Only $35.99/year

Combined NPTE FF Quizlets

Terms in this set (637)

Characterized by an extremity that has experienced trauma which results in pain and an increase in sensitivity to peripheral stimulation

Caused by increased sympathetic activity which triggers an increase of norepinephrine and subsequent vasoconstriction (which thereafter causes pain)

What is the most likely contributing factor in the development of CRPS?

The exact etiology of CRPS is unknown, however predisposing factors include trauma, surgery, CVA, TBI, and repetitive motions disorders

What is the clinical presentation of CRPS?

Intense burning and chronic pain the the affected extremity that will eventually spread proximally.

Sx can be seen in 3 stages:
1) Acute - edema, thermal changes, discoloration, stiffness, and dryness
2) Dystrophic - worsening and constant pain, edema, trophic skin changes. Xrays may reveal bone loss, osteoporosis, and bone erosion
3) Atrophic Stage - Pain that continues to spread, hardened edema, decreased limb temperature, atrophic changes to fingertips or toes. Xrays may reveal demineralization and ankylosis

Describe the 3 stages of CRPS.

1) Acute - edema, thermal changes, discoloration, stiffness, and dryness

2) Dystrophic - worsening and constant pain, edema, trophic skin changes.

3) Atrophic Stage - Pain that continues to spread, hardened edema, decreased limb temperature, atrophic changes to fingertips or toes.

What laboratory or imagine studies would confirm the dx of CRPS?

Xrays, thermographic studies, bone scan, laser doppler

If patient received an Xray, results will demonstrate bone loss, bone erosion, joint ankylosis and/or demineralization in stage 2 and 3 CRPS

Olfactory

Number - I
Type - Sensory

Main Action - Smell

Damage - Anosmia

Optic

Number - II
Type - Sensory

Main Action - Vision

Damage - Partial or full blindness in one or both eyes

Oculomotor

Number - III
Type - Motor

Main Action - Controls eye movement, constriction of pupil

Damage - Ipsilateral oculomotor palsy, eye turns down and out, pupils remain dilated and eyelids droop

Trochlear

Number - IV
Type - Motor

Main Action - Assists in controlling eye movement, inferolateral movements

Damage - Inability to look down when eye is adducted

Trigeminal

Number - V
Type - Both

Main Action - Sensory to forehead, scalp, eyelids, nose, jaw, muscles of mastication

Damage - Loss of pain and touch, paralysis of muscles of mastication

Abducens

Number - VI
Type - Motor

Main Action - Assists in controlling eye movement, turns eyes laterally

Damage - Unable to turn his eye laterally which causes double vision

Facial

Number - VII
Type - Both

Main Action - Muscles of facial expression, sensory taste on the anterior two-thirds of the tongue

Damage - Paralysis of muscles of facial expression, loss of taste

Vestibulocochlear

Number - VIII
Type - Sensory

Main Action - Hearing and balance

Damage - Progressive hearing loss, problems with balance

Glossopharygeal

Number - IX
Type - Both

Main Action - Tongue and pharynx for taste and general sensation to posterior one-third of the tongue, eustachian tube, tonsils

Damage - Loss of taste, loss of sensation of the palate on same side of injury

Vagus

Number - X
Type - Both

Main Action - Voluntary muscles of larynx and superior esophagus, sensory to pharynx, larynx, digestive tract and heart

Damage - Sagging of the soft palate, hoarseness secondary to paralysis of the vocal cords

Spinal accessory

Number - XI
Type - Motor

Main Action - SCM and trapezius

Damage - Paralysis of SCM, inability to shrug shoulders

Hypoglossal

Number - XII
Type - Motor

Main Action - Supplies the muscles of the tongue

Damage - Impaired speech secondary to inability to control tongue

Brown Sequard Syndrome
- What type of injuries?
- What tracts are damaged?

Occurs from hemisection of the spinal cord due to penetration wounds, such as gunshot or stab wounds

- Ipsilateral damage to corticospinal (paralysis) and DCML (sensory loss)
- Contralateral damage to spinothalamic (pain and temperature)

Loss from the spinothalamic tract begins several dermatome segments (approx 2-4 levels) below the level of injury

Anterior Cord Syndrome
- What type of injuries?
- What tracts are damaged?

