comp exam Flashcards
1
Q
blood pressure
A
normal <120 and <80
elevated 120-129 and <80
hypertension1 130-139 or 80-89
HTN 2 140+ or 90+
HTN 3 180+ and/or 120+
2
Q
reservoir
A
patient zero
3
Q
method of exit
A
wound, respiratory tract
4
Q
method of transmission
A
how does it travel
5
Q
method of entry
A
how it enters
6
Q
susceptible host
A
new host
7
Q
in what order do you don ppe?
A
bottom up
8
Q
in what order do you doff?
A
alphabetical order
9
Q
contact precautions
A
gloves and gown
10
Q
droplet precautions
A
mask, gloves, gown
11
Q
airborne precautions
A
N-96 mask, gloves, gown, negative airflow in private room
12
Q
which diseases are contact transmission?
A
MRSA
VRE
C. diff
scabies
zika
staph
13
Q
which diseases are droplet transmission?
A
mumps
meningitis
strep
COVID-19
flu
14
Q
which diseases are airborne transmission?
A
measles
TB
chickenpox
SARS
15
Q
what can a pta not do?
A
initial evaluation
diagnosis
prognosis
POC
discharge
16
Q
max assist
A
pt performs 25-49% of work
17
Q
mod assist
A
pt performs 50-74% of work
18
Q
min assist
A
pt performs 75% or more of work
19
Q
contact guard assist
A
PT is making physical contact with pt
20
Q
standby/supervision
A
verbal or tactile cues
instructions given to pt, but no physical contact
21
Q
modified independent
A
independent, but uses adaptive equipment or needs more time
22
Q
independent
A
without any verbal or manual assistance
23
Q
plumb line
A
ear
shoulder
hip (greater trochanter)
knee
ankle (lateral malleolus)
24
Q
8 minute rule
A
first unit must be over 8 minutes
every unit after adds 14 minutes
25
slope and rise ratio
1 inch up and 1 foot over
26
max rise
30 inches up
27
clearance width for hallway
36 inches
28
wheelchair clearance width
48 inches for ambulating person to pass
60 inches for two wheelchairs to pass each other
29
landing dimensions
5 feet in length by width of ramp
30
90 degree turn landing
5 feet by 5 feet
leaving the house considered 90 degree turn
31
180 degree turn landing
5 feet by twice ramp width
32
when did PT start?
WW1
33
standard wheelchair dimensions for adults
18in in width
16 in seat depth
20 in seat height
34
seat height measurement
(how far seat is off floor)
heel of shoe to popliteal fold
add 2 inches unless using a seat cushion
35
leg length
minimum clearance between floor and footplate is 2 inches
measured from lowest part on bottom of footplate
36
seat depth
posterior buttock to posterior aspect of lower leg on popliteal fossa
subtract 2 inches
37
seat width
hip width at widest part
add 2 inches
38
back height
measure from seat of chair to axilla
subtract 4 inches
measure with seat cushion if applicable
39
arm rest height
from seat of chair to olecranon process with elbow flexed 90 degrees
add 1 inch
measure with seat cushion if applicable
40
four point gait
bilateral ambulation aid
RA, LF, LA, RF
41
three point
one leg NWB
walker or bilateral amb aid
R&LA, F
42
two point
bilateral amb aid
RA&LF, LA&RF
TWO MOVNG TOGETHER
43
three point one
PWB
bilateral amb aid
injured foot moves with AD, strong foot
44
modified four point
one amb aid
hemi
LF, RF, RA
45
modified two point
one amb aid
hemi
RF, LF&RA
46
gait sequencing with AD.
what order does each limb move?
move device first
then weaker leg
then strong leg
if unilateral, device on side of strong leg
47
ICF model
impairment
activity limitation
participation restrictions
disability
48
difference about ICF
illustrates the person in his or her world
language places emphasis on function rather than condition
49
body functions
physiological functions of body systems
50
body structures
anatomical body parts
51
activity
execution of task
52
participation
involvement in life situation
53
environmental factors
environment where person conducts life
54
personal factors
demographics
55
SMART goals
specific
measurable
attainable
realistic
timely
56
greatest to least stability
parallel bars
standard walker - bilateral connected
FWW
4WW
axillary crutches - bilateral disconnected
forearm crutches
2 canes
single crutch - unilateral
hemiwalker
quad cane
single point cane
57
fitting a cane or walker
ulnar styloid at hand grip
elbow angle 20-25 degrees
58
fitting axillary crutches
2 inches below axilla
2 inches out, 4 forward
elbow angle 20-25 degrees
59
fitting forearm crutches
2 inches out, 4 forward
elbow angle 20-25 degrees
cuff 1-1.5 inches below elbow
60
dementia communication
simple commands
yes/no
repetition
short sentences
touch cues
call by name
move on if frustrated
say goodbye to end
decrease extraneous conversation
61
communicating with alzheimers
environment orderly
clear, concise
repetition
regular schedule
same therapist
similar exercise program
support group for family
62
communicating with parkinsons
give time to respond
clear, concise
don't repeat quickly
demonstrate
instruct with functional activities
63
when ascending stairs
up with the good
strong side next to railing
strong > weak > device
64
how to guard ascending
posteriolateral
stagger step
hand on gait belt
static when pt is moving
65
when descending stairs
down with bad
strong side next to railing
device > weak > strong
66
how to guard descending
in front of pt
stagger
gait belt
static
67
PICO
P- population or problem
I- intervention, independent variable
C- comparison
O- outcomes
68
deductive reasoning
theory to confirmation
top-down
few or nor prior observations
broad to specific
69
inductive reasoning
observation to theory
bottom-up
starts with empirical observation
specific to broad
70
ways of knowing
best to worse
scientific evidence
inductive/deductive reasoning
experience
authority
tradition
71
hierarchy of evidence
most bias control to least
experimental designs
quasi-experimental
non-experimental
case report/anecdote
72
pyramid of certainty
SR of RCT
RCT
SR of cohort studies
cohort studies
SR of case control studies
case control studies
case studies
clinical experience, expert opinion, mechanism based reasoning
73
3 pillars of EBP
evidence
expertise
pt values
74
process of EBP (5 a’s)
ask
acquire
appraise
apply
assess
75
guiding ethical principles
respect for persons
beneficence
justice
76
4 components of informed consent
disclosure
comprehension
voluntariness
competence
77
Nuremberg code
first formal guidelines
voluntary consent
competence of investigator
78
declaration of helsinki
independent review of protocols
79
belmont report
common rule
-respect for persons
-beneficence
-justice
80
national research act
clearly stated research design
informed consent
IRB
81
IRB members
at least 5
-not all same gender
-not all same professional group
-one member primarily concerned with nonscientific issues
-one public member
82
nominal variables
no numerical order
83
dichotomous nominal variables
when there can only be two answers
ex. yes/no
84
ordinal variables
rank order, unequal variables
85
interval variables
rank order, equal intervals, no true zero
86
ratio variables
interval scale with true zero, no negatives
87
reliabilty
reproducibility, consistency
can repeat on 2+ occasions
88
validity
accuracy, correctness
89
rater measurement error
error in perception of recording
90
instrument measurement error
not calibrated
91
variability of characteristic being observed error
something that is always changing
ex. blood glucose
92
relative reliability
ratio of total variability between scores to variability within scores
(ICC and kappa)
93
absolute reliabilitiy
how much is likely due to error
(standard error of the measurement)
94
acceptable ICC values
>0.90 = best for clinical measures
>0.80 = acceptable
>0.75 = good
<0.75 = poor to moderate
95
minimal detectable change (MCD)
real; not clinically significant
96
minimal clinically important difference (MCID)
real; clinically significant
normally larger than MCD
97
face validity and who it’s judged by
appears to test what is intended
judged by users of test after development
98
content validity and who it’s judged by.
