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Primary Care > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Primary Care

A

-accessible, comprehensive, coordinated and coonntinual care by providers of public health

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1
Q

PT in Primary Care

A

-triage
-determine if they should be there
-referral
-immediate or emergency care

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2
Q

Red/Yellow Flags

A
  1. Major Depression
  2. Suicide Risk
  3. Femoral Fx
  4. Cuada Equina Syndrome
  5. Cervical Myelopathy
  6. Abdominal Aortic Aneurysm
  7. Deep Vein Thrombosis
  8. Pulmonary Embolism
  9. Atypical Myocardial Infarction
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3
Q

Major Depression

A

RK:
-past/current
-female (pregnancy)
-Hx of disease
-Family Hx
-loss

CM:
Answers yes to
-have you felt down, depressed or hopeless in the last 2 weekd
-have you had little pleasure or interest doing things

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4
Q

Suicide Risk

A

RK:
-living salone
-hx of psychiatric illness
-previous suicide attempts
-Hx of chronic illnes

CM:
-expressing thoughts of death or wishing
-says yes to attempting to harm themselves (ask if they have a plan and the resources)

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5
Q

Femoral Fx

A

RK:
-osteoporosis
-female
-stress/trauma
-medicines
-running/jumping
-muscle strength

CM:
-pain in groin, ant-med thigh, greater trochanter, buttock
-deformity
-loss of function
-brusing/edema
-fulcrum test or pattellar-pubic percussion test

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6
Q

Cauda Equina Syndrome

A

RK:
-LBI
-spinal stenosis
-spinal fx
-ankylosing spondylitis
-TB

CM:
-LB/LE pain
-B/B issues
-saddle anesthesia
-urinary retention
-ataxia

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7
Q

Cervical Myelopathy

A

RK:
-c spine spodylosis/instability
-most common cause of quadriparesis/paraparesis
-old age

CM:
-slow steps
-hand dexterity
-gait issues
-paresthesias
-urinary retension
-UMNL signs

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8
Q

Abdominal aortic Aneurysm

A
  • aneurysm distal to renal srteries (>3cm
    -risk for rupture @ 5-6cm

RK:
- >60
-male
-smoking
-CAD or hyper cholesteroma
-family Hx

CM:
-back, abdominal, hip or butt pain
-no mechanical pain behaviors
-palpable mass
-bounding/visible pulse
-hearing bruits
-stop if tearing, hot, searing pain

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9
Q

Deep Vein Thrombosis

A

RK:
-hx of DVT
-hx of cancer, SLE
-infection
-chemo
-major surgery/trauma
-immobility
-post patrtem

CM:
- ache or tightness near site
-edema
-increase in skin temp

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10
Q

Pulmonary Embolism

A

-most associated with DVT, air, fat or bone marrow embolism

RK:
-hx of PE or DVT
-immobility
-hx of surgery
-late stage pregnancy
-fx

CM:
-dyspnea
-tachypnea
-chest pain
-cough
-anxiety
-palpitations

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11
Q

Atypical Myocardial Infarction

A

RK:
-smoking, high cholestrol, htn, DM, obesity
-women >55, Men >45
-family hx
-ethnicity

CM:
-SOB
-fatigue
-sleep issues
-nausea
-chest pain
-anxiety
-upper abdominal, jaw neck or tooth pain

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12
Q

Clinical Desicion Rule for DVT

A

-1 point for each

-activtive cancer (w/in 6m)
-paralysis or immobilization
-bedridden for 3 day or major surgery (12w)
-localized tenderness along venous
-entire leg swollen
-calf swelling >3cm
-pitting edema
-collateral superficial veins
-previous DVT
-alternative dx as likely (-2)

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13
Q

Clinical Desicion Rule for PE

A

-Clinical signs of DVT (3)
-tachycardia (1.5)
-immobilization 3 or surgery 4w (1.5)
-hix of PE and DVT (1.5)
-hemoptysis (coughing up blood) (1)
-cancer ttreatment, 6m (1)
-Alternative less likely (3)

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14
Q

Validity

A

-how correct it is
-measures what it should
-cannot exit without reliability

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15
Q

Reliabiliy

A

-how consistent it is
-degree of association
-can exist without validity

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16
Q

Contingency Table

A

True Positive: a; tested positive with test; have the condition

False Positive: b; tested positive; don’t have the condition

False Negative: c; tested negative; have the condition

True Negative: d; tested negative; don’t have condition

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17
Q

Sensitivity

A

-snout: rule out
-true positive test
-shows all the positive so it rules out the negatives
-a/(a+c)

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18
Q

Specificity

A

-spin: rule in
-true negative
-shows all the negative so it rules in the positives
-d/(b+d)

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19
Q

Predictive Value (+)

A

-likelyhood that the positive test = having condition
-a/(a+b)

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20
Q

Predictive Value (-)

A

-likelyhood that the negative test= not having condition
-d/(c+d)

