School of Health Sciences

Division of Health Professions

Physical Therapist Assistant Program

MODULES 1 - 5

QUIZ 1 STUDY GUIDE

International Classification of Functioning, Disability, and Health (ICF)
1 Define the International Classification of Functioning, Disability and Health (ICF)
It is a framework for describing and organizing information on functioning and disability. It
provides a standard language and conceptual basis for the definition and measurement of health
and disability. It was approved for use by the World Health Assembly in 2001, after extensive
testing across the world involving people with disabilities and people from a range of relevant
disabilities. It integrates the major models of disability. It recognizes the role of environmental
factors in the creation of disability, as well as the relevance of associated health conditions and
their effects.
2 List four aims of the ICF
1. Provide a scientific basis for understanding and studying health and health-related
states, outcomes, determinants, and changes in health status and functioning
2. Establish a common language for describing health and health-related states in order to
improve communication between different users, such as health care workers,
researchers, policy-makers and the public, including people with disabilities.
3. Permit comparison of data across countries, health care disciplines, services and time
4. Prove a systematic coding scheme for health information systems.

3 List and define the multidirectional and interactive elements of the ICF Model
 The body functions and structures of people, and impairments there of (functioning at
the level of the body)
 The activities of people (functioning at the level of the individual) and the activity
limitations of experience
 The participation or involvement of people in all areas of life, and the participation
restrictions they experience (functioning of a person as a member of society)
 The environmental factors which affect these experiences (and whether these factors
are facilitators or barriers).

4 Define impairment, activity, and participation

Impairment-Problems in body function and structure such as significant deviation or loss
Activity-The execution of a task or action by an individual
Participation-Involvement in a life situation
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Division of Health Professions
Physical Therapist Assistant Program

5 Define generic ICF qualifiers 0-9

Qualifiers are codes used to record the extent of functioning or disability in a domain or category
or the extent to which an environmental factor is a facilitator or barrier. A uniform or generic
qualifier scale is provided to record the extent of the problem in relation to impairment, activity
limitation and participation restriction. The environmental factors qualifier uses both a positive
and negative scale, to indicate the extent to which an environmental factor acts as either a
facilitator or barrier to functioning. Measurement is an area for further development, and it is
recognized that the generic qualifier requires calibration to relate its scale to existing
measurements tools.
Two constructs, performance and capacity, can be used in operationalizing the qualifier scale for
the activities and participation domains. These constructs provide a way of indicating how the
environment (in which measurement has taken place) impacts on a person’s activities and
participation, and how environmental change may improve a person’s functioning.
Capacity relates to what an individual can do in a standardized environment (this often involves
some kind of clinical assessment).
Performance relates to what the person actually does in his or her current (usual) environment
Metabolic and Endocrine Systems
1 Define both the metabolic system and the endocrine system
 Metabolic System: governs the chemical and physical changes that take place within the
body enabling it to grow and function. Metabolism (used to describe all chemical
reactions involved in maintaining the living state of cells and the organism) involves
breakdown of the body’s complex organic compounds in order to generate energy for
all bodily processes. It also generates energy for the synthesis of complex substances
that form tissues and organs. During metabolism, organic compounds are broken down
by a process called catabolism, while anabolism is the process that combines simple
molecules for tissue growth. Many metabolic processes are facilitated by enzymes. The
overall speed at which an organism carries out its metabolic processes is termed its
metabolic rate (or when the organism is at rest, its basal metabolic rate).
 Endocrine Systems: The endocrine system is the collection of glands that produce
hormones that regulate metabolism, growth and development, tissue function, sexual
function, reproduction, sleep, and mood, among other things.
2 List the definition, etiology, signs/symptoms, and treatment for osteomalacia
 Define: Is a metabolic condition where bones become soft secondary to a calcium or
phosphorus deficiency. There is adequate bone matrix, however, there is insufficient
calcification of the matrix die to the deficiency.
 Etiology: Calcium is typically lost secondary to inadequate intestinal absorption and the
phosphorus is lost secondary to an increase in renal excretion. A deficiency is vitamin D
will also cause osteomalacia.
 Signs and symptoms: Can include a vague presentation of aching, fatigue, and weight
loss. Myopathy and sensory polyneuropathy may also occur along the periarticular
tenderness and pain, thoracic kyphosis deformity, and bowing of the lower extremities.
The patient may also struggle to perform transfers and assume a standing position.
Treatment: Specific intervention will focus on the underlying etiology. Increased nutrition is
recommended, and pharmacological intervention may include vitamin D or phosphate
supplements.
3 List the definition, etiology, signs/symptoms, and treatment for osteoporosis
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Physical Therapist Assistant Program