adequately represent concept
typically questionnaire
measured by expert panel review
99
criterion-related validity
can outcomes be substituted for established gold standard
100
concurrent validity
scores form new measure correlate with scores from well-established measure administered at same time
101
predictive validity
outcome of target test can be used to predict future criterion score
102
construct validity
ability to measure theoretical dimensions of construct
103
true experimental designs (essential 3)
independent variable manipulated by experimenter
include control or comparison group
random assignment
104
concealed allocation
when a participant is determined to be eligible, researchers do not know group assignment
105
internal validity (3 components)
is evidence of a casual relationship between IV and DP
temporal precedence
covariation of cause and effect
no plausible alternative explanation
106
construct validity
to what constructs can results be generalized
107
external validity
can results be generalized to other persons, settings, or times
108
order of experimental design validity
statistical conclusion validity
internal validity
construct validity
external validity
109
per protocol analysis
analyze only who complete
110
intention to treat analysis
analyze with the group they were assigned to
111
quasi-experimental
may lack randomization
may lack comparison group
may lack both
112
between subjects design
assigned to independent groups
113
within subjects design
participants act as their own controls
114
two way factorial design
two or more independent variables
115
one way repeated measures design
subjects exposed to all levels
no control group
116
Quasi-experimental designs
lack random assignment, comparison group, or both
117
time series designs
single group - time is IV
118
one group pretest-posttest design
all receive same treatment
no comparison group - limits validity
IV is time - two levels - pre and posttest
119
Single subject AB design
baseline followed by treatment
can observe changes
unsure if confounding, maturation, or learned effect
120
SS BC design
control intervention (B) followed by experimental intervention (C)
121
interpretation of RR and OR
= 1 null
> 1 postive association, harmful
< 1 negative association, protective
122
100% sensitivity
all true positives
rule out when test negative
good screening test are highly sensitive
123
100% specificity
all true negatives
rule in when test positive
more important for diagnostic special tests
124
clinical prediction rules
diagnosis - rule in
screening - rule out
factors that predict response to treatment
125
what is a systematic review
searching
appraising
summarizing
objective and transparent process
126
point estimate
single value that represents the best estimate of population value
127
confidence interval
a range of values that we are confident contains the population value
- width concerns precision of the estimate
128
interpretation of imaging
interpreting rests primarily with radiologist
skilled review
129
what is CT good for?
bony pathologies
130
what is MRI good for?
soft tissue pathologies
131
air density
most radiolucent and absorbs least number of particles
darkest portion
132
fat density
considered radiolucent
not as dark as air, but darker than others
133
fluid density
more absorbent than air or fat
intermediate radiolucency
134
bone densities
most dense
calcium is metal like density
radio-opaque
appear white
135
wolff's law
stressed bone reacts over time by strengthening areas of increased stress and demineralizing or eliminating areas of lowered stress
136
ABCS (imaging)
alignment
bone density and dimension
cartilage
soft tissue
137
MRI
ability to image both bone and soft tissue
uses magnetic fields to produce images
138
DPT applications of bone scan
bone scans to detect stress fractures
displaced femoral neck fractures and subsequent AVN of femoral head from unrecognized FHSF
139
terrible triad
dislocation of elbow
fracture of radial head
fracture of coronoid process
140
how many vertebrae total and in each section
total: 33
cervical:7
thoracic: 12
lumbar: 5
sacral: 5 fused
coccygeal: 4 fused
141
C1 or Atlas
no vertebral body
wrapped around dens of C2
held in place by transverse ligament - prevents anterior displacement of C1 and C2
articular facets more horizontal in AP to facilitate rotation, wedge shaped in ML plane
lacks intervertebral disk - decreased shock absorption and stabilization
142
C2 or Axis
projection through C1
odontoid/dens
no IVD between it and C1
143
anklylosing spondylitis
syndesmophytes bridging anterior vertebral bodies
aka bamboo spine
uncinate joints in column two
144
sacralization
only four lumbar vertebrae
145
lumbarization
6 lumbar vertebrae
146
lateral view of lumbar
spondylolisthesis: is anterior body aligned
grade 1: 25% displacement
grade 2: 50%
grade 3: 75%
grade 4: >75%
147
retrolisthesis
superior portion of spinal column moves posterior on inferior body
148
angle that shaft of femur is offset to acetabulum
130
149
angle of inclination
normal 125
coxa vara 105
coxa valga 140
150
jones fracture
fracture of the 5th metatarsal
151
dancers fracture
tendon pulls of part of bone of 5th metatarsal
152
Name the 3 primary upward rotators of the scapula?
Upper and lower fibers of trapezius
Serratus anterior
153
Which muscles originate on the medial epicondyle?
Pronator teres
Flexor digitorum superficialis
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
154
Which muscles originate on the lateral epicondyle?
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
supinator
155
Where does the Extensor carpi Radialis Longus and where does the Extensor Carpi radialis brevis insert?
Longus: dorsal base of 2nd metacarpal
Brevis: dorsal base of 3rd metacarpal
156
Which main nerve branch(es) come off the medial cord of the brachial plexus?
Ulnar
median
157
Which main nerve branch(es) come off the posterior cord of the brachial plexus?
axillary
median
158
What is the name of the ligament that stabilizes the radial head at the proximal tibiofibular joint? Common injury in children called nursemaid’s elbow is due to laxity of this ligament in children.
annular ligament
159
What are the 3 muscles/tendons that comprise the anatomical snuff box? Which main bone can you palpate and which artery can you palpate?
Scaphoid
Radial artery
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
160
What is the name of the structure at the distal end of the ulna that articulates with the carpal bones?
Triangular fibrocartilage complex (TFCC): Shock absorption, covers end of ulna, stabilize RUJ
161
actions of Sartorius
Flex, laterally rotate and abduct hip, flex and medially rotate knee
162
pes anserine muscle action on the knee
Flex and medially rotate knee
163
What is the action of the piriformis and how does it’s action change?
a. Laterally rotate hip
b. When hip is flexed past 90 degrees, abduct the hip
164
Which main ligament resists eversion of the ankle?
deltoid
165
joint types of SC, AC, GH
SC: saddle, but functions as ball and socket
AC: planar
GH: ball and socket
166
Anatomical snuff box
Boundaries: extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus
Contents: superficial radial artery, scaphoid, cephalic vein
167
Carpal tunnel
Boundaries: flexor retinaculum, carpal bones
Contents: flexor digitorum superficialis tendons, median nerve, flexor pollicis longus tendon, flexor digitorum profundus tendons
168
1/2 LOAF
lumbricals
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis
169
femoral triangle
Boundaries: inguinal ligament, sartorius, adductor longus
Contents: femoral nerve, artery, vein and lymphatics
170
Menisci
Medial: c shaped
Lateral: circular
171
convex on concave
convex rolls and slides in opposite directions
172
concave on convex
concave rolls and slides in similar directions
173
mnemonic for levers
FRE 123
174
class 1 lever
fulcrum in middle
MA <, >, or = to 1
designed for speed and ROM when fulcrum closer to force
designed for strength when fulcrum closer to resistance
175
class 2 lever
resistance in middle
MA is > 1
advantage for force - farce arm is longer
176
class 3 lever
effort in middle
MA is < 1
advantage in speed and ROM
177
SC arthrokinematics
depression: glide superior, roll inferior
elevation: glide inferior, roll superior
protraction: glide and slide anterior
retraction: glide and slide posterior
178
orientation of clavicle:
deviated about 20 degrees posterior to frontal plane
179
orientation of scapula:
deviated about 35 degrees anterior to frontal plane
180
retroversion of humeral head:
about 30 degrees posterior to medial-lateral axis at elbow
181
which part of clavicle is convex/concave?
longitudinal is convex
transverse is concave
182
what happens at SC and AC during ST elevation
ST elevation
SC elevation
AC downward rotation
183
what happens at SC and AC during ST protraction
ST protraction
SC protraction
slight horizontal place adjustments at AC
184
what happens at SC and AC during ST upward rotation
ST upward rotation
SC elevation
AC upward rotation
185
GH abduction
inferior glide
superior roll
186
GH adduction
superior glide
inferior roll
187
GH external rotation
(vertical axis)
anterior glide
posterior roll
188
GH internal rotation
(vertical axis)
posterior glide
anterior roll
189
GH flexion
anterior spin
190
GH extension
posterior spin
191
scapulohumeral rhythm
for every 3 degrees of shoulder abduction, 2 degrees by GH abduction and 1 degree by ST upward rotation
192
SICK scapula
scapular malposition
inferior medial border prominence
coracoid pain and malposition
dysKinesis of scapula (lack of proper movement)
193
where does slap tear affect.
posterior band of inferior GH lig
194
what is the normal angle of the elbow
15 degrees valgus
ulna deviates laterally relative to humerus
carrying angle
valgus deformity - 30 lateral
varus deformity - 5 medial
195
how much compression force does radius absorb?
