Readings (Days 21-40) and Lectures 6-11 Flashcards by Danielle Hood

Abnormal immune mediated response attacks the meylin nerve coating (oligodendrocytes) and the nerve fibers in the CNS

Multiple Sclerosis

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Form of MS in which Relapses and remissions do not occur

Primary-Progressive MS

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Most common form of MS

Relapshing-remitting

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Form of MS that begins with relapsing-remitting course followed by progression to steady and irreversible worsening of neurologic function

Secondary-Progressive MS

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Form of MS that is characterized by a nearly continuous worsening of the disease from the onset without distinct attacks

Primary-Progressive MS

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Common sx of MS

paresthesias, minor visual disturbances, weakness, fatigue, sharp, shooting pain, spasticity

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slurred or poorly articulated speech with low volume, unnatural emphasis, and slow rate

Dysarthria

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Changes in vocal quality including harshness, hoarseness, breathiness, or hypernasal sounds.

Dysphonia

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Three bladder dysfunctions with MS

-small, spastic bladder (failure to store)
-flaccid, big bladder (failure to empty)
-dyssynergic bladder (coordination difficulty btwn bladder contraction and sphincter relaxation)

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What test is used to diagnose MS?

MRI

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Chronic condition characterized by widespread pain that affects multiple body regions and the axial skeleton and has lasted for >3 months.

Fibromyalgia

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FM or MPS?

-Tender points at specific cites
-No referred pain patterns
-No tight band of mm
-Fatigue and waking unrefreshed

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FM or MPS?
-Trigger points in mm
-referred patterns of pain
-tight band of muscle
-no related fatigue complaints

MPS

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What chronic condition typically has its first sx occur in early to middle adulthood and develops after physical trauma such as a MVA or viral infection?

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chronic, regional pain syndrome

Myofascial pain syndrome (MPS)

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Lie in parallel with muscle fibers and monitor changes in mm length and velocity

muscle spindles

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Receptors located at proximal and distal tendinous insertions of mm and monitor tension within mm. They also provide protective mechanism by preventing structural damage to mm in extreme tension situations

golgi tendon organs

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receptors within fascia of mm that respond to pain and pressure

free nerve endings

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receptors within fascia of mm which respond to vibratory stimuli and deep pressure

pacinian corpuscles

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Which pathway is concerned with non-discriminative sensations such as pain, temperature, tickle, itch, and sexual sensations?

Spinothalamic Tracts

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Pathway responsible for transmitting discriminative touch, stereognosis, tactile pressure, barognosis, graphesthesia, recognition of texture, two-pt discrimination, kinesthesia, proprio, and vibration

DCML

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pain produced by a non-noxious stimuli

Allodynia

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complete loss of pain sensitivity

Analgesia

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increased sensitivity to pain

hyperalgesia

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cramping, dull, aching usually describes pain of what structure?

muscle

Sharp, shooting pain usually describes pain of what structure?

nerve root

Sharp, bright, lightning-like usually describes pain of what structure?

Nerve

Burning, pressure-like, stinging, aching usually describes pain of what structure?

Sympathetic nerve

Deep, nagging, dull pain usually describes pain of what structure?

bone

Sharp, severe, intolerable pain usually describes pain of what structure?

fracture

Throbbing, diffuse pain usually describes pain of what structure?

Vasculature

A PT observes gait of a 34 y/o male pt. The PT suspects a leg length discrepancy. Which of the following gait deviations is MOST likely seen by the therapist? A. Inc DF of short limb during swing and inc PF of long limb during stance B. Dec knee flexion and inc DF of long limb during stance and inc DF of short limb during swing C. Inc DF with early heel rise of long limb at heel off and inc PF of short limb during stance D. Inc PF of long limb at heel strike and dec knee flexion of short limb during heel off

manner or style of walking

gait

Beginning of a walking event b y one limb and continuing until the event is repeated with the same limb Heel strike to next ipsi heel strike

Gait cycle

One complete gait cycle

Stride

Beginning of an event by one limb until the beginning of the same event with the CL limb

Step 2 steps= 1 stride = 1 gait cycle

Following surgery of the R hip, a patient ambulates as shown. As part of the intervention, the PT opts to include FES to help improve the gait pattern. Stimulation should be initiated for: A. R ABD during swing on R B. R ABD during stance on R C. L ABD during stance on L D. L ABD during swing on L

A PT decides to use FES to improve ambulation of a pt w/ weak tibialis anterior muscle. Stimulation for the weak muscle should be initiated in which PHASE of the gait cycle? A. Mid stance to terminal stance B. initial contact to mid stance C. Loading response to mid stance D. Initial swing to mid swing

In stance, we use FES to __________

strengthen

In swing we use FES to _____

clear ground

While evaluating the gait cycle of a 27 y/o female pt, the PT observes R pelvic hike during the swing phase of the R gait cycle. Which of the following conditions is LEAST likely to cause the problem? A. reduced R hip flexion B. Inadequate R knee flexion C. Lack of R ankle DF D. R ankle PF weakness

ROM at hip needed for normal gait: -Stance phase: __-___ deg hip flexion & __-___-___ deg hyperextension -Swing phase: __-___ deg flexion

0-30, 0-10-20 20-30

ROM at knee needed for normal gait -Stance: ___-___ flexion -Swing: ___-___ flexion

0-40 0-60

ROM at ankle needed for normal gait: -Stance: __-___ deg DF & ___-___ deg PF -Swing: __-___ deg PF

0-10, 0-20 0-10

The PT is treating a 43 y/o male 3 wks post TKA. ON evaluating pt's ROM, the PT finds the pt has 45 deg of hip flexion, 40 deg of knee flexion, 20 deg of PF, and 15 deg of DF. In which phase of gait will the pt MOST LIKELY compensate based on their range of motion values? A. ISw B. TSw C. PSw D. MSt

A PT examines the gait of a 62 y/o pt. The pt exhibits R early heel off during stance phase of gait as shown. Which of the following impairments is MOST likely associated with this finding? A. Shortening of HS B. Shortening of gastroc C. Weakness of tibialis anterior D. Weakness of iliopsoas

What is the special test being performed in the image and what does it indicate? A. Thomas Test indicating L hip flexor tightness B. Ely's test indicating L rectus femoris tightness C. Thomas test indicating L hip extensor tightness D. Ely's test indicating L hamstring tightness

In the Thomas Test, if knee extension is a result = tight _____

quads

In the thomas test, if flexed hip and increased lumbar lordosis, what is tight?

psoas

In the thomas test, if flexion, abduction, and IR what is tight?

