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- Lower femur head
- Ant. sacrum
- Longer innominate
- LARGER obturator
- Increased lumbar lordosis
- Edema @ post/sup margin of SI-joint
- Higher femur head = sole lift
- Posterior sacrum
- Shorter innominate
- Smaller obturator foramen
- Decreased lumbar lordosis
- Spongy edema @ post/inf margin of SI-joint.
- Higher femur head
- Increased width/ilium
- Narrow base of obturator
- Decreased anterior curve
- Foot diverges away from midline (foot flare, toe out, EX rotation).
- Lower femur head
- Decreased width/ilium (narrow)
- Increased base of obturator
- Increased anterior lumbar cuve
- Toe in (internal rotation)
The obturator foramen is smaller with which ilium listing?
A sole lift is needed with which ilium listing?
Spongy edema at the posterior inferior margin of the SI-joint indicates which ilium listing?
Spongy edema at the posterior superior margin of the SI-joint indicates which ilium listing?
The base of the obturator foramen has an increased width with which ilium listing?
- EX Ilium.
- Increased = excessive.
Foot flair is seen with which ilium listing?
- IN Ilium.
- (For boards foot flare = toe out).
An a/k/a for a right scoliosis in the Lovett Positive Classification of Scoliosis is _______________?
Lovett Positive Classification of Scoliosis...
- 1. Least offending = normal compensatory deviation.
- 2. The side of the AI sacrum is the same side as the PI Ilium (short leg).
- 3. The convex side of the scoliosis goes towards the side of the AI sacrum/PI Ilium.
- 4. Spinouses deviate away from convexity.
- 5. Heel life on PI Ilium side w/ sole life on the opposite side (AS Ilium).
For the LPC of Scoliosis, the AI sacrum is on the same side as the __ ilium, with a ______ leg.
For the LPC of Scoliosis, the AI sacrum is on the same side as the PI ilium, with a short leg.
For the LPC of Scoliosis, the convex side of scoliosis always goes to which ilium listing?
AI sacrum/PI lilium.
Which side do the spinouses deviate away from for a scoliosis?
Away from convexity.
For scoliosis, a heel life should be used on the side of __ ilium & a sole lift on the opposite side (__ ilium).
- For scoliosis, a heel life should be used on the side of PI ilium & a sole lift on the opposite side (AS ilium).
Absolute Contraindications vs. Relative Contraindications
- Absolute: malignancies, tumors, infections, FX's, AAA, recent surgery.
- Relative: can adjust but have to do ruther testing before adjusting (osteoporosis, spondylolisthesis, RA, cardiovascular predisposing factors, congenital abnormalities, acute spastic muscle region).
Which fracture is an exception to the absolute contraindication rule?
Is a benign tumor an absolute or relative contraindication for adjusting?
Absolute... benign could also result in a fracture.
3 findings with RA:
- 1. Haygarth's nodes (MCP).
- 2. Ulnar deviation.
- 3. Rat bite erosions.
- *Check stability = take stress films. (Flexion is better view).
Which grades of spondy's can be adjusted?
- All, so long as they are stable.
- *Adjust with knees towards chest.
Which disease process has a cold bone scan?
What is an a/k/a for bone scan?
- Syntegraphy. (Radionucleotide scan).
- *Good early detector because detects 3-5% bone loss... plain film x-ray detects 30-50% bone destruction.
Refer to a ___________ specialist if the AAA measures > ____cm.
Refer to a cardiovascular specialist if the AAA measures > 3.8 cm.
What is the best diagnostic test for diagnosing AAA?
- MRI (most specific).
- *U.S. is best initial test.
- *CT second.
Lower Cross Syndrome: Anterior Pelvic Tilt
- The ASIS move anterior to the pubic symphysis.
- Hyperlordotic lumbar curve.
- Lengthened/inhibited muscles/weak: hamstrings, glutes, abs.
- Hypertonic/Facilitate/Firing muscles: psoas, quadriceps, erector spinae.
- *Psoas: attaches to the anterior lumbar bodies... primary hip flexor.
Which muscles are facilitated with an anterior pelvic tilt with Lower Cross Syndrome?
- Psoas, quads, erector spinae.
- (Facilitated = firing = hypertonic).
Upper Cross Syndrome... Hypertonic/Facilitate Muscles: (6)
- Levator scap
- Pec major
- Upper trap
Upper Cross Syndrome... Lengthened/Inhibited Muscles: (5)
- Lower & middle trap
- Teres minor
- Longus coli & capitus
What is the close-packed position for the glen-humeral joint?
ABduction & ext. rot.
What is the close-packed position for the hip?
Maximal extension, internal rotation & ABduction.
If the hand or foot is free to move, that is what kind of exercise?
- Open chain.
- Ex) bench press, biceps curl, leg extension.
Lateral Gravity Weight Line:
- Ant body C7
- Ant 1/3 of sacral base
- Middle/hip joint
- Post to patella
- 1" ant to lateral malleolus
Structural landmark: C4/5
Structural landmark: C6
Structural landmark: T3
"It is very negative to have gonorrhea."
- Gram-negative dipplococus
- Grown in chocolate agar
- Smelly mucopurulent discharge **DDX trich**
- Salpingitis (PID)/women
What is the MC symptom w/ gonorrhea?
