Final Frontier readings Flashcards
1
Q
What nerve provides the afferent input for the corneal reflex?
A
CN V: Opthalmic branch
2
Q
What nerve provides the efferent response of the corneal reflex?
A
CN VII
3
Q
Describe the abdominal reflex and its findings.
(T7-T12)
A
Contraction of the superficial abdominal muscles when stroking the abdomen lightly (Lateral –> medial)
(+) if asymmetric = indicates UMN lesion on the absent side
4
Q
Describe the cremasteric reflex and its findings.
(L1, L2)
A
Contraction of the cremaster muscle (pulls up the scrotum) after stroking the same side of the superior/medial thigh
(+) Absent = SCI and corticospinal lesions
5
Q
What is another name for the babinski reflex? What does it indicate?
(S1, S2, tibial nerve)
A
Plantar reflex
(+) Great toe DF and fanning of the toes = UMN lesion and corticospinal lesion
6
Q
What facilitates the anal reflex? What nerve(s) provide the afferent and efferent input of the reflex?
A
Contraction of the external anal sphincter upon stroking the skin around the anus
afferent: Pudenal nerve
efferent: S2-S4
7
Q
Describe the bulbocanvernosus reflex and its findings.
(S2-S4)
A
Anal spincter contraction in reponse to squeezing the glans penis or tugging on an indwelling foley catheter
First reflex to emerge after SCI (indicates that the body is out of spinal shock)
8
Q
Is muscle wasting/atrophy more prominent with nerve root damage or peripheral nerve damage?
A
Peripheral nerve damage
The damaged peripheral nerve is supplied by more than one nerve root = more muscle fibers being affected
9
Q
Capsular pattern of shoulder?
A
ER > ABD > FLX > IR
10
Q
Mobilization/Manual therapy
humeroradial FLX
A
anterior
11
Q
Mobilization/Manual therapy
humeroradial EXT
A
posterior
12
Q
Mobilization/Manual therapy
Proximal RU joint PRON
A
Posterior
13
Q
Mobilization/Manual therapy
Proximal RU joint SUP
A
anterior
14
Q
Mobilization/Manual therapy
Distal RU joint PRON
A
Anterior
15
Q
Mobilization/Manual therapy
Distal RU joint SUP
A
Posterior
16
Q
Mobilization/Manual therapy
knee FLX
A
posterior
17
Q
Mobilization/Manual therapy
knee EXT
A
anterior
18
Q
hip capsular pattern?
A
FLX > IR > ABD
19
Q
How long are precautions for a THR implemented?
A
3-6 months
20
Q
When can a person start to perform FWB s/p uncemented THR/TKR?
A
6 weeks
21
Q
When can resisted exercises start for those s/p THR?
A
week 4
22
Q
How long is a pt NWB s/p meniscus repair?
A
3-6 wks
23
Q
At what degree is a knee brace locked at s/p ACL repair?
A
0 degrees EXT
wean off around wks 2-4
- recent clinical practice allows for ROM as tolerated after 1 week
- pt is able to unlock brace with ROM exercises
- remains locked with ambulation
24
Q
(true/false) Lack of skeletal maturity can be considered as a contraindication to ACL surgery
A
true
25
When can exercises begin after ACL repair?
POD 1
26
An ACL tendon graft goes through _______ for 2-3 weeks prior to revascularization
necrotizing process
27
(true/false) bone to bone healing is faster than soft-tissue to bone healing
true
28
What exercise precautions are in place for those s/p ACL repair?
1. avoid shear forces and stress on graft --> no OKC knee EXT in short sitting
2. avoid CKC quad strengthening between 60-90 degrees of FLX
3. use caution with knee FLX strengthening for HS tendon and knee EXT strengthening for quadriceps tendon
29
When can a functional brace be used during ACL rehab?
Starting wk 12
| reduces anteriro translation especially at low external loads
30
What muscles are inhibited with upper crossed syndrome?
- deep cervical flexors
- lower trap
- serratus anterior
31
What muscles are tight with upper crossed syndrome?
- SCM
- pectoralis
- upper trap
- lev scap
32
What muscles are inhibited with lower crossed syndrome?
- abdominals
- gluteal muscles
33
What muscles are tight with lower crossed syndrome?
