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Flashcards in Clinical Science 4 Deck (49):
1

What is the Feiss Line

- Line running from Tip of the Medial Malleolus, Navicular, to Base of 1st MT
- Foot is flat when Navicular lies below the Feiss line
- reduced longitudinal arch
- Calcaneus Valgus
- Increase weight bearing to Med aspect of foot

2

The 3 Dynamic Ligaments of the Foot and Ankle:

Tib Ant
Tib Post
Fib Longus

3

Plantar Fasciitis

Over use injury
Pain going up/down stairs
Morning Pain
Tender on palpation of Calcaneus

4

Mms involved with Foot Drop

Tib Ant
Ext Hallucis Longus
Ext digitorum Longus
(L4 + L5)

5

Test for Morton's Neuroma

Squeeze Test

6

The Inguinal Triangle is made up of:

Add Longus
Sartorius
Inguinal Lig

7

Hip Anteversion=

Toe in stance

8

Which Bursa is related directly to the hip?

Iliopectineal (iliopsoas) Bursa

9

Traction of the hip affects which Bursas?

Iliopectineal
Ishiogluteal
Trocanteric
Ischiopubic

10

Leg Length Discrepancy has an effect on:

Posture + bio mechanics

11

Supine to Sit Test results=

Post Pelvic Tilt = Short to Long

Ant Pelvic Tilt = Long to Short

12

Case Study: Hip + Ant Groin Pain. Worse in the morning and better after walking =

Osteoarthritis

Spcl Test = Scouring test (only if unDx'd)

13

Peripheral Vascular Disease PVD/PAD

-Slow progressive circulatory disorder in any BV outside the heart (Aa, Vv, Lymph)
- Brain, Heart, Legs don't receive adequate blood flow
- legs + feet MC affected

14

Conditions Assoc with PVD/PAD

DVT
Varicose Veins
Chronic Venous Insuff.
Lymphedema

15

S/Sx of PVD

50% of peole Dx'd are symptom free

16

Claudication:

MC symptom of PV is Intermittant claudication

= limping b/c of pain in thigh, calf and/or buttocks when walking

"Angina of the legs"
Demand for O2 increases with mvmt = Pain
More severe than this is Critical Limb Ischemia

17

Atherosclerosis

PVD/PAD
S/Sx depend on degree blood flow blocked to legs

18

Critical Limb Ischemia CLI

-MOST SEVERE Sx of PVD Via atherosclerosis
- lack of O2 to limb at rest
"Pain at Rest"
Can result in tissue breakdown, ulcers, gangrene
- may include all other types of PVD Sx also

19

Direction for constipation massage =

Clockwise

20

Vat Test:

Tests vert Aa blood flow
Put supine, Passive EXT + ROT of neck (performed in both directions)

+ dizziness, dysphagia, hearing/vision disturbance, syncope, nausea

21

Lower Motor Neuron Signs=

- Indicates that lesion is ABOVE the Ant. Horn Cell (spinal cord, brain stem, motor cortex)
- increased mm tone (spasticity)
- Weakness (flexors weaker than extensors in legs / opposite in arms)
- increased reflexes, up going plantar response, sustained clonus

22

Lower Motor Neuron Signs:

Lesion of either in Anterior Horn Cell
Or
Distal to Ant. Horn Cell (Ant horn cell, root, plexus, peripheral nerve)

DECREASED mm Tone
Passive Rot of neck in both directions = dizzy, nausea, syncope, dysarthria, dysphagia, hearing/vision disturbances

23

Klumpke's Paralysis

"Claw Hand"
C8/T1
- Forearm is Supinated, wrist + finger are Flexed
- affects hands + intrinsic mm + flexors of wrists/fingers

*If Horner's Syndrome is present = Miosis (constrict pupils)

24

Polio/Post Polio

Most people don't have S/sx
If yo do = fever, fatigue, flu-like, stiff neck/back, P in limbs

- spreads via contact with stool/ droplets of infected person, lives in throat & intestines
-Attacks Motor Nerves = Paralysis, mm wasting/atrophy, areflexia, mm fasciculations

25

Post Polio

People who had polio develop Post Polio Syndrom years later :(

S/Sx = tiredness, new mm weakness, mm + jt Pain

No prevention or Cure

26

Sinusitis

- Inflam of mucus lining in nasal passages/ sinus cavities

Frontal (behind forehead)
Maxillary (behind cheekbones) - largest
Ethmoid (behind nose)
Sphenoid (behind eyes)

Tx = diaphrag breathing, pre facial steam (5mins), prone my press on sinuses

27

Mvmt of Ribs with breath (inspiration vs expiration):

Insp: Ribs 1-6 = "Pump Handle" pull ribs Up + Forwards= increases Anteroposterior diameter (stenum moves with these ribs)
Ribs 7-10 = "Bucket Handle" ribs move Up + BACKWARDS

