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NPTE Final Frontier > MEGA REVIEW DAY 2 > Flashcards

MEGA REVIEW DAY 2 Flashcards

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1
Q

Types of MS: 4 (Its IN the NAMES!)
ON TEST– DRAW THE GRAPH!!!!

A
  1. Relapsing Remitting– Unpredictable attacks which may or may not leave perm deficits f/b pds of remission
  2. Progressive Relapsing– Steady decline since onset w/ superimposed attacks
  3. Primary (Chronic) Progressive– Steady INC in disability w/out attacks
  4. Secondary Progressive– STARTS as relapse-remitting PROGRESSES to primary progressive
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2
Q

What VOLUMES ALWAYS INCS in COPD?

A

INC RV, FRC, TLC

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3
Q

GOLD CLASSIFICATION- COPD

REMEMBER Start @ 30%- VERY Severe

A

Mild–> Very Severe; all stages have FEV1/FVC < 70% (remember COPD lOwer than 70%)
I: Mild– FEV1 >/= 80%, w/ or w/out sx’s of cough/sputum
II: Mod– FEV1 50-79%; SOB w/ exertion, w/ or w/out cough/sputum
III: Severe– FEV1 30-49%; greater SOB w/ ex, decd ex cap, fatigue and repd exacerbation of COPD
IV: Very Severe– FEV1 < 30% (Start here!); chronic resp failure

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4
Q

ULTT Tests

A

ULTT1= MAIN
ULTT2= MAM
ULTT3= R
ULTT4= U
ALL are CS lateral flexion C/L side

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5
Q

Helpful tips for P. nerves
See hand deformities/P. nerve lesions in notes!!!
P nerve maps!!!

A
  • Median/Ulnar or any major P. nerve– Sensory AND Motor loss
  • Interosseus– think ONLY MOTOR
  • Cutaneous– think ONLY SENSORY
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6
Q

SCI Syndromes
What MUST you draw for each????
- DCML sxs– same side
- Corticospinal sxs– same side
- Lateral (pain/temp) + Ant (crude touch) Spinothalamic sxs– OPP side

A

Anterior Cord
- HyperFLEX injury
- Motor function loss B/L, Spastic paralysis below lvl of injury, Loss of pain/temp B/L lvl of injury

Posterior Cord
- Sensory loss (DMCL–Val got GBS twice) (lose proprio, vibration, stereog)

Central Cord (sm or lg–“Walking Quads”)– MUD-E (Motor, UEs, Distal)
- HyperEXT inj
- Loss pain/temp
- Motor loss B/L UEs only

Brown-Sequard
- Brown POT – pain/temp OPP
- I/L sx’s–> motor and sensory loss

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7
Q

Pressure Ulcers— See bonus material for pics
Stages 1-Unstageable

A

Over bony areas–stage related to depth of wound bed
Stage 1: intact skin w/ non-blanchable redness
Stage 2: Partial thickness (Pink) wound. Superf in nature w/ pink/red wound bed (SHALLOW crater)
Stage 3 (FAT is 3 letters): Full thick (Fat). Subq tissue visible but no bone, tendon and mm. DEEP crater
Stage 4 (BONE is 4 letters): Full thick w/ bone exposed, tendon and mm. Undermining and tunneling w/ slough/eschar present
Unstageable: wound bed covered w/ slough/eschar– unable to ID depth
Deep tissue injury– Intact skin w/ purple/maroon appearance

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8
Q

Venous vs Arterial Insufficiency (Wounds)

A

Venous– “My (medial mall) Victory (venous) Elevates Me (elevate the leg)”
- prox to med mall
- Irreg, shallow
- Flaking, brownish–hemosiderin stain
- mild-mod pain (bc still blood there)
- Elevation DECs pain (bc gravity assists bloodflow)

Arterial– All (arterial) Losers (lat mall) stays down (NO elevation of LE)
- lower 1/3 of leg, toe, LAT mall
- smoothe edges, well-defined
- thin and shiny, hair loss, yellow nails (trophic changes–PAD)
- SEVERE pain (bc no bloodflow!)
- Elevation INCs pain (bc already NO blood there, now theres REALLY no blood if you elevate it!)

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9
Q

Burns!!!

A

Review!!!

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10
Q

REVIEW Sx PROTOCOLS!!!!

A

!!!!!!!!

