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PMR Disorders > Mix Qs > Flashcards

Mix Qs Flashcards

1
Q

Pathology in pronator Teres Syndrome

A

Entrapment of the Median nerve at the pronator teres and beneath the FDS

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2
Q

Grocery bag neuropathy

Carrying bag with arm flexed

A

Pronator Teres Syndrome

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3
Q 
Describe severity of carpal tunnel syndrome
As to: 
Mild
Moderate
Severe
A

Mild-prolongation of SNAPS w/ slight attenuation
Moderate- both SNAPS are slowed with prolonged median latency
Severe- moderate + absent SNAPs and prolongd or absent CMAPs + fibrillation potentials in thenar muscles

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4
Q

Anterior Interosseus Syndrome. Is it purely motor? Purely sensory? Or mixed?

A

Purely Motor

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5
Q

Abnormal ‘ok sign’ with weakness of FPL and FDP

A

Anterior Interosseus Syndrome

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6
Q

Possible location of radial nerve compression/neuropathies

A
  1. Axilla
  2. Spiral groove
  3. Posterior Interosseous nerve compression
  4. Wrist (Wartenberg syndrome or handcuff neuropathy
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7
Q

Saturday night palsy or honeymooner palsy

Nerve affected
Location of compression

A

Radial nerve at the spiral groove

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8
Q

Associated with Monteggia fracture or fall with outstretched hand presenting with weakness of MCP and wrist extension with preserved IP extension

A

Radial Neuropathy with posterior interosseus nerve compression

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9
Q

Muscles spared in posterior interosseous syndrome

A

Brachioradialis and ECRL

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10
Q

Types of ulnar nerve compression at the Guyon’s canal at the wrist with presenting symptoms

A 
Type 1 hypothenar and deep ulnar branch
Type 2 deep ulnar branch-hypothenar spared
Type 3 superficial ulnar sensory branch
Painless wasting of hand muscles
Intrinsic muscle atrophy
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11
Q

Possible locations of entrapment neuropathies of the median nerve

A
  1. At the wrist-Carpal Tunnel Syndrome
  2. At the forearm:
    Pronator Teres Syndrome
    Anterior interosseous syndrome (kiloh-nevin
    syndrome)
    Beneath the ligament of Struthers
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12
Q

Pathology of posterior interosseous syndrome?

A

Entrapment of the radial nerve with a fibrous band at the origin of the supinator muscle or otherwise known as the arcade of Frohse

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13
Q

What nerve and and the location of the entrapment in Wartenberg Syndrome

A

Radial nerve at the wrist. No motor weakness

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14
Q

Diagnostic Criteria for ALS

A

EL ESCORIAL WITH AWAJI MODIFICATION

A. Presence of lower motor neuron degeneration by clinical, electrophysiologic or neuropathologic examination
B. Presence of upper motor neuron degeneration by clinical exam
C. Progressive spread of sympt9ms or signs within a region or to other regions

With

Absence of EDX or pathologic evidence of other disease process
Neuroimaging evidence of other disease

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15
Q

Diagnostic categories of ALS

A

Clinically definite- clinical or EDX evidence by the presence of LMN and UMN signs in the bulbar region and atleast two spinal regions or the presence of LMN and UMN signs in 3 spinal regions

Clinically probable-UMN and LMN signs in atleast 2 regions with some UMN signs rostral to the LMN signs

Clinically possible- UMN and LMN found only in one region or UMN signs found in two or more regions or LMN signs found rostral to UMN signs

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16
Q

Medical treatment that slow progression of ALS

A

Riluzole- inhibits the presynaptic release of glutamate-> glutamate toxicity is thought to contribute to neuronal death in ALS

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17
Q

When to initiate Mech Vent Support in Patients with GBS?

A

When Vital capacity falls below 20ml/kg

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18
Q

What are the 3 types of Diabetic neuropathy?

A
  1. Demyelinating, symmetric, distal sensorimotor polyneuropathy
  2. Demyelinating asymmetric proximal polyneuropathy or diabetic amyotrophy
  3. Focal neuropathy-median, ulnar and peroneal nerves commmonly affected
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19
Q

CSF analysis findings in patients with GBS

A

Albuminocytologic dissociation or elevated CSF protein but with normal WBC level

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20
Q

3 subtypes of GBS

A

AIDP-mc
AMAN
ASMAN
Miller-Fisher

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21
Q

Triad of Miller-Fisher Variant of GBS

A

Ataxia
Areflexia
Opthalmoplegia

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22
Q

Dose of IVIG treatment for GBS

A

0.4/kg daily for 5 consecutive days

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23
Q

Most common organism responsible for GBS

A

Campylobacter Jejuni

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24
Q

Triad of Wernicke Syndrome

A

Ataxia, dementia, opthalmoplegia

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25
Q

Nerve most commonly affected by lead toxicity

A

Radial nerve, presenting as wrist drop or weakness in wrist extension

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26
Q

Most common mass affecting the brachial plexus

A

Lung
Breast
Lymphoma

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27
Q

What part of the brachial plexus is affected in Pancoast Tumor?

