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Blue Book 6 Edition

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463 views310 pages

Blue Book 6 Edition

Blue book

Uploaded by

Deepak
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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= Physical Therapy COURSE MANUAL version 6.0 Raymond Siegelman DPA fraternal etl am O08 Thomas Bianco Ee Heute Angelique Dirkes MBN y eyes Tt Lh em Edward Chavez COURSE MANUAL CONTENTS PAGE PREFACE ...sseceseeeeeee CONTENT OUTLINE STUDY TACTICS FOR EXAMINATION OF THE PATIENT/CLIENT «.....2.20++ 1. Musculoskeletal System ......2.2++ 1 Neuromuscular and Nervous Systems ML Cardovascular/Pulmonary and Lymphattc Systems. IV. Integumentary System... ee. sees ees V. Other Systems (MetabolicfEndoctine, Gastinesoa and Gentinay) and System Interactions weal STUDY TACTICS FOR EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS. . 1. Musculoskeletal System .......+. fe kon nairezeianes ete Neuromuscular and Nervous Systems «2... WCardovasculafPulmonary and Lymphatic Systems IV, Integumentary System... ..eeceeeseees Ve Othe Systems (Metbolictndoctine, Casta intestinal, 2d Genoa) ‘STUDY TACTICS FOR INTERVENTION 1. Musculoskeletal System ....2.0. 000 1, Neuromuscular and Nervous Systems... ML Cardiovascular/Pulmonary and tymphatic Systems IN. Integumentary System. a . V. Other Systems (Metabolfindcing Gastrointestinal, and Genitourinay) and System Interactions .....+- ‘STUDY TACTICS FOR EQUIPMENT, DEVICES, AND THERAPEUTIC MODALITIES «+--+ +++ |. Equipment and Devices . os 1, Therapeutic Modalities. ‘STUDY TACTICS FOR SAFETY, PROTECTION, AND PROFESSIONAL RESPONSIBILITIES; RESEARCH AND EVIDENCE-BASED PRACTICE . 1. Safety, Protection, and Professional Responsibilities... cecseveeceeeeseeseecs HI, Research and Evidence-Based Practice «22. sesesseeeeveetseetecteeeeen oot ‘STUDY STRATEGIES 1. General Study Strategies . MENTAL TRAINING FORTESTING SUCCESS ..-.0+.+eeeceeceeseeeeeeeonnaees COMPUTER-BASED EXAM STRATEGIES «2.0002 es0cseeseeecreeeeneee iv CONTENTS FOUNDATIONAL SCIENCES...» L Anatomical Position .. . I Upper Quarter Functional Anatomy Ill, Lower Quarter Functional Anatomy .. IN. Spinal Functional Anatomy... \. TM Functional Anatomy vi vi 38 2 38 7 54 58 Repel Nerous Sem». I. Cranial Nerves «4. 61 62 IK Levers... Xetra Landmars Xi. Sanding Posture Plumb Line Description) Xil. Capsular Patterns... ais ve becca 6A | XIII, Arthrokinematics Sabie se nero. + . pence BS XIV, Muscle FiberTypes 0 ..secevcceeteessarteses 1 aaazeanene wake rosie OB | XV. Gait . . 4 XVI. Pathology one 105 XVII. Physiology... ... boceteottees eo 108 XVIII. Pharmacology... AS ib va eset eestecones TTD MUSCULOSKELETAL CONDITIONS, EXAMINATION, AND INTERVENTION 5.0421 ce0.reeee10127 Upper and Lower Quarter Screening Exem .. weteeenees I. Examination Procedures . IIL Special Tests for Upper an Lower Quarter Screening IV. Selected Pelvic Girdle Dysfunctions ....-. wee \.__Diferenal Diagnosis and Treatment of Common Disorders VI. Occupational Biomechanics and Ergonomics... - cote VILL Imaging .....seeeeeeeceees NEUROMUSCULAR CONDITIONS, EXAMINATION, AND INTERVENTION 1. Selective Terminology «.. Il. Cerebral Vascular Accident Ui Traumatic Brain Injury «+... 2.0.00 IV. _Diflerential Diagnoss of Selec Neurological Problems. V. Pain Syndromes «+++ cenateeeeeeeee eae Vi. Selected Neuroherapeutc Techniques... VIL. Growth and Development in Early Childhood Vill. Spinal Cord injuries... IX. _Paychological Conditions and Terms CARDIOPULMONARY/LYMPHATIC CONDITIONS, FXAMINATION, AND INTERVENTION L- General Pulmonary Terminology «....:0. 0020+ Il. Selected Pulmonary Conditions . Testing Values « IN. ody Posioning and Pulmonary Considerations CONTENTS V. Selected Chest Physical Therapy Techniques 204 Vi. Cardiovascular Considerations and Terminology : 205 Vil. Cardiac Conditions 207 Vall, Vital Signs 2 209 IX. Diagnostic Testing 210 X. Cardiac Rehabilitation 201 Xi Lymphatic System. i ee 213 INTEGUMENTARY SYSTEM CONDITIONS, EXAMINATION, AND INTERVENTION 2.0040 215 1. Examination 215 Il, Interventions 216 IIL Wound Healing ant 218 NM. Bone Healing . cee 1 220 \. Pressure Ulcers (Bedsores, Decubitus or Trophic Uless) .. 220 VL Arterial insuticiency Ulcers : 220 VIL Venous insufficiency Ulcers . : . 221 Vill. Diabetic Foot Ulcers se 221 IX Bums wieeese cil : : 21 OTHER SYSTEMS CONDITIONS, EXAMINATION, AND INTERVENTION . Endocrine/Metabolic Disorders hc ML Hepatic/Bliary Disease IV. Gastrointestinal Disease Screening V. Genitourinary System VI. Obsteries and Gynecology/Female Reproductive System Vil. Bariatrics EQUIPMENT, DEVICES, AND THERAPEUTIC MODALITIES . 1 Ambulatory Aids and Wheelchairs Il, Orthotics I, Prosthetics IV. Therapeutic Modalities ADMINISTRATION, HEALTH CARE ROLES, DOCUMENTATION, LEGAL ISSUES . 1. General Information I. Documentation and Records Hl, Quality Assurance (QA) IV. Policies and Procedures Manual Ve Budgets Vi. Roles of Physical Therapists VIL. Other Physical Therapy Staff Mill. Facility/Personnel Management 1X. Medicolegal Considerations X. Third-Party Payers/Insurance —_- °° vi CONTENTS XI. Accrediting and Regulatory Agencies 282 XIL_ Practice Environments... : 282 285 Appendix A: Documentation Guidelines 292 ‘TEACHING/LEARNING « . General information oe 292 I. Media. : os 294 I. Principles of Leaming for Patents. ore 294 I. Teachinga Skill .......20.- 297 fe 298 \. Behavior Modification Techniques . 