Final Exam Flashcards
Primary Care
-accessible, comprehensive, coordinated and coonntinual care by providers of public health
PT in Primary Care
-triage
-determine if they should be there
-referral
-immediate or emergency care
Red/Yellow Flags
- Major Depression
- Suicide Risk
- Femoral Fx
- Cuada Equina Syndrome
- Cervical Myelopathy
- Abdominal Aortic Aneurysm
- Deep Vein Thrombosis
- Pulmonary Embolism
- Atypical Myocardial Infarction
Major Depression
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
Suicide Risk
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)
Femoral Fx
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
Cauda Equina Syndrome
RK:
-LBI
-spinal stenosis
-spinal fx
-ankylosing spondylitis
-TB
CM:
-LB/LE pain
-B/B issues
-saddle anesthesia
-urinary retention
-ataxia
Cervical Myelopathy
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
Abdominal aortic Aneurysm
- 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
Deep Vein Thrombosis
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
Pulmonary Embolism
-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
Atypical Myocardial Infarction
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
Clinical Desicion Rule for DVT
-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)
Clinical Desicion Rule for PE
-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)
Validity
-how correct it is
-measures what it should
-cannot exit without reliability
Reliabiliy
-how consistent it is
-degree of association
-can exist without validity
Contingency Table
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
Sensitivity
-snout: rule out
-true positive test
-shows all the positive so it rules out the negatives
-a/(a+c)
Specificity
-spin: rule in
-true negative
-shows all the negative so it rules in the positives
-d/(b+d)
Predictive Value (+)
-likelyhood that the positive test = having condition
-a/(a+b)
Predictive Value (-)
-likelyhood that the negative test= not having condition
-d/(c+d)
Positive Likelihood Ratio
-increased odds of having condition if testing positive
-ratio of true to false
-Sensitivity/ (1- Specificity)
-higher= more likely
Negative Likelihood Ratio
-decreased odds of having condition if testing negative
-ratio of false to true
-(1- Sensitivity)/ Specificity
-lower= less likely
Guide to Interpreting LR
-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
Minimal Detectable Change
-MDC
-amount of change needed to overcome measurement error
-increase reliability of test decreases MDC
Minimal Clinical Important Difference
-MCID
-amount of important change from the perspective of individual
-should be bigger than MDC
Examination Process
-Hx
-observation
-Scanning exam
-ROM
-Muscle
-Joing
-Palpation
-Special Tests
SINSS
-severity
-irritability
-nature of complaint
-stage
-stability
Severity
-clinician assessment of intensity of symptoms in terms of function
Fracture: high
Sprain: low
Irritability
-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
Nature of Complaint
Describe assessment of:
-structures, syndromes
-caution things
-character of problem
Stage of Pathology
-stage of injury
Stability
-progression of s/s over time
Pt Hx Red Flags
-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
Pain Referral: Heart
-Left side of chest, arm, jaw, neck
-middle of upper back
Pain Referral: Lungs
-neck and shoulders
Pain Referral: Esophagus
-front of chest
Pain Referral: Liver and Gallbladder
-front and back right side of back/abdomen
-front and back of right side of chest and neck
Pain Referral: Stomach
-middle of chest
-middle of back
Pain Referral: Pancreas
-anterior, middle abdomen
Pain Referral: Kidney
-hips and thighs
Pain Referral: Small Intestine