80%
196
guy wires of elbow
LUCL and AMCL
provide medial-lateral stability to ulnar during sag plane movement
197
functional arc of elbow
30 - 130 degrees of flexion
loss of extremes usually results in only minimal functional impairment
198
humero ulnar joint flexion
roll and slide superior
199
when are radius and ulnar parallel?
in full supination
200
how to compensate for pro/sup?
pronation: internally rotating shoulder
supination: externally rotating shoulder
201
DRUJ supination (open chain)
roll and slide inferior
202
PRUJ supination (open chain)
external rotation
203
DRUJ pronation (open chain)
roll and slide superior
204
PRUJ pronation (open chain)
internal rotation
205
PRUJ pronation (closed chain)
external rotation
206
DRUJ pronation (closed chain)
slide posterior, roll anterior
207
PRUJ supination (closed chain)
internal rotation
208
DRUJ supination (closed chain)
slide anterior, roll posterior
209
which carpals are vulnerable to compression injuries?
scaphiod and lunate
210
what artery supplies scahpoid?
radial artery
anterior interosseous artery
211
proximal 1/3 of scaphoid relies on what for blood flow?
retrograde blood flow because it has poor circulation
212
Keinbock's (lunatomalacia)
unknown cause
AVN of lunate
history of frequent trauma
ex. jack hammer operators
lunate becomes fragmented and shortened
213
which carpal bone is axis of rotation for hand?
capitate
214
arthro for wrist extension for both midcarpal and radiocarpal joints
roll posterior and slide anterior
roll follows fingers
convex on concave
215
arthro for wrist flexion for both midcarpal and radiocarpal joints
roll anterior and slide posterior
216
arthro for ulnar deviation for both midcarpal and radiocarpal joints
roll ulnarly and slide radially
roll follows thumb
convex on concave
217
arthro for radial deviation for both midcarpal and radiocarpal joints
roll radially and slide ulnarly
218
rotational collapse of wrist
zigzag deformity
dorsal intercalated segment instability - lunate's distal end dorsal
volar intercalated segment instability - lunates distal end volar
219
for ulnar deviation, which double V ligs are taut
lateral leg
palmar ulnocarpal lig
220
for radial deviation, which double V ligs are taut
medial leg
palmar radiocarpal lig
221
where is maximal grip
30 degrees of extension
222
shape of proximal base of 1st metacarpal
convex longitudinal
concave transverse
223
arthro of thumb abduction
roll anteriorly and slide posteriorly
224
arthro of thumb adduction
roll posteriorly and slide anteriorly
225
arthro of thumb flexion
roll and slide anterior
226
arthro of thumb extension
roll and slide posterior
227
arthro of MCP flexion
roll and slide anteriorly
228
arthro of MCP extension
roll and slide posteriory
229
arthro of MCP abd
roll and slide radially
230
arthro of MCP add
roll and slide ulnarly
231
arthro of IP flexion
roll and slide anteriorly
232
arthro of IP extension
roll and slide posteriorly
233
where does the cauda equina start?
L2
234
arthro of cervical extension
AO - roll posterior, slide anterior
AA - tilt posterior
ICR - slide posterior, ALL tense
235
arthro of cervical flexion
AO - roll anterior, slide posterior
AA - tilt anterior
ICR - slide anterior, lig nuchae, interspinous tense
236
arthro of protraction of cranium
lower to mid cervical flexes and upper craniocervical extends
237
arthro of retraction of cranium
lower to mid cervical extends and upper craniocervical flexes
238
arthro of craniocervical axial rotation
slides in opposite directions
spinous process to left - left transverse slides anterior and right slides posterior
239
arthro of craniocervical lateral flexion
AOJ - roll toward flexion and slide away
ICR - opposite slides.
240
arthro of thoracolumbar flexion
superior slide in both thoracic and lumbar
241
arthro of thoracolumbar extension
inferior slide in both thoracic and lumbar
242
arthro of thoracolumbar lateral flexion
slides in opposite directions.
inferior sliding on the side you are bending towards
243
nutation at pelvis
sacrum tilts anteriorly
iliac tilts posteriorly
hip flexors and lumbar extensors are tight
244
counternutation at pelvis
sacrum tilts posteriorly
iliac tilts anteriorly
hip extensors and abdominal muscles are tight
245
external oblique
twist trunk to opposite side
246
internal oblique
twist trunk to same side
247
what spinal level is ASIS at?
L4
248
where does the femoral head project at its proximal end?
medially and slightly anteriorly
249
which way does the neck displace the shaft of femur?
laterally
250
which side of femur displays convexity?
anterior
251
how is stress dissipated through femur?
compression along posterior shaft
tension along anterior shaft
252
normal and excessive anteversion and retroversion of femoral torsion angles
normal: 15
excessive: 35
retroversion: 5
253
what gait pattern is excessive anteversion associated with?
in-toeing
exaggerated hip internal rotation
compensatory to guide head back into acetabulum
254
center edge angle
35
smaller angle leads to less superior coverage. lead to superior dislocation and high compression
CEA of 15 reduces normal contact area by 35%
255
acetabular anteversion angle
20
larger angle leads to anterior dislocation
256
what is the close packed position of the hip
full extension, with slight internal rotation and slight abduction
elongates most of capsule
257
most congruent position in hip
NOT the same as close packed
90 deg flexion, moderate abduction and external rotation
258
femoral on pelvic
vex on cave
femur around fixed pelvis
259
pelvic on femoral
cave on vex
pelvis over fixed femur
260
femoral on pelvis flexion
roll post, slide ant
spin
261
femoral on pelvis extension
roll ant, slide post
spin
262
femoral on pelvis abduction
roll med, slide lat
263
femoral on pelvis adduction
roll lat, slide med
264
femoral on pelvis internal rotation
roll internal, slide external
265
femoral on pelvis external rotation
roll external, slide internal
266
pelvic on femoral flexion
roll and slide anterior
pelvis tilt anterior
iliopsoas and erector spinae involved
267
pelvic on femoral extension
roll and slide posterior
pelvis tilt posterior
taut iliofemoral lig
268
pelvic on femoral abduction
roll and slide inferior
ilium goes inf
269
pelvic on femoral adduction
roll and slide superior
ilium goes sup
270
pelvic on femoral internal rotation
opposite hip rolls and slides internal
271
pelvic on femoral external rotation
opposite hip rolls and slides external
272
trendelenburg
gluteus med weakness
if right weak, right elevates and left drops
273
compensated trendelenburg
trunk moves to weaker side
lean to weaker side
shortens lever arm
274
normal genu valgum angle
170-175
275
excessive genu valgum
< 170
knock-knee
more women
need to shift weight lat
276
genu varum
> 180
bow-leg
more men
need to shift weight med
277
which menisci is more mobile
lateral
278
where is blood supply to menisci greatest?
