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Clinical Medicine II > Final Review > Flashcards

Final Review Flashcards

1
Q

DDD/degenerative disc disease symptoms

A
  • gradual onset of pain
  • intermittent & recurring pain over several years
  • pain increases with activity or static positioning
  • stiffness
  • pain into buttock/sclerotome
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2
Q

Central spinal stenosis

A
  • narrowing of the spinal canal
  • spinal cord is being pinched
  • hyper reflexes
  • positive Babinski (normal is toes curl)
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3
Q

Lateral stenosis

A
  • narrowing of the intervertebral foramina
  • nerve root is being pinched
  • hypo reflexes
  • weakness of muscles
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4
Q

Lumbar spinal stenosis CPR

A
  • bilateral symptoms
  • leg pain > back pain
  • pain during walking or standing
  • pain relief upon sitting
  • age >48
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5
Q

Spondylolysis versus spondylolithesis

A
  • Spondylolysis: defect of pars interarticular (crack)
  • Spondylolithesis: bilateral defect with displacement of the superior vertebra (pars defect/Scotty dog)
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6
Q

Five types of spondylolithesis

A
  • Type I: congenital malformation of sacrum/L5
  • Type II: ischemic mechanical stress leads to stress fracture at par interarticular
  • Type III: degenerative (older)
  • Type IV: traumatic casting
  • Type V: pathologic
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7
Q

4 grades of spondylolithesis and treatment

A
  • Grade I: <25% slippage; typically asymptomatic
  • Grade II: 25-50% slippage, education to avoid extension & begin spinal stabilization/may cast
  • Grade III: 50-75% slippage, conservative treatment
  • Grade IV: >75% slippage; surgery
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8
Q

Physical changes within the 1st trimester of pregnancy

A
  • first 12 wks after 1st day of last menstrual period
  • breast enlargement
  • average weight gain of 5 lbs
  • may start to see increase lordosis at 10-12 wks
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9
Q

Physical changes within the 2nd trimester of pregnancy

A
  • wks 13-27
  • average weight gain of 1 lb per week
  • uterus will expand to 4x in size from wk 12 to 27
  • shift in COG due to increased size of belly & hyperlordosis
  • rectus abdominus increasing in length & diastasis recti may be forming
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10
Q

Physical changes within the 3rd trimester of pregnancy

A
  • wks 27+
  • increased fatigue
  • heart burn
  • upper respiratory breathing
  • swelling
  • hemorrhoids
  • varicose veins
  • stress incontinence
  • shortness of breath
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11
Q

Post partum musculoskeletal changes incontinence

A
  • pelvic floor muscle deficits & weakness
  • 80% vaginal births have Pudendal nerve damage
  • urinary incontinence 12 mths postpartum related to prolonged 2nd stage of labor being greater than 1hr (active pushing)
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12
Q

Pregnancy related pelvic joint pain classification

A
  • Pelvic girdle syndrome: daily pain in all 3 joints with Pos. pain provocation tests
  • Synphysiolysis: daily pain in synthesis pubis only and Pos. pain provocation test
  • One-sided SI syndrome: daily pain in one SI joint with Pos. provocation test
  • Double sided SI syndrome: daily pain in both SI joints with Pos. provocation test
  • Miscellaneous: daily pain in one or more pelvic joints with inconsistent objective findings
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13
Q

Treatment for pregnancy related pelvic joint pain

A
  • manual therapy including STM and gentle joint mobs for pain inhibition only
  • diaphragmatic breathing
  • exercise for pelvic & lumbar stability
  • postural instruction
  • body mechanics
  • belting
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14
Q

Intervention and education for ankle sprains

A
  • Acute: PRICEMEM, gentle open chain AROM in tpainfree range, ~1wk consider immobilized WBing, ice, compression, elevate
  • Progression: ROM in closed chain & open chain with goal of full closed chain DF, proprioception & neuromuscular control, and strengthening
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15
Q

Symptoms of recurrent ankle sprains

A
  • chronic ankle sprains
  • proprioception/neuromuscular control deficits
  • closed chain DF deficit
  • chronic effusion
  • alignment/foot mechanics
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16
Q

MOI for ankle fracture

A
  • Sprain w/fracture: fracture occurs as an avulsion (same side leg.) or compression (opposite lig.)
  • Direct trauma: talus fracture
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17
Q

Intervention for ankle fracture

A
  • immobilization for 8 wks
  • ORIF
  • post-immobilization manual therapy/exercise: mobilization and coordination/proprioception
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18
Q