- rectus femoris
- iliopsoas
- back extensors
34
What are the 5 D's and 3 N's?
- dysphagia
- diplopia
- dysarthria
- drop attacks
- dizziness
- ataxia of gait
- nystagmus
- nausea/vomiting
- N/T
35
What motions of the neck test both vertebral arteries?
FLX and ROT tests
36
What motions of the neck test the contralateral vertebral artery?
- EXT + ROT tests
- cervical ROT tests
37
What motions of the neck test the ipsilateral vertebral artery?
SB tests
38
What type of onset does adhesive capsulitis have?
insidious
39
what is another name for periarthritis?
adhesive capsulitis
40
Describe the initial onset stage of adhesive capsulitis.
- pain that increases with movement and is **present at night**
- loss of ER with **intact** RTC strength
41
Describe the freezing stage of adhesive capsulitis.
- persistent and intense pain **at rest**
- motion is limited in **all** directions
- lasts for 3-9 months
| cannot be fixed by injections
42
Describe the frozen stage of adhesive capsulitis.
- pain **only with movement**
- significant adhesions
- limited motions in all directions
- deltoid, RTC, biceps, and triceps atrophy
- lasts 9-15 months
43
Describe the thawing stage of adhesive capsulitis.
- minimal pain
- no synovitis but gas capsular restrictions from adhesions
- motion may improve
- stage lasts for 15+ months
44
For adhesive capsulitis, what direction mobilization would you use to improve ER and IR?
posterior glide
45
(true/false) RA can present with systemic symptoms
true
| fatigue, malaise, fever, weight loss, multi-system dysfunction
46
How long does stiffness last in the morning when RA is present?
> 45 minutes
47
How long does stiffness last in the morning when OA is present?
< 30 minutes
48
What capsular pattern is present with legg-calve-perthes disease?
absent capsular pattern
49
What gait deviations are present in those with legg-calve-perthes disease?
psoatic limp or trendelenburg
50
What gait deviations are present with SCFE?
lurch gait or trendelenburg
51
What 5 chracteristics rule-in lumbar manipulation?
**4/5 must be present:**
- pain < 16 days
- no symptoms below the knee
- FABQ < 19
- IR > 35 degrees in at least one hip
- hypomobility of 1+ level of lumbar spine
52
What percent of body weight is needed to overcome friction when performing lumbar mechanical traction?
> 25%
53
What percent of body weight is needed to achieve separation of the joint spaces when performing lumbar mechanical traction?
> 50%
54
When performing lumbar traction for the first time, a maximum of ___ pounds should be used to to determine patient response
30 pounds
55
What is the maximum duration allowed for lumbar traction?
Acute intermittent lumbar traction: < 15 minutes
Acute sustained lumbar traction: < 10 minutes
Chronic: 30 minutes
56
what is the purpose of a posterior stop on an AFO?
stops excessive PF
57
What is a posterior leaf spring AFO used for?
- allows for stored energy potential
- assists with DF
58
What is a GR-AFO used for?
- control at the ankle and knee
- prevents the knee from collapsing into FLX during the stance phase by restricting DF
59
What is another name for shin splints?
medial tibial stress syndrome
60
How do you differentiate between medial tibial stress sydrome and a stress fx?
**Medial tibial stress syndrome:**
- *non-focal pain* on the posteromedial tibial border
- pain improves with exercise and returns during cool-down
- *limited mobility* within the posterior compartment of the leg
**Stress Fx:**
- deep *focal pain*
- pain is present at rest and with activity
- *no change in ROM*
61
What are the 3 conditions that make up the female-athlete triad?
- osteoporosis
- amenorrhea
- eating disorder
62
What is another name for reactive arthritis?
reiter's syndrome
| joint inflammation secondary to infection within the body
63
Describe OKC foot supination.
INV + PF + ADD
("IPAD")
| OKC foot pronation is opposite (EV + DF + ABD)
64
Describe CKC foot supination.
INV + DF + ABD
("I DAB")
| CKC pronation is opposite (EV + PF + ADD)
65
What is RPP used for? What is the formula?
- used to estimate myocardial workload and O2 consumption
RPP = HR x SBP
66
What happens to the following values during incremental exercise?
