designed to put stress on the neurological structures of the upper limb by stretching them are_____

Upper Limb Neurodynamic Tension Tests

Elbow extension stresses the ____ and ____ nerves

radial, median

Elbow flexion stresses the ____ nerve

ulnar

Wrist and finger extension stressed the ____ and ___ nerves

median, ulnar

During ULNTT, if sx are minimal or no signs appear, the head and cervical spine are taking into ______ side flexion

Contralateral (sensitizing test)

When performing SLR, patient complaints of pain primarily in the back indicate ________

disc herniation

Which ULNTT? And which nerve(s)?

ULNT2; median, musculocutaneous, axillary

Which ULNTT? And which nerve(s)?

ULNT 3; Radial

Which ULNTT? And which nerve(s)?

ULNT4; ulnar nerve

SLR (Basic) test involves hip flexion/adduction, knee extension, and ankle DF to test _____ & ____ nerves

Sciatic, tibial

SLR2 test involves hip flexion, knee ext, Ankle DF, foot eversion, and toes extension to test ____ nerve

tibial

SLR3 involves hip flexion, knee extension, ankle DF, foot inversion to test _____ nerve

sural

SLR4 involves hip flexion and medial rotation, knee extension, ankle PF, foot inversion to test _____ nerve

Common peroneal

During the SLR, pt complaints of pain in CL side indicates ______

herniated disc

Length of Maximum protection phase of ACL Rehab

4 weeks

Length of Moderate protection phase of ACL rehab

Weeks 4-10

Length of Minimum Protection phase of ACL rehab

Weeks 11-24

Controlled pain, joint effusion, full knee ROM, good muscle strength, and independent ambulation occurs in what stage of ACL rehab?

Moderate Protection

No pain/swelling, full knee ROM, 75% mm function, symmetrical gait, unrestricted ADLs occur in what stage of ACL rehab?

Minimum Protection

Pain, hemarthrosis, decreased ROM, diminished quad activation, ambulate w crutches occur in what stage of ACL Rehab?

Maximum Protection

PRICE, gait training with crutches WBAT, PROM/AAROM, patellar mobs gd I/II, isometrics are used during what phase of ACL rehab?

Maximum protection

multiple angle isometrics, CC strength & PRE, LE stretching, endurance training, Proprio, stabilization exercises, elastic bands occur during what phase of ACL rehab?

Moderate protection

Advanced PRE, CC exercise, plyo, advance balance/proprio occur in what phase of ACL rehab?

Minimum Protection

Protect healing tissues and reflex inhibition, decrease joint effusion, ROM 0-110 deg, Active control of ROM, 75% WB are goals of what ACL rehab phase?

Maximum Protection

Full pain free ROM, 4/5 MMT, dynamic control of knee, normalized gait are goals of what ACL rehab phase?

Moderate protection

Increase mm strength, endurance, and power, improve NM control, dynamic stability, and balance, Regain CP endurance, transition to maintenance program, regain highest functional level desired, reduce re-injury are goals of what ACL rehab phase?

Minimum protection

Assisted SLRs, ankle pumps, work to full WB, CC squats, heel/toe raises, SLRs in 4 planes, Low load PRE of HS, OC knee extension (90-40deg), trunk/pelvis stabilization, aerobic conditioning are interventions for what ACL rehab phase?

Maximum protection

Proprio training (high speed steps, unstable surface, balance beam), walk/jog program at end of phase are interventions for which ACL rehab phase?

Moderate protection

Progressive agility drills, work/sport specific training, full speed jogging, sprints, running, cutting are interventions for what phase of ACL rehab?

Minimum protection

The hinged orthosis brace is typically used for how long post ACL surgery?

6 weeks

Full, active knee extension and 90-110 deg of flexion ROM is expected ____ to ____ weeks post-op ACL

4 to 6

ACL Precautions: Progress exercise more gradually for reconstruction with ______ graft then _____ graft

hamstring tendon graft; bone-patellar tendon-bone graft

ACL Precautions: Progress Knee flexor strengthening exercises cautiously if ______ tendon graft was harvested

ACL Precautions: Progress Knee extensor strengthening exercises cautiously if ______ tendon graft was harvested

patellar

ACL Precautions: When squatting, avoid knees moving ___ to _____ to avoid increasing shear forces on the tibia

anterior; toes

ACL Precautions: Avoid CC strengthening of quads between __ and ___ degrees of knee flexion

60;90

ACL precautions: During PRE to strengthen hip musculature, initially place resistance _____ knee until knee stability is established

above

ACL precautions: Avoid resisted, OC knee ext between ___ and ___ deg to ____ extension for 6-12 weeks

45;30; full

ACL precautions: Avoid applying resistance to ____ tibia during quad strengthening

distal

Want to achieve ___ deg of flexion and ___ passive ext by the first 2 weeks of ACL rehab

90, full

Want to achieve ___ to ____deg of flexion by the 3-4 weeks of ACL rehab

110-125

Minimal pain/swelling, full active knee ext (no lag), 110 deg flexion, Quad strength 50-60% CL side, no jt laxity are criteria to progress from ____ protection to ____ protection phase of ACL rehab?

Maximum; moderate

No pain/swelling, full active ROM, 75% strength compared to CL side, hamstring/quad ration >65%, functional hop text >70% of CL side, and no instability are criteria to move from ___ protection to ____ protection phase of ACL rehab

Moderate; minimum

Recommended timeline for returning to sports/vigorous activity post ACL reconstruction is ____ to ____ months post-surgery

6;12

Spoon Shaped Nails -fungal infection, anemia, iron deficiency, long-term diabetes, chemical irritants, psoriasis, developmental abnormality

Clubbed Nails -hypertrophy of underlying soft tissue, COPD, emphysema, congenital heart defects, cor pulmonale

Ape hand deformity

Bishop's Hand (Benediction hand deformity) -wasting of hypothenar mm of hand, interossei mm, and medial lumbrical mm d/t ulnar nerve palsy

Boutonniere Deformity -Ext of MCP and DIP jts and flexion of PIP joints -result of rupture of central tendinous slip of extensor hood (common after trauma or w RA)

Claw Fingers -Loss of intrinsic mm action and overaction of extrinsic extensor mm on proximal phalanx -MCP jts hyperexten and PIP/DIP jts are flexed -"Intrinsic Minus Hand" if intrinsic fx is lost

Dinner Fork Deformity -malunion distal radial fx (Colles Fracture)

Drop Wrist Deformity -Wrist ext mm paralyzed d't radial nerve palsy -wrist and fingers can't extend actively

Mallet Finger -rupture or avulsion of extensor tendon insertion on distal phalanx

Polydactyly -presence of more than the normal # of fingers or toes

Swan Neck Deformity -flexion of MCP and DIP jts, ext of PIP joint -contracture of intrinsic mm or tearing of volar plate -RA or trauma

Spyndactyly - congenital - fingers or toes may be united, joined, or webbed

Trigger Finger -thickening of the flexor tendon sheath -sticking of finger when pt tries to flex finger -common in middle aged women -RA -Worse in morning

