Tough Stuff Flashcards
Normal WBC count
5,000-10,000
What can refer pain to R inferior angle of scapula
Gallbladder
What is the Crede Maneuver used for
Areflexive bladder
What position helps GERD/hiatal hernia
L sidelying
Where does the gallbladder refer pain to
- R neck
- R shoulder
- R inferior angle of scapula
- RUQ of abdomen
Where does the liver refer pain to
- R neck
- R shoulder
- RUQ
***liver and gallbladder refer pain to similar areas
Where does the lung/diaphragm refer pain to
L neck
L shoulder
Where does the stomach refer pain to
center of chest
center of back
Where does the pancreas refer pain to
LUQ
Where do the kidneys refer pain to
R and L lower quadrants
IL shoulder
Flank pain
Where does a peptic ulcer refer pain to
mid back
Long term lithium use can lead to what
Osteoporosis
Normal glucose levels
70-100
Normal platelet levels
140,000-440,000
What level = hyperglycemia/diabetic ketoacidosis
> 300
Maximum carpet pile ADA
1/2 inch
What would cause decrease or increase in Ca levels in the blood
Hypo-parathyroidism
Hyper parapthyroidsim
What happens with Paget’s dz
Bone is turned over more often, increased risk of fx. Bone pain is common complaint.
Decrease in cortisol level =
Addison’s disease
Increase in cortisol level =
Cushing’s disease
Buffalo Hump is commonly seen with what
Cushing’s disease
Intolerance to cold is seen with which two metabolic/endocrine conditions
- Addison’s disease
- Hypothyroidism
BEST test to diagnose an ACL injury
Lachman’s
How to bias SLR for Tibial N
- Hip flex
- Knee ext
- Ankle DF
- Eversion
- Toe ext
How to bias SLR for Sural N
- Hip flex
- Knee ext
- Ankle DF
- Inversion
How to bias SLR for Peroneal N (fibular n)
- Hip flex
- Hip IR
- Knee ext
- Ankle PF
- Inversion
What glides to perform to perform opening of mouth (TMJ)
Anterior
Inferior
How much elbow flexion while in the parallel bars
20 degrees
Describe the “screw home” mechanism with knee extension
The tibia laterally rotates during the final 20 degrees of knee extension
Capsular pattern at the thoracic spine
Equal lateral flexion and rotation
Extension
End feel for Adhesive Capsulitis
Firm
Which side will the TMJ deviate to if there is an issue with the capsule
Ipsilateral
What position will the neck be in if the R SCM tears (torticollis)
R lateral flexion
L cervical rotation
Neck flexion
Capsular pattern at the shoulder
ER > Flex > IR
Capsular pattern at the hip
Flex > Abd > IR
Swan Neck Deformity
MCP flex
PIP ext
DIP flex
Boutonniere Deformity
MCP ext
PIP flex
DIP ext
What two tendons are involved with DeQuervain’s
Extensor pollicis brevis
Abductor pollicis longus
Active Compression/ O’Brien’s Test best identifies what pathology
SLAP tear
Settings for Sensory TENS
Freq = 100 Hz Duration = 100 microseconds
Settings for Motor TENS
Freq = 1-5 Hz (low) Duration = 400 microseconds
What is thermal US used for (chronic/subacute or acute)
Chronic/subacute
What is nonthermal/pulsed US used for (chronic/subacute or acute)
Acute
What frequency for US to get deep structures
1 MHz
What frequency for US to get superficial structures
3 MHz
Settings for E-Stim for small muscles
Frequency = 20-30pps
Pulse duration = 150- 350 microseconds
Settings for E-Stim for large muscles
Frequncy = 35-50 pps
Pulse duration = 150- 350 microseconds
Settings for Russain E-Stim
Frquency = 50 pps
Pulse duration = 300-400 micorseconds
-50% duty cycle
Less than ____ on 5x STS test means fall risk
12
Less than ___on Berg Balance Scale means fall risk
50 (56 = max score)
More than ___on TUG means fall risk
13.5 sec
Which artery is affected with Wallenburg’s Syndrome (lateral medullary syndrome)
PICA (ptosis, dry mouth, ataxic gait, vertigo, miosis, etc)
What artery is affected with Lateral pontine syndrome
AICA (hearing issues, IL facial sensation loss, falling toward side of lesion)
Jaw will deviate toward which side with CN5 lesion
Ipsilateral
Which cranial n is responsible for blink reflex
CN5 (trigeminal)
Facial muscles will deviate toward which side with a CN7 lesion
Contralateral
Uvula will deviate toward which side with CN10 lesion
Contralateral
Tongue will deviate toward which side with CN12 lesion
Ipsilateral
Posterior Cerebral Artery Syndrome will cause what
Homonymous hemianopsia
What score on the Glasgow coma scale means severe brain injury
8 or less
Which cranial neve is responsible for input of blink reflex
CN5
Which cranial nerve is responsible for output of blink reflex
CN7
Babinski will be seen until when
24 months (2 years)
What is the main orientation system from birth until 4 months
Vestibular (vision has not developed yet)
When does belly crawling start
7 mo
When does independent sitting start
6 mo
What will be seen with anterior cord syndrome
B loss of pain/temp and motor below the level of lesion
What will be seen with Brown Sequard Syndrome
- IL loss of vibration, fine touch, motor, and proprioception
- CL loss of pain/temp
What will be seen with central cord syndrome
UE involvement more than LE
Distal involvement more than proximal
Motor loss more than sensory loss
Weber’s syndrome involves which artery
posterior cerebral artery
What will be seen with Weber’s syndrome
CL hemiplegia
CL loss of pain/temp
IL vision loss
Verbal or visual cues with L sided stroke
Visual
Verbal or visual cues with R sided stroke
Verbal
Modified Ashworth:
Catch/release at end ROM
1
Modified Ashworth:
Catch/release and resistance throughout the rest of the ROM
1+
Modified Ashworth:
Marked increase in tone thru the ROM but it moves easily
2
Modified Ashworth:
Passive movement is difficult
3
Modified Ashworth:
Affected part is rigid flex/ext
4
C5-C6 injury
Erb’s palsy
Position for Erb’s Palsy
Waiter’s Tip:
IR, elbow extension, adduction, pronation, winged scapula
C7-T1 injury
Klumpke’s palsy
Position for Klumpke’s palsy
Loss of hand intrinsics (claw hand)
Theory of motor learning:
Focus is on normal movement, inhibition of abnormal tone/synergy
NDT (aka Bobath)
Theory of motor learning:
Stronger parts of body used to stimulate and strengthen weaker parts of body….overflow concept
PNF
Theory of motor learning:
