Abnormal ABG ConditionspH PaCO2 HCO3 Signs and Sx

Respiratory Alkalosis(dents)

↑ ↓ WNL Dizziness, early tetany, numbess, tingling, syncope

Respiratory Acidosis(hard)(dsc)

↓ ↑ WNL Early : headache, anxiety, restlessness, dyspneaLate : disorientation/confusion, somnolence, coma

Metabolic Alkalosis(wemm↑)

↑ WNL ↑ Weakness, early tetany, mental dullness, muscle twitching, ↑ DTR

Metabolic Acidosis(NaLoCo)

↓ WNL ↓ Nausea, lethargy, coma

Action Potential1 Resting State

Na+ Channel INACT gate OpenACT gate Closed

K+ Channel Gate Closed2 Depolarization

Na+ Channel INACT gate OpenACT gate Open

K+ Channel Gate Slowly Opens3 Depolarization Continues/Repolarization Begins

Na+ Channel INACT gate ClosedACT gate Slowly Closes

K+ Channel Gate Open4 Repolarization Continues

Na+ Channel INACT Gate Slowly OpensACT gate Closed

K+ Channel Gate Slowly Closes

*Whatever gate is closed that is the state of the channel*Refractory Period – Depolarization to 1/3 Repolarization

Adhesive Capsulitis (Frozen Shoulder) Stages from BRADDOM 4th Ed

Stages Symptom Duration Signs and Sx

I 1-3 mos Painful shoulder movement, minimal restriction in motion

II - Freezing 3-9 mos Painful shoulder movement, progressive loss of ROM

III - Frozen 9-15 mos Reduced pain with shoulder movement, severe loss of ROM

IV - Thawing 15-24 mos Minimal pain, progressive normalization of ROM

**Adhesive capsulitis : More common in femaleMore common in aged 40-60 Capsular pattern: ER>ABD>IR

Amputation Classification by LengthBEA AEA Pressure Sensitive Areas:

Very Short 0-35% - 1. Peroneal NerveShort 35-55% <30% 2. Hamstring TendonLong 55-90% 50-90% 3. Anterior Tibia

BKA AKA 4. Fibular head & neckShort <20% <35% 5. Anterior Tibial CrestStandard 20-50% 35-60%Long >50% >60%

Speed of Ambulation: N 3mphBKA 2.5mphAKA 1.5mph

Angles, Temperatures and Cerebellar Dysfunction

APGAR scores

0 1 2

A ppearance All blue Blue limbs All pink

P ulse 0 Less or equal to 100 >100

G rimmace None Grimace Crying

A ctivity Limp Slight flexion Spontaneous

R espiration 0 Slow and Irregular Crying

**Score of 7-10 = GOOD5-6 = impending respiratory arrest<5 = needs vetilatory support0 = dead

Avascular Necrosis1. Lunate Kienboch2. Scaphoid Preisser’s

Cerebellar DysfunctionMovement DecompositionHypotoniaAtaxiaNystagmusDysmetria, Dysdiadochokinesia, Gait DisordersAsthenia

Angles1. Acetabular Index 30°2. Center Edge (aka Angle of

Wiberg25°

3. Sacral 30°4. Neck-Shaft Angle 50-60°5. Pelvic Inclination 125° (adult)

160° (child)6. Carrying Angle 5-19°

5-10° (M)10-15° (F)

7. Q Angle 13-18°8. Tibial Torsion 20°9. Out-toeing 5-7°10. Hallux Valgus 15°

Temp in °CVery Cold 1-13Cold 13-18Cool 18-27Tepid 27-33.5Neutral 33.5-35.5Warm 35.5-36.5Hot 36.5-40Very Hot 40-60

3. Navicular Kohler4. Capitulum Panner5. Vertebral body Calve6. Entire Spine Scheuermann7. Femoral Head (children) LCPD8. Femoral Head (adult) Chandler’s9. 2nd MT Head Freiberg’s10. Tibial Tuberosity Osgood Schlatter

Modified Stahl's classification of Kienbock's disease: Stage 1: normal structure of the lunate, w/ evidence of compression fx Stage 2: rarification along the line of previous compression fractures developing within the first 3 months; Stage 3: changes of stages 1 and 2 together w/ sclerosis of proximal pole occurring at about 3 months; Stage 4: fragmentation or flattening of the lunate; Stage 5: changes of arthrosis of radial carpal and inner-carpal joints

