Egypt Physiotherapy Licensure Exam cheat sheet

Brachial plexus roots C5-T1; trunks: upper (C5-C6), middle (C7), lower (C8-T1); divisions occur anterior/posterior; cords named by relation to the second part of the axillary artery.

Musculocutaneous nerve (C5-C7) pierces coracobrachialis and becomes the lateral cutaneous nerve of the forearm; injury causes loss of elbow flexion and lateral forearm sensation.

Radial nerve runs in the spiral groove of the humerus; mid-shaft fracture causes wrist drop with sensory loss over the dorsal first web space.

Median nerve supplies thenar muscles via the recurrent branch; carpal tunnel syndrome spares the palmar cutaneous branch, so sensation over the thenar eminence is preserved.

Knee: the ACL resists anterior tibial translation and is taut in extension; the PCL resists posterior translation and is taut in flexion; the MCL is the most commonly injured knee ligament.

Hip abductors: gluteus medius and minimus (superior gluteal nerve L4-S1); a positive Trendelenburg sign indicates contralateral pelvic drop in stance on the affected side.

Shoulder elevation: 0-15 degrees from supraspinatus, 15-90 from deltoid, beyond 90 from scapulothoracic rotation in a 2:1 humeroscapular rhythm.

Close-packed positions: knee in full extension with lateral rotation, hip in extension with abduction and medial rotation, shoulder in abduction with external rotation.

Lever classes: first class = axis between load and effort (triceps at the olecranon); second class = load between axis and effort (calf raise); third class = effort between axis and load (biceps curl, most common in the body).

Muscle fiber types: type I is slow-twitch, oxidative, fatigue-resistant; type IIa is fast oxidative-glycolytic; type IIx is fast glycolytic with the highest force and earliest fatigue.

Length-tension relationship: active tension is maximal at optimal sarcomere overlap (about 2.0-2.2 micrometres) and declines when the muscle is shortened or overstretched.

Force-velocity relationship: concentric force falls as shortening velocity rises; eccentric contractions generate greater force than isometric, which exceeds concentric.

Energy systems: ATP-phosphocreatine lasts about 10 seconds; anaerobic glycolysis about 30 seconds to 2 minutes; oxidative phosphorylation dominates beyond 2 minutes.

Cardiac output = heart rate x stroke volume; Fick principle: oxygen consumption = cardiac output x arteriovenous oxygen difference.

Maximal heart rate is estimated as 220 minus age; moderate-intensity aerobic training is 40-59% of heart rate reserve using the Karvonen formula: target = resting HR + intensity x (max HR - resting HR).

Delayed-onset muscle soreness peaks 24-72 hours after unaccustomed eccentric exercise and is not caused by lactic acid accumulation.

Ventilatory thresholds: the first lactate threshold marks the intensity where blood lactate rises above baseline; the second marks the onset of rapid lactate accumulation near maximal steady state.

Training principles: overload, specificity, reversibility, individuality; strength gains in the first weeks come mainly from neural adaptation.

Inflammation: acute response is vasodilation, increased vascular permeability and neutrophil influx; chronic inflammation features lymphocytes, plasma cells and macrophages with fibrosis.

Healing phases: haemostasis (0-48 hours), inflammation (day 1-5), proliferation (day 5 to 3 weeks), remodelling (3 weeks to 12 months or more); collagen type III is replaced by type I during remodelling.

Bone healing: haematoma, soft callus, hard callus, remodelling; immobilisation and controlled loading both influence callus formation.

Fracture union is delayed when the blood supply is poor, as in the scaphoid proximal pole, femoral neck, talar neck and distal tibia.

Osteoarthritis is characterised by loss of articular cartilage, subchondral sclerosis, osteophytes and synovitis; rheumatoid arthritis is a symmetrical inflammatory polyarthritis with joint erosion and systemic features.

Osteoporosis is defined by bone mineral density T-score of -2.5 or lower; the FRAX tool estimates 10-year fracture probability.

Peripheral nerve injury: neurapraxia is a conduction block with full recovery; axonotmesis is axonal loss with intact endoneurium and good regeneration; neurotmesis is complete transection with poor recovery.

Diabetes mellitus: HbA1c of 6.5% or higher is diagnostic; peripheral neuropathy and adhesive capsulitis are common musculoskeletal complications.

Deep vein thrombosis risk factors include immobilisation, surgery, malignancy and previous thrombosis; unilateral calf swelling with warmth warrants urgent medical referral before exercise.

Ottawa ankle rules: radiography is indicated when there is malleolar pain plus bone tenderness at the posterior edge of either malleolus or the navicular or base of the fifth metatarsal, or inability to bear weight four steps.

Ottawa knee rules: radiography is indicated if age 55 or older, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, or inability to bear weight four steps.

Cervical radiculopathy: Spurling test increases pain (ipsilateral compression), and the upper limb tension test and distraction test are used; progressive weakness or myelopathic signs need urgent referral.

Rotator cuff tendinopathy management emphasises progressive loading of the cuff and scapular stabilisers; subacromial corticosteroid injection gives short-term relief but repeated injections may weaken tendon.

