Flashcards in Sb1 Deck (233):
What is supination of the foot?
- supination of foot is a combination of inward rotation at the ankle, adduction of the hindfoot, inversion of the forefoot, and medial arch elevation;
- subtalar joint supination is 3 planes of motion simultaneously:
- as foot supinates the lateral structures tighten;
- continued supination and adduction force may rupture portions of lateral collateral ligaments or avulse these ligaments from their bony attachment sites on the distal fibula, resulting in an ankle sprain;
What is pronation of the foot?
- subtalar joint pronation is also 3 planes of motion simultaneously
- abduction of forefoot;
- eversion of hindfoot;
- medial arch depressed;
- deficiency of medial forefoot post;
- hyperpronation can be a developmental response to tibia vara;
- excessive foot pronation has been speculated to be a cause of leg and foot problems among runners;
- changes in shoe design does improve foot alignment over running barefoot in a pt w/ forefoot pronation
What is forefoot varus?
Forefoot varus is the angling or inverted position of the bones in the front of the foot in relation to the heel. In an uncompensated forefoot varus deformity, this causes the bones on the inside edge of the foot to sit higher off the ground than the outside of the foot during weight bearing.
What is rearfoot valgus?
It is rare. Knock knees (tibia valgum( + ST pronation
Medial portion of calcaneus is elevated; lateral portion is depressed.
What is Relapsing-Remitting MS (RRMS)?
Relapsing-Remitting MS (RRMS). This is the most common form of multiple sclerosis. About 85% of people with MS are initially diagnosed with RRMS. People with RRMS have temporary periods called relapses, flare-ups or exacerbations, when new symptoms appear
What is Secondary Progressive MS?
In SPMS, symptoms worsen more steadily over time, with or without the occurrence of relapses and remissions. Most people who are diagnosed with RRMS will transition to SPMS at some point
What is Primary-Progressive MS (PPMS)?
Primary-Progressive MS (PPMS). This type of MS is not very common, occurring in about 10% of people with MS. PPMS is characterized by slowly worsening symptoms from the beginning, with no relapses or remissions
What is Progressive-Relapsing MS (PRMS)?
A rare form of MS (5%), PRMS is characterized by a steadily worsening disease state from the beginning, with acute relapses but no remissions, with or without recovery http://images.medicinenet.com/images/appictures/multiple-sclerosis-s5-different-types-of-ms.jpg
What is Charcot's Foot?
Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.
What does the dorsal scapular nerve innervate?
It provides motor innervation to the *Rhomboid muscles, which pull the scapula towards the spine and *Levator scapulae muscle, which elevates the scapula.
What is an arterial line?
An arterial line (also art-line or a-line) is a thin catheter inserted into an artery. It is most commonly used in intensive care medicine and anesthesia to monitor blood pressure directly and in real-time (rather than by intermittent and indirect measurement) and to obtain samples for arterial blood gas analysis.
What is Legg-Calve-Perthes disease?
Legg-Calve-Perthes disease occurs when the ball of the thigh bone in the hip does not get enough blood, causing the bone to die.
Legg-Calve-Perthes disease usually occurs in boys 4 through 10 years old. There are many theories about the cause of this disease, but little is actually known.
Without enough blood to the area, the bone dies. The ball of the hip collapses and becomes flat. Most often, only one hip is affected, although it can occur on both sides.
The blood supply returns over several months, bringing in new bone cells. The new cells gradually replace the dead bone over 2 to 3 years.
The first symptom is often limping, which is usually painless. Sometimes there may be mild pain that comes and goes.
Other symptoms may include:
Hip stiffness that limits hip movement
Limited range of motion
Thigh or groin pain that does not go away
Shortening of the leg, or legs of unequal length
Muscle loss in the upper thigh
Exams and Tests
During a physical examination, the health care provider will look for a loss in hip motion and a typical limp. A hip x-ray or pelvis x-ray may show signs of Legg-Calve-Perthes disease. An MRI scan may be needed.
The goal of treatment is to keep the ball of the thigh bone inside the socket. The provider may call this containment. The reason for doing this is to make sure the hip continues to have good range of motion.
What is a Hickman Catheter?
A Hickman line is a central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis. Some types are used mainly for the purpose of apheresis or dialysis.
What is a Swan-Genz Catheter?
Swan-Ganz catheterization is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs. It is done to monitor the heart's function and blood flow. This test is most often done in persons who are very ill.
What is the lingula?
The left lung, unlike the right does not have a middle lobe. However the term lingula is used to denote a projection of the upper lobe of the left lung that serves as the homologue.
Where would you test the L3 dermatome?
L3 - At the medial epicondyle of the femur.
A patient is positioned in supine with the hips flexed to 90 degrees and the knees extended. As the patient slowly lowers her extended legs toward the horizontal, there is an increase in lordosis of the low back. This finding is indicative of weakness of the:
In a clinical trial, patient height is measured in centimeters and weight is measured in kilograms. What inference can the physical therapist make about the scale of measurement for height and weight?
What is the ratio scale?
in ratio measurement there is always an absolute zero that is meaningful. This means that you can construct a meaningful fraction (or ratio) with a ratio variable. Weight is a ratio variable. In applied social research most "count" variables are ratio, for example, the number of clients in past six months. Why? Because you can have zero clients and because it is meaningful to say that "...we had twice as many clients in the past six months as we did in the previous six months."
What is nominal ordering?
In nominal measurement the numerical values just "name" the attribute uniquely. No ordering of the cases is implied. For example, jersey numbers in basketball are measures at the nominal level. A player with number 30 is not more of anything than a player with number 15, and is certainly not twice whatever number 15 is.
What is ordinal measurement?
In ordinal measurement the attributes can be rank-ordered. Here, distances between attributes do not have any meaning. For example, on a survey you might code Educational Attainment as 0=less than high school; 1=some high school.; 2=high school degree; 3=some college; 4=college degree; 5=post college. In this measure, higher numbers mean more education. But is distance from 0 to 1 same as 3 to 4? Of course not. The interval between values is not interpretable in an ordinal measure.
