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162 Cards in this Set
- Front
- Back
cervical DJD normally occurs here first
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C5-C6 then C6-C7
|
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cervical DJD occurs earlier in women or men?
|
men
|
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increased pain associated with cervical DJD with flexion if anterior anatomy is involved may involve_______
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herniation, disc damage
|
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increased pain associated with cervical DJD with extension if posterior anatomy is involved may involve_________
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facets, IVF encroachment
|
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cervical DJD signs are the worst at ___
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C3-C4
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T or F - cervical facet syndrome is normally localized but may radiate pain to the shoulders neck and head
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true
|
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a normal neutral, flexion and extension cervical x-ray should show less than ___mm of translation and less than ___degrees of angular displacement of one body on the next
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less than 3.5 mm
less than 11 degrees |
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approximately ___ % of patients with a radiculopathy have shoulder pain
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70%
|
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most common nerve root levels for cervical radiculopathy
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C7 (60%)
C6 (25%) |
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nerve root level(s) of suprascapular pain resulting from a radiculopathy
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C5 or C6 nerve roots
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nerve root level(s) associated with a radiculopathy resulting in interscapular pain
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C7 or C8 nerve roots
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nerve root level(s) associated with a radiculopathy resulting in scapular pain
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C8
|
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T or F - a radiculopathy of the cervical spine is likely to be exacerbated by the shoulder abducted and hand behind the head (Bakody's sign)
|
False
Bakody's sign likely to relieve symptoms |
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a patient treated for a radiculopathy should show signs of improvement within __ weeks
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6 weeks
|
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who might have been the first to describe TMJ syndrome?
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Hippocrates
|
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When evaluating a muscle strain/sprain, what should always be ruled out?
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Hemarthrosis
Fracture Radiculopathy |
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Normal jaw opening is ___ mm minimum
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40 mm min (3 finger tips)
|
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Protrusive and lateral mandibular movement is normally ____ cm
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1 cm
|
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Are x-rays ususally useful diagnosing TMJ
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No
MRI might show disc position however |
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What 4 conditons must be differentiated between when diagnosing TMJ?
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Headache
Temporal / Giant cell arteritis Trigeminal neuralgia Dental infections, parotiditis |
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2 synonyms for TOS
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scalenus anticus syndrome
cervical rib syndrome |
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T or F
TOS is often underdiagnosed. |
False
it's overdiagnosed |
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What nerve root level is normally associated with TOS?
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C8-T1
|
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TOS more prevalent in men or women?
Neurological type? Venous Type? Arterial Type? |
Neuro - Females (20-50 years)
Venous - Males (20-35 years) Arterial - Same (yng adlt->50 years) |
|
% population with cervical rib
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10%
(only 1% are symptomatic) |
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Can a TP cause TOS?
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Yes
an elongated C7 TP |
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Name 3 muscles commonly associated with TOS
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subclavian
pec minor scalenes |
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Is TOS pain normally down the medial or lateral aspect of the arm
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medial aspect
|
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Which type of TOS is by far the most common?
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Neurological
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Headaches associated with TOS are normally where?
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Occipital region
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A condition associated with TOS consisting of hand coldness, intolerance to cold, and color change.
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Raynaud phenomenom
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Swelling of the arm is associated with which type of TOS?
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Venous
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Pain, pallor, coldness and parasthesias normally in young adults is what type of TOS?
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Arterial
|
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Name 3 tests for vascular TOS
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Roos
Adsons Wrights (though aren't very reliable) |
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What grade of rotator cuff strain presents ecchymosis, arm drop sign?
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Grade 3 (severe)
|
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T or F
A grade 2 (moderate) rotator cuff strain presents a marked loss of strength and takes 2 weeks to 1 year to heel. |
True
|
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Name 3 tests for rotator cuff injury
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Codmans
Apleys Suprispinatus stress test (empty can) |
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Shoulder impingement is irritation or pinching of the ____ or ____ tendons as they pass b/t the ____ arch and the ____
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biceps brachii or rot cuff tendons passing b/t the coracoacromial arch and greater tuberosity
|
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Which stage(s) of shoulder impingement is reversible by conservative treatment?
