DDx

Question 1

Etiology of an intracranial Aneurysm?

Answer 1

• ballooning/dilation of blood vessel wall
• traumatic or congenital rupture of the middle or anterior cerebral arteries or communicating branches of the circle of willis

Question 2

SS of intracranial aneurysm?

Answer 2

• asym till rupture
• new or change in HA
• can compress other structures causing
  + ocular palsies
  + diplopia
  + squint
  + facial pain
• bitemporal deficet indicate pressure on the optic chiasm
• homo hemiopia b/c pressure on optic chaiasm
• neuro deficits
• once intracranial pressure increases vommiting, dizziness and alterations in pulse and respiratory rates
• seizures
• kernigs sign
• B/L babinski

Question 3

Tests for intracranial aneurysm?

Answer 3

• CT scan

Question 4

Treatment for intracranial aneurysm?

Answer 4

• surgery

- lumbar puncture

Question 5

Etiology of BPPB?

Answer 5

• b/c degen otoconia floating in the post semicircular canal
• debris gets stuck to the cupula making it heavier = cupulolithiasis
  debris can float int he long arm of the canal as well causing inappropriate endolymph movement = canalolithiasis
• most commong cause of vertigo

Question 6

SS of BPPV?

Answer 6

• vertgio with certain head positions
• severe vertigo for seconds to mins
• horizontal nystagmus
• diminishes over month or 2
  NO hearing loss

Question 7

Tests for BPPV?

Answer 7

• Dix Hallpike maneuver
• take sitting patient w/ 45 deg head rotation into supine while maintian head turn
• once supint the vertigo and nystagmus will begin

Question 8

Treatment for BPPV?

Answer 8

• Eply’s
• Semonts
• meds and surgery

Question 9

Etiology for cervicogenic HA?

Answer 9

• referal from soft tissue

- trigeminalcervical nucleus allows referal of the pain from the neck to the head

Question 10

SS of cervicogenic HA?`

Answer 10

• daily HA w/ neuro signs
• decreased ROM w/ pain
• restriction in the C spine especially occiput
• xray show arthrosis

Question 11

Treatment of cervicogenic HA?

Answer 11

• SMT and soft tissue

Question 12

Etiology of Classic Migraine (migraine w/ aura)?

Answer 12

• neurogenic, thought to be vascular

Question 13

SS of classical migrane?

Answer 13

• female
• unilateral throbbing (pulsating) HA
• photophobia
• phonophobia
• prodrome: bild spot w/ lights, numbness, sensory loss, weakness
• nausea
• vommiting

Question 14

Treatment of classic Migraine?

Answer 14

• SMT for chronic

- meds

Question 15

Etiology of clsuter HA?

Answer 15

• unknown

Question 16

SS of Cluster HA?

Answer 16

- middle aged male
occurs over days or weeks and appear again weeks or months later
- last 30 mins 
- triggered by alcohol or certain foods
- Horner's syndrome 
  \+ Pitosis
  \+ miosis
  \+ anhydrosis
- severe
- unilateral
- periorbital
- lacrimation
stuff nose
- facial swelling

Question 17

Treatment of Cluster HA?

Answer 17

• meds
• chronic cluster low grade mob
• episodic cluster just exercise

Question 18

Etiology of common migrane?

Answer 18

• neuro cause

- hypothetical causes

Question 19

SS of common migraine?

Answer 19

• female
• unilateral
• pulsitile
• severe HA
• no neuro
• nausea and vomitting

Question 20

Treatment of common Migraine?

Answer 20

• SMT

- meds

Question 21

SS of concussion?

Answer 21

• post trauma
• loss of awareness or memory
• papilary sign and brainstem function intact

Question 22

Treatment of concussion?

Answer 22

• ABC first aid and send to hospital

Question 23

Eitology of Crainial nerve 1 (olfactory) lesion?

Answer 23

• ethmoid #

Question 24

SS of CN 1 lesion?

Answer 24

• ansomia

Question 25

SS of CN2 (optic nerve) lesion?

Answer 25

- transection = ispsilateral blidness, loss of direct light reflex - w/ constriction = optic atrophy - compresion at the optic chaism = hemiopia

Question 26

Etiology of Occulomotor nerve (CN 3) lesion?

Answer 26

- transtentorial herniation, b/c supdural or epidural hematoma - aneurysm of carotid and posterior commnuicating artery - diabetese melitus

Question 27

SS of transtentorial herniation on CN 3?

Answer 27

- diplopia - ptosis - eye down and out

Question 28

SS of aneurysm of carotid and posterior communicating artery?

Answer 28

- dilated and fixed pupil

Question 29

SS of Diabetes Mellitus on CN3?

Answer 29

- pupil contrictor fibres fine | - central fibres damaged

Question 30

SS of CN 4 (Trochlear) lesion?

Answer 30

- cannot look down and out

Question 31

SS of Trigeminal Nerve lesion?

Answer 31

- general facial sensation - loss of corneal reflex - flaccid muscles of mastication - jaw deviates to side of lesion - tensor tympani paralysis (low pitch deafness)

Question 32

SS of CN 6 (Abducens) lesion?

Answer 32

- lateral rectus muscle weak | - cannot look out

Question 33

SS of Facial nerve (CN 6) lesion?

Answer 33

- muscles of facial expression don't work - loss of corneal reflex - loss of ant 2/3 taste - hyperacusis b/c stapedius paralysis - bell's palsy (half of face loss function)

Question 34

What is central facial palsy?

Answer 34

- corticobulbar fibres in the interal capsule transect causing contralateral weakness sparring the forehead (UMN lesion of the facial nerve)

Question 35

What is crocodile tear syndrome?

Answer 35

- lesion prox to the geniculate ganglison | - lacrimation during eating

Question 36

What is Mobeius syndrome?

Answer 36

- congenital facial diplegia and convergent strabismus

Question 37

SS of CN 8 (vesibularcochlear) lesion?

Answer 37

- vertigo | - nystagmus

Question 38

SS of CN 9 (Glossopharengheal) lesion?

Answer 38

- loss of gag (pharyngeal) reflex) - loss of carotid sinus reflex - loss of post 1/3 tongue taste - glossophanyngeal neuralgia

Question 39

SS of CN 10 (vagus) lesion?

Answer 39

``` - ipsilateral soft palate, lpharynx and larynx paralysis + dysphonia + dyspnea + dysarthia + dysphagia - uvula goes to the contralateral side - loss of gag (palatal) reflex - anesthesia of pharynx and larynx + unilateral loss of cough reflex ```

Question 40

Etiology of vagus nerve compression?

Answer 40

- aortic aneurysm | - tumours of neck

Question 41

SS of CN 11 (accessory nerve) lesion?

Answer 41

- SCM paralysis + cannot rotate to opposite side - traepzius paralysis + shoulder drop

Question 42

SS of CN 12 (Hypoglossal) lesion?

Answer 42

- tongue hemiparalysis | - ipsilateral deviation

Question 43

Etiology of facet syndrome?

Answer 43

- minor trauma (sudden head turning) - facet or capsule is the source of the pain - emniscoids can become trapped or pinched degen can cause facet pain

Question 44

SS of facet syndrome?

Answer 44

- neck and upper back pain/stiffness - sharp pain w/ motion - local pain w/ + kemps + Spurling's + Jackson's - scleratomal refferal - tender and motion restriction on palpation limited C spine A and PROM - NO nerve root tension signs - Muscle HT

Question 45

Tests for Facet syndrome?

Answer 45

- clinical | - facet arthrosis on xray

Question 46

Treatment for facet syndrome?

Answer 46

- SMT - ice - ultrasound, tens - meds, facet denervation/injections

Question 47

Etiology of Glaucoma?

Answer 47

- progressive damage to the eye b/c increased intraoccular pressure - most common cause of blindness

Question 48

SS of Glaucoma?

Answer 48

- no early symptoms - visual field loss - blindness + first there is peripheral vision loss + then central

Question 49

Tests for Glaucoma?

Answer 49

- asymmetric Intraocular pressure - elevated intraocular pressure in eye w/ most damage to optic nerve - intraocular pressure can be high or normal

Question 50

Treatment of Glaucoma?

Answer 50

- meds - laser therapy - refer to optometrist

Question 51

Types of Hematoma?

Answer 51

- subarachnoid - subdural - epidural - intracerebral

Question 52

Etiology of subarachnoid hematoma?

Answer 52

- berry aneurysm - AV malformation - trauma - hemorrhagic diathesis

Question 53

Etiology of subdural hematoma?

Answer 53

- venous bleeding between the dura and the arachnoid

Question 54

SS of subdural hematoma?

Answer 54

- gradual signs of cerebral compression | - takes hrs, days or weeks post injury to surface

Question 55

Etiology of epidural hematoma?

Answer 55

- arterial hemorrhage associated with skull # and laceration of the middle meningeal artery - # of temporal bone usually - # of occipital bone can also cause

Question 56

SS of epidural hematoma?

Answer 56

- short lucid period of consciousness followed by rapid cerebral compression signs

Question 57

Etiology of a intracerebral hematoma?

Answer 57

- hypertension - ass w/ Charcot-Bouchard aneurysms - often in the basal ganglia, thalamus, pons, cerebellum and frontal lobe

Question 58

Etiology of Herpes Zoster of the facial nerve?

Answer 58

- invasion of the 8th cranial nerve ganglia and geniculate ganglia of the facial enrve by the herpes zoster virus

Question 59

SS of Herpes Zoster of the facial nerve?

Answer 59

- pain before vessicle eruptionin 2 -3 days - severe ear pain - hearing loss - vertigo - paralysis of facial nerve - vessicles on pinna and inner ear canal

Question 60

Tests for herpes zoster of the facial nerve?

Answer 60

- elevated lymphocytes and protein in CSF

Question 61

Treatment for herpes zoster of the facial nerve?

Answer 61

- antivirals | coricosteroids

Question 62

Etiology of hyper tension HA?

Answer 62

- intracranial hypertension w/out evidence of SOL, obstruction, or infection

Question 63

SS of hypertension HA?

Answer 63

- papilledema (swelling of the optic nerve) | - partial or complete monocular vision loss

Question 64

Tests for hypertension HA?

Answer 64

- CT, MRI, EEG normal | - CSF presure increased but normal fluid

Question 65

Etiology of intracranial mass?

Answer 65

- expanding intracranial lesion - granuloma - paracytic cyst - hemorrhage - anurysm - abcess - neoplasm

Question 66

SS of Intracranial mass?

Answer 66

- b/c increased intracranial pressure - HA - vomitting - mental status changes - drowsiness - lethargy - obtuseness - personality changes - disordered conduct - impaired mental status - papilledema changes in + temp +BP + pulse + respiratoy rate suually before death

Question 67

Treatment of intracranial mass?

Answer 67

- depends on the type of mass

Question 68

Etiology of medication reaction?

Answer 68

- daily use of over the counter meds at reccomended dose or higher

Question 69

SS of Medication reaction HA?

Answer 69

- chronic overuse of analgesics | - HA

Question 70

Treatment of medication reaction HA?

Answer 70

- get patient to stop taking meds

Question 71

Etiology of pneumoccocal meningitis?

Answer 71

``` - acute bacterial infection of either: + Neisseris meningitides + strep pneumonia - meningicoccal meningitis usually occurs within the first year of life - pneumococcal meningitis common in adults w/ history of: + chronic otitis + sinusitis + mastoiditis + closed head injury w/ CSF leaks ```

Question 72

SS of pneumococcal meningitis?

Answer 72

- respiratory illness - fever - HA - stiff neckl - vommiting - adults ill w/in 24 hrs - change in conciousness - seizures and cranial neuopahties - waterhouse friderichsen syndrom w/ vascular collapse

Question 73

Tests for Pneumococcal meningitis?

Answer 73

- + brudzinski's - + kernigns - Uni or bi lateral babinski's - lumbar puncture should bne done after a CT to exclude a mass lesion - culture CSF to find: + for bacteria

Question 74

Treatment for Pneumococcal meningitis?

Answer 74

- multiple antibiotics

Question 75

Etiology of aseptic meningitis?

Answer 75

- meningitis inflammation w/out bacteria on exam | - can be due to a viral infection

Question 76

Etiology of Myofascial trigger points of suboccipital muscles?

Answer 76

- trigger pint = hypersensitive area of muscle that refers pain to another part of the body - usually b/c of repetitive trauma

Question 77

SS of Myofascial trigger points of suboccipital muscles?

Answer 77

- tenderness and hyper tonicity of suboccipital muscles | - trigger points in the suboccipitals

Question 78

Tests for suboccipital myofascial trigger points?

Answer 78

- palpation of the suboccipitals

Question 79

Treatment of suboccipital myofascial trigger points?

Answer 79

- soft tissue - stretches - MRT - postural education

Question 80

Etiology of otitis media?

Answer 80

- bacterial/viral infection of the middle ear - microrganisms from the nasopharynx migrate to the middle ear via the eustachian tube - newborns: + enteric bacteria + e coli + staph aureus - post neonatal + ecoli rarley cause - older kids + strep pneumonia + haemophilus infulenzae + s aureus

Question 81

SS of otitis media?

Answer 81

- persistent, sever earache initially - hearing loss - fever - nausea - vommiting - dirrhea - red bulging tympanic membrane - bloody purulent otorrhea

Question 82

Tests for otitis media?

Answer 82

- clinically found | - myringotomy can be performed to culture the exudate

Question 83

Treatment of otitis media?

Answer 83

- antibiotics | - refer

Question 84

Etiology of nerve root irritation or segmental radiculopathy?

Answer 84

- herniated disc | - bony changes in RA or OA can compress single roots

Question 85

SS of nerve root impingement?

Answer 85

- radicular pain w/ sensory deficits - ventral root involvment = motor weakness in dermatomal distribution - corresponding DTRs dimminished as well - pain agg by + moving spine + coughing + sneezing + valsava - ortho tests reproduce neck and arm pain - brokody's releives the pain

Question 86

Tests for nerve root impingment?

Answer 86

- MRI is the best for disc herniation | - oblique xray can be used to observe the IVF of cervicals

Question 87

Treatment for nerve root impingment?

Answer 87

- muscle relaxants - surgical decompression - chiro mob or adjustment - traction

Question 88

Etiology of Sinusitis?

Answer 88

- inflammation of the paranasal sinuses due to viral bacterial or fungal infection - acute sinusitis usually caused by acute viral respiratory infection

Question 89

SS of sinusitis?

Answer 89

- area over affected sinus tender - different sinuses blocked cause pain in that area: + maxillary: toothache, maxillary area HA + frontal: frontal area, HA + ethmoid: behind eyes and frontal (splitting HA) + spenoid: not localised - malaise - fever - chills - red translucent mucous membrane

Question 90

Treatment of sinusitis?

Answer 90

- steam inhalation

Question 91

Etiology of Temporal arteritis?

Answer 91

- chronic inflam of the large blood vessels | - usually occurs alongside polymyalgia rheumatica

Question 92

SS of temporal arteritis?

Answer 92

- severe HA --> tempral and occipital - scalp tenderness, visual disturbance - pain on chewing - blindness - arthritis, carpal tunnel - fatigue - swollen and tender nodules in tempral arteries

Question 93

Tests for Temporal arteritis?

Answer 93

- increased ESR when active - normochronmic, normocytic anemia - increased alp - biopsy required

Question 94

Treatment for Temporal arteritis?

Answer 94

- Prednisone

Question 95

Etiology of TMJ dysfunction?