HR
CO
MAP (SBP and DBP)
all increase EXCEPT for DBP which remains constant
67
What happens to the following values during initial training above altitude?
HR
CO
BP
RR
SV
All values increase EXCEPT for SV which has no change due to an increase in HR promoting oxygenation
| Above sea level has decreased O2 = hypoxia = increased RBC production
68
What happens to the following values during acclimatization above altitude?
HR
BP
CO
SV
- HR increases
- BP is normal
- CO is normal
- SV is decreased
69
What happens to the following values once a person returns to sea level after altitude training?
HR
BP
CO
SV
VO2 and O2 production
- HR and BP are normal/stable
- increased CO
- increased SV
- increased VO2 and O2 production
70
What happens to the following values during aquatic therapy?
swelling
circulation/venous return
HR
BP
CO
VO2
SV
work of breathing
Vital capacity
- swelling decreases
- venous return increases
- HR decreases
- BP decreases
- CO increases
- VO2 decreases
- SV increases
- work of breathing increases
- vital capacity decreases
| swelling decreases and circulation improves due to hydrostatic pressure
71
What do beta blockers do?
- decreases HR and contractility
- decreases myocardial O2 demand
| (-lol)
72
What will beta blockers do to HR during exercise?
will lower HR
73
What is afterload?
pressure required to pump blood out of the ventricles
74
(true/false) Those with severe pulmonary impairment will reach their cardiovascular maximum before their ventilatory maximum
False (opposite)
75
What is glossopharyngeal breathing used for?
assist with coughing
76
what is stacked breathing used for?
- improving inspiration
- ex: hypoventilation, atelectasis, ineffective cough, and uncoordinated breathing patterns during ADLs
77
What does pursed-lip breathing help improve?
- increases TV
- reduces RR and dyspnea
- facilitates relaxation of airways for better air exchange
- decreases resistance
## Footnote
used for patients with obstructive disease and those who experience dyspnea at rest or with minimal exertion
78
What does sustained maximal inspiration (SMI) / inspiratory hold help improve?
- increase inhaled volume
- restore FRC
- prevents alveolar collapse
| common in acute cases (sx, ineffective cough, etc)
79
what is segmental breathing used for?
- improve ventilation to a hypoventilated segment
- alter regional distribution of gas
- maintain or restore FRC
## Footnote
used with pleuritic, incisional, or post-traumatic pain that causes decreased movement within a portion of the thorax and for those at risk of developing atelectasis
80
What happens to HR when temperature increases?
HR increases
81
What spinal cord segments contain the sympathetic nerves?
T1-T4
| control is in medulla (cardioacceleratory center)
82
What does sympathetic stimulation do to the diameter of blood vessels?
Coronary arteries: vasodilate
peripheral arteries: vasoconstriction
83
Those with a cerebellar lesion have what kind of reflex?
normal or diminished
84
Those with a lesion of the basal ganglia have what kind reflex?
normal or decreased
85
Describe the clasp-knife effect.
an increase in resistance to PROM that suddenly gives away
86
What type of atrophy does a UMN lesion have?
disuse atrophy
| **Widespread** loss of mobility that develops within weeks to months
87
What type of atrophy does a LMN lesion have?
neurogenic atrophy
| rapid focal, significant muscle wasting consistent with degree of damage
88
With myopathy, you will see (proximal/distal) muscle weakness
proximal
89
With neuropathy, you will see (proximal/distal) muscle weakness
distal
90
(true/false) strength is impaired **ipsilaterally** if the corticospinal tract is damaged **above** the medulla
False (strength will be impaired **contralaterally** if damage is **above** the medulla -- strength will be impaired **ipsilaterally** if damage is **below** the medulla)
91
(true/false) Variant angina responds to nitroglycerin
true (most of the time)
92
What medication class is used as a long term treatment of variant angina?
calcium channel blockers
93
What is the apical pulse?
The point of maximal impulse
--> used when peripheral pulses are weak or other palpation sites are not able to be palpated
--> pt is supine - palpate at 5th ICS at the midclavicular line *(location of the mitral valve)*
94
Why must you only test one side at a time when taking a carotid pulse?