What is the most common sign of gonorrhea?
What is the most common joint affected by gonorrhea?
- Reiter's Disease
- Opthalmia neonatorum
- PID in females = MCC/infertility
- Males asymptomatic
What is the MCC of infertility of women?
- Treponema Pallidum
- Can be transported through the placenta
- Hutchinton's Triad: intersitial keratitis, notched incisors, deafness.
- MC DX Lab: VDRL.
- Best DX Lab: FTA/ABS, TPI.
- 1st stage: hard, singular, painless chancre.
- 2nd stage: maculopapular rash, condylomata lata (flat warts), alopecia... 8 wks - 2 years... Most transmission.
- 3rd stage: Tabes Dorsalis, Gummas, AA, slappage gait... >25 years, no transmission.
Which STD presents with a pailful papule?
- Chancroid: D/T Hhemophilus Ducreyi.
- Soft & painful papules.
- DX via Frei Test.
- Do cry because chancroids are painful!
What is Hutchinton's Triad?
- Interstitial keratitis
- Notched incisors
Which stage of syphillis presents with a rash?
- 2nd stage.
- (Maculopapular rash, condylomata lata, alopecia... most transmission).
Which STD presents with a greenish yellow, frothy, foul smelling discharge?
- *DDX Gonorrhea.
Which STD causes rectal strictures?
Lymphogranuloma Venereum (Chlamydia).
Red, beefy lesions are associated with which STD?
A painful, soft, flesh colored, cauliflower erosion is caused by which STD?
Genital warts (Condylomata Accuminata, HPV).
How is HIV transmitted? (4)
- 1. Breast milk.
- 2. Semen.
- 3. Vaginal secretions.
- 4. Blood.
What are the most common causes of PID?
- #1 MC: Chlamydia.
- #2 MC: Gonorrhea.
- #3 MC: Yeast.
- #4 MC: Trich.
- *1st sign/PID = abdominal pain.
- *2nd sign/PID = ammonorrhea.
What DX's are most commonly associated with AIDS? (3)
- 1. Pneumocystis carinii.
- 2. Giardia Lamblia (diarrhea).
- 3. Kaposi's Sarcoma (skin lesions).
- *Lukeima is MC cancer associated w/ AIDS.
What pathogen is responsible for infected hair follicles?
- Staph infection = furuncle (infected follicle), which is a type of pustule.
- *Nodule= big pustule.
Name two conditions associated with vesicles (small lesions filled with serous fluid).
Herpes & chicken pox.
What type of skin lesion is associated with Pemphigus Vulgaris?
- Bulla: fluid filled lesion >5cm.
- Pemphigus Vulgaris: potentially life-threatening condition, bulla (blisters) all over skin.
What is the most common benign sun-induced lesion?
Actinic Lentigo: sun/liver spot.
A non-tender epidermal cyst that is filled with sebum is referred to as...
Epiderman Cyst (Wen).
Red firey, advancing lesion on the skin caused by beta hemolytic strep...
- *Patient has fever & elevated ASO titer.
Bilateral, red, tender nodules associated with strep...
How are fungal infections diagnosed?
What condition is diagnosed via a Tzank Test?
What condition presents with knife like pain & vesicular lesions?
- Herpes Zoster (shingles).
- Found in the DRG.
- Follows course of dermatome.
Which skin condition presents with yellow honey crusted lesions around the corner of the mouth?
- *MCC: strep.
- *Also on hands/children.
Subfascial inflammation or infection of the finger pad.
Most skin conditions are caused by staph infections, with exception of which 3 conditions?
- 1. Impetigo: staph or strep (strep MC) -> yellow honey crusted lesion.
- 2. Errythmia nodosum: strep -> bilateral, red & tender nodules.
- 3. Erysipelas: strep -> fiery red advancing lesion.
Fish skin is a/k/a...
Ichthyosis: increased keratinization producing a non-inflammatory skin lesion.
Women with big breasts or obese persons often get which skin condition?
Intertrigo: reddened areas D/T moisture, friction & warmth.
Rough & thick skin due to constant scratching associated with chronic dermatitis...
What skin condition presents with inconspicuous scales on their skin?
- Lichen Planus: inflammatory pruritic DX.
- Also has whitish lines or puncta.
Autoimmune, coin-shaped lesion...
Nummular eczema: forms patches which ooze & crust over.
A Hearald Patch is associated with which skin condition?
Pityriasis Rosea: oval/round lesion caused by virus = 6 weeks of itching.
"Silver scales & pitted nails" ...
- "Silver scales & pitted nails"
A fun weekend in a whirpool may leave you with...
Scabies: caused by mites = superficial linea furrows in the groin.
Dandruff (Cradle Cap) a/k/a...
Food or medications result in what kind of allergic skin response?
Urticaria (wheals): hives due to an allergic reaction.
Depigmentation after development...
Which depigmentation disorder is visualized at birth?
- *Vitiligo is later in life.
A/K/A for Yeast infections...
- Candia Albicans: common in HIV & pregnancy.
- *Thrush: oral yeast infection.
What is the most common type of skin cancer?
- Basal Cell Carcinoma: rarely metastasizes, MC on face.
