Virtual class topics 21-30 Flashcards
What happens to lung volumes in obstructive diseases
TV increases
RV increases
FRC increases
TLC increases
Describe ankle ABI scoring
Falsely elevated >1.2 = arterial disease and diabetes
Normal - 1.19-.95
Mild - .94-.75
Moderate - .74-.50
Severe <.50
Describe arterial and venous insufficiency presentation
In terms of:
Cause
Location
Appearance
Pain
Ulcer
Complications
Arterial insufficiency
- Inadequate blood flow
- Lateral malleolus
- Pale wound, well defined edges
- Intense, worse with elevation
- Minimal exudate, dry, shiny skin, hair loss
- Gangrene, amputation risk
Venous insufficiency
- Poor blood return due to damaged veins
- Medial malleolus
- Pink, red, irregular shape, shallow edges, hemosiderin staining
- Minimal pain, relieved by leg elevation
- Moderate/heavy exudate, swelling, skin discoloration
- Cellulitis, venous stasis dermatitis
Describe the claudication grading scale
Grade 1
Initial discomfort, minimal pain
Grade 2
Moderate discomfort, attention can be diverted
Grade 3 - stop exercise, resume once pain subsides
Intense pain, attention cannot be diverted
Grade 4 - stop activity, refer to physician if pain persists
Excruciating pain, unbearable
Hello
Good bye
What are some intervention strateges for obstructive lung pathologies
Activity pacing
Pursed lip breathing
Promote huffing
Inhalation of corticosteroids, bronchodilators
What are some intervention strateges for restrictive lung pathologies
Ventilatory support
Respiratory muscle training / chest expansion exercises
Managing medications and their side effects
Describe fremitus, assessment and interpretation
Vibratiry tremors that can be felt through the chest by palpation
Assess by saying 99 and palpating the chest
Decreased fremitus
Indicates more air in the lungs
Increased fremitus
Indicates increased fluid in lungs
Describe chest percussion, assessment and interpretation
Tapping of pt chest walls
Hyperresonant to percussion (louder) - indicates more air in that area
Dullness to percussion - indicates increased secretions
Describe the difference between pneumothorax and atelactasis
Pneumothorax
Collection of air outside the lungs but in pleural cavity
Pushes trachea to opposite side
Atelectasis
lung collapse caused by blockage of air
Attracts trachea to affected side
Briefly describe Asthma, emphysema and hemothorax
Asthma
Acute narrowing of airways
Wheezing present
Emphysema
Permanent alveolar damage
Air trapped in lungs, more than in chronic bronchitis
Hemothorax
Blood in the pleural space
Describe L and R sided heart failure presentation
R sided
Peripheral edema
Enlarged liver - hepatomegaly
Abdominal discomfort
Jugular vein distention
Fluid retention
L sided
SOB
Fatigue and weakness
Orthopnea - SOB in supine
Paroxysmal nocturnal dyspnea
Cough, pink, frothy sputum
What level of table elevation will taget the middle and lower lobed during postural drainage
Middle lobe - Foot elevation of 12 inches
Lower lobe - foot elevation of 18 inches
Describe the cardic rehab phases
Phase 1
Medically stable patient after MI, CABG, PTCA, valve repair, heart transplant
FITT
F - 2-3 per day
I - 50-70% HR max
T - 10-15 mins, (30 mins phase 2)
T - ADLs, supervised ambulation
Phase 2
24 hours after discharge, lasts up to 6 weeks
Phase 3
Begins at end of phase 2 and extends indefinitely
Resistance training begins
FITT
2-3 sessions per week
70-85%
30-60 mins
Walking, treadmill, cycle
Resistance training can begin this phase
1-3 lbs of elastic bands and light hand weights
8-10 reps, progress to 12-15
Avoid upper extremity resistance as soft tissue is still healing
Phase 4
