General Board Review Flashcards
TIPS ON TAKING TEST *****
- BE CONFIDENT. You’ve passed 6 of these exams. You can do it. 1/2 the battle is in your mind. Be confident.
- Begin every new question with fresh re-start. Carry nothing from the previous question(s) forward. Don’t get discouraged, or cocky. Take 1 question at a time, and give full effort to that question.
- Read the question thoroughly. Don’t skip over small little details and words that could change things. Pay attention. Each word in the question is important. Don’t just gloss over details in the question. The details are in there for a specific reason.
- After reading the question, try to think of the answer in your mind BEFORE looking at the answer choices.
- From point above, if you know it, still verify it is right by eliminating the other choices.
- If you don’t know it, at least narrow it down to 2 choices (there will usually be 2 very wrong distractor answers).
- Trust your gut - 90% of the time it is right. And don’t second guess or dwell over or doubt yourself. Be confident with the most logical choice and move on.
- Sometimes you just don’t know - it’s fine, move on and don’t worry! Or just come back to it with a fresh look (mark it).
- *** NEVER insert more info into the question that is not there. Just take the info there and only base your reasoning/answer off just that info. Don’t assume, add info, etc.
- ** Always default to SAFETY on board questions. Make sure you as PT are keeping pt safe. ** Remember what Dr. Furze said about the board. She said in general, the board is making sure you are SAFE as a practitioner. So not that every ? is about patient safety, but in general they want to make sure you are safe. So just keep that in the back of your mind.
- *** THESE WERE THE TIPS FROM TAKING PEAT AND THEIR ADVICE:
- Perhaps MOST MOST MOST importantly, when reviewing the answers, almost NEVER was there a trick question. Just go with your gut on the one that seems most logical and that you know best.
- You will feel that you are failing throughout the test - that is normal. Don’t worry about that.
- EVERY QUESTION - give 100% mental effort, and reset for every ?
- It is a mental endurance game. Stay sharp and focussed.
- Trust your gut, don’t second guess.
- The test is NOT about memory recall of stats, diagnosis’s, etc. - it is about APPLICATION of knowledge into a real life case/patient.
- Almost 90% of questions ask you to choose the BEST answer. There may be multiple right answers, just like in the clinic there are multiple right approaches - but what they are looking for is what would be BEST. It’s ok if all of them are good answers.
- Read the entire ?. Don’t jump to conclusions while reading ?
- They don’t give you all the info. But they give you enough to answer the ?. Do NOT insert more info in - just work with what the ? is.
- Try to answer it in your head BEFORE looking at the answer choices.
- Sometimes it seems like you don’t know, or it is confusing but there is one answer that seems right and logical - go with it every time. Trust your gut.
- After going through all the answers - most seem like the logical choice. So don’t over think it, don’t think they are trying to trick you, RARELY go with the answer choice you don’t know. If you think it is right and most logical - trust your gut.
- Don’t worry too much about the details in the stem - just know what is the CONCEPT they are asking. The concept behind the question - answer that.
- Remember that you will go through periods where you get 10-15 right and it feels easy and you are cruising and doing well/confident. Then you’ll go through periods where it feels like the last 10 you got all of them wrong. That is ok. That is normal. Stay positive. You may have just got a bunch of hard one’s in a row. It’s fine. Keep head up and keep going - you’ll get to a batch of really easy ones.
- Just because there is are 2 answer choices with one being opposite than the other does NOT mean one of them is right. Sometimes that is true, sometimes it is a distractor. Don’t worry about stuff like that - just choose the BEST answer and don’t do that game.
- Don’t over think it. Go with the most logical answer.
2)
- Do 2 PEAT Exams (and write FC’s on them)
- Do the final Score builders exam (and write FC’s on them)
- Review all PT 356 app ?s
- Review the master doc of board FC’s you made
3) Go look into these links:
* PEAT provided by The Federation of State Boards of Physical Therapy https://pt.fsbpt.net/PEAT/
- International Educational Resources https://therapyexamprep.com/
- Team Educational Resources
http: //therapyteam.com/ (this is a paid course)
I have a link saved in my favorites - check that out.
OK
1) Will your facet joints open or close when you do lumbar flexion?
2) During right sidebending, will left facet joint open or close
3) When doing right lumbar rotation, will left facet joint open or close?
4) Forward flexion and backward extension of lumbar spine is in what plane
- And that motion is around what axis
5) Sidebending the trunk is in what plane
- Around what axis
6) Rotation of the trunk is in what plane
- Around what axis
7) What motions of the trunk are “coupled” together
- In lumbar spine, what is the coupling motions
- T or F: in lumbar spine, if you side bend to the left, the spinous process goes to the left?
- T or F: It is opposite in the c-spine
8) What does “coupling” of the spine movements mean?
9) What are the 2 principles of spine coupling:
1) Open
2) Open
3) Open
4) Sagittal
- medial-lateral
5) Coronal (Frontal)
- Anterior-posterior
6) Transverse (Axial)
- Verticle
7) Rotation and Sidebending are coupled together in the spine.
- Opposite (side bending to the left will cause the VERTEBRAL BODY to rotate to the right)
- True (because the vertebral body rotates right, thus spinous process goes left … same direction as the side bend)
- True (sidebending to the left in c-spine causes VERTEBRAL BODY to rotate to the left … but the spinous process will thus go right)
8) This means when a segment is rotated, then side-bending (to the same side or the opposite side) will also occur. The converse is also true: if a segment side-bends, rotation (to the same side or the opposite side) will also occur.
9)
Principle I: When the spine is in neutral, side-bending to one side will be accompanied by rotation to the opposite side in the lumbar spine (same side in c-spine).
Principle II: When the spine is in a flexed or extended position (non-neutral), side-bending to one side will be accompanied by rotation to the same side.
1) Explain concave vs. convex
2) Give some reasons why you might NOT want to do joint mobs
3) If you did this movement below, how would you grade that joint mobilization:
- Small amplitude/movement at beginning of range
- Small amplitude at end of range
- Large amplitude up to the limit of their range
- Large amplitude/mvmt performed within their range, but not to end of range and not returning to beginning of range
- Small amplitude high velocity thrust to snap adhesions at the limit of range
1) Concave forms the caved in portion, convex is the bulging out portion
2) Disease or infection, New Joint Replacement, Fracture, Osteoporosis, Tumor, Joint Hypermobility, fusion
3)
- Grade 1
- Grade 4
- Grade 3
- Grade 2
- Grade 5
1) C1 is called the:
2) C2 is called the:
3) Tip of C2 is called:
- Ligaments that prevent too much rotation (and attach to point above?
4) T or F: there is a disc between C1 and C2?
- Are there discs in sacrum and coccyx?
5) How many vertebrae are there?
6) Primary curvatures of the spine are:
- How to remember this:
7) Secondary curvatures of the spine are:
8) What areas of the spine move the most
9) What is unique anatomically about the cervical vertebrae
10) What joint is the “yes” joint in the cervical spine?
- What joint is the “no” joint in the cervical spine?
11) How do you differentiate between a pedicle and a lamina on a vertebrae?
12) How many joints on a thoracic vertebrae (and explain them):
13) Why doesn’t the thoracic spine move much?
14) T or F: Remember the “giraffe” shape of thoracic vertebra, and how spinous process points down to next vertebrae below, so touching spinous process in thoracic region is thus 1 level below actual vertebral body.
1) Atlas
2) Axis
3) Dens (Odontoid process)
- Alar lig’s
4) False
- No - those vertebrae are fuzed
5) C7T12L5S5C4 = 33
6) Thoracic and sacral
- Think of us in utero as a little bud, we are in a flexed (kyphotic) fetal position
7) Cervical and Lumbar
8) Cervical and Lumbar
9) They have a transverse foramen for the vertebral artery
10) Atlantooccipital (Occiput and C1)
- Atlantoaxial (C1-C2)
11) Think of a laminectomy … they come in from posterior back and cut out lamina. Thus, the pedicles are above/below intervetebral foramina
12) 12 (2 right sided facets for head of rib, 2 left sided facets for head of rib, the 4 facet joints for articulation of vertebrae, one above and below body, and one on each transverse process for tubercle of rib)
13) Ribs articulate with thoracic vertebrae and thus don’t allow movement
14) True
1) Outer portion of intervertebral disc is called:
2) Inner portion of intervertebral disc is called:
3) Intervertebral discs are what type of joints:
4) Facet joints are what type of joints:
5) What ligament connects the lamina together?
- This ligament (from above) restricts what motion
- What other ligaments limit flexion of the spine
- The anterior longitudinal lig restricts what motion
6) is the base of the sacrum the superior or inferior portion
- The base of a lobe of the lung is the superior or inferior portion
7) The sacral hiatus is what
- A hiatus is a ________
8) What are the extrinsic m’s of the back
- What are the intrinsic m’s of the back
9) The splenius capitus and cervicis muscles of the neck do what actions
10) What 2 muscles are innervated by the Accessory n
- This is what CN
- Axillary nerve innervates what m’s
- Teres Major muscle is primarily innervated by what n.
11) What are the upward rotators (muscles) of the scapula
- What are the downward rotators (muscles) of the scapula
- What m’s elevate the scapula
12) Rhomboid m’s are innervated by what nerve
- What nerve roots does dorsal scapular nerve come from
- Long thoracic nerve innervates what m.
- Long thoracic nerve has nerve roots from:
13) Erector spinae m’s (spinalis, longissimus, and iliocostalis) are innervated by what nerve:
- Their action is to do what:
- Iliocostalis attach where
- Longissimus muscle attaches where
- Spinalis m’s attach where:
14) The really really deep intrinsic m’s of the back are:
- These m’s attachments are:
15) What nerve roots innervate the diaphragm?
- How to remember?
- What nerve is it?
16) What does the vagus nerve do
- What Cranial Nerve is the Vagus Nerve:
17) Would sympathetic or parasympathetic innervation speed up the Heart Rate (HR) and contractile force
18) Pain sensation from myocardial ischemia is called:
1) Annulus fibrosis
2) Nucleus pulposus
3) Cartilaginous
4) Synovial
5) Ligamentus flavum
- spinal flexion
- posterior longitudinal lig, interspinous lig’s
- spinal extension
6) Superior (top)
- For the lobe of lung, apical is top and base is bottom
7) Where lower sacral and coccyx nerves run through /exit
- Hole
8) Extrinsic: traps, levator, rhomboids, lats, serratus posterior
- Erector spinae (spinalis, longissimus, iliocostalis), multifidi, QL
9) Extend head (when working bilaterally), or side bend and rotate head to side of contraction (when working unilaterally)
10) Traps and SCM
- CN XI
- Deltoid and Teres Minor
- Lower Subscapular
11) Upper trap, serratus anterior, lower trap
- Levator scapula, rhomboids, peck minor
- Levator and upper traps
12) Dorsal scapular n
- C4/C5
- Serratus ant
- C5/6/7 (remember brachial plexus drawing)
13) Dorsal rami of spinal nerves at that segment
- Extend the spine (bilaterally), side bend to ipsilateral side (unilaterally)
- On the ribs (angle of ribs)
- Transverse processes
- Spinous processes
14) Rotatores, Levatores, Multifidi - even the QL
- From transverse processes up to spinous processes above to stabilize spine
15) C3/4/5
- 3/4/5 Keeps you alive
- Phrenic nerve
16) Parasympathetic supply to heart and lungs and other structures. The most important function of the vagus nerve is afferent, bringing sensory information of the inner organs (such as gut, liver, heart, and lungs) to the brain. This suggests that the inner organs are major sources of sensory information to the brain. Motor - it provides innervation to pharynx and layrnx for speaking for those m’s.
- CN X
17) Sympathetic
18) Angina pectoris
1) How many spinal nerves are there
2) The spinal cord, like the brain is covered in what meningeal layers (from deep to superficial)
- Which one is the tough outer meningeal layer
3) Spinal cord ends where (what level)
- What is this section called where the spinal cord ends?
- What are the “horses tail” nerve fibers distal to the ending of the spinal cord
4) ** Which spinal nerve carries SENSORY fibers … dorsal or ventral?
- Which spinal nerve carries MOTOR fibers … dorsal or ventral?
- Is afferent sensory or motor, and is efferent sensory or motor?
- How to remember (from last point)
- Is ventral anterior or posterior
5) Which is singular and which is plural of these 2: ramus and rami
6) Where do the dorsal and ventral roots combine to form a spinal nerve
- The dorsal root ganglion is just lateral (outside) this area from point above, and what is the dorsal root ganglion
7) What are denticulate ligaments
8) Fluid is found in these meningeal layers. What is this fluid called:
- Where is this fluid found?
- What space / area is it found in?
9) Dorsal rami nerves innervate what things:
- Why only those m’s
10) Looking at a transverse slice of a spinal cord, the “wings” of the gray mater - is that the dorsal or ventral side
- How to remember?
11) The spinal cord gets its blood supply from what artery:
12) What is the difference between gray matter and white matter:
- Why is white matter white:
- Does the white matter have ascending or descending tracts
1) 31 (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)
2) 3 (pia is deep, arachnoid is middle, dura is outer)
- Dura
3) L1 / L2
- Conus medularis
- Cauda equina
4) Dorsal
- Ventral
- Afferent is SENSORY, efferent is MOTOR
- Efferent = effort = motor
- Ventral is anterior, dorsal is posterior
5) Ramus is singular, rami is plural
6) Intervertabral foramen
- Bulge in the spinal nerve where the dorsal (SENSORY) cell bodies are
7) Extensions of the pia mater that anchor the spinal cord to the dura
8) Cerebrospinal fluid (CSF)
- Between arachnoid and pia mater
- Subarachnoid space
9) Skin and intrinsic back m’s
- The dorsal root exits RIGHT BY the posterior intrinsic m’s of the back
10) Dorsal
- Your wings are on your back
11) Vertebral artery
12) Grey matter is distinguished from white matter in that it contains numerous CELL BODIES and relatively few myelinated axons, while white matter contains relatively few cell bodies and is composed chiefly of long-range myelinated AXONS.
- The color difference arises mainly from the whiteness of myelin sheaths covering the axons.
- BOTH
1) What is the difference between Anaerobic Metabolism and Aerobic Metabolism:
2) From question above, which is for high intensity, short duration exercise:
- Which one requires Oxygen to convert carbs into ATP
3) What are the 3 energy systems to create ATP
3A) Which energy system is 1st used and for fast bursts of energy
- How does this energy system from the point above work?
- How long will the 1st energy system last
- 2nd energy system used that gets energy from breaking down carbs/sugar is _________
- How long will the 2nd phase last
- Do the first two energy systems use O2
- 3rd energy system used is:
- The 3rd energy system uses O2 in reaction to convert substrates into ATP, but how long does it last
4) What is ATP (Adenisine Triphosphate)
- 3 primary substrates that are converted into ATP
5) Which energy system results in the formation of Lactic Acid
- How and why does lactic acid build up
- Build up of Lactic Acid causes what symptoms?
6) Which of the 3 energy systems is for low intensity but long duration exercise (aerobic)
- From point above, is this energy system aerobic or anaerobic
- T or F: This system produces the most ATP
- T or F: This system takes longer as there are more complex reactions in order to produce ATP (Krebs Cycle)
1)
- Anaerobic: Anaerobic metabolism is the creation of energy (ATP) through the combustion/conversion of carbohydrates in the ABSCENSE of oxygen (does NOT use O2 to create ATP). This occurs when your lungs cannot put enough oxygen into the bloodstream to keep up with the demands of your muscles for energy (or can’t break it down as fast to keep up with demands of energy), so it uses other quicker sources for conversion into energy. It is for quick bursts of energy (1-40 seconds and includes phosphogen and glycolytic energy systems).
- Aerobic: Aerobic is the way your body creates energy through the combustion/conversion of carbohydrates, amino acids, and fats in the presence of oxygen (requires O2 to convert these things into ATP). Combustion means burning, which is why this is called burning sugars, fats, and proteins for energy. It requires O2, and thus is not used in short distances, but long endurance sports. Because it takes longer to break down O2, your body slows down and can’t go as fast / high pace.
2) Anaerobic
- Aerobic
3)
- Phosphagen System
- Glycolytic System
- Oxidative System
3A) Phosphagen
- Creatine phosphate (CrP), which is stored in skeletal muscles, donates a phosphate to ADP to produce ATP. During rest the ATP will help to restore CrP.
- 1-10 seconds
- Glycolytic
- 10-40 seconds
- NO. The reaction to convert substrates into energy does not require O2 (but they still have O2 in their body of course)
- Oxidative
- Lasts as long as you have O2 and nutrients to convert into ATP
4) Energy source for ALL cellular functions
- Glucose (Carbs), protiens (amino acids), fats
5) Glycolytic
- During the processes of glycolysis, hydrogen ions (H+) are released into the muscle cell. … During high intensity exercise the products of anaerobic glycolysis namely pyruvate and H+ accumulate rapidly. Lactate is formed when one molecule of pyruvate attaches to two H+ ions.
- The build up of this acid causes muscle fatigue, pain, burning, nausea, weakness.
6) Oxidative
- Aerobic
- TRUE
- TRUE
MUST MUST know difference between Muscle Spindles and Golgi Tendon Organs
1) What is a muscle spindle and it’s purpose
2) What is a Golgi Tendon Organ
2A) Are these two nerve receptors from above fast and highly myelinated?
3) Which of these two are located in the tendon or the myotendinous junction?
- Which ones are stretch receptors
- Which one conveys muscle tension info to the CNS
4) What are Joint Receptors
- What types are there:
- T or F: ALL joints have free nerve endings receptors
- What do golgi ligament endings do
- Which one detects stretching of joint capsule
- Which one detects vibration, acceleration, or high velocity changes in joint position
- Which ones detect pressure
- What are free nerve endings
1) They are receptors (sensory and motor) throughout the muscle belly and they detect the LENGTH of a muscle being STRETCHED and send a signal to the brain about the length of a muscle. They’ll initiate a reflex to resist too much stretch.
2) Sensory receptor in the muscle tendon to detect TENSION or LOAD or severe contractions muscles go through, and will sense when too high / too much to shut muscle off to protect it (so lifting or muscle contraction stops).
2A) YES
3) Golgi tendon organs
- Muscle Spindles
- Golgi Tendon Organs
4) Receptors in the joints
- Free nerve endings, golgi ligament endings, golgi-mazzoni, pacinian, ruffini, merkle
- True
- Like golgi tendon organs, but these detect tension or stretch in ligaments to protect them
- Ruffini endings
- Pacinian
- Merkel (Angela Merkel puts pressure on us)
- Afferent nerves that can detect temperature, mechanical stimuli (touch, pressure, stretch) or danger (nociception). Thus, different free nerve endings work as thermoreceptors, cutaneous mechanoreceptors and nociceptors. In other words, they express polymodality.
1) Explain main difference between Type I and Type II muscle fiber types
1A) How to remember Type I
2) So which one is FAST twitch
- Which one uses oxidative system
- Which one fatigues quicker
- Which one is anaerobic
- Which one has LARGER fibers
- Which one has less blood supply
- Which one has large amounts of mitochondria
- Which one would you use in a marathon
- Which one’s are slow twitch
- Which one’s would you use in a sprint or power lift
- WHich one’s are wider
- Which one’s are redder (more blood)
3) Which of the 2 have a breakdown of 2 subtypes
- What are the 2 subtypes
- Explain each
- T or F: Type I are also called slow oxidative
- Which of Type II is fast oxidative
- Which of the 2 subtypes would fatigue faster
1) Skeletal muscle fibers can be categorized into two types: slow-twitch (Type I) and fast-twitch (Type II). Type II muscle fibers use anaerobic respiration and are better for short bursts of speed than Type I fibers, although Type II fatigue more quickly. Type I are slow twitch and use oxidative system, last longer (don’t fatigue as easily) and work at slower pace.
1A) Type I are recruited first, and are the SLOW fibers
2) Type II
- Type I
- Type II
- Type II
- Type II
- Type II
- Type I (remember oxidative takes place in mitochonria)
- Type I
- Type I
- Type II
- Type II
- Type I
3) Type II
- Type IIa and Type IIb
- Type IIa is fast twitch oxidative, and Type IIb is fast twitch glycolytic
- True
- Type IIa
- Type IIb (glycolytic)
1) There are 3 main categories of joints in the body. What are they:
- Of these 3, what one is most common
2) Another name for synovial joints is:
3) Synovial joint examples would be:
- All synovial joints have 5 distinguishing characteristics, what are they:
- T or F: These joints are most prone to injury
4) What are the subtypes of synovial joints:
- Explain each (from point above):
- Examples of uniaxial joints:
- Examples of biaxial joints:
- Examples of multiaxial joints
5) Explain what fibrous joints are:
- Is movement more or less in these joints
- Examples of fibrous joints:
6) Explain cartilaginous joints:
- Examples:
1) Synovial, Cartilaginous, Fibrous
- Synovial
2) Diarthroses
3) Hip, knee, shoulder, elbow, etc.
- Joint cavity, articular cartilage over bony ends, synovial membrane, synovial fluid, and fibrous capsule.
- True
4) Uniaxial, biaxial, multi-axial
- Uniaxial is movement in one plane at that joint, biaxial is in 2 planes, multi is multiple planes
- Hinge joint like the elbow, or pivot like atlantoaxial
- Condyloid (metacarpalphalangeal of a finger), saddle like the thumb
- Shoulder and hip (ball and socket)
5) Where bones are united or connected by fibrous tissue (NON-synovial, so none of the synovial joint components listed above).
- LESS
- Sutures (bones of cranium), syndesmosis (like in forearm and leg’s interosseous membranes), tooth (gomphosis)
6) Joints with hyaline cartilage or fibrocartilage that connects one bone to another
- IV Discs, Sternum to lower ribs (costal cartilaginous joints), pubic symphysis
1) The shoulder complex or girdle consists of how many articulations (joints):
- What are those articulations
2) With the G/H joint, what is the concave portion
3) What is the difference between osteokinematics and arthrokinematics
- How to remember
- Give examples of each for the G/H joint
4) So, rolling, gliding, and spinning is osteokinematics or arthrokinematics
5) Explain the rules of concavity and convexity
5A) Let’s give some examples of concave vs. convex movements.
- For the G/H joint, is the arthrokinematic motion (roll and glide) in the same or opposite directions?
- What about for the ulnohumeral (arthrokinematic mvmt of rolling and gliding during a joint mob)?
- What about radiohumeral?
- Radiocarpal:
- Hip:
- Tibiofemoral:
- Patellofemoral:
- Talocrural:
6) Loose pack position of G/H joint
- Closed pack position of G/H joint
7) *** WHAT IS THE CAPSULAR PATTERN OF THE G/H JOINT
8) The S/C joint is where the clavicle inserts into the sternum, but what specific part of the sternum
- What motions (osteokinematic) are allowed at the S/C joint
9) Loose pack and closed pack positions of both A/C and S/C joints are:
10) Muscles that contribute to shoulder flex:
- “ for ext
- “ for abd
- “ for add
- “ for hor abd
- “ for hor add
- “ for ER
- “ for IR
- “ Scapula elevation
- “ scapula depression
- “ scapula protraction
- “ scapula retraction
- ** “ scapular upward rotation
- ** “ scapular downward rotation
1) 4
- Glenohumeral (G/H), Acromioclavicular (A/C), Sternoclavicular (S/C), and Scapulothoracic joints.
2) The concave portion is the glenoid cavity, and the convex portion is the head of the humerus
3) Osteokinematics are normal ROM movements of bones at the joints, whereas arthrokinematics are small movements of bones at the actual joint surfaces (during joint mobs)
- Arthro means joint, so what is happening at the joint
- Osteokinematics would be shoulder flex, abd, ext, IR, etc. (normal ROM), and Arthrokinematics would be an inferior glide and P-A joint mob.
4) Arthrokinematics
5) Always use the G/H joint as the example. When the concave surface is fixed (like glenoid cavity) and the convex surface moves on it (like humeral head), the convex surface rolls and glides in OPPOSITE directions.
- When the convex surface is fixed (like humerus with radial head/olecranon or femur with tibia) and the concave surface moves on it (like radial head/olecranon or tibia), the concave surface rolls and glides in the SAME direction.
5A)
- G/H: Opposite
- Ulnohumeral: Same
- Radiohumeral: Same
- Radiocarpal: Opposite (because the moving part is the carpal bone, which is convex, and the radius which is concave is fixed)
- Hip: Opposite
- Tibiofemoral: Same
- Patellofemoral: Opposite
- Talocrural: Opposite
6) 55 deg’s of abd, and 30 deg’s of hor add (scaption plane)
- Full Abduction and ER
7) ER, ABD, than IR
8) Manubrium
- Elevation, depression, protraction, retraction
9) Loose: arm resting at side; CLosed: arm elevation
10) Long head of biceps brachii, anterior portion of deltoid, coracobrachialis, and partially the pec major
- Triceps, post deltoid, lats, teres major
- deltoid, supraspinatus
- gravity, coracobrachialis, peck major, lats, teres major
- post delt, triceps, infraspinatus, teres minor
- peck major, ant delt
- infraspinatus, teres minor, post delt
- subscap, lats, teres major, peck major, ant delt
- Levator scapulae, upper traps
- Gravity, lower traps, lats, teres major, pec minor
- Serratus ant, pec minor
- Rhomboids, middle traps
- upper trap, serratus ant, lower traps
- levator scapula, middle traps, rhomboids, pec minor
Define each of these terms below:
Concentric:
Eccentric:
Isometric:
Isokinetic:
Isotonic:
Active Insufficiency:
Passive Insufficiency:
Concentric: o Shortening (contracting) of a muscle
Eccentric: o Lengthening (elongating) of a muscle. Opposite motion of the muscle opposite doing a controlled elongation of muscle as opposite side does shortening contraction. o Example: As biceps contracts, triceps will eccentrically contract / elongate in a controlled way.
Isometric:
o Both concentric and eccentric muscles hold firm in place equally. So you generate a force without changing the length of the muscle or joint angle.
