Abnormal ABG Conditions

pH
Respiratory

Alkalosis
(dents)
Respiratory

Acidosis
(hard)
(dsc)
Metabolic

Alkalosis
(wemm)
Metabolic

Acidosis
(NaLoCo)

PaCO2

HCO3
WNL

Signs and Sx
Dizziness, early tetany,
numbess, tingling, syncope

WNL

WNL

WNL

Early : headache, anxiety,

restlessness, dyspnea
Late : disorientation/confusion,
somnolence, coma
Weakness, early tetany, mental
dullness, muscle twitching,
DTR
Nausea, lethargy, coma

Action Potential
1 Resting State
Na+ Channel
INACT gate
Open
ACT gate
Closed
K+ Channel
Gate
Closed
2 Depolarization
Na+ Channel
INACT gate
Open
ACT gate
Open
K+ Channel
Gate
Slowly Opens
3 Depolarization Continues/Repolarization Begins
Na+ Channel
INACT gate
Closed
ACT gate
Slowly Closes
K+ Channel
Gate
Open
4 Repolarization Continues
Na+ Channel
INACT Gate
Slowly Opens
ACT 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

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 female

More common in aged 40-60
Capsular pattern: ER>ABD>IR

Amputation Classification by Length

BEA
AEA
Very Short 0-35%
Short
35-55%
<30%
Long
55-90%
50-90%
BKA
AKA
Short
<20%
<35%
Standard 20-50%
35-60%
Long
>50%
>60%

Pressure Sensitive Areas:

1. Peroneal Nerve
2. Hamstring Tendon
3. Anterior Tibia
4. Fibular head & neck
5. Anterior Tibial Crest

Speed of Ambulation:
N
3mph
BKA 2.5mph
AKA 1.5mph

Angles, Temperatures and Cerebellar Dysfunction

Angles
1. Acetabular Index
2. Center Edge (aka
Angle of Wiberg
3. Sacral
4. Neck-Shaft Angle
5. Pelvic Inclination

30
Temp in C 25
Very
1-13
Cold
30
Cold
13-18
50-60
Cool
18-27
125
Tepid
27-33.5
(adult)
APGAR scores
Neutral 160
33.50
2
35.5 1
(child)
Warm
35.56. Carrying Angle
5-19
A ppearance
All blue
Blue
limbs
All pink
36.5
5-10
(M)
Hot
36.5-40
P ulse
0
Less
or
>100
10-15
(F)equal
Very
Hot
40-60
to 100
7. Q Angle
13-18
8. Tibial Torsion
20
9. Out-toeing None
5-7
G rimmace
Grimace
Crying
10. Hallux Valgus
15
A ctivity
Limp
Slight flexion
Spontaneous

R espiration

Slow and
Irregular

Crying

**Score of 7-10 = GOOD

5-6 = impending respiratory arrest
<5 = needs vetilatory support
0 = dead
Avascular Necrosis
1.
Lunate
2.
Scaphoid
3.
Navicular
4.
Capitulum
5.
Vertebral body
6.
Entire Spine
7.
Femoral Head (children)
8.
Femoral Head (adult)
9.
2nd MT Head
10. Tibial Tuberosity

Kienboch
Preissers
Kohler
Panner
Calve
Scheuermann
LCPD
Chandlers
Freibergs
Osgood Schlatter

Cerebellar
Dysfunction
Movement
Decomposition
Hypotonia
Ataxia
Nystagmus
Dysmetria,
Dysdiadochokinesia,
Gait Disorders
Asthenia

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 Values
Normal
Contraindicated
for exercise
Normal Values
for:

Hgb
12-18 mg/dL
< 8 mg/dL

Hct
36-54%
<25%

WBC
5T-10T
<5T

Platelets
150T-400T
<50T,
<20T

HCO3
22-26meq/L
<22meq/L

RBC

Hct

ESR

5.2-6.5 Mil/mm3
4.5-5.5 Mil/mm3

42-52%
37-47%

<15 mm/hr
< 25 mm/hr

**Hematocrit (Ht or HCT): volume percent of RBC in blood

AKA 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
paCO2
HCO3
Cholesterol
LDL
HDL

