PMR qbank question review Flashcards
how deep into the tissue does superficial heat penetrate?
1-2 cm
US produces the highest temps in what tissue?
bone
frequency of US is set at…
0.8 - 1.1 MHz
How deep does US heat structures to >100F
8cm
how deep does short wave diathermy penetrate
5cm
what modality helps with hematomo resolution
microwave diathermy
gate theory involves which nerve fibers
large myelinated Type A fibers
most conventional TENS setting
high frequency, low intensity
minimum amount of weight needed for cervical traction
25 lbs
muscle contraction with greatest force
fast eccentric
how much body weight is needed to help with lumbar traction
1/4-1/2 of body weight (atleast 50-100lbs)
what % of patients with polymyositis have myalgies?
<30%
what is Pannus
hypertrophied synovium
polymyositis has a strong association with?
Malignancy
what epitope is associated with RA
HLA-DR4
what percent of RA patients are RF +
80%
Pseudogout is associated with… (6)
amyloidosis hypothyroidism hypomagnesia hypophosphatemia hyperparathyroidism hemochromatosis
DISH is associated with
Metabolic syndrome
average amount of time between gout attacks
11 months
rupture of terminal portion of extensor hood?
what test to diagnose
Boutoneirre deformity
Elson test
Podagra is seen in…. (3)
RA, sarcoid, gout
where is the joint narrowed in hip OA
superolateral joint space narrowingon Xray
which diseases are associated with HLA-B27
enteropathic arthropathy
ankylosing spondylitis
Reiters syndrome
hand joint most affected by hand OA
first CMC joint
most common A-A joint subluxation direction is
anterior
chest expansion less than _____ cm is predictive of respiratory difficulties in restrictive lung disease
7-8cm
organism associated with reactive arthritis
salmonella
what effect does methotrexate have on rheumatoid nodules
worsens them
what is Caplans syndrome
coal worker with pneumoconiosis and RA with RF+
what % of patients with psoriasis develop inflammatory joint disease
5%
What is Feltys syndrome
RA, splenomegaly, and leukopenia
what test should be ordered before starting Plaquenil (Hydroxychloroquine)
eye exam
routine testing while on Methotrexate?
monthly CBC
LFT and renal every 1-3 months
Raynauds is associated with which autoimmune disorder
Scleroderma
what type of Myositis is associated with childhood
Type IV
cut off age to be diagnosed with JRA
16
Stills Disease characteristics
myalgias
rash on truck with fever
peak onset between 1-6 years, equal M and F
what is prognosis for most kids with JRA
most achieve remission
Most common bug associated with septic arthritis in neonates
S. aureus
disease with glucocerebrosidase deficiency
Gauchers disease
deficiency of enzyme homogenistic acid oxidase -
alkaptonuria - blue urine, cartilage, skin, and sclera
treatment for acute Charcot joint
total contact cast with eval q1-2 weeks
most common tendon rupture site in RA patients
Lister tubercle
myotonic muscular dystrophy affects which type of muscle fibers
skeletal, smooth, and cardiac
histologic findings of dermatomyositis
perivascular and interfascicular inflammatory infiltrates with adjoining groups of muscle fiber degeneration/regeneration
histologic findings of polymyositis
endomysial mononuclear inflammatory infiltrates and muscle fiber necrosis.
psoriatic arthritis most commonly affects which joints
DIPs
which medication can worsen psoriatic arthritis symptoms
hydroxycloroquine
second line treatment for raynauds
IV prostonoids
innervation of levator scapulae
C3/C4 nerve root and dorsal scapular nerve
pec minor insertion
coracoid process
innervation of teres major
lower subscapular nerve
brachialis insertion
coronoid process of ulna
FCR insertion
base of 2nd metacarpal
arterial supply of FCR
ulnar artery
FCU insertion
pisiform bone, hamate, and 5th metacarpal
FDP nerve roots
C8/T1
Innervation of FDP
ulnar nerve and anterior interosseous nerve
potential compression site of PIN syndrome
ECRB, supinator
PIN sensory distribution
No cutaneous innervation
Sensory fibers of dorsal wrist capsule
2 thenar muscles that are ulnarly innervated
adductor pollicis
1/2 flexor pollicis brevis
origin of lumbricals
FDP tendon
innervation of iliacus
Femoral nerve L1, L2, L3
iliospoas insertion
lesser trochanter
vastus group origin
greater trochanter
glut max insertion
fascia lata
glut med insertion
Greater trochanter
glut min action
abducts and internally rotates hip
glut med and mad action
abduct and externally rotate hip
biceps femoris long head insertion
fibular head
some LCL and lateral tibial condyle
obturator externus action
adduction and external rotation of thigh
flexor digitorum brevis innervation
medial plantar nerve
lateral plantar nerve innervated which muscles
abductor digiti minimi adductor hallucus quadratus plantae plantar interossei dorsal interossei
what structure passes through the triangular space
scapular circumflex artery
what structure passes through the triangular interval
radial nerve
radial border of Gunyon canal
hook of hamate
ulnar border of Gunyon canal
pisiform and abductor digiti minimi muscle belly
lumbosacral plexus is made up of
ventral rami of T12-S3
anterior division of femoral nerve innervates what muscles
sartorius and pectineus
saphenous nerve branches from what nerve
posterior division of femoral nerve
posterior division of obturator nerve innervates
adductor magnus
superficial posterior compartment contains which muscles
gastroc
soleus
plantaris
normal femur head subtrochanteric angle is
135 deg
what type of collagen is found in all basal membranes
Type IV
what type of collagen is found in muscle
Type III
what type of collagen is found in bone, tendon and ligaments
Type I
What type of collagen is found in epiphyseal plate
Type X
In which brain structure does clonidine act on to reduce symptoms of opiate withdrawal?