Answer 95

- stress - bruxism - head trauma

Question 96

SS of TMJ dysfunction?

Answer 96

- pain in the jaw and face around TMJ - clicking and popping sound with opening and chewing - pain when chewing hard foods

Question 97

Treatment for TMJ dysfunction?

Answer 97

- mild analgesics | - mouth guard

Question 98

Etiology of Tension HA?

Answer 98

- inhanced painproprioception | - co-mobuid migraine, mood disorder, sleep dysfunction, anxiety

Question 99

SS of tension HA?

Answer 99

- HA lasts form 30 min - 7 days - wraps around head (tight band around head) - bilateral - no nausea vomitting, photophobia - increased hypertonicity

Question 100

Treatment of Tension HA?

Answer 100

- analgesics | - tricyclic antidepressants

Question 101

Etiology of Trigeminal Neuralgia?

Answer 101

- disorder of the trigeminal nerve | - compression of the trigeminal root

Question 102

SS of Trigeminal Neuralgia?

Answer 102

- trigger point pain - eating = pain - brushing teeth = pain - last from seconds to mins most often maxillary

Question 103

Treatment for Trigeminal neuralgia?

Answer 103

- carbamazepine meds | - peripheral nerve blocks provide temporary releif

Question 104

Etiology of Vertebrobasilar artery dissection?

Answer 104

- can occur most commonly at C6 or C2 b/c of spinal manipulation or common daily actyivites like driving - intimal tearing occurs which causes decreased blood supply in itself of creates an embolis which further blocks the artery - Wallemberg's syndrome or Locked in (cerebromedullospinal disconnection) syndrome can occur

Question 105

Etiology of Wallenberg's syndrome?

Answer 105

- Vertebral artery dissection | - occlusion of the PICA

Question 106

SS of wallenberg's syndrome?

Answer 106

- vertigo - diplopia - dysarthria

Question 107

Etiology of Locked in Syndrome?

Answer 107

- vertebral artery disection

Question 108

SS of locked in syndrome?

Answer 108

- more serious than wallenberg's | - = leaves the patient paralyzed

Question 109

SS of vertebrobasilar artery dissection?

Answer 109

- neurologic dysfunction w/ sudden onset - less than 24 hrs - 5 D's and 3 Ns

Question 110

Etiology of Abdominal Aortic Aneurysm?

Answer 110

- athersclerotic aneurysms - usually below the renal arteries - > M

Question 111

SS of AAA?

Answer 111

- asym until rupture - severe middle abdominal or LBP - leg pain w/ exertion (claudication)

Question 112

Tests for AAA?

Answer 112

- pusatile mid or upper abdominal mass - palation sensitive for masses greater than 3 cm - radio graph show calcification around L2 and L4, if greater than 3.8cm aneurysm

Question 113

Treatment for AAA?

Answer 113

- refer - if 4 - 6 cm surgery - contraindication to Lumbar SMT

Question 114

Etiology for Cauda Equina Syndrome?

Answer 114

- rare central compression of the spinal cord below L1

Question 115

SS for Cauda Equina Syndrome?

Answer 115

- urinary retention (bowelk and bladder issues) - saddle paresthesia - numbness aroudnt eh groin or genital area - sexual incontience

Question 116

Tests for Cauda equina syndrome?

Answer 116

- valsava - pain radiating B/L legs - sensory or motor loss in both legs - babinski response

Question 117

Etiology of congenital hip dysplasia (dislocation()?

Answer 117

- acetabular deformities - inversion of the limbs and capsular tightness causes dislocation - breach delievers - adduction and extension of the neonats legs - hormonal laxity

Question 118

Tests for congential hip dysplasia?

Answer 118

- ortolani's sign: + abduction/ external rotation causes a clunk sound - Barlows Test + flexion and abduction w/ long axis traction or posterior rpessure of the femoral head creates clunk - Galeazzi's test + comparing knee height with infant supine and hips and knees flexed - ultrasound - radiographic findings show a distruption of shelton's line: concave curve under femoral neck going into the obturaor foramen, increased skinner angle

Question 119

Treatment of congenital hip dysplasia?

Answer 119

- depends on the age - usually harness if found early - if found later on surgery

Question 120

SS of Osteoarthritis (degenerative arthrosis)?

Answer 120

- non- inflammatory - gradual pain worse by exercise - pain worse in the morning* get better with activity - decreased ROM - tenderness - crepitus

Question 121

Tests for OA?

Answer 121

- clinical | - xray ( incidental finding)

Question 122

Treatment for OA?

Answer 122

- rehab - patient education - stretches, strenghtening exercises

Question 123

Etiology of Degenerative disc disease (DDD)?

Answer 123

- initial traumatic event | - involves forced forward flexion and/or rotational mocemtn

Question 124

SS of DDD?

Answer 124

- LBP - sometimes pain refers - exacerbated by activity + sitting + getting up from seated position + waking up in the morning + lumbar flexion lifting + vibration + coughing + sneezing + valsava

Question 125

Tests for DDD?

Answer 125

- patient prefer to stand or sit in extension position - palpation of lumbar paraspinals and spine stabilizers = tender - L spine ROM limited and painful, mostly flexion, extension can also be painful though - MRI for disc herniation - xray helpful for DDD but usually in older patients >35

Question 126

Treatment for DDD?

Answer 126

- adjustment (open space)

Question 127

Etiology of Dysmenorrhea?

Answer 127

- combination of vasoconstriction and myometrioal contraction - increased discomfort caused by fluid retention and estrogen increases salt retention

Question 128

SS of dysmenorrhea?

Answer 128

- increased pain w/ menses | - pain in lower abdomin and pelvis radiating to the back or inner thighs

Question 129

Tests for Dysmenorrhea?

Answer 129

pelvis exam/ GIT exam

Question 130

Management for dysmenorrhea?

Answer 130

- NSAIDs, decrease prostoglandins | - SMT sometimes helps, omega 3, vitamin B12

Question 131

Etiology of facet syndrome?

Answer 131

- facet and capsule are the source of the pain | - predis[posed by degeneration of the facet usually in > middle aged people

Question 132

SS of Facet Syndrome?

Answer 132

- well localised LBP - sometimes have some buttock or leg pain above the knee - sudden onset after misjudged movement or getting up from a flexed position

Question 133

Tests for Facet syndrome?

Answer 133

- no neuro signs - no nerve roots tests positive - pain is local with kemps - if repro w/ slr doesn't go past the knee

Question 134

Treatment for Facet SYndrome?

Answer 134

- SMT

Question 135

Etiology of Intervertebral disc derangment?

Answer 135

- protrusion of the nucleus through the annulus fibrosis, usually posteriolaterally - the herniated disc material releases substances that cause an autoimmune inflammatory reaction - this protrusion can sometimes sompress on nerve roots causing radicular symptoms

Question 136

SS of Intervertebral disc derangement?

Answer 136

- LBP and leg pain below the knee - agg by sudden bending or twisting - past history of LBP that has been resolved

Question 137

Tests for L5/S1 Intervertebral disc derangement causing L5 radiculopathy?

Answer 137

- usually L5 or S1 disc bulge L5 - weakness of dorsiflexion of the big toe - numbness on lateral aspect of lower leg

Question 138

Tests for L5/S1 Intervertebral disc derangement causing S1 radiculopathy?

Answer 138

- absent achilles reflex - weakness of plantar flexion - numbness on the back of the calf, lateral or sole of the foot

Question 139

Tests for general intervertebral disc derangement?

Answer 139

- SLR - well leg raise - braggards - MRI

Question 140

Treatment for intervertebral disc derrangement?

Answer 140

- avoid rotation - open up joint space ( lateral flexion) flexion distraction - pelvic blocking - activator

Question 141

Etiology for compression #?

Answer 141

- combination of flexion and axial compression - usually at T/L junction - risk factors: + early menopause + osteopenia + corticosteroids + hyperthyroidism + malignancy

Question 142

SS of compression #?

Answer 142

- acute pain doesnot radiate - agg by weight bearing - local tenderness - subsides in few days or weeks

Question 143

Tests for compression $?

