1. No response 2. Generalized response 3. Localized response 4. Confused agitated 5. Confused inappropriate 6. Confused appropriate 7. Automatic appropriate 8. Purposeful appropriate

Readings (Days 60-70) & Lectures 21-25 Flashcards by Danielle Hood

Tract that is intact w Anterior Cord Syndrome

DCML

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DCML is affected in which cord syndromes?

1.
2.
3.

Posterior cord syndrome
Brown sequard syndrome
Large lesion central cord syn drome

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A spastic bladder is seen in pts w (UMN/LMN) and injury (above/below) S2 sacral segments

UMN, above

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A flaccid bladder is seen in pts w (UMN/LMN) and injury (above/below) S2 sacral segments

LMN; below

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pressure on abdomen to void

crede’s maneuver

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pressure on bladder to void

Valsalva maneuver

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A patient with an injury at T7 vertebral level is in inpatient rehabilitation. He asks his physical therapist what to expect with their bladder control. Which of the following statements MOST accurately classifies the bladder dysfunction as well as treatment needed for this patient?

A. Spastic urinary dysfunction, Suprapubic tapping

B. Flaccid urinary dysfunction, Suprapubic tapping

C. Spastic urinary dysfunction, Crede’s maneuver

D. Flaccid urinary dysfunction, Valsalva maneuver

T7= UMN= spastic= suprapubic tapping

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intervention used for spastic bladder UMN injury

suprapubic tapping

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intervention used for flaccid bladder, LMN injury

valsalva or crede’s maneuver

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A patient has been diagnosed with C8 ASIA A injury. Which of the following is MOST appropriate about the clinical presentation of this patient?

A. Patient will be able to transfer independently on level surfaces

B. All sensation will be present at S4-S5 level

C. Patient will not be able to perform elbow flexion and wrist extension

D. Some motor function will be present at S4-S5 level

ASIA A - complete SCI
No sacral sparing, No S or M S4/S5

Become independent at C7

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What is the angle range with which the WC should be from the mat edge for transfers?

____ - ____ degrees

20-45

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“RLA RCA”

RLA (Ranchos Los Amigos)

RCA= Response, Confused, Appropriate

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What are the 3 stages in the “R” of “RLA RCA”?

No response
Generalized response
Localized response

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What are the 3 stages in the “C” of “RLA RCA”?

Confused agitated
Confused inappropriate
Confused appropriate

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What are the 2 stages in the “A” of “RLA RCA”?

Automatic appropriate
Purposeful appropriate

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RLA stages 1-8

No response
Generalized response
Localized response
Confused agitated
Confused inappropriate
Confused appropriate
Automatic appropriate
Purposeful appropriate

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“5S= 6G”

RLA interventions

LEVEL 5= S= Socialize
Level 6= G= Goal oriented

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Which RLA level is the pt in a Coma?

RLA level 1

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Which RLA level?

Non-purposeful whole body, vocal inconsistent

RLA Level 2

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Which RLA level?

Follows simple commands- close eyes, squeeze hand

Purposeful movement
Local and specific
Inconsistent

Level 3 RLA

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Which RLA level?

Aggressive, confabulations, no long or short term memory

Should use closed environment, consistency, orient pt, give options

Level 4 RLA

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Which RLA level?

-Responds consistently to simple commands
-Responds inconsistently to complex commands
-socialize for short periods
-Inappropriate use of new objects
-Can’t learn new tasks

Level 5 RLA

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Which RLA level?

-Follows simple instruction easily
-Goal oriented behavior with external input
-Carryover of previous skills present

RLA Level 6

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Which RLA level?

-Oriented in home & hospital
-Daily routine automatic but robot like
-Judgement impaired
-Able to initiate social or recreational activity with structure

RLA level 7

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Which RLA level? -Carryover of new skills present -Impaired judgement in emergency -good judgement normally

RLA level 8

25 y/o Male in IP rehab has a TBI status post motorcycle accident with ejection 25 days ago. Upon further examination, the patient seems to be in a heightened state of activity and is making up stories. They are not coordinating with the therapist at all. The PT would MOST likely classify this patient on the LOCF as: A. Level VI B. Level IV C. Level V D. Level III

25 y/o Male in IP rehab has a TBI status post motorcycle accident with ejection 25 days ago. Upon further examination, the patient seems to be in a heightened state of activity and is making up stories. They are not coordinating with the therapist at all. Which of the following strategies will be MOST beneficial while working with the patient? A. Having a different PT work with the patient every day so he gets used to meeting new people B. Involving patient in group therapy so he can make friends C. Informing the patient two days in advance about what to expect in the next few PT sessions D. Giving the patient two options and having the patient select one

25 y/o Male in IP rehab has a TBI status post motorcycle accident with ejection 25 days ago. Upon further examination, the patient seems to be in a heightened state of activity and is making up stories. They are not coordinating with the therapist at all. As the patient continues to improve, the therapist decides to progress with patient’s gait training. Which of the following is LEAST appropriate about guarding the patient? A. Therapist should stand behind the patient at all times B. One of the therapist’s hands should be placed posteriorly on the guarding belt C. Therapist’s one hand should be anterior to, but not touching, the patient’s right shoulder D. Therapist must maintain a wide BOS

A, should be posterolateral

The Labyrinth is made up of ________ & __________

semicircular canal and otolith organs

Vestibular pathologies that are Peripheral are _______ related and those that are central are _____ related

Labyrinth; Brain

There are __ Semicircular canals and __ Otolith organs

3;2

What are the otolith organs?

