Readings (Days 50-60) & Lectures 16-20 Flashcards by Danielle Hood

compression of a nerve root

radiculopathy

(follows dermatomes)

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Disturbance of a single nerve

Mononeuropathy

(ex. carpal tunnel, Guyon’s canal)

***Does not follow dermatomes

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Median n nerve root

C5-T1

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Pronator Teres syndrome involves what nerve?

Median n

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Anterior Interosseous Syndrome involves what nerve?

Median n

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Which syndrome causes forearm pain but NO sensory symptoms and unable to make OK sign?

Anterior Interosseous Syndrome

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Compression of the median n under the transverse carpal ligament

Carpal tunnel syndrome

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Nerve root of Radial n

C5-T1

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Crutch palsy involves what nerve?

Radial n

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Nerve roots of Ulnar n

C8-T1

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Ulnar n entrapment btwn two heads of FCU

Cubital tunnel syndrome

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Special tests for Cubital Tunnel Syndrome:

1=
2=
3=
4=

1= elbow flexion test
2= froment’s sign
3= Wartenberg sign
4= Tinel’s

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Ulnar n entrapment btwn hook of hamate and transverse carpal ligament

Guyon’s Canal syndrome

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Special tests for Guyon’s Canal Syndrome

1=
2=
3=

1=Froment’s
2=Wartenberg
3=Tinel’s

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A 45 y/o female pt had gradual onset wrist pain which recently increased and NPRS 8/10. Numbness and Tingling in the thumb, index, and middle fingers which increases w typing or holding cell phone and relieved by shaking hands. Reports frequent dropping of objects. Past medical hx of obesity, works as data entry specialist, typing for extended periods daily. Tinel’s sign positive @ wrist, Thenar muscle wasting, grip strength reduced in affected hand.

Which of the following is most likely the source of her problem?

A. C6 nerve root compression
B. AIN syndrome
C. Carpal Tunnel Syndrome
D. Pronator Teres Syndrome

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Which of the following special tests is most likely to be positive?

A. Fromen’ts Sign
B. Phalen’s Test
C. Wartenberg Sign
D. Finkelstein’s Test

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Which of the following would be the BEST initial intervention for the given diagnosis?

A. Ultrasound therapy with a 3 MHz frequency and 0.5 w/cm2 intensity over the volar aspect of the wrist

B. Ulnar and median n glides at the wrist joint

C. Night splint w the wrist maintained in neutral

D. Sustained stretches to the wrist flexors and extensors

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A pt who reports a recent fx of the R proximal fibula, has developed motor and sensory deficits. Which of the following is true?

A. Pt presents w PF weakness and reduced DTR

B. Pt presents w DF weakness and sensory loss on medial aspect of lower leg and R heel

C. Pt presents w invertors weakness and reduced sensation on heel

D. Pt presents w evertors weakness and reduced sensation on the lateral side of the leg and dorsum of foot

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APGAR

Appearance
Pulse
Grimace
Activity
Respiration

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A newborn is examined at birth using the APGAR screening test. The following observations are made at 5 mins: heart rate 120 bpm, strong crying, grimace with irritability testing, kicking and arm movement are present, and the baby is pink in color throughout the body. The PT should:

A. Monitor the APGAR store again at 10 minutes

B. Expect respiratory complications due to low score on respiration

C. Expect good heart rate, good respiration and normal muscle tone

D. Expect neurological complications due to low score on reflex irritability

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Normal HR for babies when born

100-140 bpm

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Normal APGAR score

8-10
** if 7 or below check at 10 mins

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Age in weeks since birth

Chronological age

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Chronical age - prematurity (from 40 weeks) = _________

Corrected or adjusted age

*used up until 2 y/o

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Weeks since mother's last menstruation

Gestational age

For a baby born at 28 weeks and who is 20 weeks old.... What is the: Gestational age= ______ Chronological age= ______ Adjusted Age= ________

Gestational age= 48 wks Chronological age= 20 wks Adjusted Age= 8 wks

Milestones months 2-3 1. 2.

1. Prone on elbows 2. Lift head in prone

Milestones Months 3-4 1. 2.

1. Supine to sidelying 2. "army crawling" (crawling)

Milestones 4-5 months 1. 2. 3. 4.

1. Prone to supine 2. Pull to sit (w/o head lag) 3. Sitting w UE support 4. Feet to mouth

Milestones months 6-7 1. 2. 3. 4.

1. Supine to prone 2. Quad 3. Ind Sitting 4. Trunk rot in sitting

Milestones 8-9 months 1. 2. 3. 4.

1. Quad creeping/ sit from quad 2. Cruises sideways 3. Stand alone 4. Grasping skills

Milestones months 10-15 1. 2. 3. 4. 5.

1. Walk unassisted 2. Transition in/out of squat 3. Floor to stand 4. Pincer grasp 5. Stack 2 cubes

PEDS poem

3 I lift my head 4 Lay on my side 5 prone to supine And 6 I sit upright 7 quadruped And at 8 I take a cruise I creep and stand alone at 9 Then walk and stack two cubes

3 I lift my head 4 Lay on my side 5 _____ to ____ And 6 I sit _______ 7 __________ And at 8 I take a cruise I creep and stand alone at 9 Then _____ and stack two cubes

3 I lift my head 4 Lay on my side 5 prone to supine And 6 I sit upright 7 quadruped And at 8 I take a cruise I creep and stand alone at 9 Then walk and stack two cubes