A

Lower trunk associated with Horner’s Syndrome

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28
Q

S/sx of Acute Brachial Neuritis or Parsonage-Turner Syndrome?

A

Severe pain in the shoulder blade, upper arm or neck followed by weakness of the muscles of the shoulder girdle 2 weeks after.

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29
Q

Antecedent events causing Parsonage-Turner Syndrome

A

Immunization
Infections
Surgery
Pregnancy

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30
Q

What part of the brachial plexus is affected in Acute brachial neuritis?

A

Upper trunk

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31
Q

Nerve root of lateral femoral cutaneous nerve?

A

L2-L3

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32
Q

3 components of the lateral collateral ligament of the ankle

A
  1. Anterior talofibular ligament
  2. Posterior talofibular ligament
  3. Calcaneofibular ligament
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33
Q

Mechanism of action of Benzodiazepines?

A

Enhancement of GABA inhibitory activity.
Effective for acute and chronic low back pain flr short term relief
Rapid withdrawals can cause seizures.
Not generally recommended for low back pain

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34
Q

Mechanism of action of Baclofen?

A

GABA derivative that inhibits transmission at the spinal level and brain

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35
Q

MOA of Dantrolene Sodium?

A

Blocks the calcium channels at the sarcoplasmic reticulum.

Side effect: severe hepatotoxicity

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36
Q

MOA of Tizanidine

A

Centrally acting alpha 2 agonist

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37
Q

Common side effects of tricyclic antidepressants?

A

Dry mouth, blurry vision, constipation, dizziness, tremors and urinary disturbances.

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38
Q

Examination maneuvers for Piriformis Syndrome

A

PACE maneuver- resisted abduction and external rotation of the thigh

Freiberg maneuver- forceful internal rotation of the extended thigh

Beatty maneuver- deep buttock pain on a side lying patient holding a flexed knee several inches off the table

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39
Q

Common pediatric PRIMARY spine malignancies

A

Osteoid osteoma
Osteoblastoma
Aneurysmal bone cysts

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40
Q

Most frequent malignant lesion affecting the pediatric spine?

A

Ewing’s sarcoma

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41
Q

Pediatric spine tumor whose pain is responsive to aspirin?

A

Osteoid osteoma

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42
Q

Describe Scheurmann disease.

A

Thoracic kyphosis with compensatory lumbar lordosis in pediatric population secondary to repetitive loading of the immature spine

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43
Q

HIV-associated spinal cord diseases

A

Vacuolar myelopathy- presents as incomplete spastic paraplegia with loss of proprioception and vibration sense

Human T-lymphotrophic virus type 1 causes progressive chronic myelopathy, presenting as progressive spastic paraplegia

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44
Q

MRI findings in transverse myelitis

A

Spinal cord swelling
Increased signal in T2 weighted images

Thoracic spine is most commonly affected

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45
Q

Most efficient wheelchair propulsion pattern?

A

Semicircular pattern

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46
Q

Most common site of fracture in patients with SCI

A

Supracondylar region of the femur

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47
Q

Medication given to reduce the incidence or postoperative recurrence of heterotopic ossification in patients with SCI

A

Etidronate

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48
Q

Most common location of heterotopic ossification in patients with SCI

A

Hip joint

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49
Q

Manifestation of cervical spondylosis

A

Ligamentous hypertrophy
Hyperostosis
Disk degeneration
Zygapophyseal joint arthropathy

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50
Q

AAP Commonly used for post TBI agitation

A

Quetiapine

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51
Q

Treatment for post TBI agitation

A
  1. Atypical antipsychotics- quetiapine
  2. Beta blockers- propanolol
  3. Benzodiazepines
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52
Q

Management of upper motor neuron bowel

A

Digital rectal stimulation
Rectal stimulant medications, enemas
electrical stimulation

GOAL: cause relaxation of the IAS and if strong enough can reflexively relax EAS

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53
Q

Causes of upper motor neuron bowel

A

Lesion above the conus medullaris at the level of T12

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54
Q

What is the cause of lower motor neuron bowel?

A

Lesions below the conus medullaris, cauda equina, pelvic surgery,vaginal delivery or chronic straining

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55
Q

Most important side effect of dantrolene sodium

A

Hepatotoxicity

Liver function test should be monitored monthly initially then several times per year

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56
Q

Most common diplegic gait pattern in older children with cerebral palsy

A

Crouch gait

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57
Q

Most common diplegic gait pattern in young children with cerebral palsy and is the precursor to crouch gait

A

Jump gait

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58
Q

Gait pattern associated with overactive rectus femoris in patients with hemiplegic cerebral palsy

A

Stiff knee gait

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59
Q

Most common site of Heterotopic ossification in burned individuals?