Use of sensory stimulation to facilitate/inhibit responses
Rood
Theory of motor learning:
encouraged pt’s to learn synergies and then abolish synergies
Brunnstrom
LE flexor synergy
Hip flexion Hip abduction Hip ER Knee flexion Dorsiflexion Inversion Toe ext
LE extension synergy
Hip ext Hip adduction Hip IR Knee extension Plantar flexion Inversion Toe flex
LE spastic resting pattern
Knee extension
Equinus/valgus ankle
Great toe DF or excessive toe flexion
**there is also a LE flexion spastic resting pattern, but extension is most commonly seen
Normal ejection fraction
55-75%
Toxicity of which drug can lead to Cushing’s Syndrome (buffalo hump, moon fact, ligament/tendon laxity)
Corticosteroids
Type of SLAP lesion:
Degenerative Fraying, biceps tendon still intact
type 1
Type of SLAP lesion:
Detachment of superior labrum/biceps from glenoid rim.
type 2
Type of SLAP lesion:
most common type
type 2
Type of SLAP lesion:
Bucket-handle tear of labrum, biceps tendon remains intact
type 3
Type of SLAP lesion:
intra-substance tear of biceps tendon. Least common type
type 4
Tendonitis or bursitis?
AROM and PROM are painful
Bursitis
What muscles are responsible for opening of the mouth (aka depression)
- lateral pterygoid
- suprahyoid
- infrahyoid
What muscles are responsible for closing of the mouth (aka elevation)
- medial pterygoid
- temporalis
- masseter
Antalgic gait patttern
____ ipsilateral step length
____ contralateral step length
Normal
Short
Difference between Smith and Colle’s fractures
Both are distal radial fractures
Smith = when you land on dorsum of the hand
Colle’s when you land on front of hand (FOOSH)
Fracture of one or more metacarpal bones
Boxer’s fracture
When does midstance start and stop
Start: when opposite leg leaves the ground for swing
Stop: when heel off occurs on reference limb
What is involved with pronation of the foot
- rearfoot valgus
- calcaneal eversion
- PF/IR of the talar head
What is the compensation for rearfoot valgus
forefoot varus
What two deformities (one rearfoot and one forefoot) will lead to excessive pronation at midstance
- ) Rearfoot valgus
2. ) Forefoot varus
What is involved with supination of the foot
- rearfoot varus
- calcaneal inversion
- DF/ER of the talar head
What is the compensation for rearfoot varus
forefoot valgus
What type of wedge would you use for forefoot varus
Medial wedge
What type of wedge would you use for forefoot valgus
Lateral wedge
What type of wedge would you use for rearfoot valgus
Medial (varus) post
What type of wedge would you use for rearfoot varus
Lateral (valgus) post
Will forefoot varus lead to pronation or supination of the foot
Pronation
**as a compensation
Willl forefoot valgus lead to pronation or supineation of the foot
Supination
**as a compensation
What is a Thomas heel used for
Pronated foot
Trunk lurching backwards during TST is due to what
hip flexor weakness (think about slingshotting leg forward)
Lack of DF at terminal stance will cause what
short CL step length
What two foot deformities can lead to pronation of the foot
Rearfoot valgus
Forefoot varus
What occurs during vaulting and what is it due to
What phase of the gait cycle does it occur during
When the CL limb plantar flexes to clear limb due to lack of knee flexion (stiff knee)
Occurs during initial swing
What is a Lisfranc amputation
When the metatarsals are removed but the tarsal bones are spared
What is a Chopart amputation
When the tarsal bones are removed and all that is left is the talus and calcaneus
What is a Syme’s amputation
Removal of B malleoli, calcaneal fat pad is maintained and attatched to the distal tibia
Which type of suspension is best used for a patient who has undergone an AKA very recently, has CHF, and has a lot of volume changes
Lanyard
Prosthetic deviations:
Causes of lateral trunk lean
- short prosthesis
- high medial wall
- abduction contracture
- weak hip abductors on prosthetic side
- short residual limb
Prosthetic deviations:
Causes of circumduction
- prosthesis is too long
- too much friction in knee (aka knee is too stiff)
- socket is too small
- excessive plantar flexion of prosthetic foot
- weak hip flexors and adductors
- painful anterior distal residual limb
Prosthetic deviations:
Buckling
-socket set forward in relation to the foot
-foot set in excessive DF
-stiff heel
prosthesis too long
-knee flex contracture
-hip flex contracture
-anterior limb pain
-decr quad strength
Will a stiff or soft heel cause buckling
prosthetics
stiff heel causes buckling
Will a stiff or soft heel cause hyperextension
prosthetics
soft heel causes knee hyperextension
Prosthetic deviations:
Vaulting
- prosthesis too long
- inadequate sock suspension
- short residual limb
- foot in excessive PF
Prosthetic deviations:
Rotation of forefoot at heel strike
- loose fitting socket
- inadequate suspension
- rigid SACH heel cushion
- short residual limb
Prosthetic deviations:
Forward Trunk Lean
- socket too big
- poor suspension
- knee instability
- hip flexion contracture
- weak hip extensors
- pain with ischial weight bearing
Prosthetic deviations:
Medial/Lateral Whip
- excessive rotation of the knee
- tight socket
- valgus in prosthetic knee
- improper alignment of toe break
- weak hip rotators
- knee instability
How often should you perform pressure relief
Every 15 min
Seat to floor height that is too low will cause what
increased pressure on ischial, poor ground clearance
Seat to floor height that is too high will cause what
feet not touching, so the patient will have to sit in a posterior pelvic tilt
Cervical traction:
Force to use in intial session
8-10#
Lumbar traction:
Force to use in initial session
30-40#
Lumbar traction in what position is best for herniated discs
prone
Lumbar traction:
How much force to overcome soft tissue and friction resistance to achieve vertebral separation
30-50% of body weight
Lumbar traction:
How much force for soft tissue relaxation
25-50% of body weight
Cervical traction:
How much force for soft tissue relaxation
12-15#
ADA:
When do you need a landing on a ramp (and how big should the ramp be?)
