Mix Qs Flashcards
1
Q
Pathology in pronator Teres Syndrome
A
Entrapment of the Median nerve at the pronator teres and beneath the FDS
2
Q
Grocery bag neuropathy
Carrying bag with arm flexed
A
Pronator Teres Syndrome
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
4
Q
Anterior Interosseus Syndrome. Is it purely motor? Purely sensory? Or mixed?
A
Purely Motor
5
Q
Abnormal ‘ok sign’ with weakness of FPL and FDP
A
Anterior Interosseus Syndrome
6
Q
Possible location of radial nerve compression/neuropathies
A
- Axilla
- Spiral groove
- Posterior Interosseous nerve compression
- Wrist (Wartenberg syndrome or handcuff neuropathy
7
Q
Saturday night palsy or honeymooner palsy
Nerve affected
Location of compression
A
Radial nerve at the spiral groove
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
9
Q
Muscles spared in posterior interosseous syndrome
A
Brachioradialis and ECRL
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
11
Q
Possible locations of entrapment neuropathies of the median nerve
A
- At the wrist-Carpal Tunnel Syndrome
- At the forearm:
Pronator Teres Syndrome
Anterior interosseous syndrome (kiloh-nevin
syndrome)
Beneath the ligament of Struthers
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
13
Q
What nerve and and the location of the entrapment in Wartenberg Syndrome
A
Radial nerve at the wrist. No motor weakness
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
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
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
17
Q
When to initiate Mech Vent Support in Patients with GBS?
A
When Vital capacity falls below 20ml/kg
18
Q
What are the 3 types of Diabetic neuropathy?
A
- Demyelinating, symmetric, distal sensorimotor polyneuropathy
- Demyelinating asymmetric proximal polyneuropathy or diabetic amyotrophy
- Focal neuropathy-median, ulnar and peroneal nerves commmonly affected
19
Q
CSF analysis findings in patients with GBS
A
Albuminocytologic dissociation or elevated CSF protein but with normal WBC level
20
Q
3 subtypes of GBS
A
AIDP-mc
AMAN
ASMAN
Miller-Fisher
21
Q
Triad of Miller-Fisher Variant of GBS
A
Ataxia
Areflexia
Opthalmoplegia
22
Q
Dose of IVIG treatment for GBS
A
0.4/kg daily for 5 consecutive days
23
Q
Most common organism responsible for GBS
A
Campylobacter Jejuni
24
Q
Triad of Wernicke Syndrome
A
Ataxia, dementia, opthalmoplegia
25
Nerve most commonly affected by lead toxicity
Radial nerve, presenting as wrist drop or weakness in wrist extension
26
Most common mass affecting the brachial plexus
Lung
Breast
Lymphoma
27
What part of the brachial plexus is affected in Pancoast Tumor?
Lower trunk associated with Horner’s Syndrome
28
S/sx of Acute Brachial Neuritis or Parsonage-Turner Syndrome?
Severe pain in the shoulder blade, upper arm or neck followed by weakness of the muscles of the shoulder girdle 2 weeks after.
29
Antecedent events causing Parsonage-Turner Syndrome
Immunization
Infections
Surgery
Pregnancy
30
What part of the brachial plexus is affected in Acute brachial neuritis?
Upper trunk
31
Nerve root of lateral femoral cutaneous nerve?
L2-L3
32
3 components of the lateral collateral ligament of the ankle
1. Anterior talofibular ligament
2. Posterior talofibular ligament
3. Calcaneofibular ligament
33
Mechanism of action of Benzodiazepines?
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
34
Mechanism of action of Baclofen?
GABA derivative that inhibits transmission at the spinal level and brain
35
MOA of Dantrolene Sodium?
Blocks the calcium channels at the sarcoplasmic reticulum.
| Side effect: severe hepatotoxicity
36
MOA of Tizanidine
Centrally acting alpha 2 agonist
37
Common side effects of tricyclic antidepressants?
Dry mouth, blurry vision, constipation, dizziness, tremors and urinary disturbances.
38
Examination maneuvers for Piriformis Syndrome
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
39
Common pediatric PRIMARY spine malignancies
Osteoid osteoma
Osteoblastoma
Aneurysmal bone cysts
40
Most frequent malignant lesion affecting the pediatric spine?
Ewing’s sarcoma
41
Pediatric spine tumor whose pain is responsive to aspirin?
Osteoid osteoma
42
Describe Scheurmann disease.