299 RESEARCH AND EVIDENCE-BASED PRACTICE 1 Terms -....+ : Ih Research Considerations . si 300 IN, Evidence-Based Practice : wee - 301 RECOMMENDED REFERENCES . PREFACE This Course Manual is intended to be used in conjunction with TherapyEid's Licensure Examination Preparatory Course for Physical Therapists. ‘The Exam Review Material portion is a condensed summary of certain content areas and basic definitions that may be germane to the National Physical Therapy Examination (NPTE). The National Physical Therapy Examination Review & Study Guide by O’Sullivan and Siegelman is also part of the course material and provides a more extensive review of information. We also urge you to consult your own notes and other targeted texts mentioned in the References of the Review’ & Study Guide if you have discerned specific weaknesses in your academic preparation. Do not be surprised or alarmed if some values presented in this Course Manual, Review & Study Guide, or other sources differ slightly. ‘The computer-simulated examinations in the Review & Study Guide with answers, rationales, and reasoning strategies provide means to look at and manipulate basic information as applied to various scenarios and selt- diagnose academic and clinical strengths and weaknesses. ‘The Study Tactics area very important element of this Course Manual. They help you to narrow the focus of exam preparation and to properly expend your time and energy in the most efficient way. Please use this information in Conjunction with the NPTE Content Outline to construct a blueprint for your individual preparation. ‘The Computer Exams and Study Strategies should provide guidance prior to and while at the testing center and when tackling the individual NPTE questions. Everyone has different needs and leaming styles. We hope this smorgasbord of information and practice ‘examinations leads you onto the pathway of success for the NPTE. Raymond Siegelman, PT, DPT, MS President Therapy CONTENT OUTLIN ‘The National Physical Therapy Examination (NPTE) is designed to determine safe and competent entry-level physical therapy practice in the United States. The test consists of 250 multiple-choice questions, but only 200 of the {questions will count. The other 50 are being tested for validity. For each question, select the best answer out of the four possible choices. You will not know which questions count, so be sure to answer them alll Time allotted for the examination is 5 hours. There are scheduled breaks or rest periods, which are optional. You must submit your answers after you complete each block of 50. Once submitted, the answers cannot be changed or revisited. Ifyou ate to fatigued to process the information on the computer screen, we strongly urge that you test for a minute or two. ‘Questions appear in random order. The outline is based on the 200 questions that are counted for grading purposes. ‘The information presented below has been adapted from the NPTE Content Quiline effective 2013-2017, Copyright 2012, Federation of State Boards of Physical Therapy. PHYSICAL THERAPY EXAMINATION 50-56 Total Questions (26.5% of the NPTE) + Testsimeasures and their application * Knowledge of anatomy and physiology related to testsmeasures * Movement analysis including gait deviations, prosthetic/orthotic gait deviations, rib cage excursion (pulmonary onl), fiction, pressure, shear, and scar integumentary only) + PT ultrasound imaging (musculoskeletal only} + Joint biomechanics (musculoskeletal only) Number of Patient/Client Examination Questions by System 1. CardiovascularPulmonary and Lymphatic 9-10 questions Musculoskeletal 21-23 questions Mi. Neuromuscular 16-17 questions 1, Integumentary 3-4 questions a 2. EXAM REVIEW MATERIAL V. MetaboticfEndocrine VI. Gastrointestinal Genitourinary System Interactions © questions © questions 1-2 questions O questions Foundations for Evaluation, Differential Diagnosis, and Prognosis, 60-70 Total Questions (32.5% of the NPTE) ‘© Knowledge of conditions/diseases and pathophysiology including prognosis Differential diagnosis, Pharmacological management -Medicalsurgical management including lab values, diagnos tic imaging, and other tests Impact of ciscases/condltions or comorbidities where primary impact is on more than one system Psychiatric or psychological conditions (system interaction involvement only) ‘© Diseases/conditions affecting connective tissue (musculoskeletal only) Number of Evaluatien, Differential Diagnosis, and Prognosis Questions by System Cardiovascular/Pulmonary and Lymphatic, Musculoskeletal Neuromuscular Integumentary Metabolic/Endocrine Gastrointestinal Genitourinary VIL. System Interactions Interventions 56-64 Total Quest ns (28.5% of the NPTE) 11-13 questions 17-18 questions 15-16 questions 3-4 questions 5-6 questions 2-3 questions 1-2 questions 6-8 questions ‘+ PT interventions and their applications for rehabilitation, health promotion, and performance + Anatomy and physiology related to PT interventions, daily activities, and environmental factors * Complications or secondary effects from PT or medical interventions ‘© Motor control and motor learning related to PT interventions (neuromuscular system only) Reflux prevention, bowel programs (gastrointestinal only) ‘© Genitourinary interventions including biofeedback, bladder programs, and pelvic floor retraining Number of Intervention Questions by System 1. CardiovasculayPulmonary and Lymphatic I, Musculoskeletal Neuromuscular