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11
Q

THA Precautions:
Ant vs Post Approach

A

AVOID!
Posterior – ESP first 6wks
- hip flex >90degs (knees lower than hips)
- ADD past midline (bed pos’ing w/ ADD wedge
- IR
- No FADDIR

Anterior
- hip flex >90degs
- Individual: hip EXT, ADD, ER past neutral
- Combined: FABER

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12
Q

Parametric Tests: 2

A
  1. Paired T-Test (2a: 1-tail 2b: 2-tail)
  2. ANOVA (3 or more ind groups compared on 1 intervention)
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13
Q

Parametric Tests

Paired T-Test
T-test think TWO groups

A

Compares diffs bw 2 matched samples
- 2a: 1-tailed= 1 end of distribution, EITHER (+) or (-)
- 2b: 2-tailed= 2 ends of distribution, BOTH (+) and (-)

Ex. Dist covered by M/F on 6MWT
1-tail= Females cover longer dist
2-tail= Looks @ BOTH males or females

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14
Q

Parametric Tests

ANOVA (3 groups) and ANCOVA

A

One way ANOVA: 3 or more ind groups compared on 1 intervention
ANCOVA: Compare 2 ore more Tx groups while controlling effects of variables (COvariates) Ex. time

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15
Q

Parametric Tests (Paired T-test and ANOVA)
Gen Details

A

Research Question
- 2 groups== IND or unpaired T-tests
- 2 Tests
Criteria/Assumptions
- EQUAL samples
- NORMAL distribution (Bell curve)
- CONTINUOUS scale= Ratio/Interval= ROM, Temp, Ht/Wt, Distance, Infinite #’s

ORDINAL== rank/scale—DIFFERENT

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16
Q

NONparametric Tests

A

Kruskal Wallis test- NONparametric equivalent to ANOVA– needs 3 groups
Chi-Square- 2 groups but NOMINAL (Y/N) data– Association study (asking is this ASSOCIATED w/ that? Y/N?= Nominal (Nominal think Nonparametric)

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17
Q

Long Sitting (Supine to Sit) Test
Rotated inominate

A
  • If leg on PFL side appears LONGER in SUPINE, then SHORTER in Long-Sit==> Anteriorly rotated inom on that side
  • If leg on PFL side appears SHORTER in SUPINE, then LENGTHENS in Long-Sit==> Posteriorly rotated inom on that side
  • MM Energy Techniques**–> Stretch BEFORE strengthen, OR isometric to opp side to pull inominate back
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18
Q

Postural Drainage: KEY POS’s

BAD lung UP

A

Key Pos’s
- SUP segs, LOWER lobes==> prone w/ 2 pillows under pelvis
- ANT apical segs, UPPER lobes==> recliner leaning slightyly backwards
- POST apical segs, UPPER lobes==> sitting on chair leaned forward
- ANT segs, UPPER lobes==> supine w/ pillows under knees

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19
Q

Postural Drainage: Tips to remember

A

BAD lung ALWAYS UP
Ex. R middle lobe= R. lung UP; L lingular= L lung UP (Both raise feet 12 in. (middle lobes raise feet 12in); LOWER lobes= raise feet 18in
Position help:
- Ant segs= Supine
- Lateral segs= S/L
- Posterior segs= Prone
- Apical= Sitting (Ant apical= recline back; Post apical= sit & lean forward

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20
Q

Contraindications to Postural Drainage
**Precautions vs Relative Contraindications (IHRRR, make sound)

A

Precautions:
- Pulm edema, Hemoptysis, Massive obesity, Lg pleural effusion, Massive ascites

Relative Contraindications: “IHRRR”
- Incd ICP, Hemodynamically UNstable, Recent esophageal anastomosis, Recent spinal fusion or injury, Recent head trauma

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21
Q

SCI Chart

A

See chart—KNOW IT!!!

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22
Q

SCI Chart Broken Down

A

C1, 2, 3/C4= High lvl injury– DEPENDENT
C5/C6– Modified DEP/IND
C7-L4/5, S1/2– IND w/ MOST

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23
Q

SCI MM’s spared

A

C1, 2, 3= Face/Neck
C4= Diaphragm (partial), Trpz (bc they are CN XI)
C5= 3BIRDS- Biceps, Brachialis, Brachioradialis, Infrasp, Rhomboids, Deltoids, Supinators
C6 (SLIP rhymes w/ 6)= PET-SLIP- P.major, ECR, T.minor, SA, LD, Infrasp, Pronator
C7= FEET- FCR, EPB/EPL, Extrinsic finger EXTs, Triceps (easy C7 one to remember)
C8= FCU, FPL/FPB & Intrinsic finger FLEXors
T1-T12= Intercostals, long mms of back (sacrospinalis and semispinalis), Abs ~T7 and below
L1, 2, 3= Gracilis, Iliopsoas, QL, RF, Sartorius
L4= TA, L5= ED, S1= PFs, S2= HS’s

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24
Q

What lvl of RLA scale do you HAVE to know?????

