Misc

Question 1

Spasticity is a ______ disorder characterized by an abnormal, _______-dependent increase in tonic stretch reflexes

Answer 1

motor;

velocity

Question 2

Where does baclofen act? Main SE? Symps of withdrawal?

Answer 2

GABA agonist at GABA-B receptors;
can cause sedation/drowsiness, lowers seizure threshold;
can get seizures, hallucinations, rebound spasticity, “itchy, bitchy, twitchy”

Question 3

Two agents used as chemoneurolysis?

Answer 3

Phenol and ethyl alcohol;

phenol will require higher concentrations for chemical denervation and neurolysis

Question 4

Peak effect and duration overall for botox?

Answer 4

4-6 weeks;

Can last 2-6 months

Question 5

What does SPLATT stand for and treat?

Answer 5

Split Anterior Tibial Tendon Transfer;

Treats equinovarus deformity of the foot due to spasticity of tib ant

Question 6

Classic symps of Parkinson’s?

Answer 6

TRAP:
Tremor (resting)
Rigidity (cogwheel)
Akinesia (bradykinesia)
Postural instability (tendency to fall to side or backward)

Question 7

Some surgical treatments for Parkinson’s?

Answer 7

1. Destructive (includes thalamotomy and pallidotomy)

2. DBS (preferred): thalamic reduces tremor on contralateral side, while pallidal controls all the cardinal symptoms

Question 8

Why SLP eval for Parkinson’s?

Answer 8

Evaluate for oropharyngeal dysphagia

Question 9

For progressive supranuclear palsy, what is a hallmark sign and earliest symptom?

Answer 9

Supranuclear ophthalmoparesis;

gait and balance impairment

Question 10

What is multiple system atrophy characterized by?

Answer 10

Combo of parkinsonism, cerebellar dysfunction, autonomic failure (CAP)

Question 11

Inaccurate measurements of wheelchairs are major contributing factor to

Answer 11

increased deformity;
pressure injury development;
patient discomfort

Question 12

How wide should seat width be for wheelchair?

Answer 12

Approx 1 inch wider than hip width; avoid pressure injury at greater trochanter of hips

Question 13

Why is seat height in foot drive, or hemi-plegic height WC, lower?

Answer 13

Allows unaffected leg to propel the chair

Question 14

What is the most commonly prescribed armrest for WC?

Answer 14

Removable desk length armrest

Question 15

Benefits of tilt and space compared to recliner?

Answer 15

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

Question 16

How much should the WC system tilt to redistribute sufficient pressure for weight shift?

Answer 16

Ideally at least 45 degrees

Question 17

For adjustable axle, what happens with moving it forward?

Answer 17

Allows for more efficient wheelchair propulsion; also can do wheelies

1. Less rolling resistance
2. Less energy to propel
3. Smaller the turning radius
4. Less stable the chair

Question 18

What happens with moving axle posteriorly?

Answer 18

1. Increased rolling resistance
2. More energy required for propulsion
3. Greater turning radius
4. Stable chair
5. Need more extension at GH joint

Question 19

Better tire for carpeting, pneumatic or solid rubber tires?

Answer 19

Pneumatic (carpeting increases rolling resistance by factor of 4; the tires provide cushioning for outdoor use)

Question 20

Advantages for camber?

Answer 20

1. Maximize lateral stability of the WC
2. Low degrees of camber make WC easier to propel
3. Protects hands of user

Question 21

What does a smaller caster mean for WC?

Answer 21

Smaller turning radius, does poorly on outdoor surfaces and carpets as it can get stuck

Question 22

Moving caster placement more posterior

Answer 22

1. decreases turning radius
2. increases maneuverability
3. decreases stability

Question 23

How are footrests measured? How far off the floor should they be?

Answer 23

Distance from heel to under surface of thigh at popliteal fossa;
should have 2 inches of clearance from the floor

Question 24

What is the most common cause of osteomalacia?

Answer 24

Vitamin D deficiency

Question 25

What is the female athlete triad?

Answer 25

Disordered eating, menstrual disorders, low BMD

Question 26

Gold standard for bone mineral density measurement testing?

Answer 26

DEXA

Question 27

Calcitonin acts through what mechanism?

Answer 27

Inhibits osteoclastic activity; | can decrease pain in acute compression fx

Question 28

Burns are number ___ cause of accidental death for those under age of 2; What about for ages 4 and 19 or less, respectively?

Answer 28

1; 2; 3

Question 29

Inflammatory mediators released upon thermal injury

Answer 29

1. Histamine 2. Prostaglandins 3. Thromboxane 4. Catecholamines

Question 30

Rule of nines for burns

Answer 30

``` Head = 9% BSA; Each UE = 9%; Each LE = 18%; Anterior trunk = 18%; Posterior trunk = 18%; Perineum = 1% BSA ```

Question 31

Consequences of burn injury if epidermis compromised?

Answer 31

1. Decreased protection 2. Increased water loss 3. Microorganism growth 4. Entry of noxious agents 5. Repeated sunburn

Question 32

Splint positioning for elbow burns? Dorsal hand burns?

Answer 32

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

Question 33

Should splinting be prescribed for exposed tendons and joints?

Answer 33

Yes

Question 34

Most common site of HO in adults after burns?

Answer 34

Elbows, followed by shoulder

Question 35

Management for MRSA furunculitis in burn patient?

Answer 35

I&D, may need abx

Question 36

How long should compression garments be worn on burn sites and at what pressures?

Answer 36

23 hr/day at least, need at least 25 mmHg

Question 37

Difference between comparative and non-comparative justice?

Answer 37

Comparative: allocation of resources based on needs or wants; non-comparative: favors equal share over individual needs

Question 38

For MS, preg _______ relapses but then ________ after delivery; any changes in long-term prognosis?

Answer 38

decreases; increases; | no

Question 39

Four types of MS; which is most common, and what is worst prognosis?

Answer 39

Primary progressive, relapsing-remitting, secondary progressive, clinically isolated syndrome; RRMS most common; primary progressive worst prognosis

Question 40

Better prognosis for MS?

Answer 40

``` Monosymptomatic; sudden, good recovery with long remission; sensory optic neuritis; longer, more complete remissions; female ```

Question 41

Most prevalent symps of MS?

Answer 41

1. Bladder and bowel dysfunction 2. Fatigue (central) 3. Pain

Question 42

Clinical findings for MS?

Answer 42

Lesions scattered in time and space based on clinical findings, or clinical finding with MRI finding

Question 43

Fatigue in MS worsens with increased

Answer 43

temperature, stress, and activity (TSA)

Question 44

Medication of choice for central spasticity in MS?

Answer 44

Baclofen

Question 45

What are the neurogenic bladder types in MS? Most common?

Answer 45

Failure to store, failure to empty, combination bladder; | failure to store

Question 46

IQ of MS patients is usually

Answer 46

intact, especially early on; processing speed often delayed