UNIT 1 Flashcards
(143 cards)
1
Q
how to tell a mechanical from a non mechanical prob
A
a mechanical prob, the px is modified by movement or rest, non mechanical prob is constant
2
Q
If we are not able to reproduce the px, we may have to
A
refer them out
3
Q
ICF model
A
health cond to body structure and function to participation rest to activity limitation then personal and env factors
4
Q
4 main parts to what we do (new pt)
A
examination -collect data
assessment - interpret data
intervention - develop and implement plan
assessment - reeval
5
Q
What is 2 compartment thinking
A
we need to be open to the idea that not everything will fit in to a cookie cutter scenario (brick wall vs permeable wall)
6
Q
A pos response to your tx indicates that your hypothesis was ___
A
correct
7
Q
2 common errors with clinical reasoning
A
over emphasising findings to help support one hypothosis
ignorning findings that don’t support your hypothesis
8
Q
SINSS
A
severity irritability nature stage stability
9
Q
What is the severity part of SINSS
A
your assessment of the intensity (min, mod max)
10
Q
what is the irritability part of the SINSS
A
amt of activity needed to cause sx
severity of sx
time it takes to subside sx
11
Q
What is nature
A
structure that is causing the issue
12
Q
what is stage
A
acute, subacute, chronic
13
Q
what is stability
A
better or worse (ease of disturbance)
14
Q
acute is what time frame
A
less than 30 days (inflammatory phase)
15
Q
sub acute is what time frame
A
30 days to 6 mos
16
Q
chronic is what time frame
A
after 6 mos
17
Q
proliferation stage is associated with what phase
A
sub acute
18
Q
a physical finding
A
sign
19
Q
problem reported by pt
A
sx
20
Q
what is clearing a jt
A
you have to check above and below the joint that is causing the prob, do passive over pressure and testing of all 3, then place a single check mark over the joint on the body chart to indicate cleared
21
Q
P1
A
primary complant
22
Q
C
A
constant
23
Q
I
A
intermittant
24
Q
/////
A
numbness or tingling
25
a sign found on an objective exam that reproduces sx (px)
comparable sign
26
D vs S
deep vs superficial
27
our focus in the subjective exam
to find all of the behavior and characteristics of their issue and sx
28
BTS
back to sleep
29
HBH
hand behind head
30
HBB
hand behind back
31
HF
horizontal flexion
32
```
red flags
(many children will fall down without loving care NN)
```
```
Malaise
Chills/fever
Wt change
Fatigue
Dizziness
Weakness
Lightheadedness
Cough
N/V
Numbness tingling
```
33
px that occurs before any resistance is felt, you would do what grades of joint mobs
1 or 2
34
If px doesn't increase when resistance is felt, you should be ok doing a grade
3 or 4
35
what is the closing part of our exam
"is there anything you can think of you need to share that I haven't asked about"
36
when should you have 3-4 hypotheses formulated
after your subjective exam
37
4 catagories to guide you to the extent of your tests/exams
px, ROM, overpressure feel, sustainability
38
3 stages of intervention
1 - to relieve the primary issue (ex: px)
2 - relieve the movement issue
3 - aid with global issues
39
when should you test pxfull mvmts
at the very last, or not at all (depends on scenario)
40
AROM tests what type of tissue
both contractile and inert (focus is on contractile)
41
PROM tests what type of tissue
inert only
42
what is PAM
Passive accessory movement (mobs)
43
PAMs test what kind of motion
arthrokinematics (mvmt within joint articulation)
44
resisted motion tests, test what type of tissue
contractile
45
how are resisted motion tests and MMT different
resisted motion tests do not test strength
46
in order for resisted motion test to really be effective, pt MUST be in ____ position
resting
47
Scale for resisted motion testing
strong and painless
strong and painfull
weak and painless
weak and painful
48
if the resisted motion test is strong and painless, this indicates that it is not ____ tissue
contractile (contractile would be painful)
49
If the resisted motion test is strong and painful, this indicates that it is probably ____ tissue that is effected
contractile (like a strain)
50
If the resisted motion test is weak and painless, this indicates that the problem is probably
neuro
51
if the resisted motion test is weak and painful
serious contractile issue or even possible fx
52
explain how we test dermatomes