A 10 month old baby with plagiocephaly and uncomplicated birth. Has had normal developmental milestones according to mom. He can sit unsupported and transition prone to supine unassisted, but is unable to perform supine to prone and sit to quad unsupported. Pt is able to pull to stand and maintain standing, ambulates less than 10 steps, L plagiocephaly moderate, and complaint with helmet use. Which of the following positions is LEAST expected during gait in this child? A. High guard position of arms B. Abd and IR of hips C. Hips and knees slightly flexed D. Pronated feet

A 10 month old baby with plagiocephaly and uncomplicated birth. Has had normal developmental milestones according to mom. He can sit unsupported and transition prone to supine unassisted, but is unable to perform supine to prone and sit to quad unsupported. Pt is able to pull to stand and maintain standing, ambulates less than 10 steps, L plagiocephaly moderate, and complaint with helmet use. Which of the following types of grasp would be LEAST expected in this pt when attempting to pick up a crayon? A. Pincer grasp B. Palmar grasp C. Three jaw chuck grasp D. Scissors grasp

B ** should be integrated by 6 months

A 10 month old baby with plagiocephaly and uncomplicated birth. Has had normal developmental milestones according to mom. He can sit unsupported and transition prone to supine unassisted, but is unable to perform supine to prone and sit to quad unsupported. Pt is able to pull to stand and maintain standing, ambulates less than 10 steps, L plagiocephaly moderate, and complaint with helmet use. Which of the following is MOST likely to be true in regard to the pt's reflex development and ability to transition positions? A. Pt has a persistent ATNR reflex B. Pt has an integrated ATNR reflex C. Pt has a persistent STNR reflex D. Pt has a persistent TLR reflex

A (*** should be integrated by 6 months)

When the reflex disappears to allow for normal development

Integrated reflex

A reflex that has not integrated and indicative of central nervous system dysfunction

Persistent reflex

The flexor withdrawal reflex Stimulus: Noxious stimulus (pinprick) to sole of foot Response: Toes ext, foot DF, LE flex Integrates: ______

1-2 months

Crossed Extension Reflex Stimulus: Noxious stimulus to ball of foot of LE in extension Response: Opposite LE flexes, add, ext Integrates:_______

1-2 months

Rooting Reflex Stimulus: Stoke side of baby's cheek Response: Head turns towards stimulus and mouth opens Integrates: ______

3 months

Traction Reflex Stimulus: Grasp forearm and pull up from supine into sitting position Response: Grasp and total flexion of UE Integration: ______

2-5 months

Asymmetrical Tonic Neck Reflex (ATNR) Stimulus: Rotation of head to one side Response: bow and arrow posture Integration ______

4-6 months

Palmar Grasp Reflex Stimulus: Maintained pressure to palm of hand Response: Maintained flexion of fingers Integration: ______

4-6 months

Moro Reflex Stimulus: Drop pt backward from sitting position Response: Ext, abd UEs, hand opening, crying, followed by flex, add of arms across chest Integration: ______

5-6 months

Symmetrical Tonic Labyrinthine Reflex Stimulus: Prone or supine Response: Prone- inc flex tone of limbs (calendar baby) Supine - inc ext tone of limbs (starfish) Integration: ______

6 months

Positive Supporting Reflex Stimulus: Contact to ball of foot in upright standing Response: Rigid ext of LEs Integration:______

6 months

Plantar Grasp Reflex Stimulus: Maintained pressure to ball of foot under toes Response: Maintained flexion of toes Integration: ________

9 months

Symmetrical Tonic Neck Reflex (STNR) Stimulus: Flex or ext of the head Response: Flex- flex of UEs, Ext of LEs Ext- Ext of UEs, Flex of LEs Onset: ______ Integration: ______

Onset: 4-6 months Integration: 8-12 months

Startle Reflex Stimulus: Sudden loud noise Response: Sudden Ext or Abd of UEs, crying Integration: _____

Persists

6 month Neonatal Reflex Integration PAM'S TP=

Palmar grasp ATNR Moro Sucking Reflex TLR Positive Support

3 month neonatal reflex integration

Rooting reflex

Traction Neonatal Reflex "Traction"

2-5 months bc c/s max is 25 lbs

9 Month Neonatal reflex integration

Plantar reflex (9's as toes)

12 month Neonatal reflex integration "BS"

Babinski, STNR

Type of CP that is Velocity dependent resistance of a muscle to stretch and causes synergy patterns, contractures, crouched gait, and toe walking

Spastic CP

Type of CP that is a disorder of coordination, force, and timing, associated w cerebellar involvement causing floppy baby/low tone, poor balance, wide BOS, and nystagmus

Ataxic CP

Type of CP that is a disorder of the basal ganglia, characterized by involuntary movements that are slow and writhing, poor stability, intention tremor, fluctuating tone, hypo becomes hyper

Hypotonic/Dyskinetic CP

A PT is treating a pt in a pediatric clinic w a diagnosis of CP. The therapist notes nystagmus, ambulation with a wide BOS and high guard arms, and the mother explains her child was termed a "floppy" baby and has always had poor balance. Which of the following treatments is LEAST appropriate? A. Stretching of hip flexors via spending time in prone B. Alternating gentle perturbations in sitting to improve stability C. Facilitating use of primitive reflexes to perform fine motor skills D. Engaging the pt in a game that involves throwing different weighted balls into buckets at different distances

What GMFCS Level?? Patient will walk w/o restrictions but will have limitations in more advances gross motor skills

Level 1

What GMFCS Level?? Pt will walk w/o AD w limitations in walking outdoors and in the community

Level 2

What GMFCS Level?? Pt will walk w AD w limitations in walking outdoors and in the community

