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BPK 481 > MT 1 > Flashcards

MT 1 Flashcards

1
Q

WHat is patellofemoral pain syndrome

A

messed up tracking of the patella into the femoral trochlear groove, usually due to the groove not being deep enough etc

cant treat, just treat the pain

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2
Q

WHat are the risk factors for patellofemoral pain syndrome

A

risk factors - decreased quad/hamstring strength, navicular drop, dynamic valgus

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3
Q

What is the clinical presentation of patellofemoral pain syndrome

A

pain w sitting, stairs, squatting at medial/lateral borders of patella

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4
Q

What is patellar tendinopathy

A

microtears along tendon, usually caused during eccentric overloading during deceleration (jumping/downhill running)

treated by overloading the tendon for acute inflamation triggering, or by modifying activity

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5
Q

What are the risk factors for patellar tendinopathy

A

high body weight, pes planus, tightness in quads/hamstrings

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6
Q

What is the clinical presentation of patellar tendinopathy

A

pain w squats/jumps at tibial tuberosity

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7
Q

What is a meniscus tear? what are the types?

A

degenerative, longitudinal, flap tear, horizontal, radial

occurs when axial load is transmitted through a flexed/extended knee that is also rotating

can remove meniscus as it wont heal

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8
Q

WHat are the risk factors for meniscus tears

A

sports or jobs that need kneeling, squatting, or climbing stairs

no arterial supply, so will eventually degenerate

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9
Q

What is the clinical presentation of a meniscus tear?

A

Pain with knee bending, alongside swelling, popping, clicking, or locking

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10
Q

what is an Anterior cruciate ligament (ACL) tear

A

partial tear or rupture of ACL caused by deceleration, change in direction, or rotary force while the foot is fixed

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11
Q

What are risk factors for ACL tear

A

decreased hip strength
*wide Q angle

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12
Q

WHat is the clinical presentation for ACL Tear

A

pain with weightbearing and swelling due to tearing of arterial supply - lots of redness as well

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13
Q

What is osgood-schlaters disease

A

traction apophysitis (growth plate) of tibial tubercle for teens

repeated tension and torquw on tibial tubercle, causing bone to grow and cause pain

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14
Q

What is the clinical presentation of osgood-schlatter’s disease

A

pain with stairs/squats

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15
Q

What is the Trendelenburg sign?

A

indicates weak gluteus medius during unilateral weight-bearing

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16
Q

What is dynamic valgus

A

internal rotation and adduction of femur , causes contralateral pelvic drop

is also associated with increased risk for anterior knee pain

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17
Q

What is pes planus

A

collapse of the medial longitudinal arch, associated with a navicular drop

10mm navicular drop associated with an inceased risk of patellofemoral pain syndrome

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18
Q

what is antalgic gait

A

limping, with the injured side having a decreased stance phase to eliminate the weight bearing of injured side

most proximal joint will compensate for injured joint

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19
Q

What is the lachman test

A

assesses stability of ACL, holds pt knee between full extension and 30 degrees of flexion. If there is a mushy or soft end feel when tibia is moved forward, or if the infrapatellar tendon slope disappears, then the test is positive

the test has a high sensitivity and specificity for ACL injury detection

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20
Q

What is the Thessaly test

A

pt flexes the knee to 20 degrees while standing on one foot and rotates the femur on tibia medially and laterally 3 times

positive if pain medially or laterally on the joint line

high sensitivity and specificity

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21
Q

What is the q angle and why is it important?

A

angle between tibial tuberosity and asis, is the angle of the hip, a greater q angle gives higher ACL risk due to increased torque during impacts

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22
Q

WHat is specificity?

