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Clin Training Phase I - Beck > Week 4: Study Qs > Flashcards

Week 4: Study Qs Flashcards

1
Q

Generally how long is the initial “acute” phase of a trauma case?
LBP case?
HA case?

A

Trauma: 0-3 days
LBP: <6 weeks
HA: continuous HA lasting up to 10 days

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2
Q

Besides length of time, what other criteria have been suggested to designate a pts LBP as acute?

A

Kessler suggests differentiating acute from chronic not based on amount of time, but rather on CLINICAL PRESENTATION

  • P relatively constant
  • PROM fo joint is spasm end-feel or empty end-feel
  • P relatively diffuse
  • increase in skin temp
  • difficulty falling asleep or sleeping
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3
Q

As defined in the CSPE protocol Emergent Referrals, what are the 3 categories of referrals and what distinguishes their
timing?

A

Emergent: life-threatening conditions, highly unstable, rapidly progressive with risk of serious consequences

Urgent: serious enough to warrant same-day service

Semi-urgent: patient should be seen within 48 hours

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4
Q

What are 2 musculoskeletal and 2 visceral examples for the emergent category?

A

Neuro-MSK: CES, dislocation

Visceral: AAA, acute-severe abdominal P, arrhythmias, diabetic crisis

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5
Q

What are 2 musculoskeletal and 2 visceral examples for the urgent referral category?

A

Neuro-MSK: AC joint dislocation, compartment syndrome

Visceral: AAA, arrhythmias, bladder infection

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6
Q

What are 2 musculoskeletal and 2 visceral examples for the semi-urgent referral category?

A

Neuro-MSK: fracture, septic arthritis, tendon rupture

Visceral: AAA, strep throat

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7
Q

What is the purpose of a problem list? What goes into a problem list?

A

Purpose: to present in 1 place a current concise picture of all the patient’s problems and significant health factors.

Problem list includes any significant concern, complaint, or finding that may affect the patient’s health (present or future), Tx, prognosis (or expected outcome).

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8
Q

If your patient comes in for a treatment and has a cold, should that be added to the problem list?

A

No, because a cold is self-limiting and is not a significant concern, complaint, or finding that affects their health, Tx, or prognosis.

May warrant a note as a SOAP entry, but rarely would qualify to be elevate to the problem list.

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9
Q

Your patient has anemia on a blood test but you are not treating it. Should that go on a problem
list?

A

Yes, because anemia is a significant finding that may affect the patient’s health (present or future), Tx, prognosis (or expected outcome).

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10
Q

You are treating a patient for a rib joint dysfunction caused by a fall. You also find out that he has a very poor diet. Should that go on a problem list?

A

“Very poor diet” is subjective and possibly not a significant concern, complaint, or finding that may affect the patient’s health (present or future), Tx, prognosis (or expected outcome).

Its important not to clutter the problem list with a lot of minor health risks. There needs to be some valid evidence that a particular factor is truly a health risk and one sig enough to impact the patient and the practitioner’s management of the patient. To a certain degree this is a judgment call, so before including questionable health risks check some reliable databases for evidence and then consult with your clinical supervisor. On the other hand, a good health promotion problem list will include important health risks so that the practitioner can help the patient make good lifestyle and nutritional choices. The CSPE care pathways on Overweight, Hypertension, and Dyslipidemia contain some good information.

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11
Q

You are treating a patient for a low back condition and they come in with a sprained ankle. Should that go on the problem list?

A

Depends on what the severity/grade of the ankle sprain. A grade 1 ankle sprain may not be a significant concern that would affect the patient’s health (present or future), Tx, prognosis (or expected outcome). However a grad 3 ankle sprain possibly would be significant enough to affect the patients Tx and prognosis.

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12
Q

Which of the following family health problems should go on to a problem list?

A. Sister and mother had breast cancer in their 60s.
B. Paternal grandfather died of an MI at 65.
C. Mother has dementia now at 80 yo

A

A — multiple 1st degree relative, youngish ages
B — 1st degree relative, young

Genetic risks are usually not strong factors unless it is in a first degree relative. In addition, genetic risks that are also impacted by lifestyle are usually not significant unless manifested at an early age or represented in multiple family members (either first or second degree).

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13
Q

What are the 3 most common diagnoses for sacroiliac injures?

A

SI syndrome
SI sprain
SI joint dysfunction

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14
Q

How does an SI syndrome differ from an SI sprain or joint dysfunction?

A

SI is P generator (for all) w/ deep referred leg P/paresthesia

(+) ortho tests
(-) neuro signs
(Same as SI sprain)

So the difference is the deep referred leg P/paresthesia

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15
Q

In SI syndrome, where are some of the common local and referral locations for pain or paresthesia?

A

Local P: posterior pelvis (usually not above L4) and groin

Referred P: buttock, groin, thigh (sometimes past the knee)

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16
Q

In the case of an SI syndrome, what are the usual tension test results? What about SMRs?

A

(-) SMRS

??? tension tests

17
Q

Where is palpatory tenderness likely to be most pronounced in SI syndrome?

A 
SI joint, medial to PSIS
Long dorsal SI lig
P with joint challenge
Altered SIJ motion palp
PI or AS ilium
18
Q

What 7 pain provocation SI tests are recommended to perform?

A 
Thigh thrust
Sacral thrust
SI compression
SI distraction
Thomas Gaenslen’s

FABER
ASLR

19
Q

Which orthopedic tests are suggested to interpret as a group of 5? What do we know about the
positive LRs for this group of 5?