Saccule Utricle

Name the semicircular canals

Anterior Posterior Horizontal

Paroxysmal means....

comes and goes

What is the most common disorder resulting in dizziness in the older population?

BPPV

Mechanical disorder caused by otoconia displaced from the macula of the utricle

BPPV

When the otoconia is dislodged from the utricle and ends up in the semicircular canals

BPPV

involuntary, rapid and repetitive movement of the eyes

Nystagmus

CupuLOlithiasis

LOnger in duration

BPPV that is short in duration (<1 min)

Canalithiasis

BPPV that is persistent in duration (>1 min)

Cupulolithiasis

Most common canal for BPPV

Posterior canal BPPV

Test in which the pt's head is turned 45 deg toward affected ear in sitting position, quickly moved to supine with head extended (20-30 deg) and rotates 45 deg toward ear

Dix-Hallpike Test

"PUP"

Posterior Canal= Upbeating torsional nystagmus

Downbeating torsional nystagmus is indicative of

Anterior canal BPPV

A patient presents with chief concerns of dizziness with rolling in bed and bending forward to load the dishwasher. She has had two falls so far. On assessment, the patient tests positive for the Dix-Hallpike test on the right side for posterior canalithiasis. Which of the following is MOST likely expected to be present in this patient? A. Downbeating torsional nystagmus for 120 seconds B. Upbeating torsional nystagmus for 70 seconds C. Downbeating torsional nystagmus for 10 seconds D. Upbeating torsional nystagmus for 40 seconds

D R upbeating (posterior "PUP) Canal= <1 min

Treatment for canalithiasis

Epley maneuver

5 Letter Words CANAL EPLEY

Epley treats Canal- ithiasis

Treatment where pt head is rotated 45 deg to symptomatic side and 30 deg below horiztonal, rotated 45 deg to other side, roll to sidelying on uninvolved side, nose down, slowly sit up keeping chin tucked and rotated

Epley Maneuver

Treatment for Cupulolithiasis

Semont/Liberatory Maneuver

6 Letter words CUPULO SEMONT

Semont treats Cupulo-lithiasis

BPPV Treatment where the head is rotated 45 deg to the L, pt then moved from sitting to R side lying and stays there for 1 min, then moves 180 deg from R to L sidelying, hold for 1 min, return to sitting

Semont/Liberatory Maneuver

non-specific treatment for BPPV that treats either side and can be used for HEP

Brandt Daroff Exercise

nystagmus towards the ground =

geotrophic= canalithiasis

nystagmus away from ground =

ageotrophic, Cupulolithiasis

Test where pt is in supine, head in 20 deg cervical flexion, turned 90 deg to one side, then to neutral, then 90 deg to other side, and back to neutral

supine roll test

For geotrophic canalithiasis is the more intense or less intense side the affected side?

more intense

For ageotrophic cupulolithiasis is the more intense or less intense side the affected side?

less intense

If a pt tests: -Neg on Dix hallpike and on the supine roll: -R geotrophic intense -L geotrophic less intense What is the likely diagnosis?

R canalithiasis

If a pt tests: -Neg on Dix hallpike and on the supine roll: -R ageotrophic intense -L ageotrophic less intense What is the likely diagnosis?

L Cupulolithiasis

BBQ Roll is AKA

Canalith Repositioning Maneuver (CRM)

Treatment for horizontal canal BPPV

BBQ roll/CRM

Intervention where pt is placed 20 deg cervical flexion, head 90 deg to one side, then rotated to neutral in supine, then 90 deg to other side, and then prone

BBQ roll/CRM

A physical therapist is treating a patient with presence of geotropic nystagmus on head turns in the supine position. The nystagmus was weaker on the right side. Which of the following is the MOST APPROPRIATE sequence of administering the intervention for these symptoms? A. Canalith repositioning maneuver with head in 20 deg extension, head turn to 90 deg to right, then moved to the left, then get the patient in prone position with neck in flexion and finally sit the patient up B. Canalith repositioning maneuver with head in 20 deg flexion, head turn to 90 deg to left, then moved to the right, then get the patient in prone position with neck in flexion and finally sit the patient up C. Canalith repositioning maneuver with head in 20 deg extension, head turn to 90 deg to left, then moved to the right, then get the patient in prone position with neck in flexion and finally sit the patient up D. Canalith repositioning maneuver with head in 20 deg flexion, head turn to 90 deg to right, then moved to the left, then get the patient in prone position with neck in flexion and finally sit the patient up

What do abnormal smooth pursuits and saccades indicate?