need a landing of 60” by 60” (5’ by 5’) for every 30” of run on a ramp
ADA:
How big does a door opening have to be?
32 in
Scoliosis:
Cobb angle that requires surgery
40 degrees
Scoliosis:
Cobb angle that requires TLSO
20-35 degrees
Scoliosis:
Cobb angle that requires close monitoring
10-20 degrees
ADA:
Toilet seat height
17-19 in
ADA:
Hallway width
36 in
6MWT MCID
50 meters
What type of precautions for:
MRSA, VRE, GNB, C-diff
Contract (gloves and gown)
What type of precautions for:
Influenza, RSV, Bordetella
Airborne (facemask and goggles)
What type of precautions for:
TB, measles, chicken pox, herpes
Droplet (isolation room, respirator)
Proper donning and doffing order:
Don: gown, mask, face shield, gloves
Doff: gloves, gown, EXIT THE ROOM, face shield, respirator
How often to give someone NTG if they are having angina
3x 5 min apart
SCI:
At what level can someone start to use a manual WC and not have to rely on power WC as much
C6
An ABI less than what means no compression due to arterial insufficiency
Less than 0.6
What type of adventitious breath sound will be heard in someone with cystic fibrosis
Ronchi (low pitched wheezing)
What type of adventitious breath sound will be heard in someone with CHF
Crackles (rales)
What type of adventitious breath sound will be heard in someone with asthma
Wheezes
What type of adventitious breath sound will be heard in someone with an upper airway obstruction
Stridor
What is defined as orthostatic hypotension
Drop in SBP by more than 20mmHG
OR
Drop in SBP and DBP by 10mmHg or more
What increases and decreases pain in someone with pericarditis
Increases: with neck or trunk movement
Decreases: with sitting up or leaning forward
Level of arousal:
Conscious of internal or external stimulation
Aware
Level of arousal:
Aware of self and environment. May still be disoriented or confused
Consciousness
Level of arousal:
State of unconscious in which there is neither arousal or awareness. Eyes remain closed and there or no sleep wake cycles
Coma
Level of arousal:
State in which patients are not vegetative and do show intermittent signs of awareness
Minimally Responsive
Level of arousal:
Marked by return of the sleep/wake cycle and vital functions (respiration, digestion, and blood pressure). Patient may appear awake but is not aware of the environment
Vegetative state
How to bias the medial meniscus during McMurray’s test
ER of tibia
Valgus stress
How to bias the lateral meniscus during McMurray’s test
IR of tibia
Varus stress
What does Apley’s test look at?
Meniscal damage
What score on the MMSE means severe dementia
below 9
What score on the 5x STS test means high risk of falls
12 sec
What score on the TUG means high risk for falls
More than 13.5 sec
Will apraxia be seen with R or L sided CVA
L sided CVA
How much cervical flexion should someone be in when doing cervical traction
25-30 degrees for C5-C7
0-5 degrees for C1-C4
Positive finding on Craig’s test
angle is greater than 8-15 degrees
State of consciousness:
Can only be aroused by vigorous stimuli
stupor
State of consciousness:
Diminished arousal/awareness. Pt difficult to arouse, once aroused confused and little interest in envoirnment
Obtunded state
State of consciousness:
Level of arousal decreased. Falls asleep quickly if not continually stimulated
lethargy
When does indepedent sitting and belly crawling emerge in a baby
6-7 months
lack of awareness of paralysis
anosognosia
cannot recognize objects presented
visual agnosia
lack of awareness of body structure/relationship of body parts
somatoagnosia
no idea how to perform something (picking up a toothbrush and trying to comb hair)
ideational apraxia
can only perform a task automatically and cannot perform it on demad
ideomotor apraxia
damage to what nerve would cause lateral wining of scapula
CN11 (spinal accessory nerve)
damage to what nerve would cause medial wining of scapula
long thoracic nerve (C5-C7)
actions of pectinues
hip flexion
hip adduction
actions of gracilis
hip adduction
actions of sartorius
hip flexion
hip ER
knee flexion
What is innervated by the superior gluteal n (L4-S1)
- gluteus medius
- glutues minimus
- TFL
What is innervated by the inferior gluteal n (L4-S2)
Gluteus maximus
what nerve provides sensation to the 1st webspace of the foot
deep peroneal
What does the deep peroneal n innervate
- tibialis anterior
- EDL
- EHL
What does the superficial peroneal n innervate
-peroneus longus/brevis
the sural n is a branch of what nerve and what does it provide
branch of tibial n
supplies sensation to lateral part of lower leg and lateral foot
What type of drugs can lead to rhabdomyolysis
Statins (antihyperlipidemia)
Ataxic breathing seen with brain stem lesion, stroke, neuron damage. Gasping and then no breathing and then gasping again
Biot’s respiration
Rapid, deep breathing
Kussmaul breathing
What is Kussmaul breathing due to
metabolic acidosis
