101 Midterm 1 Flashcards
What is arthrodial SD end-feel
Hard
What is muscular SD end-feel
Protective spasm
What is myofascial SD end-feel
Binding and hard
What is an early muscle spasm
Protective after injury
What is a late muscle spasm
Chronic
What is a hard capsular end feel example
Frozen shoulder
What techniques are 30-60 seconds
MFR
ST (Traction and Deep pressure)
What techniques are 1-2 seconds
ST (Stretching)
What techniques are 90 seconds
SCS
SCS treatment for anterior cervical vertebrae
FSARA
SCS treatment for posterior cervical vertebrae
ESARA
SCS treatment for anterior thoracic vertebrae
FSTRA
SCS treatment for posterior thoracic vertebrae
SP - ESARA
TP - ESART
SCS treatment for anterior ribs
FSTRT
SCS treatment for posterior ribs
FSARA
What techniques are 120 seconds
Ribs
Location of anterior lumbar tender points
AL1 - medial to ASIS
AL2 - medial to AIIS
AL3 - lateral to AIIS
AL4 - inferior to AIIS
AL5 - 1 cm lateral to pubic symphysis on superior ramus
SCS treatment for posterior lumbar
ESARA minus exceptions
Exceptions for SCS treatment for posterior lumbar (4)
PL3 gluteus
PL4 gluteus
UPL5
LPL5
SCS treatment for psoas
Frog leg with side bend
FSTER
SCS treatment for iliacus
Frog leg
FER
SCS treatment for piriformis
“pee-riformis”
SCS position for levator scapulae
Head ST
SCS position for trapezius
Head STRA
Arm above head
Cephalad traction (if necessary)
SCS position for SH-biceps
FAdIr (shoulder scratch)
SCS position for IT band
Slightly flex and abduct hip
SCS position for TFL
Flex hip to 45 degrees
Abduct hip
SCS position for sternocleidomastoid (AC7)
Flex down to C7
FSTRA
Neurons that contract extrafusal fibers
Alpha-motor
Neurons that contract intrafusal fibers
Gamma-motor
SCS treatment for posterior rib 1 (PR1)
ESART
What techniques are 3-5 seconds
ME
Goal of post-isometric relaxation
Muscle relaxation
Steps of post-isometric relaxation (4)
Steps of muscle energy
Engage RB
Isotonic/isometric contraction
Relaxation
Engage new RB
Goal of reciprocal inhibition
Lengthen muscle shortened by cramp
MOA of reciprocal inhibition
Gently contract antagonist muscle
Steps of oculocephalogyric reflex
IC - look towards/RI - look away from RB
Contract cervical muscles
(coordination of following flight patterns)
Goal of oculocephalogyric reflex
Relax antagonist muscle
Treats suboccipital
Goal of respiratory assist
Improve physiology
MOA of respiratory assist
Patient breathes in slow and out exaggerated
Goal of crossed extensor reflex
Treat contraindicated muscles via contralateral muscles
MOA of crossed extensor reflex
Gently flex contralateral muscle voluntarily to relax SD
Contraction
Shortening of muscle
Contracture
Tightening of muscle causing soreness
Sherrington Law
Stimulated muscles inhibit opposing muscles
Golgi tendon organ
Spindle shaped organ providing muscle tension info
Concentric contraction
Joint angle decreases
Eccentric contraction
Joint angle increases
Isometric contraction
Joint angle stays the same
Isotonic contraction
Force stays the same
Isokinetic contraction
With resistance
Isolytic contraction
Overpowering eccentric
Physician force in joint mobilization
30-50 pounds
Force in isokinetic strengthening
10-20 pounds
Force in isolytic lengthening
30-50 pounds
What do positive treatment outcomes depend on
Accurate diagnosis
Appropriate force
Sufficient localization
Negative treatment outcomes are caused by (6)
Inaccurate diagnosis
Improperly localized forces
Forces that are too strong
Inadequate patient instruction
Moving too soon after contraction into next joint position (“crashing into barrier”)
Forgetting to retest area
What is the Thomas test for
Iliopsoas
What is the Thomas test looking for
How much the opposing leg is lifted off the table (higher leg is the leg to treat)
Patient is prone for what ME muscles
Psoas
Piriformis
Patient is supine for what ME muscles
Hamstring
Patient is seated for what ME muscles
Gastrocnemius
Forearm pronation
Forearm supination
“The patient reports a 3-day history of worsening left knee pain, exacerbated by walking and relieved with rest. No recent trauma or injury.”
