final Flashcards
Hyperhidrosis
increased moisture of skin , typically affects the soles of the feet, usually idiopathic
Bromohidrosis
FOOT odor causes include poor hygiene, talc powder or topical erythromycin (topical antibiotic) can be used
Tinea pedis
Athlete’s foot, 3 types: interdigital infections, moccasin distribution, vesiculobullos (arch) infection
Interdigital tinea pedis: presentation and tx
present in the web spaces, maceration, scaling, erythema. Tx: betadine, powders, antifungal gel, anti septic castallini’s PAINT***
Mocassin tinea pedis: presentation and tx
scaling of the plantar surface, hyperkeratosis, topical or oral antifungal for tx.
Vesicular tinea pedis
marked by vesicles in the arch of the foot, crusting tx: topical antifungal
What are hyperkeratotic lesions?
corns , calluses, hammertoes. Develops in response to friction or pressure, usually over bony prominent areas.
What are hyperkeratotic lesions?
corns , calluses, hammertoes. Develops in response to friction or pressure, usually over bony prominent areas.
What are two types of corns/ hyperkeratotic lesions?
heloma dura- dorsal hard corns, usually over the PIPJ and heloma molle- soft corns, usually interdigitial corn
What are three types of ulcers?
neuropathic, vascular, and pressure
What are underlying conditions that cause chronic wounds?
diabetes, poor circulation, poor nutritional status, pressure, immunodeficiencies, infection
What are arterial ulcers?
caused by ischemia, presence of PVD, VERY PAINFUL, no debridement used, send to vascular.
What are diabetic ulcers?
trauma, pressure is SECONDARY to NEUROPATHIC disease or vascular disease related to DM.
What are pressure ulcers?
Localized, tissue damage due to pressure ( bed ulcers) decubitus ulcer (aka)
What are venous ulcers?
Caused by impaired venous return, excessive EDEMA, treated with compression. Dont use compression on sickle cell patients, most sickle cell patients develop salmonella
What is gangreene?
occurs when tissue dies (necrosis) because its blood supply is interrupted. Can be caused by infection, injury, or a complication of a long term condition.
What are the five types of gangreene?
- dry gangreene- least severe, 2. wet gangrene 3. gas gangrene- caused by bacteria, medical emergency, can have crackling sound 4. internal gangrene- intestines. 5. fournier’s gangrene- of genitals, causes death
Subungual hematoma-
blood under the nail, usually painful, caused by trauma. Tx: drill hole with a 18 gauge needle w/ cold water soak, total nail avulsion
what is onychocryptosis?
ingrown toenail. caused by chronic pressure of the nail fold by the nail plate. Leading edge of the toenail acts like a foreign body and can cause inflammation and infection
What is hallux abducto valgus?
bunion deformity, lateral deviation of hallux with or without medial and or dorsal prominence of the 1st MT head. BOTH FEET USUALLY AFFECTED** causes: biomechanics, trauma, shoe gear- MOST COMMON CAUSE
What are tx for bunions?
NSAIDS- motrin, otc pads, wider shoe gear, night splints, custom orthotics, surgery
What is hallux rigidus / limitus?
Hallux limitus- limited range of motion of the first MTPJ seen at toe off, Hallux rigidus- loss of motion MTPJ
What are common causes of hallux rigidus/limitus?
dorsiflexed 1st ray, 1st ray hypermobility, long 1st ray , prolonged 1st MTPJ immobilization
What are tailors bunions?
abduction of the 5th metatarsal , lateral bowing of the 5th metatarsal, enlargement of the 5th MT head, biomechanical, arthritic changes of the 5th MT head.
What are hammertoes?
They are contracted at the plantarflexed PIP**, DIP- neutral or hyperextended, MTP- dorsiflexed. Can be flexible, semi rigid or rigid.
What is plantar fascitis associated with?
cavus and planus feet. Hallmark symptom: first step in the morning is extremely painful- POST STATIC DYSKINESIA. Plantar pain due to repeated microtrauma. Straining of the posterior attachment to the medial tubercle.
What are treatments for plantar fasciitis?
NSAIDS, local steroid injection, strappings, orthotics, stretching, PT, SX
What is Gout?
joints are red, swollen, and extremely tender. Tophi can be at base of toe. Patients usually complain of the bed sheets touching the toe causes pain. It is a metabolic disorder with depositions of monosodium urate crystals
Why does gout occur, what body parts are involved?
Metabolic disorder, deposition of urate crystals form at coldest locations. Pred. dx in adult men. Acute gouty arthritis is the most clinical manifestation. 75% 1st MTPJ involved.
What sign helps dx Gout?
Martel’s sign xray, serum uric acid levels increased, TX- NSAIDS, colcrys, injection
What are DVT’s?
blood clots which usually form in the deep venous system of the LE. Can lead to Pulm Emb. Pain, heat, SWELLING in the affected limb, compression of calf causes pain ***
What causes DVT’s?
trauma, prolonged bed rest, chronic deep venous insufficiency, estrogen/oral contraceptive use
What are treatments for DVT?
anticoagulents, blood thinners (heparin, warfarin, coumadin, eliquis, rivaroxaban( Xarelto)
What is diabetic neuropathy?
