Oral Boards Flashcards
(77 cards)
1
Q
History Framework
A
- Focused History related to Problem: OPPQQRRSTTA
- ROS: numbness, tingling, weakness, bowel, bladder, fever, chills
- Function/Family Support/Home/Driving/Daily Routine
- Work/Recreation
- PMH
- PSH
- Meds
- All
- Family
- Social: etoh, smoking, drug
2
Q
Exam Framework
A
- VIPR (Vitals, Inspection, Palpation, ROM)
- HALS (Heart, Lung, Abd, Skin)
- NGS (Neurologic, Gait, Special tests)
- MS, CN, ROM, MMT, Reflexes, Sensory
- Gait (heels, toes, tandem, single leg)
- Special tests: Facet Loading, FABER, FAIR, Gillet, Gaenslen, SLR, Slump Sit, Yeoman
3
Q
Cervical Radiculopathy Treatment
A
- Therapy: manual and mechanical traction, ROM, posture/body mechanics, modalities for pain management
- Medications: Anti-inflammatory, Neuropathic pain agents, Opioids (short course), oral steroids, cervical epidural steroid injection
4
Q
Cervical Radiculopathy work-up
A
- EMG/NCS to rule out radiculopathy, plexopathy, or focal neuropathy
- MRI to rule neural compression
5
Q
Agitation Differential Diagnosis
A
- intracranial: bleed, hydrocephalus, seizures
- infection: meningitis, UTI, pneumonia
- medication: withdrawal or toxicity
- metabolic or electrolyte
- environmental, noxious stimulus, hunger, thirst
6
Q
Agitation work-up
A
- Head CT
- CBC, BMP, UA
7
Q
Agitation treatment
A
- Environmental modifications: turn off TV, limit visitor, re-orientation
- Regulate Sleep-Wake: melatonin, trazodone
- Medications: Propranolol, Valproic Acid, Olanzapine, Risperidone
8
Q
Advantage of Ischial containment socket?
A
Allows for more hip adduction and flexion to facilitate more normal gait
9
Q
Post-op amputee care
A
- Psychological: support groups
- Residual limb care
- shrinker/rigid removable 24hrs a day until edema has stabilized (months)
- cleaning incision with gentle soap and water, air dry.
- skin desensitization and scar massage
- Contracture prevention: lie prone 15-20min 3x a day. Extend knee fully when sitting.
- Temporary Prosthesis fitting at 2-6 weeks post surgery
10
Q
Components of a prosthesis prescription?
A
- Suspension: pin or suction
- Socket: Patellar tendon-bearing vs total contact fit
- Pylon
- Knee: polycentric, hydralauic
- Foot: SACH or Multi-axis
- Cover
11
Q
Neck and Shoulder Special Testing
A
- Nerve impingement: Spurling’s (extension, side-bend, axial compression)
- Instability
- anterior - apprehension test
- posterior - Jerk test (flex to 90, internally rotate, adduct, push humerus posteriorly)
- Labrum: O’Brien: palm down and adducted - push down while they resist
- Biceps Tendon: Speed, Yergason
- RTC Tear
- Empty Can
- Neer to Ear
- Hawkins
12
Q
Interpersonal Skills Tips
A
- Make sure you have permission to discuss (HIPPA)
- “Tell me more”
- “What is your understanding of…”
- Align with the patient against the problem. Express empathy with them regarding the situation
- Seeing a surgeon does not mean you have to have surgery
- Advise them to speak directly with the person they have issue with
13
Q
Modalities
A
- Ice/Heat
- Massage
- US
- TENS
- E-stim
14
Q
Medications
A
- Topical
- Oral
- Injections
15
Q
PT RX
A
- PT 3x a week for 6-8 weeks
- Precautions
- ROM, Stretching, Strengthening
- Modalities
- Home Exercise
16
Q
Neurologic Differential Diagnosis Framework
A
- Brain: TBI, tumor, stroke, MS
- Cord: myelopathy, transverse myelitis, infection
- Anterior Horn Cell: ALS, West-Nile, SMA
- Nerve root: AIDP, radiculopathy 2/2 to spondylosis, abscess or tumor
- Plexus: diabetic amyotrophy, radiation, structural lesion
- Peripheral nerve: polyneuropathy, focal neuropathy, mononeuritis multiplex
- NMJ: Myasthenia Gravis, Lamber-Eaton, Botulinum toxin
- Muscle: myopathy, muscular dystrophy, polymyositis
17
Q
DDx for fever and tachycardia in TBI patient
A
- PSH
- Infection (brain, blood, lung, urine)
- DVT/PE
- Medication side effect or withdrawal
- Cardiac
- Hyperthyroidism
18
Q
PSH Treatment
A
- identify and remove potential triggers: pain, fracture, DVT, infection
- medications: propranolol, bromocriptine, clonidine, baclofen dantrolene, benzos.