fast and deep breathing, slow breathing, then stop of breathing
cheyene stokes respiration
type of breathing in which the chest wall does NOT expand but the stomach rises
Paradoxical breathing (seen with SCI)
What drugs are given for asthma
Beta-agonists (causes bronchodilation and vasocontrcition)
Type of CHF where SV is low but the EF is preserved
Diastolic CHF
Type of CHF where SV is low and EF is low
Systolic CHF
What is the cause of diastolic CHF
chambers are stiff and thick so the L ventricle cannot fill well
What is the cause of systolic CHF
the chambers are stretched out and thin so the L ventricle cannot pump well
To decrease type 1 errors what do you need
high specificity
To decrease type 2 errors what do you need
high sensitivity
Sensitivity or specificity:
gets the true positives
sensitivity
Sensitivity or specificity:
gets the true negatives
specificity
what nerve will be affected with a midshaft humeral fx
radial n
what is an s3 heart sound indicative of
ventricular failure
what is an s4 heart sound indicative of
cardiomyopathy
what will increase the depth of penetration with US
incr freq will incr depth of penetration with US
normal INR in healthy people AND normal INR in those taking warfarin or blood thinner
1.1 is normal for healthy people
2-3 is normal for those on blood thinners
what is the function of the premotor area
visually guided movement
Decorticate vs decerebrate
Decorticate = UE in flex, LE in ext (lesion in diencephalon) Decerebrate = all in ext (indicative of brain stem lesion)
Minimum and maximum height for handrails
minimum = 34 inches maximum = 38 inches
what score on the MMSE means abnormal cognition
24/30 and below
when is the flexor withdrawal integrated
1-2 months
when is the traction reflex integrated
2-5 months
when is the palmar grasp reflex integrated
4-6 months
when is the moro reflex integrated
5-6 months
weak abdominals cause an anterior or posterior pelvic tilt
anterior
4 factors leading to an anterior pelvic tilt
- tight hip flexors
- tight spinal erectors
- weak glutes
- weak abdominals
5 factors leading to a posterior pelvic tilt
- weak hip flexors
- weak spinal erectors
- tight hamstrings
- tight abdominals
- tight glutes
what ligaments provide the primary restraint against horizontal shear force to the AC joint
superior and inferior capsular ligaments
coracoclaviulcar ligament offers a secondary restraint
R or L sided brain injury:
agnosia
Right
R or L sided brain injury:
global aphasia
Left
R or L sided brain injury:
speech/language issues
Left
R or L sided brain injury:
apraxia
Left
what type of disk displacement in the mandible will cause limited ROM (less than 40-50mm), Ipsilateral deviation, and a hard end feeel as the mandibular condyle jams against the displaced disk
Anteromedial disk displacement
myxedema is common with what disease
hyperthyroidism
counternutation of the sacrum = ____ilium on sacrum rotation
anterior
nutation of the sacrum = _____ilium on sacrum rotation
posterior
how does the sacrum move with nutation
anteriorly and inferiorly
how does the sacrum move with counter nutation
posteriorly and superiorly
does anterior or posterior pelvic tilt lead to lumbar lordosis
anterior pelvic tilt leads to lumbar lordosis
what do tight hip flexors lead to during gait
decreased contralateral step length
what is a common side effect of alpha 1 blockers
orthostatic hypotension
prednisone is what type of drug?
What does it treat?
What can it lead to (side effects)?
a. ) corticosteroid
b. ) rhuematoid arthritis
c. ) Cushing’s dz (moon face, HTN)
what type of dressing is good for neuropathic foot ulcers
antimicrobial
humeroulnar distal glide improves what
elbow flex
humeroulnar radial glide improves what
elbow flex
humeroulnar volar glide improves what
elbow flex
humeroulnar distraction improves what
elbow extension
open packed position of elbow
70 degrees flex
10 degrees supination
humeroulnar ulnar glide improves what
elbow extension
humeroulnar dorsal glide improves what
elbow extension
what does the talar tilt test?
inury to the calcaneofibular ligament
what does the external (lateral) rotation stress test test
injury to the syndesmosis
what does the anterior drawer test test?
injury to the anterior talofibular ligament
following symptoms: resting muscle pain, flu-like symptoms, and generalized weakness of the arms and legs. Which drug class is MOST responsible for the patient’s symptoms and presentation?f
Statins
rhabdomyolysis can occur with use of which drugs
statins
a seat depth that is too long will lead to what
posterior pelvic tilt
a seat depth that is too short will lead to what
pressure ulcers/sacral sitting
what body system should you be concerned about if someone presents with bilateral carpal tunnel
hepatic (liver)
possible liver cancer
ADA:
how far should countertop be from floor
34 inches
ADA:
how far should sink height be from floor
30 inches
ADA:
best floor plan?
