Variadas 12 Flashcards
Charlie is a 6 year old boy. 2 weeks ago he jumped off the play structure at school, landing on his feet. He has had a sore L ankle ever since. It is exacerbated when walking up hill. You suspect a grade 2 high ankle sprain. You expect all of the objective signs except:
A. Reduced dorsiflexion due to swelling in the talocrural joint
B. Pain in the distal tib-fib with a squat which is relieved by compression over the medial and lateral malleoli prior to squatting
C. Pain in the distal tib-fib when the mid
Calf is squeezed
D. Pain in the distal tib-fib when the plantar flexed ankle is passively externally rotated over a fixed tibia and fibula
E. Increased anterior and posterior translation of the fibula on the fixed tibia
A
You do not expect swelling at 2 weeks post injury. The rest of the findings correlate with a positive grade 2 tear in the interosseous ligament attaching the distal tibia and fibula. This is known as a high ankle sprain.
What should you do when your patient is experiencing AD?
If standing, sit patient down for safety. If patient is sitting, keep them seated.
Keep head elevated - DO NOT LIE PATIENT FLAT.
Find the source of the noxious stimulus.
Monitor BP.
You are the physiotherapist in a traumatic brain injury unit. Your patient has been transferred from the emergeney room to the TBI unit after being involved in a car accident . You notice that the patient has bruising behind his ear. He is adamant that he did not get into a fight.
What is this most likely called?
a) Cushing’s disease
b) Raccoon eyes
c) Battle’s sign
d) Posturing syndrome
C
Bruising behind the ear is a sign of a basal skull fracture. Although it may appear to be a bruise this is a medical emergency.
Bethany Haber has Rheumatoid Arthritis. She has been referred to you from her physiatrist for a joint count. Which of the following is the correct order to perform a joint count?
a) swelling, tenderness, overpressure
b) overpressure, tenderness, swelling
c) 2 thumb technique; bulge sign
d) swelling, overpressure, bulge sign
e) tenderness, overpressure, swelling
correct answer is A!
Swelling, Tenderness, and OverPressure spell STOP!
What are the 5 P’s of the neurovascular assessment for Compartment Syndrome?
The 5 P’s of Neurovascular Assessment
- Pain: disproportionate to activity. Will have pain with passive stretching and/or pain out of proportion to the examination
- Pallor: pale color of the skin
- Pulselessness: muscle may feel tight or full.
Take patients pulse in appropriate body area. - Paresthesia: tingling or burning sensations (paresthesia) in the skin
- Paralysis: loss of use
You are a physiotherapist in the Cardiac Rehab unit. You are seeing a new patient today. Before meeting you read their chart and notice their most recent ABG’s to be as
follows:
•pH 7.45 •PaC02 30 •HCO3 19
Which of the following correctly describes their ABG’s?
a) Metabolic acidosis
b) Compensated metabolic acidosis
c) Metabolic alkalosis
d) Compensated metabolic alkalosis
e) Compensated respiratory alkalosis
E
Compensated Respiratory Alkalosis, because PaCO2 is low and HCO3 is low.
28 year old Beth has been having recurrent heaviness, fullness and clumsiness in her right hand. She is an office worker and is 1 year post-partum. She explains that when she is at the gym her symptoms increase with exercise.
Heaviness, fullness and clumsiness during what exercise would make you consider thoracic outlet syndrome as a possible diagnosis?
a) Frontal shoulder raises with palms facing each other
b) Rows with end retraction through shoulder blades
c) Latissumuss pull down with emphasis on the eccentric phase of motion
d) a and c
B
Rows with end retraction is recreating the military brace test, which is a diagnostic test for TOS. The military press, also known as costoclavicular test, specifically looks as the vascular type of TOS, which has symptoms like fullness, heaviness, clumsiness and weakness.
Edson/military test: palpate radial pulse. Draw pt sh down and back.
Positive: pulse will decrease ot symptoms
You are a physiotherapist in the emergency room at a community hospital. You arrive to find a patient complaining of chest pain. Upon reading his chart you find he has fractured his 10th rib after falling from a ladder. His history shows a 10 pack year of smoking. You notice when he is talking he is coughing up pink frothy sputum. You lay him down, but his coughing increases. He starts to get very anxious because he is unable to get in a full breathe. Which of the following of the above signs and symptoms leads you to believe this patient has pulmonary edema?
a) Chest pain
b) Unable to get full breathe of air in
c) Harder to breathe in laying than sitting
d) b and c
e) all of the above
D
Which of the following is a contraindication to ultrasound at 1.0 watts/cm2 with a 1 MhZ sound head ?
a) Over a non-cemented metal implant
b) Over a recent fracture site
c) Over a recently repaired tendon rupture
d) All are contraindications
correct answer is B!
US is extremely painful over fracture sites, all other sites are okay.
