Misc Flashcards
Spasticity is a ______ disorder characterized by an abnormal, _______-dependent increase in tonic stretch reflexes
motor;
velocity
Where does baclofen act? Main SE? Symps of withdrawal?
GABA agonist at GABA-B receptors;
can cause sedation/drowsiness, lowers seizure threshold;
can get seizures, hallucinations, rebound spasticity, “itchy, bitchy, twitchy”
Two agents used as chemoneurolysis?
Phenol and ethyl alcohol;
phenol will require higher concentrations for chemical denervation and neurolysis
Peak effect and duration overall for botox?
4-6 weeks;
Can last 2-6 months
What does SPLATT stand for and treat?
Split Anterior Tibial Tendon Transfer;
Treats equinovarus deformity of the foot due to spasticity of tib ant
Classic symps of Parkinson’s?
TRAP: Tremor (resting) Rigidity (cogwheel) Akinesia (bradykinesia) Postural instability (tendency to fall to side or backward)
Some surgical treatments for Parkinson’s?
- Destructive (includes thalamotomy and pallidotomy)
2. DBS (preferred): thalamic reduces tremor on contralateral side, while pallidal controls all the cardinal symptoms
Why SLP eval for Parkinson’s?
Evaluate for oropharyngeal dysphagia
For progressive supranuclear palsy, what is a hallmark sign and earliest symptom?
Supranuclear ophthalmoparesis;
gait and balance impairment
What is multiple system atrophy characterized by?
Combo of parkinsonism, cerebellar dysfunction, autonomic failure (CAP)
Inaccurate measurements of wheelchairs are major contributing factor to
increased deformity;
pressure injury development;
patient discomfort
How wide should seat width be for wheelchair?
Approx 1 inch wider than hip width; avoid pressure injury at greater trochanter of hips
Why is seat height in foot drive, or hemi-plegic height WC, lower?
Allows unaffected leg to propel the chair
What is the most commonly prescribed armrest for WC?
Removable desk length armrest
Benefits of tilt and space compared to recliner?
Patient remains in same position, but orientation in space changes; shear forces are minimized, and pressure re-distributed from seating surface to back support;
get pain relief, can remain seated during weight shifts, can mobilize secretions, smaller turning radius
How much should the WC system tilt to redistribute sufficient pressure for weight shift?
Ideally at least 45 degrees
For adjustable axle, what happens with moving it forward?
Allows for more efficient wheelchair propulsion; also can do wheelies
- Less rolling resistance
- Less energy to propel
- Smaller the turning radius
- Less stable the chair
What happens with moving axle posteriorly?
- Increased rolling resistance
- More energy required for propulsion
- Greater turning radius
- Stable chair
- Need more extension at GH joint
Better tire for carpeting, pneumatic or solid rubber tires?
Pneumatic (carpeting increases rolling resistance by factor of 4; the tires provide cushioning for outdoor use)
Advantages for camber?
- Maximize lateral stability of the WC
- Low degrees of camber make WC easier to propel
- Protects hands of user
What does a smaller caster mean for WC?
Smaller turning radius, does poorly on outdoor surfaces and carpets as it can get stuck
Moving caster placement more posterior
- decreases turning radius
- increases maneuverability
- decreases stability
How are footrests measured? How far off the floor should they be?
Distance from heel to under surface of thigh at popliteal fossa;
should have 2 inches of clearance from the floor
What is the most common cause of osteomalacia?
Vitamin D deficiency
What is the female athlete triad?
Disordered eating, menstrual disorders, low BMD
Gold standard for bone mineral density measurement testing?
DEXA
Calcitonin acts through what mechanism?
Inhibits osteoclastic activity;
can decrease pain in acute compression fx
Burns are number ___ cause of accidental death for those under age of 2; What about for ages 4 and 19 or less, respectively?
1;
2;
3
Inflammatory mediators released upon thermal injury
- Histamine
- Prostaglandins
- Thromboxane
- Catecholamines
Rule of nines for burns
Head = 9% BSA; Each UE = 9%; Each LE = 18%; Anterior trunk = 18%; Posterior trunk = 18%; Perineum = 1% BSA
Consequences of burn injury if epidermis compromised?
- Decreased protection
- Increased water loss
- Microorganism growth
- Entry of noxious agents
- Repeated sunburn
Splint positioning for elbow burns? Dorsal hand burns?
Elbow extended and forearm supinated;
Wrist in 15-20 degrees extension, MCP in 60-70 degrees flexion, PIP and DIP in full extension; thumb in slight IP flexion and palmar abduction
Should splinting be prescribed for exposed tendons and joints?
Yes
Most common site of HO in adults after burns?
Elbows, followed by shoulder
Management for MRSA furunculitis in burn patient?
I&D, may need abx
How long should compression garments be worn on burn sites and at what pressures?
23 hr/day at least, need at least 25 mmHg
Difference between comparative and non-comparative justice?
Comparative: allocation of resources based on needs or wants;
non-comparative: favors equal share over individual needs
For MS, preg _______ relapses but then ________ after delivery; any changes in long-term prognosis?
decreases; increases;
no
Four types of MS; which is most common, and what is worst prognosis?
Primary progressive, relapsing-remitting, secondary progressive, clinically isolated syndrome;
RRMS most common;
primary progressive worst prognosis
Better prognosis for MS?
Monosymptomatic; sudden, good recovery with long remission; sensory optic neuritis; longer, more complete remissions; female
Most prevalent symps of MS?
- Bladder and bowel dysfunction
- Fatigue (central)
- Pain
Clinical findings for MS?
Lesions scattered in time and space based on clinical findings, or clinical finding with MRI finding
Fatigue in MS worsens with increased
temperature, stress, and activity (TSA)
Medication of choice for central spasticity in MS?
Baclofen
What are the neurogenic bladder types in MS? Most common?
Failure to store, failure to empty, combination bladder;
failure to store
IQ of MS patients is usually
intact, especially early on; processing speed often delayed