A

Posterior elbow in the affected side

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60
Q

Pattern of neuropathy in patients with deeper and larger TBSA?

A

Axonal rather than demyelinating

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61
Q

Ideally position of the hand for splinting?

A

Intrinsic plus position

MCP flexion with IP extension

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62
Q

Positioning of the hand resulting from weakness of the intrinsic and strong extrinsic muscles?

A

Intrinsic minus hand

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63
Q

2 main diseases of children for which lung transplant is performed

A

Cystic fibrosis

Primary pulmonary hypertension

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64
Q

Main reason for lung transplant in adults

A

COPD

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65
Q

Equivalent of 1 MET

A

3.5 ml/kg per minute

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66
Q

Most common feature of dermatomyositis and polymyositis?

A

Painless muscle weakness
Symmetrical and proximal
Distribution: neck, shoulder, pelvis and thigh
Difficulty lifting arm and climbing uphill

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67
Q

Most characteristic skin manifestation of dermatomyositis?

A

Gottron papules and heliotrope rash

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68
Q

Characteristic finding of inclusion body myositis?

A

Rimmed vacuoles

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69
Q

2 types of femoroacetabular impingement

A

CAM- femoral head-neck junction variety

Pincer- acetabular over coverage of the femoral neck

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70
Q

Structures of the posterolateral corner:

A
  1. LCL
  2. Popliteus tendon
  3. Posterolateral joint capsule
  4. Biceps femoris tendon
  5. Peroneal nerve
  6. Lateral head of gastrocnemius
  7. Lateral meniscus
  8. Posterior meniscofemoral ligament
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71
Q

Most common mechanism of injury of the posterolateral corner?

A

Strong hyperextension and varus force

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72
Q

2 most common types of tarsal coalition?

A
  1. Calcaneonavicular

2. Talocalcaneal

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73
Q

triangular fibrocartilage complex consists of?

A
  1. triangular fibrocartilage
  2. meniscus homologue
  3. extensor carpi ulnaris tendon sheath
  4. volar and dorsal radiocarpal ligaments.
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74
Q

Differential Diagnosis for MS

A
  1. Neuromyelitis optica
  2. Acute transverse myelitis
  3. Acute Disseminated encephalomyelitis
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75
Q

Autoimmune condition that targets the aquaporin 4 channels?

A

Neuromyelitis optica

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76
Q

Criteria for diagnosis for neuromyelitis optica

A
  1. Optic neuritis + acute myelitis
    +
    2 of the following:

contiguous spinal cord involvement spanning 3 spinal segments or more

Exclusion of MS

NMO IgG seropositive status

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77
Q

MS subtypes

A
  1. Relapsing Remitting (RRMS)
    • most common subtype
    • period of exacerbation ff by period of remission
  2. Secondary Progressive (SPMS)
    • pt w/ RRMS no longer has exacerbations but w/ persistent accumulation of disability
  3. Primary progressive (PPMS)
    • affects males and females equally
    • lack exacerbation but w/ accumulation of disability over time
  4. Progressive Relapsing (PRMS)
    • least common and most aggressive
    • assoc w/ high mortality
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78
Q

Diagnostic Criteria for Multiple sclerosis

A

McDonald’s Criteria MRI based on

Dissemination in Space
Dissemination in Time

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79
Q

Uhthoff phenomenon

A

Transient blindness or blurring of vision in patients with MS after exposure to heat e.g warm baths

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80
Q

What is the Karvonen formula?

A

target training HR = resting HR + (0.6 [maximum HR -resting HR])

Computes for the maximum heart rate

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81
Q

VO2Max

A

O2 consumed in liters/min
Or
ml/kg/min

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82
Q

Best evaluation/test for evaluation of the capacity to exercise in cardiac and pulmonary conditions

A

Cardiopulmonary exercise test CPET

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83
Q

Karvonen Equation used to estimate target heart rate

A

Target HR= (max HR-resting HR) x % intensity + resting HR

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84
Q

Stroke volume

A

Volume of blood ejected with each left ventricular contraction
Achieve max at 40% VO2

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85
Q

Cardiac output

A

HR x SV

Primary determinant of VO2max

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86
Q

Phases of throwing where majority of injuries occur?

A
  1. Late cocking phase- phase where extreme ER occurs

2. Deceleration phase

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87
Q

Independent predictors of vascular disease?

A
  1. Cigarette smoking

2. Diabetes

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88
Q

Marker of peripheral artery disease/ implicated in PAD?

A

Elevated homocysteine levels

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89
Q

Primary mechanism of injury in stingers?

A

Brachial Plexus tensile overload

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90
Q

Cause of brachial plexus tensile i juries in younger athletes?

A

Forceful contralateral neck lateral bending with ipsilateral shoulder and arm depression

Weak neck and shoulder girdle

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91
Q

Only muscle in the hamstrings group innervated by the common peroneal nerve?