7.35-7.45
35-45 mmHg
22-26 mmHg
< 200
< 100
> 60

Risk for CVA

> 240
> 160
< 35

55% Plasma
- 90% H2O, 10% Electrolytes
45% Formed elements - RBC, WBC, Platelets
Normal Fasting Blood Sugar (FBS) : 70-100 mg/dL

Blood-Ion Imbalances
Hyponatremia
Causes
Diarrhea
Vommitting
Effects
Brain cell swelling
Seizures, convolusions, lethargy
Causes
Effects

Hypokalemia
Diarrhea
Vommitting
Muscle weakness
Ventricular arrhythmias

Hypernatremia
Water loss
DM, DI
Fluid loss, dehydration
Muscle twitching
Hyperkalemia
K+ replacement overdose
Endocrine problems
Loss of muscle tone, paralysis
Impaired cardiac function

Causes
Effects

Hypocalcemia
Multiple blood transfusions
Dec. Parathyroid hormone
Muscle tetany, weakness
Cardiac arrest

Hypercalcemia
Parathyroid hormone defect
Cancer cells, deconditioning
Osteoporosis

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

BMI Classification
19
20
25
30
35
40

and below
24.9
29.9
34.9
39.9
and above

Underweight
Normal
Overweight
Obese I
Obese II
Obese III

**BMI of 30 and up = prone to Htn

Assessment of Breath Sounds and Significance

Normal
Decreased or None
Increased
Crackles
Wheezes

Normal
Hyperinflation (Emphysema, pneumothorax)
Hypoinflation (Atelectasis, pneumonia)
Pleural effusion
Secretions
Bronchoconstriction (Asthma)

**V/Q Ratio = 0.8

In COPD < 0.8
In CRPD > 0.8

Center Of Gravity
1 inch anterior to S2
Per Body Part :
Head
Sphenoid sinus
Neck
Basioccipital
Trunk
Anterior T11
Upper extremity
Just above the
elbow
Arm
Medial head of triceps
Forearm
Pronator teres
Hand
3rd MCP
Lower extremity
Just above the
knee
Thigh
Adductor brevis

Line Of Gravity ATATPAA

A nterior to AO joint
T hrough cervical vertebra
A nterior to thoracic
vertebra
T hrough lumbar vertebra
P osterior to hip joint
A nterior to knee
A nterior to ankle

Leg
Foot

Popliteus
2nd MTT

CHF Classification

Cardiac Patient MET

Requirements

Class 1: mild; no limitation

6.5 METS
Class 2: slight limitation 4.5
METS
Class 3: marked limitation
3.0 METS
Class 4: severe limitation
1.5 METS

Chronic Arterial
Insufficiency
Decreased or
Absent pulse
Cold to palpation

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

Chronic Arterial Insufficiency vs Chronic Venous

Insufficiency
Chronic Venous
Insufficiency
Normal pulse

Normal
temperature
Ulceration at lateral Ulceration at
malleolus
medial malleolus
Pale on elevation
Relief on elevation
(+) gangrene
(+) edema
(+) rest pain (if
severe)

Current Frequencies
Used for:

Low Frequency
Current

High
Frequency
Current
>500K Hz
>10K Hz

YES
YES
YES

Medium
Frequency
Current
3000-6000 Hz
100010,000Hz
YES
YES
No

MOTOR
AC-DC
FES, ES
TENS

SENSORY
TENS
IFC
Russian

THERMAL
US, IRR
SWD, MWD
UVR, LASER

1-2000 Hz
1-1000 Hz
Nerve
Muscle
Denervated
Muscle
Function

SIX Determinants of Gait

1. Heel Rise
2. Pelvic Rot
COG
3. Pelvic Tilt
COG
4. Knee Flexion
COG

No
No
No

4 - 8
4 - 8
15 Early; 30 Late

Physiologic Valgus

BOS
Reduce Displacement of COM

5.