Answer 143

``` - xray + step defect + wedge deformity + linear zone of condensation + endplate distruption + paraspinal swelling ```

Question 144

Etiology of lateral canal stenosis?

Answer 144

- disc nucleus protrudes posterolaterally into the extradural space - compresses on the nerve root

Question 145

SS of lateral canal stenosis?

Answer 145

- pain in dermatomal distribution of the cord being compressed - worse on movement - agg by: + valsava - numbness or parasthesia in dermatomal distribution

Question 146

Tests for lateral canal stenosis?

Answer 146

- hypo reflexia when test DTR - weak flaccid muscles - SLR - CT - MRI

Question 147

Treatment for lateral canal stenosis?

Answer 147

SMT, with little to no rotation

Question 148

Etiology of Lumbosacral spine sprain/strain?

Answer 148

- muscle contraction during a forcedull muscular stretch | - uisually occurs with lateral bending and flexion or lateral bending and rotation

Question 149

SS of lumbosacral sprain/strain?

Answer 149

- pain in the L/S area that is local - ROM mostly flexion is painful and reduced (AROM and RROM painful, PROM pain free) - pain worse w/ movement - muscle spasm w/ palpation

Question 150

Management of lumbosacral sprain/strain?

Answer 150

- reduced inflam - PRICE - Painfree ROM

Question 151

Etiology of metastaic tumours to the brain or spine?

Answer 151

- cancer cells migrate through lymph, blood or CSF - grow outside of the dural matter - mets from breast, prostate lungs and kidney are common

Question 152

SS of metastatic tumours to the brain and spine?

Answer 152

- persistent pain - worse at night - no mechanical aggrevation or relief - unplanned weight loss - excessive fatigue - worse w/ standing, lifting heavy objects - bed rest sometimes alleviates pain but gradually worsens

Question 153

Tests for mets?

Answer 153

- xray - CT - MRI

Question 154

Etiology of myofascial trigger point of the Piriformis?

Answer 154

- sciatic nerve can be compressed by the piriformis muscle ( piriformis syndrome)

Question 155

SS of myofascial trigger point of the piriformis?

Answer 155

- pain w/ resisted external rotation of hip | - palpation over the piriformis causes referal down back of the leg

Question 156

Etiology of myofascial trigger point of the psoas?

Answer 156

- shortening of the psoas which is a hip flexor, causing an increase in the lumbosacral angle and increasing the lumbar lordosis

Question 157

SS of Myofascial trigger point of the psoas?

Answer 157

- pain at the T/L - sometimes reffered to the knee - pain releived by sitting - patient present as being flexed forward

Question 158

Tests for myofascial trigger point of the psoas?

Answer 158

- Thomas Test

Question 159

Etiology of Myofascial pain of the QL?

Answer 159

- QL originates on the TVP of the lumbar vertebrae and inserts onto the ilac crest - serves to raise hip - QL trigger points refer into the low back, hips, butt and groin, common cause of LBP - weak abdonminal muscles causing overcomrensation by the QL

Question 160

Etiology of primary low back tumours?

Answer 160

- originate in the lumbar spine

Question 161

SS of primary low back tumours?

Answer 161

- radiating pain - loss of muscle function - unexplained weight loss - pain unrelated to activity - fatigue - chronic productive cough - night pain - smoker - unremitting pain

Question 162

Types of Prostatitis?

Answer 162

- Acute bacterial - chronic bacterial - chronic nonbacterial

Question 163

SS of acute bacterial protatitis?

Answer 163

- chills - fever - increased urinary frequency and urgency - peroneal and low back pain - dysuria - nocturia - hematuria

Question 164

SS of chronic bacterial prostatiTIS?

Answer 164

- relapsing UTI* - low back and peroneal pain - increased urinary urgency and frequency - painful urination

Question 165

SS of chronic nonbacterial prostatitis?

Answer 165

- more common than bacterial | - same as chronic but no history of UTI and no culture found on test

Question 166

SS of Reiters (reactive arthritis)?

Answer 166

- young male - LBP after + urethritis (burning on urination) + conjuntivitis - can't see cant pee cant dance

Question 167

Etiology of reiters syndrome (reactive arthritis)?

Answer 167

- seronegative arthopathy following an infection - chlamydia - salmonella

Question 168

Tests for Reiters syndrome?

Answer 168

- conjuntivitis - mucocutaneous lesion on the tongue, palate, penis or foot - urethritis that is unresponsive to antibiotics - arthritis affecting SI, knee and ankles asymetrically - increase in ESR - increase in HLA- B27 - on xray + unilateral narrowing and erosion of SI joint + sausage finger or toes because of the swelling

Question 169

Treatment for Reiters?

Answer 169

- refer | - SMT contra

Question 170

Etiology of Sacroiliac joint dysfunction?

Answer 170

- in younger patients - pregnancy - DDD - prolonged or sudden lifting or bending

Question 171

SS of sacroiliac joint dysfunction?

Answer 171

- pain over lower back - pain over unilateral SI joint after straightening from a stooped position - pain radiates down the back of the leg - pain relieved by sitting or lying

Question 172

Tests for sacroliiac joint dysfunction?

Answer 172

- compression of the SI - Ganslen's - Gillets - conisder reiters if can't see pee dance - consider AS if significant decrease in forward flexion

Question 173

Treatment of Sacroiliac joint dysfunction?

Answer 173

- SMT | - exercise

Question 174

What are the seronegative spondyloarthopathies?

Answer 174

- reiters - psoriatic - enteric - AS

Question 175

SS of psoriatic arthritis?

Answer 175

- psoriatic lesion on the extensor surfaces - pitting of nails - dry red silvery scaly rash - distal interphalangheal joint affected* - asymettrical involvement of joint - xray + sausage digits + mouse ears --> reabsorption of the terminal phalanges

Question 176

SS of seronegative spondyloarthropathies?

Answer 176

- young male - 20 - 40 - intermittent inflmmation - back pain - worse at night - radiation of pain into the buttocks, anterior or posterior thigh - early mornming stiffness - stooped posture - anemia - loss of apetite

Question 177

Tests for seronegative spondyloarthopathy?

Answer 177

- chronic back pain - stiffness - global decrease in ROM - schober test - xray + SI changes (pseudowidening, erosions, sclerosis) + trolley track appearcne w/ AS

Question 178

Treatment for seronegative spondyloarthropathy?

Answer 178

- SMT- only in remssion periods - stretching - exercise

Question 179

Etiology of lateral spinal stenosis?

Answer 179

- bony or tissue encroachment - congenital or aquired - conmgenital predisposition is short pedicles - calcified ligamentum lavum

Question 180

SS of spinal stenosis?

Answer 180

- over 50 - leg and back pain - unilateral opr bilater based off lateral or cental stenosis - onset of leg pain w/ walking that reduces after rest or maintaing a stooped posture

Question 181

Tests for Spinal stenosis?

Answer 181

- bicycle or walk test: to diff b/w vascular or neurogenic claudication - when stooped the pain remitis b/c IVF opens up in this posture - MRI - CT

Question 182

Treatment for spinal stenosis?

Answer 182

- improve or remain stable w/out treatment - if severe neuro deficit do surgery - flexion distraction is good

Question 183

Etiology of Spondylolisthesis?

Answer 183

- Isthmic b/c stress fracture of pars usually at L5 | - in gymnists that do repetivitive hyper extensioin

Question 184

SS of spondylolisthesis?

Answer 184

- young = isthmic - older = degenerative - LBP worse w/ extension

Question 185

Tests for spondylolisthesis?

Answer 185

- xray lateral - increased back or leg pain with one leg test - increased pain w/ hyperextension - palaption find step defect, or more prominent sp at the level of the spondy

Question 186

Treatment of spondylolisthesis?

Answer 186

- grade 1 can SMT | - grade 2 or 3 refer

Question 187

Etiology of UTI?

Answer 187

- dependent on age and gender | - most commonly caused by gram-negative aerobic bacteria

Question 188

SS of UTI?

Answer 188

- increased urinary frequency and urgency | - painful urination =dysuria

Question 189

Tests for UTI?

Answer 189

- urinanalysis

Question 190

Treatment for UTI?

Answer 190

- cranberry juice | - antibiotic treatment

Question 191

Etiology of avlusion fracture of the anterior superior iliac spine?

Answer 191

- adolescent athletes - occurs at apophysis - caused by the sartoris muscle

Question 192

SS of avulsion fracture of the anterior superior iliac spine?

Answer 192

- sudden acute pain near the ASIS during athletic activity - local swelling - increased pain w/ hip and trunk movement

Question 193

Tests for avulsion fracture of the ASIS?

Answer 193

- pain w/ ROM, especially abduction and flexion - + Thomas Test - + gaenslens buit pain at hip not SI - xray + see callous formation during healing phase

Question 194

Treatment of avulsion fracture of ASIS?

Answer 194

- Acute: PRICE, NSAIDs | - After 48 hrs: ice, massage, tens, ifc, us

Question 195

Etiology of bursitis?

Answer 195

- bursae protects the points of friction b/w muscle and tendons and tendon and bone - can be injured by trauma - deep bursa injury b/c repetitive motions

Question 196

What are the different shoulder bursa?

Answer 196

- subacromial | - subdeltoid

Question 197

What are the different hip bursa?

Answer 197

- subtroachanteric - iliopectineal - ischial

Question 198

What are the different knee bursa?

Answer 198

- pre patella - infrapatella - sub patellar

Question 199

What are the elbow bursa?

Answer 199

- olecronon

Question 200

SS of Bursitis?

Answer 200

- pain in all AROM - swollen and hot - RROM painfull - patient is acute

Question 201

Test for bursitis?

Answer 201

- All ROM in different motion

Question 202

Etiology of Degenerative joint disease?

Answer 202

- progressive degeneration - loss of articular cartilage - joint margin changes - weight bearing joint, pips, dips, and shoulder or elbow joint are commonly affected - women get OA of hand - men get OA of Hip

Question 203

SS of Degenerative joint disease?

Answer 203

- HX of trauma or repetitive minor trauma - stiffness and joint pain - decreased ROM - gradual onset - short period of morning stiffness - heberden's nodes at the DIPs

Question 204

Tests for DJD?

Answer 204

- crepitus and pain during passive ROM - xray + non uniform joint space loss + osteophytes + subchondral sclerosis + joint mice + facet arthrosis + loss of disc neight + subchondral sclerosis

Question 205

Treatment for DJD?

Answer 205

- SMT if tolerated - pain management: + rest + hot packs + meds + traction - weight loss, exercise - surgery if severe

Question 206

Etiology for hip dislocation?

Answer 206

- in MVA or contact sport | - Anterior or posterior

Question 207

Etiology for anterior hip dislocation

Answer 207

- hip flexed, leg abducted and externally rotated - common in sport where running and high speed and have to land with flexed knee - femoral head comes out of the head anteriorly causing fracture and tearing potential illiofemoral and pubofemoral ligaments

Question 208

Etiology for psoterior hip dislocation?

Answer 208

- 80% of hip dislocations are posterior - forces strikes flexed knee while hip is flexed adducted and interally rotated - running player tackled and falls onto a flexed knee

Question 209

SS of posterior hip dislocation?

Answer 209

- severe hip pain inn hip region and upper leg - inability to walk or do hip ROM - sometimes numbness and tiungling in the legs - affected limb of posterior hip dislocation appears shortened, internally rotated and adducted - superior dislocation: hip extended and externally rotated - inferior: hip flexed, abducted and externally rotated

Question 210

Tests for hip dislocation?

Answer 210

- xray | - CT

Question 211

Treatment for hip dislocation?

Answer 211

- refer - PRICE - post 7 days rehab - if neuro complications, surgery

Question 212

Etiology of femoral neck fracture?

Answer 212

- severe fall or MVA | - osteoporosis = most common cause

Question 213

SS of femoral neck fracture?

Answer 213

- pain in hip, buttock or pubic area - affected leg shortens - hip brusing - toe in on affected leg

Question 214

Etiology of Fibromyalgia?

Answer 214

- > Femals | - b/w 20 - 25

Question 215

SS of Fibromyalgia?

Answer 215

- chronmic diffuse pain - poor sleep - multiple somatic complaints - minimum 3 months duration - fatigue and poor sleep - morning stiffness

Question 216

Tests for fibnromyalgia?

Answer 216

- everything normal | - multiple tender points: atleast 11/18

Question 217

Treatment for fibromyalgia?

Answer 217

- SMT - Heat - massage - meds - excercise*

Question 218

Etiology of iliotibialband contracture (ITB syndrome)?

Answer 218

- gradual lateral knee pain that starts over ina few day to weeks - associated w/ running, downhill aggrevating b/c heel strike - ITB rubs against lateral femoral condyle

Question 219

SS of ITB syndrome?

Answer 219

- tender lateral femoral condyle

Question 220

Tests for ITB syndrome?

Answer 220

- Nobel's Compression test + pressure on the distal ITB while extending the knee from flexed position - ober's test + let the side lying patient leg fall behing them, if above table then ITB syndrome

Question 221

Treatment for ITB syndrome?

Answer 221

- stretching | - myofascial relase

Question 222

Etiology for inguinal hernia?

Answer 222

- bulging of organ through abnormal opending | - can be forced through the inguinal cannal

Question 223

What is a direct inguinal hernial?

Answer 223

- weakness in the floor of the inguinal canal lets herniation occur - in men >40

Question 224

What is an indirect inguinal hernia?

Answer 224

- most common | - herniation through the internal inguinal ring

Question 225

SS of inguinal hernia?

Answer 225

- lump in the groin near the thigh - pain in the groin - partial or complete blockage of the intestine

Question 226

Tests for inguinal hernia?

Answer 226

- auscultate scrotum for bowel sounds - swelling in the inguinal region when the patient cough - palation

Question 227

Treatment for inguinal herina?

Answer 227

- can usaully reduce on its own but refer to sdoc | - surgery to repair opening in the muscle or if the hernia is stragulated causing bowel obstruction

Question 228

Etiology of Juvenile rheumatoid arthritis?

Answer 228

- ages 16 or under | - = autoimmune

Question 229

SS of Juvenile RA?

Answer 229

- persistent joint swelling - pain - stiffness, worse in morning - systematic onset in 20% of patietns + affects one joint and organs + high fever + rash + splenomegaly + adenopathy + RF and ANA absent - Pauciarticular onset 40% + 4 or less joints + young girls + ANA + boys develop other spondyloathopathy - polyartcular + 5 or more joint + complete remssion + no RF

Question 230

Tests for juvenile RA?

Answer 230

- RF - increased esr - ANA - xray

Question 231

Treatment of Juvenile RA?

Answer 231

- if + RF then prognosis is poor | - refer to md for testing

Question 232

Etiology for Leg-Calve-Perthes disease?

Answer 232

- AVN of adolescent femoral head - most common osteochondroses - occurs b/w 5 and 10, usually unilateral - secondary to other condition - self limiting

Question 233

SS of Leg-Calve-Perthes disease?

Answer 233

- pain in the hip - gait disturbance - gradual onset and slow progression

Question 234

Test for Leg-Calve-Perthes disease?

Answer 234

- decreased hip abduction and internal rotation** - + trendelemberg - xray + flat femoral head (mushroom cap deformity) + fragmentation of the femoral head (snow cap deformity) + head contains areas of lucency and sclerosis

Question 235

Treatment of Leg-Calve Perthes?

Answer 235

- comange with ortho

Question 236

Etiology of Lumbar disc herniation?

Answer 236

- commonly at L4/L5 and L5/S1 | - spontaneously resolve within 6 months

Question 237

SS of Lumbar disc herniation?

Answer 237

- sudden onset of LBP and potential leg pain past the knee - dermatomal pattern - agg by, increase in intradiscal pressure - weakness in muscle - decreased sensation in dermatomal pattern - hyporeflexia when testing DTRs

Question 238

Tests for lumbar disc herniation?

Answer 238

- decreased ROM - + SLR - + kemps for referal - MRI

Question 239

Treatment for lumbar disc herniation?

Answer 239

- SMT, refer if not reponsive in 6 weeks

Question 240

Etiology of MEralgia Paresthetica?

Answer 240

- L2-3 ventral rami (lateral femoral cutaneous nerve) - uncommon excpet w/ pregnancy and obesity - trauma to groin area where nerve passes ASIS near the inguinal ligament - prolonged rest or standing can cause compression - prlonged hip extension or flexion can also cause compression - sometimes iatrogenic from surgery - sometimes an inguinal hernia can cause the compression

Question 241

SS of meralgia paresthetica?

Answer 241

- paresthesia over lateral thigh - no motor loss - decreased light touch - increased pin prink

Question 242

Tests for meralgia paresthetica?

Answer 242

- Tinel's tap near the ASIS

Question 243

Treatment of meralgia paresthetica?

Answer 243

- chiro care | - reduced casuing factors = obesity, posture or ergonomics

Question 244

Etiology of myofascial trigger point of the gluteus medius muscle?

Answer 244

- hypersensitive area or band of muscle that refers pain | - usually because of constant state of contracture (HT)

Question 245

SS of myofascial trigger point of the gluteus medias muscle?

Answer 245

- tenderness and hypersensitivity of the gluteus medias muscle - referal-> into low back and the thigh

Question 246

Treatment for myofascial trigger point of the gluteus medius muscle?

Answer 246

- Stretch | - release trigger point

Question 247

Etiology of Myofascial trigger point of the psoas muscle?

Answer 247

- HT of muscle

Question 248

SS of myofascial trigger point of the psoas?

Answer 248

- tenderness of the psoas muscle | - refer to low back, upper gluteal, upper anterior thigh

Question 249

Treatment for myofascial trigger point of the psoas?

Answer 249

- massage - stretch - release trigger point

Question 250

Etiology of Osteomyelitis?

Answer 250

- infection of the bone and bone marrow - caused by many microorganisms + s aureus + streptococci - recent compromise in the skin

Question 251

SS of osteomyelitis?

Answer 251

- bone pain - high fever - formation of an abscess at the site of infection

Question 252

Tests for osteomyelitis?

Answer 252

- culture - biopsy - xray

Question 253

Treatment for osteomyelitis?

Answer 253

- refer for antibiotic treatment

Question 254

Etiology for Paget's disease?

Answer 254

- osteitis deformans - localised areas of bone become hyperactive and relax the normal matrix with softened enlarged bone - > 40 - >m

Question 255

SS of Paget's?

Answer 255

- asymptomatic - insidious - pain - stiffness - fatigability - bone deformity - HA - decreased hearing - increasing skull size - bone ache very deep, worse at night

Question 256

Tests for Pagets?

Answer 256

- xray - elevated alkaline phosphatase* - increased urinary excretion of pyrinoline cross-links - serum calcium and phosphorus levels are usually normal

Question 257

Treatment for Pagets?

Answer 257

- chiro for non serious pain | - MD for emds to control the proliferation of bone

Question 258

Etiology of piriformis syndroime?

Answer 258

- irritation of the sciatic nerve due to piriformis contracture or spasm - mechanical or chemical irriation of the nociceptiors - causing paresthesia - can be b/c + trauma + vascular ischemia + tight external rotators + overuse

Question 259

SS of piriformis syndrome?

Answer 259

- leg length inequality - decreased internal rotation of the hip decreased adduction of the hip - foot external rotation - SI joint fixation

Question 260

Tests for pirifomis syndroim?

Answer 260

``` - palation + reproduce referal - +SLR, bonnets - + Hibbs and piriformis test - (-) nafzinger and valsalva test - normal DTR ```

Question 261

Treatment for piriformis syndrome?

Answer 261

- stretch | - trigger point release

Question 262

Etiology of poliomyelitis?

Answer 262

- polio infection - fecal oral route - to CNS where it causes lesion of the gray matter

Question 263

SS of minor polimyelitis?

Answer 263

- recovery within 24 -72 hrs - fever - HA - stiff neck - sore throat - vomiting

Question 264

SS of major poliomyelitis?

Answer 264

- fever - HA - stiff neck and back - deep muscle pan - decreased DTR and muscle weakness - hyperesthesia - paresthesia

Question 265

Tests for poliomyelitis?

Answer 265

- asymetric flaccis limn paralysis without sensory loss | - spinal tap to check CSF

Question 266

Treatment of polio?

Answer 266

refer and comange w/ physical therapy to keep the joint moving

Question 267

Etiology of psoas tendonitis?

Answer 267

- tendonitis = inflamation of a tendon - tenosynovitis = inflamation of a tendon sheath - occurs in middle aged or older people - repeated trauma, strain or excess exercise - ass w/ RA, systemic sclerosis, gout, diabetes, reiters

Question 268

SS of Psoas tendonitis?

Answer 268

- painful on hip/trunk flexion | - swollen

Question 269

Test for psoas tendonitis?

Answer 269

- calcium deposit on xray | - painful AROM

Question 270

Treatment for psoas tendonitis?

Answer 270

- rest or immobilisation for acute relief (2 - 3 days) + PRICE - NSAIDs for 7 - 10 days - corticosteroid injection`

Question 271

Etiology of Septic (Pyogenic) Arthritis?

Answer 271

- inflamation of joint caused by pyogenic microorganisms = painful and hot - Acute infection + 95 % neisseria gonorrhoeae = most common +nongonncoccal arthrits usualy staph sureus - Chronic infectious arthritis + myobacterium

Question 272

SS of septic arthritis?

Answer 272

- fever - painful swollen joints - decreased ROM

Question 273

Tests for septic arthritis?

Answer 273

- increased WBC, ESR and C-reactive protein - refer for joint aspiration for culture - xray

Question 274

Treatment of septic arthritis?

Answer 274

- refer antibiotics

Question 275

Etiology of Rheumatic fever w/ monoarthritis of the hip?

Answer 275

- affects children b/w 4 and 18 after a streptococcal infection + tonsilitis + pharyngitis

Question 276

SS of Rheumatic fever with mono arthritis of the hip?

Answer 276

- recent ilness or infection - systemic illness - tenderness and inflammation around joints* - fever - jerky movements - nodules under the skin - skin rash - sometime heart or valve inflamation can result in scarring of valves = stenosis

Question 277

Tests for Rheumatic fever?

Answer 277

- increased ESR and C-reactive protein | - abnormal ECG

Question 278

Treatment for Rheumatic fever?

Answer 278

- penicilin - salicyates - steroids

Question 279

Etiology of RA?

Answer 279

- chronic acute inflammatory disease - > F - 20 - 50

Question 280

SS of RA?

Answer 280

- symmetrical joint pain and swelling - fever - fatigue - polyarthritis - deformities of hand and wrist + swan neck and boutonneire deformity - bouchard nodes at PIP, never affects the DIPs - ulnar deviation of the wrist - can affect the cervical region

Question 281

Test for RA?

Answer 281

- RH factor - increased ESR - antinuclear antibodies (ANA) - xray + bilateral symmetry + marginal erosion + uniform joint space loss - C1 2 subluxation

Question 282

Treatment for RA?