Level 3

What GMFCS Level?? Pt self mobility will be severely limited; children transported or use power mobility outdoors and in community

Level 4

What GMFCS Level?? Pt self mobility will be severely limited; even w use of AD, requires caregiver

Level 5

GMFCS Level 1

Patient will walk w/o restrictions but will have limitations in more advances gross motor skills

GMFCS Level 2

Pt will walk w/o AD w limitations in walking outdoors and in the community

GMFCS Level 3

Pt will walk w AD w limitations in walking outdoors and in the community

GMFCS Level 4

Pt self mobility will be severely limited; children transported or use power mobility outdoors and in community

GMFCS Level 5

Pt self mobility will be severely limited; even w use of AD, requires caregiver

A PT is examining a 10 y/o pt diagnosed as level 2 on GMFCS. According to the gross motor classification, what is the MOST likely ambulation status of this patient? A. Pt will walk w/o restrictions but will have limitations in more advanced gross motor skills B. Pt will walk w AD with limitations in walking outdoor s and in community C. Pt self mobility will be severely limited, even with the use of AD D. Pt will walk w/o AD w limitations in walking outdoors and in the community

T or F: R plagiocephaly causes ipsilateral ear displaced anteriorly on the R side

T or F: L plagiocephaly causes ipsilateral ear displaced anteriorly on the R side

F, L side displacement of ear

If a child has a head position with R side bend and L rotation, how are the following named? Torticollis= Plagiocephaly=

Torticollis= R Plagiocephaly= L

If a child has a head position with L side bend and R rotation, how are the following named? Torticollis= Plagiocephaly=

Torticollis= L Plagiocephaly= R

A 6 y/o child with down's syndrome is being treated by a PT. The child has moderate developmental delay, hypotonia, and incoordination, and is able to walk w assistance. He likes dinosaurs and is hoping he gets a bunny for his bday and promises to take good care of it. The MOST appropriate PT treatment should include: A. Standing and pushing a cart full of dinosaur toys B. STS to build strength C. Rolling and somersault activities D. Rhythmic stabilization of postural extensors in sitting

Dyspraxia

inability to imitate movement

Dyspraxia

Which of the following signs and symptoms is LEAST likely to be seen in a 7 y/o male pt w muscular dystrophy? A. Using hand to help himself into standing from the ground B. Enlarged calves and toe walking C. Increased lordosis D. Distal weakness progressing proximally

Disease that involves Schmorl's Nodes and angled or wedged thoracic spine

Scheuermann Disease

SCH SCH SCH

Scheuermann Disease Schmorl's nodes Schroth method

Does Scheuermann Disease result in thoracic kyphosis or lordosis?

Kyphosis

Which palsy caused at birth results in a waiter's tip deformity?

Erb's Palsy C5-C6

Which palsy caused at birth results in a claw hand deformity?

Klumpke's C8-T1

Palsy caused at birth by stretching the head downward

Erb's Palsy C5-C6

Palsy caused at birth by stretching of arm overhead

Klumpke's C8-T1

"Pull a clump of grass"

Claw hand deformity = Klumpke's Palsy

A pt reports loss of sensation over the ulnar side of the hand. On evaluation, there is weakness in the intrinsic hand muscles leading to nonfunctional hand. Which of the following is the MOST LIKELY diagnosis? A. Radial n palsy B. Erb's Palsy C. Klumpke's Palsy D. C6 Radiculopathy

A review of the pt's medical chart shows BP of 168/90 mmHg, triglyceride level of 160/mg/dL, and a fasting blood glucose levels of 115 mg/dL. The pt's BMI is 40 kg/m2 and his waistline is 54 in. These findings are suggestive of: A. Chronic heart disease B. Type 2 diabetes C. Metabolic Syndrome D. Stage 1 HTN

Signs and sx that are risk factors and are strongly linked to Type 2 diabetes, cardiovascular disease, and stroke

Metabolic syndrome

If 3 or more of these are present: 1. Waist line circumference > 40 inches in men or >35 inches in women 2. Triglyceride level of 150 mg/dL or higher 3. High Density Lipoprotein (HDL) level <40 mg/dL in men or <50 mg/dL in women 4. SBP= 130 mmHg and/or DBP =85 mmHg 5. Fasting plasma glucose level > 100 mg/dL Diagnoses.......

Metabolic syndrome

What are the requirements for diagnosis of metabolic syndrome? Name 3 of the 5

1. Waist line circumference > 40 inches in men or >35 inches in women 2. Triglyceride level of 150 mg/dL or higher 3. High Density Lipoprotein (HDL) level <40 mg/dL in men or <50 mg/dL in women 4. SBP= 130 mmHg and/or DBP =85 mmHg 5. Fasting plasma glucose level > 100 mg/dL

HDL is good cholesterol or bad cholesterol?

good

LDL good or bad cholesterol?

bad

Area of the brain that produces hormones that control body temp, HR, hunger, mood, sex drive, sleep, thirst (or regulates the ANS)

Hypothalamus

Which pituitary gland involves antidiuretic hormone and oxytocin?

Posterior pituitary

Which pituitary gland involves GH, ACTH, TSH, FSH & LH, Prolactin?

