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jessiekate22
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Exam
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2012-06-10 20:30:42
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Second Week
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2020
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  1. What is the function of the hip?
    • - transfer body weight from trunk to legs
    • - allows to adopt numerous positions neded for: standing, walking, running, stairs
  2. Anatomy of the hip
    • Femoral neck angle 126* to shaft and 12* to frontal plane
    • - head faces acetabulum medially, cranially and slightly
    • Pelvis-acetabular labrum continuous with rim- makes the socket deeper. Transverse acetabular ligament completes circle. Acetabular notch permits vessels and nerves to pass in ligament of head. Articular fat pad moves in/out notch with pressure
  3. Glute mm
  4. Mm of the thigh and medial parts
    - Short ones usually tear
  5. Femoral triangle
    NAVEL
  6. What happens if there is a femoral nerve lesion?
    • - quads will have numbness
    • - loss of knee ext
    • - weakene hip flexion
    • - atrophy of ant thigh
    • - disabling for standing from seated position, climbing stairs, kicking, fast movement

    • Clinical test- test skin within femoral distribution
    • - test active knee ext
  7. What happens if the nerve that supplied obturator- abductors was lesion?
    - affects adductors, atrophy of medial thigh, loss of hip/thigh adduction, cutaneous sensory loss in medial thigh

    Clinical test- test skin of medial thigh, adduct thigh against resistance
  8. Sciatic lesion
    • - everts and PF
    • - common peroneal and (eversion/ DFL)
    • - Tibial N (PIFI ankle, flexion of toes
  9. Biomechanics of the hip
    • - glutes must be able to exert 2x bodyweight in unilateral stance in order to maintain pelvis at equilibrium
    • - glutes arehelped by ITB-helps stabilise and hold pelvis in single leg stance. static stabiliser during unilateral stance- tension band: protects femur from excessive medial bending deformation- converts tensile load into compression load along lateral femoral cortex- if amp below knee loss of this stabilisation
  10. What is the loose packed position of the hip?
    • - position in which the capsule is most relaxed
    • - minimal contact
    • - maximal joint place (accessory movements)
    • i this position is like sitting cross leg
    • - flexion 30 degrees
    • - abduction 30*
    • - slight ext rot
  11. What is the closed pack position for the hip?
    • - position in which capsule is maimally tensed- most stable
    • - maximal jt contact
    • - minial jt palay (accessory movement)- hard to do a jt glide