Insertional Achilles tendinitis

A
  • no true synovial sheath rather a paratenon (pseudo sheath)
  • MOI training error: overuse, change in habits (>10%/weeks), hills/slopes
  • retrocalcaneal bursa, localized pain, and x-ray may show calcification
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19
Q

Intervention for insertional Achilles tendinitis

A
  • ice/ionto
  • rest
  • stretching if needed
  • training modification
  • heel lift
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20
Q

Non-insertional Achilles tendinitis

A
  • inflammation of more superior fibers
  • tendon may thicken & degenerate, potentially posing risking of rupture
  • local tenderness, crepitus, & decreased DF ROM
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21
Q

MOI for Achilles rupture

A
  • middle age, weekend athlete
  • stop from back pedaling
  • landing from jump
  • rapid push-off with extended knee, often underlying degeneration of tendon itself
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22
Q

Presentation and intervention for Achilles rupture

A
  • Presentation: 20-25% may go unrecognized, feel pop, palpable defect, & a pos. Thompson test
  • Intervention: surgical or conservative
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23
Q

Protocol for Achilles rupture surgery

A
  • 0-3 wks: boot locked at 30 degrees PF, NWB, pain & edema control (estim or ice), toe curls
  • 3-8 wks: TTWB or PWB /if successful follow with FWB, boot locked at 10 degrees PF (adjust 5 degrees/wk), isometrics must not exceed DF allowed by boot, at 6 wks add stationary bike with heel push
  • 8-12 wks: may wear shoe with heel at 8wks (1/4 inch heel lift), FWB, manual full PROM into DF (DON’T PUSH), progress cycling in shoe
  • 3-6 mo: wean off heel lifts, closed chain exercises, balance training, cycling, stair climber
  • 6 mo: progress to jogging, running, and eccentric loading
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24
Q

Risk factors for overuse injuries

A
  • Pronation: orthotic is used to control pronation not eliminate it, may contribute to overuse injuries, “subtler joint neutral” position is never reached
  • Excessive Supination: less common, shock absorption problems, & full contact orthotic may be helpful
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25
Q

Stress fractures

A
  • females > males
  • common in the 2nd & 5th metatarsal shaft, navicular, & rhythmic overload
  • risk factors: foot posture and inappropriate footwear
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26
Q

Symptoms and intervention for stress fractures

A
  • Symptoms: progressive symptoms/overuse, stiffness/soreness after activity, mild soreness/pain during & after activity, pain during activity that alters performance, and pain during & after does not subside with complete rest
  • Intervention: immobilization for 4-6 wks and maintain cardiovascular fitness
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27
Q

Plantar Fasciitis

A
  • medial heel pain, tenderness medial toward heel, and AM pain
  • intervention: calf stretches, plantar fascia stretch, orthotics, and night splints
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28
Q

Compartment Syndromes

A
  • Fracture = acute
  • Exertional = acute: no trauma and chronic: sx arise after set distance, duration, or speed of activity & progressive tightness, cramping, aching, or deep stabbing pain
  • release = fasciotomy
  • Intervention: functional & biomechanical factors, maintain CV, similar to stress fracture
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29
Q

Hip fracture classifications

A
  • femoral neck = subcapital
  • extracapsular = trochanteric
  • proximal femoral shaft = subtrochanteric area
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30
Q

Signs and symptoms of a DVT

A
  • swelling
  • erythema
  • pain
  • Homan’s sign (but not on it’s own/discomfort in calf with forced DF and knee straight)
  • point tenderness in calf
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31
Q

Clinical complications of hip fracture

A
  • DVT
  • malunion
  • delayed union
  • nonunion
  • avascular necrosis (AVN)
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32
Q

Outcomes after hip fracture

A
  • physical & mental health before surgery is a predictor of postoperative success
  • mortality ~20% at 1 year, 50% at 2, 60% at 6, 77% at 10
  • 15-40% require institutionalized post-op care for > 1 year
  • 50-83% require AD to ambulate
  • 20-30% of patients regain their pre injury level of independence
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33
Q

Symptoms of bone and joint disease

A
  • pain
  • decrease mobility
  • deformity
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34
Q

Osteoporosis causes

A
  • BMD 2.5 standard deviation below normal for age 30, peak bone mass at age 30
  • estrogen loss
  • corticosteroids
  • loss of weight bearing/bed rest
  • hyperparathyroidism, hyperthyroidism, & chronic renal failure
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35
Q

Avascular necrosis (AVN)