-anterior lower abdomen
Pain Referral: Appendix
-right, anterior, lower mid to low abdomen and pelvis
Pain Referral: Ovaries
-bilateral pelvic
Pain Referral: Colon
-anterior pelvis
Pain Referral: Bladder
-Anterior and posterior pelvis
-genital
-back of thighs
MSK Symptom Investigation
-pain that changes over 24h
-motions change pain
Non-MSK Symptom Investigation
-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)
Sequence of Symptom Questions
-what interferes most w/ normal function
-describe it
-behavior of s/s
-intensity
-s/s elsewhere
Low Back Red Flags
-Tumor
-Infection/Osteomyelitis
-Cauda Equina
-Fx
-Abdominal Aneurysm
Back Related Tumor Red Flags
Hx:
->50
-Hx Cancer
-unexplained weight loss
-failure of treatment
Exam:
-Constant Pain
-worse at night
Back Related Infection/Osteomyelitis Red Flags
Hx:
-infection/drug use
-immunosuppressed
Exam:
-deep constant pain
-fever, malaise, swelling
-spine rigidity
Cauda Equina Red Flags
Hx:
-spinal stenosis
-DDD
Exam:
-urinary retention
-fecal incontinence
-saddle anesthesia
-weakness of LE
-sensory issues
Spinal Fx Red Flags
Hx:
-trauma
-steroid use
->70
Exam:
-tender with palpation
-edema
Abdominal Aortic Aneurysm Flags
Hx:
-back, groin pain
-PVD or CAD
-s/s not related to movement
Exam:
-Abnormal width of aortic or iliac arterial pulses
-bruit
Pelvis, Hip, and Thigh Red Flags
-colon cancer
-femoral neck Fx
-Osteonecrosis
-Legg- Calve Perthes
-SCFE
Colon Cancer Red Flags
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
Femoral Neck Fracture
Hx:
-older women
-hip, groin, thigh pain
-Hx of fall
Exam:
-severe, constant pain
-shortened LE
Osteonecrosis
Hx:
-corticosterioid
-Hx of osteonecrosis
-trauma
Exam:
-gradual onset
-stiff joint, restricted 1 deg IR or Flx
Legg-Calve-Perthes
Hx:
-5-8 yr old boys
-groin/thigh pain
Exam:
-antalgic gait
-pain worse with hip mmt (hip abd/IR)
Slipped Capital Femoral Epiphysis
Hx:
-overweight child
-Hx of growth spurt
Exam:
-aching in groin
-leg in ER
-ROM IR limitations
Knee, Leg, Ankle, Foot Red Flags
-PAOD
-DVT
-Compartment Syndrome
-Septic Arthritis
-Cellulitis
Peripheral Arterial Occlusive Disease
Hx:
->60
-DM
-H of ischemic HD
-Smoking
-sedentary
-claudication
Exam:
-cool extremity
-prolonged capillary fill time
-decreased pulses
-prolonged vascular fill time
DVT
Hx:
-surgery
-trauma
-pregnancy
-immobilization
Exam:
-pain
-edema
-warmth/redness
-relieved by rest and elevation
Compartment Syndrome
Hx:
-blunt trauma
Exam:
-severe leg pain
-swelling/tenderness
-paresthesia, pallor, pulselessness
Septic Arthritis
Hx:
-recent infection
-surgery
-immunosuppressive
Exam:
-constant aching
-joint swelling
-warmth
-elevated body temp
Cellulitis
Hx:
-recent skin ulceration
-abrasion
-venous insufficiency
-Cirrosis
-CHF
Exam:
-pain
-skin swelling
-warmth
-irregular redness
-fever, chills, weakness
Thoracic Spine and Rib Cage Regions Red Flags
-MI
-Angina (stable and unstable)
-Pericarditis
-PE
-Pleurisy
-Pneumothorax
-Pneumonia
-Cholecystitis
-Peptic Ulcer
-Pyelonephritis
-Kidney stones
-Spinal Fx
Myocardial Infarction
Hx:
-risk factors for CAD
Exam:
-chest pain
-pallor, sweating, dyspnea
-not relieved by nitroglycerin
Unstable Angina
Hx:
-Hx CAD
Exam:
-outside of the predictable pattern
-not responsive to nitroglycerin
Stable Angina
Hx:
->65
-Hx CAD
Exam:
-predictable exertion
-predictably alleviated or w/rest or nitroglycerine
Pericarditis
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
Pulmonary Embolism
Hx:
-risk factors
-immobility
-trauma
-cancer
Exam:
-chest, shoulder and upper abdominal pain
-dyspnea
-tachypnea
-tachycardia
Pleurisy
Hx:
-respiratory disorder
-infection
-pneumonia
-tumor
-TB
Exam:
-severe, sharp pain with inspiration
-dyspnea