 Define: Is a metabolic condition that presents with a decrease in bone mass that
subsequently increases the risk of fracture. It primarily affects trabecular and cortical
bone where the rate of bone resorption accelerates while the rate of bone formation
declines. Declining osteoblast function coupled with loss of calcium and phosphate salts
will cause the bones to become brittle.
 Etiology: Primary Osteoporosis can include idiopathic, postmenopausal or involutional
(senile) osteoporosis. Secondary osteoporosis can occur because of another primary
condition or with use of certain medications.
 Signs and symptoms: Include compression and other bone fractures, low thoracic or
lumbar pain, loss of lumbar lordosis, deformities such as kyphosis, decrease in height,
dowager’s hump, and postural changes.
Treatment: Management of primary osteoporosis includes vitamin and pharmacological
intervention, proper nutrition, assistive and adaptive device prescription, and patient education.
Surgical intervention may be required for fracture stabilization.
4 List the definition, etiology, signs/symptoms, and treatment for Type 1 Diabetes Mellitus
 Define: Occurs when the pancreas fails to produce enough or any insulin. This form of
diabetes is normally diagnosed in childhood but can occur at any age. It is also known as
insulin dependent diabetes or juvenile diabetes.
 Etiology: The exact cause is unknown, but genetic predisposition in combination with
exposure to a viral or environmental trigger is believed to cause an immune reaction
that damages the pancreas with subsequent failure in secretion of endogenous insulin.
 Signs and symptoms: Include rapid onset of symptoms, polyphagia, weight loss,
ketoacidosis, polyuria, polydipsia, blurred vision, dehydration and fatigue.
Treatment: Management includes exogenous insulin injections that are required to maintain
proper glucose blood levels and avoid complications. Proper nutritional management is also
required for blood glucose control. Insulin pump may be indicated for continuous administration
of insulin. Presently, there is no cure for type 1 DM and as a result, the goal is to control the
regulation of blood glucose levels.
5 List the definition, etiology, signs/symptoms, and treatment for Type 2 Diabetes Mellitus
 Define: Occurs in the population over the age of 45, however, there has been an increase
in children diagnosed with it secondary to a rise in childhood obesity. This form retains
the ability to produce some endogenous insulin.
 Etiology: Occurs secondary to an array of dysfunctions resulting from the combination
of resistance to insulin action and inadequate insulin secretion. This disorder is
characterized by hyperglycemia when the body cannot properly respond to insulin.
Obesity is found to contribute to this condition by increasing insulin resistance.
 Signs and Symptoms: Are relatively the same as with type 1, however, ketoacidosis does
not occur since insulin is still typically produced.
Treatment: Includes blood glucose control through diet, exercise, oral medications or insulin
injections when necessary.
Gastrointestinal System
1 Identify and describe the anatomy and function of the upper and lower gastrointestinal (GI)
tract, and the gland organs of the GI tract
 Definition of the GI system: is responsible for the process of digestion. It breaks down
food into its components, absorbs nutrients, and discards the waste.
 Gastrointestinal Anatomy and Function (Upper GI)
1. Mouth -Initiation of mechanical and chemical digestion
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2. Esophagus-Transports food from the mouth to the stomach