Lat Displacement of
Pelvis (Add of Hip)

Reduce Displacement of COM

5cm

6.

Knee, Ankle and Foot

Interaction

Reduce Displacement of COM

5cm

Wagners Grading of Diabetic Ulcers

Grade I
Superficial ulcer
Grade II
Reaching muscle, bone, fascia
Grade III
Deep with osteomyelotis
Grade IV
Gangrene of some parts of the foot
Grade V
Gangrene of entire foot
**start amputation at GRADE III
Diabetic Ulcer Staging
Stage I (E)
Damage to Eidermis
Stage II (D)
Up to Dermis
Stage III (S)
Up to Subcutaneous tissue
Stage IV (MB)
Up to Muscle and Bone
**Wagners Grading and Diabetic Ulcer Staging are different.
Pressure Ulcer Staging
Stage I
Non-blanchable erythema
Skin may be cool or warm
Stage II
Partial thickness skin loss
Abraision, blister, & shallow crater
Stage III
Full thickness skin loss
Stage IV
Has undermining & sinus tracts
**SINOGRAM : used to measure depth of wound

Injury to epidermis
Injury to epidermis & upper dermis
Damage up to subcutaneous tissue
Up to fascia, muscle, bone

Diagnostic Tools
X-Ray
BEST for fx
Used for bone mass or tumor
Bone Scan
BEST for stress fx and bone tumor
CxR
TB Dots ; Spots
Apex, spine, talus, capitate
Tracheal shift
MRI
BEST for ligaments
Used for muscles and articular tissues (meniscus)
CT scan
BEST for head/cephalic lesions and brain lesions
Diagnostic US
Abdominal or reproductive organs
Doppler US
BEST for DVT
Spirometry
Measures lung volumes
Confirmatory only
NOT gold standard
Disk Pressure
1.
2.
3.
4.
5.
6.
7.

20 kg wt lifted c back bent & knees ext

bend forward
20 kg wt lifted c back straight & knees bent
laugh
cough or straining
side bending
Rotation

169%
150%
73%
45-50%
5-35%
25%
20%

8. walking

15%

**Hoop stretch : stretch on anulus fibrosus when nucleus pulposus moves during trunk
movement
Energy Requirements for Ambulation
WC
Crutch walking
Single BKA
Single AKA
Double BKA
Double AKA
1 BKA & 1 AKA

Measuring Sites of
Fat Caliper

9%
60%
1040%
65%
41%
110%
75%

T high
I nfrascapular
M edial Calf
T riceps
A bdominal
B iceps
A bove ASIS
**(code : TIMTABA)

Erik Eriksons Psychosocial Development

1. Trust vs Mistrust
2. Autonomy vs Shame &
Doubt
3. Initiative vs Guilt
4. Industry vs Inferiority

0-2yrs
2-4 yrs

Infancy
Early Childhood

I trusted you
You should be
ashamed
And feel guilty
You inferior

4-5 yrs
5-12 yrs

5. Identity vs Role
Confusion
6. Intimacy versus Isolation
7. Generativity vs
Stagnation
8. Ego integrity vs Despair

13-19 yrs

Play Age
School Age;
Latency
Adolescence

19-40 yrs
40-65 yrs

Young Adulthood
Middle Adulthood

Loner
Youre useless

65 yrs to death

Maturity

And hopeless

Confused

Frontal Lobe Speech Impairments

Anomia
Agraphia
Alexia
Aprosody
Echolalia
Palilalia
Syntactic
Neologism
Jargon
Logorrhea
Aphrasia
Paraphrasia
Semantic
Paraphrasia
Phonemic
Paraphrasia

Inability to name
Inability to write
Inability to read
Absence in deflection & difference in tone
Repeats words
Repeats syllables
Telegraphic speech
Coining of new words
Incomprehensive speech
Press of speech (nonsense)
Inability to speak in phrases
Word substitution
Interchange 2 items normally found together (i.e. spoon & fork)
Interchange words that sound like them (i.e. sheep & sheet)

Gait Parameters and Max Activity of Muscles

HS

FF

MS

Ho

To

ISw

MSw

TSw

Hip

20F

15F

Knee

G.Max
0

15F

G.Med
5F

Ankle

Quads
0

Quads
5PF

T.A.