Isokinetic:
o Consistent movements at a constant speed. So muscles (concentric and eccentric) move through ROM at a constant speed.
Isotonic: Muscle contraction is generated with the muscle exerting a constant tension. Muscle movement with constant load (lifting a weight).
Active Insufficiency:
o When concentric muscles can’t contract any more (ex: wrist flexors can’t flex any more).
Passive Insufficiency:
o Opposite of active insufficiency, where the opposite eccentric muscles can’t elongate any more (as wrist flexors reach active insufficiency, the wrist extensors will be stretched fully = passive insufficiency).
1) The elbow joint consists of how many smaller joints (and name them):
2) Does the radiohumeral or the ulnohumeral joint participate in pro/supination
3) What muscles contribute to elbow flexion:
- “ elbow ext
- “ forearm supination
- “ forearm pronation
4) Palpate your biceps muscle belly and do pronation and supination - what motion (pro or supination) does the biceps participate in
1) 3 (radioulnar, radiohumeral, ulnohumeral)
2) Radiohumeral (and the radioulnar obviously)
3) Biceps brachii, brachiallis, brachioradialis, and partly the wrist flexors (common flexor tendon - CFT), partly deltoid
- Triceps, anconeus (and common extensor tendon - CET), partly deltoid
- Supinator, biceps brachii
- Pronator teres, pronator quadratus
4) Supination
1) What is the accronym to remember the bones of the wrist (carpal bones)
- That stands for:
- How do you remember trapezius and trapezium placement?
- T or F: following the thumb down (proximal) it goes the trapezium bone then the schaphoid bone under that?
1) So long the pinky, here comes the thumb
- Schaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapizius, trapezium
- Trapezium is Thumb
- True (this is important because radiographically the scaphoid and lunate are diplaced more medially than you think).
1) Another name for the hip joint
- What portion of this joint is the concave portion
2) *** The acetabulum is oriented in what directions
3) Loose pack of the hip joint is:
- Closed pack position of hip is:
- Capsular pattern of hip is:
- So open pack and closed pack position of hip both have what motion:
4) Muscle actions for the hip:
- Flexion:
- Extension:
- Abd:
- Add:
- IR:
- ER:
- Hip Stabilization
5) Normal angle of the shaft of the femur to the head of the femur is:
- If that angle is 110 deg’s it is called:
- If that angle is 140 deg’s it is called:
6) Would coxa vara cause genu varum or genu valgum
- Would coxa valga cause genu varum or genu valgum
6A) How is femoral ant/retroversion different than coxa valga/vara
- Normal femoral anteversion is about how many deg’s:
- Femoral retroversion would be how many degree’s:
- Abnormal femoral anteversion would be how many deg’s:
- Femoral anteversion would do what to the feet
- Femoral retroversion would do what to the feet
- People with femoral anteversion would compensate by walking in a toe in or toe out position to make the femur more secure in the acetabulum?
- People with femoral retroveversion would compensate by walking in a toe in or toe out position to make the femur more secure in the acetabulum?
6B) In anatomy, the word “version” refers to:
7) Average Q angle for men and women at the hip
- How is Q angle measured
- Large Q angles typically contribute to what condition
1) Iliofemoral (or coxa)
- Acetabulum
2) Inferior, lateral, and anterior
3) 30 deg’s flex, 30 deg’s abd, slight ER
- Full extension, IR, and ABduction
- Flexion, abd, IR (sometimes IR is most limited)
- Abduction
4)
- Flexion: iliopsoas, rectus femoris, sartorius, pectinius, ant portion of adductor magnus
- Extension: Glute max, hamstrings, part of glute med, post portion of add magnus
- Abd: Glute min/med (part of max), piriformis (when hip is flexed), TFL
- Add: Gravity, Adductor longus, add magnus, add brevis, pectineus, gracilis
- IR: Iliopsoas, piriformis, TFL, part of glute med and min, pectineus, add longus
- ER: Glute max, obturator externus, piriformis, gemelli, sartorius
- Stabilization: Glute med/min
5) 130 deg’s
- Coxa vara
- Coxa valga
6) Genu valgum (knocked knees)
- Genu varum (bowed legged)
6A) Coxa valga/vara has to do with the superior/inferior orientation or angle of the femoral head in relation to the shaft of the femur in the coronal/frontal plane. Ant/retroversion is how femoral head comes anterior/posterior in relation to the femoral shaft.
- 15 deg’s
- Less than 8 deg’s
- More than 20-25 deg’s
- toe out (ER)
- toe in
- Toe in
- Toe out
6B) the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. Anteversion refers to an abnormal forward rotation of the head of the femur in relation to the shaft of the femur.
7) Normal for men is 14 degrees and for women is 17 degrees
- From ASIS down quad to MIDDLE of patella, then another line from middle of patella to tibial tubercle where patellar tendon inserts. Angle is straight line perpendicular to the floor to the angle of the quad
- PFPS - Patellofemoral pain syndrome or lateral tracking of patella in femoral groove (quad tendon is more lateral pulling patella into lateral femoral groove)
1) The talocrural joint is the _______ joint:
- What motions happen at this joint:
- Loose and closed pack position of this joint is:
- Capsular pattern of this joint is most limited in what motion:
2) The subtalar joint is between what 2 bones
- What osteokinematic motions happen here
3) Supination of the foot is the same as inversion or eversion
- Inversion is when the foot/toes go medial or lateral
4) What joints are at the midtarsal joint (mid foot)
- What motions happen here
4A) Is the cuboid in front of the talus on the medial side, or in front of the calcaneus on the lateral side?
- How to remember this?
5) Muscle actions of the ankle/foot:
- DF:
- PF:
- Inv:
- Ever:
1) Ankle
- DF and PF
- Loose: 10 deg’s of PF and neutral between inv and ever. Closed: full DF
- PF more than DF
2) Talus and calcaneus
- Inversion and Eversion
3) Inversion
- Medial
4) Talocalcaneonavicular, calcaneocuboid
- Inversion and eversion
4A) In front of calcaneus on lateral side
- C = C (Calcaneus and cuboid)
5)
- DF: Ant tib, ext hallucis long, fibularis (peroneous) tertius, ext digitorum longus
- PF: gastroc, soleus, plantaris, post tib, flexor digitorum and hallucis, part of peroneus longus and brevis
- Inv: Post tib, ant tib, flexor digitorum longus
- Ever: fibularis (peroneus) longus and brevis and tertius
1) How many vertebrae make up the c-spine?
- How many cervical spinal nerves?
- What is the formula to remember how many vertebrae there are:
- How many IV discs are there, and why?
- How many spinal nerves are there
- Do spinal nerves exit above or below their corresponding vertebrae
- IV Disc L4/L5 will cause compression of what nerve if it gets a herniated disc
2) C1 is called:
- C2 is called:
- How to remember the difference between these 2
- The atlanto-occipital joint is between what 2 bones:
- Joint between C1 and C2 is called:
- What motion happens at the Atlanto-occipital joint
- What motion happens at the Atlanto-axial joint
- T or F: majority of the rotation of the skull happens at atlanto-axial joint
3) Another name for a facet joint is:
- Loose pack of c-spine is:
- Closed pack position of spine is:
4) Muscle action of c-spine is:
- Flex:
- Ext:
- Lateral Side bend:
- Rotation:
1) 7
- 8
- C7T12L5S5C4 = 33
- 23: not one between C1/C2, and sacrum and coccyx are fuzed.
- 31: 8 in c-spine, 12 in t-spine, 5 in l-spine, 5 in sacrum, 1 in coccyx
- In c-spine they exit ABOVE, below C8 they are all exiting BELOW
- L5
2) Atlas
- Axis
- An axis spins, so that has to be C2, so C2 has the Dens
- Between Occiput and C1
- Atlantoaxial
- “Yes” so flex and ext of cranium
- “No” so cervical rotation mainly, but does have some flex and ext, lat flex / sidebend
- True
3) Zygapophyseal joint
- Midway between flex and ext
- Full ext
4)
- Flex: SCM, longus capitus/colli, scalenes
- Ext: traps, erector spinae / paraspinals, spleneus capitus and cervicis
- Lateral Side bend and rotation: scalenes, SCM, trap, splenius cervicis, paraspinals, levator scapulae
1) What are the 3 cardinal planes
2) What are the 3 corresponding axes
3) Starting with the Sagittal plane, describe it’s motion
- It divides the body into what sections
- Occurs around what axis?
4) Describe motion of Frontal plane
- Another name for frontal plane
- Divides body into what sections
- Occur around what axis
5) Describe motion of Transverse plane
- Divides body into what sections
- Occur around what axis
1) Sagittal, Frontal (Coronal), Transverse
2) Anterior-posterior, Medial-Lateral, Vertical
3) Forward and back
- Right and left
- Medial-Lateral
4) Side to side
- Coronal
- Anterior and posterior
- Anterior and posterior
5) Rotation
- Top and bottom (sup and inf)
- Vertical
1) Define both of these:
- Open Chain
- Closed Chain
1A) Give an example of the quads as an explanation of how muscle work in open vs. closed chain
2) Give an example(s) of an open chain activity:
- Give an example(s) of a closed chain activity:
1)
- Open Chain: Distal segment is free (not fixed) and able to move.
- Closed Chain: Distal segment is fixed (can’t move). So body moves over a fixed position.
1A) Quads in open chain extend knee (LAQ). But in closed chain with foot fixed, it will still extend knee by bringing thighs up (ascending from a squat)
2) LAQ, kicking a soccer ball
- Squat, stance foot during gait
They will ask a ? about body composition testing:
1) What is Hydrostatic Weighing:
- What is it called when you just measure a distal limb
- Would you do volumetric displacement of the knee or shoulder?
2) What is skinfold measurement
- What are the 9 sites
2A) They will ask this … do they do skin fold measure on lateral or medial calf
3) What is BMI
- How is it calcuated?
- T or F: Increase in BMI is associated with a risk in co-morbidities and death
- You want your BMI to be less than what amount:
- “Obese” BMI is over what amount:
- “Overweight” BMI is what:
1) Calculates body density by immersing a person in water (remember water = hydro). Measure water that gets displaced (knowing lungs full of air isn’t really factored in).
- Volumetric displacement (doing water displacement of a DISTAL limb like a wrist or ankle)
- NO
2) Method of determining body fat through measuring 9 sites. Theory is that the subcutaneous fat measured in these areas will help you know total body fat composition.
- Triceps - The back of the upper arm
- Biceps: Front middle arm
- Subscapular - Beneath the edge of the shoulder blade
- Pectoral - The mid-chest, just forward of the armpit
- Midaxilla - Midline of the side of the torso
- Abdomen - Next to the belly button
- Suprailiac - Just above the iliac crest of the hip bone
- Quadriceps - Middle of the upper thigh
- Calf: medial calf
2A) MEDIAL
3) BMI = Body Mass Index
- Taking the body weight (in Kg’s) and dividing by height (in meters) … so it is kg/m^2.
- True
- 18.5 kg/m^2 (normal is 18-24)
- 30
- 24-29 ish
1) What is a plumb line:
- Plumb line should run through what landmarks:
2) Know that capsular pattern / restrictions of major joints:
- Shoulder:
- Hip:
- Knee:
- Ankle:
3) For the things below, what is the NAME of this grade of MMT, and what movement the person makes at this grade:
- 0/5:
- 1/5:
- 2-/5
- 2/5
- 2+/5
- 3-/5
- 3/5
- 3+/5
- 4-/5
- 4/5
- 4+/5
- 5/5:
6) What is an end-feel:
- Is it felt on AROM or PROM
- Types of NORMAL end-feels:
- When/where is it felt
7) What is a hard end feel and give examples:
- What is a firm end feel and give examples:
- What is a soft end feel and give examples:
8) What are the abnormal end feels:
- Give examples of each:
1) A string that is suspended to measure proper posture (or “verticality”). It is to help the PT and pt know ideal positioning based on selected body parts.
- Ear (acoustic meatus), odontoid process (dens), acromion, lumbar vertebrae, hip (slightly posterior), knee (slightly anterior), malleoli (slightly anterior), and calcaneocuboid joint
2)
- Shoulder: ER, Abd, IR
- Hip: Flex, Abd, IR
- Knee: Flex, Ext
- Ankle: PF, DF
3)
- 0/5: Zero (no palpable contraction)
- 1/5: Trace (can palpate a muscle contraction)
- 2-/5 Poor minus (can’t do full ROM w/ gravity eliminated)
- 2/5: Poor (can complete ROM with gravity eliminated)
- 2+/5: Poor Plus (can initiate some ROM movement against gravity)
- 3-/5: Fair minus (can do more than 1/2 of ROM against gravity)
- 3/5: Fair (can complete ROM against gravity, but w/o resistance)
- 3+/5: Fair plus (can complete ROM against gravity with min resistance)
- 4-/5: Good minus (completes ROM with min-mod resistance)
- 4/5: Good (completes ROM with moderate resistance)
- 4+/5: Good plus (completes ROM with mod-max resistance)
- 5/5: Normal (completes ROM against max resistance)
6) The feeling of resistance at the end of ROM
- PROM
- Hard, firm, soft
- At the end of ROM with overpressure (to feel what is restricting or stopping the movement)
7) Hard: Bone on bone (elbow, knee ext)
- Firm: Ligament, capsule, or muscle stretch (almost all joints)
- Soft: muscle or tissue on tissue (biceps, gastrocs)
8) Empty, muscle spasm, springy block, boggy, Firm, Hard, Soft
- Empty: When PT does PROM and they guard and stop you (won’t let you continue). You don’t feel anything except the pt stops the ROM movement due to pain.
- Muscle spasm: involuntary contraction or spasticity
- Firm: like in frozen shoulder when it’s firm before it should be firm, thus pathological
- Hard: bone on bone when there should not be bone on bone (like an osteophyte or fracture)
- Springy Block: Springy Block: when you try to move a joint through ROM and mid-range you feel a block and it stops you. Best example is: meniscus tear in knee
- Boggy: end feel is stopped due to edema or effusion/fluid in a joint
1) When describing the gait cycle, there are 2 ways to describe the steps / phases of the gait cycle. What are those 2 ways:
2) Regardless of which system you use to describe it, the gait cycle has 2 main steps - what are they:
- What % of gait cycle is stance phase, and what % is swing:
3) Name the phases of STANCE phase in standard terminology:
- Name the phases of SWING phase in standard terminology
3A) How to remember standard
- What one has all the swings in swing phase terminology
4) Name the phases of STANCE phase in Ranchos terminology:
- Name the phases of SWING phase in Ranchos terminology
5) Now go back through terminology of standard vs. Ranchos above and just compare
6) Peak muscle activity for the anterior tib during gait cycle is when:
- What about peak activity for gastrocs
- Quads:
- HS’s:
7) What is the range (least to most) degrees of ROM required for these motions below during gait cycle:
- Hip flexion:
- Hip Ext:
- Knee Flex:
- Knee Ext:
- Ankle DF:
- Ankle PF:
8) What is the ‘base of support’ in relation to the gait cycle
- Will BOS increase or decrease as cadence increases?
- Average BOS for adult during gait is:
9) What is ‘cadence’ in relation to gait
- How many steps per min is avg for adult in a minute
10) T or F: Most adults have some mild ‘toe out’ or ER of foot
- What is average degrees of toe out
- How many toes in toe out is normal
11) What is the double support phase during gait
- Does this phase exist when running?
- Will this phase (time in this phase) increase or decrease as you walk slower?
12) Does the pelvis rotate during gait cycle
- How many degrees
- Does the pelvis rotate with the trunk, or opposite of it
13) How many times during gait cycle is there a single support phase
- How many times is there a double support phase
14) How to measure step length
- About how far is it for an adult
15) What is a stride compared to a step
- On average how far is it?
16) Below are some abnormal gait patterns. Explain them:
- Antalgic:
- Ataxic:
- Cerebellar:
- Circumduction:
- Double Step:
- Equine
- Festinating:
- Hemiplegic:
- Parkinsonian:
- Scissor:
- Spastic:
- Steppage:
- Trendelenberg:
- Vaulting:
17) Now, from point above, match the description with the proper gait abnormality name:
- One sided LE weakness and disuse
- Toe walking, short gastrocs
- Big steps (exaggerated hip and knee flexion so toes don’t drag). Foot slap due to DF weakness
- Hip abductor weakness and thus lateral trunk flexion, so hip drops and trunk leans on stance leg
- Leg swings out during swing phase due to hip, knee, or ankle ROM deficits / pain / injury
- Alternate steps are different length and rate
- Hip hiking and excessive PF, so leg can advance.
- Walks on toes fast and almost will fall over, has to grasp an object to stop
- A protective gait pattern where involved step length is decreased to avoid weight bearing due to pain.
- Forward flexion, shuffling gait, small steps, and even festinating
- Staggering and uncoordinated due to cerebellar damage
- Stiff movement, toes catch or drag, legs held together, hip and knee joints flexed.
- Staggering, uncoordinated, and unsteadiness. Wide BOS and movements are exaggerated.
- Legs cross midline when advanced
1) Standard terminology and Rancho Los Amigos Terminology
2) Stance phase, swing phase
- Stance is 60%, and Swing is 40%
3) STANCE: Heel strike, foot flat, midstance, heel off, toe off
- SWING: Acceleration, Midswing, Deceleration
3A) S = S (standard is heel Strike)
- Rancho
4) STANCE: Initial contact, Loading Response, Midstance, Terminal Stance, Pre-swing
- SWING: Initial Swing, Midswing, Terminal Swing
5) ok
6) Ant Tib: Just after heel strike to eccentrically lower foot to ground (during loading response).
- Gastrocs: Late stance and toe off
- Quads: Midstance and initiate swing phase
- HS’s: Late swing to decelerate swing limb
7)
- Hip Flex: 0-30 deg’s
- Hip Ext: 0-10 deg’s
- Knee Flex: 0-60 deg’s
- Knee Ext: 0 deg’s
- Ankle DF: 0-10 deg’s
- Ankle PF: 0-20 deg’s
8) Distance between R and L foot
- Decrease
- 2-4 inches
9) # of steps an individual will walk over some period of time (p/min)
- 110-120 steps per min
10) True
- 7 deg’s
- 2 to 2.5 ish
11) When both feet touch the ground
- NO
- Increase
12) YES
- 8 deg’s (4 when leg goes forward during swing, and 4 deg’s when leg goes backwards)
- Opposite
13) Twice
- Twice
14) Right heel (at heel strike) to Left heel (at heel strike)
- 28 inches
15) A stride is only dealing with one foot - so from R heel strike to R heel strike (2 steps).
- 56 inches
16)
- Antalgic: A protective gait pattern where involved step length is decreased to avoid weight bearing due to PAIN. Abnormal gait due to pain in LE’s (algia = pain).
- Ataxic: Staggering and unsteadiness. Wide BOS and movements are exaggerated. Uncoordinated
- Cerebellar: Staggering and uncoordinated due to cerebellar damage
- Circumduction: Leg swings out during swing phase due to hip, knee, or ankle ROM deficits / pain / injury / poor prosthetic fit
- Double Step: Alternate steps are different length and rate
- Equine: High steps, toe walking, short gastrocs
- Festinating: Quick short steps like in Parkinson’s pt’s
- Hemiplegic: One sided LE weakness and disuse
- Parkinsonian: Forward flexion, shuffling gait, small steps, and even festinating, freeze on gait
- Scissor: Legs cross midline when advanced due to tight hip adductors or adductor spasticity
- Spastic: Stiff movement, toes catch or drag, legs held together, hip and knee joints flexed.
- Steppage: Big steps (exaggerated hip and knee flexion so toes don’t drag). Foot slap due to DF weakness
- Trendelenberg: Hip abductor weakness and thus lateral trunk flexion, so hip drops and trunk leans on stance leg
- Vaulting: Hip hiking and excessive PF, so leg can advance.
17)
- Hemiplegic
- Equine
- Steppage
- Trendelenberg
- Circumduction
- Double Step
- Vaulting
- Festinating
- Antalgic
- Parkinsonian
- Cerebellar
- Spastic
- Ataxic
- Scissor
1) Alopecia =
- How to remember
2) In a “scottie dog” view, what is the eye of the dog
- What is the nose
- What is the ear
- What is the front lower paw/leg
- What is the neck
- Body of dog
- Tail
- Back lower paw/leg
3) What is the pars articularis
- How does it get fractured most often?
1) Hair Loss
- Al, please, do something with your balding hair
2) Pedicle
- Transverse process
- Superior articular process
- Inferior articular process
- Pars articularis
- Vertebral body, lamina, and spinous process
- Opposite sup. articular process
- Opposite inf. articular process
3) Portion between the inf. and sup. articular process portion and the lamina
- Hyper extension
1) Explain the Oswestry what it is for and how to score.
- A higher score on this test means a better function or more disability?
2) Explain the DASH what it is for and how to score.
- A higher score on this test means a better function or more disability?
3) Explain the LEFS what it is for and how to score.
- A higher score on this test means a better function or more disability?
4) Explain the NDI what it is for and how to score.
- A higher score on this test means a better function or more disability?
5) T or F: NDI and Oswestry and both related to the back or spine, and are scored the exact same way (just diff. ?s)?
6) What is the only one of these main assessments where a lower score means more disability? **
- How to remember
1) For low back pain pt’s. 50 points total (10 sections, 1 score is no pain and 5 score is can’t move). Calculate by taking total score / 50 x 100% = Disability Score.
- More disability
2) Disabilities of Arm, Shoulder, and Hand (UE). 30 items, 1 score is no pain and 5 is can’t move ….
- More disability
3) Lower Extremity Functional Scale. 20 items. Score of 0 is no pain, score of 4 is extreme difficulty.
- Better function
4) Neck Disability Index. 50 points total (10 sections, and add up score and divide by 50 points possible … just like Oswestry).
- More disability
5) True
6) LEFS
- L = Lower in LEFS = and lower score on LEFS is “lower” function (or bad).
1) What is sacral nutation
- Sacral nutation would appear as an anterior or posterior pelvic tilt?
2) What is sacral counternutation
3) How could you assess this?
4) T or F: Could one side be nutated and another not?
- What would that be called?
5) How would you fix a sacral torsion
1) Base (top) of sacrum goes anterior and inferior
- Posterior
2) Base (top) of sacrum goes posterior and superior
3) Sacral torsion: find PSIS’s and go up and medial and palpate. Is one side higher/lower than another
4) Yes.
- It would be called L on R (or R on L) backwards sacral torsion for whatever side is more posterior
5) Let’s say the L side is up/high, then place pt on right side (sidelying) and do a resisted MET to L piriformis to have the piriformis pull anterior sacrum back down into position.
1) Berg Balance Scale is out of how many points?
- What is the cut off for ROF (risk of falls)
2) How is Berg and Tinetti different?
3) Tinetti is out of how many points?
- What is the cut off for ROF
4) What % of help does this level of assistance require:
- Minimum Assist (Min A)
- Moderate Assist (Mod A)
- Maximum Assist (Max A)
- Total Assist (Tot A)
5) What is the time frame or amount of minutes where you can NOT bill for any units?
- List time amounts and how many units for those time amounts:
6) So from the question above, how much time is for 1 unit
7) The CPT Code below is for what:
- 97161:
- 97162:
- 97163:
- 97164:
- 97110:
- 97530:
- 97140:
- 97116:
- 97112:
- 97113:
1) 56
- 41 (higher score = lower risk of falling, and lower than 41 is ROF … down in 20 range is huge risk of falling)
2) Berg is just balance, Tinetti has a gait element + balance
3) 28 (16 on balance, and 12 on Gait)
- 19 or less
4)
- Min A: 0-25% is what PT does to help
- Mod A: 25-50% (what PT does)
- Max A: 50-75% (what PT does)
- Tot A: 75-100% (what PT does)
5) 0-8mins
- 8-22 mins (1 unit)
- 23-37 mins (2 units)
- 38-52 mins (3 units)
- 53-67 mins (4 units)
- 68-82 mins (5 units)
- Etc.
6) After the first 8 mins, it goes in 14-15 minute increments, up to 22 mins
7)
- 97161: Low Eval
- 97162: Mod Eval
- 97163: High Eval
- 97164: Re-Eval
- 97110: Theraputic Proceedure / Ex
- 97530: Theraputic Activities
- 97140: Manual Therapy
- 97116: Gait Training
- 97112: Neuromuscular Re-Ed
- 97113: Aquatic
1) For the average adult, how much ROM do they have at these joints:
- Shoulder Flex:
- Shoulder Ext:
- Shoulder Abd:
- Shoulder ER:
- Shoulder IR:
- Elbow Flex:
- Elbow Ext:
- Forearm Pronation:
- Forearm Supination:
- Wrist Flex:
- Wrist Ext:
- Wrist Rad Dev:
- Wrist Uln Dev:
- Hip Flex:
- Hip Ext:
- Hip Abd:
- Hip Add:
- Hip ER:
- Hip IR:
- Knee Flex:
- Knee Ext:
- Ankle DF:
- Ankle PF:
- Ankle Ever:
- Ankle Inv:
- Subtalor:
- Cervical Flex:
- Cervical Ext:
- Cervical Sidebend:
- Cervical Rotation:
- ThoracoLumbar Flex:
- ThoracoLumbar Ext:
- ThoracoLumbar Sidebend:
- ThoracoLumbar Rotation:
1)
- Shoulder Flex: 180
- Shoulder Ext: 60
- Shoulder Abd: 180
- Shoulder ER: 90
- Shoulder IR: 70
- Elbow Flex: 150
- Elbow Ext: 0
- Forearm Pronation: 80
- Forearm Supination: 80
- Wrist Flex: 80
- Wrist Ext: 70
- Wrist Rad Dev: 20
- Wrist Uln Dev: 30
- Hip Flex: 120
- Hip Ext: 30
- Hip Abd: 45
- Hip Add: 30
- Hip ER: 45
- Hip IR: 45
- Knee Flex: 135
- Knee Ext: 0
- Ankle DF: 20
- Ankle PF: 50
- Ankle Ever: 15
- Ankle Inv: 35
- Subtalor: 5
- Cervical Flex: 45
- Cervical Ext: 45
- Cervical Sidebend: 45
- Cervical Rotation: 70
- ThoracoLumbar Flex: 80
- ThoracoLumbar Ext: 25
- ThoracoLumbar Sidebend: 35
- ThoracoLumbar Rotation: 45
1) What is the process for doing a Goni measurement properly:
2) Why did I put this as a question / process to review?