It reduces the risk of reflexive drop in pulse rate and/or BP due to stimulation of baroreceptors
95
Where in the heart will you hear the S3 sound if it is present?
mitral valve (apical pulse point)
96
Which heart sound is decreased if aortic stenosis is present?
S2
97
Which heart sound is decreased if 1st degree heart block is present?
S1
98
Ventricular gallop
S3
99
Atrial gallop
S4
100
What is a systolic murmur and what does it indicate?
Turbulance between S1 and S2
- indicates possible valve disease and/or aortic stenosis if not classified as normal for the patient
101
What is a diastolic murmur and what does it indicate?
turbulence between S2 and S1
- indicates possible aortic and pulmonary regurgitation
102
What abnormal heart sound would you hear if a patient has atherosclerosis or a partially blocked artery?
bruit
| commonly heard in the carotid and/or femoral arteries
103
What is Dressler syndrome?
Post-MI pericarditis
| will have a pericardial friction rub when auscultating
104
When taking BP, if the cuff is too small, what will happen to the reading?
it will read higher than the actual BP
## Footnote
If the cuff is too large, the reading will be lower than actual P
105
What BP is considered as hypotension?
SBP < 90 mmHg
OR
DBP < 60 mmHg
106
If a patient has a mediastinal shift, what position is not recommended?
S/L on the affected side due to the risk of increasing the mediastinal shift
107
A tracheal shift is an indicator of what?
upper mediastinal shift
## Footnote
- shifts contralaterally when pressure is increased on the affected side (hemothorax, pneumothorax, etc.)
- shifts ipsilaterally when lung volume and intrathoracic pressure are decreased on the affected side (atelectasis, lobectomy, pleural fibrosis, etc)
108
Cyanosis is a sign of _____.
Digital clubbing is a sign of ____.
cyanosis --> acute hypoxia
digital clubbing --> chronic hypoxemia
109
what is fremitus?
vibrations produced by the voice or by the presence of secretions within the airways
110
What caues yellow sputum?
cold
111
What caues green sputum?
bacterial infection
112
What caues pink frothy sputum?
pulmonary edema due to CHF
113
What caues brown sputum?
blood or dirt
| blood can also cause red sputum
114
What caues black sputum?
fungal infection or smoking
115
What caues mucoid sputum?
| thick, clear, white, or grey
- COPD
- asthma
- acute viral infections
116
Consolidation (ex: PNA) increases/decreases fremitus
increases
## Footnote
most conditions will have decreased fremitus
117
Fremitus (increases/decreases) with atelectasis
Fremitus will be absent
118
Central cord syndrome has more (motor/sensory) involvement
motor > sensory
119
Central cord syndrome has more (UE/LE) involvement
UE > LE
120
Brown sequard syndrome has (ipsilateral/contralateral) loss of pain and temperature
contralateral loss
121
Brown sequard syndrome has (ipsilateral/contralateral) loss of vibration, position sense, and motor control
ipsilateral loss
122
What is preserved with posterior cord syndrome?
motor function
123
What occurs to blood vessels above and below the level of lesion when autonomic dysreflexia is present?
Above level: vasodilation
Below level: vasoconstriction
124
What reflex presents itself first when the body comes out of spinal shock?
bulbocavernosus
125
(true/false) glossopharyngeal breathing helps with breathing and clearing secretions
false - only helps with breathing
126
Orthostatic hypotension is commonly seen with SCIs above what spinal level?
T6
127
Neurogenic shock occurs at what spinal level of SCI?
ABOVE T6
## Footnote
autonomic dysreflexia occurs AT or ABOVE T6
128
With an SCI, what spinal levels present with a spastic bladder and bowel (neurogenic bladder)?
Above S2
129
With an SCI, what spinal levels present with a flaccid bladder and bowel (autonomous)?
AT or below S2
130
What is a marcus gunn pupil?
An afferent pupillary defect with limited pupil constriction to light
131
Symptoms of MS are commonly (unilateral/bilateral)
unilateral
132
MS is a (UMN/LMN) disease
UMN
| hyperreflexia and spasticity
133
What is a dyssynergic bladder?
decreased coordination between contraction and relaxation of the bladder
134
What are the most common cerebellar symptoms?
