Focus Topics Lecture

Question 1

Integu– Dressings

Exudate types + Dressing Types

Answer 1

1. Very MILD exudate= Transparent**
2. Minimal exudate= HYDROgel, HYDROcolloid
3. Moderate exudate= Foams
4. **Heavy exudate “Heavy Algae”= Alginates, Hydrofiber

Question 2

Wound Debridement (think of gardening): 2 types

Answer 2

1. Selective– removal of only NONviable tissues
2. NONselective– removal of both NONviable AND viable tissues

Question 3

Wound Debridement

Selective: removal of ONLY nonviable tissues: 3 types

Answer 3

1. Sharp (exactly what it sounds like)– scalpel, scissors, forceps– “Getting weeds out”
2. Enyzmatic (use something else)– Use topical application– “something to kill weeds w/”
3. AUTOlytic (self)– Use of bodys own mechanism to remove nonviable tissues– “plants remove weeds themselves”

Question 4

Wound Debridement

NONSelective: removal of BOTH NONviable and viable tissues: 3 types
“EVERYTHING GOES”

Answer 4

1. Wet to Dry Dressings– application of moistened gauze over area of necrotic tissue to be comp. dried and removed
2. Wound Irrigation (pressure spray)– moves necrotic tissue from wound bed using pressurized fluid (irrigation)
3. Hydrotherapy– Using a whirlpool w/ agitation directed toward a wound requiring debridement

NOTE: If 50% or more of wound== Necrosis–> NONselective!!!

Question 5

Burn Types

Answer 5

See chart

Question 6

Rule of 9’s– Burns

Answer 6

9x11– 11 body areas, 9x11=99% 1% perineum=100%
Adult
- Head x1 (ant 4.5, post 4.5)
- Chest x2 (18)
- Back x2 (18)
- L Arm x1 (Ant 4.5% & Post 4.5%)
- R Arm x1 (Ant 4.5% & Post 4.5%)
- L Leg x2 (ant 9, post 9)
- R Leg x2 (ant 9, post 9)
- Perineum 1%

Child– Legs always > arms, trunk stays 18, adult head 4.5 child head 8.5

Question 7

Lab Values + Exercise Guidelines

Answer 7

See chart

Question 8

More Lab Values

Answer 8

see pics

Question 9

Motor Learning Stages:

Cognitive- WHAT to do

Answer 9

WHAT TO DO– bc your so new to it your like “what do I do?”
- Extrinsic feedback > Intrinisc fb
- KR FIRST then KP
- Feedback after EVERY trial

Question 10

Motor Learning Stages:

Associative- HOW to do

Answer 10

HOW TO DO– “How do I associate these skills to task?
- Intrinsic fb (let them “feel” it)
- Feedback–> summed (after sum of attempts), bandwidth, fading (fading away, further and further from immediate)
- Variable practice

Question 11

Motor Learning Stages:

Automatic- How to SUCCEED

Answer 11

Totally autonomous (automatic)

Question 12

Lab Values are above, but these are NO EXERCISE values

Answer 12

See chart

Question 13

Lab Vals

Platelets

Answer 13

150,000-450,000

Question 14

Lab Vals

WBCs

Answer 14

4,800-10,800

Question 15

Lab Vals

Hemoglobin (HGb)

Answer 15

Women: 12-16
Men: 13-18

Question 16

Lab Vals

Hematocrit

Answer 16

Women: 37-48%
Men: 45-52%

Question 17

Lab Vals

BUN

Answer 17

10-20

Question 18

Lab Vals

Creatinine

Answer 18

.5-1.2

Question 19

Lab Vals

Potassium

Answer 19

3.5-5
“Dont buy more than 3-5 bananas”

Question 20

Sodium
“kinda like pH”

Answer 20

135-145

Question 21

Lab Vals

Calcium
“911”

Answer 21

9-11
HypOcal= QT cries== prolonged QT

Question 22

Magnesium (Mg)

Answer 22

1.5-2.5

Question 23

Lab Vals

hba1c %

Answer 23

4-6%

Question 24

Lab Vals

INR
“again 911 but w/ decimals”

Answer 24

.9-1.1

Question 25

PreTest-PostTest Group Design Ex. LBP

Answer 25

see pics **P-value= 0.05 or 5% chance of error** IF < 0.05== Significant NOTE: I for I==> Ind variable is the Intervention****