What is interval measurement?
Interval data is like ordinal except we can say the intervals between each value are equally split. The most common example is temperature in degrees Fahrenheit. The difference between 29 and 30 degrees is the same magnitude as the difference between 78 and 79 (although I know I prefer the latter). With attitudinal scales and the Likert questions you usually see on a survey, these are rarely interval, although many points on the scale likely are of equal intervals.
A physical therapist attempts to select an appropriate intervention to treat a patient with a 10 degree limitation in knee extension. Which of the following mobilization techniques would be indicated?
Anterior glide of the tibia
A posterior glide of the tibia can help improve which motion?
A physical therapist attempts to improve a patient’s lower extremity strength. Which proprioceptive neuromuscular facilitation technique would be the MOST appropriate to achieve the therapist’s goals?
What do repeated contractions do? What are they used for?
Used to initiaite movement and sustain a contraction. Quick stretch followed by isotonic or isometric contraction. Provide resistance at the point of weakness.
What is rhythmic stabilization used for?
To increase ROM and coordinate isometric contractions. Requires isometric contractions around a joint against progressive resistance.
Capsular pattern of adhesive capsulitis?
Max loss of ER, mod loss of abd, and min loss of IR.
What is the most typical frequency and duration of hemodialysis?
Three times a week for 4 hours
A "patient problem list" should be under which section of a SOAP note?
A physical therapist works with a patient status post stroke on a mat program. The therapist assists the patient in lateral weight shifting activities while positioned in prone on elbows. Which therapeutic exercise technique would allow the patient to improve dynamic stability with this activity?
What is Approximation?
Ther ex technique designed to facilitate contraction and stability through joint compression. The compression force is most often applied to joints through gravity acting on body weight, manual contacts, or weight belts.
What is alternating isometrics?
Facilitates isometric holding - first in agonists on one side of the joint, following holding of the antagonist muscle groups. INDICATED when there is instability in WB, poor static posture control/weakness.
What is rhythmic initiation?
Facilitation technique - begins with voluntary relaxation followed by passive movement through increments in range. Followed by active-assisted and then resisted movements. INDICATED WITH hypertonicity, inability to initiate movement, motor learning deficits, and communication deficits.
What is Timing for Emphasis?
Facilitation technique that uses maximum resistance to elicit a sequence of contractions from major muscle components of a pattern of motion. Allows overflow to occur from strong to weak muscles. INDICATED with weakness and incoordination - used in conjunction with repeated contractions.
What is ankylosing spondylitis?
Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. strengthen BACK EXTENSORS!
A physical therapist observes that a patient has difficulty controlling the affected lower extremity during the loading response. This phase is characterized by:
Increased quadriceps activity (for knee ext) and decreased hamstrings activity (limit knee flex)
A patient has weakness of the quadriceps secondary to a femoral nerve injury. When examining the patient’s gait from heel strike to foot flat, the physical therapist would MOST likely observe the patient compensate for their injury by:
Leaning the trunk forward. (this is to COMPENSATE for the injury...excessive knee flexion is simply a result of weakness, not a compensation strategy).
A physical therapist administers the Functional Reach Test to a patient rehabilitating from a neurological disorder. Which bony landmark would be the MOST appropriate to utilize when formally measuring the distance the patient reached during each trial?
3rd metacarpal (NOT distal tip of third digit)
A 22-year-old male rehabilitating from a motor vehicle accident is referred to physical therapy for gait training. The patient sustained multiple injuries including a fractured tibia and a traction injury to the brachial plexus. The patient is partial weight bearing and has good upper extremity strength. The MOST appropriate assistive device is:
A patient informs a physical therapist how frustrated she feels after being examined by her physician. The patient explains that she becomes so nervous, she cannot ask any questions during scheduled office visits. The therapist’s MOST appropriate response is to:
3. suggest that the patient write down questions for the physician and bring them with her to the next scheduled visit - have the patient face the problem actively!
An athlete is forced to contemplate knee surgery after spraining the anterior cruciate ligament (ACL) while playing soccer. Which situation would provide the MOST direct support for an anterior cruciate ligament reconstruction?
Functional instability - many individuals are able to continue to function at a high level despite ligamentous and meniscal tears and injuries. Therefore, FUNCTIONAL INSTABILITY provides the MOST DIRECT SUPPORT for an anterior cruciate ligament reconstruction.
A physical therapist employed in a long-term care setting attempts to identify a screening tool that examines a patient’s ability to perform a variety of activities of daily living independently. The therapist would like to readminister the tool to assess patient progress. The MOST appropriate screening tool is the:
Barthel Index - 10 activities of daily living . Scores 0-100 (100 is independent). Goes in increments of 5
A physical therapist completes a respiratory assessment on a patient with T2 paraplegia. As a component of the assessment, the therapist measures the amount of chest excursion during inspiration. The MOST appropriate patient position to conduct the measurement is:
Supine - creates support and resistance to the diaphragm. Best initial starting position. Direct correlation of chest expansion and intercostal strength. Progress to sitting.
A physical therapist works with a 71-year-old female patient who is status post reverse total shoulder arthroplasty. What is the MOST likely reason the patient had this surgical procedure as opposed to a total shoulder arthroplasty?
irreparable supraspinatus tear - indicated when a rotator cuff cannot be repaired. Reverse concave/convex allows for greater congruency and stability.
A physical therapist assesses a patient’s sensation of light touch in the lower extremities. The therapist documents that the patient has impaired sensation of the entire right leg, yet normal sensation of the left leg. Which injury is MOST likely present?
Left hemispheric stroke. Nerve compression would only involve specific dermatomes. Spinal cord transection would likely involve both legs.
An athlete is referred to physical therapy after being diagnosed with apophysitis of the ischial tuberosity. Which mechanism of injury is MOST consistent with this condition?
a runner competing in the hurdles - hip is flexed and knee is extended
A physical therapist examines several superficial reflexes on a patient diagnosed with an upper motor neuron lesion. When assessing the cremasteric reflex the MOST appropriate stimulus is:
stroke the skin of the superior and medial thigh
A patient is unable to take in an adequate supply of nutrients by mouth due to the side effects of radiation therapy. As a result, the patient’s physician orders the implementation of tube feeding. What type of tube is MOST commonly used for short-term feeding?