Anterior pituitary

The anterior pituitary releases ACTH which goes to the ______ cortex and releases ______ and ________

adrenal cortisol; aldosterone

The anterior pituitary releases TSH (Thyroid Stimulating Hormone) which goes to the ______ gland and releases ____ & _____

Thyroid T3 & T4

The anterior pituitary releases FSH (Follicle Stimulating Hormone) and LH (Leutinizing Hormone) and Gonadotrophins to the _____ & ______ and releases ________, ______, & ________

Ovaries & Testes Estrogen, Progesterone, Testosterone

The anterior pituitary releases GH (Growth hormone) to the _____ & ______ which impacts _____ and ______

Bones & tissues Growth and metabolism

The anterior pituitary releases prolactin to the ______ to produce ______

breasts Milk

The posterior pituitary releases ADH (Antidiuretic Hormone)/Vasopressin to.......

regulate water and mineral balance

Which hormone released by the posterior pituitary regulates water and mineral balance, water retention

ADH/Vasopressin

The posterior pituitary releases Oxytocin/pitocin to.......

Stimulate uterine contraction during birth and secretion of milk from breast

Which hormone released from the posterior pituitary stimulates uterine contraction during birth and secretion of milk form the breast?

Oxytocin/pitocin

Gland that secretes endorphins and reduces a person's sensitivity to pain

Pituitary gland

Pituitary gland function

secretes endorphins and reduces a person's sensitivity to pain

Gland that produces hormones that act to control the rate at which cells burn the fuel from food

Thyroid gland

Thyroid gland function

produces hormones that act to control the rate at which cells burn the fuel from food

Gland that regulates calcium and phosphate metabolism

Parathyroid gland

Parathyroid gland function

regulates calcium and phosphate metabolism

Gland that produces corticosteroids that will regulate water and sodium balance, the body's response to stress, the immune system, and metabolism

Adrenal gland

Adrenal gland function

produces corticosteroids that will regulate water and sodium balance, the body's response to stress, the immune system, and metabolism

Which hormone (Cortisol or Aldosterone) Inc BP Inc BG Dec stress Dec inflammation?

Cortisol

What does cortisol do?

Inc BP Inc BG Dec stress Dec inflammation

Which hormone (Cortisol or Aldosterone) retains H20 & Na kicks out K+?

Aldosterone

What does aldosterone do?

retains H20 & Na kicks out K+

Mrs. Addison

Thin, brown lady walking with a stick Bronze pigmented skin weight loss, anorexia, GI disturbance generalized weakness intolerance to cold

What causes Addison's disease?

Pituitary not being able to release ACTH due to infection, neoplasm, hemorrhage, or autoimmune process

Which disease causes adrenal insufficiency Dec BP Dehydration Kyperkalemia Dec glucose Bronze pigmented skin weight loss, anorexia, GI disturbance generalized weakness intolerance to cold

Addison's disease

Mr. Cushing

White, chubby guy who loves chugging beer Ruddy appearance (red skin) weight gain centripetal obesity striae on skin round moon face

Which disease causes Elevated aldosterone and cortisol Inc BP Water retention Hypokalemia Inc glucose Ruddy appearance (red skin) weight gain centripetal obesity striae on skin round moon face Prox mm weakness & atrophy Inc susceptibility to infection osteoporosis poor wound healing

Cushing's Disease

A male pt reports having significant weight gain in his abdomen and face. The labs show high levels of cortisol and elevated blood glucose and high levels of ACTH coming from the pituitary gland. The pt MOST likely has this diagnosis: A. Addison's disease B. Hashimoto's disease C. Cushing's disease D. Cushing's syndrome

Difference between Cushing's disease and Cushing's syndrome

Disease= > ACTH secreted from pituitary gland, causing the adrenal gland to release more cortisol Syndrome= Adrenal gland secretes more cortisol causing drug toxicity

Does hypothyroidism or hyperthyroidism have the following symptoms: Dec BP Inc T3 & T4 Inc HR High BMR heat intolerance Dec BG overall fatigue diarrhea weight loss and increased appetite silky hair, moist palms increased sweating hyperreflexia Exophthalmos Grave's disease

Hyper

Does hypothyroidism or hyperthyroidism have the following symptoms: Inc BP Dec T3 & T4 Dec HR Low BMR Cold intolerance High BG Proximal mm weakness Constipation Brittle hair, nails, dry skin, hair weight gain, decreased appetite Decreased perspiration Prolonged DTRs Swelling of hands feet and face Hashimoto's disease

hypothyroidism

Lazy Husbands laying on couch all day with a comforter

Hypothyroidism: cold intolerance weight gain proximal mm weakness

A pt is referred with a diagnosis of chronic periarthritis of the shoulder. The pt feels tired all the time and has noticed recent weight loss despite increased appetite. Which of the following would be seen along with these sx if his thyroid levels are elevated? A. Inc DTR, inc HR, low BP, heat intolerance B. Dec DTR, Inc HR, High BP, Cold intolerance C. Inc DTR, Inc HR, Low BP, Cold intolerance D. Dec DTR, Inc HR, High BP, heat intolerance

Bones Stones Groans Moans Sensory Loss

Hyperparathyroidism: Elevated calcium and dec serum phosphate -Osteopenia, arthralgia -Kidney stones, renal insufficiency -Peptic ulcers -Proximal mm weakness, fatigue, depression/confusion, drowsiness -glove/stocking sensory loss

CATS are Numb

Hypoparathyroidism: low calcium and high phosphorus Convulsions cardiac Arrhythmias Twitching/Tetany, cramps muscle Spasms paresthesia of fingertips and mouth

A pt presents to the clinic w hyperfunction of the gland shown in red in the figure. Which of the following signs and sx are MOST likely to be associated with this condition? A. hypocalcemia and hyperphosphatemia B. Convulsions and tetany C. Osteopenia and peptic ulcers D. Weight gain and dec appetite

"Juvenille diabetes"

Type 1 DM

increased blood glucose levels is indicative of

Pancreas doesn't produce insulin so the body is dependent on external insulin

Type 1 DM

PPP

3 P's of Type 1 DM Polyphagia Polyuria Polydipsia

Insulin dependent DM

Type 1 DM

Insulin Resistant DM

Type 2 DM

Body produces insulin but the tissues don't absorb it due to sedentary lifestyle, HTN, inactivity

Type 2 DM

Ketoacidosis more common in Type 1 or Type 2 DM?