A

SPIN - specificity when positive rules in

if positive, for sure has the injury

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23
Q

What is sensitivity

A

SNOUT - sensitivity, when negative rules out

if negative, for sure no injury

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24
Q

What is the modified thomas test

A

test knee is at 90 degrees off a table, while opposite knee is flexed to chest. If test knee moves, contracture is present (could be a lot of things, very low specificity)

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25
Q

What is manual muscle testing

A

subjective approach where pt contracts muscle against manual resistance

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26
Q

what are the MMT scores

A

0-5, 3+ to 5 very subjective tho

0=no movement and no muscle action
1=muscle action but no movement
2=partial rom
3=full rom
3+=min break force
4-=almost mod break force
4= mod break force
4+almost max break force
5=max break force

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27
Q

What is the role of a family doc

A

general care for all people over all domains

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28
Q

What are the associations and regulatory bodies for doctors

A

association = canadian medical association/doctors of BC

regulatory= BC college of family physicians/college of physcians and surgeons of BC

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29
Q

WHat is ibuprofen

A

NSAID (nonsteroidal anti inflammatory) inhibiting prostaglandin synthesis

used for headaches, fever, pain

not to be taken by those with asthma or allergies/hypersensitivity to ibuprofen

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30
Q

What are some adverse effects of ibuprofen

A

hypotension
hypernatremia
heart burn
headache
pneumonia

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31
Q

What is the numeric pain rating scale

A

11 point scale (0-10) for pain intesnity

valid and reliable measure

MCID is 1.2 points

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32
Q

What is the visual analogue scale

A

same as nprs but 0-100
*patient draws line to indicate pain

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33
Q

WHat is the patient specific functional scale

A

11 point scale (0-10) assessing ability to perform activity, with an average score being taken over 3-5 activities

MDC was 2.5 points

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34
Q

WHat is a lateral ankle sprain

A

tear of anterior talofibular ligament, calcaneal fibular ligament, and posterior talofibular ligament

due to forced varus stress in neutral plantar flexed or internally rotated position

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35
Q

What are the risk factors for lateral ankle sprain

A

indoor sports, decreased lateral ankle strength and dorsiflexion

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36
Q

WHat is the clinical presentation of lateral ankle sprain

A

pain with weightbearing, as well as swelling, warm, less strength

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37
Q

What is a syndesmosis sprain

A

distruption to ligaments between fibula and tibia above the ankle (high ankle sprain)

happens during external rotation of foot, eversion of talus, and excessive dorsiflexion

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38
Q

WHat is the clinical presentation of a high ankle sprain

A

pain with external rotation and high heel gait (avoiding dorsiflexion)

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39
Q

WHat causes a fracture of the base of the 5th metatarsal

A

traction of fibularis brevis and lateral band of plantar fascia during inversion, caused by weight bearing activities

poor blood supply so slow healing

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40
Q

What is the clinical presentation of 5th metatarsal base fracture

A

tender and swollen

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41
Q

What is the clinical presentation of achilles tendinitis

A

pain with activities that require rapid start/stop, end range dorsiflexion, weight bearing

swelling/tenderness of achillies

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42
Q

What are risk factors for achilles tendinitis

A

higher bmi and decreased plantar flexion strength

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43
Q

What is the clinical presentation of an achilles rupture

A

inability to weightbear
audible pop when rupture
fibers bunch up (mop fibers)

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44
Q

WHat is the clinical presentation of compartment syndrome

A

Pain on outside of shin

weak tib ant/dorsiflex weakness

stretch of tib ant elicits symptoms

if acute = medical emergancy

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45
Q

What are the 4 types of nurses

A

licensed practical nurse (frontline)

Nurse practitioner

RN (can perform restricted activities without order)

registered psychiatric nurse

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46
Q

What is the role of an ER triage nurse

A

to priorize care for the most severely ill patients

conflicting results if it helps with wait times

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47
Q

what are the associations and regulatory bodies for nurses

A

British Columbia College of
Nursing Professionals - RG

Canadian Nurses Association/Nurses and Nurse Practitioners of
British Columbia - Ass

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48
Q

how does an xray work

A

higher density objects absorb more radiation, show up on imaging (metal, then bone, then soft tissue, then water, then fat, then air)

xrays are first order imaging, can detect causes of bony lesions, but not tumors/infections/soft tissue lesions

