Miscellaneous

Question 1

How is Well’s Criteria for Pulmonary Embolism scored?

Answer 1

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

Question 2

How is the Geneva Criteria for Pulmonary Embolism scored?

Answer 2

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

Question 3

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?

Answer 3

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

Question 4

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?

Answer 4

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)

Question 5

What is Osteoarthritis?

What joints mostly get affected?

Answer 5

Degeneration of articular cartilage with changes to subchondral bone and synovium

large weight bearing joints asymmetrically

Question 6

What are the distinguishing factors of OA over other forms of arthritis?

Answer 6

Asymmetrical
stiffness is less than 30 minutes in the morning
ROM improves quickly
MCPs are spared

Question 7

What is Rheumatoid Arthritis?

What joints are mostly affected?

What are common related symptoms?

Answer 7

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.

Question 8

What are the distinguishing factors for rheumatoid arthritis over other arthritis type?

Answer 8

Symmetrical polyarthritis
stiffness over one hour
hot, doughy joint during flare ups
DIP’s spared

Question 9

What is Ankylosing Spondylitis?

What joints are typically affected?

What is the common pain pattern?

Answer 9

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

Question 10

What are the distinguishing factors for ankylosing Spondylitis over other arthritis type?

Answer 10

young onset (less than 45 years old)
stiffness over 30 minutes
relieved with exercise
pain wakes during second half of night

Question 11

What is Psoriatic Arthritis?

What joints are commonly affected?

Answer 11

autoimmune disease associated with the skin condition psoriasis

peripheral joints but particularly DIPs and the PIPs of hand and feet and SIJ bilaterally

Question 12

What are the distinguishing factors for psoriatic arthritis over other arthritis type?

Answer 12

Psoriasis
Nail Lesions
Dactylitis

Question 13

What are Fluoroquinolones medications?

What are common side effects?

What are some common brand names?

Answer 13

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)

Question 14

What are Statin medications?

What MSK condition are they linked to?

Common brand names?

Answer 14

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)

Question 15

What are glucocorticoids?

What common suffixes are associated with these medications?

What is long time oral use associated with?

Answer 15

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

Question 16

What are glucocorticoids?

What common suffixes are associated with these medications?

What is long time oral use associated with?

Answer 16

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

Question 17

What is polypharmacy?

Answer 17

using more than 4 medications together at one time

Question 18

What are common side effects with NSAIDs?

Common opiod side effects?

Gabapentin?

Answer 18

gastrointestinal ulcers (look for stomach pain and GI symptoms)

constipation, dizziness, nausea, drowsiness, slowed resting respiratory rate

drowsiness, dizziness, nausea, and diarrhea

Question 19

What are common side effects of antispasmodics (muscle relaxors)?

What are common beta blocker side effects?

Answer 19

drowsiness, dizziness, headache

depressed HR/BP fatigue, dizziness
(use RPE instead of HR to dictate treatment due to numbed response to HR changes)

Question 20

What are normal biomechanics of the TMJ?

Answer 20

-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)

Question 21

What is Rocabado’s 6x6 program used for?

What are the components?

Answer 21

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

Question 22

What causes the clicking noise when opening your mouth if you have TMJ issues?

Answer 22

The mandibular condyle moving over the articular disc if the articular disc of the TMJ has slipped anteriorly as you open your jaw

Question 23

What are the three types of internal derangement of the TMJ?

Answer 23

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”)

Question 24

What medications are typically associated with GI pain/ulcers?

Answer 24

NSAIDS such as naproxen or meloxicam

Question 25

What medications are typically associated with Constipation?

Answer 25

Opioids such as tramadol and hydrocodone

Question 26

What medications are typically associated with Diarrhea?

Answer 26

gabapentin (neurontin)

Question 27

What medications are typically associated with drowsiness/dizziness?

Answer 27

Gabapentin (neurontin), opioids (oxycodone, fentanyl), and muscle relaxers (diazepam or metaxalone)

Question 28

What medications are typically associated with Headaches?

Answer 28

Muscle Relaxers (skelaxin)

Question 29

What medications are typically associated with increased fall risk?

Answer 29

benzodiazepines

Question 30

What medications are typically associated with an increased risk of fracture?

Answer 30

glucocorticoids

Question 31

What medications are typically associated with tendon ruptures?

Answer 31

Fluoroquinolones (ciprofloxacin)
Statins (simvastatin)
Glucocorticoids (dexamethasone)