Type 1 DM

Normal fasting blood glucose level

70-110 mg/dL

Fasting blood glucose indicative of DM

126+ mg/dL

Normal HbA1C levels

4-6%

HbA1C levels indicative of DM

>10%

HE IS TIRED

hypoglycemia: Headache Excessive hunger Insomnia Tachycardia Irritable Dizziness

Hypoglycemia is glucose levels ....

<70 mg/dL

"Cold & Clammy give them a candy"

in hypoglycemia when extremities get cold & clammy due to know blood flow since all blood goes to brain since not eating

Glucose <70 mg/dL

hypoglycemia

Glucose >300 mg/dL

hyperglycemia

Hyperglycemia is glucose levels.....

>300 mg/dL

"HOT & DRY = SUGAR HIGH"

dry mouth frequent, scant urination deep and rapid respirations Excessive thirst

What do you want to give someone for hyperglycemia?

insulin

what do you want to give to someone with hypoglycemia?

candy/sugary snack

What happens to blood glucose levels during exercise for someone w DM?

Exercise causes and increased insulin sensitivity so it starts to get absorbed in the tissues and blood glucose levels drop (could result in hypoglycemia)

Peak insulin hours are ___-___ hrs

2-4 Should avoid exercise during this time

When is it not safe to exercise with DM?

Blood glucose <70 or >300 mg/dL OR with ketones

A 45 y/o male who is obese (BMI 33 kg/m2) w Type 2 DM is working out on the treadmill in a hospital setting. While exercising, the pt suddenly develops lightheadedness, dizziness, and instability. The MOST appropriate action is: A. Stop treadmill, call PCP B. Stop treadmill, give pt OJ C. Stop treadmill, give insulin injection D. Keep treadmill moving and have pt drink water

FITT principles for DM: Frequency= __-___ days/wk Intensity = __-___ RPE Time= Minimum of ____ mins/week Type= _____ intensity ______ exercise involving ____ muscle groups

Frequency= 3-7 days/wk Intensity = 11-13 RPE Time= Minimum of 150 mins/week Type= moderate intensity aerobic exercise involving larger muscle groups

involuntary leakage of urine during coughing, sneezing, or exertion.

stress incontinence

involuntary contraction of the detrusor muscle with a strong desire to void

Urge incontinence

Incontinence caused by an acontractile or underactive detrusor muscle. Bladder can not empty completely and urine dribbles or leaks out.

Overflow incontinence

Incontinence due to mobility, dexterity, or cognitive deficits

functional incontinence

A 29 y/o female pt reports leakage of urine while coughing, sneezing, and climbing stairs. She is pregnant with her first child in the 3rd trimester. Which of the following diagnosis is MOST likely based on the pt presentation? A. Stress incontinence B. Overflow incontinence C. functional incontinence D. Urge incontinence

A 29 y/o female pt reports leakage of urine while coughing, sneezing, and climbing stairs. She is pregnant with her first child in the 3rd trimester. Which of the following is MOST appropriate intervention for this pt? A. Use of absorbent pads B. pelvic floor exercises targeting levator ani mm C. Scheduled toileting and prompted voiding D. Continuous catheterization

A 29 y/o female pt reports leakage of urine while coughing, sneezing, and climbing stairs. She is pregnant with her first child in the 3rd trimester. What is the BEST initial PT intervention? A. Supine and perform a max of 5 contractions held for 3 sec each B. L side lying and perform a max of 10 contractions held for 5 sec each C. R side lying and perform a max of 10 contractions held for 5 sec each D. Sitting and perform a max of 10 contractions held for 10 sec each

Laying on which side causes IVC compression?

R side

For which type of incontinence would you want to strengthen pelvic floor mm?

Stress incontinence

For which type of incontinence would you want to treat infections, use a voiding schedule?

urge incontinence

For which type of incontinence would you want to clear clutter, improve accessibility, and prompted voiding?

functional incontinence

For which type of incontinence would you want to use behavioral modification like double voiding, medication, and catheterization?

overflow incontinence

Normal weight gain for pregnancy

20-30 lbs

Where does the COM move when pregnant?

Anterior and upward

Cardiac output generally _______ in pregnancy

decreases

What happens to BP in pregnancy during the first, second, and third trimesters?

first: decreased second: decreased third: increases

What side should pregnant people lay on to decrease compression of IVC, maximize CO, and decrease GERD?

L side

How does HR change with pregnancy?

Inc 10-20 bpm

A 29 y/o female pt reports leakage of urine while coughing, sneezing, and climbing stairs. She is pregnant with her first child in the 3rd trimester. She has inc lumbar lordosis, walks with wide BOS, presents with B LE edema. Vitals are = HR: 90 bpm, BP: 118/85 mmHg, RR: 22 br/min. Which of the following is LEAST appropriate regarding physiological changes related to pregnancy? A. BP dec in 1st & 2nd trimester and then inc in the 3rd trimester B. CO is inc in pregnancy C. Resting HR is dec during pregnancy D. Metabolic rate and heat production inc during pregnancy

A 29 y/o female pt reports leakage of urine while coughing, sneezing, and climbing stairs. She is pregnant with her first child in the 3rd trimester. She has inc lumbar lordosis, walks with wide BOS, presents with B LE edema. Vitals are = HR: 90 bpm, BP: 118/85 mmHg, RR: 22 br/min. After and uncomplicated vaginal delivery of her child, pt is seen again for PT. During the treatment, the pt begins to report headache and visual disturbances, and suddenly develops a seizure. Which condition is MOST likely seen? A. Preeclampsia B. Gestational diabetes C. Eclampsia D. Ectopic pregnancy

pregnancy induced acute HTN after the 20th week of gestation

preeclampsia

What must the BP be for preeclampsia diagnosis?

