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478 Cards in this Set
- Front
- Back
|
#1 cause of upper extremity amputation in adults and what kind of amputation is it?
|
Trauma, right transradial
|
|
#1 etiology of amputation in children less than 10 years old
|
congenital
|
|
#1 cause of pediatricamputation in children age 10-20
|
tumor
|
|
How long should one wait before prescribing a prosthesis after someone terminates chemotherapy?
|
6 weeks
|
|
What is the amputee survival rate for 5 years in diabetics? Nondiabetics
|
40%, 70%
|
|
What is the most common cause of hyperlordosis in AKA patients?
|
hip flexor tightness
|
|
What % of claudicants are stable for 5 years
|
75%
|
|
A cane can support how much body weight?
|
25%
|
|
each crutch can support how much body weight?
|
45%
|
|
Increase in energy consumption for BK prosthesis in vascular vs trauma patients?
|
45% vs 11%
|
|
Increase in energy consumption for AK prosthesis?
|
65%
|
|
increase in energy consumption for bilateral AKA?
|
110%
|
|
What degree of knee flexion contracture interferes with all stage of gait?
|
30 degree
|
|
MOst common congenital amputation
|
left transverse radius upper 1/3
|
|
which congenital amputation is associated with learning difficulties
|
congenital RUE
|
|
complete absence of one or more limbs
|
amelia
|
|
partial limb deficiency
|
meromelia
|
|
When should a prosthesis for a congenital amputation be added?
|
18-24 months
|
|
When should a prosthetic elbow control mechanism be added to a prosthesis in congenital amputation?
|
36-48 months
|
|
When should an articulated knee joint be added for congenital amputation?
|
36-48 months
|
|
A replacement prosthesis is needed how often in the first 5 years of life? age 6-12? age 13-21
|
every year for first 5 years, every 2 years age 6-12,every 3 years 13-21
|
|
what is the most commonly used terminal device?
|
voluntary opening
|
|
How much force does a rubber band exert?
|
1-1.5 lbs of force
|
|
How much pinch force is needed to do adls'?
|
7 lbs
|
|
what is considered severe ABI?
|
<0.4
|
|
For proper skin healing to take place after amputation, aBI must be greater than what? transcutaneous P02 must be greater than what?
|
>0.5, >35mmHg
|
|
What is the most appropriate knee for pt with weak knee extensors and good hip extensor strength who require a KAFO?
|
posterior offset knee
|
|
What %of patients have phantom pain?
|
50-80%
|
|
What is normal step length?
|
38cm
|
|
What is normal stride length?
|
75cm
|
|
What is normal stride width?
|
5-11 cm
|
|
What is normal cadence?
|
90-120 steps/min or 80m/min or 3mph
|
|
What % of gait cycle is spent in stance?, swing? double support?
|
60, 40, 20
|
|
During which phase of the gait cycle is the extension moment of the knee the greatest?
|
heel off
|
|
What are the 6 determinants of gait?
|
pelvic rotation, pelvic tilt, knee flexion, foot motion, knee motion, pelvic lateral displacement
|
|
Which determinant of gait leads to decreased excursion in horizontal plane?
|
pelvic lateral displacement
|
|
What is the average displacement during gait?
|
5cm in vertical and horizontal plane
|
|
Where is the center of gravity
|
5cm in front of s2
|
|
Center of gravity is highest when during gait? lowest?
|
mid stance, double support
|
|
Center of gravity is highest when during running? lowest?
|
flight phase, midstance
|
|
What is gluteus maximus gait?
|
posterior trunk bending
|
|
What are the weight bearing areas on a BKA prosthesis?
|
patella tendon, popliteal bulge, pretibial area, distal end of stump
|
|
What are the weight relief areas on a BKA prosthesis?
|
fibula head, tibial crest, hamstring tendons
|
|
How is initial socket flexion for a TF prosthetic determined?
|
5 degrees+ deg of flexion contracture
|
|
What is a thomas heel?
|
medial heel wedge that tilts heel into varus (good for plantar fasciitis or pes planus)
|
|
How should a <1/2inch Leg length discrepancy be treated? >1/2inch? >1 inch
|
may disregard or placed lift inside shoe; give lift on heel; left in heel and sole
|
|
What is a Klenzak ankle?
|
single channel ankle which allow for DF assist or plantar flexion stop
|
|
What is a TRAFO and how does it work?
|
tone reducing AFO which includes a footplate that extends past the toe to discourage toe flexion and metatarsal support to discourage stimulation to a particular reflexogenic area of the foot
|
|
What is a swedish knee cage designed for?
|
to control knee recurvatum
|
|
What are the most important muscles in crutch ambulation?
|
lats and pecs
|
|
If a heel is too stiff or too high, this will cause what motion at the knee?
|
flexion
|
|
If a socket is placed too posterior, what can happen at the knee?
|
too little knee flexion
|
|
What is the only muscle firing during quiet standing?
|
gastrocsoleus
|
|
What is the difference between a hammer and claw toe?
|
Both have hyperextension at MTP and PIP. Hammer toes have hyperext at DIP While claw toes have flexion
|
|
What is a c bar (AKA short opponens splint?)
|
maintains thumb abducted in median nerve palsies and c6-c7 tetraplegics to allow feeding and writing
|
|
term used to describe the work capacity of an individual
|
VO2 max
|
|
What is the rate pressure produce? What is it used for?
|
(HRxSBP)/100; estimate of myocardial oxygen consumption
|
|
What is the target HR in an exercise program for a cardiac pt? healthy pt? pt on B blocker?
|
70% max rate obtained on ESR; 70-85% of predicted age adjusted max (220-age); 85% symptom limited HR or 90% workload performed on EST
|
|
What is the Kavornen Formula?
|
Training HR= Resting HR + [(max HR-resting HR) x 60%] This will give you low end of HR zone.
|
|
Exercise increases O2 consumption at rest. True or false
|
false
|
|
Does exercise increase the maximal HR?
|
no (220-age)
|
|
MVO2 at rest (increases/decreases/stays the same) with exercise. Max MVO2 (increases/decreases/stays the same) with exercise.
|
decreases/stays the same (max MVO2 is determined by the anginal threshold)
|
|
What % of VO2max can the UE obtain compared to the LEs?
