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206 Cards in this Set
- Front
- Back
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Supination incorporates which movements at the ankle, talus and forefoot?
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- ankle plantar flexion
- talus external rotation - forefoot adduction |
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Which directions do the tibia and femur move with foot supination?
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- tibia: external rotation
- femur: external rotation |
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Prontation incorporates which movements at the ankle, talus and forefoot?
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- ankle dorsiflexion
- talus internal rotation - forefoot abduction |
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Hallmark and other findings in osteoarthritis
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* osteophyte
- joint space narrowing - subchondral sclerosis - subchondral cyst formation |
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The following findings occur in what type of arthritis?
* osteophyte - joint space narrowing - subchondral sclerosis - subchondral cyst formation |
osteoarthritis
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Hallmark and other radiographic findings in rheumatoid arthritis
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* marginal bony erosion
- subchondral cyst formation - juxtaarticular osteopenia - joint space narrowing - ankylosis (occasionally) |
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The following findings occur in what type of arthritis?
* marginal bony erosion - subchondral cyst formation - juxtaarticular osteopenia - joint space narrowing - ankylosis (occasionally) |
rheumatoid
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What is the classic radiographic finding in calcium pyrophosphate dihydrate deposition disease?
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Chondrocalcinosis
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Chondrocalcinosis is the radiographic halmark of
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calcium pyrophosphate dihydrate deposition disease
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Radiographic findings in Paget's disease
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- enlargement of an affected bone
- increased opacity of the involved bone - disorganized and coarsened trabecular pattern |
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Characteristic radiographic findings in gouty arthritis
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- erosions slightly removed from the joint
- overhanging edge - soft-tisse tophus |
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Is arthritis in SLE erosive or non-erosive?
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non-erosive
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Does arthritis in SLE involve the articular cartilage?
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no
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Most common level(s) of occult spine fracture after trauma missed by plain radiograph
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C1 and C7
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What % of patients with one spinal fracture have other spine fracture(s)
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5-30%
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Common BP response after immobility
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orthostatic hypotension
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General description of cardiac changes after immobilty
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- blunted cardiac response to rapid change in posture
- increased resting heart rate - increased HR response to exercise |
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2 essential components of increasing speed of return to work after low back pain (and citation)
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- therapeutic functional rehabilitation
- ergonomic intervention (Loisel 1997 RCT) |
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Guidelines for exercise in pregnant women
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- 60-85% of predicted maximum heart rate
- 30-45min of exercise 3-4 days per week - avoid supine exercise as may decrease cardiac output and divert blood away from the splanchnic beds (including uterus) |
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When can you use a TLSO for scoliosis?
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When the apex is at T9 or lower
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What kind of orthosis should you use for scoliosis with an apex at T4?
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CTLSO
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Polymyositis is also known as
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idiopathic inflammatory myopaty
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EMG changes consistent with inflammatory myopathy
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- motor units: short duration samll polyphasic
- fibrillations - positive waves - high frequency repetitive discharges |
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Prevalence of shoulder pain in patients with SCI
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30-50%
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The focus of treatment for shoulder pain in patients with SCI is primarily
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pain relief
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What kind of strengthening is often helpful in SCI patients with shoulder pain?
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scapular stabilizers
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Muscles within any radiation field are at risk for ____ and ____
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fibrosis and contracture
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Muscles that are commonly shortened following radiation to the chest wall
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pec major and minor
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Long term pain relief from pec shortening requires
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stretching
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shortening of the pectoralis muscles places the scapula in what position?
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protracted and depressed
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Cisplatin is associated with what type of neuropathy?
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axonal loss sensory neuropathy
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Common musculoskeletal presentation of lead poisoning
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upper extremity weakness
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Most common pattern of nerve involvement in polyarteritis nodosa
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mononeuropathy multiplex
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Most common of the necrotizing vasculitides
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polyarteritis nodosa
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Charcot-Marie-Tooth disease type I causes what type of neuropathy?