3) For most joints, I know where the axis, stationary arm, and moveable arm of the goni goes; however, for the motions below, name where you put the axis, stationary arm, and moveable arm:
- Pronation
- Supination
- Wrist Flex and Ext:
- Ankle Inv and Ever:
- Thoracolumbar Flex and Ext:
- Thoracolumbar Sidebend:
4) ** How is the best way to remember the difference in ROM for wrist flex and ext
- Of those 2, which one moves more (larger ROM)
1)
- Place subject in proper testing position
- Stabilize the proximal joint segment (at distal portion)
- Move distal joint segment through the ROM and make an estimate of what ROM is and determine end-feel (estimate ROM by eyeball)
- Return distal segment to starting position
- Palpate the bony landmarks
- Align the goni
- Read and record the starting position and then remove the goni
- Stabilize the proximal joint segment
- Move the distal segment through ROM
- Replace and realign goni
- Record ROM
2) Cause I’ve seen a question on it and I’m positive there will be some question on it :)
3)
- Pronation: axis is lateral aspect of ulnar styloid process; stationary arm is parallel to midline of humerus; moveable arm is dorsal wrist
- Supination: axis is medial aspect of ulnar styloid process; stationary same as pronation; moveable is now ventral part of wrist
- Wrist Ext: axis is lateral aspect of wrist by triquetrum (or ulnar styloid process); moveable is 5th metacarpal
- Ankle Inv and Ever: axis is posterior aspect of the ankle midway between malleoli (where subtalor joint would be); stationary is posterior midline of leg; moveable is posterior calcaneus
- Thoracolumbar Flex and Ext: Usually uses a tape measure vs. goni, or inclinometers
- Thoracolumbar sidebend: Axis is Spinous process of S2; stationary is perpendicular to spine; moveable is between acromial processes
4) Look at ulnar styloid process during wrist flex and ext and watch where 5th metacarpal goes … much easier to see
- Wrist FLEXion (flexion is 80 vs. 70 of ext)
1) What is the apprehension test of the shoulder for (to help rule in / diagnose):
- How is the test performed
- What is a positive test
2) What is the Speed’s test of the shoulder for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test
3) What is the Drop Arm test of the shoulder for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test
4) What is the Supraspinatus test of the shoulder for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test
5) What is the Adson Maneuver test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test
6) What is the Roos test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
7) The valgus stress test of the elbow is testing for what
8) When a pt’s hand is pronated and flexed at the elbow and you do a Resisted RSC of the middle digit into extension, what are you testing for?
- What is this called
- What is test when you tap middle finger multiple times quickly
- Positive sign for the test from above
9) What is Tinel’s sign (how to do it), and what is it for?
- Name some common nerves you’d do this on?
10) How would you do a capillary refill test
- Above what amount of time for refill indicates concern/pathology
- If it takes that long to refill, it indicates what?
11) What is the Phalen’s test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
- How long must it be held?
- How long must ROOS be held?
12) What is the Ely’s test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
- What other test is in this position and what is it for:
12A) So Roos you have to hold for how long?
- Phalens you have to hold for how long?
- Capillary refilling time is concerning when it exceeds how long?
13) What is the Ober’s test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
14) What is the Thomas test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
- What is Modified Thomas test for:
15) What is the Craigs test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
16) What is the Trendelenberg test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
17) What is the trendelenberg position
- What is reverse trendelenberg position
18) What is the Lachman test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
19) If you did a valgus stress test of the knee, would you apply a force on lateral or medial knee
20) What is the Apley’s test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
21) What is the McMurray’s test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
22) Is there an anterior drawer test for the knee and the ankle?
- What is the Anterior Drawer test of the ANKLE for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
23) What is the Talor Tilt test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
23A) What is the Kleiger’s test:
24) What is the Homan’s Sign for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
25) What is the Thompson test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
26) What is the True Leg Length Discrepancy test for (to help rule in / diagnose):
- How is the test performed:
- What is a positive test:
- With the supine-sit test, what result needs to happen to help rule in a true LLD
1) Shoulder instability / capsular laxity / labral tear /
Dislocation
- Pt is laying supine with arm in 90/90 (to the square) and PT ER’s it.
- Apprehension during ER
2) Biceps tendinopathy / pathology
- Pt is sitting and it basically is a RSC of biceps / shoulder flexion resisted, and PT palpates bicepital groove
- Pain during that resistance
3) RC tear / tendinopathy (or impingement)
- Patient abducts arm out and is supposed to slowly lower arm down to the ground
- If they can’t (it drops) or is very very painful
4) To detect a supraspinatus tear
- Patient abducts arm to 90 deg’s and about 30 deg’s of hor adduction, then PT does a RSC test pushing down (basically the harmonica position, but push down)
- If the pt can’t or is very painful = supraspinatus tear
5) Thoracic Outlet Syndrome
- Pt is sitting and PT monitors the radial pulse. PT then extends and ER’s the shoulder and patient slightly extends and rotates head to compress neurovascular bundle
- Weakness, sensory loss, ischemic pain, etc. down arm and DIMINISHED PULSE during test.
6) Thoracic Outlet Syndrome
- This is the chicken dance. Pt abducts arm, ER’s arm, and does elbow flexion, then opens and closes their hands for 3 minutes
- Weakness, sensory loss, ischemic pain, etc. - can’t hold arm up that long (3 mins)
7) Tear or strain to MCL of the elbow
8) Lateral epicondylitis
- Maudley’s
- Hoffman’s
- Curling/flexing of the index and thumb during the tapping
9) Tapping on a nerve repetitively to see if there is any tingling sensation which indicates some compression or pathology of the nerve
- Medial (tap wrist), Ulnar (cubital tunnel), Tibial (tarsal tunnel)
10) Compress a nailbed and push/squeeze for a few seconds and then release it. PT will note the time it takes for nailbed to regain color.
- 2+ seconds for adults (4+ for elderly)
- Arterial insufficiency
11) Carpal Tunnel Syndrome (median nerve compression)
- Do the prayer and reverse prayer position and hold it for 60 ish seconds.
- Tingling into thumb, index finger, middle finger, or lateral half of ring finger
- 60 sec’s
- 3 mins
12) Rectus femoris tightness or contracture (short quads)
- Pt in prone and PT passively does knee flexion stretching quads
- Tightness so you can’t get knee past 90, or hip flexion occurs due to tight quads
- Phelp’s - for Gracilis tightness
12A) 3 mins
- 60 seconds
- 2+ seconds for adults (4+ for elderly)
13) Tight IT band / TFL
- Pt lies sidelying in 90/90 position at knee. PT grabs leg and does passive extension and abduction and then slowly lowers.
- If pt’s leg can’t adduct down and touch the table.
14) Tight hip flexors (Psoas or Rectus)
- Pt in supine and edge of bed and brings one leg to chest and the other he lowers off table.
- If pt’s angle from hip is high = tight psoas / hip flexor. If knee angle is less than 90, could be tight rectus femoris. If straightening the knee causes hip to lower it is tight rectus; if straightening the knee does nothing to the hip (it’s still high) = tight psoas
- IT band tightness
15) Femoral Anteversion / Retroversion
- Pt lies prone and flexes knees up to 90 deg’s. PT rotates hip until greater trochanter is parallel with table, and then PT measures angle of tibia and perpendicular axis from table. THIS IS important because in anteversion the femur head is more forward causing leg / ankle in prone to go in medially, but when you make the greater trochanter parallel to the table it brings in lower leg/ankle out much more. And visa versa for retroversion.
- Angle less than 8 degrees is femoral retroversion, and more than 15 degrees is femoral anteversion
16) Glute med weakness
- Pt stands and either walks or is asked to stand on one leg for 10 seconds
- If a drop of the pelvis happens on contralateral side = glute med weakness on ipsilateral side since it can’t hold trunk up
17) That is when you lay supine and tilt the table at an angle so the head is down (lower than legs)
- Lay supine, tilt the table, and now the head is higher than the feet.
18) ACL injury
- Pt lies supine with slight (20-30 degrees) of knee flex, and PT grabs superior tibia and does quick pull
- Anterior translation of tibia = ACL tear
19) Lateral
20) Meniscus tear
- Patient is prone with knee flexed to 90 deg’s. PT applies compressive force down tibia and medially and laterally rotates tibia
- Pain, clicking
21) Meniscus tear
- Patient is supine with knee flexed, and PT will medially rotate tibia and bring knee into full extension passively while palpating joint line. Repeat and now laterally rotate tibia and extend leg again.
- Pain, clicking, popping, crepitus heard or felt at joint line palpation
22) YES
- ATFL ligament sprain
- Pt is supine with ankle about 20 deg’s of PF. PT stabilizes or holds heel and pulls talus and calcaneus forward.
- Excessive forward translation with pain = ATFL tear
23) Calcaneofibular ligament or Deltoid ligament sprain (primarily CFL)
- Grab heel and move into inv/ever or ab/adduction at subtalor joint
- If pain or laxity on lateral side, it is calcaneofibular lig sprain; if on medial side it is deltoid sprain. And remember eversion normally gets 15 ish degrees, and inversion gets about 30 deg’s, so if you get more than that it could indicate lig tear/laxity.
23A) ER of ankle/foot to help rule in a deltoid lig or high ankle syndesmosis lig sprain.
24) Deep Vein Thrombosis
- DF foot then squeeze calf
- Pain during this
25) Ruptured Achilles tendon rupture
- Pt is prone with feet over edge of table and PT squeeze calf m’s
- If the foot does NOT PF, then ruptured achilles
26) Leg Length Discrepancy
- Patient is supine with feet about 6-8 inches apart. PT measures with a tape measure from ASIS to medial malleolus on both sides.
- More than 2 cm comparably between legs will indicate LLD
- Leg is long in supine and sitting up
Know these terms below:
Bursitis:
- It is ruled in through what imaging device:
- The end feel would be what
Contusion:
Edema:
Effusion:
Genu Valgum:
- With genu valgum, will it place stress on medial or lateral condyle/meniscus
- Will it stress MCL or LCL
- Would genu valgum be because of coxa vara or valgus
Genu Varum:
- With genu varum, will it place stress on medial or lateral condyle/meniscus
- Will it stress MCL or LCL
Kyphosis:
- What causes this
Lordosis:
- What causes this
Q Angle:
- Normal Q Angle is:
- Abnormal Q angle leads to:
Sprain:
Strain:
Tendonitis:
- Symptoms include:
Bursitis: A condition caused by acute or chronic inflammation of the bursae. Symptoms may include a limitation in active range of motion secondary to pain and swelling.
- X-ray
- Empty (pain)
Contusion: A sudden blow to a part of the body that can result in mild to severe damage to superficial and deep structures. Could be a contusion to a bone or muscle. Treatment includes AROM, ice, compression, strengthening, modalities.
Edema: Swelling. An increased volume of fluid in the soft tissue OUTSIDE a joint capsule.
Effusion: An increased volume of fluid INSIDE a joint capsule.
Genu Valgum: Knees touch so medial knee touches and ankles go out from each other. Called knocked-knee
- Lateral
- MCL
- Varum
Genu Varum: Bow legged, so knees are out and ankles are closer together.
- Medial
- LCL
- Valgus
Kyphosis: Excessive curvature of thoracic spine.
- Osteoporosis, compression fracture, arthritis, posture / weight, paralysis, age, sheuremann’s
Lordosis: Excessive curvature of l-spine or c-spine
- Weak muscles, pregnancy, weight, hip flexion contracture, spasms, disc issues
Q Angle: Degree of angulation from ASIS to mid-patella.
- 13 deg’s in males, and 18 deg’s for female
- Poor patellar tracking, PFPS
Sprain: Acute injury involving a LIGAMENT
Strain: Acute injury involving MUSCLE/tendon
Tendonitis: Condition caused by acute or chronic inflammation of a tendon.
- Gradual onset, tenderness, swelling, pain
1) What does Prophylactic mean
2) The medication Lipitor is for what
- How to remember
3) Metformin medication is for what
4) Oxicodone medication is for what
5) What is the medication valium (diazepam) for:
1) Preventative measure / therapy / meds. You do something in hopes to prevent a future disease / condition. PROactive measure
2) High cholesterol
- Lipids are fats
3) DM II
4) Pain killer / narcotic
5) Seizures and anxiety and even sleep apnea (even muscle spasms) … calm system down.
Below are common types of fractures - KNOW THEM:
Avulsion Fracture:
Closed Fracture:
Comminuted Fracture:
Compound Fracture:
Displaced Fracture:
Greenstick Fracture:
- This fracture more commonly happens to who
Linear Fracture:
Nonunion Fracture:
Oblique Fracture
Spiral Fracture:
Stress Fracture:
Transverse Fracture:
*** Best imaging device to see a stress fracture
Avulsion Fracture: Portion of bone becomes fragmented at the site of the tendon insertion due to sudden stretch of tendon.
Closed Fracture: A break in a bone where the skin over fracture remains intact.
Comminuted Fracture: A bone that breaks into fragments at site of injury.
Compound Fracture: A break of a bone that protrudes out through the skin.
Displaced Fracture: A break in a bone where the fragments are out of place.
Greenstick Fracture: Break on one side of the bone that does not damage the periosteum on opposite side.
- USUALLY SEEN IN CHILDREN.
Linear Fracture: A break that is parallel to the long axis of the bone
Nonunion Fracture: A break in a bone that has failed to unite and heal after 9-12 months. It didn’t UNITE.
Oblique Fracture: A break that is diagonol
Spiral Fracture: A break in the shape of an “S” due to TORSION or TWISTING
Stress Fracture: Break in a bone due to repeated forces to a particular portion of a bone
Transverse Fracture: A break in a bone that is at a 90 deg angle to the bone’s long axis
Bone Scan
1) From least assistive to MOST assistive, name all the orthotic options:
2) What motions does a solid AFO control
- What does a posterior leaf spring AFO do
- A floor reaction AFO controls what motion
3) Which one is often only worn by children
4) What is unique about the RGO:
- Who would use these?
5) What is a parapodium
- Can you ambulate in/with it
- What population / patient type usually uses this?
- Why would they use it
- ** Is this the better option, or is it better to manually stretch patient
6) What are the orthoses options for the spine
7) Which one of those from point above is used for scoliosis pt’s?
- What scoliotic braces are worn all day / all the time
- What scoliotic brace is worn just at night (nocturnal)
- How to remember above
1)
- Foot orthoses
- SMO: Malleolar Orthoses
- AFO: Ankle Foot Orthoses (posterior leaf –> Solid)
- KAFO: Knee Ankle Foot Orthoses
- HKAFO: Hip Knee Ankle Foot Orthoses
- RGO: Reciprocating Gait Orthoses
- Parapodium (standing frame)
2) SOlid AFO’s control DF/PF and Inv/Ever
- Helps someone with DF (from Drop Foot)
- Knee extension (forces knee ext during stance phase due to weak quads)
3) SMO
4) When pt shifts weight into one side, the mechanism will advance the other LE.
- Paraplegia pt’s
5) Standing frame
- Yes. Pt can shift weight and rock the base across the floor.
- Pediatrics
- Prevent contractures, prevent pressure injuries/ulcers, offload, ambulate
- Parapodium is much better
6)
- General back brace
- Corset
- Milwaukee / Boston Orthosis (or Charleston) for Scoliosis)
- Halo for C-spine
- TLSO: Thoracolumbosacral orthosis
7) Milwaukee
- Milwaukee and Boston
- Charleston
- Charleston is in the south and warm, so you dance during the day and you can’t wear a brace doing that dance; but Milwaukee and Boston are in the north and cold places so you need to wear the brace all the time to stay warm :)
1) From lowest / farthest level to most severe, name the upper extremity amputation types:
2) From lowest / farthest level to most severe, name the lower extremity amputation types:
3) There are really 3 types of dressings. What are they:
4) From point above, which category would these fall in:
- Air cast:
- Ace wrap:
- Plaster
5) Main disadvantage of the rigid dressing:
- What is a disadvantage of a semi-rigid dressing:
- Disadvantage of soft dressing:
6) There are some specific gait deviations for those amputee’s who wear a prosthetic.
- Why might someone walk with a lateral bend
- Why might someone walk with a circumducted gait
- Why might someone walk with a vaulted gait
- Why might someone walk with a medial whip
- Why might someone walk with a lateral whip
- Why might someone walk with a abducted gait
- Why might someone walk with a drop off gait
7) With amputees, these terms mean:
- Stump:
- Residual:
- Sound:
- Salvage:
- Transosseous vs. Transarticular
- AKA
- BKA
- AEA and BEA
8) Main reasons why people get an amputation / prosthetic:
- Congenital amputees have more LE or UE prosthetics
- Younger amputees are more likely to get an amputation from vascular disease or trauma
9) So below is an amputation type - where is this amputation:
- Symes
- Chopart’s:
- Rotationplasty:
- Forequarter:
- Boyd:
- Pirigoff:
10) T or F: The higher the amputation, the more energy expenditure / demand?
1)
- Digit amputation (either at metacarpalphalangeal, or PIP, DIP)
- Partial hand (portion of the hand at trans carpal, trans metacarpal, transphalangeal)
- Wrist Disarticulation
- Transradial (distal to elbow joint)
- Elbow disarticulation (through elbow joint)
- Transhumeral (distal to shoulder)
- Shoulder disarticulation
- Forequarter / Scapulothoracic (entire shoulder girdle)
- Below elbow (transradial) and Above Elbow (transhumeral)
2)
- Partial toe
- Toe disarticulation
- Transmetatarsal
- Lisfranc
- Transverse Tarsal (Chopart’s)
- Syme’s (at ankle removing malleoli)
- Boyd (horizontal line cutting off bottom of calcaneus)
- Pirigoff (vertical line cutting off back of calcaneus)
- Transtibial (distal to knee)
- Knee disarticulation (at knee joint)
- Transfemoral
- Hip disarticulation
- Hemipelvectomy (removal of one half of pelvis)
- Hemicorporectomy (1/2 of the CORPSE / body - removal of both LE’s and entire pelvis)
3)
- Rigid
- Semi-rigid
- Soft
4)
- Semi-rigid
- Soft
- Rigid
5) Can’t monitor / inspect wound, can’t change dressing easily / quickly, and requires a professional for placement
- Doesn’t protect as well as a rigid dressing, and may loosen and thus cause more edema
- Less protection, have to change dressing a lot (which could impact wound, risk of tourniquet effect
6)
- Lateral Bending: prosthetic is too short, prosthetic doesn’t fit well, or weak hip abd’s on prosthetic side
- Circumducted gait: prosthetic is too long, or abduction contracture, weak hip flexors
- Vaulted gait: prosthetic is too long, excessive PF at ankle, short residual limb
- Medial whip: Tight/short abductors bring leg out so they whip leg in to correct
- Lateral whip: Tight/short adductors bring leg in, so they whip leg out
- Abducted gait: Gives you a wider BOS
- Drop off: Weak quads, so knee gives out
7)
- Stump: prosthetic
- Residual: Prosthetic / Amputated side (residual = what is left after amputation)
- Sound: Good side (non-amputated side)
- Salvage: Try to save the leg
- Tranosseous is amputation through bone (like transfemoral), and transarticular is through the joint (disarticulation)
- AKA: Above knee amputation
- BKA: Below knee amputation
- Above and Below Elbow
8) Vascular disease (like DM II) is about 45%, then trauma is another 45%, then cancer, congenital, etc.
- UE
- Trauma (older people are more from DM II)
9)
- Symes: ankle joint (ankle disarticulation)
- Chopart: Tarsal (midtarsal joint)
- Rotationplasty: Upsidedown tibia approach so ankle becomes knee.
- Forequarter: entire shoulder girdle
- Boyd: horizontal line cutting off bottom of calcaneus
- Pirigoff: vertical line cutting off back of calcaneus (where achilles attaches)
10) True
1) MUST MUST MUST know wound staging. How many stages are there in wound staging:
2) What are the stages:
3) What is the Wagnar / Wagner grading for ulcers: *****
4) List examples of:
- High absorption dressings:
- Moderate/Medium absoprtion dressings:
- Low absorption dressings:
1) 4
2)
- Stage I - redness, heat and edema involving the epidermis (NON-blanchable erythema of INTACT skin), reversible with decreased pressure, dermis is not involved
- Stage II - partial thickness skin loss with tear in epidermis, blanchable, both epidermis/dermis are involved, infection and/or necrosis may be present
- Stage III - full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia, infection and/or necrosis may be present
- Stage IV - full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone and supporting structures
3) For Diabetic / Neuropathic wounds:
Grade 0 = Intact skin
Grade 1 = Superficial ulcer (not into subcutaneous layer)
Grade 2 = Deep ulcer into subcutaneous layer (possible
bone/muscle exposure …. no infection yet)
Grade 3 = Deep, infected ulcer
(osteitis/abscess/osteomyelitis)
Grade 4 = Partial foot / digit gangrene
Grade 5 = Full foot gangrene
4)
- HIGH Absorption Dressings: Alginate, Hydrofibers, …. Foam, Gauze (For more FULL thickness, high exudate wounds)
- Medium Absorbers: Foam, Gauze, Hydrocolloids (just depends on thickness and how much you put on). For secondary dressings primarily for excess exudate
- LOW Absorbers: Collagens, Hydrocolloids, Hydrogels, Transparent films. (For LOW exudate, more shallow, Stage I and II type wounds)
1) What is MAIN drug used for Rheumatic disease
- What do they do?
2) What are Glucocorticoids / Cortisosteroids
- Main drug that is a corticosteroid
1) DMAA or DMARDS (Disease Modifying Antirheumatic Agent)
- Halts the progression of rheumatic disease by modifying the pathology of the immune response
2) Reduce inflammation in chronic conditions through vasoconstriction
- Prednisone is a corticosteroid. An anti-inflammatory agent. It prevents the release of substances in the body that cause inflammation
1) If I did a Thompson test, what injury am I testing for
2) If I did an arthrogram, what am I typically looking into
- What is an angiogram:
3) Capsular pattern of shoulder is (in what order):
- T or F: Adhesive capsulitis will present with this capsular pattern
4) If I did a speed’s or Yergason test, what am I testing for
- How do you perform each of these tests
5) What is a Colles fracture
- What is it’s opposite?
- How to remember?
6) Involuntary contraction to the SCM muscle is what diagnosis:
- If not caused by congenital, what else could cause it
7) Fracture or Degeneration at L4/L5 level is called:
8) A few conditions where there is pain at anatomical snuffbox
8A) How to remember what tendons are involved in a De Quervan’s Tenosynovitis:
9) What is the special test for De Quervain’s Tenosynovitis
10) What is this:
X-linked recessive trait manifesting in only male offspring (females become carriers). Clinical presentation includes: waddling gait, PROXIMAL muscle weakness, toe walking, hypertrophy of CALF, difficulty climbing stairs. Rapid progression of disease with inability to ambulate by 10-12 yrs of age and death often in age 20’s.
11) XX chromosomes are what gender
- XY chromosomes are what gender
- X-linked recessive trait means:
1) Achilles tendon rupture
2) An arthrogram is an X-ray image or picture of the inside of a joint (e.g. shoulder, knee, wrist, ankle) after a contrast medium (sometimes referred to as a contrast agent or “dye”) is injected into the joint. For example, in the shoulder, for adhesive capsulitis (by detecting decreased volume of fluid in joint capsule)
- An angiogram is a diagnostic test that uses x-rays to take pictures of your blood vessels. A long flexible catheter is inserted through the blood stream to deliver dye (contrast agent) into the arteries making them visible on the x-ray to see if / where occlusion is.
3) ER, Abd, IR
- True
4) Biceps tendinitis
- Speeds: is a RSC of biceps with elbow extended and supinated
- Yergason’s: elbow bent and pronated and pt supinates while you resist, but you feel bicepital groove
5) Fracture to distal radius, where bone is displaced POSTERIORLY or dorsally
- Smith’s fracture (distal radius fracture with anterior displacement)
- In church History, the Smith’s were out in front (ventral), thus the Colles were in the back (dorsal)
6) Torticollis
- Ocular torticollis - CN IV damage
7) Spondylolisthesis
8)
- De Quervain’s Tenosynovitis (entrapment or inflammation / tendinitis of the abductor pollicis longus and extensor pollicis brevis tendons).
- Schaphoid fracture
8A) Both are for the thumb (so pollicis), one is abductor, one is extensor, one is longus, one is a brevis … AL (abductor longus)
9) Finkelstein’s
10) Duchenne Muscular Dystrophy
11) Female
- Male
- Girls carry it, but boys get it
1) Define how to differentiate the differences between a SPRAIN:
- Grade 1:
- Grade 2:
- Grade 3:
2) Are these same grades (from point above) the same for muscles
- Is a muscle injury called a sprain?
3) Injury in growing kids (going through growth spurts) where there is pain on anterior knee at patellar tendon: insertion (tibial tuberosity)
- What is it
4) An infection that occurs within the bone
- Most common ways people get this?
5) Condition where there is general knee pain, articular cartilage damage to patella, and more common in younger females
6) Condition where there is sharp pain first steps in the morning in heel
7) If a drop arm test or empty can test is positive, the pt has what condition:
8) Positive painful arc indicates what condition:
- Pain at top of shoulder ROM (170 ish deg’s) usually indicates what
9) A Cobb angle is measured for what diagnosis
- Angle from 25-40 deg’s requires what intervention:
- Angle of 40 deg’s or more requires what intervention:
- WHen should someone be assessed
10) Tinnitus is:
- 2 special tests of the ear to detect hearing deficits
11) Osteosarcoma is:
- What type of bones does an osteosarcoma effect
- A pt that gets this will most likely end up getting a what:
12) An amputee pt will have what complications post surgery
13) Besides war and trauma, most common reason someone gets an amputation is:
1)
- Grade 1: Small microscopic tears. Swelling / inflammation / pain, but no signficant damage. MILD tear.