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21
Q

Positive Likelihood Ratio

A

-increased odds of having condition if testing positive
-ratio of true to false
-Sensitivity/ (1- Specificity)
-higher= more likely

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22
Q

Negative Likelihood Ratio

A

-decreased odds of having condition if testing negative
-ratio of false to true
-(1- Sensitivity)/ Specificity
-lower= less likely

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23
Q

Guide to Interpreting LR

A

-most powerful tool for quantifying importance of a particular test

> 10/<0.10: large probability
5-10/0.5-1: moderate
2-5/0.2-0.5: small
1-2/0.5-1: rare

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24
Q

Minimal Detectable Change

A

-MDC
-amount of change needed to overcome measurement error
-increase reliability of test decreases MDC

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25
Q

Minimal Clinical Important Difference

A

-MCID
-amount of important change from the perspective of individual
-should be bigger than MDC

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26
Q

Examination Process

A

-Hx
-observation
-Scanning exam
-ROM
-Muscle
-Joing
-Palpation
-Special Tests

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27
Q

SINSS

A

-severity
-irritability
-nature of complaint
-stage
-stability

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28
Q

Severity

A

-clinician assessment of intensity of symptoms in terms of function

Fracture: high
Sprain: low

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29
Q

Irritability

A

-ease with which symtoms can be provoked
1. Amount of activity needed to trigger s/s
2. Severity of s/s
3. What activity and amount of time for symptoms to subside

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30
Q

Nature of Complaint

A

Describe assessment of:
-structures, syndromes
-caution things
-character of problem

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31
Q

Stage of Pathology

A

-stage of injury

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32
Q

Stability

A

-progression of s/s over time

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33
Q

Pt Hx Red Flags

A

-trauma: Fx
-age >50: cancer, AAA, fx, infection
-Hx cancer
-fever,chills, sweats: infection, cancer
-unexplained weight loss: cancer
-infection
-immunosuppression
-rest/night pain: cancer, infection, AAA
-saddle anesthesia: cauda equina
-B/B dysfunction: cauda equina
-LE neuro deficit: cauda equina

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34
Q

Pain Referral: Heart

A

-Left side of chest, arm, jaw, neck
-middle of upper back

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35
Q

Pain Referral: Lungs

A

-neck and shoulders

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36
Q

Pain Referral: Esophagus

A

-front of chest

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37
Q

Pain Referral: Liver and Gallbladder

A

-front and back right side of back/abdomen
-front and back of right side of chest and neck

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38
Q

Pain Referral: Stomach

A

-middle of chest
-middle of back

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39
Q

Pain Referral: Pancreas

A

-anterior, middle abdomen

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40
Q

Pain Referral: Kidney

A

-hips and thighs

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41
Q

Pain Referral: Small Intestine

A

-anterior lower abdomen

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42
Q

Pain Referral: Appendix

A

-right, anterior, lower mid to low abdomen and pelvis

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43
Q

Pain Referral: Ovaries

A

-bilateral pelvic

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44
Q

Pain Referral: Colon

A

-anterior pelvis

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45
Q

Pain Referral: Bladder

A

-Anterior and posterior pelvis
-genital
-back of thighs

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46
Q

MSK Symptom Investigation

A

-pain that changes over 24h
-motions change pain

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47
Q

Non-MSK Symptom Investigation

A

-referral from organ systems
-pain doesn’t fluctuate with mmt
-insidious onset
-vague pain
-during eating or urinating

Unusual:
-throbbing, pounding, pulsating (vascular)
-shooting, burning, shocking (neuro)
-aching, squeezing, cramping (visceral)

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48
Q

Sequence of Symptom Questions

A

-what interferes most w/ normal function
-describe it
-behavior of s/s
-intensity
-s/s elsewhere

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49
Q

Low Back Red Flags

A

-Tumor
-Infection/Osteomyelitis
-Cauda Equina
-Fx
-Abdominal Aneurysm

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50
Q

Back Related Tumor Red Flags

A

Hx:
->50
-Hx Cancer
-unexplained weight loss
-failure of treatment

Exam:
-Constant Pain
-worse at night

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51
Q

Back Related Infection/Osteomyelitis Red Flags

A

Hx:
-infection/drug use
-immunosuppressed

Exam:
-deep constant pain
-fever, malaise, swelling
-spine rigidity

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52
Q

Cauda Equina Red Flags

A

Hx:
-spinal stenosis
-DDD

Exam:
-urinary retention
-fecal incontinence
-saddle anesthesia
-weakness of LE
-sensory issues