Thoracic kyphosis with compensatory lumbar lordosis in pediatric population secondary to repetitive loading of the immature spine
43
HIV-associated spinal cord diseases
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
44
MRI findings in transverse myelitis
Spinal cord swelling
Increased signal in T2 weighted images
Thoracic spine is most commonly affected
45
Most efficient wheelchair propulsion pattern?
Semicircular pattern
46
Most common site of fracture in patients with SCI
Supracondylar region of the femur
47
Medication given to reduce the incidence or postoperative recurrence of heterotopic ossification in patients with SCI
Etidronate
48
Most common location of heterotopic ossification in patients with SCI
Hip joint
49
Manifestation of cervical spondylosis
Ligamentous hypertrophy
Hyperostosis
Disk degeneration
Zygapophyseal joint arthropathy
50
AAP Commonly used for post TBI agitation
Quetiapine
51
Treatment for post TBI agitation
1. Atypical antipsychotics- quetiapine
2. Beta blockers- propanolol
3. Benzodiazepines
52
Management of upper motor neuron bowel
Digital rectal stimulation
Rectal stimulant medications, enemas
electrical stimulation
GOAL: cause relaxation of the IAS and if strong enough can reflexively relax EAS
53
Causes of upper motor neuron bowel
Lesion above the conus medullaris at the level of T12
54
What is the cause of lower motor neuron bowel?
Lesions below the conus medullaris, cauda equina, pelvic surgery,vaginal delivery or chronic straining
55
Most important side effect of dantrolene sodium
Hepatotoxicity
Liver function test should be monitored monthly initially then several times per year
56
Most common diplegic gait pattern in older children with cerebral palsy
Crouch gait
57
Most common diplegic gait pattern in young children with cerebral palsy and is the precursor to crouch gait
Jump gait
58
Gait pattern associated with overactive rectus femoris in patients with hemiplegic cerebral palsy
Stiff knee gait
59
Most common site of Heterotopic ossification in burned individuals?
Posterior elbow in the affected side
60
Pattern of neuropathy in patients with deeper and larger TBSA?
Axonal rather than demyelinating
61
Ideally position of the hand for splinting?
Intrinsic plus position
MCP flexion with IP extension
62
Positioning of the hand resulting from weakness of the intrinsic and strong extrinsic muscles?
Intrinsic minus hand
63
2 main diseases of children for which lung transplant is performed
Cystic fibrosis
| Primary pulmonary hypertension
64
Main reason for lung transplant in adults
COPD
65
Equivalent of 1 MET
3.5 ml/kg per minute
66
Most common feature of dermatomyositis and polymyositis?
Painless muscle weakness
Symmetrical and proximal
Distribution: neck, shoulder, pelvis and thigh
Difficulty lifting arm and climbing uphill
67
Most characteristic skin manifestation of dermatomyositis?
Gottron papules and heliotrope rash
68
Characteristic finding of inclusion body myositis?
Rimmed vacuoles
69
2 types of femoroacetabular impingement
CAM- femoral head-neck junction variety
| Pincer- acetabular over coverage of the femoral neck
70
Structures of the posterolateral corner:
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
71
Most common mechanism of injury of the posterolateral corner?
Strong hyperextension and varus force
72
2 most common types of tarsal coalition?
1. Calcaneonavicular
| 2. Talocalcaneal
73
triangular fibrocartilage complex consists of?
1. triangular fibrocartilage
2. meniscus homologue
3. extensor carpi ulnaris tendon sheath
4. volar and dorsal radiocarpal ligaments.
74
Differential Diagnosis for MS
1. Neuromyelitis optica
2. Acute transverse myelitis
3. Acute Disseminated encephalomyelitis
75
Autoimmune condition that targets the aquaporin 4 channels?
Neuromyelitis optica
76
Criteria for diagnosis for neuromyelitis optica
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
77
MS subtypes
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
78
Diagnostic Criteria for Multiple sclerosis
McDonald’s Criteria MRI based on
Dissemination in Space
Dissemination in Time
79
Uhthoff phenomenon
Transient blindness or blurring of vision in patients with MS after exposure to heat e.g warm baths
80
What is the Karvonen formula?
target training HR = resting HR + (0.6 [maximum HR -resting HR])
Computes for the maximum heart rate
81
VO2Max
O2 consumed in liters/min
Or
ml/kg/min
82
Best evaluation/test for evaluation of the capacity to exercise in cardiac and pulmonary conditions
Cardiopulmonary exercise test CPET
83
Karvonen Equation used to estimate target heart rate
Target HR= (max HR-resting HR) x % intensity + resting HR
84
Stroke volume
Volume of blood ejected with each left ventricular contraction
Achieve max at 40% VO2
85
Cardiac output
HR x SV
Primary determinant of VO2max
86
Phases of throwing where majority of injuries occur?