A

Short head of the biceps femoris

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92
Q

Cause of stingers in older athletes?

A

Cervical root compression due to forceful cervical extension and rotation resulting un narrowing of the neuroforamen

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93
Q

Mainstay of pharmacologic therapy in Exercise-induced bronchospasm?

A

Short-acting beta agonist 15 mins before exercise

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94
Q

3 most common causes of anemia in the athlete

A

Iron- deficiency anemia- menstruating athlete
Physiologic anemia- MC in endurance athlete
Foot strike hemolysis-RBC destruction in the feet

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95
Q

Female athlete triad

A

Anorexia
Amenorrhea
Skeletal demineralization

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96
Q

Calcium and Vit. D recommended dose per day?

A

Calcium- 1200 to 1500 mg

Vit. D- 400 to 800 IUs per day

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97
Q

Most common cause of acute injury to the pressure epiphysis

98
Q

Most common elbow injuries in wheelchair athlete?

A

Lateral epicondylitis
Osteoarthritis
Olecranon bursitis
Ulnar neuritis

99
Q

Final product if plasmin-mediated degradstion of cross-linked fibrin and is highly sensitive for patients with acute venous thrombosis.

100
Q

What is the mainstay of treatment for chronic venous insufficiency?

A

Compression therapy wi5 pressure of 30-40 mmHg at the ankles

101
Q

Most common sites of pressure ulcer formation

A
  1. Ischium
  2. Sacrum
  3. Trochanter
  4. Heel
102
Q

Normal Cerebral blood flow

A

50 ml/100 gm of brain tissuer per minute

103
Q

Normal motor conduction velocities in full-term infants

A

NCV in children and adults are equalized by 5 years of age

Full term infants-NCV not less than 20m/s

104
Q

Disease with Presence of Cramp potentials with taut muscles and electrical silence?

A

McArdle Disease

105
Q

Median nerve and peroneal nerve anatomic variant?

A
  1. Martin-Gruber Anastomosis- branch of median nerve i.e. AIN joining the ulnar nerve.

On NCV-median nerve CMAP is smaller at the wrist compared to the forearm and ulnar nerve CMAP-larger amplitude at wrist compared to above and below elbow.

  1. Accessory Deep Peroneal nerve- branch attached to superficial peroneal nerve which innervates the extensor digitorum brevis after passing the lateral malleolus

On NCV- deep peroneal nerve stimulation at the fibular head has larger CMAP compared to ankle. Stimulation behind the lateral malleolus is confirmatory.

106
Q

Median Nerve Neuropathies

A
  1. CTS
  2. Pronator Syndrome
  3. Anterior Interosseus Syndrome- FPL, PQ and FDP affected
  4. Median nerve Entrapment at the forearm
107
Q

Radial Neuropathies

A
  1. Entrapment at the axilla
  2. Radial nerve entrapment at the spiral groove (Saturday night palsy/Honeymooner Palsy
  3. Posterior Interosseus Nerve compression
    A. Radial tunnel syndrome-fibrous bandat radial head or tendinous margin of ECRB
    B. PIN Syndrome or supinator syndrome- entrapment at supinator muscle called Arcade of Frohse
    C. Monteggia Fracture/ elbow dislocation/ fall on outstretched hand
  4. Radial nerve entrapment at the wrist ( Wartenberg or handcuff neuropathy)
108
Q

Muscles spared in PIN compression?

A

Brachioradialis

ECRL

109
Q

Ulnar nerve compression at the elbow: causes

A

Proximal to elbow-nerve entrapment by Arcade of Struthers, fibrous structure associated with the medial triceps muscles

Cubital Tunnel Syndrome- entrapment at the cubital tunnel, fibrous entrance to the FCU- MC site

110
Q

Electrodiagnostic Hallmark of Lambert-Eaton Syndrome?

A

Profound potentiation or increase in CMAP of more than 200% after a maximal contraction

111
Q

Presynaptic Neuromuscular Junction disorders?

A

LEMS and Botulism

112
Q

High-yield muscle to test in cranial nerves for patients with suspected ALS?

113
Q

Highly sensitive and specific test for Dermatomyositis and findings of the test

A

Muscle biopsy showing deposition of complement membrane attack complex on small blood vessels- highly sensitive and specific with perifascicular atrophy and decreased capillary density

114
Q

Malignancies associated with dermatomyositis?

A

Ovarian cancer in women

Small cell lung cancer in men

115
Q

What disease and where can you find Gottron papules?

A

Dermatomyositis

Extensor surfaces of joints

116
Q

Triad of normal pressure hydrocephalus?

