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MMD Exam 1 Lab Flashcards

1
Q

define dermatome

A

an area of skin innervated by sensory fibers from a single spinal nerve

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2
Q

define myotome

A

a group of muscles innervated form a single spinal segment

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3
Q

an area of skin innervated by sensory fibers form a specific peripheral nerve

A

peripheral nerve sensory field

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4
Q

muscles innervated by a specific peripheral nerve

A

peripheral nerve motor innervation

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5
Q

name the DTR, motor innervation, and sensory innervation: C5

A

DTR: biceps
motor: deltoid
sensory: deltoid tuberosity

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6
Q

name the DTR, motor innervation, and sensory innervation: C6

A

DTR: brachioradialis
motor: biceps, wrist ext
sensory: anatomical snuffbox

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7
Q

name the motor innervation and sensory innervation: C3-4

A

motor: upper traps
sensory: upper traps

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8
Q

name the DTR, motor innervation, and sensory innervation: C7

A

DTR: triceps
motor: triceps/wrist flex
sensory: posterior long finger

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9
Q

name the motor innervation and sensory innervation: C8

A

motor: thumb IP extension
sensory: medial border of small finger

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10
Q

name the motor innervation and sensory innervation: T1

A

motor: finger abduction
sensory: medial forearm

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11
Q

name the sensory innervation: T2

A

medial arm

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12
Q

UMN screen consists of:

A

babinski, hoffman’s, clonus, gait, and balance

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13
Q

sensation is screen with light touch; a more thorough exam can include what?

A

2 point discrimination, sharp-dull, and/or monofilament testing

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14
Q

name the condition(s) to the labs: HbA1c

A

diabetes
4- 5.6 = normal, 5.7 – 6.4 = high risk
>6.5 = DM

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15
Q

name the indications/conditions for the labs: rheumatoid factor (RF)

A

multiple joint pain - identifies autoimmune related arthritis
RA, SLE (lupus), some cancers

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16
Q

name the indications/conditions for the labs: creatine phosphokinase (CK/CPK)

A

muscle pain, cardiac problems
MI, myopathy, muscle breakdown, rhabdomyolysis

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17
Q

name the indications/conditions for the labs: erythrocyte sedimentation rate (ESR, “seds”)

A

inflammatory arthritis - nonspecific marker of inflammation
RA, SLE (lupus), severe infection/cancer

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18
Q

name the indications/conditions for the labs: potassium (K+)

A

muscle weakness, kidney disease - can trigger arrhythmia
kidney disease

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19
Q

name the indications/conditions for the labs: cyclic citrullinated protein (CCP)

A

multiple joint pain, inflammation - nonspecific marker of inflammation
RA, SLE (lupus)

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20
Q

name the indications/conditions for the labs: antinuclear antibody (ANA)

A

multiple joint pain, swelling, inflammation - identifies autoimmune related arthritis
RA, SLE (lupus)

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21
Q

which imaging modality?
good appreciation of basic bony anatomy

A

radiography
low radiation

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22
Q

which imaging modality?
excellent demonstration of cortical bone anatomy; high sensitivity to variances in the density of tissues; multiplanar views of anatomy (3D)

A

computed tomography (CT)
*high radiation

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23
Q

which imaging modality?
excellent demonstration of soft tissues and bone marrow; multiplanar views of anatomy (3D); mulitple sequences allowing various tissue characteristics

A

MRI
no radiation

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24
Q

which imaging modality?
good sensitivity to increased metabolic activity/bone turnover