Study These Flashcards
A

TBI- RLA Lvl IV: Confused & Agitated

25
TBI- **RLA Lvl IV: Confused & Agitated** Motor vs Behavioral Probs
**Motor probs:** - Goals: Inc endurance, Maint jt mob, Dec risk secondary impairs - Intervention: Prepare MULT acts, Give pt CHOICES (make them feel they are in charge) **Behavioral probs:** - Goals: Dec outbursts, Dec agitation - Interventions: Be CALM, Be CONSISTENT (same tx time, same PT, same location), Provide orientation, Know when to STOP or CHANGE act.
26
NPTE questions---
READ STEM FIRST!!! LOOK FOR KEYWORDS AND WORDS LIKE "MOST, LEAST, ETC" | !!!!!!!!
27
More on RLA Lvl IV: Confused & Agitated
- ALWAYS orient the pt!!! - use the SAME people, Introduce yourself!! - Be calm, composed - Give OPTIONS (This OR That) - More-- daily routine, orient pt, chart/white board to doc progress NEVER use Y/N questions OR open-ended questions!!!!
28
TBI-RLA Scale Broken down
1-3= **Response**; 4-6= **Confused**; 7-8= **Appropriate** 1: No **response** 2: General **response** 3: Localized **response** **4: Confused-Agitated** 5: **Confused-**INappropriate 6: **Confused-** Appropriate 7: Automatic-**Appropriate** 8: Purposeful-**Appropriate**
29
# Balance Strategies 2 types:
Corrective (Ankle strategy & Hip strategy) Protective (Stepping strategy & Reach/Grasp strategy)
30
# Balance Strategies **Corrective: Ankle (small) vs Hip (large)** - Bring us back to neutral
**Ankle strategy: OA (Opp Ankle)** - Sway/Perturb= Small, slow, near midline - MM's activation= Dist--> Prox - **w/ FORWARD sway=** Gastroc--> HS's--> Paraspinals (Forward sway think POST mm's bc its OPP - **w/ BACKWARD sway=** Tib ant-->Quads-->Abs (Backward sway think ANT mm's bc opp **Hip strategy** - Sway/Perturb= Lg, (bc Lg jt), fast - MM's activation= Prox--> Dist (do it and you'll feel it, same w/ ankle) - **w/ FORWARD sway=** Abs-->Quads (same side mm's) - **w/ BACKWARD sway=** Paraspinals-->HS's
31
# Balance Strategies **Protective: Stepping vs Reach/Grasp ** - EXTRA strategy to help out
**Stepping strategy:** - Sway/Perturbs= Fast and Lg - **COM exceeds BOS** **Reaching/Grasp strategy:** - UEs - Extend BOS to stabilize posture Suspension think Lowering BOS closer to floor, bend knees/lower BOS
32
ROODS Approach **What do you IMMEDIATELY think of?**
Facilitory vs Inhibitory
33
# ROODS Approach **Facilitatory Tech's** Think **ACTIVATE** LOOK @ the words used!!! Ex. Flaccid mm's
- Approx - Lt manual resist, Manual contact - **Quick** icing - Lt touch - **Tapping, brushing, hacking** - **High freq** vibration - **Quick** stretch - **Fast** spinning or rolling
34
# ROODS Approach **Inhibitory Tech's** Think **PREVENT Activation or Inhibit** Look @ Words used!!! Ex. Spasticity
- **DEEP** pressure - **Prolooonged** stretch - Neutral warmth or **prolonged** cold - Maintained touch-- myofascial release--hold it there to RELAX mm's - **Rhythmic** swinging - **LOW freq** vibration - **Slow-**stroking - **Slow** rocking or rolling
35
Mod. Ashworth for Grading Spasticity
0= NO inc in mm tone 1= Slight inc in mm tone, manifested by **catch and release** OR by **min resist @ end of ROM when affected part moved into flex/ext** 1+= Slight inc in mm tone, manifested by **catch** f/b MIN resist t/o remainder (less than 1/2) of ROM 2= **More marked inc** in mm tone t/o **MOST of ROM,** but affected part **easily moved** 3= **Considerable inc** in mm tone, **passive mvmt is diff** 4= Affected part(s) **rigid in flex or ext**
36