1. Late cocking phase- phase where extreme ER occurs
| 2. Deceleration phase
87
Independent predictors of vascular disease?
1. Cigarette smoking
| 2. Diabetes
88
Marker of peripheral artery disease/ implicated in PAD?
Elevated homocysteine levels
89
Primary mechanism of injury in stingers?
Brachial Plexus tensile overload
90
Cause of brachial plexus tensile i juries in younger athletes?
Forceful contralateral neck lateral bending with ipsilateral shoulder and arm depression
Weak neck and shoulder girdle
91
Only muscle in the hamstrings group innervated by the common peroneal nerve?
Short head of the biceps femoris
92
Cause of stingers in older athletes?
Cervical root compression due to forceful cervical extension and rotation resulting un narrowing of the neuroforamen
93
Mainstay of pharmacologic therapy in Exercise-induced bronchospasm?
Short-acting beta agonist 15 mins before exercise
94
3 most common causes of anemia in the athlete
Iron- deficiency anemia- menstruating athlete
Physiologic anemia- MC in endurance athlete
Foot strike hemolysis-RBC destruction in the feet
95
Female athlete triad
Anorexia
Amenorrhea
Skeletal demineralization
96
Calcium and Vit. D recommended dose per day?
Calcium- 1200 to 1500 mg
Vit. D- 400 to 800 IUs per day
97
Most common cause of acute injury to the pressure epiphysis
Fall
98
Most common elbow injuries in wheelchair athlete?
Lateral epicondylitis
Osteoarthritis
Olecranon bursitis
Ulnar neuritis
99
Final product if plasmin-mediated degradstion of cross-linked fibrin and is highly sensitive for patients with acute venous thrombosis.
D-Dimer
100
What is the mainstay of treatment for chronic venous insufficiency?
Compression therapy wi5 pressure of 30-40 mmHg at the ankles
101
Most common sites of pressure ulcer formation
1. Ischium
2. Sacrum
3. Trochanter
4. Heel
102
Normal Cerebral blood flow
50 ml/100 gm of brain tissuer per minute
103
Normal motor conduction velocities in full-term infants
NCV in children and adults are equalized by 5 years of age
Full term infants-NCV not less than 20m/s
104
Disease with Presence of Cramp potentials with taut muscles and electrical silence?
McArdle Disease
105
Median nerve and peroneal nerve anatomic variant?
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.
2. 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
Median Nerve Neuropathies
1. CTS
2. Pronator Syndrome
3. Anterior Interosseus Syndrome- FPL, PQ and FDP affected
4. Median nerve Entrapment at the forearm
107
Radial Neuropathies
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
Muscles spared in PIN compression?
Brachioradialis
| ECRL
109
Ulnar nerve compression at the elbow: causes
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
Electrodiagnostic Hallmark of Lambert-Eaton Syndrome?
Profound potentiation or increase in CMAP of more than 200% after a maximal contraction
111
Presynaptic Neuromuscular Junction disorders?
LEMS and Botulism
112
High-yield muscle to test in cranial nerves for patients with suspected ALS?
Trapezius
113
Highly sensitive and specific test for Dermatomyositis and findings of the test
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
Malignancies associated with dermatomyositis?
Ovarian cancer in women
| Small cell lung cancer in men
115
What disease and where can you find Gottron papules?
Dermatomyositis
Extensor surfaces of joints
116
Triad of normal pressure hydrocephalus?
Dementia
Gait ataxia
Urinary incontinence
117
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
Charcot Marie Tooth Disease
118
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
Charcot Marie Tooth Disease or Hereditary Sensory Motor Neuropathy
119
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?
Os trigonum
120
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
Ankle foot orthosis
121
Type of inflammatory myositis not responsive to steroids?
Inclusion body myositis
122
Most common inflammatory myopathyin individuals over 50 years old?
Inclusion body myositis
123
Features of inclusion body myositis?
Asymmetrical weakness, including finger flexors and knee extensors
‘Intrinsic positive hand’ with difficulty making a fist
124
Muscle biopsy findings in inclusion body myositis?
Rimmed vacuoles, cytoplasmic inclusions and mono nuclear cell invasion in endomysial fibers
125
Anti retroviral which may cause myopathy?