- supportive therapy: cooling, nutrition, hydration, pain mgt
19
Q
Migraine treatment options
A
- diet, hydration, sleep, stress mgt
- TCA’s (amitriptyline)
- antiepileptics (depakote, topiramate)
- propranolol
- abortive: sumatriptan
20
Q
Myopathy labs
A
CBC, CMP, CK, ESR, CRP, AST, ALT, aldolase, LDH, ANA
21
Q
EMG Timeline/Prognosis
A
- Neurapraxia: conduction block that resolves in a few weeks
- Axontonmeisis: immediate decrease in proximal amplitude. Distal NCS amplitude decrease with wallerian degeneration after 5 days for motor fibers and 10 days for sensory fibers. Immediate reduced recruitment. Spontaneous activity seen in 2 weeks (paraspinals) to 6 weeks (foot) depending on distance from injury to the muscle. Reinnervation seen after at least 2-3 months.
- Best to preform studies at 1 month and 3-6 months
- Absent or small CMAP at 3-6 months indicates a poor prognosis. CMAP amplitude is a good estimate of number of axons and comparison studies can be helpful
- Normal to reduced recruitment indicates a good prognosis
- Discrete (single unit) or lack of recruitment at 3-6 months indicates a severe injury, unlikely to regain function
- Ideal window for nerve transfer surgery is 3-6 months and surgery is still possible up to 12-18 months.
22
Q
DOC exam
A
- AV-MOE
- Auditory: startle, localization, command following
- Visual: starte, fixation, tracking, object recognition
- Motor: posturing, withdrawal, localization, object manipulation, functional object use
- Oral: reflexive movement, vocalization, words
- Eye: unarousable, opening to stimulation, spontaneous opening, attention
23
Q
Rhem labs
A
RF, anti-CCP, ESR, CRP, ANA, HLA-B27
24
Q
Rheumatoid Arthritis Treatment
A
- DMARD (methotrexate, etc)
- NSAIDS
- Corticosteroids
- PT/OT for strength and ROM
- Isometric exercises if acutely inflamed
- Total joint replacement
25
Indications for cervical spine fusion
* For degenerative disease: neurologic deficit refractory to 6 weeks of conservative treatment with osteophytes, herniated disc, or loss of disc height with foraminal stenosis
* For instability: greater than 3.5mm of subluxation between adjacent segments
26
Ankylosing spondylitis treatment
* NSAIDs, Steroids, DMARDs
* Sleep prone on a firm mattress
* PT for ROM and aerobic endurance
27
Fibromyalgia treatment
* duloxetine, pregabalin, TCA's,
* PT, OT, aquatherapy aerobics
* lifestyle modifications: sleep, home life, stressors
* Pain psychology
28
Rancho Los Amigos Scale
1. no response
2. generalized
3. localized
4. agitated
5. inappropriate
6. appropriate
7. automatic
8. purposeful
29
Return to Play
1. limited activity
2. light cardio
3. cardio with directional movement
4. sports specific cardio
5. full practice
6. cleared to play
30
Treatment for stable thoracic and lumbar fracture?
Jewett or CASH brace to limit hyperflexion
31
Neurogenic bladder treatment
* CIC q 4-6 hrs to keep volumes less than 500cc
* Anticholinergic medications to prevent detrusor contraction
* Alpha blockers to relax internal urethral sphincter
* Bladder botox
* Sphincterotomy
32
Medical Complications of SCI
* autonomic dysreflexia
* orthostatic hypotention
* neurogenic bowel and bladder
* skin
* lungs
* bone
* hypercalcemia, hypercalciuria: IVF, bisphosphonates
* spasticity
* sexual function
* temperature regulation
* DVT: 8 -12 weeks LMWH
* Ulcers: PPI x 4 weeks
* neuropathic pain
* depression
33
pressure ulcer grading
1. non-blanchable erythema
2. into dermis
3. through dermis
4. muscle, tendon, or bone exposed
34
When to treat UTI in SCI?