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uniform demyelination of peripheral nerves
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In a patient with transfemoral amputation, how in knee stability maintained in extension in stance phase (from heel contact to foot flat)
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prosthetic knee joint is aligned posterior to the trochanteric knee ankle line
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In a prosthetic limb, a plantar flexion bumper than is too stiff promotes knee _____
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knee flexion
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In a prosthetic limb, an extensive foot dorsiflexion promotes knee _____
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knee flexion
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In a prosthetic limb, a change in heel height from low to high promotes knee _____
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knee flexion
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Two prosthetic causes of knee instability
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- knee excessively anterior relative to hip and ankle
- excessive socket flexion |
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Surgery of choice for a patient with rheumatoid knee arthritis, severe pain and loss of function
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total knee arthroplasty
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What is the role for hemiarthroplasty in rheumatoid arthritis?
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contraindicated...the whole joint is involved
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What is the effect of synovectomy in knee rheumatoid arthritis
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temporary pain relief and decreased swelling
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Inheritance of myotonic dystrophy
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autosomal dominant
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Gene for myotonic dystrophy is on chromosome __
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19
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Systemic manifestations fo myotonic dystrophy
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- cataracts
- testicular atrophy - heart disease - dementia - baldness |
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How does a transplanted heart acheive maximal heart rate?
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relies on circulating catecholamines (the heart is dennervated)
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Relative SBP and DBP in patients after cardiac transplant
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high than controls
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Relative resting heart rate after cardiac transplant
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higher (loss of vagal input)
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Relative peak heart rate during maximal exercise after cardiac transplant
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lower
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CMMS currently reimburses inpt rehabiltation based on what kind on system?
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prospective payment system (PPS)
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Most sensitive electrodiagnostic test for myasthenia gravis
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single fiber EMG (with jitter measurement), ~95% sensitive
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Sensitivity of peripheral nerve stimulation in diagnosis of myasthenia gravis
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about 90%
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Sensitivity of acetylcholine receptor antibody testing in diagnosis of myasthenia gravis
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about 90%
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Best way on clinical exam to try to differentiate stress fracture from medial tibial stress syndrome
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stress fracture has more focal pain with percussion
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Risk of urinary retention after stroke is ____
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low
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Post-acute stroke bladder problem is usually
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disinhibited bladder with urinary incontinence
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Percentage of patient with rheumatoid arthritis that have rheumatoid nodules
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50%
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Is keratoconjenctivitis sicca rare or common in RA?
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common
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Is microcytic anemia rare or common in RA?
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common
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What renal disease is associated with RA?
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glomerular disease (rare)
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Indications for spinal instrumentation in neuromuscular scoliosis
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- primary curve >25 degrees
- forced vital capacity > 35% |
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1st line med therapy for SCI patients with neuropathic pain
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TCA
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2 common side effects of paroxetine
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- insomnia
- sexual dysfunction |
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Common anticholinergic side effects of TCAs
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- dry mouth
- urinary retention - sedation |
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Can you take disease modifying agents (such as etanercept) in the post-operative period?
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generally no - need to stop immunosupression in order to allow tissue healing and avoid infectious complications
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4 most common causes of death (in the first year) in patients with SCI who survive more than 24 hours
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- pulmonar dysfunction (pneumonia/ARDS)
- non-ischemic heart disease - septicemia - pulmonary embolus |
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A football player with bilateral arm pain after a play should be considered to have ______ until proven otherwise
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cervical spinal cord injury
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If you suspect cervical SCI in a football player should you remove the helmet?
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no
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A football player has a temporary stinger involving 1 limb, when can he return to play?
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when neuro exam normal
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Initial treatment of osteoarthritis is
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therapy to relieve joint symptoms (including ROM and strengthening)
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Key elements of guiding "light duty" work recommendations
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- return to work ASAP so progress at work is expected
- fit duties to impairment - avoid provocative activities |
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What is the most common pattern of spinal cord injury in children less than 6 year old?
