AS FAST AS YOU CAN Flashcards
What type of medication is Atenolol and why might a patient be on it? How might one side effect of this med change the way you treat?
Beta Blocker
CHF, hypertension
Orthostasis - pt ed re: changing positions
What type of patient might be taking Fosomax? What are some considerations in treatment for a patient for whom this is a prescription?
Osteoporosis (age over 45ish, post-menopausal or w/ long-term steroid use)
Manips are contraindicated (mobs are fine)
Why might a patient be on Warfarin? What type of med is this? What are some precautions for PT with its prescription?
For any kind of clotting disease: AFib, Stents, Post-Op
Blood Thinner / Anticoagulant
Be aware of potential for profuse bleeding, NO MANIP, NO INSTRUMENT ASSISTED TECHNIQUES
What makes Xarelto a different kind of anticoagulant?
If you are taken to the ER they can give you something to decrease the bleeding.
No blood level monitoring or dietary changes (as with Coumadin)
NO MANIP! NO IASTM!
What makes Praxada a different kind of anticoagulant?
No monitoring, but no antidote for bleeding
Higher chance of GI bleed
NO MANIP! NO IASTM!
What type of side effects might we expect to see in a patient who uses Proventil (Albuterol)?
Rapid HR, Increased BP, Tremors, sometimes dizziness
What type of patients may come to you with a prescription for Glucotrol? What are some warning signs you may have to look out for in this population?
Diabetes
Signs of hypoglycemia: tiredness, fatigue, sweating, blurred vision, trouble concentrating
What type of medication is Protonix (Pantoprazole)? What might be the implications of taking this medication for a patient involved in PT?
Proton Pump Inhibitor
Keep upright as much as possible (to control digestion)
What are three common types of SSRIs and why might a PT want to know if a patient is on one?
Celexa, Prozac, Zoloft - patients on antidepressants have poorer outcomes for many conditions.
What type of medication is dilaudid and what side-effect is this commonly associated with?
Opioid
High risk of falls
What are two side effects of Gabapentin a PT may want to know about?
Can cause sedation and/or fatigue
What are 4 functions of NSAIDs?
Antipyretic (decrease fever), Anti-coagulant, Analgesic, Anti-inflammatory
What is important to remember when taking an NSAID for its anti-inflammatory properties?
Need to be taken continually to achieve this effect (otherwise, just affecting pain)
What are some of the risks/side effects of NSAID use?
Can develop ulcers, bleeding *the warning signs of which are only present in 1/5 of those who take them (warning signs = nausea, heartburn, abdominal pain, vomiting blood or in stool, can also cause dizziness)
What is the difference in function bw aspirin, NSAIDs, and acetaminophen?
Aspirin provides all of the following: antipyretic, analgesic, anti-inflamm, anticoag
NSAIDs: provide the same but not really much anticoag (Names: Motrin, Aleve, Celebrex, Ibuprofen)
Acetaminophen: Only Analgesic and Antipyretic (Tylenol)
What type of drug is meclizine and who should it not be given to?
Anti-histamine
Should not be given to anyone who has vestib issues bc it’s a vestibular suppressant!
A 65 y.o. male presents w/ onset of diffuse muscle weakness and inability to ambulate 7 days ago. His PMH is significant for DM, cholesterolemia. How might this patient’s medications play into his presentation?
He may be on a statin and these can cause sudden myopathy.
The longer a patient is on them, they can also cause rhabdo (CK elevated!)!
Jeri is 6 weeks post reverse shoulder arthroplasty and is taking Naproxyn for simultaneous arthritis in her knees. What’s wrong with this picture?
NSAIDs reduce bone healing! The patient can take extra-strength Tylenol or a low-dose narcotic instead if needed.
What’s a wacky long-term side-effect of taking a fluoroquinolone?
Tendinopathy anywhere from 2hrs to 6 months post dosage.
What is the differential diagnosis for a 70 y.o. female w/ COPD, DM, who has a heart valve replacement and after a recent increase in her prednisone dose presents to you with swelling in her RIGHT ankle and fatigue?
Fracture? DVT? Cellulitis?
-steroids can throw diabetic sugar out of control
Why should prednisone be tapered?
Allow adrenal glands to resume natural cortisol production (w/ long-term use can have adrenal atrophy / stop producing cortisol).
Of the following, which are substantial risk factors for injury in runners?
- Weekly mileage / intensity
- Previous injury
- Competitive Training
- Biomechanics
- Terrain/Surface
- Running technique
Mileage/Intensity
Previous Injury
Competitive Training
Running Technique
What are 4 BIG causes of PFP? Of these, which can PT affect?
