Readings (days 70-80) & Lectures 26-30 Flashcards by Danielle Hood

one stride =___________

one gait cycle

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During closed chain ankle DF, the ____ moves on the _____

tibia; talus

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_____ rocker occurs in IC and LR

Heel rocker

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_____ rocker occurs in MSt and TSt

Ankle rocker

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_____ rocker occurs in PSw and ISw

forefoot rocker

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What orthosis helps with DF assist in the swing phase?

Posterior leaf spring

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Posterior leaf springs assist ________ in the swing phase

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Hinged AFO allows _____ or ____ and prevents _____ to _____ movement

DF or PF; lat to med

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Which prosthetic allows DF/PF but prevents lat to medial movement?

Hinged AFO

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Which prosthesis limits all motions?

Solid AFO

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stops/pegs ________ movement

restrict

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springs ____ movement

assist

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Rate Product Pressure (RPP)= ____ x ____

RPP= HR x SBP

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LUB DUB=

S1 & S2

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APT M 2245

Auscultation

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A 60 y/o male in IP Acute. Acute exacerbation of COPD sx. 25-pack year hx of smoking, been educated on risks of continued smoking, but defers getting help to stop.

pH: 7.28
PCO2: 62 mmHg
HCO3: 25 mmHg

FEV1/FVC: <70%, FEV1: 45%

HR: 80 bpm
RR: 24 breaths/min
SpO2: 85%

Barrel shaped chest, elevated shoulder girdles and increased use of accessory mm while breathing. Crackles heard over the lung.

Which of the following is the MOST likely treatment?

A. Bicarbonate infusion to decrease metabolic acidosis

B. Have the patient to breath into a rebreathing mask to decrease
respiratory alkalosis

C. Fluid and saline infusion to
decrease metabolic alkalosis

D. Use of supplemental oxygen to decrease respiratory acidosis

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A 60 y/o male in IP Acute. Acute exacerbation of COPD sx. 25-pack year hx of smoking, been educated on risks of continued smoking, but defers getting help to stop.

pH: 7.28
PCO2: 62 mmHg
HCO3: 25 mmHg

FEV1/FVC: <70%, FEV1: 45%

HR: 80 bpm
RR: 24 breaths/min
SpO2: 85%

Barrel shaped chest, elevated shoulder girdles and increased use of accessory mm while breathing. Crackles heard over the lung.

The PT decided to use postural drainage for airway clearance in this patient. The PT positions the patient in a seated position leaning forward over a folded pillow. Based on the position of the patient, which lobe is MOST likely being drained?

A. Posterior apical segments of upper lobe

B. Anterior apical segments of upper lobes

C. Superior segments of the lower lobes

D. Anterior basal segments of lower lobes

B= backwards lean
C= prone
D= elevate bed

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A 60 y/o male in IP Acute. Acute exacerbation of COPD sx. 25-pack year hx of smoking, been educated on risks of continued smoking, but defers getting help to stop.

pH: 7.28
PCO2: 62 mmHg
HCO3: 25 mmHg

FEV1/FVC: <70%, FEV1: 45%

HR: 80 bpm
RR: 24 breaths/min
SpO2: 85%

Barrel shaped chest, elevated shoulder girdles and increased use of accessory mm while breathing. Crackles heard over the lung.

Which of the following exercises would be MOST likely recommended for this patient?

A. Inspiratory muscle training

B. Pursed lip breathing exercises

C. Segmental breathing exercises

D. Incentive spirometry

A= strengthening
C= to expand segment or lobe of lung
D= inflating collapsed lung or after atelectasis

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How long should you hold positions for postural drainage?

5-10 minutes

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postural drainage in prone w pillows under pelvis

superior segments lower lobes

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postural drainage sitting on a chair leaning forward over pillows

post apical segments of upper lobes

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postural drainage supine lying, pillows under knees

ant segments of upper lobes

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postural drainage sitting in recliner leaning slightly backwards

Ant apical segments of Upper lobes

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A PT instructed a patient in home postural drainage positioning. Which of the following position will be MOST appropriate for right lateral segment?

