Conditions And Management Flashcards
1
Q
What is the measurement for a AAA that needs referrall? When it is emergent?
A
> 6cm always needs to be referred. If accompanied with sx like pulsating pain, nausea, vomiting, LBP, etc its an emergent referral.
2
Q
What is the imaging of choice for ruptured or leaking AAA?
A
CT of abdomen
3
Q
What is the gold standard imaging for AAA? Xrays and AAA?
A
B-mode US of aorta (not abdominal US)
Usually can see AAA with xray d/t calcification
4
Q
Most common presentation in symptomatic AAA patients?
A
Pain is felt in back, abdomen, flank, groin or testicles. Pain is unaffected by position that patient is in.
5
Q
Triad of signs of rupture?
A
Pulsatile mass
Hypotension
Back pain
6
Q
When to refer with CES?
A
Always! Can lead to permanent BB and sexual dysfunction
7
Q
M/C cause of CES? Second M/C cause? Third?
A
Midline disc herniation
Central stenosis
Tumor/SOL
8
Q
T or F: trauma is a common cause of CES
A
FALSE
9
Q
Classic CES presentation
A
LBP
Bowel/bladder incontinence
Saddle paresthesia and/or sexual dysfunction
10
Q
1st and most sensitive and specific sign for CES?
A
Impaired bladder sensation
11
Q
Gold standard imaging for CES?
A
MRI
CT is second best
12
Q
CES management
A
Manipulation is contraindicated Urgent referral (emergent if d/t trauma) Need decompressive surgery w/in 48 hours to avoid permanent damage
13
Q
CES prognosis?
A
Depends on how long the patient was symptomatic.
Signs of poor prognosis:
Sphincter involvement
Sensory impairment
Speed of onset
14
Q
How much aspirin should you give a suspected MI patient?
A
325mg
15
Q
Which vein is involved in 80% of proximal DVT cases?
Which vein is commonly involved in distal DVT cases?
A
Popliteal vein
Tibial veins of calf
16
Q
Which has a higher incidence of embolism, proximal or distal DVT?
A
Proximal (much higher!)
17
Q
Signs of DVT?
A
Warm, swollen, tender leg
Swelling of superficial calf veins
Pitting edema
18
Q
Risk factors for DVT
A
Active cancer Clotting disorder Heparin induced thrombocytopenia Immobilization Major surgery Bedridden Hx of embolism
19
Q
DDx of DVT?
A
Acute muscle strain
Cellulitis
Baker’s cyst
Hematoma
20
Q
Ideal DVT test? Other tests?
A
Dopler US
D-dimer (fibrin degradation product)
Venography (usually not needed)
21
Q
Management of DVT?
A
Anticoagulant therapy
Compression socks
22
Q
How long should you try conservative treatment for dyslipidemia before the patient needs aggressive intervention?
A
After 3 months of conservative care
23
Q
Best natural supplements for dyslipidemia?
A
Garlic and red yeast rice
24
Q
Meningitis presentation
A
Fever, fatigue, malaise Severe headache Maybe rash Neck and/or head stiffness and pain \+ Bruzinski, + Kernig's test
25
What is unstable angina?
Recent change in severity and frequency of episodes
| Anginal pain without exertion
26
What are some discogenic clues
```
Mannequin sign
Decrease sagittal TL motion
+ Valsalva
DeJerine's triad
Flexion load sensitivity
Sitting poorly tolerated
P centralization with repetitive loading
```
27
When to order MRI in disc case?
```
Progressive neuro deficits
No response to conservative care
Profound muscle weakness at first
Signs of CES
Disc is unlikely cause of sx
Pre-surgical consultation
```
28
Early management of disc herniation?
Attempt to centralize P
Reduce herniation
Teach patient how to protect and stabilize spine
29
How many BP readings are needed for diagnosis of HTN?
2 readings X 2 visits
30
HTN in 19-39yo most commonly caused by which 3 diseases?