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- SCI in motor vehicle collision
- injury at T1 or lower - more likely to have complete injuries |
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In descending order, list the 6 highest risk factors for late post-traumatic seziures
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- bilateral parietal contusion (66%)
- penetration of the dura (62.5%) - multiple intracranial operations (36.5%) - multiple subcortical contusions (33.4%) - subdural hematoma with evacuation (27.8%) - midline shift greater than 5mm (25.8%) |
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Define myopathy
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disease or abnormal condition of striated muscle
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Define myalgia
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muscle aching or weakness without serum CK elevations
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Define myositis
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muscle symptoms accompanied by CK elevation
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Define rhabdomyolysis
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muscle complaints with CK elevations 10 times the upper limit of normal and cretinine elevation.
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Rhabdomyolysis occurs in what % of patients on statins (monotherapy)?
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0.1%
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Overall death rate from statins
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0.15 per 1 million prescriptions
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Best way to determine if patient is ready to return to work after an injury...
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functional capacity evaluation
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If deficits are noted on a functional capacity evaluation, what best ensures return to work?
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work hardening program over several weeks.
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Is work conditioning job specific?
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no
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Athletes with repeated shoulder dislocations should consider what type of intervention?
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shoulder stabilization surgery
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Statin induced myopathy typically affects what type of fibers?
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type II
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Guidelines for reinstituting statins after myopathy...
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start at lower dose after symptoms and CK are back to normal
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Which type of bone metastases have the highest rate for pathological fracture?
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lytic lesions
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Are bony mets from prostate cancer usually blastic of lytic?
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blastic
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Are bony mets from breast cancer usually blastic of lytic?
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lytic
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Are bony mets from lung cancer usually blastic of lytic?
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lytic
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Are bony mets from kidney cancer usually blastic of lytic?
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lytic
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Should a patient with posterior interosseous nerve injury have sensory complaints?
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no
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% of patients with post-traumatic hydrocephalus that gain significant benefit from shunting
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50%
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The interdisciplinary approach to patient care emphasizes
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common patient and team goals
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Needle EMG insertion for indicis proprius?
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- forearm fully pronated
- 2 fingerbreadths proximal to the ulnar styloi and just radial to the ulna |
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Needle EMG insertion for extesnor digitorum communis?
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Junction of the upper and middle third of the forearm between the radius and ulna
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Needle EMG insertion for extensor pollicis brevis?
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4 fingerbreadths proximal to the wrist and directly over the ulnar side of the radius
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Needle EMG insertion for extensor pollicis longus?
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Mid-forearm along the radial border of the ulna.
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When should upper extremity prosthesis fitting be initiated in the adult?
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within the first month (maximize level of acceptance and use)
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2 most common levels for osteoporotic fractures of the spine?
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- midthoracic spine
- thoracolumbar junction (fractures at other levels should trigger investigation for pathologic fractures) |
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Top 3 causes of traumatic SCI in the US are
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- MVC
- falls - violence |
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Custom seating should be used on WCs in cerebral palsy patients with...
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fixed deformities
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Adapted strollers are good for cerebral palsy patients when...
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needed as a backup to WC, or for children who can walk but need to periodically rest after seizure or from fatigue
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In L&I cases, discussions with the case manager should be done...
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in the setting that the patient requests
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Blink reflex studies may be helpful in assessing which conditions?
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- facial nerve lesion
- trigeminal nerve lesion - brain stem lesions |
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Do demyelinating peripheral neuropathies affect potentials of the blink reflex study?
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yes
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Top 3 places where bone mineral density changes are seen after stroke
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- humerus of the paretic side
- proximal femur of paretic side - distal radius of paretic side |
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Mechanism of action of rituximab (rituxan)
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it's a monoclonal antibody that binds B-lymphocyte CD20 surface antigens (depletes B cell population)
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What medication can you use in treatment of RA for patients on MTX who fail TNF-a blocker therapy?