Answer 282

- contraindication for cervical SMT | - adjust, soft tissue, remmber no cure

Question 283

Etiology of sacroiliac joint dysfunction?

Answer 283

- pregnancy - leg length inequality - trauma - ligament laxity

Question 284

SS of sacroiliac dysfunction?

Answer 284

- Low back or SI joint pain - worse when sitting or weight bearing - fell stiffness

Question 285

Tests for sacroiliac dysfunction?

Answer 285

- Si compression - yeomans - gaenslens - gillettes - faber - xray negative

Question 286

Treatment for sacroiliac dysfunction?

Answer 286

- chiro | - massage

Question 287

Etiology for segmental radiculopathy?

Answer 287

- herniated disc | - muscular entrapment

Question 288

SS of segmental radiculopathy?

Answer 288

- radicular pain ventral root = motor weakness and muscle atrophy - dorsal root = sensory changes in dermatomal distribution - DTR dimminished - pain aggrevated by moving spine, coughing, sneezing, valsalva - muscle stretches can agg the pain

Question 289

Test for segmental radiculopathy?

Answer 289

- xray - CT - SLR - increased thecal pressure - musc wasting

Question 290

Treatment for segmental radiculopathy?

Answer 290

- muscle relaxant - surgical decompression - chiro treatment, mobilisation, cervical traction

Question 291

Etiology of Slipped capital femoral epiphysis?

Answer 291

growth plate of the femoral head slipps back and inward - results b/c deformity of the ball and socket = limitation of moevment - most common cause for limp in kids

Question 292

SS of SCFE?

Answer 292

- limited ROM - limp - decreased internal rotation* - > boys - slippage 12-15 - sometimes bilateral

Question 293

Tests for SCFE?

Answer 293

- xray frog leg + see that the femoral head is below klein's line: line at the superior part of the fenmoral neck intersects the femoral head, if it doesn't this indicated SCFE

Question 294

Treatment for SCFE?

Answer 294

- surgery

Question 295

Etiology of thrombophlebitis (DVT)?

Answer 295

- inflammation of a vein ass. w/ blood clot formation - usually in the legs or pelvis - occurs in patients reovering from child birth, surgery or prolonged bed rest - oral contraceptives predisposes females to this - clot in the leg can dislodge and cause blockage in the lung = pulmonary embolism

Question 296

SS of thrombophlebitis?

Answer 296

- pain and swelling in the posterior calf | - prolonged period of bedrest or position where stasis of blood may occur

Question 297

Test for Thrombophlebitis?

Answer 297

- homans test | - diagnostic ultrasound

Question 298

Treatment for Thrombophlebitis?

Answer 298

- anticoagulant therapy (warfarin, herparin)

Question 299

SS of ALS?

Answer 299

- progressive muscle weakness and atrophy - signs of anterior horn dysfunction seen inhand first - site of onset is random, progression is asymettrical - fasiculation and UML signs

Question 300

SS of Aneurysmal Bone cyst?

Answer 300

- benign usualy before 30 - metaphsysi of long bone - xray + well circumsribed, eccentric, periosteal bulging

Question 301

Treatment of ABC?

Answer 301

- surgical removal of lesion | - get xray and refer

Question 302

SS of angina?

Answer 302

- precipitated by exertion and relieved by rest or sublingual nitroglycerine - lasts usually less than 30 mins

Question 303

SS of Bicipital tendonitis?

Answer 303

- tenderness over the proximal bicipital groove of the humerus, - resisted supination and flexion is painful - yergasons, resisted supination and flexion - speeds, 90 deg shoulder flexion + elbow extension, resist extension force applied to forearm

Question 304

SS of lateral epicondylitis?

Answer 304

- lateral elbow pain (tennis elbow) - repetitive tearing of extensor carpi radialis brevis tendon and extensor carpi radialis longs - repetitive wrist extension, radial deviation and supination - cozen's: arm pronated wrist radially deviated and extended, resist flexion - mills: pronation, extension of arm and flexion of the wrist, while palp epicondyle,

Question 305

Etiology of ITB sprain/strain?

Answer 305

- ITB rubs against the lateral epicondyle of the femur - worse with running (downhill bad b/c heel strike) - hyper pronation is bad for it as well

Question 306

SS of ITB sprain/Strain?

Answer 306

- insidious onset of lateral knee pain - agg w/ downhill running - pain with leg extension

Question 307

Tests for ITB sprain/strain?

Answer 307

- lateral epicondyle palpation* | - nobels test, applying pressure ar various degress of flexion and extension

Question 308

SS of popliteal tendonitis?

Answer 308

- insidious onset lateral knee pain - agg by + downhill running + walking - popliteal muscle allow internal rotation of the leg and pull the posterior lateral meniscus back during knee flexion

Question 309

Tests for popliteal tendonitis?

Answer 309

- Tenderness at insertion point of distal femur, just anterior to the LCL* - tenderness can also be found behind the LCL - pain w/ resisted internall rotation mostly when combined with 30 deg of knee flexion - foot may be hyperpronated

Question 310

Treatment for popliteal tendonitis?

Answer 310

- adjust areas around to improve function - PRICE - pain free ROM

Question 311

Etiology of fibular head fixation?

Answer 311

- sudden onset of lateral knee pain - usually after sudden dorsiflexion or plantarflexion injury at the ankle - hamstring curls the biceps femoris draws the fibular head posteriorly leading to fixation

Question 312

SS of fibular head fixation?

Answer 312

- tender over proximal fibular head - peroneal nerve impingment potential - ankle involvement* - agg by + leg curls (hamstring) - forced dorsiflexion = pain - hurts with running, tennis, squash

Question 313

Etiology of lateral collateral ligament tear?

Answer 313

- severe varus stress* | - accompanied by a lateral meniscus injury

Question 314

Etiology of patellar #?

Answer 314

- anterior knee pain after trauma - knee hitting dashboard in a car accident - usually comminuted

Question 315

Test for Patellar #?

Answer 315

- xray | - pain localized over the patella

Question 316

Etiology for patellofemoral syndrome (runner's knee(?

Answer 316

- anterior knee pain - b/c running - b/c going up and down steps and sitting for long periods of time - tracking disorder of the patella b/c weak VMO

Question 317

SS of patellofemoral pain syndrome?

Answer 317

- insidious onset - crepitus when squat - pain going up stairs or running - iritation tot he infrapatellar fat pad

Question 318

Test for patellofemoral pain syndrome?

Answer 318

- palpation and auscultation of the patella as it undergoes ROM - if pain only at the bottom of ROM most probably meniscus not PFPS - chronic overpronation

Question 319

Etiology of Chondromalacia Patella?

Answer 319

- not a tracking disorder (VMO is normal) - decrease in patellar cartillage - history of patellar injury

Question 320

SS of chondromalacia patella?

Answer 320

- insidious - crepitus when squat - pain with running prolonged sitting, going up stairs

Question 321

Tests for chondromalacia patella?

Answer 321

- xray if management for PFPS is not working

Question 322

Etiology of Patellar tendonitis (jumper's knee)?

Answer 322

- anterior knee pain w/ jumping or sprinting | - occurs b/c of repetitive stress

Question 323

SS of patellar tendionitis?

Answer 323

- anterior knee pain with jumping or running

Question 324

Tests for patellar tendonitis?

Answer 324

- pain at patellar tendon or tibial tuberosity | - resisted extension beyong 90 deg is painful*

Question 325

SS of Osgood-Schlatter's disease?

Answer 325

- young athlete - pain and swelling at tibial tuberosity - resisted extension painful

Question 326

Etiology of Osteochondritis Disicans?

Answer 326

- anterior knee pain and crepitus - usually occurs at the lateral femoral condyle - caused by squating, running and rising from a seated position - condyle fragement in the joint space

Question 327

SS of osteochondritis dissecans?

Answer 327

- locking of the knee with a feeling of instability - agg by + squating + running + rising from a seated position - anterior knee pain

Question 328

Treatment of osteochondritis dissecans?

Answer 328

- refer for surgery

Question 329

Etiology of pes anserine bursitis?

Answer 329

- near the proximal medial tibia - conjoined tendons of sartorius, gracilis and semitendinosus, lies superficial to the MCL - diabetic, older, overweight

Question 330

SS of pes anserine bursitis?

Answer 330

- insidious onset of pain anterior medially in the knee - pain on knee flexion* - painful resisted external rotation and internal rotation - exaccerbated by walking up and down stairs

Question 331

Etiology of Plica syndrome?

Answer 331

- chronic overuse of the knee from embryonic dividers in the knee - mediopatellar plica most commonly involved similar to pes anserine pain

Question 332

SS of plica syndrome?

Answer 332

- clicking - snapping - occasionaly giving way - anterior medial pain - aggrevated by prolonged standing, squatinng, sitting or stair climbing -

Question 333

Tests for plica syndrome?

Answer 333

- taut band on the medial peripatellar region reproducing pain *

Question 334

osgood schlatter vs patellar tendonosis?

Answer 334

• Is there tenderness directly anterior and posterior to the patella. Is there pain on extension? If this is an adolescent athlete, select O-S, otherwise, patellar tendinosis.

Question 335

Etiology of baker's cyst?

Answer 335

- popliteal cyst - fluid distension of gastrocnemio-semimebranosus bursa - joint effsion displaced into this cyst as a prtective mechanism

Question 336

SS of backer's cyst?

Answer 336

- popliteal swelling - bowstrings test - posterior knee pain

Question 337

Treatment of backer's cyst?

Answer 337

- refer for drainage

Question 338

Etiology of MCL tear?

Answer 338

- valgus stress injury

Question 339

Test for MCL injury?

Answer 339

- valgus stress tests at different degrees of flexion

Question 340

Etiology of an ACL tear?

Answer 340

- pop during an injury - anterior force causing anterior slippage of the tibia on the femur - twisting motions w/ deceleration + skiers + football + basketball + soccer - flexed knee gets a valgus load with internal rotation of the tibia

Question 341

Tests for ACL tear?

Answer 341

- lachman test: knee 30 deg of flexion and pulled forward to see if anterior displacement - anterior draer test: knee at 90 and anterior draw - slocum test - MRI

Question 342

Etiology of compartment syndrome?

Answer 342

- exertional compartment syndome seen mostly in athletes b/c increased exercise - blunt trauma to the leg can also cause an increase in the pressure

Question 343

SS of compartment syndrome?

Answer 343

- ache in the leg 10 - 30 mins post exercise | - redness

Question 344

Treatment for compartment syndrome?

Answer 344

- PRICE | - if trauma, care doesn't work, or professionaol athlete refer

Question 345

Etiology of dislocated patella?

Answer 345

- a young athlete with weak VMO, undergos trauma where the patella will displace laterally - high school football

Question 346

Etiology of meniscal tear?

Answer 346

- due to rotational injury, usually accompanies ACL and MCL injury

Question 347

SS of meniscal tear?

Answer 347

- swelling - knee locking untill patient reaches full extension - knee giving way

Question 348

Tests for meniscal tear?

Answer 348

- medial joint line tenderness - McMurray's - apleys - basically compression + rotation to mimic the injury - use MRI

Question 349

Treatment for meniscal tear?

Answer 349

- PRICE, painfree ROM, strenghten, ADL, proprioception, Return to sport

Question 350

Etiology of PCL tear?

Answer 350

- resists posterior translation of the tibia on the femur | - blow to the anterior tibia when the knee is flexed

Question 351

SS of PCL tear?

Answer 351

- lack of pain - posterior drawer test - revere lachman test - hughston's test - sag sign - bounce home test

Question 352

Etiology of osteosarcome?

Answer 352

- 3rd most common primary bone tumour - b/w 10 -25 - >M

Question 353

SS of osteosarcoma?

Answer 353

- pain with activity - limp - site of tumour has swelling, redness and heat

Question 354

Etiology of suppurative osteomyelitis?

Answer 354

- due to staph aureus - invades bone via hematogenous spread, post operative or puncture wounds - age 2 - 12, >M

Question 355

SS of suppurative osteomyelitis?

Answer 355

- fever - chills - pain - swelling - prior infection

Question 356

Etiology of osteomyelitis?

Answer 356

- infection of the joint

Question 357

SS of osteomyelitis?

Answer 357

- tenderness and pain in the joint

Question 358

Etiology of Leukemia?

Answer 358

- malignant disease of the bone marrow and blood b/c proliferating WBCs - most common = acute form in kids - b/w 2 - 5 yrs

Question 359

SS of Leukemia?

Answer 359

- generalized joint pain - weakness - lethargy - xray + osteopenia of long bone + raindrop skull

Question 360

SS of growing pains?

Answer 360

- diagnosis of exclusion - ages 2 - 5 and 10 - 12 - intermittent pain - more muscular pain

Question 361

Etiology of Juvenile RA?

Answer 361

- from 2 - 12 - seronegative - autoimmune

Question 362

SS of Juvenile RA?

Answer 362

- high fever - rash - uveitis - pericarditis - flare up = stills disease - must rule out lyme disease - symmettrical distribution, potential atlantoaxial instability

Question 363

Etiology of OA?

Answer 363

- older patient | - trauma or surgery to knee

Question 364

SS of OA?

Answer 364

- stiffness - knee pain, worse w/ prolonged sitting or walking - mild swelling - progressive bowlegged

Question 365

Etiology of acromioclavicular joint sprain?

Answer 365

- direct trauma from a fall on the superior aspect of shoulder with arm adducted - indirect force from FOOSH injury, usually affects the AC ligaments and spares the coracoclavicular ligaments - car accident - sports injury - heavy lifting or pulling

Question 366

Tests for AC joint sprain?

Answer 366

- O'Brien test - pain w/ >90 deg abduction - pain with passive horizontal adduction

Question 367

Type 1 AC joint sprain?

Answer 367

- AC ligaments sprained, - minimal tenderness - swelling - no displacment

Question 368

Type 2 AC joint sprain?

Answer 368

- AC sprain and slight coracoclavicular sprain | - slight elevation of the lateral clavicle (step off)

Question 369

Tpe 3 AC joint sprain?

Answer 369

- complete AC and coracoclavicular ligament sprain - elevated clavicle - AC tenderness

Question 370

Management of AC sprain?

Answer 370

- Acute: PRICE | - if grade 3 refer to ortho

Question 371

Etiology of Adhesive capsulitis?

Answer 371

- unknown cause - ages 40 - 65 - > W - diabetes - prolonged imobilization of arm - tendonitis - non dominant arm

Question 372

SS of adhesive capsulitis?

Answer 372

- decreased ROM, abduction and external rotation = capsular pattern - pain with abduction and external rotation

Question 373

Stage 1 adhesive capsulitis?

Answer 373

- peradhesive - gradual onset of painful abduction and external rotation - no limited ROM

Question 374

Stage 2 adhesive capsulitis?

Answer 374

- acute adhesive synovitis - painful arc - decreased ROM - constant pain - pain decreased with motion - muscle atrophy

Question 375

Stage 2 adhesive capsulitis?

Answer 375

- extreme decrease in ROM | - gradual improvement of ROM

Question 376

Etiology of Bicipital Tendonitis?

Answer 376

- inflammation of the tendon sheath surrounding the long head of the biceps - b/c repeated overhead throwing activity of lifting

Question 377

SS of Bicipital Tendonitis?