IT band/TFL

In the thomas test, if lateral rotation of the tibia, what is tight?

biceps femoris

In the thomas test, if hip flexion, hip abduction, and ER, what is tight?

Sartorius

Which sub phase of the gait cycle will MOST likely show limitation in the hip ROM? A. LR B. IC C. MSt D. TSt

FLOP

if FLexors are involved, the OPposite side gets step length discrepancy

In a pt who has L hip flexor tightness, what gait abnormality is MOST likely to be demonstrated? A. shorter step length w L LE B. Shorter step length w R LE C. Backward lean during stance phase on L LE D. Lateral lean during swing phase on R LE

A 74 y/o contractor has a prominent forward lean when they are in stance phase on the R LE. From this observation, the PT would hypothesize that the MOST LIKELY cause is: A. Weak glute max on L B. Weak glute med on L C. Weak quads on R D. Weak HS on R

Trunk leans are usually due to _____ muscles

weak

Increased resistance to passive motion regardless of movement velocity

rigidity

What type of rigidity is a jerky, ratchet-like resistance to passive movement as mm alternately tense and relax?

Cogwheel

What type of rigidity is a sustained resistance to passive movement in all directions with no fluctuations?

lead pipe rigidity

Rigidity is often (symmetrical/asymmetrical)?

asymmetrical especially in early stages of PD prox affected first

involuntary shaking or oscillating movement of a part or parts of the body resulting from contractions of opposing muscles

tremor

Tremor present at rest and surpressed briefly by voluntary movement and disappears w sleep is what kind of tremor?

Resting tremor

unintentional rapid short steps is defined as

festinating gait

trembling of legs and transient inability to effectively step, or absence of leg movement/akinesia is defined as

Freezing of gait

excessive sweating

hperhidrosis

Patients with PD young onset age or tremor predominant have a ______ progression

slower

Pts w PD who present with postural instability and gait disturbances tend to have a _____ progression

rapid

Hoehn and Yahr Classification of Disability Scale is used to diagnose what disease?

What is the gold standard for measuring progression of PD?

Unified Parkinson's Disease Rating Scale (UPDRS)

Hoehn and Yahr stages: I: II: III: IV: V:

I: minimal or absent; unilateral II: minimal bilateral, midline involved, balance ok III: impaired righting reflexes, live independently IV: all sx present and severe, stand/walk w assist only V: confined to be or wheelchair

Gold standard drug therapy for PD

Carbidopa/Levodopa (sinemet)

F.A.S.T

Face drooping Arm weakness Speech difficulty Time to call 911

Temporary interruption of blood supply to the brain

Transient Ischemic Attack TIA

TIA is a precursor to susceptibility for ____ infarction and _____infarction

cerebral myocardial

1. Anterior Communicating Artery 2. Posterior communicating artery 3. Middle cerebral artery 4. Superior cerebellar artery 5. Anterior inferior cerebellar artery 6. Posterior inferior cerebellar artery 7. Vertebral Artery 8. Basilar Artery 9. Posterior cerebral artery 10. Posterior communicating artery 11. Anterior cerebral artery

Scores of 13-15 on GCS are classified as:

mild

1. Corpus Callosum 2. Primary motor cortex 3. Primary somatic sensory cortex 4. Primary visual cortex 5. Posterior cerebral artery 6. Anterior cerebral artery

the GCS looks at what 3 activities?

Eye opening Best Motor response Verbal response

1. Tips of anterior cerebral artery 2. Tips of posterior cerebral artery 3. Wernicke's area 4. Broca's area 5. Middle cerebral artery

strokes caused by small vessel disease deep in the cerebral white matter

lacunar stroke

Score of 8 or < on GCS are classified as:

Severe

Score of 9-12 on GCS is classified as:

moderate

Type of rigidity where UE are flexed and LE extended

decorticate rigidity

Type of rigidity where UE and LE are both extended

decerebrate rigidity

RLA level I:

No response -deep sleep, no response to stimuli

RLA Level II:

Generalized Response -inconsistently and non purposefully reacts to stimuli

RLA Level III:

Localized Response -Specifically but inconsistently Reacts to stimuli -follow simple commands (ex. close eyes, squeeze hand) inconsistently

RLA Level IV:

Confused Agitated -heightened activity state -bizarre non-purposeful behavior -inappropriate verbalizations -confabulation -lacks short and long term recall -very brief gross attention to environment

RLA Level V:

Confused Inappropriate -respond to simple commands fairly consistently -highly distractible, unable to focus on specific task -inappropriate, confabulatory verbalization -inappropriate use of objects -perform previously learned tasks but no new info

RLA Level VI:

Confused Appropriate -goal-directed behavior but dependent on external input -follows simple commands consistently & shows carryover for relearned tasks -responses appropriate to situation -past memories

RLA Level VII:

Automatic Appropriate -appropriate and oriented w setting -daily routine automatic but robot-like -shallow recall -carryover for new learning but decreased rate -initiates social or recreational activities

RLA Level VIII:

Purposeful Appropriate -recall past and recent events -carryover w new learning -may still show decreased ability in emergencies or unusual circumstances

The_______ lobe is the primary motor cortex and ____'s speech area, is responsible for motor planning, language production, problem solving, emotions, and olfaction.

frontal Broca's

The _____ lobe is the postcentral gyrus/primary somatosensory area, is responsible for sensation, taste and perceptual function.

parietal

The _____ lobe is the primary auditory cortex, ____'s speech area, and is responsible for hearing, language understanding and formulation, storage of auditory and visually presented info, and recent memory

Temporal

The ______ lobe is the primary visual cortex and is responsible for vision, visual understanding and integration of sensory info (somatosensory, visual, auditory)

occipital

5 stages of Stance Phase

IC (heel strike) LR (foot flat) MSt (SL stance) TSt (heel off) PSw (toe off)

What phase of gait is the weight-acceptance period?