A
  • hip is most common joint
  • men age 30-60
  • trauma
  • long term steroid use
  • RA/Lupus
  • Alcoholism
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36
Q

Symptoms of avascular necrosis (AVN)

A
  • antalgic gait
  • pain in the groin down to medial knee
  • throbbing deep hip pain
  • restricted hip internal rotation, flexion, & abduction
37
Q

Osteomyelitis

A
  • infection of the bone
  • Causes: open injury to the bone, bacteremia, septsis, pre-existing infection, chronic open wound or soft tissue infection
38
Q

Risk factors for osteomyelitis

A
  • diabetes
  • hemodialysis
  • immunosuppression
  • sickle cell disease
  • intravenous drug abuse
  • elderly
  • renal/hepatic failure
  • alcohol abuse
39
Q

Symptoms of osteomyelitis

A
  • pain/tenderness in the infected area
  • swelling & warmth in the infected area
  • fever
  • nausea secondarily from being ill with infection
  • drainage of pus through the skin
40
Q

Management of osteomyelitis

A
  • prevention of infections
  • screening
  • diagnosis: often late due to lack of signs/symptoms and/or being mistaken for something else, need imaging & ID specific pathogen
  • Treatment: immediate & aggressive treatment, high-dose antibiotics, possibly surgery
41
Q

Hip OA

A
  • focal loss of articular cartilage with variable subchondral bone reaction
  • joint pain and functional impairment seen
  • Treatment goals: relieve Sx, minimize disability, education, modification of activities, & maintain ROM
  • consider footwear or use of AD
42
Q

Conservative interventions for hip OA

A
  • gait & balance training
  • manual therapies
  • systematically progressed therapeutic strengthening, flexibility, & endurance
  • use of AD can improve function associated with WBing activities
43
Q

What does treatment and timing of rehab depend on for fractures to the forearm, wrist, and hand

A
  • number of fragments
  • fragment orientation
  • approach used to restore alignment
  • method used to maintain reduction
  • involvement of articular surfaces
44
Q

Colles fracture

A
  • radial fracture with dorsal displacement of the distal fragment & possible radial shaft of the carpal bones
  • falling onto palm of hand
  • greater the extension of the wrist at impact results in greater injury including a comminuted fracture
45
Q

Management of a Colles fracture

A
  • management ranges from closed reduction with cast or external fixation to surgical reduction & internal fixation
  • fracture healing takes 5-8 wks with expected full functional recovery in 4 mo
46
Q

Smiths fracture

A
  • distal portion of radial fracture dislocates palmarly
  • falling onto dorsal side of hand
  • surgery usually required
  • fracture healing in 5-9 wks with expected full functional recovery in 6 mo to 1 year
47
Q

General treatment for wrist fractures

A
  • While casted: ROM digits, elbow, and shoulder with the goal to reduce edema, prevent capsular/tendinous tightness
  • Cast removed: gentle ROM thumb & wrist (pain free range) for edema control
  • If continued limited ROM: joint mobs may need to be incorporated
  • Once full ROM: strengthening exercises can be added
48
Q

Scaphoid fracture

A
  • most common fracture of carpal bones
  • FOOSH Hx
  • Complications: non-union or necrosis due to blood flow interruption
49
Q

Rehab for scaphoid fracture

A
  • During immobilization focus to reduce edema, maintain ROM of uninvolved distal joints
  • Cast removed with use of a thumb spica splint: exercises for differential gliding of the wrist & fingers, strengthening with putty, sustained grip, & gradual closed chain activities
  • return to full activity within 12 wks after cast removal
50
Q

Distal phalanx fracture rehab

A
  • Splint 2-4 wks
  • AROM at 2-4 wks
  • PROM 5-6 wks
  • PRE (progressive resistance exercise) 7-8 wks
51
Q

Middle phalanx rehab

A
  • splinting for 3 wks
  • AROM when non painful
  • PROM 4-6 wks
  • PRE 6-8 wks
52
Q

Proximal phalanx rehab

A
  • buddy tape (unless intra-articular)
  • AROM immediately
  • PROM 6-8 wks
53
Q

Intrinsic plus position

A
  • wrist extension
  • MCP flexed to 60-70 degrees
  • IPs fully extended
54
Q

Myositis ossificans

A
  • abnormal formation of bone within a muscle following a muscle contusion injury
  • may develop in as many as 70-75% of moderate to severe quadriceps contusions
55
Q

Symptoms of myositis ossificans

A
  • prolonged disability
  • severe pain
  • a significant loss of function
56
Q