Central vestibular pathology

Responsible for maintaining focus on an image during rapid head movements

VOR

T or F: VOR is intact in BPPV

Diplopia, difficulty swallowing are examples of _______ vestibular pathology

central

hearing loss, fullness in ears, tinnitus, are examples of _______ vestibular pathology

peripheral

A PT is assessing a patient with chief concerns of dizziness and loss of balance. Presence of which of the following findings during assessment will MOST likely lead the therapist to refer the patient to a physician? A. Mild ataxia B. Positional testing reproducing the nystagmus C. Sudden onset of ringing in the ears D. Pendular nystagmus

Pendular nystagmus

eyes oscillate at equal speeds

jerk nystagmus

nystagmus will incorporate slow and fast phases

inflammation of the vestibulocochlear n

Vestibular Neuritis

Vestibular Neuritis and Labyrinthitis are examples of ______ vestibular disorders

peripheral

Which peripheral vestibular disorder may also include hearing loss and tinnitus?

Labyrinthitis

overproduction of fluid within the ear causing an increase in pressure and vertigo

Meniere's disease

slow growing tumor that develops from the balance and hearing nerves supplying the inner ear

Acoustic Neuroma/Vestibular Schwannoma

slow growing tumor that develops from the balance and hearing nerves supplying the inner ear

Meniere's disease

overproduction of fluid within the ear causing an increase in pressure and vertigo

VORx1

just head moves; target still

VORx2

head and target move

Female 50 y/o in OP Ortho for dizziness while walking and with head turns. Past hx of BPPV. PT exam reveals hearing loss on L side, positive head impulse test, negative dix-hallpike and negative log roll test. The PT decides to not refer the patient the patient to an MD, which of the following LEAST likely to be present? A. Veering to one side with head turns while walking B. Abnormal Smooth pursuits C. 2 falls in last 3 months D. Nystagmus that subsides quickly

B, abnormal smooth pursuits seen with Central vestibular pathology

Female 50 y/o in OP Ortho for dizziness while walking and with head turns. Past hx of BPPV. PT exam reveals hearing loss on L side, positive head impulse test, negative dix-hallpike and negative log roll test. What is the MOST likely diagnosis in this case? A. R BPPV B. Vestibular neuritis C. Labrynthitis D. Meniere’s disease

C, hearing loss Meniere's would be fullness of ear and vestibular neuritis has no hearing loss

Female 50 y/o in OP Ortho for dizziness while walking and with head turns. Past hx of BPPV. PT exam reveals hearing loss on L side, positive head impulse test, negative dix-hallpike and negative log roll test. Which of the following is the MOST appropriate initial intervention for this patient? A. Balance exercises B. VOR x 1 in sitting C. VOR x 2 in standing D. Refer the patient to a physician

B, VORx2 too advanced, balance exercises too general, referral not necessary

best scientific evidence, clinical experience, patient values=

evidence based practice

What type of study has several articles covering many different populations?

Meta Analysis

1. 2. 3. 4. 5. 6. 7.

1. Meta Analysis 2. Systematic Review 3. Randomized Controlled Trials 4. Cohort Studies 5. Case Control Studies 6. Cross Sectional Studies 7. Case Series/Case Reports

"MSR CO CA CRO CA"

Levels of Evidence 1. Meta Analysis 2. Systematic Review 3. Randomized Controlled Trials 4. Cohort Studies 5. Case Control Studies 6. Cross Sectional Studies 7. Case Series/Case Reports

Gold standard of clinical information, highest form of evidence

Meta-Analysis, Systematic Reviews

study in which all studies included have a statistical analysis

meta analysis

a study that is basically a summary of all included papers

systematic review

Study used to determine efficacy of an intervention

Randomized Control Trials (RCTs)

Study in which information is collected from random samples and random populations to reduce bias

RCTs

Observational study that compares a cohort who share a common characteristic with and without the intervention

Cohort study

Two PT students are reviewing the literature to determine efficacy of body weight support training in people with a spinal cord injury. According to levels of evidence, which studies provide the LEAST evidence supporting use of body weight support training? A. Cohort studies B. Randomized controlled trials C. Clinical case series D. Cross sectional studies

C, "MSR CO CA CRO CA"

Study that compares a group of individuals with a specific condition with a group of people without the same condition (controls)

Case Control Study

Observation study where data is collected from a population or a representative subset at a single point in time

Cross sectional study

Observational research design that involves repeated observations or measurements of the same individuals or groups over an extended period of time

Longitudinal studies

Study that is a document clinical case of a single patient or a series of patients

Case Series/Case Report

Three DPT students are looking at effects of drugs on falls. The students are using data from previous patient medical records to compare drug usage in fallers and non-fallers. Which of the following will be the MOST appropriate study design? A. Clinical case report B. Retrospective cohort C. Randomized controlled trials D. Prospective cohort

B, looking at something that's already happened

What kind of study collects data as circumstances change?