Which 2 phases of gait consist of SL stance while the other leg goes through swing?

LR and MSt

Which 2 phases of gait make up the weight unloading period?

TSt and PSw

Normal base or step width with gait

8-10 cm

Avg step length of gait

28 in

Avg Stride length of gait

56 in

Avg lateral pelvic shift in gait

1-2 in

Vertical pelvic shift should be no more than _____ inches in either direction during normal gait

Gait speed

1.4 m/s or 3 mph

Metabolic disease that depletes bone mineral density/mass and predisposes ppl to fracture

Osteoporosis (W>M)

Decalcification of bones d/t vitamin D deficiency

Osteomalacia

Inflammatory response within bone caused by infection

Osteomyelitis

Common tendon dysfunction whose cause is poorly understood but likely related to degenerative collagen changes within the tendon

tendonosis/tendonopathy

inflammation of bursa secondary to overuse, trauma, gout, or infection

Bursitis

inflammatory response within a mm following a traumatic event that caused micro-tearing of the musculotendinous fibers

Muscle strain

Dysfunction of sympathetic nervous system to include pain, circulation, and vasomotor disturbances

Complex Regional Pain Syndrome (CRPS)

Metabolic bone disease involving abnormal osteoclatic and osteoblastic activity and thought to be linked to viral infection and environmental factors

Paget's Disease (Osteitis deformans)

Spasm/tightness of SCM causing dysfunction observed as side-bending toward and rotation away from affected SCM

Torticollis

compression fracture of posterior humeral head

hill-sachs lesion

tearing of superior glenoid labrum from anterior to posterior

SLAP (Superior labrum, anterior to posterior) lesion

Avulsion of anteroinferior capsule and ligaments associated w glenoid rim

Bankart's lesion

Condition where there is an impaired blood supply to the femoral head

Avascular necrosis (AVN)

Angle of femoral neck with shaft of femur is <115 deg

coxa vara

Angle of femoral neck with shaft of femur >125 deg

Coxa valga

Inflammation of deep trochanteric bursa from a direct blow, irritation by IT band, and biomechanical/gait abnormalities causing repetitive microtrauma

Trochanteric bursiitis

Unhappy triad

Injury to the MCL, ACL, and Medial meniscus

Malalignment in which patella tracks superiorly in femoral intercondylar notch

Patella alta

Malalignment in which patella tracks inferiorly in femoral intercondylar notch

Patella baja

Degenerative condition of the patellar tendon typically of the deep aspect of the tendon

Patellar tendonosis/tendonopathy (Jumper's KNee)

Increased compartmental pressure resulting in a local ischemic condition caused by direct trauma, fracture, overuse, muscle hypertrophy

Anterior Compartment Syndrome

Another name for shin splints

Anterior tibial periostitis Anterior Tibialis & Extensor hallucis longus

Grades for Lateral Ligament sprains of ankle

-Grade I: no loss of fx, minimal tearing of ATFL -Grade II: some loss of fx, partial disruption of ATFL & CFL -Grade III: complete loss of fx, complete tearing of ATFL & CFL with partial tear of PTFL

Entrapment of the posterior tibial nerve or one of its branches within the tarsal tunnel

tarsal tunnel syndrome

Peroneal muscular atrophy that affects motor and sensory nerves; initially affects mm of lower leg and foot but eventually progresses to mm of hands and forearm

Charcot-Marie-Tooth disease

abnormal mechanical alignment of tibia, shortened rearfoot soft tissues, or malunion of calcaneus causing rigid inversion of calcaneus when subtalar joint is in neutral

Rearfoot Varus

abnormal mechanical alignments of the knee (Genu valgum) or tibial valgus causing eversion of calcaneus with a neutral subtalar joint

Rearfoot valgus

Congenital abnormal deviation of head and neck of talus causing inversion of forefoot when subtalar joint is in neutral

Forefoot varus

Congenital abnormal development of head and neck of talus resulting in eversion of forefoot when the subtalar joint is in neutral

Forefoot valgus

likely impairment causing "foot slap"

weak DF -Common Peroneal n Palsy -Distal peripheral neuropathy

likely impairment causing "Foot flat"

marked weakness of ankle DF -Common Peroneal n Palsy -Distal peripheral neuropathy

likely impairment of premature elevation of the heel in MSt or TSt

Lack of Ankle DF -muscle tightness of PF

likely impairment of "drop foot"

weak DF or pes equinus deformity

Compensatory mechanism demonstrated by exaggerated ankle PF during MSt leading to excessive vertical movement of the body

vaulting

likely impairment causing anterior trunk lean

weak quads -to move COM anterior to the axis of rotation of the knee

likely impairment causing lateral trunk lean towards the stance LE

"Trendelenburg" Weak hip ABDuctors

Likely impairment causing Excessive downward drop of the CL pelvis during stance

"Trendelenburg" Hip pain, Hip OA, Hip flexion contracture

likely impairment causing hip hike during Swing

reduced hip flexion reduced knee flexion lack of ankle DF

likely impairments causing hip circumduction during swing

reduced knee flexion, lack of ankle DF

Hip flexion contracture will cause a _________ hip extension and _______ in step length on opposite side

decreased, decrease

Weakness of hip flexors will cause a ______ hip flexion and _____ in step length on the same side

decreased; decrease

Gait deviations of weak hip flexors: 1=___ 2=___ 3=___ 4=___

1= circumduction 2= fwd trunk lean 3= increased knee flexion 4= hip hike

Weak usually means ________ ROM or ________ clearance

incomplete; incomplete

Early usually means ____

tight

A PT notices a pt is experiencing early toe-off during terminal stance in gait. Which of the following identifies a likely cause and an appropriate intervention to address that cause? A. hip flexion contracture, prolonged stretch B. Hip adductor weakness, progressive strengthening C. Gastroc weakness, ultrasound D. Great toe flexion weakness, progressive strengthening