Frequently related to flexion injuries of the cervical region, such as fractures, dislocations, or cervical disc protrusion

Damage to corticospinal (paralysis) and spinothalamic (pain and temperature) BELOW level of lesion

Central Cord Syndrome
- What type of injuries?
- What tracts are damaged?

Frequently related to hyperextension injuries to the cervical region. Also has been associated with congenital or degenerative narrowing, which give rise to hemorrhage and edema, creating damage to central aspects of cord

Damage to the central region of the spinal cord, which includes
- central corticospinal tracts (B/L motor paresis: upper > lower extremities; distally > proximally)
- decussating fibers of the lateral spinothalamic tract (variable impairments: loss of pain and temperature in the arms)

True or False. With central cord syndrome, there is complete perseveration of sacral tracts, normal sexual, bowel, and bladder function retained.

True

Cauda Equina Syndtome
- What type of injury?
- Presentation?

- Lower Motor Neuron Injury
- Areflexic bowel and bladder; saddle region anesthesia; LE paralysis and paresis

Conus Medullaris Syndrome
- What type of injury?
- Presentation?

- Mixture of Upper and Lower Lower Motor Neuron Injury
- LMN deficits of anal sphincter; Areflexic bladder; LE paralysis

What is spinal shock? How long does it typically last?

Characterized by an initial absence of ALL reflex activity and impairment of autonomic regulation, resulting in hypotension, loss of control of sweating, loss of deep tendon reflexes, and loss of babinski response

Typically lasts 24 hours, with a gradual return of reflexes 1-3 days after injury

What is autonomic dysreflexia? What SCI does it typically occur in? Symptoms of Autonomic Dysreflexia?

Acute onset of autonomic activity from noxious stimuli BELOW the level of lesion that initiated a mass reflex response

Typically occurs in T6 injuries and above

Symptoms:
- Extremely high BP (a rise of systolic of 20-30 mmHg; ex. 250-300 mmHg systolic)
- Severe headache
- Sweating above injury level
- Slow Pulse/ Bradycardia
- Goose Bumps
- Pallor
- Blurry Vision

What are typical causes of autonomic dysreflexia? How do you treat autonomic dysreflexia?

Causes include:
- ingrown toe nails
- blocked catheters
- UTI
- bowel/bladder irritation
- electrical stimulation
- pressure sore

Treatment:
- sit person up to decrease BP
- try to find/remove noxious stimuli (ex. loosen tight clothing, abdominal binder, or restrictive devices)
- obtain medical assistance

What is neurogenic shock?

Systolic blood pressure below 100 mmHg and HR below 80 BPM

Occurs more often in cervical and upper thoracic level injuries

Control of the abdominal muscles originates from T___-T___. When fully innervated, they play an important role in maintain intrathoracic pressure for effective respiration.

T6-T12.

With paralysis of the abdominal musculature, this results in decreased expiratory reserve volume, decreased cough effectiveness, and decreased ability to expel secretions.

Damage to which spinal cord levels affect spontaneous respiration

C1-C2

An artificial ventilator or phrenic n. stimulator is required to sustain life.

Damage to C1-C2 causes what pulmonary complications?

Affects spontaneous respiration. An artificial ventilator or phrenic n. stimulator is required to sustain life.

Damage to C3-C4 causes what pulmonary complications?

Affects diaphragm innervation, as well as scalenes and levator scapulae function?

Damage to which spinal cord levels affect diaphragm innervation, as well as scalenes and levator scapulae function?

C3-C4

In the acute stage of recovery, a mechanical ventilation is required. With recovery and training, they will likely be able to breathe on their own or may need a part time ventilatory support

UMN vs LMN Bladder/Bowel

UMN Bladder - Any lesion that occurs above the conus medullaris. Bladder/Bowel is characterized by spastic or hyperreflexic (failure to store urine)

LMN Bladder - Any lesion of conus medullaris or sacral segments. Bladder/Bowel is characterized as flaccid or areflexic (failure to empty urine)

When to use suprapubic tapping vs valsalva maneuver for bladder management?