Blood ValuesHgb Hct WBC Platelets HCO3

Normal 12-18 mg/dL 36-54% 5T-10T 150T-400T 22-26meq/LContraindicated for exercise

< 8 mg/dL <25% <5T <50T, <20T <22meq/L

Normal Values for: RBC Hct ESR♂ 5.2-6.5 Mil/mm3 42-52% <15 mm/hr♀ 4.5-5.5 Mil/mm3 37-47% < 25 mm/hr

**Hematocrit (Ht or HCT): volume percent of RBC in bloodAKA packed cell volume (PCV) AKA erythrocyte volume fraction (EVF)

**Decreased or nonfunctional RBC in blood: Anemia Most common anemia: Iron Deficiency Anemia (IDA)

**Increased RBC in blood: Polycythemia**Erythropoiesis: RBC formation

Blood Values 2

pH 7.35-7.45paCO2 35-45 mmHgHCO3 22-26 mmHg Risk for CVACholesterol < 200 > 240LDL < 100 > 160HDL > 60 < 35

55% Plasma - 90% H2O, 10% Electrolytes45% Formed elements - RBC, WBC, PlateletsNormal Fasting Blood Sugar (FBS) : 70-100 mg/dL

Blood-Ion ImbalancesHyponatremia Hypernatremia

Causes DiarrheaVommitting

Water lossDM, DI

Effects Brain cell swellingSeizures, convolusions, lethargy

Fluid loss, dehydrationMuscle twitching

Hypokalemia HyperkalemiaCauses Diarrhea

VommittingK+ replacement overdoseEndocrine problems

Effects Muscle weaknessVentricular arrhythmias

Loss of muscle tone, paralysisImpaired cardiac function

Hypocalcemia HypercalcemiaCauses Multiple blood transfusions

Dec. Parathyroid hormoneParathyroid hormone defectCancer cells, deconditioning

Effects Muscle tetany, weaknessCardiac arrest

Osteoporosis

**Chvostek test : tapping the parotid gland, (+) if facial muscles twitch/spasm(+) CN 7 affectation or HYPOCALCEMIA

BMI Classification

19 and below Underweight20 – 24.9 Normal25 – 29.9 Overweight30 – 34.9 Obese I35 – 39.9 Obese II40 and above Obese III

**BMI of 30 and up = prone to Htn

Assessment of Breath Sounds and Significance

Normal NormalDecreased or None Hyperinflation (Emphysema, pneumothorax)Increased Hypoinflation (Atelectasis, pneumonia)

Pleural effusionCrackles SecretionsWheezes Bronchoconstriction (Asthma)

**V/Q Ratio = 0.8In COPD < 0.8In CRPD > 0.8

Center Of Gravity – 1 inch anterior to S2

Per Body Part :Head Sphenoid sinus

Line Of Gravity – ATATPAA

A nterior to AO joint

Neck BasioccipitalTrunk Anterior T11Upper extremity Just above the elbow

Arm Medial head of tricepsForearm Pronator teresHand 3rd MCP

Lower extremity Just above the kneeThigh Adductor brevisLeg PopliteusFoot 2nd MTT

Chronic Arterial Insufficiency vs Chronic Venous InsufficiencyChronic Arterial

InsufficiencyChronic Venous

InsufficiencyDecreased or Absent pulse

Normal pulse

Cold to palpation Normal temperatureUlceration at lateral malleolus

Ulceration at medial malleolus

Pale on elevation Relief on elevation(+) gangrene(+) rest pain (if severe)

(+) edema

Current Frequencies

Used for: Low Frequency Current

Medium Frequency Current

High Frequency Current

1-2000 Hz 3000-6000 Hz >500K Hz1-1000 Hz 1000-10,000Hz >10K Hz

Nerve YES YES NoMuscle YES YES NoDenervated Muscle YES No NoFunction MOTOR

AC-DCFES, ESTENS

SENSORYTENSIFCRussian

THERMALUS, IRRSWD, MWDUVR, LASER

SIX Determinants of Gait 1. Heel Rise

Line Of Gravity – ATATPAA

A nterior to AO joint

Cardiac Patient MET Requirements

Phase 1 = 5 METSPhase 2 = 9 METS (Ascend Stairs)Phase 3 = Community -> maintenance

