PT Final Exam Review: Cardiovascular & Pulmonary, Neuromuscular & Nervous, Musculoskeletal, System Interactions, Genitourinary, Metabolic & Endocrine, Integumentary, Equipment & Devices, Therapeutic Modalities, Safety & Protection, Research & Evidence-Based Practice

Flashcards covering key definitions and concepts from Cardiovascular & Pulmonary Systems, Neuromuscular & Nervous Systems, Musculoskeletal System, System Interactions, Genitourinary System, Metabolic & Endocrine, Integumentary System, Equipment, Devices & Technologies, Therapeutic Modalities, Safety & Protection, and Research & Evidence-Based Practice.

Intermittent claudication

Exertional limb pain due to peripheral arterial insufficiency; relieved by rest. Typical in atherosclerotic disease.

ABI (Ankle-Brachial Index)

Ratio of systolic ankle pressure to systolic brachial pressure.

Normal ABI

≥1.00–1.30 (≥1.3 may indicate a noncompressible calcified vessel).

PAD (Peripheral Arterial Disease) ABI

≤0.90.

Nitrates (e.g., nitroglycerin)

Cause systemic vasodilation, decreasing preload and blood pressure.

Beta-blockers (effect on exercise)

Blunt heart rate response (decreased resting and peak HR), potentially reducing cardiac output at high intensities; use RPE for exercise prescription.

Postural Drainage (Basic Rule)

Position patient to drain the target bronchopulmonary segment vertically, percuss over bony chest wall, not over breast, sternum, or spine.

Postural Drainage (Upper Lobes Apical)

Patient sitting, leaning back 30–40°, percuss over upper anterior chest under clavicles and between scapulae.

Postural Drainage (Right Middle Lobe / Lingula)

Head down 15–20°, lie on left/right side with pillow under knees; percussion over lateral chest below axilla.

Postural Drainage (Lower Lobes Posterior Basal)

Trendelenburg (head down), prone; percussion over lower posterior ribs.

Activity pacing

Energy conservation strategy involving breaking tasks, scheduling rests, and prioritizing activities; important for CHF, COPD, chronic fatigue.

ACBT (Active Cycle of Breathing Technique)

Three parts: breathing control, thoracic expansion exercises, forced expiratory technique (huff) to clear secretions.

Pursed-lip breathing

Inhale through nose, exhale slowly through pursed lips (~2x longer than inhale) to improve expiratory flow, reduce dyspnea, and prevent airway collapse in COPD.

V-fib (ventricular fibrillation)

Chaotic ECG, no organized QRS, no pulse; requires immediate CPR + unsynchronized defibrillation.

V-tach (ventricular tachycardia)

Wide QRS, regular rhythm. If pulseless, treat like V-fib (CPR + defib); if with pulse and unstable, synchronized cardioversion.

A-fib (atrial fibrillation)

Irregularly irregular rhythm, no discrete P waves; carries stroke risk and requires anticoagulation consideration.

1st-degree AV block

PR interval >200 ms; usually asymptomatic and requires observation.

Cheyne-Stokes respirations

Cyclical crescendo–decrescendo tidal volumes with periods of apnea; often seen with advanced CHF or CNS injury.

Dyspnea

Subjective breathlessness.

Eupnea

Normal breathing.

Apnea

Absence of breathing.

Kussmaul’s respirations

Deep, labored, rapid respirations associated with metabolic acidosis (e.g., diabetic ketoacidosis).

Apical pulse auscultation (PMI)

Left 5th intercostal space at the mid-clavicular line, used for accurate HR when peripheral pulses are diminished.

Tachycardia

Heart rate >100 bpm.

Bradycardia

Heart rate <60 bpm.

Pneumonia with dyspnea (positioning)

Upright sitting or leaning forward (tripod) to maximize diaphragmatic descent and accessory muscle use.

NDT (Neuro-Developmental Treatment)

Therapeutic approach focusing on handling, postural control, facilitation of normal movement patterns, and inhibition of abnormal tone.

PNF (Proprioceptive Neuromuscular Facilitation)

Uses diagonal, functional patterns (D1/D2 flexion/extension) with techniques like rhythmic initiation and repeated contractions to improve motor control.