- Grade 2: Partial tear
- Grade 3: Full rupture
2) YES
- No, muscle is STRAIN. Strain a muscle, sprain a ligament
3) Osgood-Schlatter’s
- A childhood repetitive use injury that causes inflammation and a painful lump below the kneecap where patellar lig inserts at tibial tuberosity. Osgood-Schlatter disease affects children experiencing growth spurts. Children who play sports in which they regularly run and jump are most at risk. The disease causes a painful lump below the kneecap. The condition usually resolves on its own, once the child’s bones stop growing.
4) Osteomyelitis
- Could be from a fracture or injury, but usually from STAPH infection (bacteria)
5) PFPS (Patellofemoral pain syndrome)
6) Plantar fasciitis
7) Rotator cuff tear
8) Either rotator cuff tendinitis (slight tear) or shoulder impingement (bone spurs)
- A/C degeneration/arthritis
9) Scoliosis
- Spinal brace/orthosis
- Surgery
- When moderate scoliosis is detected
10) Ringing in ear
- Rinne and Weber
11) Bone tumor
- LONG bones
- Amputation (transfemoral or transtibial)
12)
- Gait and balance impairments
- Prosthetic management and AD training
- Fatigue easily
- Wounds and residual limb management/care
- Phantom pain
- Hypersensitivity on residual limb
- Psychological issues (cosmetic, self-esteem, purpose)
- Contractures **
13) DM II or some vascular disease.
1) 3 parts of the sternum are called (from top to bottom)
- At the top of the sternum is a little notch. It is called:
2) How many “true ribs” are there - and what are they
- How many false ribs are there
- How many floating ribs are there
3) What connects the ribs to the sternum
4) ANother name for these ribs is:
- True ribs
- False Ribs
- Floating ribs
5) What connects the false ribs to the sternum
6) The top hole of the rib cage is called:
- The bottom hole of the rib cage is called:
- The bottom hole is covered by what:
- Excursion of the diaphragm means diaphragm goes up (exhale) or down (inspire)
- Normal excursion amount is what:
7) Is the clavicle and scapula part of the thoracic axial skeleton or the shoulder girdle
8) What type of joints are these:
- Sternoclavicular (S/C)
- Sternocostal
- Costochondral
9) What articulates at the costotransverse joint
10) ANother name for a facet joint is:
- DO these facet joints have a capsule
- Are costovertebral and costotransverse joints synovial joints:
11) T or F: You can get OA at a facet joint
- This arthritis is best seen on what imaging
1) Manubrium, body, and xiphoid process
- Jugular notch
2) 7 (first 7 ribs bilaterally)
- 5
- 2 (last two)
3) Costal cartilage
4)
- True: Vertebrocostal
- False: Vertebrochondral
- Floating: Vertebral
5) Costal arch
6) Superior thoracic aperture (inlet)
- Inferior thoracic aperture (outlet)
- Diaphragm
- Up (exhale)
- 3-5 cm
7) Shoulder girdle
8)
- S/C: Synovial (with a disc)
- Syndchondroses
- Cartilaginous
9) Tubercle of the rib
10) Zygapophysial joint
- Yes. They are a synovial joint
- YES
11) YES. It is a synovial joint, so there is articular cartilage over sup and inf articular processes, so they get arthritis
- MRI
1) What are the 3 intercostal m’s
- Which of these m’s is oriented / angled in (towards midline)
- How can you remember this (from point above)
- Which of the two work during INSPIRATION to elevate the rib
- How to remember this
- If looking from inside the body and you see intercostal m’s oriented out pointing lateral, which one’s are those
2) What structure passes through the anterior and posterior scalene m’s
3) What is main vein that drains blood from the head/brain
- What is main artery that ascends up from heart through neck to supply brain to head/neck
4) What muscle protracts the scapula
- This muscle is innervated by what nerve:
- What is another action of this muscle
- DOes this muscle elevate the ribs?
- If you injure this muscle (or nerve) you get what pathology:
1) Internal and external intercostal m’s, then the innermost intercostal m’s
- External
- Ex to Sex (external m’s point in to sex organs)
- External
- What happens to a guy during sex … raise (inspiration)
- Internal
2) Brachial plexus
3) Jugular vein
- Carotid artery
4) Serratus Anterior
- Long thoracic nerve (C5/6/7)
- Help upwardly rotate the scapula (with arm abduction motion), and elevate ribs
- Yes
- Scapular winging
1) List the order (from superior to inferior, or largest to smallest) the bronchial tree of the trachea:
2) What is the difference between ventilation and respiration
- What is it called where gas exchange happens in blood vessels
3) Your abdominal wall has layers of m’s. Name them from outermost to innermost:
4) Is the trachea or the esophogus more anterior (in front)
5) The subclavian vein empties into ________ vein which empties into ________
6) Two major trunks coming off heart are:
7) Sack covering over the heart is called:
8) What is cardiac tamponade
1)
- Trachea
- L and R Main Bronchus (bronchi)
- Lobar bronchi
- Segmental bronchi
- Bronchopulmonary segments
- Terminal bronchioles
- Respiratory bronchioles
- Alveolar ducts
- Alveolar sacs
(This is where the gas exchange / respiration happens between O2 and CO2).
2) Ventilation is the movement of air into and out of the lungs.
- Respiration is the exchange of gases (oxygen and carbon dioxide) across a membrane either in the lungs or at the cellular level.
- Diffusion
3) Rectus abdominus is outermost in anterior portion. Then external oblique, then internal oblique. Then transverse abdominus.
4) Trachea
5) Brachiocephalic vein –> Superior Vena Cava
6) Aortic trunk and pulmonary trunk
7) Pericardium
8) When fluid accumulates in pericardial cavity, which compromises heart’s ability to contract and work properly thus impacting cardiac output
1) What 2 main arteries come off the aorta to supply blood to the heart itself:
- The L side (main one from point above) then becomes what artery (that wraps around the left backside of heart):
- From main point above, the L Coronary Artery then goes down the front part of the heart. What is that artery’s name
- The R coronary artery then has a branch that goes down in the front on the right side (R ventricle). This artery is called:
1A) The R coronary artery runs through what?
- From point above, what is that
- So the coronary sinus is what
- Is the coronary sinus sitting in the coronary sulcus
2) The big huge vein on the back of the heart (that drains blood of the heart) is called:
- The word sulcus means:
- It drains into where?
4) Main artery on the back of the heart is:
- Does the artery from the point above come off the R or L coronary artery?
5) What is Heart Dominance
- What % are R heart dominant?
6) R Coronary a supplies blood to what structure:
7) Most occlusions to heart (leading to MI) occurs in what artery:
8) What is a hiatus
- What 4 things go through a hiatus in the diaphragm
9) What is the covering over the lungs called:
- It has 2 layers. Explain both:
- There is fluid between these 2 layers. Why?
- What if air or fluid gets into this space?
- WOuld fluid in this space be consolidation in lung or pleural effusion
- What is the proceedure to remove fluid in those spaces:
- What is the proceedure to remove fluid if it gets into the pericardial cavity:
10) Which lung has 3 lobes, which has 2:
- Why only 2 on that side
- What are the lines called that seperate each lobe of the lung
- The superior lobe of the L lung has a unique anatomical feature. What is it:
11) The root of the lung where all a’s, v’s, and bronchial tree enter lung is called:
12) 3 surfaces of the lung:
- 3 borders of lung
1) R and L coronary artery
- L Circumflex artery
- Anterior interventricular branch (left anterior descending branch of L coronary artery)
- R marginal branch (or R Coronary artery)
1A) Coronary sulcus
- The groove (coronary groove) that runs under each atria where the coronary a’s and v’s run)
- The great vein (on posterior heart) where blood of the heart drains back into the R. atrium
- Yes
2) Coronary Sinus (that runs in the Coronary sulcus)
- Groove
- R atrium (like sup and inf. vena cava)
4) Posterior interventricular branch (posterior descending artery)
- R Coronary artery
5) The artery that supplies the posterior third of the interventricular septum – the posterior descending artery (PDA) determines the coronary dominance. If the posterior descending artery is supplied by the right coronary artery (RCA), then the coronary circulation can be classified as “right-dominant”.
- 2/3’rds
6) R atrium, most of R ventricle, SA node (usually) and AV node (usually)
7) Left anterior descending branch of L coronary artery
8) Hole or gap
- Descending aorta
- Inf. Vena Cava
- Esophogus
- And thoracic duct
9) Parietal Pleura
- The parietal pleura lines the thoracic cavities, and then there is an inner layer called the visceral pleura that lines the actual lung (visceral = organ)
- Reduces friction during respiration.
- BAD - compress or collapse lung. Needs to be taken out.
- Pleural effusion (consolidation is IN the lung itself, pleural effusion is fluid in parietal space)
- Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier.
- Pericardiocentesis is a procedure done to remove fluid that has built up in the sac around the heart (pericardium). It’s done using a needle and small catheter to drain excess fluid.
10) R lung has 3 lobes, L has 2
- The heart (mediastinum)
- Both lungs have an Oblique fissure (oriented in a diagonol between middle and inferior lobs), and the R lung also has a horizontal fissure (horizontal line between middle and superior lobe or R lung)
- Lingula (near where the middle lobe would be)
11) Hilum
12) Surfaces: Costal, mediastinal, diaphragmatic
- Borders: Anterior, inferior, posterior
1) What is the difference between the Thymus and Thyroid gland
2) Main function of thymus gland is:
- Main function of thyroid gland is:
- Which gland goes away (for most) after puberty
- Where is the Thymus gland located:
- Where is the Thyroid gland located:
1) The thyroid and thymus glands are both endocrine glands, but they are different, and their functions differ.
The thyroid is located in the NECK. It produces two primary hormones - thyroxine (T4) and triiodothyronine (T3) (and Calcitonin). These govern metabolism.
The thymus is located in the upper chest (mediastinum area) and is much larger in children than in adults (and typically goes away after puberty). It’s involved in IMMUNE function. White blood cells pass through the thymus. They are then called T-cells (for thymus). They assist in the immune response by what we call cell-mediated immunity (as opposed to humoral immunity, which has to do with antibodies produced by bone marrow).
2) Immune function (t-cells or t-lymphocytes)
- Produce T3 and T4 which help with metabolism
- Thymus
- Chest, behind sternum
- Neck (goiter)
1) What is the sac covering over the heart
- The heart and great vessels area is called:
- Are there also 2 layers of the pericardium (like the pleura around the lungs)
- Purpose of the 2 layers?
- If fluid gets into this space, what is it called:
- The proceedure to remove that fluid in pericardial cavity is called:
- That space where fluid gets is called:
- So what is pericarditis
2) What is the name of the valve between the R atrium and the R ventricle
3) *** Think of the flow of blood of the heart. From start to finish, name the VALVES the blood will go through, in order:
- Which of those 4 valves only has 2 cusps (all others have 3):
- The valve (from question above) is between what two chambers of the heart?
4) What is the name of the little tendinous structures that hold valves in place as blood tries to push them out/up
- THe muscle that holds the tendinous chords (from point above) tied to the valves
5) What is a septum (in relation to the heart)
6) Muscle of the heart is called:
- Has 3 layers - name them
7) Pectinate m’s are in the atrium wall or ventricular walls?
8) Purpose of the papillary m’s
9) ***** Name in order from outer most to innermost the layers of the heart from mediastinal space all the way down to blood in a chamber:
10) The inner chamber walls look similar in the atrium and ventricles, but have different names. What are those names for atrium vs. ventricles:
- How to remember
11) Hole between the two atria is called:
- Atrial septal defect would be what:
- Can a child (or adult) get ventricular septal defect
11A) Explain difference between foramen ovale and fossa ovalis
12) Which ventricle has thicker myocardium?
- Why
- How many papillary m’s does the L ventricle have?
13) What are the heart sounds - what do they represent?
- 1st heart sound (lub) is what?
- 2nd heart sound (dub) is what?
- T or F: the lub is beginning of systole, and dub is end of systole?
14) Which valve is MOST associated with heart disease?
- Why?
- This pathology is called:
- What does it lead to (from point above)
- Mitral regurgitation is what, and how is it caused:
- What might be the next valve to get these conditions? Why?
15) Two phases of the cardiac cycle are:
- Systole is:
- Diastole is:
- Would the tricuspid valve and mitral valve be open or closed during diastole?
- Would the aortic and pulmonary valve be open or closed during systole
16) Does the heart have a fibrous skeleton for support?
1) Pericardium
- Mediastinum
- Yes - fibrous and visceral layer of the pericardium
- Reduce friction of the beating heart
- Cardiac tamponade
- Pericardiocentesis
- Pericardial cavity
- Inflammation / infection of the pericardium surrounding the heart
2) Tricuspid valve
3) Tricuspid valve –> Pulmonary Valve –> Mitral (or Bicuspid) Valve –> Aortic Valve
- Mitral (bicuspid)
- L atrium to L ventricle
4) Choardae Tendineaa
- Papillary muscle
5) Wall between the atrium, or ventricles
6) Myocardium
- Epicardium (outer layer), myocardium (middle layer), endocardium (inner layer)
7) Atrium
8) They hold the chordae tendinaea so when blood from ventricles push up to aortic or pulmonary trunks, these m’s hold the tricuspid and mitral valves down so blood doesn’t regurgitate backwards into atria (so when blood goes from R ventricle up to pulmonary valve, the papillary muscle holds chordae tendinea taut so tricuspid valve isn’t pushed up into R atrium holding valve closed so no blood goes up into R atrium).
9) Fibrous pericardium –> Parietal pericardium –> Pericardial cavity –> Visceral pericardium –> Epicardium –> Myocardium –> Endocardium –> Chamber with blood
10) Atrium is the pectinate muscle
- Ventricles is the trabeculae carneae
- Pecks are higher, so pectinate is in higher chambers
11) Oval foramen (foreamen ovale) … but it closes up after childhood
- Blood flows from L to R atrium (high pressure to low)
- Yes of course. This again takes blood from L to R ventricle (due to high to low pressure), and could lead to CHF
11A) Foreaman is a hole, fossa is a hollow depression. Foreaman ovale is hole shunting blood from R atrium to L atrium in fetus. It closes at birth once lungs start working to become the closed/fuzed fossa ovalis.
12) Left
- Hypertrophy from working hard being it is the L ventricle
- 2 (only two cusps on mitral valve)
13) Lub / Dub. They are the sounds of the valves closing.
- Tricuspid and Mitral valve closing
- Aortic and Pulmonary Valve closing (semi-lunar valves)
- True
14) Mitral valve
- Because of the continuous high pressure it is under
- Mitral stenosis (or narrowing / calcification)
- Narrowing of valve, so less blood getting through, so higher BP
- Caused by abnormalities of the valves (leaflets), rupture or fibrosis of a papillary muscles, or rupture of the chordae tenineae
- Aortic valve … again due to higher pressure / more blood volume
15) Systole and Diastole
- Systole: heart during contraction/pumping
- Diastole: heart at rest
Systole occurs when the heart contracts to pump blood out, and diastole occurs when the heart relaxes after contraction
- OPEN
- OPEN
16) YES
1) The pacemaker of the heart is the:
2) From start to finish, go through the conduction system of the heart (as the impulse would flow):
3) If I wanted to listen specifically to the aortic valve, where on the body would I listen?
- If I wanted to listen to the pulmonary valve, where would I listen?
- The tricuspid valve?
- Mitral valve?
4) The posterior mediastinum contains what structures:
1) SA Node
2) SA Node –> AV Node –> Internodal bundle –> Interatrial Bundle (to L atrium) –> Atrioventricular Bundle of HIS –> L and R Bundle Branch –> Purkinjie fibers –> Septomarginal trabecula
2) 2nd intercostal space R of the manubrium
- 2nd intercostal space L of the manubrium
- 5th intercostal space just L of sternum
- 5th intercostal space a few inches L of sternum (midclavicular line)
4) Esophogus, thoracic aorta, thoracic duct, nerves
1) The CNS contains what:
- T or F: Brainstem is included as part of brain?
2) In the spinal cord, is “afferent” sensory or motor?
- Is dorsal or ventral have efferent fibers
- How to remember that dorsal is sensory
- Does the wing of the gray part have efferent or afferent fibers
- Is the butterfly portion of the spinal cord gray mater or white mater?
- Does anterior or ventral spinal roots carry information to or away from the brain
- Dorsal or posterior nerve roots carry info to or from brain (CNS)
3) Is the gray mater or white mater where cell bodies / neurons reside?
- So what does the white mater consist of?
4) There are 2 hemispheres of the brain. Which side controls RIGHT sided structures / actions?
5) What are the lobes of the brain?
6) Are cranial nerves part of the CNS or PNS
7) How many spinal nerves are there
8) What is the ANS (Autonomic nervous system)
- Fight or flight is what division?
- Main neurotransmitter for sympathetic n.s.
- Main neurotransmitter for parasympathetic n.s.
- The entire purpose of the ANS (symp and parasymp) is to do what?
- Is the ANS voluntary or involuntary?
8A) Is the pre-ganglionic neuron for sympathetic system short or long?
- What is neurotransmitter for BOTH sympathetic and para at preganglionic synapse
- What is post ganglionic synapse neurotransmitter for sympathetic
- Are pre-ganglionic fibers short or long in para
- T or F: neurotransmitter for both pre and post for para is AcH
- How to remember if sympathetic is short or long pre-ganglionic fibers
9) What is the somatic nervous system
- Is this voluntary or involuntary?
10) What system is responsible for mood, emotion, aggression, fear, sexual behavior, motivation, memory, etc.
- Structures of this system include:
1) Brain and spinal cord
- True
2) Afferent is sensory, efferent is motor (e = effort/motor)
- Ventral
- DRG = dorsal root ganglion which contain the sensory fibers / nerve cells
- Afferent (wing = dorsal)
- Gray
- Away
- Towards
3) Gray
- Axons (from above) … myelinated axons / nerve fibers carrying signals up and down (ascending and descending tracts of axons)
4) Left hemisphere of the brain
5) Frontal lobe, parietal lobe, occipital lobe, temporal lobe
6) PNS
7) 31 (8 cerv, 12 thor, 5 lumb, 5 sac, 1 coccy)
8) Sympathetic and Parasympathetic
- Sympathetic
- Norepinephrine
- AcH (acetylcholine)
- MAINTAIN HOMEOSTASIS
- Involuntary
8A) Short
- AcH
- Norepinephrone
- Long
- True
- S = S (Sympathetic = Short for pre)
9) Sensory and motor nerves of the PNS that controls our muscles and movement
- Voluntary
10) Limbic system
- Fornix, amygdala, hippocampus, thalmus / hypothalamus
*** MUST KNOW
1) What are the functions of the FRONTAL lobe of the brain:
- An injury to this lobe would manifest how?
- Is Broca’s area in frontal lobe?
- Is Wernecke’s area in the frontal lobe?
- From the last 2 points, which is responsible for production of speech, which is for comprehension of speech
2) What are the functions of the PARIETAL lobe of the
brain:
- An injury to this lobe would manifest how?
3) What are the functions of the OCCIPITAL lobe of the brain:
- An injury to this lobe would manifest how?
4) What are the functions of the TEMPORAL lobe of the brain:
- An injury to this lobe would manifest how?
5) Broca’s area is what:
- What lobe is it found in:
6) Wernicke’s is what?
- What hemisphere is it typically in?
- What lobe is it in?
7) What is Homonymous Hemianopsia
- It would result from damage (ie: CVA) to which artery
- R side of brain damage results in what sided homonymous hemianopsia
1) Frontal: Movement, intellect, personality, judgement / reasoning, speech, logic, math
- Weakness, motor changes, personality changes, speech deficits, cognition deficits
- Yes (Left Frontal Lobe … or in the dominant hemisphere, so usually left side of brain).
- No - it’s in the temporal lobe
- Broca’s is for production, Wernecke’s is for comprehension
2) Parietal: Sensation, touch, kinesthesia, vibration, temperature, hearing, language
- Sensory deficits, impaired language
3) Occipital: Vision, process visual info (colors, lights, shapes)
- Visual deficits, impaired ocular muscle movement, reading and writing impairment, blindness
4) Temporal: Hearing, memory, Wernicke’s area
- Wernicke’s aphasia (receptive deficits), hearing deficits, learning deficits, difficulty with memory
5) Area responsible for speech production. Responsible for controlling the movement of the muscles of the speaking apparatus and related movements of lips, tongue, larynx, and pharynx
- Frontal
6) Area in brain responsible to understand / comprehend and produce meaningful speech (understanding language)
- Left Hemisphere
- Temporal lobe
7) Homonymous is same side. Hemi is half. Hemianopsia, or hemianopia, is a visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes. Homonymous hemianopsia (or homonymous hemianopia) is hemianopic visual field loss on the same side of both eyes.
- MCA
- Left
1) What are the meninges
- Which layer is impermeable
- How many layers … and what are they?
- What is inner most layer
- What is outer most layer
- T or F: Dura mater lines the periosteum of bone (skull)
- Which layers forms around the contours of the brain and spinal cord?
2) What is the fluid found in meninges
- Where is this fluid (from last point) found (what meningeal layers)?
3) What is the epidural space
- In the brain, is the epidural space real (actual space) or potential?
- In the spinal cord, is the epidural space real or potential?
- How to remember this (from the last 2 points)
4) How many ventricles are there in the brain?
- What are they (name them)?
- What are they?
- What connects the 3rd and 4th ventricle?
- T or F: It is in the ventricles where CSF is made?
- What is CSF made by (in what anatomical structure)?
- What pathology can happen in these ventricles?
- T or F: CSF gives cushion or buoyancy for brain?
4A) How to remember syringomyelia?
5) What is the Blood Brain Barrier (BBB)?
1) Connective tissue layers / coverings around the CNS (brain and spinal cord). They protect the brain and spinal cord from infections and foreign particles
- The arachnoid layer is impermeable
- 3 (Dura, arachnoid, pia)
- Pia
- Dura
- True
- Pia
2) Cerebrospinal fluid (CSF)
- Subarachnoid space
3) Epi - above/outer. So, place between outer dura and periosteum of skull or vertebrae.
- Potential
- Real
- Well fluid getting into the epidural space of the brain is a pathology (ie: hematoma). Whereas Dr’s place anesthesia into epidural space in spinal cord for pain control.
4) 4
- L and R lateral ventricle, 3rd ventricle, 4th ventricle
- Fluid filled cavities (filled with CSF) to protect and nourish the brain. CSF passes through them to cushion / protect brain and provide antibodies to protect brain.
- Cerebral aqueduct
- True
- Choroid plexus
- Excess fluid (CSF) causing hydrocephaly (enlargement of ventricles of brain) or syringomyelia (excess CSF in spinal cord)
- True
4A) You need a syringe to get liquid out, and mye is prefix for spinal cord
5) Responsible for the exchange of nutrients between the CNS and the vascular system. It protects the CNS (brain and spinal cord) by restricting certain molecules / toxins from crossing the barrier, while letting others in.
***** THERE WILL BE A ? ON THIS STUFF **
1) Which hemisphere (right or left) is responsible for:
1A) Language 1B) Logic, rational, analytical, mathematic, reasoning 1C) Musical, artistic, spatial relationships, imagination, creativity 1D) Hand-eye coordination 1E) Movements 1F) Nonverbal 1G) Left hand control 1H) Science and math and numbers 1I) Impulsive
1A) Left (usually ... whatever is dominant) 1B) Left 1C) Right 1D) Right 1E) Left 1F) Right 1G) Right 1H) Left 1I) Right
***** THERE WILL BE A ? ON THIS STUFF **
1) Below is a certain tract in the brain/spinal cord. You need to identify whether it is an ascending or descending tract:
a) Corticospinal:
b) Spinocerebellar:
c) Spino-olivary:
d) Vestibulospinal:
e) Spinothalamic:
f) Fasciculus cuneatus:
g) Fasciculus gracilis:
2) Now explain the function of each of these tracts:
a) Corticospinal:
b) Spinocerebellar:
c) Spino-olivary:
d) Vestibulospinal:
e) Spinothalamic:
f) Fasciculus cuneatus:
g) Fasciculus gracilis:
3) Ascending tracts (spino-cortical) are for motor or sensory?
- Descending tracts (cortico-spinal) are for motor or sensory?
4) In a cross section of the spinal cord, is the gray mater or white mater where the tracts are?
1)
a) Corticospinal: descending
b) Spinocerebellar: ascending
c) Spino-olivary: ascending
d) Vestibulospinal: descending
e) Spinothalamic: ascending
f) Fasciculus cuneatus: ascending
g) Fasciculus gracilis: ascending
2)
a) Corticospinal: motor tract responsible for ipsilateral voluntary movement
b) Spinocerebellar: Sensory tract that ascends to cerebellum for ipsilateral proprioception, tension in m’s, joint sense, posture
c) Spino-olivary: ascends to cerebellum and relays info from proprioceptive organs
d) Vestibulospinal: motor tract responsible for ipsilateral gross postural adjustements
e) Spinothalamic: Sensory tract for pain, and temp
f) Fasciculus cuneatus: sensory tract for trunk, neck, and UE sensation
g) Fasciculus gracilis: sensory tract for trunk and LE sensation
3) Sensory
- Motor
4) White
Know these terms:
1) Axon:
2) Dendrite:
2A) Terminal Branches:
2B) Synapse:
2C) Action potential:
3) Endoneurium:
3A) Perineurium:
4) Epineurium:
5) Motor unit:
6) Myelin:
- Demyelination results in what:
- Demyelination in the CNS is:
- Demyelination in the PNS is:
7) Nerve Conduction Velocity (NCV):
8) Neurons:
9) Nodes of Ranvier:
11) Saltatory Conduction:
12) Schwaan Cell:
- What is a Schwaan’s cells counterpart in the CNS
13) What are the types of cells the myelinate axons in the:
- CNS:
- PNS:
1) Axon: Part of the neuron going AWAY from the cell body (conducting impulse away from cell body)
2) Dendrite: An extension of the cell body that receives signals from other neurons (these are the projecting arms of the cell body … axon is portion going away from cell body to pass signal)
2A) Terminal Branches: These are the ends of the axon where the signal passes over to a dendrite
2B) Synapse: Junction between 2 nerve cells where signal passes
2C) The impulse or signal
3) Endoneurium: Innermost covering of a peripheral nerve that covers individual axon
3A) Perineurium: Middle layer of covering surrounding a group of axons
4) Epineurium: Outermost covering of a peripheral nerve that covers entire nerve
5) Motor unit: A single motor neuron and all the muscle fibers it innervates
6) Myelin: Coverings over axons to help propogate / speed up the conduction speed and signal. They are protiens and lipids that form to create a sheath around nerves to increase conductivity of the nerve impulse.