leegumentary Metabolic/Endocrine . Gastrointestinal VIL. Genitourinary VIII, System Interactions 11-12 questions 21-22 questions 17-19 questions 3-4 questions 2-3 questions 1-2 questions 1-2 questions O questions CONTENT OUTLINE 3 Equipment, Devices, Therapeutic Modalities 11-14 Total Questions (6% of the NPTE) Selection, application, and adjustment as well as indications, contraindications, and precautions of devices land equipment that assist in patient management : Prosthetic devices, Orthotic protective, supportive Indications, precautions, and contraindications for modality use Physical agents including thermal modalities, electrotherapy, iontophoresis, phonophoresis, ultrasound ‘Mechanical modalities such as traction devices Biofeedback Pressure dlferential modalities (intermittent compression) Diathermy Number of Nonsystem Questions Equipment and Devices 5-6 questions Therapeutic Modalities 6-8 questions Safety and Protection; Professional Respot ies; Research 11-14 Total Questions (6.5% of the NPTE) Factors influencing injury prevention and safety Functions, implications, and precautions related to catheters, monitoring devices, IV lines, and tubes, Emergency preparedness including CPR, first aid, and disaster response Infection control including universal/standard precautions, sterile technique, and isolation Signs and symptoms of neglect, and physical, sexual, and psychological abuse Standards of documentation Patien/client rights including IDEA, ADA, and HIPAA Legal issues including sexual harassment and OSHA Roles and responsibilities of the PTA, support staff, and other health care professionals Research design and interpretation including quantitative and qualitative means and hierarchy of evidence ‘Measurement science including validity and reliability Statistics including ANOVA, test, chi square, likelihood ratio, and correlation coefficient Data collection techniques such as surveys and direct observation Number of Nonsystem Questions Safety and Protection 4-5 questions Professional Responsi ies 3-4 questions Research and Evidence-based Practice 4-5 questions ee STUDY TACTICS FOR EXAMINATION OF THE PATIENT/CLIENT |, MUSCULOSKELETAL SYSTEM 1, Extensive knowledge of special tests and measures to assess the musculoskeletal system is a requirement. This includes all tests actoss the age span. The anatomical and physiological basis forthe tests and measures right be stressed in some questions. Straightforward anatomy or physiology questions that are not applied 10 pationt examination or intervention will not be part of the exam, An example would be origins or insertions ‘of muscles, 2, Decisions about which tests are appropriate based on the information presented in the question, which tests are best to use (or not use), and perhaps which order to apply the tests are considerations. According to current best evidence, what are the outcome measures othe more commonly used tests? 3. Special tests are worth knowing. These could include such entities as Lachman's test, Finkelstein’ test, neural tension tess (e.g, slump test, straight leg raising [SLR)), flexion in abduction and external rotation (FABER) test, Ober’ test, McMurray’s test, drop arm, drawer signs, open can, and so forth. The Review and Study Guide has concise sections summarizing most ofthe special tests. ‘a. Muscle testing and goniometry techniques are not sessed, Use of manual muscle test (MMT) and ROM results in diagnosis or treatment planning could be very important. Have a sense of the mechanisms or forces that could result in knee, spine, or other ligament or bony injuies. . Examination of the spine and TM) may require some special attention in terms of ultimate manual therapy intervention. Know about normal and abnormal end-feels of peripheral joints i. Screening for nerve root disorders, pain distribution, and referred pain patterns from other systerns that ‘may mimic musculoskeletal disorders, scoliosis, and capsular tightness may be challenging. 4, Briefly review examination of some childhood disorders such as hip dysplasia, slipped capital femoral epiphysis, Osyood-Schlatter disease, and others, 5, Are you able to understand the mechanism for or recognize various hand or finger deformities? (mallet finger, swan neck deformity, etc.) 6. There may be a question on PT ultrasound imaging of the musculoskeltal system including connective tissue, Ultrasound imaging is new to the NPTE. 7. Movement analysis. a. What movement deficit may result from an injury or impairment? The converse might be, given the movement deficit, what would be the most ikely injury or mechanism of injury? b. Identifying substitution or compensatory mations or positions based on muscle or joint dysfunction. What is the result if motion is restricted by contracture or deformity Think of such things as lordosis, scoliosis, deviated mandible, rotated pelvis, hip flexion contracture, arthritis of the hands or feet, and so on. cc. How might tenodesis substitute for a lack of muscle activity? dd. How might the musculoskeletal system be impacted if there is an injury affecting nerves or blood vessels? fe. Gait. (1) Describe the gait eycle, including the pattern of activity of the major muscle groups during gait and stance (2) What role do the various muscles play during gait and quiet stance? @) What factors might determine household versus community ambulation status? (4) What impact might muscle weakness, joint contracture, muscle