Hip abductors are active in _____ phase using a ______ contraction and hip adductors are active in ____ phase using a _____ contraction to stabilize pelvis

stance eccentric stance concentric

A PT is evaluating a 26 y/o female basketball player with a vague diagnosis of R knee pain. The pt is performing a jump landing as shown in the video. The PT treatment should MOST likely focus on: A. Strengthening of the R glute med B. Strengthening of the R adductor magnus C. Strengthening of the R vastus medialis D. Strengthening of the R tibialis anterior

Glute Max is _______ contracting during ___ phase and ____ active during ____ phase

eccentric ;stance concentric; pre-swing

A 74 y/o retired contractor walks to the treatment room w a prominent backward lean, when the pt is in stance on the LLE. From this observation, you hypothesize that the MOST LIKELY cause is: A. wk hip extensors on L during stance phase B. Wk hip flexors on L during stance C. Wk hip extensors on R during swing D. Wk hip flexors on R during swing

Weak muscles are ______ to the trunk

magnets

2 causes of backward lean during stance: Weak hip __________ Hip __________ contracture

Extensors flexion

Cause of forward trunk lean

wk hip flexors

A 74 y/o retired contractor walks to the treatment room. Pt presents w a backward trunk lean during the swing phase of gait. What is the MOST likely cause? A. Glute max weakness B. Hip flexor weakness C. Glute med weakness D. Vastus medialis weakness

hip _______ weakness causes backward trunk lean in stance while hip ______ weakness causes backward trunk lean in swing

extensor flexor

A PT checks the active and passive ankle ROM. The pt lacks 10 deg of passive ankle DF. The same limitation of 10 deg in ROM limitation is present whether the knee is extended or flexed. The muscle is MOST likely contributing to the restriction in PROM is? A. Tibialis Anterior B. Hamstrings C. Gastroc D. Soleus

2 things that cause Excessive Knee Extension during gait

Quad weakness Excessive ankle PF

Ankle and ______ like to stay in symmetry

pelvis

What happens at the pelvis, lower back, trunk, and knee with excessive ankle PF?

The pelvis likes to stay in symmetry with the ankle (forward tilt) Low back counteracts with lordosis Trunk leans fwd to balance low back Knee hyperextends since ankle and hip are going forward

A pt presents to the clinic w reports of knee pain. On evaluation the PT notices that the pt has excessive ankle PF along with excessive anterior pelvic tilt. What could be the MOST correlated motion at the knee joint? A. Genu valgum B. Coxa Vara C. Medial tibial torsion D. Knee hyperextension

A therapist is assessing a 37 y/o male who reports knee pain after prolonged weight bearing. The therapist decides to assess the patient's gait and notes that the pt has knee hyperextension from heel strike through MSt phase. Which of the following is the LEAST likely cause of this presentation? A. Quadriceps femoris weakness B. Pes Equinus C. Achilles tendon contracture D. Short hip extensors

A 60 y/o male pt has L sided anterolateral hip pain, pain during WB, stiffness -L hip flexion 95 deg -hip IR 12 deg -L hip flexors, adductors, extensors 4/5 -Hip abductors 3/5 -Antalgic gait As per what the pt reports and the PT exam findings, what is the MOST likely diagnosis? A. Avascular necrosis of the hip B. Osteoporosis of hip C. Osteomyelitis of hip D. Osteoarthritis of hiphe f

A 60 y/o male pt has L sided anterolateral hip pain, pain during WB, stiffness -L hip flexion 95 deg -hip IR 12 deg -L hip flexors, adductors, extensors 4/5 -Hip abductors 3/5 -Antalgic gait Which of the following gait deviations will MOST likely be seen in this pt? A. Trunk lean to L during L MSt B. Posterior lean of trunk during R IC C. Trunk lean to the R during R stance phase D. Posterior tilt of pelvis during L MSt

A 60 y/o male pt has L sided anterolateral hip pain, pain during WB, stiffness -L hip flexion 95 deg -hip IR 12 deg -L hip flexors, adductors, extensors 4/5 -Hip abductors 3/5 -Antalgic gait After conservative PT for 6 months failed, pt underwent a THA on the L side using a posterolateral approach. The PT is now working on a gait training program for the pt. The therapist should instruct the pt to hold the can in the: A. L hand to decrease activity in L hip abductors B. L hand to facilitate activity in the L hip abductors C. R hand to decrease activity int he L hip abductors D. R hand to facilitate activity in the L hip abductors

Transfemoral amputation means _____ knee amputation

Above

Transtibial amputation means ______ knee amputation

below

A pt comes to a PT clinic following a L below knee amputation. Assuming the black dot in the middle was the pt's COM before amputation, which of the following locations is MOST likely to be the new COM after amputation? A. Moves higher on the R side (Yellow dot) B. Moves lower on the R side (Red dot) C. Moves higher on the L side (Blue dot) D. Moves lower on the L side (Green dot)

When you cut a lower limb, the COM moves _____

With UE amputation, COM moves _____

lower

If R arm is amputated and L leg is amputation, COM moves ____.

up; bc LEs weigh more so more weight loss (Upper body has more body mass)

For prosthetics, if a person has a R trunk lean, they likely have a _____ lateral wall acting as a _____ glute med

lower weak

low walls in prosthethics = ____ muscles

Weak

high walls in prosthetics= _____ muscles

tight

K levels with prosthetics K0=____ K1=____ K2=___ K3=____ K4=____

K0= not candidate K1=household ambulation K2= limited community ambulation K3= Community ambulation; varied cadence K4= high levels of activity

What are two causes of lateral bend during Stance with AKA?

