Miscellaneous Flashcards
Describe the Five types of Incontinence
- Stress- Involuntary loss during exertion
- Urge- Loss with Urgency
- Mixed- Both Stress and Urge
- Overflow- Overfull bladder
- Reflex- Present with Neurologic Lesions
What is the Female Athlete Triad?
- Eating Disorders
- Ammenorhea
- Osteoporosis
Define Independent and Dependent Variable
- Independent Variable- The Variable manipulated by the researcher
- Dependent Variable- The Variable Measured by the researcher
Define Measurement Validity
- An indication of whether the measurement is an accurate representation of the phenomenon of interest
Describe a Between Subjects/ Completely Randomized design
- A Single Independent Variable is used and assigns different groups of subjects to each level of that variable
- Each individual subject is measured on only one level of the independent variable (Three Different Braces)
Describe a Within Subjects/ Repeated Measures Design
- Uses a single independent variable and measures each subject under all levels of that variable
- Each subject measured on all levels (Medication doses of 200, 400, 600 mg)
Describe a Factorial Design
- Uses two or more independent variables
Describe as Completely Randomized Factorial Design
- Uses Two or more independent variables and each subject is tested at only one level of each variable
- If two variables and three levels each, would require 9 groups of subjects
Describe a Within Subjects Factorial Design
- Measures each subject in all levels of all variables
Describe a Mixed Factorial Design
- Measures at least one of the variables at only one level and at least one of the variables in all levels
- Combination of between subjects and repeated measures
When is a correlation coefficient used?
- To learn about the association between two variables
- (relationship between thigh girth and knee extensor force)
When is a Regression Analysis used?
- When the question concerns prediction
- (If the pnt has 50-60 deg ROM the second day after surgery, how much longer will he remain in the hospital?)
When would you use a Chi Square, ANOVA, or t-test?
- To question whether a treatment has an effect
- (Does Spinal traction reduce the symptoms of root compression?)
What is Sensitivity?
- The proportion of patients with a disorder who also have a positive clinical test
What is Specificity?
- The proportion of patients without the disorder who also have a negative clinical test
How do you calculate Positive Likelihood Ratios?
- Sensitivity divided by 1 minus the Specificity
How do you Calculate Negative Likelihood Ratio?
- 1- Sensitivity divided by the Specificity
What is Number Needed to Treat and how do you calculate it?
- The number of people who need to be treated to affect a change in one person
- One - Control Group divided by Experiment Group
- Control Group and Experiment group are numbers of people per group who did not respond to the treatment
Briefly Describe the Convex-Concave rule
- Convex on Concave - Opposite Directions
- Concave on Convex - Same Directions
What are some signs and symptoms of Rheumatoid Arthritis?
- Symmetric Arthritis of small joints in hand (except for DIPs)
- Same in the Wrists, Feet, And Knees all with morning stiffness
- Rheumatoid Factor may be present
What X Ray changes occur with Rheumatoid Arthritis?
- Periarticular Osteopenia occurs first
- Erosions may develop at joint margins
- Loss of Joint Space, malalignment, and progressive Osteopenia
What are the most common hand deformities in RA?
- Swan Neck
- Boutoniere
- Ulnar Deviation at MCPs
What are the types of Juvenile RA?
- Pauciarticular- Involving < or equal to 4 joints- Most Common
- Polyarticular- Similar in Nature to Adult RA
- Systemic Onset- Fever, Arthritis, Rash, and other organ involvement
What are some common blood tests to diagnose RA?
- Rheumatoid Factor (Sensitive)
- Anti CCP Ab- Anticyclic Citrullinated peptide Antibodies (Specific)
What areas of the spine are affected by RA?
- The Synovium of the Odontoid Process and The Transverse Ligament that holds C2 to C1 via the Dens
- RA can lead to Axis Joint Instability
What is a Darrach Procedure and when is it indicated?
- Excision of the Distal Ulna
- For relief of pain following distal RU disruption and/or RU arthritis
- Typically used in the elderly with low physical demands
Describe Typical Lupus Arthtitis
- Arthralgia without visible joint swelling
- When inflammation present, typically involves small joints of hands
- Arthritis is not erosive (unlike RA) although joint deformities may be seen
Name the Seronegative Arthropathies
- Ankylosing Spondylitis
- Reiter Syndrome
- Psoriatic Arthritis
- Arthritis associated with inflammatory Bowel Disease
- These have an increased incidence of HLAB27 but negative in Rheumatoid Factor and Anti Nuclear Antibody
What is Reiter Syndrome?