5DF

10-20E
0 (4F)

30F

20PF

T.P.
P.F.

P.F.

20F

30F

30F

Iliopsoas
60F

30F

Hams
0

10PF

**Study using kinesthetic cues

Garden Femoral Neck Fx
Grade I
Incomlpete Fx
Grade II
Complete without displacement
Grade III
Complete, with partial displacement
Grade IV
Complete, with total displacement
Le Fort Facial Fx
Grade I
Grade II
Grade III

Horizontal, along maxilla

Pyramidal Fx, maxilla, & bridge of nose
Zygomas & superior orbital fissure

Glasgow Outcome Scale (GOS) for TBI

Grade
Description
I
Death
II
Persistent vegetative state
III
Severely disabled (conscious but
diabled)
IV
Moderately disabled (disabled but
indep)
V
Good recovery

GOS-E counterpart
I
II
III and IV
V and VI
VII and VIII

Glasgow Outcome Scale Extended (GOS-E)

I
Death
II
Vegetative State
Has sleep-wake cycle
III
Lower Severe Disability
Needs full assistance in ADL
IV
Upper Severe Disability
Needs supervision
V
Lower Moderate
Indep ADLs, can shop and travel in public
Disability
VI
Upper Moderate
Can return to work, needs modifications
Disability
VII
Lower Good Recovery
Return to work without modifications ; reports
difficulty
VIII
Upper Good Recovery
No difficulty

Heart Valves
Auscultation

Location

Aortic

2nd (R) ICS

3rd (L) IC

Pulmonary

2nd (L) ICS

3rd (L) C

Mitral

5th (L) ICS

4th (L) C

Tricuspid

4th (L) ICS

4th (R) IC

To remember, use this cheat code:

APMT
2 2 5 4.. R L L L
3 3 4 4.. L L L R
Heart Sounds
S1
LUBB
S2
DUBB
S3
S4

closure of atrioventricular valves

closure of semilunar valves
rapid filling of ventricles
atrial systole

Louder, Longer, Lower p

Shorter, higher
Ventricular gallop in CHF
Atrial gallop in MI/Htn

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

Modalities
HMP
Treatment T : 4044C
Tank T : 71C
[Wadsworth 7080C]
[Hecox 65-90]
Standard Size : 10x
12
Whirlpool
Treatment T : 4555C
103-110F

Paraffin Wax
Treatment T : 4044C
Melting Pt : 50-54C
Self-Sterilizing T :
65-70C

Parts of whirlpool that are

contaminated :
Bottom
Overflow
Agitation Pipe
Thermometer
Edges
Drainage

Contrast Bath
Treatment T :
Braddom
IER
100-110F
4045C
50-55F
1520C

Hemodynamics
Pulse Pressure (PP)
Mean Arterial Pressure (MAP)
End Systolic Volume
End Diastolic Volume
Stroke Volume
Cardiac Output
Karvonens Formula

Systolic BP Diastolic BP
Diastolic BP + 1/3 PP
Or
[Systolic BP + (2*Diastolic BP)] / 3
50 mL
120 mL
End Diastolic Volume End Systolic Volume
70 mL
Stroke Volume x Heart Rate
4-6L / min
60-80% (Max HR Resting HR) + Resting HR

**For Karvonens 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

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
I

Kurtzke Scale for MS 7

Domains

1.
2.
3.
4.
5.
6.
7.