-Low lateral wall -short prosthesis

What are two causes of hip abduction during stance with AKA?

-long prosthesis -abducted hip joint

What causes lordosis during stance with AKA?

anterior socket wall discomfort (high wall)

What causes forward flexion during stance with AKA?

unstable knee joint

A pt with a R above knee prosthetic limb is displaying R lateral trunk bending while ambulating. Which of the following would be the MOST likely cause of this gait abnormality? A. Short prosthesis B. Medial wall too low C. Lateral wall too high D. Long prosthesis

During stance phase with AKA, there is a heel whip. What are two causes for this?

-malrotation of prosthesis -knee bolt rotated

During heel contact with an AKA, there is foot rotation. What are 2 causes of this?

-stiff heel cushion -malrotated foot

A 28 y/o pt with a L AKA is referred to an OP amputee clinic. During gait analysis, the PT observes a medial heel whip during heel off on the L side. Which of the following is the MOST likely cause of this deviation? A. Taut extension aid B. Inadequate medial rotation of knee joint C. Prosthetic knee bolt is externally rotated D. Short prosthesis

If ankle PF is restricted by stiff heel cushion, the knee will ___ more than normal to allow the sole of foot to reach floor

flex

If there is a heel cushion that is too soft or allows excessive PF, the knee goes into _____

hyperextension

The PT is observing the gait of a pt w R transfemoral amputation. The therapist notices excessive R PF at heel strike. What could be the possible cause for this foot slap? A. PF bumper too rigid B. PF bumper too soft C. Heel cushion too rigid D. Excessive inset of foot

The PT is observing the gait of a pt w R transfemoral amputation. The therapist notices excessive R DF at heel strike. What could be the possible cause for this? A. DF bumper too rigid B. DF bumper too soft C. Heel cushion too soft D. Excessive inset of foot

The PT is observing the gait of a pt w R transtibial amputation. The therapist notices reduced R PF at heel strike. What could be the MOST likely cause? A. PF bumper too rigid B. PF bumper too soft C. Heel cushion too soft D. Excessive inset of foot

2 Orthotic causes for toe drag

-inadequate dorsiflexion assist -inadequate PF stop

Inadequate assist is similar to ____ muscles and inadequate stop is similar to _____ muscles with orthotics

weak spastic

A PT is observing the gait of a pt and notes that pt demonstrates circumduction in the swing phase of the gait cycle with their current orthotic. Which of the following orthotic impairment would potentially contribute to this gait deviation? A. Excessive DF assist B. Inadequate PF stop C. Inadequate knee lock D. Excesive PF stop

A 58 y/o pt had a L knee amputation 4 days ago. Has an incision with staples and sutures at the site, redness and swelling over the stump. While examining the wound site, PT observes the exudate from the wound site. Which of the following findings indicates an infected wound and should be reported to the physician? A. Dark red blood B. Bright red blood C. Viscous yellow exudate D. Serosanguineous exudate

A 58 y/o pt had a L knee amputation 4 days ago. Has an incision with staples and sutures at the site, redness and swelling over the stump. To prevent contracture in this pt, emphasis should be placed on designing a positioning program that maintains ROM of hip in: A. flexion and abduction B. Extension and adduction C. Adduction and lateral rotation D. Flexion and medial rotation

A 58 y/o pt had a L knee amputation 4 days ago. Has an incision with staples and sutures at the site, redness and swelling over the stump. The pt was discharged from the hospital with a soft dressing and was advised to come back for follow up a week later. During the follow up visit, the pt reports shooting pain at the end of the residual limb. Examination of the residual limb does not show any erythema. What is the MOST likely cause of this shooting pain? A. Cellulitis B. Dermatitis C. Impetigo D. Neuroma

When proper loading of residual limb with the prosthesis is achieved, the following can be observed: Pressure tolerant ares: Transient redness (is/is not) to be expected after prosthetic use

When proper loading of residual limb with the prosthesis is achieved, the following can be observed: Pressure sensitive ares: (Some/No) Redness should be observed after prosthetic use

After gait training a pt with a new below knee prosthesis, you notice redness along the patellar tendon and medial tibial flare. This would indicate: A. The socket is too small, and the residual limb is not seated properly B. The socket is too large and pistoning is occurring C. Improper weight distribution during stance D. Pressure tolerant weight bearing during stance

During the Assessment of Skin sensation, which of the following structures are responsibly for transmission of hot sensation? A. Meissner corpuscles B. Krause end bulbs C. Golgi tendon organs D. Ruffini endings

__________ corpuscles are responsible for transmitting sensations of fine touch, discriminative touch, and vibration

Meissner

________ Corpuscles are responsible for pressure and vibration sensory modalities

Pacinian

_________ endings are responsible for heat sensation

Ruffini

___'s are sensitive to muscle contraction force

Golgi tendon organs

_______ end bulbs are responsible for cold sensation

Krause end bulbs

inadequate drainage of venous blood from a body part, usually resulting in edema and/or skin abnormalities and ulcerations

venous insufficiency

Lack of adequate blood flow to a region of the body

arterial insufficiency

ALMA

Arterial Lateral MAlleolus

VENMO

VENous Medial malleOlus

Venous insufficiency is ______ to the medial malleolus

proximal

Wounds that have a irregular, shallow appearance and have flaking, brownish discoloration are indicative of (arterial/venous) insufficiency

venous

Wounds on the lower 1/3 of the leg, toe, and lateral malleolus are indicative of _______ insufficiency.

Arterial

Wounds with smooth edges, well defined, that are deep, thin and shiny skin, hair loss, and yellow nails are indicative of __________ insufficiency

Arterial

Elevation (increases/decreases) pain with venous insufficiency

decreases

Elevation (increases/decreases) pain with venous insufficiency

increases

A 61 y/o female presents with a wound on her R LE and has a history of painful cramping in the legs especially after walking for a few minutes. Medical history is significant for DM II and HTN. Which of the following would BEST describe the characteristic of this wound? A. Wound located on dorsum of toes, base of the wound is pale and necrotic with lack of granulation tissue B. Wound located on dorsum of foot, hemosiderin staining present along with fibrosis of dermis C. Wound located on medial malleolus with swelling of bilateral LE that is relieved with rest D. Pitting edema in the LE, numbness and tingling along with hyperkeratosis of the skin

Cramping after walking is indicative of ______ insufficiency and common in those with ____ and ____.