- A Seronegative arthropathy that is triggered by infection, typically Chlamydia, Shigella, or Yersinia
Name some typical findings of Ankylosing Spondylitis
- Onset in late teens to 20s
- Insidious in nature
- Increase pain with rest
- Decreased pain with Activity
- +++Stiffness
What causes Gout and Pseudogout?
- Gout- Uric Acid Crystals in Synovial Joints
- Pseudogout- Calcium Pyrophosphate
What is a typical onset of Gout?
- Begin with sudden onset of burning pain
- Often Starts at Night
- Joint appears red, Swollen, and hot to touch
- Usually resolve within 7-10 days with RICE and NSAIDs
How is definitive diagnosis of Gout or Psuedogout made?
- Examination of joint fluid under Microscope
What is differential Diagnosis of a single, red, hot joint?
- Infection
- Gout
- PsuedoGout
- Rheumatoid Arthritis
- Seronegative Arthropathy
What is Virchows Triad?
- Classic pathogenesis for Deep Vein Thrombosis
- Endothelial Damage
- Alteration in Blood Flow
- Hypercoagulability
What are some symptoms of DVT?
- Calf Pain
- Swelling
- Warmth
- Low Grade Fever
- Palpable Cord and Pain along the course of the involved nerve
What is Homans Sign?
- Calf Pain with Forced passive dorsiflexion
- uses to assess for DVT
What are some common signs and symptoms of Pulmonary Embolism?
- Pleuritic Chest Pain and Dyspnea
- Tachycardia
- Bulging Neck Veins
At what levels is the International Normalized Ration (INR) usually kept in order to prevent DVT?
- Between 2 and 3
What is Complex Regional Pain Syndrome (RSD)?
- Syndrome in which pain is out of proportion with injury and is characterized by Autonomic Dysregulation
Describe the signs of Complex Regional Pain Syndrome (RSD)
- Burning Type Pain
- Trophic Changes
- Allodynia or pain with stimulus that does not normally cause pain
What NMES settings should be used after Knee Surgery to help the quadriceps recover?
- 2500 Hz alternating current
- 75 bursts per second
- 2 second ramp up and down
- 10 second stimulation with 50 second rest
Describe some settings of Ultrasound
- Non Thermal- between .1 and .3 W/cm2
- Thermal- Above .3 W/cm2
- Deeper Penetration- 1MHz
- Shallow Pentration- 3 MHz
How do NSAIDs work?
- Inhibit the Synthesis of Prostaglandins
- Prostaglandin Biosynthesis is catalyzed within the cell by the COX enxyme
- NSAIDs inhibit the COX Enzyme so no Prostaglandin can be produced
What are PPV and NPV?
- Positive Predictive Value- the percentage of persons with a positive test result who actually have the disesae
- Negative Predictive Value- The percentage of people with a negative test result who do not have the disease
What is Horner Syndrome?
- An interruption of sympathetic nervous system innvervation to the head and face
What are common signs and symptoms of Horner Syndrome?
- Ptosis- Droopy Eyelid
- Miosis- Constricted pupil
- Anhidrosis- Absence of sweat production
- All on the affected side of the face only
What are some common tests used to diagnose Developmental Dysplasia of the hips in infants?
- Ortolani Sign
- Barlows Test
- Galeazzi sign
How is Developmental Dysplasia of the hips treated?
- 1.5 years- usually need open surgical reduction
What are some Brachial Plexus Palsies seen in infants?
- Erb-Duchenne Palsy (C5-6) (Best Prognosis)
- Klumpkes Palsy (C8-T1) (Worse Prognosis)
- Complete Plexus Palsy (worst prognosis)
What is Osteochondritis Dissecans and How is it Treated?
- Necrotic Bone Lesion
- Most common in knee in teenagers
- Diagnosed with Radiology
- Treatment is casting x 2-3 months, but if loose body present surgery is required
What is Osgood Schlatters and How is it Treated?
- Traction Apophysitis of the Tibial Tubercle in Skeletally immature patients
- Treated with RICE, NSAIDs, Activity Modification and Stretching/Strengthening
- Condition is self limiting and often resolves with skeletal maturity
What is Sinding Larsen Johanssen Syndrome?
- Traction Apophysitis of the Distal Patellar Pole
What is Legg Calve Perthes and How is it Treated?