peripheral (external) border
from capillaries within synovial membrane and capsule
279
tibia on femoral extension
roll and slide anterior
280
tibia on femoral flexion
roll and slide posterior
281
femoral on tibia extension
roll anterior and slide posterior
282
femoral on tibia flexion
roll posterior and slide anterior
283
what happens with a larger Q-angle
larger lateral muscle pull on patella
284
arthro in ankle dorsiflexion
talus rolls anterior, slides posterior
pulls achilles taut
285
arthro in ankle plantarflexion
talus rolls posterior, slides anterior
anterior capsule taut
286
what is an unstable position in the ankle?
full plantarflexion
slackens most collateral ligaments of ankle
places narrower width of talus between malleoli
287
pes planus
flattening of arch
288
rigid pes planus
dropped arch in non weight bearing
289
flexible pes planus
dropped arch only when foot loaded
290
pes cavus
abnormally raised medial longitudinal arch
291
characteristics of pes planus
excessive calc eversion
increased flexibility of foot
uneven weight distribution
hallux valgus
postural symptoms
292
characteristics of pes cavus
limited pronation
rigidity
uneven weight distribution
digital contractures
tendency for lateral ankle instability/sprains
293
how long is a stride length?
144 cm
294
how long is a step length?
72 cm
295
ground clearance in gait
min 1 cm
296
cadence of gait
133 bpm
purple haze - left up right up
297
is there a pain signal or center in the brain?
no
pain is an experience
298
cortical smudging
poor localization
blurring of pain map
need to retrain where the body is
299
central sensitization
become efficient at feeling pain
increase perception of pain in other regions
changes in properties in neurons
CNS is now on higher alert
300
allodynia
normally benign stimulus
cold, heat, light touch
301
hyperalgesia
increased perception of noxious stimulus
302
how can you treat catastrophizing?
graded exercise or exposure
hurt doesn't equal harm
303
role of stress on pain
HPA axis (hypothalamus-pituitary adrenal axis)
activated during periods of stress and homeostatic imbalance
amygdala activates HPA during stress
hypothalamus releases CRH
pituitary gland secretes ACTH
ACTH acts to release cortisol from adrenals
304
hierarchy of listening
ignore message
pretend to listen
selective listening
attentive listening
empathetic listening
305
4 pillars of PNE
educate about pain
aerobic exercise
sleep hygiene
goal setting
306
PNE
emphasizes that any credible evidence of danger to body tissues can increase pain and any credible evidence of safety can decrease pain
307
graded exercises
for avoiders
small amounts to build up
hurt doesnt equal harm
sore but safe
308
pacing exercises
for persisters
slow them down
don't let them go crazy
goals: functional and fun
309
OARS
open questions
affirmations
reflective listening
summarizing
310
positive body language signals
sitting on edge of seat
standing, hands on hip
tilted head
moving closer
rubbing palms together
uncrossed arms
body leaning forward
hand on cheek
touching chin
relaxed mouth, chin forward
311
negative body language signals
rocking motion of torso
downcast eyes/lack of eye contact
arms crossed
leg or foot swinging
foot or finger tapping
short breaths/sighing
wringing hands
slumping in chair/fidgeting in chair
lowering of chin
hunched shoulders
fist clinched
legs crossed
body turned slightly away
grooming
yawning
signs of being nervous
312
3 injury mechanisms
high-magnitude stress applied for a brief time
low-mag stress applied for a long duration
moderate-mag stress applied to tissue repeatedly
313
what is the effect of progressive underload?
doing less needs lower set-points for thresholds
314
what is the effect of progressive overload?
doing more needs higher set-points for thresholds
315
mechano-coupling
mechanical trigger or catalyst
316
cell-cell communication
communication throughout a tissue to distribute the loading message via cell signaling
317
what are gap junctions?
specialized regions where cells connect and communicate charged particles.
CCC
318
where does the change happen in muscles?
z discs
319
inflammatory phase
damaged cells initiate inflam response
injury by-products removed by leukos
prepares tissue for proliferative
day 0 - day 4
320
proliferation phase
granulation tissue forms
tissue integrity is restored, strength not at peak yet
day 4 - week 2-6
321
repar and remodeling
ongoing
decres in type III and cres in type I
collagen in wound matures and strengthens
max strength of new tissue regained in this phase around 4-5 weeks
week 2 - ongoing up to 18 months after wound closure
322
type I collagen
found in body
most abundant in body
323
type II collagen
found in cartilage
324
type III collagen
found in intestines, muscles, blood vessels, uterus
325
motor learning: three phases
cognitive: attention, overcorrection, poor quality, stiff movement, focus on performance
associative: refinement, less overcorrection, errors reduce, less cog attention needed
autonomous: little cog guidance, focus on unrelated topics
326
why NM control first?
force that cannot be controlled by muscle will transmit to surrounding ST
increased injury risk
327
stabilization continuum (most - least)
floor
sport beam
half foam roll
airex pad
dyna disc
328
four skeletal muscle characteristics
elasticity - Lengthen
extensibility - shorten
excitability - respond to stim
contractility - shorten and contract
329
physiology of muscle healing
longer than other tissues
active contraction under load is essential
330
what actions cause greater DOMS
eccentric
331
lactate hypothesis
lactate does not cause DOMS
332
dorsal =
ventral =
sensory
motor
333
posterior horn
sensory processing
334
anterior horn
motor signals to skeletal muscles
335
lateral horn
only in thoracic and lumbar regions
central component in sympathetic ans
336
where is parasym
thoracic and lumbar
337
where is sym
cranium and sacrum
leads to every part of body
norepinephrine
338
horner syndrome
sympathetic postganglionic interruption lead to domination by PSNS
miosis: decreased pupil size
anhidrosis: decreased sweating
ptosis: drooping eyelid
one side of face
339
raynaud's syndrone
sympathetic disorder
body feels numb and cold
excessive constriction
fingers, toes, ears, and tip of nose
changes in color of skin
340
orthostatic hypotension
sudden drop in BP when a person stands up
decrease in blood to brain
feels dizzy
341
sliding filament theory
electrical impulse generates to NMJ
impulse spreads across sarcolemma into T tubules
receptors release ca2+ into muscle fiber
Ca2+ binds to troponin
tropomyosin uncovers active site on actin
myosin crossbridge heads bind actin, form actomyosin complex
heads pull actin to center of sarcomere (power stroke)
force is produced
342
type I muscle fibers
slow twitch
low peak force
fatigue resistant
constant oxygen supply
aerobic
long term activity
343
type II muscle fibers
fast twitch
rapid and high peak force
low capacity for oxidative metabolism/anaerobic
fatigue easily
344
in what order does blood leave and return to heart?
left vent
arteries
veins
right atrium
345
which ventricle is larger and why
left is bigger and stronger
pumps to body
oxygenated blood is heavier
346
what vein does the anterior descending (inter-ventricular) artery run with
great cardiac vein
347
flow of blood through the heart
enters R atrium from sup and inf vena cava
passes though AV valve into R ventricle
through valve into pulmonary trunk
through pulm arteries to lungs
oxygenated and returned to LA via pulm veins
through AV valve into LV
through valve into aorta and through body
348
sound 1
lub
mitral and tricuspid valves closing at onset of systole
349
sound 2
dub
aortic and pulmonic valves closing at onset of diastole
350
sound 3
ventricular gallop
volume related
associated with cordae tendineae, heart failure
does not eject enough blood
the sound of more blood entering the ventricle
351
sound 4
atrial gallop
pressure related
vibration of vent wall due to hypertension and MI
352
why would S4 exist
the walls are thicker and need more pressure to expand and make space because they are stiffer than normal
353
where to listen
APT M 2245
aortic valve - 2nd-3rd right interspace
pulmonic valve - 2nd-3rd left interspace
tricuspid valve - left sternal border
mitral valve - apex
354
order of abnormal sounds
S3 before S4
S4 before S1
355
duration of each segment of ECG
p wave - .8 sec
PR segment - .8
QRS interval - .8
ST segment - .12
T wave - .16
356
atrial depolarization
p wave
357
ventricular depolarization and atrial repolarization
QRS interval
358
ventricular repolarization
st segment and t wave
359
cardiac cycle according to the ventricles
ventricular diastole - after t wave through first half of QRS
ventricular systole - second half of QRS through t wave
360
ejection fraction
ratio of available blood pumped to pumped blood
EF = SV/EDV
.4 has pathology
.7 is normal
.8 is trained
361
what is the parietal pleura?
outer most layer
inner surface of thoracic cavity and diaphragm
362
what is the visceral pleura?
inner layer
outer surface of the lung
363
how many lobes does the right lung have?