Related to serum glucose, encompasses sensory, motor, and autonomic, loss of sensation, atrophy of interosseous, tingling/shooting pain
What are tx for diabetic neuropathy?
creams- Arnica, pills- GABA, injections
What is objective medical documentation?
**written documentation of observable, measurable and reproducible findings from examination and supporting lab or tests
Why is documentation important?
patient care, communication, written records, legal records
What are the elements of good documentation?
accuracy, legibility, timeliness, unaltered, professionalism, completeness
BUN
blood urea nitrogen
COPD
chronic obstructive pulm disease
ECG/ EKG
electrocardiogram
GI
gastrointestinal
RBC
Red blood cell
ROM
range of motion
What is the chief complaint?
In patient’s words, brief statement of the reason the patient is seeking care.
What is the history of present illness?
HPI includes facts that explore in detail the CC
NLDOCAT used for HPI
nature( pain) , location, duration, onset, cause, aggravating/alleviating, treatments attempted*****
Past medical history includes:
childhood illness, major adult illnesses , accidents, immunizations, dev’t history
Past surgical history
Operations include: indication, date, outcome complications
Social history includes: travel,smoking/alcohol. What are pack years?
number of cigarettes/ packs per day and duration of time. If patient has smoked 2 packs per day for 20 years: 2x 20= 40 pack years*****
Medications asked can include:
name, dose, freq., duration, alt/compli medical practices, herbal therapies, vitamins, supplements
Allergies can include:
drug causing reactions, PCN , Sulfa drugs, codeine
Review of systems:
typically 3 questions for each system- general: fatigue, fever, sweating. Start from head , work way down. Excessive thirst, hunger- DIABETES
healthy pulse and resp rate should be:
60-100, and 15-20
For the physical exam, General includes:
Awake, alert, oriented (AAOx3)
Objective physical exam includes:
vascular, neurologic, orthopedic, dermatologic
Assessment-
your opinion, evaluation, diagnosis, diff. diagnosis
Subjective vs objective data:
subj- what the patient relates, what others relate to you about the patient obj- what YOU observe, direct measurements( bp, temp) labs, xrays, etc
Symptoms vs signs
symptoms are SUBJECTIVE , and a response to what the patient feels , described by the patient to clarify the illness, symptoms are not absolute. Signs are OBJECTIVE finding upon physical examination of the patient. signs can be observed and quantified.
Proper way to correct a written note:
initial and date, cross out with black ink, one line cross out
osteoblasts
bone formation
osteoclasts
bone resorption
What are ligaments
specialized connective tissue that connects bones, joint stability, barrier protection . Composed of COLLAGEN type I 90%, similar to tendons however, more elastin, uniform microvascularity, not under muscle tension. Exercise increases strength
What is articular cartilage?
covers articulating surfaces, decreases friction, distributes loads, avascular, aneural
What is articular cartilage composed of?
water 65-80% , 90% in osteo arthritis , increase water, decrease strength. Collagen type II - 95%, proteoglycan 10-15% provides compressive strength. Chondrocytes: 5 % collagen
What is a capsule?
connective fibers, attaches around articular ends of bones, richly vascularized, reinforced by collateral ligaments * heals similar to tendons, however, more vascular- faster healing w/less complication**
What are the three types of muscle and their differences?
SKELETAL- attached to bones with single long multinucleated cells with striations, CARDIAC- walls of the heart, uninucleate cells striations with intercalated disks, SMOOTH-walls of hollow visceral organs, single fusiform cells, uninucleate, NO striations
Basic unit of contration
myofibril that consists of sarcomere with H band(thick) and I (thin) band endoym-perimy-epimysium bind fasicles to form muscles
What are differences between the types of muscle fiber?
type 1 : slow twitch, red fiber, aerobic oxidation, endurance actibity. type 2- fast twitch, white fiber, anarobic , strength activity
What are the different types of muscle contraction?
isotonic- contraction in which the muscle length will shorten and movt of a limb takes place. isometric- muscles shortens, but no movement in limb takes place. Isokinetic- muscle shortens and movt takes place, speed of contraction remains the same through entire motion.
What are tendons?
collagen structures that transmit muscle motion to produce joint motion. Composed of fibroblasts 85% type 1 collagen, 5% type 2 collagen
What is the sagittal plane
a vertical plane dividing the body into right and left parts
Coronal /frontal plane
a vertical plane dividing body into anterior and posterior parts
transverse/horizontal plane
A plane parallel to the floor or supporting surface, dividing body into superior and inferior parts
what are the cardinal planes of the foot
sagittal- dividing foot into med and lat, frontal- distal(ant) and prox (post) parts, transverse- dorsal (sup) and plantar (inf) parts
inversion
movement in which the plantar surface of the foot moves toward the midline. medial border is elevated. vara/ varus /varum- sole/calcaneus moves medially
genu varum-
bow legged (knees out)
genu valgus
knock kneed (knees close together)
active vs passive ROM
active- movement by the PATIENT. Joint range of motion available. Passive- movement by the examiner, joint range of motion available
1st MPJ- dorsiflexion is what degree
greater than 65 degrees dorsiflexion
Subtalar joint ROM
prone position,20 degrees inversion 10 degrees eversion 30 degrees total
Pes cavus
high arch
pes planus
flat foot