Arterial DM HTN

Pressure ulcer stage where reddened area does not go away

Stage 1

Pressure ulcer stage where first 2 layers of skin are affected

Stage 2

Pressure ulcer stage where subcutaneous fat may be visible

Stage 3

Pressure ulcer stage where you are down to the bone

Stage 4

A PT is treating a pt who was originally diagnosed w a stage 3 pressure injury. The pt presents to clinic with ulcer shown in the picture. Which of the following findings is MOST accurate? A. No change has occurred in the pressure injury B. It has improved to Stage 1 C. It has improved to Stage 2 D. It has become unstageable

T or F: Names of pressure injuries can change

F they can only change from Stage 3 to healing Stage 3 for example

Diabetic ulcers are generally located on the _____ of the foot

weight bearing surface

Whichulcerss are edematous? Arterial or Venous insufficiency?

venous

What condition has initial symptoms of pain and paresthesia localized to the affected dermatome, presents as a rash, is mostly unilateral, raised to palpation, and is pink with silvery white appearance?

herpes zoster (shingles)

T or F: Herpes Zoster (Shingles) can spread by contact and airborne

A 32 y/o female pt arrived at a clinic with the following skin disorder. Which of the following is the MOST appropriate diagnosis and precaution to be taken? A. herpes simplex virus type 1, contact precautions B. Herpes zoster, airborne precautions C. Dermatitis, contact precautions D. Herpes simplex virus type 2, contact precautions

Herpes simplex virus type 1 involves cold sores _____ the waist

above

Herpes simplex virus type 2 involves cold sores _____ the waist

below

A 32 y/o male presents with a skin condition as shown in the picture. There are irregular areas of localized skin edema. Which of the following is the MOST likely diagnosis for this patient? A. Blisters B. Vesicles C. Wheals D. Pustules

MMMH THFC

very Mild exudate: Transparent films Minimal exudate: Hydrogell dressing, Hydrocolloid Moderate exudate: foams Heavy exudate: Calcium alginates

A pt has a Grade III pressure ulcer on the hip. The wound has excessive amounts of exudate present. Which of the following is the MOST appropriate dressing to use? A. Calcium Alginate B. hydrocolloid dressing C. Hydrogel dressing D. Transparent Film

T or F: You use selective debridement when healthy tissue < dead tissue

F, when dead tissue < healthy tissue

Removal of non viable tissues from a wound

Selective debridement

Use of a scalpel, scissors, forceps to remove non viable tissues from a wound

sharp debridement

use of a topical application to remove non viable tissues from a wound

Enzymatic debridement

Use of the body's own mechanism to remove nonviable tissue from a wound

Autolytic debridement

Removal of both nonviable and viable tissues from a wound (more than 50% necrotic)

Nonselective debridement

Type of nonselective debridement where there is Application of a moistened gauze over area of necrotic tissue to be completely dried and removed

Wet to dry dressings

Type of nonselective debridement where necrotic tissue is moved from the wound bed using pressurized fluid

Wound irrigation

Type of nonselective debridements where a whirlpool with agitation is directed toward a wound

Hydrotherapy

A pt has a deep partial thickness wound with 20% necrosis and 80% granulation tissue. Which of the following is MOST appropriate wound care option? A. Wet to dry dressings B. wound irrigation C. hydrotherapy D. Sharp debridement

RYB system (Red Yellow Black) Red wound:______ Yellow wound:________ Black wound:______

Red: cover, keep moist & clean, protect from trauma Yellow: clean & remove yellow layer, cover with moisture retentive dressing (hydrogel, foam) Black: debride as ordered

A pt develops a Stage 2 pressure injury over the sacrum and is referred to PT for wound care. Which of the following is the MOST appropriate initial application to clean the wound? A. Povidone-iodine solution B. Sterile normal saline C. Zinc oxide cream D. Nitrofurazone solution

Burn that involves the epidermis, has a dry, red skin without any open areas, and heals in 5 days without scarring

Superficial

Burn that involves epidermis and some dermis, has weeping blisters and is extremely painful, heals in 2 wks with minimal scarring

Superficial partial thickness

Burn that involves epidermis and dermis, mottled red with white areas, can take 3 wks to heal

Deep partial thickness

Burn that involves epidermis, dermis, and some subcutaneous tissue, is dry, rigid, leathery eschar, requires surgical closure and takes 4 wks to heal

Full thickness

Burn that involves epidermis, dermis, subcutaneous tissue, has charred, dry and deep tissue exposed, requires surgical intervention, and may cause amputation/paralysis

Subdermal

A pt has a burn injury from a MVA with burns present over anterior R arm, Anterior R leg, anterior chest and abdomen. The burnt areas appear waxy white. What type of burn does this pt have? A. Superficial burn B. Superficial partial thickness C. Deep partial thickness D. Subdermal

A pt has a burn injury from a MVA with burns present over anterior R arm, Anterior R leg, anterior chest and abdomen. The burnt areas appear waxy white. Which of the following BEST represents the percentage of body surface area involved? A. 31.5% B. 18% C. 36.5% D. 45%

Rule of 9s

A: 4.5 B. 4.5 C.18 D. 4.5 E. 1 F. 9 G. 9 H. 4.5 I. 4.5 J. 18 K. 4.5 L. 9 M. 9

A pt has a burn injury from a MVA with burns present over anterior R arm, Anterior R leg, anterior chest and abdomen. The burnt areas appear waxy white. A few months later, pt is concerned about a scar on his R arm that appears as shown. What is the type of scar seen in this pt? A. normal scar B. hypotrophic scar C. Hypertrophic scar D. Keloid scar