3
364
how many lobes does the left lung have?
2
365
define compliance
ability of lungs to expand
inspiration
disease - emphy, asthma, pneumonia
366
define elasticity
ability to recoil
expiration
367
restrictive lung disease
less compliance
greater stiffness
cannot inhale
air cannot enter
pulmonary fibrosis
368
obstructive
loss of recoil
cannot exhale
air cannot leave
emphy, COPD
369
what is pulmonary ventilation (VE)
amount of air moved in and out of lungs in a given time period
anatomical dead space + alveolar ventilation
VE = TV x f
5000ml = 500ml x 10
370
tidal volume (TV)
amount of air moved per breath
600ml in men
it is greater in trained athletes
371
residual lung volume (RLV)
air left in lungs after max exhalation
1200 ml in men
372
inspiratory reserve volume (IRV)
maximum inspiration at end of tidal inspiration
3000ml
373
expiratory reserve volume (ERV)
maximum expiration at end of tidal epiration
1200ml
374
total lung capacity (TLC)
volume in lungs after maximal inspiration
6000ml
TLC = IC + TV + ERV + RLV
375
forced vital capacity (FVC)
maximum volume expired after maximum inspiration
4800ml
FVC = IRV + TV + ERV
376
inspiratory capacity (IC)
max volume inspired following tidal expiration
3600ml
IC = IRV + TV
377
functional residual capacity (FRC)
volume in lungs after tidal expiration
2400ml
FRC = ERV + RLV
378
amount of blood lost throughout capillaries
starts at 20 liters
ends at 17 liters
3 liters drained by lymphatic system
379
what happens to blood when it loses its plasma?
gets thicker and thicker
high viscosity will cause blood clots
tissues will get puffed up and cause swelling
380
function of thymus
differentiation and maturation of T cells
381
what is the difference between endocrine and exocrine?
endo - no ducts
exo- has ducts
382
describe tropic hormones
secreted by endocrine to stimulate the activity of another endocrine gland
383
what is the adenohypophysis?
anterior lobe of pituitary
384
what is the neurohypophysis?
posterior lobe of pituitary
385
growth hormone (GH)
signals growth of body
386
prolactin
stimulates breast tissue to produce milk
387
thyroid stimulating hormone (TSH)
stimulates thyroid gland to secrete hormones that influence metabolism
388
adrenocorticotropic hormone (ACTH)
stimulates adrenal gland to signal hormones that help deal with stress
389
melanocyte stimulating hormone (MSH)
stimulates melanocytes to produce more melanin and darken the skin
390
follicle stimulating hormone (FSH)
testes or ovaries to stimulate maturation of egg/sperm and induce secretion of sex hormones
391
lutinizing hormone (LH)
during menstrual cycle and signals ovulation
392
antidiuretic hormone (ADH)
stimulates collecting tubules of kidney to concentrate urine to reduce water loss.
393
oxytocin
induces contractions of smooth muscle of sexual organs
394
thyroid hormone
contain iodine
increase metabolic rate
395
calcitonin
reduces excessive calcium by slowing down osteoclast activity
actively secreted in childhood to increase bone formation
396
parathyroid hormone (PTH)
opposes calcitonin
increases calcium levels in blood by activating osteoclast, stimulating kidney to reabsorb calcium, or activation of vitamin D production for calcium to be absorbed from food
397
aldosterone
secreted by adrenal cortex
response to decrease in blood volume or BP
stimulates kidneys to reabsorb more water
398
glucocorticoids
secreted by adrenal cortex
keep blood glucose high to maintain brain activity during stressful situations
can direct lymphocytes or decrease inflammation
399
what hormone is produced in kidneys?
erythropoietin (EPO)
stimulates production and maintenance or RBC
released when kidney detects decres in oxygen
red bone marrow produces more RBC
400
2 major functions of the kidneys
filtration of blood
removes metabolic wastes from the body, esp those containing nirtogen
401
what does kidney regulate?
blood volume and composition
electrolytes
blood pH
blood pressure
402
what do diuretics do?
lower BP
release everything from kidney
more water in blood = kidney working harder
403
ADH vs aldosterone
ADH just reabsorbs water
aldosterone reabsorbs water and sodium
404
three functions of the kidney
removes nitrogenous wastes
~urea
~uric acid
~creatinine
~ammonia
maintains homeostasis
~fluid balance
~electrolyte balance
~acid-base balance
excretory organ
~via blood filtration and formation of urine
405
does stomach absorb nutrients?
No. only digests
406
how much absorption occurs in the small intestine?
90%
407
where are acids neutralized in digestive system?
duodenum
408
the jejunum is the location of most:
chemical digestion
nutrient absorption
409
large intestine functions
reabsorption of water
compaction of intestinal contents into feces
absorption of imp vitamins produces by bacteria
storage of fecal material prior to defecation
410
3 functions of the liver
metabolic function
hematological regulation cleans toxins out of blood
bile production - aids in digestion of lipids
411
what forms the common bile duct?
cystic duct and common hepatic duct
dumps bile into duodenum
412
what are the functions of the gall bladder?
stores bile
releases bile into duodenum
413
where does right lymphatic duct drain?
into junction of right internal jugular and right subclavian veins
414
where does the thoracic duct drain into?
left internal jugular and subclavian veins
415
5 functions of the skin
protection: kill bac, against UV, block moisture
body temp regulation
cutaneous sensation
synthesis of vitamin D
excretion - sweat
416
3 degrees of burns
first: superficial epi
second: epi through superficial dermis
third: entire epi and dermis
417
atherosclerosis
build up of plaques breaking off leading to myocardial infarction
418
arteriosclerosis
inability of vessels to dilate and lead to MI
419
elevated ST segment
MI
420
describe skewed to the right
tail faces right
positive skew
mean > median/mode
421
describe skewed to the left
tail faces left
negative skew
mean < median/mode
422
z scores for CI calculations
90% = z 1.65
95% = z 1.96
99% = z 2.58
423
error: liar or blind
type 1: liar, p value
type 2: blind
424
if p value is less than or equal to alpha,
reject the null
425
if p value is greater than alpha,
fail to reject the null
426
what p value and CI are analogous to each other?
