NPTE study guide 2023

NPTE study guide 2023 Most common thumb deformity in patients with RA - ANS-Boutonniere deformity - metacarpophalangeal joint flexion with interphalangeal hyperextension. Chronic synovitis associated with RA eventually forces MCP into forced flexion, placing tension on the IP extensor mechanism, resulting in hyperextension. Maximum amt of knee flexion required to for gait - ANS-0-60 degrees, the greated amount being from initial to midswing. Transtibial amputation changes in stance and swing phase for: 1. Prosthetic limb 2. intact limb - ANS-1. Shortened swing phase, longer step length, shortened single leg support time 2. extended stance time, shortened swing time, longer single leg support Acetic acid 1. uses 2. polarity 3. current used for administration - ANS-1. used with iontophoresis to treat myositis ossificans (calcium deposits) 2. acetic acid has negative polarity, so a negative pole is used to deliver the medication. 3. low-amp direct current is always used with iontophoresis. Pancreas dysfunction 1. symptoms 2. exacerbations 3. referral pattern - ANS-1. epigastric pain. Possible nausea, fever, abdominal tenderness 2. pain worsens after eating or when in supine 3. pain may radiate into the back Liver dysfunction 1. symptoms 2. exacerbations 3. referral pattern - ANS-1. Dull/cramping pain. Nausea, vomiting, restlessness if more severe. 2. N/A 3. referred to abdomen, right lower thoracic, right upper trap, right shoulder pain Gallbladder dysfunction 1. symptoms 2. exacerbations 3. referral pattern - ANS-1. General Pain 2. digesting foods high in refined carbs and sat fats. 3. Right shoulder, between scapulae, over right 10th rib, right upper quadrant epigastric area. Kidney dysfunction 1. symptoms 2. exacerbations 3. referral pattern - ANS-1. vague to severe cramping, possible accompanying fever and chills 2. N/A 3. flank pain radiating anteriorly or to lower abdominal quadrant Which of these diseases affect deep tendon hyperreflexia 1. Addison's disease 2. Anklyosing spondylitis 3. Graves disease 4. Cushing's syndrome - ANS-1. not addison's, it's an adrenal cortex hypofunction decreasing cortisol and aldosterone production. Hypotension, weakness, anorexia, altered pigmentation are symptoms 2. not ankylosing spondylitis. It does cause spinal inflammation yielding back pain, stiffness, impaired extension, but no tendon effects. 3. YES TO GRAVES. An autoimmune disease making certain bodies over stimulate the thyroid gland. It's the most specific cause of hyperthyroidism, which can contribute to hyperreflexia (UMN lesion) Multiple sclerosis and some pharm products can also cause hyperreflexia. 4. Not Cushing's. Causes hyperfunction of adrenal gland, overproducing cortisol. Symptoms turn into hyperglycemia, growth failure, truncal obesity, hypertension, "moon shaped face." No affect on UMNs. 1. restrictive vs obstructive lung conditions 2. which is a restrictive disease - Asthma - Bronchiectasis - Sarcoidosis - Chronic Bronchitis 3. What values of pulmonary function change with restrictive disease - ANS-1. Restrictive individuals can fully expand lungs despite relatively normal airways. Obstructive individuals have a hard time exhaling due to damaged lung tissue or narrowing of airways 2. Sarcoidosis. Inflamed lymph nodes, lungs, liver or other tissues, eventually causing fibrotic changes restricting lunge expansion and ventilation. 3. decreased residual volume and decreased total lung capacity 1. preload vs afterload 2. what is inversely proportional to afterload - ANS-1. preload aka end-diastolic volume is the amount of blood in the left ventricle prior to contraction. Afterload is the tension against the ventricle that it must contract against, aka the force required to open the aortic valve 2. stroke volume (amt of blood pumped out of the ventricle each beat) is inversely proportional to afterload. If after load is higher (could be from increase aortic pressure), not as much blood will be pumped out of the ventricle, hence, lower stroke volume. 1a. max amount of knee flexion required for gait on level surface 1b. phase of gait in which most knee flexion is required 2a. max amount of hip flexion required for gait "" b. phase of gait in which most hip flexion is required 3a. max amount of plantar flexion "" b. phase of gait in which most plantar flexion is required - ANS-1a. 0-60 degrees b. initial swing to mid swing 2a. 0-30 degrees b. initial to midswing requires 20-30 degrees 3a. 20 degrees b. 20 degrees is required from terminal stance to preswing Hip Flexors: Name muscles, myotome, nerve and/or cord segment of that nerve, reflex (if there is one), arterial supply - ANS-1. Psoas, L2 myotome, ventral rami of L1-L3. aortic lumbar branches, renal, common iliac, deep circumflex iliac arteries. 