Answer 377

- speeds - yergasons: pain and click - pain w/ pressure on the bicipital groove and in the biceps muscle belly - pop with flexion, abduction and external rotation - pain is more anterior

Question 378

Etiology of Breast Cancer?

Answer 378

- carcinoma within the breast duct - lobular cancer - fam history - BRACA gene - early menarche late menopause - oral contraceptives

Question 379

SS of Breast Cancer?

Answer 379

- non movable lump - exaggeration of unusual skin - peau d'oragne

Question 380

Etiology of cholecystitis?

Answer 380

- acute inflammation of the gallbladder wall | - response to cystic duct obstuction by cholelithiasis (gallstones)

Question 381

SS of cholecystitis?

Answer 381

- colicky pain - sever right upper quadrant - radiates to the lower scapular/ shoulder - nausea - involuntary guarding of the right side - gallbladder becomes palpable - pain with deep inspiration and right upper quadrant palpation (murphy's sign) - takes 2 - 3 days to resolve

Question 382

Etiology of glenohumeral dislocation?

Answer 382

- direct or indirect injury | - anterior most common, b/c external rotation and extension of humerus

Question 383

SS of glenohumeral dislocation?

Answer 383

- pain | - can't use arm

Question 384

Etiology of gout?

Answer 384

- peripheral joint arthritis b/c crystal deposition | - usually in the olecranon and in the big toe of foot

Question 385

SS of acute gout?

Answer 385

- no warning - minor trauma, purine rich food, alcohol, fatigue, stress - monoarticular - pain gets woese and more severe - swelling, warmth, redness and tenderness - big toe is most common

Question 386

SS of chronic gout?

Answer 386

- permanent erosive joint deformity - decreased ROM of hand and feet - urate deposits in bursae and tendons - enlarging tophi

Question 387

Etiology of Myocardial Infarction?

Answer 387

- abrupt redcution of blood flow to part of the myocardium - thrombus - plaque rupture

Question 388

SS of myocardial infarction?

Answer 388

shortness of breathe or fatigue - deep substernal pain - pressure on the chest ( elephant sitting on chest) - radiation to the back, jaw, or left arm - similar pain to angina pectoris, but long, not reliefed with rest - severe pain - restless - aprehensive with pale, cool, diaphoretic skin - peripheral/central cyanosis

Question 389

Etiology of myofascial trigger point of the subscapularis muscle?

Answer 389

- b/c heavy push motion - swimmers often get this injury, leads to instability of the rotator cuff and impingement syndrome - bench press - push motions - popping shoulder - throwing

Question 390

SS of myofascial trigger point of the subsacpularis muscle?

Answer 390

limited abduction and external rotation - local pain - pain with pushing

Question 391

Etiology of Pneumonia?

Answer 391

- acute infection of the lung parenchyma, involving alveolar spaces and interstitial tissue - caused by bacteria such as S. Pneumoniae = most common and H. Influenzae

Question 392

SS of pneumonia?

Answer 392

- previous upper respiratory tract infection - sudden shaking chill, if persistent chills = other diagnosis - fever - pain with breathing on the affect side - cough -> purulent and blood streaked - dyspnea - increased temp 38 - 40 deg - increased pulse and respirations to

Question 393

Etiology of Polymyalgia Rheumatica?

Answer 393

- pain and stiffness in the proximal muscle groups w/out weakness of atrophy - elevated ESR - underlying temporal arthesis (swelli gof blood vessels)

Question 394

SS of polymyalgia rheumatica?

Answer 394

- severe pain the proimal muscle groups - pain and stiffness of the neck, pectoral and pelvic girdles - morning stiffness - systemic complaints: fever, depression, weight loss

Question 395

DDx polymyalgia rheumatic and RA?

Answer 395

- Polymyalgia does not have hjoint synovitis, RH factor or rheumatoid nodules

Question 396

DDX polymyalgia rheumatica and multiple myeloma?

Answer 396

- no monoclonal (plasma) overproduction

Question 397

DDx polymyalgia rheumatica and fibromyalgia?

Answer 397

- systemic features and elevated ESR

Question 398

Etiology of Pulmonary (bronchiogenic) Carcinoma?

Answer 398

- 90% of the primary lung tumours | - most common in 45 - 70 yrs olds that smoke cigarettes

Question 399

SS of pulmonary (bronchiogenic) carcinoma?

Answer 399

- cough with hemoptysis - blood streaked sputum - horners syndrome: exothalamos, miosis, pitosis, ipsilateral facial anhidrosis - pancoast syndrome: pain, numbness, weakness in the affected arm

Question 400

Etiology of rotator cuff strain and tear?

Answer 400

- trauma or activity that injured the supraspinatus (abduction), infaspinatus (abduction and internal rotation), teres minor (external rotation) subscapularis (internal rotation) - prolonged or repetitive use of muscle tendon: over head throwing, lifting activites, baseball, football, swimming - trauma to shoulder, usually b/c abduction and external rotation

Question 401

Grade 1 rotator cuff strain?

Answer 401

- takes 7 days to 4 weeks to hea; - min fibre tearing - slight decrease in the strenght - min pain

Question 402

Grade 2 rotator cuff strain?

Answer 402

- takes 2 weeks to 3 months to heal - partial tearing of the fibres - mod pain - strength loss

Question 403

Grade 3 rotator cuff strain?

Answer 403

- takes 2 months to 1 yr to heal | - full muscle tear

Question 404

SS of Rotator cuff strain?

Answer 404

- immediate pain - popping or tearing sensation at th etime of injury - increased shoulder pain with movement, specifically active and resisted ROM - decreased strength

Question 405

Etiology of SC joint sprain (dislocation)?

Answer 405

- blow to the acromion of the scapula - force transmitted through the pectoral girdle with a FOOSH - clavicle can also break

Question 406

Etiology of subacromial bursitis?

Answer 406

- subacromial bursa bound superiorly by coracoacromial ligament and acromion, inferiorly bound by rotator cuff and capsule - previous tendonitis, tenosynovitis or inflammatory process in the bone or joint

Question 407

SS of acute subacromial bursitis?

Answer 407

- excrutiating pain w/out relief on repositioning - AROM painful - pain and limitation on passive abduction and external rotation - empty end feel b/c cannot go into full ROM without pain - heat - swelling

Question 408

SS of chronic subacromial bursitis?

Answer 408

- vague - pain after excessive overhead use - night pain

Question 409

Etiology of Supraclavicular nerve entrapemnt?

Answer 409

- inn. C3, c4 arising, supplying the supraspinatus and infraspinatus compression in the posterior triangle

Question 410

SS of supraclavicular nerve entrapment?

Answer 410

- numbness and tingling along top and anterior shoulder | - decreased shoulder abduction strength

Question 411

Etiology of SUpraspinatus tendonitis?

Answer 411

- eccentric overload of the supraspinatus

Question 412

SS of Supraspinatus tendonitis?

Answer 412

- pain and weakness on full passive abduction | - painful arc

Question 413

Tests for subacromial impingement?

Answer 413

- neers - empty can - hawkins kennedy

Question 414

Etiology of syringomyelia?

Answer 414

- fluid filled neuro cavity (thecal sac) in the spinal cord (syringomyelia) or brain (syringobulbia) - related to congenital annomilies - usually in the cervical area

Question 415

SS of syringomyelia?

Answer 415

- spinothalamic fibres interupted thus decreased pain and temp sensation - deficits begin in the fingers then spread - cape like sensory deficit over shoulders and bacl - corticospinal tract compression = motor involvement, spasticity of the legs

Question 416

SS pf syringobulbia?

Answer 416

- vertigo - nystagmus - unilateral or bilateral facial sensation im,apirment - dysarthia - dysphagia - horseness

Question 417

Etiology of TOS?

Answer 417

- women b/w 35 - 55 - compression of the subclavian vessies, lower or medial trunks of thebrachial plexus against a cervical rib, Pec minor HT or HT scalene muscles

Question 418

SS of TOS?

Answer 418

- pain and paresthesia medially in the arms - mild or moderate sensonary imapirment in the c8 - T1 dermatomal distribution - aching in the supper arm, shoulder and neck - waking up in the middle of the night, shake hand to normalize - discoloration of the hands

Question 419

Test for TOS?

Answer 419

- adson's - wrights - edens - east (ROO's)

Question 420

Etiology of abdominal aortic Aneurysm?

Answer 420

- in L2 - L4 region - AAA - caused by arthrosclerosis - hypertension - smoking - trauma - arteritis

Question 421

SS of AAA?

Answer 421

- deep boring pain when ruture - visceral pain in the lumbosacral region - abdominal pulsation - asymptomatic until rupture

Question 422

Tests for AAA?

Answer 422

- palpation - auscultation - lateral or ap lumbar films

Question 423

Etiology for Angina Pectoris?

Answer 423

- myocardial ischemia b/c coronary atherosclerosis

Question 424

SS of Angina Pectoris?

Answer 424

- vague ache that becomes sever with exertion - felt beneath sternum - radiates to the left shoulder and inside of arm - agg by exertion, emotional stress - relieved by rest, vasodilation of coronary arteries by sublingual nitoglycerin

Question 425

Tests for Angina Pectoris?

Answer 425

- ECG testing - stress ECG - coronary angiography

Question 426

SS of Asthma?

Answer 426

- recurrent: - dyspnea - wheezing on inspiration and expiration b/c constriction of the bronchi - coughing - viscous exercise - emotional stress - hypertinic accessory musckles of breathing - tripod stance

Question 427

Tests for Asthma?

Answer 427

- pulmonary function test | - lung volumes and capacity

Question 428

Treatment for asthma?

Answer 428

- elimination of causitive agent - bronchodilators - beta-adrenergic drugs

Question 429

Etiology of Bronchitis?

Answer 429

- inflammation of the mucous membranes of the tracheobronchial tree

Question 430

SS of acute bronchitis?

Answer 430

- rpoductive cough - fever - H/T of mucous secreting structures - back pain - b/c spread of the URTI

Question 431

SS of Chronic bronchitis?

Answer 431

- excessive mucous production w/ productive cough at least 3 months in at least 2 years - frequent chest infections - cyanosis - hypoxemia - hypercapnia - cor pulmonale (RSHF) - respiratory failure

Question 432

Test for bronchitis?

Answer 432

- clinically - pulmonary function test - chest xray

Question 433

SS of cervical facet joint syndrome?

Answer 433

- neck and upper back stiffness - sharp pain with neck movements - absence of arm numbness and weakness - sudden onset - refered pain - decreased ROM + kemps for local pain

Question 434

SS of costovertebral dysfunction?

Answer 434

- localised over non- articular rib tubercle posteriorly - sharp sudden pain - pain on deep inspiration or coughing - pain with direct prssure of the T spine

Question 435

Etiology of Cholelithiasis?

Answer 435

- formation of presence of calculi in the gallbladder | - female, fat >40

Question 436

SS of cholelithiasis?

Answer 436

- asymptomatic for long periods of time - pain occurs in the right upper quadrant, radiating to the right lower scapula - colic is constant - nausea

Question 437

Tests for Cholelithiasis?

Answer 437

- ultrasound

Question 438

Etiology of GERD?

Answer 438

- incompetence of the lower esophageal sphincter

Question 439

SS of GERD?

Answer 439

- heart burn w or w/out regurgitation - epigastric pain after large meal or when lay down - esophagitis, esophageal strictyure - esophageal ulcer - barret's metaplasia

Question 440

Treatment for GERD?

Answer 440

- elevated head of bed - avoid acid: coffee. alcohol, fat, chocolate - avoid antricholeinergic drugs and smoking

Question 441

Etiology of Gastric/Peptic/duodenal ulcer?

Answer 441

- NSAIDs - H pylori - these disrupt the normal mucosal lining and make it more susceptible to acid

Question 442

SS of gastric/ peptic ulcer?

Answer 442

- eating exacerbates the pain | - burning pain

Question 443

SS duopdenal ulcer?

Answer 443

- epigastric burning pain | - relieved by food, reoccurs 2 -3 hrs after meal

Question 444

Tests for GERD?

Answer 444

- contrast medium endoscopy to rule out stomach cancer

Question 445

Etiology of Hiatal Hernia?

Answer 445

- protrusion of the stomach above the diaphragm

Question 446

SS of Hiatal Hernia?

Answer 446

- chest pain | - GERD

Question 447

SS of intercostal Neuritis?

Answer 447

- unilateral pain, extending in a band like pattern around the chest

Question 448

Etiology of intercostal neuritis?

Answer 448

- idiopathic - diabetes - herpes zoster - osteophytic encroachment - rib sublux

Question 449

SS of Kidney Stones?

Answer 449

- sudden severe pain felt over the posterior lower ribs - radiates anteriorly into the groin - nausea

Question 450

Test for Kidney Stones?

Answer 450

- location of pain - urinanalysis w/ hematuria - xray showing opacity

Question 451

Etiology of Pancreatitis?

Answer 451

- biliary tract disease | - predisposed by alcoholism and excess fat

Question 452

SS of Pancreatitis?

Answer 452

- fever - elevated WBC - severe abdominal pain radiates to the back - abdominal pain that radiates to the back - sitting up and leaning forward reduce the pain - coughing, movement and deep breathing accentuate pain - nausea

Question 453

Tests for pancreatitis?

Answer 453

- serum amylase and lipase

Question 454

Etiology of Pnemothorax?

Answer 454

- spontaneous in tall people - trauma - free area in the visceral and the parietal pleura

Question 455

SS of Pneumothorax?

Answer 455

- sudden sharp chest pain - dysponea - occasionally a dry hackin cough - pain refered to the same side shoulder, across the chest of the abdomin

Question 456

Tests for Pneumothorax?

Answer 456

- decreased chest wall motion on the affected side | - increased resonnacnce on percussion, absent tactile femitis

Question 457

Etiology of Pulmonary Embolism?

Answer 457

- blood clot or nitrogen buble blocvking a pulmonary artery, restricting blood flow to lung parenchyma

Question 458

SS of Pulmonary Embolism?

Answer 458

- dysponea - sudden chest pain - shock - cyanosis

Question 459

SS of pulmonary infarction?

Answer 459

- 6 to 24 hrs after formation of embolus - pleural effesion - hemoptysis - leukocytosis - fever - tachycardia - arrhythmia - striking distension of the neck veins

Question 460

Etiology of Scheuermann's disease?

Answer 460

- males - 13 -17 - thoracic spine

Question 461

SS of scheurmann's disease?

Answer 461

- pain - fatigue - increased kyphosis

Question 462

Etiology of shingles?

Answer 462

- herpes zoster | - invaded the posterior root ganglion of the thoracic and trigeminal nerves

Question 463

SS of shingles?

Answer 463

- intermittent or constant pain that is superficial or deep - fever - HA - vessicles form leaving that area of skin hypersensitive - unilateral

Question 464

SS of Thoracic compression #?

Answer 464

- sudden Thoracic pain - hyperflexion, axial compression - pathological # if patient is above 50 - long term corticosteroid use and over 70 suggests compression # - pain with percussion and deep pressure

Question 465

Etiology of URTI?

Answer 465

- common cold - picornaviruses - rhinovirus - echovirus - coxdakievirus

Question 466

SS of URTI?

Answer 466

- burning in the nose or throat - sneezing - rhinorrhea - no fever - pharyngitis - mild cough

Question 467

Etiology of anterior interossesous nerve syndrome?

Answer 467

- entrapment of the motor branch of the median nerve - innervates the FPL, FDP and pronator quadratus - compressed at the flexor digitorum superficialis or the deep head of the prionator teres

Question 468

SS of anterior interossesou nerve syndrome?