Suprapubic tapping - involves tapping directly over the bladder with fingertips to cause a reflexive emptying of the bladder. Only works for UMN bladder

Valsalva Maneuver - involves straining the bladder. Only works for areflexive bladder

Where do UMN lesions occur?

Central nervous system cortex, brain stem, corticospinal tracts, spinal cord

Where do LMN lesions occur?

Cranial nerve nuclei/nerves, peripheral nerves, Spinal cord: anterior horn cell & spinal roots

UMN Lesion: Tone

Is tone velocity dependent?

Increased: hypertonia

Velocity dependent

LMN Lesion: Tone

Is tone velocity dependent?

Decreased or absent: hypotonia, flaccidity

Not velocity dependent

UMN Lesion: Reflexes

Increased: hyperreflexia, clonus

Exaggerated cutaneous and autonimic reflexion, + Babinski

A positive babinski is present within an UMN or LMN lesion?

UMN Lesion

LMN: Reflexes

Decreased or absent: hyporeflexia

Cutaneous reflexes decreased or absent

UMN: Involuntary Movements

Muscle spasms: flexor or extensor

LMN: Involuntary Movements

With denervation: fasciculations

UMN: Strength

Weakness or paralysis:
- Ipsilateral (ex. stroke)
- Bilateral (SCI)

If corticospinal tract is lesioned
- Above decussation = contralateral weakness
- Below decussation = ipsilateral weakness

Strength/weakness distribution is never focal

LMN: Strength

Ipsilateral weakness or paralysis

Strength/weakness distribution is segmental or focal pattern (root innervated pattern)

UMN: Muscle Bulk

Disuse atrophy: Variable, widespead distribution, especially in antigravity muscles

LMN Muscle Bulk:

Neurogenic atrophy: rapid, focal distribution, severe wasting

UMN: Voluntary Movements

Impaired or absent: dyssynergic patterns or obligatory mass synergies

LMN: Voluntary Movements

Weak or absent if nerve interrupted

Name common diagnosis/pathology with UMN lesions (3)

- Stroke
- TBI
- Spinal Cord Injury

Name common diagnoses/pathologies with LMN lesions (4)

- Polio
- GBS
- Peripheral Nerve Injury/Peripheral Neuropathy
- Radiculopathy

What part of the brain is typically affected with Parkinson's Disease?

Basal Ganglia

Lesion in Cerebral Cortex/Corticospinal Tract : Sensation

Impaired or absent: Depends on lesion location; contralateral sensory loss

Lesion in Basal Ganglia: Sensation

Not Affected

Lesion in Cerebellum: Sensation

Not Affected

Lesion in Spinal Cord: Sensation

Impaired or absent below the level of lesion

Lesion in Cerebral Cortex/Corticospinal Tract: Tone

- Hypertonia/spasticity
- Velocity dependent
- Initial flaccifity due to cerebral shock

ex. stroke

Lesion in Cerebral Cortex/Corticospinal Tract: Reflexes

Hyperreflexia

Lesion in Cerebral Cortex/Corticospinal Tract: Strength

- Contralaterla weakness or paralysis: hemiplegia or hemiparesis
- Disuse weakness in chronic stage

Lesion in Cerebral Cortex/Corticospinal Tract: Muscle Bulk

- Normal during acute stage
- Disuse atrophy in chronic stage

Lesion in Cerebral Cortex/Corticospinal Tract: Involuntary / Voluntary Movements

Involuntary Movement: Flexor and/or extensor spasms

Voluntary Movement: Dyssynergistic abnormal timing; co-activation fatigability

Lesion in Cerebral Cortex/Corticospinal Tract: Postural Control

- Impaired or absent, depends on lesion location
- Impaired balance

Lesion in Cerebral Cortex/Corticospinal Tract: Gait

Impaired: Gait deficits due to abnormal weakness, synergies, spasticity, and timing deficits

