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Siegelman Notes

 ↓ cortisol = inability to regulate potassium and sodium


 (+) Adrenal insufficiency = hyponatremia, hyperkalemia, hypoglycemia,
and may have acidosis
 Adam’s forward bend test = standard screening test for scoliosis
 DVT = ↑ swelling ,T°, tenderness and pain in calf with Wt. bearing
 Stage 3 Lyme disease – intermittent arthritis with marked pain and
swelling; large joints
 S3 = d/t poor ventricular compliance and TURBULENCE; low frequency
sound in EARLY DIASTOLE
 S4 =d/t exaggerated atrial contraction and subsequent turbulence; low
frequency; LATE DIASTOLE
 Heart Murmurs = Swishing sounds in SYSTOLE, DIASTOLE OR B9TH
 Pericardial Rub = leathery sound during SYSTOLE
 Stemmer sign = Lymphedema0
 Pain and tenderness with palpation over Mcburney’s point = acute
appendicitis
 (+) Murphy’s sign [pain and tenderness over the COSTALVERTEBRAL
ANGLE] = Acute Cholecystitis / acute pyelonephritis
 Hiatal Hernia pain = shar0 and localizes to the lower esophagus/ upper
stomach area
 GERD = persistent burning pain in the esophagus, throat or chest
 Beta-blocker = ↓ sympathetic response to activity; ↓ HR at rest and will
blunt the HR response to activity
 Pursed lip breathing = emphysema; ↑ resistance on exhalation – ↑ P° =
prevent airway collapse. Occurs via collateral ventilation through pores
of Khon and canals of Lambert
 Asbestosis = fibrotic changes within the lung tissue
 Stress fracture = pain and swelling with weight bearing
 Compartment syndrome = P° within muscles builds to dangerous levels;
can ↓ blood flow, prevents nourishment and O²
--- ACUTE compartment syndrome – medical emergency; caused by
severe injury. Pain , ↓ pulses, paresthesias, pallor, and paralysis
--- CHRONIC compartment syndrome – aka: “ Exertional Compartment
syndrome” ; not a medical emergency; caused by athletic exertion;
bursting type of P° and pain
 Shin splints “ medial tibial stress syndrome”
 Reliability coefficients above 0.75 = good reliability
 0.50 to 0.75 = moderate reliability
 Coefficients below 0.50 = poor reliability
 ICA = uncal herniation, coma and death
 Acute arterial insufficiency = cause significant pain, pale or cyanotic skin,
and ↓ or absent pulses
 Chronic arterial insufficiency = pain, ↓ or absent pulses and dependent
rubor along with TROPHIC CHANGES (nail changes, loss of hair, and pale,
shiny skin)
 Spondylolisthesis = forward translation of a vertebral body; bilat. Pars
defect; L5- S1 ------ MOI : minor overuse trauma, repetitive
hyperextension
 Spondylosis = break in the vertebra ( pars interarticularis)
 In examining : Cognition → Sensory → Static balance → Dynamic
balance → Locomotor

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 Primary impairments should always be identified before functional
deficits
 Boutonnière deformity = PIP √, MCP / , DIP / ; Rupture with volar
slippage of the lateral bands
 Prosthetic causes of circumduction (SWING) = long prosthesis, locked
knee unit, loose knee friction, inadequate suspension, small or loose
socket and plantar flexed foot
 Unstable knee unit = forward flexion during STANCE
 Inadequate socket flexion= lordosis during STANCE
 Sharp or high medial wall or abducted hip = Abducted gait
 Head jolt test (+) test → worsening of baseline headache after asking to
turn head @ frequency of 2-3x a second; indicative of MENINGEAL
IRRITATION
 Kernig’s sign - test for meningeal irritation ; supine, LE flexed at hip ajd
knee – knee is straightened; (+) test → resistance to knee straightening
 Postoperative delirium = incoherent thought and speech, disorientation,
impaired memory and attention
 Interval delirium = manifest delirium ff a lucid interval of 1
postoperative day or more; sx worse @ night
 Preop risk factors for bilat. Total knee arthroplasty are assoc. with a
significantly higher incidence of acute delirium
 Pneumothorax cause ↑ (+) pressure on the lung --- not allowing to
inflate = min. air movement and ↓ or absent breath sounds
 Crackles = indicate atelectasis or secretions
 During pregnancy – hormone relaxin → lead to abnormal movement and
pain affecting SACROILIAC JOINTS
 Nitroglycerin = ↑ coronary blood flow by dilating coronary arteries and
improving flow to ischemic areas; Low doses = vasodilation (venous >