CHF Classification

Class 1: mild; no limitation 6.5 METSClass 2: slight limitation 4.5 METSClass 3: marked limitation 3.0 METSClass 4: severe limitation 1.5 METS

2. Pelvic Rot ↑COG 4 - 8°3. Pelvic Tilt ↓COG 4 - 8°4. Knee Flexion ↓COG 15° Early; 30° Late Physiologic Valgus ↑BOS

Reduce Displacement of COM6°

5. Lat Displacement of Pelvis (Add of Hip)

Reduce Displacement of COM 5cm

6. Knee, Ankle and Foot Interaction

Reduce Displacement of COM 5cm

Wagner’s Grading of Diabetic UlcersGrade I Superficial ulcerGrade II Reaching muscle, bone, fasciaGrade III Deep with osteomyelotisGrade IV Gangrene of some parts of the footGrade V Gangrene of entire foot**start amputation at GRADE III

Diabetic Ulcer StagingStage I (E) Damage to EidermisStage II (D) Up to DermisStage III (S) Up to Subcutaneous tissueStage IV (MB) Up to Muscle and Bone**Wagner’s Grading and Diabetic Ulcer Staging are different.

Pressure Ulcer StagingStage I Non-blanchable erythema

Skin may be cool or warmInjury to epidermis

Stage II Partial thickness skin lossAbraision, blister, & shallow crater

Injury to epidermis & upper dermis

Stage III Full thickness skin loss Damage up to subcutaneous tissueStage IV Has undermining & sinus tracts Up to fascia, muscle, bone**SINOGRAM : used to measure depth of wound

Diagnostic ToolsX-Ray BEST for fx

Used for bone mass or tumorBone Scan BEST for stress fx and bone tumorCxR TB « Dots ; Spots »

Apex, spine, talus, capitateTracheal shift

MRI BEST for ligamentsUsed for muscles and articular tissues (meniscus)

CT scan BEST for head/cephalic lesions and brain lesionsDiagnostic US Abdominal or reproductive organsDoppler US BEST for DVTSpirometry Measures lung volumes

Confirmatory onlyNOT gold standard

Disk Pressure

1. 20 kg wt lifted c back bent & knees ext 169%2. bend forward 150%

3. 20 kg wt lifted c back straight & knees bent 73%4. laugh 45-50%5. cough or straining 5-35%6. side bending 25%7. Rotation 20%8. walking 15%

**Hoop stretch : stretch on anulus fibrosus when nucleus pulposus moves during trunk movement

Energy Requirements for Ambulation

WC 9%Crutch walking 60%Single BKA 10-40%Single AKA 65%Double BKA 41%Double AKA 110%1 BKA & 1 AKA 75%

Erik Erikson’s Psychosocial Development

1. Trust vs Mistrust 0-2yrs Infancy I trusted you2. Autonomy vs Shame & Doubt 2-4 yrs Early Childhood You should be ashamed3. Initiative vs Guilt 4-5 yrs Play Age And feel guilty4. Industry vs Inferiority 5-12 yrs School Age; Latency You inferior5. Identity vs Role Confusion 13-19 yrs Adolescence Confused6. Intimacy versus Isolation 19-40 yrs Young Adulthood Loner7. Generativity vs Stagnation 40-65 yrs Middle Adulthood You’re useless8. Ego integrity vs Despair 65 yrs to death Maturity And hopeless

Frontal Lobe Speech Impairments

Anomia Inability to nameAgraphia Inability to writeAlexia Inability to readAprosody Absence in deflection & difference in toneEcholalia Repeats wordsPalilalia Repeats syllablesSyntactic Telegraphic speechNeologism Coining of new wordsJargon Incomprehensive speechLogorrhea Press of speech (nonsense)Aphrasia Inability to speak in phrasesParaphrasia Word substitutionSemantic Paraphrasia Interchange 2 items normally found together (i.e. spoon & fork)Phonemic Paraphrasia Interchange words that sound like them (i.e. sheep & sheet)

Gait Parameters and Max Activity of Muscles

HS FF MS Ho To ISw MSw TSwHip 20F 15F 0 10-20E 20F 30F 30F

Measuring Sites of Fat Caliper

T highI nfrascapularM edial CalfT ricepsA bdominalB icepsA bove ASIS

**(code : TIMTABA)

G.Max G.Med IliopsoasKnee 0

Quads

15F

Quads

5F 0 (4F) 30F 60F 30F 0

HamsAnkle 0

T.A.

