MEGA REVIEW DAY 1

Question 1

Normal end feels: 3

Answer 1

Hard: bone to bone stiff sensation that is painless Ex. Elbow EXT
Soft: yielding compression Ex. Elbow/knee flex
Firm: toward end ROM= elastic resistance Ex. ER shoulder (lig or capsular end feel restricting more mvmt)

PAIN and end feel? == Empty bc wont get full ROM from them!

Question 2

EmPty end feel think…

Answer 2

Pain

Question 3

Abnormal End Feels:

Answer 3

Springy–> meniscus tear
Boggy–> edema
Mushy–>
Empty–> Pain

Question 4

Scapular Winging types: 2
most common?

Answer 4

1. Open book palsy/Medial winging–> Serratus Ant (Long thoracic N.)
2. Sliding door palsy/Lateral winging–> Trapz (CN XI)

activate SA–> push up, SA pushup

Question 5

Scapular UPWARD rot and DOWNWARD rot

Answer 5

UPward: Upper/Lower trpz, Serratus Ant
DOWNward: Pec minor, rhomboids, levator scap

Question 6

When will you SEE medial winging d/t Serratus ant (long thoracic nerve) lesion?

Answer 6

Lifting arm above 90degs shoulder FLEX
THINK… bc Serratus punches are given @ 90degs shoulder flex

Question 7

Heart sounds

Answer 7

APT-M 2245
Mitral site BEST for auscultation if S3 (vent gallop) present

Question 8

Heart sounds

Answer 8

APT-M 2245
Mitral site BEST for auscultation if S3 (vent gallop) present

Question 9

Erbs point auscultation

Answer 9

5th point–> 3rd ICS

Question 10

More on heart sounds:

Answer 10

S1/2== normal
S3 (CHF)/4(HTN, MI, vent hypertrophy)== abnormal (will hear these @ apex, mitral valve)

Question 11

RPE (6-20 scale) and SHVEM

Answer 11

Start @ 13!
S= 13 (Somewhat hard)
H= 15 (Hard)
V= 17 (Very hard)
E= 19 (Extremely hard)
M= 20 (Max exertion)
REVERSE SHVEM, start @ 13
S= 13 (Somewhat hard)
H= 11 (Light just opp hard)
V= 9 (Very light)
E= 7.5 (Extremely light)
M= 6 (No exertion)

Question 11

RPE (6-20 scale) and SHVEM

Answer 11

Start @ 13!
S= 13 (Somewhat hard)
H= 15 (Hard)
V= 17 (Very hard)
E= 19 (Extremely hard)
M= 20 (Max exertion)
REVERSE SHVEM, start @ 13
S= 13 (Somewhat hard)
H= 11 (Light just opp hard)
V= 9 (Very light)
E= 7.5 (Extremely light)
M= 6 (No exertion)

Question 12

RPE rx for DM

Answer 12

11-13 for DM, progress to 12-17

Question 13

EASY way to breakdown Dermatomes

Answer 13

C1-C4= head/neck
C5-T1= arm
C6-C8= fingers

Question 14

Sensory Examination

Superficial Sensation

Answer 14

Exteroreceptors–> Receive stimuli from EXTERNAL environment via skin and subQ tissue Ex. Pain, temp, lt touch

Question 15

Sensory Examination

Deep Sensation

Answer 15

Proprioreceptors–> Receive stim from mm’s, tendons, fascia
Ex. Pos. sense/awareness of jts @ rest, kinesthesia, vibration

Question 16

Sensory Examination

Cortical Sensation

Answer 16

Combo of BOTH Superf/Deep
Ex. Stereognosis (ID obj), 2-pt discrim, barognosis (pressure), graphestesia (drawing letters), localization, recognition of texture, double simultaneous stimulation

Question 17

DCML mnemonic

Answer 17

Poor Val Got GBS Twice
Proprio, Vibration, Graphestesia, Barognosis, Stereognosis, 2-pt discrim