Putting ROODs Approach into practice Pt w/ R. CVA (perceptual defs). Biceps grade 2 on MAS. Most effective intervention? Think SPASTIC...think INHIBIT (slow words)
A: Proloooonged cyro to L. biceps bc this will **inhibit** the mm
37
Lymphedema Mgmt UE exercises **What should you remember about this? **
PROXIMAL muscles FIRST!!!! When it comes to Ex's for lymph03dema.... Start PROXIMAL!!!
38
**Techniques** for Lymphedema and **Direction**:
Technique: **Stroking/Massage** Direction: **Dist--> Prox** Technique: **Decongestion** Direction: **Prox--> Dist** (think traffic jam, have to clear the congestion proximally BEFORE the distal can come through!!!) Technique: **Exercise** Direction: **Prox--> Dist**
39
Iontophoresis **At least remember the NEGATIVE (ISAD) ions**
ISAD (Ions) - **Iodine (-)**: Sclerotic scars - **Salicylate (-):** Analgesic (Sal has pain, analgesic) - **Acetate (-):** C**A**lcium deposits - **Dexamethasone (-):** Msk inflammation Rest are all (+)-- some to easy remember - **Z**inc (+): Wound**Z**-- Dermal **ulcers** - LidoCAINE/XyloCAINE (+): Analgesic - Copper (think old fungal penny on ground) (+): Fungal infx - Magnesium (think "**spastic maggy")** (+): Muscle spasm
39
Iontophoresis **At least remember the NEGATIVE (ISAD) ions**
ISAD (Ions) - **Iodine (-)**: Sclerotic scars - **Salicylate (-):** Analgesic (Sal has pain, analgesic) - **Acetate (-):** C**A**lcium deposits - **Dexamethasone (-):** Msk inflammation Rest are all (+)-- some to easy remember - **Z**inc (+): Wound**Z**-- Dermal **ulcers** - LidoCAINE/XyloCAINE (+): Analgesic - Copper (think old fungal penny on ground) (+): Fungal infx - Magnesium (think "**spastic maggy")** (+): Muscle spasm
39
Iontophoresis **At least remember the NEGATIVE (ISAD) ions**
ISAD (Ions) - **Iodine (-)**: Sclerotic scars - **Salicylate (-):** Analgesic (Sal has pain, analgesic) - **Acetate (-):** C**A**lcium deposits - **Dexamethasone (-):** Msk inflammation Rest are all (+)-- some to easy remember - **Z**inc (+): Wound**Z**-- Dermal **ulcers** - LidoCAINE/XyloCAINE (+): Analgesic - Copper (think old fungal penny on ground) (+): Fungal infx - Magnesium (think "**spastic maggy")** (+): Muscle spasm
40
E-stim parameters for **MM Contractions**
**Pulse Freq:** 35-80 pps **Pulse Duration: Sm mm's= 150-200 Lg mm's= 200-250 (larger #)** **Amplitude:** Injured= >10% MVIC UNinjured= >50% MVIC **On:Off Times/Ratio:** JUST REMEMBER 1:5 INITIALLY--- can then progres "On" time **Ramp Time:** @ least 2s (1-4) **Tx Time:** 10-20 mins **to produce 10-20 reps** **X/Day:** Every 2-3hrs when awake
41
Common GAIT abnorms: 4
1. Step LENGTH devs 2. Trunk bending devs (**Magnet Theory in STance)** 3. LLD devs 4. Inad mm control devs
42
Practice + tips Pt w/ weak tib ant (DFs), PT uses FES to improve ambulation. Stimulation initiated for weak mms during which phase of gait cycle?
Initial Swing to Mid Swing **Bc FOOT CLEARANCE**, functionally this is THE MOST IMPORTANT and functional answer. **TIP: ALWAYS pick MOST functional mvmt** If they cannot clear the foot== higher risk of falls
43
Lumbar spine mobilizations **CLOSING and GAPPING** Remember... "Bar OPENS= Pop the Top, Cheers" "Bar CLOSES= Bottoms UP (finish your drinks) | ALWAYS DRAW THE "C"
**Flexion: OPENS or INCs gap** **Extension: CLOSES or DECs gap** - Imagine vertebrae as letter "C"-- DRAW IT! - Always PA mob - If it says **U/L-- mob TP, or it will say facet joints** - If it says **B/L-- mob SP**
44
Ex. PT det's manual therapy to improve **closing (Bottoms UP) of T4-T5 facets (think TPs)**. Hand/finger placements for PA mob? MAKE THE C!!!