95% CI
.05 p value
427
what are the four powers of power?
alpha
effect size
variance
sample size
428
what are the 4 assumptions of parametric tests?
scale data - ratio or interval
random sampling
equal variance - roughly equivalent before starting
normality - normal distribution
429
effect size for t-test
use cohen's d
small d = 0.20
medium d = 0.50
large d = 0.80
extra large d = 1.0 or 1.1
430
ANOVA effect size small
eta squared: .01
cohen's f: .10
431
ANOVA effect size medium
eta squared: .06
cohen's f: .25
432
ANOVA effect size large
eta squared: .14
cohen's f: .40
433
describe tukey's honestly significant difference
IG only
middle of the road in terms of risk
most common
best balance of type I and II error
434
describe sidak
RM
adjusted alpha
good balance of type I and II error
most common
435
strength of correlation
0: null
1.0: perfect pos
-1.0: perfect neg
436
conventional effect sizes for r
small: .10
medium: .30
large: .50
437
when do you use non parametric tests?
when you violate more than 2 parametric assumptions
438
non para for unpaired t test
Mann-Whitney U
439
non para for paired t test
sign test
~ scores converted to signs
wilcoxon signed ranks test (more common)
~ gives magnitude of change
440
non para for IG ANOVA
kruskal-wallis ANOVA
441
non para for RM ANOVA
freidmans ANOVA
442
spearman rank (rho) correlation coefficient
non para analog of pearson r
at least one variable will be ordinal
non normal distribution of ratio/interval data
can be used with curvilinear
443
goodness of fit chi square
compare observed frequencies of 1 variable to uniform frequencies
444
tests of association chi square
much more common
compare observed frequencies of one variable to observed frequencies of another variable
445
ICC model 1
raters chosen from larger population
some subjects assessed by different raters
446
ICC model 2
each subject assessed by same set of raters
test-retest and inter-rater
can generalize to other raters
447
ICC model 3
same set of raters but only represent raters of interest
only for intra-rater
cannot generalize
448
ICC form 1
single measurement
449
ICC form k
several measurements
450
3 diagnosis classifications
patho-anatomical
movement system
treatment response
451
what is motor learning?
set of processes associated with practice or experience that lead to relatively permanent changes in the capacity for skilled movement
452
example of active insufficiency
max. extension of knee then flexion of hip
have more hip flexion when knee is flexed than extended
453
example of passive insufficiency
unable to flex trunk fully without bending knees
-passive hamstring insufficiency
454
grading of joint play (0-6)
0 - ankylosed
1 - significant hypomobility
2 - hypomobility
3 - normal
4 - hypermobility
5 - significant hypermobility
6 - subluxation
455
grading for reflexes
0 = nor response; abnormal
1+ = slight but present response; could be normal
2+ = brisk response; normal
3+ =. very brisk response; could be normal
4+ = repeating response; abnormal
456
frontal lobe
reasoning
logic
speech
personality
motor activity
457
parietal lobe
understanding speech
sensation
458
occipital lobe
vision
459
temporal lobe
hearing
balance
460
limbic lobe
emotions
461
insular cortex
visceral
autonomic
taste
462
where is broca's area located?
inferior frontal gyrus
left hemisphere in right handed person
463
where is the acoustic area?
superior temporal gyrus
464
what is the location of the primary motor cortex?
in the precentral gyrus, anterior to central sulcus
465
what does the hypothalamus do?
regulate homeostasis
endocrine regulation
satiety and hunger
emotions
autonomic nervous system
circadian rhythms
466
pituitary gland
secretions regulated by the hypothalamus control metabolism, stress response, urine production
467
what can a lesion in cerebellar circuits cause?
wide based ataxic gait
468
what are the two longitudinal sections that the whole brainstem has?
basilar - anterior
tegmentum - posterior
469
what section of the brainstem is only in the midbrain?
tectum
470
cranial nerves in the forebrain
1 and 2
471
cranial nerves in the midbrain
3 and 4
472
cranial nerves in the pons
5, 6, 7, and 8
473
cranial nerves in the medulla
9, 10, 11, and 12
474
what does the cerebellum do?
coordinate ongoing movement
475
lesions to paravermal
gait and limb ataxia
476
lesions to lateral hemisphere
hand ataxia
477
lesions to vermal and flocculonodular
truncal/gait ataxia
nystagmus
478
which BG are output
substantia nigra pars reticulata
globus pallidus internus
479
which BG are input
caudate
putamen
subthalamic
480
SWM: projection fibers
project out
travel through internal capsule
481
SWM: commissural fibers
connect homologous areas of cerebral hemispheres
example: corpus callosum
cingulate gyrus surrounds the CC
482
SWM: association fibers
connect cortical regions within one hemisphere
short connect adjacent gyri
long connect lobes within one hemisphere
483
at what level does the spinal cord end?
L1-L2
484
oculomotor system
lateral rectus - abd
medial rectus - add
inferior rectus - down
superior rectus - up
inferior oblique - extorsion
superior oblique - intorsion
(LR)6(SO4)3
485
what is an activity?
task or action done by an individual
486
what is participation?
involvement in life situation
487
Total hip arthroplasty precautions (posterior)
no hip flexion greater than 90 deg
no hip adduction past midline
no hip internal rotation past neutral
488
Total hip arthroplasty precautions (anterior)
no hip extension past neutral
no active hip abduction
no hip external rotation past neutral
489
TKA recommendation
no twisting of LW in WB position
no sitting with legs crossed
avoid low soft chairs
do not forcefully bend operated knee
do not kneel on operated knee
use of walker as needed
490
total shoulder or rotator cuff repair
NWB and immobilized constantly unless PROM
no abduction or extension past neutral
AROM of elbow, wrist, hand
outpatient 5 times per week for 4 weeks is common
491
describe a discectomy
removal of disc fragments that compress spinal nerve root
492
describe a laminectomy
removal of part of lamina to depress spinal canal
493
describe a fusion
use of instrumentation and/or bone grafting to stabilize vertebral segments
494
describe a vertebroplasty
injection of bone cement to stabilize a vertebra with a compression fracture
495
describe a kyphoplasty
insert inflatable balloon to restore height prior to injection of bone cement
496
inpatient rehabilitation facility
relatively medically stable
min 3 hours of therapy a day
must need 2/3 therapies
sees physician once a week
497
skilled nursing facilites
require medical services
at least 1 hour of therapy a day
one service
sees physician every 30 days
498
long term acute care hospital
very close medical supervision, but considered stable
might get PT
499
dynamic gait index (DGI)
assess ability to modify balance while walking in presence of external demands
500
what is a large meaningful change for 6 min walk test?
40 meter improvement
501
contraindications for CR
unstable angina
resting SBP > 200 mmHg or resting D > 110 mmHg
orthostatic BP drop > 20 mmHg with sympotms
502
4 ways to diagnose orthostatic hypotension
SBP decrease of 20 mmHg or more
DBP decrease of 10 mmHg or more
SBP decreases under 90 mmHg
HR increase of 10 bpm or more
503
pulse 4 point scale
0: absent
1+: palpable, thready and weak, easily obliterated
2+: normal, easily identified, not easily obliterated
3+: increased, moderate pressure of obliteration
4+: full, bounding, cannot obliterate
504
sternal precautions
no pushing, pulling, lifting over 8-10 lbs
no raising arms above the shoulder
no arms behind the back
do not push up from a chair
do not carry children, pets, groceries
505
when does a pt need supplemental oxygen?
<88% on room air
506
nasal canula rates
1-6
above 4 causes dryness
507
INR
time for blood to clot
508
troponin
will be elevated in MI
509
BNP
identify CHF when over 100
510
d-dimer
blood clot breakdown
identify embolism/DVT
511
BEFAST stroke signs
balance
eyes
face
arms
speech
time
512
what scan is the earlier indicator for stroke?