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49
Q

WHat are the ottawa ankle rules

A

rules to prevent unnecessary xrays

ankle xray if : pain in malleolar zone, or if bony tenderness along distal 6cm of posterior edge of tibia/tip of malleoli, or if cant weightbear for 4 steps

foot xray if: tenderness at base of 5th metatarsal, or tenderness at navicular bone, or cant weightbear for 4 steps

can rule out ankle fracture presence, less specific in kids, more false positives in kids

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50
Q

What are axillary crutches

A

easily adjustable cheap crutches that can be used for stair climbing

they are awkward in small areas and hard to use in crowded areas

2in below axilla and 2in lateral/6in anterior to foot
*more stable than the other ones

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51
Q

what is the forearm crutch

A

allows use of hands and easier to fit into a car

less lateral support due to no axillary bar and cuffs can be hard to remove

2in lateral/6in anterior to foot, 20-30 degrees of elbow flexion, and 1-1.5in below elbow

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52
Q

compare the 3 point and 4 point gait pattern

A

4 point uses both feet, is more stable, used when there is bilateral issues, uses crutch then opposite etc

3 point is one leg, with body weight through hands

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53
Q

What is the ankle squeeze test

A

squeeze tibia and fibula together down the leg to assess for syndesmosis injury, if fracture, contusion, and compartment syndrome are ruled out

good sensitivity, okay specificity

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54
Q

WHat is the anterior drawer test

A

test for injuries to anterior talofibular ligament

pulls foot forward, by increasing inversion you can stress the ligaments

100% sensitivity, 67% specificity
* For a ATFL/CFL Injury

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55
Q

What is the lower extremity functional scale

A

20 item questionnaire to examine functional status of pt, each item ranked 0-4

MDC is 15 points in pt with traumatic injuries and 8 in pt w anterior knee pain

MCID is 9 points

56
Q

What are the 4 types of labral tears

A

radial flap - most common, usually traumatic but can also be caused by w-sitting, makes a clicking noise as the fold flaps in/out of acetabulum
-radial fibrilated - pain with stairs/jumping
-longitudinal peripheral - pain with stairs/jumping
-abnormally mobile

type of tear determines type of treatment

57
Q

WHat causes labral tears?

A

degenerative, traumatic, or idiopathic, can be caused by femoral acetabular impingement, or hypermobility

58
Q

What is the clinical presentation of a labral tear

A

pain with activities that involve adduction, walking, pivoting

sharp pain in groin or butt

clicking/instability
pain with FADDIR (flex, add, int rotate)

59
Q

WHat is femoral acetabular impingement

A

head of femur isnt fitting in the pocket, associated with labral tear

two types:
Pincer - acetabulam too deep
Cam - too big head of femur

60
Q

what is the clinical presentation of femoral acetabular impingement

A

pain with prolonged sitting/pivoting, deep anteroir groin pain, clicking/locking with stiffness

structural issue - cant be treated with physio

61
Q

What is osteoarthritis

A

wear/tear damage of articular cartilage and increased osteophyte activity

primary - degenerative over time
secondary - due to underlying cause (infection, trauma, etc)

62
Q

WHat are the risk factors for osteoarthritis

A

obesity, developmental dysplasia, and trauma, AGE

63
Q

what is the clinical presentation for osteoarthritis

A

pain with activities

64
Q

WHat is snapping hip syndrome

A

iliopsoas rubbing against bony tissue due to tightness (internal)

can be snapping of IT band or glutes over greater trochanter (external)

can be loose bodies/labral tear (intraarticular)

65
Q

What are the risk factors for snapping hip syndrome

A

weight lifting/dancing

66
Q

what is the clinical presentation for snapping hip syndrome

A

painless, with audible pop

67
Q

WHat is a groin strain

A

strain of hip adductors (adductor magnus is most common, causes bleeding/bruising)

Occurs usually with directional change, due to high torque

68
Q

WHat are risk factors for groin strains

A

sports with kicking/decrease in hip adduction strength

69
Q

What is the clinical presentation of groin strain

A

hard to weight bear, especially on one leg

stabbing pain in groin

edema

bruising

pain with resisted adduction or passive abduction

70
Q

What is MO

A

Myositis ossificans

bone formation inside soft tissue (muscle belly), developing after a traumatic injury