A

bone scan/scintigraphy
moderate radiation

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25
which imaging modality? good demonstration of soft tissues; allows real-time, dynamic imaging; convenient and cost-effective
ultrasound no radiation
26
which imaging modality? simple, quick, accurate, modest cost; suited to serial testing, if same device
dual energy x-ray (DEXA) low radiation
27
what is front line for conventional musculoskeletal imaging?
radiography (x-ray)
28
x-rays work by _____, a process of reduction in number of x-ray photons in the beam due to tissue densities
attenation
29
radiopaque or radiolucent? not easily penetrated by x rays increased radiodensity (more dense) osteoblastic lesions/metal appears white
radiopaque
30
radiopaque or radiolucent? easily penetrated by x rays decreased radiodensity (less dense) osteoclastic lesions/air appears black
radiolucent
31
order materials on x ray from least to most radiodensity
air, fat, fluid, bone, metal
32
"one view is no view" meaning
at least 2 images are required to gain 3D perspective of x-ray combination of the 3 common projections: lateral, AP/PA, oblique
33
describe the ABCS of image interpretation
alignment bone density cartilage spaces (joints, subchondral bone, growth plates) soft tissues
34
what is the gold standard for soft tissue imagining (ligament, cartilage, intraosseous abnormalities, bone tumors)?
MRI
35
difference between T1 and T2 weighted MRIs
T1 lights up for fat - good for bones T2 lights up for fluid - good for inflammation
36
what are the main benefits and risks of CT?
improved ability to identify subtle pathology differentiates bone/soft tissue well high doses of radiation
37
bone scan is ____ for bone changes due to fracture, tumor, infection (OA, muscle trauma, metastatic CA)
sensitive
38
hallmark signs of OA
joint space narrowing bone spurs sclerotic borders subchondral bone cysts
39
progressive, systemic inflammatory CT disease affecting synovial joints soft tissue changes and joint deformity due to tissue destruction women 3x more likely than men peak onset 35-40 y/o
RA
40
you identify bilateral erosion on radiograph and suspect RA or OA?
RA
41
salter harris (epiphyseal) fracture classes 1-5
– GR I: Fx through the physis (growth plate) only – GR II: Fx through the physis and Metaphysis – GR III: Fx through the physis and Epiphysis – GR IV: Fx through the physis, Metaphysis & Epiphysis – GR V: crush/compression injury to the physis
42
you review the information on the body chart and the documentation on the referral form and use the chart shown to help you develop what 4 hypotheses?
a) Formulate an initial HYPOTHESIS b) Competing MSK Hypothesis c) Competing MSK referral d) Competing Non-MSK
43
after you've developed your initial hypotheses, you determine the ____ of the condition and plan your ____ ____
SINSS (severity, irritability, nature, stage, stability), objective exam
44
a dynamic process in which the physical therapist makes a clinical judgement based on data gathered during the examination
evaluation
45
PT diagnosis includes information related to the resulting:
impairment (tone), activity limitations (inability to ambulate), and participation restrictions (inability to work) of the pathology or disease identified
46
once you review data collected from your objective exam, your next two steps are to:
modify your working hypothesis if needed develop the problem list
47
the two main components of prognosis
level of improvement amount of time
48
80% of the information needed to determine/make a diagnosis is contained in the ____ exam
subjective
49
the main problem in the patient's own words: body region of symptoms/concerns and activity limitation
chief complaint
50
describe the differences between constant and intermittent pain
constant, varying with activity = inflammatory and mechanical constant, nonvarying = acute disease state or serious pathology intermittent = mechanical
51
at what point of the subjective exam do you ask the patient "what happened" regarding their pain/illness?
history of present illness (date of onset, mode of onset, immediate or delayed sxs, have sxs gotten worse/better/same, any treatment to date, effects of past tx)
52
items from history that may suggest serious pathology indicating need for MD referral
red flags
53
items from history that indicate a more extensive psychosocial exam may be required; factors that increase the risk of developing or perpetuating long-term disability and work loss
yellow flags
54
when planning the objective exam, you must modify the ___ _____ and establish the ____
initial hypothesis, SINSS
55