-decreased chest wall excursion
Pneumothorax
Hx:
-coughing
-strenuous exercise
-trauma
Exam:
-chest pain with inspiration
-difficulty breathing
-hyperresonance
-decreased breath sounds
Pneumonia
Hx:
-infections
Exam:
-pleuritic pain
-fever, chills, HA, nausea
Cholecystitis
-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
Peptic Ulcer
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
Pyelonephritis
-kidney infection
Hx:
-women
-UTI
-Kidney stones
Exam:
-fever, chills, malaise, flank pain
-enlarged prostate
-murphy’s sign
Nephrolithiasis
Hx:
-hot and humid climate
-Hx kidney stones
Exam:
-severe back or flank pain
-chills, fever, vom
-renal colic
-UTI symptoms
Spinal Fx
Hx:
-trauma
-osteoporosis
-steroid
->70
-loss of function/mobility
Exam:
-midline tenderness
-T11-L1
-bruising
-LE neuro defects
-increased thoracic kyphosis
Head Region Red Flags
-meningitis
-brain tumor
-Subarachnoid hemorrhage
Meningitis
Hx:
-infection
-Skull fx
Exam:
-Positive slump sign
-HA
-Fever
-GI signs
-photophobia
-confusion
Primary Brain Tumor
Hx:
-20-64 yrs
Exam:
-HA
-altered mental status
-ataxia
-speech
-sensory issues
-GI signs
-Seizures
Subarachnoid hemorrhage
Hx:
-smoking, HTN
-sudden HA (worst of pt life)
Exam:
-LOC
-tumor signs
-rigidity, fever, photophobia, vom
Cervical Ligament Instability/Cord compromise
Hx:
-trauma
-RA or AS
-contraceptive
Exam:
-long tract neuro signs
-dizziness, nystagmus, vertigo
-clonus/Babinski
Cervical/Shoulder Entrapment/Neuropathies
Hx:
-Paresthesias
-pain at rest
-retrograde distribution
Exam:
-muscles tender to palpation
-muscle and sensory issues in specific nerve patterns
Spinal Accessory Nerve Issues
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
Axillary Nerve Issues
Hx:
-shoulder dislocation
-traction force
-trauma
-brachial neuritis
Exam:
-weakness of shoulder abduction and flx
-lack of later sensation of arm
Long Thoracic Nerve Issues
Hx:
-sport playing that involves arms
Exam:
-serratus anterior weakness w/ scapular winging
-loss of scapulohumeral rhythm
Suprascapular Nerve Issue
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
Pancoast’s Tumor (apical lung tumor)
Hx:
-men >50
-smoking
Exam:
-nagging type pain in shoulder
-burning pain
-ulnar nerve distribution
Elbow, Wrist, and Hand Red Flags
-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
Fx’s
Hx:
-trauma
-osteoporosis
-steroids
Exam:
-signs of inflammation
Radial Head Fx
Hx:
-FOOSH
Exam:
-antero lateral pain at elbow
-cant supinate or pronate
-elbow held at side at 70 flx, slightly sup
Distal Radius (Colles’) Fx
Hx:
-FOOSH with extension
->40y
-osteoporosis
Exam:
-wrist in neutral
-swelling
-extension of wrist is painful
Scaphoid Fx
Hx:
-FOOSH
Exam:
-swelling
-held in neurtral
-pain in snuffbox
Lunate Fx/Dislocation
Hx:
-FOOSH
-diffuse synovitis
Exam:
-wrist swelling and pain
-decreased motion and grip strength
Triangular Fibrocartilaginous Complex tear
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
Space infection of hand
Hx:
-skin puncture
-bite
-abscess
-tenosynovitis
Exam:
-inflammation in palm
-infection
Long Flexor Tendon Rupture
Hx:
-RA
-corticosteroid
-trauma
Exam:
-strain s/s
-inflammation
-decreased motion
-defect
Raynaud’s Phenomenon
Hx:
-RA
-oocclusive vascular disease
-smoking
-beta blockers
Exam:
-hands or feet that blanch or cyanotic then turn red
-pain and tingling
Complex Regional Pain Syndrome
Hx:
-trauma
-pain that does not respond to analgesics
Exam:
-pain not consistent with typical injury
-hypersensitivity
-swollen area
General Health Screen Components
-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
CV System Review
-Syncope
-palpitations
-Sweats
-edema
-skin discoloration
Pulmonary System Review
-dyspnea
-cough