A 
Thigh thrust
Sacral thrust
SI distraction
SI compression
Thomas Gaenslen’s

3 (+) tests have a +LR 4.1
3 (+) tests AND no P centralization have +LR 7

20
Q

What are the various ways the active SLR can be positive? (3)

A
  • Reproduced P
  • Can’t raise SX leg to target area 4-8” (even if no P)
  • Raise both legs to the same height but cheats on SX side
21
Q

What two things does a positive active SLR suggest?

A

SIJ may be cause of P or suggests Posterior Pelvic P syndrome (2˚ to pregnancy)

Suggests SIJ may because of functional instab

Suggests bracing the SIJ or incorporating abdominal bracing may be therapeutically useful

22
Q

What is the every next thing to do when getting a positive active SLR?

A

Re-test with patient actively bracing or with a trochanteric belt

23
Q

What procedures do we use (and what are the findings) that would support an SI joint
dysfunction diagnosis?

A

PHYSICAL EXAMINATION - focal SIJ tenderness (medial to the PSIS)

  • Tenderness along the long dorsal SI ligament
  • Pain aggravated by joint challenge.
  • Altered SIJ motion palpation
  • May be associated with PI or AS ilium
  • P with ortho tests
  • possible guarded or limping gait, difficulty changing position
  • piriformis spasm same side
  • gluteal and/or erector spinal mm spas, and/or MFTP
  • (-) SMRs including (-) SLR
24
Q

What is the muscle imbalance that Janda suggested might accompany an SI joint restriction?

A

Ipsi piriformis short, tight
Ipsi glut max inhibited
Ipsi iliopsoas short, tight

Contra glut med inhibited

25
Q

What are the 3 painful disorders that we associate with the piriformis muscle? What
distinguishes them from each other?

A

Piriformis spasm
- involuntary contraction of mm causing local P

Piriformis MFPS
- tender nodule associated with deep referred P to posterior thigh, but no nerve involvement

Piriformis syndrome

  • neuropathic leg P due to nerve irritation (sciatic)
  • sitting intolerance >15-20 minutes
  • P with bowel movements
  • dyspareunia (women), erectile dysfunction
26
Q

What symptoms might accompany a piriformis syndrome if the pudendal nerve were entrapped?

A

Dyspareunia (women)

Erectile dysfunction

27
Q

What are three different approaches to palpating the piriformis muscle?

A
  • int and ext rotate femur to palpate tendon near greater trochanter
  • oblique approach: scooping under glut max
  • intrarectal palpation (most direct)
28
Q

What are 6 exam procedures and their findings that could support a piriformis injury?

A
  1. Leg traction = moderate relief
  2. “Piriformis sign” = femur may be externally rotated (look at foot)
  3. Limited internal rotation of LE
  4. SLR may be (+) and SLR + int rotation at ~20˚ = local P or sciatic Sx into foot
  5. Pace (seated resisted leg ABD. Positive = butt or leg P)
  6. Beatty (side posture, hip and knee flexed, pt lifts knee above table, doc adds resistance. Positive = butt P)
  7. FAIR tests (side posture, hip and knee flexed, stretch toward floor. Positive = sciatic P)

**not sure what specific 6 LeF was referring to….

29
Q

What additional exam findings would support a piriformis syndrome?

A

Motor paresis, DTR changes, sensory changes may occur but rarely

SIJ dysfunction may be associated

30
Q

Name the various components of a management plan.

A
  1. Goals & outcome measures
  2. Services
  3. Treatment & re-evaluation schedule
  4. Referrals & follow up
  5. Other conditions to treat OR monitor

And then, Prognosis comes after Mgmt plan

31
Q

What are three outcome measures that are typically used to monitor a patient’s pain reduction?

A

OPS
PSFS
Pain-free ROM

32
Q

What would be 3 treatment goals for an acute ankle sprain. How would you measure the
outcome for each of those goals?

A

Decrease P, swelling
Prevent mm, nerves, lig from atrophy injury
Stabilize/protect joint from injury (taping)
Propriceptive training — wobble board time
Strengthening

33
Q

What are the four main blocks in the UWS Treatment Intervention Matrix?

A

CMT
STM
Exercise
Activity mod

34
Q

What is a typical timing for a formal reevaluation of the patient in acute/subacute, recurrent/flare-up, chronic stages?

A

Acute/subacute
- 2-4 weeks

Recurrent/flare-up
- 1-2 weeks

Chronic stages
- 2-4 weeks

35
Q

What are components of a typical treatment schedule?

A

not great evidence. No one knows what the frequency pattern is so it’s been like exercise: 2-3x/week.

  1. 1980s David Cassidy looked at ~400 pts. Divided pts to see if they responded to manipulation or others. Method: tx 5 days/week for 3 weeks. Pts who responded well were the ones who came in every day and this who didn’t respond as well missed appointments.
  2. Cox. 5x/day for 3 weeks. Same informal observation: pts that were treated everyday did better than those who missed appointments.
  3. Mitch haus. 2 studies. CGH designed to look at frequency. Outcome: higher frequency density at front end got better response.
36
Q

How does the “50%” rule apply to modifying a typical treatment plan?

A

When outcome measures tell you pt is 50% better then cut frequency in 1/2.

For example:
Week 1: 4x/week
Week 2: 2x/week

37
Q

What is a common difference between the duration of typical treatment plan vs a typical
rehabilitation program?

A

??

38
Q

In formulating a mgmt plan for MSK problems, consider adding (4):

A
  • yellow flags if necessary (e.g., fear avoidance behavior, catastrophizing)
  • address load sensitives (through behavioral modifications)
  • prescribe positons/movements that have a directional preference (through exercise prescription)
  • address abnormal motor control and muscle balance issues (through exercise prescription)

Clin Training Phase I - Beck (14 decks)

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