Zidovudine
126
Myopathy relieved by intake of 40mg of fructose or sucrose and improve exercise tolerance?
McArdle disease or myophosphorylase deficiency
127
Myopathy with second wind phenomenon..
McArdle disease
‘Second wind’ phenomenon-improve exercise tolerance, muscle stiffnes and cramps after rest
128
Lab tests pertinent for McArdle Disease?
Increased uric acid, creatine kinase and elevated ammonia on forearm exercise testing
129
Acid Maltase deficiency or Pompe disease pertinent muscle to study in EMG.
Thoracic paraspinal muscles-only site of membrane instability
130
Hallmark of Emery-Dreifuss muscular Dystrophy?
Elbow flexion contractures
131
Spinal cord level that are not functional ambulators?
T12 and above
132
Body weight transmissionin percentage in
A.unilateral cane opposite the affected side
B. Forearm or arm cane
C. Bilateral crutches
A. Unilateral cane opposite the affected side- 20-25%
B. Forearm or arm cane- 40-50%
C. Bilateral crutches- 80%
133
Gold standard for degenerative cervical spine conditions?
CT Myelography
134
Type of leprosy which commonly affects the ulnar nerve
Lepromatous type*
135
Predictors of ambulation in a patient with cerebral palsy?
Sitting independently by 2 years old and having less than 3 primitive reflexes present by 18 to 24 months
136
At what age is self catheterization possible?
Mental age of atleast 5 years old
137
Treatment of choice in primary dystonias?
Deep Brain stimulation
138
Treatment of choice of secondary dystonias in cerebral palsy?
Intrathecal baclofen
139
2 muscle groups responsible for hip dislocations in patients with cerebral palsy?
Iliopsoas
| Adductors
140
Orthopedic deformities resulting from lackmof axial weight-bearing in patients with cerebral palsy?
Femoral anteversion
Acetabular dysplasia
Coxa valga
141
At what age is X-ray of the hip in patients with bilateral CP indicated?
At age 30 months or younger
142
Parameters and values to monitor for hip dislocation in patients with CP?
Acetabular index- >30%
Reimer migration index->33%
Both will need further ortho treatment
143
Most common spinal segment affected in colorectal cancer metastases?
Lumbar spine
144
Most common cancers that metastasizes to the thoracic spine?
Lung, breast prostate and renal cell carcinoma
145
Most common source and organism in vertebral osteomyelitis?
E.coli
UTI
Commonly affects the lumbar spine
146
Pathognomonic for vertebral osteomyelitis in plain xray?
Periosteal reaction
147
Most common organism responsible for most spinal infections?
Staphylococcus Aureus
148
Gold standard for diagnosing sacroiliac joint pain?
Fluoroscopically guided injection of local anesthetic into the sacroiliac joint
149
Low back pain generally peaks at what age of gestation and when is it relieved?
Pain peaks at 36 AOG and is relieved at 3 months postpartum
150
Common direction of the scoliotic curve in idiopathic scoliosis?
Right thoracic, left lumbar
151
Time period where development of DVT in patients post THR?
3months post op
-Brotzman
152
Associated nerve injury in anterior and posterior hip dislocation
Posterior Hip dislocation- sciatic nerve injury (weakness of ankle dorsi and plantar flexion)
Anterior hip dislocation- femoral nerve injury (weakness of quadriceps)
153
Pathognomonic for meniscal (bucket-handle) tear?
Locking of the knee in a slightly flexed position with difficulty working into full extension.
154
Muscles that support the medial longitudinal arch of the foot?
Tibialis anterior and tibialis posterior
155
Condition associated with tibialis posterior rupture?
Rheumatoid arthritis
156
Often seen in ballet dancers, dnacers and gymnasts who perform repetitive and forceful toe flexion?
Flexor hallucis longus overload
157
Test to check for tibialis posterior function
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
4 Plantar foot muscles that originate in the volar calcaneus and may contribute to plantar fasciitis.
Adductor hallucis
Quadratus plantae
Flexor digitorum brevis
Abductor digiti minimi quinti
159
Normal ankle brachial index to check for perfusion
ABI 0.8-1.3
>1.3 poor perfusion
160
Normal transcutaneous oxygen pressure
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
Degenerative changes of what muscle tendons are implicated in lateral epicondylosis?
ECRB
| EDC
162
Degenerative changes of what muscle tendons are implicated in medial epicondylosis?
Pronator Teres
| FCR
163
Cause of distal biceps tendonitis and rupture?