|
70%
|
|
When can a cardiac patient return to work?
|
sedentary work 5-7 METS, Greater than 7 mets = any job
|
|
AFter cardiac surgery, what is the most common injury to the brachial plexus?
|
lower trunk/medial cord/C8-t1 nerve root
|
|
In endurance exercise, what energy source do you predominately use?
|
FFA (Early on you use glycogen)
|
|
What is Fick's Equation and what is it used for?
|
technique for estimating cardiac output. CO= O2 absorbed per min by the lung (ml/min)/ AV O2 difference in blood (ml of blood) or VO2= CO x AV o2 difference.
|
|
Describe type 1 muscle fibers?
|
one slow ox...slow twitch, oxidative, slow fatiguing
|
|
Describe type 2 muscle fibers?
|
fast twitch, glycolytic, easy fatiguing
|
|
How long after uncomplicated MI can a maximal effort EST be perfomred
|
6 weeks (gives time for scar to form)
|
|
At what PO2, should supplementary oxygen be used?
|
PO2 < 55-60mmhg
|
|
On PFTS, what is the best indicator of COPD?
|
mid max expiratory flow rate
|
|
At what FEV1 do COPDs generally start experiencing dyspnea?
|
1500ml
|
|
At what FEV1 do people benefit from pulmonary rehab?
|
FEV<2000ml
|
|
Pursed lip breathing can increase TV? true or false
|
true
|
|
What are the most important muscles in expiration?
|
abdominals (And internal intercostals)
|
|
What are the muscles of inhalation?
|
diaphragm, external intercostals, SCM, serratus anterior, anterior scalene
|
|
What position is best for drainage of superior segments of lower lobes?
|
prone
|
|
In DMD, what is the first sign of respiratory decompensation?
|
hypercapnia in REM sleep (later will have hypercapnea in all phases)
|
|
What happens to Vital capacity in upright vs supine position for SCI pt? normal pt?
|
In SCI, VC increases when supine. In normal pt, VC decreases when supine
|
|
Does exercise improve spirometric values in copd pt?
|
no
|
|
At what PCO2 and FEV1 should a copd pt be placed on nocturnal ventilation?
|
FEV1< 25% of norm, PCO2>45mmHg
|
|
What rate must peak cough flow be to avoid intubation?
|
2.7L/sec or 160L/min
|
|
What is the difference between a Hill Sachs deformity vs Bankart lesion?
|
Hill Sachs is a fracture of posterior superior humeral head while a bankart lesion is a tear of the glenoid labrum
|
|
Where does most of cervical rotation occur?
|
c1-c2
|
|
Where does most cervical flexion occur?
|
c5-c6
|
|
What is the most important structure for atlanto-axial stabilization?
|
transverse cruciate ligament (prevents forward translation)
|
|
What ligament controls lateral movement and rotation of the AA joint?
|
alar ligament
|
|
What is the most common cervical ligament damaged in rear end collision?
|
ALL between C4-C7
|
|
What is a Monteggia fracture/dislocation and what nerve is most commonly involved?
|
frx of proximal ulna with dislocation of proximal radius; PIN
(MUGR: Monteggia ulna, Galeazzi radius) |
|
What is a Galeazzi fracture-dislocation?
|
fracture of the radius and dislocation of the distal ulna
|
|
What is the criteria for lumbar
spinal stenosis? |
<10mm widest AP diameter, lateral recess stenosis <3mm, canal area< 1.45cm2
|
|
What is the most common cause of low grade chronic metatarsalgia?
|
hyperpronation of depressed transverse arch
|
|
Immobilization causes atrophy of this muscle fiber type predominantly?
|
type 1
|
|
Aging causes atrophy more of this type of muscle fiber?
|
type 2
|
|
An immobolized muscle will lose how much strength per day?
|
1-3%
|
|
If immobilized for 3-5 weeks, pt will lose approximately what % of muscle strength?
|
50%
|
|
How does muscle hypertrophy occur?
|
increased number of myofibrils
|
|
With maximal exercise, how much increase in strength occurs per week
|
8%
|
|
Electrical stimulation transforms this type of muscle fiber?
|
type iib to type 1
|
|
What are types of conversion modalities?
|
US, diathermy
|
|
What are types of convection modalities?
|
whirlpools, fluidotherapy
|
|
What are types of conduction modalities?
|
paraffin, cold packs
|
|
Ultrasound is set at one intensity what penetration does it achieve?
|
0.5-2 watts/cm2; 5-7cm
|
|
What is the most common frequency of short wave diathermy?
|
27.12Mhz
|
|
Quad effort is decreased by how much with 20cc knee effusion?
|
60%
|
|
High Frequency TENS stimulates what nerve fibers
|
Abeta
|
|
What are shoulder precaution for the first 4 weeks after total shoulder arthroplasty
|
no active flexion/abduction. NO ER
|
|
What type of collagen is in articular cartilage?
|
type 2
|
|
What is a crescent sign?
|
thin curvilinear lucent line parallel to the femur bone seen in avascular necrosis.
|
|
what muscle is most commonly involved in a stinger?
|
deltoids
|
|
osteochondritis dessicanse is located classically here
|
lateral aspect of the medial femoral condyle
|
|
How much weight is needed for cervical traction?
|
>25lbs
|
|
What much weight is needed for lumbar traction?
|
>50lbs for posterior vertebral separation, >100lbs for anterior separation
|
|
During muscle contraction, What bands stay the same and which ones shorten?
|
H band, I band and z bands shorten (HIZ shortens) and A band stays the same
|
|
What are the components of the sinuvertebral n?
|
branch of the ventral rami (Somatic) and gray ramus communicans
|
|
After 6 months of disability from LBP, what % return to work? after 1 year? after 2 years?
|
50%, 25%, 0%
|
|
mode of inheritance for SMA1 and chromosome involved
|
autosomal recessive;5q11
|
|
Is CPK elevated in type 1 SMA?
|
usually no, may see mild elevation
|
|
What is seen on EKG in SMA 2?
|
tremulous baseline from cardiac fasciculations
|
|
What is the average age of death in SMA 2?
|
12 years
|
|
What is Kugelberg-Welandar Dz?
|
SMA type III
|
|
In SMA type III, which muscles become weak first?
|
pelvic girdle
|
|
What is the gene involved in DMD And Beckers?