Subjective
“The patient describes a throbbing headache that started two days ago, mainly located in the temples, with occasional nausea but no vomiting.”
Subjective
“The patient states, ‘I feel more anxious than usual,’ and reports difficulty sleeping over the past week. No significant changes in appetite or weight.”
Subjective
“The patient notes that the shortness of breath has gradually worsened over the past week, now occurring even at rest. Denies chest pain or palpitations.”
Subjective
“The patient reports that since starting the new medication, they have experienced mild dizziness and dry mouth, but no other side effects.”
Subjective
T: 37.2°C, P: 84 bpm, BP: 124/82 mmHg, RR: 19/min, O2 Sat: 98% on room air.
Objective
The patient appears alert, oriented, and in no acute distress.
Objective
Regular rate and rhythm, normal S1 and S2, no murmurs, rubs, or gallops.
Objective
Lungs are clear to auscultation bilaterally, no wheezes, rales, or rhonchi.
Objective
Soft, non-tender, mild tenderness in the right upper quadrant, positive bowel sounds in all four quadrants, no masses or organomegaly palpated.
Objective
“The patient is a 69-year-old man with a history of hypertension and type 2 diabetes who presented with acute onset of severe retrosternal chest pain. The ECG and cardiac markers are within normal limits, making unstable angina the most likely diagnosis.”
Assessment
“The patient is a 42-year-old woman on postoperative day 1 following a laparoscopic cholecystectomy. She is improving well, with stable vital signs and no signs of infection.”
Assessment
“The patient is a 46-year-old female with paranoid schizophrenia, who has shown minimal improvement on her current medication regimen. She is now more engaged in daily activities, indicating slight improvement.”
Assessment
“The patient is a 28-year-old, G2P1102, who had a spontaneous vaginal delivery. She is stable on postpartum day 1, with no significant complications noted.”
Assessment
“The patient is a 58-year-old male presenting with new-onset weakness and difficulty speaking. The findings are consistent with a likely transient ischemic attack, pending further imaging.”
Assessment
“Advance diet as tolerated. Follow-up with abdominal ultrasound tomorrow. Monitor CBC, electrolytes, BUN, and creatinine daily.”
Plan
“Increase risperidone dose. Continue with individual, group, and milieu therapy.”
Plan
“Start the patient on a beta-blocker and aspirin. Schedule an echocardiogram to evaluate for left ventricular function. Arrange a cardiology consultation for further management.”
Plan
“Initiate IV antibiotics with broad-spectrum coverage. Obtain blood cultures and monitor daily. Reassess in 48 hours to narrow antibiotic coverage based on culture results.”
Plan
“Continue postpartum care. Repeat CBC in the morning. Discharge planning for tomorrow, pending stable labs and patient condition. Provide breastfeeding support and advise on contraception.”
Plan
Direct technique meaning
Into the restrictive barrier
Into the limitation
Against the direction of ease
Indirect technique meaning
Away from the restrictive barrier
Away from the limitation
Into the direction of ease
It’s late on a Friday afternoon and you are tired. Your 15th and last patient, a 62-year-old widower is particularly challenging because he has come in frequently during the last three months, each time complaining of a new ache or pain. You have been unable to find a physical cause for his complaints and conclude that his symptoms are part of his grieving process. Your offers to refer him to a support group were rejected, and he seems to have no insight at all. Which of the following questions represents mindfulness, and is most important to contemplate to make this encounter more successful, for you and for the patient?