Stroke, TBI, SCI are examples of ____ Lesions

UMN

Polio, Guillain-Barre, Peripheral n injury, peripheral neuropathy, radiculopathy are examples of ____ Lesions

LMN

A lesion affecting the CNS, cortex, brain stem, corticospinal tracts, and spinal cord are ____ lesions

UMN

Lesions affecting the cranial nn, spinal tools, anterior horn cells, or peripheral nerves are ____ lesions

LMN

hypertonia and velocity dependent tone is associated with ____ lesions

UMN

hypotonia, flaccidity, and non-velocity dependent is associated with ___ lesions

LMN

Hyperreflexia, clonus, positive babinski are associated with ___ Lesions

UMN

hyporeflexia is associated with ____ lesions

LMN

Muscle spasms are associated with ___ lesions

UMN

Fasciculations are associated with ___ lesions

LMN

oral hygiene, showering, dressing, toilet hygiene, feeding, personal device care are examples of ______

ADLs

money management, functional communication, socialization, functional and community mobility, health maintenance are examples of ___

IADLs

bed mobility transfers, walking, stair climbing are examples of _____

Functional mobility skills

When the BOS and COM are moving simultaneously, this is an example of ____

mobility

Maintaining posture in a stable, unchanging position with COM over BOS is ____

Stability

Stability is adjusted and maintained while limbs are moving is an example of____

dynamic postural control

disorder of motor components of speech articulation -scanning speech

Dysarthria

impaired ability to perform rapid alternating movements

Dysdiadochokinesia

Inability to judge the distance or range of movement to reach an object

Dysmetria

Movement performed in a sequence of component parts rather than a single, smooth activity

Dyssynergia -index finger to nose

Loss of ability to associate mm together for complex movements

Asynergia

Ambulatory patterns demonstrating broad BOS, irregular stepping patterns, unsteady, irregular, staggering, veering, swaying

Gait ataxia

Rhythmic, quick, oscillatory, back and forth movement of the eyes

Nystagmus

Involuntary oscillatory movement resulting from alternate contractions of opposing mm groups

tremor

Inability to initiate movement -seen in late stages of PD -freezing episodes

Akinesia

Involuntary, slow, writhing, twisting movements

Athetosis

decreased amplitude and velocity of voluntary movement

Bradykinesia

involuntary, rapid, irregular and jerky movement involving multiple jts -HD

Chorea

Increased mm tone causing greater resistance to passive movement

Rigidity

CN I and function

Olfactory -smell

CN II and function

Optic -vision

CN III and function

Oculomotor -elevate eyelids -up, down, in (eyes) -constricts pupil -accommodates lens

CN IV and function

Trochlear -adduction and downward motion of eye and inward rotation

CN V and function

Trigeminal - Sensation of face, cornea, anterior tongue -mm of mastication -Dampens sound

CN VI and function

Abducens -Turns eye out

CN VII and function

Facial - Ant tongue taste -mm of facial expression -dampens sounds -tearing -salivation

CN VIII and function

Vestibulocochlear - Balance -hearing

CN IX and function

Glossopharyngeal -Post tongue taste -sensation of post tongue and oropharynx - salivation

CN X and function

Vagus - Thoracic and abdominal viscera -mm of larynx and pharynx -Decreases HR -Increase GI Motility

CN XI and function

Spinal Accessory - Head movements (STM & Trap)

CN XII and function

Hypoglossal -Tongues movements and shape

CN I test

odors like lemon oil, coffee, cloves, tobacco

CN II Test

Snellen chart visual acuity

CN III, IV, and VI Test

-Eqaulity and size of pupils, reaction to light -"H" test

CN V test

-Sensory test of face (sharp/dull, light touch) -opening & closing jaw against resistance

CN VII test****

asymmetry of face -smile?

CN VIII test

-tuning fork (webers test) -rub fingers -Rinne test ****

CN IX test

-taste post 1/3 of tongue -gag reflex

CN X test

-Examine swallow -observe uvula for asymmetry

CN XI test

strength of SCM and trap

CN XII test

tongue protruded and moving side to side

Trendelenburg positioning is optimal for facilitating secretion drainage from the ____ lobes of the lungs

lower

sensation of difficult or labored breathing

dyspnea

dyspnea at rest and/or with exertion, wheezing are indications for what breathing technique?

Pursed lip breathing

Hypoxemia, tachypnea, atelectasis, anxiety, excess pulmonary secretions are indications for what breathing technique?

diaphragmatic breathing

HR traditionally increases ___ beats/min per MET level increase in activity

SOB that increases in the recumbent position

Orthopnea -need more pillows

Normal heart sounds are lub (S___) which occurs at the time of closure of the ____& _____ valves and mark the beginning of systole and dub (S___) which occurs at time of ______/______ valve closure and marks end of systole

S1; mitral & tricuspid S2; aortic/pulmonic

Valve best auscultated at 2nd IC space, right sternal border

Aortic

Valve best auscultated at 2nd IC space, left sternal border

Pulmonic

Valve best auscultated at 4th IC space, left sternal border

Tricuspid

Valve best auscultated at 5th IC space, midclavicular line

Mitral

The angina scale goes from ___ (No angina) to ___(most pain ever experienced)

0;4

The dyspnea scale goes from ___ (No dyspnea) to ___ (Severe difficulty, cannot continue)

0;4

Cardiac Rehab is traditionally begun in the ____ setting

acute hospital

What phase of Cardiac rehab focuses on assessing pt's hemodynamic response to activity and increased ind in functional mobility?

Phase 1

MCID for the 6MWT in a patient with Heart failure is ____m

Beta blockers ______ HR and contractility therefore reducing energy demand

decrease

Calcium Channel Blockers ____ BP therefore decreasing work of the heart

Decrease

Nitrates are vaso______ that decrease preload and afterload and ______ coronary arteries; decreasing myocardial work

dilators; dilate

ACE inhibitors and ARBs normalize ___ and reduce workload on the heart

____-sided Heart failure occurs with LV insult, reducing CO, and backup of fluid in lungs= SOB and cough

left

_____-sided heart failure occurs from direct insult to RV d/t increased PA pressure, increased afterload, and high demand on RV , backing blood up in the RA = jugular venous distention, and peripheral edema

Right

____ causes increased peripheral arterial pressure, increased afterload, and pathological hypertrophy of the LV

Hypertension

_____ is a result of acute injury to myocardial tissue, damaged ventricular contractility, systolic dysfunction

CAD

The usual abnormal heart sound associated with CHF is the presence of an S__ heart sound

3 -low frequency -early diastole

Valve ______ involves narrowing of a heart valve limiting the flow of blood through the valve

Stenosis

Valve _______ involves enlarged valve cusps that become floppy and bulge backward, sometimes causing regurgitation

Prolapse

Valve ________ refers to the fwd/bkwd movement of blood resulting from incomplete valve closure

Regurgitation

the movement of air through the conducting airways

ventilation

Amount of air inspired or expired during normal resting ventilation

Tidal volume TV

Quantity of air that can potentially be exhaled beyond the end of a tidal exhalation