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rituximab
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Mechanism of action of etanercept
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TNF alpha antagonist
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Mechanism of action of abatacept
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block co-stimulatory molecules of t-cell activiation
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Mechanism of action of anakinra
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inhibits interleukin-1 type receptors
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Next step in management in a vent dependent tetraplegic patient 12 months after injury
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EMG to evaluate phrenic nerves to consider phrenic nerve pacing
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What pulmonary parameter should you follow in patients with ALS? Why?
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- forced vital capacity
- correlates with disease progression and disability |
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Double limb support normally is ___% of the gait cycle
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20%
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Single limb support normally is ___% of the gait cycle
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40%
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Stance phase normally is ___% of the gait cycle
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60%
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Swing phase normally is ___% of the gait cycle
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40%
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Define minimally conscious state
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severely altered consciousness in which minimal but definitie behavioral evidence of self or environmental awareness is demonstrated
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Examples of interactions/awareness that may be seen in minimally conscious state
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- simple gestures
- purposeful behavior - appropriate cry, smile or vocalization - reaching for object - purposeful visual tracking |
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Define vegetative state
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preserved hypothalamic and brainstem autonomic function and sleep/wake cycles in the absence of cortical activity (judged behaviorally)
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Define coma
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not awake and not aware of surroundings
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Which type of Charcot Marie Tooth disease has the most functional variability?
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CMT type II
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EMG findings in CMT I typically indicate
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demyelination
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EMG findings in CMT II typically indicate
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axonal loss
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Inheritance of Charcot Marie Tooth Disease is
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autosomal dominant
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Motor NC velocities in CMT 1 are...
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less than 70% of the lower limits of normal
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SCI with weakness greater in upper extremities than lower is ____ pattern
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central cord
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SCI with paralysis, bilateral loss of pain and temp and relatively preserved proprioception/vibration is ____ pattern
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anterior spinal cord syndrome
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Incomplete SCI with loss of proprioception more is ________ syndrome
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posterior cord syndrome
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Why is truck driving thought to be associated with increased low back pain?
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whole body vibration; possibly increased disc protrusion
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What is the recruitment ratio in myopathy?
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less than 5
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Increased recruitment ratio and large motor unit amplitudes are associated with ______ process
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neuropathic
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Are f-waves abnormal in myopathy?
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usually not
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7 causes for circumduction gait in a patient with transfemoral ampuatation
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- excessive mechanical resistance to knee flexion
- too much stability - prosthesis too long - increased medial brim pressures - inadequate suspension - patient lacks confidence - inadequate hip flexion |
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To allow pronation of the foot, which 2 joints must have their axis of rotation in parallel?
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-talonavicular and calcaneocuboid joints (transverse tarsal joint)
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What position must the midfoot be in to supinate?
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rigid (transverse tarsal joint axes must intersect)
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General approach to therapy after severe stroke
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Work on higher level functions such as gait even if they're having problems with balance, etc.
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Lifestyle factors that negatively impact bone mineral density
|
* smoking
* high intake of caffeine - high protein intake - phosphorus |
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Autonomic dysreflexia occurs in patients with SCI level ___
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T6 and above
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Top two causes of autonomic dysreflexia
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- bladder distention
- bowel impaction |
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In a patient with transtibial amputation, which has more cardiovascular demand...ambulation unilaterally with crutches or ambualtion with prothesis
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Ambulation with crutches has higher O2 consumption, HR, energy costs and respiratory exchange rate
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7 poor prognostic factors for surgical repair after nerve injury
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- advanced age
- stretch/dislocation injury - repair after >5 months - prior radiation - nerve discontinuity > 2.5cm - proximal nerve injury - poor condition of nerve endings |
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The Moro reflex integrates at what age?