Question 18

Lateral Spinothalamic (STT)
Ant STT

Answer 18

Lateral= Pain + Temp
LPT
Anterior= crude touch

Question 19

Glasgow Coma Scale
All w/ mnemonics

Answer 19

See pic

Question 20

Glasgow Coma Scale Totals

Answer 20

<8= coma
3-8= severely abnormal
9-12= moderately abnormal
13-14= mildly abnormal
15= mild TBI

Question 21

Glasgow Coma Scale
EMV
4, 6, 5

Answer 21

• Eyes (4 letters, so 4)
• Verbal (the V in front is 5 roman numeral)
• Motor (remaining 6)

Question 22

Glasgow Coma Scale
HOW to remember Ea section

Answer 22

Eyes Opening (1-4)– “Waking husband up Sunday morning”
- 4: Spontaneous (he spontaneously wakes up on his own)
- 3: To speech (you call him to wake up)
- 2: To pain (you pinch him to wake up)
- 1: No response

Motor (1-6)– “OLD BEN”
- 6: Follows motor commands (Obeys commands)
- 5: Localizes
- 4: w/Drawals (flexor w/drawal)
- 3: Abnormal flexion (Bending)
- 2: Extensor resp
- 1: No resp

Verbal (1-5)– Think baby or child growing up (meaning lvs going UP)
- 1: No response
- 2: Incomprehensible sounds (making sounds)
- 3: Inappropriate words (saying words)
- 4: Confused conversation (having conversation)
- 5: Oriented

Question 23

Normal Blood Gases

Answer 23

PaCo2: 35-45
pH: 7.35-7.45
HCO3-: 22-26
Remember ROME
Resp (CO2)–> OPP to pH direction; Metabolic (HCO3-)–> EQUAL to pH direction

Question 24

pH + Normal Blood Gases Questions **STEPS!**

Answer 24

1. **Look @ pH** **Normal** 7.35-7.45: Answer is **Compensated** 2. **Look @ PaCO2** **Normal** 35-45: Answer is **Metabolic** 3. **Look @ HCO3-** **Normal** 22-26: Answer is **Respiratory** 4. **None of three are normal** Answer is **Partially Compensated**

Question 25

Stages of Lymph03dema (0-3) ALL FIRST

Answer 25

see pics

Question 26

Stage 0 Lymph03dema

Answer 26

**Latency** - NO edema (Heaviness only) - NEGATIVE stemmer - Tissue/skin appear normal

Question 27

Stage 1 Lymph03dema

Answer 27

**Reversible** - Edema present (**PITTING**) - Edema INCs w/ standing/activity - NEGATIVE stemmer

Question 28

Stage 2 Lymph03dema

Answer 28

**Spontaneously IRreversible** - Edema present; soft/pitting EARLY then progresses to **brawny, NONpitting** - POSITIVE stemmer (maybe neg. early on) - Tissue appears **fibrosclerotic; proliferation of adipose tissue**

Question 29

Stage 3 Lymph03dema

Answer 29

**Lymphostatic Elephantiasis** (think elephant feet) - Edema present; SEVERE **brawny, NONpitting** - POSITIVE stemmer - **SKIN CHANGES!!!!-->** Papillomas, deep skinfold, warty protrusions, hyperkeratosis, mycotic infxs

Question 30

Stages of LI**P**edema

Answer 30

2 lips== B/L, P is for proximal, LEs only, NEVER feet See pics

Question 31

Lymph03dema vs LIPedema

Answer 31

NOTE w/ Lymphedema: - U/L OR B/L asymmetric - cellulitis common - NO pain - distal edema present in **foot** - Stemmer (+), Stages II/III

Question 32

Cranial Nerves How do you remember where they ARE?

Answer 32

CE (1,2), MI (3,4), PONS (5,6,7,8), MEDU (9, 10, 11, 12)

Question 33

CN 7 and 9 differentiation

Answer 33

7 (facial)= ANT 9 (trigeminal)= POST (P is backwards 9) Taste= facial Sensory= Trigeminal

Question 34

Common gait abnorms: 4 ELABORATE

Answer 34

1. Step LENGTH deviations (FLOP= tight hip flexors OPP leg step leg length 2. Trunk bending deviations (**Magnet Theory in STANCE only!!!)** 3. LLD deviations (think David in his High Heels) 4. Inad mm control deviations

Question 35

IMPORTANT Gait definitions

Answer 35

Gait cycle: Heel strike to next I/L heel strike Stride: one full gait cycle (heel strike to NEXT same foot heel strike) Step: One foot to the other foot

Question 36

Ex. shorter step length on R. side

Answer 36

A: R. glute max contracture - Tight EXTs or stuck in EXT, SO will have shorter step length bc cant go into hip flexion bc EXTs are tight!!!