3. Stomach- Grinding of food secretion of hydrochloric acid and other exocrine
functions, secretion of hormones that release digestive enzymes from the liver,
pancreas, and gallbladder to assist with digestion
 Gastrointestinal Anatomy and Function (Lower GI Small Intestines)
1. Duodenum- Neutralizes acid in food from the stomach and mixes pancreatic and
biliary secretions with food.
2. Jejunum-Absorbs water, electrolytes, and nutrients
3. Ileum-Absorbs bile and intrinsic factors to be recycled
 Gastrointestinal Anatomy and Function (Lower GI Large Intestines)
 Ascending colon, Transverse colon, Descending colon, sigmoid colon,
rectum, and anus-Continues to absorb water and electrolytes, stores
and eliminates undigested food as feces

 Gland Organs-Anatomy and function

1. Gallbladder-Stores and releases bile into the duodenum to assist with digestion
2. Liver-Bile is produced and is necessary for absorption of lipid soluble substances,
assist with red blood cell and vitamin K production, regulates serum level of
carbohydrates, proteins and fats
3. Pancreas-Exocrine-secretes bicarbonate and digestive enzymes into the
duodenum; Endocrine-Secretes insulin, glucagon, and other hormones into the
blood to regulate serum glucose level.

2 List the definition, etiology, signs/symptoms and treatment for irritable bowel syndrome (IBS)
 Define: Consists of recurrent symptoms of the upper and lower gastrointestinal system
that interfere with the normal functioning of the colon
 Etiology: Is unknown, but one theory believes that the colon or large intestine may be
sensitive to certain foods or stress. Other theories hypothesize that the immune system,
serotonin, and bacterial infections may all be causative factors. It occurs in as many as
20% of adults, more common in females, and begins prior to the age of 30 in 50% of
patients. Females have a slightly higher rate of incidence which may be triggered by food
sensitivities, stress, anxiety, caffeine, smoking, alcohol or high fat intake.
 Signs/Symptoms: Abdominal pain, bloating or distention of the abdomen, nausea,
vomiting, anorexia, changes in form and frequency of stool, and passing of mucus in the
stool.
Treatment: Changes in lifestyle and nutrition, decrease in stress, pharmacological intervention,
adequate sleep, exercise, and psychotherapy may all assist in alleviating symptoms. Patients
with IBS should avoid large meals, milk, wheat, rye, barley, alcohol, and caffeine. Although the
symptoms can be severe, it does not lead to serious disease. They can typically be controlled by
diet, pharmacological, intervention and stress management.
3 List the definition, etiology, signs/symptoms and treatment for Crohn’s disease
 Define: Is one of the two major types of inflammatory bowel disease. It may affect any
part of the GI tract. Inflammation extends through all layers of the intestinal wall and
may involve lymph nodes and supporting membranes in the area. Ulcers form as the
inflammation extends into the peritoneum. It commonly peaks at 15 and 30 yrs.
Increases with age more frequent in women.
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 Etiology: Lymphatic obstruction, infection, allergies, immune disorders, such as altered