Locus coeruleus
which nuclei helps with visual perception
lateral genicular nucleus of thalamus
space between pharyngeal surface of tongue and epiglottis
valleculae
which MCA branch supplies subcortical structures
M1
vertebral arteries branch off the
subclavian arteries
Role of donepazil in mild/moderate/severe dementia
improve well being ( improve cognitive function and ADLs)
greatest modifiable risk factor for stroke
HTN
what % of strokes are ichemic
87%
left visual neglect and left homonymous hemianopsia
right PCA
what artery is indicated with amaurosis fugax
ICA
Anton syndrome is…
Bilateral visual field cuts that result in a denial of cortical blindness
A transient inability to read faces
A syndrome of nausea, vomiting and alexia
An oculomotor palsy with a contralateral hemiplegia
decerebrate posturing is seen in lesions of the….
decorticate posturing is seen in lesions of the…
Brainstem
cortex
presentation of lateral medullary syndrome
sensation changes on ipsilateral face, sensation changes on contralateral body ataxia dysphagia/hiccups etc NO motor weakness
presentation of Weber syndrome
ipsilateral CN3 palsy
contralateral hemiplegia
presentation of Medial medullary syndrome
Ipsilateral CN12 palsy
contralateral hemiplegia
contralateral tactile sensory loss
Presentation of Miller-Gubler syndrome
Ipsilateral CN6 paralysis
contralateral hemiplegia
contralateral sensory loss
Pure Motor hemiplegia stroke - where is the lesion
posterior limb of internal capsule
pure sensory stroke - where is the lesion
Thalamus
The mortality rate in the first 24 hours after a subarachnoid hemorrhage
25%
treatment for early posttraumatic seizure
IV valproic acid
uses spiral and diagonal components of movement rather than the traditional movements in cardinal planes of motion with the goal of facilitating movement patterns that will have more functional relevance than the traditional technique of strengthening individual group muscles.
NMF (neuromuscular facilitation)
encourage normal movement and tone, while suppressing the inhibitive movements patterns that arise after stroke. This approach is most commonly used.
Bobath
focuses on using abnormal movement in an attempt to improve motor control
Brunnstrom approach
Cantu return to play - how long should they sit out if loss consciousness for >5min
1 month
hemorrhagic stroke in which area is most likely to be associated with a seizure
Temporal
a coma can result from damage in which area?
brainstem of bilateral cerebral hemispheres
what type of exercise is used to treat ataxia
Frenkel exercises are used to treat ataxia. They usually consist of many repetitions of slow exercise.
Which Brunnstrom stage of motor recovery is defined as the stage of maximal spasticity?
Stage 3
A 60-year-old male with a past medical history of an MI with resultant cardiomyopathy, now presents with a large territory stroke. What is the most likely cause?
mural thrombus
Nearly 1/2 of intracerebral hemorrhages occur at what structure?
Putamen
Which is an environmental risk factor for the development of Parkinson’s?
pesticide exposure
dysarthria and clumsy hand syndrome is found from a lesion in the?
pons and anterior limb of internal capsule
A patient with a Ranchos Los Amigos rating of VI will most likely require what level of assistance?
moderate assistance
In an upper division MCA stroke, which is most likely?
stronger legs than arms
Pure lower MCA division presentation
No weakness
No sensory changes
language, visual deficits and awareness of deficits are usually significant.
Alexia without agraphia is most likely to occur with an infarct in which location?
PCA
Presentation of Benedikt syndrome
contralateral chorea as it affects the red nucleus. The red nucleus contributes to coordination and body positioning.
This stroke rehabilitation approach utilizes a system of therapeutic exercises enhanced by cutaneous stimulation; in addition to, proprioceptive maneuvers to promote recovery.
Rood approach
first muscles to become weak with DMD
neck flexors
most common heart defect with Downs syndrome
VSD
a congenital deformity in which the limbs are extremely shortened so that the feet and hands arise close to the trunk
phocomelia
Sinding-Larsen-Johansenn disease
(patellar tendonitis) in pediatrics will present with anterior patella pain and similar x-ray findings.
is the most common cause of limping and pain in a child’s hip.
Transient (toxic) synovitis of the hip
The most common level of a pars defect in children is at
L5`
Which type of JRA is associated with iridocyclitis?
pauciarticular
In JRA, which joint tends to be affected more in children?
cervical spine
where is osteosarcoma found in the bone
metaphysis
where is Ewing sarcoma found in the bone
diaphysis