5PF 5DF 0

T.P.P.F.

20PF

P.F.

10PF 0 0

**Study using kinesthetic cues

Garden Femoral Neck FxGrade I Incomlpete FxGrade II Complete without displacementGrade III Complete, with partial displacementGrade IV Complete, with total displacement

Le Fort Facial FxGrade I Horizontal, along maxillaGrade II Pyramidal Fx, maxilla, & bridge of noseGrade III Zygomas & superior orbital fissure

Glasgow Outcome Scale (GOS) for TBIGrade Description GOS-E counterpart

I Death III Persistent vegetative state IIIII Severely disabled (conscious but diabled) III and IVIV Moderately disabled (disabled but indep) V and VIV Good recovery VII and VIII

Glasgow Outcome Scale – Extended (GOS-E)I DeathII Vegetative State Has sleep-wake cycleIII Lower Severe Disability Needs full assistance in ADLIV Upper Severe Disability Needs supervisionV Lower Moderate Disability Indep ADLs, can shop and travel in publicVI Upper Moderate Disability Can return to work, needs modificationsVII Lower Good Recovery Return to work without modifications ; reports difficultyVIII Upper Good Recovery No difficulty

Heart ValvesAuscultation Location

Aortic 2nd (R) ICS 3rd (L) ICS

Pulmonary 2nd (L) ICS 3rd (L) CC

Mitral 5th (L) ICS 4th (L) CC

Tricuspid 4th (L) ICS 4th (R) ICS

To remember, use this cheat code: APMT 2 2 5 4.. R L L L 3 3 4 4.. L L L R

Heart SoundsS1 “LUBB” closure of atrioventricular valves Louder, Longer, Lower pitchS2 “DUBB” closure of semilunar valves Shorter, higherS3 rapid filling of ventricles Ventricular gallop in CHFS4 atrial systole Atrial gallop in MI/Htn

**Resting membrane potential of cardiac mm cells = -88mV

ModalitiesHMPTreatment T° : 40-44°CTank T° : 71°C [Wadsworth 70-80°C] [Hecox 65-90°]Standard Size : 10”x 12”

Paraffin WaxTreatment T° : 40-44°CMelting Pt : 50-54°CSelf-Sterilizing T° : 65-70°C

WhirlpoolTreatment T° : 45-55°C 103-110°F

Contrast BathTreatment T° :Braddom IER100-110°F 40-45°C50-55°F 15-20°C

Hemodynamics

Pulse Pressure (PP) Systolic BP – Diastolic BPMean Arterial Pressure (MAP) Diastolic BP + 1/3 PP

Or[Systolic BP + (2*Diastolic BP)] / 3

End Systolic Volume 50 mLEnd Diastolic Volume 120 mLStroke Volume End Diastolic Volume – End Systolic Volume

70 mLCardiac Output Stroke Volume x Heart Rate

4-6L / minKarvonen’s Formula 60-80% (Max HR – Resting HR) + Resting HR

**For Karvonen’s Formula : 60-80% for initial session 60-90% for athletes 40-60% for sedentary individuals

**If case is sedentary individual for initial session, use initial session formula.

Hoen & Yahr Scale for PD

Parts of whirlpool that are contaminated :BottomOverflowAgitation PipeThermometerEdgesDrainage

Kurtzke Scale for MS – 7 Domains

I Minimal or absent symptoms, unilateral if present

II Minimal, bilateral, midline involvement, balance not impaired

III Impaired righting reflex, ADL restricted, difficulty standing and turning

IV Severe symptoms, needs assist in walking and standing

V Confined to bed or wheelchair

Intelligence Quotient (IQ) Scoring

130 and up Genius, Very Superior120-129 Superior110-119 Above Average90-109 Average80-89 Below Average70-79 Borderline50-69 Mild MR Moron Educable up to Grade 6