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6 months
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The asymmetric tonic neck reflex integrates at what age?
|
6 months
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The plantar grasp reflex integrates at what age?
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12-14 months (after walking starts)
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Protective extension in sitting is seen anteriorly at
|
5-7 months
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Protective extension in sitting is seen laterally at
|
6-8 months
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Protective extension in sitting is seen posteriorly at
|
7-8 months
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Pharmacologic treatment of pts with first ischemic stroke and single positive antiphaspholipid antibody test
|
ASA 325mg q day
OR Moderate Warfarin (INR 1.4-2.8) |
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Arthritis mutilans is found typically found in what disease process?
|
psoriatic arthritis
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What is Auspitz's sign?
|
pinpoint bleeding after scraping of psoriatic plaque
|
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What is dactylitis?
|
"sausage digits"
- combination of tenosynovitis and arthritis of DIP or PIP |
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What is Jaccoud's arthritis?
|
non-erosive deforming arthritis in SLE
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Non-erosive deforming arthritis in SLE is called
|
Jaccoud's arthritis
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When is surgery usually indicated for closed nerve injury of the UE?
|
incomplete loss of function but no improvement over several weeks or no return of function at 2 months (peripheral nerve) or 4 months (brachial plexus).
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Chances of successful surgical repair of close nerve injury start to decline after
|
6 months
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Target exercise intensity for optimal aerobic training in a healthy young individual based on HR?
|
70-80% of maximum heart rate
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Target exercise intensity for optimal aerobic training in a healthy young individual based on Borg scale?
|
11-15 (13 if you have to pick one number)
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What is the range on the Borg scale?
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6-20
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6 major characteristics of central autonomic dysfunction in children after severe brain injury
|
- HTN
- Hyperpyrexia - rigidity - tachypnea - tachycardia - diaphoresis |
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Are there any medications proven to be useful in treatment of autonomic dysfunction in children after severe TBI?
|
no
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2 main goals of knee orthoses
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- prevent genu recurvatum
- provide mediolateral stability |
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What movements are restricted/allowed in the Swedish knee cage?
|
- prevents recurvatum
- permits flexion |
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What movements are restricted in the 3 way knee stabilizer?
|
lateral, medial, posterior
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Define central sensitization in pain
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complex set of activation dependent post-translational changes occuring at the dorsal horn, brainstem and higher cerebral sites that sensitizes the central nervous system to further perception of pain.
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Define wind-up
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an amplified evoked response to repeated afferent inputs at the level or the dorsal horn
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The most common benign brain tumor in adults is
|
meningiomas (15% of all primary brain tumors)
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Is temporary weakness of the peri-articular muscles after knee arthroplasty normal?
|
yes
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Why is there loss of full flexion and extension after knee arthroplasty?