tightness have on gait? (6) Know a litle bit about footprint analysis as a tool to examine gait o foot deformities. (©) What are the gait deviations associated with specific orthopedic conditions (e.g, Trendelenburg gait) and, by extension, Trendelenburg test? STUDY TACTICS FOR EXAMINATION OF THE PATIENT/CLIENT 5 8 Joint biomechanics, structure, and function. ‘a, What are the directions of forces or positions that may cause injury or impairment to joints? What are the shapes and features of joints and supporting structures that dictate functionality or direction for joint ‘mobilization? This includes vertebral and temporomandibular as well as peripheral joints. Don't forget the hands and feet. . b. Know something about kinetic chains and the intertelationship of hip, knee, and ankle/foot problems. For example, is there a relationship between hip antetorsion, tibial torsion, toeing in or out, varus/valgus problems at the fot, and so on? Cc. Joint integrity testing is worth reviewing, This includes apprehension/provocation tests, compressionvdistraction tess, drawer tests, joint play (glides, rolls, end-feels, capsular testing. 4. Pay particular attention to ligament or capsular tightness or laxity. There will probably be less emphasis on bursae, cartlage, and discs. ‘STUDY STRATEGIES FOR MUSCULOSKELETAL SYSTEM EXAMINATION 1, There are 21-23 questions related to the musculoskeletal system on the NPTE. There isa lot to study; however, if you feel confident in this area, be selective in what you choose to review. The preparatory course and simulated examinations will help to diagnose your strengths and weaknesses and focus your studying. ‘The musculoskeletal questions (examination, diagnosis, and intervention) account for nearly one-third ofall INPTE questions! 2. Focus on knowledge of orthopedic tests and measures. Be able to appropriately select and prioritize the use of tests 3. The addition of PT ultrasound imaging or other graphics adds an additional dimension to these types of questions. 4. Movement analysis and joint information are the basis of much orthopedic examination, Questions involving this Information may be challenging and require in-depth analysis. if you have a strong background in anatomy/kinesiology, perhaps you can spend less time studying this material 5. While gait and gait analysis cover an extensive amount of information, the NPTE emphasis probably will be minor. 6. There is an element of evidence-based practice associated with these musculoskeletal examination questions. The Orthopedic Clinical Practice Guidelines in the Review and Study Guide and perhaps some clinical prediction rules (eg., Ottawa ankle and knee rules and others) might be of some help. | NEUROMUSCULAR AND NERVOUS SYSTEMS 1. Be aware of the common examination findings associated with stroke, spinal cord injury, Parkinson's disease, cerebral palsy, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Down syndrome, traumatic brain injury, and a host of other common neurological entities that PTs might encounter, 2. Review test/measures of balance and fll risk. Include vestibular testing. 3. What are the different manifestations of left and right cerebrovascular accident (CVA)? a. Given a certain arterial lesion inthe brain, what would you expect to find? b. Given set of symptoms, what artery might be affected? 4. Know how to assess tone, especially related to posture or positioning, 5. Know a bit about pain scales as well as perceptual deficits such as apraxia, agnosia, and unilateral neglect. What are visual deficits associated with neuromuscular conditions such as hemianopsia or diplopia? 6. Know something about the Glasgow Coma Scale and the Rancho Los Amigos Scale. Knowledge of common. functional, functional balance, and locomotion tests is expected. Some examples are POMA, Berg Balance, Timed Up and Go, Functional Reach, Mini Mental State Exam, FIM, SF-36, and WeeFIM. There might be a question related to newborn, preterm, or infant examination. Certainly know the APGAR screening test. OF Course, some of these tests impact more than one system. _ °° °° °°. 6 EXAM REVIEW MATERIAL 7. Naturally, you should know about testing of cranial and peripheral nerve problems. Be able to interpret dermatomal, myotomal, sensory, and reflex anomalies. 8. Differentiate berween expressive, receptive, and global aphasia. 9, Neuroanatomy. ’ ‘a. A comprehensive background in peripheral nerve distribution and motorisensory functionality, cranial nerve function (including various branches of cranial nerves), and major spinal tracts such as spinothalamic, corticospinal, dorsal columns, corticobulbar, dermatomes, and myotomes is very useful. | b. Brachial plexus and specific spinal level nerve root functionality is also important. ‘€. Gross anatomy of major parts of the brain and functionality is a necessity to be able to provide context for a variety of clinical scenarios. d. In addition, a solid background in autonomic nervous system function can be important. 10. Neurophysiology. 1. Basic neurophysiology such as propagation of neural impulses, latency periods, fiber types, and soon is not very important; however, application of neurophysiology such as in nerve conduction velocity tests, neuropraxia, and EMG may be worth reviewing very briefly. 