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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
Minimal Detectable Change
-MDC -amount of change needed to overcome measurement error -increase reliability of test decreases MDC
25
Minimal Clinical Important Difference
-MCID -amount of important change from the perspective of individual -should be bigger than MDC
26
Examination Process
-Hx -observation -Scanning exam -ROM -Muscle -Joing -Palpation -Special Tests
27
SINSS
-severity -irritability -nature of complaint -stage -stability
28
Severity
-clinician assessment of intensity of symptoms in terms of function Fracture: high Sprain: low
29
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
30
Nature of Complaint
Describe assessment of: -structures, syndromes -caution things -character of problem
31
Stage of Pathology
-stage of injury
32
Stability
-progression of s/s over time
33
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
34
Pain Referral: Heart
-Left side of chest, arm, jaw, neck -middle of upper back
35
Pain Referral: Lungs
-neck and shoulders
36
Pain Referral: Esophagus
-front of chest
37
Pain Referral: Liver and Gallbladder
-front and back right side of back/abdomen -front and back of right side of chest and neck
38
Pain Referral: Stomach
-middle of chest -middle of back
39
Pain Referral: Pancreas
-anterior, middle abdomen
40
Pain Referral: Kidney
-hips and thighs
41
Pain Referral: Small Intestine
-anterior lower abdomen
42
Pain Referral: Appendix
-right, anterior, lower mid to low abdomen and pelvis
43
Pain Referral: Ovaries
-bilateral pelvic
44
Pain Referral: Colon
-anterior pelvis
45
Pain Referral: Bladder
-Anterior and posterior pelvis -genital -back of thighs
46
MSK Symptom Investigation
-pain that changes over 24h -motions change pain
47
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)
48
Sequence of Symptom Questions
-what interferes most w/ normal function -describe it -behavior of s/s -intensity -s/s elsewhere
49
Low Back Red Flags
-Tumor -Infection/Osteomyelitis -Cauda Equina -Fx -Abdominal Aneurysm
50
Back Related Tumor Red Flags
Hx: ->50 -Hx Cancer -unexplained weight loss -failure of treatment Exam: -Constant Pain -worse at night
51
Back Related Infection/Osteomyelitis Red Flags
Hx: -infection/drug use -immunosuppressed Exam: -deep constant pain -fever, malaise, swelling -spine rigidity
52
Cauda Equina Red Flags
Hx: -spinal stenosis -DDD Exam: -urinary retention -fecal incontinence -saddle anesthesia -weakness of LE -sensory issues
53
Spinal Fx Red Flags
Hx: -trauma -steroid use ->70 Exam: -tender with palpation -edema
54
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
55
Pelvis, Hip, and Thigh Red Flags
-colon cancer -femoral neck Fx -Osteonecrosis -Legg- Calve Perthes -SCFE
56
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
57
Femoral Neck Fracture
Hx: -older women -hip, groin, thigh pain -Hx of fall Exam: -severe, constant pain -shortened LE
58
Osteonecrosis
Hx: -corticosterioid -Hx of osteonecrosis -trauma Exam: -gradual onset -stiff joint, restricted 1 deg IR or Flx
59
Legg-Calve-Perthes
Hx: -5-8 yr old boys -groin/thigh pain Exam: -antalgic gait -pain worse with hip mmt (hip abd/IR)
60
Slipped Capital Femoral Epiphysis
Hx: -overweight child -Hx of growth spurt Exam: -aching in groin -leg in ER -ROM IR limitations
61
Knee, Leg, Ankle, Foot Red Flags
-PAOD -DVT -Compartment Syndrome -Septic Arthritis -Cellulitis
62
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
63
DVT
Hx: -surgery -trauma -pregnancy -immobilization Exam: -pain -edema -warmth/redness -relieved by rest and elevation
64
Compartment Syndrome
Hx: -blunt trauma Exam: -severe leg pain -swelling/tenderness -paresthesia, pallor, pulselessness
65
Septic Arthritis
Hx: -recent infection -surgery -immunosuppressive Exam: -constant aching -joint swelling -warmth -elevated body temp
66
Cellulitis
Hx: -recent skin ulceration -abrasion -venous insufficiency -Cirrosis -CHF Exam: -pain -skin swelling -warmth -irregular redness -fever, chills, weakness
67
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
68
Myocardial Infarction
Hx: -risk factors for CAD Exam: -chest pain -pallor, sweating, dyspnea -not relieved by nitroglycerin
69
Unstable Angina
Hx: -Hx CAD Exam: -outside of the predictable pattern -not responsive to nitroglycerin
70
Stable Angina
Hx: ->65 -Hx CAD Exam: -predictable exertion -predictably alleviated or w/rest or nitroglycerine
71
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
72
Pulmonary Embolism
Hx: -risk factors -immobility -trauma -cancer Exam: -chest, shoulder and upper abdominal pain -dyspnea -tachypnea -tachycardia
73
Pleurisy
Hx: -respiratory disorder -infection -pneumonia -tumor -TB Exam: -severe, sharp pain with inspiration -dyspnea -decreased chest wall excursion
74
Pneumothorax
Hx: -coughing -strenuous exercise -trauma Exam: -chest pain with inspiration -difficulty breathing -hyperresonance -decreased breath sounds