71
Q

What are the risk factors for MO

A

likely to occur in paralyzed people and young athletes

72
Q

what is the clinical presentation of MO

A

fast growing swollen lump

may limit movement/ROM

73
Q

What is hip dysplasia

A

Hip socket doesnt fully cover ball portion of upper thigh bone, allowing hip to become dislocated partially or fully

74
Q

what are the risk factors for hip dysplasia

A

babies born in breech position/swaddled too tightly

checked for by moving infants legs in a variety of positions that help indicate if the hip joint fits well together

75
Q

what is atenolol

A

beta blocker that lowers BP and BPM, taken to treat hypertension, cannot be taken by those with sinus bradycardia

cauases bradyarrhytmia, hypotension, dizzyness, depression

76
Q

WHat is a celebrex

A

anti-inflammatory drug (* NSAID) , used for acute pain treatment, osteoarthritis, ankylosing spondylitis, etc

inhibits prostaglandin synthesis, not to be taken by people with asthma/ allergies

can cause hypertension, nausea, and headaches

77
Q

Who is elegible for home care

A

must be a Canadian citizen, resident of bc, and 19+

must be unable to function independently due to chronic, health-related problems

each service has own assessment criteria

78
Q

What is an OT

A

occupational therapist, their role is to adjust individuals abilities to allow them to be able to perform certain tasks

79
Q

What are the regulatory bodies and associations for OTs

A

canadian association of occupational therapists

college of occupational therapists of BC

80
Q

What is the WOMAC

A

3 dimensional (pain, stiffness, and physical function) survey,

on a scale from 0-4

has a moderate reliability

81
Q

What is the FADDIR Test

A

tests for anterior/superior impingement syndrome, anterior labral tear, and iliopsoas tendinitis

positive if pain, stresses the anterolateral labrum

cannot determine presence of pathology

82
Q

What is the FABER

A

test to dectect femoral acetabular impingement, however it is not good at detecting

83
Q

WHat are the indications for a total hip arthoplasty (THA)

A

pain with motion and weight bearing/mechanically limited ROM

joint deterioration and loss of articular cartilage

84
Q

How is a THA performed

A

hip into an open packed position, dislocated, head of femur is cut, prosthesis is shoved into hollow opening, femur is shoved back into socket

85
Q

What are the contraindications for THA

A

absolute: active infection, cancer, etc
relative: localized infection, insufficient glute med muscle function, dental work/surgery in the last year (increased infection risk)

86
Q

WHat are the 2 types of fixation for THA

A

cemented - press fit, goal is to get weight bearing asap for shorter recovery. has a greater prosthetic survival rate compared to cementless/hybrid

uncemented - porous implants that allow bone ingrowth to fixate the prosthesis, takes longer for this growth to occur tho (longer time to weight bearing) but introduces less foreign objects (less infection) .worse prosthetic survival rate than hybrid and cemented

87
Q

WHat are the 2 approaches to THA

A

traditional approach - long cuts to expose joint better and faster, however causes more soft tissue trauma and longer recovery

minimally invasive approach - more cosmetic benefits due to smaller cuts, but takes longer. damages less soft tissue so faster recovery

ultimately depends on surgeon

88
Q

What are the precautions post THA

A

posterior approach - no bending forward more than 80 degrees, no crossing legs, no internal rotation

anterolateral approach - no bending forward more than 90 degrees, no external rotation, no crossing legs, no abduction (abductors are cut)

89
Q

why are there hip precautions following a THA

A

dont cross/twist/bend to mitigate risk of early THA dislocation

no real evidence to support this tho

90
Q

what is deep vein thrombosis

A

clot in deep calf/thigh/pelvic region, causing blocked veins

surgery increases the risk of this as clots float around more due to bleeding

91
Q

WHat are the risk factors for DVT

A

weak pulse in foot
sedentary lifestyle
obesity
old age
heart failure
use of oral contraceptives
pregnancy