11. Pain mechanisms, including the Gate Theory, should be reviewed, 12. Reflexes and other basic neurological determinants, ‘a. Reflexes and reflex testing, sensory testing, deep tendon reflexes (OTRs), neural provocation, developmental milestones. These can include asymmetrical tonic neck reflex (ATR), symmetrical neck reflex (STNR), various righting reflexes, rooting/sucking, tonic labyrinthine, tactile defensiveness, and so ‘on. Know the major ones well! b. Neurological cognition, perception, awareness, memory, arousal level testing is worth reviewing. 13, Knowledge of movement analysis associated with spasticity, flacciity, rigidity, and cerebellar dysfunction is ‘worth knowing, This could be related to gait, balance, or coordination. ‘STUDY STRATEGIES FOR NEUROMUSCULAR AND NERVOUS SYSTEMS EXAMINATION 11. Focus on selectionfprioritization and outcome measures of appropriate tests and measures during systems review and formal examination. What isthe relevance ofthe information for differential diagnosis and intervention? 2. Concentrate on the major neurological problems seen by PTs. 3. This category may include examination of adults as well as children or infants. Ill, CARDIOVASCULAR/PULMONARY AND LYMPHATIC SYSTEMS 11. Be familiar wth the norms for vital signs (adult and pediatric), including how and winere to assess peripheral pulses. 2. Know a bit about heart sounds and basic electrocardiographic (ECG) changes and the implications for intervention. Can you recognize premature veniricular contractions (PVCs), Fwave changes, S-T segment changes, sinus bradycardia, or conduction anomalies? 3. Do you understand the physiological implications of exercise parameters for the cardiovascular and pulmonary systems such as target heart rate, ratings of perceived exertion, exercise tolerance test results, jection fraction, anginal pain, ambulatory endurance, and so on? 4, You should be pretty comfortable classifying breath sounds (ales, wheezes, etc), breathing patterns, and other observable signs such as sputum color, diaphoresis, capillary filling, nail bed and lip color, and so on. 5. Know about the musculature that affects breathing and movernent of the thorax such as the diaphragm, intercostals, stemocleidomastoid, and others. 6. Anatomy. ‘a. The locations of the lobes of the lungs. b. Chambers of the heart and the valves. STUDY TACTICS FOR EXAMINATION OF THE PATIENT/CLIENT 7 c. Coronary circulation, peripheral circulation, and circulation to the brain including name/location of major vessels. 7. Certainly consider the impact of such entities as spinal cord injury, circumferential burns, Parkinson's disease, and scoliosis on cardiopulmonary function. . 8. Know little bit about tests that determine blood flow such’as Doppler ultrasound or even Doppler ‘echocardiography. STUDY STRATEGIES FOR CARDIOVASCULAR/PULMONARY AND LYMPHATIC SYSTEMS EXAMINATION 1. Primary stress should focus on the selection and performance of various tests and meaningfulness of signs _and symptoms in order to make judgments about differential diagnosis, prognosis, and intervention. These ‘questions can be quite challenging. A thorough understanding of physiology and exercise physiology is important. Anatomy is of secondary importance. 2, There are no lymphatic physical therapy examination questions. 1V, INTEGUMENTARY SYSTEM. 1. Anatomy. a. Layers of the skin and structures associated with the layers such as hai follicles, sweat glands, etc. 2. Physiology of the integument in terms of body temperature regulation, barter to infection, and the healing process. a. Skin color, temperature, appearance, nail shape, hai distibution, 3._ Its very important to be able to differentiate various kinds of ulcer (rteriavenous}, burns, and other skin lesions, scars, and wounds. 4, How does one determine the depth, circumference, or tage of healing of a wound or burn? Do you know the procedure for culturing a wound? 5. Can you determine the percentage of a burn in an adult and child 6. Screening for skin cancer such as melanoma is well worth knowing! 7. Be able to determine if pressure, shear, or friction are having an impact on the wound or scar formation. ‘Thus, what positions or movements need to be minimized or avoided? ‘STUDY STRATEGIES FOR INTEGUMENTARY SYSTEM EXAMINATION 1. Differentiating and assessing various integumentary conditions are most important. 2, There are just a few questions (3-4) in this area. V. OTHER SYSTEMS (METABOLIC/ENDOCRINE, GASTROINTESTINAL, AND GENITOURINARY) AND SYSTEM INTERACTIONS 1. Basic anatomical and physiological knowledge of the male and female genital and reproductive systems, 2, Pelvic floor muscle assessment. 3. History taking including pain, bleeding, difficult urination, sexual dysfunction, substance abuse, and so on. ‘STUDY STRATEGIES FOR OTHER SYSTEMS AND SYSTEM INTERACTIONS EXAMINATION 1. There are only one or two examination questions on other systems, and questions deal only with the ‘genitourinary system. Budget your time wisely. 2. There are no examination questions in the area of system interactions. STUDY TACTICS FOR EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS I. MUSCULOSKELETAL SYSTEM 11. Review and be thoroughly familiar with the major pathological conditions affecting the musculoskeletal system actoss the lifespan. These would be conditions most likely to be seen by physical therapists. There are many. 2. What ae the signs and symptoms, characteristics, imaging findings, and relevant laboratory data regarding each? 3. Certainly collagen and connective tissue disorders deserve your attention. This includes all forms of arthritis, fibromyalgia, chronic fatigue syndrome, systemic lupus erythematosus (SLE), Lyme disease, Paget’ disease, capsulitis including capsular pattems, and so on. 4. Degenerative conditions might include osteoporosis, spondylosis, spinal stenosis, chondromalacia, and others. 