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53
Q

Spinal Fx Red Flags

A

Hx:
-trauma
-steroid use
->70

Exam:
-tender with palpation
-edema

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54
Q

Abdominal Aortic Aneurysm Flags

A

Hx:
-back, groin pain
-PVD or CAD
-s/s not related to movement

Exam:
-Abnormal width of aortic or iliac arterial pulses
-bruit

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55
Q

Pelvis, Hip, and Thigh Red Flags

A

-colon cancer
-femoral neck Fx
-Osteonecrosis
-Legg- Calve Perthes
-SCFE

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56
Q

Colon Cancer Red Flags

A

Hx:
->50
-Bowel Disturbances
-Hx cancer in immediate fam
-pain unchanged by position

Exam:
-hypo or hyperactive bowel
-tenderness in abdomen
-ascites
-metastases to liver,lung, brain, bone

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57
Q

Femoral Neck Fracture

A

Hx:
-older women
-hip, groin, thigh pain
-Hx of fall

Exam:
-severe, constant pain
-shortened LE

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58
Q

Osteonecrosis

A

Hx:
-corticosterioid
-Hx of osteonecrosis
-trauma

Exam:
-gradual onset
-stiff joint, restricted 1 deg IR or Flx

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59
Q

Legg-Calve-Perthes

A

Hx:
-5-8 yr old boys
-groin/thigh pain

Exam:
-antalgic gait
-pain worse with hip mmt (hip abd/IR)

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60
Q

Slipped Capital Femoral Epiphysis

A

Hx:
-overweight child
-Hx of growth spurt

Exam:
-aching in groin
-leg in ER
-ROM IR limitations

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61
Q

Knee, Leg, Ankle, Foot Red Flags

A

-PAOD
-DVT
-Compartment Syndrome
-Septic Arthritis
-Cellulitis

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62
Q

Peripheral Arterial Occlusive Disease

A

Hx:
->60
-DM
-H of ischemic HD
-Smoking
-sedentary
-claudication

Exam:
-cool extremity
-prolonged capillary fill time
-decreased pulses
-prolonged vascular fill time

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63
Q

DVT

A

Hx:
-surgery
-trauma
-pregnancy
-immobilization

Exam:
-pain
-edema
-warmth/redness
-relieved by rest and elevation

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64
Q

Compartment Syndrome

A

Hx:
-blunt trauma

Exam:
-severe leg pain
-swelling/tenderness
-paresthesia, pallor, pulselessness

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65
Q

Septic Arthritis

A

Hx:
-recent infection
-surgery
-immunosuppressive

Exam:
-constant aching
-joint swelling
-warmth
-elevated body temp

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66
Q

Cellulitis

A

Hx:
-recent skin ulceration
-abrasion
-venous insufficiency
-Cirrosis
-CHF

Exam:
-pain
-skin swelling
-warmth
-irregular redness
-fever, chills, weakness

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67
Q

Thoracic Spine and Rib Cage Regions Red Flags

A

-MI
-Angina (stable and unstable)
-Pericarditis
-PE
-Pleurisy
-Pneumothorax
-Pneumonia
-Cholecystitis
-Peptic Ulcer
-Pyelonephritis
-Kidney stones
-Spinal Fx

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68
Q

Myocardial Infarction

A

Hx:
-risk factors for CAD

Exam:
-chest pain
-pallor, sweating, dyspnea
-not relieved by nitroglycerin

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69
Q

Unstable Angina

A

Hx:
-Hx CAD

Exam:
-outside of the predictable pattern
-not responsive to nitroglycerin

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70
Q

Stable Angina

A

Hx:
->65
-Hx CAD

Exam:
-predictable exertion
-predictably alleviated or w/rest or nitroglycerine

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71
Q

Pericarditis

A

Hx:
-autoimmune diseases
-MI
-Renal failure
-open heart surgery
-radiation

Exam:
-sharp feeling in chest that might be referred to neck or shoulder
-increased pain with sidelying
-releived by sitting forward

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72
Q

Pulmonary Embolism

A

Hx:
-risk factors
-immobility
-trauma
-cancer

Exam:
-chest, shoulder and upper abdominal pain
-dyspnea
-tachypnea
-tachycardia

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73
Q

Pleurisy

A

Hx:
-respiratory disorder
-infection
-pneumonia
-tumor
-TB

Exam:
-severe, sharp pain with inspiration
-dyspnea
-decreased chest wall excursion

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74
Q

Pneumothorax

A

Hx:
-coughing
-strenuous exercise
-trauma

Exam:
-chest pain with inspiration
-difficulty breathing
-hyperresonance
-decreased breath sounds

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75
Q

Pneumonia

A

Hx:
-infections

Exam:
-pleuritic pain
-fever, chills, HA, nausea

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76
Q

Cholecystitis

A

-most common in middle age women
-WBC elevated

Exam:
-colicky pain in R upper abdomen
-worsen w/ ingestion of fatty foods
-s/s don’t increase with activity or decrease with rest

77
Q

Peptic Ulcer

A

Hx:
-burning pain in epigastrium
-symp relieved by food
-infection
-stressors

Exam:
-tenderness at R epigastriumm
-constipation, bleeding, vom, tarry colored stools, coffee ground emesis