A. Position A
B. Position B
C. Position C
D. Position D

A= L side
C= sup segments of lower lobes
D= L middle/lingular lobe

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Contraindications of postural drainage: 1. 2. 3. 4. 5. 6. 7.

1. Increased intracranial pressure 2. Hemodynamically unstable 3. Recent esophageal anastomosis 4. Recent spinal fusion or injury 5. Recent head trauma 6. Diaphragmatic hernia 7. 9 months pregnant (cant be supine)

An 85-year-old patient with chronic congestive heart failure was recently admitted to the hospital. Which of the following plans for prophylactic respiratory care is LEAST appropriate? A. Frequent turning and positioning every 2 waking hours B. Gentle percussion 2 times per day C. Vigorous chest vibrations, with the foot of the bed elevated, 4 times per day D. Gentle coughing and deep breathing exercises every 4 hours

C, foot end of bed increases overload, pt also elderly and will not tolerate this A= true, to prevent development of atelectasis and pneumonia B= true, good D= true, prevent development of atelectasis

HR Max=

HR max= 220 - age OR HR Max= 207-0.7x age

Karvonen formula

HRR x exercise intensity + Resting HR (HR Reserve= HR max- Baseline HR)

A 75-year-old individual has limited endurance. There is no history of cardiorespiratory problems. After an exercise tolerance test, which was negative for coronary heart disease, the BEST initial exercise prescription for this individual would be: A. 90-100% HR max B. 60-70% HR max C. 40-50% HR max D. 30-40% of HR max

B, no cardio probs so can start higher but not too high A= athletes C & D= too conservative

A patient diagnosed with congestive heart failure is participating in cardiac rehabilitation. During treadmill training the patient becomes fatigued with an increased pulse and respiratory rate. In which situation would the PT terminate the exercises? A. Having an S1 and S2 heart sound B. Onset of diaphoresis C. An increased respiratory rate of 30 breaths per minute. D. A decrease in diastolic blood pressure of 5 mmHg

B, red flag, cold sweats A= normal D= within range of 10mmHg

Cardiac Rehab phases: 1. 2. 3. 4.

1. Acute/Monitoring phase 2. Subacute/conditioning phase 3. Training phase 4. Maintenance period

No resistance training in which phases of cardiac rehab?

Phases I & II

Which phase of cardiac rehab? F - Short sessions 2-3 times a day I - 50%-70% HR max T - 10-15 mins (phase I) and 30 mins (phase II) per session T - ADLs, supervised ambulation

Phases I & II

A 60-year-old male is undergoing cardiac rehabilitation post complicated MI in the hospital. On day two, the PT wants to progress the patient to sitting. Which of the following is an appropriate INITIAL task for this patient? A. Make the patient stand and do weight-bearing activities B. Make the patient sit on the upright chair during the visitor’s time C. Make the patient sit on reclining chair and check vitals D. Patient is not ready for upright posture yet

A 60-year-old male is undergoing cardiac rehabilitation post MI in the hospital. On day 3, the patient has progressed to walking. Which of the following is the MOST appropriate statement to document the activity? A. Patient ambulated for 20 minutes with RPE 10/20 B. Patient ambulated 300 ft with RPE 4/20 C. Patient ambulated 500 ft in 6 minutes with RPE 10/20 D. Patient ambulated in the ICU hallway with RPE 10/20

C A= didn't state how far B= distance? RPE is 6-20 D= not detailed enough

What phase of Cardiac Rehab? F - 2-3 sessions/week I - 70%-to-85% of the peak achieved on the test (i.e., HR max) T - 30-60 minutes with 5-10 min of warm up and cool down T - Single mode of training (walking) or multiple modes using (treadmill, cycle, ergometer)