A physical therapist employed in an acute care hospital prepares to work on standing balance with a patient rehabilitating from abdominal surgery. The patient has been on extended bed rest following the surgical procedure and has only been out of bed a few times with the assistance of the nursing staff. The MOST important objective measure to assess after assisting the patient from supine to sitting is:
Systolic BP - decrease of 20 mmHg or more is indicative of orthostatic hypotension
A physical therapist inspects a burn obtained as a result of iontophoresis. The therapist describes the burn as an acidic reaction. If the therapist is correct, the pH of the skin would MOST likely be: (2,4,6,or8)
2. Normal pH of skin is 3-4. 2 would yield acidic reaction
A physical therapist attempts to palpate the lunate by moving his finger immediately distal to Lister’s tubercle. Which wrist motion will allow the therapist to facilitate palpation of the lunate?
Flexion - lunate is central and proximal
A physician indicates that a patient rehabilitating from a cerebrovascular accident has significant perceptual deficits. Which anatomical region would MOST likely be affected by the stroke?
A physical therapist reviews the results of a pulmonary function test for a 58-year-old male patient recently admitted to the hospital. The therapist notes that the patient’s total lung capacity is significantly increased when compared to established norms. Which medical condition would MOST likely produce this type of result?
Emphysema - Lungs are hyperinflated
A physical therapist instructs a patient to squeeze a piece of paper between the index and middle fingers while the therapist attempts to pull it away. This type of testing would be the MOST appropriate to assess which myotome?
A physical therapist treats a female patient with multiple sclerosis for impaired balance and coordination. The patient reports that since being diagnosed four years ago, her symptoms have gradually gotten worse without any plateau or lessening in severity. Which terminology would MOST accurately describe the patient’s disease course?
A patient diagnosed with Guillain-Barre syndrome works on weight shifting activities while standing in the parallel bars. The PRIMARY objective of this activity is to improve:
CONTROLLED mobility - ability to move within a WB position or rotate around a long axis - 3rd stage of motor control
A physical therapist asks a physical therapist assistant to complete a lower extremity isokinetic test on a patient. The physical therapist assistant is willing to complete the test, however, indicates it has been quite some time since they have set up the isokinetic device. The MOST appropriate physical therapist action is:
observe the physical therapist assistant complete the set up
A patient with a transtibial amputation is observed ambulating with excessive knee flexion from heel strike through midstance on the prosthetic side. A possible cause for this deviation is:
The socket is aligned in excessive flexion - this will create increase flexion moment at the knee which will result in excessive flexion from heel strike through stance phase.
A physical therapist works on balance reactions with a patient who has Charcot’s foot. The development of this medical condition is MOST likely related to:
Altered sensation - mainly seen in patients with diabetes secondary to peripheral neuropathy. Loss of sensation predisposes joints of foot to repetitive trauma and joint destruction.
A physical therapist employed in a skilled nursing facility works on balance reeducation activities to improve a patient’s independence with functional activities in the kitchen. Which of the following tests would provide the therapist with the MOST useful information on the patient’s ability to safely perform meal preparation?
Multi Directional reach test - reach in different planes while cooking
A physical therapist observes a three-year-old child with Down syndrome in her preschool classroom. The therapist notices that the child assumes a “W” sitting position during circle time activities. What is the MOST likely rationale for the child assuming this sitting position?
Decreased core strength is main, underlying cause.
A patient treated in an acute care hospital one day ago is not able to attend a scheduled physical therapy session due to suspected critical limb ischemia. Which symptom is MOST commonly associated with this condition?
severe pain in the legs and feet at rest - often seen while in bed
A 47-year-old patient with a diagnosis of CVA with left hemiplegia is referred for orthotic examination. Significant results of manual muscle testing include: hip flexion 3+/5, hip extension 3/5, knee flexion 3+/5, knee extension 3+/5, ankle dorsiflexion 2/5, and ankle inversion and eversion 1/5. Sensation is intact and no abnormal tone is noted. The MOST appropriate orthosis for this patient is a:
plastic articulating ankle-foot orthosis - strength at hip and knee allows AFO to be used.
A patient with T10 paraplegia is discharged from a rehabilitation hospital following 12 weeks of intense rehabilitation. Which of the following pieces of equipment would be the MOST essential to assist the patient with functional mobility?
WHEELCHAIR - A patient with a lesion above T12 would NOT be a functional ambulator - would use wheelchair as PRIMARY mode of mobility
According to proponents of evidence-based medicine, the BEST source of information upon which to make clinical decisions about therapy for an individual patient is a:
Systematic reviews - considered to provide the highest level of evidence for or against a therapy
A physical therapist treats a patient with several injuries impacting the upper extremity including mallet finger. The therapist notes that the affected finger is immobilized using a static splint. Which position of the finger would be MOST essential when splinting?
5 degrees of hyperextension at the distal interphalangeal joint - extensor heals at an optimal position without becoming excessively lengthened. Position of PIP is not critical and flexion of DIP would cause contracture.
What is Mallet Finger?
A mallet finger is a deformity of the finger caused when the tendon that straightens your finger (the extensor tendon) is damaged. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that straightens the finger (see Figure 1a and 1b).
What is Swan Neck Deformity?
Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP flexion with PIP hyperextension).
A physical therapist treats a patient with a peroneal tendon subluxation. To observe the subluxation, the therapist positions the patient in a prone position with the knee flexed to 90 degrees. Which action would be the MOST appropriate to reproduce the subluxation?
ACTIVE ankle dorsiflexion and eversion
A physical therapist transports a patient in a wheelchair to the parallel bars in preparation for ambulation activities. The patient is status post abdominal surgery and has not ambulated in over two weeks. The MOST appropriate action to facilitate ambulation is:
Demonstrate ambulation in the parallel bars - model apporpriate techique in controlled learning environment.