Rule of 9s

A. 8.5 B. 18 C. 4.5 D. 4.5 E. 1 F. 6.5 G. 6.5 H. 8.5 I. 4.5 J. 18 K. 4.5 L. 6.5 M. 6.5

A scar that is flat and similar to skin color

Normal scar

A scar with thick fibrous tissue that remains within the original wound border

Hypertrophic scar

An excessive scar tissue that grows outside of the original margins of the wound

Keloid scar

Type of wound closure with clean, straight lines, edges well approximated with sutures, rapid healing, usually best cosmetic outcome

Primary intention

Type of wound closure with larger wounds with tissue loss, edges not approximated, heals from inside out, granulation tissue fills in the wound, longer healing time, larger scars

Secondary intention

Type of wound closure with a delay typically 3-5 days before injury is sutures, used to manage infected or unhealthy wounds, larger scar Starts as more open, allow it to fill in with secondary concept, then once it is closed enough, you go in to close it with sutures

Tertiary intention

thin, bright red drainage/exudate

sanguineous

thin, watery, pale red to pink drainage/exudate

serosanguineous

thin, watery, clear drainage/exudate

serous

thick or thin, opaque tan to yellow drainage/exudate

purulent

thick opaque yellow to green with offensive odor draiange/exudate

foul purulent

DIMES

Debridement Infection Moisture balance Edge Support Services

ABI Indications: >1.2=___________ 1.19-0.95=______ 0.94-0.75=_________ 0.74-0.50=________ <0.50=________

>1.2= falsely elevated, arterial disease, diabetes 1.19-0.95= normal 0.94-0.75= mild arterial disease 0.74-0.50= moderate arterial disease <0.50= severe arterial disease

Edema: 1+=____ 2+=____ 3+=____ 4+=____

1+= indentation barely detectable 2+= returns to normal in 15 sec 3+= returns to normal in 30 seconds 4+= indentation lasts >30 seconds

Chronic autoimmune disease of skin characterized by erythematous plaques covered with a silvery scale; common on ears, scalp, knees, elbows, and genitalia

Psoriasis

ABCDEs

Asymmetry Border Color Diameter Elevation (or Evolving)

Bluish discoloration of skin caused by extravasation of blood into the subcutaneous tissues

Ecchymosis

Tiny red or purple hemorrhagic spots on the skin

Petechiae

General term used to describe any disorder that interferes with arterial or venous blood flow of the extremities

Peripheral vascular disease (PVD)

Thickening, hardening, and loss of elasticity of arterial walls

Arteriosclerosis

damage to endothelial lining of the vessels and the formation of lipid deposits, eventually leading to plaque formation

Atherosclerosis

Inadequate drainage of venous blood from a body part, usually resulting in edema and/or skin abnormalities and ulcerations

venous insufficiency

The most important therapeutic measure for prevention and treatment of venous leg ulcers

compression therapy

What allows uptake of glucose from the blood stream and lowers plasma glucose levels?

insulin

complex disorder of carbohydrate, fat, and protein metabolism caused by deficiency or absence of insulin secretion by the cells of the pancreas or defects of insulin receptors, causing an abnormally high level of sugar or glucose in the blood

Diabetes Mellitus

Insuling-dependent, or juvenile-onset diabetes that has decrease in insulin secretion; prone to ketoacidosis

Type 1 diabetes

Type of diabetes resulting from inadequate utilization of insulin (insulin resistant), decline in pancreatic insulin production

Type 2 diabetes

FPG for diagnosis of DM

FPG >/= 126 mg/dL

Exercise recommendations for DM with Cardiovascular Training: Frequency= __-__ days/wk Intensity=__-__% VO2max or RPE of ___-___ Time= __-___ minutes Type=

Frequency= 3-7 days/wk Intensity= 50-80% VO2max or RPE of 12-16 Time= 20- 60 minutes Type= rhythmic, large mm groups, biking, walking

Exercise recommendations for resistance training with DM: Frequency= __-__ days/wk Intensity=__-__% VO2max or RPE of ___-___ Time= __-___ minutes Type=

Frequency= 2-3 days/wk Intensity= 60-80% 1RM, 2-3 sets of 8-12 reps Type= major mm groups

Hyperglycemia cutoff for exercise with DM

FBG >300 mg/dL

Hypoglycemia cutoff for exercise with DM

BG <70 mg/dL

Obesity is defined as

BMI >/= 30

Morbidly Obese is defined as

BMI >40

Overweight is defined as

BMI 25-29.9

What type of thyroidism involves weight gain, mental and physical lethargy, dry skin and hair, Low BP, constipation, intolerance to cold?

Hypothyroidism

What type of thyroidism results in nervousness, hyperreflexia, tremor, hunger, weight loss, fatigue, heat intolerance, palpitations, tachycardia, and diarrhea?

Hyperthyroidism

What disorder is caused by decrease in production of cortisol and aldosterone?

Addison's Disease

What disorder is being described? -bronze skin pigment -weak, dec endurance -weight loss, GI disturbances, dehydration -anxiety/depression -dec tolerance to cold -intolerance to stress

Addison's Disease

Metabolic disorder resulting form chronic and excessive production of cortisol by the adrenal cortex

Cushing's disease

Name the disorder: -dec glucose tolerance -round "moon" face -obesity -dec testosterone levels or menstrual periods -muscular atrophy -edema -hypokalemia

Cushing's Disease

Water temp for Rehab exercise in aquatic therapy should be between ___ and ___ deg celsius, ___ and ___ deg farenheit

33-34 deg C 91-93 deg F

Water temp for Intense training should be between __ and ___ deg C and ___ and ___ deg F