- Idiopathic Avascular Necrosis of the Femoral Head
- Often seen in 4-12 year olds, more in boys
- Treated with ROM into Abduction, maintaining the involved portion of the femoral head in the acetabulum
- Sometimes Surgical procedure is required (Salters Osteotomy, Femoral Osteotomy)
What is Slipped Capital Femoral Epiphysis and How is it Treated?
- Displacement of the Capital Femoral Epiphysis
- Often in obese boys, 10-16 years old
- Limited Internal Rotation at Hip
- Treatment usually require screw fixation
What is Nursemaids Elbow?
- Dislocation of the Radial Head from the Annular Ligament
- Reduction achieved with Supination
What are most common locations for plantar ulcers in patients with diabetes?
- First Metatarsal head
- Fifth Metatarsal Head
- Great Toe
What is the Arcade of Frohse, and why is it clinically relevant?
- It is a fibrous arch and part of the supinator muscle in the forearm
- The radial nerve passes through this fibrous arch before becoming the Posterior Interosseous Branch
- This is a site of nerve entrapment and will present clinically with finger drop (MP joints)
What is Meralgia Parasthetica?
- Compression of the Lateral Femoral Cutaneous Nerve of the Thigh
- Usually from tight clothing or heavy tool belt
How does an Obturator Nerve Entrapment Present?
- They are rare
- Usually occur after traumatic event such as childbirth or pelvic trauma
- Weakness of the Adductors and may or may not have sensation loss to medial thigh
How does Saphenous Nerve Entrapment present?
- Pain in the knee and usually without sensory loss to medial leg
- Pain can be ellicited with palpation of entrapment site between the Sartorious and Gracilis
What sites can the Fibular Nerve be entrapped?
- Popliteal Space behind Knee
- Fibular Head
- Anterior Compartment (as Deep Fibular)
- Lateral Compartment (as Superficial Fibular)
What are Signs of Superficial Sensory Fibular Nerve Entrapment?
- Occurs after the innervation of Fibularis Muscles, nerve is purely cutaneous
- Loss of Sensation to Distal leg and Dorsum of the Foot
How is Deep Fibular Nerve most often injured?
- Anterior Compartment Syndrome
- Treated with Fasciotomy
What is Anterior Tarsal Tunnel Syndrome?
- Entrapment of the Deep Fibular Nerve at the ankle as it passes deep to the inferior extensor retinaculum
- Occurs in Skiers, Runners, etc who wear tight fitting boots/shoes
- Sensation to 1st web space and Motor to EDB and EHB
What is Tarsal Tunnel Syndrome?
- Compression of the Tibial Nerve as it passes through the Posterior Tarsal Tunnel
- Pain, Parasthesias pattern consistent with one or both of the plantar nerves
What are the contents of the Tarsal Tunnel?
- Tibialis Posterior
- Flexor Digitorum Longus
- Flexor Hallucis Longus
- Posterior Tibial Nerve, Artery, Vein
- Tom Dick And Very Nervous Harry
Describe Peripheral Neuropathy (Polyneuropathy)
- Causes include Toxicity, Alcoholism, Nutritional Deficiencies and Systemic Infection or Disease
- Stocking Glove pattern of sensory loss, often affects most distal nerves first (feet then hands)
What are some common causes of Clubbing and Cyanosis?
- Heart Failure
- Lung Failure
What is Bells Palsy?
- Idiopathic Unilateral Facial Nerve Paralysis
- Hallmark Sign is paralysis that is of rapid onset and typically occurs overnight
- Usually Self Limiting
What are some factors that might precipitate Gout Flare Up?
- Diet heavy in Meat and Seafood
- Heavy Alcohol Consumption, especially beer
- Aspirin Use
- Use of Diuretics
- High Blood Pressure
- Chronic Kidney Disease
What are some Symptoms of Hiatal Hernia?
- Heartburn and Chest Pain
- Often confused with Heart Attack
- Can be diagnosed with barium swallow and x ray
What is Best VO2 usage to mobilize fat vs carbohydrate?
- < 30% VO2 Max uses mostly fat
- > 70% VO2 Max uses carbohydrate
What are some visceral pain referrals of the cervical spine?
- liver
- pancreas
- perforated duodenal ulcer
What are some visceral pain referral sites of the thoracic spine?
- gastroesophegeal reflux
- cholecystitis
- penetrating duodenal ulcer
What are some visceral pain referrals sites of the Lumbosacral spine?
- pancreatitis
- rectal lesions
- renal colic