U shaped or L shaped
ADA:
optimal turning radius
5 feet x 5 feet
unconscious patient with an absence of the pupillary light reflex suggests damage to
the midbrain
what does the pons assist with
assists with regulation of respiration rate and is associated with the orientation of the head in relation to visual and auditory stimuli
what does the medulla do
influences autonomic nervous activity, respiration/heart rate regulation, and reflex centers for vomiting, coughing, and sneezing
rationale for using hydrocolloids or hydrogels
provide for absorption of mild to moderate amounts of exudate while maintaining a moist wound environment to facilitate autolysis.
closed packed position at the hip
full hip extension, internal rotation, and abduction
prolonged use of heparin, coumadin, corticosteroids, and aspirin can lead to what
secondary osteoporosis
Biofeedback:
high or low sensitivity when first starting for muscle relaxation
start with low
Biofeedback:
high or low sensitivity when first starting for muscle strengthening
start with high
Cause of mallet finger
extensor tendon avlusion
Cause of Duputryen’s contracture
fixed flexion deformity of 4th or 5th finger fascia, due to age
Cause of ape hand
median nerve palsy
Cause of Swan neck deformity
Loss of volar plate
Cause of Boutonniere deformity
Rupture of extensor hood
When is the gallant reflext integrated
12 months
When is the landau reflex integrated
begin at 3 months, fullly integrated at 2 years of age
When is the moro reflex integrated
28 wks gestation to 5 months of age
When is the plantar grasp reflex integrated
28 wks gestation to 9 months of age
Which test is best for TOS?
Adsons (disappearance of radial pulse when extending head and rotating toward affected shoulder)
What is blount’s dz
disorder of growth plates in kids
-extreme varus with hyperextension
What 3 things are involved with talipes equinovarus
- ) Forefoot adducted
- ) Hindfoot varus
- ) Ankle equinus
Gold standard test for determining if someone has a RTC tear?
Arthrogram
Increase in proportion of type 1 or type 2 fibers as we age
Increase in proportion of type 1 fibers
Concussion grade:
transient confusion, no LOC. Mental status resolves in 15 min or less
grade 1
Concussion grade:
transient confusion, no LOC. Sx last 25 min
grade 2
Concussion grade:
LOC
grade 3
Which cranial nerve is the issue if the eye is stuck in elevation and abduction
CN4
Difficulty swallowing means which cranial nerve may be down
CN11
What part of the spinal cord does post polio syndrome affect
Anterior horn
Does GBS start in LE or UE
LE then goes up to upper extremity (ascending weakness for GBS)
Common cause of spina bifida
decrease in folic acid
Spina Bifida
open spinal cord, not covered with skin
-spinal nerve paralysis
Myelomeningocele
Spina bifida:
Skin covered, no issues
Meningocele
What type of cues to use for someone who has had a L side stroke
visual
What type of cues to use for someone who has had a R side stroke
verbal
What is seen with Erb’s palsy (C5-C6)
Waiter’s tip position (shoulder add, ir elbow ext and pronation
What is seen with Klumpke’s palsy (C7-T1)
Loss of hand intrinsics, claw hand
-also Horner’s Syndrome can occur due to T1 involvement
LE extensor synergy pattern
Hip ext, add, IR
Knee extension
PF, inv
Toe flex
LE flexor synergy pattern
Hip flex, abd, ER
Knee flexion
DF, Inv
Toe ext
LE PNF pattern:
D1 flexion
Hip flex, add, ER
Ankle DF, Inv
LE PNF pattern:
D1 extension
Hip ext, abd, IR
Ankle PF, Ev
LE PNF pattern:
D2 flexion
Hip flex, abd, IR
Ankle DF, Ev
LE PNF pattern:
D2 extension
Hip ext, add, ER
Ankle PF, inv
LE spastic resting pattern:
Extension (this is the most common spastic resting pattern in the LE)
Knee extension
Equinus/valgus ankle
Great toe DF OR excessive toe flexion
Will Addison’s dz cause too high or too low K+
too high K+ with Addison’s
Will Cushing’s dz cause too high or too low K+
too low K+ with Cushing’s
Is S3 or S4 atrial gallop/cardiomyopathies
S4
Is S3 or S4 ventricular gallop
S3 (indicative of CHF)
How often should you measure HR/RPE when following the Bruce Protocol
Every 1 min
How often should you check BP when following the Bruce Protocol
At every stage (3 min)
Normal EKG changes during exercise
- P wave incr in height
- R wave decr in height
- ST segment becomes sharply upsloping
- QT interval shortens
- T wave decr in height
- J point become depressed
Abnormal EKG changes during exercise
- ST segment depression more than 1mm (ischemia)
- ST segment elevation more than 1mm
- Incr PR interval
- Missing Q wave
- Missing P wave
- Incr/decr wave time
Normal HR for babies to age 1
100-160 bpm
Normal HR for children 1 to 10
60-140 bpm
What occurs with the valsalva manuever
- Decr in BP and incr in HR
Overshoots - Incr in BP and decr in HR
-due to overactivation of PNS/vagus n
What is a disadvantage of fluroscopy
high radiation (fluroscopy is a continuous x ray used to visual the heart and lungs)
An ABI less than ___means no compression
Less than 0.6
ABI less than __means arterial insuff
Less than 0.8
Pressures greater than __mmHg are contraindicated due to causing lymphatic collapse
45 mmHg
Short stretch bandages:
___resting pressure, ___working pressure
low resting pressure
high working pressure
Should you decongest proximal or distal lymphatic segments first?
decongest proximal first
should stroke be proximal to distal or distal to proximal when performing lymphatic draininage?
distal to proximal
Contraindications for manual lymphatic drainage
- Acute infection (cellulitis)
- Acute DVT
- Malignancies
- Renal failure
- Cardiac edema
Will edema with lymphedema go away with elevation
no
Is R or L drainage area larger (lymphatic system)
L is larger
Do arterial or venous ulcer feel better with elevation
venous feels better with elevation
Do arterial or venous ulcers increase pain with dependency
pain incr with dependency with venous ulcers
Are arterial or venous ulcers more pain
arterial are more painful
Do arterial or venous ulcers have more drainage
venous have more drainage
Compression/unna boot is best for venous or arterial ulcers
venous
Are hydrogels absorptive
no, they are used for dryer wounds
Are hydrofibers absorptive
yes, they are the most absorptive
Is gauze absorptive
Yes
Can gauze be used for infected wounds?