Lesion in Basal Ganglia: Tone

Lead-pipe rigidity: increased, uniform resistance

Cogwheel rigidity: increased, ratchet- like resistance

Lesion in Basal Ganglia: Reflexes

Normal or may be decreased

Lesion in Basal Ganglia: Strength

Disuse weakness in chronic stage

Lesion in Basal Ganglia: Muscle Bulk

Normal or disuse atrophy

Lesion in Basal Ganglia: Involuntary Movements / Voluntary Movements

Involuntary Movements: Resting tremor

Voluntary Movements: Bradykinesia (slowness or movement) or Akinesia (absence of movement)

Lesion in Basal Ganglia: Postural Control

Impaired: stooped (flexed)

Impaired balance

Lesion in Basal Ganglia: Gait

Impaired: shuffling, festinating gait

Lesion in Cerebellum: Tone

Normal or may be decreased

Lesion in Cerebellum: Reflexes

Normal or may be decreased

Lesion in Cerebellum: Strength

Normal or weak: asthenia

Lesion in Cerebellum: Muscle Bulk

Normal

Lesion in Cerebellum: Involuntary/ Voluntary Movements

Involuntary Movements - None

Voluntary Movements - Ataxia (impaired coordination), intention tremor, dysdiadochokinesia, dysmetria dyssynergia, and nystagmus

Lesion in Cerebellum: Postural Control

Impaired: Truncal ataxia & Impaired balance

Lesion in Cerebellum: Gait

Impaired: Ataxic gait defcitis, wide based, unsteady

Lesion in Spinal Cord: Tone

Hypertonia/spasticity below the level of the lesion

Initial flaccidity due to spinal shock

Lesion in Spinal Cord: Reflexes

Hyperreflexia

Lesion in Spinal Cord: Strength

Impaired or absent below the level of the lesion. Includes paraplegia or paraperesis; tetraplegia or tetraparesis

Lesion in Spinal Cord: Muscle Bulk

Disuse atrophy

Lesion in Spinal Cord: Involuntary/Voluntary Movements

Involuntary Movements: Spasms

Voluntary Movements: Above lesion of lesion is intact. Below level of lesion movements are impaired or absent

Lesion in Spinal Cord: Postural control

Impaired below level of lesion; Impaired balance

Lesion in Spinal Cord: Gait

Impaired or absent: depends on level of lesion

Normal: 7.35-7.45
Acidemia: <7.35
Alkalemia: >7.45

PaCO2 Values

Normal: 35-45 mmHg
Resp. Acidosis: >45
Resp. Alkalosis: <35

HCO3 Values

Normal: 22-26 mEq/L
Met. Acidosis: <22
Met. Alkalosis: >26

What if PCO2 > 45 torr? Include key symptoms.

Respiratory Acidosis:

Caused by hypoventilation, CO2 retention, pulmonary edema (L sided heart failure), airway obstruction

Symptoms:
- visual disturbance
- confusion
- drowsiness

What if PCO2 <35 torr? Include cause & symptoms.

Respiratory Alkalosis:

Caused by Hyperventilation

Symptoms:
- lightheadedness
- tetany (muscular spasms)
- convulsions

What if PHCO3 >26? Include cause & symptoms.

Metabolic Alkalosis

Caused by loss of gastric secretions, antacid, low potassium

Symptoms:
- Agitation

What is pHCO3 <22. Include cause & key symptom

Metabolic acidosis.

Caused by diabetic ketoacidosis, diarrhea, renal failure, shock, sepsis, lactic acidosis

Symptoms:
- Hyperventilation

Range for Hypoxemia Values PO2

PO2 < 75-80

(Normal: 80-100)

Range for Hyperoxia Values PO2

PO2 > 100-120

(Normal: 80-100)

Arteriosclerosis

Thickening, hardening, and loss of elasticity fo arterial walls

Occurs with abnormal blood flow (peripheral vascular disease)

Atherosclarosis

The most common form of arteriosclerosis, associated w/ damage to the endothelial lining of vessels and the formation of lipid deposits, eventually leading to plaque formation

Occurs with abnormal blood flow (peripheral vascular disease)

Arteriosclerosis Obliterans

A peripheral manifestation of atherosclerosis characterized by intermittent claudication, rest pain, and trophic changes. Most likely to lead to ulceration

Occurs with abnormal blood flow (peripheral vascular disease)

Buerger's Disease (Thromboangiitis Obliterans)

Inflammation that leads to arterial occlusion and tissue ischemia, especially in young men who smoke

Occurs with abnormal blood flow (peripheral vascular disease)

Raynaud's Disease

A vasomotor disease of small arteries and arterioles that is most often characterized by pallor and cyanosis of the fingers. Both the hands and feet may be affected.