OP Phase III

Strength training in Phase III Cardiac Rehab

Begin with the use of elastic bands and light hand weights (1-3 pounds) or 30-50% of max weight used to complete 1RM Begin with 8-10 reps, progress to 12-15 reps Avoid upper extremity resistance as soft tissue is still healing

A 58-year-old female patient with uncomplicated MI, has been discharged from the acute care. Which of following activities would be MOST appropriate during early phase 2 rehabilitation? A. 30 minutes walking at 3 mph with no incline B. 15 minutes of elastic band training with yellow elastic bands C. 15 minutes upper limb workout with 2-pound hand weights D. 30 minutes walking at 5 mph with 5% incline

A B & C= too much, for Phase III D= progress to this

Phase 4 of Cardiac Rehab

-Progression: 50-85% of functional capacity, 3-4/week, 45 minutes or more/session -Discharge: Typically, 6-12 months

Which phase of Cardiac Rehab? -Progression: 50-85% of functional capacity, 3-4/week, 45 minutes or more/session -Discharge: Typically, 6-12 months

Phase IV

A 45-year-old patient has been walking three days/week for 20 minutes for the past three weeks. When progressing the exercise program, which of the following modifications will MOST likely accomplish the weight loss goal? A. Walk 6 days/week at current walking speed and increase the duration to 45 minutes B. Increase the walking speed and keep the duration at 20 minutes C. Walk 5 days/week and decrease the duration to 10 minutes D. Decrease the walking speed and increase the duration at 25 minutes

degeneration of intervertebral discs

Spondylosis

degeneration of intervertebral discs

Spondylolysis

breaking in the pars or arch of vertebra

Spondylolysis

Forward slipping of one vertebra over another

Spondylolisthesis

Forward slipping of one vertebra over another

Retrolisthesis

Backward slipping of one vertebra over another

Retrolisthesis

T or F: All spinal conditions starting with "S" are relieved by sitting and worsened by standing

T or F: Disc herniation is relieved by sitting and worsened by standing

F, relieved by standing and worsened by sitting

A B= SIJ dysfunction C= stenosis D= facet joints

19 y/o female in OP Ortho. Severe LBP that started 2 weeks ago after a gymnastic competition, she can sit comfortably, walking to the bus stop with her backpack on or standing in the kitchen to bake worsens the pain, she's been a gymnast for 12 yrs, Extension AROM painful at end ranges, negative SLR, ODI: 40. Which of the following is the MOST appropriate intervention based on the patient’s presentation? A. Bed rest for two weeks along with hot packs 3x/day for 15 mins each B. Flexion-biased exercises C. High velocity thrust to the lumbar spine to improve lumbar extension D. Extension-biased exercises

B, sitting relieving, standing aggravating

19 y/o female in OP Ortho. Severe LBP that started 2 weeks ago after a gymnastic competition, she can sit comfortably, walking to the bus stop with her backpack on or standing in the kitchen to bake worsens the pain, she's been a gymnast for 12 yrs, Extension AROM painful at end ranges, negative SLR, ODI: 40. After 4 weeks of PT, the patient was reevaluated again and the score on the Oswestry disability index was 25. What can be interpreted from this score? A. Patient’s condition is improving B. Patient’s condition is getting worse C. Patient can be discharged from care as the patient is fine D. Patient needs to see their physician for pain management

A, higher score= more disability

T or F: In scoliosis, the vertebral bodies deviate toward the concave side and the spinous process rotates to the convexity of the curve.