- *Waxy & indurated.
What type of skin cancer do field workers get?
Squamous Cell Carcinoma: malignant tumor of epitheial cells = itchy, irregular & flaky.
What type of skin cancer is most invasive?
- *Most serious factor = irregular border.
What is the name of a premalignant condition caused by sun exposure which leads to SSC?
Which can be peeled off; thrush or leukoplakia?
What psychological disorder causes emotional problems to become physical?
- Somatization Disorder.
- Ex). Person in bad car accident in which the passenger dies... presents w/ SX of paralysis but WNL.
Which somatoform disorder allows for the patient to admit that they are exaggerating?
Body dysmorphic disorder.
ADD is a problem of which lobe?
Dyslexia is a problem of which lobe?
What type of condition is autism?
A person with which personality disorder is introverted & withdrawn?
- Schizoid: ungluing of reason & emotion.
- Emotionally cold & distant.
- Delusions & hallucinations.
Denial is most commonly seen with what condition?
A smoker leading an anti-smoking league is an example of what type of defense mechanism?
Delirium tremens is associated with...
- *Also folate deficiency.
What condition has the same SX as depression, but not as severe?
Depression associated with monopause...
Which type of incontence is associated with obesity?
- Stress incontinence.
- *Overflow = prostate.
- *Pathological = DX.
The MMPI is used for...
- Personality evaluation.
- (Minnesota Mental Personality Index)
The Beck Test is used for...
Measuring severity of depression.
Flooding is used for treatment of...
The MMSE (Folstein Test) is used to screen for...
The Stanford Binet Test is used for...
- IQ test, <5 YO.
- *Wechsler Scale = IQ Testing/school age children.
Person associated with the collective unconscious of man...
Person associated with the Hierarchy of Human Needs...
"Plsss respect my needs!"
- 1. Physiology.
- 2. Love.
- 3. Safety.
- 4. Self-esteem/respect.
- 5. Self-actulaizations.
Person associated with operant conditioning:
Aceetaminophen (_______) is an antipyrectic that causes liver damage.
Charcoal absorbs oral overdoses with exception of which substance?
_______: antiviral (herpes).
_________: treats chronic gout.
- Allopurinol: decreases xanthine oxidase activity; used to treat chronic gout.
- *Opposite of logic! Acute = colchicine... Chronic = allopurinol.
________ decreases kidney function, causes lung problems, muscle weakness, anemia & CNS problems.
Aluminum toxicity = slow poisoning over a long period of time.
Which toxic substance smells like garlic?
_______: sleeping pills which cause respiratory depression.
_________: blocks Epi & NorEpi.
Beta blockers: for hypertension & arrhythmias.
Which toxic substance causes blue mucous membranes & cherry red lips?
Drug used to treat schizophrenia?
________ increases the effectiveness of ACH.
_______: used to treat symptomatic gout.
________: tastes like almonds/cherries & is toxic to the CNS & heart.
Cyanide: found in plants, apple seeds, mango seeds, peach pits & bitter almonds.
Overdoes of which drug can cause a heart block?
Digitalis: used to increase cardiac contractility (antiarryhthmic agent).
Best substance to remove lead from blood during chelation therapy?
______: substance that makes you vomit when a an oral drug is taken is excess.
- Emetic: for use when too much ingested.
- *Don't use with gasoline.
Drug used for arthritis?
Fledene: RA & OA only.
Drug used for Tourette's?
Haldo (Haloperidol): motor & verbal tics.
Blue gums are associated with which kind of poisoning?
Lead: battery factory workers, kids... affects the CNS.
_______: used to treat angina & coronary artery disease.
Feldene is an aka for ______.
Feldene (NSAID): antipyretic, analgesic.
________: causes deafness & Reye's Syndrome.
Salicylates (Aspirin): causes bleeding; inhibits prostaglandins, & is associated with deafness/tinnitis & Reye's Syndrome.
Brand name drug for treat insomnia...
Seconal makes you feel sleepy.
_________: predisposes elderly to falls.
________: causes hypertension in those taking MAO inhibiters (anti-depressants).
Tyramine: found in whine & cheese.
_______: anticoagulant; vitamin K antagonist; increases clotting time.
Warfarin/Coumadin: found in rat poison, causes difficulty breathing.
Types of pneumoconiosis: (5)
- 1. Asbestosis: mesothelioma.
- 2. Siderosis: iron dust.
- 3. Anthracosis: coal dust (Woolsorter's DX).
- 4. Byssinosis: cotton dust = textile workers.
- 5. Silicosis: glass, sand/stone dust (pottery).
Which type of pneumoconiosis is associated with iron dust?
- Siderosis. (Sider sounds like solder).
Which type of pneumoconiosis is associated with pottery?
Which type of pneumoconiosis is associated with cotton dust (textile workers)?
Pin point pupils indicate ___________.
At what week can you feel the fundus?
Where are ectopic pregnancies most commonly located?
- Fallopian tubes.
- (Can happen in ovary & peritoneum also).
Alpha Fetoprotein is used to diagnose...
Neural tube defects, Downsyndrome (Trisomy 21).
In which stage of labor does the cervix dilate?
What is the primary cause of dysmenorrhea?