78 year old Vince Lowit has been referred to physiotherapy for an update on mobility status. Past medical history reveals COPD, uncontrolled DMIl, left below knee amputation, Uncontrolled HTN and angina. He is currently in the emergency room after suffering a pulmonary embolism. Which of the following is the most common cause of pulmonary emboli?
a) DVT
b) Uncontrolled HTN
c) Chronic venous insufficiency
d) COPD
A
DVT is the most common cause of PEs. The other conditions may lead to DVTs.
78 year old Vince Lowit has been referred to physiotherapy for an update on mobility status. Past medical history reveals COPD, uncontrolled DMII, left below knee amputation, Uncontrolled HTN and angina. He is currently in the emergency room after suffering a pulmonary embolism. To reduce his risk of further complications while on bed rest you prescribe the following:
A) Heel slides with his intact limb followed by skin checks of his heel
B) Compression stockings and elevating his right ankle on a pillow when he sleeps
C) Low molecular weight heparin
D) A & B
E) All of the above
A
Compression stockings and elevation are contraindicated since he has uncontrolled HTN. Only heel slides are appropriate to prevent DVTs. We cannot prescribe drugs.
Craig is a 63 year old male who entered the emergency room last night due to an acute exacerbation of his Emphysema. He has a 47 pack yr history and was diagnosed with emphysema 15 years ago. He also has type Il diabetes. You are the PT on the Cardioresp unit and are called down to perform IPPA. What do the P’s in IPPA stand for?
a) Pulse and Pulmonary
b) Percussion and Pulse
c) Percussion and Palpation
d) Palpation and Pulse
answer is C
IPPA is the objective assessment of the pulmonary system and stands for Inspection, Palpation, Percussion and Auscultation.
OSGOOD SCHLATTER DISEASE
TREATMENT
The number one priority is to decrease loading of the knee by the quadriceps muscle/tendon
. We can do this by:
- activity modification, limiting squatting, jumping and stairs
- gentle pain free stretching of the quadriceps and hamstrings (progress to dynamic and PNF as pain allows)
We then want to manage pain: - bracing/taping (e.g. patellar strap)
- ice
- rest
Samantha Edwards is 46 years old and has a desk job. On the weekend she picked up her 3 year old daughter and felt a sharp pain in her back. She is unable to pick up her shoes without the pain shooting down her right leg and she has not attended work in 3 days as her pain is exacerbated by sitting at her desk. Which trunk position should Samantha avoid?
a) Extension
b) Extension + Rotation
c) Flexion
d) Flexion + Rotation
answer is D
Due to her age, aggravating factors, and the sudden nature of the pain, she likely experienced a disc herniation. Flexion and Rotation puts posterior pressure on the discs and strains the PCL.
A physiotherapist is working with a women’s hockey team. The coach is late for practice, so the physiotherapist starts the warm-up. One of the players states that she sees no benefit in a warm-up.
When explaining the benefits of a warm-up, which of the following statements would be incorrect?
a. There is an increase in muscle temperature which increases the efficiency of muscle contraction by reducing muscle viscosity and increasing the rate of nerve conduction.
b. There is dilation of the capillaries which increases circulation and augments oxygen delivery to the active muscles.
c. There is increased flexibility which makes the musculoskeletal system less susceptible to injury.
d. There is a decrease in venous return which occurs as blood is shifted centrally from the periphery.
The correct answer is D
There is an increase in venous return which occurs as blood is shifted centrally from the periphery due to increased muscle pumping action.
A student physiotherapist is starting their first placement at a seniors complex. During their orientation, they are required to sit in on a seminar to learn more about the older adult.
Which of the following statements is true regarding the older adult?
a. Resting heart rate decreases with age.
b. Stroke volume decreases with age.
c. Cardiac output increases with age.
d. Blood pressure decreases with age.
The correct answer is B
a.Resting heart rate decreases with age. -
FALSE
• Resting heart rate is not influenced by age.
However, maximal heart rate is age related and decreases with age as it is calculated very generally by: 220 minus age.
b. Stroke volume decreases with age. - TRUE
• Stroke volume decreases with age as heart muscle weakens and stiffens and cannot pump as much blood out with each contraction.
c. Cardiac output increases with age. - FALSE Cardiac output (CO) decreases because it is
directly related to stroke volume (SV) which
decrease with age. CO = SV x HR.
d. Blood pressure decreases with age. - FALSE
• Blood pressure increases with age because of increased peripheral vascular resistance.
A physiotherapist is working with a new patient who is recovering from a total hip replacement. Prior to discharge, the physiotherapist is reviewing a home exercise program with the patient and his wife.
While the patient is eager and on board with the program, his wife is expressing doubts about the program and does not think the exercises should be performed without a physiotherapist present.