|
xp21.2
|
|
First muscle to become weak in DMD?
|
gluteus maximus (Which leads to increased lumbar lordosis)
|
|
First muscle to become tight in DMD?
|
TFL/ITB (leading to wide based gait)
|
|
what gait pattern is seen in DMD when quads weaken?
|
rise onto toes to put weight line in front of knee and behind the hip
|
|
how much VC is lost after scoliosis surgery?
|
10%
|
|
When should scoliosis surgery be performed in DMD>?
|
When VC btw 1500-1800 and scoliosis curve>35 deg
|
|
What mobility deficit in DMD ultimately leads to cessation of ambulation?
|
ankle plantar flexion contracture
|
|
What is mode of inheritance of Emily-Dreifuss Muscular Dystrophy?
|
x linked recessive
|
|
What are the predominant areas of weakness in Emily Dreifuss MD?
|
slowly progressive weakness and atrophy in humeroperoneal distribution
|
|
What disease is associated with early contractures of the elbow, achilles tendon, and cervical paraspinals?
|
Emery Dreifuss Muscular Dystrophy
|
|
What is mode of inheritance of Fascioscapulohumeral muscular dystrophy?>
|
autosomal dominant
|
|
In myotonic dystrophy, is distal or proximal weakness more prominent?
|
distal
|
|
What type of CP is associated with greatest delay in walking?
|
dyskinetic
|
|
Most common type of CP seen in premies?
|
diplegic
|
|
Persistenc of how many primitive reflexes is associated with poor prognosis in CP?
|
3 or more at 18-24 months
|
|
W sitting is due to spasticity in what muscle group?
|
medial hamstrings
|
|
What is the SPLATT procedure and what is it used for?
|
splint anterior tibial tendon transfer - for equinovarus deformity
|
|
Best prognosis for ambulation in CP?
|
sitting by 2 yo.
|
|
What is the difference between the atonic neck reflex and symmetric tonic neck reflex?
|
STNR appears as ATNR is disappearing aroudn 5 months old. SNTR: forward head flexion will produce flexion of the upper extremities and extension of the lower extremities; extension of the head will produce extension of the upper extremities and flexion of the lower extremities. ATNR= Response observed - a UE flexion tone on the side opposite to the head turn with an increase in UE extensor tone in the side to which the head is turned
|
|
What reflexes are normally present at 1 year? (3)
|
parachute, foot placement(holding up infant, rubbing dorsum of foot against side of table - infant should lift foot and place on table), landau (Response observed - When the infant is suspended by the examiner’s hand in the prone position, the head will extend above the plane of the trunk. The trunk is straight and the legs are extended so the baby is opposing gravity. When the examiner pushes the head into flexion, the legs drop into flexion.
|
|
at what age can an child safely control an electric WC?
|
3
|
|
When should you start intermittent catheterization in spina bifida?
|
age 5
|
|
What is the most common type of scoliotic curve?
|
right thoracic
|
|
When do you start bracing for scoliosis?
|
20-40 degrees
|
|
when should scoliotic surgery be done?
|
curve>50 degrees or curve progression >40 deg despite bracing or increasing thoracic lordosis with bracing
|
|
What % of myelomeningocele develop clinically significant hydrocephalus?
|
90%
|
|
What type of hip disorder is associated with congenital muscular torticollis?
|
hip dysplasia
|
|
Most common cause of painful hip in children<10?
|
acute transient synovitis
|
|
What is Benedikts syndrome?
|
contralateral impairment of pain and temp; ataxia, chorea; oculomotor n. palsy due to posterior circulation stroke
|
|
Describe lateral medullary syndrome? which artery is most commonly involved?
|
vertebral artery (90%); Ipsilateral horners, dysphagia, dysarthria, ataxia, face pain/temp impairment. Contralateral pain and temp on body.
|
|
What is millard gubler syndrome
|
stroke in lateral pons. CN 6-7 involvement with contralateral hemiplegia (millard has 7 letters, gubler has 6)
|
|
depression in CVA is associated with this area of stroke
|
left frontal lobe
|
|
stroke in this area of the brain is more likely have seizures?
|
frontotemporal
|
|
What is the vascular supply to the hippocampus?
|
PCA
|
|
What is the vascular supply to basal ganglia?
|
MCA
|
|
What is the blood supply to anterior and posterior limbs of IC? genu?
|
MCA; ACA
|
|
Site of wernicke's aphasia
|
superior temporal gyrus
|
|
site of broca's aphasia
|
posterior inferior frontal gyrus
|
|
Which types of aphasia are not caused by MCA stroke?
|
transcortical motor (ACA) and transcortical sensory (PCA)
|
|
What is the time period for an immediate posttraumatic seizure?
|
24h
|
|
What is the time period for early PTS?
|
within first week
|
|
What is normal intracranial pressure?
|
0-10mm Hg
|
|
At what ICP will neuro deficits become evident?
|
>40
|
|
What is the most common late PTS?
|
focal
|
|
Describe the eye opening parameters on the GCS?
|
1. eyes do not open
2. eyes open only to pain 3. eyes open to voice 4. opens eyes spontaneously |
|
Describe the verbal response parameters on GCS?
|
1. no verbal response
2. incomprehensible 3. inappropriate words 4. confused speech 5. oriented, conversing normally |
|
Describe the motor response parameters on the GCS?
|
1. no movements
2. extension to painful stimuli 3. abnormal flexion to painful stimuli 4. flexion/withdrawal to painful stimuli 5. localizes painful stimuli 6. obeys commands |
|
What are the 5 outcomes on the glasgow outcome scale?
|
death, vegetative state, severe disability, moderate disability, good recovery
|
|
In addition to eye opening, verbal, and motor responses, this scale includes pupillary reactivity, oculocephalic reflexes, and occulovestibular reflexes to predict outcome after tBI
|
Glasgow-Liege Score
|
|
Describe Rancho VI?
|
confused and appropriate
|
|
Describe Rancho VII?
|
purposeful and appropriate
|
|
What areas of the brain are most susceptible to hypoxia?
|
cerebellar purkinje fibers, hippocampus, outer cortex and basal ganglia
|
|
In spasticity, which nerve tracts are excitatory to antigravity muscles?