27-28 deg C 81-83 deg F

What happens to the following during Aquatic therapy? SV= CO= HR=

SV= inc CO= inc HR= same/dec

Upward force that works opposite to gravity

buoyancy

pressure exerted by the water on immersed objects

hydrostatic pressure

friction occurring between molecules of liquid resulting in resistance to flow

Viscosity

Type of arthritis that happens between 15-50 y/o

Type of arthritis that happens after age 40

Type of arthritis that has inflammatory synovitis and irreversible structural damage to cartilage and bone

T or F: OA is usually asymmetrical while RA is bilateral

_____arthritis typically involves the DIP, PIP, 1st CMC of hands, cervical/lumbar spine, hips, knees, 1st MTP of feet while _____arthritis typically involves MCP, PIP of hands, wrists, elbows, shoulders, cervical spine, MTP, talonavicular and ankle

osteo; rheumatoid

chronic degenerative disorder primarily affecting the articular cartilage of synovial joints, with eventual bony remodeling and overgrowth at the margins of the joints (spurs and lipping) -also progression of synovial and capsular thickening and joint effusion

Upper GI Tract: 1= 2= 3=

1= mouth 2= esophagus 3= stomach

Middle GI Tract: 1= (a, b, c)

Small intestine (duodenum, jejunum, and iileum)

Lower GI Tract: 2= (a,b,c)

Large intestine (cecum, colon, rectum)

In which tract does the ingestion and initial digestion of food happen?

Upper GI

In what tract does the major digestion and absorption occur?

Middle GI

In which tract does the absorption of water and electrolytes, storage and elimination of waste products happen?

Lower GI

Visceral pain from the liver, diaphragm, or pericardium can refer to _____

the shoulder

Visceral pain from the gall bladder, stomach, pancreas, or small intestine can refer to the ______ and ______ regions

midback; scapular

Cholelithiasis is AKA

gallstones

Test for gallbladder pain

Murphy's Sign Palpate near R subcostal margin as pt takes deep breath and pain is elicited

Name the special test: Palpate near R subcostal margin as pt takes deep breath and pain is elicited

Murphy's Sign (gallbladder)

Protrusion of the stomach upward through the diaphragm or displacement of both the stomach and gastroesophageal junction upward into the thorax

hiatal hernia

Ulcerative lesions that occur in the upper GI tract in areas exposed to acid-pepsin secretions, affecting one or all layers of the stomach or duodenum

Peptic Ulcer Disease

Two chronic inflammatory disorders of the bowel characterized by remissions and exacerbations

Inflammatory Bowel Disease (IBD) : Crohn's Disease and Ulcerative Colitis

Disease involving granulomatous type of inflammation anywhere in the GI tract with skip lesions (areas of adjacent normal tissue)

Crohn's Disease

Disease involving ulcerative and exudative inflammation of the large intestine and rectum, characterized by varying amounts of bloody diarrhea, mucus, and pus

Ulcerative colitis

Abnormally increased motility of the small and large intestines

Irritable bowel syndrome (IBS)

Special test for Appendicitis

Blumberg's sign Rebound tenderness in response to depression of the abdominal wall at a site distant from the painful area

Blumberg's sign

Rebound tenderness in response to depression of the abdominal wall at a site distant from the painful area

McBurney's Point

point tenderness with Apendicitis 1.5-2 in above ASIS in RLQ

Normal weight gain during pregnancy

20-30 lbs

Normal potassium serum level

3.5-5.5 mEq/L

Normal sodium serum level

135-146 mEq/L

Which occurs w water intoxication? Hyponatremia or hypernatremia

hyponatremia

Which occurs w water deficits? Hyponatremia or hypernatremia

hypernatremia

Normal calcium levels

8.4-10.4 mg/dL

Most commonly used class used to treat edema

Thiazide diuretics

separation of the rectus abdominis mm in the midline at the linea alba

Diastasis Recti

What amount of separation is considered significant with diactasis recti?

2 finger widths

Name the test: Pt hook-lying, have pt slowly raise head & shoulders off floor reaching hands towards knees, until spines of scapula leave the table. PT places fingers horizontally across midline of the abdomen at the umbilicus. Positive test is fingers sinking into gap between mm, or visible bulge between mm bellies

Diastasis Recti

Pregnancy induced, acute hypertension after the 24th week of gestation

Preeclampsia

Used to prevent transmission of infectious agents including epidemiologically important microorganisms that are spread by direct or indirect contact with the patient or the pt's environment Also used where the presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggest increased potential risk for transmission

Contact precautions

Used to prevent transmission of pathogens spread through mucous membranes or close respiratory contact with respiratory secretions

Droplet Precautions

Used to prevent transmission of infectious agents that remain infectious over long distances when suspended in the air

Airborne precautions

Name the Isolation type: MRSA, C Diff, lice, scabies, impetigo

Contact precautions

Name the Isolation type: Mumps, Strep A

Droplet precautions

Name the Isolation type: Measles, Tuberculosis

Airborne precautions

Name the Isolation type: Chickenpox, herpes zoster in immuno-comprimised hosts, smallpox

Airborne + Contact precautions

Carcinomas originate in epithelial tissues such as ______,______,______, ______, & ______

skin, stomach, colon, breast, rectum

Sarcomas originate in connective and mesodermal tissues such as _____, _____, & _____

muscle, bone, fat

Leukemias & Myelomas affect the ______ & _____ _____

blood and bone marrow

Aerobic exercise recommendations for those with Cancer: ___ to ____ intensities (___-___%) ___-____ on Borg RPE scale ___-___ days/wk ___-____ minutes/session

low to moderate (40-60%) 11-13 3-5 days/wk 20-60 mins/session

Normal Platelet Count: _______-_____cells/mm^3

150,000-450,000

Normal WBC count: ______-______ cells/mm^3

4800-10800

Normal Hemoglobin (Hgb) levels for women: ____-____g/dL

12-16

Normal Hemoglobin (Hgb) levels for men: ____-____g/dL

13-18

Normal Hematocrit (HCT) for women: ____-_____%

37-48%

Normal Hematocrit (HCT) for women: ____-_____%

45-52%

What is the cutoff for platelet counts with exercise? _______ cells/mm^3

20,000