Eccentric overload of the biceps during deceleration and follow-through phase of throwing
164
Biceps tendon rupture would result in what percentage of flexion and supination loss of strength?
8% flexion strength
| 21% of supination strength
165
Condition associated with lateral epicondylosis?
Posterior Interosseus Syndrome
Pain 3-4cm distal to the lateral epicondyle
166
Gold standard for diagnosis of SLAP lesions?
Arthroscopy
167
Condition associated with medial epicondylosis?
Acute rupture of the UCL
168
Common cause of SLAP lesions?
Injury during the late cocking phase of overhead throwing and traction during the deceleration phase
169
Last elbow physis to close in children?
Medial epicondylar apophysis
Closes at 14 yo in females and 17 yrs old in males
170
Test for scapholunate instability or Dorsal Intercalated Segmental instability(DISI)?
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
Normal scapholunate angle
30-60 degrees
172
Pathology behind Kienbock’s Disease?
Progressive collapse of the lunate resulting from compressive forces to the wrist causing microfractures in the lunate with vascular compromise and AVN
173
What is the primary stabilizer of the distal radioulnar joint?
Triangular Fibrocartilage Complex injuries
174
How many percent of axial loading is transmitted to the TFCC and distal radioulnar joint?
18% to the TFCC
| 82% to the RUJ
175
What is a Stener lesion?
Interposition of the adductor policis at the base of the first proximal phalanx with the ruptured ends of the UCL
176
Pathology in Gamekeeper’s thumb?
Radially directed forces of the first proximal phalanx resulting in UCL injury
177
Type of acromion associated with greater rotator cuff injury?
Type 3-hooked acromion resulting in greater outlet impingement associated with a greater curve
178
Presenting symptom of delayed radiation myelopathy?
Brown-Sequard Syndrome
179
```
State side effects of these chemotherapeutics agents.
Bleomycin
Doxorubicin
Trastuzumab
Vinca alkaloids (Vincristine)
Taxanes (Docetaxel)
Thalidomide
Platins (Cisplatin)
```
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
First line therapy in the treatment of primary breast, ovarian and lung cancers
Taxanes (Docetaxel)
181
Standard of care for lymphedema management?
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
Finger/hand pressure in manual lymphatic drainage?
30-45 mmHg
183
What is Remedial lymphedema?
Repetitive movements designed to encourage rhythmic serial muscle contractions in lymphedematous territories
184
Complication of vigorous shoulder ROM/stretching immediately post MRM?
Seroma formation
185
Complication of head and neck cancer irradiation?
Osteoradionecrosis
186
Most often affected location of osteoradionecrosis?
Mandible
187
Time course of bone marrow recovery?
Every 3-4 weeks or 21 to 28 days
188
Cut off platelet count below which physical therapy is contraindicated?
25,000 and lower
189
Intensity target for cardiac primary prevention?
80 to 85% of predicted max HR/peak HR from exercise tolerance test.
190
Intensity target for cardiac secondary prevention?
60% or more of HR max
191
Hallmark of severe COPD
Carbon dioxide retention and active exhalation
192
Goal of Pulmonary rehabilitation program
1. Improving Disease management and exercise capacity and improve peripheral efficiency and decrease dyspnea
193
Pathogens to consider in the first month post transplant?
Staph Aureus
Vancomycin-resistant Enterococcus
Clostridium Difficile colitis
194
Pathogens to consider on the first 6 months post transplant?
```
M. TB
Nocardia
Leishmania
EBV
HSV
HHV6
hep B and hep C
BK virus
Aspergillus and Listeria monocytogenes
```
195
Standard test for exercise tolerance in patients with pulmonary disease?
6 minute walk test
196
When is Milwaukee brace the orthosis of choice in idiopathic scoliosis?
Scoliotic curves of T9 or higher
197
Recommended elbow angle in wheelchair prescription?
100-120 degrees
198
Upper limb injury common in manual wheelchair users secondary to a seat height that is too low.
Shoulder impingement
199
Wheelchair propulsion technique commonly seen in patients wih paraplegia?
Single-looping over
200
How to compute for rate pressure product?
(HR x SBP)/100
201
Most common culprit in shunt infections?
Staphylococcus epidermidis
202
What is Arnold-Chiari Malformation type II?
Displacement of cerebellar tissue into the spinal canal accompanied by caudal dislocation of the lower brainstem and fourth ventricle
203
Leading cause of death for infants with Myelomeningocele?
Symptomatic Chiari II malformation
204
Constellation of stridor, central apnea and aspiration associated with Chiari II malformation?