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arterial); additional effects = ↓ Left ventricular end diastolic pressure
and reducing Myocardial O² consumption
 Benign Paroxysmal Positional Vertigo (BPPV) – POC: Canalith
Repositioning tx; goal of tx : remove OTOCONIA that have been
dislodged and are free-floating in the SCC or canalithiasis
 Gaze stability exercises and postural stability exercises = for unilat and
bilat vestibular hypofunction (UVH, BVH)
 Habituation training = when pt with UVH presents with continual
complaints of dizziness ; pt’s with central vestibular lesions
 Drain posterior basal segment of Left lower lobe → prone, with pillow
under the hips and bed flat
 Drain lingula = side-lying with bed flat
 Taking statins --- S/E: myalgia, cramps, stiffness, spasm, or weakness
affecting exercise tolerance
 Spastic or reflex bladder = stroking, kneading, or tapping the suprapubic
area
 Flaccid or LMN bladder = credé maneuver. Valsalva maneuver or using
timed voiding program
 Stage 3 ulcer = full thickness skin loss with damage to or necrosis of
subcutaneous tissue ; deep crater
 Stage 1 = nonblanchable erythema of intact skin
 Stage 2 = partial-thickness skin loss (epi/dermis); superficial,
abrasion ,blister, or shallow crater
 Stage 4 = FULL-thickness skin loss with extensive destruction, tissue
necrosis and damage to muscle, bone, or supporting structures;
UNDERMINING or SINUS TRACTS
 Neoprene sleeve = painful arthritic knee
 Derotation brace = rotatory instabilities 2° to cruciate ligaments

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 Rhythmic stabilization = improve postural instability
 Spinning and rolling on a scooter board = ↑ mobility based on fast
vestibular stimulation
 ↑ knee extension = anterior glide and ER of tibia
 Vasculitis = extra-articular complications of RA
 Turf toe = sprain of MTP jt of 1st toe d/t hyperextension (pushing off into
a sprint)
 Calcaneocuboid joint subluxation = “cuboid syndrome” ; minor
disruption or subluxation of the calcaneocuboid portions of the midtarsal
joint
 Hallux rigidus = “stiff big toe” ; degenerative arthritis and stiffness d/t
bone spurs, affects MTP jt @ base of the hallux; SX: pain and stiffness in
the jt @ base of big toe (walking, standing, bending)
 Metabolic Syndrome = abdominal obesity ( waist circumference > 40
inches in men; > 35 inches in women) ; elevated triglycerides – 150
mg/dL or higher; low HDL --- <40 mg/dL in men ; <50 mg/dL in women ;
fasting plasma glucose level > 110 mg/dL
 Obesity = associated with: HTN, HYELPERINSULINEMIA (type 2 DM),
DYSLIPIDEMIA, HYPERGLYCEMIA
 Prospective (forward-in-time) study ; cohort (grp of participants) --- with
a similar condition is followed for a DEFINED period of time.
 Randomized controlled trial = random assignment to either an
experimental or a control group for the purposes of studying an
intervention; highest level of significant rigor
 Case Control Study = retrospective (backward-in-time) study of a group
of individuals with a similar condition COMPARED with a group that does
NOT have the condition
 Between subject design = comparisons are made between groups of
subjects