Pyramidal
P
Cerebellar
Brainstem
Bowel and Bladder
Sensory
Visual
Mental

C?
Ba
ba
Sa
Vira
Mall

Intelligence Quotient (IQ) Scoring

130 and up
120-129
110-119
90-109
80-89
70-79
50-69

Genius, Very Superior

Superior
Above Average
Average
Below Average
Borderline
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
9
8
7
6
5
4
3
2
1
0

Normal, no evidence of disease

Minor signs, able to do normal activities
Some signs, normal activities with effort
Cares for self, unable to do normal activity or work
Requires occassional assistance, able to care to most needs
Requires considerable assistance, & frequent medical care
Requires special care and assistance. Disabled
Severely disabled. Death not imminent, hospitalization indicated
Very sick, active support treatment & hospitalization needed
Moribund, fatal progressing rapidly
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

Hyoid
Thyroid
Cricoid
Trachea
Superior angle of scapula
Spine of scapula
Inferior angle of scapula
Manubrium sterni
Sternal angle of Louis
Xiphoid process
Iliac crest
Iliac tubercle
PSIS
**Scapula 237
**Sternum 2459

Levels:
C3
C4
C6
C6-T4
T2
T3
T7
T2
T4-T5
T9 (T6 Dermatome)
L4
L5
S2

Ligaments & Other Names

Deltoid ligament
Pouparts ligament
Cotyloid ligament
Coronary ligament
Landsmeer ligament
Lanciniate ligament
Transverse carpal ligament
Spring ligament
Y-ligament of Bigelow

MCL of ankle
Inguinal ligament
Acetabular labrum
Meniscotibial ligament
Oblique retinacular ligament
Flexor retinaculum (ankle)
Flexor retinaculum (wrist)
Plantar calcaneonavicular ligament
Iliofemoral ligament

**Flexor Accessorium : Quadratus plantae

**Artery of Trueta : Medial Femoral Circumflex Artery
**Musculospiral nerve : Radial nerve
**Bells 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
TLC

IC
VC
4500 mL

6000 mL

3000 mL

FRC
2500 mL
RV
1500 mL

IRV
3000 mL
TV
500 mL
ERV
1000 mL
RV
1500 mL

**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

Full Inspiration
Normal
Inspiration
Normal Expiration
Full Expiration
Dead Space

: prevents switch off in apnea

Macnabs Classification for Disk Herniation
Protrusion (Bulging)
Bulging of margins, intact annulus fibrosus
Prolapse
Pulposus goes through incomplete tear of fibrosus
Extrusion
Pulposus goes through complete tear of fibrosus
Sequestration
Pulposus goes out of torn fibrosus
**CODE : PPES or BPES
Patellofemoral Pain Syndrome (PFPS) Staging
Stage I (S)
S welling
Stage II (F)
F issuring
Stage III (D)
D eformed surfaces on underside of patella
Stage 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 Myopathies
1. Von Gierke
2. Pompe
3. Cori
4. Anderson
5. McArdle
6. Hers
7. Tarui

Congenital Myopathies
1. Central Core
2. Nemaline Myopathy
3. Myotonia Congenita
4. Paramyotonia Congenita
5. Swartz Jampel

Glucose -6- phospatase

Acid Maltose
Debrancher
Brancher
Muscle Phosphorylase
Liver Phosphorylase
Phosphofruktokinase

Chromosome 1
Rod Body Myopathy
Thomsens
Infantile Hercules
Eulenberg disease
Grip Myotonia
Dwarfism, short neck, flat fascie, bhepharospasm

METS Chart
Lying quietly = 1.0
Sitting at ease = 1.2 - 1.6
Sitting while writing = 1.9 - 2.2
Standing at ease = 1.4 - 2.0
Standing/dressing/undressing =
2.3 - 3.3
Light housework = 1.7 - 3.0
Light industrial work = 2.0 - 5.0
Hall Ambulation (5-7') = 2.0 - 2.5
>7' = 3 - 4
Mucopolysaccaridosis

Use of bedpan = 45
Heavy housework =
3-6
Office work = 1.3 2.5
Walking at 1 mph =
2.3
Walking at 2 mph =
3.1
Walking at 3 mph =
4.3
Marital sex = 5- 6
Extramarital sex =
7- 8
Ascending stairs =
9.0