ERV Expiratory Reserve Volume

The volume of air remaining in lungs when ERV has been exhaled

RV Residual Volume

_____ = RV + ERV

FRC Functional residual capacity

Volume of air remaining in lungs at end of tidal exhalations

FRC Functional residual capacity

IRV + TV + ERV = _____

VC Vital capacity

All the possible volume of air within lungs that is under volitional control

VC Vital capacity

TV + IRV+ ERV + RV + _____

TLC Total Lung Capacity

Volume of air that can be forcefully exhaled during the first second of a forced vital capacity maneuver

FEV1 Forced expiratory volume in 1 second

In healthy ppl, the FEV1 is ___% or more of the total FVC

70 (FEV1/FVC>70%)

gas exchange within the body

respiration

decreased amount of oxygen in the arterial blood to tissues

hypoxemia

when hypoxemia is worsened it turns into ___

hypercapnea

increased amount of carbon dioxide within the arterial blood

hypercapnea

intermittent bubbling or popping sound that may be present form secretions in the airways

crackles

Partially obstructed bronchi and bronchioles may result in an expiratory _____

wheeze

Rapid, shallow breathing limited chest expansion inspiratory crackles digital clubbing cyanosis are signs of _____ lung disease

restrictive

glide happens in the opposite direction of the roll if the moving surface is _______

convex

Roll and Glides: 1. Shoulder 2. Elbow 3. Prox RU 4. Distal RU 5. Wrist 6. Fingers 7. Hip 8. Knee 9. Ankle

1. oppo 2. Same 3. O 4. S 5. O 6. S 7. O 8. S 9. O

EDAB

PRONATION -eversion, DF, abd *OC

IPAD

Supination (Superior product) -inv, PF, ADD *OC

Gd I Mobs

Baby Small amp beginning of range

Gd II Mobs

Big Large Amp, within range

Gd III Mobs

Big Large amp, to limit of ROM, into tissue resistance

Gd IV Mobs

Baby Small amp, rhythmic oscillation, at end range, in tissue resistance

Gd V Mobs

Thrust Small amp, high velocity to snap adhesions at range limit

Upper Crossed Syndrome inhibited Deep cervical flexors = ______ ________

inhibited lower trap and serratus anterior

Upper Crossed Syndrome Facilitated SCM and Pec = _______ _________

facilitated upper trap & levator scap

facilitated =

tight

inhibited =

weak

Lower Crossed Syndrome Inhibited abdominals = ________ ________

inhibited glute min, med, and max

Lower Crossed Syndrome Facilitated Rec Fem & Iliopsoas = ________ ________

Facilitated thoraco-lumbar extensors

With Trendelenburg gait, the R side is weak if the ___ side drops

During an isometric mm contraction, the mm torque is >/= or < load torque

During a concentric mm contraction, the mm torque is >/= or < load torque

During an eccentric mm contraction, the mm torque is >/= or < load torque

Eccentric mm contractions relationship with gravity

fall towards

Concentric mm contractions relationship with gravity

up away from gravity

A patient who is seen 3 months post R ankle fx has AROM 0-20 deg DF and 0-5 deg PF. To restore motion required for normal PF, which of the following jt mob techniques should the PT perform?

Anterior glide of talus

A PT is testing Active shoulder ROM of a 45 yr old female pt. The PT asks the pt to move the shoulder to full IR. During IR at the shoulder jt (GH jt), the humerus will slide:

Posteriorly

A pt presents to an OP clinic w shoulder pain. He demonstrates limited Active and Passive motion of the shoulder jt, and increased pn with both motions. The best initial intervention is:

gd I/II to relieve pain

A pt presents with limitations in shoulder active and passive ROM that are pain free. The best initial intervention is:

gr III/IV mobs

A pt demonstrated painful ROM in abd during ROM exam of shoulder. Which of the following jt mobilization techniques is MOST appropriate for the patient?

Large amp oscillations within the available ROM in an inf direction

A PT exam reveals PSIS is low on the L and ASIS is high on the L. Interventions should MOST likely include:

Stretching the L hip extensors to correct left posterior rotated innominate

Glute Max is supplied by what nerve: A. R inf gluteal n B. R sup gluteal n C. R femoral n D. R obturator n

The most appropriate treatment for R trendelenburg would be: A. Stand on R leg & abd L leg B. Stand on L leg & ext R leg C. Stand on R leg & flex the R leg D. Stand on L leg & flex the R leg

What exercise is LEAST appropriate for R trendelenburg? A. Side lying SLR of R leg B. Isometric R ABD strengthening in supine position C. Clam shells of the R leg D. Bridging in supine position

A PT evaluating mm function during gait. The 3 hamstring mm contract eccentrically during which phase of gait cycle? A. initial Sw B. terminal sw C. midstance D. Term stance

Pronation PPP means:

Pronation, Prox RU jt, Posterior glide

Which glide will help improve supination at the prox RU jt?

inferior glide

Rule of 6: ____ wks, ___ wks, ___ months

6,12,6

The first 6 weeks post-surgery are the ____ phase

protective; passive, no resistance

The 6-12 weeks of the post-surgical phase are the ______ phase

moderate; some AROM, Weight

The 6th month mark post-surgery means:

back to ADLs

A 39 yr old comes to OP clinic reporting of neck problems. Which of the following exercise combinations is MOST appropriate for a pt who has a fwd head posture? A. Strengthen the deep cervical flexors and stretch the SCMs and upper cervical extensors B. Strengthen the deep cervical flexors and SCMs and stretch the upper cervical extensors C. Strengthen the cervical extensors and stretch the SCMs and deep cervical flexors D. Strengthen the cervical extensors and SCMs and stretch the deep cervical flexors

Screw Home Mechanism TOLL

TOLL Tibia OC Lateral Lock

Screw Home Mechanism CC

Femur moves medially on tibia

Upward Rotation of the Shoulder

"UP"set "T"hor "S"macks "L"oki "U"pper Trap Upper Trap, Serratus ant, Lower Trap = upward rotation

Downward rotators of scapula

Rhomboids, Levator Scap, Pec Minor

Upward rotation of scapula is due to two things: ______________ or ____________________

-Tight upward rotators -Weak downward rotators

When training for daily activities, it will always focus on choosing MOST appropriate interventions. 1st Priority:_________ 2nd priority: _________

-safety -most relevant exercise to task

Achilles Tendon Repair Conventional approach to weight bearing

6 wks immobilization and NWB

Achilles Tendon Repair Early Mobilization approach to weight bearing

Immediately after surgery or after 1-2 wks

Phase 1 of Achilles Tendon Repair ____ wks __ROM of non-immobilizeds jts mm setting exrecise of __, _______, ________, & __ weight shifting activities in __________ stance while wearing orthosis

4 A DF, invertors, evertors, PF BL

The inability of a two jt mm to shorten simultaneously at both jts

Active insufficiency

The inability of a two jt mm to lengthen simultaneously at both jts

Passive insufficiency

-Toeing in -Subtalar pronation -Lat patellarsubluxation -Med tibial torsion -medial femoral torsion are examples of what hip malalignment?