Question 26

Ex. Group of PT students compiling injury prevention program for adolescent soccer players. **P-value set at 0.05**. **Critical value for rejecting null hypothesis **is 1.45, and **statistical test result is 1.85**. Make sense of these #'s

Answer 26

1. If you exceed/pass **critical value (bare minimum)==Statistically significant**-- Critical value is MIN value to prove research is significant, so we want the statistical value to EXCEED this (> critical value= sig.) 2. P-value should always be LESS THAN Alpha value 3. P < 0.05== Significant 4. **Null hypothesis** says NO DIFFERENCE; so REJECTING THIS we say there IS A DIFFERENCE (alternate hypothesis)

Question 27

Lvls of research evidence

Answer 27

see pyramid Top 3: 1. Meta analysis 2. Systematic Review 3. RCTs

Question 28

Reliability-- consistency of instrument/measure "Does it give me the same results over and over?"

Answer 28

1. InTRArater== 1 person performs test several times (1 PT) 2. IntERrater== bw 2 or more== test performed by 2 or more indivs on diff subjs testing 1 variable (ex goni) 3. Test-Retest== Same test to same indivs on 2 occasions (its in the name)

Question 29

Validity-- consistency again "Does this measure what I want it to measure?

Answer 29

1. Content== test should measure specifically what the pt problem is (ex. balance/falls-BERG, TUG) 2. Construct (think TOOLS)== test should measure what its SUPPOSED to measure (ex. Goni for ROM) 3. **Concurrent (think GOLD standard)**== test performed and compared to GOLD STND. and results matched

Question 30

Type I Error (False Pos)

Answer 30

incorrectly reject a true null hyp think "theres an I in P"

Question 31

Type II Error (False Neg)

Answer 31

failing to reject a false null think "II can be converted to N"

Question 32

Hallways and Ramps for WC

Answer 32

- Hallway-- 36in width w/ turning NOT reqd; Turning reqd= 60in - Ramps-- every inch of threshold ht there is 12in of ramp **Slop of 1:12** and **1 step= 7in**-- see ex. but essentially if 2 steps = 7 (1 step) x 12 = 84 and 2 steps so 84x2= 168 inches

Question 33

W/C Measurements

Answer 33

see pics

Question 34

UNcompensated Forefoot valgus **Rearfoot will be...**

Answer 34

Neutral

Question 35

CRPS main sx

Answer 35

Impaired sensation

Question 36

White color finger while applying Cryo

Answer 36

Raynauds

Question 37

US Freq Deep vs Superf

Answer 37

Superf= 3 MHz (3 is backwards S) Deep= 1 MHz

Question 38

Uncompensated Forefoot valgus Explain Heel or rearfoot is either gonna stay where it is and NOT help (UNcompd) OR its gonna move the OPP way so that forefoot can go to neutral (COMPENSATED)

Answer 38

**Calcaneus is gonna decide Comp vs UNcomp** - UNcomp= Heels gonna stay down or wherever it is, "not gonna help you" - OR it will do the OPP motion to HELP you and COMPENSATE Ex. - If **heel in neutral** and **forefoot in varus (big toe OFF ground, small toe ON ground**-- UNcompensated forefoot varus Ex. - If **heel is in varus** and **forefoot in neutral**-- Compensated forefoot valgus (bc heel did the OPP motion to compensate) ## Footnote Forefoot Valgus= big toe down, little toe UP; Forefoot Varus= big toe up, little toe down

Question 39

Aquatic Tx CONTRAindications DO NOT DO!

Answer 39

1. Cardiac failure and unstable angina (nitrates) 2. Resp dysfunction, **Vital capacity < 1L**-- hydrostatic pressure FURTHER DECs VC (already goes down w/ aquatic tx) 3. Severe PVD 4. Danger of bleed or hemorrhage 5. Severe kidney disease (bc fluid imbalances already and water inc's this) 6. Open wounds W/OUT occlusive dressings, colostomy and skin infx's

Question 40

Modified Ashworth

Answer 40

0: NO inc in mm tone 1: SLIGHT inc in mm tone, manifested by **catch and release** OR by **min resist @ end ROM** when affected part moved **1+:** Slight inc in mm tone, manifested by **catch, f/b MIN resist t/o remainder (LESS than half) of ROM** 2: More **marked inc in mm tone thru MOST of ROM**, but affected part **EASILY moved** 3: CONSIDERABLE inc in mm tone, **passive mvmt is DIFFICULT** 4: Affected part **rigid in flex/ext**

Question 41

Tibial N. think...