|
vestibulospinal and reticulospinal
|
|
In spasticity, which nerve tracts are excitatory to antigravity antagonists?
|
corticospinal
|
|
In spasticity, which nerve tract is inhibitory?
|
lateral reticulospinal
|
|
What are risk factors for HO after TBI?
|
spasticity
> 2weeks of unconsciousness long bone fractures decreased range of motion |
|
What is the most common joint involved in TBI heterotopic ossification?
|
HIP (HESK: hip>elbow=shoulder>knee)
|
|
What is the treatment for HO in TBI?
|
20mg/kg/day of etidronate for 3months then 10mg/kg/day for 3-6 more months
|
|
What is the best test for auditory verbal memory?
|
Wechsler memory scale
|
|
Where is DAI usually found?
|
midbrain, pons, corpus collosum, and white matter of cerebral hemispheres
|
|
where is the lesion in decerebrate posturing?
|
upper pons and midbrain (below red nucleus and above vestibular nuclei)
|
|
Where is the lesion in decorticate posturing?
|
cerebral hemispheres (below thalamus and above red nucleus)
|
|
Where is the most common location of cerebral hematoma following blunt trauma?
|
frontoorbital
|
|
Subchondral cysts and sclerosis is seen with what type of arthritis.
|
OA
|
|
most common joint affected in OA?
|
CMC
|
|
Which joint is most likely to develop contractures in RA?
|
shoulder
|
|
Most common tendon torn in RA?
|
EPL
|
|
Most common eye symptom in RA?
|
keratoconjunctivitis
|
|
What is Felty's syndrome?
|
RA, splenomegaly, leukopenia
|
|
What is Caplan's syndrome?
|
RA with multiple pulmonary nodules
|
|
What is Jaccoud's arthritis?
|
non-erosive arthritis similar to RA but wihtou marginal erosions
|
|
Which type of JRA is associated with iridocyclitis?
|
pauciarticular
|
|
What is seen on muscle biopsy in polymyositis?
|
perifascicular atrophy
|
|
What is seen on muscle biopsy in inclusion body myositis?
|
rimmed vacuoles
|
|
What spinal cord abnormality is correlated with charcot shoulder?
|
syringomyelia
|
|
What is the Bunnel littler test?
|
limited PIP jt flexion with MCP in full extension (signifies intrinsic hand muscle tightness)
|
|
What is antihistone antibody associated with?
|
drug induced SLE
|
|
What kind of splint is used in Boutonniere's deformity?
|
tri point splint
|
|
What is the cause of the boutonniere's deformity?
|
ruptured central slip of extensor tendon and volar subluxation of the 2 lateral bands
|
|
What is the cause of swan neck deformity? how is it splinted?
|
spasm contracture of interossei and damage to oblique ligament with dorsal slippage of later bands; figure of 8 splint
|
|
which type of osteoporosis is associated with postmenopausal period?
|
type 1
|
|
This type of bone is preferentially lost in type 1 osteoporosis?
|
trabecular
|
|
Most common site of fracture in primary type II (Senile) osteoporosis?
|
radius
|
|
what type of crystals are seen in pseudogout?
|
POistive birefringent (rhomboid and short)
|
|
Gout is assoicated with these type of crystals.
|
negative birefringent (long and needle like)
|
|
What is the most common cause of emergent abdominal surgery in sCI?
|
gallstones (increased risk in T10 and above)
|
|
How much bone is lost 14 months after SCi?
|
1/3
|
|
What are risk factors for hypercalcemia after SCI?
|
male, complete, <21yo, tetras
|
|
Artery of adamkiewics supplies what spinal cord levels?
|
T9 through L1
|
|
What level of SCI is independent driving possible?
|
C6
|
|
What is the triad of neurogenic shock?
|
hypotension, hypothermia, bradycardia
|
|
What is the minimum strength needed for functional ambulation?
|
bilateral hip extensors at least 3/5, unilateral knee extensor at least 3/5, and maximum of long leg brace and one short leg brace
|
|
What is the formula for the H reflex?
|
9.14 + 0.46(leg length in cm)+ 0.1(age in years)
|
|
How many polyphasics are considered normal with monopolar needles? concentric needles?
|
30%, 15%
|
|
What Percentage in CMAP drop is considered a risk factor for poor outcome in GBS?
|
90% drop (CMAP<10% of normal)
|
|
What is the best therapy for acute GBS?
|
plasmapheresis
|
|
mode of inheritance for CMT type 1?
|
AD
|
|
which type of CMT has the slowest recorded nerve conduction velocities?
|
Type III, Dejerine Sottas syndrome <10m/s
|
|
When comparing side to side comparisons within the first 2 weeks following a lesions such as Bell's palsy, sparing of ___% or more ofthe response compared to uninvolved side suggests good prognosis?
|
10
|
|
Which 2 conditions are associated with bilateral facial palsy?
|
Lymes, GBs
|
|
How are R1 and R2 used in prognosis for bell's palsy?
|
If R1 present at 4 weeks, good prognosis. If R2 absent at weeks, poor prognosis
|
|
What is the most common muscle invovled in martin gruber syndrome?
|
FDI
|
|
When do children have nerve conduction velocities equal to adult?
|
3-5 years of age
|
|
AFter 50 years of age, NCV decrease by this much after every decade?
|
1-2m/s
|
|
What aids drug is most commonly associated with polyneuropathy?
|
DDI
|
|
Most common peripheral neuropathy in AIDS
|
distal symmetric polyneuropathy primarily an axonopathy.
|
|
When you increase your low frequenc filter, you (increase/decrease/don't change) your peak latency.
|
decrease
|
|
When you increase your low frequenc filter, you (increase/decrease/don't change) your amplitude.
|
decrease
|
|
When you increase your low frequenc filter, you (increase/decrease/don't change) your onset latency.
|
stays the same
|
|
When you decrease your high frequency filter, you (increase/decrease/don't change) your peak latency.
|
increase
|
|
When you decrease your high frequency filter, you (increase/decrease/don't change) your onset latency.
|
increase
|
|
If postpolio survivor has 4/5 strength, how many axons are intact? 3/5 strength?
|
40%, 10%
|
|
what are frenkels exercises?
|
used in ataxia
|
|
what is Uhthoff's phenomenon?