- Larger q angle, sulcus, larger patellar tilt angle
- Lower peak torque knee ext
- Lower hip abduction strength
- Lower hip ER strength
2-4
What are some hallmarks of ITB Syndrome?
Lateral Knee Pain
- also, worse w/ running for longer time or distance
- increased pain w/ prolonged sitting
- worse w/ longer strides, downhill
What are some diff dx of “lateral knee pain” that may present as ITB Syndrome?
Lateral meniscus, peroneal nerve entrapment, low back, hip
At what points during gait will a person w/ ITB Syndrome have pain?
just BEFORE the leg strikes the ground w/ the knee in 25-30 deg of flexion and WHEN the leg strikes the ground
What tests can you use test for ITB pathology?
Noble’s (not great), Ober’s, Thomas
What is one pathology that can be caused or mimicked by cambered/crowned road running?
Alignment/LLD (leg length discrepancy) can also create ITB Syndrome
Is there a correlation bw ITB tightness and injury?
Nope
Is hip abductor weakness correlated w/ ITB strain?
You betcha
What is a common name for medial tibial stress syndrome?
Shin splints
What are some risk factors for MTSS? Specifically where might we expect more ROM?
Prior history of injury or stress fracture
Less seasoned runners
Increased PF ROM*
Increased BMI
Higher navicular drop*
Greater hip ER in hip flexed position* (unknown mechanism)
What is the most common site for bone stress?
Tibia
What is a Hoffa impingement?
Inflammation of the infrapatellar fat pad
What is a typical dosage for eccentrics for patellar tendinopathy?
Eccentric Squatting to 60-70 deg of knee flexion
3x15, 2x day
Can begin by rising bilaterally, lowering unilaterally
2-3/10 pain appropriate
What are some signs and symptoms of Achilles Tendinopathy?
Tenderness, either at mid-portion or insertion
Localized pain/stiffness esp following inactivity (i.e. sleep, prolonged sitting)
Intermittent pain w/ activity
Positive arc sign - area moves proximal/distal w/ ROM
Royal London Hospital Test - not super helpful, but area is LESS TTP upon DF = positive
What are two risk factors for Plantar Fasciitis/Fasciopathy?
Decreased DF ROM
High BMI
What are 2 things commonly seen in a patient presenting w/ Plantar Fasciitis/Fasciopathy?
Recent increase in WB
Plantar Medial Heel Pain
What are some differential diagnoses of Plantar Fasciitis/Fasciopathy?
Calcaneal Stress Fracture, Tarsal Tunnel (squeezing of posterior tibial nerve running under flexor retinaculum), S1 Radiculopathy
What are some possible interventions for Plantar Fasciitis/Fasciopathy?
Low-dye taping (strong evidence)
Stretching
ALL THE Mobs: Joint, Soft Tissue, Neural (A level evidence)
According to the pain monitoring model, what level of pain is ok to reach after activity? What should pain do week to week?
5, decrease
Mulligan techniques are implemented in WB as often as possible - why is this?
more likely to retain positive effect
What are some things we expect to be positive with a cervicogenic headache?
Cervicogenic means the headache is coming from pathology from C1-C3 (though C1-C2 is most typical).
We expect to see 1) restricted c-spine ROM, 2) rotation towards the affected side, 3) positive flexion rotation test
What makes a flexion rotation test positive and what are norms for this motion?
normal = 44 deg
17 deg loss of ipsilateral rotation
Mobilization w/ movements are usually performed _________ to movement plane.
Perpendicular
T/F: Mobilization w/ movements should be painless.
T!
For MWM for the knee, what dictates which direction we go?
Lateral glide for lateral knee pain, Medial glide for medial knee pain.
What is the rationale behind MWM in Mulligan’s method? What are the implications of this for a patient’s movement?
Minor positional faults - if mobs are correctly chosen correctly should see improvements in both flexion and extension.
What type of glide would you apply during abduction for a typical shoulder impingement patient?
Likely inferior and posterior.
For patients with frozen shoulder, what range of mobilizations was most effective and what was the proposed reason for why?
End-range more effective than mid-range = results joint-based, not tissue based.
In what direction should our MWM be at the elbow? What measure might we be most interested in improving that we include while we are completing a mob?
Lateral for lateral pain, medial for medial pain
Grip strength while completing mob
What motions occur at the subtalar joint?
Pronation: Eversion, Abduction, DF (Tibial IR)
Supination: Inversion, Adduction, PF (Tibia ER)
What motions occur at the mid-tarsal joint?
Pronation: Eversion LA, Abduction OA, DF OA
Supination: Inversion LA, Adduction OA, PF OA
(same as subtalar except eversion/inversion only on LA)
When your foot is pronated, what occurs at the mid-tarsal joint? What implications does this have for gait? Howsabout when you’re supinated?
