Osce Flashcards
(133 cards)
0
Q
What fibres does a hallux proprioception test
A
A-alpha fibres
Know where the foot is in space
1
Q
Cramps
A
Involuntary, painful, self limiting contractions of skeletal muscle
2
Q
Fasciculation
A
Random, painless muscle contracture
Twitch
3
Q
Muscle atrophy
A
Muscle bulk is smaller than expected for body size
4
Q
Muscle hyper trophy
A
Muscle bulk is larger than expected for body size
5
Q
Muscle psuedohypertrophy
A
Muscle bulk appears larger than expected for body size-however this is due to overgrowth of fibrous or fatty tissue
6
Q
Allodina
A
Pain evoked by a stimulus that does not normally evoke pain
7
Q
Hyperalgesia
A
Increased pain response to a stimulus that is normally painful
(Suggested to be a consequence of peripheral and/or central sensitisation)
8
Q
Dysthesia
A
A spontaneous or evoked unpleasant abnormal sensation
Eg; finding pins and needles unpleasant
9
Q
Paraesthesia
A
A spontaneous or evoked, abnormal but not unpleasant sensation
(Eg; if someone finds pins and needles abnormal but not unpleasant)
10
Q
Hyperesthesia
A
Increased sensitivity to stimulation, including diminished threshold & increased response
11
Q
Grading reflexes
A
Absent/present/exaggerated
Note symmetry
12
Q
Neurological assessment risk factors
A
Diabetes mellitus, alcoholic neuropathy, nerve entrapments, loss of sensation, spina bifida, cerebal palsy, muscular dystrophy, sudden falls, post surgery (eg; mortons neuroma)
13
Q
Homocysteine
A
Amino acid - alterations in it’s metabolism are a recognised independent risk factor for PAD
14
Q
Hypohidrotic skin is indicative of PAD
Clinically presents
A
As the metabolic need of the skin are not being met.
Clinically presents as dry flaking skin of the dorsum/plantar & extending up the leg
15
Q
Intermittent clarification
A
Transient ischaemic muscle pain that occurs during exercise - strong indication of significant PAD
16
Q
Rest pain
A
Typically occurs when legs are elevated.
Persistent pain that is caused by nerve ischaemia -> ischaemic neuropathy
17
Q
Orthotic therapy
A
The use of an appliance or apparatus to support, align, prevent it correct deformity or to modify position or motion and improve the function of the moveable parts of the body
18
Q
Orthosis
A
Orthotic device
Plural- orthoses
19
Q
Anatomy of a non-cast insole
A
Consists of base- generally just a vehicle, can provide some cushioning
And
Padding- this will determine the function of the device (cushioning, padding, deflection, alter plantar pressures)
20
Q
Shell material
A
Polypropylene
-3mm or 4mm
21
Q
Polypropylene
A
Yields pressure and torque
Economical
Oven temp 180-200degrees C - 3min per mm
Copolymer polypropylene (contains up to 15% polypropylene)
22
Q
Carbon composites shell material
A
Carbon composites make light rigid shell materials from carbon fibre composite & polypropylene
23
Q
Ethyl vinyl acetate
A
Grinds easily
Retains shape well
Reflect body heat
Lasts 1yr
24
Shore value
= hardness (not density)
25
Low density EVA (220)
Shock absorption
Shoe uppers in temporary shoes
Stabilisers in AFO
Shore value of 25/35
26
Medium density EVA 270
```
Heel lifts
Shoe blessings
Moulded insoles
So-rigid stabiliser
Shore value 35-50
```
27
High density EVA 350+
```
Shoe lifts
Heel lift
Block heels
Wedge bottom
Rigid insole
```
28
EVA is mouldable at what temperature?
120-170* C depending on density with an oven time of 2minutes per mm
29
PPT
Lining material
30
Open cell polyurethane memory foam
PPT
31
PORON
4000
92 ultra soft
94 slow memory
Dual layer
32
Plastazote
Lining material
33
Coverings
Vinyl
| Cambrelle
34
Types of padding
Corrective padding
Compensatory padding
Palliative padding
35
Corrective padding
Used to realign musculoskeletal components of the foot and restore function
36
Compensatory padding
When correcting is not possible (when correction is not possible) padding compensates for the loss of function
37
Palliative padding
Used to cushion or redistribute load away from a specific area
38
Padding principles
Use stretch of materials
Bevels
Allow function
39
Strapping
Rounded ends
Never end in a double thickness
Should not interfere with normal foot function (except splint)
Should not overlap tendons or interfere with function
Avoid peri-ungual tissue
Avoid nail plate
Half the strap on the pad and half on the skin
40
Felt
2, 3, 5, 7, 10mm
Matted wool
Material of choice for corrective padding- most durable
41
Fleecy foam
Soft foam with strength of fleece.
Cushion & protect areas from stress and pressure.
Highly compressible, instant recovery, ideal for light cushioning
42
Foams
Molefoam - latex foam bonded with a brushes surface
Absorbs pressure
Instantaneous recovery
Ideal for cushioning & plantar pressure redistribution
43
Fleecy web
100% cotton padding with a raised fleecy surface.