|
fatigue worsened by heat in MS
|
|
Which drug has been shown to decrease disability progression in MS?
|
avonex
|
|
what is normal bladder capacity?
|
450cc
|
|
What is the rule of 9s for a child?
|
18% head, 9% each arm, 18% for front torso, 18% for back torso, 14% for each leg
|
|
Most commonly involved joint in burn HO?
|
elbow
|
|
What is the most common area for Pott's disease mets?
|
thoracolumbar vertebral body
|
|
What cancers metastize to the bone?
|
breast, lung, thyroid,kidney, prostate (BLT pickle)
|
|
What cancers metastasize to the brain?
|
breast,lung, GI,skin
|
|
What is the most common type of astrocytoma found in children?
|
medulloblastoma
|
|
Most commonly involved joint in burn HO?
|
elbow
|
|
What is the most common area for Pott's disease mets?
|
thoracolumbar vertebral body
|
|
What cancers metastize to the bone?
|
breast, lung, thyroid,kidney, prostate (BLT pickle)
|
|
What cancers metastasize to the brain?
|
breast,lung, GI,skin
|
|
What is the most common type of astrocytoma found in children?
|
medulloblastoma
|
|
what is the most common pediatric cancer?
|
ALL
|
|
cisplatin is associated with this neuropathy
|
sensory axonal neuropathy
|
|
which nsaids at the least effect on renal function?
|
sulindac
|
|
Which TCA has the least anticholinergic side effects?
|
desipramine
|
|
what antiepileptic medications increases serum level of tegretol?
|
valproate
|
|
What are dimensions of standard wheelchair?
|
16 inches deep, 18 inches wide
|
|
how do you determine WC seat width?
|
widest part of hip + 1 inch
|
|
How do you determine WC seat depth?
|
rear of buttocks to popliteal fossa and subtract 2-3inches
|
|
How do you determine seat height?
|
bottom of heal to posterior thigh and add 2inches for leg rests
|
|
how do you determine height of back rest on a wheelchair?
|
buttock to spin of scapula minus 2-3inhces except if no upper extremity function
|
|
What type of tires are best for carpet?
|
pneumatic tires
|
|
What type of orthotic is used in spondylolisthesis?
|
Williams brace that limits extension and lateral bending
|
|
What is the most stable flexion/ext removable cervical orthosis?
|
SOMI
|
|
What would you expect from a successful stellate ganglion block?
|
Horner's syndrome
|
|
What is a type 1 error?
|
probability of rejecting the null hypothesis when the null hypothesis is true
|
|
What is a type II error?
|
probability of accepting the null hypothesis when null is false
|
|
If someone has 100% loss of UE function, what is the whole person impairment rating?
|
60%
|
|
If 100% loss of hand, what is whole person impairment rating? UE impairment rating?
|
54%, 90%
|
|
If 100% loss of thumb, what is whole person impairment rating? hand impairment rating?
|
20%, 40%
|
|
SEcond most common type of primary brain tumor?
|
meningiomas
|
|
What type of brain tumor has a dural tail on MRI?
|
meningioma
|
|
most common source of intracranial mets
|
lungs
|
|
after headache, what is the most common presentation of metastatic brain tumors?
|
motor impairment
|
|
what is target central perfusion pressure?
|
>70mmHg
|
|
What is the relative increase in risk of CVA in smokers?
|
2x
|
|
how long is increase in risk of CVA in smokers seen after quitting?
|
5 years
|
|
does tight glycemic control reduce risk of stroke?
|
no
|
|
most common cause of death occurring 2-4 weeks after stroke?
|
PE
|
|
What age group is Legg-Calve Perthes disease seen?
|
AGe4-8
|
|
What is Virchow's triad?
|
stasis, hypercoagulability, vessel wall damage
|
|
How do MUPs look in the diaphragm?
|
typically small amplitude, short duration
|
|
urinary creatine levels are increases/decreased in steroid myopathy?
|
increased
|
|
This much strength is needed in the shoulder girdle to use a balanced forearm orthosis?
|
minimum 2/5 strength
|
|
difficulty walking down steps is associated with weakness in this muscle
|
quads
|
|
best parameter to monitor respiratory status in ALS
|
Vital capacity
|
|
most common nerve entrapment associated with injuires to the throwing arm in baseball players
|
ulnar n. entrapment at the elbow
|
|
most common early symptom in cervical syringomelia
|
atrophy and weakness of intrinsic hand muscles
|
|
In eccentric contraction, which type of motion produces the greatest force? fast or slow?
|
fast (opposite for concentric contraction)
|
|
How long does Wallerian degeneration occur?
|
3-7 days
|
|
In CHF, CO is primarily determined by what?
|
HR
|
|
Peak HR is heart transplants is what % lower than norms?
|
25%
|
|
What is the incidence of encephalopathy after CABG?
|
7%
|
|
How are the lumbar facet joints innervated?
|
dually innervated by paired articular branches from the medial branches of the dorsal rami
|
|
What % deficit on a FCE can be met with a work hardening program?
|
20%
|
|
What is work hardening vs conditioning?
|
Work conditioning is general physical reconditioning while work hardening has job specific training.
|
|
Where should the headrest on an automobile be to limit the amount of flexion and extension in whiplash?
|
at ear level
|
|
What is the Kirkaldy-Willis degeneration cascade?
|
dysfunction of 3 joint complex (2 facets and intervertebral disk), instability (laxity), and stabilization (OA of the facets)
|
|
Most common upper extremity n. involved in peripheral neuropathy
|
ulnar n.
|
|
What is the % of nerve injury after THA found on EMG? What is the most common n. affected?
|
75%, peroneal
|
|
most common presentation of HIV neuropathy?
|
distal symmetric sensory and motor axonopathy
|
|
HIV polyradiculopathy frequenlty affects what part of the spinal cord and is usually associated with this infection?
|
cauda equina, CMV
|
|
muscle fibers more susceptible to disuse atrophy
|
type 1
|
|
How does Myotonic dystrophy differ from MG on EMG?
|
no postexercise facilitation
|
|
EMG abnormalities are more common in proximal/distal muscles in Lambert Eaton syndrome?
|
distal
|
|
What is the definition of fibromyalgia?
|
excessive tenderness in 11/18 spots with 4kg of pressure
|
|
radiation myelopathy predominantely affects this part of the spinal cord
|
lateral
|
|
Pneumonia is most common in what lobe in SCi?