A patient explains to her therapist that she was instructed to bear up to five pounds of weight on her involved extremity. The patient’s weight bearing status would be BEST described as:
PWB (in contrast, TTWB allows no weight to be placed, just toes on ground to assist with balance).
A physical therapist completes an upper extremity manual muscle test on a patient diagnosed with rotator cuff tendonitis. Assuming the patient has the ability to move the upper extremities against gravity, which of the following muscles would NOT be tested with the patient in a supine position?
Middle trap - test in prone
A patient rehabilitating from a radial head fracture is examined in physical therapy. During the examination, the physical therapist notes that the patient appears to have an elbow flexion contracture. Which of the following would NOT serve as an appropriate active exercise technique to increase range of motion?
Maintained pressure - can produce a calming effect and create relaxation of muscle unit. No evidence of long-term effects.
How slow deflate BP cuff?
2-3 mm Hg per second
A physically active 19-year-old male receives pre-operative instruction prior to anterior cruciate ligament reconstruction. The patient’s past medical history includes a medial meniscectomy of the contralateral knee eight months ago. The MOST likely functional level of the patient following rehabilitation is:
Return to previous level
A patient involved in a motor vehicle accident sustains an injury to the posterior cord of the brachial plexus. Which muscle would NOT be affected by the injury?
Infraspinatus (C4-C6) - does not use posterior cord
physical therapist assesses the vital signs of a patient with a blood disorder. The therapist records the patient’s blood pressure as 150/85 mm Hg. Which condition is MOST likely the cause of the abnormal blood pressure measurement?
Polycythemia - increase in # of RBC and concentration of hemoglobin
What is thrombocytosis?
Increase in platelet count of blood.
Leukocytosis vs Leukopenia?
Leukocytosis is an increase in the number of white cells in the blood, especially during an infection. Leukopenia is a decrease
What is anemia?
Reduction in the O2 carrying capacity of blood due to abnormality of qual or quan of RBC
What is flooding?
Technique to help patients heal their traumatic memories; bring up the past and solve with current awareness
What is operant conditioning?
Learning occurs when an individual emerges in specific behaviors in order to receive certain consequences. E.g. positive reinforcement, negative reinforcement, extinction, and punishment.
What is role playing?
Participants take place of someone by acting that part
What is modeling?
Watching others- learning through observation. No specific verbal direction from the therapist.
What is the prime mover in an SLR?
A physical therapist reviews a laboratory report for a patient recently admitted to the hospital. The patient sustained burns over 25 percent of her body in a fire. Assuming the patient exhibits hypovolemia, which of the following laboratory values would be the MOST significantly affected?
Hematocrit - rises after a burn and decreases with fluid replacement.
What is hematocrit?
Volume percentage of RBC in whole blood
What is erythrocyte sedimentation rate?
Non-specific test for inflammatory disorders often associated with conditions. Based on how quickly RBCs sink to the bottom of a test solution containing anticoagulated blood.
What is oxygen saturation rate?
Indicates the saturation of hemoglobin with oxygen. Normal is 95-98% Not related to total blood volume.
What is prothrombin time?
Used to monitor oral anticogulant therapy or to screen for selected bleeding disorders.
Common methods of autolytic debridement? (4)
Transparent films, hydrocolloids, hydrogels, and alginates
A physical therapist performs autolytic debridement in an attempt to remove nonviable tissue from a stage IV pressure ulcer. Autolytic debridement removes necrotic tissue by using:
The body's own mechanisms
A physical therapist reviews the medical record of a 46-year-old female diagnosed with myasthenia gravis. A recent physician entry indicates that the patient is currently taking immunosuppressive medication. Which laboratory test should be the MOST frequently monitored based on the patient’s medication?
White Blood cell Count
Immunosupressive medications lower a patient's resistance to infection.
A physical therapist examines a patient with a dorsal scapular nerve injury. Which muscles would you expect to be MOST affected by this condition?
Levator Scap and rhomboids
Anterior shoulder glides can imrpove which ROMs (3)
Extension, ER, and horz. ABD
Posterior shoulder mobs are for?
Flexion, IR, and Horiz ADD
A physical therapist instructs a patient to make a fist. The patient can make a fist, but is unable to flex the distal phalanx of the ring finger. This clinical finding can BEST be explained by:
a ruptured flexor digitorum profundus tendon
The MOST important contribution case reports make to evidence-based practice in physical therapy is:
Can generate hypothesis for future studies. Hard to justify relationship between one treatment and the outcome of a single patient.
What are longitudinal studies?
Follow patients for long periods of times; good for data on natural history of disease states.
patient’s pulmonary function tests reveal that the patient has a forced vital capacity (FVC) of 4.0 liters and a forced expiratory volume in 1 second (FEV1) of 3.5 liters. These results would be MOST anticipated with a diagnosis of:
Idiopathic pulmonary fibrosis - restrictive lung disease; inflammation within alveolar walls and subsequent fibrosis.
What is cystic fibrosis?
Characterized by thick secretions in airways due to too much mucus (either high production or cannot get it out) Obstructive lung disease
What is emphysema?
Characterized by enlargement of the distal airways and destructive changes to alveolar walls. Can result in airway collapse. Obstructive lung disease. Also part of COPD
What is chronic bronchitis?
Part of COPD. Obstructive. Hypersecretion of mucus.
A physical therapist prepares to administer ultrasound to a patient with lateral epicondylitis. When applying ultrasound the amount of heat absorbed is LEAST dependent upon:
Choice of coupling agent
Sitting, leaning back at a 30-40 degree angle is postural drainage position for which segments?
Apical segments of the R and L upper lobes
head down on left side, 1/4 turn backward is postural drainage position for?
R middle lobe
supine with two pillows under the knees is postural drainage position for?
Anterior segments of R and L upper lobes
prone with two pillows under the hips is postural drainage position for?
Superior segments of the R and L lower lobes
What is the quad:hams strength ratio?
What % BW traction force is recommended to decrease muscle spasm in lumbar spine?