F, Vertebral bodies rotate to the convexity of the curve ̶ Spinous process deviates toward the concave side

Concave or Convex side of scoliosis? * High pelvis * Tight muscles * Spinous process rotation * Anterior rib distortion * A decrease in vertebral height * Narrowing of the intercostal spaces * Decrease in lung volume

Concave

Concave or Convex side of scoliosis? * muscles lengthen * body of vertebra rotates towards * posterior rib distortion * opening of the intercostal spaces * increase in lung volume

Convex

A 13-year-old girl has been diagnosed with structural idiopathic scoliosis. The physical therapist notices a left thoracolumbar structural scoliosis. Which postural deviation would be expected in this patient: A. The body of the thoracic vertebrae rotated to the right B. High right shoulder C. Spinous processes of thoracic spine rotated to the left D. Right anterior rib hump and left posterior rib hump

Spinal mobs: Gapping, increased space, upglide, flexion= _______

Opening

Spinal mobs: Closing, decreased space, downglide, extension = ___________

closing

Flexion of the spine ________ the gap

increases

Extension of the spine _______ the gap

decreases

A 36-year-old female is experiencing tenderness in her cervical spine at the level of C5-C6 vertebrae. The physician diagnoses reduced space between the vertebrae. What will be the MOST appropriate PT intervention? A. Provide an ice pack to relieve pain B. Perform cervical mobilization by moving the C5 vertebrae anteriorly C. Perform cervical mobilization by moving the C6 vertebrae anteriorly D. Provide ultrasound therapy to relieve pain

B, would be moving into flexion which increases the gap

The manual therapy technique appropriate to correct a bilateral closing restriction of C5 on C6 is: A. Central PA glide on the spinous process of C6 while stabilizing C5 B. Central PA glide on the spinous process of C5 while stabilizing C6 C. Unilateral PA glide on the right transverse process of C6 while stabilizing C5 D. Unilateral AP glide on the left transverse process of C6 while stabilizing C5

A, closing restriction means it can't close so need to move C6 on C5 to close gap

T or F: In the cervical C2-C7, the side-bending and rotation are in the same direction

T or F: In the lumbar spine, the side-bending and the rotation occur in the same direction

F, oppo Cervical is same direction

Which of the following coupling motions will close the right lumbar facet joints from a neutral position? A. Lumbar extension, right side flexion, left rotation B. Lumbar extension, left side flexion, right rotation C. Lumbar flexion, right side flexion, left rotation D. Lumbar flexion, left side flexion, right rotation

A patient presents to the clinic with reports of left sided neck pain that started about two weeks ago. After assessing, the PT concludes that the patient has a closing restriction at C5-C6 level on the left. Which of the following is MOST appropriate about this patient? A. Side bending and rotation to the left is restricted at C5-C6 level B. Side bending and rotation to the right is restricted at C5-C6 level C. Side bending is restricted to right, and rotation is restricted to the left at C5-C6 level D. Side bending is restricted to the left, and rotation is restricted to the right at C5-C6 level

A 52-year-old patient presents to the clinic with chronic LBP. After mobility assessment of the lumbar spine, the PT concludes that the patient has an opening restriction at right L2-L3 level. Which of the following should the PT implement in the treatment? A. PA glide to right L2 transverse process B. PA glide to left L2 transverse process C. PA glide to L3 spinous process D. PA glide to L2 spinous process

A patient presents with reports of pain and numbness in the right arm extending to the thumb. The PT performs the special test as shown in the picture below. If the test is positive, which is the MOST appropriate intervention? A. Strengthen the right levator scapulae and sternocleidomastoid muscles B. Perform (Posterior-Anterior) PA glide of the C6 vertebrae with right side bending and rotation C. Stretch the right pectoralis minor and sternocleidomastoid muscles D. Perform grade 3 manipulation of the first and second ribs

MAIN MAM R U

ULNT1: Median, AIN n (C5, C6, C7) ULNT2: Median, Axillary, Musculocutaneous n ULNT3: Radial n ULNT4: Ulnar n

ULNT1

Median, AIN n (C5, C6, C7) MAIN

ULNT2

MAM Median, Axillary, Musculocutaneous N

ULNT3

R Radial n

ULNT4

U Ulnar n

The patient has reports of numbness and tingling in the right forearm. The PT decides to perform upper limb tension test on the patient. The test in the picture below is found to be positive. Based on the findings, which nerve is MOST likely causing the numbness and tingling? A. Anterior interosseous nerve B. Ulnar nerve C. Radial nerve D. Musculocutaneous nerve

D A= shoulder abd 110 deg

superior labrum tearing or pulling away by the biceps insertion which is under the subacromial arch

SLAP lesion

T or F: a Bankart tear is at the superior labrum

F, inferior labrum

What should injury is a dislocation and fracture of the posterior humerus with an anterior dislocation?