UE Flexion Synergy (Brunnstrom)

Scapular retraction/elevation, shoulder abduction/ER, elbow flexion, forearm supination, wrist/finger flexion.

UE Extension Synergy (Brunnstrom)

Scapular protraction, shoulder adduction/internal rotation, elbow extension.

Clonus testing

Rapidly dorsiflexing the ankle and maintaining stretch, observing for sustained rhythmic oscillations (positive indicates UMN lesion).

Weak quadriceps (gait deviation)

Forward trunk lean in stance to bring line of gravity anterior to the knee for stability; may also show hyperextension at the knee.

Tenodesis grasp (C6 tetraplegia)

Passive finger flexion due to passive tension created by wrist extension, allowing for functional grip.

Ankle strategy (balance)

Used for small perturbations on a firm surface, involving distal to proximal muscle activation (gastroc/soleus → hamstrings → paraspinals).

Hip strategy (balance)

Used for larger/faster perturbations, involving hip flexion/extension to regain center of mass.

Stepping strategy (balance)

Used when the center of mass exceeds the base of support, requiring a step to regain balance.

Autonomic dysreflexia

Seen in SCI at T6 and above, triggered by noxious stimuli below the lesion, causing sudden severe hypertension, pounding headache, flushing/sweating above lesion, and bradycardia.

Shoulder subluxation after CVA (appropriate intervention)

Support hemi-arm with slings that avoid IR/adduction, positioning, scapular stabilization, NMES to supraspinatus/deltoid, gentle ROM, functional use.

Cranial Nerve I testing

Smell (one nostril).

Cranial Nerve II testing

Visual acuity, visual fields, pupillary reflex (afferent).

Cranial Nerve III/IV/VI testing

Extraocular movements, convergence; PERRLA (pupils equal, reactive and accommodate) for CN III.

Cranial Nerve V testing

Facial sensation, corneal reflex, jaw clench.

Cranial Nerve VII testing

Facial expressions (smile, eye closure).

Cranial Nerve VIII testing

Whisper test, tuning fork (Weber/Rinne) or Dix-Hallpike for vestibular.

Cranial Nerve IX/X testing

Gag, swallow, palate elevation, voice quality.

Cranial Nerve XI testing

Shoulder shrug, SCM resisted turn.

Cranial Nerve XII testing

Tongue protrusion, strength.

Ashworth Scale (Grade 0)

No increase in muscle tone.

Ashworth Scale (Grade 1)

Slight increase, catch and release or minimal resistance at end ROM.

Ashworth Scale (Grade 1+)

Slight increase, catch followed by minimal resistance through remainder (<half) of ROM.

Ashworth Scale (Grade 4)

Rigid in flexion/extension.

Anterior cord syndrome

Motor loss and pain/temperature loss below lesion, with dorsal column (proprioception) preserved; often from flexion injuries.

Central cord syndrome

Greater UE weakness than LE, with sacral sparing; often in older patients with hyperextension injuries.

Brown-Séquard syndrome (hemisection)

Ipsilateral UMN weakness and loss of proprioception; contralateral loss of pain/temperature below the lesion.

Cauda equina syndrome

LMN signs, asymmetrical weakness, and bowel/bladder involvement.

SCI C5 AD/Orthosis

Elbow flexion present; uses mobile arm support, power wheelchair, requires min assist for transfers.

SCI C6 AD/Orthosis

Wrist extensors (tenodesis grasp) present; uses transfer board (max assist), power or manual wheelchair with friction rims.

Cerebral (cortical) symptoms

Weakness, spasticity, hyperreflexia, positive Babinski, focal deficits (aphasia, apraxia).

Basal ganglia (extrapyramidal) symptoms

Rigidity, bradykinesia, resting tremor, chorea, athetosis (movement disorders).

Dix-Hallpike test

Diagnostic test for posterior canal BPPV, indicated by reproduction of vertigo and torsional nystagmus.

Epley maneuver

Canalith repositioning procedure used to treat posterior canal BPPV.

Head impulse (Halmagyi) test

Quick head thrust while patient fixes on a target; abnormal VOR shows a corrective saccade, indicating peripheral vestibular hypofunction.

Ataxic gait

Wide base, unsteady, variable step length, truncal instability, dysmetria on heel-to-toe, often due to cerebellar lesion or sensory ataxia.