    • This position involves
    • - maximal ext
    • - slight internal rotation
    • - slight abduction
  12. What is the capsular pattern for the hip
    • - characteristic pattern of decreased movements due to entire capsule being shortened. If jt was swollen the capsule would become tight tight and short. This is the same for each jt
    • - gross limitation of flexion, abduction, int rotation
    • - slight limitation of ext
    • - little or no limitation of ext rot
  13. History taking of a hip pt
    • - not a common area of treatment
    • - if sporting injury usually soft tissue (mm) or referral from Lsp
    • - If OA usually gross degeneration before presentation for treatment- maybe ready for hip replacement
  14. Body chart for a hip pt
    • - groin/ inguinal area
    • - greater trochanter area
    • - posterior buttock in hamstring area
    • - not usually below the knee
    • - usually deep pain
    • - may be intermittent click/ clack
    • - sometimes ITB is tight andclick across the greater trochanter
  15. Hip pt pain aggravated by?
    • - sit to stand
    • - weight- bearing after sitting
    • - squat
    • - walking long distances
    • - slopes and stairs
    • - rot in WB
    • - lying on that side in bed
  16. Daily pattern for hip pain pt
    • - AM: stiff; pain first few steps
    • - Pm: can't lie on it thou occasionally prefers to lie on as hip in mid position
    • - Day: worse if WB
  17. What are some extrinsic hip disorders
    • - hip and groin pain due to urogenital or abdominal organ disease eg appendicitis
    • - disease of local structures eg lymphadenopathy
    • - referred pain from knee, SIJ (butt pain), L1- L2 radiculopathy (into groin), and somatic lumbar, dysfunction/ arthritis
  18. Neurological: spinal nerves
  19. Intrinsic hip disorders
    • - groin or lateral thigh pain commonly
    • - butt or posterior thigh pain infrequently
    • - may radiate anteriorly to just above knee as far as the shin
    • - extent of radiation related to degree of inflammation
    • - Bursitis (trochanteric, psoas, ischial)
    • - tendinopathies common (painful static mm test), tender to palpate, pain on stretching
    • - hip OA common in elderly
    • - tumours
    • - peripheral nerve entrapment
  20. Lateral femoral cutaneous nerve entrapment
    • - compressed by inguinal ligament
    • - all nerve pains- burning, tingling, or itchiness in ant thigh (meralgia paraesthetica)
    • - no motor loss
    • - ext aggravates
  21. How do you manage LFCN?
    • - avoid aggravating activities/ postures
    • - local massage (free up the lig)
    • - cortisone injection
    • - microsurgery to decompress nerve
  22. Trochanteric bursitis
    • - greater trochanter very tender
    • - associated with gluteal tendinitis
    • - pain may radiate to lateral thigh
    • - pain lying on side
    • - pain on abduction of thigh
    • - common in athletes and middle aged women
  23. How do you treat ITB?
    • - stretch
    • - biomechanics of fott: orthotics, heel wedge etc
    • - tape patella
    • - mobilise patella
    • - abductors may be weak
  24. How do you treat trochanteric bursitis?
    • - biomechanical abnormalities? eg leg length discrepancy, pronated feet
    • - avoid painful activities
    • - EPA (eg heat and ice)
    • - tendon stretches
    • - deep friction massage
    • - NSAIDs
    • - Corticosteroid injections
  25. What is ITB syndrome?
    • - friction between ITB and lateral epiconyle of femur
    • - Common in runners (running down hll), cyclists, repetive stair walking, running on uneven camber (longer side gets stretched)
    • - Ober's test for tightness of ITB
  26. What is snappy hip?
    • Snapping hip: ITB slips over greater or lesser trochanter and makes snapping noise
    • - local: gull, deep ache
    • - hip pain in young people
    • - treatment- stretch psoas
    • - can be connecte with bursitis
  27. Osteoarthritis- thomas test
    • - 50 year plus
    • - pain and xray changes poor correlation
    • - pain related to WB
    • - worsens with activity and eased by rest
    • - loss of ROM; wasting
    • - flexion, LR deformity
    • - anttalgic, swinging or trendelenburg gait
    • Stick used for OA hip to help take load off and pelvic will drop
  28. How do you manage OA?
    • - pt education
    • - leg length eg heel raise
    • - weight los
    • - passive jt mobs: eg traction
    • - exercise: increase ROM, strengthen glutes and quads
    • - OT eg home modifications
    • - analgesics, NSAIDS
    • - walking stick
    • - THR- total hip replacement
  29. Irritable hip in a child
    • 8-12 age
    • - child with a limp
    • - may have hx of truma
    • - transient virus or synovitis (inflammation)
  30. What are the ranges of the hip when walking?
    • 37° flexion
    • 15° extension
    • 7° abduction
    • 5° adduction
    • 4° internal rotation
    • 9° external rotation
  31. What are the ranges when climbing and descending the stairs
    • 67* flexion up
    • 36* flexion down
  32. Degree of movement when tying shoe laces?
    • 129° flexion
    • 18° abduction
    • 13° external rotation
  33. What is pharmacology?
    • - science or study of drugs/ medicines
    • - action/ effect on body
    • - how this is produced
    • - properties of drugs
  34. What are some of the sources of drugs?
    • - micro-organism- penicillum, cytosporin drugs
    • - plants- pawpaw, fox glove
    • - synthesised in the lab
  35. What is the tradename and generic name of a drug
    • - tradename- panadol
    • - generic name- paracetamol
  36. Generic brands
    • - same drug, dosage form and strength
    • - different trade names
  37. Medicines in Australia
    • - small quantity- supermarkets
    • - OTC in pharmacies
    • - Prescription

    • - Aust has a subsidised med scheme
    • - PBS- pharmaceutical Benefits Scheme
    • - provides timely, affordable access to wide range of medicines for all australians
    • - over 50- set up under National health act 1953