- ataxic gait
- dysdiadokinesia
- intention tremor
- dysmetria
135
(true/false) Lhermitte sign can be used for dx of MS
true
136
What is uhthoff phenomenon?
increased neuro s/s due to heat
| pseudoexacerbation / pseudoattack
137
What is pseudobulbar affect?
involuntary emotional expression disorder
| sudden and unpredictable episodes of crying, laughing, etc
138
What is the most common bowel complaint of MS?
constipation
| < 3 bowel movements/wk
139
With MS, the goal is to increase (intensity/duration) first.
duration
140
For use of baclofen, PT treatment time should be based on what factor?
The time of baclofen administration
| PT session should try to be in the middle of the dose cycle
141
GBS is a (UMN/LMN) condition
LMN
| flaccidity and hyporeflexia
142
(true/false) GBS is asymmetrical
false (symmetrical)
143
With GBS, are proximal or distal muscles more affected?
distal > proximal
144
With Myasthenia gravis, are proximal or distal muscles more affected?
proximal > distal
145
(true/false) myasthenia gravis has motor and sensory involvement
false (pure motor involvement)
146
(true/false) PD does not affect the sensory system
true
147
Is ALS symmetrical or asymmetrical?
asymmetrical
148
What involuntary movements are present with ALS?
fasciculations
149
What involuntary movements are present with MS?
- intention and postural tremors
- muscle spasms
150
When are symptoms of myasthenia gravis more severe?
- Later in the day
- after prolonged activity
- fluctuation in intensity of activity
151
What are hallmark problems of myasthenia gravis?
- fatigue
- fluctuating ASYMMETRIC ptosis
152
(true/false) unilateral neglect is due to sensory loss
False
caused by lesion(s) to the the inferior and posterior portions of the parietal lobe
153
What side is unilateral neglect on in most cases?
left side of the body
154
What is unilateral visual inattention?
unilateral neglect
| "hemi-inattention, hemineglect, and unilateral spatial neglect"
155
What is anosognosia?
lack of awareness and/or denial, of a paretic extremity as belonging to the person and/or lack of insight concerning disability
| common for patients to claim that the limb has a mind of its own
156
What is somatoagnosia?
lack of awareness of the body structure and relationship of body parts to oneself or others
157
What is the common name for autopagnosia?
somatoagnosia
| also called simply body agnosia
158
Where is the lesion found that causes somatoagnosia?
dominant parietal lobe (left)
159
What is right-left discrimination?
inability to identify the left and right side of the body
160
(true/false) those with right-left discrimination are able to imitate movements of the examiner.
false (unable)
161
# body scheme impairment
characterized by difficulty in naming the fingers on command, identifying which finger was touched, and/or unable to mimick finger movements
finger agnosia
162
What is figure-ground discrimination?
inability to distinguish a figure from the background in which it is embedded
163
what is form discrimination?
inability to perceive or attend to subtle differences in form and shape
## Footnote
Often confuses objects of similar shape or does not recognize the object when placed in an unusual position
(ex: mistaking a pen as a toothbrush)
164
What is topographical disorientation?
difficulty understanding and remembering the relationship of one location to another
| regardless of utilizing a map or not
165
What is the most common form of agnosia?
visual agnosia
## Footnote
inability to recognize familiar objects despite normal function of the eyes and optic tracts
166
What is prospagnosia?
inability to recognize familiar faces
167
(true/false) another name for color blindness is color agnosia
false
## Footnote
color agnosia is when the pt is unable to identify and/or name colors on command but they can correctly match colored chips
168
What is simultanagnosia?
The inability to perceive a visual stimulus as a whole
| punched out visual picture
169
What is astereognosis?
inability to recognize an item by handling them
| **note:** tactile, proprioception, and thermal sensations may be intact
170
What is ideomotor apraxia?
disconnection between the idea of a movement and its motor execution
--> pt is able to carry out the task automatically and describe how the task is done... HOWEVER, the pt is unable to imitate gestures or perform the task on command
171
What is ideational apraxia?
Inability to perform a purposeful motor act with/without a command.
## Footnote
- The pt no longer understands the overall concept of the task and/or cannot retain the idea of the task.