METS depending on
speed
1mph + 2.3
2mph - 3.1
3mph = 4.3
Basketball = 9 METS

I Hurler

Alpha -L- idouronidase

II Hunter
III San Filippo

Sulfo diuronidine sulfatase

Sulfo gluco samine sulfatase

IV Morquio

N acetyl galacto samine -6- sulfate

sulfatase

VI Maroteaux
Lamy

Sulfo galacto samine sulfatase

Most common
Hepatosplenomegaly
Death by cardiac failure
Only x-linked
CNS deterioration
Coarse face
Waddling gait
Platyspondyly
Cord compression
Cardiorespiratory failure
Atlantoaxial instability
N intelligence

** Autosomal Recessive except II

Nerve Fiber Classification
General determined by size and myelin sheath
A alpha
Extrafusal muscle fibers (motor)
A beta
Proprioception, vibration, stimulated by TENS
A gamma
Intrafusal
A delta
Fast pain
B
Preganglionic fibers, MOST SENSITIVE to ULTRASOUND
C
Slow pain
Sensory determined by function
Ia
Annulospiral endings reciprocal inhibition
Ib
Golgi tendon organ autogenic inhibition
II
Flower spray endings
III
Fast pain
IV
Slow pain
Ia stimulus : stretch ; response : contraction
Ib stimulus : tension ; response : relaxation
Stages of Osteoporosis
Stage I
Spotty
Stage II
Diffused
Stage III
Generalized
RSD Stages
I Acute
II Dystrophic
III Atrophic

Pain (localized)
Pain (diffused) and atrophy
Atrophy and autonomic changes

**RSD Triad :
(HAT)
**AKA :

H yperpathia any stimulus is perceived as pain

A utonomic phenomenon
T rophic skin changes
Complex Regional Pain Syndrome (CRPS)
Causalgia (PNI)
Shoulder-Hand Syndrome (CVA)
Sudecks Atrophy (Fx and Osteoporosis)

Milestones
Prone to Supine: 4 mos
Supine to Prone: 7 mos

7 Months:
Cervical Lordosis

10 Months:
Lumbar Lordosis

Pull to Sit: 5 mos

Pull to Stand: 10 mos
Sitting Supported: 6 mos
Sitting Unsupported: 7 mos
10 Months:
Creep
Crawl
Cruise

Transfers Cube
Holds Bottle
Mirror Image
Stranger Anxiety
14 Months:
Walks alone
Wide BOS
Hip and Knee Flexion
Crayon on Palm
Scribbles
Removes Garment

Phonophoresis
U
HyaluronidasE
D
L
E
Zinc
M
E
A
R

Bangs Objects
Pincer Grasp
Peek-a-Boo
Love Affair
18 Months
Walks Low guard
Walks Backward
Sits Self in Chair
Crayon on Butt E
Drinks from Cup N
Dumps Raisin
Points to Body Pa

B
U
R
Xylocaine
I
T
I
S

CopPer
U
N
G
A
L

Reaction of Degeneration
Normal
Partial
Complete
Absolute

Faradic (AC)
Smooth Tetanic
Tetanic
No
No

Galvanic (DC)
Brisk, Twitch
Sluggish
Very Slow
No

Piagets 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 Proteins
Albumin
Most abundant
Fibrinogen
Clotting factor I (remember the code)
Gobulin
Becomes Immunoglobulin (Ig) - natural immune system
IgG only Ig that crosses placenta
IgA in body fluids (LAWAY, PAWIS)
IgM largest, first to react in food antigens (MATAKAW)

IgE allergic reactions : hypersensitivity type I - anaphylactic

IgD activation of B cells : humoral immunity

Hypersensitivity reactions
Type I Anaphylactic
(ONEaphylactic)
Type II Cytotoxic, cytolytic (cyTWOtoxic)
Type III Immune complex (THREEmune)
Type IV Cell-mediated/delayed

Shrimp, peanut, pollen., dust

Incompatible blood types (blood transfusion)
Autoantibodies against own cells
(autoimmune diseases) RA, SLE, MG
Cellular immunity by WBC (T-cell)
Contact dermatitis appears 24 hrs after
exposure