2 abnormal readings of 140/90 mmHg+ within 4 hours

T or F: Preeclampsia is not an emergency

F, IT IS AN EMERGENCY

A 20 y/o female after and] uncomplicated delivery has a 3 cm diastasis recti and weak abdominal mm. Which of the following exercises is MOST appropriate for the pt? A. Sitting on a swiss ball B. Head lifts w arms bracing the abdomen C. Double leg lifts D. Deep breathing exercises in bridging postions

Abnormal length for diastasis recti diagnosis

>2 cm

T or F: Perform all abdominal contractions with an EXHALATION to minimize intra-abdominal pressure

What type of incontinence is seen with DM?

overflow incontinence

How to differentiate GERD from angina

angina gets worse with any activity GERD gets worse in supine

All of the following are guidelines in treating pts w GERD except: A. Any intervention requiring a supine position should be scheduled before meals and avoided just after eating B. Encourage the pt to sleep on R side to prevent nocturnal reflex C. Modification of position towards a more upright posture may be required if symptoms persist during therapy D. Encourage the pt to sleep on L side to reduce nocturnal reflex

T or F: Laying on the L side relaxes the stomach and internal organs

Lying on which side relaxes the stomach and internal organs?

L side

T or F: Laying on the R side relaxes the stomach and internal organs

F, L side

A 44 y/o male who consumes excessive amounts of alcohol, is referred to PT for knee pain. During treatment, the pt reports R side shoulder pain. Which of the following structures is the MOST likely source of the referred pain? A. prostate B. Appendix C. Liver D. Kidney

Where does the prostate refer pain?

LBP, pelvic region, groin, lower abdomen

Where does the Appendix refer pain?

RLQ, lower abdomen, LBP

Where does the Liver refer pain?

RUQ, abdomen

Where does the kidney refer pain?

Mid back, T10-T12 Mid back to groin (Flank pain) Ipsi shoulder

Pain referring to the mid-back/scapula could be coming from: 1. 2. 3. 4.

1. esophagus 2. gallbladder 3. stomach 4. pancreas

Pain referring to the L shoulder could be coming from: 1. 2. 3. 4.

1. Heart 2. Diaphragm 3. spleen 4. tail of pancreas

Pain referring to the R shoulder could be coming from: 1. 2. 3.

1. gall bladder 2. liver 3. head of pancreas

Pain referring to the pelvis/low back/sacrum could be coming from: 1. 2. 3.

1. colon 2. appendix 3. pelvic viscera

A Pancoast tumor (Upper lung tumor) mimics TOS with C8-T12 pain. What is differential diagnosis here?

If it is a lung issue, there would be SOB, chest pain, cough, cancer sx, weight loss

"Good Luck Hot Pack"

RUQ pain: Gallbladder, Liver, Head of Pancreas, peptic ulcers

"AC"

RLQ pain: Appendix, Crohn's Disease

"DUI"

LLQ pain: Diverticulitis, Ulcerative colitis, IBS

"Don'T Banana SPLit"

LUQ pain: Diaphragm, Tail & Body of pancreas, Spleen

RUQ pain: Gallbladder, Liver, Head of Pancreas, peptic ulcers

Good Luck Hot Pack

RUQ pain:

"Good Luck Hot Pack" Gallbladder, Liver, Head of Pancreas, peptic ulcers

RLQ pain:

"AC" Appendix, Crohn's Disease

RLQ pain: Appendix, Crohn's Disease

"AC"

LLQ pain: Diverticulitis, Ulcerative colitis, IBS

"DUI"

LLQ pain:

"DUI" Diverticulitis, Ulcerative colitis, IBS

LUQ pain: Diaphragm, Tail & Body of pancreas, Spleen

"Don'T Banana SPLit"

LUQ pain:

"Don'T Banana SPLit" Diaphragm, Tail & Body of pancreas, Spleen

A 44 y/o male pt is being evaluated by a PT. The pt reports referred pain in the L shoulder w diagnosis of a positive Kehr's sign. Which of the following is LEAST LIKELY be a potential cause of a positive Kehr's sign and L shoulder pain? A. Recent laparoscopy B. Intra-abdominal bleeding C. Rupture of the spleen D. Trauma to head of pancreas

What is Kehr's sign?