Hill Sach's

A baseball pitcher is being treated following a Bankart repair. Which of the following movement combinations is MOST important to avoid following this procedure? A. Shoulder flexion > 90° with the elbow flexed B. Horizontal adduction with internal rotation C. Horizontal abduction with external rotation D. Horizontal abduction with internal rotation

C ER, ABD, Ext cause injury

Rule of 6 for Rehab

* 6 weeks ◦ passive (max protection phase) * +6 weeks ◦ active phase (moderate protection) starting motions * 6 months ◦ minimal protection phase (return to ADLs)

Rule of 6 for Rehab

What TMJ muscle is responsible for opening of the mouth?

"La La La" Lateral Pterygoid

"La La La" Latera Pterygoid

Lateral Pterygoid; opens mouth

What TMJ mm close the mouth? 1. 2. 3.

1. Temporalis 2. Masseter 3. Medial pterygoid

1. Temporalis 2. Masseter 3. Medial pterygoid are responsible for

closing mouth

What TMJ mm are responsible for protrusion of the mandible? 1. 2.

1. Medial Pterygoid 2. Lateral Pterygoid

1. Medial Pterygoid 2. Lateral Pterygoid Are responsible for:

protrusion of the mandible

What TMJ mm are responsible for retraction of the mandible?

Temporalis m (post. fibers)

Temporalis m (post. fibers) is responsible for:

retraction of the mandible

What TMJ mm are responsible for lateral deviation of the mandible? 1. 2.

1. CL Lateral Pterygoid 2. CL Medial Pterygoid

1. CL Lateral Pterygoid 2. CL Medial Pterygoid Are responsible for:

lateral deviation of the mandible

"pops" or "clicks" heard on opening and closing of mouth

Disc displacement with reduction

A patient presents with limited mouth opening of 25 mm due to pain. There are no reports of clicking sound or mouth deviation when opening the mouth. The patient is unable to completely close the mouth with teeth clenched together. What is the MOST likely diagnosis based on the patient’s symptoms? A. Hypomobility B. Disc displacement with reduction C. Synovitis D. Capsulitis

C, inflammation with no deviation A= limited ROM, no pain B= would have clicking/popping D= inflammation with deviation

- 2-13 y/o -Deformity/flattening of femoral head due to loss of bloody supply - Femoral head necrosis -pain -limping -Extension limited

Legg Calve Perthes

- 2-13 y/o -Deformity/flattening of femoral head due to loss of bloody supply - Femoral head necrosis -pain -limping -Extension limited

-10-17 y/o -overweight -Displacement of femoral head due to slippage from the growth plate -pain -limping -flexion limited

Slipped Capital Femoral Epiphysis (SCFE)

-10-17 y/o -overweight -Displacement of femoral head due to slippage from the growth plate -pain -limping -flexion limited

6 y/o male in Public School has pain in R hip, thigh, groin, knees on standing, walking, running, Has leg length discrepancies in both legs, trendelenburg gait positive on R, Hip Extension 10 deg, Hip abduction 15 deg, Hip IR 5 deg. What is the MOST LIKELY diagnosis for the patient? A. Congenital dysplasia of the Hip B. Osteoarthritis of the hip C. Legg Calve Perthes disease D. Slipped Capital Femoral Epiphysis