Answer 468

- local proximal anterior forearm pain - due to repetitive activity or single vilent forearm muscle contraction - weakness of pinching thimb and index finger

Question 469

Tests for anterior interosseous nerve syndrome?

Answer 469

- froment sign (instead of an ok with the dip of the thumb flexed it is extended so that the thumb and the index grip flat - resisted elbow pronation w/ full elbow flexion - numbness of the pronator quadratus

Question 470

Treatment for anterior interosseous nerve syndrome?

Answer 470

- NSAIDS - splinting - rest

Question 471

Etiology of Avascular nercrosis of the scaphoid?

Answer 471

- # of scaphoid b/c of FOOSH

Question 472

SS of scaphoid AVN?

Answer 472

- pain at the anatomical snuff box after a foosh - extension, flexion and radial deviation are all decreased - hematoma - tenderness to pressure over the scaphoid

Question 473

Test for Scaphoid AVN?

Answer 473

- xray in 2 weeks post injury to show the non- union

Question 474

Etiology of carpal tunnel syndrome?

Answer 474

- compression in the tunnel from prolonged/repetitive extension - fluid retention with pregnancy, RA, diabetes, connective tissue disorders, vitamin B deficiency

Question 475

SS of carpal tunnel syndrome?

Answer 475

- pain, numbness and tingling in the palmar surface of the thumb and radial two and one half fingers - worse at night, burning and aching

Question 476

Tests for carpal tunnel?

Answer 476

- tinels tap - phalen's - reverse phalen's

Question 477

Treatment for carpal tunnel?

Answer 477

- splinting - ergonomic change - vitamin B suplemments

Question 478

Etiology of Colle's #?

Answer 478

- silver fork # - # withing the epiphysis of the radius - FOOSH

Question 479

SS of Colle's #?

Answer 479

- hand is displaced dorsally and laterally | - used xray to confirm

Question 480

Etiology of cubital tunnel syndrome?

Answer 480

- compression of the ulnar nerve at the elbow - compression between the 2 heads of the Flexor carpi ulnaris - seen in baseball pitchers

Question 481

SS of cubital tunnel syndrome?

Answer 481

- elbow pain - medial forearm pain - paresthesia into the ring and the little finger

Question 482

Tests for cubital tunnel syndrome?

Answer 482

- pain reproduced with passive or resisted elbow flexion, while elbow is maximally flexed

Question 483

Treatment for cubital tunnel syndrome?

Answer 483

-PRICE

Question 484

Etiology of de quervian's syndrome?

Answer 484

- stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis as a result of chronic microtrauma - activity with forceful gripping, ulnar deviation and repetitive use of the thumb

Question 485

SS of de quervain's syndrome?

Answer 485

- local pain over the anatomical snuffbox - pain radiates up distal forearm - swelling in the tendons

Question 486

Tests for de quervain's syndrome?

Answer 486

- Finklestein's

Question 487

Treatment for de quervain's syndrome?

Answer 487

- activity modification | - NSAIDS

Question 488

SS of diabetes mellitus?

Answer 488

- peripheral neuropathy - sensory deficits, beginning with a glove and stocking distribution - numbness, tingling and paresthesia B?L in all extremities

Question 489

Tests for Diabetes mellitus?

Answer 489

- oral glucose test | - fasting glucose test

Question 490

Etiology of Guyon's cannal compression?

Answer 490

- compression of the ulnar nerve in the tunnel of guyon - constant compression from handlebars (cyclists) - vascular abnormalities - # of the hook of hamate

Question 491

SS of guyon canal compression?

Answer 491

- numbness/tingling or pain in the fourth and fifth digits

Question 492

Tests for guyons canal compression?

Answer 492

- tinels at the wrist for ulnar nerve | - froment's sign`

Question 493

Treatment for guyon's canal compression?

Answer 493

- change activites

Question 494

Etiology of Median nerve palsy?

Answer 494

- originated fomr the C5 - T1 spinal nerves (lateral and medial cords) - compression points: + axilla + bicipital aponeuosis + sublimis bridge + next to humerus + pronator teres + carpal tunnel

Question 495

SS of median nerve palsy?

Answer 495

- decreased sensation over the thumb, 2, 3 and half of the 4th digit

Question 496

Etiology for a metacarpal #?

Answer 496

- direct blow or axial force ex. punching a wall | - alsoe called bar room #

Question 497

SS of metacarpal #?

Answer 497

- pain over the metacarpal joint - usually 4th metacarpal - rotational deformity at the metatcarpal with flexion

Question 498

Tests for metacarpal #?

Answer 498

- xray | - percussion of the finger will increase pain

Question 499

Etiology of Myasthenia Gravis?

Answer 499

- neuromuscular transmission is blocked by autoantibodies that bind acetylcholine rexeptors at the post-synaptic NMJ - idipathic or ass. with RA. SLE

Question 500

SS of Myasthenia Gravis?

Answer 500

- young women - double vision - difficulty swallowing - weakness of more used arm - weakness of the jaw muscles when chewing - single sided miosis

Question 501

Tests for myasthenia gravis?

Answer 501

- drug testing w/ anticholinesterase, causes temporary increase in strength

Question 502

SS of palmaris longus muscle strain?

Answer 502

- pain at the medial epicondyle of the humerus or distal flexor retinaculum - potential compressio nof the median nerve due to inflammation - pain with active or resisted wrist flexion

Question 503

Etiology of Radial tunnel syndrome (Posterior Interosseous nerve syndrome)?

Answer 503

- compression of the superficial branch of the radial nerve in the proximal forearm or back of the arm, radiating pain into the dorsum of forearma nd hand - lesions at the elbow include + trauma + ganglia + lipoma + bone tumour + radial bursitis

Question 504

SS of radial tunnel syndrome?

Answer 504

- posterior wrist or forearm pain - weakness of wrist extension or thumb and index finger extension - no sensory loss* - pain is reproduced w/ forceful wrist extension

Question 505

Tests for Radial Tunel syndrome?

Answer 505

- localized tinel's sign - tenderness along the course of the radial nerve - ddx from lateral epicondylitis - palpation and muscle testing

Question 506

Etiology of Pronator Teres Syndrome?

Answer 506

``` - compression at + bicipital aponeuosis, + between the 2 heads of the pronator teres + FDS + ligament of struthers + median artery + bicipital tuberosity bursa ```

Question 507

SS of pronator teres syndrome?

Answer 507

- anterior forearm pain - rrepetitive pronation and wrist flexion - carpanter - weight lifter - no trauma

Question 508

Tests for Pronator teres syndrome?

Answer 508

- pressure over the pronator teres - resisted elbow flexion and supination w/ max elbow flexion, implies bicipital aponeurosis or ligament of struthers - resisted pronation, keeping elbow extended and wrist flexed, suggests pronator teres compression - resisted middle finger flexion suggests compresion b/c FDS

Question 509

Etiology of radial nerve palsy?

Answer 509

- branch of posterior cord C5 - T1 - compression at + axilla + spinal groove + humerus # + saturday night palsy + arcade of frohse + wrist

Question 510

SS of radial nerve palsy?

Answer 510

- decreased posterior arm forearm and back of hand sensation

Question 511

Test for radial nerve palsy above elbow?

Answer 511

- triceps - brachioradialis - ECRL - ECRB

Question 512

Tests for radial nerve palsy below the elbow?

Answer 512

- supinator - ECU - ED - extensor digiti minimi - Abductor pollicis longus - extensor indicis - extensor pollicis brevis - extensor policis longus*

Question 513

Test for median nerve palsy?

Answer 513

- pronator teres - flexor carpi radialis - palmaris longus - flexor digitrum superficialis - flexor digitorum profundus - flexor policis longus - pronator quadratus - abductor pollicis brevis - flexor pollicis brevis - opponens pollicis - 1st and 2nd lumbrical

Question 514

Etiology of Raynaud's phenomenon?

Answer 514

- spasm of arterioles in the digits and sometimes the nose and tongue - cold and cyanosis - common in young women - seondary to other conditions + scleroderma + RA + SLE + obstructive arterial disease + neurogenic lesion + drug intoxications

Question 515

SS of Raynaud's Penomenon?

Answer 515

- intermittent blanching or cyanosis of the digits is precipitated by exposure to the cold or emotional upset - do not occur above the MCP and spares the thumb - pain is uncommon but paresthesias are frequency - lasts minutes to hrs - phenomenon is due to an underlying condition, the raynauds disease is idiopathic

Question 516

Etiology of a Smith's # (reverse colle's #)

Answer 516

- hyperflexion

Question 517

SS of smith's #?

Answer 517

- anterior displacment of the distal radial bone fragment

Question 518

SS of RA?

Answer 518

any of 4 - morning stiffness > 1 hr - arthritis of 3 or more joints - arthritis of the hadn - symmetrical arthritis - rheumatoid nodules - Rh factor - synovial thickening

Question 519

Etiology of a Ulnar nerve palsy?

Answer 519

``` compression at: - axilla - upper arm (above elbow) = + weak FCU and FDP - cubital tunnel = most common - guyon's canal ```

Question 520

SS of ulnar nerve palsy?

Answer 520

- decreased medial forearm and palmar 4th and 5th digit sensation

Question 521

Tests for ulnar nerve palsy?

Answer 521

- flexor carpi ulnaris - flexor digitorum profundus - interossei - lumbricals 3 and 4 - adductor pollicis - abductor digiti minimi - flexor digiti minimi brevis - opponens digiti minimi

Question 522

Treatment for cervical disc?

Answer 522

- SMT adjacent to the level of herniation after trial of mobilisation, improvement should be seen in 6- 8weeks

Question 523

Treatment for cervical rib induced TOS?

Answer 523

adjust | - gradual improvement in 3 months

Question 524

Etiology of Chronic Fatigue Syndrome?

Answer 524

- chronic and persistent fatigue and cognitive difficulties of 6 months duration - females > males - epstein-barr infection prior

Question 525

SS of chronic fatigue?

Answer 525

4 of following - fatigue - short term memory impairment - sore throat - tender lymph nodes - myalgia - chest pain - palpitation - HA - photophobia - depression - mood swings

Question 526

Treatment for chronic fatigue?

Answer 526

- chiro care and comange w/ other modalities of care

Question 527

Etiology of DISH?

Answer 527

- general spinal and extraspinal articul;ar disorder | - ligamentous calcification and ossifiation specifically the ALL

Question 528

SS of DISH?

Answer 528

- Males > Females - diabetes - dysphagia - decreased rotation (<45 deg)

Question 529

Tests for DISH?

Answer 529

xray - ossification of atleast 4 flowing segments - disc height normal - sometimes also ossification of the PLL

Question 530

Etiology for TVP #?

Answer 530

- avulsion of the paraspinal muscle with severe hyperextension and lateral flexion injury to the lumbar spine

Question 531

Etiology for Pars #?

Answer 531

- hyperextension of the lumbar spine - # at L4 or L5 - oblique xray can see the scotty dog collar brokern

Question 532

SS of pars and TVP #?

Answer 532

- flank pain | - hematuria if renal damage

Question 533

SS of spinal stenosis?

Answer 533

pain in back or legs with - walking - urnning - climbing stairs - pain relieved with flexion, uphill walking therefore less painful then downhill walking)

Question 534

Etiology of Toticolis?

Answer 534

- involuntary tonic contraction or intermittent spasm of the neck muscles, especially the SCM

Question 535

Etiology of congenital torticolis?

Answer 535

- b/c birth trauma causing SCM to become fibrous

Question 536

Etiology of Adult torticolis?

Answer 536

- CNS infection - tumour - basal ganglion disease - spontaneous recovery

Question 537

SS of congenital torticolis?

Answer 537

- fixed asymetry of the head | - bruising of the SCM can be seen days after the delivery

Question 538

SS of adult onset torticolis?

Answer 538

- painful SCM spasm

Question 539

Treatment for torticolis?

Answer 539

- SMT | - SCM massage and lengething

Question 540

Names for acoustic neuromas?

Answer 540

- acoustic schwannomas | - acoustic neurinomas

Question 541

Etiology of Acoustic neuroma?

Answer 541

- from schwan cells arising from the vestibular division of the vestibulocochlear nerve - the 5th and 7th cranial nerves can also be affectd

Question 542

SS of acoustic neuroma?

Answer 542

- hearing loss* - tinnitus* - gradual onset - dizziness and unsteadiness (not true BPPV b/c not position related)

Question 543

Treatment of acoustic neuroma?

Answer 543

- refer for surgery

Question 544

Etiology of acute vestibular neuritis?

Answer 544

- sudden onset of severe vertigo that is at first persistent then becomes paroxysmal - neuron inflamation of the vestibulocochlear nerve because viral infection

Question 545

SS of acute vestibular neuritis?

Answer 545

- first attack of vertigo is sever and persists - accompanies by nausea and vomitting - lasts 7 to 10 days - nystagmus toward affected side - no hearing loss or tinnitus* - sometimes dysarthia, ataxia and disdiadochokinesis

Question 546

Tests for acute vestibular neuritis?

Answer 546

- audiologic assessment - MRI of head - electronystagmography w/ caloric testing

Question 547

Treatment of acute vestibular neuritis?

Answer 547

- refer to MD meds same as meniere's disease | - vestibular training and balance exercises

Question 548

Etiology of Benign Paroxysmal Positional Vertigo (BPPV)?

Answer 548

- vertigo less than 30 sec brought on by certain head positions - cupulolithiasis: deposits of debris in the cupular of the posterior semicircular canal - occurs when patient lies on one side or tips their head backward to look up

Question 549

SS of BPPV?

Answer 549

- vertigo when head in certain position usually lying on ear or tipping head backward - Nystagmus - non hearing loss or tinnitus* - gets better in few weeks to months

Question 550

Tests for BPPV?

Answer 550

- positional nystagmus - dix hall pike - CNS lesion is vertical nystagmus, continues for as long as the position is held - audiologic assessment - electronystagmography with caloric testing - head MRI

Question 551

Treatment for BPPV?

Answer 551

- avoid the provocative position - otoconia repositing maneuvers - epleys - semont - habituation exercises - if last >1 consider surgery

Question 552

Etiology of a concussion?

Answer 552

- transient post traumatic loss of awareness or memory - lasts from seconds to minutes - pupilary and other brain stem functions are still intact

Question 553

SS of postconcussion syndrome?

Answer 553

- HA - dizziness - difficulty concentrating - variable amnesia - depression - apathy - anxiety

Question 554

Test for concussion?

Answer 554

- state of conciousness - breathing pattern - pupil size - reaction to light - occulomotor activity - motor activity in the limbs - CT - MRI - glasgow coma scale

Question 555

Treatment for concussion?

Answer 555

- observe for 24 hrs | - if no fracture or hematoma seen in xray or CT no need to be hospitalised

Question 556

What is diplopia?

Answer 556

- double vision

Question 557

Myopia?

Answer 557

- nearsighted

Question 558

Hyperopia?

Answer 558

- farsighted

Question 559

Etiology of primary Encephalitis?

Answer 559

- aacute inflammation of the brain b/c viral invasion or hypersensitivity - usually b/c viral infection + arbovirus + poliovirus + echovirus + coxsackievirus

Question 560

Etiology of secondary encephalitis?

Answer 560

complication of infection: - measles - chickenpox - rubella - smallpox

Question 561

SS of encephalitis?

Answer 561

- fever - HA - nausea - stiff neck - altered conciousness - personality changes - seizures - paresis

Question 562

Tests for encephalitis?