Excessive anteversion

-Toeing out -Subtalar supination -Lat tibial torsion -Lat femoral torsion are examples of what hip malalignment?

Excessive retroversion

-Pronated subtalar jt -medial rotation of leg -short ipsi leg -ant pelvic rotation are examples of what hip malalignment?

Coxa Vara

-Supinated subtalar jt -Lat rotation of leg -Long ipsi leg -Post pelvic rotation are examples of what hip malalignment?

Coxa valga

Forward head posture is due to ______ deep neck flexors or _____ SCM

weak; tight

What are our deep neck flexor muscles?

longus coli and longus capitis

what is the function of the lymphatic system?

immune system, drainage

The portion of the interstitial fluid that then enter the lymphatic system

lymph

Nodes, tonsils, thymus, spleen, thoracic duct, bone marrow are examples of

lymphatic organs

Submaxillary, cervical, axillary, iliac, mesenteric, inguinal, popliteal, cubital, supraclavicular, parasternal are examples of

Major lymph nodes

The thymus is responsible for

T4 cell and lymphocyte production

Flow of Lymph "CV NoTeD"

Capillaries, vessels, nodes, trunks, ducts

Flow of Lymph "RULe"

Right UE Lypmh Duct Face

L side of the body lymphatics are drained into the _______ duct

Thoracic

Amount of lymphatic fluid transported

Lymphatic load

Maximum amount of fluid that lymphatic system can transport

Transport Capacity

If lymphatic load is (>//

lymphedema

4 causes of lymphedema high ____ low______ _______ (low Transport capacity) ____ (increased Lymphatic load)

-Lymphatic load -transport capacity -lymph node removal -venous insufficiency (venous pooling)

a chronic disorder characterized by an abnormal accumulation of lymph fluid in the tissues of one or more body regions

lymphedema

A 76 y/o female presents w/ a dx of secondary lymphedema. The pt states that she had breast cancer last year and had surgery to remove the cancer. All of the following are a cause/form of secondary lymphedema EXCEPT: A. infection B. Milroy's disease C. Fibrosis D. Chronic venous insufficiency

B A. infection (acquired; decreases TC) B. Milroy's disease (congenital- lymph system doesn't function well) C. Fibrosis (acquired- decreased TC due to thickening) D. Chronic venous insufficiency (can happen later on- acquired)

Pressure on the edematous tissues with the fingertips causes an indentation of the skin that persists for several seconds after the pressure is removed indicating short duration edema with little or no fibrotic change sin skin or subcutaneous tissus

Pitting edema

Pressure on the edematous area feels hard with palpation indicates severe form of interstitial swelling with progressive, fibrotic changes in subcutaneous tissues

Brawny Edema

Most severe and long duration form of lymphedema. Fluid leaks from cuts or sores, wound healing is significantly impaired Almost exclusively in LE

Weeping edema

A positive Stemmer Sign is an indication of Stage ___ or ___ lymphedema

II, III

What is a positive Stemmer Sign?

Skin on the dorsal surface of fingers or toes cannot be pinched

Lymph03dema

0-3 are stages of lymphedema

Complete the names of the stages of Lymphedema Stage 0: _______ Stage 1: _______ Stage 2: _______ Stage 3: _______

Latency Reversible Spontaneously Irreversible Lymphostatic Elephantiasis

Name the Stage of Lymphedema: -No clinical edema, reports of heaviness -Negative stemmer sign -Tissue & skin appear normal

Stage 0: latency

Name the Stage of Lymphedema: -Edema present (soft and pitting) -Edema increases w standing and activity but reduces on elevation -Negative stemmer sign

Stage 1: Reversible

Name the Stage of Lymphedema: -Hard swelling present, progresses to non-pitting brawny edema -Positive stemmer sign -Tissue appears fibrosclerotic

Stage 2: Spontaneously Irreversible

Name the Stage of Lymphedema: -Severe brawny nonpitting edema -positive stemmer sign -skin changes (papillomas, deep skinfold, warty protrusions, hyperheratosis, mycotic infections) -bacterial and viral infections

Stage III: Lymphostatic Elephantiasis

A femalr pt is referred to her local clinic w lymphedema. The PT notices she has notable swelling that is hard and fibrotics, has a positive Stemmer sign, and hyperkeratosis of skin. Which of the following stages of lymphedema would the pt be MOST likely in?

Stage III

Scale for Grading of Pitting Edema

1+ 2+ 3+ 4+

Scale for grading of Pitting Edema Explained:

1+: Mild; <1/4 in 2+: Moderate; returns to normal within 15 seconds; 1/4-1/2 in 3+: Severe; 15 to 30 seconds to rebound; 1/2 to 1 inch 4+: Very severe, takes >30 seconds to rebound; >1in

A 45 yr old man w lymphedema of the L leg is being examined by a PT. The PT determines that it is an early-stage II lymphedema and pitting scale grade is 3+. Which of the following statements is MOST likely the clinical presentation? A. The indentation produced is > 1 in B. Indentation on finger pressure lasts for <15 seconds C. The indentation on finger pressure lasts for 20 seconds D. The indentation produced is less than 1/2 in

A PT is examining a 46 yr old patient who underwent a radical mastectomy with axillary node removal. Which of the following signs would indicate INITIAL development of lymphedema in the patient? A. non-pitting edema of lower leg and foot B. Shallow wound beds on the forearm C. Atrophy of the biceps muscle D. Decreased flexibility of the fingers

Bilateral condition affecting the lower extremities that involves accumulation of adipose tissue

Lipidema

Lipedema "2 lips"

We have two lips= lipedema is bilateral

Lipedema affect the ______ areas of the LEl it affects skin ______, ______, and _____

proximal; elasticity, sensitivity, bruising

A 49 y/o pt presents to a clinic with swollen legs. The PT suspects lipedema as a diagnosis. Which of the following is LEAST likely seen as patient's presentation? A. Pt is susceptible to bruising of the affected area B. Pt would have a negative Stemmer Sign C. Pt has a high likelihood of developing cellulitis D. Pt would report pain on pressure

C (this would happen in Lymphedema Stage III)

Girth measurements are circumferential measurements of the involved limb in comparison to uninvolved limb at the landmark and at ___ cm intervals, and are used to measure the _____ limb.

10; proximal

Volumetric measurements measure the ____ limb by immersing the limb in a tank of water to a predetermined anatomical landmark and measure the volume of water _______.

distal; displaced

use of a low level alternating electrical current to measure the resistance to the flow through the extracellular fluid in the UE. The ____ the resistance to flow, the more extracellular fluid is present.