2. Iliacus, L2 myotome, femoral nerve L2-L3. Internal iliac, medial circumflex femoral artery. 3. Rectus Femoris, L3, femoral nerve L2-L4, L4 reflex. Lateral circumflex femoral artery. 4. TFL, Superior Gluteal nerve L4-L5. Superior gluteal, lateral circumflex femoral arteries. 5. Sartorius, L2 myotome, femoral nerve L2-L3. superficial circumflex iliac, profunda femoral, lateral femoral, descending geniculate arteries. Knee extensors: Name muscles, myotome, nerve and cord segment of that nerve, reflex (if there is one), arterial supply. - ANS-1. Rectus Femoris, L3 myotome, femoral nerve L2-L4, L4 reflex, lateral circumflex femoral artery. 2. Vastus medialis, L3 myotome, femoral nerve L2-L4, L4 reflex. profunda femoris artery 3. Vastus Lateralis, L3 myotome, femoral nerve L2-L4, L4 reflex. Lateral circumflex femoral artery. 4. Vastus intermedius, L3 myotome, femoral nerve L2-L4, L4 reflex. Lateral circumflex femoral artery. Hip Extensors: Name muscles, myotome, nerve and cord segment of that nerve, reflex (if there is one), arterial supply - ANS-1. Gluteus Maximus, inferior gluteal nerve L4-S2. Super and inferior gluteal, profunda femoral arteries. 2. Biceps Femoris, Sciatic Nerve L5-S2. Profunda femoral, inferior gluteal, medial circumflex femoral arteries. 3. Semitendinosus, Sciatic Nerve L5-S2, L5 reflex. Internal Iliac, popliteal, profunda femoral arteries. 4. Semimembranosus, Sciatic Nerve L5-S2. Internal iliac, popliteal, profunda femoral arteries. tibial rotators (medial) Name muscles, myotome, nerve and/or cord segment of that nerve, reflex (if there is one), arterial supply - ANS-1. Semitendinosus, Sciatic Nerve L5-S2, L5 reflex. Internal Iliac, popliteal, profunda femoral arteries. 2. Semimembranosus, Sciatic Nerve L5-S2. Internal iliac, popliteal, profunda femoral arteries 3. Gracilis, Obturator Nerve L2-L4. Medial Circumflex femoral artery. 4. Sartorius, L2 myotome, femoral nerve L2-L3. superficial circumflex iliac, profunda femoral, lateral femoral, descending geniculate arteries. 5. Popliteus: Tibial nerve L4-S1. popliteal artery. Hip Abductors Name muscles, myotome, nerve and/or cord segment of that nerve, reflex (if there is one), arterial supply - ANS-1. gluteus medius, L5 myotome, Superior gluteal nerve L4- S1. Superior Gluteal Artery. 2. gluteus minimus, L5 myotome, superior gluteal nerve L4-S1. Superior gluteal artery. 3. tensor fascia latae, Superior Gluteal nerve L4-L5. Superior gluteal, lateral circumflex femoral arteries. Hip Adductors Name muscles, myotome, nerve and/or cord segment of that nerve, reflex (if there is one), arterial supply - ANS-1. adductor longus, Obturator nerve L2-L3. Profunda femoral artery 2. adductor brevis, Obturator nerve L2-L4. Obturator artery, medial circumflex femoral artery. 3. adductor magnus, Obturator nerve L2-L4 (anterior fibers), Sciatic Nerve L4-S1 (posterior fibers). Medial circumflex femoral, inferior gluteal, obturator, popliteal arteries. 4. gracilis, Obturator Nerve L2-L4. Medial Circumflex artery. 5. pectineus, Femoral Nerve L2-L3. Obturator artery. Hip External Rotators Name muscles, myotome, nerve and/or cord segment of that nerve, reflex (if there is one), arterial supply - ANS-1. piriformis, sacral plexus L5-S1. Inferior + Superior gluteal, internal pudendal arteries. 2. quadratus femoris, nerve to quadratus femoris off sacral plexus L4-S1. Inferior gluteal artery. 3. obturator internus, nerve to obturator internus off sacral plexus L5-S1. Inferior Gluteal Artery 4. obturator externus, obturator nerve L3-L4. Obturator and medial circumflex femoral arteries. 5. superior gemellus, Nerve to obturator internus L5-S2. Inferior gluteal artery. 6. inferior gemellus, Nerve to quadratus femoris L4-S1, inferior gluteal artery. How should a patient with CRPS be educated with performance of their HEP - ANSPerformance of pain-free activities to patient's tolerance for short durations. 1. what affect does diaphragmatic breathing have on respiration 2. what respiratory conditions would instruction on diaphragmatic breathing be indicated for - ANS-1. increase tidal volume, lower respiratory rate, decrease use of accessory muscles. Collectively, these decrease work of breathing. 2. atelectasis - areas of lungs don't collapse properly tachypnea - short, fast breaths hypoxemia - low blood oxygen COPD Braden Scale 1. What's it for 2. What are the categories within the scale 3. What information do score ranges provide and what are the score ranges - ANS-1. determining amount of risk for developing a pressure ulcer 2. sensory perception, moisture, activity, mobility, friction/shear, nutrition 3. scored from 6-23. 9 very high risk, 10-12 high, 13-14 moderate, 15-18 at risk. Provide Blood Glucose Ranges for: 1. Hypoglycemia - signs and symptoms 2. pre-meal (prepandial) 3. post meal (postpandial) 4. hyperglycemia - signs and symptoms - ANS-1. 