- pt may not be able to formulate the motor patterns required for a task
172
What descending spinal tract will result in a positive babinski sign, absent abdominal and cremasteric reflex, and the loss of fine motor/skilled voluntary movement if damaged?
corticospinal (pyramidal) tracts
173
What type of hematoma is chronic in nature and is often mistaken as dementia?
epidural hematoma (hemorrhagic stroke type)
174
What type of hemorrhagic stroke results in a midline shift of the brain?
subdural hematoma
175
What type of hemorrhagic stroke reults in the inability to identify the lateral ventricles?
subarachnoid
| worst prognosis and often leads to death
176
(true/false) cardiac arrythmias are common in those with PD
false
177
What mnemonic is used to identify the primary signs of PD?
"TRAPP"
- Tremor (resting)
- Rigidity
- Akinesia and bradykinesia
- Postural instability
- Pill rolling
178
What is akinesia?
inability to initiate movement
179
What is sialorrhea?
excessive saliva production (drooling)
180
What is bradyphrenia?
slowing of the thought process
181
What is one orthotic option for treatment of festinating gait?
Toe wedge to displace the pt's COG backward and improve stability
182
What drugs are used to treat tremor in those with PD?
anticholinergic drugs
183
What drug is commonly used to enhance dopamine release?
amantadine
184
What medication is commonly used in early stages of PD to slow down progression of the disease?
Selegiline
185
Huntington's disease results in degeneration of what structures?
Basal ganglia and cerebral cortex
186
What is the difference between spasticity and synergy?
spasticity = increased tone (test with PROM)
Synergy = Energy (test with AROM)
187
What is the UE Spasticity pattern?
Scapula: RET and DRoT
Shoulder: ADD, IR, DEP
Elbow: FLX
Forearm: PRON
Wrist: FLX and ADD
fingers: FLX and thumb ADD
| "Chicken dance"
188
What is the LE spasticity pattern?
Pelvic: RET
hip: EXT, ADD, IR
knee: EXT
Ankle and foot: PF and INV
Toe: FLX
| "Pointe Dancer" - SAME AS LE EXT SYNERGY PATTERN
189
What is the UE FLX synergy pattern?
Scapular: RET, ELEV, hyperEXT
shoulder: ABD, ER, FLX
elbow: FLX
wrist and finger: FLX
| "Johnny bravo flexing his biceps"
190
What is the UE EXT synergy pattern?
Scapular: PROT
Shoulder: ADD, IR, EXT
Elbow: EXT
Forearm: PRON
Wrist and hand: FLX
| "Johnny Bravo flexing his Triceps"
191
What is the LE FLX synergy Pattern?
Hip: FLX, ABD, ER
Knee: FLX
Ankle and foot: DF, INV
Toe: DF
| Sitting with one leg crossed
192
What is the LE EXT synergy pattern?
Hip: EXT, ADD, IR
knee: EXT
Ankle and foot: PF, INV
toe: PF
| "Pointe dancer" - SAME AS LE SPASTICITY PATTERN
193
What hip motions are limited in those with piriformis syndrome?
FADIR
194
What motions are limited in those with LCPD?
EXT/ABD/IR
| Presents with FADER positioning
195
What motions are limited in those with SCFE?
FABIR
| presents with ER and ABD
196
What motions are limited by hip OA?
FADIR
197
What motions are limited by FAI?
FADIR
198
What is rhythmic rotation used for? Describe.
Used for increasing ROM
- AROM/PROM in rotation along a longitudinal axis
199
What is rhythmic initiation used for? Describe.
used to initiate movement, teach a movement pattern, and synchronize components of a skill
PROM --> AAROM --> AROM --> resisted AROM
200
What are slow reversals used for? Describe.
Used to increase agonist motion while strengthening the antagonist/agonist
- concentric contractions of agonists without relaxation between reversals
201
What are contract relax/hold relax techniques used for? Describe.
Used for tightness of a muscle
- move to range of limitation and have the pt perform maximal contraction of the antagonist
(contract relax- only ROT)
(hold relax - no motion)
202
What are agonist reversals used for?
Increasing control through lengthened contraction
concentric --> eccentric --> concentric contraction of the agonist
203
What are repeated contractions used for? Describe.
agonist strengthening
- isotonic contraction of the agonist - at weakness, repeated stretch back into pattern
204
What is rhythmic stabilization used for? Describe.