75
Pneumonia
Hx: -infections Exam: -pleuritic pain -fever, chills, HA, nausea
76
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
77
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
78
Pyelonephritis
-kidney infection Hx: -women -UTI -Kidney stones Exam: -fever, chills, malaise, flank pain -enlarged prostate -murphy's sign
79
Nephrolithiasis
Hx: -hot and humid climate -Hx kidney stones Exam: -severe back or flank pain -chills, fever, vom -renal colic -UTI symptoms
80
Spinal Fx
Hx: -trauma -osteoporosis -steroid ->70 -loss of function/mobility Exam: -midline tenderness -T11-L1 -bruising -LE neuro defects -increased thoracic kyphosis
81
Head Region Red Flags
-meningitis -brain tumor -Subarachnoid hemorrhage
82
Meningitis
Hx: -infection -Skull fx Exam: -Positive slump sign -HA -Fever -GI signs -photophobia -confusion
83
Primary Brain Tumor
Hx: -20-64 yrs Exam: -HA -altered mental status -ataxia -speech -sensory issues -GI signs -Seizures
84
Subarachnoid hemorrhage
Hx: -smoking, HTN -sudden HA (worst of pt life) Exam: -LOC -tumor signs -rigidity, fever, photophobia, vom
85
Cervical Ligament Instability/Cord compromise
Hx: -trauma -RA or AS -contraceptive Exam: -long tract neuro signs -dizziness, nystagmus, vertigo -clonus/Babinski
86
Cervical/Shoulder Entrapment/Neuropathies
Hx: -Paresthesias -pain at rest -retrograde distribution Exam: -muscles tender to palpation -muscle and sensory issues in specific nerve patterns
87
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
88
Axillary Nerve Issues
Hx: -shoulder dislocation -traction force -trauma -brachial neuritis Exam: -weakness of shoulder abduction and flx -lack of later sensation of arm
89
Long Thoracic Nerve Issues
Hx: -sport playing that involves arms Exam: -serratus anterior weakness w/ scapular winging -loss of scapulohumeral rhythm
90
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
91
Pancoast's Tumor (apical lung tumor)
Hx: -men >50 -smoking Exam: -nagging type pain in shoulder -burning pain -ulnar nerve distribution
92
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
93
Fx's
Hx: -trauma -osteoporosis -steroids Exam: -signs of inflammation
94
Radial Head Fx
Hx: -FOOSH Exam: -antero lateral pain at elbow -cant supinate or pronate -elbow held at side at 70 flx, slightly sup
95
Distal Radius (Colles') Fx
Hx: -FOOSH with extension ->40y -osteoporosis Exam: -wrist in neutral -swelling -extension of wrist is painful
96
Scaphoid Fx
Hx: -FOOSH Exam: -swelling -held in neurtral -pain in snuffbox
97
Lunate Fx/Dislocation
Hx: -FOOSH -diffuse synovitis Exam: -wrist swelling and pain -decreased motion and grip strength
98
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
99
Space infection of hand
Hx: -skin puncture -bite -abscess -tenosynovitis Exam: -inflammation in palm -infection
100
Long Flexor Tendon Rupture
Hx: -RA -corticosteroid -trauma Exam: -strain s/s -inflammation -decreased motion -defect
101
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
102
Complex Regional Pain Syndrome
Hx: -trauma -pain that does not respond to analgesics Exam: -pain not consistent with typical injury -hypersensitivity -swollen area
103
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
104
CV System Review
-Syncope -palpitations -Sweats -edema -skin discoloration
105
Pulmonary System Review
-dyspnea -cough -clubbing of nails -wheezing -stridor (gasping)
106
CV/Hematologic System Review
-exertional dyspnea -palpitations -angina -fatigue -pallor -clubbing finger/toes -lightheadness -syncope Looking for: -blood cell conditions -bleeding disorders
107
GI System Review
-swallowing difficulties -indegestion -intolerance -bowl dysfunction
108
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
109
Reproductive System Review
- urethral/vagina dysfunction* -sexual dysfunction -pain with intercourse* -menstruation -Hx pregnancy* -menopause
110
Urinary System Review
-color* -flow -force -difficulty initiation/incontinence*
111
Nervous System Review
-numbness/tingling* -weakness -tremors/seizures -vision -sexual difficulties -hearing -incontinence* -vom w/o nausea* -balance problems*
112
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
113
Integumentary System Review
-changes of nails/skin/hair -itching -changes in sweating and dryness
114
Psychologic System Review
-general health screen -major clinical depression -chemical dependence -abuse
115
MSK System Review
-location -description of pain -onset of symptoms -changes in pain -mmts ass with pain
116
DDx: Joint Pain
-OA MC -PTs are primary care -RA -OA -SLE -Gout -Psoriatic arthritis -Reactive Arthritis -Septic Arthritis
117
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
118
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
119
Non-Specific LBP
-common -35-55yrs -1:1 male to female -degenerative arthritis -potential hip referral Non-joint involvement: -N/A
120
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%