Who is required to report suspected abuse

A
  • any person licensed to practice medicine or any of the healing arts
  • any professional staff person, not previously enumerated, employed by a private or state-operated hospital, institution or facility to which children have been committed or where children have been placed for care & treatment
57
Q

Who can you report suspected abuse to

A
  • in place of a report you can immediately notify the person in charge of the institution or department, or his designee, who shall make such report forthwith
  • report to local department of the county or city wherein the child resides or wherein the abuse or neglect is believed to have occurred or to the departments toll free child abuse & neglect hotline
58
Q

Are you liable if you report suspected abuse by sharing health protected documents

A
  • any person who makes a report shall be immune from any civil or criminal liability on account of such report, records, information, photographs, video recordings, appropriate medical imaging or testimony, unless such person acted in bad faith or with a malicious purpose
59
Q

Immersion burns

A
  • identified by sharply delineated water lines
  • often seen as glove or stocking distribution patterns that result from holding the hands or feet in very hot water
60
Q

Contact burns

A
  • when young children pull pots of hot liquid off a stove
  • first point of contact occurs on the face, chin, neck, & axilla and the flow pattern lessens along the torso
  • when hot liquids are thrown at a child the burns are usually not present on the neck & axillary area
61
Q

Accidental burns

A
  • superficial because of the tendency to pull away when something hot is encountered
  • brushing against a hot object such as a cigarette causes a burn pattern that is shallow & irregular
62
Q

Intentional burns

A
  • symmetrical
  • deep
63
Q

Shaken baby syndrome

A
  • shaking is a prevalent form of abuse seen in very young children
  • SBS generally occurs when a frustrated caregiver shakes an infant vigorously usually in an attempt to stop crying or other unwanted behaviors
  • violently shaking an infant can cause the brain to move within the skull resulting in cerebral contusions, bleeding in the eyes, and SCI
64
Q

Neer’s 3 stages on subacromial rotator cuff impingement

A
  • Stage 1: young (<25 y/o), edema and hemorrhage, & pain with >90 degrees abduction
  • Stage 2: age 25-40 y/o, fibrosis, irreversible changes in supraspinatus or bicep tendon, & pain at night, difficulty positioning shoulder for comfort
  • Stage 3: operative?, age >40 y/o, tendon degeneration/supraspinatus tears, history of shoulder pain, & muscle weakness/atrophy
65
Q

Bankart lesion

A
  • avulsion of capsule & glenoid labrum off anterior glenoid rim
  • result of traumatic anterior shoulder dislocation
66
Q

Hill-Sachs lesion

A
  • a compression or “impaction fracture” of the posteromedial aspect of the humeral head after anterior shoulder dislocation
67
Q

4 types of labral tear

A
  • Type I: degeneration of superior labrum with loss of horizontal ABD w/ER
  • Type II: detachment of labrum & biceps tendon anchor with loss of stability
  • Type III: vertical tear of labrum with biceps intact
  • Type IV: tear of labrum into biceps tendon
68
Q

Adhesive capsulitis

A
  • frozen shoulder
  • GH joint hypomobility due to development of dense adhesions, capsular restrictions, & thickening
  • insidious onset b/w 40-60 y/o
  • associated with trigger points, guarding or subscapularis
  • probably but not conclusively inflammatory
  • Primary = iidopathic
  • Secondary = Systemic (diabetes), Extrinsic (cardiopulmonary, CVA, fractures), or Intrinsic (tendinopathy)
69
Q

Stages of development of adhesive capsulitis

A
  • Freezing (2-3 wks): continuous pain, severe limitation of movement soon after onset
  • Frozen (4-12 mo): atrophy, pain (although less & occurring primarily with movement), loss of ROM
  • Thawing (12-24+ mo): decreased pain and restricted ROM
70
Q

AC sprains and dislocations

A
  • direct force to acromion or when force is transmitted proximally to AC from FOOSH
  • 1st degree/Grade 1: minimal loss of function
  • 2nd degree/Garde 2: moderate pain, some dysfunction
  • 3rd degree/Grade 3: AC w/coracoclavicular ligament injury, may have significant dysfunction
71
Q

Stage 0 of lymphedema

A
  • lymph transport is impaired but there is no clinical evidence of swelling
  • may last months or years
  • Sx progression from stage 0 to stage 1: sensation of heaviness, fatigue, ache, or pain in the limb at risk
72
Q

Stage 1 of lymphedema

A
  • chronic inflammatory response to the excessive protein in the interstitium
  • pitting on pressure
  • reverses with elevation
  • Progression from stage 1 to stage 2: subcutaneous tissues begin to fibrose due to protein buildup
73
Q