Bioimpedance measurements; higher

__________/_________ is measured during rest and exercise to identify lymphatic insufficiency

Lymphoscintigraphy/Lymphangiography

Doppler US is used to d/d lymphedema and lipidema from _______ __________

venous insufficiency

enlargement of lymph nodes

Lymphadenopathy

inflammatory infection of lymph nodes

lymphadenitis

inflammation or infection of lymph vessels

lymphangitis

A PT is assessing a pt's lymph nodes six months post-chemotherapy treatment. When assessing the lymph nodes, which presentations are LEAST likely to require referral to physician? A. hard and immobile lymph nodes less than 1 cm in diameter B. Rubbery and firm lymph nodes more than 1 cm in diameter C. soft and non tender lymph nodes less than 1 cm in diameter D. Palpable and tender lymph nodes more than 1 cm in diameter

soft, non-tender, non-palpable, moveable up to 1 cm is ________ for palpation of lymph nodes

normal

Tender, hard, immobile, metastatic tumors are _______ for palpation of lymph nodes

Abnormal, report to physician

Form of Complete Decongestive Therapy (CDT) that is done by clearing _____ areas first, then _____ areas. This means you stroke ______ to ______ and towards specific lymph nodes

Proximal; distal Distal; proximal

Phase _ of CDT is called _______ Phase and includes: -Manual lymphatic drainage (MLD) -Multiple layer compression bandaging -Skin and nail care -Exercise

I; Intensive

Phase _ of CDT is called _______ Phase and includes: -Self-MLD by pt -Compression therapy (garment during day; multiple layer bandage at night) -skin and nail care -Exercise

II; Maintenance

During Phase I of Lymphatic drainage, you want to use _________ bandages aka ______ ______ bandages as it has low resting pressure and high working pressure. It should be wrapped from ______ to ____ direction, worn for ____ hrs /day (Works when working out and low when not to let fluid move out)

low-stretch; short stretch Distal; proximal 24

Exercise during CDT should be performed wearing compression garment/bandages, no _____, and from _______ to _____ direction.

HITT, proximal; distal

During Phase II management of lymphedema, ______ bandages should be worn during day and ______ bandages at night

compression; short stretch

Swimming is not recommended for pts with lymphedema. T or F

F Breathing, walking, swimming, biking are all good

Patients should perform self MLD in Phase II as needed. T or F

CE MI PONS MEDU

Cerebrum, Midbrain, Pons, Medulla Oblongota

1. Cerebrum 2. Brain stem 3. midbrain 4. Pons 5. Medulla Oblongota 6. Cerbellum 7. Spinal Cord

1. Frontal lobe 2. Parietal lobe 3. Occipital Lobe 4. Temporal Lobe

Frontal lobe "A CEO"

Apraxia, Aphasia Controls plan Emotional Olfaction

Apraxia

inability to perform skill tasks

Aphasia

speech

Temporal lobe lesion affects:

Hearing, language comprehension, aphasia (Wernicke's)

1. Broca's area 2. Wernicke's area

Frontal Lobe Aphasia "BEAN"

Broca's (broken speech) Expressive Aphasia Non-fluent aphasia

What is treatment for Broca's aphasia?

Yes/no questions

Temporal lobe aphasia:

Wernicke's Aphasia (trouble understanding what you hear "receptive aphasia") Word Salad

Treatment for Wernicke's Aphasia

Gestures and demonstration

A PT is assessing a 65 y/o pt and asks the pt how he is doing. The pt's response is, "I am frontiwarrior". Which of the following is the MOST appropriate diagnosis of this finding? A. Wernicke's B. Broca's C. Non-fluent Aphasia D. Lesion to CN VII

Parietal lobe lesions

-Perceptual disorders -sensory loss (unilateral neglect)

Occipital lobe lesions "O-SEE-pital"

-visual loss -inability to identify previously known objects

see something but don't know what it is

visual agnosia

difficulty naming people by vision

Prosopagnosia

1. Oh 2. Oh 3. Oh 4. To 5. Touch 6. And 7. Feel 8. A 9. Girl's 10. Vagina 11. Ah, 12. Heaven

1. Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Vestibulochlear 9. Glossopharyngeal 10. Vagus 11. Accessory 12. Hypoglossal

1. Some 2. Say 3. Money 4. Matters 5. But 6. My 7. Brother 8. Says 9. Big 10. Brains 11. Matter 12. More

1. sensory 2. sensory 3. motor 4. motor 5. both 6. motor 7. both 8. sensory 9. both 10. brains 11. motor 12. motor

What cranial nn are located on the cerebrum?

1 & 2

What cranial nn are located on the Midbrain?

3 & 4

What cranial nn are located on the PONS?

5,6,7,8

What cranial nn are located on the Medulla?

9, 10, 11, 12

A. Trochlear B. Optic C. Vestibulocochlear D. Facial E. Olfactory F. Vagus G. Oculomotor H. Trigeminal I. Hypoglossal J. Glossopharyngeal K. Accessory L. Abducens

loss of smell

anosmia

visual clarity

Visual acuity

Presbyopia

far sighted

Myopia

Near sighted

What cranial nn involves vision color, acuity, peripheral vision, and the pupillary light reflex?

CN II, optic

Which CN causes blindness, myopia, presbyopia when affected?

CN II, optic

Pupillary Light Reflex "SAME"

Pupillary Light Reflex has Sensory (Afferent) And Motor (Efferent) Branches

Describe what this response to PLR means:

Normal response L CN2, L CN3, R CN3 intact

Describe what this response to PLR means:

R CN 3 effected, L CN 2 intact, L CN 3 intact

Describe what this response to PLR means:

L CN 3 effected R CN 2 intact R CN 3 intact

Describe what this response to PLR means:

L CN 2 effected

A therapist is assessing the CN integrity. On shining light in the pt's R eye none of the pupils constrict, however on shining the light in the pt's L eye, both pupils constrict. Which of the following is MOST appropriate about this finding? A. L optic nerve is affected B. R oculomotor n is affected C. R optic n is affected D. L oculomotor n is affected

What cranial nerve moves the eyeballs (up, down, in, up & in), opens eyelids, and constricts pupils?

CN III, oculomotor

When affected, what CN causes strabismus, ptosis, and dilation of pupils?

CN III, oculomotor

abnormal position of eyeball (usually laterally)

strabismus

drooping of eylids

ptosis

Which CN moves the eyeball down and in?

CN IV, trochlear

Which CN moves eyeball out?

CN VI, abducens

Weber Test "CANS"

Conductive= louder in Affected ear Sensorineural= louder on Normal ear Tells what side is affected

Which test places the base of the tuning fork on the bridge of the forehead, nose, or teeth?

Weber test

Which test places the tuning fork behind the Pinne and moves fork beside the ear and asks if it's now audible?

Rinne test "Rinne behind the Pinne" For conductive vs sensorineural hearing loss

Which hearing loss is caused when Air Conduction>Bone Conduction?

Sensorineural/normal

Which hearing loss is caused when Bone Conduction > Air Conduction?