A

Dementia
Gait ataxia
Urinary incontinence

117
Q

Characterized as wasting of the distal limb muscles, particularly the peroneal innervated muscles, with distal sensory loss, decreased or absent muscle stretch reflexes, and skeletal deformity

A

Charcot Marie Tooth Disease

118
Q

Hereditary Neuropathy that presents with slow progression of onset, starting in the first 2 decades of life. Children and teenagers might first present with steppage gait, associated with weakness of the peroneal innervated muscles and the development of pes cavus

A

Charcot Marie Tooth Disease or Hereditary Sensory Motor Neuropathy

119
Q

What condition involves an ossicle arising from the posterior talar process that is present in approximately 10% of the population. It is often found in athletes who perform frequent and forceful plantar flexion?

A

Os trigonum

120
Q

In a 35-year-old patient with Charcot-Marie-Tooth (CMT) disease, orthotic management will most likely consist of:
A. custom-molded, longitudinal arch supports
B. an ankle-foot orthosis
C. a knee cage brace
D. a resting wrist splint set at 10 degrees of extension

A

Ankle foot orthosis

121
Q

Type of inflammatory myositis not responsive to steroids?

A

Inclusion body myositis

122
Q

Most common inflammatory myopathyin individuals over 50 years old?

A

Inclusion body myositis

123
Q

Features of inclusion body myositis?

A

Asymmetrical weakness, including finger flexors and knee extensors
‘Intrinsic positive hand’ with difficulty making a fist

124
Q

Muscle biopsy findings in inclusion body myositis?

A

Rimmed vacuoles, cytoplasmic inclusions and mono nuclear cell invasion in endomysial fibers

125
Q

Anti retroviral which may cause myopathy?

A

Zidovudine

126
Q

Myopathy relieved by intake of 40mg of fructose or sucrose and improve exercise tolerance?

A

McArdle disease or myophosphorylase deficiency

127
Q

Myopathy with second wind phenomenon..

A

McArdle disease

‘Second wind’ phenomenon-improve exercise tolerance, muscle stiffnes and cramps after rest

128
Q

Lab tests pertinent for McArdle Disease?

A

Increased uric acid, creatine kinase and elevated ammonia on forearm exercise testing

129
Q

Acid Maltase deficiency or Pompe disease pertinent muscle to study in EMG.

A

Thoracic paraspinal muscles-only site of membrane instability

130
Q

Hallmark of Emery-Dreifuss muscular Dystrophy?

A

Elbow flexion contractures

131
Q

Spinal cord level that are not functional ambulators?

A

T12 and above

132
Q

Body weight transmissionin percentage in

A.unilateral cane opposite the affected side
B. Forearm or arm cane
C. Bilateral crutches

A

A. Unilateral cane opposite the affected side- 20-25%
B. Forearm or arm cane- 40-50%
C. Bilateral crutches- 80%

133
Q

Gold standard for degenerative cervical spine conditions?

A

CT Myelography

134
Q

Type of leprosy which commonly affects the ulnar nerve

A

Lepromatous type*

135
Q

Predictors of ambulation in a patient with cerebral palsy?

A

Sitting independently by 2 years old and having less than 3 primitive reflexes present by 18 to 24 months

136
Q

At what age is self catheterization possible?

A

Mental age of atleast 5 years old

137
Q

Treatment of choice in primary dystonias?

A

Deep Brain stimulation

138
Q

Treatment of choice of secondary dystonias in cerebral palsy?

A

Intrathecal baclofen

139
Q

2 muscle groups responsible for hip dislocations in patients with cerebral palsy?

A

Iliopsoas

Adductors

140
Q

Orthopedic deformities resulting from lackmof axial weight-bearing in patients with cerebral palsy?

A

Femoral anteversion
Acetabular dysplasia
Coxa valga

141
Q

At what age is X-ray of the hip in patients with bilateral CP indicated?

A

At age 30 months or younger

142
Q

Parameters and values to monitor for hip dislocation in patients with CP?

A

Acetabular index- >30%
Reimer migration index->33%

Both will need further ortho treatment

143
Q

Most common spinal segment affected in colorectal cancer metastases?

A

Lumbar spine

144
Q

Most common cancers that metastasizes to the thoracic spine?

A

Lung, breast prostate and renal cell carcinoma

145
Q

Most common source and organism in vertebral osteomyelitis?

A

E.coli

UTI

Commonly affects the lumbar spine

146
Q

Pathognomonic for vertebral osteomyelitis in plain xray?

A

Periosteal reaction

147
Q

Most common organism responsible for most spinal infections?

A

Staphylococcus Aureus

148
Q

Gold standard for diagnosing sacroiliac joint pain?

A

Fluoroscopically guided injection of local anesthetic into the sacroiliac joint

149
Q

Low back pain generally peaks at what age of gestation and when is it relieved?

A

Pain peaks at 36 AOG and is relieved at 3 months postpartum

150
Q

Common direction of the scoliotic curve in idiopathic scoliosis?

A

Right thoracic, left lumbar

151
Q

Time period where development of DVT in patients post THR?