immunoglobulin. A production and increased suppressor T-cell (immune) activity.
Genetic factors
 Signs/Symptoms: discomfort, diarrhea (creates malabsorption), usually with pain in the
right lower quadrant or generalized abdominal pain and fever. Weightless, nausea,
vomiting and bloody stools.
Treatment: Fecal occult test shows minute amounts of blood in stools, small bowel x-ray shows
irregular mucosa, ulceration and stiffening, barium enema reveals the string sign, fissures,
ulcerations, narrowing of the bowel. Sigmoidoscopy and colonoscopy (assessing the degree of
inflammation) show patchy areas of inflammation, which helps rule out ulcerative colitis. The
mucosal surface has a cobblestone appearance. When the colon is involved, ulcers may be seen.
4 List the definition, etiology, signs/symptoms and treatment for dysphagia
 Define: Difficulty or discomfort in swallowing, as a symptom of disease
 Etiology: Achalasia-LES doesn’t relax to properly let food enter your stomach, Diffuse
spasm, esophageal stricture (narrowing), esophageal tumors, foreign bodies, GERD,
food allergy, scar tissue development, radiation therapy.
 Signs/Symptoms: Pain while swallowing, being unable to swallow, having the sensation
of food getting stuck in your throat or chest or behind your breastbone, drooling, being
hoarse, brining food back up, frequent heartburn, food or stomach acid back up into
your throat, unexpectedly losing weight, coughing or gagging when swallowing, having
to cut food into smaller pieces or avoiding certain foods because of trouble swallowing.
Treatments: may be referred to a speech or swallowing therapist, surgery, mediations,
esophageal dilation,
5 List the definition, etiology, signs/symptoms and treatment for hepatitis A B C D E
 Is an inflammatory process within the liver. Viral hepatitis is most common and is
classified as hepatitis A, B, C, D, E or G. Hep A, B, and C are the most common
 Etiology: Many instances of hepatitis are viral in nature. Others include a chemical
reaction, drug reaction or alcohol abuse. Other viruses that can cause hepatitis include
Epstein-Barr virus, herpes virus 1 and 2, varicella-zoster virus, and measles.
 Signs/Symptoms: Fever, flu-like symptoms, abrupt onset of fatigue, anorexia, headache,
jaundice, darkened urine, lighter stool, enlarged spleen and liver and intermittent
pruritis (desire to scratch).
 Treatment: Acute viral hepatitis usually resolves with medical treatment, but can
become chronic in some cases. Chronic hepatitis may result in the need for liver
transplant.
A. Type A (HAV): Is a virus that affects the liver and its function. Transmission
occurs by close personal contact with someone that has the infection or through
the fecal-oral route (contaminated water and food sources). The flu-like
symptoms represent an acute infection; this form does not progress to chronic
disease or cirrhosis (scarring and liver failure) of the liver. Patients usually
recover in 6-10 wks tx is supportive and the virus is self-limiting.
B. Type B (HBV): is a virus that affects the liver and its function. Transmission of
this virus occurs through the sharing of needles, intercourse with an infected
person, exposure to an infected persons blood, semen or maternal-fetal
exposure. Approximately 10% of cases progress to chronic hepatitis since the
body cannot always rid itself of HBV. Treatment includes hepatitis B
immunoglobulin (HBIG) for the unvaccinated patient within 24 hrs of exposure.
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Physical Therapist Assistant Program

The patient should then receive the vaccination series at one and six months. If
the patient is already vaccinated, they may require another dose of the HBV
vaccine.
C. Type C (HCV): is a virus that affects the liver and its function. It is one of the
primary causes for chronic liver disease and eventual liver failure. Transmission
of this virus occurs through the sharing of needles, intercourse with an infected
person, exposure to an infected persons blood, semen, body fluids or maternal-
fetal exposure. The virus accounts for 90% of post transfuction hepatitis cases.
Like hep B, this virus is often asymptomatic, and the acute infection can be mild.
Patients with hep C have an increased frequency of manifesting conditions such
as hashimotos thyroiditis, diabetes mellitus, and corneal ulceration. Treatment
may include the use of inferno alfa-2b to reduce inflammation and liver damage
but only a small percentage of patients with hep c benefit from the medication.
There is no vaccine to prevent this virus and no immunoglobulin fully effective
in treating the infection. Chronic hepatitis occurs in 50% of cases and 20% of
those cases progress to cirrhosis of the liver.
D. Type D- in the US, is confined to people frequently exposed to blood and blood
products, such as I.V. drug users and hemophiliacs. Also known as delta virus, it
requires a concomitant infection with hepatitis B to survive.
E. Type E-Was formerly grouped with type C under the name non-A non-B
hepatitis. In the US, this type mainly occurs in people who have visited an
endemic area, such as India, Africa, Asia or central America. It can be
transmitted via the fecal-oral route or vertically from mother to child during
childbirth.
F. Type G: GB virus C, formerly known as hepatitis G virus and also known as
Human pegivirus – HPgV is a virus in the family Flaviviridae (ticks and
mosquitoes) and a member of the Pegivirus, is known to infect humans, but is
not known to cause human disease