121
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
122
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
123
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
124
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
125
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
126
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
127
Limb Pain
-calf/thigh pain -gait issues -not typically managed by PTs
128
Dizziness
-impariment in spatial percepttion and sability -consider neck conditions -very common 17-20% -rare in children, concerns for tumor, concussions, nutrition -4 types
129
Vertigo
-sensation of spinning -asym of vestib sys (peripheral 40%, central 25%) -2-10% incidence
130
Vertebra Artery Insufficiency
-usually basilar -drop attacks, dizziness, dysphagia, dysarthria, diplopia (4 Ds) -nausea, numbness, nystagmus (3 Ns) -CN signs -markers for CVA
131
Upper Cervical Ligamentous Instability
-occipital HA and numbness -limited AROM -signs of myelopathy
132
Serious Patthologic Neck Conditions
-Vertebral Artery Indufficiency -Upper cervical ligamentous instability -Cervical Myelopathy -Neoplastic Conditions -Inflammatory or Systemic Disease
133
Dysequilibrium
-dizziness, imbalance, unsteadiness w/o vertigoo -changes in brain or body
134
Presyncope
-vascular comprimise -CV disease -hypoglycemia or meds
135
Non-Specific Dizziness
-panic/anxiety -cervicogenic
136
Cervicogenic Headache
-non throbbing, secodary to other coonditions -15-20% -cervical spine dysfunction -unilateral -provoked by neck mmts -mild to moderate
137
Migraine Headache
-pounding, pulsating -10-15% -unilateral but can shift sides - >1 sign of: n, v, photophobia, phonophobia
138
Cluster Headache
-Crushing -<1% -clusters every other day for 8 days -other S/s: congestion, edema, sweating, ptosis, restlessness
139
Tension Headache
-band, tightening ->40% -stress, anxiety, depression -bilateral -mild to moderate
140
Concussion Physical Neuro S/S
-HA -N/V -balance -dizziness -visual issues -sensitivity to light/noise -numbness and tingling -dazed
141
Concussion Emotional S/S
-irritable -sadness -nervousness
142
Concussion Cognitive S/S
-mental fog -feeling slow -concentration issues -remembering issues -forgetful -confusion -slow responses
143
Concussion Sleep S/S
-drowsiness -Sleep (more or less) -difficulty falling asleep
144
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
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TBI S/s
-double vision, severe HA, sezizure, LOC, consciouness issues
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High Risk Sites of Overuse Injury
-femoral neck -anterior cortex of tibia -med malleolus -navicular -base of 2nd and 5th met head -talus -patella
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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
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Bone Scan
-distribution and metabolic activity of disease in bone -lack of soft tissue -substance injected to watch metabolic uptake -moderate radiation
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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
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Diagnostic Ultrasonograph
-reflected sound waves and tissue absorption -leision to muscles and tendons -real time -dependent on operator -no deeper structures -based on echogenicity
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Radigraphy
-bony anatomy -not good for soft tissues -xray -cheaper
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Echogenicity
Hyperechoic (fast): white (bone, tendon, ligament, nerve, muscle) Hypochoic: dark (nerve, background of muscle) Anechoic (slow): black (vasculature, cyst) Isoechoic: relatively same
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DEXA
-Dual x-ray absorptiometry -serial testing -inconsistent devices -tissue density, bone mass -low radiation
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Bone T-Scores
Osteoporosis: -2.5 SD away from mean Osteopenia: less than -1.0--2.5 SD from mean
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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)
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Canadian Cervical Spine Rule
-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
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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
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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
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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
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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
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Radiopaque
-Metal/lead/bone -white/grey
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Radiolucent
-air/gas -black