Prospective cohort study

collecting and analyzing non-numerical data

qualitative research

collecting and analyzing numerical data

quantitative research

Which of the following instruments is MOST appropriate for measuring patients’ quality of life? A. Dynamic Gait Index (DGI) B. Oswestry low back pain disability index (ODI) C. Timed up and go test (TUG) D. Medical Outcomes Study 36-item short form (SF-36)

What type of data can be nominal or ordinal?

Qualitative

What type of data can be discrete or continuous?

Quantitative

"NOn-parametric"

NOn-parametric= Nominal & Ordinal

Gender and blood types are examples of ______ data

nominal

MMT grades, level of assistance, joint laxity grades are examples of _____ data

Ordinal

Data that can be classified into mutually exclusive categories within a variable

nominal data

Data measures in rank where the order of the variables matters

ordinal data

Data where the difference between two values is meaningful; holds no true zero and can represent values below zero

Interval data

Temperature and IQ Test scores are examples of _____ data

Interval

Data where all the properties of an interval variable and a clear definition of zero

Ratio data

"Rati0"

RatiO= True 0

Height, money, age, and weight are examples of _____ data

Ratio data

A researcher is collecting ROM data on volleyball players during shoulder abduction motion. The results of the tests are BEST categorized as which of the following types of data? A. Interval data B. Ordinal data C. Nominal data D. Ratio data

The extent of the research instrument to consistently have the same results when used in the same situation on repeated occasions

Reliability

Intra-rater reliability

within itself; test performed by 1 person several times

Inter-rater reliability

between individuals; test performed by 2 or more individuals on different subjects for testing 1 variable

test performed by 2 or more individuals on different subjects for testing 1 variable

Inter-rater reliability

test performed by 1 person several times

intra-rater reliability

Test-retest reliability

machine, device, or test you're using; same test to the same individuals on two occasions

same test to the same individuals on two occasions

test-retest reliability

A physical therapist performed a balance test using a new equipment on a healthy individual. The same PT repeated the same test following a week after initial assessment. Which is the most important factor responsible for the success of this assessment? A.Test-retest reliability B. Intra-rater reliability C. Inter-rater reliability D. Content validity

extent to which the instruments used in the experiment measure exactly what you want them to measure

validity

Content validity

Test should measure specifically what the patient problem is

validity

extent to which the instruments used in the experiment measure exactly what you want them to measure

Test should measure specifically what the patient problem is.

content validity

Test should measure what it's supposed to measure

Construct validity

Test should measure what it's supposed to measure

Goniometer measuring ROM only is an example of _________

construct validity

Using a TUG to test functional balance and fall risk is an example of ________

content validity

What is the strongest form of validity?

Concurrent validity

Test performed and compared to the GOLD standard test and results are matched

Concurrent validity

Heart rate measured by peripheral pulse being compared with ECG readings is an example of ________

Concurrent validity

Special tests for ligaments compared to MRI is and example of _______

Concurrent validity

Weakest form of validity

Face validity

The outcome measure should measure what is looks like it will measure related to patient problem

Face validity

A researcher performed hand grip testing manually on a patient who had a stroke and compared the outcomes to that of computerized handheld dynamometer. What type of validity is the researcher trying to establish? A. Content validity B. Construct validity C. Face validity D. Concurrent validity

D, comparing to GOLD standard

Type I Error "P"

"I" can be converted to "P"= false Positive

Type II Error "N"

"II" can be converted to "N"

incorrectly rejecting a true null hypothesis (false positive)

Type I error

incorrectly rejecting a true null hypothesis (false positive)

Failing to reject a false null hypothesis (false negative)

Type II error

Failing to reject a false null hypothesis (false negative)

Ability of a diagnostic test to identify true disease without missing anyone by leaving the disease undiagnosed

Sensitivity

Ability of a diagnostic test to identify true disease without missing anyone by leaving the disease undiagnosed

Ability of a diagnostic test to be correctly negative in the absence of disease without mislabeling anyone

Specificity

helps to rule conditions out

sensitivity

helps to rule conditions in

specificity

Accurate test in understanding presence of disease OR that the pt has the condition

sensitivity

Accurate test to determine absence of disease OR ensure that the person is healthy

Specificity

A PT is using a new special screening test to help determine if a tennis player has a rotator cuff tear among other possibilities. The test has a very high sensitivity of 0.93 (or 93%). If the results of the test are negative, the PT should: A. Try another special test for rotator cuff tear B. Consider the test results inconclusive C. Rule in rotator cuff tear D. Rule out rotator cuff tear