6 y/o male in Public School has pain in R hip, thigh, groin, knees on standing, walking, running, Has leg length discrepancies in both legs, trendelenburg gait positive on R, Hip Extension 10 deg, Hip abduction 15 deg, Hip IR 5 deg. What is the MOST appropriate intervention for this child? A. Improving the strength of abductor muscle strength using closed chain exercises B. Improving the flexibility of abductor and external rotators C. Improving the containment of the femoral head in acetabulum using the brace D. Improving the flexibility of adductor and internal rotators

C, Atlanta Scottish Rite-Hospital Orthosis

6 y/o male in Public School has pain in R hip, thigh, groin, knees on standing, walking, running, Has leg length discrepancies in both legs, trendelenburg gait positive on R, Hip Extension 10 deg, Hip abduction 15 deg, Hip IR 5 deg. Which of the following orthotic is MOST appropriate to maintain the hip position for this patient? A. Pavlik harness B. Scottish rite brace C. Hip spica D. Frejka pillow

B A= hip dysplasia C= immobilization after amputation D= infants, hip dysplasia

Primary restraint for anterior translation and medial rotation of the tibia on the femur

ACL

Primary restraint for anterior translation and medial rotation of the tibia on the femur

Primary restraint for posterior translation and medial rotation of the tibia on the femur

PCL

Primary restraint for posterior translation and medial rotation of the tibia on the femur

Primary restraint for valgus and lateral rotation of the tibia

MCL

Primary restraint for valgus and lateral rotation of the tibia

Primary restraint for varus and lateral rotation of the tibia

LCL

Primary restraint for varus and lateral rotation of the tibia

A 25-year-old male soccer player had to undergo an ACL reconstruction surgery. It has been three weeks since the surgery and the patient is undergoing PT treatment. Which of the following is MOST appropriate while exercising this patient? A. Short arc quads between 30° to full extension B. Closed chain strengthening exercises of quadriceps between 60° to 90° of knee flexion C. 50 lbs. weights at ankle during quadriceps strengthening D. Squatting with knees staying posterior to the toes

D A= causes shear forces B= should not do CC in this range yet C= too much weight

Avoid _________ strengthening of the quads between 60-90 deg of knee flexion

Closed chain

Avoid closed chain strengthening of the quads between __-__ deg of knee flexion

60-90

Avoid resisted open chain knee extension between ___ - ___ deg to full extension for at least 6 wks or as long as 12 weeks

45-30

The conventional approach to achilles tendon repair for weight bearing

6 weeks immobilization & NWB

The Early Mobilization approach to achilles tendon repair for weight bearing

Immediately after surgery or after 1-2 wks

Phase 1 of Achilles Rehab: ___-___ weeks 1. 2. 3.

4-6 weeks 1. AROM non-immobilized jts 2. mm setting exercise of DF, invertors, evertors, PFs 3. Weight shifting in BL stance with orthosis

Patient is an eight-weeks post-op case of Achilles tendon repair. The patient has recently started discontinuing the CAM boot and unable to bear weight with reports of pain with weight-bearing. The PT should FIRST emphasize: A. Stretching of posterior compartment muscles in standing B. Heel lift C. Continue with CAM boot D. Notify the doctor

B A= avoid C= done at wk 6 D= not necessary

pulls the skin upwards and increases the lymphatic drainage through an increase in interstitial space beneath the underlying skin, alleviating the interstitial pressures and therefore reducing edema and pain

KT taping

A 20-year-old reports of pain, stiffness and feeling of weakness in the left knee which aggravates after playing. There is no crepitus, and no popping or locking of the joint movement. Palpating the lower pole of patella and quadriceps tendon reproduces pain. What is MOST likely diagnosis? A. Jumper’s knee B. Meniscal tear C. Osteochondritis dissecans D. Osgood-Schlatter syndrome

A B= no crepitus in this pt C & D= too young

A 32-year-old patient is referred to PT for gait training post right tibial plateau fracture. The patient is currently on non-weight bearing precautions for the right lower extremity. Which of the following is MOST appropriate to be used to train this patient? A. Bilateral canes B. Parallel bar C. Hemi walker D. Single crutch