78
Q

Pyelonephritis

A

-kidney infection

Hx:
-women
-UTI
-Kidney stones

Exam:
-fever, chills, malaise, flank pain
-enlarged prostate
-murphy’s sign

79
Q

Nephrolithiasis

A

Hx:
-hot and humid climate
-Hx kidney stones

Exam:
-severe back or flank pain
-chills, fever, vom
-renal colic
-UTI symptoms

80
Q

Spinal Fx

A

Hx:
-trauma
-osteoporosis
-steroid
->70
-loss of function/mobility

Exam:
-midline tenderness
-T11-L1
-bruising
-LE neuro defects
-increased thoracic kyphosis

81
Q

Head Region Red Flags

A

-meningitis
-brain tumor
-Subarachnoid hemorrhage

82
Q

Meningitis

A

Hx:
-infection
-Skull fx

Exam:
-Positive slump sign
-HA
-Fever
-GI signs
-photophobia
-confusion

83
Q

Primary Brain Tumor

A

Hx:
-20-64 yrs

Exam:
-HA
-altered mental status
-ataxia
-speech
-sensory issues
-GI signs
-Seizures

84
Q

Subarachnoid hemorrhage

A

Hx:
-smoking, HTN
-sudden HA (worst of pt life)

Exam:
-LOC
-tumor signs
-rigidity, fever, photophobia, vom

85
Q

Cervical Ligament Instability/Cord compromise

A

Hx:
-trauma
-RA or AS
-contraceptive

Exam:
-long tract neuro signs
-dizziness, nystagmus, vertigo
-clonus/Babinski

86
Q

Cervical/Shoulder Entrapment/Neuropathies

A

Hx:
-Paresthesias
-pain at rest
-retrograde distribution

Exam:
-muscles tender to palpation
-muscle and sensory issues in specific nerve patterns

87
Q

Spinal Accessory Nerve Issues

A

Hx:
-penetrating injury
-direct blow
-surgery around neck

Exam:
-asymmetry of neck line and dropping of shoulder
-inability to shrug
-lack of scapular stabilization
-weakness of shoulder abduction

88
Q

Axillary Nerve Issues

A

Hx:
-shoulder dislocation
-traction force
-trauma
-brachial neuritis

Exam:
-weakness of shoulder abduction and flx
-lack of later sensation of arm

89
Q

Long Thoracic Nerve Issues

A

Hx:
-sport playing that involves arms

Exam:
-serratus anterior weakness w/ scapular winging
-loss of scapulohumeral rhythm

90
Q

Suprascapular Nerve Issue

A

Hx:
-deep, poorly localized pain
-fx of scap
-traction MOI
-direct compression

Exam:
-similar to RC tear w/ wasting of supra and infra
-loss of strength in shoulder abd and ER

91
Q

Pancoast’s Tumor (apical lung tumor)

A

Hx:
-men >50
-smoking

Exam:
-nagging type pain in shoulder
-burning pain
-ulnar nerve distribution

92
Q

Elbow, Wrist, and Hand Red Flags

A

-fx
-radial head fx
-Distal radius fx
-Scaphoid fx
-Lunate fx/dislocation
-TFCC tear
-Space infection of hand
-Long Flexor Tendon rupture
-Raynaud’s Disease
-Complex Regional Pain Syndrome

93
Q

Fx’s

A

Hx:
-trauma
-osteoporosis
-steroids

Exam:
-signs of inflammation

94
Q

Radial Head Fx

A

Hx:
-FOOSH

Exam:
-antero lateral pain at elbow
-cant supinate or pronate
-elbow held at side at 70 flx, slightly sup

95
Q

Distal Radius (Colles’) Fx

A

Hx:
-FOOSH with extension
->40y
-osteoporosis

Exam:
-wrist in neutral
-swelling
-extension of wrist is painful

96
Q

Scaphoid Fx

A

Hx:
-FOOSH

Exam:
-swelling
-held in neurtral
-pain in snuffbox

97
Q

Lunate Fx/Dislocation

A

Hx:
-FOOSH
-diffuse synovitis

Exam:
-wrist swelling and pain
-decreased motion and grip strength

98
Q

Triangular Fibrocartilaginous Complex tear

A

Hx:
-fall after FOOSH pronated
-ass with colles’ fx

Exam:
-ulnar side wrist pain
-tenderness and clicking during ulnar dev
-weak grip strength
-dorsal ulnar head sublux

