NPTE stuff i can't remember

action of rhomboids

retract, elevate, & downwardly rotate scapula

action of serratus anterior

protract, depress, & upwardly rotate scapula

action of pectoralis major

protract & depress scapula

flex, IR, & horizontally ADD shoulder

action of pectoralis minor

protract, depress, & downwardly rotate scapula

action of teres major

extend, ADD, & IR shoulder

action of latissimus dorsi

extend, ADD, & IR shoulder

action of sartorius

flex, ABD, & ER hip

action of pectineus and gracilis

flex, ADD, & IR hip

which joints are convex-on-concave?

1. glenohumeral

2. sternoclavicular (elevation/depression)

3. proximal radioulnar

4. radiocarpal

5. carpometacarpal (ABD/ADD)

6. coxofemoral

7. proximal tibiofibular

8. tibiofemoral (CKC)

9. talocrural

10. subtalar

upper body dermatomes

C5: lateral shoulder & deltoid

C6: thumb

C7: 2nd & 3rd fingers

C8: 4th & 5th fingers

T1: medial forearm

T2: medial arm

lower body dermatomes

L1: groin

L2: anterior medial thigh

L3: middle anterior leg, patella

L4: middle anterior leg, medial lower leg, ½ of 1st toe (dorsal & plantar)

L5: lateral leg, 2nd-4th toes (dorsal & plantar)

S1: posterior thigh, lateral lower leg, 5th toe (dorsal & plantar)

S2: posterior gastroc, heel

upper body myotomes

C4: shoulder shrug

C5: shoulder ABD

C6: elbow flexion + wrist extension

C7: elbow extension + wrist flexion

C8: thumb ABD

T1: finger ABD

lower body myotomes

L2: hip flexion

L3: knee extension

L4: DF

L5: 1st toe extension

S1: PF & eversion

upper body deep tendon reflexes (DTRs)

C5: biceps brachii

C6: brachioradialis

C7: triceps

lower body deep tendon reflexes (DTRs)

L4: quadriceps (patellar)

L5: hamstrings

S1: gastroc-soleus (Achilles)

which gait phase is maximal hip flexion needed?

initial contact & terminal swing

which gait phase is maximal hip extension needed?

terminal stance

which gait phase is maximal knee flexion needed?

initial swing

which gait phase is maximal ankle PF needed?

terminal stance and pre-swing

which gait phase is maximal ankle DF needed?

mid-swing and terminal swing

what can cause a low or high prosthetic wall during gait?

low: weak IL muscles

high: tight IL muscles

what gait deviations can a long or short prosthesis cause during gait?

long: circumduction during swing

short: lateral trunk lean (toward residual limb)

what can cause an inadequate prosthetic assist or stop during gait?

inadequate assist: weak muscles

inadequate stop: tight muscles

ACL vs PCL repair protocols

ACL: aggressive, FWB within few weeks, RTS @ 6-12 months

PCL: slow, FWB may be restricted longer, RTS @ 9-12 months; prevent posterior tibial translation

symptoms of anterior cerebral artery (ACA) infarction

• CL LE hemiparesis & hemisensory loss

• problems with bimanual tasks, imitation

• urinary incontinence

• slowness, delay, motor inaction

• CL grasp and sucking reflexes

symptoms of middle cerebral artery (MCA) infarction

• CL UE hemiparesis & hemisensory loss

• CL HH

• perceptual deficits

• aphasia

symptoms of posterior cerebral artery (PCA) infarction

• CL HH

• prosopagnosia (visual agnosia)

• dyslexia without agraphia

• topographical disorientation

• memory deficits

UE flexion synergy pattern

scapula retraction/elevation

shoulder ABD, ER

elbow flexion

forearm supination

wrist and finger flexion

UE extension synergy pattern

scapula protraction

shoulder ADD, IR

elbow extension

forearm pronation

wrist and finger flexion

LE flexion synergy pattern

hip flexion, ABD, ER

knee flexion

ankle DF, inversion

LE extension synergy pattern

hip extension, ADD, IR

knee extension

ankle PF, inversion

UE spasticity pattern

scapula retraction, downward rotation

shoulder depression, ADD, IR

elbow flexion

forearm pronation

wrist flexion, ADD

finger flexion (clenched fist)