Thyroid problems
Fibromyalgia
Renal disease
31
How to manage stage 1 HTN patients with no signs of end organ failure?
Can be treated conservatively w/ weight loss, exercise, DASH diet and CoQ10 supplements
32
How often should you monitor HTN patients?
Every visit
33
What is the definition of lumbar functional instability?
Spine's inability to maintain proper mechanical stiffness in neutral, midrange and end-range movements
Theorized to be a problem with the mechanoreceptors and proprioceptors in and around the spine.
34
4 factors that predict better LFI patient outcome?
<40yo
Combined 91 degree SLR
Aberrant flexion movement pattern
+ Prone extension test
35
What is reversed lumbopelvic rhythm?
When extending from flexion the lumbar spine moves before the hips
36
Diagnostic imaging is not indicated in the first six weeks of treatment if what criteria is met?
```
No neuro symptoms
No trauma
No constitutional symptoms
No symptoms of malignancy
18-50 yo
```
37
What imaging is best for neuro? For suspected osseous changes?
MRI
CT
38
LFI and history clues
LFI and PE clues
Repeated episodes with minor triggers
Reports painful catch
```
Poor or temporary relief from manipulation
+ prone instability test
Painful arc
Reversed lumbopelvicc rhythm
Hypermobile segments
```
39
Definition of radiographic hypermobility
2 views (flexion and extension) must demonstrate >=4mm of sagittal translation
40
Classical presentation of centra lumbar spinal stenosis?
```
Older patient
Bilateral leg deficits and/or pain
Not bothered by sitting
Wide based gait
Thigh pain with 30 second sustained extension
```
41
What structures often cause CLSS?
Disc bulging, facet enlargement, thickening of ligamentum flavum?
42
What is the measurement for relative and absolute CLSS?
12mm diameter
10mm diameter
43
What is more likely to cause sx similar to lx disc herniation, lateral recess stenosis or central canal stenosis?
Lateral recess!
44
Will central canal stenosis cause dermatomal pain?
Unlikely. Usually just bilateral leg pain that isn't specific to dermatome since one nerve root isn't affected.
45
Neurogenic claudication is associated with which spinal condition?
Central Lx spinal stenosis
46
Best clues to rule in central lumbar stenosis
```
No pain when sitting
Cauda equina sx
Urinary problems
Bending over improves symptoms
Bilateral buttock or leg pain
Neurogenic claudication
```
47
Neurogenic vs vascular claudication: Which condition's may be provoked by walking uphill? Downhill?
Uphill= vascular to do ^ metabolic demand
Downhill: neurogenic d/t ^ lx lordosis
48
What is more common in myelopathy issues, motor or sensory deficits?
Motor is more common.
Sensory deficits are more common in NR issues.
49
M/C nerve roots involved in Cx radiculopathy?
C6 and C7
50
Clues from history indicating Cx radiculopathy?
```
Sharp shooting pain
Pain follows a thin band
DeJerine's triad
Arm pain exceeds neck pain
Acute NR pain may be constant and worse at night
```
51
What are the 5 best tests to rule out Cx nerve damage?
```
Cx compression
Cx distraction
Shoulder abduction
Valsalva
Median nerve tension test
```
52
Exam procedures for cord lesion
```
Upper Extremity:
Observe intrinsic hand muscles
Finger escape sign
Rapid open and close of hands
Dynamic Hoffman's
Scapulohumeral reflex
```
Lower Extremity:
Wide based gait
Rhomberg's test
Babinski
Do sensory, DTRs, muscle tests, vibration, position sense in both
53
5 main symptoms of Complex Regional Pain Syndrome
Pain- severe, burning, allodynia, regional
Autonomic dysfunction (thickened nails, warm/red skin, darkened rapidly growing hair, temp changes), spasms
Edema
Movement disorder
Dystrophy/atrophy
54
How to manage acute otitis media or otitis media with effusion?