-clubbing of nails
-wheezing
-stridor (gasping)
CV/Hematologic System Review
-exertional dyspnea
-palpitations
-angina
-fatigue
-pallor
-clubbing finger/toes
-lightheadness
-syncope
Looking for:
-blood cell conditions
-bleeding disorders
GI System Review
-swallowing difficulties
-indegestion
-intolerance
-bowl dysfunction
Stool Color Meanings
Black, Tarry, Shiny, Sticky: upper Gi bleeding
Black, not sticky: ingestion of iron, licorice
Lack Grey, pale: obstructive jaundice
Bright red: lower GI bleeding
Reproductive System Review
- urethral/vagina dysfunction*
-sexual dysfunction
-pain with intercourse*
-menstruation
-Hx pregnancy*
-menopause
Urinary System Review
-color*
-flow
-force
-difficulty initiation/incontinence*
Nervous System Review
-numbness/tingling*
-weakness
-tremors/seizures
-vision
-sexual difficulties
-hearing
-incontinence*
-vom w/o nausea*
-balance problems*
Endocrine System Review
-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
Integumentary System Review
-changes of nails/skin/hair
-itching
-changes in sweating and dryness
Psychologic System Review
-general health screen
-major clinical depression
-chemical dependence
-abuse
MSK System Review
-location
-description of pain
-onset of symptoms
-changes in pain
-mmts ass with pain
DDx: Joint Pain
-OA MC
-PTs are primary care
-RA
-OA
-SLE
-Gout
-Psoriatic arthritis
-Reactive Arthritis
-Septic Arthritis
Criteria for Inflammatory Back Pain
-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
Ankylosing Spondylitis
-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
Non-Specific LBP
-common
-35-55yrs
-1:1 male to female
-degenerative arthritis
-potential hip referral
Non-joint involvement:
-N/A
Classification for RA
-morning stiffness
-arthritis of >3 joints
-arthritis of hand joints
-symmetric arthritis
-nodules
-serum rheumatoid factor
-radiographic changes
4+ Sensitivity 85%, Specificity 90%
Rheumatoid Arthritis
-20-50y
-Females more likely
-family hx
-autoimmune
-Sx increase with rest and intense activity, decrease with short rest, mild activity
-severe stiffness
Systemic Lupus Erythematosus
-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
Gout
-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
Psoriatic Arthritis
-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
Reactive Arthritis (Reiter’s Syndrome)
-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
Septic Arthritis
-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
Limb Pain
-calf/thigh pain
-gait issues
-not typically managed by PTs
Dizziness
-impariment in spatial percepttion and sability
-consider neck conditions
-very common 17-20%
-rare in children, concerns for tumor, concussions, nutrition
-4 types
Vertigo
-sensation of spinning
-asym of vestib sys (peripheral 40%, central 25%)
-2-10% incidence
Vertebra Artery Insufficiency
-usually basilar
-drop attacks, dizziness, dysphagia, dysarthria, diplopia (4 Ds)
-nausea, numbness, nystagmus (3 Ns)
-CN signs
-markers for CVA
Upper Cervical Ligamentous Instability
-occipital HA and numbness
-limited AROM
-signs of myelopathy
Serious Patthologic Neck Conditions
-Vertebral Artery Indufficiency
-Upper cervical ligamentous instability
-Cervical Myelopathy
-Neoplastic Conditions
-Inflammatory or Systemic Disease
Dysequilibrium
-dizziness, imbalance, unsteadiness w/o vertigoo
-changes in brain or body
Presyncope
-vascular comprimise
-CV disease
-hypoglycemia or meds
Non-Specific Dizziness
-panic/anxiety
-cervicogenic
Cervicogenic Headache
-non throbbing, secodary to other coonditions
-15-20%
-cervical spine dysfunction
-unilateral
-provoked by neck mmts
-mild to moderate
Migraine Headache
-pounding, pulsating
-10-15%
-unilateral but can shift sides