|
LLL (right mainstem bronchus is the only one assessible by suction)
|
|
does unemployment prior to injury, reduce return to work after SCI?
|
no
|
|
which type of MRI is most sensitive for assessing acute brain ischemia?
|
diffuse weighted MRI
|
|
most common cause of death in first month of stroke
|
pulmonary embolus
|
|
most frequent initial symptom in MS
|
sensory complaints
|
|
most common urologic dysfunction in MS
|
detrusor hyperreflexia
|
|
Which swallowing phase is primarily affected in dysphagia with Parkinsons disease?
|
oral
|
|
what percent of patients with a history of ventricular arrhythmias will have an arrhythmia during cardiac rehab?
|
80%
|
|
Cognitive function at 5 years after CABG correlates with cognitive function at this time period postop
|
at 8 weeks
|
|
when are cognitive deficits most prominent after CABG?
|
3 days
|
|
how much knee flexion is required to descend stairs step over step after a TKA?
|
110 degrees
|
|
most common spinal problem seen with achondroplasia during childhood
|
kyphosis
|
|
Which 2 descending tracts are generally excitatory to extensor muscles and are under inhibitory cortical control?
|
vestibulospinal and reticulospinal
|
|
Which 2 descending tracts facilitate drive to the flexor muscles?
|
rubrospinal and corticospinal (rubrospinal only to the cervical cord)
|
|
at what joint does most of the pronation and supination of the foot occur?
|
subtalar joint
|
|
Most common osteoporotic fracture
|
vertebral compression
|
|
Primary osteoporosis is divided into 2 types - what are they?
|
type 1: postmenopausal (trabecular bone)
type 2: senile (corticol and trabecular bone) |
|
What is a good predictor of cauda equina syndrome in the ER if the patient is able to void?
|
high postvoid residual
|
|
Recovery from cauda equina syndrome is greatest if decompressive surgery occurs within how many hours?
|
48
|
|
What is the most common dysfunctional scapular pattern?
|
protracted and downwardly rotated scapula which manifests on exam as a prominence of the inferomedial scapular border
|
|
What are the starting and ending points for the Bruce protocol?
|
Starts at 1.7mph with 0% and ends with 5.5mph at 20% grade (8 - three minute stages)
|
|
Which type of exercise is better for tendinitis (eccentric vs concentric)?
|
eccentric
|
|
In young pts who dislocate their shoulder anteirorly, redislocation incidence is reduced after 3 weeks of sling immobility with the shoulder in what position?
|
10 degrees of external rotation
|
|
triple phase bone scan finding in acute CRPS
|
increased activity all images
|
|
triple phase bone scan finding in dystrophic CPRS
|
normal uptake in all phases except increased static phase
|
|
triple phase bone scan finding in atrophic CPRS
|
decreased uptake in all phases, except normal static images
|
|
Definition of a sarcomere
|
area between to Z lines (z line is the boundareeZ of the sarcomere)
|
|
What is the A band in a sarcomere?
|
thick myofilaments (myosin)
|
|
What is the I band in a sarcomere?
|
area occupied by the thin filaments (actin) not overlapped by myosin
|
|
what parts of the sarcomere shrink during contraction?
|
HIZ shrinkage - H, I, Z
|
|
What is the H zone in a sarcomere?
|
contains thick filaments but no thin filaments
|
|
number of white blood cells in a septic joint
|
>100,000
|
|
most common organism in nongonococcal monoartheritis
|
staph aureaus
|
|
involvement of this joint is relatively common in psoriatic arthritis but not RA
|
DIP
|
|
classic xray finding for RA
|
periarticular osteopenia
|
|
pencil in cup deformity - which disease?
|
psoriatic arthritis
|
|
papulosquamous skin rash that appears on the soles and soles and is highly associated with reactive arthritis
|
keratoderma blennorrhagicum
|
|
Risk factors associated with worse functional outcome in ankylosing spondylitis
|
young age at onset, history of physically demanding job, smoking, higher levels of education, family h/o illness
|
|
in this illness, erosions are slightly removed from the joint and are both atrophic/hypertrophic leading to "overhanging edges"
|
gout
|
|
illness with negative birefringent crystals - crystals turn blue when aligned across the direction of polarization
|
gout
|
|
needle shaped crystals
|
gout
|
|
rhomboidal shaped crystals
|
pseudogout
|
|
biopsy shows perifascicular atrophy
|
dermatomyositis
|
|
biopsy shows rimmed vacuoles
|
inclusion body myositis
|
|
normal AP diameter of C-spine on MRI
|
14mm
|
|
radiologic view used to assess intertubercular groove size in bicipital tendinitis
|
Fisk view
|
|
primary muscle involved in lateral epicondylitis
|
ECR- brevis
|
|
modifications needed to tennis racket if lateral epicondylitis occurs
|
reduce string tension and increase grip size
|
|
difference between wrist splint for lateral vs medial epidicondylitis
|
lateral -30-40 deg of extension
medial - neutral wrist splint |
|
lumbar spinal stenosis A-P diameter cut off
|
10mm
|
|
Muscle biopsy findings in HIV inflammatory myopathy
|
fiber size variability, fiber degeneration, endomysial infiltrates with cytoplasmic bodies and nemaline rod bodies
|
|
Muscle biopsy finding in zidovudine myopathy
|
mitochondrial dysfunction
|
|
Polymyositis muscle biopsy
|
endomysial mononuclear cells and myonecrosis
|
|
dermatomyositis muscle biopsy
|
vasculitis of endomysial and perimysial capillaries, perifasciular atrophy
|
|
IBM muscle biopsy finding
|
rimmed vacuoles
|
|
muscles involved in inclusion body myositis
|
quads, TA, long finger flexors and proximal muscles
|
|
EMg pattern for chronic IBM
|
mixed motor unit potentials with long duration,high amplitde polyphasic MUAPs as well as typical myopathic units
|
|
how do you differentiate steroid myopathy vs polymyosistis exacerbation on urine testing?