Answer 41

Gastrocs

Question 42

Ankle Control AFOs

Answer 42

**Anterior Stop:** Limits DF, helps w/ **paralyzed PFs** to achieve **propulsion** in **late stance** **Plastic Solid AFO:** Limits **all motion** **Hinged AFO:** permits **sag plane** **BICAAL:** Consists of **anterior and posterior spring** **Solid AFO:** provides **M/L stability** **Spiral AFO:** controls, but does NOT eliminate motion

Question 43

ALL DF ASSIST

Answer 43

Bi-axial Klenzac jt AFO w/ DF assist Posterior leaf spring AFO **NOTE: ** BICAAL has a spot for both Anterior stop or Post stop--- IF BICAAL w/ **peg in ANT chamber== ANT (DF) STOP**-- helps to improve propulsion (**PFs)** during late stance

Question 44

Benign Prostatic Hyperplasia BPH

Answer 44

- Hypertrophy of prostate glands (surrounds urethra) - ==> Narrowing of urethra lumen which **inc's Urinary Retention** and **dilation of urinary bladder**

Question 45

Pt recently underwent **radical lymph node dissection 2ndary to prostate cx.** According to hx, most important to educate on?

Answer 45

Routinely monitor for changes in **fitting of socks OR indentations left by socks=== bc swelling/lymphedema**

Question 46

TALOfib vs TIBIOfib lig

Answer 46

Anterior TALOfib== Lateral ankle sprain (MOI is PF+INV) == Anterior Drawer (can also do for Deltoid (medial) ligs Calcaneofibular lig== Talar Tilt Tibiofibular lig== High Ankle Sprain== Syndesmotic squeeze or Kleigers ER/DF (MOI of high ankle sprain)

Question 47

MS and **dysmetria** intervention?

Answer 47

**PNF using Dynamic Reversals w/ carefully graded resistance**

Question 48

ASIA Scale

Answer 48

see pics

Question 49

Normal Toe Out==

Answer 49

5-7 degs

Question 50

FYI

Answer 50

Inferior glenohumeral ligament is taut/ stretched with 90 degrees of shoulder abduction. Middle glenohumeral ligament is taut between 45-60 degrees of abduction.

Question 51

Special tests AC jt

Answer 51

Horiz ADDuction Test

Question 52

Adhesive Capsulitis mob

Answer 52

Capsular pattern of restriction is present in adhesive capsulitis i.e. lateral rotation> abduction> medial rotation. Clinical studies have demonstrated that posterior glide is more effective than an anterior glide to increase glenohumeral external rotation range of motion (exception to the convex- concave rule) in adhesive capsulitis. Patient’s external rotation can be treated with posterior glide and inferior glide are used to resolve abduction. So, posterior inferior glides should be given in this patient.

Question 53

Hand deformities

Answer 53

Boutonniere Deformity: Rupture of the central band (central slip) of the extensor hood results in the lateral bands of the extensor apparatus (extensor hood) slipping in a volar direction to the PIP joint, causing PIP flexion and DIP extension. Swan Neck Deformity: Laxity of the PIP joint with an over- stretched palmar plate and bowstringing of the lateral bands of the extensor hood result in hyperextension of the PIP and flexion of the DIP joints. Ulnar drift: Ulnar deviation of the digits because of weakening of the capsuloligamentous structures of the metacarpophalangeal joints and the accompanying “bowstring” effect of the extensor communis tendons. Mallet finger: It is the result of a rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger. The distal phalanx rests in a flexed position.

Question 54

Major association w/ Radial N injury

Answer 54

Weak grip Wrist drop

Question 55

Bowstring injury

Answer 55

Annular pulleys along with other flexor pulleys share a similar function of holding the underlying tendons at a relatively close distance to the joints. With injury to these structures, the force of a strong contraction of the extrinsic finger flexors causes the tendon to pull away from the joint’s axis of rotation, a phenomenon referred to as “bowstringing” of the tendon.

Question 56

29) During exams week, the physical therapist observes the posture of a 29-year-old female patient. The PT notices that she has a forward head posture. Which of the following characterizes forward head posture?

Answer 56

With a forward head posture, the patient has his lower cervical spine flexed along with upper cervical extension. This causes the head to translate anteriorly and the load of the weight of the head (load arm) on the long cervical extensors increases resulting in an increase in the external moment arm (resistance arm). (The external moment arm is the perpendicular distance between the axis of rotation and the external force.)