Readings (Days 21-40) and Lectures 6-11 Flashcards
Abnormal immune mediated response attacks the meylin nerve coating (oligodendrocytes) and the nerve fibers in the CNS
Multiple Sclerosis
Form of MS in which Relapses and remissions do not occur
Primary-Progressive MS
Most common form of MS
Relapshing-remitting
Form of MS that begins with relapsing-remitting course followed by progression to steady and irreversible worsening of neurologic function
Secondary-Progressive MS
Form of MS that is characterized by a nearly continuous worsening of the disease from the onset without distinct attacks
Primary-Progressive MS
Common sx of MS
paresthesias, minor visual disturbances, weakness, fatigue, sharp, shooting pain, spasticity
slurred or poorly articulated speech with low volume, unnatural emphasis, and slow rate
Dysarthria
Changes in vocal quality including harshness, hoarseness, breathiness, or hypernasal sounds.
Dysphonia
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)
What test is used to diagnose MS?
MRI
Chronic condition characterized by widespread pain that affects multiple body regions and the axial skeleton and has lasted for >3 months.
Fibromyalgia
FM or MPS?
-Tender points at specific cites
-No referred pain patterns
-No tight band of mm
-Fatigue and waking unrefreshed
FM
FM or MPS?
-Trigger points in mm
-referred patterns of pain
-tight band of muscle
-no related fatigue complaints
MPS
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?
FM
chronic, regional pain syndrome
Myofascial pain syndrome (MPS)
Lie in parallel with muscle fibers and monitor changes in mm length and velocity
muscle spindles
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
receptors within fascia of mm that respond to pain and pressure
free nerve endings
receptors within fascia of mm which respond to vibratory stimuli and deep pressure
pacinian corpuscles
Which pathway is concerned with non-discriminative sensations such as pain, temperature, tickle, itch, and sexual sensations?
Spinothalamic Tracts
Pathway responsible for transmitting discriminative touch, stereognosis, tactile pressure, barognosis, graphesthesia, recognition of texture, two-pt discrimination, kinesthesia, proprio, and vibration
DCML
pain produced by a non-noxious stimuli
Allodynia
complete loss of pain sensitivity
Analgesia
increased sensitivity to pain
hyperalgesia
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
C
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
B
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
D
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
D
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
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
B
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
A
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
D
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
B
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
C
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?
PD
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
- Anterior Communicating Artery
- Posterior communicating artery
- Middle cerebral artery
- Superior cerebellar artery
- Anterior inferior cerebellar artery
- Posterior inferior cerebellar artery
- Vertebral Artery
- Basilar Artery
- Posterior cerebral artery
- Posterior communicating artery
- Anterior cerebral artery
Scores of 13-15 on GCS are classified as:
mild
- Corpus Callosum
- Primary motor cortex
- Primary somatic sensory cortex
- Primary visual cortex
- Posterior cerebral artery
- Anterior cerebral artery
the GCS looks at what 3 activities?
Eye opening
Best Motor response
Verbal response
- Tips of anterior cerebral artery
- Tips of posterior cerebral artery
- Wernicke’s area
- Broca’s area
- 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?
IC
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
2
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
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
A
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
D
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
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
C
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)
A
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
A
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
A
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
D
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