B, other options need foot on the ground

A patient with T-score of -2.6 and no fractures reports of increased middle and lower back pain during breathing and other functional activities. Which of the following is the MOST beneficial intervention? A. Lumbar extension and core stabilization exercises B. Lumbar rotation and core stabilization exercises C. Lumbar rotation and extension exercises D. Lumbar flexion and rotation exercises

A, -1 to -2.5 = osteopenia and bones are fragile so would want to avoid rotation and flexion

T OR F: LE progresses faster in rehab protocol bc LE has more stability and UE has more Mobility

Which progresses faster in rehab protocol: LE or UE?

LE, more stability and UE more mobility

Match the following: 1. Rehab phase in which protection of operated tissues is paramount in the presence of tissue inflammation and pain (0-6 wks) 2. Rehab phase of little to no protections of operated tissues is required. Full pain free AROM should be there, jt capsule should be clinically stable. (6-12 weeks post op) 3. Rehab phase in which inflammation has subsided, pain and tenderness are minimal and tissues can withstand gradually increasing levels of stress(4-6 wks post-op) A. Minimal Protection Phase B. Maximal Protection Phase C. Moderate Protection Phase

1. B 2. A 3. C

What types of mobilizations can be used during the maximal protection phase of Rehab protocols?

Grade I/II

What types of mobilizations can be used during the Moderate protection phase of Rehab protocols?

Grade III

A 73-year-old male retired professor underwent a Total Shoulder Arthroplasty (TSA). Surgical notes mentioned that rotator cuff was intact. At one-week post-op, which of the following activities should be AVOIDED? A. Passive shoulder flexion to 90° B. Passive assisted shoulder ER to 45° C. Grade I and II mobilization D. Active scapular and elbow ROM exercises

B, ant approach

Which of the following bed-to-chair transfers would be MOST APPROPRIATE for a 65-year-old patient status post right THA whose surgeon utilized ANTERIOR approach? A. Ask the patient to point their toes to the left and perform a stand pivot transfer into a chair placed to the patient’s right B. Ask the patient to point their toes to the right and perform a stand pivot transfer into a chair placed to the patient’s left C. Utilizing a sliding board, have the patient transfer into a chair placed to the patient’s right without assistance D. Quad-pivot transfer into a chair placed to the patient’s left

B, want to pivot on the sound leg

A physical therapist is treating a 21-year-old athlete post ACL reconstruction and plans to work on strengthening his quadriceps muscle at four weeks post op. Which of the following exercises would be BEST to serve the purpose at this time? A. Seated knee extension to 0° with 3 lbs. ankle weight B. Half squats - up to 90° C. Sit to stand exercise: Rising from a chair without using hands D. Hamstring curls in prone

C, in moderate protection phase A= open chain B= CC from 60-90 deg too much stress D= Concentric HS, Quads Eccentric

Closed Chain Precautions with ACL Reconstruction

Avoid CC activities between 60-90 deg knee flexion

Open Chain Precautions with ACL Reconstruction

-Resistance applied above knee -Avoid OC resisted knee extension between 30-45 deg and full extension 6-12 wks -No resistance to distal tibia

A 70-year-old male underwent a total knee arthroplasty ten days ago. While treating the patient in a sub-acute care facility, the therapist asks the patient to perform ankle pumps to reduce swelling in the leg before starting gait training. While performing bedside ankle pumps, patient reports to develop sudden dyspnea and the therapist notes sweating in the patient. What is the MOST APPROPRIATE next step? A. Position patient in dyspnea relieving position B. Give ankle pumps in supine position C. Continue ankle pumps as it is expected to have dyspnea with the activity D. Call EMS (911) for help

D, symptom does not match the exercise Could be DVT dislodged & turned into PE d/t dyspnea

Hallmark signs of DVT: 1. 2. Other signs & Sx:

