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Unit 20 > AS FAST AS YOU CAN > Flashcards

AS FAST AS YOU CAN Flashcards

1
Q

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?

A

Beta Blocker
CHF, hypertension
Orthostasis - pt ed re: changing positions

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2
Q

What type of patient might be taking Fosomax? What are some considerations in treatment for a patient for whom this is a prescription?

A

Osteoporosis (age over 45ish, post-menopausal or w/ long-term steroid use)
Manips are contraindicated (mobs are fine)

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3
Q

Why might a patient be on Warfarin? What type of med is this? What are some precautions for PT with its prescription?

A

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

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4
Q

What makes Xarelto a different kind of anticoagulant?

A

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!

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5
Q

What makes Praxada a different kind of anticoagulant?

A

No monitoring, but no antidote for bleeding
Higher chance of GI bleed

NO MANIP! NO IASTM!

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6
Q

What type of side effects might we expect to see in a patient who uses Proventil (Albuterol)?

A

Rapid HR, Increased BP, Tremors, sometimes dizziness

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7
Q

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?

A

Diabetes

Signs of hypoglycemia: tiredness, fatigue, sweating, blurred vision, trouble concentrating

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8
Q

What type of medication is Protonix (Pantoprazole)? What might be the implications of taking this medication for a patient involved in PT?

A

Proton Pump Inhibitor

Keep upright as much as possible (to control digestion)

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9
Q

What are three common types of SSRIs and why might a PT want to know if a patient is on one?

A

Celexa, Prozac, Zoloft - patients on antidepressants have poorer outcomes for many conditions.

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10
Q

What type of medication is dilaudid and what side-effect is this commonly associated with?

A

Opioid

High risk of falls

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11
Q

What are two side effects of Gabapentin a PT may want to know about?

A

Can cause sedation and/or fatigue

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12
Q

What are 4 functions of NSAIDs?

A

Antipyretic (decrease fever), Anti-coagulant, Analgesic, Anti-inflammatory

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13
Q

What is important to remember when taking an NSAID for its anti-inflammatory properties?

A

Need to be taken continually to achieve this effect (otherwise, just affecting pain)

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14
Q

What are some of the risks/side effects of NSAID use?

A

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)

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15
Q

What is the difference in function bw aspirin, NSAIDs, and acetaminophen?

A

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)

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16
Q

What type of drug is meclizine and who should it not be given to?

A

Anti-histamine

Should not be given to anyone who has vestib issues bc it’s a vestibular suppressant!

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17
Q

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?

A

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!)!

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18
Q

Jeri is 6 weeks post reverse shoulder arthroplasty and is taking Naproxyn for simultaneous arthritis in her knees. What’s wrong with this picture?

A

NSAIDs reduce bone healing! The patient can take extra-strength Tylenol or a low-dose narcotic instead if needed.

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19
Q

What’s a wacky long-term side-effect of taking a fluoroquinolone?

A

Tendinopathy anywhere from 2hrs to 6 months post dosage.

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20
Q

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?

A

Fracture? DVT? Cellulitis?

-steroids can throw diabetic sugar out of control

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21
Q

Why should prednisone be tapered?

A

Allow adrenal glands to resume natural cortisol production (w/ long-term use can have adrenal atrophy / stop producing cortisol).

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22
Q

Of the following, which are substantial risk factors for injury in runners?

  1. Weekly mileage / intensity
  2. Previous injury
  3. Competitive Training
  4. Biomechanics
  5. Terrain/Surface
  6. Running technique
A

Mileage/Intensity
Previous Injury
Competitive Training
Running Technique

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23
Q

What are 4 BIG causes of PFP? Of these, which can PT affect?

A
  1. Larger q angle, sulcus, larger patellar tilt angle
  2. Lower peak torque knee ext
  3. Lower hip abduction strength
  4. Lower hip ER strength

2-4

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24
Q

What are some hallmarks of ITB Syndrome?

A

Lateral Knee Pain

  • also, worse w/ running for longer time or distance
  • increased pain w/ prolonged sitting
  • worse w/ longer strides, downhill
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25
Q

What are some diff dx of “lateral knee pain” that may present as ITB Syndrome?

A

Lateral meniscus, peroneal nerve entrapment, low back, hip

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26
Q

At what points during gait will a person w/ ITB Syndrome have pain?

A

just BEFORE the leg strikes the ground w/ the knee in 25-30 deg of flexion and WHEN the leg strikes the ground

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27
Q

What tests can you use test for ITB pathology?

A

Noble’s (not great), Ober’s, Thomas

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28
Q

What is one pathology that can be caused or mimicked by cambered/crowned road running?

A

Alignment/LLD (leg length discrepancy) can also create ITB Syndrome

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29
Q

Is there a correlation bw ITB tightness and injury?

A

Nope

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30
Q

Is hip abductor weakness correlated w/ ITB strain?

A

You betcha

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31
Q

What is a common name for medial tibial stress syndrome?

A

Shin splints

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32
Q

What are some risk factors for MTSS? Specifically where might we expect more ROM?

A

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)

33
Q

What is the most common site for bone stress?

A

Tibia

34
Q

What is a Hoffa impingement?

A

Inflammation of the infrapatellar fat pad

35
Q

What is a typical dosage for eccentrics for patellar tendinopathy?

A

Eccentric Squatting to 60-70 deg of knee flexion
3x15, 2x day
Can begin by rising bilaterally, lowering unilaterally
2-3/10 pain appropriate

36
Q

What are some signs and symptoms of Achilles Tendinopathy?

A

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

37
Q

What are two risk factors for Plantar Fasciitis/Fasciopathy?