- >1 sign of: n, v, photophobia, phonophobia
Cluster Headache
-Crushing
-<1%
-clusters every other day for 8 days
-other S/s: congestion, edema, sweating, ptosis, restlessness
Tension Headache
-band, tightening
->40%
-stress, anxiety, depression
-bilateral
-mild to moderate
Concussion Physical Neuro S/S
-HA
-N/V
-balance
-dizziness
-visual issues
-sensitivity to light/noise
-numbness and tingling
-dazed
Concussion Emotional S/S
-irritable
-sadness
-nervousness
Concussion Cognitive S/S
-mental fog
-feeling slow
-concentration issues
-remembering issues
-forgetful
-confusion
-slow responses
Concussion Sleep S/S
-drowsiness
-Sleep (more or less)
-difficulty falling asleep
Trauma (kinds)
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
TBI S/s
-double vision, severe HA, sezizure, LOC, consciouness issues
High Risk Sites of Overuse Injury
-femoral neck
-anterior cortex of tibia
-med malleolus
-navicular
-base of 2nd and 5th met head
-talus
-patella
CT Scan
-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
Bone Scan
-distribution and metabolic activity of disease in bone
-lack of soft tissue
-substance injected to watch metabolic uptake
-moderate radiation
MRI
-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
Diagnostic Ultrasonograph
-reflected sound waves and tissue absorption
-leision to muscles and tendons
-real time
-dependent on operator
-no deeper structures
-based on echogenicity
Radigraphy
-bony anatomy
-not good for soft tissues
-xray
-cheaper
Echogenicity
Hyperechoic (fast): white (bone, tendon, ligament, nerve, muscle)
Hypochoic: dark (nerve, background of muscle)
Anechoic (slow): black (vasculature, cyst)
Isoechoic: relatively same
DEXA
-Dual x-ray absorptiometry
-serial testing
-inconsistent devices
-tissue density, bone mass
-low radiation
Bone T-Scores
Osteoporosis: -2.5 SD away from mean
Osteopenia: less than -1.0–2.5 SD from mean
Pittsburgh Guidlines for Knee Trauma
-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)
Canadian Cervical Spine Rule
-guidlines for immobilization and/or imaging after trauma to neck
-positive= refer
- High risk factor for immobilization (any of these)
->65
- dangerous MOI
-Numbness and tingling in extremities - Low risk factor for assessment of ROM
-Complex rearending
-cannot ambulate
-neck pain
-pain at midline of c-spine - Can Ptt voluntarily actively rotate 45deg
-yes: treat
-no: immobilize and image
Ottawa Knee Rule
-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
Ottawa Ankle and foot Fracture rules
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
New Orleans Criteria
-for suspecting head injury (must have GCS 15)
-HA
-vomiting
- >60
- intoxication
-short term memory deficits
-physical evidence of trauma above clavicle
-seizure
Canadian CT Head Rule
-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
Radiopaque
-Metal/lead/bone
-white/grey
Radiolucent
-air/gas
-black
Purposes of Scanning Exam
-narrow search
-look for red flags
-determine body regions
-identify primary impariments
-improve outcomes
-provide guidance
When to Scan
- No obvious MOI
- Proximal Cause for Distal S/s
- Non-mechanical sounding Sx
LQ Scan
- Vitals***
- Observation: posture, plumb line
- Gait: look for gross abnormalities
- Functional MMts: squats***
- Balance Testing***
- Clear the spine**
- SI Joint Provocation**
- Myotomes: include functional testing
- Dermatomes
- DTR: patellar, med hamstring, achilles
- UMN Testing: Babinski, clonus***
- Neurodynamic Testing: SLR, slump test**
- LE ROM: FABER, flx, DF/PF, toe flx/ext
- Pulses (optional)
- Lymph Nodes (optional)
Observations from Behind
Even: ears, scapula, ribs, arm gaps, iliac crests, PSIS, booty cheeks, knees, how many toes can you see?