70 mg/dL - headache, hunger, dizziness, sweating, clumsiness, shaking, syncope 2. 70-130 mg/dL 3. 180 mg/dL 4. 180-200 mg/dL - thirst, frequent urination, prior to onset of ketoacidosis (EMERGENCY) P-value 1. what is it 2. what type of research study does it correspond to - ANS-1. It's a measure of the probability of whether a statistical outcome happened by chance 2. quantitative study effect size 1. what is it 2. what type of research study does it correspond to - ANS-1. a measure of the strength of the relationship between two variables or the extent of an experimental effect 2. quantitative study 1. what is the most likely contributor to functional loss after a CNS lesion 2. considering task-specific intervention, what would be appropriate to work on to help patient clear his leg for swing phase - ANS-1. weakness and/or inability to recruit agonist muscles for a task, rather than antagonist hypertonicity. 2. Something that promotes motor funciton, is active rather than passive, and recruits as many muscles as possible that are used for swing phase - i.e standing marches or standing leg kicks what spirometric measures combine to form the following: 1. Inspiratory capacity 2. total lung capacity 3. Functional residual capacity - ANS-1. inspiratory reserve volume + tital volume 2. vital capacity + residual volume 3. expiratory reserve volume + residual volume Dantrolene sodium 1. what is it 2. what's it used for 3. what complications can arise from using it - ANS-1. It's a post-synaptic muscle relaxor that disrupts calcium release from the sarcoplasmic reticulum 2. spasticity 3. because it's a muscle relaxor, it causes generalized weakness throughout the body. This can make activities like walking difficult as it provides sustained muscle activity with large muscle groups What types of conditions are these bandages indicated for: 1. short stretch compression 2. triangular 3. elastic - ANS-1. lymphedema 2. shoulder subluxation 3. ankle sprains, post amputation wrapping Hormones most responsible during pregnancy for ligamentous laxity - ANS-relaxin and progesterone What would you do if a patient told you days after s/p laminectomy and fusion that he/she was still getting radicular symptoms down the affected leg - ANS-Say that it's normal after surgery, especially in the acute stage. Surgery will cause inflammation and edema to the area that can irritate the nerve and cause radicular symptoms. As inflammation is relieved and swelling reduced, the symptoms will decrease and eventually cease. Staph infections 1. what increases the chances of getting one 2. how is it treated - ANS-1. internal fixation surgeries. The bacteria can bind to the metal and alloy surgical tools, the clothing of the medical team, or even be on the patient's skin already 2. Peripherally inserted central catheter (PICC) line. A month or more of low-dose intravenous antibiotic therapy is administered. 1. what's the most common clinically used biofeedback modality 2. what's it do - ANS-1. electromyographic biofeedback 2. uses electrodes placed as closed as possible to the target muscle to provide audio and/or visual feedback of muscle activity. Helps the patient to try and better recruit the target muscle Wagner _______ Classification Scale 1. what does it classify 2. How is it scored and what does each score mean - ANS-Wagner ULCER Classification Scale 1. Classifies the depth and presence of infection in non-vascular diabetic foot ulcers 2. 0 - preulcerative lesions, bony changes 1- superficial ulcer, no subcutaneous involvement 2- deep ulcer penetration into bone, joint capsule, tendon or ligament 3- deep ulcer with oseitic or osteomyelitis 4- gangrene present in a digit 5- gangrene requiring amputation of the foot How can a tight and spasming piriforming/piriformis syndrome affect: 1. stride length 2. hip mechanics 3. acetabulofemoral osteokinematics 4. the lumbar spine - ANS-1. it would likely reduce stride length on affected side to reduce tension on piriformis 2. extreme tightness can cause abnormal hip mechanics and alignment, causing a functional leg length discrepancy 3. Since piriformis is a primary external rotator, the joint would present more externally roated if tight or spasmed. 4. a decreased lordosis may be observed as an attempt to functionally bring the origin of the piriformis closer to its insertion to adapt for its tightness and relieve pressure. Name 5 things an informed consent document must include - ANS-1. in case of an injury, if compensation is available 2. emphasis that participation is voluntary 3. who should be contact in case of injury (research dr, participant's dr, etc) 4. required procedures for the study 5. freedom to withdraw from the study Continues...