How do I feel about the fact that he has rejected my efforts to help him with his real problem, the recent loss of his wife
One of your colleagues made a serious mistake and administered the wrong antibiotic to a patient. Now it is 3 a.m. and you are trying to stabilize the patient, with mixed results so far. In the light of day, you will have to talk with the family and reveal the error to them. Which of the following questions are most important to contemplate to make that encounter more successful, for yourself and for the patient’s family?
What are my beliefs about such mistakes
You just saw a patient whom you have known for many years-one of the first in your practice. You found her breast cancer during a routine check and supported her throughout her treatment. For 8 years she was in remission but now the cancer has recurred, and you had to give her the sad news. First, she was shocked and then she cried. You reassured her that you would continue to support her and made arrangements to start treatment. Even though you have to give such bad news two to three times a week, you felt quite sad and discouraged after she left. Which of the following considerations is most important to contemplate in order to optimize future encounters for yourself as well as for the patient?
I give bad news quite frequently, so what is it about this patient that makes me feel so discouraged?
Your first patient is new, and you are trying to establish a rapport with her. As you are ready to examine her ears, you notice that the otoscope specula are once again missing. Clearly the exam rooms were not adequately restocked. This makes you angry because you have complained about this problem to the clinic administrator without results. The nursing aide responsible for restocking either is incompetent or lazy. This clinic should be able to hire better support staff. What could you contemplate during the clinical encounter to reduce your frustration and stay focused on the patient?
What successful strategies have I employed in the past to reduce stress
Right now, you are way behind in your schedule. Three patients are waiting to talk to you, you are late for rounds, and you promised the social worker to call a nursing home on behalf of a patient. Your boss interrupts to tell you that for the second time you are passed over during the search for an Associate Unit Director. This seems very unfair, and you suspect that your race and gender had something to do with it. It annoys you even more because you have been putting a lot of effort into your job and have sacrificed valuable time that you could have spent with family. What should you contemplate to reduce your frustration and get ready for seeing the patients and catching up with the other tasks?
I’m so mad, I should call my spouse, even if the patients have to wait a bit longer
For some years you’ve seen each in a couple for preventive care and minor health care problems. Today you had to tell the wife that she has gonorrhea, who assures you she only has sex with her husband. After the initial shock she besieged you with questions about her partner’s status and the possibility of him having affairs. You are aware that the husband has had affairs, and know that you must respect his privacy, but on the other hand you feel sympathy for the wife. What could you contemplate that might help you balance your feelings towards the wife with upholding the ethical principles?
Do I experience a similar type of helplessness and frustration as she does?
You are following up with Mrs. Gonzales, who has persistent headaches. You’ve talked with her at length and done all the exams that seem appropriate, but you can’t arrive at a specific diagnosis. She is about to walk in. What could you contemplate (in the spirit of mindfulness) to improve the situation for yourself and for Mrs. Gonzales?
Am I assuming something about this patient that might not be true?
You have good rapport with a 70-year-old woman with diabetes whom you’ve known for a long time. Sometimes her daughter brings her to the office, worried that she seems to be forgetful. She also mentioned some safety issues- namely burning food and serving spoiled food. You wonder how meaningful the daughter’s concerns could be since your patient always seems well put together and so much in charge of her own life. Her diabetes is a bit less under control at the moment, but she has been abroad visiting relatives and thus you thought that her diabetes self-care may have suffered in the process. What can you contemplate to make sure that you are not overlooking the onset of dementia?
Does the patient remind me of my own parents and their struggle to lead and independent life?
Your new admission is a 90-year-old man in renal failure who has not much longer to live, and there is little you can offer medically at this point. You communicated this to the family who has assembled around his bed. As you leave the room you are disturbed by the feeling that you did so little for him. What can you contemplate to maximize your future impact in this and similar situations, for your patients as well as for yourself?
What would I want and need from my physician if I were dying?
Your department chair asked you to take over the establishment of a new pain center, and this means that you will need to cut down on your patient load. You’ll need to transfer to colleagues some patients with whom you have long-standing relationships. What can you contemplate to prepare yourself for informing your patients about the upcoming transfers and changes?
What are my feeling about saying good-bye to these patients
