Module 8 - Neuro & Musculoskeletal

Question 1

What is BPPV?

Answer 1

Benign Paroxysmal Positional Vertigo - a syndrome that may be a manifestation of several varied inner ear conditions. ** Occurs with position change.

Question 2

What does the Hallpike-dix maneuver test for?30-45 degrees

How is it done?

Answer 2

Nystagmus.

1. 1st check pt for spontaneous nystagmus while seated.
2. Next, bring the pt quickly back to recumbent or supine position with head extended 30-45 degrees over table and tilted 30-45 degrees to one side.
3. Repeat above two times - once with head to right and once with head to left.
4. Observe the pt for latency, duration, direction, and fatifability of nystagmus in supine and upright position.

Question 3

If nystagmus is vertical or torsional in nature and lasts less than 30 sec. it is consistent with a:

Answer 3

posterior semicircular canal variant

Question 4

If nystagmus is direction and horizontal (beating toward ground) and lasts about 1 min. it is consistent with a:

Answer 4

horizontal canal variant

Question 5

Vertigo that is spontaneous (not position related) and the presence of focal neurologic findings suggest a:

Answer 5

central etiology

Question 6

BPPV can be confirmed by ____________ and a ____________ Hallpike-dix test result.

Answer 6

history; postitive

Question 7

When the Hallpike-dix test is positive if ____________ is characteristic and _________ and ________ are elicited with the affected ear _________.

Answer 7

nystagmus; dizziness, vertigo; down.

Question 8

Symptom of vertigo is differentiated from sycope or disequilibrium by careful ____________.

Answer 8

history.

Question 9

Treatment for BPPV are typically ____________ maneuvers.

Answer 9

postional (liberatory maneuvers and physical therapy interventions

Question 10

Describe Epley’s manuever

Answer 10

Moving the patient from one head-hanging positon to another. Must not lie flat for 48-72 hours following.

Question 11

Meniere’s is a ___________ condition of the inner ear characterized by ___________ _________ and _____________ ___________.

Answer 11

chronic; recurrent vertigo, hearing loss

Question 12

Four sx assoc with Meniere’s:

Answer 12

1. spinning vertigo/dizziness
2. sensorineural hearing loss
3. tinnitus
4. feeling of fullness in affected ear

Question 13

Weber test result in Meniere’s? Rinne result?

Answer 13

Sound will lateralize to the unaffected ear.

air conduction will be greater than bone conduction.

Question 14

Should Meniere’s pt be referred?

Answer 14

Yes

Question 15

Definitive dx for Meniere’s requires ________ episodes of spontaneous vertigo lasting __________min., _______________ documented _________ ________ and _____________ or aural ______________. With the exclusion of other causes.

Answer 15

2; 20min; audiometrically, hearing loss; tinnitus, fullness

Question 16

Tension headache: bilateral or unilateral, pulsating or nonpulsating?

Answer 16

bilateral, nonpulsating

Question 17

Is bell’s palsy unilateral or bilateral facial paralysis?

Answer 17

unilateral

Question 18

Which cranial nerve is affected with Bell’s?

Answer 18

VII

Question 19

Bell’s has acute onset with max paralysis in ____ to _____ _______.

Answer 19

48-72 hours

Question 20

Bell’s pt may have altered _________ and sensitivity to _________.

Answer 20

taste; sound

Question 21

Bell’s palsy is a common neuropathy with __________ disease.

Answer 21

Lyme

Question 22

T/F

Bell’s is more common in pregnancy.

Answer 22

True

Question 23

Prevention of _____ ___________ is the most important goal in Bell’s.

Answer 23

eye injury

Question 24

In Bell’s, ____________ _____________ can cause blindness. To prevent administer ______________ bid and ___________ at HS.

Answer 24

exposure keratitis; methylcellulose; ocular lubricant

Question 25

What med is recommended for all Bell's pts? Dose?

Answer 25

Prednisone 60-80mg/day for 1 wk with tapered dose 2nd week

Question 26

What med should be added if Bell's is severe? dose? | What for pain?

Answer 26

Valcyclovir 1000mg TID | NSAIDs

Question 27

Recovery time for Bell's? at most?

Answer 27

4-6months; 12 at most

Question 28

Bell's and pregnancy.

Answer 28

Referral should be considered

Question 29

What disorders should be referred to neuro?

Answer 29

Trigeminal neuralgia, meningitis

Question 30

Things to look for in meningitis:

Answer 30

nuchal rigidity, brudzinki's , kernig

Question 31

meds for exposure to meningitis:

Answer 31

rifampin, cipro

Question 32

Minor MSK injuries: | RICE

Answer 32

Rest Ice Compression Elevation

Question 33

Carpal tunnel results from entrapment of the _________ nerve in the carpal tunnel of the wrist.

Answer 33

median

Question 34

Most useful clinical test for carpal tunnel?

Answer 34

Phalen's test

Question 35

First line tx for carpal tunnel

Answer 35

night time splinting

Question 36

If night time splinting with addl conservative modality is ineffective :

Answer 36

Single injection of methylprednisolone 40mg

Question 37

Bursitis is a pathologic _____________ disorder of the _______.

Answer 37

inflammatory; bursae

Question 38

Common features of bursitis:

Answer 38

pain at motion and at rest; regional loss of ROM; visible swelling; tenderness to palpation

Question 39

Most common type of bursitis? Who is most commonly affected?

Answer 39

Subacromial; older adults secondary to overuse and throwing athletes <25

Question 40

The _________ and ___________ inpingement signs are the most sensitive and specific for subacromial bursitis.

Answer 40

Neer and Hawkins

Question 41

Management of bursitis?

Answer 41

Gentle ROM joint activities, avoid exacerbating activities, NSAIDs. DO NOT IMMOBILIZE! For severe cases: corticosteroid injections - limited to 3 injections in 12 months at least 30 days apart.

Question 42

What does Lachman test assess? How is it done?

Answer 42

ACL; flex knee 15-30degrees, one hand below knee joint on posterior tib-fib and other hand on ant femur. Lift up on lower leg while pushing down on upper leg. IF ACL is intact should feel a knock or firm stop.

Question 43

What does McMurray test? how?

Answer 43

For tears in cartilage/meniscus. Flex the knee while rotating the tibia internally and externally on the femur, then while flexing and externally rotating the leg apply valgus stress on the joint while extending leg and palpating medial joint line. If click or pop is heard or felt the medial meniscus is torn.

Question 44

Thessaly test is for ___________ and is done with pt _________.

Answer 44

meniscus tears; standing.

Question 45

What is most common depressive disorder? | How is it dx?

Answer 45

- DSM-5 Major Depressive Disorder (MDD) - Must have 5 sx in a 2wk timeframe - Must have one of the following: depressed mood or loss of interest or pleasure - Other sx for the five: weight change, inability to concentrate, agitation or lethargy, recurrent thoughts of death, feelings of guilt or worthlessness