5, Repetitive stress syndrome such as carpal tunnel, epicondylosis (tennis elbow), de Quervain’s syndrome, Osgood Schlatter disease, 6. Trauma or stress-related sprains (especially knee and ankle), strains, back (disc, facet, malalignment), neck ‘whiplash, torticolis) and TMJ problems, foot disorders and handfinger disorders, bursitis. 7. Posture-related problems such as scoliosis, kyphosis, lordosis, leg-length discrepancy, thoracic outlet syndrome. 8. With full knowledge of the myriad of musculoskeletal-related pathologies, be able to differentiate among ‘them and make a diagnosis based on a scenario involving a set of signs and symptoms or other information such as mechanism of injury, night pain, etc. The converse might be true as well. Given a diagnosis, what are likely signs and symptoms? 9. Please consider referred pain patterns from other systems—Gl, GU, cardiovascular 10. What are the common medical or surgical procedures associated with all of the conditions? For example, is the patient a candidate for a total joint replacement Will gold therapy be effective? 11. What are the effects, side/adverse effects, and implications forthe physical therapist or patientclient being administered steroids, NSAIDS, DMARDS, aspirin, gold therapy, muscle relaxants, and anti-osteoporosis agents? ‘STUDY STRATEGIES FOR MUSCULOSKELETAL SYSTEM EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS: 1, There are a substantial number of questions (18) in this area. 2. Focus on entities most commonly seen by physical therapists. Limit study on such things as bone tumors, metabolic dysfunction, and ather areas of peripheral concem for PT. 3. Using a regional approach to prepare (foot, ankle, leg, knee, thigh, hip, pelvis, shoulder, elbow, wrist, hand, ‘TM, spine, and so on) might be helpful. When rereviewing you may be able to concentrate on a region or ‘two that gives you the most trouble. Remember, everyone has his/her own particular strengths and weaknesses. 4, There might be a question regarding which imag ‘You might be asked to identify something from pharmacology. Il, NEUROMUSCULAR AND NERVOUS SYSTEMS 11. As mentioned in the Study Tactics for Examination ofthe Patien/Client, you must know the signs, symptoms, ‘and characteristics of nervous system conditions of the CNS, PNS, and autonomic nervous system that are most commonly seen by physical therapists. ig technique is best to gather information about a situation. ray, CT scan, or MRI. You must give some thought to STUDY TACTICS FOR EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS 9 2, Ensure that you review blood supply (ischemia) deficiencies to the central nervous system and how the patient might be affected. isthe primary deficiency balance, communication, visual disturbance, cognition, ‘motor, sensory, reflex? Its a sure bet you will be asked some CVA questions, Spend ait time on perceptual problems such as apraxia, agnosia, igure-ground, unilateral neglect, and so on, What are the outcomes if a major tract of the spinal cord is affected? Certainly spend time reviewing peripheral nerve lesions and resultant sensory and motor deficits. 6. Consider pediatric conditions and developmental delay and the impact on reflexes, tone, equilibrium, gait, Posture, cognition. What imaging results will help you determine the neuromuscular problem? There may be a question on imaging results such as MRI or CT scan. 8. Given all the signs, symptoms, and characteristics, you need to be able to make differential diagnoses related to the nervous system. Conversely, you might be given a diagnosis and asked to select a set of symptoms that would be expected to go with that diagnosis. 9. Can you select an appropriate or best prognosis for the patient given the scenario information? Don't forget to factor in any comorbidity if given as par of the question. 10. Can you select the best ireaiment decisions in terms of overall management relative to functional goals and strategies? 11. There may be a question or two related to possible medical, pharmacological, or surgical intervention related to a neuromuscular disorder and how this might affect PT intervention or management. For example, a side effect of many Parkinson's disease medications (L-dopa, Sinemet) is dyskinesia. Tremor and paucity of ‘movernent may be improved with medication; however, the trade-off is choreiform movements. What is the possible impact on the patient functionally or psychosocially that you must consider as a PT? Consider the Use of opioid narcotics for acute pain (morphine, hydrocodone, Percodan, etc.) or chronic pain (Fentanyl, the use of non-narcotics such as acetaminophen (Tylenol), the use of muscle relaxants and anti-spastcity agents such as Valium, Flexeril, Norflex, and the use of Baclofen or botulinum toxin specifically for spasticity STUDY STRATEGIES FOR NEUROMUSCULAR AND NERVOUS SYSTEMS EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS 1. This i a significant aspect ofthe exam; spend time in this area if itis a perceived weakness. You need a sound foundation in order to solve the problems. 