Conductive hearing loss

A patient reports experiencing sudden onset of mild hearing loss on the L side. Rinne test was consistent with bone conduction > air conduction on both sides. Weber's test finding show sound was louder in the L ear. Which of the following is MOST appropriate? A. R side sensorineural hearing loss B. L side conduction hearing loss C. R side conduction hearing loss D. L side sensorineural hearing loss

The restaurant opens @ 3 and closes @ 7 means:

CN 3 opens eyelids and CN 7 closes eylelids

which CN provides sensation to face and anterior tongue?

CN 5, trigeminal

Which CN includes the mm of the face and taste to anterior tongue?

CN 7; facial

TriCHEWminal means:

Trigeminal n (CN 5) includes mm of mastication for chewing

Which CN has the afferent response of corneal reflex?

CN 5, trigeminal SAME

Which CN has efferent response of corneal Reflex?

CN 7, facial SAME

S-5 T-7 means...

Sensory, CN 5 supplies ant 2/3 of tongue CN 7 supplies ant 2/3 tongue taste

P/9 means....

CN 9 supplies sensation and test to Posterior 1/3 of tongue

Lick your lesion means:

for CN XII hypoglossal, your tongue stays on the side of the lesion

Which CN has the afferent response to the gag reflex?

CN IX, Glossopharyngeal SAME

Which CN has the efferent response to the gag reflex?

CN X, vagus SAME

When PT asks the pt to say "Ahhh", the PT finds the patient's uvula deviated to the L. Which CN is MOST likely affected? A. L vagus n B. R vagus n C. L hypoglossal n D. R glossopharyngeal n

Which lobe of the brain involves touch perception, body orientation and sensory discrimination?

Parietal Lobe

Which part of the brain involves involuntary responses?

Brainstem

Which lobe of the brain involves auditory processing, language comprehension, memory, and information retrieval?

Temporal lobe

Which lobe of the brain involves motor control, problem solving, and speech production?

frontal lobe

Which lobe of the brain involves sight, and visual reception, and visual interpretation?

Occipital lobe

What part of the brain involves balance and coordination?

cerebellum

Name the CN: Identify familiar odors w eyes closed

CN 1; olfactory

Name the CN: Test visual fields

CN 2, Optic n

Name the CN: Upward, downward, and medial gaze

CN 3, oculomotor

Name the CN: Downward and in gaze

CN 4; trochlear

Name the CN: Sensation of face, mm of mastication, corneal reflex, jaw reflex

CN 5, trigeminal

Name the CN: Lateral gaze

CN 6, abducens

Name the CN: MM of facial expression, ant 2/3 tongue taste, identify familiar tastes, close eyes tight, smile with teeth, puff cheeks

CN 7, facial

Name the CN: hearing tests, balance and coordination tests, finger to nose

CN 8; vestibulocochlear

Name the CN: Taste to posterior 1/3 tongue, ability to swallow, gag reflex (afferent)

CN IX, glossopharyngeal

Name the CN: Gag reflex (efferent), say "Ahh", rise of uvula when stroked

CN X, vagus

Name the CN: Resisted shoulder shrug

CN XI, accessory

Name the CN: Tongue protrusion, if injured, will deviate toward lesion

CN XII, hypoglossal

MCID for 6MWT is ___ to ____ m.

25-35

Use ____ as a means of prescribing exercise intensity for patients with cardiovascular and pulmonary diseases.

RPE

Positioning a patient so that the bronchus of the involved lung segment is perpendicular to the ground is the basis for _______

Postural drainage

A force rhythmically applied with the therapist's cupped hands to the patient's chest wall is _____

Percussion

Rate Product Pressure = _____ x _____

HR, SBP

Auscultation of heart sounds Mnemonic

APT M 2245

CO= _____ x _____

HR, SV

how many times the heart is beating

How much blood is sent out during each heart beat

T or F: SBP should increase during exercise.

T or F: DBP should increase with exercise.

T or F: HR, CO & SBP can increase with exercise.

DBP should remain fairly constant throughout exercise but may increase/decrease ~____ mmHg.

Myocardial O2 demand= _______

Rate Pressure Product

A PT is performing an exercise stress test on a patient whose resting RR= 24, BP 133/88. Which of the following is an ABNORMAL response to aerobic exercise? A. DBP dec to 86mmHG B. DBP increase to 95 mmHG C. RR inc to 34 bpm D. SBP dec to 100 mmHG

Which of the following categories MOST appropriately describes the type of HTN with BP 133/88? A. Normal B. Elevated C. Pre-HTN D. Stage 1

D SBP 130-199 DBP 80-89

Name the BP category: Less than 120/80 mmHG

Normal

Name the BP category: SBP btwn 120-129 and DBP <80

Elevated

Name the BP category: SBP btwn 130-139 DBP between 80-89

Stage 1 HTN

Name the BP category: SBP at least 140 or DBP at least 90 mmHG

Stage 2 HTN

Name the BP category: Systolic >180 Diastolic >120

HTN crisis

Fight & Flight = ______ Nervous System = _______ HR

Sympathetic; increases Hot Tea SNS= gets excited about tea = needs to beat faster = gets message and heart beats faster

Rest & Digest = ______ Nervous System = ________ HR

Parasympathetic; decreases Cold Tea PNS = wants to slow HR = gets message and decreases HR

A 32 y/o healthy male is working out on a stationary bike in an OP PT clinic. After the first four minutes of constant-load, submaximal exercise, VO2 reaches steady state, indicating that: A. Levels of lactic acid in the blood has reached steady state B. The ATP demand is being met aerobically C. The exercise should be discounted immediately D. The respiratory rate is insufficient to meet the ATP demand

Because of _____ amounts of O2 at high altitudes, athletes bodies work to produce ____ RBCs when they train high above sea level

lower, more

30 y/o male client visits a town which is 9,000 feet above sea level. What are the INITIAL cardiovascular responses during the first week in town? A. Increased BP, increased CO w Tachycardia and no significant changes in SV B. Dec BP, dec CO with bradycardia and inc SV C. Inc BP, dec CO w bradycardia and inc SV D. Dec BP, Inc CO w tachycardia and inc SV

Lack of O2

Hypoxia

For CO to stay at a normal level if the HR increases, the SV must _______.

Decrease

With altitude changes, the ____ responds first and the ___ takes longer to react.

HR, SV

Once back on land after high altitude, HR & BP stabilize, ___ & ___ increase since the body is getting used to performing well @ reduced O2 levels; body now happy w high )2 levels on land

CO, SV

Cardiovascular effects of Aquatic Therapy: HR:___ BP:___ SV:___ CO:___

dec dec inc inc

Respiratory effects of Aquatic Therapy: Vital capacity:________ Work of breathing:________

dec inc

vital capacity

ability to take big breaths

MSK effects of Aquatic Therapy: Weight bearing:_________ Edema:__________

dec dec

Beta-blockers _______ HR and contractility and lower myocardial oxygen demand

reduce

Beta-blockers prescribed for ppl w/ ________ and _______

CAD; HTN

SHVEM 13= 15= 17= 19= 20= 11= 9= 7.5= 6=

RPE SCALE: 13= somewhat hard 15= hard 17= very hard 19= extremely hard 20= maximal exertion 11= light 9= very light 7.5= extremely light 6= no exertion

Frank-Starling Rule

if ventricle is stretched, has more chance of strong contraction

Aortic auscultation landmarks

2nd IC space, R sternal border

Pulmonic auscultation landmarks

2nd IC space, L sternal border

Tricuspid auscultation landmarks

4th IC space, L sternal border

Mitral auscultation landmarks

5th IC space, midclavicular line

onset of systole is what heart sound?