Lateral epicondylalgia: pain on resisted wrist extension and grip; eccentric loading and isometric holds are evidence-based; corticosteroid injection has higher recurrence at one year.

ACL rehabilitation: early range of motion, quadriceps activation, closed-chain strengthening, and return-to-sport criteria including limb symmetry index of 90% or more on hop tests.

Manual therapy and exercise are more effective than either alone for many musculoskeletal conditions; passive techniques are adjuncts to active rehabilitation.

Red flags for low back pain: age over 50 with new pain, unexplained weight loss, night pain, history of cancer, fever, bladder or bowel dysfunction, saddle anaesthesia and progressive neurological deficit.

Osteoarthritis of the knee: strengthening, aerobic exercise and weight loss are first-line; walking aids reduce joint load; arthroplasty is considered after failed conservative care.

Upper motor neuron signs: spasticity, hyperreflexia, positive Babinski sign, clonus and loss of dexterity; lower motor neuron signs: flaccidity, atrophy, fasciculations and hyporeflexia.

Stroke: the middle cerebral artery is most commonly affected; contralateral hemiparesis and aphasia suggest dominant hemisphere involvement.

Brunnstrom stages of recovery run from flaccidity (1) through spasticity and synergy development (2-3) to near-normal movement (6).

Ashworth and modified Ashworth scales grade resistance to passive movement from 0 (no increase) to 4 (rigid); the Tardieu scale adds velocity of stretch.

Berg Balance Scale has 14 items scored 0-4 for 56 total; scores of 45 or below indicate increased fall risk; 41-56 is low risk.

Spinal cord injury: ASIA A is complete loss below the level; the level is the most caudal segment with normal sensory and motor function; T6 and above carries autonomic dysreflexia risk.

Autonomic dysreflexia: sudden severe hypertension, bradycardia, headache and sweating triggered by bladder or bowel distension; sit the patient up and remove the stimulus.

Parkinson disease: bradykinesia, rigidity, resting tremor and postural instability; physiotherapy targets cueing for gait, amplitude training and fall prevention.

Multiple sclerosis: fatigue management, energy conservation and cooling strategies; exercise does not worsen disease progression and improves function.

Normal arterial blood gas: pH 7.35-7.45, PaCO2 35-45 mmHg, PaO2 80-100 mmHg, HCO3 22-26 mEq/L; respiratory acidosis shows low pH with raised PaCO2.

6-minute walk test: a fall in oxygen saturation below 88% or a drop of 4% or more is a stopping criterion; the minimal clinically important difference in chronic lung disease is about 30 metres.

Airway clearance techniques include active cycle of breathing, autogenic drainage, positive expiratory pressure and high-frequency chest wall oscillation; postural drainage is timed with secretion location.

Pursed-lip breathing reduces dynamic hyperinflation and dyspnoea in obstructive disease by prolonging expiration and creating back pressure.

Cardiac rehabilitation phases: inpatient phase, early outpatient phase up to 12 weeks, and maintenance; exercise prescription uses 40-70% of heart rate reserve for moderate intensity.

Borg Rating of Perceived Exertion 6-20 scale; 11-13 corresponds to moderate exercise and 12-14 is a typical cardiac rehabilitation target.

Absolute contraindications to exercise testing include acute myocardial infarction within 2 days, unstable angina, uncontrolled arrhythmia and acute pulmonary embolism.

Cystic fibrosis: exercise capacity and airway clearance adherence predict outcomes; the FEV1 percentage predicted guides severity classification.

Incentive spirometry is used postoperatively to prevent atelectasis; it is less effective than early mobilisation and directed coughing in patients who can cooperate.

Gross motor milestones: head control at 3 months, sitting without support at 6-8 months, crawling at 9 months, pulling to stand at 9-10 months, independent walking at 12-15 months.

Primitive reflexes: Moro disappears by 4-6 months, asymmetric tonic neck reflex by 6 months, palmar grasp by 4-6 months; persistence suggests neurological involvement.

Cerebral palsy: classified by tone (spastic, dyskinetic, ataxic) and distribution (hemiplegic, diplegic, quadriplegic); the Gross Motor Function Classification System has five levels.

Gross Motor Function Measure is a validated outcome for cerebral palsy; the 66-item version covers lying, sitting, crawling, standing, walking and running.

Developmental dysplasia of the hip: Ortolani and Barlow tests in infants, limited abduction and asymmetric skin folds; Pavlik harness is used in early infancy.

Clubfoot (talipes equinovarus) is managed with the Ponseti method of serial casting and Achilles tenotomy, followed by bracing to prevent relapse.

Spina bifida: the level of the lesion predicts function; latex allergy risk is high and should be screened before procedures.

Brachial plexus birth injury: Erb palsy (C5-C6) gives the waiter's tip posture; most recover with positioning and range of motion; persistent cases need specialist referral.

Torticollis: congenital muscular torticollis responds to positioning, stretching and tummy time; plagiocephaly should be assessed concurrently.