92
Q

WHat are the signs/symptoms for DVT

A

dull ache/pain, especially with passive dorsiflexion
swelling/redness/warm skin (due to blood pooling) -> can cuase a broney edema, which is where the fluid cant mobilize and it can become hard and stiff
weak pulse in foot
only imaging can confirm
* And or pitting edema (you poke and the finger leaes an dindent – can still be mobilized)

93
Q

WHat are complications of DVT

A

pulmonary embolism (shortness of breath/ rapid and shallow breathing, with lateral chest pain)

94
Q

WHat is homan sign

A

foot is passively dorsiflexed with knee extended, with pain in calf indicating positive for DVT

not indicative of DVT tho, can be many reasons why this can be positive. should not be used to diagnose a DVT, still requires ultrasound

95
Q

WHat is tylenol 3 with codeine

A

opiod (* aka narcotic) used for pain relief

not to be used by kids under 12, people with respiratory depression, acute/severe bronchial asthma, or gastrointestinal obstructions

can cause sweating, nausea/vomiting, dizzyness

96
Q

WHat is heparin

A

blood thinner used to break down clots with embolisms and thrombosis, shouldnt be used for people with uncontrolled bleeding, pregnant people, or those with severe thrombocytopenia

inhibits formation of fibrin clots

can cause thrombocytopenia and uncontrolled internal bleeding

97
Q

What is the purpose of a walker

A

improve balance and relieve weight bearing on lower extremity with very high stability

98
Q

What are the types of walker

A

standard (no wheels) - most stable, but slowest, harder for people w low strength, ideal for uneven outdoor situations

front wheeled walker - less stable, but faster walking pattern, hard to turn though

4 wheeled walker - for those who dont need weight bearing relief, easy to move around but not ideal for those with balance issues

walker handles should be in line with patients wrist creases

99
Q

WHat is the role of a social worker

A

works with people to achieve optimum psychological and social functioning

100
Q

WHat are the regulatory bodies/associations for social workers

A

bc association of social workers

canadian association of social workers

BC college of social workers

101
Q

What is the TUG test

A

Timed up and go - get up from chair, walk 3m, turn around and sit back down in chair, without physical assistance

10s is good, and if successful, you can dwell alone (aka you wont be hit by a car)

102
Q

What is MRSA

A

methicillin resistant staphylococcus aureus

bacteria resistant to antibiotics

spread prevented by washing hands and chilling out on anti bacterial stuff

103
Q

WHat are risk factors for MRSA

A

antibiotics within 3 months

hospital visit in the last 12 months

infections

104
Q

WHat is radicular pain

A

pain from a nerve injury

105
Q

What spinal levels are the Illiac crest, psis, and z-joints at

A

illiac crest - L4
PSIS - S2
z-joint - 2in left/right of spinous process

106
Q

Why are most slipped disks slipped backwards

A

hella anterior ligaments creating a wall, while the posterior ligaments have exposed areas

107
Q

What is zygapophyseal joint dysfunction

A

lesion to joint, usually caused by disk degeneration/narrowing via increased loading/osteoarthritis causing damage to nerve roots

can result from hyper/hypo mobility instability

pain w only extension and usually mechanically based

108
Q

what are the risk factors for Z-joint dysfunction

A

degenerative disk disease and increased age

109
Q

WHat is the clinical presentation of z-joint dysfunction

A

unilateral back pain/tenderness, stiffness, pain apon extension (due to joint space decreasing, touching the nerve)

no pain with flexion as this increases the joint space

can palpate the zjoint, causing pain

110
Q

WHat is spondylosis

A

arthritis of the disks, with the posterior wearing away first which causes initial pain with extension

usually due to bad posture/prolonged immobilization

111
Q

what are the risk factors for spondylosis

A

increased age and intervertebral disk degenration

112
Q

what is the clinical presentation of spondylosis

A

pain with extension/side bending
progeressive hypomobility
cant palpate pain (cant touch vertebral body)

113
Q

WHat are the types of lumbar disk herniation?

