ABPTS PCS cheat sheet

Motor milestones: head control ~3-4 months, independent sitting ~6-8 months, cruising ~9-10 months, independent walking ~12-15 months.

Primitive reflexes (Moro, ATNR, STNR, palmar grasp) integrate by 4-6 months; persistence beyond 6 months suggests CNS dysfunction.

Piaget stages: sensorimotor (0-2 y), preoperational (2-7 y), concrete operational (7-11 y), formal operational (11+ y).

Bone mineral density peaks near age 30, then declines; women lose accelerated density in the first 5-7 years postmenopause.

Sarcopenia reduces muscle mass ~3-8% per decade after 30, accelerating after 60; strength loss exceeds mass loss.

Maximal heart rate estimate = 208 - (0.7 x age); resting HR decline and reduced max HR with aging lower exercise capacity.

Vision changes with age: presbyopia by ~45 y, reduced contrast sensitivity, delayed dark adaptation, increased glare sensitivity.

Fall risk increases with age-related declines in vestibular function, proprioception, and reaction time; gait speed <0.8 m/s predicts adverse outcomes.

Cardiac output = heart rate x stroke volume; Fick principle: VO2 = CO x arteriovenous O2 difference.

Normal resting values: HR 60-100 bpm, BP <120/80 mmHg, respiratory rate 12-20/min, tidal volume ~500 mL.

Vital capacity = inspiratory reserve + tidal + expiratory reserve volume; residual volume cannot be exhaled.

Muscle fiber types: Type I slow oxidative (endurance), Type IIa fast oxidative-glycolytic, Type IIx fast glycolytic (power, fatigable).

Length-tension relationship: maximal active tension near resting sarcomere length (~2.0-2.2 micrometers).

Force-velocity relationship: concentric force decreases as velocity increases; eccentric contractions generate higher force.

Upper motor neuron lesion signs: hyperreflexia, spasticity, positive Babinski, clonus; lower motor neuron: flaccidity, atrophy, fasciculations.

Normal joint end-feels: bony (elbow extension), capsular (shoulder rotation), soft tissue approximation (knee flexion).

Pattern recognition compares presentation to illness scripts; hypothetico-deductive reasoning generates and tests hypotheses.

Red flags warranting referral: unexplained weight loss, night pain unrelieved by rest, fever, progressive neurologic deficit, bowel/bladder change.

Sensitivity rules out disease when negative; specificity rules in disease when positive; choose test based on pretest probability.

Likelihood ratio positive = sensitivity / (1 - specificity); LR >10 markedly increases post-test probability, LR <0.1 markedly decreases it.

Vascular claudication pain is relieved by rest within minutes; neurogenic claudication is relieved by sitting or flexion.

Cauda equina syndrome: saddle anesthesia, bilateral sciatica, urinary retention, reduced anal tone - emergent referral.

Systemic causes of musculoskeletal pain include polymyalgia rheumatica, hypothyroidism, and metastatic disease; bilateral/girdle patterns raise suspicion.

Occam's razor favors one unifying diagnosis; Hickam's dictum allows multiple coexisting conditions when evidence demands.

Goniometry: measure passive ROM with stabilization proximal to the joint; document active and passive values plus end-feel.

Manual muscle testing grades 0-5: 3 = antigravity full ROM, 4 = holds against moderate resistance, 5 = normal against maximal resistance.

Deep tendon reflexes: biceps C5-6, brachioradialis C5-6, triceps C7, patellar L3-4, Achilles S1-2.

Dermatomes: C6 thumb, C7 middle finger, C8 little finger, L4 medial malleolus, L5 dorsum of foot, S1 lateral foot.

Sensation testing uses sharp/dull, light touch, and vibration; compare bilaterally and proximally to distally.

Special tests have limited diagnostic accuracy alone; combine with history and cluster findings to improve post-test probability.

Outcome measures should be valid, reliable, and responsive; document baseline and re-measure at defined intervals.

Vital sign screening before exercise: resting HR, BP, and oxygen saturation establish safety parameters for intervention.

Training specificity: overload, progression, and specificity govern adaptation; SAID principle states adaptation follows demand.

Strength gains: 60-70% 1RM for 8-12 reps builds endurance-hypertrophy; 80-90% 1RM for 3-6 reps builds maximal strength.

Aerobic prescription (FITT): 150 min/week moderate or 75 min/week vigorous; 3-5 days/week at 40-85% VO2 reserve.

Motor learning: practice variability and random practice improve retention and transfer more than blocked practice.

Neuroplasticity is driven by task-specific, repetitive, salient practice with sufficient intensity and adequate rest.

Progressive mobility: PROM, AAROM, AROM, then resisted; pain and tissue healing stage guide progression.

Outcome measurement should include body function, activity, and participation per the ICF framework.

Gait training: reduce weight-bearing as tolerated, progress assistive device from walker to cane to none as balance and strength improve.

Core ethical principles: autonomy, beneficence, nonmaleficence, justice, and veracity guide clinical decisions.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, voluntariness, and documentation.

Confidentiality is limited by duty to warn, mandated reporting of abuse, and court order.

Scope of practice defines permitted activities by licensure; delegating beyond scope creates liability.

Documentation should be timely, objective, and defensible; record skilled services, progress, and rationale.

Reimbursement models include fee-for-service, capitation, and value-based payment; documentation supports medical necessity.

Direct access allows evaluation/treatment without referral in many jurisdictions, with referral triggers for red flags or nonresponsive conditions.

Conflict of interest and gifts must be disclosed; patient welfare supersedes financial gain.

Levels of evidence: systematic reviews/meta-analyses > RCTs > cohort > case-control > case series > expert opinion.

PICO frames clinical questions: Population, Intervention, Comparison, Outcome.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence; a positive test in a low-prevalence population has lower PPV.

Number needed to treat = 1 / absolute risk reduction.

Internal validity is threatened by selection, measurement, and confounding bias; randomization reduces selection bias.

Statistical significance (p <0.05) does not equal clinical significance; consider effect size and confidence intervals.

Intention-to-treat analysis preserves randomization and reflects real-world effectiveness.