MRI
513
NIHSS outcomes
very severe - >25
severe - 15-24
mild to moderate - 5-14
mild 1-5
514
benign lesions
< 6 mm
uniform color
distinct borders
symmetric
seldom bleed or ulcerate
soft to firm
slow rate of growth or change
515
malignant lesions
> 6 mm
multiple shades
irregular, blurred borders
asymmetric
often bleed or ulcerate
firm to hard
variable rate of growth
516
superficial burns
epidermis only
no blisters
red
painful
517
superficial partial thickness burns
epi and superficial dermis
blisters
red
painful
518
deep partial thickness burns
majority of dermis
hair follicles/sweat glands intact
519
full thickness burns
subcutaneous fat layer
minimal pain
susceptible infection
increased depth = decreasing pain
520
subdermal burns
muscle, bone, adipose tissue
insensate
521
stage 1 wound
intact, reddened skin that does not blanch
522
stage 2 wound
shallow open ulcer with red/pink wound bed, denoting partial-thickness loss of dermis, without slough. Can present as open or ruptured blister
523
stage 3 wound
subcutaneous fat may be visible but no bone, muscle or tendon exposed. May include tunneling or undermining
524
stage 4 wound
muscle/tendon/bone exposure. Tunneling/undermining, eschar/slough over at least part of wound bed
525
hemoglobin for women
12-16 g/dL
526
hemoglobin for pregnant women
> 11 g/dL
527
hemoglobin for men
14-18 g/dL
528
white blood cell count for adults
5,000-10,000 / mm3
529
troponin for women
less than 14 ng/mL
530
troponin for men
less than 22 ng/mL
531
BNP for adults
less than 100 pg/mL
532
d-dimer for adults
less than 250 ng/mL
less than 0.4 mcg/mL
533
hematocrit for women
37-47%
534
hematocrit for pregnant women
> 33%
535
hematocrit for men
42-52%
536
INR for adults
0.8-1.1
537
Critical values of hemoglobin
Below 5 and above 20
538
Critical value of INR
Above 5.5
539
Critical values of hematocrit
Less than 15% or above 60%
540
Critical value of BNP
Over 400
541
Critical value of white blood cell count
Less than 2,500 or more than 30,000
542
medial winging
retraction and elevation
long thoracic involvement
weakness of SA
543
lateral winging
elevation, upward rotation, and protraction
dorsal scap involvement
weakness of rhomboids
544
load
< 25% for endurance
> 40% for hypertrophy
> 85% for athletes
545
test cluster for subacromial impingement/pain syndrome
hawkins-kennedy
painful arc
infraspinatus test
546
diagnostic cluster for anterior instability
anterior apprehension
relocation
547
test cluster for labral pathology
biceps load I
biceps load II
speed's test
passive compression test
active compression test (o'brien's)
548
cluster for AC joint pathology
cross body adduction
resisted extension test
active compression test
549
what is prolotherapy?
hypertonic dextrose injections create acute inflammation, leads to improved healing
550
anatomic vs reverse total shoulder: which has less restrictions?
reverse
551
what is the concavity of the HRJ?
cave on vex
552
synkinetic with PRUJ
ext and pro go together
flex and sup go together
553
what is the concavity of PRUJ?
vex on cave
554
what is the concavity of DRUJ?
cave on vex
least congruent in pronation
most congruent in supination
555
what is the scapholunate angle?
30-60 deg in the palmar direction
at risk during FOOSH
556
what extensors make up part of the snuff box?
AbdPL
EPB
557
what nerve is entrapped by anterior interosseous syndrome?
median
558
what nerve is entrapped in posterior interosseous syndrome?
radial nerve
559
amount of activity - kennedy stages
pain after - reduce by 0-25%
pain before and after - reduce by 25-50%
pain before during and after, perf unaffected - 50-75%
pain before during and after, perf affected - 75-100%
560
what is the radial nerve neural hand deformity?
wrist drop
561
what is the ulnar nerve neural hand deformities?
wartenburg - DM pull pinky into abd
froment - add poll impacted
claw hand
562
what is the median nerve neural hand deformities?
ape hand
okay sign
563
what forces favor filtration?
glomerular HP
bowman's OP
564
what forces oppose filtration?
bowman's HP
glomerular OP
565
what GFR is considered kidney failure?
less than 15%
566
nephrotic syndrome
inflammation occludes glom capillary lumen
567
nephritic syndrome
circulating immune complexes become trapped in glomerular membrane
568
clinical manifestations of kidney failure
tired, weak, pale skin
itchy, dry skin, less sweating
metallic taste
hypertension
platelet dysfunction
anorexia, nausea
electrolyte imbalances
respiratory distress
infections
memory loss
osteodystrophy
569
steps in excitation contraction coupling
action potential to t tubule
depolarization of t tubule
open SR calcium release channels
increase intracellular calcium concentration
calcium bind to troponin C
tropomyosin moves and allows interaction of actin and myosin
cross-bridge cycling
contraction/force generation
570
metaplasia
conversion of one cell type to another
cause: irritation, inflammation
cigarette smoker
GERD
571
function of neutrophil
inflammation
defense against foreign substances like bacteria, fungi
572
function of monocytes
immature macrophages
clean up debris/damaged cells
573
eosinophils
attack parasites, cancer cells
play a role in asthma and allergy
574
basophils
produce allergic response like sneezing
575
components of tissue healing
fibronectin - helps with blood clot
proteoglycans - hydration
elastin
collagen - support and tensile strength
576
wound healing continuum colors
black- dead
yellow- infection
red- healing in granulation phase
pink- healing, re-epi
577
you get a papercut and experience pain at the site. this response is related to:
increases exudate and chemical mediators at the site
578
innate immunity
born with it
1st reponder
rapid and always the same
nonspecific
non adaptive
579
acquired/adaptive immunity
slower response
diverse
specific
has memory
self and non self recognition
580
pathophysiology of AIDS
transmitted through bodily fluids
risk factors include: poverty, drugs, bad health care
581
hypersensitivity type 1
IgE mediated
most common
immediate
severe - anaphylactic shock
582
hypersensitivity type 2
IgG, IgM mediated
antibody mediated
basis of autoimmune disease
583
hypersensitivity type 3
IgG, IgM, complement mediated
formation of antigen-antibody immune complexes
massive inflammatory response
584
hypersensitivity type 4
T cell mediated
delayed
transplant rejection
585
general features of anemia
weakness
fatigue
dyspnea
hypoxia of brain tissue
pallor - absence of red
tachycardia
severe - heart failure
increased respiration rate
bone pain
586
iron deficiency anemia (definition and causes)
iron does not meet demands of hemoglobin production
causes:
decreased iron consumption
increased iron demand
587
megaloblastic - pernicious anemia
absence of intrinsic factors in stomach
inhibits absorption of B12
588
sickle cell anemia
genetic
crescent shaped
abnormal S hemoglobin
fragile, stiff, distorted
deliver les oxygen
clog and break into pieces
1 in 600 AA
589
thalassemia (def)
genetic
absence of alpha or beta globin
mediterranean descent
hypercoagulability - compensation - hyperplasia
hemolytic
590
GH excess in adults
acromegaly
excess after long bone fushion
very rare
common casue:
adenoma of pit gland
hypothalamic tumors that sec GHRH
591
diabetes insipidus
condition of ADH
inability of the body to concentration or retain water
592
syndrome of inappropriate ADH
excessive release of ADH
water intoxication
hyponatremia
593
what hormones does the adrenal cortex secrete?
adrenocorticoids
594
what hormones does the zona glomerulosa secrete?
mineralocorticoids
595
what hormones do the zonas reticularis and fasciculata secrete?
glucocorticoids and androgens
596
what happens in acute adrenal crisis?
caused by:
trauma, hemorrhage, thrombosis
serious, life threatening, severe hypotension, shock, death
597
what is addison's disease and what causes it?
primary adrenal insuff
adrenal cortical hormones are deficient and ACTH levels are elevated
causes:
autoimmune destruction
TB
fungal infection
adrenal hem from anticoags
598
what is an adrenal crisis and what are the symptoms?
extreme stress without steroid coverage
need to be injected with glucocorticoids
symptoms:
severe drop in BP causing dizziness
light headedness
GI stuff
confusion and lethargy
muscle cramps and weakness
599
what is cushing syndrome and what causes it?
excess glucocorticoid production
causes:
adrenal gland tumor
ectopic production
glucocorticoid drugs
600
what to look out for when working with dialysis pts?
depression
lack of motivation
calling in to therapy
weakness, fatigue
tachycardia, dizziness, nausea
schedule before dialysis or on day off
monitor vitals before, during and after
601
between T3 and T4, which is more active and which is released at a higher quantity?