35-49 Moderate MR Imbecile Trainable in domestic repetitive work

20-34 Severe MR Idiot Cognitive abilities up to 3-5 y/o

<20 Profound MR Complete dependence, accident prone

Karnofsky Scale for Cancer

10 Normal, no evidence of disease9 Minor signs, able to do normal activities8 Some signs, normal activities with effort7 Cares for self, unable to do normal activity or work6 Requires occassional assistance, able to care to most needs5 Requires considerable assistance, & frequent medical care4 Requires special care and assistance. Disabled3 Severely disabled. Death not imminent, hospitalization indicated2 Very sick, active support treatment & hospitalization needed1 Moribund, fatal progressing rapidly0 Dead

**After 8 : unable to work, able to live at home, assistance is needed**After 5 : unable to care for self, instititional or hospital care needed. Disease is progressing rapidly

Landmarks and Anatomic Levels: Hyoid C3 Thyroid C4

1. Pyramidal  P2. Cerebellar C ?3. Brainstem Ba4. Bowel and Bladder ba5. Sensory Sa6. Visual Vira7. Mental Mall

Cricoid C6 Trachea C6-T4 Superior angle of scapula T2 Spine of scapula T3 Inferior angle of scapula T7 Manubrium sterni T2 Sternal angle of Louis T4-T5 Xiphoid process T9 (T6 Dermatome) Iliac crest L4 Iliac tubercle L5 PSIS S2**Scapula 237**Sternum 2459

Ligaments & Other Names

Deltoid ligament MCL of anklePoupart’s ligament Inguinal ligamentCotyloid ligament Acetabular labrumCoronary ligament Meniscotibial ligamentLandsmeer ligament Oblique retinacular ligamentLanciniate ligament Flexor retinaculum (ankle)Transverse carpal ligament Flexor retinaculum (wrist)Spring ligament Plantar calcaneonavicular ligamentY-ligament of Bigelow Iliofemoral ligament

**Flexor Accessorium : Quadratus plantae**Artery of Trueta : Medial Femoral Circumflex Artery**Musculospiral nerve : Radial nerve**Bell’s nerve : Long Thoracic nerve**Strap muscles : Suprahyoids and Infrahyoids**Triangularis : depressor anguli oris**Twin muscles : Gemelli superior and inferior**Brachiocephalic Artery Innominate artery

Lung Volumes and Capacities

Full Inspiration

Normal Inspiration

Normal Expiration

Full Expiration

Dead Space

**DRG of Medulla : inspiration DIN**VRG of Medulla : expiration VEX**Upper Pons : Pneumotaxic Center PU

: switch-off inspiratory ramp signal**Lower Pons : Apneustic Center LA

: prevents « switch off » in apneaMacnab’s Classification for Disk Herniation Protrusion (Bulging) Bulging of margins, intact annulus fibrosusProlapse Pulposus goes through incomplete tear of fibrosus

TLC

6000 mL

VC

4500 mL

IC

3000 mL

IRV 3000 mL

TV500 mL

FRC2500 mL

ERV1000 mL

RV1500 mL

RV1500 mL

Extrusion Pulposus goes through complete tear of fibrosusSequestration Pulposus goes out of torn fibrosus**CODE : PPES or BPES

Patellofemoral Pain Syndrome (PFPS) StagingStage I (S) S wellingStage II (F) F issuringStage III (D) D eformed surfaces on underside of patellaStage IV (F) F emoral cartilage involvement (the bed of patella**CODE : PFPS-SFDF**Patellar Tilt : Tilting of patella laterally during knee flexion

If (-) patellar tilt, knee flexion = 110 degrees

Metabolic Myopathies1. Von Gierke Glucose -6- phospatase2. Pompe Acid Maltose3. Cori Debrancher4. Anderson Brancher5. McArdle Muscle Phosphorylase6. Hers Liver Phosphorylase7. Tarui Phosphofruktokinase

Congenital Myopathies1. Central Core Chromosome 12. Nemaline Myopathy Rod Body Myopathy3. Myotonia Congenita Thomsen’s

Infantile Hercules4. Paramyotonia Congenita Eulenberg disease

Grip Myotonia5. Swartz Jampel Dwarfism, short neck, flat fascie, bhepharospasm

METS Chart

Mucopolysaccaridosis

I – Hurler Alpha -L- idouronidase Most commonHepatosplenomegalyDeath by cardiac failure