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Purposes of Scanning Exam
-narrow search -look for red flags -determine body regions -identify primary impariments -improve outcomes -provide guidance
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When to Scan
1. No obvious MOI 2. Proximal Cause for Distal S/s 3. Non-mechanical sounding Sx
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LQ Scan
1. Vitals*** 1. Observation: posture, plumb line 2. Gait: look for gross abnormalities 3. Functional MMts: squats*** 4. Balance Testing*** 5. Clear the spine** 10. SI Joint Provocation** 6. Myotomes: include functional testing 7. Dermatomes 8. DTR: patellar, med hamstring, achilles 9. UMN Testing: Babinski, clonus*** 12. Neurodynamic Testing: SLR, slump test** 11. LE ROM: FABER, flx, DF/PF, toe flx/ext 13. Pulses (optional) 12. Lymph Nodes (optional)
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Observations from Behind
Even: ears, scapula, ribs, arm gaps, iliac crests, PSIS, booty cheeks, knees, how many toes can you see? -knee valgum/varum
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Observations from Side
-spinal curves -ears even with acromion -ASIS to PSIS angle -knee recurvatum
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Observations from Front
Even: ears, clavicles, niples, arm gaps, iliac crests, ASIS, greater troch, knees, foot arch -knee valgum/varum
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Gait Observations
-decreased WB -hip, ankle, foot -BOS -flat food -shuffling
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Functional Movements
Squat: -how low -lean -trunk // to tibia -DF -knee -arms -hips -asymetries/leaning
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Balance Testing
-Eyes open and closed -bilat and SL
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Myotome Testing
-fatiguable weakness=nerve root -constant weakness=MMT -C5-T1 -L2-S1 Heel (L4) and Toe walking (S1/S2)
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Dermatome Testing
-test face first -C4-T2 -L2-S2 T2: arm and axilla T5: Nipplie line T8: xiphoid process T10: umbilicus L1: inguinal
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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
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UMN Signs
-babinski -clonus UE: Hoffman's
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Clearing the Spine
Normal: flx/ext, LSB, rot Provocation: compression and distraction, 5-8s Lumbar, cervial Spine and SI joint
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ROM
LQ: -FABER -FADIR -hip and knee ex -toe flx/ext UQ: -hold and check for s/s
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Straight Leg Raise
-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
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Slump Test
-test neuromobility 1. Hands behind back 2. Head and neck flexed 3. Lumbar flx 4. Straighten knee 5. overpressure 6. DF of ankle
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Pulses
-Carotid, axilla, brachial, radial, ulnar -femoral, popliteal, post tib, dorsalis pedis 0: absent 1: reduced 2: slightly reduced 3: normal 4: bounding
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Lymph Nodes
-inguinal area, axilla, neck (behind ears and jaw) -check for swelling, pain
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UQ Scan
1. Vitals (HR and BP) 2. CNs (optional)*** 1. Observation: posture, plumb line, head, face, neck, mouth*** 3. 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)
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Upper Limb Tension Testing
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
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Thoracic/Abdominal Scan
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)*** 7. DTR: Upper AND lower*** 8. UMN Testing: Upper AND Lower*** 9. Slump Test*** 5. Dermatomes (T2, T5, T8, T10, L1) 6. Superficial Abdominal Reflex (T7-T12) 10: Aortic Pulse Palpation 11. Abdominal Palpation 12: Chest Ascultation (heart and lungs) (optional)***
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Respiratory Excursion
-watch Manual: -symmetry -upper: anterior/posterior -Middle: bucket handle, med/lat -Lower: caliper/ in and out
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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
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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
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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
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Chest Ascultation
Heart: -aortic, tricuspid, pulmonary, mitral (top r, bottom r, top L, bottom far L) Respiratory: -3 on each side
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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

Primary Care (7 decks)

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