Answer 562

- normal glucose - no bacteria - virus isolated from the CSF - MRI detect the brain inflammation the earliest

Question 563

Treatment for encephalitis?

Answer 563

- refer for meds to control virus

Question 564

Etiology of Facet Syndrome?

Answer 564

- well localised LBP w/ some hip or butt pain above the knee - sudden onset after misjudged movement - facet and the capsule are the source of the pain, mediated by the medial branch of the posterior primary rami - meniscoids become entraped or pinched and cause pain - substance ) - degeneration in older individuals

Question 565

Tests of Facet syndrome?

Answer 565

- local pain - absence of neuro symptoms - absence of nerve root tension signs/tests - local pain w/ kemps, if repro w/ SLR does not extend past the knee - xray, general degeneration and hyperlordosis

Question 566

Etiology of Herpes Zoster Oticus (Pamsy hunt, viral neuonitis, ganglionitis)?

Answer 566

- invasion of the vestibulocochlear and the geniculate ganglion of the facial nerve by the herpes zoster virus

Question 567

SS of Herpes Zoster Oticus?

Answer 567

- severe ear pain - hearing loss - vertigo - paralysis of the facial nerve - vesicles in the ear canal - vertigo lasts from days to weeks - facial sensory loss can resolve or become permenant

Question 568

Treatment for Herpes Zoster Oticus?

Answer 568

- refer to MD, corticosteroids, antiivirals, decompression

Question 569

Etiology of primary hypertension?

Answer 569

- elevated systolic or diastolic BP | - unknown cause

Question 570

Etiology of secondary hypertension?

Answer 570

``` - renal parenchymal disease + glomerulonephritis + pyelonephritis + polycystic renal disease + collagen disease of the kindey - pheochromocytoma (adrenals) - cushings - Addisons - hyperthyroidism - myexedema - excessive alcohol - oral contraceptives ```

Question 571

SS of hypertension?

Answer 571

- dizziness - flushed face - ha - fatigue - epitaxis - Left ventricular HT - renal changes + hemorrhage + excudate

Question 572

Tests for hypertension?

Answer 572

- higher systolic and diastolic BP

Question 573

Treatment of hypertension?

Answer 573

- lifestyle change: + weight reduction + salt decrease

Question 574

Etiology of Orthostatic hypotension?

Answer 574

- fall in BP > 20/10 mm Hg when stand up | - b/c hypovolemia

Question 575

SS of orthostatic hypotension?

Answer 575

- faint - light headed - dizzy - confused - visual blurring - all b/c decreased blood flow to the brain

Question 576

Etiology of Labyrinthine Tumor?

Answer 576

similar to acoustic neuroma

Question 577

Etiology of Labyrthitis?

Answer 577

- inner ear bacterial infection - seondary to otitis media or purulent meningitis - usually get meningitis after

Question 578

SS of Labyrinthitis?

Answer 578

- severe vertigo and nystagmus - complete hearing loss - sometimes facial paralysis

Question 579

Treatment of Labyrinthitis?

Answer 579

- IV antibiotics

Question 580

Etiology of Meniere's disease?

Answer 580

idiopathic

Question 581

SS of meniere's disease?

Answer 581

- recurrent prostrating vertigo - sensory hearing loss - tinnitus - feeling of fullness in the ear - sudden onset - nausea and vommiting - feeling of fullness*

Question 582

Treatment of Meniere's disease?

Answer 582

- vestibular neurectomy relieves th vertigo and preserves the hearing - meds - SMT

Question 583

Etiology of Motion sickness?

Answer 583

- repetitive angular and linear acceleration and decelleration causing nausea and vommiting - basically the excessive stimulation of the vestibular apparatus

Question 584

SS of motion sickness?

Answer 584

- cyclic nausea and vomiting

Question 585

Etiology of Multiple sclerosis?

Answer 585

- progressive CNS disorder, characterized by patches of demylination in the brain and the spinal cord - idiopathic - > W - 20 - 40 - mostley affect the lateral and the posterior columns

Question 586

SS of MS?

Answer 586

- paresthesias in extremities, trunk or side of the face - weakness or clumsiness of a leg or a hand - visual disturbances: partial blindness

Question 587

Tests for MS?

Answer 587

- diagnosis of exclusion - brain MRI - lumbar puncture

Question 588

Treatment for MS?

Answer 588

- corticosteroids - symptomatic treatments - regular exercise

Question 589

Etiology of Myringitis?

Answer 589

- Inflammation of the tympanic membrane secondary to viral or bacterial infection

Question 590

SS of Myringitis?

Answer 590

- inflammation of the tympanic membrane - vesicles develop on the tympanic membrane - pain is sudden onset and lasts from 24 - 48 hrs - if hearing loss and fever = ostits media

Question 591

Treatment for myringitis?

Answer 591

- differential cause if bacterial or mycoplasmal | - rupture the vesicles and give antibiotics

Question 592

Etiology of Otitis media?

Answer 592

- bacterial or viral infection in the middle ear, usually after an URTI - common in young children - escherichia coli - staph aureus - stepth pneumonia - h influenzae

Question 593

SS of otitis media?

Answer 593

- persistent severe earache - hearing loss - fever - nausea - dirreha

Question 594

SS of chronic otitis media?

Answer 594

- conductive hearing loss b/c perforation in the tympanic membrane

Question 595

Etiology of Temporal Bone fracture?

Answer 595

- bleeding from ear after a skull injury - facial paralysis - permanent hearing loss - assessed w/ Weber's and Rinne's tests

Question 596

Treatment of temporal bone fracture?

Answer 596

- penicillin to prevent meningitis | - tympanic repair if patientexperiences hearing loss

Question 597

Etiology of temporal lob seizures?

Answer 597

- comples partial seizure | - originate in the temporal lobe

Question 598

SS of temporal lobe seizures?

Answer 598

- losses contact w/ surroundings for 1 - 2 mins - stare - purposeless movements - unintelligible sounds - mental confusion

Question 599

Etiology of TIA?

Answer 599

- sudden focal neural abnormalities of breif duration | - due to cerebral emboli in the internal carotis, middle cerebral or the vertebrobasilar system

Question 600

SS of TIA?

Answer 600

- last from 2 - 30 min - resolve without any persisting neurological function compromise - 5 ds and 3 NS

Question 601

Etiology of Atelectasis?

Answer 601

- airless states of the lung - caused by intraluminar bronchial obstruction which result from: + bronchial excudate + endobronchial tumours + granuloma

Question 602

SS of Atelectasis?

Answer 602

- pain oni the affected side - sudden onset of dyspnea and cyanosis - drop in BP - tachycardia - elevated temperature - shock - dullness on percussion - no breath sounds with auscultation - mediastinum deviates towards the side of lung collapse

Question 603

Etiology of Bronchiectasis?

Answer 603

- irreversible focal bronchial dilation - chronic infection - diverse conditions - congenital or hereditary - inhalation of noxious chemicals - preceding atelectasis

Question 604

SS of bronchiectasis?

Answer 604

- chronic cough with sputum prodcution

Question 605

Etiology of costochondritis?

Answer 605

- inflammation of the costochondral or costosternal joints that causes local pain and tenderness - b/c repetitive micro trauma

Question 606

SS of costochondritis?

Answer 606

- insidious onset - chest wall pain usually w/ repetiive motion or unaccustomed activity ex. painting - worse when move trunk, deep inspiration or exertion - pain decreased with decreased breathing or changing position - sharp pain - wax and waning - mostly bilateral - if unilateal and edema = tietze

Question 607

Treatment of costcoshondirits?

Answer 607

- NSAIDS - stretching and local heat - avoid repetive use of the musculature in the area - modify ergonomics

Question 608

Treatment of myofascial trigger point of the pectoralis muscle?

Answer 608

- pec is stretched w/ horizontal abduction | - prees down on coracoid process

Question 609

Etiology of scalene trigger point?

Answer 609

- ipsilateral lateral flexion and contralateral rotation overuse

Question 610

Treatment of the myofascial trigger point of the serratus anterior muscle?

Answer 610

- stretched with arm abducted and lateral flex to the opposite side

Question 611

Etiology of COPD?

Answer 611

- airflow obstruction due to chronic bronchitis or emphysema - progressively worsens - chronic productive cough for 3 months for atleast 2 years

Question 612

SS of COPD?

Answer 612

- productive cough - worse in morning and produces a small amount of colorless sputum - dyspnoea - cyanosis - cor pulmonae - elevated and distension of julglar veins - peripheral edema - crackles w/ inspiration

Question 613

Etiology of Pancoast Tumor?

Answer 613

- in the apex of the pleura - direct spread from a sulcus bronchiogenic carcinoma - pain in the shoulder and ulnar distribution of the arm - also cause horner syndrome

Question 614

SS of Pancoast tumor?

Answer 614

- pain in the shoulder an ulnar distribution of the arm - horner syndrome - unremmiting pain - xray: + apical cap on the lung

Question 615

Etiology of Pleurisy?

Answer 615

- direct entry of infectious or irritating substance into the plueral space - trauma, asbestos

Question 616

SS of pleuristy?

Answer 616

inflam of the pleura - stabbing chest pain - worse by cough, respiration, trunk bending - pain occurs with deep breathe or cough - local spot of pain - motion and breathe sounds of the affected side is diminished

Question 617

Tests for plueisy?

Answer 617

- recent infection - no nausea vomiting or disturbed bowel function - pain agg by breathing or coughing - intercostal neurtitis if no pain on respiration

Question 618

Etiology of Subacute endocardidits?

Answer 618

- previous infection - congestive heart failure - IV drug users

Question 619

SS og Subacute endocarditis?

Answer 619

- fever and chills - anorexia - weight loss - malaise - HA - night sweats - shortness of breath - cough - dyspnea - petichiae - splinter hemorrhages - osler nodes: tender nodes on distal digits - janeway lesion: non tender macuale on palms and soles - roth spots: retinal hemorrhages w/ small clear centers

Question 620

Etiology of achilles tendonitis?

Answer 620

- formed from the gastrocs and the soleus, inserting into the superior aspect of the calcaneus - overuse in running or jumping - direct trauma from forced dorsiflexion

Question 621

SS of achilles tendonitis?

Answer 621

- pain with palpation - pain with passive dorsiflexion - palpable scarring in the tendon

Question 622

Treatment of achilles tendonitis?

Answer 622

- rest ice and NSAIDs | - do not exercise through the pain or will form a rigid scar

Question 623

Etiology if Anterior talo-fibular ligament sprain?

Answer 623

- excessive inversion

Question 624

Tests for anterior talo-fibular ligament sprain?

Answer 624

- talar tilt test | - anterior drawer test

Question 625

Treatment of grade 1 anterior talo fibular ligament sprain

Answer 625

PRICE

Question 626

Treatment of grade 2 anterior talo fibular ligament sprain

Answer 626

- PRICE - crutches - rehab w/ ROM and ankle strenghtening

Question 627

Treatment of grade 3 anterior talo fibular ligament sprain

Answer 627

- refer

Question 628

Etiology of calcaneal spur?

Answer 628

ossification b/c of plantar fascia traction on the periosteum of the calcaneus - stress at the plantar aspect of the calcaneus at the acttachment of the plantar aponeurosis - excessive running, standing or walking - can occurs by itself or with diseases like reiters, AS, DISH

Question 629

SS of calcaneal spur?

Answer 629

- constant pain on the undersurface of the heel, radiates from the anterior portion into the rest of the plantar aspect of the foot - pain with walking or standing - pain relieved by rest - local tenderness is found over the medial portion of the spur - swlling - passive dorsiflexion of the toes may accentuate the pain

Question 630

Test for calcaneal spur?

Answer 630

- see on an xray

Question 631

Treatment for calcaneal spur?

Answer 631

- PRICE - heel lifts - donut shaped show inserts which take pressure off of the heel spurs - surgery - shock wave therapy

Question 632

Etiology for Charcot's joints?

Answer 632

- rapid destructive arthropathy of various causes from impaired pain perception and position sense - no sensation of pain or proprioception compromised the protective reflexes of the joint = trauma to occurs, mostly in the knee

Question 633

SS for charcots joints?

Answer 633

- confused with OA - mild pain, but usually not present - hemorrhagic effusion - subluxation and instability - acute joint dislocation - neurogenic arthropathy progresses more rapidly than OA - neurological disorder that results in painless but destructive arthropathy

Question 634

Tests for charcots joint?

Answer 634

- 6 D's: increased density, debris, destruction, distension, dislocation and disorganization - parrots beak deformity

Question 635

Distribution of charcots joint based off of the underlying neurological condition. What is the distibution of tabes doralis charcots joint?

Answer 635

- knee and hip

Question 636

What is the distibution of diabetes melitis charcots joint?

Answer 636

- foot

Question 637

What is the distibution of Syringomyelia charcots joint?

Answer 637

- upper limb, especialy the elbow and shoulder

Question 638

Treatment of charcots joint?

Answer 638

- treatment of underlying neurlogical condition | - surgery and prevention

Question 639

Etiology of Diabetes Melitus Type 1?

Answer 639

- impairment in insluin secretion (type 1) - hyperglycemia - diabetic ketoacidosis - any age mostly develops in childhood or teen years

Question 640

SS of Diabetes mellitus?

Answer 640

- polyuria - polydipsia - weight loss - hyperglycemia = + blurred vision + fatigue + nausea

Question 641

Tests for diabetes mellitus?

Answer 641

- fasting glucose: > 140 mg/dL or > 7.77 mmol/L | - almost 0 blood insulin

Question 642

Etiology of type 2 Diabetes Melitus?

Answer 642

- non insulin dependent - hyperglycemia and insulin resistence - diabetic ketoacidosis is rare - ass. w/ obesity - vaginal candidiasis (yeast infection)

Question 643

SS of type 2 diabetes mellitus?

Answer 643

- atherosclerosis leads to symptomatic coronary artery disease - claudication - skin breakdown - infection - retinopathy, macular edema -> blindness - diabetic neuropathy, glove stocking sensory deficits - foot ulcers and joint problems

Question 644

Tests for diabetes mellitus?

Answer 644

- overnight fasting blood glucose: | + > 140 mg/dL or >7.77 mmol/L

Question 645

Treatment for diabetes mellitus?

Answer 645

- diet to reduce weight - patient education - oral drug to control hyperglycemia

Question 646

Etiology of gout?

Answer 646

- monosodium urate crysta deposition in avascular tissues - Tophi are deposited in the jonit and are large enough to be seen on xray - b/c decreased renal clearance of urate

Question 647

SS of gout?

Answer 647

- starts w/out warning - precipitated by minor trauma - overindulgence in purine rich food, alcohol - fatigue - emotional stress - medical stress - acute monarticular pain - nocturnal - progressively more severe - acute infection - warm shiny or purplish skin - big toe, ankle, knee and elbow = common sites

Question 648

Tests for gout?

Answer 648

- elevated blood urate + > 7mg/dL - needle shaped urate crystals are free in the fluid or engulfed by phagocytes - xray + punched out lesions in the subchondral bone

Question 649

Treatment of gout?

Answer 649

- nsaids - colchicine, allopurinol - diet prevention

Question 650

Etiology of hallux limitus?

Answer 650

- limited ROM in the big toe - biomech abnormalities - pressure from shoe can cause the pain or neuritis

Question 651

SS of hallux limitus?

Answer 651

- pain w/ swelling - bony proliferation around the dorsal aspect and lateral aspect of the metatarsal head - alignment of the joint is altered in hallux valgus - limited dorsiflexion of the big toe - xray: + djd of 1st metatarsal head + lateral osteophytes + naroowing of JS - Lab no rheumatoid factor or HLA - B27 = this

Question 652

Treatment of hallux limitus?

Answer 652

- pad area - local anesthetic - antiinflamatory - show modification - analgesics

Question 653

Etiology of Hallux Valgus?

Answer 653

- lateral deviation of the hallux | - excessive pronation of the ankles

Question 654

SS of hallux valgus?

Answer 654

- bunion at 1st met head - pain at 1st met head - lateral deviation of 1st met head

Question 655

Tests for hallux valgus?

Answer 655

- enlarged 1st MTP joint w/ lim motion - pain on palp of joint - increased dorsiflexion of the the 1st big toe - xray + JS narrowing + bony spurs extending from the metatarsal heads

Question 656

Treatment for hallux valgus?

Answer 656

- passive exercises and toe traction - local anesthetic - orthotics

Question 657

Etiology of mortons neuroma (interdigital nerve pain?

Answer 657

- neuroma usually b/w 3rd and 4th digit - loss of fat pad protecting the interdigital nerves of the foot - repetitive trauma - improper foot wear - gradual persistent benign thickening and enlargement of the perineurium of one or more of the interdigital nerves of the foot

Question 658

SS of Mortons neuroma?

Answer 658

- pain along one or more nerves of the foot radiating to the ball or the toes - patients with neuroma complain of a mild ache or discomfort in the foot near the 4th metatarsla head - burning or tingling near 4th metatarsal head - feels like a marble or a pebble is inside your foot

Question 659

Tests for mortons neuroma?

Answer 659

- plantar palpation of ther interdigital space | - thumb pressure applied b/w 3rd and 4th metatarsal heads = pain w/ morton neuroma

Question 660

Treatment for morton's neuroma/

Answer 660

- resloves quick with insoles - lidocaine helps w/ neuralgia - corticosteroids - surgical excession of the neuroma

Question 661

Etiology of Osteochondritis Dissecans?

Answer 661

- loss of blood supply to an ares of bone underneath the joint surface = pain - AVN of bone - cartilage eventually seperates from the diseased bone - fragments break loose into the knee joint causing locking of the joint

Question 662

SS of osteochondritis dissecans?

Answer 662

- weakness - sharp pain - joint locking

Question 663

Tests for osteochondritis dissecans?

Answer 663

- xray - MRI - arthroscopy - positive wilsons test

Question 664

Treatment for osteochondritis dissecans?

Answer 664

- if not fragmented the bone can be fixed in place with pins or screws - if fragements bone graft

Question 665

Etiology of Osteoid Osteoma?

Answer 665

- benign bone tumor of the long bones - small lucent nidus surrounded by sclerotid region - 10 - 25 yrs olds

Question 666

SS of osteoid osteoma?

Answer 666

- painful, worse at night | - releieved w/ aspirin

Question 667

Tests for osteoid osteoma?

Answer 667

- xray + small lucent zone surrounded by a larger sclerotic zone + similar appearance to a brodie's abcess

Question 668

Treatment for osteoid osteoma?

Answer 668

- small radiolucent zone is located and surgically removed

Question 669

Etiology of Raynaud's Disase?

Answer 669

- spasm of arterioles in the digits and occasionally nose and tongue with intermittent pallor or cyanosis - disease = idiopathic - phenomenon= b/c underlying conditions

Question 670

Etiology of Raynaud's Phenomenon?

Answer 670