25% of BW
What % BW traction force is recommended for mechanical separation in lumbar spine?
A physical therapist employed in an acute care hospital reviews the results of recent laboratory testing for one of his patients. A note in the medical record indicates that the patient was dehydrated at the time the blood sample was taken. Which finding would be MOST likely based on the patient’s hydration status?
Increased blood urea nitrogen level - used to assess kidney function. High level indicative of dehydration, renal failure, or HF. Normal levels are 10-20 mg/dL. Hematocrit and Hemoglobin may both also be increased.
A patient reports experiencing pain with active shoulder range of motion testing. The therapist hypothesizes that the pain may be associated with anterior glenohumeral instability. Which portion of the shoulder range of motion would the therapist expect the pain to be MOST pronounced?
80-90 degrees of lateral rotation- most pressure on anterior structures of shoulder
A physical therapist examines the abdomen of a patient with suspected referred shoulder pain from the viscera. Which component should be assessed FIRST?
A patient with a neurological disorder expresses that she is no longer able to differentiate between the tastes of many foods on the front portion of her tongue. Which cranial nerve would potentially contribute to this reported finding?
CN VII - does anterior 2/3rds of tongue.
A physical therapist positions a patient in supine prior to performing a manual muscle test of the supinator. To isolate the supinator and minimize the action of the biceps, the therapist should position the patient’s elbow in:
Terminal Elbow Flexion - this max shortened position limits muscle's ability to function as a supinator.
A patient rehabilitating from cardiac surgery is monitored using an arterial line. The PRIMARY purpose of an arterial line is to:
What measures R atrial pressure?
Swan-Ganz Catheter. Can also measure pulmonary artery pressure.
A physical therapist conducts an inservice on exercise guidelines for a group of senior citizens. As part of the inservice the therapist discusses the benefits of improving cardiovascular status through a low intensity activity such as a walking program. What frequency of exercise would be the MOST desirable to achieve the stated objective?
5 times per week
A physical therapist examines the foot of a 17-year-old female referred to physical therapy with lower leg pain. After placing the foot in subtalar neutral, the therapist determines that the medial border of the foot along the first metatarsal is higher than the lateral border of the foot along the fifth metatarsal. This position would MOST appropriately be documented as:
What is forefoot valgus?
Forefoot is everted in comparison to the rearfoot in STJ neutral; high arches or cavus feet. MTP 5 is higher than MTP 1
What is rearfoot varus?
This is by far the most common foot disorder we will see.
Calcaneus is inverted (more than 3-4 degrees of normal inversion)
What is rearfoot valgus?
Often a result of compensation for forefoot varus - calcaneus is everted in STJ neutral
When measuring back height, which method is MOST accurate?
measure from the seat of the chair to the base of the axilla and subtract four inches; should be below the inferior angle of the scapula (must also account for seat cushion)
A physical therapist plans to perform a sensory examination on a patient with a suspected neurological lesion. Which sensation should the therapist assess FIRST?
TEMPERATURE! (test superficial sensations before deep and combined cortical). (other superficial: pain, crude touch, pressure).
A physical therapist is concerned that a 77-year-old female taking diazepam for anxiety may be a significant fall risk. Which side effect of the medication is MOST responsible for this increased risk?
A patient diagnosed with infrapatellar tendonitis completes a series of functional activities. After completing the activities the physical therapist instructs the patient to use ice massage over the anterior surface of the knee. The MOST appropriate treatment time is:
5-10 minutes (15-20 for ice pack)
What is slipped capital femoral epiphysis?
separation between ball of hip joint and femur at the growth plate.
A patient diagnosed with infrapatellar tendonitis completes a series of functional activities. After completing the activities the physical therapist instructs the patient to use ice massage over the anterior surface of the knee. The MOST appropriate treatment time is:
A physical therapist consults with an orthotist regarding the need for an ankle-foot orthosis for a patient status post CVA. The patient has difficulty moving from sitting to standing when wearing a prefabricated plastic ankle-foot orthosis (AFO). The therapist indicates the patient has poor strength at the ankle, intact sensation, and does not have any edema or tonal influence. The MOST appropriate type of AFO for the patient would incorporate:
an articulation at the ankle joint
What is the main purpose of a posterior leaf spring (PLS)?
Prevent foot drop via dorsiflexion assist.
A patient’s medical chart indicates that a patient has a lesion in the posterior portion of the spinal cord. Which of the following impairments would MOST likely be observed?
inability to determine joint position
(Proprioception is in the dorsal ML tract & tactile location. AL ST tract does pain, temp, and light touch)
What is cubital tunnel syndrome?
Also known as ulnar neuropathy, is increased pressure on the ulnar nerve in the cubital tunnel formed by the medial epicondyle, olecranon, and UCL of the elbow. SS: pain, sesnory disturbances, muscle weakness, and muscle wasting. DD: medial epiconylitis, UCL sprain, distal humerus fracture. MOST distingusied by paresthesia in Digits 4 and 5
A patient is scheduled to undergo a transtibial amputation secondary to gangrene of his left foot. In addition, the patient is one month status post right total knee arthroplasty due to osteoarthritis. Given the patient’s past and current medical history, the physical therapist can expect which of the following tasks to be the MOST difficult for the patient following his amputation?
moving from sitting to standing - requires strength and dynamic balance. Harder than ambulating in the parallel bars.
A physical therapist examines a 26-year-old female whose subjective complaints include morning stiffness of her hands and visible swelling. The patient indicates that the stiffness seems to diminish with activity. This description BEST describes:
A physical therapist instructs a patient diagnosed with C6 tetraplegia in functional activities. Which of the following activities would be LEAST appropriate?
independent self-range of motion of the lower extremities - more appropriate for C7 tetraplegia. (C6 can do sliding board transfers with assist).
A physical therapist attempts to confirm the fit of a wheelchair for a patient recently admitted to a skilled nursing facility. After completing the assessment, the therapist determines the wheelchair has excessive seat width. Which adverse effect results from excessive seat width?
