Truelearn NPTE study guide

What is the rancho los amigos scale?

a scale to determine cognitive function following TBI

Level I: no response to pain, touch, sound, or sight

Level II: generalized reflex response to pain

Level III: localized response, blinks to strong light, turns toward/away from sound, responds to physical discomfort, inconsistent response to commands

Level IV: confused/agitated; alert, performed motor activities but behavior is non-purposeful, extremely short attention span

level V: confused/non-agitated; gross attention to environment, highly distractible, inappropriate verbalization

Level VI: confused/appropriated. inconsistent orientation to time and place. consistently follows simple directions

level VII: automatic/appropriated. skilled noticeably deteriorated

Level VIII: purposeful/appropriate

Lymphedema stage 0

Latency;

has no outward swelling and the body can continue to respond appropriately to lymphatic load

Lymphedema stage I

reversible;

-has soft or pitting edema

-no skin changes

-negative stemmers sign

lymphedema stage II

spontaneously irreversible;

-swelling that can no longer pit (no indentation)

-skin changes are present; hard with decreased mobility

-fibrotic tissue with brawny, hard swelling

- positive stemmers sign (inability to lift a skin fold to the second toe)

-frequent infections

lymphedema stage III

lymphostatic elephantiasis;

-positive stemmers sign

-non-pitting edema

-much greater skin volume; skin changes more pronounced and hard with little mobility

-darkened skin with papillomas (benign skin growths), deep skin folds, hyperkeratosis

-infection is common

Spinalthalamic tract relays which types of information in the spinal cord?

-pain (fast nociception- localized well defined pain; A delta fibers)

-crude touch

-temperature

dorsal column-medial leminiscus(DCML) tract relays which type of information in the spinal cord?

-light touch (discriminative)

-conscious proprioception

-vibration

spinocerebellar tract relays which type of information in the spinal cord?

unconscious proprioception

anterior spinalthalamic tract relays which type of information in the spinal cord?

slow nociception - diffuse, and poorly localized pain; C fibers

lateral corticospinal tract relays which type of information in the spinal cord?

voluntary fractionally movement to limbs and multi-joint movement or fine motor

medial corticospinal tract relays which type of information in the spinal cord?

motor to axial and abdominal muscles

the gracile fasciculus relays which type of information in the spinal cord?

part of DCML that relays light touch and proprioception to lower leg

the radial nerve innervates what muscles?

triceps, brachioradialis, supinator, extensor carpi radialis longus and brevis, extensor carpi ulnaris and finger extensors

The results of a MMT are 5/5 for all motions except elbow extension, which is 1/5, elbow flexion is 4-/5 supination is 4/5, wrist extension is 1/5, and finger extension is 1/5. which of the following is most likely the explanation for the weakness?

radial nerve injury

3 multiple choice options

what muscles would be weak with a median nerve injury?

wrist and finger flexors

what type of glide at the hip would improve hip extension ROM?

grade 4 anterior glide

3 multiple choice options

what type of glide at the hip would improve hip flexion ROM?

grade 4 posterior glide

3 multiple choice options

common fibular (peroneal) nerve innervates which compartments of the leg?

anterior and lateral compartments of lower leg

grade 3 mobilization to the distal femur in a posterior direction results in an increase of what ROM?

knee extension

when a patient performs forward flexion, a rib hump on the right side is revealed. this means the vertebrae is rotated __ and protrudes ___ on the right side of the body

to the right; posteriorly

3 multiple choice options

what are the symptoms of systemic lupus erythematous

-malaise

-fever

-skin lesions (butterfly rash across the cheeks/nose)

-chronic fatigue

-arthritis

-arthralgia

-anemia

-commonly have Raynaud phenomenon

what is the common clinical presentation of scleroderma?

-skin becomes firm and edematous

-fibrosis of skin, joints, blood vessels, organs

-commonly accompanied by Raynaud phenomenon

when the angle of inclination is >140 degrees, this is termed as?

coxa valga

3 multiple choice options

when the angle of inclination is <125 degrees, this is termed as?

coxa vara

3 multiple choice options

describe stage 1 of pressure ulcer

non blanching erythema; intact epidermis

describe stage 2 of pressure ulcer

partial thickness ulcer involving epidermis and dermis; blanchble

describe stage 3 of pressure ulcer

-full thickness ulcer extending through dermis in to subcutaneous tissue

-blisters and weeps

-does not blanch

-less painful than stage 1&2;

- diminished sensation to light touch and pin prick

-requires surgery

describe stage 4 of pressure ulcer

-Full-thickness tissue loss with exposed bone, muscle, or tendon;