refers to the clinician’s assessment of the intensity of the patient’s symptoms and the patient’s perception of their symptoms as they relate to a functional activity or limitation
severity
56
refers to the relationship among the amount of activity required to provoke a patient symptoms, the magnitude of those symptoms and the time it takes for the symptoms to subside to baseline
irritability 3 components: - time or activity to onset - magnitude of symptoms provoked - time for symptoms to subside
57
represents the clinician’s assessment of the hypotheses of structures (if appropriate), syndrome/classification or pathoanatomic structures causing symptoms... AND ...the character of the presenting person or the problem (psychological, personality, ethnic and socioeconomic factors or the patient’s pain tolerance)
nature
58
general rehab stage classifications
acute - 1 week (7-10 days) subacute - 2-7 weeks chronic - 7+ weeks
59
refers to the progression of the patient's pain (or symptoms) over time; is it getting better, staying the same, or getting worse
stability
60
will SINSS limit the examination?
yes, determines whether to be gentle or vigorous severe & irritable: limit exam, don’t make pnt worse non-severe & irritable: no limit to exam, reproduce symptoms
61
severity ratings
minimal: symptoms do not limit or hinder activity • minimal or no pain with movement • pain rated at 0-3/10 moderate: pain reduces activity levels to 40-70% of normal • reports pain or guarding with activity or certain movements • pain rated at 4-7/10 high: pain symptoms severely reduce or stop activities; ADLs are avoided or severely limited • pain rated at 8-10/10
62
irritability ratings
minimal • tolerates repetitive or sustained activities • continues activity after the onset of pain • pain eases in a short time or position change moderate: • tolerates brief activities or positions < 10min • continues light activities after the onset of pain • pain eases in similar time as onset (may be longer) high • activity not tolerated – are avoided • unable to continue activity after pain onset • pain takes a long time to ease
63
stage ratings
General Medical Classification - Acute pain: Recent onset (0-6 weeks) - Sub-acute pain: Pain may be due to later stages of tissue healing or early stages of developing chronic symptoms (6-12 weeks). - Chronic pain: Longer duration – usually past expected recovery time (> 3 months) General Rehab Classification - Acute conditions: 1 week (7-10 days) - Sub-acute conditions: 2-7 weeks - Chronic conditions: 7+ weeks
64
stability ratings
getting better staying the same (ISQ) getting worse
65
if AROM is normal, apply ____ to determine end-feel and assist in clearing the joint
overpressure
66
during the objective exam, you are looking for two sets of data:
what the patient feels (subjective) responses that can be measured or found by the clinician (objective)
67
typical sequence of testing position
standing - sitting - supine - prone
68
functional quick test
movement, activity, or position that reproduces problem
69
selective tissue tension tests allow you to differentiate between:
contractile vs. non-contractile origin AROM, PROM, resisted isometric tests
70
____ tests both contractile and inert structures; ____ tests just inert structures
AROM, PROM
71
PROM provides the following
range of movement: stability and mobility capsular vs non-capsular pattern of restriction end feels
72
____ _____ tests check the status of contractile tissue, neuro deficit, or pain inhibition
isometric strength
73
muscle test findings: strong and painless = strong and painful = weak and painless = weak and painful =
strong and painless = normal strong and painful = minor disorder weak and painless = neuro deficit, disuse weakness, complete rupture weak and painful = partial tear
74
when passive movement > active without pain and the resisted test is weak and painless
non-contractile neuro findings neuro weakness limits AROM
75
joint mobility findings: normal mobility, painless = normal mobility, painful = hypomobile, painless = hypomobile, painful = hypermobile, painless = hypermobile, painful =
normal mobility, painless = normal normal mobility, painful = minor sprain hypomobile, painless = joint contracture, adhesion hypomobile, painful = acute sprain, guarding hypermobile, painless = complete rupture hypermobile, painful = partial tear
76
PT diagnosis is a description of underlying condition with qualifying statements regarding patient’s problem list must include:
suspected patho-anatomical/pathology impairments functional limitations participation restrictions

MMD (4 decks)

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