Central ventilatory dysfunction
205
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?
Sprengel’s deformity
206
Condition where there is congenital fusion of the cervical vertebrae, with restriction in contact sports indicated?
Klippel-Feil Syndrome
207
Age when X-ray is recommended for children with Downs Syndrome? What us the acceptable atlantidens interval?
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
Hallmark of Acute Gouty attack?
Neutrophilic synovitis
209
Median nerve innervated muscles (9)
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
Presynaptic neuromuscular junction disorders
LEMS and Botulism
211
Postsynaptic neuromuscular junction disorder
Myasthenia Gravis
212
Most sensitive test for Myasthenia Gravis?
Single fiber EMG
213
Cancer associated with Lambert Eaton Myasthenic Syndrome?
Oat cell carcinoma of the lung
214
Muscles spared in diabetic amyotrophy?
Glutes and hamstrings
215
Sensory loss in diabetic amyotrophy?
Femoral and saphenous distribution
Iliopsoas, adductors and quads
216
Sensory responses with freater affectation in GBS?
Median, and ulnar sensory responses more than the sural.
217
Time duration which differentiates CIDP from GBS?
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
Differences in CIDP vs. GBS
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
Areas of sparing in leprosy?
Palms of hands and soles of feet
220
Type of leprosy resulting from immune cell mediated response to kill the bacilli?
Tuberculoid type
221
One the drugs use to treat leprosy and its side effect?
Dapsone- causes progressive motor neuropathy affecting the hip girdle and muscles of both hands and feet symmetrically
222
Neuropathy associated with vasculitic and connective tissue diseases?
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Mononeuritis multiplex (asymmetrical mixed motor and sensory pattern)
Lower extremities more affected-peroneal nerve affected 63% of the time
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223
Pressure gradient driving cerebral blood flow
| State the formula and normal value.
Cerebral perfusion pressure (CPP)
| MAP- ICP >60mmHg
224
Normal ICP
20-25mmHg
225
Brown Sequard Syndrome
Greater ipsilateral weakness and position sense loss, contralateral pain and temperature sensation loss
226
Phases of spinal shock
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Phase I (0-24 hrs)
Motor neuron hyperpolarization manifesting as hyporeflexia
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Phase II (day 1 to day 3)
Denervation supersensitivity and receptor upregulation manifesting with reflex return
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Phase III ( 1-4 wks)
Interneuron synapse growth, early hyper reflexia
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Phase IV (1-12months)
Long axon synapse growth, later hyper reflexia
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227
Level of distribution of the artery of Adamkiewicz?
T12-L2 on the left side supplying the caudal 2/3 of the spinal cord
228
Anterior cord syndrome?
Paraplegia, loss of pain and temperature sensation, relative sparing of touch and position sensation
Often caused by flexion teardrop fractures
229
Clay shoveler’s fracture
Avulsion fracture of the spinous process of C6, C7 or T1. Typically not associated with neurologic injury
230
Central cord syndrome
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
Predictors of ambulation in patients with SCI after 1 year (3)
Strong quadriceps femoris
Strong gastrocsoleus
Light touch sensation at L3 and S1 dermatomes
232
Pressure from what artery compresses the trigeminal nerve causing trigeminal neuralgia?
Superior cerebellar artery
233
Myokymia is classically seen in what disorders?
1. Radiation injury
2. GBS
3. Multiple sclerosis
4. Brainstem tumors
5. occasionally in entrapment neuropathies but not in CTS
234
Pressure from what artery compresses the trigeminal nerve causing trigeminal neuralgia?
Superior cerebellar artery
235
Myokymia is classically seen in what disorders?
1. Radiation injury
2. GBS
3. Multiple sclerosis
4. Brainstem tumors
5. occasionally in entrapment neuropathies but not in CTS
236
Contents of the Carpal Tunnel
1 median nerve
4 tendons of the flexor digitorum superficialis
4 tendons of the flexor digitorum profundus
1 tendon of the flexor pollicis longus
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hallmark of acute gouty attack?
Neutrophilic synovitis
238
Common and early X-ray finding in patients with Rheumatoid Arthritis?
Juxta-articular Osteopenia
239
hallmark of acute gouty attack?
Neutrophilic synovitis
240
Common and early X-ray finding in patients with Rheumatoid Arthritis?
Juxta-articular Osteopenia
241
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?
Parvo virus B19 infection / Erythema Infectiosum / Fifth disease
242
Describe the Noble test
| what structure is tested?
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.