1. Dyspnea 2. Tachypnea Other: 1. swelling in LE 2. anxiety 3. Fever 4. excessive sweating (diaphoresis) 5. cough 6. Blood in sputum (hemoptysis)

A patient presents to the emergency department with reports of severe muscle pain and weakness, along with dark urine and fatigue. The patient reports having engaged in a strenuous workout the day before but has no prior history of muscle injury. Blood tests reveal elevated levels of creatinine kinase and myoglobin. What is the MOST LIKELY diagnosis for this patient’s symptoms? A. Osteoarthritis B. Cellulitis C. Rhabdomyolysis D. Tendinitis

C A= not sudden B= hot, red, edematous D= w/ active movement

Normal CK levels: __-____

20-100

Rhabdomyolysis CK level:

in the 1000s

Medical condition characterized by the breakdown of skeletal muscle tissue, resulting in the release of muscle cell contents into the bloodstream. The released contents can include myoglobin, creatinine kinase (CK), potassium, and other muscle cell components.

Rhabdomyolysis

Medical condition that can lead to kidney damage, electrolyte imbalances, metabolic acidosis, and death if not given immediate medical attention

Rhabdomyolysis

What medication is considered to be one of the medications increasing the risk of rhabdomyolysis?

Statins (treat hyperlipidemia)

Name the condition: Pulsating feeling in the abdomen, abdominal bulge

AAA (Aortic Abdominal Aneurysm)

Name the condition: Tenderness at McBurney’s point, RLQ pain, mild fever

Appendicitis

Name the condition: 6 ‘P’s: Pain, Palpable tenderness, Paresthesia, Pallor, Paresis, Pulselessness

Acute Compartment Syndrome

Name the condition: Saddle anesthesia, loss of bowel bladder function, urine retention, lower extremity weakness

Cauda Equina

Name the condition: Left neck and jaw pain along with chest pain

MI/ Cardiac Arrest

Name the condition: Sudden hives, itching, shortness of breath, rapid or weak pulse

Anaphylaxis

Name the condition: Excessive thirst, confusion and difficulty concentrating and fruity odor in breath

Diabetic Ketoacidosis (DKA)

A physical therapist is treating a patient for osteoarthritis in both knees since a few months. One day, the patient reports moderate right shoulder pain, but gives no history of trauma and reports that the pain started one morning and got severe very quickly. Currently he reports pain on 6/10 that does not change with medication or rest. What is the MOST APPROPRIATE next step for the therapist? A. Evaluate the patient for shoulder osteoarthritis B. Ask the patient about his use of NSAIDs in recent times C. Activate 911, as it is indicating a myocardial infarction D. Treat with hot and TENS for pain

B, could be a peptic ulcer

A 59-year-old male patient is being evaluated for left shoulder pain. The patient reports that his shoulder pain is closely associated with activity, including stress at work. The patient reports that at worst, the pain radiates into his neck, and he feels shortness of breath which subsides with rest. What would the MOST APPROPRIATE intervention be? A. Begin passive range of motion exercises within the pain free range of motion B. Postpone treatment and refer the patient to his physician for further evaluation C. Apply modalities to the shoulder and instruct the patient on activity modification D. Begin the patient with rotator cuff exercises within the pain reduced range of motion and instruct patient on activity modification

B, heart related

A physical therapist employed in an outpatient clinic that gets a referral from a bariatric surgeon. The therapist is referred a patient who is moderately obese with poor cardiovascular endurance. The PT designs an exercise program to begin with. Which exercise program prescription do you think is the most apt to START with? A. 3-5 times a week, intensity 60% HRmax while walking on a treadmill B. 5 times a week, cycling with intensity as tolerated for 20 mins/day C. 5 times a week, a combination of cycling and walking for 45 mins/day at normal walking/cycling pace D. 7 days a week, with weightlifting 3 times and 4 days cardio for 90 mins at 70-85% HRmax

C A= no time reported B= minimum of 150-300 mins/week D= too high of intensity to start with