- Dysmenorrhea (painful menses):
- Primary cause: increased prostaglandin.
- Secondary cause: pathology (endometriosis).
Abnromal, painful, or prolonged labor.
Thinning of the cervix...
Decent of the fetal skull to the level of the ischial spines...
MC diagnosis & treatment of Endometriosis?
The baby drops into the pelvis __ weeks before delivery.
The baby drops (lightening) into the pelvis 2 weeks before delivery.
Pain in the abdomen at ovulation...
First pregnancy with a viable infant...
What is the MC complication of childbirth?
Post partum infection: most commonly from c-section.
The time period from placental delivery to 6 weeks post partum is referred to as....
- *Infection during this time = Puerperal Sepsis.
_____: the first perception by the mother of fetal life.
Quickening: 20th week.
Identifies the fetal position (cm) in relation to the spines of the ischium.
- (Eclampsia = HEP + convulsions).
MCC post partum hemorrhage...
MC malignancy of the female genital tract?
Malignancy of the placenta...
Herniation of the urinary bladder into the vagina, due to ligament laxity...
Palpable nodules in breast after ovulation, associated with caffeine, obesity, diabetes & sugar...
Fibrocystic breast disease.
VERY high HCG is due to?
- Hydatidifiorm mole: benign trophoblastic tissue of the placenta.
- *Malignant = choriocarcinoma.
Commonly seen with a cystocele; herniation of the rectum into the vagina...
Hormone responsible for ovulation?
Stages of labor: (4)
- 1st: Dilation; release of mucous plug/first contraction -> 10cm (longest stage).
- 2nd: Expulsion; 10cm -> delivery/baby.
- 3rd: Placental delivery; delivery/baby -> delivery/placenta (most dangerous to mother).
- 4th: Stabilization; hours after labor when tone of the uterus is reestablished.
Placenta ______: obstruction of the internal os.
- Placenta praevia.
- *low lying placenta.
Placenta _______: spontaneous abortion/premature seperation.
- Placenta abruptio.
- *Normally placed placenta.
Placenta ______: does not separate after delivery.
- Accreta stays in there like concrete.
________ placenta: umbilical cord stays attached at the margin.
Battledore: rare & does not affect placental functioning.
Pap Smear Classifications:
- 1. Normal.
- 2. Atypical or benign (infection/inflammation).
- 3. Dysplasia/Pre-Cancerous.
- 4. In Situ/Non-Invasive Carcinoma.
- 5. Malignancy/Invasive.
Most common type of anemia during pregnancy?
When does the posterior frontanelle close?
- 3 months.
- (Anterior frontanelle @ 2 years).
born between 26 & 37 weeks, weighing less than 5 lbs (2500g).
_______: a benign condition in which the baby's head is an unusual shape due to scalp swelling.
- Caput succedeum. (coneheads)
________: similar to seborrheic dermatitis in an adult.
Kwashiorkor presents with which sign?
Ascities (due to protein malnutrition).
What is the MC cancer in children?
- Acute lymphocytic lukemia.
- *Also the MC cancer w/ Down's Syndrome.
Volvus = absent bowel sounds = emergency surgery required.
What is the MC malignancy of the cranium in children?
Congenital agangliosis of the myenteric plexus...
Hirschprung's DX = no peristalsis.
What is the most common cause of painful scoliosis in kids?
Rubella "Affects the little fella"
- Rubella (German Measles): 3 day measles = maculopapular rash & mild fever.
- *May result in birth defects if Mom gets it during 1st trimester.
________ has a prodromal stage of coryza, Koplic spots, maculopapular rash & high fever.
- Rubeola has a prodromal stage of coryza (runny nose), Koplic spots on the buccal mucosa, maculopapular rash & high fever.
- *MC complication = bronchopneumonia.
What disease can cause sterility in males after puberty?
Mumps: mild disease in the parotid gland that can produce orchitis (swelling of one or both testicles).
A/k/a for the barking cough associated with croup?
A/k/a for Whooping cough?
Which childhood disease presents with a gray pseudomembrane?
- Diptheria: corybacterium diptheria.
- *DX via Schick Test.
Which strep infection results in desquamation of the superficial layer of skin?
Scarlet Fever: peeling of skin, strawberry tongue, ASO titer.
Young child presents with high fever that broke & a rash appeared...
________ reflex: Dr rotates head of supine baby & the ipsilateral arm & leg extend, while the contralateral arm & leg flex.
Tonic Neck Reflex.
_______ reflex: infant raises head & arches back when prone.
________ reflex: run a finger down the spine of a prone infant = whole body extends.
______ reflex: running a finger down the ipsilateral paraspinal muscles = baby contracts to that side.
MC plasma cell dyscrasia?
- Arcus Senalis: grayish opaque ring around the cornea (arcs).
- >40 YO = normal.
- <40 YO = hypercholesteremia.
Hardening of the lens...
Presbopia: loss of elasticity of the lens = hardening = cannot focus on close objects.
_________: inability to hear high frequencies.
MC endocrine malfunction of the elderly?
Bed sore which requires protein for healing...
Decubitus ulcer: most common over sacrum & hip.
MC visual problem in the elderly causing blindness?
Macular Degeneration: cannot see center.