Question 37

2 Tests for High Ankle Sprain **Think TIBIOfibular ligament!!!**

Answer 37

1. Syndesmotic squeeze (Hopkin's) Test-- bc gapping @ the syndesmosis distally 2. Kleigers (ER/DF) Test --crank on it-- NEUTRAL foot and have them short sit w/ foot hanging off edge--**Same MOI as high ankle sprain**

Question 38

Ankle special tests differentiation:

Answer 38

Talar tilt w/ ankle in **neutral DF**== CFL, can also tilt into EVERSION for deltoid lig (medial ligs) Ant Drawer w/ ankle **neutral DF**== Anterior TALOfibular lig (depending on where you stabilize/mob== ligs tested (ATFL vs deltoid ligs) Compression of shafts of tib/fib @ mid calf== Syndesmotic squeeze== TIBIOfibular ligament Squeezing calf w/ ankle neutral DF== Thompson== Achilles rupture--- + will be absent PF

Question 39

Appendicitis tests **RLQ pain==AC==Appendicitis/Crohn's**

Answer 39

1. Obturator sign (ER)-- passive stretch into IR, supine 2. Psoas sign (hip flexor)-- passive stretch into hip EXT, S/L w/ affected side UP 3. McBurneys pt-- bw ASIS/umbillicus--RLQ 4. Rovsing's Sign-- palpate **LLQ**== pain in RLQ MORE!--> Blumbergs (rebound tender), Inch+Pinch on R (right on appendix site), Single hop test (RLQ pain), Markel sign (heel drop sign)

Question 40

3 Diff **Murphy's Signs**

Answer 40

1. **Acute Cholecystitis--gallbladder**- RUQ-- deep breath and pull up into rib one 2. **Murphy's Punch for Kidneys--kidneys**- pyelonephritis 3. **Lunate dislocation (hand)--** knuckles lining up one (middle knuckle lines up= (+)-- remember middle knuckle usually protrudes out more

Question 41

Referred Pain Patterns ALL!!!!

Answer 41

RUQ: Good Luck Hot Pack (Gallbladder, Liver, Head of pancreas, Peptic ulcers RLQ: AC (Appendix, Crohn's) LUQ: Dont Banana Split (Diaphragm, Body/tail of pancreas, SpLeen (Kehrs sign) SLR and pain in L. shoulder) LLQ: DUI (Diverticulitis, Ulcerative colitis, IBS) Heart== L shoulder/arm

Question 42

Functional Independence Measure (FIM) **Assist lvls--Patient participitation** 7 (BEST)--> 1 (WORST)

Answer 42

Outcome measure assesses **lvl of functional status** of person **based on lvl of assistance required** **7:** COMPLETE IND (timely, safely) **6:** MOD IND (use of AD) **5:** Supervision (cueing, setup, coaxing) **4:** MIN A (**Pt participation= 75% or more)** **3:** MOD A (**Pt participation= 50-74%**) **2:** MAX A (**Pt participation= 25-49%**) **1:** DEPENDENT (**Pt participation= LESS than 25%)**

Question 43

Straight Leg Raise Test: 4 SLR (Basic), SLR 2, SLR 3, SLR 4

Answer 43

**SLR (Basic)--Sciatic + Tibial** - Hip flex/add - Knee ext - Ankle DF **SLR 2 (TED-Tibial Eversion DF)--Tibial** - Hip flex - Knee ext - Ankle DF - Foot eversion - Toe ext **SLR 3 (SID- Sural Inversion DF)--Sural** - Hip flex - Knee ext - Ankle DF - Foot inversion **SLR 4 (PIP--Peroneal Inversion PF)--Common Peroneal** - Hip flex + IR - Knee ext - Ankle PF - Foot inversion