Difficulty propelling the wheelchair - excessively abduct the shoulders to reach the wheels; less functional, harder with tight spaces. (Insufficient trunk support would be due to bad back height).
What is the Galant Reflex?
Stimulated by stroking lateral to the spine; response is sidebending to the same side as the side of the stimulus
What is the symmetric tonic neck reflex?
Head position is stimulus. When head is flexed, UEs flex and LEs extend. When head extends, UEs extend and LEs flex.
What is the plantar grasp reflex
Pressure on balls of feet cause toes to curl
What is positive supoort reflex?
LEs extend with WB
While reading the Methods section of a research report, a physical therapist notes the investigators used a repeated measures design. This form of experimental design:
Controls for differences between subjects - ALL subjects receive ALL levels of the independent variable. Effective for controlling differences (age, gender, etc) between subjects. Subjects act as own control; also called "within-subjects" design
In research, what is matching?
subjects with similar characteristics are assigned to different treatment groups May or may not be included in a repeated measures design.
What happens when you select subjects that are homogenous to specific trait?
research eliminates these traits as variables that may interfere with the dependent variable. can or cannot be used in repeated measures design.
A physical therapist reviews the parameters of several pain modulation theories using transcutaneous electrical nerve stimulation (TENS). When comparing sensory stimulation to motor stimulation, sensory stimulation requires:
GREATER FREQUENCY! (keep phase charge below motor threshhold)
A patient reports shoulder pain during active shoulder range of motion testing. The pain is most pronounced when the shoulder is in 170-180 degrees of abduction. Which condition would be MOST commonly associated with this finding?
AC arthritis - narrowing of the joint or formation of osteophytes
A 52-year-old male being treated for low back pain indicates that he recently was diagnosed with benign prostatic hyperplasia. Which symptom is MOST commonly associated with this condition?
Urge to urinate frequently!
What type of pain is commonly associated with BPH
Low back, abdominal, and thigh pain. NOT epigastric.
Where do compression fractures in the spine most commonly occur?
Mid-thoracic and mid-lumbar.
How does RA affect synovial joints?
By primary tissue inflammation rather than joint destruction.
What is osteogenesis imperfecta?
Inherited disorder of connective tissue; results in joint laxity, weak muscles, and diffuse osteoporosis (increased risk of recurrent fractures). USUALLY SEEN IN CHILDREN!
What is functional urinary incontinence?
Mental or physical problems such as dementia or arthritis prevent you from getting to the bathroom in time.
What is overflow urinary incontinence?
If you can't empty your bladder, you may have overflow incontinence. This means you may dribble urine.
Weak bladder muscles
Conditions that block the flow of urine, such as tumors or an enlarged prostate
What is urge urinary incontinence?
This is also called overactive bladder (OAB). With this type, you have an urgent need to go to the bathroom and may not get there in time.
Causes of overactive bladder include:
Damage to the bladder's nerves
Damage to other parts of the nervous system
Damage to muscles
Conditions such as multiple sclerosis, Parkinson's disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Bladder problems, such as infections and bladder stones, and certain medications can also cause it.
What is stress urinary incontinence?
With this type, urine leaks due to weakened pelvic floor muscles and tissues. It can happen when pressure on your bladder increases -- such as when you exercise, laugh, sneeze, or cough.
Pregnancy and childbirth can stretch and weaken a woman’s pelvic floor muscles. Other things that can lead to stress incontinence are being overweight or obese, taking certain medications or, in men, having prostate surgery.
What is Gaenslen's Test?
Gaenslen's Test is one of the five provocation tests that can be used to detect musculoskeletal abnormalities and primary-chronic inflammation of the lumbar vertebrae and Sacroiliac joint (SIJ). The subsequent tests include; the Distraction Test, Thigh Thrust Test, Compression Test and the Sacral Thrust Test.
Specifically, Gaenslen's test can indicate the presence or absence of a SIJ lesion, pubic symphysis instability, hip pathology, or an L4 nerve root lesion. It can also stress the femoral nerve.
If the patient’s normal pain is reproduced, the test is considered positive for a SIJ lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion. Meanwhile the femoral nerve may also be stressed by this test.[
What is sensitivity?
The possibility of a positive test resulting in someone with the pathology
What is specificity?
The probability of a negative test resulting in someone without the pathology
What is Positive Likelihood Ratio (LR+)
The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.
What is Negative Likelihood Ratio (LR-)
The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.
What is reliability?
Likelihood of results from test to be reproduced again (Expressed as percentage or as decimal)
What is gillet's test?
The Gillet Test is also known as the Sacral Fixation Test, Ipsilateral Posterior Rotation Test, Marching Test and the Ipsilateral Flexion Kinetic Test. Many different variations of the Gillet Test have been described in the literature.
To perform this test, the patient stands while the examiner palpates the posterior superior iliac spine (PSIS) with one thumb and palpates the sacrum with the other thumb at a level parallel to the first thumb. The patient is then instructed to stand on one leg while pulling the hip of the side being palpated into 90° or more of hip flexion. The test is then repeated on the other side and compared bilaterally. The examiner should compare each side for quality and amplitude of movement.
In a normally functioning pelvis, the pelvis of the side being palpated should rotate posteriorly, causing the PSIS to drop or move inferiorly. A positive test is noted when the PSIS on the ipsilateral side of the knee flexion does not move or moves minimally in the inferior direction. . A positive test is indicative of sacroiliac joint hypomobility.
A patient who has been on bed rest for three weeks has developed a plantar flexion contracture. Which phase of the gait cycle would be MOST problematic for the patient based on the described impairment?
Midstance to heel off
A physical therapist administers iontophoresis to a patient with a lower extremity ulceration in an attempt to promote tissue healing. Which ion would BEST meet the stated objective?`
What does acetate do in iontophoresis?
From acetic acid, is negatively charged ion used to treat specific calcific deposits
What does magnesium do in iontophoresis?
From magnesium sulfate, is positively charged and used as a muscle relaxant and vasodilator
What does zinc do in iontophoresis?