What geriatric disease is diagnosed via autopsy?
Checks for glaucoma (increased intraocular pressure).
___: measures blood volume, oxygen uptake transport & metabolism.
PET (Positron Emission Test)
_______: foreskin becomes entrapped behind the glans penis.
Paraphimosis: can be medical emergency.
______ maneuver: used to treat BPPV.
______ sign: tibial edema w/ Grave's (Hyperthyroidism).
Assault = _______.
Battery = _______.
- Assault = threat of violence (spoken).
- Battery = adjusting without consent (touching).
What type of dispute resolution has no appeal process?
______: a false statement submitted in writing that harms another.
- (Slander = speech).
Failure to conform to the standard of care...
- *Each state has its own state laws = governs chiropractic = standard of care.
The burden of proof lies with whom?
body of law which allows an injured person to obtain compensation from the person who caused injury.
What kind of incontinence is associated with arthritis, Alzheimer's & Parkinson's?
- Stress = women, sneezing, laughing, etc.
- Urge = eldery (cannot get there on time).
- Overflow = BPH (cannot empty bladder = dribbling).
side lying, bottom arm extended over head, upper leg bent.
Newborn vital signs:
- Pulse: 120-160 BPM
- BP: >60mmHg (systolic)
- Resp: 40-60 breaths/min.
What is the first step for choking procedures with a coughing adult?
- Nothing! Let them cough!
- *If not coughing: start by giving 5 back blows.
What is the first thing to do with a conscious choking infant?
- Five back blows.
- *Check pulse @ brachial A w/ infants.
How many chest compressions for unconscious persons?
Which sign is found behind the head indicating a possible skull fracture?
Battle sign: eccymosis around the mastoid = possible basilar skull fracture.
Recovery position for cardiogenic shock?
Upright/semi-recumbant (feet higher than head).
Recovery position for a patient with a femur fracture?
- Femur fracture = hypvolemic = elevate legs.
- *Cold & clammy skin.
Recovery position for neurogenic/vasogenic shock?
Recovery for septic shock?
Recovery position for anaphylactic shock?
- *Lower extremity/pelvic = supine.
Which degree of burn causes blisters?
What type of hematoma has a fast bleeding rate?
What should you give someone with heat cramps?
What type of hematoma is considered to be a form of stroke?
Subarachnoid = result of cerebral aneurysm.
What type of hematoma results from a serious head injury & bleeds slowly?
Subdural: one of the deadliest of all head injuries... symptoms show up 1-2 weeks later.
- Cathode: large filament, small filament, focusing cup.
- Focusing cup: controls # of electrons created.
- Large & small filaments: source of electrons.
- Thermionic emission: electrons boiled off in focusing cup, controlled by mA.
- Anode: rotates to dissipate heat.
- Focusing spot = detail.
Where does thermionic emission ocurr?
- In the focusing cup.
- (Electrons boiled off = x-rays created... controlled by mA).
What are the source of the electrons made of?
Large & small filaments are made of Tungsten.
What structure is responsible for dissipating heat?
What structure is responsible for detail?
- The focal spot.
- (Small = better detail).
What controls density?
mAs... ^ mAs = more electrons = more x-rays = ^ density (darker).
What kind of relationship does density & mAs have?
Is high or low kVp better for the body?
- High kVp.
- * ^ kVp = ^ energy = strong penetration.
- *short wavelength (bullets) = greater ability to penetrate body.
What kind of relationship does kVp & contrast have?
- Inversely related.
- ^ kVp = low contrast
- low kVp = ^ contrast
- (contrast = detail)
What causes a film to be soft & sticky?
Decreased rolling time.
How should you store films?
@ 60-80% vertical.
Is the kVp high or low for a bone film?
- Low kVp = high contrast, short scale, bone film, less scatter, high absorption.
- High kVp = low contrast, long scale, more grey, soft tissue film, more scatter, decreased absorption.
How do you lower contrast?
- Increase kVp by 15% & decrease mAs by 50%.
- (= longer scale = more grey).
- *Soft tissue film.
How do you raise contrast?
- Decrease kVp by 15% & increase mAs by 100%.
- (=shorter scale = fewer grey = more black & white).
What is the 15% rule?
An increase in kVp by 15% will double the overall density (darkness) of the film.
Differential Absorption: (4)
- 1. Gas = black
- 2. Fat = black
- 3. Muscle, H2O, ST = grey
- 4. Bone & metal = white
- *Denser tissue absorbs x-rays.
Water appears the same color on x-ray as what two structures?
Muscle & soft tissue.
What structure has the same density as gas?
At which side is the intensity of the x-ray greater?
- *Intensity & density decrease on the anode side = place the thinner portion of what is being x-rayed toward this end (anode-heel effect).
Anode vs Cathode
- Anode: less x-ray, smaller focal spot, more detail, thinner body part.
- Cathode: more x-ray, larger focal spot, less detail, thicker body part.
As you ________ the FFD, the image gets ________ & clearer.
- As you increase the FFD, the image gets smaller & clearer.
- *FFD: length of space from the focal spot (or tube) to the recording medium (or film).
- *This decreases magnification & distortion.
________ screens increase density on the film by intensifying the action of the x-rays.
- Intensifying screens increase density on the film by intensifying the action of the x-rays.