Elevation fo the leg causes L shoulder pain d/t intra-abdominal fluid or air in cavity

A hiatal hernia causes ______ pain

shoulder

A femoral hernia causes lateral _______ pain and ____ pain

pelvic wall; groin

An inguinal hernia causes ____ pain

groin

A 44 y/o male pt is being evaluated by a PT. The pt underwent a hernia repair 3 weeks ago and should AVOID which of the following activities? A. Walking at a metabolic equivalent of "4" three weeks after surgery B. Stretching of the anterior spinal and hip musculature before the incision is fully healed C. Stretching of the posterior spinal and hip musculature before the incision is fully healed D. Wall sits performed in an upright position

Umbilical hernia causes pain around umbilical ring in the mid to lower _______

abdomen

4 MET = ______

4 MPH

Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

Cholecystitis

Special test for Cholecystitis

Murphy's sign

Murphy's sign (RUQ)

Palpate near R subcostal margin as pt takes deep breath. If pain and tenderness is elicited during inspiration, test=positive

Name the test: Palpate near R subcostal margin as pt takes deep breath. If pain and tenderness is elicited during inspiration, test=positive

Murphy's sign (RUQ)

cholecystitis is inflammation of the _____

gallbladder

ulcerative lesions in the stomach caused by chronic use of NSAIDs, stress, anxiety, H. pylori bacteria

Gastric ulcers

ulcerative lesions in the duodenum caused mainly by H. Pylori infection

Duodenal ulcers

When pain increases w the presence of food due to acid secretion, and pain after eating, it is a _________ ulcer

gastric

When pain increases with absence of food, early morning, and in between meals, it is a ______ ulcer

duodenal

coffee ground emesis and melena tarry stools are characteristic of

peptic ulcer disease and duodenal ulcers

uLcerative colitis

LLQ pain

cRohn's disease

RLQ pain

Inflammatory bowel disease that: -Is only in the large intestine & rectum -continuous lesions

Ulcerative colitis

Inflammatory bowel disease that: -occurs anywhere in the GI tract -Skip lesions -pain relieved by flatulence

Crohn's disease

"Can't see Can't Pee Can't Climb a Tree"

Inflammatory Bowel Disease--> Crohn's disease Conjunctivitis Urethritis Knee OA

"NPTE Syndrome"

IBS caused by emotional stress, anxiety

spastic, nervous or irritable colon

Irritable bowel syndrome (IBS)

Ribbon like stools

IBS

Pain is relieved by defecation Sharp cramps in morning or after eating N/V, bloating, foul breath, diarrhea Sx disappear while sleeping

IBS

A pt reports L lower abdominal pain. The pt reports LBP accompanied with weight loss, nausea, vomiting, and has had bloody stool lately. The pt's pain is MOST likely due to which diagnosis? A. Crohn's disease B. Ulcerative colitis C. Appendicitis D. Acute pancreatitis

3 special tests for appendicitis

McBurney's point tenderness Rovsing's sign for pain migration Blumberg's sign for rebound tenderness

Point between ASIS and umbilicus on R side

McBurney's point

Where is McBurney's point?

between ASIS and umbilicus on R side

psoas sign

passive hip ext or resisted hip flexion causes pain (appendicitis)

Special test for appendicitis where passive hip ext or resisted hip flexion causes pain

Psoas sign

Special test for appendicitis where you push on abdomen and release, causing pain

Blumberg's sign

push on abdomen and release, causing pain

special test where you palpate LLQ and pain is elicited in RLQ

Rovsing's sign (Appendicitis)

special test where you palpate LLQ and pain is elicited in RLQ

A 30 y/o male pt presents w R lower abdominal pain. The PT performed the "pinch-an-inch," resulting in a positive finding. Which condition below is MOSTLY related to the sx described? A. Appendicitis B. Diverticulitis C. Crohn's Disease D. IBS

pouch like herniations on colon area causing LLQ pain

Diverticulitis

"pinch-an-inch" test

LLQ, test for diverticulitis

melena tarry stools are characteristic of

duodenal ulcers

coffee ground emesis is indicative of

gastric ulcers

UMN or LMN: Spasticity, hyperreflexia, sensation

UMN

Ascending tracts of the SC: ____ & ___

DCML, ALS

Descending tracts of SC

Corticospinal

Which tract is responsible for vibration, proprioception, stereognosis and 2 pt discrimination?

DCML

The DCML is responsible for: 1. 2. 3. 4.

1. vibration 2. proprio 3. stereognosis 4. 2 pt discrimination

The Anterior STT is responsible for: 1.

1. crude touch

Which tract is responsible for crude touch?

Ant STT

Which tract is responsible for pain and temperature?

Lat STT

What is the Lateral STT responsible for?

pain and temperature

Which tract is responsible for movements?

CST

The CST is responsible for: 1.

1. movements

"Poor Val got GBS Twice"

DCML Proprio Vibration Graphesthesia Barognosis Sterognosis

Draw alphabet letter on patient’s hand while their eyes are closed and have them guess the letter is

graphesthesia

Lifting two objects and telling which is heavier is

barognosis

close eyes, place object in hand and tell what it is by touching it is

sterognosis

"Licensed PT"

Lateral STT Lat= Pain and Temp

A pt presents w the inability to sense and name the alphabets that the PT is drawing on the pt's hand. Which of the following is MOST likely to be affected along with this presentation? A. Temp sensation B. Joint proprio C. Pain sensation D. Crude touch sensation

Which cord syndrome is caused by medical error (Iatrogenic)?

Posterior Cord Syndrome

What tract is shown in blue?

DCML

What tract is shown in yellow?

CST

Posterior cord syndrome impacts what tract?

DCML Poor Val got GBS twice

Which cord syndrome is caused by hyperflexion injury?

Anterior cord syndrome

Anterior cord syndrome impacts what tracts?

Bilateral STT and CST

Brown Sequard Syndrome is AKA

Hemi-cord syndrome

Brown Sequard Syndrome impacts what tract?

R DCML R CST R ALS

Which cord syndrome is caused by gunshot wounds or stab injuries?

Brown Sequard Syndrome

Hemi cord syndrome is AKA

Brown Sequard Syndrome

POT

Brown Sequard Syndrome lose Pain & Temp on Oppo side

Which cord syndrome has the best prognosis for walking?