Mobilize TP of T5 to move T5 (bottom) UP to improve CLOSING
45
Burns and Contracture Predisposition Pos's **If you know where they are at most risk for contracture, just put them in the OPP position!!!**
**Most common contracture pos's:** Neck= flexion Shoulder= ADD/IR Elbow= flexion Forearm= PRO Wrist/Hand= **Claw hand (intrinsic minus) w/ MCP ext, IP flex, thumb ADD** Hip= flex/add Knee= flex Ankle= PF SO THEN PREVENTATIVE POSITIONING IS JUST THE OPPOSITE-- see chart
46
Garment Compression Classification for **Lymph03dema**
**NOTE: Compression MUST ALWAYS BE LOWER than DBP** Class I (Least) to Class IV (Most)-- things to remember + see chart **Class I 20-30: Least compression**-- think MILD lymphedema, **Stage I, elderly** **Class II 30-40:** ALWAYS **UE lymphedema** (most common for UE lymph) **Class III 40-50:** think **LE lymphedema, Stage II** (high-int acts) **Class IV 50-60 (really high, rare):** usually only thru recommendation
47
What type of STRETCH bandage for lymph03dema?
SHORT (LOW) stretch **w/ more layers DISTALLY than proximally**-- easy to remember bc short person is LOW to ground NO BP on lymph arm ever!!!! No heat!! bc will inc swelling
48
Diastasis Recti
Split of rectus abdominis @ **linea alba** **Test:** Pt in *Hooklying*-- raise head/shoulders OFF floor--reach hands towards knee until scap leaves floor--> PT places one finger of one hand horiz. across midline of abdomen @ umbilicus **Interpret**: If split is **>2cm= Concern** **Treat:** First **protect (binding/bracing)** abd musculature then **progress to head lifts THEN head lifts w/ PPTs**
49
Supraventricular arrhythmias aka
Atrial arrhythmias
50
SUPRAvent arrhythmias Types: 4 **Atrial arrhythmias are NEVER an emergency bc Vents are still FINE**
1. PAC 2. Atrial **Tachy** (Rate= 100-250bpm) 3. Atrial **Flutter; F-waves** (Rate= 250-350bpm) 4. Atrial **Fibrillation; quivering** (Rate= 400-600bpm) **Atrial probs are NEVER 911--> Insuff CO though, blood pooling--> clot risk (if A-fib)**
51
Incremental Exercise What should you think of?
HR & BP - SHOULD Inc **linearly** w/ inc'ing **work rate**
52
# Incremental Exercise HR and CO (HR * SV)
Incs linearly w/ inc work rate Reaches plateau @ **100% VO2 max**
53
# Incremental Exercise BP (MAP)
MAP incs linearly - SBP Incs - DBP remains **fairly constant (+/- 10)**
54
Cardinal Signs L. vs R. sided HF
**L. Sided HF:** 1. DOE 2. Cough 3. will also see Pulm edema (pump failure) **R. Sided HF** 1. JVD 2. Peripheral edema
55
Lumbar Traction **Key stuff**
**Supine (Flex bias) w/ pillows under knees-->** IVJs, Facet jts, MM elongation **Prone (Ext bias)-->** **P**osterior disc herniation To **Inc IV space of:** - L5-S1 (**L**ower=**L**ittle bit): 45-60degs hip flexion (obv supine) - L3-4 (higher): 75-90deg hip flexion
56
Lumbar Traction **% BW Parameters**
**Disc protrusion/herniation, spasm, elongation**= 25% BW **Jt distraction**= 50lbs OR 50% BW (obv more bc need to **distract)** NO >50% BW **NOTE: CS traction= 5-7% BW or 25lbs**
57
Above Knee Prosthesis: Above Knee Amp; Transfemoral **LOW (Weak) walls vs HIGH (High and Tight) walls**
**LOW walls (think loW=Weak)** - Think WEAK mm's - Ex. LOW ant thigh wall= weak quads - Ex. LOW lateral wall= weak abd's **High walls (think High and TIGHT)** - Think TIGHT mms - Ex. HIGH ant thigh wall= tight hip flexors- pulls pelvis ANTERIORLY

NPTE Final Frontier (19 decks)

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