- *Consists of flourescent crystals.
- *Decreases patient exposure.
- *Large crystals = faster = higher contrast = short scale (less patient exposure) = less detail
_____: picture made by the useful beam.
- *Penumbra: blurry halo parts (unsharpness).
- *Pneumbra: tube too close, patient too far, filament too big.
- *Object as close to film, or ^ OFD = better detail... smaller = better detail.
Increased OFD = ...
Increased OFD = image becomes bigger/blurrier (more penumbra).
What is the best test for screen film contact?
- Wire Mesh Test.
- *Poor screen film contact reduces the image sharpness.
What are the two types of distortion?
- 1. Size.
- 2. Magnification.
What two things can affect distortion?
What is the sole purpose of the grid?
To improve the quality of the film by absorbing scatter radiation.
What factor must be altered when using a grid?
You must increase exposure factors to maintain density... this increases patient dose.
What is the grid ratio in a chiropractic office?
Name an example of the air-gap technique.
- Lateral cervical view.
- *Reduces patient dose but can distort or magnify the image.
What is the best way to reduce scatter radiation?
Collimation: limits the size of the beam.
Use of a filter removes high or low energy photons?
- Low (spaghetti noodles).
- *Made of aluminum.
What is the safe limit of REMS per year?
- 5... wear photosensitive badge on collar.
___ = 5(age-18)
MPD (Maximum Permissible Dose).
What type of radiation composes the majority of useful beams?
- Bresstrahlung (Braking Radiation).
- *Interacts with the target nucleus.
- *Characteristic = inner shell electron knocked out of place & replaced by an outer shell electron.
What is the primary form of scatter?
Compton: knocks out an outer shell electron.
What type of scatter changes direction with no energy loss & causes fog?
(It has 3 names...)
Classical (Thompson/Coherent) Scatter.
Temperatures too ___ will increase density.
Temperatures too hot will increase density.
Processing Factors: (4)
- 1. Developer: develops exposed silver halide crystals.
- 2. Rinse: removes silver halide crystals.
- 3. Fixer: hardens the image.
- 4. Washing: removes developer & fixer.
A brown film is due to...
A MILky film is due to...
Black & branching lightning like lines on a film is due to...
______: changes AC to DC.
______: beam of radiation loses energy as it passes thru matter.
Why is green or blue tint added to films?
To reduce glare.
6 things that are hyper intense on a T2 MRI:
- 1. Water (H2O).
- 2. Neoplasms.
- 3. Edema.
- 4. Inflammation.
- 5. Healthy NP.
- 6. CSF.
What color is bone on a T1 MRI?
Bone is hypointense (black) on both T1 & T2 MRI's.
Is MRI or CT better diagnosing for soft tissue structures?
What happens when any of the structures on the T1 MRI list become inflamed?
They take on the brightness of T2.
Which of the following should be performed to correct an increased throacic kyphosis?
A. Strengthen the deep neck felxors.
B. Strengthen the scalene muscles.
C. Stretch the lower traps.
D. Strengthen pec major.
- Which of the following should be performed to correct an increased throacic kyphosis?
- A. Strengthen the deep neck felxors.
- B. Strengthen the scalene muscles.
- C. Stretch the lower traps.
- D. Strengthen pec major.
Which of the following muscles should be inhibited in UCS?
A. Rhomboids, SA & post delt.
B. Pec maj, mec min & SCM.
C. Scalenes, ant delt & long coli.
D. Longus capitus, SA & teris maj.
- Which of the following muscles should be inhibited in UCS?
- A. Rhomboids, SA & post delt.
- B. Pec maj, mec min & SCM.
- C. Scalenes, ant delt & long coli.
- D. Longus capitus, SA & teris maj.
Which muscle should be strengthened if a patient has AHC?
D. Longus coli
- Which muscle should be strengthened if a patient has AHC?
- A. SCM
- B. Suboccipitals
- C. Scalenes
- D. Longus coli
Which of the following muscles should be facilitate in UCS?
A. Rhomboids, SA & post delt
B. Pec makor, pec minor & SCM
C. Scalenes, ant delt & longus coli
D. Longus capitus, SA & teres maj
- Which of the following muscles should be facilitate in UCS?
- A. Rhomboids, SA & post delt
- B. Pec makor, pec minor & SCM
- C. Scalenes, ant delt & longus coli
- D. Longus capitus, SA & teres maj
Scleratogenous pain referral originates from where?
Facets... does not go below the knee.
In addition to the flank, where is another location kidney pain refers to?
The groin (from the urethra).
Pancreatitis is associated with which condition?
- Chronic alcoholism.
- *Pain at T10-12 with leaning forward.
- *Epigastric region.
The 4 F's are associated with which organ?
- Gall bladder... refers pain to the right scapula
In addition to the left shoulder, where is another location of pain referral associated with heart attacks?
Down the medial arm.
SI joint pain may refer to ________?
The periumbilical region.
Where does cystitis refer pain to?
- The suprapubic region.
- *Cystitis = gall bladder.
VBI 5 D's & 3 N's:
- Drop attack
- *Listen: slurred speech, giddiness, voice changes, decreased speech context & inappropriate reactions.