99
Q

Space infection of hand

A

Hx:
-skin puncture
-bite
-abscess
-tenosynovitis

Exam:
-inflammation in palm
-infection

100
Q

Long Flexor Tendon Rupture

A

Hx:
-RA
-corticosteroid
-trauma

Exam:
-strain s/s
-inflammation
-decreased motion
-defect

101
Q

Raynaud’s Phenomenon

A

Hx:
-RA
-oocclusive vascular disease
-smoking
-beta blockers

Exam:
-hands or feet that blanch or cyanotic then turn red
-pain and tingling

102
Q

Complex Regional Pain Syndrome

A

Hx:
-trauma
-pain that does not respond to analgesics

Exam:
-pain not consistent with typical injury
-hypersensitivity
-swollen area

103
Q

General Health Screen Components

A

-Fatigue
-Malaise: uneasiness, feeling hat something isn’r right
-Fever, chills, sweats
-Weight loss/gain: 5% BMI, depression/cancer/GI
-Nausea/vom: metabolic, CV, liver, pregnancy
-Dizziness/lightheadedness: neuro, CV, DM, anxiety
-Paresthesia, numbness, weakness: renal, neuro, endocrine, drugs
-Change in Mentation: dementia, head injury, drugs, infection

104
Q

CV System Review

A

-Syncope
-palpitations
-Sweats
-edema
-skin discoloration

105
Q

Pulmonary System Review

A

-dyspnea
-cough
-clubbing of nails
-wheezing
-stridor (gasping)

106
Q

CV/Hematologic System Review

A

-exertional dyspnea
-palpitations
-angina
-fatigue
-pallor
-clubbing finger/toes
-lightheadness
-syncope

Looking for:
-blood cell conditions
-bleeding disorders

107
Q

GI System Review

A

-swallowing difficulties
-indegestion
-intolerance
-bowl dysfunction

108
Q

Stool Color Meanings

A

Black, Tarry, Shiny, Sticky: upper Gi bleeding

Black, not sticky: ingestion of iron, licorice

Lack Grey, pale: obstructive jaundice

Bright red: lower GI bleeding

109
Q

Reproductive System Review

A
  • urethral/vagina dysfunction*
    -sexual dysfunction
    -pain with intercourse*
    -menstruation
    -Hx pregnancy*
    -menopause
110
Q

Urinary System Review

A

-color*
-flow
-force
-difficulty initiation/incontinence*

111
Q

Nervous System Review

A

-numbness/tingling*
-weakness
-tremors/seizures
-vision
-sexual difficulties
-hearing
-incontinence*
-vom w/o nausea*
-balance problems*

112
Q

Endocrine System Review

A

-general health
-psychological: personality, memory loss
-GI: n/v, anorexia, dysphagia, diarrhea, constipation
-Uro-genital
-MSK
-Sensory
-dermatologic
-Misc.: temp intolerance, visual issues, orthostatic hypo, bruising, thirst

113
Q

Integumentary System Review

A

-changes of nails/skin/hair
-itching
-changes in sweating and dryness

114
Q

Psychologic System Review

A

-general health screen
-major clinical depression
-chemical dependence
-abuse

115
Q

MSK System Review

A

-location
-description of pain
-onset of symptoms
-changes in pain
-mmts ass with pain

116
Q

DDx: Joint Pain

A

-OA MC
-PTs are primary care

-RA
-OA
-SLE
-Gout
-Psoriatic arthritis
-Reactive Arthritis
-Septic Arthritis

117
Q

Criteria for Inflammatory Back Pain

A

-morning stiffness
-improves with exercise, not with rest
-pain at night (specifically 2nd half)
-alternating butt pain
-age of onset <50 or younger, insidious, 3m of LBP

118
Q

Ankylosing Spondylitis

A

-rare
-<40yrs
-3:1 male to female
-autoimmune arthritis
-pain at rest that decreases with activity
-pain at night

Non joint involvement:
-IBS, uveitis (eye)
-weightt loss
-cardiopulm complications

119
Q

Non-Specific LBP

A

-common
-35-55yrs
-1:1 male to female
-degenerative arthritis
-potential hip referral

Non-joint involvement:
-N/A

120
Q

Classification for RA

A

-morning stiffness
-arthritis of >3 joints
-arthritis of hand joints
-symmetric arthritis
-nodules
-serum rheumatoid factor
-radiographic changes

4+ Sensitivity 85%, Specificity 90%

121
Q

Rheumatoid Arthritis

A

-20-50y
-Females more likely
-family hx
-autoimmune

-Sx increase with rest and intense activity, decrease with short rest, mild activity
-severe stiffness

122
Q

Systemic Lupus Erythematosus

A

-15-40ys
-Black females more likely
-family Hx
-Infection, sunlight, uv, meds

Sx: increase with rest, intense activity, decrease with short rest, mild activity
-moderate stiffness

Exam:
-skin rash, fever, photosensitivity, dyspnea, peripheral neuropathies

123
Q

Gout

A

-40s men, 50s women
-males more often
-nutrition, renal disorders, increased uric acid, cancer/treatment, HTN, diuretics

Sx: inc WB activity, joint use, dec w/ rest, but still there
-excruciating pain
-stiffness
-night pain
-rapid progression