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STAGE 1
Stage 2 and 3 are irreversible |
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4 types of shoulder impingement
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Anterosuperior
Posterosuperior Subcoracoid Spinoglenoid |
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This type of shoulder impingement is a primary mechanical impingement
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Anterosuperior
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This type of shoulder impingement involves the suprascapular nerve
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Spinoglenoid
|
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This type of shoulder impingement is an internal impingement
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Posterior superior
|
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T or F
Subcoracoid type of shoulder impingement is very rare |
True
|
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Type of shoulder impingement involving forward elevation (flexion) and abduction
i.e. throwing, swimming |
Anterosuperior
|
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Type of shoulder impingement could result in atrophy of the infraspinatus from repeated ballistic overhead activities
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Spinoglenoid
|
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Type of shoulder impingement results in posterior shoulder pain resulting from repeated overhead abduction-external rotation
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Internal
|
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3 types of Glenohumeral instability
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Traumatic
Atraumatic dislocation Acquired |
|
T or F
Traumatic type glenohumeral instability is more common in elderly than young |
False
More common in young |
|
T or F
Glenohumeral instability is a common cause for poor response to conservative treatment |
True
in biceps tendinopathy, rot cuff inj, impingement, and subacrom bursitis |
|
Calcific tendinopathy commonly occurs in what muscles of the shoulder?
|
supraspinatus
infraspinatus (occasionally) |
|
4 phases of calcifying tendinopathy
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Formative
Resting Resorptive Postcalcific |
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2 causes of the loss of ROM in Frozen shoulder
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adhesive capsulitis
soft tissue contracture around the GH joint |
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4 stages of Frozen shoulder
|
Pre-adhesive
Acute adhesive synovitis Maturation Chronic |
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Is Frozen shoulder more common in laborer or sedentary people?
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Sedentary people
women > men |
|
MCL or LCL more common elbow sprain?
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MCL
|
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Panner's disease is synonymus with
|
Elbow Osteochondritis
|
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Most common body part affected by osteochondritis
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1. knee (most common)
2. ankle 3. elbow |
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Elbow osteochondritis is commonly associated with VARUS or VALGUS stress?
|
Valgus
i.e. throwing |
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Tennis elbow or Carpenter's elbow is synonymus with
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Lateral epicondylitis
|
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Most common overuse injury of the elbow
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Lateral epicondylitis
|
|
T or F
Inflammation is a key factor in diagnosing lateral epicondylitis |
False
no signs of inflammation |
|
pitted nails may indicate
|
psoriasis or alopecia areata
|
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ulnar deviation of fingers and wrist
Haygarth's and Bouchard's nodes often present |
Seal fin deformity
|
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associated with severe/chronic ulnar neuropathy where the interossei muscles of the hand atrophy
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Skeleton hand
|
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associated with metacarpal fracture - rotational displacement
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Skewed finger/hand
|
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nails become thin and concave dorsally
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Spoon nails
|
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finger deformity where proximal interphalangeal joint is hyperextended and distal joint is flexed
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Swan neck deformity
|
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fusiform swelling in the flexor digitorum superficicalis tendon, snapping initially then locking
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Trigger finger/thumb
|
|
ischemic contracture of anterior forearm muscles with varying degree of neurological deficits
|
Volkman's ischemic contracture
|
|
associated with severe/chronic radial neuropathy usually with lesion at elbow
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Wrist drop deformity
(Drop hand) |
|
spider fingers
|
arachnodactyly
|
|
congenital anomaly - extra toes / fingers
|
polydactyly
|
|
congenital anomaly - fusion or webbing of the toes / fingers
|
syndactyly
|
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most common compressive neuropathy
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carpal tunnel syndrome
|
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CTS is often accompanied by
|
wrist flexor tendonopathy
|
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T or F
In CTS, numbness is usually over the palm and ant wrist |
False
thumb, index, and middle finger (if palm is numb, the lesion is likely near the elbow or brachial plexus) |
|
BEST test for CTS
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Phalen's compression test
|
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tenosynovitis of the abductor pollicus longus and extensor pollicus brevis at snuff box
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de Quervain's tenosynovitis
|
|
washer woman's strain
blackberry thumb |
de Quervain's tenosynovitis
|
|
test for de Quervain's
|
Finkelstein's
|
|
a ganglion cyst of the distal interphalangeal joint is aka
|
mucous cyst
|
|
T or F
Ganglion cysts are connected to the skin. |
False
must differentiate b/t a ganglion and a skin tumor or sebaceous cyst |
|
Which is soft and large?