When pronated, the oblique and longitudinal axes of your foot are unlocked/parallel which allows for a flexible foot that absorb force. When supinated, this allows for locked axes (looks like the calcaneus and talus stacked right on top of each other) that create a stable base for push-off.
The ligaments of the foot are active in ________ and the muscles of the foot are active in ________.
Standing vs. propulsion
What is the Windlass Mechanism?
As you extend your great toe slack is taken up which means you get more PF of the first ray creating an overall stronger arch / stronger lever –> implications for push-off in gait
Describe foot movements during the gait cycle?
Heel strike - going into pronation
Foot flat - in pronation
Mid-stance - going to supinate
Toe-off - supinated
How big does a leg-length discrepancy have to be to be clinically significant and where is this measured from?
2cm, measures from the ASIS to malleolus
What is ideal foot alignment?
- Calcaneal bisection w/in 4 deg of lower leg bisection (so, only mild RF varus/valgus
- FF perpendicular to RF bisection (so, no F varus/valgus)
- Metatarsals in same plane (no PF of 1st ray)
- At least 10 deg ankle DF w/ knee ext, 20 w/ knee flexed
- 9-14cm anterior lunge test (or shouldn’t see more than a 2cm difference relative other side)
What are some common structural causes of excessive pronation?
RF varus
FF varus
Pes planus
Equinus (no DF)
What are some potential gait compensations for equinus?
foot flat landing abducted foot position early heel-off mid-stance knee hyperex decreased step length decreased velocity decreased stance time OAMTJ pronation (will attempt to get DF from midfoot)
Two categories for foot orthoses are ACCOMMODATIVE and BIOMECHANICAL/FUNCTIONAL - what’s the difference and what are indications for each?
ACCOMM - compressible material doesn’t block motion but could block velocity; IND: inadequate motion, need shock attenuation, poor sensation, off-load focal areas
*not an adequate trial to see if the below will help
BIOMECH/FUNCTIONAL - Rigid/Semi-Rigid/Flexible, conform exactly to foot contour, rigid enough to maintain structure w/ WBing, control abnormal motion, but allow normal motion; IND: pt has adequate ROM, can reach subtalar neutral, has to be for a biomech problem
What is the Maitland Clinical Prediction Rule for who will do well with Lumbar Thrust Mobilization?
- Sx duration less than 16 days.
- No sx below knee.
- FABQ <19
- Hypomobility in L Spine
- At least one hip has IR ROM greater than 35 deg
What does Morton’s extension provide?
Helps to prevent excessive motion of the great toe.
What is the typical break in period for a biomechanical/functional orthotic?
1 hr per day increasing over 1-2 weeks
What is the flow of valgus to varus throughout the life span?
You are born w/ varus. Bw 18-24 mths you move to neutral. Then you move to valgus again up to 4 y.o. when you reach peak valgus. Then, at 7 y.o. normal adult alignment is reached.
How much in-toeing (through tibial torsion) is considered normal by maturity?
10-15 deg
How is a torus (buckle) fracture typically treated?
just splinting
At what point does bowing correct itself?
<20 deg angulation or 4 y.o.
T/F: In kids, ligaments are stronger than bone.
TROOF
What is the acronym for Salter Harris classifications?
S - straight across A - above L - lower T - Through or Two E - Erasure or Crush R
5 types
What are the names for apophyseal avulsions at the following sites in pediatrics: medial epicondyle, inferior patella pole, tibial tubercle, calcaneus, base of 5th met?
Medial Epicondyle: Little League Elbow Inferior Patella Pole: Sindig Larsen Johanssen Tibial Tubercle: Osgood Schlatter's Calcaneus: Sever's Base of 5th Met: Iselin's
At what age do we stop worrying about the presence of Osgood Schlatter’s?
18-20
How is the Beighton scored and what score is considered significant for hypermobility?
1 point for ability to perform each per appendage
4/9 considered significant
What criteria are necessary for the dx of Juvenile Hypermobility Syndrome?
MSK joint pain lasting longer than 3 mths in 4 or more joints, ligament sprains, tendone injuries, hx of sublux or disloc.
Can also have skin hyper extensibility, GI sx, cardio hx, chronic pain
What type of Osteogenesis Imperfecta is likely to have the best prognosis?
Type I
When is Blount’s Disease more likely to be prominent?
After walking has begun
What are some risk factors for greater progression of scoliosis?
- Double curvatures or thoracic curvatures
- Lower Risser grades (more growth remaining)
- Premenarchal girls
- Age <12 y.o.
- Cobb Angle > 20 deg (SURGERY w/ 40 deg)
What might cause lateral elbow pain in a pediatric patient?
Panner’s Disease (osteochondritis of the capitellum)