Teach patient autoinflation
Endonasal
CMT to upper Cxsq
55
Red flags for cancer causing LBP?
```
History of cancer
Patient >50yo
Unexpected weight loss
No relief with bed rest
No response to tx w/in 1 month
Pain > 1 month
```
56
What is the alarm sign when doing an SLR?
Patient points to specific location where pain is occurring
This indicates a mass of some sort
57
Structures that can cause TOS
Scalene
Pec minor
Scar tissue b/t clavicle 1st rib
Cx rib
58
3 presentatins of TOS. Which is most severe?
Vascular (immediate referral)
True neurogenic: very rare
Nonspecific neurogenic: no deficits but paresthesia
59
Sinusitis
Clues from Hx
Clues from PE
```
Craniofacial pressure
HA
Pharyngeal dyscharge
Congestion
Sore throat
```
```
Olfactory disturbance
Nasal speech
Maxillary toothache
Periorbital edema
Red nasal sinuses
Deviated septum
```
60
Bakody's sign
Rust's sign
Doorbell sign
Miner's sign
Arm abducted over head
Using hands to stabilize neck
Pressing on Cx NR to illicit thoracic or arm pain
Standing up using arms to "walk up" legs
61
6 best SI tests
```
ASLR
Compression
Distraction
Thigh thrust
Sacral thrust
Gaenslens
```
62
Knee tests: 5 basic questions
Is there internal derangement?
Is the knee stable?
What is the primary pain generator?
What is the biomechanical or manual therapy assessment?
Are there other factors along the kinetic chain?
63
Cruciate ligament tests
Anterior and posterior drawer
Slocum
Lachman
Pivot shift
64
Chondromalacia patella tests
```
Clarke's test
Patellar grind
Patellar facet pinch
Waldron's test
Step up bench test
```
65
Osteochondritis Dissecans tests (where is pain often felt?)
Wilson's test
Varus stress test with internal and external rotation
Pain is usually felt in the popliteal fossa
66
Meniscus tests. Where is pain usually felt?
```
Apley's compression
Hyperflexion test
McMurray's
Cabot's
Payr's
Ege's
Steinman's
Thessaly
```
Pain is usually along the joint line, either internally or laterally
67
ITB syndrome tests
Noble's
Ober's
Renne's
68
Plica tests
Hughston
Plica stutter
Plica pinch
69
Knee Collateral ligament tests
Appley's distraction
Wobble test
Valgus/varus stress tests
70
Indications for imaging ankle immediately after injury
Fail 4-step test
Tenderness 6cm up tib/fib
Tenderness at styloid of 5th metatarsal, navicular
71
Orthos for AC joint
Paxino's squeeze
O'brien's
Resisted horizontal adduction
Passive horizontal adduction
72
Orthos for biceps tendon
Instabilty:
Yergason's
Modified Yergasons
Tendinopathy:
Speed's
Biceps hyperextension test
73
Shoulder impingement tests
Painful arc
Neer's
Hawkins-Kennedy
74
RTC tests
```
Empty can (add mm test)
Codman's arm drop
Napoleon
Hug
Lift off
Trumpet/Buglers
External Rotation Lag sign
```
75
GH Labrum tests
```
O'brien's
Crank
Clunk
Biceps load
Biceps provocation
Passive compression test
```
76
Shoulder instability tests
```
Dugas
Faegin's
Anterior/posterior load shift
Anterior apprehension test
Relocate release
Posterior apprehension test
Norwood test
Sulcus sign
```
77
Upper crossed syndrome
```
Tight:
Suboccipitals
SCM
Upper traps
Pecs
```
```
Weak:
Deep neck flexors
Middle/lower traps
Rhomboids
Serratus anterior
```
78
Lower crossed syndome
Tight:
Psoas
Lx paraspinals
Weak:
Abs
Glutes