Polio Stages
I Acute
II Convalescence
(Intermediate) Stage

Fever & flu symptoms

Muscle paralysis & weakness
Cervical & back rigidity
(+) Kernig, Brudzinkski
III Residual Stage
True LLD limb shortening
Quadriceps gait gait deviation
**Code for time-line : 6-6-6-6

1-6 weeks
6 weeks to 6 months
6 months onwards

Sharrads Index
Months
UE
1
2.5
2
2.0
4
1.5
6
1.0
**Golden period for polio : 6 months

LE
2.0
1.5
1.0
0.75

Proper Measures for WC and ADA Guidelines

Wheelchair
Backrest
Width:
16-18
Height:
16
Seat to axilla minus 4
Seat
Depth:
Width:
Height:

Popliteal fossa minus 2

1 from each G. Troch
Seat to foot plate plus 2

Wheel Diameter: 22-24

Caster Diameter: 5-8
Guard Belt :
4-6
Prosthetic Fitting for Children
Above/Below Elbow
Above/Below Knee
Active Terminal Device
Elbow Unit
Functional Hand

3-6 mos
8-10 mos
2 yrs
2-3 yrs
3 yrs

ADA Guidelines
Door Width:32-36
Corridor:
36
Ramp Ratio:
1:12 or 8.3%
Standard Step Height: 7
Ramp Resting Area:
60x60
Grab Bar Height:
33-36
Toilet Seat :
17-19
(Elevated):
48
Distance between bed and wall
For 90 turn:
32
For 180 turn:
60

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

Congenital
Amputations
1. Amelia (Whole
UE)
2. Achiella (Wrist)
3. Phocomelia
(seal limbs)
4. Hemimelia
(half of distal
limb)

Active Controlled Knee

Joint

3-4 yrs

Stages for Disease Progression for Rheumatoid Arthritis

I Early Stage
Osteoporosis, no bone destruction & deformities
II Moderate
Osteoporosis, with or without bone destruction, no deformities, slight cartilage
involvement, adjacent muscle atrophy, (+) rheumatoid nodules
III Severe
+ bone destruction & deformity
IV - Terminal
Bony ankylosis
Thumb Nalebuff Deformity in Rheumatoid Arthritis
Type I
Thumb boutonniere
Type II
Volar subluxation of 1st CMC
Type III
Thumb flexed and adducted towards hand
Radiographic findings in RA (ABCDES)
A bnormal alignment
B one involvement
C artilage involvement
D eformities
E rosion
S oft tissue swelling

Resmeth Statistical Tests

2
Direct and Related
N

McNomer

Cochraine Q

Wilcoxon Sign Rank

2 Way ANOVA

IR

Correlated T-Test

Repeated T-Test

Chi-Square

Chi-Square

Mann-Whitney U

Kruskal Wallis

IR

T-Test

ANOVA, MultiANOVA,
ANCOVA

Indirect and Unrelated

N

Rockwood Classification for AC joint separation

Type I
AC sprain
Type II
Torn AC, sprained CC
Type III
Torn AC & CC, widened by 25-100%
Type IV
Torn AC & CC, clavicle displaced posteriorly
Type V
Torn AC & CC, widened by > 100%
Type VI
Torn AC & CC, clavicle displaced inferiorly under biceps
**Grades IV, V and VI = OPERATIVE to restore
SLAP types

Type
Type
Type
Type

I
II
III
IV

Superior labrum flayed, intact attactment

Small tearm biceps labrum complex unstable
Bucket handle tear, intact biceps labrum complex
Bucket handle tear, extends to biceps tendon that subluxes into the joint

Salter and Harris Epiphyseal Plate Fx

Type I
Epiphyseal plate
Type II
Epi plate plus triangular segment of metaphysis
Type III
Epi plate + Epiphysis
Type IV
Epi plate + Epiphysis + Meta physis
Type V
Comminuted Epi plate
**Bone growth stops at Type IV and V.
Gustillo-Anderson
Type I
Type II
Type III
IIIA
IIIB
IIIC