Stage 2 of lymphedema

A
  • non-pitting
  • does not reduce on elevation of the limb
  • clinical fibrosis is present = skin is thick and rigid
  • clear, sticky lymph fluid may ooze from pores
  • chronic inflammation can lead to recurrent bacterial and fungal infections
74
Q

Stage 3 of lymphedema

A
  • AKA lymphostatic elephantiasis
  • severe non-pitting
  • large lobular folds
  • fibrotic edema with atrophic skin changes such as thickened, leathery, keratotic skin, skin folds with tissue flaps, papillomas (warty like overgrowth)
75
Q

High output failure

A
  • lymphatic load is too great to transport the fluid from the interstitium
  • lymph collectors will work overtime with a functional reserve to mobilize the lymph fluid to lymph node groups
  • if functional reserve is used up = damage to the lymph collector walls and valves = reduced transport capacity & low output failure
76
Q

Low output failure

A
  • lymphatic system has difficulty transporting a minimal amount of high protein fluid from the interstitium due to damage in the lymph vessels or lymph nodes
  • lymphatics are mechanically insufficient causing the transport capacity to drop below the normal lymph load
  • lymph becomes stagnant in the interstitium = increased colloid osmotic pressure, high protein in the interstitium, & decreased absorption
  • swelling is produced in the extracellular space
77
Q

Combined insufficiency

A
  • combination of a high output failure & a low output failure
  • high output failure due to infection, trauma, or surgery
  • low output failure due to previous injury to lymph vessels or nodes (ei radiation therapy)
78
Q

Sources for metastatic tumors of bone

A
  • prostate
  • breast
  • lung
  • kidney
  • thyroid
  • GI
79
Q

Skeletal system involvement in metastatic bone tumors

A
  • primary Sx are pain & neurological findings
  • spine involved 50% pf the time = cord compression
  • x-ray for early diagnosis but bone scan is preferred (1/3 pos. scan with neg. x-ray)
  • treatment is mostly palliative
80
Q

Spinal metastasis

A
  • from lungs, breasts, prostate, kidney
  • goes to thoracic lumbosacral, cervical spine
  • initial diagnosis = radiography &neurological exam
  • Symptoms: weakness, sensory loss, bowel & bladder sphincter disturbance
  • Treatment: radiotherapy to reduce pain, compress tumor, & restore neurological function
81
Q

Osteoblastoma symptoms

A
  • pain for several months: not as severe os osteoid osteoma, less likely to be relieved with NSAIDs, poorly localized
  • possible scoliosis
  • nerve root impingement
82
Q

Chondroblastoma

A
  • slow growing tumor usually at epiphyseal plate usually femur/tibia/humerus
  • benign but locally aggressive & usually bust be excised
  • Symptoms: localized pain, limited joint motion, swelling at end of long bones, & tenderness at end of long bones
83
Q

Hemanginoma

A
  • growth of the endothelial cells that line blood vessels
  • may involve skin showing up in neonates: self resolving or permanent
  • some involve vertebral bodies: 10% of pop, females> males between 40-60 y/o
84
Q

Indications for ACLR

A
  • disabling instability
  • frequent knee buckling
  • high risk of re-injury
  • rule of 3rds
85
Q

Contraindications for ACLR

A
  • inactive lifestyles
  • advanced arthritis in the knee
  • poor compliance
86
Q

Current recommendations for individuals with an acute ACL injury

A
  • go through 10 sessions of a progressive exercise therapy program over 5 weeks before deciding if ACL reconstruction is warranted
  • without proper guidance results may be poor
  • individuals who avoid high risk activity or mitigate their activity seem to be more successful without surgery
87
Q

Interventions for ACL

A
  • NWB & WB exercises can be incorporated as long as undue strain on the healing graft is avoided: limit knee ROM to 90-45 degrees NWB and progress to 90-10 degrees by wk 12
  • eccentric strengthening
  • NMES: freq. 35-80, duration 350-400 or Russian
  • neuromuscular training
88
Q

Open and closed chain exercises in ACL repair

A
  • closed chain example: wall slides and step ups in pain free ranges typically 0-60 degrees
  • mix of open and closed chain exercises are safe as long as undue strain on the healing graft is avoided
  • limited knee ROM to only 90-45 degrees for NWB exercises early on
  • Progress to knee ROM from 90-10 degrees by wk 12

Clinical Medicine II (21 decks)

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