II – Hunter Sulfo diuronidine sulfatase Only x-linked

Lying quietly = 1.0Sitting at ease = 1.2 - 1.6Sitting while writing = 1.9 - 2.2Standing at ease = 1.4 - 2.0Standing/dressing/undressing = 2.3 - 3.3 Light housework = 1.7 - 3.0Light industrial work = 2.0 - 5.0Hall Ambulation (5-7') = 2.0 - 2.5

>7' = 3 - 4

Use of bedpan = 4-5 Heavy housework = 3-6 Office work = 1.3 - 2.5Walking at 1 mph = 2.3Walking at 2 mph = 3.1 Walking at 3 mph = 4.3Marital sex = 5- 6Extramarital sex = 7- 8Ascending stairs = 9.0

METS depending on speed1mph + 2.32mph - 3.13mph = 4.3

Basketball = 9 METS

III – San Filippo Sulfo gluco samine sulfatase CNS deteriorationCoarse face

IV – Morquio N – acetyl galacto samine -6- sulfate sulfatase Waddling gaitPlatyspondylyCord compressionCardiorespiratory failureAtlantoaxial instability

VI – Maroteaux – Lamy

Sulfo galacto samine sulfatase N intelligence

** Autosomal Recessive except II

Nerve Fiber Classification

General – determined by size and myelin sheathA alpha Extrafusal muscle fibers (motor)A beta Proprioception, vibration, stimulated by TENSA gamma IntrafusalA delta Fast painB Preganglionic fibers, MOST SENSITIVE to ULTRASOUNDC Slow pain

Sensory – determined by functionIa Annulospiral endings – reciprocal inhibitionIb Golgi tendon organ – autogenic inhibitionII Flower spray endingsIII Fast painIV Slow pain

Ia – stimulus : stretch ; response : contractionIb – stimulus : tension ; response : relaxation

Stages of OsteoporosisStage I SpottyStage II DiffusedStage III Generalized

RSD StagesI – Acute Pain (localized)II – Dystrophic Pain (diffused) and atrophyIII – Atrophic Atrophy and autonomic changes

**RSD Triad : H yperpathia – any stimulus is perceived as pain(HAT) A utonomic phenomenon

T rophic skin changes**AKA : Complex Regional Pain Syndrome (CRPS)

Causalgia (PNI)Shoulder-Hand Syndrome (CVA)Sudeck’s Atrophy (Fx and Osteoporosis)

Milestones

Prone to Supine: 4 mosSupine to Prone: 7 mos

7 Months:Cervical LordosisTransfers CubeHolds Bottle

10 Months:Lumbar LordosisBangs ObjectsPincer Grasp

Pull to Sit: 5 mosPull to Stand: 10 mos

Mirror ImageStranger Anxiety

Peek-a-BooLove Affair

Sitting Supported: 6 mosSitting Unsupported: 7 mos

14 Months:Walks aloneWide BOS↑Hip and Knee FlexionCrayon on PalmScribblesRemoves Garment

18 MonthsWalks Low guardWalks BackwardSits Self in ChairCrayon on Butt EndDrinks from Cup NeatlyDumps RaisinPoints to Body Parts

10 Months:CreepCrawlCruise

PhonophoresisULZincER

HyaluronidasE D E M A

CopPer U N G A L

BURXylocaineITIS

Reaction of Degeneration

Faradic (AC) Galvanic (DC)Normal Smooth Tetanic Brisk, TwitchPartial ↓ Tetanic ↓ SluggishComplete No Very SlowAbsolute No No

Piaget’s Stages of Cognitive Development

1. Sensorimotor 0-2 yrs Infancy

2. Pre-operational 2-7 yrs Preschool and early elementary

3. Concrete Operational 7-11 yrs Middle school and late elementary

4. Formal Operational 11 yrs onwards Adolescence and adulthood

**to remember the age: two(2) 7-11

Plasma ProteinsAlbumin Most abundantFibrinogen Clotting factor I (remember the code)Gobulin Becomes Immunoglobulin (Ig) - natural immune system

IgG – only Ig that crosses placentaIgA – in body fluids (LAWAY, PAWIS)IgM – largest, first to react in food antigens (MATAKAW)

IgE – allergic reactions : hypersensitivity type I - anaphylacticIgD – activation of B cells : humoral immunity