SCI Levels
C4
40-50%
C5

50-60%

C6
C7-C8

60-70%
70%

T1-T8

70-80%

T9-T12
T12-L3
L4-L5

100%

Open Fx Classification
Wound < 1 cm
Wound > 1 cm, < 10 cm
Wound > 10 cm
A dequate tissue covering
B ony exposure
C irculatory involvement

Powered WC
Sip & puff
WC c joystick
Oblique handrim projections
Vertical handrim projections
Community Amb in WC
C7- friction handrims
C8- standard handrims
KAFO
Walker
Swing to
KAFO
KAFO
AFO

Walker
Loftstrand
Loftstrand

SCI Functional Levels

SO
Stand Only
TA
Therapeutic Amb
HA
Household Amb
CA
Community Amb

Intact phrenic nn
Balanced forearm
orthosis
Sliding board
C7 Indep s
equipment
C8 can wheelie
T1 WC to floor
T4 Squat pivot

Swing to
4 point
2 point

T2 and up
T3 T11
T12 L2
L3 and down

Types of Aphasia
Fluency
Comprehension
Repetition
Fluency
Comprehension
Repetition

(+)
(+)
(+)
Anomic

(-)

(-)
Conduction

(+)
Transcortical
Sensory

(-)
Wernicke

(-)
(+)
(+)
Transcortical
Motor

(+)
Transcortical
Motor

(+)
(+)
Transcortical
Motor

(+)
Transcortical
Motor

Types of Heart Block

1st Degree
Delay in impulse greater than normal
nd
2 Degree Wenckebach
Alternating conduction, somtimes has impulse
3rd Degree Adam-Stokes
Complete heart block, no impulses
Syndrome
**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 7
Systolic BP
< 120 mmHg
120-140 mmHg
140-160 mmHg
> 160 mmHg

Normal
Prehypertension
Stage I Hypertension
Stage II Hypertension

Muscle
Serratus Anterior
boxer's
muscle
saw muscle

Action on
scapula

Action on
scapula
Abd
Protract

Upward
Rotators

Lower Depress

Downwar
Levator Scapulae
d
Rotators

Elevate

Downwar
d Rot

Retract

Rhomboids

Long
thoracic
C5-C7

Upper Elevate
Middle Retract,
Adduct

Upward
Rotators

Trapezius
monk's hood
musculous
cucularis

Innervati
on

Diastolic BP
80 mmHg
80-90 mmHg
90-100 mmHg
> 100 mmHg

Testing
procedure
in scaption

Affected in
Radical
mastectomy

Upper - Shrugs
Middle - Prone
arm lift
Lower superman
position 145 deg
abduction

CN XI
C3, C4

Dorsal
Scapular
Nerve(C
5)

Radical neck
dissection

Shrug and Lift

Off

Prone arm lift

and Lift Off

UE Muscle Synergy
Vestibular Tests and Lesions
BPPV
Rhombergs
Tandem Rhombergs
Single Leg Stance
Ambulation

Vitamins & Deficiencies

(-)
(-)
(-)
Normal

UVL
( + ) in acute
(+)
(+)
Wide base

BVL
( + ) in acute
(+)
(+)
Wide base

Vitamin
Deficiency
A
Retinol
Night Blindness (Nyctalopia)
B1
Thiamine
Beriberi
B2
Riboflavin
Cheilosis (Scarring of mucus membrane)
B3
Niacin
Pellagra
B6
Pyridoxine
Dermatitis
B12
Cyanocobalamine Pernicious Anemia
Folate
Folic Acid
Macrocytic Anemia
C
Ascorbic Acid
Scurvy
D
Cholecalciferol
Osteomalacia (Adult), Rickets (Children)
E
Alpha tocopherol RBC Hemolysis
K
Minaquinones
Hemorrhagic Manifestation
Soluble: ADEK
**B12: Best absorbed in ileum
**Folate: Decrease risk for spina bifida

**Fat