T3 is more active
T4 is released in higher quantity
602
what does calcitonin do?
opposite action of parathyroid hormone
does NOT increase levels of calcium and phosphorus in blood
inhibits activity of osteoclasts and stops bone reabsorption
603
what are the causes of goiter?
graves disease
TSH secreting tumor
iodine deficiency
604
what is hyperthyroidism?
tissues are exposed to high levels of circulating thyroid hormones
605
clinical manifestations of Graves disease
goiter
excessive sympathetic system activity
increased respiratory rate
increased DTRs
exophthalmos - bulging eyes
sweating, heat intolerance
increased appetite
weight loss
frozen shoulder
calcific tendinitis of the wrist
606
what is a thyroid storm?
sudden, worsening of hyperthy
high fever
servere tachycardia
heart failure
irritability
607
what is hypothyroidism?
deficient thyroid hormone
creates a generalized depression of body metabolism
608
describe acquired hypothyroidism
destruction of thy gland
impaired pit function
impaired hypothal function
iodine deficiency
autoimmunity that blocks TSH or TSH receptors - hashimoto thyroiditis
609
clinical manifestations of hypothyroidism
weakness and fatigue
weight gain, loss of appetite
cold intolerance
decreased GI motility
mental dullness
large tongue
peripheral edema
myxedema coma
delayed relaxation of DTR
bradycardia
hair loss
610
actions of parathyroid hormone
bone remodeling
bone reabsorption
inhibits phosphate reabsorption
stims Ca+ reabsorption
activates vitamin D
611
what are the manifestations of hyperparathyroidism?
bone damage
hypercalcemia
hypertension
hypercalciuria
hypergastrinemia
diminished DTRs
kidney damage
glove stocking sensory damage
stones, bones, groans, psychiatric overtones
612
what are the manifestations of hypoparathyroidism?
hypocalcemia
NM irritability
tetany
spasm
paraesthesia
cardiac arrhythmias
613
what is Chvostek's sign?
hypopara
hyperirri facial nerve when tapped
614
what is trousseau sign?
carpal spasm when BP cuff inflated for over 3 min
615
what are the 4 types of cells in the pancreas?
beta cells - secrete insulin
alpha cells - secrete glucagon
delta cells - secrete somatostatin
remaining secrete pancreatic peptide or other peptides
616
where is glucose produced?
beta cells
GLUT2 transporter moves glucose from blood to cell
as calcium increases in beta cells, insulin goes out
617
what is diabetes mellitus?
increased blood glucose levels (hyperglycemia)
disruption of metabolism of carbohydrate, proteins, fats
618
what is diabetic ketoacidosis?
metabolic derangement seen more in T1D
ketones detected in blood and urine
produce hydrogen ions - metabolic acidosis
protein catabolism
619
who is at high risk for T2D?
age greater or equal to 45 yrs old
hypertension
positive family history
HDL chol <35 mg/dl
triglycerides greater or equal to 250 mg/dl
obesity
sed lifestyle
cigarette smoking
620
pathophysiology of T2D
insulin is present but not used by tissues
beta cells gradually fail
normally diagnosed while being treated for something else
621
what is the normal level for fasting blood glucose levels?
<100mg/dl
622
what is the prediabetes level for fasting blood glucose levels?
100-125 mg/dl
623
what is the diabetes level for fasting blood glucose levels?
greater to equal to 126 mg/dl
624
what is the normal level for HbA1c levels?
<5.7%
625
what is the prediabetes level for HbA1c levels?
5.7 - 6.4%
626
what is the diabetes level for HbA1c levels?
greater than or equal to 6.5%
627
what is the normal level for oral glucose tolerance test levels?
< 140 mg/dl
628
what is the prediabetes level for oral glucose tolerance test levels?
140-199 mg/dl
629
what is the diabetes level for oral glucose tolerance test levels?
greater than or equal to 200 mg/dl
630
manifestations of T2D
insidious
blurred vision
fatigue
skin infections
polyuria
fatigue
polydipsia
631
manifestations of T1D
sudden
blurred vision
fatigue
skin infection
polyuria
fatigue
weight loss
polyphagia
polydipsia
632
what are the extreme complications of hypoglycemia?
< 70 mg/dl
shakiness
pale skin color
cold clamy skin
dizziness
sweating
clumsy/jerky movements
hunger
seizure
headache
increased HR
coma - below 50 mg/dl
633
what are the extreme complications of hyperglycemia?
> 300 mg/dl with ketones
ketones with one or more of the following require ER
DKA: rate and depth of respiration increases
marked fatigue
nausea and vomiting
breath that smells fruity
a very dry mouth
634
what is the somogyi phenomenon?
increased fasting blood glucose levels during early morning that is triggered by preceding hypoglycemic event
cause:
large insulin doses
skipped meals
heavy exercise
635
what is the dawn phenomenon?
increased fasting blood glucose in the early morning not triggered by hypoglycemic event
more common
result of circadian variation in hormone secretion
636
PT considerations of hyperthyroidism
they are deconditioned
know S&S
be familiar with their treatments
some meds can make them fluctuate between hyper and hypo
monitor vitals during treatment
if thyroidectomy: watch for hypoPT signs
radioactive for 24 hrs after treatment
decreased bone density
637
where is bilirubin produced?
in bone marrow and also liver as end product of hemoglobin breakdown
638
what causes jaundice?
imbalance between synthesis and clearance of bilirubin
- excessive destruction of RBCs
- excessive production of bilirubin
- obstruction of bile flow
639
clinical manifestations of cirrhosis
hepatomegaly
weight loss, weakness, anorexia, jaundice
pain in right quad
fatigue with mild exertion
impaired coag
portal hypertension
hepatic encephalopathy
640
risk factors of hepatitis
injection drug users
acupuncture
tattoo inscription/removal
ear and body piercing
recent operative procedure
hemodialysis
health care worker exposed to blood products/body fluids
exposure to certain chemicals/bisexual activity
travel to high risk areas
consumption of raw shellfish
641
which types of hep are transmitted by contact with infected blood?
B, C, D
642
implications to PT with hep
wear PPE
need a balance of activity and rest
look for side effects of medications: muscle pain, headache, skin irri, depression, hair loss, cough, anything intolerable - report to physician
643
what are the most common causes of pacreatitis?
gall stones
alcohol
toxins: acetaminophen
644
clinical manifestations with acute pancreatitis
mild nonspecific pain to profound shock
abdo pain abruptly in mid epigastrium
pain radiates to back and worse by lying or supine
645
normal range of pH
7.35-7.45
single value: 7.4
646
what is the normal range for PaCO2?
35-45 mmHg
single value: 40
647
what is the normal range for HCO3
22-26
single value: 24
648
what is cell proliferation?
increase in cell number by mitotic cell division
649
what is cell differentiation?
giving them a job
650
grade 1 cancer
differ slightly from normal
well differentiated
651
grade 2 cancer
more abnormal
mod differentiated
652
grade 3 cancer
poorly diff
653
grade 4 cancer
immature, primitive, undiff cells
difficult to determine cell of origin
anaplastic
654
what are the 7 warning signs of cancer?
change in bowel or bladder habits
a sore throat that does not heal
unusual bleeding or discharge from body orifice
thickening or lump in breast or elsewhere
indigestion or difficulty swallowing
obvious change in wart or mole
nagging cough or hoarseness
655
symptoms of chemo induced peripheral neuropathy (CIPN)
glove and stocking
symmetric
tingling
numbness
burning
impaired sensation to touch and vibration
sensitivity to heat and cold
656
what are treatments for lymphedema?
complete decongestive therapy
- manual lymphatic drainage
- compression - bandages
- exercises