Exam:
-fever, tachycardia

124
Q

Psoriatic Arthritis

A

-Psoriasis in teens-20s, arthritis follows 20ys later
-family Hx

Sx: inc w/ rest, intense activity, dec w/ short rest, mild activity
-tenderness in joints
-moderate stiffness

Exam:
-psoriasis, fever, fatigue

125
Q

Reactive Arthritis (Reiter’s Syndrome)

A

-peak onset in 20s
-males
-veneral or dysenteric disease

Sx: inc w/ rest, intense activity, dec w/ short rest, mild activity
-tenderness in joints
-moderate to severe stiffness

Exam:
-urethitis, conjuctivitis, n/v, weight loss

126
Q

Septic Arthritis

A

-abrupt onset
-corticosteroid use, DM, infect, joint trauma

Sx: inc WB activity, joint use, dec w/ rest, but still there
-excruciating pain
- less stiffness
-night pain
-rapid progression
-severe Sx

Exam:
-fever, chills

127
Q

Limb Pain

A

-calf/thigh pain
-gait issues
-not typically managed by PTs

128
Q

Dizziness

A

-impariment in spatial percepttion and sability
-consider neck conditions
-very common 17-20%

-rare in children, concerns for tumor, concussions, nutrition
-4 types

129
Q

Vertigo

A

-sensation of spinning
-asym of vestib sys (peripheral 40%, central 25%)
-2-10% incidence

130
Q

Vertebra Artery Insufficiency

A

-usually basilar
-drop attacks, dizziness, dysphagia, dysarthria, diplopia (4 Ds)
-nausea, numbness, nystagmus (3 Ns)
-CN signs
-markers for CVA

131
Q

Upper Cervical Ligamentous Instability

A

-occipital HA and numbness
-limited AROM
-signs of myelopathy

132
Q

Serious Patthologic Neck Conditions

A

-Vertebral Artery Indufficiency
-Upper cervical ligamentous instability
-Cervical Myelopathy
-Neoplastic Conditions
-Inflammatory or Systemic Disease

133
Q

Dysequilibrium

A

-dizziness, imbalance, unsteadiness w/o vertigoo
-changes in brain or body

134
Q

Presyncope

A

-vascular comprimise
-CV disease
-hypoglycemia or meds

135
Q

Non-Specific Dizziness

A

-panic/anxiety
-cervicogenic

136
Q

Cervicogenic Headache

A

-non throbbing, secodary to other coonditions
-15-20%
-cervical spine dysfunction
-unilateral
-provoked by neck mmts
-mild to moderate

137
Q

Migraine Headache

A

-pounding, pulsating
-10-15%
-unilateral but can shift sides
- >1 sign of: n, v, photophobia, phonophobia

138
Q

Cluster Headache

A

-Crushing
-<1%
-clusters every other day for 8 days
-other S/s: congestion, edema, sweating, ptosis, restlessness

139
Q

Tension Headache

A

-band, tightening
->40%
-stress, anxiety, depression
-bilateral
-mild to moderate

140
Q

Concussion Physical Neuro S/S

A

-HA
-N/V
-balance
-dizziness
-visual issues
-sensitivity to light/noise
-numbness and tingling
-dazed

141
Q

Concussion Emotional S/S

A

-irritable
-sadness
-nervousness

142
Q

Concussion Cognitive S/S

A

-mental fog
-feeling slow
-concentration issues
-remembering issues
-forgetful
-confusion
-slow responses

143
Q

Concussion Sleep S/S

A

-drowsiness
-Sleep (more or less)
-difficulty falling asleep

144
Q

Trauma (kinds)

A

Major: Fx, instabiltiy, imaging

Minor: pathological (osteoporosis), tumors

Repetitive Overuse: bony stress

Fx Screening: ascultation w/ bony precussion, tuning fork

Head Injury: TBI, Concussion (functional not anatomic disturbaces

145
Q

TBI S/s

A

-double vision, severe HA, sezizure, LOC, consciouness issues

146
Q

High Risk Sites of Overuse Injury

A

-femoral neck
-anterior cortex of tibia
-med malleolus
-navicular
-base of 2nd and 5th met head
-talus
-patella

147
Q

CT Scan

A

-Conventional Tomography
-different depths of bone, complex
-computer mathmatically reconstructs image
-expensive
-high radiation
-some soft tissues

Saggital view: left and right
Coronal: front and back
Axial: transverse

148
Q

Bone Scan

A

-distribution and metabolic activity of disease in bone
-lack of soft tissue
-substance injected to watch metabolic uptake
-moderate radiation

149
Q

MRI

A

-Magnetic Resonance imaging
-soft tissue focused (joints)
-no radiation
-body’s absorbed radio frequencies
-expensive

T1:
-weighted image
-fat brightest
-best anatomical definition

T2:
-weighted image
-water shows brightest
-swelling

Magnetic Resonance Arthrogram
-use contrast into joint

150
Q

Diagnostic Ultrasonograph

A

-reflected sound waves and tissue absorption
-leision to muscles and tendons
-real time
-dependent on operator
-no deeper structures
-based on echogenicity