Exercising in community
50-85% functional capacity
3-4 times per week
45 mins or more
Discharge from supervision in 6-12 months
Describe weight reduction exercise guidelines
F - 5-7 days per week
I - 40-60% VO2
T - 45 - 60 mins per session, 250-300 mins per week
T - Aerobic and resistance exercise
List and describe the types of studies by strength of evidence in descending order
Meta analysis
Synthesis of huge body of evidence
Statistics performed to determine outcomes
Systematic review
Summary of many papers
No statistical review
RCT
Used to determine the efficacy of an intervention
Cohort studies
Observe two different groups of people over time and compare outcomes
Case control studies
Compares a group of individuals with a specific condition with a group of people without the same condition
Cross sectional analysis
Observational study where the investigator measured outcome and exposure in the participants at the same time
Case series / case reports
Document clinical case of a single patient or a series of patients
Describe qualitative data and its types
Qualitative
Analysis of non-numerical data
Statistical analysis not performed
Interested in emotional or subjective experiences
Nominal - names
Data that can be organized into mutually exclusive groups with no overlap
EX: Gender, blood type, hair color
Ordinal
Data organized by ranking system, spaces between categories in system not meaningful, rank itself only important
EX: MMT grades, level of assistance, joint laxity grades
Describe quantitative data and its types
Quantitative
Collecting and analyzing numerical data
Analysis of quantifiable outcome measures
Statistical analysis performed
Interval
Data that is ordered in ranking system and space between rankings meaningful
No true 0
EX: temperature
Ratio
Data organized in ordered ranking system, meaningful space between rankings with a true 0, negative values not possible
EX: Height
Describe validity
In terms of:
Content
Construct
Concurrent
Face
Construct validity
Does the test measure the thing (construct) you want to measure
Content validity
Does the test measure all relevant parts of the construct
Concurrent validity
Comparing the new measure to the current gold standard
Face validity
Does an outcome measure appears like it measures what it should
Describe the types of error
Type 1
False positives
Incorrect rejection a true null hypothesis
Type 2
False negative
Failing to reject a false null hypothesis
Describe speceficity and sensitivity
Sensitivity
Ability of a test to identify true disease
Snout
Specificity
Ability of a test to correctly identify absence of a disease
Spin
Describe the peripheral nerve sensation to the hand
Radial
- Lateral 3.5 fingers, dorsal side, not tips
- Lateral part of dorsal hand
- Wraps around base of thumb, most lateral postion of thenar eminance on volar surface
Median
- Lateral 3.5 fingers, volar side, tips of fingers dorsal side
- Thenar eminence, lateral palm
Ulnar
- Medial 1.5 fingers, dorsal and volar surfaces
- Medial part of volar and dorsal hand
Describe peripheral nerve sensation to the lower leg and foot
Tibial
-Heel of foot
Deep peroneal
-1st web space
Superficial peroneal
-Dorsum of foot (except first web space)
- Anterolateral part of lower leg
Sural
-Posterolateral leg
Saphenous
-Medial lower leg
What are some peripheral vestibular pathologies
BPPV
Vestibular neuritis
Labyrinthitis
Acoustic neuroma
Describe BPPV and what are its causes
When the otolith crystals get stuck in the semicircular canals
Infection, head trauma, Vestibular weakness, advancing age
Describe the dix halpike test and its interpretation
Duration of symptoms?