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 Hamstring/Quadriceps torque generation @ various speeds in 15 to 45
y/o Males:
--- 65% @ 60°/sec
--- 69% @ 180°/sec
--- 71% @ 300°/sec
 Hydrocolloidal dressing = changed every 3-5 days or when drainage
leaks out; odor and yellowish color is to be expected as the dressing
material melts
 Salter Harris type
◎TYPE 1 -- Nondisplaced fracture across the growth plate
◎TYPE 2 – Angulated and displaced fractures across the growth plate
and continuing up through the shaft of the bone
◎TYPE 3 – displaced in 3 directions:
» posteromedial (MC)
» posterolateral
» anterolateral
--Starts through the growth plate but turns and exits through the
end of the bone and into the adjacent joint
◎TYPE 4 – Fracture through all 3 elements ( Growth plate, metaphysis
and epiphysis); starts ABOVE the growth plate, cross the growth plate
and exit through the JOINT CARTILAGE
 Most common affected nerves : MEDIAN > RADIAL > ULNAR
 Neurogenic (neurological) TOS = compression of the brachial plexus;
S/E: wasting of the thenar area, numbness or tingling in the fingers, pain
in the shoulder and neck, ache in the arm or hand and weakening grip
 Vertebral artery occlusion – MC Initial Sx: vertigo, dizziness, nausea,
vomiting, and head or neck pain; others: weakness, hemiparesis, ataxia,

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diplopia, pupillary abnormalities, speech difficulties and altered mental
status
 CRPS – dysfxn in CNS or PNS; Key Sx: continuous, intense pain out of
proportion to the severity of the injury, gets worse; chronic pain;
dramatic changes in the color and t° of the skin over the affected limb or
body part, accompanied by intense burning pain, skin sensitivity,
sweating and swelling
◎STAGE 1 : Hyperalgesia, allodynia, hyperpathia with edema, ↑
sweating, thin, shiny skin
◎STAGE 2 : ↑ pain with edema and atrophic skin and nail changes
◎STAGE 3 : spreading pain, hardening of edema, cool, dry, and cyanotic
skin, developing osteoporosis and ankylosis
 Mouth opening : Lateral pterygoid, ant. Head of digastrics, suprahyoid
muscles
 Mouth closing : Masseter, temporalis, medial pterygoid and lateral
pterygoid
 Protrusion: temporalis, medial pterygoid and lateral pterygoid
 Retrusion : Temporalis and suprahyoid muscles
 Systematic review including meta-analysis of RCT = best research
evidence of effectiveness of an intervention
 Pancreatitis = occurs midline or to the left of the epigastrium, below
xiphoid process. Referral pain: middle or lower back and rarely to the
upper back
 Small intestine pain = midabdominal, about the level of the umbilicus;
pain is referred to the back if intense
 Large intestine and Colon pain = (IBS) poorly localized to the
midabdominal area, pain can be referred to the sacrum
 Appendiceal pain = located on the RLQ, referred to the periumbilical
area or right hip

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 Stutter test = plica condition; pt seated @ edge of the examination table
with the knees flexed to 90° ; examiner places a finger over the patella as
the pt ACTIVELY extends the knee; (+) when patella jumps or stutters
between 60° and 45° of Knee FLEXION
 Thessaly test = meniscal tear; pt standing flat footed on one leg with
knee flexed to 20° ---- pt rotates the knee and body, internally and
externally, three times, keeping knee flexed to 20° ; (+) test is
reproduction of joint line pain
 Ely’s test = implicates ↓ muscle length of rectus femoris; prone—
examiner passively flexes the patient’s knee; (+) test when ipsilat. Hip
flexes during knee flexion
 Injures soft tissues → develop Hematoma → MYOSITIS OSSIFICANS
 Myositis ossificans = benign, ossifying soft-tissue lesion within skeletal
muscle; appears on plain film ~ 2-4 wks after injury
 Peabody developmental motor scales (PDMS-2) = standardized
assessment of gross motor and fine motor skills divided into 6 subtests
with an age range of 1-72 months
 Functional Independence measure for children (WeeFIM) =
comprehensive criterion-referenced assessment of 18 items in 6
subscales of fxnal performance ( self-care, sphincter control transfers,
locomotion and cognitive fxn); 6mos to 8 years
 Denver Developmental Screening Test (Denver II) = personal-social, fine
motor-adaptive, language, gross motor, and behavior categories; 1 week
to 6 ½ years
 Movement Assessment of Infants (MAI) = muscle tone, reflexes,
automatic reactions and volitional movement; birth to 12 months
 Posterior tibial tendon = helps hold up the arch up and provides support
when stepping off on the toes when walking; if inflamed, overstretched,
or torn → FLAT FOOT