light touch sensation
53
What is DTR
deep tendon reflex (with reflex hammer)
54
what is the segment for achilles reflex
S1
55
segment for hamstring reflex
L5
56
segment for patellar reflex
L4
57
Scale for reflexes grading
```
0 nothing
1 hypo
2 normal
3 hyper
4 clonus
```
58
hyporeflex would indicate
peripheral issue
59
hyper reflexive indicates
systemic issue (cortex, spinal cord)
60
order of your obj eval
```
OPAPP
RMLNF
SC
observe, palpate, arom, prom, pam
resisted testing, mmt, length test, neuro, functional
special tests, clear
```
61
when does discharge planning start
day 1
62
what 4 main factors need to be considered when determining a prognosis
demographics
disease factors
bio-behavioral factors
other med conditions
63
how many nocioceptors are in art cart
none
64
2 functions of rectus femoris
knee ext, hip flexion
65
origin of rf
A I I S
66
actions of adductor longus
adducts hip, IR hip, flexes hip
67
actions of TFL
FBI
68
glut min and med actions
FBI
69
glut max axns
EEEswings (extends hip, extends knee, externally rotates hip, abduction and adduction)
70
O and I for glut min and med
ilulm to greater trochanter
71
O and I for glut max
illum, sacrum and coccyx
| to the gluteal tuberosity and the IT band
72
explain muscle length test for gastroc
start with them in seated pos on table
goni measure dorsi
(below lat malleolus, 5th meta, fib head)
the have them extend knee and remeasure, if second measurement is a smaller number they are tight
73
explain Thomas test
you have pt at end of table (like they were going to sit on it) you guide them back to a supine position as you keep your hand at lumbar spine
as you stabalize tightly as ASIS and PSIS you have them grab behind their opposing knee and have them hold it as you let testing leg drop. if they can reach all the way to table with testing leg, iliopsoas is not tight. if leg reaches table but knee extends then the tight muscle is the RF, If you can abd the leg and get more depth then TFL is the prob
74
how do we grossly test labrums
compression
75
before we palpate muscle tissue, what should we have pts do to ensure we are on the correct structure
have them contract the muscle
76
list inert tissue
bone, capsule, lig, bursa, fascia (anything but muscle)
77
unwilling to move vs unable to move
unwilling -dt px
| unable - dt tissue immobility
78
AROM tests
contractile tissue and lets you see their response to the movement
79
list the abnormal end feels
empty, spasm, springy, capsular
80
what is a capsular pattern
a predictable loss of function that goes along with OA or degneration (look up the specific motions)
81
px before end feel is usually what stage
acute inflammation
82
px right at resistnace would correspond with what stage
subacute
83
if there is no px even after resistance, this would make you think
there is no inflammation
84
px felt with AROM and PROM with mvmt in agonist direction of muscle would make you think
inert tissue
85
essentially, contractile tissue should not experience px with _____ROM
PROM
86
px felt when going opp direction of the muscle (PROM AND AROM) would make you think
contractile tissue - stretch
87
if you are extending the hip in PROM and there is px in the hip flexors, what tissue is this
contractile
88
with PROM, if px is felt and you are not stretching the antagonist, then the issue is probably inert tissue
correct
89
myotomes (8)
```
L2 - hip flexion
L3 - knee ext
L4 - dorsi and inversion
L5 - toe ext
S1 - peroneals
S2 toe flexion
S1 and S2 together - knee flexion and hip ext
```
90
L3 dermatome location
medial lower thigh
91
L4 dermatome location
medial lower calf
92
L5 dermatome
top of foot
93
S1 dermatome
peroneals
94
S2 dermatome
behind knee
95
hip flexion corresponds with
L2
96
knee extension corresponds with
L3
97
Dorsi flexion corresponds with
L4
98
toe ext corresponds with
L5
99
peroneals correspond with
S1
100
toe flexion corresponds with
S2
101
L5 dermatome is where
top of foot
102
S1 dermatome is where
peroneals
103
S2 dermatome is where
behind the knee
104
L3 dermatome is where
low medial thigh
105
L4 dermatome is where
medial calf
106
pronated posture suggests what muscle is elongated
tib. posterior
107
supinated posture suggests that what is elongated
peroneals (tib post is shortened)
108
TF angle should be
170-175
109
if TF angle is greater than 180
genu varum (bow leg)