Yes
WC prescription:
Seat width
Hip width + 2 inches
WC prescription:
Seat depth
Posterior thigh - 2 inches
WC prescription:
Seat height
Leg length + 2 inches
WC prescription:
hanging elbow angle
+ 1 inch for armrest height
Ergonomics while seated at work:
Chair height: feet on floor
Knee flexion to 90 degrees, elbows at 90 degrees
Shoulders in neutral
ADA guidelines:
Doorway
Minimum is 32 inches
ADA guidelines:
Carpet pile
Less than 1/2 inch pile
ADA guidelines:
Hallway width
Minimum 36 inches
ADA guidelines:
Wheelchair turning radius
60 inches
ADA guidelines:
Bathroom sink
29-40 inches
Lumbar traction in what position is good for herniated disks
Prone
What poundage of traction to reduce muscles spasms in lumbar spine
25-50#
triad of sx for mitral valve prolapse
- dyspnea
- fatigue
- palpitations
How long should pressure garments be worn if a burn takes longer than 14 days to heal
23 hours
The ____glenohumeral ligament is the primary stabilizer against anterior translation in 90 deg of abd at ER (throwers position)
inferior
The ___glenohumeral ligament stabilizes against anterior translation with the arm in ER and less than 90 deg of abduction
middle
The ____glenohumeral ligament is an important inferior stabilizer
superior
Which glenohumeral ligaments helps with inferior stabilization
superior
Where is pain located with ulcerative colitis
left lower quadrant
Where is pain located with Crohn’s colitis
right lower quadrant
Type of MS:
steady functional decline and disease progression since onset with lack of discrete attacks
Primary progressive MS (PPMS)
Type of MS:
steady functional decline and disease progression since onset with occasional acute attacks where the periods between attacks are characterized by continuing disease progression
Progressive-relapsing MS (PRMS)
Type of MS:
attacks of neurological decline followed by full or partial recovery weeks or months later where the periods between relapses are characterized by lack of disease progression
Relapse-remitting MS (RRMS)
Type of MS:
relapsing-remitting multiple sclerosis that progresses to steady functional decline with or without continued attacks.
Secondary progressive MS (SPMS)
Which is more severe Weckenbach or Mobitz 2?
Mobitz 2 (you want slow/stop exercise for mobitz 2)….for Weckenbach you want to monitor exercise
What precautions are needed for Ebola
contact
What precautions are needed for Rubella (mumps)
droplet
What precautions are needed for Rubeola (measles)
airborne
What 3 diseases require airborne precautions
TB, chickenpox, measles (Rubeola)
Is dependent edema seen in venous or arterial ulcers
venous
Is nystagmus and vertigo seen in unilateral or bilateral vestibular hypofunction
unilateral
How should the bed be positioned for someone with atelectasis
Trendelenburg
Is Trendlenburg bed ok for someone with CHF
no
Is Trendelenburg bed ok for someone with pulmonary edema
no
Is Trendelenburg ok for someone with atlectasis
yes
How should ankle pumps be performed in someone who has lymphedema
with the limb elevated
Should someone with lymphedema wear compression garments while exercising
yes
Is exercising in a pool good for someone who has low BP (orthostatic hypotension)
yes
Which muscles are usually weak in those with patellofemoral dysfunction
- hip abductors
- hip ERs
- hip extensors
Runners with achilles tendonitis often present with
- resting calcaneal inversion
- excess pronation
f waves will be seen in a sawtooth pattern in place of P waves
atrial flutter
What artery is often involved with pusher syndrome
MCA
What muscles should be strengthened for someone with FAI?
- hip ERs
- hip extenders (glute max)
What motion should be avoided with FAI
IR of hip
anteriorly displaced sternum and increased anterior to posterior dimension of the chest.
pectus carinatum
posteriorly displaced sternum and decreased anterior to posterior dimension of the chest as well as impaired respiration, which can cause difficulty breathing and shortness of breath
pectus excavatum
What does a Klenzak joint assist with
dorsiflexion
What is involved:
torsional upbeating nystagmus in the left ear down position.
L posterior canal BBPV
which canal (ant or post) involved with downbeating torsional nystagmus
anterior canal involvement
How many deg of flexion should the neck be in for the supine roll test (tests the lateral canals)
30 deg of flexion
With a unilateral vestibular lesion, will the eyes beat towards or away from the affected side
Away
Will someone with an acute vestibular lesion fall away or toward side of lesion?