The physiotherapist recommends a pool program twice a week. Which of the following statements is true regarding the properties of water and its therapeutic benefits?
a. Viscosity provides the patient with relative weightlessness and joint unloading allowing for ease of active movement.
b. Approximately 80% of a patient’s body weight is reduced when standing at a water depth at the level of the ASIS.
c. Hydrostatic pressure can decrease venous return and improve blood flow to the limbs.
d. Increasing the surface area moving through water will increase resistance.
A. Viscosity provides the patient with relative weightlessness and joint unloading allowing for ease of active movement. - FALSE
• Buoyancy is what provides the patient with relative weightlessness and joint unloading.
b. Approximately 80% of a patient’s body weight is reduced when standing at a water depth at the level of the ASIS. - FALSE
Approximately 50% of a patient’s body weight is reduced when standing at a water depth at the level of the ASIS.
C. Hydrostatic pressure can decrease venous return and improve blood flow to the limbs. - FALSE
• Hydrostatic pressure can assist in venous return which centralizes blood flow and can assist in decreasing effusions.
d. Increasing the surface area moving through water will increase resistance. - TRUE
Waters viscosity creates resistance with all active movements. The larger the surface area moving, the more resistance and thus potential for strengthening of the muscles involved in that movement.
A patient developed frozen shoulder after being immobilized due to a humeral fracture. She is now three months post fracture which healed without incident. She has come to physiotherapy hoping to increase her shoulder range of motion. During treatment, the physiotherapist initiates manual therapy to increase her glenohumeral abduction range of motion.
Which glide would be the most appropriate to use?
a. Posterior glide
b. Anterior glide
c. Superior glide
d. Caudal glide
The correct answer is D
a. Posterior glide
• Used to increase flexion and internal rotation
b. Anterior glide
• Used to increase extension and external rotation
During an initial assessment, the physiotherapist is assessing the gait pattern of their patient post anterior tibiofibular ligament. You notice they are experiencing early push off in stance phase.
Which of the following is false regarding the ranges required during the stance phase of gait.
a. Knee joint: requires a maximum of 60 degrees of flexion
b. 1st MT joint: requires a maximum of 70 degrees of extension
c. Hip joint: requires a maximum of 30 degrees of hip flexion
d. Ankle joint: requires a maximum of 20 degrees of plantar flexion
The correct answer is A
a.Knee joint: requires a maximum of 60
degrees of flexion - FALSE
• Only require up to 40 degrees of knee flexion in terminal stance. Up to 60 degrees is required for midswing.
b. 1st MTP joint: requires a maximum of 70 degrees of extension - TRUE
• During toe off, 70 degrees of extension is required for push off.
c. Hip joint: requires a maximum of 30 degrees of hip flexion - TRUE
• Requires 30 degrees of hip flexion at heel strike.
d. Ankle joint: requires a maximum of 20 degrees of plantarflexion - TRUE
Requires 20 degrees plantarflexion for toe
off.
During an initial assessment, the physiotherapist is assessing the gait pattern of their patient post anterior tibiofibular ligament. You notice they are experiencing early push off in stance phase.
You determine your next step in treatment is to provide dorsiflexion mobilization to help improve their range of motion. Which of the following statements is false regarding grade 2 joint mobilizations?
a. Grade ll oscillations decrease pain by stimulating mechanoreceptors that inhibit the perception of pain at the spinal cord level.
b. Grade ll oscillations improve range of motion by stretching the joint capsule.
c. Grade ll oscillations are used when pain is experienced concurrently with tissue limitation.
d. Grade ll oscillations are large amplitude performed within available range, not reaching the limit.
B
Grade Il oscillations improve range of motion by stretching the joint capsule. - FALSE
Grade Il oscillations are used primarily for treating joint pain which can in turn improve ROM.
There is no stretched placed on the joint capsule because the oscillations are not within a range that places any stress onto the joint capsule.
A patient sustained right cerebellar damage after a stroke. She has positive findings for dysdiadochokinesia.
Which of the following would be an expected finding?
a. Difficulty with right upper limb finger to nose accuracy
b. Difficulty with left upper limb finger to nose accuracy
c. Difficulty with right upper limb rapid alternating supination/pronation
d. Difficulty with left upper limb rapid alternating supination/pronation
The correct answer is C
a. Difficulty with right upper limb finger to nose accuracy
• This is a test for dysmetria.
b. Difficulty with left upper limb finger to nose accuracy
c. Difficulty with right upper limb rapid alternating supination/pronation - CORRECT
Dysdiadochokinesia is the medical term for difficulty with rapid alternating movements. It is tested in the upper limb with alternating supination/pronation. Because the patient has sustained a right cerebellar injury, we would anticipate right sided coordination deficits as the cerebellum is connected to ipsilateral body function.
d. Difficulty with left upper limb rapid alternating supination/pronation