Relapsing-remitting MS (RRMS)

MS type characterized by relapses with recovery periods.

Secondary progressive MS (SPMS)

MS type starting as RRMS, then experiencing a progressive decline.

Primary progressive MS (PPMS)

MS type with steady progression of symptoms from onset.

Motor Learning (Cognitive Stage)

Early stage where patient verbalizes and rehearses movements, often requiring frequent feedback and blocked practice.

Motor Learning (Associative Stage)

Intermediate stage with fewer errors where the patient begins to self-correct; benefits from variable practice.

Motor Learning (Autonomous Stage)

Final stage where movement becomes automatic; benefits from dual-task training and random practice.

Pseudomyostatic contracture

Contracture due to hypertonicity/spasticity, may respond to tone management.

Myostatic contracture

Shortened muscle without pathology (e.g., immobilization), responds to stretching.

Periarticular contracture

Contracture within joint capsule/ligamentous structures, treated with joint mobilizations, ROM, splinting.

Fibrotic (irreversible) contracture

Fibrous tissue replacing muscle, often requires surgery.

Blocked practice

Repetitive practice of the same task, useful for the cognitive stage of motor learning.

Random practice

Practicing tasks in a variable order, leading to better retention.

Subacromial impingement

Compression of the supraspinatus tendon/bursa under the acromion, causing painful arc (60–120°), weakness, and positive Neer/Hawkins tests.

Achilles tendinopathy strengthening

Eccentric heel drop protocol (Alfredson): 3 sets × 15 reps, twice daily for 12 weeks (slow controlled eccentric lowering off a step).

Inflammatory phase of healing

0–72 hours, focus on pain/edema control and tissue protection.

Proliferative / repair phase of healing

~72 hours–6 weeks, characterized by collagen formation, controlled ROM, and progressive loading.

Maturation / remodeling phase of healing

6+ weeks, involves progressive strengthening and high-level activity as tolerated.

Thoracic outlet syndrome (TOS)

Neurovascular compression at the scalene/first rib/costoclavicular space.

Long thoracic nerve neuropathy

Causes serratus anterior weakness, leading to scapular winging and difficulty with overhead reach.

Axillary nerve neuropathy

Causes deltoid weakness (impaired shoulder abduction) and sensory loss over the lateral shoulder (regimental badge area); common after anterior shoulder dislocation.

Humeroulnar posterior glide

Elbow mobilization technique to improve extension.

Humeroulnar anterior glide

Elbow mobilization technique to improve flexion.

Rotator cuff repair (post-op protocol)

Sling for 4–6 weeks (no active shoulder motion initially), passive motion limited per surgeon (e.g., PROM only for 4–6 weeks), no heavy lifting for 12 weeks.

Shoulder closed-pack position

Full abduction & external rotation.

Elbow (ulnohumeral) closed-pack position

Full extension.

Knee closed-pack position

Full extension.

Hip closed-pack position

Full extension, slight internal rotation and abduction (or full extension, medial rotation, abduction).

Ankle closed-pack position

Maximum dorsiflexion.

Important muscle groups for transfers

Gluteus maximus (hip extension), quadriceps (knee extension), hamstrings (control), core/abdominals, triceps (for sit-to-stand).

Craig’s test (femoral anteversion)

Patient prone, knee flexed 90°, rotate hip until greater trochanter is most lateral; angle of tibia relative to vertical.

Spurling’s test

Cervical extension + rotation + axial compression reproduces radicular arm pain, indicating nerve root compression.

Plantar fasciitis (exam findings)

Point tenderness at medial calcaneal tubercle, pain worse with first steps, positive windlass test, decreased dorsiflexion.

Isotonic strengthening

Muscle changes length against a constant load (concentric/eccentric).

Isometric strengthening

Muscle contracts with no change in length; useful early or when joint motion is contraindicated.

Isokinetic strengthening

Muscle contraction at a constant angular velocity (e.g., Biodex); useful for objective strength and rehab.

CMC dorsal glide (thumb)

Mobilization technique for the thumb carpometacarpal joint to increase flexion.

CMC palmar glide (thumb)

Mobilization technique for the thumb carpometacarpal joint to increase extension.