A physical therapist is evaluating the sensitivity of the Kleiger’s test in a group of ballet dancers. Which of the following results indicates a true positive finding? A. Patients with a history of ankle pain and medial ankle sprain will test negatively B. Patients with a history of ankle pain and medial ankle sprain will test positively C. Patients with no history of ankle pain and medial ankle sprain will test negatively D. Patients with no history of ankle pain and medial ankle sprain will test positively

If the test is negative and you can rule out the disease, then the test has high _________

Sensitivity SnOUT

If the test is positive and you can rule the disease in, then the test has high_________

Specificity SpIN

A PT is using a new special screening test to help determine if a tennis player has lateral epicondylitis among other possibilities. The test has a specificity of 0.91. If the results of the test are positive , the PT should? A. Try another special test for lateral epicondylitis B. Consider the test results inconclusive C. Rule in lateral epicondylitis D. Rule out lateral epicondylitis

TP/(TP + FN) =

Sensitivity True positive/ (True positive + false negative)

TN/ (TN + FP)=

Specificity True negative/ (True Negative + False Positive)

A researcher is collecting data on 100 patients with venous insufficiency. Out of the 100 patients with venous insufficiency, 70 patients had a positive doppler test and 30 patients had a negative doppler test. What is the sensitivity of the test? A. 20% B. 80% C. 40% D. 70%

D TP= 70% FN= 30% Sn= TP/(TP+FN) Sn= 70/(70+30) Sn= 70/100

tools designed to improve decision making in clinical practice by assisting practitioners in making a particular diagnosis, establishing a prognosis, or matching patients to optimal interventions based on a parsimonious subset of predictor variables from the history and physical examination.

clinical prediction rules

A 67-year-old patient, who had a total hip replacement one week ago, reports a new onset of calf pain. Which of the following findings should be reported to the physician immediately in suspicion of DVT? A. Bedridden for more than 3 days, history of DVT, calf swelling more than 3mm on symptomatic side and active cancer B. History of hip arthritis, swelling around the hip joint C. B/L pitting edema and painful straight leg raises D. Trochanteric bursitis, painful hip internal rotation and swelling on lateral side of hip

T or F: A Wells criteria score of >/= 2 is indicative of a likely DVT

T or F: A Wells criteria score of <2 is indicative of a likely DVT

F, score >/= 2 is likely DVT

Previously diagnosed DVT, active cancer, paralysis/paresis, bedridden 3 days, major surgery last 3 months, calf tenderness, LE swelling, unilateral calf swelling >3 cm, Unilateral pitting edema, collateral superficial veins

Wells Criteria

A 45-year-old male presents to the clinic with ankle pain. Which of the following finding indicates that the patient needs to be referred out for imaging? A. Reduced ROM of ankle dorsiflexion B. Pain on palpation over tip of lateral malleoli C. Reduced strength of ankle dorsiflexors D. Pain on palpation over the talus

Ottawa Ankle Rules

-Bone tenderness @ post. edge of distal 6 cm or tip of lat malleolus -Bone tenderness at post. edge of distal 6 cm of medial malleolus -Inability to WB 4 steps -Bone tenderness at navicular -Bone tenderness at base of 5th MT

Ottawa Ankle Rules

the outcome or variable of interest in an experiment or study

dependent variable

Variable that is manipulated or changed by the researcher to observe its effect on the dependent variable

independent variable

Considered as an independent variable in an analysis; a potential source of variation or confounding factor that potentially influences the dependent variable

Covariate

Which data is more powerful, parametric or non-parametric?

Parametric Equal distribution, normal distribution, randomization of sample, quantitative data

Parametric or non-parametric: Equal distribution, normal distribution, randomization of sample, quantitative data, more powerful

Parametric data

Parametric or non-parametric: Unequal distribution, no randomization of sample, non-normal distribution, Qualitative data, less powerful

Non-parametric data

Compares the difference between 2 matched groups Ex. 20 athletes before and after an intervention

Paired T Test

Compares the difference between 2 independent groups Ex. 20 athletes vs 20 non-athletes

Independent samples T-test

Directional hypothesis, 1 end of distribution, either positive or negative

1 tailed T-Test

Non-directional, 2 ends of distribution, both positive and negative

2 tailed T-test

At least 3+ independent groups compared on 1 intervention

One-way ANOVA

At least 3+ independent groups compared on 2 interventions

Two-way ANOVA

Effect of strength training on 3 equal groups: 30 athletes, 30 obese, 30 overweight is an example of what ANOVA?

one way ANOVA

Effect of strength training and gender on 3 equal groups: 30 athletes, 30 obese, 30 overweight is an example of what ANOVA?

two-way ANOVA

Individuals measured over time is an example of what ANOVA?

Repeated measures ANOVA

The effect of three different diets on weight loss measured at baseline, 2 weeks, and 4 weeks is what kind of ANOVA?