Genitourinary Systems
1 Describe the anatomy and function of the female and male genitourinary systems
 Muscles of the pelvic Floor
 Pelvic diaphragm-Levator ani: pubococcygeus, puborectalis, iliococcygeus, and
coccygenus (ischiococcygenus)
 Urogenital diaphragm-Deep transverse peritoneal, urethrae sphincter
 Urogenital triangle-Female: bulbocavernosus, ischiocavernosus, superficial
transverse perineal. Male: bulbospongiosus, ischiocavernosus, superficial
transverse perineal
 Anal triangle: internal anal sphincter, external anal sphincter
 Female genital system
 External genitalia-Mons pubis, labia majora, clitoris, vestibule of vagina, bulbs
of vestibule, greater vestibular (bartholin’s) glands, skenes gland
Function: provides protection and hydration of vaginal tissues and urethra
 Vagina-Musculomembraneous tube connected to the cervix
Function: receptable for male sperm, birth canal, excretory duct for menstrual
fluid
 Uterus- hollow muscular organ
Function: Houses the fetus during development
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 Uterine tubes-Extend laterally from the ovaries to the uterus

Function: Provides transport for the ovum from the ovary for fertilization an
implantation within the uterus.
 Ovaries-Almond shaped glands suspended in the broad ligaments
Function: Produce hormones such an estrogen and progesterone. Storage of
oocytes prior to ovulation

 Male genital system

 Penis-External genital that expels urine during voiding and semen during the act
of copulation
 Scrotum-Cutaneous fibromuscular external sac for the testes, ductus deferens,
epididymis, nerves and blood vessels
 Testes-Produce sperm and hormones such as testosterone
 Ductus/vas deferens-Carries sperm from the testes to the seminal vesicles to
form the ejaculatory duct
 Epididymis-Encased within the scrotum, stores sperm
 Seminal vesicles-Internal tubes that secrete a thick fluid to combine with sperm
within the ejaculatory duct
Prostate-Internal organ lying inferior to the bladder. Produces and secretes fluid to combine
with sperm, seminal vesicle fluid, and bulbourethral gland fluid to create semen.

3 List the definition, etiology, signs/symptoms and treatment for endometriosis

 Define: a condition resulting from the appearance of endometrial tissue outside the
uterus and causing pelvic pain
 Etiology: Retrograde menstruation- menstrual blood containing endometrial cells flows
back through the fallopian tubes and into the pelvic cavity instead of out of the body.
Surgical scar implantation, endometrial cell transport, immune system disorder.
 Signs/symptoms: painful periods, pain with intercourse, pain with bowel movements or
urination, excessive bleeding, infertility, fatigue, diarrhea, constipation, bloating or
nausea especially during menstrual periods.
Treatment: Medication or surgery, pain medication, hormone therapy in reducing or eliminating
pain.
4 List the definition, etiology, signs/symptoms and treatment for vulvodynia
 Define: Is a chronic pain syndrome that affects the vulvar area and occurs without
identifiable cause.
 Etiology: Injury or irritation of the nerves surrounding your vulvar region, past vaginal
infections, allergies or sensitive skin, hormonal changes, muscle spasm or weakness in
the pelvic floor, which supports uterus, bladder and bowel.
 Signs/Symptoms: feeling of burning or irritation. Soreness, stinging, rawness, painful
intercourse, throbbing, itching.
Treatment: focuses on relieving symptoms, medications, biofeedback therapy, local anesthetics,
nerve blocks, pelvic floor therapy, surgery.
5 List the definition, etiology, signs/symptoms and treatment for prostatitis
 Define: Inflammation of the prostate gland
 Etiology: Acute bacterial prostatitis is often caused by common strains of bacteria. The
infection can start when bacteria in urine leak into your prostate. Antibiotics are used
to treat infection. If they don’t eliminate the bacteria, then they may get this condition.
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Physical Therapist Assistant Program