Occurs with abnormal blood flow (peripheral vascular disease)

Intermittent Claudication

Painful cramping or aching of the LEs during walking due to muscle not receiving the blood perfusion needed for normal function

What is the most important screening test for individuals with arterial disease?

Doppler Ultrasound - Measures blood flow to the LEs

true or false. Chronic venous insufficiency is the most common cause of leg ulcers

True

Clinical Presentation of venous insufficiency

- Swelling of unilateral or bilateral LEs (early stage - elevation relieves swelling)
- Complaints of itching, fatigue, aching, heaviness in involved limbs
- Skin changes (hemosiderin staining and lipodermatosclerosis)
- Fibrosis of the dermis
- Increase in skin temp of LEs
- Wounds
- Granulation tissue
- Tissue is wet from exudate
- Signs and sx of lymphedema may be present

What is the most important therapeutic measure for prevention and treatment of venous leg ulcers?

Compression therapy

What should a clinician check on an individual with diabetes suspected diabetic neuropathy?

Check protective sensations in the LEs using monofilaments

Stage 1 Pressure Ulcer

nonblanchable erythema of intact skin. Reddened area that does NOT go away.

stage 2 pressure ulcer

partial thickness skin loss involving epidermis, dermis, or both

stage 3 pressure ulcer

subcutaneous fat may be visible

stage 4 pressure ulcer

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

Unstageable pressure ulcer

Relate to not be able to visualize the wound base because of necrotic tissue

Rule of 9's for adults?

Head and Neck: 9%
Anterior trunk: 18%
Posterior trunk: 18%
Arms: 9% each
Legs: 18% each
Perineum: 1%

Rule of 9's for children?

Head and neck: 17%
Anterior trunk: 18%
Posterior trunk: 18%
Arms: 9% each
Legs: 13% each
Perineum: 1%

What is classified as a critical burn?

10% of body with degree burns and 30% of more with second degree burns

What is classified as a moderate burn?

less than 10% w/ 3rd degree burns and 15-30% w/ 2nd degree burns

What is classified as a minor burn?

Less than 2% w/ 3rd degree burns and 15% with second degrees burns

Epidermal Burn (1st Degree)

(what part of the skin is damaged & presentation of skin)

Damage to epidermis only.

Pink or red appearance. No blistering. Minimal edema.

Tenderness, delayed pain

Superficial Partial Thickness Burn (2nd Degree)

(what part of the skin is damaged & presentation of skin)

Damage to epidermis and upper layers of dermis

Bright pink or red appearance. Blanching with brisk capillary refill. Blisters. Moderate Edema.

Painful, sensitive to touch

Deep Partial-Thickness Burn (2nd degree)

(what part of the skin is damaged & presentation of skin)

Severe damage to epidermis and dermis w/ injury to nerve endings, hair follicles, and sweat glands

Mixed red or waxy white appearance; Blanching w/ slow capillary refill; Broken blisters; Marked edema

Sensitive to pressure but insensitive to light touch or soft pin prick. Keloid and/or hypertrophic scarring

Full Thickness Burn (3rd degree)

(what part of the skin is damaged & presentation of skin)

Complete destruction of epidermis, dermis, and subcutaneous tissues

White (ischemic), charred, tan, or black appearance; No blanching; Poor distal circulation

Little pain; destroyed nerve endings

Subdermal Burn

Complete destruction of epidermis, dermis, with involvement of subcutaneous tissue and muscle

Charred appearance; Destruction of vascular system that may lead to additional necrosis

What are common complications of burn injuries (6)

- infection (leading cause)
- shock
- pulmonary complications
- metabolic complications
- cardiac and circulatory complications
- integumentary scars

What are 3 common pulmonary complications associated with a burn injury?