Repeated Measures ANOVA

parametric test that examines whether there are significant differences among the means of two or more groups while statistically controlling for the influence of one or more continuous covariates

ANCOVA

AnCOva

Extension of ANOVA with COvariate being controlled

A PT is looking at squat activity in 20 obese and 20 normal weight patients. Both groups performed 10 bilateral squats at 100-degrees of knee flexion. The PT hypothesizes that knee moments will be higher in obese. Which is the MOST appropriate test? A. One way ANOVA B. Two-way ANOVA C. One tailed t-test D. Two tailed t-test

C, 2 equal groups= parametric test- T-test= individual groups A & B require 3+ groups D- we don't know the direction

Are ANOVAs and T-tests parametric or non-parametric tests?

Parametric

Are Chi Square tests, Mann Whitney U tests, and Kruskal Wallis Tests Parametric or non-parametric?

Non-parametric

Non-parametric test that Uses nominal/categorical data to find a difference between groups

Chi Square Test

Do parametric or non-parametric tests use and unequal distribution of data?

Non-parametric

Use of continuous or ordinal data to test the null hypothesis with two independent samples from the same population for a non-parametric test

Mann Whitney U Test

3 or more groups compares in a non-parametric test

Kruskal Wallis Test

A study is looking at effects of different exercise options for a patient with knee OA. The study compared pool exercise, treadmill walking, and ankle weights on knee pain in three equal groups of 30 adults each. An appropriate statistical test to assess the effectiveness of treatment in three groups is: A. K Wallis test B. Two paired t-tests C. ANOVA D. Chi square

C, 3 equal groups=parametric= ANOVA, 3 different interventions A= non-parametric w unequal groups B= 2 equal groups D= 2 unequal groups, nominal data

In a research study on patients who are obese with THA, a correlation coefficient (r) of +0.80 was found for the relationship between weight and BMI. Which of the following interpretations of this finding is MOST appropriate? A. Weight and BMI have a high positive correlation B. 80 percent of the variability in BMI can be accounted for by weight C. 80 percent of the variability in weight can be accounted for by BMI D. There are no significant differences between the weight and BMI level

A, +0.80= positive and high (0.76-1.00)

measurement of the degree or strength of a relationship

correlation

Used to determine how one variable affects another and is expressed in the form of an equation

Regression

A PT collected data on patients with THA and plotted the relationship of trunk flexion with waist circumference. The regression plot showed a R square value of 0.64 (See picture). What is the best way to describe the slope? A. Weak positive slope B. Weak negative slope C. Strong positive slope D. Strong negative slope

1. 2. 3. 4. 5. 6. 7. 8.

1. SA Node 2. AV Node 3. AV Bundle 4. L & R bundle branches 5. Purkinje Fibers 6. L atrium 7. L ventricle 8. Apex

What tells the Atria to contract?

the SA Node

What connects the atria and ventricle and tells the ventricle to contract?

AV Node

Where does the pulse of the heart go through?

AV bundle

Steps of the conduction of the heart:

-SA node tells atria to contract -AV node connects the atria and ventricle and tells ventricle to contract -Pulse goes through the AV bundle -To the bundle of His -to Purkinje fibers -heart contracts

A clinician is auscultating a patient’s lungs. During auscultation the clinician hears low pitched gurgling and snoring sounds. Which of the following sounds is the clinician MOST likely hearing? A. Vesicular B. Wheezes C. Bronchial D. Rhonchi

D A= low pitch, normal B= high pitch whistling C= loud, hollow, echoing sounds (Normal)

Vesicular breath sounds

low pitch, normal

low pitch, normal breath sounds

vesicular breath sounds

wheezes

high pitch whistling

high pitch whistling breath sounds

wheezes

loud, hollow, echoing breath sounds (normal)

Bronchial breath sounds

loud, hollow, echoing breath sounds (normal)

Snoring, low pitch breath sounds

Rhonchi

Snoring, low pitch breath sounds

A patient with dyspnea on exertion and has an FEV1 /FVC ratio of 65%. They report chest tightness and frequent coughing. Which lung volume would be decreased compared to a patient with a healthy pulmonary system? A. Functional residual capacity B. Residual volume C. Total lung capacity D. Expiratory reserve volume

What is the cutoff for an FEV1/FVC ratio for Obstructive pulmonary disease?

<70%

What is the cutoff for an FEV1/FVC ratio for Restrictive pulmonary disease?

>80%

an FEV1/FVC ratio <70%=

obstructive pulmonary disease

an FEV1/FVC ratio >80%=

restrictive pulmonary disease

how does the Inspiratory Reserve Volume for those with obstructive pulmonary disease compare to those who are healthy?

Same

How do RV, TLC, and TV for pts w obstructive pulmonary disease compare to those who are healthy?

RV= inc TLC= inc TV= inc

What happens to the Expiratory reserve volume for ppl w obstructive pulmonary disease?