Nerve damage in the lower urinary tract which can be caused by surgery or trauma to
the area.
 Signs/Symptoms: pain or burning sensation when urinating, difficulty urinating such as
dribbling or hesitant urination, frequent urination, urgent need to urinate, cloudy urine,
blood in urine, pain in the abdomen, groin or lower back, pain the area between the
scrotum and rectum, pain or discomfort of the penis or testicles, painful ejaculation,
flulike symptoms.
Treatment: Antibiotics, alpha blockers, anti-inflammatory agents.
Lymphatic System
1 Identify and describe the anatomy and function of the lymphatic system
 Define: the network of vessels through which lymph drains from the tissues into the
blood.
 Function: Collection and transportation of fluids and other materials that are not
reabsorbed by the venous system, maintenance of fluid balance within he body and
immune system defense.
 Lymph: Is the fluid transported by the lymphatic system. It originates as a component of
the interstitial fluid and primarily consists of water, proteins, fatty acids, and cellular
components. The lymphatic system consists of a network of both superficial and deep
lymph vessels that transport lymph throughout the body.
 The first lymph vessel: is the smallest vessel and is known as the initial lymph vessel.
These initial lymph vessels are located near blood capillaries and are responsible for
collecting fluid from the interstitium that is not picked up by the venous system. The LS
transports the majority of extracellular proteins since they are often too large to be
transported by the venous system. It is normally responsible for collecting 10-20% of the
interstitial fluid, while the venous system collects the other 80-90%.
 From the initial lymph vessels, lymph is transported toward larger lymph vessels known
as lymph collectors. The lymph collectors then transport lymph to even larger lymph
vessels known as lymphatic trunks. The two main lymphatic trunks are the right,
lymphatic duct which drains lymph from the right arm and right side of the head, and
and the thoracic duct, which drains lymph from the remainder of the body. These vessels
empty lymph directly into the venous system via the subclavian veins.
 The lymphatic system is under control of the autonomic nervous system, which
produces contractions of smooth muscle within the lymph vessel walls to help move the
lymph fluid along. Skeletal muscle contraction can also help to compress the lymph
vessels and move lymph. One-way valves help maintain the unidirectional flow of lymph
throughout the entire lymphatic system.
Lymph nodes are specialized structures contained throughout the lymphatic system, but found
most commonly in the neck, axilla, chest, abdomen, and groin. The lymph nodes collect lymph
from several adjacent areas and function primarily to filter waste products and foreign materials
from the lymph and provide immune system defense with the use of T and B lymphocytes.
2 Define and distinguish between pitting edema and non-pitting edema
 Non-pitting edema: Fluid accumulation that is harder and not compressible when
pressure is applied. This type of edema is observed in the later stages of lymphedema
 Pitting edema: fluid accumulation that can be compressed and demonstrates an
indentation with applied pressure. This type of edema may be observed in the early
stages of lymphedema.
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3 Know the definitions for lymphedema stages 0-3

 Stage 0

This stage is known as the latent (or preclinical) stage. There is no visible
edema, though the transport capacity of the lymph system has been affected.

 Stage 1

This stage is known as the spontaneously reversible lymphedema stage. Pitting

edema is present and increases with activity or heat, but will diminish with
elevation or rest.

 Stage 2

This stage is known as the spontaneously irreversible lymphedema stage. The

edema is now non-pitting and does not change with elevation or rest. The skin
begins to demonstrate fibrotic changes and the risk for infection increases.
Stemmer’s sign is positive at this stage.

 Stage 3

This stage is known as the lymphostatic elephantiasis stage. It is characterized

by extensive non-pitting edema, significant fibrotic changes to the skin, and the
presence of papilloma’s, deep skinfolds, and hyperkeratosis, infection is
common at this stage. Stemmer’s sign remains positive at this stage.

4 Identify precautions and relative contraindications of Complete Decongestive Therapy

CDC consists of manual lymphatic drainage, compression therapy, exercise, and skin care. It
helps to maintain the reduction in edema that is achieved by MLD. It helps to reduce the limb
size by improving the reabsorption ability of the capillaries and reduce the filtration of fluids into
the inerstitium.
 Acute infection
 Cardiac edema
 Diabetes
 Hypertension
 Malignancy
 Renal insufficiency
 Deep vein thrombosis
5 Define Stemmer’s sign
 Stemmer’s sign: A test used to aid in the diagnosis of lymphedema. Stemmers sign is
positive if the skin at the dorsal base of the second toe/finger can’t be easily lifted away
from the bone, which indicates thickening of the skin due to fibrotic changes.
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Physical Therapist Assistant Program