Turn pt head 45 degrees to side you wish to test
Move pt into supine position with head extended
Upbeating torsional nystagmus - posterior canal
Down Beating torsional nystagmus - anterior canal
Canalithiasis
Symptoms last a short duration, less than 1 minute
Cupulolathiasi
Symptoms last longer than 1 minute
Describe the supine roll test and its interpretation
Pt in supine, 30 degrees flexion
Rotate head toward testing side and assess for symptoms
Geotropic - beats toward ground - canal - stronger = affected
Ageotropic - beats away from ground - cupulo - weaker = affected
Describe epley’s manuever
Used to treat BPPV in the posterior canal
- Turn head to affected side
- Lay pt in supine with head 20-30 extended
- Turn head 45 opposite way
- Roll onto shoulder head is facing, maintain nose down
- Sit pt up
Describe the treatment strategy for cupulolithiasis
Semont maneuver / liberatory maneuver
Turn head 45 degrees opposite of affected side
Lay in side lying on side pt is not looking, remain here for 1 min
Quickly move pt 180 degrees to side lying on opposite side
Return to sitting after 1 min
Describe the brandt darroff exercise
Alternating side lying while looking toward the ceiling
Used when pt cannot tolerate epley / semont
Describe treatment for horizontal canal BPPV
Supine, 20 degrees cervical flexion
Turn head 90 degrees to affected side
Turn head back to neutral
Turn head to unaffected side
Roll towards unaffected side into prone
At each step wait for symptoms to resolve
What is the name of the treatment used for horizontal canal cupulolithiasis
Gufoni manuever
What are the central vestibular pathology tests
Smooth pursuit -H test
Saccade - Look quickly between 2 target
If impairments present, this is a problem
Describe how to test the VOR
Head impulse test
Turn head quickly, look for lag, present on side with ipsilateral impairment
Describe signs of central vestibular pathology
Intense ataxia
Abnormal smooth pursuits / saccades
Diplopia, drop attacks, dysphagia
Pendular nystagmus
Describe labyrinthitis
Inflammation of labyrinth
Hearing loss, tinnitus
Sudden onset of vertigo, nausea, vomiting
Positive head impulse test
Lasts days to weeks
Describe Vestibular neuritis
Inflammation of vestibular postion of CN VIII
No hearing loss
Sudden onset of vertigo, nausea, vomiting
Positive head impulse test
Lasts days to weeks
Describe Meniere’s disease
Overproduction of fluid within the inner ear
increased pressure in inner ear
increase in pressure leads to vertigo
Vertigo, hearing loss, tinnitus, fullness in ear
Describe Acoustin neuroma
Slow growing tumor that develops from the CN VIII
Hearing loss, tinnitus, loss of balance, vertigo, facial numbness and weakness or loss of movement (CNV)
Describe treatment of Unilateral bilateral vestibular hypofunction
Unilateral
Gaze stability exercises
X1 and X2
Postural stability and balance
Habituation
Bilateral
Gaze stability, X1 but not X2, unless asymmetrical involvement
Imaginary targets
Walking
Describe the muscles that move the mouth
Mouth opening - 35-55 - lateral pterygoid
Mouth closing - Temporalis, masseter, medial pterygoid
Protrusion of mandible - 7mm - Medial and lateral pterygoid
Retraction of mandible - 3-4 - temporalis
Lateral deviation of mandible - 10-15 - Contralateral pterygoids
Describe the presentation of various TMJ disorders
Hypomobility
Jaw deviation to ipsilateral side, limited opening, no pain
Disc displacement
Clicking
Synovitis
No deviation, pain
Capsulitis
Jaw deviation to ipsilateral side, limited opening, pain
Describe Legg-calve-perthes disease
Deformity / flattening of femoral head due to loss of blood supply, causes femoral head necrosis
Age 2-13
Short stature, males
Limited extension, abduction and IR
Pain worsens with activity
Limping
Stiffness
Treat with bracing, surgery
Describe slipped capital femoral epiphysis and treatment
Displacement of femoral head due to slippage from the growth plate
Age 10-17
Overweight
Flexion, abduction and IR limited
Pain worsens with activity
Limping
Stiffness
Surgical treatment to stabilize
Describe spondylosis
In terms of:
Age
Pain location
Agg
Easing
SLR
Imaging
Degeneration of intervertebral disc space
Age: >50
Pain location: Back
Agg: Extension
Easing: Flexion
SLR: negative