Transverse stretch allows the padding to conform to the skin which prevents creasing
Conforms well to difficult areas (bony prominences)
44
Bevelling appropriate angle
45*
45
Before you apply a pad you should
Check for allergy
Use a barrier wipe
Precut your pad and strapping tapes before applying to the patient
46
Types of digital pads
```
Digital covers
Digital props
Digital crescent
Horseshoe pad
Interdigital cover or wedge
```
47
Basic pad shapes
Crescent pad- used on digits to protect IPJs
Digital cover or oval pad- usually used in conjunctions with a cavity or aperture- used to hold medicaments or protect bony prominence
48
Replaceable toe prop
Can be used to straighten toes of reduce the pressure on the apices of toes
49
Horseshoe pad
I-shaped pad used to deflect pressure away from either IPJs
50
Plantar pads
```
PMP
Plantar cover
Shaped metatarsal bar
Straight metatarsal bar
Valgus pad
```
51
Plantar cover
Anterior border- follows the webbing of 1-5
Posterior border- thumbs width distal from the styliod
Follow the medial and lateral lines of the foot
52
Wing
Material is removed from the pad leaving a back-beveled crescent shape cut-out to accommodate a lesion, usually either under the 1st or 5th or both MPJs
53
Straight Metatarsal bar
Short plantar cover with a straight distal edge
| - usually used to assist propulsion if the is a problem at the MPJs
54
Shaped met bar
Used the same way as a straight met bar.
Follows the metatarsal formula (parabola)
Can be used to offload the met heads
55
Hammer toe
Fixed flexion deformity of the proximal IPJ
56
Mallet toes
Fixed flexion deformity of the distal IPJ
57
Claw toes
Fixed flexion deformity of the proximal and distal IPJs
58
Adducto varus
Congenital flexor tightness
| (Curly toes) distal IPJ is flexed and varus
59
Anatomical landmarks relevant for the manufacture of orthoses
Webbing 1-5
Styloid process
Sustentaculum tali
Calcaneal bisection
60
Four orthotic materials used for corrections
```
High density EVA 350+
Medium density EVA 270
Polyethylene
Polypropylene
Carbon composites
```
61
Covering options for orthoses
Vinyl
| Cambrelle
62
Sterilisation
Rendering an item free of all living microorganisms
63
Disinfection
Reducing the level of micro organisms to a level which is harmless to health
64
Antisepsis
The destruction or inhibition of microorganisms on living tissue
65
Asepsis
The absence of infection resulting from contamination
| Achieved through sterilisation & disinfection
66
Endogenous
From the patient
67
Exogenous
Infection from an external route
68
Nosocomial
Hospital acquired infection
48hrs after administration
30days after discharge
69
Steps to reduce risk of infection
| Minimum
```
Hand hygiene
PPE
Sharps handling by and disposal
Reprocessing
Cough hygiene
Aseptic non-touch technique
Waste management
```
70
Hand hygiene how long?
15-20 seconds for routine hand wash or alcohol was
30seconds for aseptic procedure
5minutes for surgical
71
5moments of hand hygiene
```
Before touching patient
Before procedure
After procedure/body fluid exposure
After touching a patient
After touching a patients surroundings
```
72
Invasive treatment on a patient why PPE do you wear
Gloves
Apron
Eyewear
Face mask
73
When do we wear gloves
When there is risk of exposure to blood or bodily fluid, skin that is not intact or mucus membranes
Handling waste
When performing invasive procedure
74
Cleaning the treatment area includes
| Cleaning with neutral detergent
```
Patient chair
Operator chair
Work top trolley
Nail drill
Diagnostic equipment
```
75
When cleaning he patients foot fr toe to heal with alcohol or chlorhexidine we must assess:
Nail size & shape
Skin quality & colour skin temp
Presence of hair
Neuro responsiveness
76
Limitations of a mod root technique
Maximum correction of 8-12degrees with extrinsic stabilisers
Limited effect on a greater amount of rear-foot control is needed or a forefoot varus/valgus is present
77
When will you use a mod root technique orthotic
Where mid foot and moderate rear-foot control is required
78
What is a modified root device
Slightly altering the forefoot plaster additions and the shape of the orthotic shell of the root balance technique to allow for greater rear-foot inversion with gentle forefoot control and emphasised mid tarsal control. This is tolerated much more readily in shoes.