Dec

A patient with stable angina is participating in outpatient cardiac rehabilitation. When the physical therapist auscultates the patient’s heart, they hear an S4 heart sound. When can this heart sound be heard and what condition does it MOST LIKELY indicate? A. Abnormal sound heard in early diastole; congestive heart failure B. Abnormal sound heard in late diastole; congestive heart failure C. Abnormal sound heard in early diastole; myocardial infarction D. Abnormal sound heard in late diastole; hypertension

D, B= S3 abnormal heart sound

S4 abnormal heart sound can be hear in

late diastole

S4 abnormal heart sound is indicative of

MI, HTN

S4 abnormal heart sound is AKA

"atrial gallop"

S3 abnormal heart sound is AKA

"ventricular gallop"

When can S3 abnormal heart sound be heard?

early diastole

S3 abnormal heart sound is indicative of...

congestive heart failure

S3 & S4 are always associated with....

diastole

depolarization=

contract

repolarization=

relax

Record of the electrical activity of the heart

ECG

Atrial depolarization is shown on the ECG as the ______

P wave

atrial depolarization (contraction)

QRS complex

ventricular depolarization and atrial repolarization

ventricular depolarization and atrial repolarization is shown on the ECG as the __________

QRS complex

T wave

ventricular repolarization (relaxation)

ventricular repolarization is shown on the ECG as

T wave

What can indicate myocardial ischemia on the ECG?

ST segment depression

PR Interval

how much time it took the atria to contract & send signal to ventricle

PR Interval

A PT examines the output from a single lead electrocardiogram of a patient in an inpatient clinic. The six-second ECG strip is shown in picture below. The PT should determine the heart rate of the patient as? A. 110 beats per minute B. 70 beats per minute C. 90 beats per minute D. 60 beats per minute

C 9 Rs 9 x 10= 90 bpm

30 Large boxes on ECG=

6 seconds

1 small box on ECG=

0.2 seconds

How do you calculate HR on ECG?

Count off 30 large boxes (6 seconds), count # of R waves, and multiply by 10

AV Heart blocks: 1st degree: 2nd degree: 3rd degree:

1st degree: delay in conduction 2nd degree: partially blocked conduction 3rd degree: fully blocked conduction

What does a 1st degree AV Block look like on the ECG?

PR interval > 1 large box

2nd degree AV Block Type 1 is AKA

Wenckenbach

2nd degree AV block Type 2 is AKA

Mobitz II

Type 1 2nd degree AV Block (Wenckenbach)

PR interval gets progressively longer every beat until the QRS is dropped (AV node disease)

What type of AV block?: PR interval gets progressively longer every beat until the QRS is dropped (AV node disease)

Type 1 2nd degree AV Block (Wenckenbach)

Type 2 2nd degree AV Block (Mobitz II)

PR intervals constant & QRS is dropped intermittently (Bundle of His & Purkinje disease)

What type of AV block?: PR intervals constant & QRS is dropped intermittently (Bundle of His & Purkinje disease)

Type 2 2nd degree AV Block (Mobitz II)

A 50-year-old male patient is diagnosed with a Mobitz Type II Wenckebach heart block. What would a physical therapist expect to find on the ECG strip? A. An increase in PR interval lengths with no dropped beats B. No relationship between P waves and QRS complexes C. A gradual increase in PR interval length in all the beats preceding a dropped beat D. Normal PR intervals in all the beats preceding a dropped beat

D A= 1st degree B= 3rd degree C= predictable dropped beat, Type 1

What type of AV block occurs when the Atria and Ventricles are not communicating?

3rd Degree AV block

Atria and Ventricles are not communicating

Call 911 for which type of AV block?

3rd degree

The heart block poem

If the R is far from P, Then you have a first degree Longer, longer, longer drop! Then you have a wenckenbach If some Ps don't get through, then you have a Mobitz II If Ps and Qs don't agree, then you have a third degree

B, (wenckenbach) PR intervals progressively longer then QRS drops expectedly

Male 55 y/o in OP ortho, CABG surgery 6 months ago. Pst medical Hx of MI, metabolic syndrome, hx of smoking x 15 yrs. Has HTN, 30 BMI, uses Beta blockers, Aspirin. Vitals: Resting BP: 133/88 mmHg HR: 70 bpm RR: 24 breaths/min He experiences SOB while ambulating inclined surfaces. During exercise tolerance test, PT sees Wenckenbach heart block on ECG. The PT's BEST response should be to: A. Stop the treadmill session immediately and call the cardiologist B. Continue without any modifications and monitor ECG C. Reduce the treadmill speed and monitor ECG D. Stop the treadmill, have the patient rest, and then resume at a lower intensity

Male 55 y/o in OP ortho, CABG surgery 6 months ago. Pst medical Hx of MI, metabolic syndrome, hx of smoking x 15 yrs. Has HTN, 30 BMI, uses Beta blockers, Aspirin. Vitals: Resting BP: 133/88 mmHg HR: 70 bpm RR: 24 breaths/min He experiences SOB while ambulating inclined surfaces. During exercise tolerance test, PT sees Wenckenbach heart block on ECG. Patient did not come for PT for 3 consecutive visits. On following up with the patient’s caretaker, he mentioned that the patient was taken to the emergency room as he was experiencing increased shortness of breath at rest and cough with no evident peripheral edema. Which of the following is MOST LIKELY causing the patient’s symptom? A. Biventricular heart failure B. Right-sided heart failure C. Cor pulmonale D. Left-sided heart failure