- Slower conduction of signal
- MS (Multiple Sclerosis)
- GBS (Guillain-Barre Syndrome)
7) Nerve Conduction Velocity (NCV): Measures speed of a nerve impulse along an axon of a nerve
8) Neurons: Nerve cells of the CNS - contain cell body, axon, dendrite
9) Nodes of Ranvier: Brief gaps in myelination of an axon; helps facilitate rapid conduction of nerve impulses so signal can jump from gap to gap
11) Saltatory Conduction: An action potential moving along an axon in a jumping fashion from node to node
12) Schwaan Cell: Myelinating cell in PNS
- Oligodendrocytes
13)
- CNS: Oligodendrocyte
- PNS: Schwann cell
MUST KNOW DIFFERENCE BETWEEN NERVE FIBERS:
1) Of all the nerve fibers, which are the noxious fibers
- What does noxious mean
2) Which are the smallest fibers?
- Are these fibers fast or slow noxious
3) Which ones are poorly myelinated, so they are slow
- Are A-delta fibers noxious
- Are A-delta fibers myelinated
4) Which fibers are largest and fastest
- Are A fibers highly myelinated?
- Are A-alpha or A-beta fibers faster
5) What are the sub-types of A fibers (list them and their function):
6) What is the purpose/function of muscle spindles?
- What is the purpose/function of golgi tendon organs
7) What is a baroreceptor
- What is the ability to evaluate weight of objects?
1) C fibers (and D, but D are faster and larger)
- PAIN
2) C fibers
- Slow
3) C fibers
- Yes (fast noxious)
- Yes
4) A fibers
- YES
- A-alpha
5)
- Alpha: muscle spindle (Ia) and golgi tendon (Ib)
- Beta: touch, pressure, vibration, kinesthesia, position
- Delta: pain, temp, fast noxious
6) Senses muscle stretch / length
- Senses muscle load
7) Senses changes in pressure
- Barognosis, or baresthesia, (to differentiate objects of different weights by holding or lifting them. It is the opposite of abaragnosis, the inability of evaluating the weight of objects).
1) What are the main UE reflexes to test, and what muscle and dermatome level does it test
2) What are the main LE reflexes to test, and what muscle and dermatome level does it test
3) Dermatome area for these:
- C1:
- C2:
- C3:
- C4:
- C5:
- C6:
- C7:
- C8:
- T1:
- L1:
- L2:
- L3:
- L4:
- L5:
- S1:
- S2:
- S3-5:
4) If there was MOTOR impairment to these areas, what m’s would be effected:
- C1:
- C2:
- C3:
- C4:
- C5:
- C6:
- C7:
- C8:
- T1:
- L1:
- L2:
- L3:
- L4:
- L5:
- S1:
- S2:
- S3-5:
1)
- Biceps: C5 (C5/6)
- Brachioradialis: C6 (C5/6)
- Triceps: C7
2)
- Quads/Patellar: L3/4
- Achilles: S1/2
3)
- C1: Vertex of skull (upper surface of head)
- C2: Temple, forehead, occiput
- C3: Neck
- C4: Top of shoulder
- C5: Lateral arm
- C6: Radial side of forearm down into thumb
- C7: Middle of forearm to middle finger(s)
- C8: Medial arm down to medial 5th digit
- T1: Inner arm
- L1: Anterior groin
- L2: Middle of thigh
- L3: Anterior thigh down to medial knee
- L4: Medial lower leg down to medial malleolus
- L5: Lateral lower leg down to dorsum of foot / big toe
- S1: Lateral and plantar side of foot
- S2: Back of lower leg / thigh
- S3-5: Saddle area
4)
- C1: None
- C2: Longus colli, SCM, rectus capitus (NOT facial m’s since those are from CN’s)
- C3: Splenius capitus
- C4: Traps, levator, scalenes (4/5/6)
- C5: Deltoid, supraspinatus, infraspinatus, biceps, rhomboids
- C6: biceps, brachioradialis, supinator, wrist extensors
- C7: Tricpes, wrist flexors, serratus, lats, pecs
- C8: Ulnar deviators, thumb extensors,
- T1: N/A
- L1: None
- L2: Psoas, hip adductors
- L3: Quads, Psoas
- L4: Quads, tib anterior, extensor hallucis, ext digitorum longus
- L5: tib ant, ext hallucis longus, perenials, glute med
- S1: calf and hamstrings
- S2: calf and hamstrings
- S3-5: bladder, rectum, pelvic floor
MUST KNOW CRANIAL NERVE’s:
1) True or False: CN’s must be in roman numerals?
2) The key is to remember the mneumonic. So, what is the mneumonic to remember what each CN is?
3) From point above, what are the CN’s
4) Now, what does each CN do (it’s function):
- Olfactory (1)
- Optic (2)
- Occulomotor (3)
- Trochlear (4)
- Trigeminal (5)
- Abducens (6)
- Facial (7)
- Acoustic / Vestibulocochlear (8)
- Glossopharyngeal (9)
- Vagus (10)
- Spinal Accessory (11)
- Hypoglossal (12)
5) For a CN screen, how would you test:
- CN V:
- CN VII:
- CN XII:
5A) Must know which CN’s are for sensory and which are for motor. What is the numonic to remember:
- What does that code mean:
- So now list each cranial nerve and what fibers it carries
5B) What is the motor aspect of the Vagus nerve (CN X)
6) What is the CN for:
- Parasympathetic to visceral organs
- SCM and Trap muscles
- Vision
- Smelling
- Facial Sensation
- Facial movements / expression
- Posterior 1/3rds of tongue taste
- Anterior 2/3rds of tongue taste
- Tongue muscle movement
- Salivation and Swallowing
- Hearing / Vestibular
- Eye movement for Lateral Rectus
- Eye Movement for 4 eye m’s
- Eye movement for sup oblique m
7) What CN will test reaction to light?
- What CN will test blink reflex
- What CN tests visual fields (ability to see)
- What CN tests downward and inward gaze
- What CN tests clenching jaw down
- What CN tests face sensation
- What CN tests tongue protrusion
- If one side of CN XII gets injured will tongue deviate towards that side or opposite?
- Balance and coordination tests what CN
- Resisting a shoulder shrug tests what CN
- Closing your eyes tight, smiling, whistling, puffing cheekcs tests what CN
- Taste on posterior 1/3rd of tongue tests what CN
- Taste on anterior 2/3rds of tongue tests what CN
- Testing gag reflex or ability to swallow tests what CN
- A lateral gaze look with eyes tests what CN
- Face sensation and clenching teeth tests what CN
8) List what each of these eye m’s do:
- Lateral rectus:
- Medial rectus:
- Superior rectus:
- Inferior rectus:
- Superior Oblique:
- Inferior Oblique:
- which one’s are innervated by Occulomotor nerve:
- which one is innervated by trochlear nerve:
- which one is innervated by abducens nerve
1) TRUE
2)
On Old Olympus Towering Top A Finn And German Viewed Some Hippos
3)
- Olfactory (1)
- Optic (2)
- Occulomotor (3)
- Trochlear (4)
- Trigeminal (5)
- Abducens (6)
- Facial (7)
- Acoustic / Vestibulocochlear (8)
- Glossopharyngeal (9)
- Vagus (10)
- Spinal Accessory (11)
- Hypoglossal (12)
4)
- Olfactory (1): Smell
- Optic (2): Vision
- Occulomotor (3): Eye movement (4 occular m’s)
- Trochlear (4): Eye movement (sup. oblique m)
- Trigeminal (5): Facial sensation, and m’s of mastication
- Abducens (6): Eye movement (lateral rectus m)
- Facial (7): Facial movement/expression, anterior 2/3’rds of taste
- Acoustic / Vestibulocochlear (8): Hearing / Vestibular
- Glossopharyngeal (9): Tounge sensation (post 1/3rd of taste, salivation, swallowing)
- Vagus (10): Parasympathetic to visceral organs
- Spinal Accessory (11): SCM and Traps
- Hypoglossal (12): Tongue Movement (tongue m’s)
5)
- CN V: Open and close jaw
- CN VII: Facial expressions
- CN XII: Stick tongue out
5A)
- Some say marry money but my brother says big brains matter more
- S = sensory, M = motor, B = both
- Olfactory (1) - sensory
- Optic (2) - sensory
- Occulomotor (3) - motor
- Trochlear (4) - motor
- Trigeminal (5) - both
- Abducens (6) - motor
- Facial (7) - both
- Acoustic / Vestibulocochlear (8) - sensory
- Glossopharyngeal (9) - both
- Vagus (10) - both
- Spinal Accessory (11) - motor
- Hypoglossal (12) - motor
5B) pharyngeal and laryngeal branches transmit motor impulses to the pharynx and larynx
6)
- Vagus (X)
- Spinal Accessory (XI)
- Optic (CN II)
- Olfactory (CN I)
- Trigeminal (CN V)
- Facial (CN VII)
- Glossopharyngeal (CN IX)
- Facial (CN VII)
- Hypoglossal (CN XII)
- Glossopharyngeal (CN IX)
- Acoustic / Vestibulocochlear (CN VIII)
- Abducens (CN VI)
- Oculomotor (CN III)
- Trochlear (CN IV)
7) CN III (Oculomotor)
- Sensory portion of V, motor portion of VII (not II or III)
- CN II (Optic)
- CN IV (Trochlear … sup oblique)
- CN V (Trigeminal)
- CN V (Trigeminal)
- CN XII (hypoglossal)
- Towards the injured side
- CN VIII (Vestibulocochlear)
- CN XI (spinal accessory)
- Facial (CN VII)
- Glossopharyngeal (CN IX)
- Facial (VII)
- Glossopharyngeal (CN IX)
- Abducens (CN VI … lateral rectus)
- Trigeminal (CN V)
8)
- Lateral deviation of eye
- Medial deviation of eye
- upward and outward
- downward and outward
- downward and inward
- upward and inward
- All others
- Trochlear: sup oblique
- Abducens: lateral rectus
1) What m’s does this nerve innervate:
- Axillary:
- Long Thoracic:
- Dorsal Scapular:
- Suprascapular:
- Subclavius:
- Musculocutaneous:
- Median:
- Ulnar:
- Radial:
- Thoracodorsal:
- Subscapular:
2) What m’s will these nerve’s innervate:
- Lumbar Plexus:
- Sacral Plexus:
- Inf. Gluteal Nerve:
- Superior Gluteal Nerve:
- Sciatic Nerve - Tibial Division:
- Sciatic Nerve - Fibular Division:
- Deep Peroneal / Fibular Nerve:
- Superficial Fibular Nerve:
- Femoral nerve:
- Obturator nerve:
- Tibial nerve:
1)
- Axillary: Deltoid and Teres minor
- Long Thoracic: Serratus Anterior
- Dorsal Scapular: Rhomboids, levator scapulae
- Suprascapular: Supraspinatus, infraspinatus
- Subclavius: Subclavian muscle
- Musculocutaneous: Biceps, brachiallis, and corachobrachialis
- Median: Wrist flexors, lateral part of hand m’s
- Ulnar: Flexor carpi ulnaris, extensor carpi ulnaris, hand intrinsics, 1/2 of flexor digitorum profundus
- Radial: Triceps, brachioradialis, supinator, anconeus, wrist extensors
- Thoracodorsal: Lats
- Subscapular: Subscapularis, and part of teres major
2)
- Lumbar Plexus: Psoas major/minor, QL
- Sacral Plexus: Piriformis, Gemelli, Obturator internus, quadratus femoris
- Inf. Gluteal Nerve: Glute max
- Superior Gluteal Nerve: glute med and min, TFL, and glute max
- Sciatic Nerve - Tibial Division: Semitendinosous, semimembranosus, biceps femoris long head
- Sciatic Nerve - Fibular Division: biceps femoris short head
- Deep Peroneal / Fibular Nerve: ant tib, extensor digitorum longus, extensor hallucis longus, fibularis tertious, extensor digitorum brevis
- Superficial Fibular Nerve: peroneal / fibular longus, and brevis
- Femoral nerve: quads, sartorius, iliacus, pectineus
- Obturator nerve: adductors longus/brevis/magnus, gracillis, obturator externis
- Tibial nerve: Gastroc, soleus, plantaris, flexor digitorum longus, flexor hallucis longus, post tib, popliteus, foot intrinsics on plantar foot (from medial and lateral plantar n. coming off of tibial n).
1) You can grade a DEEP TENDON reflex. List the various grades you can give a deep tendon reflex response:
2) If you wanted to test superficial sensations, what would you be testing for:
- If you wanted to test deep sensations, what would you be testing for:
3) Define or explain how you’d test/assess these sensation terms below:
- Barognosis:
- How to remember point above
- Deep Pain:
- Graphesthesia:
- How to remember point above
- Kinesthesia:
- Light Touch:
- Localization:
- Proprioception:
- Stereognosis:
- How to remember point above
- Superficial Pain:
- Temperature:
- Two-Point Discrimination:
- Vibration:
4) So if I could not do these things below, what would it be called (what term defines this sensation deficit):
- Can’t identify an object without sight?
- Can’t identify where a limb is in space
- Can’t identify a letter or number drawn on the hand with eyes closed
- Don’t feel anything with a squeeze to forearm or calf
- Can’t perceive different weight of objects
1)
- 0: No reflex / response
- 1+: Diminished reflexed
- 2+: Active normal reflex response
- 3+: Exaggerated response
- 4+: Hyperactive (not normal)
2) Superficial: temp, light touch, pain
- Deep: proprioception, kinesthesia, vibration
3)
- Barognosis: Perceive the weight of different objects in your hand
- BAR of weights to weight things out
- Deep Pain: Squeeze the forearm or calf
- Graphesthesia: Identify a number or letter drawn on the hand without visual input
- Draw a graph on your skin/arm
- Kinesthesia: identify direction / extent of a movement of a joint
- Light Touch: Perceive touch through light pressure (ie: cotton ball or feather)
- Localization: ability to identify the exact location of touch
- Proprioception: identify where a body part is in space (static position of an extremity in space)
- Stereognosis: identify an object without sight
- Bryan did this in class
- Superficial Pain: Perceive noxious stimulus with a pin, paper clip, toothed popsicle stick
- Temperature: Perceive warm vs. cold
- Two-Point Discrimination: Using a 2 point caliper on the skin, identify one or two points without visual input
- Vibration: Perceive vibration from a tuning fork
4)
- astereognosis
- Proprioception
- agraphesthesia
- Deep pain
- Abarognosis (NOT baresthesia, which is ability to differentiate weights)
1) What does ALS stand for:
- Other name for this condition is:
- What is ALS:
- Where does the injury/pathology take place?
- Is this demyelination or axon degeneration?
- Is there motor weakness, sensory loss, or both?
- Will there be UMN or LMN signs, or both?
- What is prognosis
- How do they eventually die
2) What does MS stand for:
- What is MS:
- Where does the injury/pathology take place?
- Is this demyelination or axon degeneration?
- Will there be UMN or LMN signs, or both?
3) What does GBS stand for:
- What is GBS:
- Where does the injury/pathology take place?
- Is this demyelination or axon degeneration?
- Will there be UMN or LMN signs, or both?
4) What is Myasthenia Gravis:
- How does it happen?
- Main s/s
5) What is Muscular Dystrophy
- Will you see this more in males or females
- Clinical presentation of MD is:
6) So, if I had LMN signs and disease process only effected PNS or peripheral nerves, I’d have which of these conditions:
- If I had UMN and LMN signs, I’d have:
- If I only had UMN signs, I’d have:
- If the signs start more distal first, I’d have:
- T or F: ALL these conditions are progressive?
- Why does GBS have a better prognosis than MS or ALS?
- What has the worst prognosis
- Will you get sensory s/s with ALS?
- Will you get sensory s/s with MS or GBS?
- How do people usually die from these conditions?
- Patients will get Paresthesias - what is that?
- Will someone with muscular dystrophy or MG lose sensory component?
7) UMN Signs are:
8) LMN Signs are:
9) So how to remember what type of atrophy belongs to UMN vs. LMN
10) Why might someone get a neuropathy:
11) What pathologies or conditions would present with UMN signs
1) ALS: Amyotrophic Lateral Sclerosis
- Lou Gehrig’s
- Upper and Lower motor neurons axon degeneration (axon gradually breaks down and dies).
- Anterior horn cell
- This is NOT demyelination (like MS or GBS where myelin sheath breaks down), ALS is just axon degeneration in CNS and in the PNS.
- Just motor (it is in anterior horn cells - so just motor) - thus sensory stays in tact.
- UMN and LMN signs since it is in CNS and PNS
- Very bad - 2-5 yrs
- Respiratory failure
2) Multiple Sclerosis (MS):
- Demyelinating disease of the CNS. So nerves loose demyelination causing slowed signal and slowed movements, processing, etc.
- In the brain and spinal cord (central nervous system).
- Demyelination. In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged.
- UMN signs
3) Guillain Barre Syndrome (GBS):
- Just like MS, but now in Peripheral Nerves (so demyelination of peripheral nerves).
- Peripheral nerves in PNS
- Both (like stated above in MS)
- LMN signs
4) Myasthenia Gravis: A nervous condition down at the Motor end plate (or NMJ). So AcH can’t get released normally at NMJ, so a contraction can’t happen.
- Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs. The name myasthenia gravis, which is Latin and Greek in origin, means “grave, or serious, muscle weakness.”
- Muscle weakness, fatigue
5) Muscular Dystrophy: Disease or wasting to the actual Muscle itself. A genetic disorder where there is an absence of dystrophin, a protein needed to build and maintain muscle mass. Without dystrophin, muscles eventually waste away. Results in muscle weakness, and eventually respiratory failure.
- X-linked recessive trait manifesting in only male offspring (females become carriers).
- Clinical presentation includes: waddling gait, proximal muscle weakness, toe walking, hypertrophy of CALF, difficulty climbing stairs. Rapid progression of disease with inability to ambulate by 10-12 yrs of age and death often in age 20’s.
6) GBS
- ALS
- MS
- GBS
- True
- Because GBS is in PNS, and those nerves can grow back. Most pt’s with GBS can’t recover and get better (where CNS pathologies pt’s can’t).
- ALS (2-5 yrs)
- NO (anterior horn cell)
- Yes
- It impacts diaphragm and they have respiratory issues
- Abnormal sensation = Numbness, tingling, can’t feel
- No (those are just in the muscle)
7)
- Spastic
- Hyperreflexia
- Hypertonic
- Disuse atrophy
- Positive Babinski’s and clonus
8)
- Flaccid
- Hyporeflexia
- Hypotonic
- Wasting atrophy
- No Babinski or clonus
- Fasciculations (Brief, spontaneous contraction or twitch in a muscle)
9) Alphabetical …. disuse atrophy vs. wasting atrophy. D is higher in alphabet so UMN, and Wasting is lower so LMN
10) Trauma, DM II, Idiopathic, Genetics, infection, inflammation, post-surgical, compression, etc.
11) Cerebral Palsy (CP), Stroke (CVA), ALS, MS, Hydrocephalus, Brain tumor
1) Define these terms:
- Akinesia:
- Dyskinesia:
- Asthenia:
- How to remember asthenia:
- Ataxia:
- Athetosis:
- Bradykinesia:
- Chorea:
- Clasp-Knife Response/RIgidity:
- This clasp knife rigidity would be graded how on modified ashworth scale
- Clonus:
- Cogwheel Rigidity:
- Dysdiadochokinesia:
- Dysmetria:
- Dystonia:
- Fasciculation:
- Hemiballism:
- Kinesthesia:
- Lead Pipe Rigidity:
- Rigidity:
- Tremor:
2) Explain difference between ballismus vs. chorea vs. athetosis
3) How are athetosis and dystonia related?
4) Difference between clasp-knife and cogwheel rigidity
- On Modified Ashworth Scale, Clasp Knife is rated a:
- On “, Cogwheel is rated a:
- On “, lead pipe rigidity is rated a:
5) What is difference between cogwheel and lead pipe rigidity:
6) What is Dysmetria
1)
- Akinesia: Inability to initiate movement / lack of movement (like in Parkinson’s disease)
- Dyskinesia: abnormal movements, uncontrolled involuntary movements
- Asthenia: Generalized weakness or lack of energy, body fatigue or tiredness
- Has NOTHING to do with asthma, but asthma can make you tired, weak, fatigued, etc.
- Ataxia: Inability to perform coordinated movements (cerebellar deficit)
- Athestosis: Involuntary slow writhing movements of limbs (not trunk). Abnormal flinging uncordinated movements caused by damage to BASAL GANGLIA. Low and high tone
- Bradykinesia: Slow movements
- Chorea: Movements that are QUICK / SUDDEN, random, and involuntary. Dance like. Think of chorea like choreograph, dance like quick sudden mvmts. From basal ganglia damage
- Clasp-Knife Response/Rigidity: Form of resistance seen during ROM of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement through the ROM (just releases).
- 1 (1+ is cogwheel, lead pipe is more 3+ or rigid)
- Clonus: UMN lesion sign where pt involuntarily has spasm contraction of a muscle (done with DF at ankle)
- Cogwheel Rigidity: Rigidity where there is jerky resistance throughout entire ROM.
- Dysdiadochokinesia: Inability to perform rapidly alternating movements (hands doing pro/supination). It’s a coordination issue, so cerebellar damage.
- Dysmetria: OVERSHOOTING/UNDERSHOOTING
- Dystonia: Closely related to athetosis; however, there is a larger AXIAL muscle involvement rather than appendicular muscles/limbs
- Fasciculation: Muscular twitch. Seen in LMN
- Hemiballism: Involuntary and VIOLENT movement of a large body part (from damage to basal ganglia)
- Kinesthesia: Ability or awareness to perceive the direction and extent of movement of a joint or body part
- Lead Pipe Rigidity: Form of stiffness/rigidity or constant resistance throughout ROM
- Rigidity: State of sever hypertonicity where a sustained muscle contraction does not allow for any movement
- Tremor: Involuntary rhythmic oscillatory movements secondary to a basal ganglia lesion.
2) They are all abnormal uncontrolled movements, but:
- Ballismus: violent (ballismic missile)
- Chorea: sudden / quick / dance-like (choreograph dance)
- Athetosis: slow writhing
3) Both are involuntary uncontrolled writhing movements, but athetosis involves limbs more where dystonia is more trunk.
4) When doing PROM, clasp knife will be jerky and then just release (like pocket knife going in). Clasp knife will be hard/rigid at start of ROM but then release at end of ROM. Cogwheel Rigidity is jerky and stiff throughout whole ROM.
- 1
- 1+
- 3+
5) Cogwheel rigidity and leadpipe rigidity are two types identified with Parkinson’s disease: Cogwheel rigidity is JERKY resistance to passive movement as muscles tense and relax. Leadpipe rigidity is SUSTAINED resistance to passive movement throughout the whole range of motion, with no fluctuations.
6) Overshooting and undershooting
1) What is the balance reflex?
- What does this reflex do?
2) What are the postural strategies (how many)
3) From point above, which is the first posture / balance strategy we use (if it is a little balance issue or perterbation, on solid ground)?
- Do m’s in this strategy fire proximal to distal or distal to proximal?
- If we sway slightly backwards, and using this 1st strategy, what m’s kick in first, then what muscle, then what muscle
- If we sway slightly forward, and using this 1st strategy, what m’s kick in first, then what muscle, then what muscle
4) If I used hip strategy (2nd one), do m’s kick on or fire proximal to distal or distal to proximal
- If I sway forward to catch myself, what is happening to my head and hips/buttocks
- If I sway forward (head goes forward, hips back), what m’s fire first, then what m’s?
- If I sway backward (head goes back, hips forward), what m’s fire first, then what m’s?
- T or F: The hips will move the same direction as the head?
5) If the perturbation or loss of balance is very small, what strategy would we use
- T or F: The greater force, loss of balance, perturbation, etc. the higher up we go in what postural strategy we use to correct or catch ourselves?
6) Another method or postural sway / balance strategy they didn’t teach in school is the suspensory strategy. What is that?
- Examples of when we use this?
7) When would we employ the stepping strategy?
8) What things factor into our balance?
1) VOR: Vestibulo-ocular reflex
- Allows for head/eye movement coordination. It allows for gaze stabilization during body movements so eyes can maintain a steady image while your head/body moves.
2) There are 5: ankle, hip, stepping, reaching, and suspensatory
3) Ankle
- Distal to proximal
- Ant tib, quads, abs
- Gastrocs, HS’s, paraspinals
4) Proximal to distal
- They go opposite to “balance” each other. Essentially we lower our COG down and have head go opposite direction of hips so as to make our COG even/balanced over our legs. If you fall back, hips go back and head goes forward (and visa versa)
- abs, quads
- paraspinals, HS’s
- False
5) Ankle
- True
6) Crouch down, do knee and hip flexion, and get COG low to the ground to avoid falling
- Skateboarding, surfing, snowboarding
7) If our COG gets way outside our BOS?
8) Vision, Vestibular, and muscles (somatosensory component)
1) What is aphasia?
- What causes it?
- What determines what type of aphasia it is?