LE spasticity pattern

pelvis retraction

hip extension, ADD, IR

knee extension

ankle PF, inversion, equinovarus

anosognosia vs somatoagnosia

ano: lacks awareness/denies disability

somato: lacks awareness of body’s relationship

Ranchos Los Amigos LOCF scale

I: no response

II: generalized response

III: localized response

IV: confused agitated (confabulatory, prosopagnosia)

V: confused inappropriate (highly distractible)

VI: confused appropriate (goal-directed responses)

VII: automatic appropriate (robot-like, social interactions)

VIII: purposeful appropriate

which muscles are intact with C1-C3 SCI?

face, neck

which muscles are intact with C4 SCI?

diaphragm, trapezius

which muscles are intact with C5 SCI?

biceps, brachioradialis, brachialis, deltoid, rhomboids, supinators

which muscles are intact with C6 SCI?

pectoralis major, ECR, teres minor, SA, LD, infraspinatus, pronators

which muscles are intact with C7 SCI?

triceps, extrinsic finger extensors, FCR

which muscles are intact with C8 SCI?

wrist & finger flexors

which muscles are intact with T1-T12 SCI?

intercostals, semispinalis

T7+: abdominals

*HKAFO/KAFO

which muscles are intact with L1-L3 SCI?

gracilis, iliopsoas, QL, RF, sartorius

*B KAFO

which muscles are intact with L4 SCI?

transversus abdominis

*B AFO

which muscles are intact with L5 SCI?

extensor digitorum

*B AFO

which muscles are intact with S1 SCI?

PFs

*B AFO

which muscles are intact with S2 SCI?

hamstrings

*B AFO

Meniere’s disease vs unilateral vestibular hypofunction (UVH)

Meniere’s: episodic vertigo, sense of fullness, hearing loss

UVH: resting/spontaneous vertigo, ataxia

motor learning stages

cognitive → associative → automatic

arterial vs venous insufficiency

arterial: pallor with elevation, ulcers @ LM, eschar, shiny & dry; ABI < 0.8

venous: hemosiderin, pain with dependency, ulcers @ MM, exudate; ABI > 1.4

S3 vs S4 heart sounds

S3: ventricular gallop, early diastole, CHF

S4: atrial gallop, late diastole, MI, HTN

normal white blood cell (WBC) count

5,000-10,000 cells/mm3

normal hematocrit (Hct) level

males: 45-52%

females: 37-47%

normal hemoglobin (Hgb) level

male: 14-18 g/dL

female: 12-16 g/dL

normal platelet count

150,000-400,000 cells/mm3

which lab values should exercise be deferred with?

platelets < 10,000 &/or temp > 100.5ºF

WBC < 500,000/mm3 & fever

INR > 6.0

Hgb < 8 g/dL

HCt < 25%

FITT principle for cardiac rehab phase I & II

F: 2-3x/day

I: 50-70% HRmax

T: 10-15 min

T: sitting in recliner, ambulation

FITT principle for cardiac rehab phase III

F: 2-4x/week

I: 70-80% HRmax

T: 30-60 min + 5-10 min warmup & cooldown

T: strength training

FITT principle for cardiac rehab phase IV

F: 3-5x/week

I: 50-85% HRmax

T: 30-60 min

T: aerobic, low-level resistance

which vital responses warrant exercise termination?

• BP: >240/ >110 mmHg

• SBP drops > 20 mmHg (> 10 mmHg = caution)

• rapid increase in HR, HR doesn’t increase, decreased HR with increased intensity

• significant angina, severe leg claudication, undue dyspnea, exercise fatigue, dizziness

• pallor, cold sweats, ataxia, new murmur, pulmonary rales, S3 heart sound

• 2nd or 3rd degree HB, R or L bundle branch block, acute ST changes

which ECG presentations warrant exercise termination?

• a-fib

• symptomatic a-flutter

• 2º HB

• ST depression > 2 mm (myocardial ischemia)

which ECG presentations warrant exercise termination and call to 911?

• 3º HB

• ST elevation > 1 mm (myocardial infarction)

• ≥ 2 couplets

• multifocal PVC

• v-tach

• v-fib

which values increase with obstructive lung diseases?

FRC, RV, TLC

which values are normal with restrictive lung diseases?