151
Q

Radigraphy

A

-bony anatomy
-not good for soft tissues
-xray
-cheaper

152
Q

Echogenicity

A

Hyperechoic (fast): white (bone, tendon, ligament, nerve, muscle)
Hypochoic: dark (nerve, background of muscle)
Anechoic (slow): black (vasculature, cyst)
Isoechoic: relatively same

153
Q

DEXA

A

-Dual x-ray absorptiometry
-serial testing
-inconsistent devices
-tissue density, bone mass
-low radiation

154
Q

Bone T-Scores

A

Osteoporosis: -2.5 SD away from mean
Osteopenia: less than -1.0–2.5 SD from mean

155
Q

Pittsburgh Guidlines for Knee Trauma

A

-Guidelines for needing imaging after knee injury

-if you’ve had a MOI to knee (imaging)
-<12 (growth plate) or >50 (bone density) (imaging)
-Inabilitty to weight bear for 4 steps (imaging)

156
Q

Canadian Cervical Spine Rule

A

-guidlines for immobilization and/or imaging after trauma to neck
-positive= refer

  1. High risk factor for immobilization (any of these)
    ->65
    - dangerous MOI
    -Numbness and tingling in extremities
  2. Low risk factor for assessment of ROM
    -Complex rearending
    -cannot ambulate
    -neck pain
    -pain at midline of c-spine
  3. Can Ptt voluntarily actively rotate 45deg
    -yes: treat
    -no: immobilize and image
157
Q

Ottawa Knee Rule

A

-guidlines for imaging based on pain

->55
-Tenderness at head of fib
-isolated tenderness to patella
-inability to flx 90
-inability to weight bear 4 steps

158
Q

Ottawa Ankle and foot Fracture rules

A

Midfoot zone Rules:
-Inability to bear weight
-tenderness to base of 5th MT
-Tenderness to navicular

Malleolar zone rules:
-inability to bear weight
-tenderness to posterior lateral malleolus
-tenderness to posterior medial malleolus

159
Q

New Orleans Criteria

A

-for suspecting head injury (must have GCS 15)

-HA
-vomiting
- >60
- intoxication
-short term memory deficits
-physical evidence of trauma above clavicle
-seizure

160
Q

Canadian CT Head Rule

A

-for suspecting head injury (must have GCS 13-15)

-failure to reach 15 on GCS within 2 hours
-suspected open skull fx
-signs of basal skull fx
-vomiting 1+
->64y
-amnesia before impact >30mins
-dangerus MOI

161
Q

Radiopaque

A

-Metal/lead/bone
-white/grey

162
Q

Radiolucent

A

-air/gas
-black

163
Q

Purposes of Scanning Exam

A

-narrow search
-look for red flags
-determine body regions
-identify primary impariments
-improve outcomes
-provide guidance

164
Q

When to Scan

A
  1. No obvious MOI
  2. Proximal Cause for Distal S/s
  3. Non-mechanical sounding Sx
165
Q

LQ Scan

A
  1. Vitals***
  2. Observation: posture, plumb line
  3. Gait: look for gross abnormalities
  4. Functional MMts: squats***
  5. Balance Testing***
  6. Clear the spine**
  7. SI Joint Provocation**
  8. Myotomes: include functional testing
  9. Dermatomes
  10. DTR: patellar, med hamstring, achilles
  11. UMN Testing: Babinski, clonus***
  12. Neurodynamic Testing: SLR, slump test**
  13. LE ROM: FABER, flx, DF/PF, toe flx/ext
  14. Pulses (optional)
  15. Lymph Nodes (optional)
166
Q

Observations from Behind

A

Even: ears, scapula, ribs, arm gaps, iliac crests, PSIS, booty cheeks, knees, how many toes can you see?
-knee valgum/varum

167
Q

Observations from Side

A

-spinal curves
-ears even with acromion
-ASIS to PSIS angle
-knee recurvatum

168
Q

Observations from Front

A

Even: ears, clavicles, niples, arm gaps, iliac crests, ASIS, greater troch, knees, foot arch
-knee valgum/varum

169
Q

Gait Observations

A

-decreased WB
-hip, ankle, foot
-BOS
-flat food
-shuffling

170
Q

Functional Movements

A

Squat:
-how low
-lean
-trunk // to tibia
-DF
-knee
-arms
-hips
-asymetries/leaning

171
Q

Balance Testing

A

-Eyes open and closed
-bilat and SL

172
Q

Myotome Testing

A

-fatiguable weakness=nerve root
-constant weakness=MMT

-C5-T1
-L2-S1

Heel (L4) and Toe walking (S1/S2)

173
Q

Dermatome Testing

A

-test face first

-C4-T2
-L2-S2

T2: arm and axilla
T5: Nipplie line
T8: xiphoid process
T10: umbilicus
L1: inguinal