Hypersensitivity reactionsType I – Anaphylactic (ONEaphylactic) Shrimp, peanut, pollen., dustType II – Cytotoxic, cytolytic (cyTWOtoxic) Incompatible blood types (blood transfusion)Type III – Immune complex (THREEmune) Autoantibodies against own cells

(autoimmune diseases) – RA, SLE, MGType IV – Cell-mediated/delayed Cellular immunity by WBC (T-cell)

Contact dermatitis – appears 24 hrs after exposure

Polio Stages

I – Acute Fever & flu symptoms 1-6 weeksII – Convalescence (Intermediate) Stage

Muscle paralysis & weaknessCervical & back rigidity(+) Kernig, Brudzinkski

6 weeks to 6 months

III – Residual Stage True LLD – limb shorteningQuadriceps gait – gait deviation

6 months onwards

**Code for time-line : 6-6-6-6

Sharrad’s Index

Months UE LE1 2.5 2.02 2.0 1.54 1.5 1.06 1.0 0.75

**Golden period for polio : 6 months

Proper Measures for WC and ADA Guidelines

Wheelchair ADA GuidelinesBackrestWidth: 16-18”Height:16”

Seat to axilla minus 4”

Door Width: 32-36”Corridor: 36”Ramp Ratio: 1:12 or 8.3%Standard Step Height: 7”

SeatDepth: Popliteal fossa minus 2”Width: 1” from each G. TrochHeight:Seat to foot plate plus 2”

Ramp Resting Area: 60”x60”Grab Bar Height: 33-36”Toilet Seat : 17-19”

(Elevated): 48”Wheel Diameter: 22-24” Distance between bed and wall

For 90° turn: 32”For 180° turn: 60”

Caster Diameter: 5-8”Guard Belt : 4-6”

Prosthetic Fitting for Children

Above/Below Elbow 3-6 mosAbove/Below Knee 8-10 mosActive Terminal Device 2 yrs

Congenital Amputations1. Amelia (Whole UE)2. Achiella (Wrist)3. Phocomelia (seal

limbs)4. Hemimelia (half of

Surgical Rhizotomy: nerve roots Myotomy : muscle Tenotomy : tendons Neuretomy: peripheral

nerves Myetomy : spinal cord

Elbow Unit 2-3 yrs Functional Hand 3 yrsActive Controlled Knee Joint 3-4 yrs

Stages for Disease Progression for Rheumatoid Arthritis I – Early Stage Osteoporosis, no bone destruction & deformitiesII – Moderate Osteoporosis, with or without bone destruction, no deformities, slight cartilage

involvement, adjacent muscle atrophy, (+) rheumatoid nodulesIII – Severe + bone destruction & deformityIV - Terminal Bony ankylosis

Thumb Nalebuff Deformity in Rheumatoid ArthritisType I Thumb boutonniereType II Volar subluxation of 1st CMCType III Thumb flexed and adducted towards hand

Radiographic findings in RA (ABCDES)A bnormal alignmentB one involvementC artilage involvementD eformitiesE rosionS oft tissue swelling

Resmeth Statistical Tests

2 3Direct and Related

N McNomer Cochraine Q

O Wilcoxon Sign Rank 2 Way ANOVA

IR Correlated T-Test Repeated T-Test

Indirect and UnrelatedN Chi-Square Chi-Square

O Mann-Whitney U Kruskal Wallis

IR T-Test ANOVA, MultiANOVA, ANCOVA

Rockwood Classification for AC joint separationType I AC sprainType II Torn AC, sprained CCType III Torn AC & CC, widened by 25-100%Type IV Torn AC & CC, clavicle displaced posteriorlyType V Torn AC & CC, widened by > 100%Type VI Torn AC & CC, clavicle displaced inferiorly under biceps

Congenital Amputations1. Amelia (Whole UE)2. Achiella (Wrist)3. Phocomelia (seal

limbs)4. Hemimelia (half of

Surgical Rhizotomy: nerve roots Myotomy : muscle Tenotomy : tendons Neuretomy: peripheral

nerves Myetomy : spinal cord

**Grades IV, V and VI = OPERATIVE to restore

SLAP typesType I Superior labrum flayed, intact attactmentType II Small tearm biceps labrum complex unstableType III Bucket handle tear, intact biceps labrum complexType IV Bucket handle tear, extends to biceps tendon that subluxes into the joint

Salter and Harris Epiphyseal Plate FxType I Epiphyseal plateType II Epi plate plus triangular segment of metaphysis Type III Epi plate + EpiphysisType IV Epi plate + Epiphysis + Meta physisType V Comminuted Epi plate**Bone growth stops at Type IV and V.