- Blades of grass.
- Candle flame.
- Sheaves of wheat (grain)... Osteoporosis Circumstricta.
- >50 YO (osteosarcoma <30 YO)
A carrot stick fracture involves what?
The vertebral body.
HLA B27 (+):
- Reiter's (Reactive Sclerosis)
What is the number one cause of bone spurs?
- Plantar fascitis.
- *2nd = Reactive Sclerosis (Reiter's)
The pneumonic CREST is associated with which disease?
- Esophadeal DX
- Sclerodactyly: localized thickening & tightening of the fingers/toes.
- Telangiectasia: spinder veins.
What is the name of the disease which causes cracking in articular cartilage & the underlying subchondral bone?
- Osteochondritis dessicans: AVN causes fragmentation of cartilage & bone resulting in fragments within a joint space.
- Rare... 16-25 YO athletes.
- Joint mice.
- Refer to ortopedic surgeon.
An elongated pedicle is associated with what condition?
Type 1 Spondy.
Posterior gliding takes place on what axis?
Cranial nerve lesions are what type of lesions?
Define anosmia & parosmia..
- Anosmia: lost sense of smell.
- Parosmia: distorted sense of smell.
Which condition is associated with the Swinging Light Test?
Swinging light test = Marcus Gun Pupil (pupillary afferents).
What is an a/k/a for indirect light reflex?
Eyes converge, pupils constrict, lens convexity.
What disease attacks CN's first?
Which muscle is associated with ptosis?
Levetor palpebrae: eyelids drooping.
Which CN innervates the muscles of mastication?
- Trigeminal (V).
- Int. ptyrgoid: closes jaw.
- Ext. ptyrgoid: opens jaw.
- *Muscles of facial expression = CN VII (Facial N).
Which two CN's are involved with the corneal blink reflex?
V & VII
Which CN's are involved with the occulocardiac reflex?
V & X.
Which CN gives sensory innervation to the anterior 2/3 of the tongue?
Tic Douloureux is associated with which CN?
- Tic Douloureux (Trigeminal Neuralgia): CN V... extreme, sporadic, sudden burning/shock-like face pain, lasting from seconds to minutes/episode.
- *Repetitive, occurring several times/day.
- Pain typically on the side of jaw or cheek.
- *CAN adjust this patient.
Chvostek's Test is associated with which CN?
Chvostek's Test: tap the muscles of mastication = Facial N (VII) problem... (+) associated with hypocalcemia & tetany.
Which CN is associated with taste to the anterior 2/3 of the tongue?
Which condition is treated with an eye patch, artificial tears & a referral to a neurologist?
- Bell's Palsy: self-resolving flaccid paralysis, decreased corneal reflex, no control of saliva.
- Due to: trauma, virus or immune response.
- Results in: unilateral facial paralysis, twitching, weakness, drooping eyelid (ptosis), corner of mouth drooping, drooling, dry eyes & taste impairment.
- *Forehead does not wrinkle = can't raise eye brow on affected side.
A patient presents with an abnormal neuro exam, but can raise both eye brows. Which condition is still in the running to be a DX?
- Stroke (UMNL).
- *Bell's Palsy (LMNL) = cannot raise both eyebrows.
Rhomberg's tests which 3 structures?
- 1. Cerebellum
- 2. Post columns
- 3. CN VIII
- *DX MS
Which tuning fork is used to test CN VIII?
4 tests for the vestibular portion of CN VIII?
- 1. Balance
- 2. Mittelemeyer: pt marches in place w/ eyes closed.
- 3. Barany Caloric Test: irrigating cold (away from side/stimulus) or warm (toward side/stimulus) water into the ear canal = nystagmus.
- 4. Romberg's
A/k/a for Endolymphatic Hydrops?
Meniere's Disease (Central Vertigo): idiopathic episodic rotational vertigo, hearing loss & tinnitus.
Which CN's are associated with the gag, uvular & carotid reflexes?
IX & X.
Which CN's are associated with the ability to swallow?
- CN IX: stylopharyngeus muscle innervation.
- CN X: epiglotis & laryngeal muscle innervation.
CN X: Uvular Reflex
Uvula Away from side of lesion.
A patient fell asleep next to an open window. Which CN is affected & what is your treatment plan?
- XI (Spinal Accessory):
- Torticollis (Wry Neck) = spasm of SCM.
- Cryotherapy, trigger points, TENS, spray & stretch.
Which CN is tested with tongue to cheek?
- CN XII: tongue muscles.
- *Deviates to side of lesion... look for atrophy & fasciculations.
- *Also test by having patient stick out tongue.
What is Westphal's Sign?
Absence of any DTR, especially patellar (LMNL).
0+ & 1+ inicate what kind of lesion?
The trigeminal N is responsible for which DTR?
- Jaw Jerk reflex.
- Biceps: MCN (C6)
- Brachioradialis: Rad N (C6)
- Triceps: Rad N (C7)
- Patellar (Knee Jerk): Femoral (L2-4)
- Post Tib: Tibial (L5)
- Med Hamstring: Sciatic (L5)
- Achilles (Ankle Jerk): Tibial (S1)
_________ reflex: withdrawal reflex to noxious stimuli.
- Superficial reflex.