2. Neuro questions tend to be less concrete than orthopedic questions. You must be on your toes in terms of evaluative and analytical reasoning skills. Clinical judgment could be an important factor in selecting the best option. 3. Ifyou have had litle clinical experience in adult or pediatric neurological rehabilitation or habilittion, these | {questions can be quite challenging. Budget your time appropriately. Work hard in this area. Ill, CARDIOVASCULAR/PULMONARY AND LYMPHATIC SYSTEMS Be aware ofthe characteristics, signs, and symptoms of the usual cardiac, vascular, lymphatic, and pulmonary disorders seen by physical therapist, 2, Cardiac: congestive hear failure, angina, electrical conductivity disorders, myocardial infarction, coronary artery disease. Vascular: hypertension, arterial disease (arteriosclerosis, Raynaud's disease) and ulcers, venous disorders (deep venous thrombosis {DVTI, venous insufficiency) and ulcers, lymphatic (adenopathy, lymphangits, lymphatic disease secondary to surgery, radiation, infection, etc.). c. Pulmonary: pneumonia, tuberculosis, all types of chronic obstructive pulmonary disease (COPD), cystic. fibrosis, trauma including flail chest, pneumothorax, hemothorax, disorders secondary to spinal cord injury (SCI, Parkinson's discase, scoliosis, circumferential burns. 2. Given a scenario with diagnostic information, be able to identify the correct cardiac, vascular, pulmonary, or lymphatic diagnosis, 10 EXAM REVIEW MATERIAL, ‘a. Consider arterial blood gases (ABGs), oxygen saturation via pulse oximeter, pulmonary function tests {PFTS), pain distribution, sputum, cough, edema, fatigue, perceived exertion, ECG, imaging result, vital signs, heart sounds, Be familiar with the norms for vital signs (adult and pediatric); laboratory information such as blood gases, blood values such as hematocrit, white blood cell (WBC), and red blood cell (RB. ‘What isthe relevance of these results forthe patient/lient mentioned in the question scenario? What values are normal? Abnormal? 3. Be able to caalesce all ofthe information to select the most appropriate prognosis or treatment decisions. Consider comorbidities. 4, Though probably not an exam emphasis, don’t forget to review pediatric pulmonary and cardiovascular disorders. 5. Medical and surgical management ofthis population is worth reviewing. Pharmacological management of Patients with pulmonary or cardiac/vascular conditions can play a big role in PT decision-making, Surgical management such as the coronary artery bypass grafting (CABG) procedure has implications for the PT as well 6. Consider the setting where the patient is being seen—ICU, CCU, acute care, rehab, home, etc. STUDY STRATEGIES FOR CARDIOVASCULAR/PULMONARY AND LYMPHATIC SYSTEMS EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS 1. These types of questions can be quite challenging. They require detailed knowledge and the ability to apply, evaluate, or analyze that knowledge. 2. This material requires serious review. Many PT exam candidates don’t have an interest in cardiopulmonary issues. In some cases, PT programs may not overly emphasize this area. It will be costly if you don't put in the time, There can be 11-13 questions in this area. IV, INTEGUMENTARY SYSTEM 1, The primary focus should be on the characteristics of various types of ulcers (arterial, venous, pressure, diabetic), burns, skin cancer especially melanoma, skin disorders such as dermatitis and wounds, and skin infections. Toss in methicillinresistant Staphylococcus aureus (MRSA) to cover all the bases. 2. Based on the appearance of the lesion and other descriptors, be able to diagnose the type or depth of lesion. Is ita venous or an arterial ulcer? Is ita superficial partial thickness burn versus a deep parial-thickness burme 3. Given a particular situation, what isthe best course of action for the patient? What is the prognosis and ukimate outcome? Consider the age ofthe patient, medical condition or comorbidity, extent ofthe burn or wound, nutritional status, or any other complicating factors. 4, Consider the medications (topical or systemic) being used, Has the wound or bum been surgically debrided? STUDY STRATEGIES FOR INTEGUMENTARY SYSTEM EVALUATION, DIFFERENTIAL DIAGNOSIS, AND. PROGNOSIS 1. This integumentary category amounts to alittle over 2% of the exam questions, 2. Solid understanding of relevant diseases/conditions is necded to establish a plan of care. \V. OTHER SYSTEMS (METABOLIC/ENDOCRINE, GASTROINTESTINAL, AND GENITOURINARY) ‘AND SYSTEM INTERACTIONS ‘Awareness of the laboratory values for diabetes and other major endocrine deficiencies is worthwhile, 1. Metabolic/endocrine: emphasize diabetes as well as adrenal gland disorders (Cushing's disease, Addison's disease); thyroid and parathyroid disorders; metabolic disorders such as dehydration; gout, alkalosis/acidosis, ‘metabolic bone disease such as Paget’, and osteoporosis. Metabolic syndrome can fallin this category or in. ‘cardiovascular. Know what itis and the PT ramifications. ‘a. What are the characteristics, signs, symptoms, and relevant laboratory findings? Referred pain patterns? 'b, How isthe patient being managed medically? STUDY TACTICS FOR EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS. 11 cc. Can you diagnose the problem based on the information given? Can you implement an appropriate plan of care or select the best prognosis for a patient problem? 