S1 "lub"

onset of diastole is what heart sound?

S2 "dub"

ventricular filling associated w heart failure is what heart sound?

S3 "ventricular gallop"

ventricular filling and atrial contraction is what heart sound?

S4 "atrial gallop"

closure of mitral & tricuspid valves is what heart sound?

S1 "lub"

closure of aortic & pulmonary valves is what heart sound?

S2 "dub"

What heart sound is the loudest @ base of heart?

What heart sound is the loudest @ apex of heart?

What heart sound is the loudest @ Erb's point (between Pulmonic and Tricuspid areas)?

S1 & S2 equal

what heart sound indicates early diastole?

what heart sound indicates late diastole?

A PT is using aquatic therapy to treat a 29 y/o pt who has a recent ACL repair. The pt is immersed to the level of sternoclavicular notch. Which of the following is the MOST expected physiological response of aquatic therapy? A. Dec CO B. Dec SBP C. Inc HR D. In VO2 max

The 54 y/o male pt's chart states that he has been taking beta-blockers for the past 5 years. Prior to starting an exercise training program, the pt should receive an explanation of the: A. greater benefits from CV exercise to be achieved at lower SBP rather than at higher SBP levels B. Need to use measures other than HR to determine intensity of exercise C. Greater benefits from CV exercise to be achieved at lower HR than at higher HR levels D. Need for longer warm-up periods and cool-down periods during exercise sessions

A 45 y/o male with a BMI of 38 kg/m2 is enrolled in a 6-wk fitness training program. Which is the MOST appropriate measure to assess change in fitness from pre and post fitness training? A. The time it takes for the HR to return to baseline B. Resting respiration rate at pre-training C. Rating on a Wong Bake Scale D. Inc in BP during exercise

A 48 y/o male pt reports of SOB and fatigue. Which valve is being auscultated in the picture? A. Tricuspid valve B. Pulmonary valve C. Mitral valve D. Aortic valve

A PT is performing cardiac auscultation. The therapist hears a "dub" sound. Which of the following is associated with this heart sound? A. Closing of bicuspid and tricuspid valves B. Opening of aortic pulmonary valves C. Closing of aortic and pulmonary valves D. Abnormal heart sound

ASIA A

Complete: no sensory or motor below S4-S5

ASIA B

Sensory incomplete: sensory but no motor preserved below level and S4-S5 -no motor 3 levels below motor level

ASIA C

Motor Incomplete: Some motor spared more than 3 levels below motor level

ASIA D

Motor Incomplete: 1/2 or more mm below lesion are grade 3+

ASIA E

Normal

Neurological level of injury

the most caudal level of the spinal cord with normal motor and sensory function on L & R sides of the body

Motor level

lowest myotome with a key mm that has a grade of at least 3; mm above are 5

Sensory level

most caudal level with normal light touch and pinprick sensation

Sensation scoring: 0=_____ 1=_____ 2=_____

absent impaired normal

ISNCSCI mucles: C5= C6= C7= C8= T1= L2= L3= L4= L5= S1=

C5= elbow flexors C6= wrist extensors C7= elbow extensors C8= finger flexors T1= finger abductors L2= Hip flexors L3= Knee extensors L4= Ankle dorsiflexors L5= Long toe extensors S1= Ankle PF

Cord syndrome that is typically caused by gunshot or stab wounds

Brown Sequard Syndrome

Cord syndrome with hemisection of the spinal cord

Brown Sequard Syndrome

Brown Sequard Syndrome has ________ loss of proprio, light touch, and vibration due to damage to the _____ and paralysis caused by damage to the _____.

ipsi DCML Lateral CST

Brown Sequard Syndrome has _________ loss of sense of pain and temperature due to damage to the ____

Contralateral STT

Anterior cord syndrome has loss of motor function due to _____ damage and loss of sense of pain and temperature due to ____ damage below the level of lesion

CST STT

What is normally preserved with Anterior Cord Syndrome?

proprio light touch vibration

Which SCI syndrome often requires a longer length of stay during inpatient rehab?

Anterior cord syndrome

What is the most common SCI syndrome?

central cord syndrome

What SCI syndrome is caused by hyperextension injuries to the cervical region?

central cord syndrome

Central cord syndrome typically has characteristics of ______ severe neurological involvement of UE than the LE

Which SCI syndrome has ability to recover to ambulation?

Central cord syndrome

Individuals with _______ injuries exhibit areflexic bowel and bladder and saddle anesthesia,

Cauda equina

Cauda equina lesions are ______ nerve injuries

LMN

________ occurs when the very distal portion of the spinal cord is damages (typically UMN & LMN damage)

conus medullaris syndrome

Autonomic dysreflexia occurs in levels ____ T6

above

AD produces acute onset of autonomic activity from noxious stimuli ____ level of lesion; sending a stimuli to the lower spinal cord and initiating a mass response resulting in elevated BP

below

Symptoms of AD: 1. 2. 3. 4. 5. 6. 7. 8. 9.

1. HTN 2. bradycardia 3. headache 4. sweating 5. spasticity 6. restlessness 7. vasoconstriction below lesion 8. vasodilation above lesion 9. constricted pupils 10. nasal congestion 11. piloerection 12. blurred vision

A rise in SBP of ___-____ mmHg is diagnostic of an AD episode

20-30

If someone has sx of AD and is laying down, they should be ______, loosen clothing and restrictive devices

Seated (to lower BP)

velocity dependent increase in resistance to passive stretch

spasticity

Baclofen, tizanidine, diazepam, and dantrolene sodium are used to treat ____

spasticity

Orthostatic HTN is usually only significant in ppl w SCI above __

Inspiratory Reserve Volume (IRV)

Total amount you can breathe in (5-6x TV) (additional are that can be forcibly inhaled after the inspiration of a normal tidal volume)

Expiratory Reserve Volume (ERV)

max air out (2-3x TV) (additional air that can be forcibly exhaled out after the expiration of a normal tidal volume)

Residual Volume (RV)

air remaining in lungs that after expiratory reserve volume is exhaled

Normal Residual Volume

1200 mL

Tidal Volume (TV)

air inspired during normal, relaxed breathing

Normal ERV

1200 mL

Normal Tidal Volume

500 mL

Normal IRV

3100 mL

Maximum amount of air that can fill the lungs

Total lung capacity (TLC)

TLC =

TLC= TV +IRV + ERV + RV

Total amount of are that can be expired after fully inhaling

Vital Capacity (VC)

Normal total lung capacity

6000 mL

Normal vital capacity

4800 mL

Vital Capacity (VC) =

VC = TV + IRV + ERV =~80%TLC

Maximum amount of air that can be inspired

Inspiratory Capacity (IC)

Normal inspiratory capacity

3600 mL

Inspiratory Capacity (IC) =

IC = TV + IRV

Amount of air remaining in lungs after normal expiration

Functional residual capacity (FRC)

Normal FRC

2400 mL

FRC=

FRC = RV + ERV

A therapist is performing spirometry to assess the lung function of pt with a dx of restrictive pulmonary disease. After a normal exhalation, the therapist asks the patient to exhale the maximal amount of air that he can. Which of the following parameters is being assessed? A. IC B. ERV C. TLC D. TV

when the lungs are a problem, it's a _______ disease

obstructive

When posture or external things cause breathing issues, it's a _______ disease.