A

Decreased DF ROM

High BMI

38
Q

What are 2 things commonly seen in a patient presenting w/ Plantar Fasciitis/Fasciopathy?

A

Recent increase in WB

Plantar Medial Heel Pain

39
Q

What are some differential diagnoses of Plantar Fasciitis/Fasciopathy?

A

Calcaneal Stress Fracture, Tarsal Tunnel (squeezing of posterior tibial nerve running under flexor retinaculum), S1 Radiculopathy

40
Q

What are some possible interventions for Plantar Fasciitis/Fasciopathy?

A

Low-dye taping (strong evidence)
Stretching
ALL THE Mobs: Joint, Soft Tissue, Neural (A level evidence)

41
Q

According to the pain monitoring model, what level of pain is ok to reach after activity? What should pain do week to week?

A

5, decrease

42
Q

Mulligan techniques are implemented in WB as often as possible - why is this?

A

more likely to retain positive effect

43
Q

What are some things we expect to be positive with a cervicogenic headache?

A

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

44
Q

What makes a flexion rotation test positive and what are norms for this motion?

A

normal = 44 deg

17 deg loss of ipsilateral rotation

45
Q

Mobilization w/ movements are usually performed _________ to movement plane.

A

Perpendicular

46
Q

T/F: Mobilization w/ movements should be painless.

A

T!

47
Q

For MWM for the knee, what dictates which direction we go?

A

Lateral glide for lateral knee pain, Medial glide for medial knee pain.

48
Q

What is the rationale behind MWM in Mulligan’s method? What are the implications of this for a patient’s movement?

A

Minor positional faults - if mobs are correctly chosen correctly should see improvements in both flexion and extension.

49
Q

What type of glide would you apply during abduction for a typical shoulder impingement patient?

A

Likely inferior and posterior.

50
Q

For patients with frozen shoulder, what range of mobilizations was most effective and what was the proposed reason for why?

A

End-range more effective than mid-range = results joint-based, not tissue based.

51
Q

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?

A

Lateral for lateral pain, medial for medial pain

Grip strength while completing mob

52
Q

What motions occur at the subtalar joint?

A

Pronation: Eversion, Abduction, DF (Tibial IR)
Supination: Inversion, Adduction, PF (Tibia ER)

53
Q

What motions occur at the mid-tarsal joint?

A

Pronation: Eversion LA, Abduction OA, DF OA
Supination: Inversion LA, Adduction OA, PF OA
(same as subtalar except eversion/inversion only on LA)

54
Q

When your foot is pronated, what occurs at the mid-tarsal joint? What implications does this have for gait? Howsabout when you’re supinated?

A

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.

55
Q

The ligaments of the foot are active in ________ and the muscles of the foot are active in ________.

A

Standing vs. propulsion

56
Q

What is the Windlass Mechanism?

A

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

57
Q

Describe foot movements during the gait cycle?

A

Heel strike - going into pronation
Foot flat - in pronation
Mid-stance - going to supinate
Toe-off - supinated

58
Q

How big does a leg-length discrepancy have to be to be clinically significant and where is this measured from?

A

2cm, measures from the ASIS to malleolus

59
Q

What is ideal foot alignment?

A
  • 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)
60
Q

What are some common structural causes of excessive pronation?

A

RF varus
FF varus
Pes planus
Equinus (no DF)

61
Q

What are some potential gait compensations for equinus?

A 
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)
62
Q

Two categories for foot orthoses are ACCOMMODATIVE and BIOMECHANICAL/FUNCTIONAL - what’s the difference and what are indications for each?

A

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

63
Q

What is the Maitland Clinical Prediction Rule for who will do well with Lumbar Thrust Mobilization?

A
  1. Sx duration less than 16 days.
  2. No sx below knee.
  3. FABQ <19
  4. Hypomobility in L Spine
  5. At least one hip has IR ROM greater than 35 deg
64
Q

What does Morton’s extension provide?

A

Helps to prevent excessive motion of the great toe.

65
Q

What is the typical break in period for a biomechanical/functional orthotic?

A

1 hr per day increasing over 1-2 weeks

66
Q

What is the flow of valgus to varus throughout the life span?

A

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.

67
Q

How much in-toeing (through tibial torsion) is considered normal by maturity?

A

10-15 deg

68
Q

How is a torus (buckle) fracture typically treated?

A

just splinting

69
Q

At what point does bowing correct itself?

A

<20 deg angulation or 4 y.o.

70
Q

T/F: In kids, ligaments are stronger than bone.

A

TROOF

71
Q

What is the acronym for Salter Harris classifications?

A 
S - straight across 
A - above 
L - lower 
T - Through or Two 
E - Erasure or Crush
R

5 types

72
Q

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?

A 
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
73
Q

At what age do we stop worrying about the presence of Osgood Schlatter’s?

A

18-20

74
Q

How is the Beighton scored and what score is considered significant for hypermobility?

A

1 point for ability to perform each per appendage

4/9 considered significant

75
Q

What criteria are necessary for the dx of Juvenile Hypermobility Syndrome?

A

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

76
Q

What type of Osteogenesis Imperfecta is likely to have the best prognosis?

A

Type I

77
Q

When is Blount’s Disease more likely to be prominent?

A

After walking has begun

78
Q

What are some risk factors for greater progression of scoliosis?

A
  1. Double curvatures or thoracic curvatures
  2. Lower Risser grades (more growth remaining)
  3. Premenarchal girls
  4. Age <12 y.o.
  5. Cobb Angle > 20 deg (SURGERY w/ 40 deg)
79
Q

What might cause lateral elbow pain in a pediatric patient?

A

Panner’s Disease (osteochondritis of the capitellum)

Unit 20 (1 decks)

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