toward
What is the #1 reason for bilateral vestibular lesion
systemic drugs used to treat other conditions (chemotherapy)
What will someone with a bilateral vestibular lesion complain of
VERY off balance
Bouncing off the walls (oscillopsia)
–everything feels like it is bouncing
What will someone with a unilateral vestibular lesion complain most about
dizziness
What things do you look for to diagnose acute vestibular syndrome
HINTS
HI = head impulse test
N = nystagmus assessment
TS = test of skew deviation
Strokes of which two arteries will often lead to vertigo, nausea/vomiting
AICA/PICA
also will lead to IL Horner’s syndrome
Where is the talocrural joint the most stable
Full DF
What does it mean if S1 is absent
heart block
What does it mean if S2 is absent
aoritic stenosis
What does is mean if S3 is heard
CHF (can also be non pathological in athletes)
Arterial or venous ulcer:
pain incr with leg elevation
arterial
Arterial or venous ulcer:
pain incr with dependency
venous
Arterial or venous ulcer:
pain decr with elevation
venous
Arterial or venous ulcer:
pain decr with dependency
arterial
What kinds of foods make GERD worse
- coffee
- fatty foods
Posterior hip precautions:
Should you turn towards or away from surgical side while turning
turn away from surgcial side
Anterior hip precautions:
Should you turn towards or away from surgical side while turning
turn towards surgical side
What does the suprascapular n (C5-C6) innervate
Supraspinatus, infraspinatus
What does the suprascapular n (C5-C6) provide sensory input to
GH capsule
What innervates trapezius and SCM
CN 11 (spinal accessory n)
What does the long thoracic n (C5-C7) innervate
Serratus anterior
What does the musculocutaneous n (C5-C6) innervate
Coracobrachialis, brachialis, biceps brachii
What nerve provides sensation to the lateral forearm
Musculocutaneous n (C5-C6)
What does the axillary n (C5-C6) innervate
Teres minor
Deltoid
What nerve provides sensation to the proximal lateral arm
Axillary n (C5-C6)
Dull ache in the lateral shoulder what nerve should you suspect is the issue
Suprascapular n (C5-6)
What nerve roots does the radial n come from
C6-T1
What nerve is impacted with a midshaft humeral fx
radial n
What nerve is impacted with poor crutch use
radial n
What nerve provides sensory input to the 1st webspace of thumb
Radial n
What does the radial n (C6-T1) innervate
triceps brachii brachioradialis anconeus ECRB extensor digitorum supinator Abductor pollicis longus Extensor pollicis brevis/longus Extensor indicis
What does the median n (C5-T1) provide sensory input to
lateral hand (1st 3 digits and 1/2 of 4th)
What does the median n innervate
pronator teres palmaris longus flexor carpi radialis flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus abductor pollicis longus opponens pollicis
What nerve innervates supinator
radial n
What nerve innervates abductor pollicis longus
median n
What nerve innervates pronator teres
median n
What does the anterior interosseous n innervate (hint: there are 3 mm)
flexor pollicis longus
pronator quadratus
flexor digitorum profundus
Radial deviation weakness will be seen with injury to what nerve
median (C5-T1)
pronation weakness will be seen with injury to what nerve
median n
What nerve is injured:
cannot make a fist (fingers 1-3 do not flex when trying to make a fist)
median n lesion
What nerve is injured:
loss of lumbricals 3-4
ulnar n
What nerve is injured:
at rest fingers 4 and 5 are flexed and the others are straight
ulnar n
What nerve levels for the ulnar n
C8-T1
What nerve innervates flexor carpi ulnaris
ulnar n
What nerve is injured:
you cannot adduct the thumb
ulnar n
What does the ulnar n innervate
flexor carpi ulnaris flexor digitorum profundus (medial half!) ADDUCTOR POLLICIS opponens digiti quinti palmaris brevis
What does the femoral n innervate
Iliopsoas
Sartorius
Pectineus
Quads
What innervates gracilis
obturator n (L2-L4)
What nerve roots does the femoral and obturator n come from
L2-L4
What innervates pectineus
femoral n
What innervates sartorius
femoral n
What nerve dose the saphenous n come from
femoral n
What is normal on the reflex scale
2+
What is normal on the pulse scale
3+
Where does the saphenous nerve provide innervation
sensory to medial calf
What nerve provides sensation to the medial calf
saphenous n
What does the obturator n innervate
adductor longus/brevis
gracilis
adductor magnus
obturator externus
What nerve is injured:
loss of hip ER and adduction
Obturator n
What does the superior gluteal n (L4-S1) innervate
Gluteus medius
Gluteus minimus
TFL
What does the inferior gluteal n (L5-S2) innervate
Gluteus maximus
What nerve is affected:
posterior lean at initial contact
inferior gluteal n
What nerve is affected:
trendelenburg gait
superior gluteal n
What nerve innervates gluteus medius
superior gluteal n
What nerve innervates gluteus max
inferior gluteal n
What nerve innervates the gastroc-soleus
tibial n
What nerve roots does the tibial n come from
L4-S3
What nerve does the sural nerve come from
Tibial n
What does the tibial n innervate
Gastroc Soleus Popliteus Tibialis posterior Flexor digitorum longus Flexor hallucus longus
What nerve innervates tibialis posterior
tibial n
What does the common peroneal n split into
superficial peroneal
deep peroneal
What nerve provides sensation to the first webspace of the foot
deep peroneal n
What nerve provides sensation to the lower leg and dorsum of the foot (except for the first webspace)
superficial peroneal n
What nerve innervates poplitus
tibial n
Where does the sural n provide innervation to
lateral side of lower leg, posterolateral lower leg, and lateral foot
What does the superficial peroneal n provide innervation to
peroneus longus/brevis
What does the deep peroneal n provide innervation to
TA
Extensor digitorum longus
Extensor hallucis longus
What nerve innervates TA
deep peroneal n
What nerve innervates peroneus longus/brevis
superficial peroneal n
Which n is injured:
weak eversion
superificial peroneal n
Which n is injured:
foot drop/lack of DF
deep peroneal n
The plantar nerve provides innervation to the intrinsics of the foot. What nerve does the plantar n arise from
tibial n
What nerve provides sensation to the heel
tibial nerve
Does the saphenous or sural nerve provide sensation to the medial lower leg
saphenous =medial
Does the saphenous or sural nerve provide sensation to the lateral lower leg
sural = lateral
What nerve innervates extensor digitorum longus and extensor hallucis longus
deep peroneal n
What is seen with trochlear n injury
inability to depress/adduct the eye
In a stroke is the upper or lower face more affected
lower face more affected
What is the only sensory change seen with Bell’s palsy
sensation changes to the ant 2/3 of tongue
What provides sensation to the anterior 2/3 of tongue and posterior 1/3 of tongue
anterior 2/3 = facial n
posterior 1/3= glossopharyngeal (CN 9)
What cranial n does sensory to post 1/3 of tongue, sensory to middle ear, and the gag reflex sensory portion
glossopharyngeal (CN9)
What is responsible for the motor portion of the gag reflex
CN10 (CN9 is responsible for the sensory portion)
What type of drug can be used to treat Meniere’s dz
Diuretics
What cranial nerves provide the input and output portions of the blink reflex
Input = CN5 Output = CN7
pulmonic valve location
2nd IC space, L sternal border
aortic valve location
2nd IC space, R sternal border
tricuspid valve location
4th IC space, L sternal border
mitral valve location
5th IC space, midclavicular line
where is Erb’s point located?
what can be best heard at Erb’s point?