    • - pt make contribution govt pays the rest
    • - 170 million prescriptions per yr
    • -cost about 6 billion/ yr
  38. What are the regulations of drugs
    • - theraputic drugs administration (TGA)
    • - Commonwealth Agency regulates meical devices and drugs
    • - Administers the Therapeutic goods act 1989
    • - national system of controls relating to Quality, safety, efficacy and timely availability of therapeutic drugs used in Aust, whether produce in Aust or else where or exported
  39. Aust register of therapeutic goods
    • - prescription and over the counter meds which meet with aust standards of qualitiy, safety and eficacy
    • - lawful supply of any therapeutic good in aust requires the product to be on the list

    • Meds may be:
    • - registered (Aust R number)
    • - Listed (aust L number)
  40. Aust R products
    • - this means the meds have evidence supporting what they claim to do
    • - meds that are registered include:
    • - almost all prescription meds
    • - products such as vaccines
    • - almost all conventional OTC meds eg packs of asprin, paracetamol sold in supermarkets
    • - very small number of complementary meds where TGA is satisfied that specific claims of efficacy in treatment or preventio of disease are supported by adequate evidence
    • - approval of AUST R products based on satisfactory assessment of their quality, efficacy and safety
  41. Aust L products
    • Quality and safety
    • - Consist mainly of complementary meds
    • - herbal meds, most vitamin and mineral supplements
    • - other nutritional supplements
    • - traditional meds (eg Chinese meds, aromatherapy oils)
    • - means regulating prodcuts that seem by their nature to have low risk of causing adverse effects
    • -sponsors of products must hold evidence to sustantiate their claims
    • - make sure you don't get adverse efects
  42. Registration/ approval process
    • - sponsor (pharmaceutical company) applies to TGA to register new drug or new presetation of drug or new indication
    • - Australian Drug Elevation Committee (ADEC) advises TGA on quality, safety, efficacy
    • - once approved by TGA, the pharmaceutical company can market the drug for approved indications; GPs can prescribe on private prescription only
  43. PBS approval
    • - pharmacetical company may then apply to Dept Health and Aged Care of listing on the PBS
    • - Pharmaecutical Benefits Advisory Commitee (PBAC) advises Minster for Health on comparative safety, efficacy, cost- effectiveness, and clinical use for new drug relative to existing therapies
    • - if PBS listing is recommeneded, the pahrmaeutical company negotiates the PBS listed price with the Pharmaceutics Benefit Pricing Authority
  44. Types of prescriptions
    • - private prescriptions (pay full cost)
    • - Pharmacetical Benefits (subsidised)
    • - Sometimes require Authority (Dr obtains this by contacting HIC)- though health insurance commision
    • - sometimes only for specific purpose
  45. Brand substitution
    • - originator- only one company has a right to the particular drug
    • - One pharmaceutical company produces new drug product
    • - pt for number of yrs
    • - off pt; other companies make own brand
    • - if demonstrate bioequivalent, can interchange
    • - bioequivalent; same formulation, same dose, demonstrate similar pharmacokinetics and effect
    • - attain similar concentrations in body at similar times and no clinically important differneces between therapeutic and adverse effects
  46. Scheduling of drugs
    • - Schedule 1: Not currently in use
    • - Schedule 2: Pharmacy Medicine
    • - Schedule 3: Pharmacist only medicine
    • - Schedule 4: Prescription Only meds or prescription animal remedy
    • - Schedule 5: Caution
    • - Schedule 6: Posion
    • - Schedule 7: Dangerous posion
    • -Schedule 8: Controled Drugs- morphine toxiodon- drugs addiction- opiode type
  47. Schedule 8
    • - Controlled drugs (drugs of additiction)
    • - morphine, xycodone, methadone, fentanyl, pethidine
    • -suply by medical practioners, authorise nurse practioners, authorised midwife practioners and veterinary surgeons
    • - all transactions recorded in drug register
    • - Authenticity of prescription must be verified
    • - illegal to have pssession unless prescribed for or authorised to have in possession
  48. Schedule 2
    • - pharmacy only meds
