Miscellaneous Flashcards
How is Well’s Criteria for Pulmonary Embolism scored?
Symptoms of DVT (+3)
No other likely Diagnosis (+3)
Heart Rate over 100 (+1.5)
Previous DVT/PE (+1.5)
Immobilization or surgery in last 4 weeks (+1.5)
Hemoptysis (+1)
active malignancy (+1)
Score of 0-1=low risk
2-6=Moderate Risk
7+= high risk
How is the Geneva Criteria for Pulmonary Embolism scored?
HR > 94 (+5) or 74-94 (+3)
Pain on LE deep venous palpation and unilateral edema (+4)
Previous DVT/PE (+3)
Unilateral LE pain (+3)
Surgery or Fracture within 1 month (+2)
Hemoptysis (+2)
Active Malignancy (+2)
Age over 65 (+1)
Score of 0-3=low risk
4-10=moderate risk
11 or higher=high risk
If there is no gap between fracture ends what kind of healing happens?
If there is <1mm of a gap how does this change the healing process?
How long is this healing process?
Primary or Direct Healing
if gap is <.01mm then cutting cones cross fracture line and osteoclasts come followed by osteoclasts to build new bone
If the gap is <1mm the gap is filled with perpendicular lamellar bone which will later be remodeled
Takes months to years
If there is a gap between fracture ends what type of healing takes place?
What are the different phases and the timeline for each phase?
Secondary or indirect fracture healing
Inflammatory Phase-Hematoma Forms (days 1-5)
Reparative Phase-Soft callus formation (days 4-14)
(angiogenesis, woven bone formed, chondrocytes replace clot with cartilage)
Modeling Phase-hard callus formation (weeks 2-3)
(cartilage calcifies, woven bone fills fracture line. Clinical union
Remodeling Phase-weeks 3-14
(osteoclasts/blasts remodel cartilage and woven bone into lamellar bone for up to one year after fracture)
What is Osteoarthritis?
What joints mostly get affected?
Degeneration of articular cartilage with changes to subchondral bone and synovium
large weight bearing joints asymmetrically
What are the distinguishing factors of OA over other forms of arthritis?
Asymmetrical
stiffness is less than 30 minutes in the morning
ROM improves quickly
MCPs are spared
What is Rheumatoid Arthritis?
What joints are mostly affected?
What are common related symptoms?
an auto-immune condition that causes primary tissue inflammation with remissions and exacerbations
smaller joints such as PIPs, and MCP joints
fever, fatigue, depression, weight loss, dry eyes, etc.
What are the distinguishing factors for rheumatoid arthritis over other arthritis type?
Symmetrical polyarthritis
stiffness over one hour
hot, doughy joint during flare ups
DIP’s spared
What is Ankylosing Spondylitis?
What joints are typically affected?
What is the common pain pattern?
chronic inflammatory disease that affects axial skeleton, eventually causing autofusion of vertebrae
symmetrical in SI joints and asymmetrical in periphery, mostly in spine joints and SI joints and occasionally in LE and shoulders
Pain is worse with rest and relieved with exercise, pain causes waking during the second half of the night
What are the distinguishing factors for ankylosing Spondylitis over other arthritis type?
young onset (less than 45 years old)
stiffness over 30 minutes
relieved with exercise
pain wakes during second half of night
What is Psoriatic Arthritis?
What joints are commonly affected?
autoimmune disease associated with the skin condition psoriasis
peripheral joints but particularly DIPs and the PIPs of hand and feet and SIJ bilaterally
What are the distinguishing factors for psoriatic arthritis over other arthritis type?
Psoriasis
Nail Lesions
Dactylitis
What are Fluoroquinolones medications?
What are common side effects?
What are some common brand names?
antibiotics that are associated with achilles tendon ruptures
Can cause ruptures and tendinopathies in other muscles including quads, patellar, wrist extensors, biceps, supraspinatus, etc
Also inhibits chondrocytes and can cause joint pain or muscle pain
ciprofloxacin (cipro)
What are Statin medications?
What MSK condition are they linked to?
Common brand names?
medication to treat hyperlipidemia
associated with tendinopathies and tendon ruptures, especially in achilles, quads, and distal biceps
also associated with rhabdomyolysis and myalgia usually in calves and thighs
atorvastatin (lipitor)
simvastatin
rosuvastatin (cipro)
What are glucocorticoids?
What common suffixes are associated with these medications?
What is long time oral use associated with?
corticosteroids
-methasone, -sonide, isone, etc.
if used over 3 months or more there is an associated risk with tendon ruptures especially in achilles, quads, and patellar; also can cause osteoporosis and spinal fractures
What are glucocorticoids?
What common suffixes are associated with these medications?
What is long time oral use associated with?
corticosteroids
-methasone, -sonide, isone, etc.
if used over 3 months or more there is an associated risk with tendon ruptures especially in achilles, quads, and patellar; also can cause osteoporosis and spinal fractures
What is polypharmacy?
using more than 4 medications together at one time
What are common side effects with NSAIDs?
Common opiod side effects?
Gabapentin?
gastrointestinal ulcers (look for stomach pain and GI symptoms)
constipation, dizziness, nausea, drowsiness, slowed resting respiratory rate
drowsiness, dizziness, nausea, and diarrhea
What are common side effects of antispasmodics (muscle relaxors)?
What are common beta blocker side effects?
drowsiness, dizziness, headache
depressed HR/BP fatigue, dizziness
(use RPE instead of HR to dictate treatment due to numbed response to HR changes)
What are normal biomechanics of the TMJ?
-During initial opening (10mm) the mandibular condyle rotates on the articular disc
-to open further (20-40mm) the mandibular condyle and the articular disc translate anteriorly, assisted by the lateral pterygoid
-closing reverse this movement (posterior translation following by rotation)
What is Rocabado’s 6x6 program used for?
What are the components?
Used to treat anterior TMJ disc displacement
-Tongue clucking
-controlled TMJ rotation (open mouth while tongue is pressed to roof of mouth)
-Mandibular Rhythmic Stabilization
-upper cervical distraction
-chin tucks
-scapular retractions
What causes the clicking noise when opening your mouth if you have TMJ issues?
The mandibular condyle moving over the articular disc if the articular disc of the TMJ has slipped anteriorly as you open your jaw
What are the three types of internal derangement of the TMJ?
Normal
Reducing-articular disc slips back into place when jaw is fully opened
Non-Reducing-articular disc never gets back in position (usually means there is no “pop”)
What medications are typically associated with GI pain/ulcers?
NSAIDS such as naproxen or meloxicam
What medications are typically associated with Constipation?
Opioids such as tramadol and hydrocodone
What medications are typically associated with Diarrhea?
gabapentin (neurontin)
What medications are typically associated with drowsiness/dizziness?
Gabapentin (neurontin), opioids (oxycodone, fentanyl), and muscle relaxers (diazepam or metaxalone)
What medications are typically associated with Headaches?
Muscle Relaxers (skelaxin)
What medications are typically associated with increased fall risk?
benzodiazepines
What medications are typically associated with an increased risk of fracture?
glucocorticoids
What medications are typically associated with tendon ruptures?
Fluoroquinolones (ciprofloxacin)
Statins (simvastatin)
Glucocorticoids (dexamethasone)