2) What are the main 2 types of aphasia?
- Is Broca’s fluent or non-fluent aphasia?
- Another term for Broca’s aphasia?
- Why (from point above)
- T or F: With Broca’s (or non-fluent) you can comprehend just fine, just can’t produce speech
- What lobe is it found in?
- What hemisphere is it found in
3) Other term for Fluent aphasia?
- Yet another term
- Explain this aphasia
- Where is Wernicke’s area
4) So Non-Fluent aphasia is called:
- Another term for Wernicke’s aphasia
- Another term for fluent aphasia
- Another term for Broca’s aphasia
- If you can comprehend everything but can’t produce speech, you have what aphasia
- If you can’t comprehend anything but can produce speech, you have what aphasia
- Which one will you see someone get really frustrated when trying to speak?
5) What is it called if you have both Broca’s and Wernicke’s?
- Explain this aphasia:
6) What is abulic aphasia
- What artery is damaged (from CVA) in Broca’s and Wernecke’s aphasia
- What artery is damaged (from CVA) in Abulic aphasia?
1) A neurological impairment of speech.
- It is the result of some brain injury / head trauma / CVA / tumor / infection.
- The severity of the injury, location of injury, blood vessels involved or effected.
2) Fluent and Non-Fluent
- Non-fluent
- Non fluent, or expressive aphasia
- Broca’s area is responsible for production of speech (actual movement of m’s and through to create speech sound). So when this area can’t work, you are NOT fluent.
- True
- Frontal Lobe
- Left (in the dominant hemisphere, so usually left side of brain).
3) Wernicke’s Aphasia
- Receptive aphasia
- Word output and speech production is fine, but not able to comprehend. Just rambling jargon non-sense. Speech lacks substance
- L side of brain in temporal lobe (usually L side … dominant side)
4) Broca’s
- Receptive aphasia
- Wernicke’s
- Expressive aphasia
- Broca’s (or expressive aphasia)
- Wernicke’s (receptive aphasia)
- Broca’s … because they can comprehend everything, just can’t talk right so it is frustrating.
5) Global aphasia
- It impacts receptive and expressive abilities (so Broca’s and Wernicke’s)
6) Mutism, social issues
- MCA
- ACA
1) What is the official term for a stroke
- What is a stroke
2) What are primary risk factors for getting a stroke
3) What are secondary risk factors for getting a stroke
4) What is a TIA
- How is this different from a stroke
- Do both have F.A.S.T. symptoms?
- Do both have vision and speech problems
- What medication would be given to treat TIA’s
4A) What is a complete stroke:
- A right brained stroke presents with symptoms on what side of the body?
- What is a “stroke in evolution”
5) Define these terms:
- Embolus:
- Thrombus:
- Hemmorage:
- Infarction:
- Occlusion:
6) Difference between infarction and occlusion:
7) Difference between embolus and thrombus:
1) CVA: Cerebrovascular Accident
- An ischemic event where not enough blood (Oxygen) gets to a portion of the brain as a result of ischemia or hemmorrhage.
2)
- HTN
- Cardiac disease (Atherosclerosis, arrythmias)
- DM II
- SMoking
- MI
3)
- Obesity
- Surgery
- High cholesterol
- Stress
- Lack of exercises
- Alcohol consumption
4) Transient Ischemic Attack. A TIA is a mini-stroke, without (sometimes) any major effects. A TIA is a small clot that lead to interruption of blood flow to brain. TIA’s don’t cause permanent damage, but indicates future risk of a stroke.
- Symptoms resolve quickly (within 24-48 hours)
- Yes
- Both have vision and speech problems, but again, if they resolve quickly = TIA
- Blood thinners / thrombolytics
4A) A CVA that presents with total neurological deficits at the onset.
- Opposite side (left)
- A CVA caused by a thrombus that gradually progresses. Neurological deficits are not seen for one or two days after onset.
5)
- Embolus: A solid, liquid, or gaseous blood formation that travels throughout bloodstream to cerebral arteries causing an occlusion of a blood vessel (and then infarction).
- Thrombus: Atherosclerotic plaque or blood clot that blocks an artery causing occlusion or eventually an infarct (tissue death).
- Hemmorage: Abnormal bleeding in the brain due to rupture of a blood vessel. No Oxygen gets to brain tissue distal to hemmorage, and excess blood pooling causing pressure / damage to brain tissue.
- Infarction: obstruction of the blood supply to an organ or region of tissue, typically by a thrombus or embolus, causing local death of the tissue.
- Occlusion: the blockage or closing of a blood vessel or hollow organ.
6) Infarction is tissue death (necrosis) due to inadequate blood supply to the affected area. It may be caused by artery blockages, rupture, mechanical compression. Occlusion is just a vessel that is being blocked somehow.
7) An embolus is a thrombus (blood clot) that travels to distant site.
1) What is a synergy pattern
2) Generally - flexion synergy pattern is the limb / joint / body part moving into flexion. The extension synergy pattern is the limb / joint / body part moving into extension. BUT … list the flexion synergy pattern for:
- Toes:
- Ankle:
- Hip:
- Forearm:
- Shoulder:
What is the Extension synergy pattern for:
- Toes:
- Ankle:
- Hip:
- Forearm:
- Shoulder:
3) T or F: Synergy patterns happen after someone has a stroke/CVA
- The strange movement in both flexion and extension synergy patterns happens where (and why)
1) After someone has a CVA, the higher centers of their brain are damaged. These higher centers are responsible for complex motor patterns - so when those higher centers are damaged, the brain can’t control gross motor patterns. Some patients lose independent control of selected muscle groups, resulting in coupled joint movements that are often inappropriate for the desired task
2)
- Toes: Extension
- Ankle: DF and Inversion
- Hip: Flex, Abd and ER
- Forearm: Supination (remember cause bicep flexes and does supination)
- Shoulder: Flex, Abd and ER
(If other joint isn’t listed, assume it is in flex)
- Toes: Toes flex
- Ankle: PF and inversion
- Hip: Ext, IR, Add
- Forearm: Pronation
- Shoulder: Ext, IR and Add
(If other joint isn’t listed, assume it is in ext)
3) TRUE
- Toes (flexion synergy pattern has toes extend, and extension synergy pattern has toes flex)
1) Explain difference between Motor Control and Motor Learning:
2) Briefly explain the history and development of thought for motor control:
3) What is the 3 stage model of motor learning:
3A) Feedback is needed more when you are learning a new motor task, so what stage(s) is feedback needed more?
- If learning a really hard task, how frequently should feedback of performance be:
- If learning a simple task, how frequently should feedback of performance be:
4) Feedback is imperative for motor learning. Feedback allows for motor learning. Define these forms of feedback (for motor learning):
- Intrinsic feedback:
- Extrinsic feedback:
- Knowledge of Results:
- Knowledge of Performance:
- Inherent feedback is intrinsic or extrinsic feedback?
5) Practice refers to the repeated performance of a movement/task in order to learn and improve and acquire a skill. Define these terms related to practice:
- Mental Practice:
- Massed Practice:
- Distributed Practice:
- Constant Practice:
- Variable Practice:
- Random Practice:
- Blocked Practice:
6) Define these motor learning terms:
- NDT:
- Fascilitation:
- Inhibition:
1)
- Motor Control: Study of movement or ability to regulate movement
- Motor Learning: Study of the acquisition or modification of movement. It utilizes different forms of feedback, practice strategies, and transfer of learning to different environments to learn (or re-learn) motor movement.
2) It used to be thought that motor control was a reflex or heiarchachal where the cortex was perceived as the highest functioning system, and the spinal cord was just reflexive / responsive. New models were then developed to challenge these theories and now we know the cortex is not solely responsible for all motor movement.
3)
- Cognitive Stage: Initial stage. Conscious processing. Acquire info. A controlled environment is best for this stage. Needs external feedback for correction / improvement.
- Associative Stage: Intermediate stage. Moves from conscious thought to trial and error action. This is where one practices. Relies less on feedback, and more on practice (trial and error), and intrinsic learning/feedback.
- Autonomous Stage: Final stage of transitioning to a SKILLED movement. Person makes movement AUTOMATIC and is SKILLED, and no real need to conscious / cognitive processing to perform action. It becomes an automatic response.
- Expert stage:
3A) More in cognitive stage, and then some (but less) in associative
- Every 5 or so repetitions
- Every 15-20 repetitions
4)
- Intrinsic feedback: Your own internal feedback. Visual, vestibular, sensory, proprioceptive, somatosensory, self talk, etc.
- Extrinsic feedback: Feedback from others or environment (verbal feedback from others)
- Knowledge of Results: Feedback on the overall outcome / result. Result is at the END
- Knowledge of Performance: Feedback regarding the specific actual movement / task (not the entire thing)
- Intrinsic
5)
- Mental Practice: Cognitive rehearsal of a task or experience without any physical movement
- Massed Practice: The practice time in a trial is greater than the amount of rest between trials. LITTLE REST BREAKS
- Distributed Practice: The amount of rest time between trials is equal to or is greater than the amount of practice time for each trial. LARGER REST BREAKS
- Constant Practice: Practice of a task under a uniform condition
- Variable Practice: Practice of a task under differing conditions
- Random Practice: Varying practice amongst different tasks
- Blocked Practice: Consistent practice of a single task.
6)
- NDT: Neuromuscular developmental treatment. This is a hands-on treatment approach where experience in movement ensures that a particular pattern is readily accessible for motor performance. It is a form of motor learning to help someone develop motor control.
- Facilitation: A technique used to elicit voluntary muscular contraction.
- Inhibition: A technique utilized to decrease excessive tone or abnormal movement patterns.
A therapist can use an NDT approach / technique of manual contacts to decrease abnormal tonal movements, or facilitate certain movements to accomplish therapeutic goals.
1) What is the Brunnstrom stages of motor recovery (what is it for):
- How to remember that:
- How many stages?
- What are the stages?
1A) Spasticity starts at what stage?
- Spasticity ends at what stage?
- HEIGHT of spasticity is what stage?
2) What does PNF stand for
- What is PNF
3) What is the Developmental Sequence
- What are the example stages
- What are the main stages of the developmental sequence
4) There are certain keys to ensuring you do PNF right. What are they:
5) For UE, what motions is D1:
- For UE, what motions is D2:
6)
- For D1 UE, what are the specific shoulder, elbow, wrist motions performed?
- For D2 UE, what are the specific shoulder, elbow, wrist motions performed?
6A) T or F: With D1, for UE and LE, your extremity starts OUT (abduction). With D2, extremity starts IN (adduction)?
- T or F: with UE D1 and D2 you start UP
7)
- For D1 LE, what are the specific hip, knee, ankle motions performed?
- For D2 LE, what are the specific hip, knee, ankle motions performed?
8) Besides the UE and LE, what other PNF patterns are there?
1) These are stages of progression following a CVA
- BrUNden couldn’t say name right, like stroke pt’s struggle speaking
- 7
- Stage 1: Flaccid, no volitional movement
- Stage 2: Limb synergies (flexion or extension pattern). A little spasticity.
- Stage 3: Spasticity increases (height of spasticity)
- Stage 4: Spasticity begins to decrease, movement is not as much synergies
- Stage 5: More control of movement, less spasticity (or digression/disappearance of spasticity)
- Stage 6: Joint movements with some coordination (selective control). NO SPASTICITY!
- Stage 7: NORMAL motor function / coordinated movement
1A) Stage 2
- Stage 6 it is gone
- Stage 3
2) Proprioceptive Neuromuscular Fascilitation
- Therapists uses specific hand holds to help restore normal function / movement. Either used as a stretch technique to get greater flexibility (contract relax), or for neuro pt’s to help strengthen weaker muscle groups
3) A progression of motor skill acquisition - progressing through more advanced movements as you develop (as a child, or in motor re-learning after brain damage, or after an amputation or neuro injury)
- Fetal, prone on elbows, roll over, quadruped, sitting, crawl, tall kneel, half kneel, pull to stand, cruise, stand, walk, run, jump
- Immobility, Mobility, Stability, Controlled mobility, Skill … (Initial random uncontrolled movements (mobility) are followed by maintenance of a posture (stability), then movement within a posture (controlled mobility), and finally, movement from one posture to another posture (skill).
4)
- Work in diagonal movements
- Give quick stretch to initiate mvmt
- Resistance given during movement pattern
- Follow developmental sequence (progress through stages of motor control)
5) D1: NOT draw the sword … hand down to same side and goes up to opposite side.
- D2: Draw the sword (hand down at opposite hip and goes up to same side)
6)
- D1:
START:
- Shoulder: IR, Ext, Abd
- Elbow: Ext, Pronation
- Wrist: Ext
- Fingers: Ext
END:
- Shoulder: ER, Flex, Add
- Elbow: Flex, Supination
- Wrist: Flex
- Fingers: Flex
- D2:
START:
- Shoulder: IR, Ext, Add
- Elbow: Flex, Pronation
- Wrist: Flex
- Fingers: Flex
END:
- Shoulder: ER, Flex, Abd
- Elbow: Ext, Supination
- Wrist: Ext
- Fingers: Ext
6A) TRUE
- False, you start D1 and D2 DOWN
7)
- D1:
START:
- Hip: IR, Abd, Ext
- Knee: Ext
- Ankle: PF
END:
- Hip: ER, Add, Flex
- Knee: Flex
- Ankle: DF
- D2:
START:
- Hip: ER, Ext, Add
- Knee: Ext
- Ankle: PF
END:
- Hip: IR, Flex, Abd
- Knee: Flex
- Ankle: DF
8) Pelvis and Scapula
*** KEY NEURO TERMINOLOGY … KNOW THESE TERMS:
1)
- Agnosia:
- Agraphesthesia:
- Agraphia:
- So “graph” must mean:
- Anosognosia:
- Aphasia:
- Apraxia:
- Ataxia:
- Astereognosis:
- Body Schema:
- Decerebrate Rigidity:
- Decorticate Rigidity:
- Diplopia:
- Dysarthria:
- Dysphagia:
- Dysprosody:
- Dys vs. A prefix
- Emotional Lability:
- Hemiparesis:
- Hemiplegia:
- Homonymous Hemianopsia:
- Neologism:
- Perseveration:
- Synergy:
- Unilateral Neglect:
2) ** These are the one’s you need to review over and over:
- Neologism:
- Dysprosody:
- Anosognosia:
- Agnosia:
- What artery is impacted if someone has Homonymous Hemianopsia:
- Agnosia: The inability to interpret information or identify things/objects (even people) (it’s GONE)
- Agraphesthesia: The inability to recognize symbols, letters, shapes, or numbers traced on the skin.
- Agraphia: The inability to write due to a lesion in the brain. Usually this deficit is found in people with aphasia
- Graph: write
- Anosognosia: The denial or unawareness of one’s illness (usually in someone with unilateral neglect - could be physical or mental ilness)
- Aphasia: Speech impairment - loss of ability to understand or express speech, caused by brain damage.
- Apraxia: Inability to carry out a familiar purposeful movement (can’t do the movement) due to brain damage. You can’t even process or try to do movement.
- Ataxia they can carry out the movement with little coordination. So you try to do the movement, but it’s uncoordinated.
- Astereognosis: Inability to recognize objects by the sense of touch when vision occluded (Brian reaching hand in bag for a COMB).
- Body Schema: Having an understanding of the body as a whole and the relationship of its parts to the whole.
- Decerebrate Rigidity: A characteristic of a corticospinal lesion at the level of the brainstem that results in EXTENSION of the trunk and ALL extremities (dEcErEbratE).
- Decorticate Rigidity: A characteristic of a corticospinal lesion at the level of the diencephalon where the trunk and LE’s are in extension, but UE’s are positioned in flexion. LOOKS LIKE kangaroo or T-rex arms with straight body and legs.
- Diplopia: Double vision
- Dysarthria: Slurred and impaired speech due to motor deficit of the tongue or other facial m’s necessary for speech
- Dysphagia: Inability to swallow properly
- Dysprosody: Impairment in the rhythm and inflection of speech
- Dys is dysfunctional whereas A is CAN’T
- Emotional Lability: A characteristic of a right hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation
- Hemiparesis: A condition of weakness of one side of the body
- Hemiplegia: A condition of paralysis on one side of the body
- Homonymous Hemianopsia: The loss of the right or left half of the field of vision in both eyes. From damage to MCA
- Neologism: a newly coined word or expression. (loggoria)
- Perseveration: The state of repeatedly performing the same segment of a task or repeatedly saying the same word/phrase without purpose.
- Synergy: Mass movement patterns that are primitive in nature and coupled with spasticity due to brain damage
- Unilateral Neglect: The inability to interpret stimuli and events on the contralateral side of a hemispheric lesion. Left-sided neglect is most common with a lesion to the right inferior parietal or superior temporal lobes.
2)
- Neologism: a newly coined word or expression. (loggoria)
- Dysprosody: Impairment in the rhythm and inflection of speech
- Anosognosia: The denial or unawareness of one’s illness (usually in someone with unilateral neglect - could be physical or mental ilness)
- Agnosia: The inability to interpret information or identify things/objects (even people) (it’s GONE)
- MCA
1) What is a “complete” spinal cord injury
- What is an “incomplete” spinal cord injury
1A) Do the ascending tracts in the spinal cord do motor or sensory?
- Do descending tracts do motor or sensory?
1B) Now, imagine an axial cutout of a spinal cord so you can see all the tracts … what is the main big tract in the posterior section of the spinal cord:
- Does this tract (from above) do pain and temp?
- Where are pain and temp running through?
- There are 2 main sections in the DCML … what are they
- What do these 2 main sections do:
- So spinothalamic tract is mainly for what:
1C) What are the main tracts on the very outside/lateral part of the spinal cord
- Is this an ascending or descending tract?
- What is it’s purpose?
1D) What is the main motor tract?
- Is this an ascending or descending tract?
- Where is it located?
- What is it’s purpose?
1E) The spinothalamic tract - is it sensory or motor?
- Ascending or descending?
- How can you know if it is ascending or descending
- What is the function of this tract?
1F) What is purpose of vestibulospinal tract
- What is purpose of tectospinal tract?
2) Know and define these specific spinal cord lesion types:
- Anterior Cord Syndrome:
- What part/section is damaged:
- How does this injury usually happen:
- What are s/s:
- Are these complete or incomplete:
- Brown-Sequard’s Syndrome:
- What part/section is damaged:
- How does this injury usually happen:
- What are s/s:
- Are these complete or incomplete:
- Cauda Equina Injury:
- What part/section is damaged:
- What are s/s:
- Are these complete or incomplete:
- Is this a CNS or PNS injury? - Central Cord Syndrome:
- What part/section is damaged:
- How does this injury usually happen:
- What are s/s:
- Are these complete or incomplete: - Posterior Cord Syndrome:
- What part/section is damaged:
- How does this injury usually happen:
- What are s/s:
- Will they lose motor function?
3) What is the ASIA impairment scale
- What are the levels / grades you can get from this test?
- From point above, what do each mean:
4) What is “neurologic level” in this ASIA scale:
- What is motor level:
- What is sensory level:
- What is motor index scoring:
5) When performing the ASIA, are there specific spots you have to test sensation?
- When testing muscle strength, what would you test for the ASIA to determine C5 level
- What would you test (for m’s) for C6
- “ C7
- “ C8
- “ T1
- “ L1/2
- “ L3
- “ L4
- “ L5
- “ S1/2
1) A lesion to the spinal cord where there is no preserved motor or sensory function below the level of the lesion. And no sacral sparing.
- A lesion to the spinal cord with incomplete damage to the cord. There may be scattered motor function, sensory function, or both below the level of the lesion. Sacral sparing.
1A) Ascending: Sensory
- Descending: Motor
1B) DCML (Dorsal column medial lemniscus). The dorsal column–medial lemniscus pathway (DCML) (also known as the posterior column-medial lemniscus pathway (PCML)) is a sensory pathway of the central nervous system that conveys sensations of fine touch, vibration, two-point discrimination, and proprioception (position) from the skin and joints.
- No
- Anterolateral spinothalamic tract
- Fasciculus Gracilis and Fasciculus Cuneatus
- Gracilis: tactile and proprioceptive info from the LOWER half of the body (lower trunk and LE’s)
- Cuneatus: tactile and proprioceptive info from UE’s and torso
- Pain and Temp
1C) Spinocerebellar
- Ascending
- Carries information from Golgi tendon organs and muscle spindles UP to the cerebellum for the coordination, posture of movements.
1D) Corticospinal tract
- Descending
- One area is in the mid lateral section, another is anterior middle section.
- Carry motor signals from brain to m’s to control movement of ipsilateral limbs and trunk
1E) Sensory
- Ascending
- If it is spino-thalamic, it starts in spine and goes up to thalamus. If it is cortico-spinal, starts in cortex and goes down to spinal cord.
- Transmit pain, temp, touch up to somatosensory portion of the thalamus
1F) Vestibulospinal: A reflex or response to maintain balance/equilibratory as a result of input of the vestibular apparatus.
- Tectospinal: Coordinates head and eye movements.
2)
- Anterior Cord Syndrome:
- Compression/Damage to anterior part of cord and
anterior spinal artery.
- Typically from cervical flexion
- Loss of motor function, pain, temp
- Incomplete
- Brown-Sequard’s Syndrome:
- What part/section is damaged: One half (either side)
- How does this injury usually happen: Stab wound
- What are s/s: Loss of vibration and position on same
side, loss of pain/temp on contralateral side.
- Incomplete
- Cauda Equina Injury:
- What part/section is damaged: Injury BELOW L1
- What are s/s: flaccid, areflexia, impaired bowel and
bladder function, LE’s, LMN
- Are these complete or incomplete: Could be
complete, but usually incomplete
- PNS, after L1/2 these are spinal nerves so peripheral
nerves
- Central Cord Syndrome:
- What part/section is damaged: Central part of spinal
cord damaged / compressed
- How does this injury usually happen:
Cervical Hyperextension
- What are s/s: UE’s effected more than LE’s and
motor deficits more than sensory
- Incomplete
- Posterior Cord Syndrome:
- What part/section is damaged: Posterior section of
spinal cord is damaged / compressed and posterior
spinal artery.
- How does this injury usually happen:
- What are s/s: Loss of pain, proprioception, 2 point
discrimination, and stereognosis.
- No
3) ASIA: American Spinal Injury Association. It is a specific objective test to determine if someone has a complete or incomplete spinal cord injury, and what level of SCI.
- A, B, C, D, E
- A: Complete - no sensory or motor function preserved below level, and sacral S4-5 has no feeling (no sacral sparing).
- B: Sensory Incomplete - Sensory is preserved partially below level of lesion, but no motor function below neurologic level
- C: Motor Incomplete - Some motor function below neurologic level, most key muscle groups have a muscle grade of 3 or less
- D: Motor Incomplete - Some motor function below neurologic level, most key muscle groups have a muscle grade of 3 or more.
- E: Normal - Sensory and motor functions are normal
4) The lowest level where both sensory and motor function is preserved
- Motor level: Most caudal segment/level where m’s have a MMT of 3 or greater, and the level above is a 5/5
- Sensory level: Most caudal dermatome with a normal score (2/2) for pinprick and light touch.
- Motor index scoring: Testing each key muscle using the 0-5 MMT scoring, with a total of 25 per extremity and a total possible score of 100
5) yes. They are called “key sensory points.” And there is a specific spot for each dermatome level.
- C5: Biceps flexion
- C6: Wrist extensors
- C7: Triceps (elbow extensors)
- C8: Finger flexion
- T1: Finger abduction
- L1/2: Hip Flexors
- L3: Quads
- L4: Ankle DF’s
- L5: Big Toe Ext
- S1/2: Calf
1) If someone had a COMPLETE C4 spinal cord injury, determine what level of assistance they would need for the activity below:
- Bed mobility:
- Transfers:
- Weight Shift:
- Wheelchair Management:
- Wheelchair Mobility:
- ROM / Positioning:
C5:
- Bed mobility:
- Transfers:
- Weight Shift:
- Wheelchair Management:
- Wheelchair Mobility:
- ROM / Positioning:
C6:
- Bed mobility:
- Transfers:
- Weight Shift:
- Wheelchair Management:
- Wheelchair Mobility:
- ROM / Positioning:
C7-8:
- Bed mobility:
- Transfers:
- Weight Shift:
- Wheelchair Management:
- Wheelchair Mobility:
- ROM / Positioning:
Paraplegia:
- Bed mobility:
- Transfers:
- Weight Shift:
- Wheelchair Management:
- Wheelchair Mobility:
- ROM / Positioning:
1) C4: - Bed mobility: Dependent - Transfers: Dependent - Weight Shift: Can use a power recliner wheelchair - tilt chair - (otherwise dependent) - Wheelchair Management: Dependent - Wheelchair Mobility: Supervision to mod ind - ROM / Positioning: Dependent
C5:
- Bed mobility: Mod to max assist
- Transfers: max assist w/ slide board
- Weight Shift: Can use a power recliner wheelchair - tilt chair - (otherwise dependent)
- Wheelchair Management: Dependent
- Wheelchair Mobility: mod ind
- ROM / Positioning: Dependent
C6:
- Bed mobility: Min assist
- Transfers: Min assist w/ slide board
- Weight Shift: Mod ind
- Wheelchair Management: Min assist
- Wheelchair Mobility: Mod ind
- ROM / Positioning: Mod assist
C7-8:
- Bed mobility: Independent
- Transfers: Mod ind
- Weight Shift: Mod ind
- Wheelchair Management: Some asst req’d
- Wheelchair Mobility: Mod ind
- ROM / Positioning: Min assist
Paraplegia:
- Bed mobility: Ind
- Transfers: Ind
- Weight Shift: Mod ind
- Wheelchair Management: Ind
- Wheelchair Mobility: Ind (unless uneven surface or uphill)
- ROM / Positioning: Ind
1) What are some potential complications that can come from a spinal cord injury:
2) From the point above, answer the questions below about these conditions:
- Autonomic Dysreflexia:
- What is it:
- Above/Below what level of SCI:
- s/s:
- Causes:
- Fixes:
- With autonomic dysreflexia, you’d obviously check their BP, but FIRST thing you’d do is:
- Then after you have done that (from point above), more often than not the noxious stimulus is what:
- Orthostatic hypotension:
- What is it:
- s/s:
- Causes:
- Fixes:
- Pressure Ulcers:
- What is it:
- s/s:
- Causes:
- Fixes:
- Spasticity:
- What is it:
- s/s:
- Causes:
- Fixes:
- DVT - Deep Vein Thrombosis:
- What is it:
- s/s:
- Causes:
- Fixes:
- Special test to rule in:
- Diagnostic tool to rule in:
- Ectopic Bone:
- Other name for this:
- What is it:
- s/s:
- Causes:
- Fixes:
1)
- Autonomic Dysreflexia
- Spinal Shock
- Orthostatic Hypotension
- Pressure Ulcers
- Spasticity
- Contractures
- Incontinence
- DVT: Deep Vein Thrombosis
- Ectopic Bone
- Psychological, emotional, sexual, social
2)
- Autonomic Dysreflexia:
- What is it: Common complication for a SCI pt where
some noxious stimulus below SCI level creates pain
(which pt can’t feel), it triggers the ANS to set off. If
not treated, pt can go into convulsions, hemmorage,
death. - Above/Below what level of SCI: Above T6
- s/s: so blood pressure spikes, sweating, HR
DEcreases, HA’s, blurry vision, goose bumps / cold
below and warm/flush above level, etc. - Causes: kink in catheter, sitting on something, full
bladder or UTI, tight clothing, ingrown toenail, ulcer,
extreme temp. change, etc. - Fixes: Fix whatever it is setting it off (quickly, it is a
medical emergency)
- What is it: Common complication for a SCI pt where
- SIT THEM UP! ***
- Some issue with their catheter, so check that.