A

3months post op

-Brotzman

152
Q

Associated nerve injury in anterior and posterior hip dislocation

A

Posterior Hip dislocation- sciatic nerve injury (weakness of ankle dorsi and plantar flexion)
Anterior hip dislocation- femoral nerve injury (weakness of quadriceps)

153
Q

Pathognomonic for meniscal (bucket-handle) tear?

A

Locking of the knee in a slightly flexed position with difficulty working into full extension.

154
Q

Muscles that support the medial longitudinal arch of the foot?

A

Tibialis anterior and tibialis posterior

155
Q

Condition associated with tibialis posterior rupture?

A

Rheumatoid arthritis

156
Q

Often seen in ballet dancers, dnacers and gymnasts who perform repetitive and forceful toe flexion?

A

Flexor hallucis longus overload

157
Q

Test to check for tibialis posterior function

A

Rise of the calcaneus in line with the leg in or in slight calcaneal varus during tiptoeing. Dysfunctional tib posterior allows the calcaneus to rise in valgus

158
Q

4 Plantar foot muscles that originate in the volar calcaneus and may contribute to plantar fasciitis.

A

Adductor hallucis
Quadratus plantae
Flexor digitorum brevis
Abductor digiti minimi quinti

159
Q

Normal ankle brachial index to check for perfusion

A

ABI 0.8-1.3

> 1.3 poor perfusion

160
Q

Normal transcutaneous oxygen pressure

A

The normal TcPO2 is greater than 50 to 60 mm Hg
Impaired wound healing- <40mmHg
20mmHg- assoc with pain, ischemic ulcers
<20mmHg- at risk for amputation

161
Q

Degenerative changes of what muscle tendons are implicated in lateral epicondylosis?

162
Q

Degenerative changes of what muscle tendons are implicated in medial epicondylosis?

A

Pronator Teres

FCR

163
Q

Cause of distal biceps tendonitis and rupture?

A

Eccentric overload of the biceps during deceleration and follow-through phase of throwing

164
Q

Biceps tendon rupture would result in what percentage of flexion and supination loss of strength?

A

8% flexion strength

21% of supination strength

165
Q

Condition associated with lateral epicondylosis?

A

Posterior Interosseus Syndrome

Pain 3-4cm distal to the lateral epicondyle

166
Q

Gold standard for diagnosis of SLAP lesions?

A

Arthroscopy

167
Q

Condition associated with medial epicondylosis?

A

Acute rupture of the UCL

168
Q

Common cause of SLAP lesions?

A

Injury during the late cocking phase of overhead throwing and traction during the deceleration phase

169
Q

Last elbow physis to close in children?

A

Medial epicondylar apophysis

Closes at 14 yo in females and 17 yrs old in males

170
Q

Test for scapholunate instability or Dorsal Intercalated Segmental instability(DISI)?

A

Watson Test-positive test result is indicated by a painful click and dorsal shift of the scaphoid bone relative to the lunate bone during this movement.

171
Q

Normal scapholunate angle

A

30-60 degrees

172
Q

Pathology behind Kienbock’s Disease?

A

Progressive collapse of the lunate resulting from compressive forces to the wrist causing microfractures in the lunate with vascular compromise and AVN

173
Q

What is the primary stabilizer of the distal radioulnar joint?

A

Triangular Fibrocartilage Complex injuries

174
Q

How many percent of axial loading is transmitted to the TFCC and distal radioulnar joint?

A

18% to the TFCC

82% to the RUJ

175
Q

What is a Stener lesion?

A

Interposition of the adductor policis at the base of the first proximal phalanx with the ruptured ends of the UCL

176
Q

Pathology in Gamekeeper’s thumb?

A

Radially directed forces of the first proximal phalanx resulting in UCL injury

177
Q

Type of acromion associated with greater rotator cuff injury?

A

Type 3-hooked acromion resulting in greater outlet impingement associated with a greater curve

178
Q

Presenting symptom of delayed radiation myelopathy?

A

Brown-Sequard Syndrome

179
Q 
State side effects of these chemotherapeutics agents.
Bleomycin
Doxorubicin
Trastuzumab
Vinca alkaloids (Vincristine)
Taxanes (Docetaxel)
Thalidomide
Platins (Cisplatin)
A

Bleomycin-acute pneumonitis
Doxorubicin-cardio toxicity/cardiomyopathy
Trastuzumab-cardiac toxicity

Vinca alkaloids (Vincristine)-peripheral neuropathy and autonomic neuropathy with weakness of wrist (motor>sensory neuropathy)and digital extensors but intact vibration sense

Taxanes (Docetaxel)-neuropathy manifesting as diminished vibration sense, reduction of SNAPs with proximal muscle weakness

Thalidomide-neuropathy

Platins (Cisplatin)-sensory neuropathy affecting large sensory fibers leading to proprioceptive deficits (sensory>motor neuropathy)

180
Q

First line therapy in the treatment of primary breast, ovarian and lung cancers

A

Taxanes (Docetaxel)

181
Q

Standard of care for lymphedema management?