Used to initiate co-contraction and improve stabilization
- simultaneous isometrics of the muscles with hands on different sides
205
What are slow reversal holds used for?
improve stability
- isometric contraction and any range with slow-reversal.
206
What is suspected if ankle SBP is higher than UE SBP?
ischemia
207
What causes a boggy end feel?
fluid within the joints
| bursitis has an empty end feel
208
What are the phases of the gait cycle? List both traditional and RLA terms.
Initial contact --> heel strike
Loading response --> foot flat
midstance
terminal stance --> heel off
Preswing --> toe off
initial swing --> acceleration
midswing
terminal swing --> deceleration
209
What ROM is required at the hip for stance phase and swing phase?
Stance phase:
- FLX (0-30)
- hyperEXT (0-20)
Swing phase:
- FLX (20-30)
210
What ROM at the knee is required during stance and swing phase?
Stance:
- FLX (0-40)
Swing:
- FLX (0-60)
211
What ROM of the ankle is needed for stance and swing phase?
Stance:
- PF (0-20)
- DF (0-10)
Swing:
- DF (0-20)
212
When are the pre-tibial muscles activated during gait?
| TA, EDL, EHL
1. Prior to and during heel strike -- eccentric contraction to lower the foot to the ground
2. prior to and during swing -- concentric contraction of DF
213
When are the calf muscles activated during gait?
1. mid stance -- eccentric control of the tibia over the foot
2. heel off -- concentric control of PF
214
When are the quads activated during gait?
1. heel strike -- eccentric contraction to prevent buckling/rapid knee FLX
2. pre-swing -- eccentric contraction to slow down the tibia
215
When are the HS activated during gait?
1. before heel strike -- eccentric contraction to prevent hyperEXT
2. swing phase -- concentric control of knee FLX
216
When are the hip ABD active during gait?
stance phase -- eccentric control of the pelvis (stabilization)
217
When are the hip ADD active during gait?
stance phase -- concentric control of the pelvis (stabilization)
218
What position would you place the UE in if you want to stretch the inferior GH ligament?
90 degrees ABD
219
What position would you place the UE in if you want to stretch the middle GH ligament?
45-60 degrees ABD
220
What are the actions of the lumbricals?
MCP FLX, IP EXT
221
To test the functioning of the lower trapezius, what movements should be resisted?
DEP, ADD, URoT
222
What is the functional position of the hand when splinting/casting?
wrist FLX, phalangeal FLX and thumb ABD
223
What is the CPP of the radiocarpal joint?
EXT and RD
224
A PT is forming a HEP involving E-stim for a pt who has Bell's palsy. What muscle should be stimulated?
A. SCM
B. Masseter
C. temporalis
D. frontalis
D (frontalis)
| only mentioned muscle that is INNV by CN VII
225
What test will be positive if SCFE is present?
A. ober
B. fulcrum
C. log roll
D. Barlow
A (ober)
226
What skin change associated with aging has the greatest effect on wound healing?
decreased epidermal proliferation
227
A pt with a BKA prosthesis has an excessively firm heel. What gait deviation is likely to be present?
excessive knee FLX in foot flat
228
A patient with a L4-L5 herniated NP is most likely to have sensory deficits in which location?
dorsum of great toe
229
A pt with swan neck deformity would benefit from stretching of what structures in the hand?
intrinsic muscles
230
What position is most appropriate to mobilize the radial nerve?
shoulder EXT, elbow EXT, Wrist FLX
231
What position is most appropriate to mobilize the median nerve?
Shoulder ABD, elbow and wrist EXT
232
What position is most appropriate to mobilize the ulnar nerve?
Shoulder FLX, elbow FLX, wrist EXT
233
A PT is working with a child who recently achieved independent sitting. What should be the next focus of intervention?
creeping on hands and knees
234
A pt presents to the clinic with T2DM, what will happen to glucose and insulin levels during exercise?
glucose and insulin decrease
235
For a pt with a T12 SCI, achievement of which ROM is most important for the pt to ambulate?
A. 30 degrees PF
B. full hip EXT
C. normal Knee FLX
D. 110 degrees SLR
B (full hip EXT)
236
What is Homan's sign? What does it indicate?