- Orthostatic hypotension:
- What is it: Decrease in Blood Pressure as a result of
changing positions (more than 20mmHg in systolic, or
10mmHg in diastolic) - s/s: dizzy, lightheaded, nausea, blacking out
- Causes: Changes in position (too quickly)
- Fixes: Monitor vitals (especially BP). Use elastic
stockings (ACE wrap or abdominal binding), move
positions slower
- What is it: Decrease in Blood Pressure as a result of
- Pressure Ulcers:
- What is it: Because SCI pt’s lose sensation and motor
control, they can’t feel wounds, and can’t reposition
themselves to offload and weight shift. This develops
pressure ulcer, or skin breakdown. - s/s: skin breakdown, blanching, open wound
- Causes: Sustained pressure of a bony prominence on
skin over time. Friction or shearing force on skin. - Fixes: Change positions, tilt table, prop w/
pillows/cushion, nutrition and hydration, surgery if
necessary, wound mngmt
- What is it: Because SCI pt’s lose sensation and motor
- Spasticity:
- What is it: Hypertonic m’s
- s/s:
- Causes: SCI, brain injury, stress, UTI, bladder / catheter
obstruction, touch - Fixes: Meds, stretch, pool therapy, weight bearing,
estim, splints/casting/orthodic, standing frame,
surgery
- DVT - Deep Vein Thrombosis:
- What is it: Formation of blood clot in lower leg and
becomes an embolus. Pt’s with SCI’s are at a greater
risk since they don’t move LE’s to pump blood back to
heart. - s/s: Leg pain, edema in LE’s, positive Homan’s sign,
warmth in area - Causes: Inability to move due to SCI
- Fixes: Anticoagulant meds, PROM muscle contraction,
ankle pumps
- Homan’s
- Doppler
- What is it: Formation of blood clot in lower leg and
- Ectopic Bone:
- Other name: Heterotopic ossification
- What is it: Spontaneous formation of bone in the soft
tissue. Usually happens by a joint (like the knees or
hips) . - s/s: Pain, edema, decreased ROM
- Causes: Abnormal calcium buildup
- Fixes: Meds, PT to restore ROM and function
IMPORTANT SCI terminology:
- Cauda Equina Injury:
- Dermatome:
- Myelotomy:
- Myotome:
- Neurectomy:
- Neurogenic Reflexive Bladder:
- Neurologic Level:
- Paraplegia:
- Sacral Sparing:
- Spinal Shock:
- Tenodesis:
- Tenotomy:
- Tetraplegia (Quadraplegia):
- Zone of Preservation:
2) A cauda equina injury happens below what level?
- Will this injury present with UMN or LMN signs?
- Is Sacral sparing complete or incomplete SCI
- What is Spinal Shock:
- Tenodesis grasp is important to teach people with what level of SCI
- Explain difference of a neuroectomy, tenotomy, and myelotomy
- Cauda Equina Injury: Term to describe injuries below L1, so LMN signs or LMN lesion
- Dermatome: Area of skin innervated by a spinal level
- Myelotomy: Surgical procedure that severes (cuts) certain spinal tracts within the spinal cord in order to decrease spasticity (to improve function)
- Myotome: Area of muscle innervation by a spinal level
- Neurectomy: Surgical removal of a segment of a nerve in order to decrease spasticity (to improve function)
- Neurogenic Reflexive Bladder: The bladder empties reflexively for a pt with an injury above the T12 area. So the sacral arc remains intact.
- Neurologic Level: Lowest segment of the spinal cord with intact strength and sensation. Muscle groups must receive a “fair” grade (or 3/5 with a 5/5 at level above).
- Paraplegia: A term used to describe injuries that occur at the level of the thoracic region or below (so only LE’s impacted)
- Sacral Sparing: An INCOMPLETE SCI/lesion where some of the innermost tracts remain innervated. If you have sacral sparing, you still have saddle region sensation, and pelvic floor / sphincter muscle control.
- Spinal Shock: A physiologic response that occurs 30-60 mins after trauma to the spinal cord and can last up to several weeks. It presents with total flaccidity and areflexia below level of lesion.
- Tenodesis: Pt’s with tetraplegia that have no motor control of for grasping objects with UE can develop a tenodesis grip. They have tight finger flexors (which they can’t move) and can extend wrist to form a grasp (since they have C6). You want them in elbow ext, wrist ext, and finger flexion (so they can grip things via finger flexion). If you have C6 you can do it
- Tenotomy: Surgical release of a tendon in order to decrease spasticity
- Tetraplegia (Quadraplegia): Term used by ASIA to describe injuries that occur at the level of the c-spine
- Zone of Preservation: A term used to describe poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury
2) L1 (where spinal cord ends)
- LMN … peripheral nerves
- Incomplete
- Shock spinal cord goes into following trauma, where inflammation causes paralysis and areflexia below lesion.
- C6/7
- All are surgical proceedures to reduce spasticity. Teno is release of a tendon, neuro is severe a nerve, and myelo is getting rid of a spinal tract.
** WILL BE A ? ON GLASGOW COMA SCALE and RANCHO LEVELS*
1) What is the Glasgow Coma Scale
- What is range of scores for this scale
- A higher score is better or worse
2) So what are the ranges for the Glasgow Coma Scale, and what do they mean:
3) What is tested / assessed during a Glasgow Coma Scale assessment
4) What is the Rancho Los Amigos Levels of Cognitive Functioning:
- How many Rancho levels are there?
5) Explain each of the Rancho Levels:
1) Way to quantify the extent of a TBI (traumatic brain injury) based on s/s
- 3-15
- Better
2)
- 8 or less = coma
- 9-12: moderate brain injury
- 13-15: mild brain injury
3)
- Eye Opening ability (spontaneous = 4, to speech = 3, to pain = 2, no eye opening = 1)
- Motor Response (obeys commands = 6, localized pain = 5, withdraws = 4, abnormal flexion = 3, extensor response = 2, nothing = 1)
- Verbal Response (oriented = 5, confused conversation = 4, inappropriate words = 3, incomprehensible sounds = 2, nothing = 1)
4) Tool used to rate how people with brain injury are recovering. … Each level describes a general pattern of recovery, with a focus on cognition and behavior.
- 8
5)
- Level I: No response (deep sleep and totally unresponsive to stimuli)
- Level 2: Generalized Response (pt reacts inconsistently and non-purposefully to stimuli. Regardless of stimuli, response is same … response could be abnormal mvmt or vocalization or physiologic response)
- Level 3: Localized Response (pt reacts specifically to local stimuli, and relate to stimulus provided. They will follow simple commands, but delayed).
- Level 4: Confused-Agitated (pt is in a heightened state of anxiousness, frustration, confusion. Has bizarre behavior, lacks attention abilities, no memory, easily agitated)
- Level 5: Confused -INAppropriate (pt is still confused, but not as hostile or agitated now. Has better attention, but easily distracted. Needs to focus on specific task. Can somewhat converse/socialize for short period. Learning is still hard. Very little carry over of info learned. VERY INAPPROPRIATE CONVERSATION / COMMENTS)
- Level 6: Confused - Appropriate (Pt has better behavior, but still needs some direction. Shows some carryover from previously learned info. Still has memory issues, but are appropriate.
- Level 7: Automatic-Appropriate (Pt appears appropriate and oriented and not confused. Goes through daily routine normally but robotically. Starting to recall and carryover learning. More social, but judgement a little impaired).
- Level 8: Purposeful - Appropriate (Pt is normal again. Abel to remember/recall, responsive to environment, doesn’t need supervision)
KNOW DEVELOPMENTAL MILESTONES:
Explain what child can do at these stages and in these positions:
1) For Newborn - 1 month:
- Prone:
- Supine:
- Sitting:
- Fine Motor:
2) 2 - 3 months:
- Prone:
- Supine:
- Sitting:
- Fine Motor:
3) 4-5 months:
- Prone:
- Supine:
- Sitting:
- Standing:
- Fine Motor:
4) 6-7 months:
- Prone:
- Supine:
- Sitting:
- Standing:
- Fine Motor:
5) 8-9 months:
- Prone:
- Supine:
- Sitting:
- Standing:
- Fine Motor:
6) 10-12 months:
- Standing:
- Mobility:
- Fine Motor:
7) 12-15 months:
- Standing:
- Mobility:
- Fine Motor:
8) 16-24 months:
- Gross Motor:
- Fine Motor:
9) 2 years:
- Gross Motor:
- Fine Motor:
10) 3-5 yrs (Preschool):
- Gross Motor:
- Fine Motor:
11) 5-8 yrs (Early School Age):
- Gross Motor:
- Fine Motor:
12) 9-12 yrs (Later School Age):
- Gross Motor:
- Fine Motor:
1) For Newborn - 1 month:
- Prone: fetal / flexed position (may lift head occassionally)
- Supine: Lays, mostly flexion
- Sitting: Can’t sit, head bobs
- Fine Motor: Only closed fist, objects in direct line of sight
2) 2 - 3 months:
- Prone: Prone on Elbows, rolls to supine
- Supine: Legs kick
- Sitting: Can’t sit, but head control better
- Fine Motor: Uses palmar grasp
3) 4-5 months:
- Prone: Bears weight through arms extended, pivots, reaches for toys
- Supine: Rolls from supine to prone, plays with feet in mouth
- Sitting: Can sit for second or two, good head control
- Standing: Can’t stand, but will bear with through LE’s when supported
- Fine Motor: Grasps and releases toys
4) 6-7 months:
- Prone: Rolls (everything same from above)
- Supine: Rolls and lifts head (everything same from above)
- Sitting: Can sit independently
- Mobility: Starts crawling
- Standing: Can’t stand yet
- Fine Motor: Rakes with fingers to pick up toys
5) 8-9 months:
- Prone: Gets to hands and knees / quadruped
- Supine: Doesn’t like supine
- Sitting: Can sit and transition to other positions
- Standing: Starts to stand against furniture
- Mobility: Cruising along furniture, crawls
- Fine Motor:
6) 10-12 months:
- Standing: Stand briefly without support, pulls to stand using half-kneel transition
- Mobility: Walks with 2 hands holding their hands. Bear crawls on hands/feet
- Fine Motor: Can put objects in container
7) 12-15 months:
- Standing: Stands ind.
- Mobility: Walks without support
- Fine Motor: Builds tower, turns over objects
8) 16-24 months:
- Gross Motor: Squats, walks backward, goes up/down stairs, kicks and throws balls, pick up toy from floor without falling
- Fine Motor: Stacks 6 cubes, does vertical/horizontal strokes with crayon on paper
9) 2 years:
- Gross Motor: Rides tricycle, walks downstairs using alternating feet, runs on toes
- Fine Motor: Turns knob, opens and closes jar, button a button
10) 3-5 yrs (Preschool):
- Gross Motor: Throws ball 10 feet, hops 2-10 times, catches ball
- Fine Motor: Copies a circcle or cross, cuts with scissors, starts to demonstrate hand preference
11) 5-8 yrs (Early School Age):
- Gross Motor: Skips, gallops, jumps
- Fine Motor: Hand preference is evident, can button small buttons
12) 9-12 yrs (Later School Age):
- Gross Motor: Mature patterns of movement, jumps, runs
- Fine Motor: Draw, handwriting developed
MUST KNOW THE PRIMITIVE REFLEXES:
1) What is a primitive reflex:
2) What does the word “integrate” mean with regards to primitive reflexes?
- Does the primitive reflex go away?
3) ATNR
- What does ATNR stand for:
- When does it appear (onset):
- When does it integrate:
- What is the stimulus:
- What is the response:
** ATNR is the __________ pose
4) STNR
- What does STNR stand for:
- When does it appear (onset):
- When does it integrate:
- What is the stimulus:
- What is the response:
- Purpose of reflex:
5) TLR
- What does TLR stand for (or Symmetrical Tonic Labyrinthine reflex):
- When does it appear (onset):
- When does it integrate:
- What is the stimulus:
- What is the response:
- Big picture - this reflex does what?
6) What is the Landau reflex:
- When does this appear:
- When will this reflex integrate ***
7) Palmar Grasp Reflex
- What is it / purpose:
- When does it appear (onset):
- When does it integrate:
- What is the stimulus:
- What is the response:
8) T or F: The plantar reflex is the same as palmar, but it is the toes curling / flexing around your finger of pressure
9) Rooting
- What is it / purpose:
- When does it appear (onset):
- When does it integrate:
- What is the stimulus:
- What is the response:
10) Moro
- What is it / purpose:
- When does it appear (onset):
- When does it integrate:
- What is the stimulus:
- What is the response:
*** How to remember MORO
11) What is the startle reflex
- What is the Positive support reflex:
- What is the walking (stepping) reflex:
11A) What is the Galant Reflex
11B) What is the positive support reflex
12) ***** SO WHAT REFLEX INTEGRATES LATEST (LAST)
- What reflex integrates fastest
1) Response to some stimulus, and these “primitive” reflexes are seen in infants / young children
2) Basically it means it doesn’t present any more as a reflex (Integration refers to the inhibition by higher centers of neurological control which modify the reflex in such a way that the pattern of response is no longer stereotypical).
- The reflex does not disappear; it may reactivate under stress, after injury, or during activities requiring great strength.
3) ATNR
- What does ATNR stand for: Asymmetrical Tonic Neck Reflex
- When does it appear (onset): Birth
- When does it integrate: 4-6 months
- What is the stimulus: Rotation of the head
- What is the response: Arm and leg on face side will extend, and then arm and leg on other side (or back of head) will flex
*** ATNR is the HERCULES / DAB pose
4) STNR
- What does STNR stand for: Symmetrical Tonic Neck Reflex
- When does it appear (onset): 4-6 months
- When does it integrate: 6-8 months
- What is the stimulus: Flex and Ext the neck
- What is the response: With neck flex … the UE’s flex and LE’s extend. With neck Ext … the UE’s will extend and LE’s will flex
- Purpose: prepare baby for crawling
5) TLR
- What does TLR stand for: Tonic Labyrinthine Reflex (so labyrinth in inner ear … so related to head position)
- When does it appear (onset): Birth
- When does it integrate: 6 months
- What is the stimulus: Hold baby in hand in prone, then supine
- What is the response: In prone, baby’s extremities FLEX, and in supine, baby’s extremities EXTEND
- This reflex serves to limit the child’s ability to flex the neck in a supine position. You can decrease impact of reflex by lying in sidelying or supine with hip flexion. If in prone they will flex head, in supine they will extend head
6) Suspend baby out in the air in prone and their head and LE’s will all extend
- Starts 6ish months (after STNR and TLR integrate)
- 12 months - 2 ish yrs old
7) Palmar Grasp Reflex
- What is it: A reflex to help child to grasp and do fine motor skills
- When does it appear (onset): Birth
- When does it integrate: 6 months
- What is the stimulus: Pressure in palm on ulnar side of hand
- What is the response: Flexion of fingers to grip your fingers
8) True
9) Rooting
- What is it / purpose: Baby turns head toward mother’s breast / food to survive.
- When does it appear (onset): Birth
- When does it integrate: 3 months
- What is the stimulus: Touch on the cheeck
- What is the response: Turn head to same side with mouth open
10) Moro
- What is it / purpose: Fight or Flight response - you hold baby and just barely let them fall and go, and they will extend arms/legs since they are scared.
- When does it appear (onset): Birth
- When does it integrate: 6 months
- What is the stimulus: Dropping
- What is the response: Arms abduct, fingers extend, legs extend, cry
*** MORO: You Moron, why would drop a baby?
11) Startle: like the Moro, when you do a sudden noise, it startles them (but elbows are flexed)
- Positive Support: Weight placed on balls of feet and the legs will stiffen/straighten and trunk goes into extension
- Walking: when supported and feet placed flat on ground, baby will reciprocally walk
11A) Stimulated by touching the skin along the spine from the shoulder to the hip on one side. Response / reflex is lateral flexion of trunk towards side stimulated. It will go away at about 2 months
11B) Stimulated by bearing weight through feet. The response is for LE’s to extend so an infant can bear weight to walk
12) Landau (2 years)
- Galant (2 months)
KNOW these MAJOR neuro conditions:
Explain each condition below:
1) ALS:
- What is it
2) MS:
3) GBS:
4) MG:
5) MD:
6) Alzheimer’s Disease
7) Carpal Tunnel Syndrome
8) Cauda Equina Syndrome:
9) Cerebral Palsy (CP):
10) If you see synergy patterns, it means the person had what injury accident:
- If you see spasticity, it could be the person had what injury
- Brunnston’s stages of recovery is for what injury
- Gross Motor Function Classification System is for what
- DMD will present with proximal or distal manifestations
- GBS will present with proximal or distal manifestation
- Clinical prediction rule for carpal tunnel is:
- Major s/s of MD
- Major s/s of MS
- MOST strokes happen in what artery
- WHO will get Alzheimers
1) ALS: Amyotrophic Lateral Sclerosis (Lou Gherigs)
- Upper and Lower motor neurons AXON DEGENERATION (axon gradually breaks down and dies). This is NOT demyelination (like MS or GBS where myelin sheath breaks down), ALS is just axon degeneration in CNS and PNS.
- UMN and LMN signs since it is in CNS and PNS
- Only motor weakness (not sensory loss) since it is injury to the anterior horn cell of spinal cord. Presentation starts distal and moves proximal.
- Average life expectancy is 2-5 yrs (and typically this effects males more than females, age 40-70 yrs old).
2) MS: Multiple Sclerosis
- Demyelinating disease of the CNS … brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. This will result in vision loss, cognitive processing slowing, motor weakness, balance and coordination issues, fatigue, etc.
- UMN signs
- Main s/s = OPTIC NEURITIS
3) Guillain Barre Syndrome (GBS):
- Just like MS, but now in Peripheral Nerves (so demyelination of peripheral nerves, showing as LMN signs). Much better prognosis, as peripheral nerves can regenerate.
- Distal manifestations first
4) Myasthenia Gravis (MG):
- A nervous condition down at the Motor end plate (or NMJ). So AcH can’t get released normally at NMJ, so a contraction of the m’s can’t happen properly. Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs. The name myasthenia gravis, which is Latin and Greek in origin, means “grave, or serious, muscle weakness.”
5) Muscular Dystrophy (MD):
- Disease or wasting to the actual Muscle itself. A genetic disorder where there is an absence of dystrophin, a protein needed to build and maintain muscle mass. Without dystrophin, muscles eventually waste away. Results in muscle weakness, and eventually respiratory failure.
X-linked recessive trait manifesting in only male offspring (females become carriers). Clinical presentation includes: waddling gait, proximal muscle weakness, toe walking, hypertrophy of calf, difficulty climbing stairs. Rapid progression of disease with inability to ambulate by 10-12 yrs of age and death often in age 20’s.
6) Alzheimer’s Disease:
- Alzheimer’s disease is a progressive neurological disorder that destroys memory and other important mental functions. Brain cell connections in the cerebral cortex and subcortical areas, and the cells themselves, degenerate and die, eventually destroying memory and other important mental functions. The brain cell damage and loss is irreversible, and progresses (gets worse) with time. Memory loss and confusion are the main symptoms. It is made manifest in those who are older once cells and neuron connections die; and it is more common in women than in men.
- OLDER WOMEN is the answer; and it is progressive; and exercise helps delay progression
7)
- CTS Clinical Prediction Guide:
> Age greater than 45
> Decreased sensation to thumb, index, and middle
fingers
> Shaking hand to relieve symptoms
- Phalen’s and Reverse Phalen’s Test (Phalen’s is only relevant if combined with muscle weakness and sensation impairments. By itself with no other exam findings, it is irrelevant). MUST do phalen’s for 60 seconds
- Tinel’s sign
- EMG study
- More likely in women, usually in 40-60 age range
- Pins and needles, numbness, and m’s weakness in median nerve innervation / distribution
8) Cauda Equina:
- Cauda equina syndrome (CES) is a condition that occurs when the bundle of spinal nerves below the end of the spinal cord (L1) known as the cauda equina is damaged. Could be caused by compression of the nerve roots, trauma, infection, tumor, injury, etc. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Since it is below where the spinal cord ends, it is a peripheral nerve injury, so you’d see LMN signs.
9) Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It’s caused by damage that occurs to the immature brain as it develops, most often before birth (like a fetal stroke, gene mutation, maternal infection, lack of O2 in utero, etc.).
Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with abnormal reflexes, flacid/floppiness, muscle tone or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking, or some combination of these. Main s/s is SPASTICITY. Some even have trouble eating, swallowing, eye movement, or breathing (any muscle can be impaired). It could effect the entire body, or just a part.
Cerebral palsy’s effect on function varies greatly. Some affected people can walk; others need assistance. Some people show normal or near-normal intellect, but others have intellectual disabilities. Epilepsy, blindness or deafness also might be present.
10) Stroke
- CP, SCI, Stroke, etc.
- Stroke
- CP
- Proximal
- Distal
- Over 45, paresthesia in median nerve distribution, shaking hands to relieve symptoms
- Big calf, waddling gait, x-linked, fast digression
- Optic neuritis
- MCA
- OLDER women
1) What is a stroke:
- Other name for a stroke:
2) Signs of a Stroke:
3) How to quickly assess for a stroke:
4) Types of a stroke:
- Ischemic:
- Hemmorrhagic:
- TIA:
- Lacunar
- How to remember Lacunar
5) People who recover from stroke may experience:
6) Risk factors that lead to increased risk of stroke:
7) For the arteries below, how would a stroke to this artery present / effect:
- MCA:
- T or F: These are most common strokes?
- Presentation / symptoms for MCA stroke:
- ACA:
- Presentation / symptoms for ACA stroke:
- PCA:
- Presentation / symptoms for PCA stroke:
- VBA:
8) Right vs. Left Stroke:
9) T or F: A Left CVA means left brained, so right sided impairments?
10) What is the homonculus
- Where on the homonculus is the LE?
- Where is UE and face?
- So a MCA stroke would manifest in more UE or LE deficits
- ACA stroke would manifest in more UE or LE deficits
11) What is “locked in syndrome”
- What causes it?
- Where in the brain would the blood occlusion happen
- Do they recover
12) How do you remember Lacunar stroke?
- Most strokes happen at what artery?
1) Astrokeis a sudden interruption in the blood supply of the brain. Moststrokesare caused by an abrupt blockage of arteries leading to the brain (ischemicstroke). Otherstrokesare caused by bleeding into brain tissue when a blood vessel bursts (hemorrhagicstroke).
- CVA: Cerebrovascular accident
2)
- FAST: Face droops, arm weakness, slurred speech, time counts - call 911
- One sided weakness
- Face droops
- Difficulty speaking / smiling (slurred speech)
- Fatigue, nausea, vomit, lightheaded
3) FAST (see point above) … ask them to smile, speak, and raise arms
4)
- Ischemic Stroke: A blockage / blood clot in the artery. Could be from a thrombus, embolus, or lacunar
- Hemorrhagic Stroke: Caused by a blood vessel rupture, so excess bleeding.
- Ministroke / Transient Ischemic Attack (TIA): A temporary blockage in the artery. Ministrokes don’t cause permanent damage but they do increase your risk for stroke. And symptoms disappear much quicker.
- Lacunar: stroke to DEEPER parts of brain (thalamus, basal ganglia, etc.)
- Hakuna Matata - simba went DEEP into the forest
5)
- One sided Weakness / paresis, paralysis, spasticity
- Changes in sensation
- Memory, cognitive, attention, or perception problems
- Depression
- Fatigue
- Vision problems
- Communication / speech problems
- Behavior changes
- Synergy patterns or spasticity
- Cosmetic / psychological / emotional
6)
- HTN (high blood pressure)
- Smoking and Alcohol use
- Diabetes, high cholesterol, being overweight, atherosclerosis, etc.
- Previous history of stroke
- Age
- Family history of strokes
- Sometimes its just a fluke accident
7)
- MCA: Middle Cerebral Artery. MOST strokes occur at the MCA. The MCA supplies the OUTER portions of the brain (frontal, temporal, and parietal lobes), and will result primarily in FACE and UE paralysis (even though lower extremities and trunk also can be involved), contralateral motor and sensory deficits.