-often undermining

what are the characteristics of superficial burn

-<3 days to heal

-blanching present

-pink, red, wet

-sensation intact and painful

-does not blister or scar

what are the characteristics of partial thickness burn

-3-7 days to heal

-pink, red, edema

-blanches

-blisters and weeps

-more painful than stage 1

-intact to light touch

what are the characteristics of deep partial thickness burn

-2-6 weeks to heal

-blisters and weeps

-skin is white and waxy

-does not blanch

-less painful than stage 1&2

- diminished sensation to light touch and pin prick

-requires surgery

what are the characteristics of full thickness burn

-requires surgical intervention (time to heal depends)

-white, waxy, leathery, dark eschar

-high risk for infection

- absent sensation to light touch and pin prick

-large areas require skin graft

what is the proper splint position to immobilize the wrist, MCP, and IP joints following a fracture?

wrist: 0-30 of extension, MCP: 70-90 flexion, and IP: full extension

3 multiple choice options

what are the pathological changes in a patient with multiple sclerosis

demyelination and plaques in the white matter

3 multiple choice options

two-point discrimination is the most defined and should be tested on which area of the body?

distal upper extremities

3 multiple choice options

what is the BEST instructions to give to a patient for pursed-lip breathing?

expiration should be twice as long as inspiration

3 multiple choice options

describe the characteristics of inflammatory phase in wound healing

-prepares the wound for healing;

-redness, edema, warmth, and pain;

-typically lasts 1-6 days

describe the characteristics of proliferative phase in wound healing

-the rebuilding of damaged structures;

-inflammatory response subsides;

-epithelialization, collagen production, wound contraction, and neovascularization occur simultaneously

-occurs between 3-20 days

describe the characteristics of maturation phase of wound healing

-scar is remodeling with changes in size and form

-scar tissue matures and strengthens

-typically lasts between 9 days and 2 years

abnormal kidney function is determined by ___?

elevated blood urea nitrogen and creatine levels

3 multiple choice options

the apprehension test involves a ___ directed force to the posterior humeral head, and stresses the ___.

anterior; anterior structures (glenohumeral ligament, anterior capsule, labrum)

3 multiple choice options

what are symptoms of complex regional pain syndrome (CPRS)?

severe pain/hypersensitivity when touched lightly, vascular changes, limited PROM

what causes scapula winging?

tight pec minor and weak serrates anterior

what is the most common DMARD?

methotrexate

3 multiple choice options

what is the effective doses to administer iontophoresis

effective drug delivery: 40 - 80 mA-min;

treatment dosage example: 2 mA x 20 min

where does the left middle cerebral artery provide blood supply?

the lateral convexity of the cortes areas- controls right upper extremity motor and sensory function, expressive and receptive language, loss of visual field

what impairments are present with left middle cerebral artery stroke?

right upper extremity weakness and aphasia

what impairments are present with right middle cerebral artery stroke?

loss of visual field, homonymous hemianopsia, spatial neglect

what impairments are present with left middle cerebral cortex damage?

apraxia

what is apraxia

inability to perform motor activities upon command while sensory and motor systems are still intact

what is hemianopsia

cut in a visual field that may occur after a stroke

what is the most common shoulder dislocation?

anterior

3 multiple choice options

what is a hill-sachs lesion?

compression fracture of posterosuperior humeral head; when humeral head anteriorly dislocates, humeral head strikes against the front of the glenoid

what is a reverse hill-sacs lesion?

part of the anteriormedial potion of the humeral head fractures due to a posterior dislocation of the shoulder

what is a bankhart lesion?

part of labrum tears during anterior dislocation of shoulder

what is a bony bankhart lesion?

a piece of the anterior inferior glenoid is fractured during anterior dislocation of shoulder

tightness in the posterior capsule presents as limited PROM of which motion?

internal rotation

tightness in the inferior capsule presents as limited PROM of which motion?

abduction

tightness in the superior capsule presents as limited PROM of which motion?

adduction

tightness in the anterior capsule presents as limited PROM of which motion?

external rotation

what are intrinsic cues (sensory events occurring during movement)

-visual

-vestibular

-proprioceptive

-cutaneous

what are extrinsic cues?

-auditory

-tactile

-visual

what kind of intervention does mid portion achilles tendinopathy respond best to?

slow, controlled, eccentric loads; lowering into dorsiflexion off a step; improve dorsiflexion ROM, plyometrics once reduction of pain and strength is built

cholecystitis symptoms worsen when eating what types of foods?

fatty foods

what is a clinical sign/symptom of peptic ulcer disease?

dark, tarry-looking stool

what is indicative of an inverted t-wave?

ventricular repolarization

what conditions would an inverted t-wave appear on an ECG

myocardial ischemia, ventricular overload, hypertrophic cardiomyopathy, acute cerebrovascular events, myocarditis, pericarditis, PE

what drugs are used to treat seizures

barbiturates, benzodiazepines, and hydantoins

what nerve roots are affected for erbs palsy and what motions do they exhibit?

C5/C6 nerve.

-shoulder internal rotation and adduction with wrist flexion and finger extension ("waiters tip")

-increased risk during breech vaginal delivery, with use of forceps, weight over 8 lbs

what nerve roots are affected for klumpke's palsy and what motions do they exhibit?