Arthrosynovial cyst or Tenosynovial cyst |
Arthrosynovial
|
|
a possibly beneficial test for a Ganglion cyst
|
Allen's
|
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In a Slipped Capital Femoral Epiphysis, which direction is the femoral epiphysis displaced?
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posterior and inferior
due to a weakness in the epiphyseal growth plate |
|
aka - adolescent coxa vara
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slipped capital femoral epiphysis
|
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mild limp or awkward gait with the affected foot turned out, and a externally rotated and adducted thigh
Possible pos. Trendelenburg |
Slipped Capital Femoral Epiphysis
|
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Pediatric condition involving avascular necrosis of the femoral capital epiphysis ossification center resulting in deformity of the femoral head and degenerative arthropathy
|
Legg-Calve-Perthes (LCP)
|
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T or F
Legg-Calve-Perthes will present a negative Fabere's |
False
+ Fabere + Thomas +Trendelenburg +Grinding w/circumduction + Anvil |
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Ant or sup displacement/dislocation of the femoral head from the acetabulum in young children
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Congenital Hip Dislocation
|
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aka neonatal hip displasia
|
congenital hip dislocation
|
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What during the 1st trimester may cause congenital hip dislocation of the baby?
|
maternal hyperthyroidism
|
|
T or F
In congenital hip dislocation, the gluteal fold would be higher on the dislocated side. |
True
|
|
Tests for Congenital Hip Dislocation
|
+ Trendelenburg (in older children)
+ Ortolani's Click + Alli's sign + Barlow's |
|
most common knee sprain
|
MCL
|
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most common severe knee sprain / rupture
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ACL
|
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what is affected in the Unhappy Triad
|
ACL, MCL, medial meniscus
|
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what is affected in the New Unhappy Triad
|
ACL, MCL, lateral meniscus
|
|
MCL or LCL?
valgus / abduction force injury |
MCl
|
|
MCL or LCL?
varus / adduction force injury |
LCL
|
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ACL or PCL?
post to ant force injury |
ACL
|
|
ACL or PCL?
ant to post force injury |
PCL
|
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Which ligament is most commonly vulnerable with all of the directional knee injuries?
|
ACL
|
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Most meniscus tears are Medial or Lateral?
|
Medial
|
|
Which meniscus is "C" shaped?
|
Medial
Lateral is "O" shaped |
|
T or F
The menisci are not vital to knee function. |
False
this was once thought, but now we know they distribute the load |
|
Which compresses the lateral meniscus and tractions the medial meniscus?
Valgus or Varus stress |
Valgus
(opposite for Varus) |
|
2 types of meniscal tears
|
Traumatic
Degenerative |
|
What is considered a "red flag" if suspecting a traumatic meniscal tear?
|
pain is localized at joint line
knee locking and catching |
|
Tests for meniscal tear
|
Apley's prone compression/grind
Bounce home test Steinman's etc. |
|
Clarke's test
|
Chondromalacia Patella
|
|
avascular necrosis of subchondral bone and overlying articular cartilage that may lead to fragmentation or fracture
|
Osteochondritits Dessicans
|
|
2 forms of osteochondritis dessicans
|
juvenile
traumatic |
|
most common site of osteochondritis dessicans
|
knee
|
|
Test for osteochondritis dessicans
|
Wilson's
|
|
traction apophysitis of tibial tubercle
|
Osgood Schlatter's
|
|
Is Osgood Schlatter's synonymous with osteochondritis?