A

Complete (or complex) decongestive therapy
2 phase multi modal system consisting of:

Phase 1-reductive phase
MLD + compressive bandages (21-24hrs/day)+ remedial exercises

Phase 2 compressive garments in am, compressive bandage at night + remedial exercises

182
Q

Finger/hand pressure in manual lymphatic drainage?

A

30-45 mmHg

183
Q

What is Remedial lymphedema?

A

Repetitive movements designed to encourage rhythmic serial muscle contractions in lymphedematous territories

184
Q

Complication of vigorous shoulder ROM/stretching immediately post MRM?

A

Seroma formation

185
Q

Complication of head and neck cancer irradiation?

A

Osteoradionecrosis

186
Q

Most often affected location of osteoradionecrosis?

187
Q

Time course of bone marrow recovery?

A

Every 3-4 weeks or 21 to 28 days

188
Q

Cut off platelet count below which physical therapy is contraindicated?

A

25,000 and lower

189
Q

Intensity target for cardiac primary prevention?

A

80 to 85% of predicted max HR/peak HR from exercise tolerance test.

190
Q

Intensity target for cardiac secondary prevention?

A

60% or more of HR max

191
Q

Hallmark of severe COPD

A

Carbon dioxide retention and active exhalation

192
Q

Goal of Pulmonary rehabilitation program

A
  1. Improving Disease management and exercise capacity and improve peripheral efficiency and decrease dyspnea
193
Q

Pathogens to consider in the first month post transplant?

A

Staph Aureus
Vancomycin-resistant Enterococcus
Clostridium Difficile colitis

194
Q

Pathogens to consider on the first 6 months post transplant?

A 
M. TB
Nocardia
Leishmania
EBV
HSV
HHV6
hep B and hep C
BK virus
Aspergillus and Listeria monocytogenes
195
Q

Standard test for exercise tolerance in patients with pulmonary disease?

A

6 minute walk test

196
Q

When is Milwaukee brace the orthosis of choice in idiopathic scoliosis?

A

Scoliotic curves of T9 or higher

197
Q

Recommended elbow angle in wheelchair prescription?

A

100-120 degrees

198
Q

Upper limb injury common in manual wheelchair users secondary to a seat height that is too low.

A

Shoulder impingement

199
Q

Wheelchair propulsion technique commonly seen in patients wih paraplegia?

A

Single-looping over

200
Q

How to compute for rate pressure product?

A

(HR x SBP)/100

201
Q

Most common culprit in shunt infections?

A

Staphylococcus epidermidis

202
Q

What is Arnold-Chiari Malformation type II?

A

Displacement of cerebellar tissue into the spinal canal accompanied by caudal dislocation of the lower brainstem and fourth ventricle

203
Q

Leading cause of death for infants with Myelomeningocele?

A

Symptomatic Chiari II malformation

204
Q

Constellation of stridor, central apnea and aspiration associated with Chiari II malformation?

A

Central ventilatory dysfunction

205
Q

Condition associated with failure of the scapula to descend from the cervical region overlying the 1st to 5th rib resulting in shortened neckline lack of normal scapulothoracic motion and malpositioning of the GH?

A

Sprengel’s deformity

206
Q

Condition where there is congenital fusion of the cervical vertebrae, with restriction in contact sports indicated?

A

Klippel-Feil Syndrome

207
Q

Age when X-ray is recommended for children with Downs Syndrome? What us the acceptable atlantidens interval?

A

Age of 3 years, before joining special olympics and then at age 8 yrs then every decade thereafter.

Acceptable ADI greater than 4mm in 7 yo
No more than 3mm for 8 yo
Up to 5 mm has been acceptable

208
Q

Hallmark of Acute Gouty attack?

A

Neutrophilic synovitis

209
Q

Median nerve innervated muscles (9)

A
  1. Pronator teres
  2. FDS(inserts at PIP D2-4)
  3. FDP to D2-3 (inserts DIP at D2-4)
  4. FCR
  5. FPL
  6. Pronator quadratus
  7. Abductor pollicis Brevis
  8. opponens pollicis
  9. 1st and 2nd lumbricals
210
Q

Presynaptic neuromuscular junction disorders

A

LEMS and Botulism

211
Q

Postsynaptic neuromuscular junction disorder

A

Myasthenia Gravis

212
Q

Most sensitive test for Myasthenia Gravis?

A

Single fiber EMG

213
Q

Cancer associated with Lambert Eaton Myasthenic Syndrome?

A

Oat cell carcinoma of the lung

214
Q

Muscles spared in diabetic amyotrophy?

A

Glutes and hamstrings

215
Q

Sensory loss in diabetic amyotrophy?

A

Femoral and saphenous distribution

Iliopsoas, adductors and quads

216
Q

Sensory responses with freater affectation in GBS?