110
if TF angle is less than 170
genu valgus
111
angle from asis, patella and tibial tuberosity
Q angle
112
what is super tight in genu recurvatum
quads (and gastroc will be too)
113
if a person has a flexed knee posture, what is tight
post capsule (quads will be weak)
114
with ant pelvic tilt, quads are
quads are tight
| gluts are weak
115
with post pelvic tilt what is tight
hams are tight
116
ant pelvic tilt, ____ are tight
quads and hip flexors
117
ant pelvic tilt ____ are tight
quads and hip flexors
118
ant pelvic tilt _____ are tight
quads and hip flexors
119
decreased lumbar curve indicates tight
hams (post pelvic tilt)
120
in addition to tight quads, with ant pelvic tilt, what 2 muscle groups are weak
hams and abs
121
speed of ossilation of mobs
2-3 oscillations per sec or 30 sec)
122
absolute contraindications for joint mobs
```
Malignancy – especially bone
Tuberculosis – acts like severe OA
Osteomyelitis – bone inf
Osteoporosis
Fracture
Ligamentous rupture (eg Alar ligament)
Disc prolapse with nerve root compression
```
123
the assessment of joint mobility we do (scale 0-6), what findings would we not want to do joint mobs and why
4, 5, 6 we typically don’t do mobs on unless they have px (these are hyper mobile)
124
difference btwn grade 1 and grade 2 mob
both are before resistance
There is only one difference between a Grade 2 oscillation and a Grade I: Grade 2 amplitude is large and a Grade I amplitude is small.
125
so grades 1 and ___ are small ossilations and grade 2 and ____ are large ones
1 and 4 = small
| 2 and 3 = large
126
why might you want to do a grade V
to "snap" adhesions or alter/move structures in the joint
127
small, slowly adapting mechanoreceptors, found in the superficial joint capsule. They provide information concerning the static position of the joint, and contribute to regulation of postural muscle tone; kinesthetic sense; direction and speed of movement, and regulation of muscle tone (describes what type of mechanoreceptor)
type 1
128
medium sized, rapidly adapting mechanoreceptors, found in the deeper layers of the joint capsule. They fire only on quick changes in movement (i.e. are dynamic), providing information about acceleration and deceleration of joint movement (i.e. the change in speed of movement) (describes what type of mechanoreceptor)
type 2
129
dynamic/inhibitive mechanoreceptors are type
3
130
non adapting px receptors are type
4
131
we want to stimulate these receptor types with standard joint mobs
1 and 2
132
in the stress/strain curve, grade 1 and 2 joint mobs are where on the graph
elastic
133
in the stress/strain curve, grade 3 and 4 joint mobs are where on graph
plastic
134
the only time you might do joint mobs on a hypermobile joint is to tx
px
135
after a grade III or IV joint mob, _____ should be done to optimize mobility in the joint
exercise
136
What is post pred value
High PPV: indicates a (+) test is a strong predictor of the disorder“True positives (likely hood they actually have the pathology)
137
you want sensitivity closest to
1.0
138
sensitivity tests
Test’s ability to detect patients who actually have the disorder as indicated by a reference standard
139
specificity tests
Test’s ability to detect patients who actually do not have the disorder as indicated by a reference standard
140
spin snout
| if specificity is high (rule in) and the test you do is pos, the likely hood that they have it is
very high
141
spin snout
| if specificity is low and the test you do is pos, the likleyhood they have it is
unclear
142
most widely used imaging
xray
143
explain grading scale for PAM assessment
```
0/6 = there is no motion between the two articulating surfaces. Mobilization/manipulation is not indicated because the joint is ankylosed.
1/6 = there is considerable limitation in the excursion between the two joint surfaces.
2/6 = there is slight limitation in the excursion between the two joint surfaces.
3/6 = the amount of movement between the joint surfaces is normal.
4/6 = there is a slight increase in the excursion between the two joint surfaces. The patient should be treated with stabilization and postural re-education. Taping and bracing may also be used.
5/6 = there is a considerable increase in the excursion between the two joint surfaces. Treatment is similar to that listed in 4/6.
6/6 = The joint is unstable.
```