|
serial urine creatine secretion is increased with steroid myopathy, but remains stable in polymyositis
|
|
transfer of thermal energy between 2 bodies in direct contact
|
conduction
|
|
uses movement of medium (water,air) to transport thermal energy
|
convection
|
|
transformation of energy (sound or electromagnetic) to heat
|
conversion
|
|
most commonly used frequency for ultrasound
|
0.8-1.1MHz
|
|
amount of weight needed for cervical spine traction
|
25lbs
|
|
rhythmic circular pattern with fingertips - type of massage
|
effleurage
|
|
kneeding massage, compressing skin between thumb and fingers
|
petrassage
|
|
percussion massage
|
tapotement
|
|
Fast glycolytic, fast fatigable muscle fibers
|
Type 2B
|
|
fast oxidative glycolytic, fatigue resistant muscle fibers (have capacity for both anaerobic and aerobic energy transfer)
|
type 2A
|
|
What is the Henneman size principle?
|
motor units are recruited in order of increasing size, increasing contraction strength and diminishing fatigue resistance
|
|
diathermy with deepest level of penetration
|
ultrasound
|
|
What 3 factos have been shown to improve outcomes after acute stroke?
|
1. acute inpatient rehab
2. early rehab (Within 72h) 3. rehab in interdisciplinary setting (vs multidisciplinary) |
|
FIM score range
|
18-24
|
|
The motor subscale of the FIM is both valid and stable in the elderly population. What about the cognitive subscore?
|
valid but not stable
|
|
Describe Berg testing?
|
14 common activities of balance, total score of 56, correlates with laboratory tests of balance
|
|
What determines a patient's Case Mix Group (4 components)?
|
1. Primary diagnosis
2. FIM motor score 3. FIM cognitive score 4. age at admission |
|
What is the Katz index?
|
measures ability to perform ADLs in the geriatric population
|
|
What is the Barthel index?
|
0-100 scale that measures self care and mobility
|
|
Ligamentous instability of the lower cervical spine is significant with more than ?mm between adjacent vertebrae and ?degree of angulation
|
3.5mm, 11 degrees
|
|
What are the Ottawa ankle rules for ankle pain?
|
get xrays if pain in malleolar zone and any of the following:
1. bony tenderness along distal 6cm of fibula 2. bony tenderness along distal 6cm of tibia 3. inability to weight bear |
|
What are the Ottawa ankle rules for foot pain?
|
Get xrays of midfoot if bony pain at midfoot and any 1 of the following
1. bony tenderness over 5th metatarsal 2. bony tenderness over navicular 3. inability to weight bear |
|
What are the bone scan findings in RSD?
|
Stage 1 (radionucleotide arteriorgram): may see increased uptake
Stage 2 (blood pool stage): may see diffuse uptake Stage 3 (delayed stage): most important phase; diffuse periarticular assymetric uptake in affected limb |
|
shoe modifications for plantar fasciitis
|
long medial heel counter (to minimize heel valgus); high heel or posterior heel elevation
|
|
shoe modifications for achilles tendonitis
|
posterior heel elevation to reduce tension on achilles tendon or foam filled posterior heel counter (may need backless shoe for pump bump)
|
|
shoe modifications for metatarsalgia
|
wide width, lower heel, transverse metatarsal bar, rocker sole to reduce motion of painful joints
|
|
orthotics for knee OA
|
1. valgus orthosis if medial compartment OA
2. lateral wedge |
|
most common nonaxial location of bony mets
|
proximal femur
|
|
first line therapy for bony pain from cancer
|
nsaids (2nd line includes steroids, calcitonin, bisphosphanates)
|
|
Fracture risk is increased for bony mets with these characteristics
|
1. trochanteric lesion
2. lytic lesion 3. lesion size >2/3 diameter 4. pain intensity is severe |
|
What are the indications for surgery after pathologic fracture?
|
1. life expectancy >1mo with fracture of weight bearing bone
2. Life expectancy > 3mon with fracture of non weight bearing bone |
|
most common symptom of brain mets
|
headaches
|
|
first line treatment of brain mets
|
corticosteroids
|
|
most common symptom of malignant brachial plexopathy
|
pain
|
|
part of plexus most commonly involved by malignant brachial plexopathy
|
lower plexus
|
|
part of plexus most commonly involved in radiation induced brachial plexopathy
|
upper
|
|
Is pain commonly seen in radiation induced plexopathy?
|
no (~18% vs 89% seen malignant brachial plexopathy)
|
|
Incontinence and impotence in a cancer patient strongly suggest this type of neuropathic condition
|
bilateral lumbar plexopathy
|
|
what is the most common type of myelopathy seen with delayed radiation myelopathy
|
brown sequard syndrome
|
|
Should the shoulder be vigorously mobilized immediately after axillary lymph node resection for breast cancer?
|
NO, this increases risk of seroma formation. Flexion and abduction should be limited for 1 week.
|
|
Methadone acts on these 2 receptors
|
mu opioid and NMDA receptors
|
|
Pathologic finding of zidovudine induced myopathy
|
ragged red fibers
|
|
Usual presentation of zidovudine induced myopathy
|
severe proximal myalgias that improve 4 weeks after removal of medication
|
|
describe facet innervation at the cervical vs lumbar level
|
At the cervical level, the facet joint is innervated by the medial branch at that level. At the lumbar level, the facet is innervated by the level above and at that level. So at L4-L5 facet, L3 and L4 spinal nerves innervate it.
|
|
treatment of posterior elbow dislocation
|
reduce dislocation, splinting up to 10 days, initiate ROM, NSAIDs
|
|
olecranon osteophyte formation associated with posterior elbow pain and lack of full extension (Seen in this condition)
|
valgus extension overload syndrome of the elbow
|
|
Hypertrophy of the medial epicondyle leading to microtearing and fragmentation of the medial epicondylar apophysis
|
Little leaguer's elbow
|
|
treatment for little leaguer's elbow if displacement of medial epicondyle <5mm? >5mm?
|
<5mm: brief immobilization, no throwing for 6-12 weeks
>5mm: ORIF |
|
epiphyseal aseptic necrosis of the capitellum seen in young boys
|
Panner's disease (osteochondritis dissecans)
|
|
treatment for Panner's disease
|
conservative: immobilize, then gradual ROM
|
|
Which portion of the scaphoid bone is most prone to necrosis?
|
proximal
|
|
Which finger injury requires an ortho referral - jersey finger of mallet finger?