Question 44

LBP Conditions Table

Answer 44

See Table: **Breakdown:** 1. Spondys vs 2. Disc Herniation vs 3. Spinal stenosis (narrowing of vert canal)

Question 45

# LBP Cond's Spondy's

Answer 45

Spondylosis--think DEGEN, >50yo Spondylolysis--think Pars fx, scotty dog, 15-20yo Spondylolisthesis--think slippage (usually anterior), 20yo (can progress to degen w/ age)-- **TEST= Stork Test** **Aggravating factors:** Ext, Standing mostly; bending to lift objs (spondylolysis/listhesis) **Relieving factors:** Sitting (all 3); bending (spondylosis) **SLR Test:** NEGATIVE all 3 **Imaging:** X-ray (all 3)

Question 46

# LBP Cond's Disc Herniation (think posterolat nucleus protrusion)

Answer 46

**Age:** 30-50 **Loc:** Back, leg (U/L) **Aggravating:** Sitting (flex bias), Bending, **A**scending stairs **Relieving:** Extension, Standing (Ext bias), **D**escending stairs **SLR Test:** POSITIVE **Imaging:** MRI/CT--bulging disc

Question 47

# LBP Cond's Spinal Stenosis Test: **Van Gelderan** Think narrowing vert canal **"The shopping cart leaners"**

Answer 47

**Age:** >60 **Loc:** back, legs (B/L) **Aggravating:** Ext, Standing (Ext bias) **Relieving:** Sitting, Bending **SLR:** POSITIVE **Imaging:** CT, MRI and X-ray

Question 48

HypERthyroid- "Hyper David who never gains wt" HypOthyroid- "Lazy husband laying on couch all day w/ comforter" ALL FIRST

Answer 48

See table: HypER-- sped up HypO-- slowed down

Question 49

HypERthyroid **Dis's== Exopthalmos (bulging eyes), Grave's**

Answer 49

- INCd T3/4== LOW TSH (bc trying to lower T3/4) - INCd HR, DEC BP (bc NOT sedentary) - High BMR (sped up) - Heat INtolerance (bc always moving/sweating) - INCd GLU absorb (bc moving always)== Lower blood glucose - Restless, insomnia (obv) - Diarrhea (bc sped up) - Silky hair, moist palm (bc always sweating) - Wt LOSS + Incd appetite (always eating, never gain wt) - INCd perspiration - HYPERreflex (bc HYPERthryoid)

Question 50

HypOthyroid **Dis's== Myxedema, Hashimoto's**

Answer 50

- DECd T3/4, HIGH TSH bc trying to INC T3/4 - DECd HR, HIGH BP (bc sedentary so makes sense) - Low BMR (slowed down) - COLD intolerance (lazy guy laying on couch w/ comforter, hes cold) - DECd GLU absorb (sedentary), higher blood glucose - Sleepy, tired, **Prox mm weakness (bc laying on shoulder & prox mm's)** - Constipation (bc slowed down) - Brittle nails, dry skin and hair (bc slowed down) - Wt GAIN, decd appetite (not eating, but still gain wt) - Decd perspiration (not moving) - Prolooonged DTRs (bc HypOthyroid)

Question 51

Types of HAs ALL FIRST

Answer 51

**U/L=** Cervicogenic, Cluster, Migraines **B/L=** Tension

Question 52

# Types of HA: Cervicogenic

Answer 52

**U/L** - pain in **occipital region-- spreads to frontal area** - Sx's aggravated by **mvmt** or sustained **postures**

Question 53

# Types of HA: Cluster the "stabbing pain" one

Answer 53

**U/L, M>F** - pain around **one eye** - sharp, **stabbing,** throbbing - **Autonomic sx's:** sweating face, lacrimation

Question 54

# Types of HA: Migraines "photophobia" one

Answer 54

**U/L, F>M** - pain on **one side of face** - **pulsating quality** - Aggravation w/ routine phys act and assocd w/ **nausea, vom, photophobi**