FEV1/FVC ratio

which respiratory condition causes a tracheal deviation toward affected side?

atelectasis

position to drain upper lung lobe apical segments

sitting against pillow

which lung lobes and segments involve a sitting position for postural drainage?

upper lobe apical segments

upper lobe posterior segments (forward bending)

which lung lobes and segments involve a supine position for postural drainage?

upper lobe anterior segments

which lung lobes and segments involve a prone position for postural drainage?

lower lobe superior segments

which lung lobes and segments involve a side-lying position for postural drainage?

lower lobe anterior basal segments (FOB elevated 30º)

lower lobe posterior basal segments (FOB elevated 30º)

which lung lobes and segments involve a quarter turned position for postural drainage?

lingua (R side-lying, FOB elevated 15º)

middle lobe (L side-lying, FOB elevated 15º)

lower lobe lateral basal segments (FOB elevated 30º)

vesicular lung sound

soft, relatively low pitched “muffled rustling” of leaves

inspiration

heard over most of lung field

bronchovesicular lung sound

intermediate loudness & pitch

inspiration = expiration

heard over 1st and 2nd ICS (next to sternum & b/t scapula)

bronchial lung sound

loud, high pitched “hollow echoing”

expiration

heard over manubrium

tracheal lung sound

very loud, relatively high pitched “wind blowing through pipe”

inspiratory = expiratory

heard over trachea

rhonchi lung sound

continuous low pitched “snoring”

expiration

indicates mucus or obstruction

pleural rub lung sound

low pitched “sandpaper rubbing together”

inspiration & expiration

heard over lower lateral chest

indicates pleural effusion or pneumonia

crackles/rales lung sound

brief discontinuous, high pitched “popping of bubble wrap”

inspiration > expiration

indicates CHF, obstruction

wheezing lung sound

high pitched “continuous & musical whistling”

expiration

indicates obstruction (asthma)

stridor lung sound

high pitched “crowing”

inspiration

indicates tracheal or laryngeal obstruction = EMERGENCY

partially compensated alkalosis/acidosis

all values abnormal but HCO3 and CO2 going in same direction

uncompensated alkalosis/acidosis

all values abnormal but HCO3 and CO2 going in opposite directions

compensated alkalosis/acidosis

normal pH, either HCO3 or CO2 are abnormal

characteristics of first degree epidermal burns

• pink/red color

• no blistering (dry)

• minimal edema

• delayed pain

• no scarring

characteristics of second degree superficial partial thickness burns

• bright pink/red

• blanches with brisk capillary refill

• blisters, moist

• painful

• temperature changes

• minimal or no scarring

characteristics of second degree deep partial thickness burns

• mixed red or waxy white

• blanches with slow capillary refill

• broken blisters,

• marked edema

• insensitive to light touch or pain

• excessive scarring

characteristics of 3rd degree full thickness burns

• white, charred, tan or black

• no blanching

• dry leathery surface

• little pain

• hypertrophic scarring

Wagner scale of diabetic foot ulcers

grade 0: no open ulcers

grade 1: superficial ulcer

grade 2: extends into tendons, bones, or joint capsule

grade 3: tendonitis, osteomyelitis, cellulitis, or deeper tissue abscess

grade 4: wet or dry gangrene of toe or dorsal foot

grade 5: extensive gangrene with necrosis, amputation

most to least absorptive wound dressings

gauze → alginates, hydrofibers → semipermeable foams → hydrocolloids → hydrogels → transparent films

which wound dressings can be used with infections?

impregnated gauze, alginates, hydrogels

characteristics of hyperparathyroidism

“moans”: mental problems

“groans”: myalgia, gout

“stones”: kidney stones

“bones”: bone decalcification, pathological fractures

characteristics of hypoparathyroidism

convulsions, agitation, tetany, spasms, numbness

which conditions/visceral structures refer pain to the right upper quadrant (RUQ)?

peptic ulcers, gallbladder, head of pancreas, R kidney

which conditions/visceral structures refer pain to the right lower quadrant (RLQ)?

appendix, Crohn’s disease

which conditions/visceral structures refer pain to the left upper quadrant (LUQ)?

diverticulitis, ulcerative colitis, IBS

which conditions/visceral structures refer pain to the left lower quadrant (LLQ)?

diaphragm, body & tail of pancreas, spleen, L kidney

which conditions/visceral structures refer pain to the mid-back and scapula?

esophagus, gallbladder, stomach, pancreas

which conditions/visceral structures refer pain to the pelvis, low back, and sacrum?

colon, appendix, pelvic viscera

signs for cholecystitis

Murphy’s sign, Boas sign (radiates to R scapula)

signs for pancreatitis

Cullen’s sign, Grey Turner’s sign (radiates to back & worse in supine)