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1
Q

What were the minor side effects found in the Thiel et al National study?

A

Fainting
Dizziness
Light-Headedness

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2
Q

The Thiel study also found there can be a risk for up to how many days post treatment?

A

7 days

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3
Q

The Rubinstein study found adverse effects common in what percent?

A

56%

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4
Q

What were the symptoms after 3 tx?

A

Tiredness
Dizziness
Tinnitus
Nausea

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5
Q

What was the findings of the Cassidy study?

A

There was no increased associated between VBA stroke and chiropractic visits in those older than 45

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6
Q

T or F

There are numerous sensitive and reliable screening tests for VBA

A

False

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7
Q

A history of this condition is important for the DC to consider when dealing with VBA

A

Hx of TIA’s

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8
Q

The Vertebral artery supplies what percent of blood to the brain?

A

20%

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9
Q

What is the most common symptom associated with VA occlusion?

A

Vertigo

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10
Q

What is the typical headache presentation of a VA occlusion?

A

Unilateral Occipital HA

Sharp

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11
Q

T or F

The headache with a VA occlusion is usually on the same side as the insufficiency

A

True

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12
Q

What other symptoms will accompany VA occlusion?

A

Nausea

Vertigo

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13
Q

According to Dutton what is the most common mechanism of injury to the VA?

A

Hyperextension with or without rotation

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14
Q

Median nerve entrapment aka?

A

Prontator Teres Syndrome

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15
Q

Describe the common entrapment site for Pronator Teres Syndrome

A

Between the 2 heads of pronator teres and the arch of the flexor digitorum superficialis.

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16
Q

What is the most common cause of median nerve entrapement?

A

Fibrous bands

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17
Q

What are the medial, lateral and superior borders of the CT?

A

Medially: pisiform/hamate
Laterally: navicular/trapezium
Superior: transverse carpal ligament

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18
Q

T or F

With CTS symptoms are worse at night

A

False

Worse upon wakening
** this is confusing because Souze states that they are worse upon wakening and worse at night…

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19
Q

T or F

Hypothenar atrophy is seen with CTS

A

False

Thenar

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20
Q

Who are more commonly affected by CTS?

A

Women in 40’s and 50’s 4X more likely

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21
Q

What is the second most common WC injury

A

CTS

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22
Q

T or F

After 50 years of age CTS becomes more common in men

A

False

men and women equal after 50

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23
Q

Why are women predisposed to CTS?

A

Smaller wrist bones
Genetic link
strong hormonal changes during menses, pregnancy and menopause

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24
Q

What are the goals for management of the acute phase of CTS?

