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