Located: 3rd IC space, L sternal border
Aortic and Pulmonic murmurs are best heard here
efficacy vs. effectiveness
efficacy = under ideal conditions effectiveness = under real life conditions
Action of teres minor and teres major
Teres minor = ER of shoulder Teres major (aka: little lat) = IR of shoulder
What nerve innervates flexor pollicis longus
median n
What nerve innervates abductor pollicis longus
radial n
Pain with painful arc 60-120 deg =
subacromial impingement
pain with painful arc at 170-180 deg =
AC joint issue
Positive Jobe’s test =
supraspinatus injury (jobe’s test = empty can)
Positive Hornblower’s sign (Patte test) means what
teres minor injury
what type of end feel with subacrominal bursitis
empty
what type of end feel with mensicus tear
springy block
boggy end feel =
hemarthrosis
Is first 30-60 of shoulder elevated due to GHJ or scapulothoracic joint
GHJ
Opening or closing restriction?
Difficulty SB to R and pain on R
closing (need to close)
Opening or closing restriction?
Difficulty SB to R and pain in L
opening (need to open)
Opening or closing restriction?
Difficulty SB to L and pain in R
opening (need to open)
Opening or closing restriction?
Difficulty SB to L and pain in L
closing (need to close)
Are upglides or downglides the only thing actually possible in C-spine due to anatomical situation
upglides
How to glide to improve ER/IR in someone with adhesive capsulitis? (or anyone with capsular pattern in shoulder)
also….what is the capsular pattern in the shoulder???
posterior
ER > abduction > IR
3 contraindications for joint mobs
- ) Joint effusion
- ) Inflammation
- ) Hypermobility
Following a flexor tendon repair which active movement should you try to prevent
active flexion
want passive flexion, active extension
Sunburst pattern =
Ewings Sarcoma
Where does nodding occur
C1-occiput
Where does most of rotation come from
C1-C2`
degree to which data sets are different from each other
t-test
Assess goodness of fit between observed and expected values
Chi-squared test
Level of measurement?
Weight
ratio
Level of measurement?
temperature
interval
Level of measurement?
Borg scale
ordinal
Level of measurement?
RPE
ordinal
Level of measurement?
MMT
ordinal
Level of measurement? assistance level (minA,modA, etc)
ordinal
Level of measurement?
blood type
nominal
Looks at strength of relationship between 2 variables
Correlation coefficient (r)
Used as a predictor/forecaster of data points
Regression analysis
What does this describe? (research/statistics)
Predicting VO2 max based on an exercise stress test
regression analysis
Represents variance from mean
Standard deviation (68-95-99.7)
Analyzes variance inside groups to determine whether the means of several groups are equal.
ANOVA testing
Key differences (2) between ANOVA and T test
ANOVA looks at mean and variance, while t-test only looks at mean
ANOVA used for 3+ data groups
Sensitivity or Specificity?
good at catching positives
sensitivity
Sensitivity or Specificity?
good at catching negatives
specificity
what is p-value compared to to determine significance
alpha level
higher than ____ is a positive liklihood ratio
1
lower than ____is a negative likelihood rati
1
indicates how far an item deviates from the population mean in terms of SDs
Z-score
the probability of rejecting the null hypothesis when the null is true (false positive/type 1 error)
alpha level
the probability that the results are merely due to chance if the null hypothesis is true
p-value
p-value less than ___ means statistical sig
0.05
What is this?
95% of the data set falls between two numbers
Confidence interval (usually set at 95%)
do you want a high or low alpha when safety is critical?
low alpha
number of patients who need tx to prevent 1 bad outcome
Number needed to treat (NNT)
Is a high or low number needed to treat (NNT) good or bad
low is better
What is the ideal Number needed to treat
1
what does an arterial line (a-line) do?
measures BP in real time
Can also get arterial blood gas analysis
**this is directly in an artery
when are chest tubes commonly seen
following open heart surgery or post-trauma t
*keep below level of lungs
purpose of NG tube
to deliver meds and nutrition via nose into stomach
how deep should compression depth be for adults?
for kids?
adults: 2 hands in center of chest, go AT LEAST 2 in deep
kids: 2 fingers on center of chest, only 1.5 inches deep
when is a positive pressure room used?
those with severely compromised immune system
-neutropenia, HIV, cancer, organ transplant pts
2-24 heel raises = what MMT score for plantar flexors
4/5
how many heels raises do you need to do to achieve 5/5 MMT for plantar flexors
25
Do you let HOB go below ___degrees if they have a nasoentric tube
30 deg
need to place HOB below __degrees to prevent risk of aspiration
30 deg
sign of symptom?
things you see/observe
sign
sign or symptoms?
things pt reports
symptom
function of poplitues muscles
flexion of knee
IR of tibia
what cranial nerve is AICA associated with?
CN 7 (IL facial sensation issues with
what cranial nerve is PICA (Wallenburg’s/lateral medullary syndrome) associated with?
CN 9
What cranial nerve is medial medullary syndrome associated with
CN12
R or L MCA stroke: Broca’s aphasia
right
R or L MCA stroke: Werneicke’s aphasia
left
what is a main side effect of levodopa (sinemat)
orthostatic hypotension
what is a main side effect of anticholinergics
dry mouth, blurred vision, constipation