``` - secondary to other conditions: + scleroderma + SLE + RA - neurolesions - drug intoxication - dysproteinemia - myxedema - primary pulmonary hypertension - trauma ```

Question 671

SS of Raynaud's phenomenon?

Answer 671

- intermittent blanching or cyanosis of the digits precipitated by exposure to cold or by emotional stressor - color change - does not affect the thumb - no pain, often paresthesia - vasospasm of the digital arteries - warm hands restores the color and sensation

Question 672

Test for Raynauds?

Answer 672

- in disease the tropic skin changes are not present whereas in phenomenon there will be changes in the skin according to the underlying disease

Question 673

Etiology for Reiter's syndrome?

Answer 673

- seronegative arthropathy - can't see cant pee cant dance - infectious +chlamydia +shingella +salmonella +yersina +campylobacter - men 20 - 40 - increased incidence in people with HLA-B27

Question 674

SS of Reiter's syndrome (reactive arthritis?

Answer 674

- urethritis - fever - conjunctivitis - arthritis - asymetrical - back pain

Question 675

Tests for Reactive arthrits?

Answer 675

- peripheral arthritis w/ urethritis or cervicitis - ddx in several months - positive gonococcal culture, rapid response to penicillin - arthritis or skin lesion similar to psoriatc

Question 676

Treatment for reactive arthrits?

Answer 676

- tetracycline for up to 3 months reccomended

Question 677

Etiology of RA?

Answer 677

- idiopahtic - >W - b/w 25 - 50

Question 678

SS of RA?

Answer 678

- insidious - progressive joint involvement - tenderness in inflamed joints - synovial thickening - siffness for > 30min - early afternoon fatigue and malaise also occur

Question 679

Tests for RA?

Answer 679

- lab findings - increased ESR - RF - no crystals - xray + soft tissue sweeling + periarticular arthritis + JS narrowing + marginal erosion

Question 680

Treatment for RA?

Answer 680

- improve w/ conservative treatment - contra for cervical manipulation b/c atlanto axial instability - NSAIDs

Question 681

Etiology of infectious (septic arthrits)?

Answer 681

- mos commonly caused by neisseria gonorrheoae - spreads from infects surfaces, cervix, rectum or pharynx to small joints fo the hands, wrists elbows, knees and ankles - nongonococcal arthritis is caused by Staph Aureus

Question 682

SS of infectioous (septic) arthritis?

Answer 682

- acute onset of joint pain and swelling - rapid onset - mod to severe joint pain - warmth - tenderness - restricted motion

Question 683

Tests for infectious arthrtis?

Answer 683

- increased WBC - increased ESR - increased c reactive protein - viscosity and glucose conentrations usually decreased

Question 684

Treatment for infectious arthritis?

Answer 684

- depends on the results of culture, wheterh antibacterial or antiviral

Question 685

Etiology of Epiphysitis of the calcaneus (sever's disease)?

Answer 685

- develops from 2 centers of ossification - one begins at birth and other doesn't begin before the 8th yr - in ages 8 - 16 - excessive strain w/ vigorous activities

Question 686

SS of Sever's disease?

Answer 686

- heel pain | - history of trauma

Question 687

Tests for sever's disease?

Answer 687

- location of pain along the margins of the heel - patients age - history of athletic involvement - warmth and swelling - xray no relpful

Question 688

Treatment for severs disease?

Answer 688

- heel pads: reduce the pull of the achilles on the heel | - immobilization of the foot in a cast is usually effective

Question 689

Etiology of posteriolateral talar tubercle fracture?

Answer 689

- sudden jump on the ball of the foot or toes or from steeping backward off a chair with force - tow walkers more prone to this injury

Question 690

SS of posteriolateral tala tubercle #?

Answer 690

- pain and swellin behind the ankle - difficulty walking downhill or descending stairs - persistent swelling with no obvious history of injury - heat may be present but is mild

Question 691

Tests for posteriolateral talar tubercle #?

Answer 691

- plantar flexion = pain | - lateral flexion xray = see #

Question 692

Treatment of posteriolateral talar tubercle #?

Answer 692

- refer - immobilize for 4 - 6 weeks - if pain still there corticosteroids and an anestetic may be effective

Question 693

Etiology of tibial nerve neuralgia (tarsal tunnel syndrome)?

Answer 693

- compression of the tibial nerve at the medial part of the ankle under the tarsal tunnel - synovitis of the flexor tnedons - inflam arthritis - venous stasis edema

Question 694

SS of Tarsal tunnel syndome?

Answer 694

- pain in and around ankle that extends into the toes - pain worse w/ walking - releieved with rest - can occur while standing or while wearing various types of foot wear

Question 695

Tests for tarsal tunnel syndrome?

Answer 695

- tapping the posterior nerve below the medial malleolus, when the site of compression is struck it will generate distal tingling - electrodiagnostic testing - when swelling in the area of the nerve try to determine why?

Question 696

Treatment for tarsal tunnel?

Answer 696

- strap foot into neutral or more inverted position - orthotic - corticosteroids w/ local anesthetic

Question 697

Etiology of varicose veins?

Answer 697

- valvular dysfuinction - weakness in the vein wall - hormonal changes ( preggo) - abdominal tumor - prolonged standing aggrevates but does not cause varicose veins - deep thrombphlebitis

Question 698

SS of varicose veins?

Answer 698

- aching - fatigue - heat - relieved by elevating leg or wearing compression socks - symptoms do not relate to the size of degree of varicosities - worsen with menstration - tense and palpable

Question 699

Tests for varivose veins?

Answer 699

- seen by patient - pain relief when the leg is elevated - sometimes trendelembergu = retrograde flow of blood = incompetent saphenous valve

Question 700

Treatment for varicose veins?

Answer 700

- incurable - symptom relief is primary goal - compression socks - cosmetic surgery

Question 701

Etiology of Venous Thrombosis?

Answer 701

- can occur in superfical or deep veins - Superficial thrombophlebitis - deep vein thrombosis - chronic venous insufficiency - anticoagulant drugs can prevent these from forming

Question 702

SS of venous thrombosis?

Answer 702

- acute thrombophlebitis arise over hours to 1 or 2 days - superficial thrombophlebitis - pain - tenderness - erythema - warmth - palpation of a superficial cord in the leg reflects occlusion of a superficial vein - DVT can be asym -

Question 703

Where can DVT occur?

Answer 703

- popliteal, femopral and inliac segments = hard cord in the femoral triangle, medial thigh or popliteal space - with an iliofemoral DVT we can see dilated superficial veins over the leg, thigh , hip and lower abdome

Question 704

Treatment for Venous throbosis?

Answer 704

- no therapy - warm compress - NSAIDs - acute DVT hospitslb/c risk of pulmonary embolism

Question 705

Etiology of acute bronchitis?

Answer 705

- bacterial or viral infection of the bronchial tress

Question 706

SS of acute bronchitis?

Answer 706

- prior URTI - distressing cough - initially non-productive cough but becomes prulent - if fever = pneumonia - dyspnea - crackling - wheezing

Question 707

Treatment for acute bronchitis?

Answer 707

- rest | - antibiotics

Question 708

Etiology of Asthma?

Answer 708

- airway obstruction and inflammation\ | - due to brachospasm trigger by a hypersensitivity reaction

Question 709

SS of Asthma?

Answer 709

- varies - wheezing, cough and shortness of breath - itching voer anterior neck - dry cough - dyspnea - tightness or pressure in the chest - tachycardia - high pitched wheeze - hyperinflated chest - cyanosis

Question 710

Treatment of Ashtma?

Answer 710

- control allergne exposure - anticholinergics to relax smooth muscle long term: corticosteroids

Question 711

Etiology of Bronchiectasis?

Answer 711

- infection - mechanical alteration b/c atelectasis or loss of parenchymal volume - unilateral or bilateral - chronic inflammation and loss of cila

Question 712

SS of Bronchiectasis?

Answer 712

- begins in early childhood - chronic cough - worsen gradually - wheezing - dyspnea - crackles - airflow obstruction

Question 713

Treatment of bronchiectasis?

Answer 713

- refer for anti biotics

Question 714

Etiology of Chronic obstructive pulmonary disease?

Answer 714

- chronic bronchitis or emphysema and progressive obstruction - smokers, dilation of submucosal glands and dilated ducts - panacinar emphysema: affects whol acinus - centrilobular emphysema: begins in the respiratory bronchiole and spreads peripherally

Question 715

SS of COPD?

Answer 715

- smokers develop productive cough - as gets worse intervals between syumptoms shorten - hyperinflation of the lungs - breath sounds decreased

Question 716

Treatment of COPD?

Answer 716

- reduce environmental exposure i.e smoking - oxygen therapy - reduce symptoms using anti inflamatories

Question 717

Etiology of congestive heart failure?

Answer 717

- plasma volume increases and increased fluid in the lungs, abdomin and peripheral tissue - b/c L ventricular failure: coronary heart disease and hypertension and b/c R ventricular failure: L ventricle failure and tricuspid regurg

Question 718

SS of CHF?

Answer 718

- right sided, left sided or both - gradual or sudden onset - cyanosis - edema - LVF: pink frothy sputum - RVF: peripheral edema

Question 719

Etiology of scleroderma?

Answer 719

- degenerative adn vascular abnormalities in the skin (Scleroderma), articular structures and internal organs (esopahgus, GI, lung, heart, kidney) - unknown cause - degen changes - > W - cicumscribed patches or linear sclerosis

Question 720

SS pf scleroderma?

Answer 720

``` - CREST: + calcinosis + Raynauds + esophageal dysfucntion + sclerodactyly: taught shiny and pigmented skin, mask like face + telangiectasia - musculoskeletal pain: friction rubs on the jonits - renal insufficiency - cardiac arythmia, lung fibrosis - dysphagia ```

Question 721

Etiology of sinus infection?

Answer 721

- inflammation of the paranasal sinuses - acute by: + streptococci + pneumococci + Haemophilus influenzae + staphylococci - chronic sinusitis by: + gram nergative

Question 722

SS of sinus infection?

Answer 722

- area over the sinus tender adn swollen - maxillary, ethmoid and frontal sinusitis cause local pain and frontal HA - malaise - fevers - chills - nasal mucosa

Question 723

SS of myofascial trigger point of the intercostal muscles?

Answer 723

- pain local to trigger point extends anteriorly when severe - restricted rotation of T spine - chest pain with deep respiration

Question 724

SS of myofascial trigger point of the pectorals?

Answer 724

- refered pain, localizes substernally, anterior chest and breast, extends down the ulnar aspect of the arm to the 4th and 5th digits - can be mistaken for ischemic pain if on the left side

Question 725

SS of myofascial trigger point of the scalene muscle?

Answer 725

- refered pain radiates anterior, lateral or posterior - anterior pain: pectoral - lateral pain: down front and back of the arm (skipping elbow) - posteriorly: upper vertebral border of the scapula and the area medial to it

Question 726

SS of myofascial trigger point of the serratus anterior muscle?

Answer 726

- refered pain to the side and back of the chest and down ulnar side of the arm

Question 727

SS of hypocalcemia?

Answer 727

- muscle cramps - tetany - convulsion - caused by decreased magnesium

Question 728

SS of hypercalcemia?

Answer 728

- excessive bone reabs - constipation - anorexia - nausea - abdominal pain

Question 729

SS of chromium toxicity?

Answer 729

- skin irritation - potential perforation of the nasal spteum - carcinoma of the lung

Question 730

SS of folic acid deficiency?

Answer 730

- in prego women = spina bifida, neural tube defects

Question 731

Niacin (B3) deficiency?

Answer 731

``` - pellegra + dermatitis + dirreaha + dementia + death ```

Question 732

SS of cerebral beri-beri?

Answer 732

- also called wenicke koraskoff syndrome - mental confusion - aphonia - confabulation -> nystagmus

Question 733

SS of peripheral beri beri?

Answer 733

- paresthesia of toes - burning of feet - peripheral neuropathy

Question 734

SS of vitamin D deficiency?

Answer 734

- rickets | - osteomalacia