Central cord syndrome

Walking SCI IS AKA

CENTRAL CORD SYNDROME

Central cord syndrome is AKA

Walking SCI

For a small lesion with Central Cord syndrome, what is impacted?

Pain and Temp bilaterally (LST crosses at central cord)

For a large lesion with Central Cord syndrome, what is impacted?

Bilateral DCML lost Pain and Temp lost CST lost (motor)

Which cord syndrome impacts UE more than LE

central cord syndrome

Which cord syndrome is caused by hyperextension injury?

central cord syndrome

"MUD-E"

Central cord syndrome Motor UE Distal > Prox hyperExtension injury

In stroke, _____ side is affected whereas with SCI, _____ side is affected (except POT)

oppo; same

A pt w hx of stab wound disrupting L side of SC is being evaluated by the PT. Which of the following is the MOST LIKELY presentation for this pt? A. Sx of damage to CST and STT seen on R side of body and sx of damage to DCML on L side of body B. Sx of damage to CST and DCML seen on R side of body and sx of damage to STT on L side of body C. Sx of damage to CST & STT on L side of body w sx of damage to DCML on R side of body D. Sx of damage to CST and DCML on L side of body and sx of damage to STT on R side of body

D (Same side except POT) POT= ALSTT - Pan and Temp lost on R in this scenario

At what vertebral level does the SC end?

L1 vertebral level

What has bilateral saddle distribution, symmetric sensory and symmetric motor, and is UMN & LMN?

Conus Medullaris

What has Unilateral saddle distribution, asymmetric sensory, asymmetric motor and is LMN?

Cauda Equina

No sensory or motor function in the lowest sacral segments (S4 & S5) is a ______ injury

complete

What is a complete SCI?

No sensory or motor function in the lowest sacral segments (S4 & S5)

What is an incomplete SCI?

Motor and/or sensory fx below the neurological level including sensory and/or motor function at S4 & S5

Motor and/or sensory fx below the neurological level including sensory and/or motor function at S4 & S5 is a ______ SC injury

incomplete

Anterior cord syndrome, Posterior cord syndrome, brown sequard syndrome, and central cord syndrome are examples of _______ SC injuries

Incomplete

ASIA A

Complete SCI S & M loss at S4 & S5 (no sacral sparing)

ASIA B

Incomplete No motor function 3 segments below lesion level Sensory spared

ASIA C

Incomplete Sensory intact Motor intact (Majority of mm below lesion <3/5)

ASIA D

Incomplete Sensory intact Motor intact (majority of mm below lesion >3/5)

ASIA E

Best= normal "E is ME"

"E is ME"

ASIA E = ME = Normal sensory and motor

Pt with 40% mm below lesion have >3/5 = ASIA ____

ASIA C * 60% <3/5

Pt w/ * 49% mm below lesion <3/5 * 51% mm below lesion >3/5= ASIA____

ASIA D

Pt w/ * 51% mm below lesion 3/5= ASIA ____

ASIA D

Pt w/ * 50% mm below lesion >3/5= ASIA ___ * 50% <3/5

ASIA D

The most caudal segment of the spinal cord with normal sensory function on BOTH sides of the body

Sensory level

The most caudal segment of the spinal cord with normal motor function on BOTH sides of the body

Motor level

The most caudal segment of the spinal cord with normal sensory and motor function on BOTH sides of the body

Neurological/Functional Level

A PT is treating a 22 y/o male pt who has been classified as ASIA C. Which of the following is TRUE about this pt? A. Motor function is preserved with only 1/3 of the key muscles below the neurological level of injury have a muscle grade of less than 3 B. Motor function is preserved with at least 1/2 of the key muscles below the neurological level of injury have a muscle grade of more than 3 C. Motor function is preserved with all of the key muscles below the neurological level of injury have a muscle grade of more than 3 D. Motor function is preserved with more 1/2 of the key muscles below the neurological level of injury have a muscle grade of less than 3

Autonomic Dysreflexia occurs at or above ___

diagnosis of Autonomic dysreflexia is a rise in SBP of ___ to ___ mmHg

20-30

PT intervention for AD episode 1. 2. 3.

1. Sit up and Lower legs (drops BP) 2. Remove painful stimuli 3. Monitor vitals

24 y/o female in OP neuro, anterior cord syndrome status post 3 months Past medical hx: multiple fx of LE status post car accident, whiplash associated disorder, post concussion syndrome, cervical level injury Based on the pt's diagnosis, which of the following functions is MOST likely to be intact? A. Ability to sense cold and hot objects B. Ability to name the number drawn on hand C. Ability to button the shirts D. Ability to ambulate using bilateral AFOs

24 y/o female in OP neuro, anterior cord syndrome status post 3 months Past medical hx: multiple fx of LE status post car accident, whiplash associated disorder, post concussion syndrome, cervical level injury The image shows the patient’s assessment on ASIA. What is the MOST appropriate conclusion based on this finding? A. C7 ASIA B B. C6 ASIA A C. C5 ASIA A D. C6 ASIA B

24 y/o female in OP neuro, anterior cord syndrome status post 3 months Past medical hx: multiple fx of LE status post car accident, whiplash associated disorder, post concussion syndrome, cervical level injury During the treatment session today, the therapist had to stop the intervention because the patient developed blurriness in the vision and reported a severe headache. The therapist suspects the patient to have autonomic dysreflexia. What other signs and symptoms are MOST likely to be present in that case? A. Bradycardia and hypertension B. Hypotension and bradycardia C. Tachycardia and hypertension D. Hypotension and tachycardia