-C8/T1 nerve roots

-MCP extension, flexion of phalangeal joints ("claw position")

- affects muscles of hand and sensation of medial arm

what is Huntingtons disease? s/s?

neurodegenerative disease due to genetic abnormality on chromosome 4>breakdown of basal ganglia> too much dopamine

-causes sx to present in ages 30-40yrs

-leads to death within 10-20yrs of dx

s/s:

-movement dysfunction ( chorea): fidgety, uncontrollable writhing movements

-hyperkinesia - quick mvmnts

-ataxia

-cognitive sx (executive function, inattention, depression, psychosis )

-spasticity

-clonus

What is Alzhiemer's Disease? s/s?

-slow degenerative disease causing progressive loss of memory, cognition, and language

-accumulation of hyper-phophorylated Tau protein and extracellular amyloid- plaques causing loss of nerve cells.

s/s: primary sx-progressive memory loss

-dx in 60 yrs +

What is Korsakoff's syndrome? s/s

-neurological condition caused by chronic alcoholism

-confabulation, decreased short-term memory, decreased long term memory

What is Parkinson's disease?

-Movement disorder caused by the death of cells that generate dopamine in the basal ganglia and substantial nigra.

-dx in 60+ yrs

-s/s: resting tremor,

-bradykinesia- slowed movement

-rigidity

-resting tremor

-facial weakness/rigidty

-shuffling gait

-difficulty initiating movement

-cognitive sx

-reduction in capacity for language

-balance deficits

what are common spastic gait abnormalities?

can be unilateral or bilateral-

-stiff-legged

-circumduction

-scissoring

-toe-walking

-decreased arm swing

-unsteady and falling toward side of greater spasticity

-localized in unilateral or bilateral corticospinal tracts

- commonly seen with cerebral palsy, multiple sclerosis, spinal cord lesions, and cortical, subcortical, brainstem infarcts.

what is ataxic gait?

describes as wide-based, unsteady, staggering side to side

-falling toward side of worse pathology.

-can be detected with tandem gait testing

-seen in pts with cerebellar dysfunctions

what is vertiginous gait?

Unsteady, wide-based walking with swaying and falling, worsened with eyes closed and feet together

-seen in pts with ischemic of vestibular nuclei, BPPV, Menderes disease

what is anterograde amnesia

unable to recall recent memory, able to recall older information and memory

-typically from damage to frontal or temporal lobes of brain

what is retrograde amnesia?

inability to recall past memories

what is post-traumatic amnesia?

causes both retrograde and anterograde amnesia; the time between the injury and when the patient is able to recall recent events

what is transient global amnesia

temporary loss of the ability to form new memories or recall recent memories that occurs without a clear neurological explanation

what type of diagnostic tool is used on infants to determine if they are having seizures

electroencephalograms

which gait parameters are WNL in patients with mid-stage Parkinson's disease

speed, stride length, double limb support

what are the symptoms of a failing ventriculoperitoneal (VP) shunt for CSF?

-headaches

-cognitive difficulties

-nausea

-vomiting

-drowsiness

(emergent situation!!)

what is summed feedback of motor learning?

feedback given after a set number of trails, such as every 3rd attempt

what is constant feedback in motor learning?

PT gives feedback after every trial

what is faded feedback in motor learning?

feedback is given initially after every trial and then less often such as every 2nd trial, then every 4th trial

what is bandwidth feedback in motor learning?

feedback given only when the patient makes an error that is outside acceptable performance

what is MOI to the cervical spine would result in complete bilateral loss of motor, pain, and temperature below the level of lesion with vibration preserved throughout?

hyperflexion - anterior cord syndrome

3 multiple choice options

what is MOI to the cervical spine would result in motor loss with greater involvement of UE>LE?

hyperextension - central cord syndrome

3 multiple choice options

what is MOI to the cervical spine would result in unilateral loss of motor and sensory function on the ipsilateral side of lesion, loss of temperature and pain on the contralateral side

Ipsilateral penetration - unilateral hord hemisection

2 multiple choice options

what score is considered fall risk on the TUG?

>14 sec

what score is considered fall risk on functional reach

<10 inches

what score is considered fall risk on BERG

< 45/56

what score is considered fall risk on 5x STS

>16 sec

what score is considered fall risk on 30sec STS

for ages 60-64:

<12 female

<14 male

what is the number one most effective intervention to treat uterine prolapse?

kegel exercises to strengthen pubococcygeal muscles

which motions at the ankle isolate the common peroneal (fibular) nerve during SLR test?

PF and INV PIP

3 multiple choice options

which motions at the ankle isolate the common tibial nerve during SLR test?

DF and EV (or toe ext) TED

3 multiple choice options

which motions at the ankle isolate the common sural nerve during SLR test?

DF and INV SID

3 multiple choice options