Cryotherapy reduces tissue temperature, pain and oedema; apply for 10-20 minutes with a barrier; contraindications include cold hypersensitivity, Raynaud phenomenon and impaired sensation.

Thermotherapy increases blood flow and tissue extensibility; avoid over acute inflammation, malignancy, bleeding and areas with impaired sensation.

Therapeutic ultrasound: continuous mode heats (1 MHz for deep, 3 MHz for superficial); pulsed mode is non-thermal; avoid over the heart, eyes, pregnant uterus, growth plates and malignant tissue.

Ultrasound dose: 0.5-1 W/cm2 for acute, 1-2 W/cm2 for chronic; treatment time equals area in cm2 divided by effective radiating area, rounded to 5 minutes.

TENS: conventional high-frequency (80-120 Hz) for pain gating; low-frequency (2-4 Hz) for endorphin release; contraindicated with pacemakers, over the carotid sinus, thorax and pregnant abdomen.

Interferential current uses two medium-frequency currents producing a beat frequency; it penetrates deeper with lower skin impedance.

NMES parameters: pulse width 200-400 microseconds for muscle strengthening, frequency 35-50 Hz for tetanic contraction, with rest ratios to limit fatigue.

Laser therapy doses are in joules per cm2; Class 3B and 4 lasers require eye protection for patient and therapist.

Traction: cervical traction uses about 10-15% of body weight; lumbar traction about 25-50% of body weight, with contraindications including spinal instability and malignancy.

Reliability is consistency of measurement; validity is the extent to which a test measures what it intends; responsiveness is the ability to detect clinically meaningful change.

Intraclass correlation coefficient: below 0.5 poor, 0.5-0.75 moderate, 0.75-0.9 good, above 0.9 excellent reliability.

Minimal detectable change = 1.96 x standard error of measurement x square root of 2; it must be exceeded to conclude real change in an individual.

Minimal clinically important difference is the smallest change patients perceive as beneficial; it is context and population specific.

Numeric Pain Rating Scale 0-10; a reduction of 2 points or 30% is commonly used as clinically meaningful.

Goniometry: normal shoulder flexion 180 degrees, elbow flexion 150 degrees, hip flexion 120 degrees, knee flexion 135 degrees, ankle dorsiflexion 20 degrees.

Manual muscle testing grades 0-5: 0 no contraction, 1 trace, 2 active movement with gravity eliminated, 3 against gravity, 4 against gravity with some resistance, 5 normal.

Timed Up and Go: 10 seconds or less indicates independent mobility; 20 seconds or more suggests need for assistance; 30 seconds or more indicates high fall risk.

Sensitivity is true positives divided by all with the condition; specificity is true negatives divided by all without it; a high-sensitivity test is useful for ruling out.

Informed consent requires capacity, adequate disclosure of risks and benefits, comprehension, voluntariness and documentation; consent can be withdrawn at any time.

Confidentiality may be breached only when required by law, when there is serious risk to the patient or others, or with the patient's consent; disclose the minimum necessary information.

Scope of practice: a physiotherapist must work within their training and competence, and refer or delegate when care exceeds that scope.

Documentation should be contemporaneous, objective, dated and signed; record assessment findings, treatment provided, response and any referral or advice.

Duty of care and negligence: a breach requires a duty, a failure to meet the standard of a reasonably competent practitioner, causation and harm.

Infection control: hand hygiene before and after every patient contact; standard precautions apply to all patients regardless of diagnosis.

Patient safety: identify patients with two identifiers, check allergies and contraindications before modalities, and use falls precautions for high-risk patients.

Professional boundaries: avoid dual relationships, and disclose any conflict of interest that could affect clinical judgement.

Mandatory reporting applies to suspected abuse of children or vulnerable adults and to certain communicable diseases, per local law.

Study designs ranked by internal validity for therapy questions: systematic review of randomised trials, randomised controlled trial, cohort, case-control, cross-sectional, case series, expert opinion.

Randomisation reduces selection bias; allocation concealment prevents foreknowledge of assignment; blinding reduces performance and detection bias.

Intention-to-treat analysis includes all randomised participants in their assigned group and preserves the benefit of randomisation.

PICO frames a clinical question: population, intervention, comparison, outcome.

Levels of evidence: level 1 is systematic reviews of randomised trials; level 5 is expert opinion or bench research.

Sensitivity and specificity describe a diagnostic test; the likelihood ratio positive equals sensitivity divided by (1 minus specificity).

p value is the probability of observing the result, or a more extreme one, if the null hypothesis is true; it is not the probability that the null is true.

Confidence interval: a 95% interval excluding the null value (1 for ratios, 0 for differences) corresponds to statistical significance at the 0.05 level.

Number needed to treat equals 1 divided by the absolute risk reduction; a smaller value indicates greater clinical benefit.

Parametric tests (t-test, ANOVA) assume normally distributed data and homogeneity of variance; non-parametric alternatives include Mann-Whitney U, Wilcoxon and Kruskal-Wallis.