|
pain, edema, procedure itself
|
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ankle dorsiflexion weakness after knee arthorplasty is concerning for
|
peroneal nerve injury (direct pressure, hematoma, etc) - likely needs exploration
|
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Mechanism of action of etidronate
|
block late phase bone mineralization by preventing the conversion or amorphous calcium phosphate to hydroxyapatite
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Differential diagnosis of acute/subactue patchy sensory loss with normal motor NCS and small/absent sensory NCS
|
- paraneoplastic
- connective tissue disease (Sjogren's) - post-infectious - pyridoxine intoxication - isolated autoimmune process |
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Learned avoidance behaviors in pain behaviors are a form of _____ learning
|
operant learning
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Define respondent learning
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aversive stimulus is paired with a netural stimulus sot hat over time the neutral stimulus will come to elicit an aversive response
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2 major physical exam findings for poor prognosis after TBI
|
- decerebrate posturing
- flaccid muscle tone |
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7 major findings for good prognosis after TBI
|
- younger age
- reactive pupils - conjugate eye movement - decorticate posturing - early spontaneous eye opening - absence of ventilaroy support need - higher Disability Rating Score on admission |
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Differential diagnosis of acute/subactue patchy sensory loss with normal motor NCS and small/absent sensory NCS
|
- paraneoplastic
- connective tissue disease (Sjogren's) - post-infectious - pyridoxine intoxication - isolated autoimmune process |
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Learned avoidance behaviors in pain behaviors are a form of _____ learning
|
operant learning
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Define respondent learning
|
aversive stimulus is paired with a netural stimulus sot hat over time the neutral stimulus will come to elicit an aversive response
|
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2 major physical exam findings for poor prognosis after TBI
|
- decerebrate posturing
- flaccid muscle tone |
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7 major findings for good prognosis after TBI
|
- younger age
- reactive pupils - conjugate eye movement - decorticate posturing - early spontaneous eye opening - absence of ventilaroy support need - higher Disability Rating Score on admission |
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Mechanism of action of aledronate
|
inhibits normal and abnormal bone resorption
|
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Mechanism of action of amantadine (for mvnt disorders)
|
block nicotinic ACh ion channels
|
|
|
Mechanism of action of amitriptyline
|
- NE/serotonin reuptake inhibitor
- alpha-1 adrenergic blocker - antimuscarinic |
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Mechanism of action of baclofen
|
binds GABA-B receptors, inhibiting calcium influx into presynaptic terminals and suppressing spinal cord excitatory neurotranmitters
|
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Mechanism of action of capsaicin
|
depletes substance P from unmyelinated peripheral neurons
|
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Mechanism of action of carbamazepine
|
unknown
|
|
|
Mechanism of action of clonidine
|
central alpha-adrenergic agonist (decreases sympathetic discharge)
|
|
|
Mechanism of action of cyclobenzaprine
|
unclear.
Related to TCAs, thought to act at brainstem to reduce skeletal muscle hyperactivity but not effective for spasticity of central origin |
|
|
Mechanism of action of dizepam
|
post-synaptic facilitation of GABA (spasticity)
|
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Mechanism of action of dantrolene
|
reduces excitation-contraction coupling via reduction of sarcoplasmic reticulum Ca release
|
|
|
Mechanism of action of gabapentin
|
unclear
GABA analog without activity at GABA receptors |
|
|
Mechanism of action of lidocaine (patch)
|
inhibits Ca-mediated Na and K ion changes (stabilizes membranes)
|
|
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Mechanism of action of metaxalone
|
unknown; may be related to overall CNS depression
|
|
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Mechanism of action of methylphenidate
|
facilitates NE and dopamine release
|
|
|
Mechanism of action of modafinil
|
acts on anterior hypothalamus and other CNS centers
- increase glutaminergic transmission - decreases GABAergic transmission |
|
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Mechanism of action of oxybutynin
|
muscarinic blocker
- direct antispasmodic effect on smooth musle |
|
|
Mechanism of action of phenytoin
|
centrally acting modifying of Na, Ca, and K resulting in membrane stability
|
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|
Mechanism of action of prednisone
|
adrenocorticosteroid with glucocorticoid and mineralocorticoid activity
|
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Mechanism of action of sildenafil
|
selective PDE-5 inhibitor that increases cGMP levels and promotes smooth muscle relaxation in the corpus cavernosum
|
|
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Mechanism of action of tizanidine
|
central alpha-2 adrenergic agonist (presynaptic inhibition of motorneurons)
|
|
|
Mechanism of action of tolterodine
|
(Detrol)
- muscarinic blocker (antispasmodic effect on smooth muscle) |
|
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Mechanism of action of topiramate
|
Na channel blocker
|
|
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Mechanism of action of Tramadol
|
centrally acting synthetic non-opiod analogue of codeine
**weak Mu receptor agonism - serotonin/NE reuptake blockage - enhances serotonin release |
|
|
Mechanism of action of trazadone
|
? serotonin reuptake inhibitor
|