2, Gastrointestinal: gastroesophageal reflux disease (GERD), ulcers, appendicitis inflammatory bowel disease such as Crohn's disease, diverticular disease, pancreatic disorders, irtable bowel syndrome, gallbladder disorders, liver disorders such as hepatitis or cirrhosis, and cancer. Bowel disorders and bowel programs: associated with spinal cord injury or developmental disorders in children worth a look. Can you differentiate among various Gl problems? b, What are the referred pain patterns? How will a Gl disorder impact treatment planning and prognosis for the PT? 3. Genitourinary: kidney disorders including traurna, bladder disorders such as infection, incontinence ofall types. Women's health issues may be part ofthe mix. Be able to dently the diagnosis based on characteristics, lab results, referred pain patterns, signs, and symptoms. '. Based on the diagnosis, establish an effective treatment plan and a realistic prognosis. Know something about bladder programs with spinal cord injuries and other relevant neurological conditions. 4, System interactions: ths is a broad category covering an indeterminate coupling of comorbidities e.g. diabetes and cardiac disease, obesity and hypertension, dementia and fractures), cancer, pregnancy, morbid ‘obesity, and psychiatric/psychological conditions. 1. Can you diagnose the problems and establish management priorities? What information might be available related to lab or imaging results? b. Are there any overriding psychosocial or psychiatric conditions that will temper PT management decisions? cow isthe patient being managed medically? What medi forthe PT? STUDY STRATEGIES FOR OTHER SYSTEMS EVALUATION, DIFFERENTIAL DIAGNOSIS, AND PROGNOSIS 1. Definitely be well informed about diabetes, incontinence, GERD, pregnancy-related problems, morbid ‘obesity, and common psychological/psychiatric problems such as depression, schizophrenia, conversion disorder, 2. Sorting out diagnoses/prognoses and setting reat ment priorities for patients with multiple physical andlor ‘mental problems or conditions that affect multiple systems can be extremely challenging and will require high levels of analysis, evaluation, and inferential reasoning, 3. These questions consitute over 15% of the NPTE. | OBSERVATION: Having prepared students for the licensure exam for nearly 25 years, it is not uncommon for an exam candidate o ask a TherapyFd instructor on-site or e-mail a request saying, “On what page can 1 locate the answer to a particular question?” Needless to say, many questions involve high-level problem solving, Sometimes the scenarios are unique. This requites the candidates to “think on their feet,” manipulate 1s are involved? What are the implications the information in the ster of the question, and arrive at a best answer. There may be many pages where relevant information might be located; however, the best solution needs to be derived from the candidate's thinking and be in agreement with what evidence in the feld is considered to be best. There may be no single page where the answer is spelled out in black and white, LMU 1 2 3. STUDY TACTICS FOR INTERVENTION ISCULOSKELETAL SYSTEM Many of the questions in this category might deal with application of musculoskeletal interventions for ‘orthopedic conditions commonly seen by physical therapists, Any setting (inpatient, outpatient, school system, or community) and pediatric up to fail elderly may be an element ofthe question. Be aware of possible contraindications or complications from the intervention as well as impact of the treatment on other systems. Expect quite a few questions dealing with manual therapy techniques forthe limbs, neck, spine, and TM). Specific mobilization directions and type (glide, roll, rotation, et.) oscillation grades; sot tissue mobilization, muscle energy techniques, end-eels, hand placement, and so on could be the emphasis. ‘Consider peripheral joint thrust and nonthrust procedures; appropriate spinal nonthrust and thrust. Don't forget about ankle‘foot problems with consideration of the entire lower extremity kinetic chain. Think about the knee/patellatibiafibula, or famurtibia mobilization. The wrist and hand might be targets as well, Review intervention considerations for sacroiliac, lumbosacral, innominate, and facet joint problems. Consider precautions and ADL implications. Implementation of appropriate postsurgical interventions for joint replacements (positioning, transfers, dos and don‘s), ligament repair (anterior cruciate ligamentiposterior cruciate ligament [ACL/PCL), and fracture stabilization, to name a few. ‘Common interventions postfracture. Think about the anatomy and blood supply, Colles’ fracture is always ‘worth a look. Don't forget about epiphyseal problems with youngsters. ‘Consider whether the problem is acute, subacute, or chronic. fs there a comorbidity (diabetes, pregnancy, ‘osteoporosis, GERD, cardiac) to factor in? a, What activites may be inadvisable? b. How often does one exercise? ‘Whats the impact of medication? ‘Whats the best position for exercise; what are the effects of weakness or tightness or how to counter deformity (torticollis? ‘e, How much weight bearing is allowed? 4. When can the patient return to work or athletics? Specific conditions that may be addressed: a. All forms of degenerative and rheumatoid arthritis and related disorders such as SLE, ankylosing spondylitis, spondylolysis, spinal stenosis, spondylolisthesis, and fibromyalgia. b. Osteoporosis ‘c. Sprains (especially the knee and ankle) and strains.

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