79
Assessing the negative cast
```
Forefoot to rearfoot relationship
Lateral border (straight)
Toe positions (PF /DF)
Skin contact (esp MLA)
Suitability for pouring
Finger impression (4&5)
```
80
Right ventricle failure presents
Peripheral oedema
81
Left ventricular failure presents as
Pulmonary oedema
82
Positive clinical test for lymphoedema
Inability to pinch the skin
83
PAD symptoms
```
Cramp-like pain
Tightness
Tiredness
Impotency
Rest pain
```
84
Pink skin indicates
Healthy normal circulation
85
Blue skin indicates
Venous stasis
Cassis plastic disorder
Cold chilblains
Hazy blue may indicate infection/necrosis
86
Brown skin indicates
Hamosiderosis
| Wet gangrene
87
Black skin indicates
Necrosis
| External shoe dyes/bruise
88
Pale skin
Cold
Cardiac failure
Vasspastic disorder
89
White with demarcation line indicates
Ischaemia
90
Red skin indicates
Infection
Cellulitis
Heat inflammation
Cacao spastic disorders
91
Doppler assessment sound interpretation
Assess: phase volume clarity
92
Pathological artery sound interpretation
Monophonic
Low volume
Whooshing or knocking
93
Non-pathological artery sound interpretation
Multiple phases
High volume
Clearly defined audio absent of whooshing
95
Management for normal results for a TBI greater than 0.75 with risk factors
Rescreen in 1year
96
Management for ABI 0.5-0.9 &/or signs and symptoms of PAD including waveform analysis
Rescreen in 3months & of ABI still less than 0.9 with other signs and symptoms refer to GP for intensive risk factor modification
96
Reason ABI is not suitable in people with diabetes mellitus
Arterio-venous shunting & reducing tissue percussion while large artery flow remains adequate
Medial arterial calcification
More distal location of atherosclerosis
Distal atherosclerosis associated with medial arterial calcification
97
TBI les than 0.70 & other signs and symptoms
Rescreen in 3months and if TBI is still less than 0.70 with other symptoms then refer to GP for intensive risk factor modification
98
Cellulitis
Is a diffuse bacterial infection of the skin and subcutaneous tissues.
Produces redness, heat swelling & itching may cause systemic reactions such as fever
99
If a patients pain/symptoms get worse as the day goes on or are exacerbated by heat and relieved with leg rest elevation what is that indicative of?
CVI
100
ABI of 0.40-0.8 is
Intermittent claudication
101
ABI less than 0.4 is defined as
Critical limb ischaemia
102
ABI of less than .90
Pathology
103
Common locations of a heloma durum
```
IPJs
Plantar aspect of the MPJs
Extensor hallux longus tendon
Styloid process
Medial 1st MPJ
```
104
Hyperkeratosis caused by
```
Intermittent ischaemia
Reactive hyperaemia
Accelerated proliferation of epidermal cell
Increased cell adhesion
Reduced desquamation
then hyperkeratosis
```
105
What makes a shoe safe?
```
Firm heel counter
Beveled heel
Broad flared heel
Laces or fastening
Thin firm midsole
Textured sole
```
106
What makes an unsafe shoe?
```
Soft or stretched uppers
High heels
Narrow heels
Lack of laces
Slippery or worn soles
```
107
Meissners corpuscle
Touch and low frequency vibration
108
Merkles disc
Primarily involved in touch
109
Ruffini ending
Detects heavy continuous touch & high frequency vibrations; largest of encapsulated nerve endings
110
Asepsis
The absence of infection resulting from contamination.
111
Antisepsis
The destruction or inhibition of microorganisms on living tissues
112
Disinfection
The process of reducing the level of microorganisms to one which is harmless to health
113
Sterilisation
The process of rendering an item free of all living microorganisms
114
Podiatry clinical area includes
Patient chair, operator chair, work top trolley, nail still, diagnostic equipment
115
Blood or bodily substance comes in contact with skin
Wash with soap and water
| - report exposure to supervisor
116
Blood or bodily substances comes into contact with non-intact skin
Wash with soap and water & cover all skin breaks with water resistant occlusive dressing
- report the exposure to your supervisor
- incident report
- follow up with GP
117
Sharp/needle stick injury
Wash wound with water & let it bleed freely for a few seconds
- report exposure to your supervisor
- incident report
- Follow up appointment with GP
118
Blood or bodily substance is the eye
Irrigate with water while flushing the eyelids up and down
- report the exposure to your supervisor
- incident report
- follow up appointment with GP
119
Blood or body substance splashes into the mouth
Spit the substance out, rinse with water several times
- report the exposure to your supervisor
- incident report
- follow up appointment with GP
120
Myotomes that plantar flex
S1
121
Myotonia that dorsiflex
L4
122
Myotomes that wiggle the toes
L5
123
Myotomes that straighten the knee
L3
124
Neuro vascular risk category assessment group 3A
Ulcer history
125
Neuro vascular risk category group 3B
Amputation
126
Neuro vascular risk category group 2B
PAD
127
Group 2A neuro vascular risk category
Peripheral neuropathy & deformity
| No PAD
128
What risk category would a peripheral neuropathy, no PAD, no deformity be classed as?
Group 1
129
Neuro vascular risk category group 0
No peripheral neuropathy, no PAD
130
What is the final forward flow of a triphasic waveform representive of?
Late diastole elastic recoil of the artery
131
Venous stasis dermatitis
Eczematous process that develops due to insufficient venous return.
Erythemathous
Pruritic plaques on the leg
132
Haemosiderin
Yellow to brown iron rich pigments caused through the breakdown of red blood cells.
Usually an indicator of underlying pathology
