Random OSCE Flashcards
What are the types of toe walking
-Idiopathic
-Autisim, sensory stimulation
-Cerebral Palsy, Calf muscle spasticity
When is Toe walking not considered normal
-Above the age of 3
What are the issues associated with toe walking
-narrow calcaneus
-falls
-Knee instability
-quality of life
What are the causes of Idiopathic Toe Walking
-Tactile Processing, response to touch sensations
-Proprioceptive processing, sense of body position in space
-Vestibular processing, maintaining balance
-Moto control, control of specific body movement
-How long and flexible the leg and foot muscle are
What is a red flag in the birthing history
-Premature delivery
What are the muscle changes associated with toe walking
-Shortening of gastric and soleus
-Short hamstrings
-Contracted hip flexors/adductors
What are the traditional therapies to ITW
-Night braces
-Gait training
-serial casting
-AFO’s
-HEP
-Manual stretching
-Gait plates
-Botox
-Surgery
What other therapies can you use
-Taping
-Orthotics
-Footwear
-Squatting
How to treat a MSK/Sensory toe walking
-Heel lift to bring ground up to the heel
-Myofascial release
-eccentric strengthening
-Weight shifting training
-Casting
What some exercise for toe walking
-Calf stretching
-ice skating on towels
-Foot intrinsic
-Deficit calf raises
What would you suspect of a 7 year old new toe walker?
=tethered cord syndrome
What are some the primitive reflexes
-Grasp
-Step
-Crawl
-Tonic neck
-moro reflex
-Tonic labyrinth
How to rate a reflex response
0 absent
1 hypoactive
2 normal
3 brisk without clonus
4+ hyperactive with unsustained clonus
5 hyperactive with sustained clonus
How to rate motor strength
0 no movement
1 Flicker
2 moves with gravity eliminated
3 moves against gravity but not resistance
4 moderate movement against resistance
4- slight move against resistance
4+ sub maximal movement against resistance
5 normal movement
What are some conditions associated with hyporeflexia
-CMT
-Polio
-Muscular dystrophy
-Friedreich ataxia
-Neuropathy
-Stroke
-CP
What are some conditions associated with hyperreflexia
-Spinal cord injury
-Cerebral Palsy
-Cerebellar ataxia
-Angelmanns syndrome
How to rate a Gowers sign
-Mild, prolonged or rise using single hand action
-Moderate, forming prone crawl position, and using one or two hands on thigh
-Severe, using the thigh with both hands, additional aid to rise, unable to rise
What is ankle clonus
-Series of involuntary, rhythmic contraction and relaxation
What is an ankle clonus indicating
-Sign of neurological condition
-Upper motor neurone lesions
-associated with spasticity
What does ANTT stand for
-Aseptic non-touch technique
What should you be checking when using dressings
-Package intact
-Date
How to perform Donning and doffing
Donning (put on)
-Gown
-Mask
-Glasses
-Gloves
Doffing (put off)
-Gloves
-Gown
-Glasses
-Mask
5 hand hygiene moments
-Before touching a patient
-Before clean/aseptic procedures
-After body fluid exposure/risk
-After touching a patient
-After touching patient surroundings
Melanomas
A: Asymmetry
B: Borders (irregular)
C: Colour (not uniform)
D: Diameter (>.5mm)
E: Evolution
What are the Instruments and order used in IGTN Surgery
-Nail splitter
-Beaver blade with handle
-Elevator
-Mosquito forceps
-Currette
-Phenol applicator
How to dress after a IGTN
-Bactigras
-melonite
-Gauze
-Tube gauze
-Hypafix
Patient instructions post-surgery
-Leave dressing on for first 24 hours, keep dry
-Bleeding may be present in first 24 hours
-Avoid tight fitting shoes and return to activity
-Dressing change every 24 hours, keeping toe clean and dry
-Paracetamol maybe needed if pain is present after LA wears off
-Contact clinic or GP is bleeding does not stop, or too painful
Contraindications
-Pregnant or breast feeding
-PVD
-Allergies to LA
-Severely infected to nails
Dosage calculation
-3mg/kg up to 200mg
-20mL max dose
Example:
-1% lidocaine
-Patient 70kg
-3x70=210
-210/10=21mL
-This patient max dose is 20mL
-If using 2% its half the dose
Procedure types
-Partial nail avulsion
-Total nail avulsion
ABI calculation
-Use higher of the two
-Ankle BP/Brachial BP
ABI interpretation
> 1.3: poorly compressible vessels
1.3-0.90: normal
0.90-0.80: mild arterial obstruction
0.80-0.50: moderate obstruction
<0.50: severe obstruction
What are some precautions of LA
-Allergies
-Local inflammation or infection
-Anticoagulated patients
-neuromuscular disease
-Neurological disease
-Renal, Liver problems
-Elderly and children
Which drugs are involved in triple whammy
-ACE inhibitor or ARB
-Diuretic
-NSAIDs
What are the consequences of triple whammy
-Acute Kidney failure
What are some RA surgeries you can perform
-Arthroplasty
-Arthrodesis
-synovectomy
-Tendon release surgery
Attachments to the medial tubercle
-Plantar fascia
-Flexor digitorum brevis
-Abductor hallucis
What is the tests for beightons score
-Elbow hyperextension
-Thumb to forearm
-passive extension at 5th metacarpal
-Knee hyperextension
-Floor touch with knees hyperextended
-out of 9 score
How to interpret a Beighton’s score
-4/9 hypermobile
-7/9 for children between 6-12
What is intoeing
-Internal FPA during gait
-Internally rotated gait profile
-Prevalence unknown, no clear data in normal population
Concerns over intoeing gait
-awkward gait
-fatigue
-tripping clumsiness
-future concerns
What are some causes of in toeing
-Tight hip muscles
-Femoral torsion
-genicular bias, soft tissue contracture
-Tibial torsion
-Metatarsus adducts
-Conditions or syndromes
What are some management strategies for in toeing
-Casting
-Splinting
-Gait plates
-Stretches
-Functional exercises
-Posture modifications
Areas we need to assess for in toeing
-Gait
-Hips
-Femur
-Genicular
-Tibia
-Foot
-Soft tissues
-Conditions
What is a normal finding for Gait
-FPA abducted to parallel
What is normal finding for hips and femur
-Lateral and medial rotation same
-Femoral torsion of 15-20 degrees
What is a normal finding at Genicular
-Lateral and medial rotation 2:1 ratio
-nil posterior soft tissue contracture
What is a normal findings of Tibia
-Lateral torsion developing from 0 to 20
What is a normal finding of the foot
-Rectus foot NWB and WB
-may or may not be postural metatarsus adducts
What is a normal finding for soft tissues
-Normal tone, nil restrictions, functional
What is a normal finding for conditions
-Screening, tone, contractions etc
What is a example of strength program to correct intoeing?
-Big bear walks
-sumo frog jumps
-Cheeky crab walks
-Penguin walk
What are some causes of flat feet
-Heredity
-Joint laxity
-Obesity
-Early shoe wearing
What is the management of flexible flatfoot
-Reassurance
-Education
-Advice
-Avoid inserts
What should you promote or encourage in flexible flat feet
-Avoiding obesity
-healthy diet, limiting TV, encourage active play
When should you be concerned about flat feet in children
-Rigid
-Painful
-Very severe
Facts about arch height
-1 in 5 never develop an arch
-Most of the time arches are low due to loose joints
-Children can be different heights and that’s the same with arch height
-if asymptomatic treating may cause problems