A

Reduce any internal swelling, decrease pain or numbness/tingling frequency

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25
What are the goals of subacute CTS management?
Retrain pt to proper activities to reduce stress on CT
26
T or F Souza states there is a very high associated between keyboard use and CTS
False
27
What percent of patients fully recover with conservative treatment after 2-12 weeks
30%-70%
28
What is the standard for conservative treatment of CTS?
Nocturnal neutral splinting or cock-up splint
29
What percent according to Souza of ppl with a splint will eventually have surgery for CTS?
41%
30
What is the classic presentation for numbness and tingling in digits
the fingers and thumb with radiations into the forearm. No palm involvement
31
Where is the most common site for TOS?
Lower brachial plexus (C7-T1)
32
According to Souza what factors have been shown to contribute to TOS?
``` Trauma Posture (rounded shoulders) Tight scalene Tight pec minor Cervical Ribs ```
33
When stenosis is suspected in the cervical spine what special imaging is suggested
CT
34
T or F Grip is stronger in supination than pronation
True
35
The wrist can be between what degrees of motion without an effect on strength
15 degrees of palmar flexion and 30 degrees of extension
36
What are some predictors of prolonged recovery from whiplash one year following the initial injury?
``` More symptoms greater initial pain greater initial disability Depressed mood fear of movement and a passive coping style ```
37
T or F Standard care and inpatient rehabilitation showed slower recovery times in whiplash management
False Fitness training and outpatient rehabilitation
38
In what notches are the maximum readings on the Jamar Dynamometer found?
Second and third handle positions
39
What is the starting pull for cervical traction? What was the initial time?
10-12 pounds 15 minutes 6 sessions 2-3 times per week for 3 weeks
40
What muscles are affected in Intersection Syndrome?
The APL, and EPB crossing over the wrist extensors
41
Intersection Syndrome is more common in what population of ppl?
Canoeists Weight Lifters Recreational Tennis players
42
What are the goals of the acute stage of CTS
Reduce any internal swelling, decrease pain or numbness/tingling frequency
43
What is the standard for conservative care of CTS?
Nocturnal splinting or cock-up splinting worn for several weeks
44
Adjustments to what carpal bones have been shown to improve the acute and subacute stages of CTS according to Souza?
Lunate and radioulnar articulation.
45
Open chain exercises for the acute stage of CTS include?
Mild isometrics in pain free ROM with a focus on extension
46
Describe the open chain exercises recommended in the subacute phase of CTS
Isometrics progressing to isotonic exercises with a focus on wrist extension, pronation and supination. Flexor exercises should be performed but not emphasized.
47
Patient presents with a complaint of volar forearm pain...what are you thinking?
Pronator Syndrome
48
Where are some of the specific sites of entrapment for Pronator Syndrome?
- Bicipital Aponeurosis - Between the heads of the pronator teres (often due to hypertrophy) and the arch of the FDS. - Beneath the Ligament of Struthers (supracondylar arch) * *this is the most proximal site of entrapment - median artery and bicipital tuberosity bursa.
49
Provocation with resisted pronation, keeping the elbow extended and the wrist flexed suggests compression where with Pronator Syndrome?
Pronator Teres Compression
50
T or F The Anterior Interosseous nerve is a sensory branch of the median nerve
False Motor
51
Pressure in the cubital tunnel is increased with what motions of the elbow and wrist?
Elbow flexion and wrist extension (3 fold) | Cocking position of throwing (6 fold)
52
Night splinting in what position has been recommended to help with Cubital Tunnel Syndrome?
Elbow flexion to 45 degrees in neutral rotation
53
The patient complains of numbness or tingling over the dorsolateral aspect of the wrist and hand.
Cheiralgia Paresthetica | aka Wartenberg's Syndrome
54
What nerve is affected in Cheiralgia Paresthetica?
The Superficial branch of the radial nerve
55
T or F Distal pole fractures of the scaphoid usually result in avascular nercrosis
False Proximal Pole * * Vascular supply to scaphoid runs distal to proximal * * Proximal pole account for about 20% of fractures.
56
What is one of the most sensitive ways to evaluate for a scaphoid fracture?
Stretch the patient's pronated hand carefully into maximum ulnar deviation. **positive predictive value is 52%
57
What are the 3 common clinical manifestations of Ehlers-Danlos Syndrome?
1. Hypermobile Joints 2. Fragile Blood Vessels 3. Various cutaneous abnormalities including hyper-elasticity
58
Describe the gait typical of Ehler's Danlos patients.
Hyperextension of the hips and gene recurvatum (hyperextended knees)
59
Marfan's patients have problems in what 3 distinct organ systems?
1. Musculoskeletal 2. Ocular 3. Cardiac
60
What is the physiological affect of Ritalin?
Causes the release of norepinephrine, dopamine, and serotonin from storage vesicles resulting in CNS stimulation
61
What are some side affects of Ritalin
``` Decrease in appetite Increase in blood pressure restlessness Insomnia dizziness psychic disturbances ```
62
What is the age group affected by Wilm's Tumors?
Less than 5 years old
63
What is used to dx a Wilm's tumor?
US and CT
64
What are the signs and symptoms of Wilm's Tumor?
``` Palpable abdominal mass Fever Anorexia Abdominal pain Hematuria Hypertension ```
65
What is the most common solid neoplasm outside the CNS in paediatric malignancies?
Neuroblastoma
66
Age group for Hodgkins Lymphoma?
10-16 years
67
What is the second most common malignancy of childhood?
Ewing's
68
T or F Ewings is often metaphyseal
False Diaphyseal
69
What is the 5 year survival rate with aggressive treatment of osteogenic sarcoma?
75%
70
Where are unicameral bone cysts more commonly found in the skeleton?
Proximal humerus and femur
71
What bone tumor has a classic patient presentation of night pain relieved by aspirin.
Osteoid Osteoma
72
Blount's Disease aka?
Tibia Vara
73
T or F Blount's Disease is disruption of the medial proximal tibial growth plate leading to a valgus deformity
False Varus
74
There is a higher incidence of Blount's Disease in what populations?
Black children Obese children Family hx Certain geographic areas
75
What is diagnostic for Blount's Disease?
Increased uptake on bone scan
76
What is the incidence of growing pains in children 6-19 years?
15%
77
What are the peak ages for growing pains?
3-9 and again in adolescence
78
T or F There are clear direct indicators of a relationship between height, weight and rate go growth with growing pains
False
79
T or F Bilateral pain unrelated to activity level and unassociated with systemic indicators such as fever or fatigue is likely benign and often represents growing pains
True
80
What are the characteristics of growing pains?
- intermittent - bilateral usually lower leg - usually asymptomatic during the day with no swelling, tenderness, or stiffness reported - associated with complaints of headache and stomach ache
81
In a patient 65 years + what constitutes the beginning of mild hypertension?
160/90
82
What maneuver attempts to distinguish pseudohypertension from true hypertension?
Osler's Maneuver * while taking the pulse, the artery proximal to the pulse is occluded. If the distal pulse remains unchanged there may be sufficient stiffness in the arteries to falsely raise the BP
83
What is a common cause of orthostatic hypotension?
Anithypertensive medications | Diabetes
84
Normal respiratory rate for seniors?
12-20 breaths per minute

Advanced CLET (2 decks)

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