|
jersey finger
|
|
anatomic course of ACL
|
anterior tibia to lateral femoral epicondyle
|
|
anatomic course of PCL
|
psterio tibia to medial femoral epidocondyle
|
|
What is Donaghues Triad?
|
MCL +ACL and Med Meniscus injury
|
|
What is the most common site of osteochondritis dissecans of the knee?
|
medial femoral condyle
|
|
What fracture is associated with syndesmosis injury?
|
Maissoneuve Frx (speciffically associated with disruption of the anterior tibiofibular ligament)
|
|
Position with most pressure on the lumbar intervertebral disk
|
sitting with a flexed posture
|
|
What causes more pressure on a lumbar intervertebral disc - sitting or standing?
|
sitting
|
|
posterolateral disc herniation at L4-L5 will most likely impinge this nerve root
|
L5
|
|
far lateral disc hernation at L4-l5 may impinge this nerve root
|
L4
|
|
Most common level of spondylolysis
|
L5
|
|
What is the radiologic criteria for cervical spine instability?
|
translation >3.5mm or rotational motion >11 degrees in flexion/extension film
|
|
What is the radiologic criteria for lumbar spine instability?
|
translation>5mm or rotational motion > 15 degrees in flexion/extension
|
|
What r the 3 phases of the degenerative cascade?
|
dysfunction, instability, stabilization
|
|
What is a Jefferson frx?
|
burst fracture of C1
|
|
When should surgery be performed for spondylolisthesis?
|
>50% slippage/symptomatic
|
|
What are Waddel's signs?
|
DO REST: distraction, overreaction, regionalization, simulation, tenderness
|
|
What is the major predictor of falls in parkinsons disease?
|
postural instability
|
|
What is the mode of inheritance of SMA
|
autosomal recessive chromosome 5
|
|
What are the first signs of botulism?
|
bulbar signs
|
|
myopathy with vacuoles and lysosomal glycogen accumulation
|
pompe's
|
|
Which muscles affected least in sMA?
|
facial muscles
|
|
Tongue enlargement is seen in this metabolic myopathy?
|
Pompe's
|
|
myopathy characterized by acid maltase deficiency leading to increased deposition of glycogen in skeletal and cardiac muscles
|
pompe's disease
|
|
myopathy characterized by absense of myophospesterase leading to cramping during exercise
|
mcardle
|
|
When should scoliosis be operated on in DMD? When is surgery contraindicated?
|
curve >25, contraindicated in FVC<40%
|
|
myopathy associated with malignant hyperthermia
|
central core myopathy
|
|
This muscle is involved in limb girdle MD which differentiates it clinically from facioscapulohumeral dystrophy
|
deltoid
|
|
mode of inheritance of limb girdle MD
|
AR 15q
|
|
#1 muscle to test in facioscapulohumeral dystrophy
|
tib ant (affected at same time as shoulder girdle muscles)
|
|
mode of inheritance of Emery Dreifuss
|
x linked
|
|
classic triad of emery dreifuss
|
1. cardiomyopathy
2. weakness in humeroperoneal distribution 3. early contractures |
|
mode of inheritance of myotonic dystrophy
|
AD, chromo 19, CTG repeats
|
|
mode of inheritance of hyperkalemic periodic paralysis
|
AD chromo 17
|
|
describe the splint used for swan neck deformity
|
ring splint that promotes flexion at PIP
|
|
describes splint used for boutonniere's deformity
|
ring splint that promotes extension at PIP
|
|
What is Felty's syndrome?
|
RA, splenomegaly, leukopenia
|
|
how does a chronic hematoma appear on MRI?
|
hypointense on T1, and hyperintense on T2 (if acute will be hypointense at T2)
|
|
Most sensitive CSF marker for MS
|
oligoclonal IgG bands
|
|
most common bladder dysfunction in MS
|
hyperactive bladder with weak sphincter
|
|
Out of the 6 determinants of gait, which one reduces displacement in the horizontal plane?
|
lateral displacement of the pelvis
|
|
Incidence of scoliosis in Freidrich's ataxia
|
100%
|
|
cervico-thoracic-lumbar-sacral orthosis used for scoliosis
|
Milwaukee brace
|
|
single fiber potentials that wax and wane in frequency and amplitude; dive bomber
|
myotonic discharges
|
|
groups of MUAPs firing repetitively with semiregularity between each discharge and within each discharge (marching soldiers)
|
myokymia
|
|
Which type of shoe is better at accomodating orthotics? blutcher or bal
|
blutcher
|
|
Knee flexion required to descend step over step after TKA
|
110 degrees
|
|
arthritis mutilans is highly characeteristic of this disease
|
psoriatic arthritis
|
|
keratoderma blennorhagica is seen in this disease
|
reactive arthritis
|
|
True or false: +RF is commonly found in systemic juvenile RA
|
false
|
|
juvenile RA with the worst prognosis
|
RF+ polyarticular RA (usually girls >10yo)
|
|
this type of juvenile RA is associated with chronic eye inflammation
|
early onset pauciarticular JRA
|
|
type of juvenile RA associated with +ANA
|
early onset pauciarticular JRA
|
|
knee that medicare will cover for household ambulator or use of prosthesis only for transfer
|
constant friction knee
|
|
highest level of partial foot amputation for which shoe filler is adequate
|
lisfranc (amputation at tarsal- metatarsal junction)
|
|
cause of lateral whips
|
excessive internal rotation of prosthesis knee
|
|
cause of medial whips
|
excessive external rotation of prosthetic knee
|
|
During quiet standing, line of gravity passes, (Ant/post) to hip joint, (ant/post) to knee joint, (ant/post) to ankle joint
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posterior to hip joint
anterior to knee joint anterior to ankle joint (which tends to dorsiflex ankle - that's why you need gastrocs in quiet standing) |
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this is associated with poor prognosis in legg-calve perthes?
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involvement of the lateral portion of the femoral head
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most common congenital abnormality seen with congenital scoliosis
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unilateral renal agenesis
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This type of JRA is associated with HLA -B27 in 90% of cases with 50% developing AS
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late onset pauciarticular
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earliest PFT change seen in DMD
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maximal static airway pressure changes (ae 5-10)
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Best predictor of survival in CF
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FEV1 - If <30%, refer for lung transplant surgery.
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