Gustillo-Anderson Open Fx ClassificationType I Wound < 1 cmType II Wound > 1 cm, < 10 cmType III Wound > 10 cm

IIIA A dequate tissue coveringIIIB B ony exposureIIIC C irculatory involvement

SCI LevelsC4 40-50% Powered WC

Sip & puffIntact phrenic nn

C5 50-60% WC c joystickOblique handrim projections

Balanced forearm orthosis

C6 60-70% Vertical handrim projections Sliding boardC7-C8 70% Community Amb in WC

C7- friction handrimsC8- standard handrims

C7 – Indep s equipmentC8 – can wheelie

T1-T8 70-80% KAFO Walker Swing to T1 – WC to floorT4 – Squat pivot

T9-T12 100% KAFO Walker Swing toT12-L3 KAFO Loftstrand 4 pointL4-L5 AFO Loftstrand 2 point

SCI Functional LevelsSO Stand Only T2 and upTA Therapeutic Amb T3 – T11HA Household Amb T12 – L2CA Community Amb L3 and down

Types of Aphasia

( - )Fluency (+)Comprehension (+) ( - )Repetition (+) ( - ) (+) ( - )

Anomic Conduction Transcortical Sensory

Wernicke

FluencyComprehension (+) (+)Repetition (+) (+) (+) (+)

Transcortical Motor

Transcortical Motor Transcortical Motor Transcortical Motor

Types of Heart Block1st Degree Delay in impulse greater than normal2nd Degree – Wenckebach Alternating conduction, somtimes has impulse3rd Degree – Adam-Stoke’s Syndrome Complete heart block, no impulses**ST segment elevation : myocardial infarction (heart attack)**ST segment depression : myocardial ischemia**Prolonged PR interval : Heart Block**Wide, bizzare, odd QRS complex : premature ventricular contraction

Hypertension Grading Scale – JNC 7Systolic BP Diastolic BP

Normal < 120 mmHg 80 mmHgPrehypertension 120-140 mmHg 80-90 mmHgStage I Hypertension 140-160 mmHg 90-100 mmHgStage II Hypertension > 160 mmHg > 100 mmHg

UE Muscle Synergy

MuscleAction on scapula

Action on scapula Innervation Testing procedure Affected in

Serratus Anterior boxer's muscle saw muscle

Upward Rotators

AbdProtract

Long thoracicC5-C7

in scaptionRadical

mastectomy

Trapezius monk's hood musculous

cucularis

Upward Rotators

Upper - Elevate

CN XIC3, C4

Upper - Shrugs

Radical neck dissection

Middle - Retract, Adduct

Middle - Prone arm lift

Lower - Depress

Lower - superman position 145 deg

abduction

Levator ScapulaeDownward

Rotators Elevate

Dorsal Scapular

Nerve(C5)

Shrug and Lift Off

RhomboidsDownward

Rot RetractProne arm lift and

Lift Off

Vestibular Tests and Lesions

BPPV UVL BVL CVLRhomberg’s ( - ) ( + ) in acute ( + ) in acute ( - )Tandem Rhomberg’s ( - ) ( + ) ( + ) ( + )Single Leg Stance ( - ) ( + ) ( + ) UnableAmbulation Normal Wide base Wide base Ataxic

Vitamins & Deficiencies

**Fat

Soluble: ADEK**B12: Best absorbed in ileum**Folate: Decrease risk for spina bifida

Vitamin DeficiencyA Retinol Night Blindness (Nyctalopia)B1 Thiamine BeriberiB2 Riboflavin Cheilosis (Scarring of mucus membrane)B3 Niacin PellagraB6 Pyridoxine DermatitisB12 Cyanocobalamine Pernicious AnemiaFolate Folic Acid Macrocytic AnemiaC Ascorbic Acid ScurvyD Cholecalciferol Osteomalacia (Adult), Rickets (Children)E Alpha tocopherol RBC HemolysisK Minaquinones Hemorrhagic Manifestation