|
No
often incorrectly defined |
|
Can Osgood Schlatter's be bilateral?
|
Yes
|
|
Fibromyalgia has been linked to low levels of ___
|
serotonin
|
|
Fibromyalgia has been linked to a 4-fold increase in ____
|
nerve growth factor
|
|
A typical patient with fibromyalgia has seen ___ physicians and had it for ___ years before being properly diagnosed
|
15 docs
5 years |
|
how many tender points must be present to indicate fibromyalgia?
|
11 of 18 (bilateral)
|
|
Name the 9 locations of the indicative tender points of fibromyalgia
|
1. Occiput
2. Cervical (C5-7 art pills) 3. 2nd rib 4. Lat epicondyle 5. Knee (medial) 6. Trap 7. Supraspinatus 8. Gluteal region (sup-lat) 9. Greater trochanter |
|
Must differentiate fibromyalgia from ___
|
myofascial pain syndrome
|
|
progressive degeneration, loss of articular cartilage and joint margin changes of diarthrodial joints
|
Osteoarthrosis
|
|
DJD synonymous with ___
|
osteoarthosis/itis
|
|
T or F
PIP, DIP and cervical spine often affected by osteoarthrosis |
True
|
|
T or F
Primary osteoarthosis is due to metabolic disturbances. |
False
Secondary (Primary is due to wear and tear) |
|
Where are men and women more likely to develop osteoarthrosis?
|
men = hip
women = hand |
|
Heberden's nodes
|
Osteoarthrosis
|
|
Bouchard's nodes
|
RA
|
|
Seal fin deformity
Swan neck deformity Boutenniere deformity Bouchard's nodes |
RA
|
|
chronic autoimmune inflammatory disease resulting in symmetrical joint pain and swelling and destruction of the joints
|
RA
|
|
RA begins with which joints?
|
PIP and MCP
|
|
What is the key finding of RA?
|
symmetry
|
|
Rheumatoid nodules are most commonly found where?
|
distal to the olecranon
|
|
T or F
RA never affects the DIP |
True
|
|
What syndrome occurs as result of RA that may develop due to atrophy of lacrimal glands?
|
Sjogren's syndrome
|
|
What are the Cardinal signs of acute inflammation?
|
SHARP
Swelling Heat A loss of function Redness Pain |
|
3 phases of soft tissue healing
|
I - Acute inflammation
II - Post acute repair/proliferation III - Remodeling |
|
How long does each phase of soft tissue healing last?
|
I - 1-2 days, up to 5
II - 48 hours to 6 weeks III - 3 weeks to 12 months |
|
Which phase of soft tissue healing involves granulation and epithelialization
|
Phase II
|
|
T or F
Scar tissue is stronger than original tissue |
False
only 80% |
|
T or F
Corticosteroids slow healing. |
True
|
|
2 types of strokes
|
ischemic
intracerebral hemmorrhage (ICH) |
|
focal brain ischemia causing sudden onset of transient neurological deficits
|
Transient ischemic attack (TIA)
|
|
mini-stroke
|
TIA
|
|
insufficient blood supply to the brain due to disruption in blood flow supplied by the carotid or vertebral artery
|
Vertebrobasilar Ischemia (VBI)
|
|
"beauty parlor stroke"
|
VBI
|
|
odds of VBI from manipulation
|
1 in 5.85 million
|
|
Hoffman's test
|
flicking finger
|
|
Brudzinski's test
|
meningitis
|
|
Babinski
|
UMN lesion (pyramidal)
|
|
Mill's test
|
lat epicondylitis
|
|
Cozen's test
|
lat epicondylitis
|
|
Golfer's elbow
|
med epicondylitis
|
|
hypertrophy of synovial tissue and infiltration of white cells
(destructive) |
pannus
common in RA |
|
Due to pannus, there may be instability at what spinal level seen in RA
|
C1-C2
|
|
___% of pop has fibromyalgia
|
2 %
|
|
fibromyalgia was once called ___
|
rheumatism
|
|
Fibromyalgia presents pain with ___ lbs. of force applied to tender points
|
8.8 lbs.
|