* symptomatic and greater than 100,000 bacteria on culture and greater than 10 WBC
* asymptomatic but positive UA and upcoming bladder study or growing urease producing bugs
35
presents with new progressive pain and loss of reflexes after an SCI
syringomyelia
36
Work-up and Treatment for syringomyelia
MRI with contrast, NSG consult, avoid valsalva, shunting, neuropathic pain medications
37
MAS scale
* 1 = catch and release at end of range
* 1+ = catch and resistance less than half of ROM
* 2 = catch and resistance more than half of ROM
* 3 = passive movement difficult
* 4 = rigid
38
Multiple Sclerosis Work-up and Treatment
* MRI showing lesions in space (cord, periventricular) and time, CSF showing oligoclonal IgG bands
* High dose IV steroids, plasmaphresis, interferon beta and other immunomodulatory agents
* Neurostimulation: amantadine, methylphenidate, modafinil
* Referral to MS specialist
* submaximal exercise
* avoid heat
39
CRPS DDx
central sensitization, thalamic stroke, malingering, functional neurologic disorder
40
CRPS Work-up options
XR, EMG, US, MRI, Triple-phase bone scan
41
CRPS Treatment
* oral medications: neuropathic pain agents, steroids
* topical medications: capsaicin cream, lidocaine cream, compounded cream
* modalities: TENS
* therapy: desensitization therapy, work-hardening
* procedures: stellate ganglion block, peripheral nerve block, spinal cord or peripheral nerve stimulator
42
FAIR test
* tests for piriformis irritation of sciatic nerve
* flex hip to 60 degrees, adduct, and internally rotate
43
Low back pain treatment
* PT: core strength, glute/hip girdle strength, hamstring and hip flexor flexibility, postural mechanics, progressive strength, gait
* Oral medications
* Topical
* Injections
* Modalities: heat, cold, tens
44
Low back and leg pain DDx
* Anterior horn cell, radiculopathy, plexopathy, peripheral nerve
* Hip joint, SI joint
* IT band
* muscle, disc, ligament, vertebrae
45
Peripheral Neuropathy - Tier 1 work-up
* CBC, CMP
* Hba1c, fasting glucose, 2-hour glucose tolerance test
* B12
* SPEP
* Lower yield: TFT's, ESR, ANA, Folate, UA
46
Peripheral Neuropathy Tier 2 work-up
* Vitamins/minerals: copper, zinc, Vit. E, B1, B6, folate, celiac panel
* HIV/HTLV-1
* Hep B/C
* UPEP/immunofixation
* Cryoglobulins
* ANCA
* ANA
* CK
47
Peripheral Neuropathy - Tier 3
* CMT2 genetic testing
* salivary gland biopsy
* abdominal fat pad biopsy
* malignancy work-up: Chest CT
* nerve/muscle biopys
* anti-neural antibodies (gangliosides, Hu, CVs)
* CSF studies
48
Low Back Pain Axial vs Radicular
* Axial: Muscle strain, Ligament tear, compression fracture, annular disc pain, SI joint, spondylolysis, Z-joint
* Radicular
* Nerve root irritation: disc herniation, foraminal stenosis, Z-joint cyst, spondylolisthesis
* Spinal stenosis
* Piriformis syndrome
49
Flexion vs Extension based pain
* Flexion: disc pain, compression fracture, muscles, ligaments
* Extension: spinal stenosis, spondylolysis, spondylolisthsis, central disc herniation, Z-joint pain
50
Low back pain special tests
* Extension and rotation
* Slump sit
* SIJ manuvers
* Sit to Stand
* Tender midline
51
Reasons to get urgent surgical consultation for back pain
* more than 5mm movement of vertebral segments
* bowel/bladder incontinence, urinary retention
* spinal fracture
* intractable pain
52
Back pain treatment
* Relative rest, postural education, directional preference exercises
* Lumbar and core stabilization, hip mobility, proprioceptive training, stationary bike, aquatic, sport specific
* NSAIDS, oral steroids, muscle relaxers
* Modalities: cold, heat, tens, manual therapy, traction
* Injections, ablation
53
Things you can prescribe in therapy
* ROM
* Strength
* Postural training
* Aerobic training
* Aquatic
* Balance
* Endurance
* Proprioception
* HEP
54
Fall prevention
* Lighting