Ribs 11-12= "Caliper Action" increases Lat diameter

28

Red Flags for Headaches:

-Neuro Sx/S (altered mental sate, weakness, Diplopia, papilledema, focal Neuro deficits)
- Immunosuppression / Cancer
- Meningitis
- Sudden HA onset after 50 yrs (brain tumor)
-Thunderclap HA (severe sudden)
- Sx of Giant Cell Arteritis
- Systemic Sx (fever, weight loss0
- progressively worsening HA
- Red eye / halos around lights

29

For every inch of head forward posture:

It increases the weight of the head on the spine by 10lbs

2x weight/pressure

30

What is Rebound Tenderness:

- Physical sign that may be found when examining the abdomin.
- Refers Pain upon REMOVAL of pressure
- Indicates possible Appendicitis

31

Define Hemophilia:

Bleeding disorder where normal clotting factors are weak/absent

ABSOLUTE CI for Massage

32

Why does Edema occur on Pt's with Chronic Kidney Disease?

1. Heavy loss of protein in urine

2. Impaired kidney function

33

Define Chronic Kidney Disease

Gradual loss of kidney function

Dangerous levels of fluid, electrolytes + wastes build in body

34

CI's for Hypertension, why do we have to be careful?

because we increase blood circulation which can increase Intravascular Pressure.

Someone with HT already has excess pressure against BV walls

35

Asthma

- Airways narrow, swell, produce excess mucus
= Difficulty breathing, coughing, Wheezing, shortness of breath

CI's = acute attack, respitory tract infection

Allergy induced
Occupational Astra
Exersize-induced

36

Extrinsic vs Intrinsic Asthma

Extrinsic: Attack are related to irritants + most childhood asthma

Intrinsic: No known cause + adult onset

37

Degrees of severity of Asthma: (3)

Mild - occasional wheezing/coughing

Moderate - Daily symptoms

Severe - daily, nocturnal, absence from work/school, hospital admittance

38

Thrombophlebitis:

Inflam of the wall of a vein with assoc thrombosis, often occurs in legs during preganancy

39

What's the difference btw Emphysema & Chronic Bronchitis

Both are types of COPD that often coexist

Emphysema: "Pink Puffer"

Bronchitis: "Blue Bloater"

40

Emphysema:

Form of COPD = permanent enlargement of airways / destruction of ALVEOLI - enlarged air spaces called "Bulae"

Proteolytic enzymes destroys lung tissue -Mainly caused by smoking, irreversible.

"Pink Puffer"

41

Chronic Bronchitis;

Form of COPD, long term cough that lasts for at least 3 months for 2 consecutive years
- Inflam/irritation to bhronchioles = mucus that inter fears with breathing
Difficult to expel with coughing + perf habitat for bacteria/infection
Caused by smoking

42

Postural drainage positions for upper, mid (right), lower lobes:

Upper lobes: seated

Right Middle: laying supine with pillow under R thorax + knees

Lower: Pt prone, triangle of pillows under hips

*diaphrag + segmental & pursed lip breathing + cough coaching

43

Buerger's Disease:

Thromboangiitis Obliterans (aka Buerger's Disease)

Recurring progressive Inflam + clotting of sm & med arteries/veins of hand and feet

44

Cor Pulmonale:

- Right Heart failure b/c of long term high BP on Aa and Right Lung Ventricle

- Can also be caused by Chronic Long conditions that lower blood O2 levels for long periods (COPD, Cystic Fibrosis, Kyphosis/Scoliosis, Interstial lung disease, sleep Apnea)

45

Critical Limb Ischemia (CLI)

Most severe PVD caused by Atherosclerosis

"Pain at rest"
Tissue necrosis b/c of lack of O2 = gangrene / ulcers :(

46

S/Sx of PVD:

Cold feet
Burning aching Pain while lying down, relieved by sitting
Pallor when legs are raised
Brittle, thin, shiny skin
Non healing wounds/ulcers
Red/blue extremities
Fungal infections

47

Upper body Dermatomes:

C1 top of head
C2 temporal/occipital region
C3 neck adn post cheek
C4 Sup shoulder & clavical
C5 Deltoid + Lat Arm
C6 Lat Forearm, thumb, index finger
C7 Post Lat Forearm & middle finger
C8 Medial forearm, ulna border & ring/little finger
T1 Med side of forearm & upper arm

48

Lower body Dermatomes:

L1 Back, hip, groin
L2 Ant sup thigh, med thigh, above knee
L3 Back, Ant thigh + Med knee
L4 Lat thigh/knee, ant med lower leg to med big toe
L5 Lat knee & Lat lower leg & top of foot

49

Functional Organization of the cerebral cortex (sensory areas)

Primary somatosensory area
Primary visual area
Primary gustatory
Primary olfactory