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 In scoliosis = LUMBAR and THORACIC SPINE rotation and side bending
occur to the OPPOSITE side
 Forceful PROM in the presence of spasticity = ↑ risk of developing HO
 Slocum test = test for AMRI and ALRI
 Manual traction
◎C1-C2 – neutral (0-5°)
◎C3-C4 – 10-20°
◎C5-C7 – 25-30°
 Limited tibial advancement = compensatory gait : CIRCUMDUCTION
 Exaggerated FLEXOR Synergy : FABER
 Exaggerated EXTENSOR Synergy: EXADIR
 Lateral Glide = ↑ supination and calcaneal inversion
 Medial glide = ↑ eversion
 2:1 = safely stress the aerobic system
 1:1 = initial prescription for inpatient rehab with a goal of achieving a 2:1
 5:1 or 10:1 = too stressful to begin outpatient; 5:1 --- for later exercise
program
 Baroreflex impairment = small ↑ or no ↑ in HR upon standing
 Volume depletion = exaggerated ↑ in HR upon standing
 Panafil = keratolytic enzyme used for selective debridement
 Addison’s Dse = cardinal symptom: ASTHENIA, others: anorexia, weight
loss, nausea and vomiting, abdominal pain and syncope
 Hypertrophic scars = Thick and Pink
 Atrophic scars = Thin and white
 Excoriation = abrasion or scratch mark
 Scale = flake of exfoliated epidermis ( dandruff, psoriasis, dry skin)

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 Later stages of AD = profound communication deficits (inability to
speak), global deterioration of mental functions (delusions,
hallucinations, fragmented memory), agitation, and pacing (sundowning)
 Mild AD = memory loss, absentmindedness, anxiety and irritability,
difficulty concentrating and occasional word- finding problems
 Stage 3 of GOLD = muscle wasting
※advanced stage = ↑ anteroposterior-to-lateral diameter of the chest
 Stage 4 of GOLD = Supplemental Oxygen
 Wet-to-dry dressings = help remove necrotic tissue
 Calcium Alginate = used in HEAVY exudates
 Hydrogel = nonadherent, keeps wounds moist, protects granulation
buds
 Valsalva maneuver = ↑ intrathoracic Pressure = slowing of pulse, ↓
return of blood to the heart = ↑ Venous pressure
 Guideline for using supplemental oxygen = SpO² <88% or PaO²
<55mmHg
 Short stretch compression wrap (Comprilan) = low resting pressure,
high working pressure; has enough pressure to enhance lymphatic return
at rest
 Hallmark of POLYNEUROPATHY = symmetrical involvement of sensory
fibers, progressing from DISTAL to PROXIMAL ---- “Stocking and glove
distribution”
 Atropine = anticholinergic agent; produces ↑ in HR and contractility; tx
symptomatic sinus bradycardia and exercise-induced bronchospasm
 T12 = LMN / Flaccid bowel ; loss of spinal defecation reflexes; manual
removal of stool may be required
 Interstitial cystitis = Goal of PT: Relax and lengthen tight pelvic floor
muscles and release trigger points

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LEVEL ↓ INTENSITY

MOTOR ↓ Therapeutic effect; ↓ Quality of


contraction
SENSORY ↓level of Sensory for tx of pain

Pulse Rate
↓ ↑
Motor level ↓ Quality of More uncomfortable/
contraction muscle fatigue

 Intractable constipation (obstipation) = can cause partial or


complete bowel impaction, pain, tenderness in the lower
abdomen. Referred pain = anterior hip groin, or thigh
 L2 nerve compression= pain in the back and front of thigh to knee
 S1 nerve root compression = pain in the buttock, thigh, posterior
leg
 Pain in the bladder = refer : medial thigh and leg
 Coupled movement in the spine = when occiput is sidebent into
one direction, C1 rotate into the OPPOSITE direction. Side bending
and rotation occur in the same direction from C2-C7 regardless if
the spine is in flexion or extension

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