* Railings
* Remove rugs and clutter
* Grab bars
55
Fall DDx
* Orthostatic
* Cardiac
* Seizure, stroke
* Vision
* Hearing
* PN
* Weakness
* OA
56
Heart rate precautions for those on beta-blocker
20bpm above resting
57
What is the timed get up and go test
* get up, walk 3 meters and back, sit down
* more than 14 seconds indicates increased risk for fall
58
Joint injection procedure steps
* informed consent
* rule out allergies
* 4ml 1% lidocaine and 1 ml corticosteroid
* 22 to 25 gauge 1.5-2 inch needle
* mark landmark
* shoulder: sulcus between acromion and humeral head, direct towards coracoid process
* knee: finger-tip lateral to patellar ligament and above tibial plateau, direct post-medial to about 3 cm depth
* sterilize skin
* insert needle, aspirate, inject
* dispose of needle properly
59
Neuropathic pain medications
* gabapentin, pregabalin
* amitriptyline, nortriptyline
* duloxetine, venlafaxine
60
Metabolic abnormalities that can cause AMS
salt water (glucose, sodium), blood, urine, thiamine, thyroid, calcium, CO2,
61
Treatment of medial tibial stress syndrome
shoe orthotics, softer running surface, correct overpronation, reduce milage, relative rest, PT, NSAIDS ice, surgery (fasciotomy)
62
When is surgery indicated for vertebral compression fracture?
* more than 25% loss of height
* significant neurologic deficits
63
Neurogenic vs Vascular claudication
* Vascular claudication is worse with activity whereas neurogenic is worse with spine extension (walking downhill) which narrows spinal canal
* Vascular claudication will show skin changes (shiny, hairless, thin)
* Neurogenic claudication may present with bowel or bladder changes
64
When is surgery indicated for spondylolisthesis?
greater than 50% slippage or neurologic symptoms
65
SI joint tests
* FABERE (test c/l joint)
* Gaenslen: Pt. lays on back. Have patient hold up and flex asymptomatic side. Flex asymptomatic hip and extend symptomatic side (off the table).
* Sacral compression test: patient lays on side - compress lateral illium into table
* Yeoman: patient prone. flex knee on symptomatic side to 90. Passively extend hip while stabilizing the ipsilateral SI joint
* Gillet test: positive if PSIS does not move inferiorly with standing hip flexion on that side
* Seated flexion test: positive if PSIS does not rise on symptomatic side with forward seated flexion
66
three risk factors for vertebral osteomyelitis
IVDA, DM, immunocomprimised status
67
treatment for acute myelopathy
IV steroids and surgical decompression
68
Lab to check when HO is suspected
Alk Phos
69
Important exam maneuver when cauda equine is suspected
rectal tone
70
Mneumonic for cognitive areas to test in brain injury
* Judgement
* Insight
* Memory
* Processing speed
* Attention
71
Associated with poor prognosis in brain injury due to cardiac arrest
* No pupillary/corneal reflex or extensor motor responses 3 days afterwards
72
Good outcome in DOC is unlikely if…
Coma longer than 4 weeks or PTA longer than 3 months
73
Brain injury scales
* GCS
* CRS-R
* GOAT (\>75), OLOG (\>25)
* MMSE, MoCA - detect mild cognitive impairment
* PSCC - post concussive symptoms scale
74
Energy increase after amputation
20/40/60/200, double if dysvascular
75
work-up for suspected Myasthenia Graves
edrophonium test, ach receptor antibodies, RNS, single-fiber EMG
76
Lateral epicondylitis treatment
* eccentric exercises
* therapeutic US
* friction massage
* activity modification
* wrist immobilization splints
* steroid injection
77
Physiologic changes with prolonged bed rest
* decrease muscle strength 1% per day
* decrease bone mass of vertebrae 1% per week
* decrease plasma volume and stroke volume
* increase resting and active heart rate
* orthostatic hypotension
* coagulopathy with increased risk of DVT
* increased insulin resistance
* atelectasis