- True
- Face and UE > LE impairments
- ACA: Anterior Cerebral Artery. Supplies blood to interior brain (portions of frontal, temporal, and parietal lobes), and will result in more LE and saddle/genital issues (remember the homunculus … the inner/medial areas are legs, saddle region). People with a ACA stroke will experience contralateral motor and sensory deficits more in lower extremities, and experience bowel/bladder issues.
- LE > UE impairments
- PCA: Posterior Cerebral Artery. Supplies primarily posterior brain (occipital lobe). These patients will primarily have their VISION impacted (hemianopsia).
- VBA: Vertebral Basilar Artery. This artery supplies blood to brainstem, posterior brain, and cerebellum. If a stroke happens here, you would see cerebellar impacts (gait deviations, coordination, and balance issues), but they also get “locked in syndrome” (or tetraplegia) which is they are conscious but lose all their motor and sensory and communication abilities during the stoke.
8)
- Right: weakness or paralysis to Left side, poor attention, impaired judgement, spatial deficits, memory deficits, emotional lability, impulsive behavior, difficulty processing visual cues
- Left: weakness or paralysis to Right side, impaired processing, more frustrated, aphasia (speech and language), dysphagia, motor apraxia, difficulty processing verbal cues
9) True
10) A cortical homunculus is a distorted representation of the human body, based on a neurological “map” of the areas and proportions of the human brain dedicated to processing motor functions, or sensory functions, for different parts of the body.
- LE is inner / medial
- UE and Face is more outer/lateral
- UE
- LE
11) Also known as pseudocoma, is a condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking.
- Stroke, Traumatic brain injury, tumor
- Brain stem (the pons is impacted, which relays other communication to diff. parts of the brain)
- Rarely do these people recover and “come out” of it
12) Akuna Matata - they went deep into forest (so deep stroke in deep structures of brain like thalamus and basal ganglia)
- MCA
1) Down Syndrome (what is it … s/s … explain it)
2) What is the official name for a ‘Waiter’s Tip’ hand position (condition)
- What is it - explain it (how it happens, and how it presents):
3) GBS
3A) So does Muscular Dystrophy (DMD) present with more proximal or distal involvment?
- Does GBS present with more proximal or distal involvement at first?
- What is a main s/s that shows someone has MS
- AFP (alpha-fetoprotien) test is done to help rule in what condition
- 2 main types of spina bifida
4) Parkinson’s:
5) Huntington’s:
6) MS:
7) Spina Bifida
8) Glasgow coma scale is used for what injuries:
- You must must know Glasgow Scale levels. List the LOC (loss of consciousness), PTA (post-traumatic amnesia), GCS (glasgow coma scale) for mild, moderate, and severe cases:
9) Trigeminal Neuralgia:
10) Will a C7 SCI (spinal cord injury) have any respiration / breathing impairments
- Someone with C7 SCI can do what, and can’t do what?
11) Will someone with L3 spinal cord injury have any sexual impairment
- Will they have bladder issues?
- Are they more prone to UTI’s
1) A congenital disorder arising from a chromosome defect, causing intellectual impairment and physical abnormalities including short stature and a broad facial profile. It arises from a defect involving chromosome 21, usually an extra copy (trisomy-21).
s/s include: hypotonia, ligament laxity, flattened nasal bridge, enlarged tongue, developmental delay, cognitive deficits.
Exercise is essential for children with Down Syndrome, to prevent obesity.
2) Erb’s Palsy
- “Waiter’s Tip” position from a legion of C5-C6 nerve
An injury to the arm from a fall on neck/shoulder region (or being pulled out of the womb incorrectly). It is a brachial plexus injury to C5-C6 nerves, which results in the “Waiters Tip” hand position. Anything innervated by C5-C6 is lost. So: suprispinatus, deltoid, infraspinatus, teres minor, biceps brachii, brachialis, supinator, brachioradialis, and extensor carpi ra/dialis longus. You thus can’t flex shoulder, can’t abduct shoulder, can’t laterally rotate shoulder, or flex elbow. You can, however, flex wrist since this is C7.
3) GBS: Guillain-Barre Syndrome
- This is the demyelinating disease of the PNS (or lower motor neurons). It manifests as distal symmetrical motor weakness and mild distal sensory impairments due to the myelin sheath over nerves degenerating. Complications from GBS include muscle weakness, respiratory impairments/paralysis (due to diaphragm becoming weak), dysphagia, bladder weakness, even arrythmia’s. The prognosis for GBS is much better than Multiple Sclerosis (which is the demyelinating disease of the CNS) due to the fact that peripheral nerves can regenerate over time (most will recover).
Etiology of disease is unknown, however, it is considered to be an autoimmune response to a previous respiratory infection, influenza, immunization, or surgery.
Guillain-Barre Syndrome (GBS) is a temporary inflammation and demyelination of the myelin sheaths of peripheral nerves. A physical and neurological examination, strength testing, and review of medical history are all important to help diagnose GBS. It can be diagnosed through a cerebralspinal fluid (CSF) test where you’d find elevated levels of protein without an increase in leukocytes. Additionally, electromyography tests will result in abnormal or slowed nerve conduction.
3A) DMD: Proximal
- GBS: Distal
- Optic neuritis
- Spina Bifida
- Occulta (hidden and closed), and myelomeningocele (open and dangerous)
4) Parkinson’s:
- Parkinson’s disease (PD) is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. So, dopamine levels drop which leads to movement disorders (tremors, shuffled gait, gait and balance deficits, LE weakness, rigidity, brady/hypokinesia, poor posture, motor planning and initiation dysfunction, etc.). Once disease is diagnosed and shows up on imaging, about 60% of the damage to substantia nigra has been done (thus symptoms show up years before, but won’t show on imaging until about 60% of this area of the brain has degenerated). It is a progressive disorder.
Medications like Levodopa and Carbidopa can help decrease the speed of progression (minimizing bradykinesia, rigidity, and tremors). There is also an option of dopamine replacement therapy. PT can help with LE strengthening, gait improvements, and balance.
Symptoms: tremors, freeze on gait, shuffled gait, impaired movement, forward flexed posture, impaired initiation of movement, lack of dissociation of limbs, gait and balance impairments. Resting tremors in hands or feet will increase with stress and disappear with movement or rest.
5) Huntington’s:
- Huntington’s disease is an inherited/genetic disease, and it is a progressive disorder. It causes the progressive breakdown (degeneration) of nerve cells in the brain (the basal ganglia). Huntington’s disease has a broad impact on a person’s functional abilities and usually results in movement, thinking (cognitive) and psychiatric disorders.
Most people with Huntington’s disease develop signs and symptoms in their 30s or 40s. But the disease may emerge earlier or later in life. It is fatal (progressive), and typically pt’s have 15-20 yrs prognosis after diagnosis. Signs of the disease are mental deterioration, speech disturbances, ataxic gait, and enlarged ventricles in the brain.
Medications are available to help manage the symptoms of Huntington’s disease, but treatments can’t prevent the physical, mental and behavioral decline associated with the condition.
6) MS: Multiple Sclerosis
- Demyelinating disease of the CNS … brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body (plaque buildup on nerve axons, which slows and disrupts or even stops nerve conduction). Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. This will result in vision loss, cognitive processing slowing, motor weakness, balance and coordination issues, fatigue, etc.
- UMN signs with MS. MS is the demyelinating disease of the CNS (or upper motor neurons).
- It manifests as ataxia, balance dysfunctions, fatigue, visual problems, sensory changes, clumsiness, muscle weakness, paresthesias, and optic neuritis. Optic neuritis, inflammation of the CN II is usually the first symptom seen due to CN II becoming demyelinated from the upper motor neurons in the cerebral cortex degenerating/demyelinating.
- Interventions include regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance activities, gait training, and core stabilization.
7) Spina Bifida is a birth defect that occurs when the spine and spinal cord don’t form properly in utero. It’s a type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the baby’s brain, spinal cord and the tissues that enclose them.
Normally, the neural tube forms early in pregnancy and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube doesn’t close or develop properly, causing defects in the spinal cord and in the bones of the spine. It typically happens in the lumbar/sacral region. To detect whether a baby has spina bifida, a AFP (alpha-fetoprotien) test is done to see if there are elevated levels of this protein in the blood. You can usually see a buldge with hair in that area.
Spina bifida can range from mild to severe, depending on the type of defect, size, location and complications. When necessary, early treatment for spina bifida involves surgery — although such treatment doesn’t always completely resolve the problem.
There are 3 forms of spina bifida: 1) Occulta, which means hidden. This is the mildest and most common type. There is a small gap between vertebrae and some protrusion posterior of spinal cord, but skin covers. 2) Myelomeningocele, which is also known as open spina bifida. It is most severe type. The spinal canal is open, thus highly prone to infections, so surgery is needed. A sac is formed on baby’s back, and since it is below L1, if there is any damage, it would be LMN signs, LE muscles/sensory weakness, and even sacral bowel or bladder issues.
8) TBI (Traumatic Brain Injury)
- > Mild
> LOC: 0-30 min
> PTA: Less than a day
> GCS: 13-15
> Moderate
> LOC: 30 min – 24 hours
> PTA: 1-7 days
> GCS: 9-12
> Severe
> LOC: 24+ hours
> PTA: 7+ days
> GCS: Less than 9
9) Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It is usually the result of abnormal pressure on or irritation of the trigeminal nerve. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. Symptoms are typically unilateral and may be either episodic or constant. You will have sudden pain described as sharp, jolting, stabbing, or shock-like or persistent burning or aching sensations on one side of the face.
10) Remember that the diaphragm is innervated by the Phrenic Nerve (C3/4/5 keeps you alive), so diaphragm will be fine. However, all thoracic musculature (abd, intercostals) below C7 will not be innervated, so accessory breathing will most certainly be impaired.
- They will be able to move UE’s, so feeding, grooming, dressing, etc. will be in tact. They can even do slide board type transfers and propel a manual wheelchair. But gross motor like sitting up or walking won’t happen.
11) YES
- Yes
- Yes
1) Name the m’s of the anterior - lateral abdomen from superficial to deep
2) Name the m’s of the posterior - lateral low back from superficial to deep
3) Which way does the fibers of the ex. oblique run compared to the internal oblique
4) Ext. Oblique muscle has what action
- It is innervated by what nerve
5) Weakness of the abdominal m’s can lead to a:
6) Attachments of the rectus abdominus m. are:
- Innervated by:
- What separates the two bellies of this muscle
1) Rectus abdonimus is most superficial directly anterior, but then external oblique, then internal oblique, then transverse abdominis. Psoas and QL are deep.
2) Lats, then midline is erector spinae (spinalis, longissimus, iliocostalis), and lateral to erector spinae is obliques. (Serratus posterior is superficial to erector spinae). Then you have deep paraspinals (multifidi, rotatores), and then even deeper is QL and Psoas are very deep.
3) Ex oblique runs down and anterior to sex organs (EX = SEX), and internal run more in a transverse / side to side orientation.
4) Bilateral contraction does flexion of trunk. Unilateral will side bend to that side, and rotate that side’s shoulder to contralateral side.
- Intercostal nerves T7-T11 and subcostal nerve (T12)
5) Herniation of visceral contents (inguinal, umbilical, or linea alba hernias)
6) Originates from pubic crest and symphysis, and goes up and inserts into costal cartilage of lower ribs, and xiphoid process.
- Intercostal nerves T7-T11 and subcostal nerve (T12)
- Linea alba
1) What is referred visceral pain
2) So if you had a pt come in and present with a certain pain, but could not reproduce it through muscle testing or special testing, then what organ refers pain to the:
- Right shoulder:
- Left Shoulder (Jaw and Radiating down L Arm):
- Mid back and mid stomach:
- L Low Back down around to groin:
- L mid back and L mid stomach:
- Lower mid abdomen
- R lower quadrant
1) When the abdominal viscera is inflammed, injured/damaged, compressed, or some ischemic event - it sends pain along certain paths which manifests as superficial somatic pain.
2)
- Right shoulder: Liver, gallbladder, duodenum
- Left Shoulder/Jaw/UE: Heart, spleen
- Mid Back/Stomach: Stomach
- L Low back / groin: Kidney
- L mid back/stomach: spleen
- Lower mid abdomen: colon
- R lower quadrant: appendix
1) A network or connection of veins or arteries linked together providing multiple paths of blood flow is called:
2) T or F: Veins throughout the body are oriented with large deep veins, and a network of superficial veins with many connecting veins between
3) The small intestine’s parts are called:
- Which of those (from point above) connects the small intestine to the large
- Portion between the stomach emptying contents into small intestine is called:
- From point above, that dumps stuff into what part of the intestine?
- What is tube called that releases bile into small intestine
- That bile comes from where
- The organ from point above sits under what organ
4) The Greater Omentum is what:
5) Large Intestine is called:
- Left colic flexure is what
6) Appendix is on the R side or L side of Abdomen
7) Descending colon turns into what:
- THe answer to point above then turns into what:
- What condition is often associated in this area:
8) A hiatus is what
- What are some of the hiatus’ in the abdomen
9) What are the attachments for the QL muscle
- What does this muscle do
- QL is innervated by what nerve(s)
- The muscle just anterior to the QL that also acts as a low back stabilizer is the _________ muscle
10) The top of the abdominal cavity is enclosed by what:
- What nerve innervates this muscle
11) Nephron is the term for what
- Function of the kidneys is:
- The tube that leaves the kidneys is what
- From point above, this leads to what/where
- Tube that leaves the structure from the last point above
- What is a kidney stone
12) Other names for a kidney stone:
1) Anastamosis
2) True
3) Jejunum and ileum
- Ileum
- Duodenum
- Jejunum
- Bile duct
- Gallbladder (stores and releases, liver produces it)
- Liver
4) Yellow fatty portion of abdominal wall that holds all abdominal contents in place (ligament of visceral organs so gravity doesn’t pull them down - they stay in place)
5) Colon
- Curved/rounded portion of colon where colon changes directions
6) R
7) Sigmoid colon
- Rectum
- Diverticulis
8) A hole
- YOu have a hiatus for the esophogus to pass through diapragm to stomach, you have a hiatus for inf. vena cava and descending abominal aorta to pass through diaphragm, you have hiatus’ through adominal m’s for iliac artery and vein to descend into LE’s, etc. Hiatus for inguinal lig’s
9) It attaches to iliac crest, up to 12 rib, and then on transverse processes of lumbar vertebrae
- With pelvis fixed, it will laterally flex trunk/lumbar spine; with pelvis in open chain it will hip hike. Working bilaterally it helps with extension of back.
- T12 (subcostal) and L1-5 nerves
- Psoas
10) Diaphragm
- Phrenic Nerve (C3/4/5 keeps you alive)
11) Kidneys
- The kidneys perform many crucial functions, including: maintaining overall fluid balance. regulating and filtering minerals from blood. filtering waste materials from food, medications, and toxic substances
- Ureter
- Bladder
- Urethra
- Kidney Stones: Kidney stones, or renal calculi, are solid masses made of crystals. Kidney stones usually originate in your kidneys. However, they can develop anywhere along your urinary tract.
12) Renal calculi, Nephrolithiasis, renal stone
1) What is the main muscle of the pelvic floor
- From point above, it has 3 parts, what are they
- These m’s are innervated by what nerve
- Purpose of these m’s
- The hole of the pelvic floor m’s where we deficate, what is that called?
- What goes through that hole?
- The hole of the m’s where the vagina exits is called:
2) Other 2 muscles that form the posterior part of the pelvic floor
- Which of those is superior / on top
1) Levator ani muscle
- Puborectalis, pubococcygeus, iliococcygeus
- S3/4 ventral rami / Perineal branch of Pudendal nerve
- They are the pelvic diapragm, giving support to pelvic viscera and complete the enclosure of the abdomen to maintain pressures. It supports uterus/vagina/rectum
- Rectal hiatus
- Rectum –> Anus
- Urogenital hiatus
2) Coccygeus and Piriformis
- Piriformis
1) All the veins of the UE’s and Head/Neck dump blood back into the heart through the:
- All the veins of the LE’s and Trunk dump blood back into the heart through the:
2) 4 Chambers of the heart are:
- Flow of blood through the heart goes through what chambers in what order
- T or F: Veins dump blood into heart into the L atrium
- What vein dumps heart blood back into heart
3) What valve does blood flow through to get into the R ventricle, and then what valve when it leaves R ventricle
- What valve does blood flow through to get into the L ventricle, and then what valve when it leaves R ventricle
4) The semilunar valves are what
- So the other two valves together are called what
- Why are aorta and pulmonary called “lunar”
5) When blood leaves the R ventricle and goes through the pulmonary trunk, does it flow through the pulmonary veins or pulmonary arteries to get to the lungs?
- How do you remember that?
6) Main difference between all veins in the body compared to pulmonary veins
- Pulmonary veins dump blood into what chamber
7) What are the little strands that hold the cusps of the valves?
- What m’s hold the things from point above
- What is the point of the chordae tendinae and papillary m’s
8) The muscular wall between the two ventricles is called:
9) 3 layers of muscle for wall of heart is (from outside to inside):
- WHich one is the thick muscular portion
- WHich layer has arteries, nerves, lymphatics
9A) Besides the 3 layers mentioned above, what is another layer around the heart
- What is it (from point above)
- How many layers is the pericardium
10) How many different arteries branch off the aortic arch to supply blood to the body (and what are they)
- How many different arteries branch off the aortic arch to supply blood to the heart (and what are they)
- T or F: There really is not brachiocephalic a on the L side
- The R brachiocephalic a branches to become what a’s
1) Superior Vena Cava
- Inferior Vena Cava
2) R Atrium, L Atrium, R Ventricle, L Ventricle
- R atrium, R ventricle, L atrium, L ventricle
- False (into R atrium)
- Coronary sinus
3) Tricuspid, Pulmonary
- Mitral (bicuspid), Aortic
4) Pulmonary and Aortic
- Atrioventricular valves
- Cause blood goes UP to the moon
5) Pulmonary arteries
- Vessels that leave heart are arteries, vessels coming into heart are veins
6) The pulmonary veins are oxygenated blood, whereas all other veins are de-oxygenated blood
- L atrium
7) Chordae Tendinae
- Papillary m’s
- Hold valve closed so when blood pumps out through semilunar valves, it doesn’t backflow into atrium through atrioventricular valves
8) Interventricular septum
9) Epicardium, myocardium, endocardium
- Myocardium
- Epicardium
9A) Pericardium
- Double walled connective tissue covering / protection over the heart
- 2
10) 3 (R Brachiocephalic a, L common carotid a, L subclavian a)
- 2 (R and L coronary a’s)
- True
- R subclavian a, and R common carotid a
1) Where is the apex of the heart
- What is the base of the heart
- Apex of lung / apical part of a lobe?
- Base of lung lobs?
- Apex of sacrum?
- Base of sacrum?
*** What to remember about base vs. apex
2) Does the heart have it’s own blood supply?
- What are these arteries called?
- Where do these a’s (from point above) start?
3) What are the main 2 arteries coming out of aorta to supply blood to the heart?
- What is main branch off the R coronary artery in the front of the heart
- The L coronary artery branches into what a’s
- What is the main artery on the back of the heart
- Does the Post. Interventricular a. come off the R or L coronary a?
4) Tricuspid valve prevents blood from what chamber entering into what chamber
- Pulmonary valve prevents blood from entering back into what chamber
- Mitral / Bicuspid valve prevents blood from what chamber entering into what chamber
5) What is systole
- What is diastole
- What is atrial systole
- What is atrial diastole
- What is preload
- Is preload the same thing as EDV?
- What is afterload
- Is afterload ESV?
- What is stroke volume
- Each beat of the heart typically ejects what % of blood w/n the ventricle?
- Normal SV is what amount:
- If you increase preload, what will that do to SV
- If you increase afterload, what will that do to stroke volume
- If CO decreases, what would that do to afterload
- What is cardiac output
- Normal CO p/min is:
- Intense exercise CO is:
1) The bottom pointed part (more of the left ventricle point by 5th intercostal space)
- Upper border of the heart involving the L atrium, part of R atrium and greater vessels
- Apex/apical is top part of lobe
- Base is bottom of lobe of lung
- Apex is tip on bottom of sacrum
- Base is top portion of sacrum
*** It is less about WHERE, and more about how it looks / shape that determines it. Apex is the pointed portion
2) YES
- Coronary arteries
- Coming out the aorta
3) R and L Coronary a’s
- Marginal a.
- L Circumflex a, and anterior interventricular a.
- Posterior Interventricular artery
- 2/3rds of the time it is the R coronary a (R heart dominant)
4) Prevents blood from R ventricle going into R atrium
- R Ventricle
- L Ventricle blood from going into L Atrium
5) Systole: when heart is pumping / contracting
- Diastole: When heart is relaxed
- Atrial Systole: When atria contract and push blood into ventricles
- Atrial Diastole: When atria relax and are repolarizing
- Preload: Preload is the initial stretching of the cardiac myocytes (muscle cells) prior to contraction. It is tension in the ventricular (both) walls at the end of diastole when blood is filled up in ventricles before contraction. It reflects the venous filling pressure that fills the L ventricle during diastole.
- NO. Preload is pressure vs. EDV is actual volume of or amount of blood
- Afterload: Afterload is the RESISTANCE the L ventricle must overcome to push blood out during contraction. Or, pressure the heart must work against to eject blood during systole (ventricular contraction). Refers to the forces that impede the flow of blood out of the heart, primarily the pressure in the peripheral vasculature, the compliance of the aorta, and the mass and viscocity of blood.
- No (same as above)
- SV: SV = EDV - ESV. Volume of blood ejected by each contraction/beat of the L ventricle.
- 60%
- Normal SV is 60-80 mL
- Increase it
- Decrease it
- Increase it
- CO / Q: SV x HR. Amount of blood pumped from the L or R Ventricle per minute (total blood in circulation)
- Normal CO is 4.5-5.0 L/min at rest (increases with exercise)
- Can get up to 25 L /min with intense exercise (5x higher)
1) What are baroreceptors
- If the sympathetic n.s. gets turned on, what will baroreceptors do
2) What nerve innervates parasympathetic activity of heart
- Does the vagus nerve only innervate the heart?
- When the vagus nerves overreacts, what happens
3) What is a Chemoreceptor
- Give an example of how it works
4) What is the Valsalva Maneuver?
- When doing this, what will it do to blood pressure?
1) Baroreceptors are mechanoreceptors that detect changes in PRESSURE (in joints or vessels). In vessels, they maintain blood pressure. They are located in the carotid sinus and in the aortic arch. Their function is to sense pressure changes by responding to change in the tension of the arterial wall. The baroreflex mechanism is a fast response to changes in blood pressure. They are part of the ANS (sympathetic and parasympathetic n.s.)
- Increased blood pressure due to increased contractility, increased HR, venoconstriction.
2) Vagus nerve
- No, it does parasympathetic activity for all visceral organs
- Vasovagal syncope (HR slows way down to dangerous level).
3) A sensory cell or organ responsive to chemical stimuli.
- When the lungs are low on O2, it sense low O2 levels to increases respiration, or the opposite.
4) Forced expiration against a closed epiglottis and rectum produces increased intrathoracic pressure. Forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while expelling air.
- It decreases cardiac output and thus blood pressure
1) The trachea bifurcates at what
- Bifurcates means what
- What does the trachea bifurcate into / become
- From there, how does it keep branching?
2) The lungs are covered by what connective tissue layer?
- Then the space between lungs and _________ is what:
** MUST KNOW LUNG VOLUME TERMS **
3) Describe each term below:
- Tidal Volume (TV):
- Inspiratory Reserve Volume (IRV):
- Expiratory Reserve Volume (ERV):
- Residual Volume (RV):
- Vital Capacity (VC):
- Functional Reserve Capacity (FRC):
- Inspiratory Capacity (IC):
- Total Lung Capacity (TLC):
- Anatomic Dead Space:
4) Tidal volume makes up about what % of total lung capacity?
- What % is IRV:
- What is % of ERV:
- T or F: You can never forcefully exhale all air out of lungs?
- Related to the point above, this is called:
- What % is Vital Capacity? Thus what is % of RV:
4A) Total lung volume (amount … in normal healthy lung):
- ” Tidal volume:
- ” Vital Capacity:
- ” RV and ERV:
- IRV:
5) What is ventilation / inhalation vs. respiration
6) What is Forced Expiratory Volume (FEV)
- FEV1 should be about how much:
- What is Peak Expiratory Flow (PEF)
1) Sternal angle (about T2)
- Split / divide
- R and L main / primary bronchus
- Becomes lobar bronchi –> segmental bronchi –> secondary then tertiary bronchus –> Bronchioles –> Terminal Bronchial –> Respiratory Bronchial –> Alveolar sac –> Alveoli
2) Visceral Pleura
- Pleural cavity is space, and outer connective tissue layer is the parietal pleura
3)
- Tidal Volume (TV): Normal breathing. Inspired and expired air with each breath during normal breathing.
- Inspiratory Reserve Volume (IRV): Max volume of air you can breathe in after normal tidal volume.
- Expiratory Reserve Volume (ERV): Max volume you can exhale after normal tidal volume
- Residual Volume (RV): Volume of air remaining in lungs at the end of max exhalation.
- Vital Capacity (VC): VC = TV + IRV + ERV. So it is tidal volume plus IRV and ERV (max exhale, then max inhale)
- Functional Residual Capacity (FRC): ERV + RV (so volume of air in lungs after normal TV exhalation.
- Inspiratory Capacity (IC): TV + IRV. Max air you can inhale
- Total Lung Capacity (TLC): ALL volumes added together.
- Anatomic Dead Space: Volume of air that occupies the non-respiratory airways
4) 10%
- 50%
- 15%
- True
- Residual volume
- 75% is VC, 25% is RV
4A) 6000mL
- 500 mL
- 4,800mL (need to get at least 2,500 in hospital)
- Both are 1,200 mL each
- 3,100 mL
5) Inhalation is breathing air in and out; respiration is exchange of gas (O2/CO2)
6) Measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath
- 80% in 1st second
- PEF: Max flow of air during the beginning of a forced expiratory maneuver