-knee valgum/varum
Observations from Side
-spinal curves
-ears even with acromion
-ASIS to PSIS angle
-knee recurvatum
Observations from Front
Even: ears, clavicles, niples, arm gaps, iliac crests, ASIS, greater troch, knees, foot arch
-knee valgum/varum
Gait Observations
-decreased WB
-hip, ankle, foot
-BOS
-flat food
-shuffling
Functional Movements
Squat:
-how low
-lean
-trunk // to tibia
-DF
-knee
-arms
-hips
-asymetries/leaning
Balance Testing
-Eyes open and closed
-bilat and SL
Myotome Testing
-fatiguable weakness=nerve root
-constant weakness=MMT
-C5-T1
-L2-S1
Heel (L4) and Toe walking (S1/S2)
Dermatome Testing
-test face first
-C4-T2
-L2-S2
T2: arm and axilla
T5: Nipplie line
T8: xiphoid process
T10: umbilicus
L1: inguinal
Reflex Testing
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
UMN Signs
-babinski
-clonus
UE: Hoffman’s
Clearing the Spine
Normal: flx/ext, LSB, rot
Provocation: compression and distraction, 5-8s
Lumbar, cervial Spine and SI joint
ROM
LQ:
-FABER
-FADIR
-hip and knee ex
-toe flx/ext
UQ:
-hold and check for s/s
Straight Leg Raise
-test for sciatic n
- actively raise leg
- passively raise leg
- flex/ext head
- 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
Slump Test
-test neuromobility
- Hands behind back
- Head and neck flexed
- Lumbar flx
- Straighten knee
- overpressure
- DF of ankle
Pulses
-Carotid, axilla, brachial, radial, ulnar
-femoral, popliteal, post tib, dorsalis pedis
0: absent
1: reduced
2: slightly reduced
3: normal
4: bounding
Lymph Nodes
-inguinal area, axilla, neck (behind ears and jaw)
-check for swelling, pain
UQ Scan
- Vitals (HR and BP)
- CNs (optional)***
- Observation: posture, plumb line, head, face, neck, mouth***
- Gait: look for gross abnormalities
- Clear the spine
- UE ROM (apleys)
- Dermatomes (C4-T2)
- Myotomes (C5-T1)
- DTR: bicep, brachioradialis, tricep
- UMN Testing: Hoffman’s ***
- Upper Limb Tension Testing**
- Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
- Thyroid (optional)
- Lymph Nodes (neck, and axilla) (optional)
Upper Limb Tension Testing
- Use elbow to depress scap
- Abduct
- Extend wrist and fingers
- ER
- Elbow extension
- Lat sidebending
+ Findings: differences btw sides, different elbow ROM, reproduction of s/s
Thoracic/Abdominal Scan
- Observation: posture, plumb line, sitting, rib hump, rashes
- Vitals (HR and, BP)
- Respiratory Excursion
- Clear the spine (sitting, cue for thoracic only)***
- DTR: Upper AND lower***
- UMN Testing: Upper AND Lower***
- Slump Test***
- Dermatomes (T2, T5, T8, T10, L1)
- Superficial Abdominal Reflex (T7-T12)
10: Aortic Pulse Palpation
- Abdominal Palpation
12: Chest Ascultation (heart and lungs) (optional)***
Respiratory Excursion
-watch
Manual:
-symmetry
-upper: anterior/posterior
-Middle: bucket handle, med/lat
-Lower: caliper/ in and out
Superficial Abdominal Reflex
-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
Aortic Pulse Palpation
-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
Abdominal Palpation
-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
Chest Ascultation
Heart:
-aortic, tricuspid, pulmonary, mitral (top r, bottom r, top L, bottom far L)
Respiratory:
-3 on each side
Lab Values
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