Question 55

# Types of HA: Tension **ONLY B/L one**

Answer 55

**B/L, band across forehead one** - Tight or pressure across **forehead like a band** - **Mm tightness/tender in facial and CS mm's** - Assocd w/ **stress, anxiety, depress-- aka STUFF THAT CAUSES TENSION!!!**

Question 56

Aquatic Therapy All first Think **Heart is HAPPY**

Answer 56

see table

Question 57

Active Insuff vs Passive Insuff

Answer 57

Active= SAME motion as mm Passive= OPPOSITE motion as mm

Question 58

One (psoas) and Two (Rec Fem) Joint **Hip Flexor**

Answer 58

**Psoas--** 1 jt hip flexor--crosses 1 jt **Rec Fem--** 2 jt hip flexor-- crosses 2 jts: Hip AND Knee **Thomas Test Interpretations:** Sign vs Structures Affected - EXTd knee==> Quads, rec fem - Flexed hip==> Psoas - Abd'd hip==> TFL/ITB - Lateral rotation of tibia==> Biceps fem (bc biceps fem, lateral HS== ER tibia + knee flex) ## Footnote If you see Thomas Test question + hip FLEXOR stretch-- go w/ Thomas Test -- think HIP FLEXORS **Ely's Test--- think QUADS!!!!**

Question 59

AV Blocks Summary

Answer 59

**Block, ECG Interp, PT Response:** - First Degree-- INC PR interval (looong PR)-- Continue exercise, benign - Second Degree Type I (Weckenbach)-- Progressive inc in PR interval, then DROP! (long, looonger, drop)-- Monitor and cont @ LOWER intensity - Second Degree Type II (Mobitz II)-- Normal PR interval until SUDDEN drop (norm, norm, drop)-- STOP exercise, **NO 911** - Third Degree--No relationship (NO comm. bw Ps & Qs)--**Stop IMMEDIATELY and refer, 911!!!**

Question 60

PICO question What is it? Example?

Answer 60

**P:** Population/Problem (Ex. LBP) **I:** Intervention/Dx/Prognosis (Ex. traction) **C:** Comparison bw Tx groups (Ex. nothing) **O:** Outcome measures used to measure variables (Ex. Outcome, **Dep variable)**

Question 61

How do you remember **I**ndependent variable?

Answer 61

**I for I** **I**nd variable is the **I**ntervention!!!

Question 62

Isolated Precautions ALL FIRST

Answer 62

See table

Question 63

# Isolated Precautions: KEY STUFF Iso Type: **Contact Precautions**

Answer 63

MRSA, VISA, VRE, C-Diff, Hep-A/B PPE: **Gloves & Gown** Hand wash BEFORE and AFTER

Question 64

# Isolated Precautions: KEY STUFF **Droplet Precautions**

Answer 64

Mumps (Rubella), Strep, Meningitis, PNA, Influenza PPE: **Mask when w/in 3ft** Hand was **UPON ENTERING and Leaving room**

Question 65

# Isolated Precautions: KEY STUFF **Airborne Precautions**

Answer 65

Measles, TB, Varicella, Herpes Zoster (dermatomal pattern rash) PPE: **N-95 mask, Gown and Gloves--discard mask upon LEAVING room** Hand was UPON ENTER and LEAVING **private room w/ NEGATIVE air flow**

Question 66

Heart sounds and CLOSING of valves

Answer 66

S1-- assocd w/ closing of **Tricuspid/Mitral valves-- "S1TM"** S2-- assocd w/ closing of **Aortic/Pulmonic valves-- "S2AP", SAP and 2 looks like S** S3-- early DIASTOLE-- CHF-- heard @ **apex (bottom of heart--mitral valve** S4-- MI/HTN/Vent hypertrophy-- heard @ **apex (bottom of heart--mitral valve**

Question 67

WOUNDS!

Answer 67

**A**rterial-- L**A**T malleolus-- pain w/ elevation **Venous (VenMO)--** M**E**DIAL malleoulus-- elevation DECs pain (gravity assists w/ venous return)

Question 68

MS and Unthoff's

Answer 68

Neuro sx's worsen w/ in the heat AVOID HEAT **"Oof, its hot"**