- Pulmonary Edema (if individual inhaled hot gases, smoke, poisoning, etc)

- Restrictive lung disease from burns of the trunk

- Pneumonia

What is a common metabolic complication with burn injuries?

Increased metabolic and catabolic activity - results in weight loss, reduced energy, and negative nitrogen balance

Hypertrophic vs Keloid Scar

Hypertrophic: raised scar that stays within the boundaries of the burn wound

Keloid: raised scar that extends beyond boundaries of original burn

What are the common topical medications to put on burns?

- Silver sulfadiazine
- Sulfamylon
- Neomycin
- Bacitracin

What is an allograft?

Use of other human skin (ex. cadaver skin) until autograft is available

What is a xenograft?

Use of skin from other specific (ex. pigskin); typically a temporary graft

What is a biosynthetic graft?

Combination of collagen and synthesis

What is an autograph?

Use of patient's own skin

What is a split thickness graft?

contain epidermis and upper layers of dermis from donor site

What is a full thickness graft?

contain epidermis and dermis from donor site

What are 5 physiological effects that increases with heat application?

- increase of CO (HR x SV)
- increase vasodilation
- Increased HR
- Increased RR
- Increased metabolic rate

What are 5 physiological effects that decreased with heat application?

- Decrease blood to internal organs
- Decrease blood flow to resting muscles
- Decrease in muscle activity
- Decrease of BP

What is the typical temperature for a hot back?

165- 170 deg F

How many layering of towels do you need for a hot pack?

6-7 layering

Hot pack peaks heat in the first ______ minutes of application, during this time patient is at greatest risk of burns.

What is the typical temperature for paraffin baths?

125-127 deg F

Contraindications to thermotherapy? (7)

- acute muscle trauma
- arterial disease
- bleeding or hemorrhage
- over compromised circulation
- over malignancy
- peripheral vascular disease
- thrombophlebitis

AKA ANY CIRCULATION ISSUES

What is the sequence of patient sensation with cold therapy?

- Cold
- Burning
- Aching
- Analgesia
- Numbness

Numbness is the ultimate goal. Keep cold pack on until them.

Contraindication to cryotherapy (9)

- Over compromised circulation
- peripheral vascular disease
- over regenerating nerves
- raynaud's phenomenon
- cold intolerance / urticaria
- cryoglobulinemia (inflammation of blood vessels)

What are the 4 negative medial polarity ions for iontophoresis?

Mneumonic: "I SAD" (negative emotions for negative polarity)

- Iodine
- Salicylate
- Acetate
- Dexamethasone

What iontophoresis medication can be used for hyperhidrosis?

water

What iontophoresis medication can be used for analgesic purposes?

Salicylate
Lidocaine
Xylocaine

(Candy CAINES make me feel better)

What iontophoresis medication can be used for calcium deposits?

Acetate

What iontophoresis medication can be used for musculoskeletal inflammation?

Dexamethasone

(Your EX inflames you)

What iontophoresis medication can be used on sclerotic scars?

Iodine

(Scar from Lion King has a scar over his "I""

What iontophoresis medication can be used on dermal ulcers?

Zinc

(Z for woundZ or ulZers)

What iontophoresis medication can be used on fungal infections?

Copper

(Copper is brown and so is fungal infections)

What iontophoresis medication can be used for edema reduction?

hyaluronidase

What iontophoresis medication can be used muscle spasm?

Calcium Magnesium

(Drink milk to decrease spasm)

What is duty cycle?

ratio of on time to total cycle time (how long the current is in contact with the skin). Duty cycle typically does not cross 50%, 1/2, 1:2

ex. On 10 sec, off 50 sec = 10/60 or 1:6 duty cycle

What is MVIC?

maximum voluntary isometric contraction

In Estim (FES & NMES) what is the typical ramp up time?

Ramp up time is the take to reach peak intensity. This time is typically 1-4 seconds

In Estim (FES & NMES) what is the typical pulse frequency?

35-80 pps

Conventional Tens / High Tens
- Amplitude
- Pulse Frequency
- Pulse Duration
- Tx Time

- Sufficient for sensory response
- High (30-150 pps)
- Short (50-100 usec)
- Variable