From zinc oxide, is postively charged, and used to promote healing, most often with ulcerations and open lesions
What does lidocaine do in iontophoresis?
Lidocaine, from xylocaine, is positively charged ion used to treat pain and inflammation associated with acute inflammatory conditions
What is segmental breathing?
Also known as localized or thoracic expansion exercise, is intended to improve regional ventilation in patients with pulmonary disease and to prevent and treat pulmonary complications after surgery; enhance expansion of specific lung segment to facilitate chest wall motion and increase ventilation.
A physical therapist performs segmental breathing exercises with a patient following atelectasis. Which manual contact would be the MOST appropriate to emphasize lingula expansion?
place the hands on the left side of the chest below the axilla
physical therapist administers a submaximal exercise test to a patient in a cardiac rehabilitation program. The protocol requires the patient to ride a cycle ergometer for a predetermined amount of time using progressive workloads. In order to predict the patient’s maximum oxygen uptake it is necessary to determine the relationship between:
HR and workload
A physical therapist employed in a large medical center reviews the chart of a 63-year-old male referred to physical therapy for pulmonary rehabilitation. The chart indicates the patient has smoked one to two packs of cigarettes a day since the age of 25. The admitting physician documented that the patient’s thorax was enlarged with flaring of the costal margins and widening of the costochondral angle. Which pulmonary disease does the chart MOST accurately describe?
When does passive insufficiency occur?
When a two-joint muscle is passively stretched across two joints at the same time, resulting in an inability to permit normal elongation simultaneously over two joints. Actin filaments are pulled away from myosin heads so they cannot create as many cross-bridges. Occurs with passive movement.
When does active insufficiency occur?
When a muscle is in a shortened position; the overlap of myosin and actin reduces the number of sites available for cross-bridge formation. Occurs with active movement.
A physical therapist positions a patient in prone to measure passive knee flexion. Range of motion may be limited in this position due to:
Passive insufficiency of the knee extensors
A physical therapist incorporates electrical stimulation as part of the plan of care for a patient rehabilitating from a lower extremity injury. Which of the following recommendations would be LEAST effective to minimize electrode resistance?
Using small electrodes; would increase resistance.
What does water do with electrode resistance?
Water serves as a conductive substance that reduces electrode resistance.
What does uneven contact or pressure do with electrode resistance?
Increases electrode resistance and can severely limit the effectiveness of electrotherapy.
A pregnant patient indicates that her physician ordered genetic testing. Which condition would be LEAST likely to be identified through the testing process?
MEningitis - LP is gold standard for dx. It is hereditary and would not require genetic testing.
What is metatarus adductus?
Metatarsus adductus, also known as metatarsus varus, is a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward. MTP bones slanted medially.
What is calcaneovalgus?
A flexible calcaneovalgus foot is a postural deformity in infants which causes the foot to appear to be pushed up against the front of the leg. “Calcaneo” describes an upward-position of the foot, and “valgus” describes an outward position. Thus a calcaneovalgus foot is one that is positioned upward and outward.
The deformity is caused by abnormal positioning of the foot while the baby is in the uterus due to crowding. Calcaneovalgus feet can be associated with other problems caused by crowding in the uterus, including hip dysplasia and muscular torticollis. Due to the association with hip dysplasia, it is recommended that infants with calcaneovalgus feet have their hips examined by a trained healthcare provider.
Calcaneovalgus feet that are flexible will almost always improve spontaneously with time. Gentle stretching may facilitate improvement. Most feet will look normal within one to two months. Rarely, in the more severe cases, a series of casts may be required. Calcaneovalgus feet that are rigid may be due to a more serious foot problem and should be evaluated early by a pediatric orthopaedic specialist.
What is Syndactyly?
Webbed toes or fingers; usually between MTP 2 and 3.
What is Talipes Equinovarus
Also known as club foot - is a deformity characterized by adduction of the forefoot, varus positioning of the hindfoot, and PF at the ankle. Positioning associated with Talipes Equinovarus would likely result in limitation in DF ROM. Without treatment, ankle is rolled in; walk on sides of feet.
A physical therapist observes the gait of a patient following a lateral ankle sprain. The patient walks without crutches, but it is evident that walking is extremely painful. Which description is MOST accurate when describing the unaffected extremity during walking?
shorter swing phase and shorter step length
A physical therapist attempts to examine the relationship between scores on a functional independence measure and another measurement whose validity is known. This type of example BEST describes:
What is face validity?
Refers to whether the test "looks valid." Refers to what is is superficially supposed to measure.
What is predictive validity?
Form of validity that is demonstrated when a score is helpful in predicting a specific future outcome. Example is a career aptitude test.
What is content validity?
Refers to extent to which a measure represent all facets of a given concept or constuct
What is concurrent validity?
Demonstrated when a test score correlates well with a measure that has been previously validated.
A physical therapist develops a chart detailing expected functional outcomes for a variety of spinal cord injuries. Which is the highest spinal cord injury level at which independent transfers with a sliding board would be feasible?
A patient rehabilitating from a spinal cord injury has significant lower extremity spasticity which often results in the patient’s feet becoming dislodged from the wheelchair footrests. The MOST appropriate modification to address this problem is:
Heel loops and/or toe loops
A physical therapist utilizes a manual assisted cough technique on a patient with a mid-thoracic spinal cord injury. When completing this technique with the patient in supine, the MOST appropriate location for the therapist’s hand placement is:
A 28-year-old male referred to physical therapy by his primary physician complains of recurrent ankle pain. As part of the treatment program, the therapist uses ultrasound over the peroneus longus and brevis tendons. The MOST appropriate location for ultrasound application is:
POSTERIOR to lateral malliolus. (EDL is anterior)
What attaches to the sustentaculum tali?
Spring ligament aka calcaneonavicular ligament.