A

protrusion - bulge but no escape AF

extrusion/prolapse - attached to disk but escapes AF

sequestration - fully out of disk (full collapse resulting in less pain, as there isn’t anything pressing on nerves)

caused by bending with twisting motion

114
Q

what are the risk factors for lumbar disk herniation

A

smoking, previous herniation, diabetes (high arterial concentration, so diabetes/high bp/etc impacts degeneration)

115
Q

what is the clinical presentation of lumbar disk herniation

A

may have radicular pain, pain with lumbar flexion, and pain in lumbar area

116
Q

What is spondylolisthesis

A

progression of spondylosis (complete weardown)

anterior slippage and inability to resist shear forces of vertebral segment below it

can be caused by degeneration, pathologic process, or congentially

117
Q

What are the risk factors for spondylolisthesis

A

ligament laxity/ twice as commen in women (heel height/hormonal interactions/lower muscle mass)

118
Q

What is the clinical presentation for spondylolisthesis

A

chronic midline pain at lumbosacral junction

pain worsens with activity

leg pain with radicular pattern due to nerve root foramen being significantly more narrow

119
Q

WHat is spinal stenosis

A

narrowing of spinal canal caused by disk protrusions, boney narrowing, or joint swelling, or bad posture (spondylolisthesis)

120
Q

what are the risk factors for spinal stenosis

A

being over 50

121
Q

what is the clinical presentation of spinal stenosis

A

history of lower back pain/leg pain

pain with standing/lumbar extension

short hip flexors

122
Q

What is a myotome? what is the lower leg myotomes?

A

group of muscles that are supplied by a nerve root

to test for these, isometric strength test should be performed for 5s

SPARTAN KICK
L2-hip flexion
L3 - knee extension
L4- ankle dorsiflexion
L5 - big toe extension
S1 - ankle plantar flexion, ankle eversion, hip extension
S2-knee flexion

123
Q

What are dermatomes

A

areas of the skin that supply nerve roots

lots of overlap with these

can sense light touch, proprioception, vibration, pain, and temperature (DCML and spinothalamic)

124
Q

WHat are the deep tendon reflexes

A

patellar - tests L3/L4
achillies - tests S1/S2
medial hamstring - L5/S1
Lateral hamstring - S1/S2

125
Q

How are deep tendon reflexes graded

A

0-absent
1-diminished (hyporeflexia)
2-average
3- exxagerated
4 - clonus (hyperreflexia) - tested with quick passive dorsiflexion of ankle -3+ beats is positive

126
Q

WHat does the babinski test for

A

corticospinal tract impariment (positive is flaring of toes)

127
Q

What are the signs for a UMN

A

disuse atrophy, hyperreflexia, spastic paresis, positive babinski

128
Q

what are the signs for LMN

A

denervation atrophy, hyporeflexia, flaccid paresis, negative babinski

128
Q

WHat are some red flags for lower back pain

A

bowel/bladder/genital dysfunction (s2 dysfunction)
saddle paraesthesia (pins/needled between asshole and genitals)

129
Q

WHat is the slump test

A

assess neural sensitivity by getting pt to slump w hands at side, put head down, then raise leg, then dorsiflex in that order

not super specific due to setup of test

130
Q

what are the wadell signs

A

signs that essentially individual is faking it, originally used to assess if pt would make a quick recovery post surgery

  1. widespread tenderness that doesnt make sense
  2. pain with simulated axial loading/spine rotation
  3. inconsistant test results
  4. myotomes/dermatomes dont add up
  5. overreactions dueing exam

3/5 mean positive, and is a poor prognosis

131
Q

What is Lipitor

A

cholestrol meds used to treat hypertriglyceridemia

not to be used by those with active liver disease or nursing mothers

can cause diarreha, arthralgia, myalgia, pain

132
Q

What is cyclobenzaprine

A

muscle relaxant, used to treat musculoskeletal conditions, dont use if have heart issues/hyperthyroidism

acts at brainstem

can cause constipation, dizzyness, and fatigue

133
Q

What is hypercholestrolemia

A

high cholesterol >200mg/dl

risk factors include smoking, hypertension, low HDL, family history

134
Q
A

BPK 481 (2 decks)

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