Restrictive

In obstructive disease: IC is N/? ERV is N/? VC is N/? FVC is N/?

IC= N or < ERV= N or < VC= N or < FVC= N or <

In COPD: RV is N/? FRC is N/? TLC is N/?

RV= N or < FRC= N or < TLC= N or <

A pt diagnosed with idiopathic pulmonary fibrosis has been participating in PT in the hospital to prepare for discharge. Which of the following is MOST likely to be seen on a pulmonary function test? A. Inc tidal volume B. Dec inspiratory reserve volume C. Inc Residual volume D. Inc functional residual capacity

CBABE

Obstructive conditions Chronic Bronchitis, Bronchial asthma, bronchiectasis, cystic fibrosis, emphysema

PAINT

Restrictive lung disease into pleural, alveolar, interstitial, neuromuscular, and thoracic cage abnormalities

COPD Severity Classification Stage I= ____ Stage 2=____ Stage 3=____ Stage 4 =____

Stage I= mild >80 FEV1 Stage 2= mod 50-80 FEV1 Stage 3= severe 30-50 FEV1 Stage 4 = very severe <30 FEV1

For a person with COPD, Which of these pulmonary tests will MOST likely be decreased when compared with those of a healthy individual? A. Total lung capacity B. FEV1/FVC ratio C. Residual Volume D. Functional Residual Capacity

During the exam of a person with COPD, PT finds that a patient has a weak wet cough. Which of the following is MOST appropriate to help this patient clear secretions? A. Assisted coughing in the supine position B. Postural drainage in the side lying position C. Huffing D. Mechanical percussion

Vesicular breath sounds ________ breaths are longer than ______ breaths. They have _____ intensity and ____ pitch over ____ lungs

inspiratory; expiratory; soft; low; most

Broncho-vesicular breath sounds: inspiratory breaths are /= expiratory breaths. They have ______ intensity and ______ pitch. They can be heard between ____ & ___ interspace _____eriorly and between ______

=; intermediate; intermediate; 1st & 2nd; anteriorly, scapulae

Bronchial breath sounds: ______ sounds are longer than _______ sounds. They have ___ intensity and ____ pitch. They can be heard over _____.

expiratory; inspiratory; loud; high; manubrium

Tracheal breath sounds: inspiratory breaths are /= expiratory breaths. They have ____ intensity and _____ pitch. They can be head over ____.

=; very loud, relatively high, trachea

Breath sounds further down to the lungs sound _____ and closer to the trachea sound _____.

lower, loudest

A PT is auscultating a 41 y/o male pt in an OP clinic. The PT hears a low pitch, soft sound all over the thorax. Which of the following sounds is the PT auscultating? A. Vesicular sounds B. Bronchial Sounds C. Broncho-vesicular sounds D. Tracheal sounds

Rhonchi are continuous ____-pitched rattling lung sounds that often resemble ______

low; snoring Seen in: COPD, bronchiectasis, pneumonia, chronic bronchitis, CF

Wheezes are ____-pitched sounds heard in (inspiration/expiration) caused by airway (obstruction/restriction)

high; expiration; obstruction Seen in: COPD, asthma

Crackles are brief, discontinuous, popping lung sounds that are ____-pitched and can be heard in ______ phases of respiration.

high; both

Pleural rub is auscultation in the ______ lateral chest areas in _________ and ________.

lower; inspiration; expiration Seen with: pleural inflammation

A 76 year old pt has been tansferred to an acute care unit with sx of CHF> During auscultation, the PT hears an S3 heart sound. Which of the following high-pitched breath sounds is MOST likely associated w the dx of CHF? A. Rhonchi B. Wheeze C. Crackles D. Pleural rub

Abnormal Voice Sounds: Denver Broncos won super bowl in 99

Bronchophony= increased vocal resonance w greater clarity and loudness of spoken words Ex.) "99"

Abnormal voice sounds: EA Sports

Egophony = form of bronchophony in which the spoken long "E" changes to a long, nasal sounding "A"

Abnormal voice sounds: Whisper b/c birds are PECKing @ food

Whispered pectoriloquy= increased loudness of whispering

A PT assessed a pt's vocal sounds as part of a respiratory exam. The PT positions the stethoscope over the thorax and asks the pt to say "E". Which type of voice sounds is assessed using this technique? A. Bronchophony B. Egophony C. Pectoriloquy D. Rhonchi

Normal pH levels

7.35-7.45

pH levels <7.35=_____

acidic

pH levels >7.45=____

alkaline

Normal PaCO2 levels

35-45 mmHg

PaCO2 levels >45= ____

acidic

PaCO2 levels <35=____

alkaline

Normal HCO3 levels=____

22-26 mEq/L

HCO3 levels <22=____

acidic

HCO3 levels >26=____

alkaline

For Uncompensated Respiratory Acidosis: Decide /= pH:___ PaCO2: __ HCO3:___

< > =

For Uncompensated Respiratory Alkalosis: Decide /= pH:___ PaCO2: __ HCO3:___

> < =

For Uncompensated Metabolic Acidosis: Decide /= pH:___ PaCO2: __ HCO3:___

< = <

For Uncompensated Metabolic Alkalosis: Decide /= pH:___ PaCO2: __ HCO3:___

> = >

The PT is reviewing the lab reports of a pt admitted in an ICU. HCO3= 14 mEq/L PaCO2= 40 mmHG pH= 7.20 The BEST dx for this pt would be: A. Uncompensated metabolic acidosis B. Uncompensated respiratory alkalosis C. Uncompensated respiratory acidosis D. Uncompensated metabolic alkalosis

A PT who is a chronic smoker is diagnosed w COPD and undergoes ABG analysis. The PT is MOST likely to see which of the following changes in the ABG report? A. dec PaCO2, inc PaO2, dec pH B. Dec PaCO2, dec PaO2, inc pH C. Inc PaCO2, inc PaO2, Inc pH D. Inc PaCO2, dec PaO2, dec pH

CO2 normally causes (respiratory/metabolic) problems

respiratory acidic

HCO3 normally causes (respiratory/metabolic) problems

metabolic alkaline

if pH is neutral, it is (compensated/uncompensated)

compensated

if PaCO2 is normal, the answer is (metabolic/compensated/respiratory)

metabolic

if HCO3 is normal the answer is, (metabolic/compensated/respiratory)

respiratory