Calf pain with DF
--> indicates possible DVT
237
Why should you not check for Homan's sign if the patient has a known DVT?
Can lead to formation of an embolus
238
What are the s/s of Addison's disease?
- decreased BP
- dehydration
- hyperkalemia
- hypoglycemia
- bronze skin
- weight loss/GI disturbance
- generalized weakness (asthenia)
- cold intolerance
| "Mrs. Addison is a petite brown lady who is always cold and shaky"
239
What are the s/s of Cushing's disease?
- increased BP
- water retention
- hypokalemia
- hyperglycemia
- hirsuitism
- weight gain/obese
- moon face
- buffalo hump (osteoporosis)
- proximal muscle weakness
- poor wound healing
| Santa Claus
240
What is the difference between cushing's disease and cushing's syndrome?
**Cushing's Disease**: Pituitary adenoma causing increased secretion of ACTH by the PITUITARY GLAND --> increased cortisol production (produced by adrenal gland)
**Cushing's syndrome**: Adrenal gland tumor resulting in the secretion of more cortisol by the ADRENAL GLAND --> drug toxicity
| symptoms are common
241
What are the s/s of hyperthyroidism?
- increased HR
- decreased BP
- hyperreflexia
- decreased glucose levels (increased glucose absorption)
- increased metabolism
- heat intolerance
- diarrhea
- weight loss
- INCREASED appetite
- restlessness, insomnia
- sweating, silky hair, and moist palms
- Grave's disease
- goiter
242
What causes goiter?
| enlarged thyroid gland
iodine deficiency
| more commonly seen with hyperthyroidism
243
What are the s/s of hypothyroidism?
- decreased HR
- decreased BP
- prolonged DTRs
- cold intolerance
- decreased metabolism
- weight gain
- constipation (slowed digestion)
- DECREASED appetite
- brittle nails, skin, and hair
- myxedema
- Hashimoto's disease
244
What is hashimoto's disease? What are the s/s
Autoimmune disease with inflammation of the thyroid gland
-- common cause of **hypothyroidism** and shares similar s/s
245
What are the s/s of hyperparathyroidism?
Bones: Osteoporosis
Stones: Kidney stones/renal insufficiency
Groans: GI/peptic ulcers
Moans: fatigue, weakness, depression
Sensory: glove and stocking distribution
246
What is the cause of hyperparathyroidism?
Increased calcium in the blood accompanied by decreased serum phosphate
| excess calcium is brought into the bloodstream from the bones
247
What is the cause of hypoparathyroidism?
decreased calcium in the blood accompanied by increased serum phosphate
248
What are the s/s of hypoparathyroidism?
"CATS are NUMB"
Convulsions
Arrythmias
Tetany / twitching (Chvostek's sign)
Spasms / cramps
NUMB fingertips and/or mouth
249
What is the cause of Hyperthyroidism?
Increased T3 and T4
| low TSH levels (feedback mechanism)
250
What is the cause of hypothyroidism?
Decreased T3 and T4
| high TSH level (feedback mechanism)
251
What type of urinary incontinence would best benefit from a voiding schedule?
urge incontinence
## Footnote
definition: involuntary contraction of the detrusor muscle with a strong desire to void - commonly seen with infections, PD, and UMN lesions
252
What type of urinary incontinence would best benefit from catheterization, medication, and behavioral modification such as double voiding?
overflow incontinence
## Footnote
Definition: caused by an underactive detrusor muscle leading to an overdistended bladder. The bladder cannot empty completely and urine dribbles/leaks out. -- commonly seen with BPH and DM
253
What type of urinary incontinence would best benefit from improving accessibility to the bathroom and prompted voiding?
functional incontinence
254
What is the hallmark sign of labyrinthitis when performing a differential diagnosis between peripheral vestibular disorders?
Hearing loss and tinnitus
255
What is the hallmark sign of meniere's disease when performing a differential diagnosis between peripheral vestibular disorders?
aural fullness
256
What is the hallmark sign of acoustic neuroma/vestibular schwannoma when performing a differential diagnosis between peripheral vestibular disorders?
- facial numbness
- weakness or loss of facial muscle movement