174
Q

Reflex Testing

A

0: no response
1: low
2: normal
3: brisk
4: very brisk
5: sustained/clonus

C5: biceps
C6: brachiorad
C7: Triceps
L4: patellar
L5: medial hamstring
S1: achilles

175
Q

UMN Signs

A

-babinski
-clonus

UE: Hoffman’s

176
Q

Clearing the Spine

A

Normal: flx/ext, LSB, rot

Provocation: compression and distraction, 5-8s

Lumbar, cervial Spine and SI joint

177
Q

ROM

A

LQ:
-FABER
-FADIR
-hip and knee ex
-toe flx/ext

UQ:
-hold and check for s/s

178
Q

Straight Leg Raise

A

-test for sciatic n

  1. actively raise leg
  2. passively raise leg
  3. flex/ext head
  4. DF finally

Pain in 0-30: acute/severe MSK
Pain in 30-70: nerve issue
Pain >70: not positive
Crossed SLR sign: opposite s/s, disc protrusion

179
Q

Slump Test

A

-test neuromobility

  1. Hands behind back
  2. Head and neck flexed
  3. Lumbar flx
  4. Straighten knee
  5. overpressure
  6. DF of ankle
180
Q

Pulses

A

-Carotid, axilla, brachial, radial, ulnar
-femoral, popliteal, post tib, dorsalis pedis

0: absent
1: reduced
2: slightly reduced
3: normal
4: bounding

181
Q

Lymph Nodes

A

-inguinal area, axilla, neck (behind ears and jaw)
-check for swelling, pain

182
Q

UQ Scan

A
  1. Vitals (HR and BP)
  2. CNs (optional)***
  3. Observation: posture, plumb line, head, face, neck, mouth***
  4. Gait: look for gross abnormalities
  5. Clear the spine
  6. UE ROM (apleys)
  7. Dermatomes (C4-T2)
  8. Myotomes (C5-T1)
  9. DTR: bicep, brachioradialis, tricep
  10. UMN Testing: Hoffman’s ***
  11. Upper Limb Tension Testing**
  12. Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
  13. Thyroid (optional)
  14. Lymph Nodes (neck, and axilla) (optional)
183
Q

Upper Limb Tension Testing

A
  1. Use elbow to depress scap
  2. Abduct
  3. Extend wrist and fingers
  4. ER
  5. Elbow extension
  6. Lat sidebending

+ Findings: differences btw sides, different elbow ROM, reproduction of s/s

184
Q

Thoracic/Abdominal Scan

A
  1. Observation: posture, plumb line, sitting, rib hump, rashes
  2. Vitals (HR and, BP)
  3. Respiratory Excursion
  4. Clear the spine (sitting, cue for thoracic only)***
  5. DTR: Upper AND lower***
  6. UMN Testing: Upper AND Lower***
  7. Slump Test***
  8. Dermatomes (T2, T5, T8, T10, L1)
  9. Superficial Abdominal Reflex (T7-T12)

10: Aortic Pulse Palpation

  1. Abdominal Palpation

12: Chest Ascultation (heart and lungs) (optional)***

185
Q

Respiratory Excursion

A

-watch

Manual:
-symmetry
-upper: anterior/posterior
-Middle: bucket handle, med/lat
-Lower: caliper/ in and out

186
Q

Superficial Abdominal Reflex

A

-stroke in each of 4 quadrants in counterclockwise motion
-Upper: t7-t9 (right below xiphoid)
-lower: t10-t12 (under belly button)

+: abdomen contraction toward stimulus, normal

  • : absense is abnormal
187
Q

Aortic Pulse Palpation

A

-supine with knees flexed to relax tissue
-left side of linea alba
-check for bounding or pain and size (more tthan 1-2 fingers)

0: absent
2: normal
4: bounding

188
Q

Abdominal Palpation

A

-knees bent
-starts superficial then deep

LUQ: stomach, L kidney, liver

RUQ: liver, gallbladder, r kidney

LLQ: sigmoid colon, L ovary, spermatic cord

RLQ: appendex, r ovary, colon

189
Q

Chest Ascultation

A

Heart:
-aortic, tricuspid, pulmonary, mitral (top r, bottom r, top L, bottom far L)

Respiratory:
-3 on each side

190
Q

Lab Values

A

Hemoglobin: 12-18
- <8: no exercise
->10: resistve as allowed

Hematocrit: 37-52%
-<25: no exercise
->30: resistve as allowed

WBC: 4,500-11,000
-<1,000 mask and no exercise
-1,000-5,000 light or no

Platlets: 150,000-450,000
-<20,000 no exercise
-20-30: light
-30-50: moderate
->50: resistive as tolerated

Glucose: 80-120
-<70: snack
->180-200: insulin

Fastin Blood Glucose: 70-110

Primary Care (7 decks)

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