Imaging: radiograph positive
Describe spondylolysis
Age
Pain location
Agg
Easing
SLR
Imaging
In terms of:
Defect in pars interarticularis of vertebral arch
Age: 15-20
Pain location: Back
Agg: extension
Easing: Flexion
SLR: Negative
Imaging: radiograph positive
Describe spondylolesthesis
Age
Pain location
Agg
Easing
SLR
Imaging
In terms of:
Forward slip of vertebrae
Age: 20
Pain location: Back
Agg: Extension
Easing: Flexion
SLR: negative
Imaging: Radiograph positive
Describe disc herniation
Age
Pain location
Agg
Easing
SLR
Imaging
In terms of:
Age: 30-50
Pain location: Back, leg
Agg: Flexion
Easing: Extension
SLR: Positive
Imaging: MRI, CT
Describe spinal stenosis
Age
Pain location
Agg
Easing
SLR
Imaging
In terms of:
Age: >60
Pain location: Back, Leg
Agg: extension
Easing: Flexion
SLR: Positive
Imaging: MRI, CT, radiograph
Describe scoliosis presentation
Convex side
- Direction of vertebral rotation
- Long and weak muscles
- Posterior rib deviation
- Same side shoulder high
Concave side
- Direction of spinous prcess deviation
- Short and tight muscles
- Anterior rib deviation
- decreased lung volumes
- Same side pelvis high
Derscribe the S3 and S4 heart sounds
S3 - early diastole - CHF
S4 - Late diastole - MI, hypertension,
Describe the types of AV blocks
1st degree
Lengthened PR interval
> 1 large box
Continue exercise
2nd degree
Type 1 - Wenckebach - length, length, length drop
Disease of AV node
Monitor, lower intensity
Type 2 Mobitz - random drop in QRS complex
Stop exercise
Refer this individual to physician
3rd degree
No correlation between P and QRS complex
Stop exercise
Call 911
Describe how to interpret ST segment changes
Depression more than 2 small boxes - Myocardial ischemia
Elevation more than 1 small box- Myocardial infarction - call 911
Describe atrial tachycardia, flutter and fibrillation
Atrial tachycardia
150-250 beats per minute
Fast atrial contraction, QRS for each PVC
Atrial flutter
Saw toothed pattern
Multiple atrial contractions per ventricular
Stop exercise
Atrial fibrillation
No clear P waves, quivering of atria
Stop exercise
Describe bigemony, trigemony, multifocal PVC’s and Couplet’s
Bigeminy
1 normal beat followed by 1 PVC
Trigeminy
2 normal beats followed by 1 PVC
Multifocal PVC
2 different looking QRS complexes
Call 911
Couplet
2 PVCs in a row, stop exercise
3 or more in a row considered V-tach - stop exercise
Describe the expected developmental milestones at months 2-3
Prone on elbows
Lift head in prone
Describe the expevcted developmental milestones at months 3-4
Supine to sidelying
Describe the expected developmental milestones at months 4-5
Feet to mouth
Prone to supine
Pull to sit without head lag
Sitting with UE support
Describe the expected developmental milestones at months 6-7
Supine to prone
Quadruped and sitting from quadruped
Independent sitting
Trunk rotation in sitting
Describe the expected developmental milestones at months 8-9
Creeping
Cruises on furniture
Can stand alone
Improved grasping
Describe the expevcted developmental milestones at months 10-15
Unassisted walking
Squatting
Pincer grasp
Stacking objects
Floor to stand
Describe which reflexes are integrated at months 1-2
Flexor withdrawl
- Noxious stimulus to sole of foot
- Toes extend, foot dorsiflexes, LE flexes uncontrollably
Crosed extension
- Noxious stimulus on ball of foot
- Opposite LE flexes, then abducts and extends
Describe which reflexes are integrated at month 3
Rooting
- Stroking the side of the baby’s cheek
- Head turns toward stimulus, mouth opens
Describe which reflexes are integrated at months 2-5
Traction
- Grasp forearm and pull up from supine into sitting
- Flexion of the UE to prevent pulling
Describe which reflexes are integrated at month 6
Palmar grasp
- Pressure on palm of hand
- Maintained gripping
ATNR
- Rotation of the head to one side
- Bow and arrow posture
Moro
- Drop baby backward from sitting position
- Extension, abduction of UEs, hand opening and crying, followed by flexion and protection tone
TLR
- Prone or supine
- Prone - increased flexor tone of all limbs
- Supine - increased extensor tone of all limbs
Positive support
- Contact ball of foot in upright standing
- Rigid extension, co-contraction of LEs
Describe which reflexes are integrated at month 9
