Week 2.1 Do Not Want to Miss List

Question 1

what percent of men and women are depressed

Answer 1

10-25% women

5-12% men

Question 2

what do you follow these two questions with if yes?

• felt down, depressed or hopeless in the last two weeks
• little interest or pleasure

Answer 2

you note 3-4 of the following symptoms

• weight change
• insomnia
• psychomotor agitation
• agitation
• fatigue
• feelings of worthlessness guilt
• difficulty concentrating
• recurrent thoughts of suicide

Question 3

what do you do if the symptoms are not accounted for by bereavement, substances and the symptoms are causing significant impairment socially, occupationally, or function

Answer 3

consultation

Question 4

who has the highest suicide risk

Answer 4

middle aged women

Question 5

who has a higher suicide contemplation, and who has a higher risk of attempts

Answer 5

higher contemplation is men, attempts is women

Question 6

what are some risk factors for suicide

Answer 6

widowed, divorced, living alone, psychiatric illness, suicide attempts, chronic progressive illnesses, significant loss, unemployed, hopelessness, family history suicide

Question 7

what are some phrases that are concerning

Answer 7

I don’t know how much longer I can take this, stopping therapy, stopping other treatments

Question 8

what is the sensitivity of people expressing thoughts about death? what about wishing they were dead?

Answer 8

100%

92%

Question 9

what are some of the issues to consider with suicidal patients

Answer 9

own a gun? have a plan? medications? who do we need to contact?

Question 10

why is it so important to diagnose and image a femoral head and neck fracture

Answer 10

to prevent non-displaced going to a displaced fracture, which could require surgery.

Question 11

where do osteoporotic fractures usually occur?

Answer 11

femur and lumbar spine

Question 12

what are some manifestations of a femoral head or neck fracture

Answer 12

pain and local tenderness, 
deformity, 
edema, 
ecchymosis, 
loss of function and mobility 
pain in the anterolateral thigh, knee and even the groin or the butt

Question 13

_% of those suffering from a hip fracture die within the first year

Answer 13

30%

Question 14

what is the MOI of a hip fracture

Answer 14

trauma, slip and fall, sneeze, lifting things in and out of the car, trying to open a window (decreased bone density)

Question 15

what are some disorders associated with compromised bone density

Answer 15

renal failure, GI issues, RA, ankylosing spondy, hyperparathyroidism, hyperthyroidism, T2DM, MS, alcoholic, Cushing’s

Question 16

what are some meds associated with fracture

Answer 16

aluminum, anticonvulsants, steroids, cytotoxic drugs, thyroxine, heparin and warfarin, methotrexate, caffeine, more that 3 cups coffee per day, soft drinks, tobacco

Question 17

what are some risk factors for fatigue fractures

Answer 17

female, hormone imbalances, running, jumping and marching, new activity, increase intensity, changes surface or footwear, nutritional, leg length discrepancy, decreased strength

Question 18

what is the patellar pubic percussion test

Answer 18

lateral to the symphysis, on the pubic tubercle, you put the stethoscope, and you tap the patella

Question 19

what is a negative or normal PPPercussion test

Answer 19

sharp and distinct sound

Question 20

what is a positive (fracture) PPP Test

Answer 20

not a sharp and distinct sound

Question 21

what is the fulcrum test

Answer 21

put your arm under the femur, where you think the stress fracture is, and push down on the distal femur, until they have pain (which would be a stress fx)

Question 22

What are the risk factors for caudal equina syndrome

Answer 22

low back injury, central disc herniation, stenosis, spinal fracture, ankylosing spongy, tuberculosis, Pott’s disease

Question 23

what are some of the clinical manifestations of cauna equina syndrome

Answer 23

urinary dysfunction, bowel dysfunction, incontinence, retention, sexual dysfunction like lack of sensation or impedance, sensory issues, saddle region things, LE motor deficits, and lower limbs weak

Question 24

what is the most common cauna equina manifestation

Answer 24

retention of urine

Question 25

what is the manifestation for cervical myelopathy based on the history

Answer 25

impaired hand dexterity
gait and balance issues (slow and stiff)
numbness and paresthesias of the extremities
neck stiff
urinary dysfunction (retention and urgency and frequency)

Question 26

what are some of the physical exam findings of a cervical myelopathy

Answer 26

hand (intrinsics atrophy)
muscle weakness, esp. in the triceps
muscles weak in the LE
UMN signs of the DTR hyperactive) and babinski and Hoffman positive

Question 27

what are the risk factors for a cervical myelopathy

Answer 27

• cervical spine spondylitis changes
• age 50-60
• history of neck trauma like a MVA or sports injury
• RA