    • - must be purchased from a pharmacy where professional advice is available
  49. Schedule 3
    • - pharmacist only medicine
    • - pharmacist must personally hand to customer
    • - give customer opportunity to seek advice on use
    • - stored in enclosed area to which public do not have access
    • - S3R class which must be recorde in prescription book or approved recording system (cough/ cold preparations containing pseudoephedrine) + asthma inhalers
  50. Scheule 4
    • - prescription only medicines
    • - supply by medical practioners, authorise nurse practioners, authorised midwife, dentist, vet, optometrists
  51. Standard for unifrom scheduling of drugs and poisons
    • - move over last 10+ yrs to provide unifrom scheduling of drugs throughout states and territories of Aust
    • - prior to this many anomalies state to state
    • - state expect to move towards adhering to them
    • - many states expected / territories have adopted standard either completely or partly
    • - also attempting to unify scheduling and control of poisons and drugs between Aust and NZ
    • - referred to as trans tasman harmonisation
  52. MIMS online
    - all info about drugs
  53. Pharmacokinetics
    • - plasma drug concentration
    • - how body affects drug after administration
    • - absorption
    • - distribution
    • - metabolism
    • - excretion
    • - time course of drug in body
  54. Pharmacokinetics- was of administration
    • - IV (intravenous)
    • - oral, IM, SC, rectal
    • - topical- on top of skin
    • - above 2- slow effects
  55. Drugs
    • - tetracycline: not given to children, distributes to teeth, bones
    • - Anaesthesia- fat soluble and distributes to brain rapidly
    • - blood brain barrier- protets brain by limiting substances entering, enothelial cells covere with fatty sheath of glial cells, tight intracellular junctions
    • - placental barier- separates blood vessels of mother and foetus. Enzymes in placenta can metabolise some substances, some drugs can cross
    • - drugs can distribute into breast milk
  56. Drug metabolism
    • - foreign substances
    • - inactive or less active metabolites (usually)
    • - not always the case
    • - morphine M3G (not active) and M6G (24 x more potent
    • - prodrugs metabolised to active drug
  57. Excretion
    • - unchanged drug excreted in urine (kidneys)
    • - also in expired air )lungs)
    • - sweat
    • - bile (Gi tract)
  58. Pharmacodynamics
    • - what drugs do in the body
    • -response (effect) and relate to dose administered
    • - where do the drugs act
    • - proteins such as enzymes, ion channels, carriers/ transporters, receptors in body
    • - can bind to produce direct or indirect effect
    • - most drugs bind to specific proteins called receptors
  59. Types of receptors
    • - opiod receptors, beta receptors
    • - beta blockers (propranolol
    • - beta 2 agonist: salbutamol (asthma)
  60. Opiod receptors in thebody
    • - morphine, heroin
    • - produce respiratory depression (and analgesi etc)
    • - overdose
    • - administer naloxone- helps unblock receptors people can breath
    • - anatogonist
    • - reverses effect of morphine, heroin
  61. Factors modifying response to medicine
    • - disease (ADME)
    • - renal disease- elimination reduced
    • - liver disease and metabolism
    • - age affect organ function
    • - may need to reduce dosage
    • - pharmacodynamic response also modified
    • - advanced age- less receptors, reduced response
    • - tolerance (bigger doses required to give same effect)
    • - compliance
    • - drug interactions
    • - increase of decrease effect of other drug
    • - probenecid (penecillin) and penicillin (used beneficially)
    • - genetic effects
    • - poor metabolisers and ectensive metabolisers
    • - codeine, isoniazid
  62. Factors to consider when recommending medicines
    • - has the pt had medicine before
    • - allergic
    • - what other medications is pt taking
    • - what concurrent illnesses/ disease
    • - age
    • - preg or breast feeding
    • - what is evidence that drug is the best choice for treating the problem
    • - need to e aware of side effects
  63. Analgesics
    • - paracetamol
    • - NSAIDS- aspirin, nonselective and selective NSAIDS
    • - opiods
  64. Resources
    • - MIMS
    • - Aust handbook
    • - therapeutic guidelines
    • - CMI can bedownloaded
    • - pharmacists

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