Plantar grasp
- Maintained pressure to ball of foot under toes
- Maintained toe flexion
Describe which reflexes are integrated at month 12
Babinski
STNR
- Flexion or extension of the head
- Head flexion - flexion of UE, LE extension
- Head extension - extension of UEs, flexion of LEs
Describe the APGAR test
Appearance - Blue, blue extremities, pink
Pulse - absent, <100, 100-140
Grimace - No reponse, grimace, cry or withdrawl
Activity - flaccid, some flexion, active motion extremities
Respiration - absent, weak cry or hypoventilation, strong cry
8-10 = normal
5-7 = blow by oxygen
3-4 = mask ventilation
Describe the different types of age
Gestational age - weeks in gestation + weeks of life
Chronilogical age - Age in weeks since birth
Corrected age - chronilogical age minus premature weeks
Describe CP and its types
Spastic
Velocity dependent resistance of a muscle to stretch
Synergy patterns, contractures, crouched gait, toe walking
Ataxia
Disorder of coordination, force, timing and associated with cerebellar involvement
Floppy baby, low tone, poor balance, wide BOS, nystagmus
Hypotonic / dyskinetic
Disorder of basal ganglia, characterized by athetoid writhing
Poor stability intention tremor, fluctuating tone
Describe gross motor classification of CP
Level 1
Walk without restrictions
Advanced motor skills limited
Level 2
Walk without assisted device
Outdoor walking limited
Level 3
Walk with assisted device
Limitations outdoors
AD > WC
Level 4
Chair mobility
WC > AD
Level 5
Chair mobility
Describe plagiocephaly
Result from prolonged asymmetrical pressure on the premature skull
Creates parallelogram shape
Named for side of flat spot
Presentation
- Occipital parietal flattening, contralateral occipital bossing
- Anterior bossing ipsilateral to flat spot
Describe downsyndrome patients
Extra copy of trisomy 21
Forceful neck flexion and rotation activities should be limited due to ligamentous laxity
Encourage motor function and avoid hyperextension of the elbows and knees during weight bearing activities
Describe autism spectrum disorder patients
Social communication skill limitations, especially non-verbal skills
Hypo-reactive or hyper-reactive to sensory input
- Hypo - sensory seeking
- Hyper - sensory avoiding - most
Describe muscular dystrophy
X linked recessive, inherited by boys
Dystrophen gene missing
Causes pseudo hypertrophy
Maintain mobility as long as possible
Do not over fatigue
Describe Scheuermann disease
Wedge shaped vertebrae
Increased thoracic kyphosis
SS
Schmorl nodes
Pain with extension and rotation
Treatment
Schroth method
Pec stretches
Describe ERB and Klumpke palsy
ERB - C5-C6
Stretching of head downward
Loss of abduction and ER
Waiter’s tip deformity
Klumpke C8-T1
Stretching or arm overhead
Paralysis of the intrinsic hand
Claw hand
What is parametric and non-parametric data
Parametric
Ratio and interval data - quantitative data
Bell shaped curve, normal distribution
Randomized of sample
More powerful
Non-parametric
Nominal and ordinal data - qualitative data
Unequal distribution
Non randomized sample
Less powerful
Describe a T test, paired T test, 1 and 2 tailed T test. What kind of data?
T-Test
2 independent groups
Equal distribution
Paired T-test
2 dependent groups
Equal distribution
One tailed T test
T-test with assumption of outcome
2 tailed T-test
T-test with no assumption of outcome
Parametric data
Describe the one way anova, two way anova and repeated measures anova tests
One way anova
3 or more independent groups
Equal distribution
1 variable
Two way anova
3 or more independent groups
Equal distribution
2 variables
Repeated measure anova
3 or more dependent groups
Equal distribution
Same individuals meausred continuously over time
Describe the Chi square, Mann whiteny U and Kruskal wallis tests
Chi square test
2 Independent unequal groups
Nominal data only
Mann whiteny U
2 independent unequal groups
Ordinal data only
Kruskal Wallis test
3 independent unequal groups
Ordinal data only
What are the ottowa ankle rules
X-ray of foot if any one of following:
Pain on lateral or medial malleolus
Inability to bear weight for at least 4 steps
What are the foot radiograph rules
Seek x-ray if:
Bone tenderness at navicular bone
Bone tenderness at base of 5th metatarsal