A physical therapist treats a 32-year-old female rehabilitating from a closed head injury presently functioning at Rancho Los Amigos level IV. The therapist treats the patient in her home for 60 minute sessions, three times per week. Recently the therapist has noticed that the patient becomes increasingly combative as the session progresses and believes the deterioration in behavior is linked to the patient becoming fatigued. The MOST appropriate treatment modification is:
Increase rest periods during existing treatment sessions
A physical therapist examines a patient diagnosed with left-sided heart failure. Which finding is NOT typically associated with this condition?
Dependent Edema - associated with RHF - fluid builds up behind R ventricle and fluid builds in liver, abdomen, and ankles.
What are symptoms of LHF or congestive HF
PULMONARY EDEMA (caused by abnormal accumulation of fluid in alveolar spaces of the lungs), Persistant cough with pink, forthy sputum, and muscular weakness.
What is atrial tachycardia?
R-R interval is irregular with a rate more than 100 BPM. It is defined as 3 or more consecutive preamture atrial complexes where an ectopic focus in either atria initiates an impulse before the SA node
What is sinus arrhythymia?
An irregularity in rhythm where the cardiac impulse is initiated at the SA node, but with a variable quickening and slowing of the impulse formation
An entry in the medical record indicates that electromyography revealed denervation of the flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles. This finding would MOST likely be associated with:
Anterior interosseous syndrome (innervated by C8-t1)
What is anterior interosseuous symdrome?
Characterized by an injury to the AI nerve, branch of median nerve - sometimes entrapped or pinched as it passes between the 2 heads of the pronator teres muscle. This leads to pain and functional impairment of FPL, lateral half of FDP, and PQ.
What is anterior compartment syndrome?
Compression of nerves and blood vessels in anterior compartment of lower leg - SERIOUS - threatens viability of limb. *would not impact UE muscles
What is Erb's Palsy?
Upper bachial plexus injury or palsy that usually results from a difficult birth. Muscles affected are supplied by C5 and C6, which results in loss of function at rotator cuff and other muscles nearby.
What is Dysphagia?
Inability to properly swallow
What is verbal apraxia?
Non-dysarthric and non-aphasic impairment of prosody (stress and intonation) and articulation of speech; impaired due to deficits in motor planning; unable to initiate learned movement even though the understand the task.
Lesions found in L frontal lobe, near Broca's area.
What is Broca's aphasia?
Also expressive aphasia, impairment of speech and expression.
A physical therapist employed in a rehabilitation hospital examines a patient that exhibits several signs and symptoms of anemia. Which question would be the MOST useful to gather additional information related to anemia?
Do you experience heart palpitations or shortness of breath at rest or with mild exertion?
What does susceptibility to bruising indicate?
a coagulation disorder
A physical therapist performs postural drainage to the anterior basal segments of the lower lobes. During the treatment session the patient suddenly complains of dizziness and mild dyspnea. The MOST appropriate therapist action is to:
Elevate the patient's head.
How does vascular pain present?
Diffuse, throbbing and aching. Poorly localized.
What is internal validity?
Internal validity refers to how well an experiment is done, especially whether it avoids confounding (more than one possible independent variable [cause] acting at the same time). The less chance for confounding in a study, the higher its internal validity is.
What is external validity?
External validity is the validity of generalized (causal) inferences in scientific research, usually based on experiments as experimental validity. In other words, it is the extent to which the results of a study can be generalized to other situations and to other people.
What does the medial and lateral plantar nerve innervate?
The sole of the foot and plantar surface of the toes, among other things. These nerve branch from the tibial nerve which comes from the sciatic nerve.
What does the deep peronal nerve innervate?
The triangular area between the first and second toes. It is a branch of the sciatic nerve.
A physical therapist reviews a physician examination which indicates diminished sensation in the L3 dermatome. The MOST appropriate location to confirm the physician’s findings is:
Anterior Thigh (L2 - L3)
What is aversive conditioning?
The individual is exposed to an unpleasent stimulus while engaging in the targetted behavior.
What is extinction?
Withholding of reinforcement for a previously reinforced behavior which decreases the future probability of that behavior. Goal is a loss in the strength of a conditioned response when the unconditioned stimulus or reinforcement is withheld
What is operent conditioning?
Learning that takes place when the learner recognizes the connection between the behavior and its consequences.
What is rational emotive imagery?
Form of intense mental practice for learning new emotional and physical habits. The behavioral technique focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives.
What is foot progression angle?
The angle between the longitudinal axis of the foot and a straight line progression of the body in walking. Negative for in-toeing and positive for out-toeing
A physical therapist reads in the medical record that the foot progression angle of a four-year-old child was recorded as -10 degrees (minus 10 degrees). Which range of motion measurement at the hip would MOST likely be associated with the obtained foot progression angle?
75 degrees of hip medial rotation and 25 degrees of hip lateral rotation (more medial and less lateral is seen with in-toe. Sum of IR and Er should be 95-110.)
What is the bacteria most commonly associated with meningitis and how is it treated?
Neisseria meningitidis and treated primarily with penicillin G.
What is the bacteria most commonly associated with pneumonia and how is it treated?
Streptococcus pneumoniae and treated with penicillin or ampicillin. Or if penicillin-resistant, Vancomycin.
What is the bacteria most commonly associated with gastric ulcer disease and how is it treated?
Helicobacter pylori in upper GI tract. Treated weith antibiotics like Amoxicillin or Clarithromycin; may be combined wiht other meds
What is the bacteria most commonly associated with tetanus and how is it treated?
Clostridium tetani; treated with penicillin and vancomycin - marled by continuous state of muscular contraction and rigidity of voluntary muscles.
A physical therapist examines a patient who complains of abdominal pain. The patient’s symptoms include left lower quadrant abdominal pain, loss of appetite, and nausea. The clinical presentation is MOST consistent with:
Where would pain be with appendicitis?
Right lower Quadrant
Where would pain for peptic ulcer and pancreatitis be felt?
Is chronic bronchitis obstructive or restrictive?
Obstructive. Increased mucus secretions.
What is hypoventilation?
State in wich a reduced amount of air enters the alveoli, resulting in decreased levels of oxygen and increased levels of CO2 in the blood. Caused by shallow breathing, slow breathing, or diminished lung function.