A

Median, and ulnar sensory responses more than the sural.

217
Q

Time duration which differentiates CIDP from GBS?

A

CIDP -symmetrical, motor weaknes lasting for atleast 2 months

GBS- weakness sets in 3 weeks after infection, peaks at 2 weeks and maximizes at 4 weeks

218
Q

Differences in CIDP vs. GBS

A

GBS-no remission

     - do not respond to steroids
     - onset 3 weeks post infection, peaks at 2 weeks and nadirs by 4 weeks.

CIDP-has recurrence and remission (polyphasic, common in younger pts) (older patients-monophasic)
Very responsive to steroids and may induce remission
Weakness progressive within 2 MONTHS

219
Q

Areas of sparing in leprosy?

A

Palms of hands and soles of feet

220
Q

Type of leprosy resulting from immune cell mediated response to kill the bacilli?

A

Tuberculoid type

221
Q

One the drugs use to treat leprosy and its side effect?

A

Dapsone- causes progressive motor neuropathy affecting the hip girdle and muscles of both hands and feet symmetrically

222
Q

Neuropathy associated with vasculitic and connective tissue diseases?

A 
Mononeuritis multiplex (asymmetrical mixed motor and sensory pattern)
Lower extremities more affected-peroneal nerve affected 63% of the time
223
Q

Pressure gradient driving cerebral blood flow

State the formula and normal value.

A

Cerebral perfusion pressure (CPP)

MAP- ICP >60mmHg

224
Q

Normal ICP

225
Q

Brown Sequard Syndrome

A

Greater ipsilateral weakness and position sense loss, contralateral pain and temperature sensation loss

226
Q

Phases of spinal shock

A 
Phase I (0-24 hrs)
Motor neuron hyperpolarization manifesting as hyporeflexia
Phase II (day 1 to day 3)
Denervation supersensitivity and receptor upregulation manifesting with reflex return
Phase III ( 1-4 wks)
Interneuron synapse growth, early hyper reflexia
Phase IV (1-12months)
Long axon synapse growth, later hyper reflexia
227
Q

Level of distribution of the artery of Adamkiewicz?

A

T12-L2 on the left side supplying the caudal 2/3 of the spinal cord

228
Q

Anterior cord syndrome?

A

Paraplegia, loss of pain and temperature sensation, relative sparing of touch and position sensation
Often caused by flexion teardrop fractures

229
Q

Clay shoveler’s fracture

A

Avulsion fracture of the spinous process of C6, C7 or T1. Typically not associated with neurologic injury

230
Q

Central cord syndrome

A

Results from compression of the spinal cord between the vertebral body and ligamentum flavum or hypertrophied facet joints occurring only with cervical spinal cord lesions characterized by sacral sensory sparing amd greater weakness in the UE than LE

231
Q

Predictors of ambulation in patients with SCI after 1 year (3)

A

Strong quadriceps femoris
Strong gastrocsoleus
Light touch sensation at L3 and S1 dermatomes

232
Q

Pressure from what artery compresses the trigeminal nerve causing trigeminal neuralgia?

A

Superior cerebellar artery

233
Q

Myokymia is classically seen in what disorders?

A
  1. Radiation injury
  2. GBS
  3. Multiple sclerosis
  4. Brainstem tumors
  5. occasionally in entrapment neuropathies but not in CTS
234
Q

Pressure from what artery compresses the trigeminal nerve causing trigeminal neuralgia?

A

Superior cerebellar artery

235
Q

Myokymia is classically seen in what disorders?

A
  1. Radiation injury
  2. GBS
  3. Multiple sclerosis
  4. Brainstem tumors
  5. occasionally in entrapment neuropathies but not in CTS
236
Q

Contents of the Carpal Tunnel

A

1 median nerve
4 tendons of the flexor digitorum superficialis
4 tendons of the flexor digitorum profundus
1 tendon of the flexor pollicis longus

237
Q

hallmark of acute gouty attack?

A

Neutrophilic synovitis

238
Q

Common and early X-ray finding in patients with Rheumatoid Arthritis?

A

Juxta-articular Osteopenia

239
Q

hallmark of acute gouty attack?

A

Neutrophilic synovitis

240
Q

Common and early X-ray finding in patients with Rheumatoid Arthritis?

A

Juxta-articular Osteopenia

241
Q

Which self-limiting viral infection may present with arthralgia/arthritis in infected adults and may manifest with skin rashes in a lacy pattern with macular central clearing?

A

Parvo virus B19 infection / Erythema Infectiosum / Fifth disease

242
Q

Describe the Noble test

what structure is tested?

A

Noble test- clinical tool in evaluating ITB syndrome. Involves compressing the lateral femoral condyle as the knee is activelt flexed to 30 degrees.

rationale: The ITB moves over the lateral femoral condyle at this angle.

PMR Disorders (1 decks)

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