D, lung respiration sx (L side usually pushes blood out to body) B= would have edema cause (R side normally collects blood)

ST segment depression is indicative of

myocardial ischemia

ST segment elevation is indicative of

myocardial infarction

A 58-year-old male is performing a Bruce protocol in your clinic with ECG leads attached. During the protocol, the PT sees the picture shown below. What is the MOST likely diagnosis and intervention? A. Myocardial ischemia that has an elevation of the ST segment greater than 1 mm and the PT should stop the protocol B. Myocardial infarction that has an elevation of the ST segment less than 1 mm and the PT should stop the protocol and call 911 C. Myocardial ischemia that has an elevation of the ST segment less than 1 mm and the PT should stop the protocol D. Myocardial infarction that has an elevation of the ST segment greater than 1 mm and the PT should stop the protocol and call 911

Atrial Tachycardia= ____- ____ bpm

100-250

100-250 bpm is indicative of

atrial tachycardia

Atrial flutter = ____-___ bpm

250-350 bpm

Atrial flutter

Atrial fibrillation = ___-_____ bpm

400-600

400-600 bpm

Atrial fibrillation

What happens when the Atria started earlier than usual or didn't wait for the ventricle to relax?

Premature atrial contraction (PAC)

Atria started earlier than usual or didn't wait for the ventricle to relax

Atrial Tachycardia

Atria contracts 3 times to generate same amount of blood for 1 contraction

What happens when Atria contracts 3 times to generate same amount of blood for 1 contraction

Atrial Tachycardia

What happens when the atria contracts super fast, and the ECG has saw-toothed appearance?

Atrial Flutter

atria contracts super fast, and the ECG has saw-toothed appearance

What happens when it takes about 10 times the amount of contractions for the Atria to send blood to the ventricle?

Atrial fibrillation (STOP EXERCISE)

takes about 10 times the amount of contractions for the Atria to send blood to the ventricle

What is the arrow pointing to?

PAC premature atrial contraction

Interpret the ECG

Atrial tachycardia

Interpret the ECG

Atrial flutter

Interpret the ECG

Atrial fibrillation

A PT is ambulating a 75-year-old male who is in recovering from a prostatectomy procedure. The patient reports palpitations, shortness of breath and fatigue. What should be the interpretation and immediate action according on the ECG strip shown below? A. Ventricular fibrillation; Call for a defibrillator B. Premature ventricular contractions; Take him to his bed and monitor for changes in ECG C. Atrial Fibrillation; Stop exercise and report to the physician D. 3rd degree heart block; activate emergency

A physical therapist is performing joint mobilization on a patient in the outpatient clinic. The PT notes the electrocardiogram in the photograph. The physical therapist’s INITIAL response should be to: A. Continue with joint mobilizations at same intensity B. Continue with joint mobilizations at a lower intensity C. Stop the treatment and monitor ECG for 10 minutes D. Activate the emergency system or call 911

D, ventricular fibrillation, QRS waves are all over trying to keep up using the blood that is there

Interpret the ECG

PVCs (Premature ventricular contractions)

What does this represent?

Bigeminy, 1 normal beat followed by 1 PVC

What does this represent?

Trigeminy, 2 normal beats followed by 1 PVC

What does this represent?

Couplet, 2 consecutive PVCs together with no normal beat between them

PVCs happen when

ventricle contracts before the atria no P, wide QRS

What is it when ventricle contracts before the atria no P, wide QRS

PVCs

PVCs that occur 3 or more in a row

Ventricular tachycardia

PVCs that occur 3 or more in a row

Bigeminy

1 normal beat followed by 1 PVC

Trigeminy

2 normal beats followed by 1 PVC

Couplet

2 consecutive PVCs together with no normal beat between them

Multifocal PVC

more than 1 PVC present and 2 do not appear similar in configuration (911)

Multifocal PVC

A patient one month post myocardial infarction is being seen in a clinic. When increasing the patient to 5 METS of workload, the therapist notes that the ECG reads 1 unifocal PVC. The PT’s IMMEDIATE action should be: A. Continue to exercise and increase the intensity B. Stop exercise because patient is undergoing ischemia C. Keep exercising at a lower intensity, consultation with physician is not required here D. Stop exercise and consult with physician before starting any exercise

STOP EXERCISE AND CALL EMS IF THESE ARE ON ECG:

* more than 6 PVC in one minute * 3 degree AV block * More than 2-4 couplets/ min * 3 or more PVC in a row * V Tach * V Fib * ST depression >2 mm * ST elevation >1mm * Multi focal PVC