- *Pharyngeal (gag)
- *Abdominal (T7-12): should go to side you are stroking.
- *Cremasteric (L1, 2): femoral & genitofemoral N.
- *Geigel's: female cremasteric.
- *Plantar (L4-S2): stroke up the sole of the foot & see curling of the toes & pulling away of the foot (tibial N).
MCC of serious injury?
- *Also the MCC of unintentional deaths.
________ prevention: rehab.
Tertiary prevention: rehab.
Excess heat is most detriment to a patient with...
MCC of workplace injury?
- *Musculoskeletal injuries = most costly work related injury.
Safety of x-ray machines?
Which chemical causes precipitation during water purification?
Aggregation of colloidal particles occurs during the _____ phase of water purification.
Which trace element is most likely to be decreased in the elderly?
Where do most injuries occur?
In what stage of the water purification process is the most anaerobic bacterium?
Excessive chlorination is most likely to cause calcium by which agent?
What is the number one cause of death in the US?
What is added to the water purification process to take out particles?
What substances are the cause of acid rain?
- Sulfur dioxide & nitrogen oxide.
- *Sulfuric acid is present, but not the cause.
MC air pollutant?
- Carbon monoxide
- *Greenhouse effect = carbon dioxide.
The FDA does not regulate ______.
Other than smoking, what is the major cause of lung cancer?
The lateral horn is present at which segments?
- *Motor & sympathetic NS.
- *Blood vessels sympathetic only.
- *Skeletal mm.
Where do lesions occur which result in flaccid paralysis, absent DTR's/pathologic reflexes, atrophy & fasciculations?
- LMNL: anterior horn cells -> myoneural junction.
- *Superficial reflexes are absent with both UMNL & LMNL.
_______ reflexes are integrated by the brainstem & are absent in UMNL & LMNL's.
- Visceral organic reflexes.
- *Ciliospinal: cervical sympathetics.
- *Oculocardiac: CN V & X.
- * Caroitid sinus: CN IX & X.
Babinski Reflex (Extensor Response)
: stroke up the lateral aspect of the great toe (backwards 7)...
- Pathological = dorsiflexion of the big toe w/ splaying of the other toes, due to myelopathy (UMNL).
- *Chaddock: make a C around the lat malleolus.
- *Oppenheim: kick Dr. Oppenheim in the shin (stoke down the tibial crest to the ankle).
- *Gordon's: Grab calf.
- *Schaefer: Squeeze achille's.
- *Rossolimo: tap the ball of the foot or the tup of the toes.
Hoffman & Tromner's are done Life U style for boards... eat it, Strutton!!
- Hoffman: flick middle finger (dorsum).
- Tromner's: tap middle three fingers (palmar).
- *Gordon's finger: stroke pisiform.
- *Chaddock's wrist: distal ulna.
Erb's palsy is affected by which discs?
- (C5/C6 NR's)
- Erb's Palsy = waiter's tip deformity, upper brachial plexus injury (birth trauma).
Klumpke's Palsy is associated with which nerves?
- (C6/7 disc).
- Klumpke's Palsy = lower brachial plexus injury.
Hip flexion is associated with which nerve root(s)?
- L1-L3: hip flexors (iliopsoas = primary hip flexor).
- *Meralgia Paresthetica.
Foot drop is associated with which discs?
- (L4/L5 NR).
- *Slappage gait (toe heel).
If the pt reports that laying on the floor makes their back pain better, what does that mean?
- Better on floor = extension makes it better.
- *Sitting to standing = worse = extension makes worse.
Pt presents with decreased patellar reflex & medial shin pain... which disc?
- *Weak leg mm, sensory loss & caudal equina.
- *TX: flexion distraction & extension exercises (pt said extension makes it feel better).
Which muscle & NR is responsible for dorsiflexion & inversion?
Tibialis Anterior, L4.
9er: disc problem.
Which NR is responsible for hip abduction?
- *Hip extension = S1... Plantar flexion, eversion & hip extension.
What foot position does a patient with L4 failure present with?
Does heel walk or toe walk receive dual innervation?
Heel walk: L4 & L5.
All wrist & finger extensors are innervated by which nerve?
- *Motor: wrist/finger extension, thumb abduction.
- *Sensory: posterior hand (dorsal web between thumb & index).
Crutch palsy is due to a lesion of which nerve?
- *Wrist drop, Saturday night palsy.
Which nerve is responsible for elbow flexion?
Loss of thumb pinch, opposition & abduction is due to a problem with which nerve?
- Median: carpal tunnel, pronator teres (carpenters), pregnancy, ape hand.
- *Lat 3 fingers.
- *Test: phalen's, reverse phalen's, tinnel.
- Radial = thumb abduction.
- Ulnar = thumb adduction.
- Median = thumb opposition.
- *Treatment: adjust carpal, ergonomics, TF/pronator teres.
The tunnel of Guyon presents with _____ symptoms, due to compression of the _____ nerve.
- The tunnel of Guyon presents with distal symptoms, due to compression of the ulnar nerve.
- *Tunnel/Guyon: pisiform/hamate.
- *Cubital tunnel: proximal & distal SX.
- Scapular*Elevation & retraction/scapula
- *Rhomboids & levator scapula.
The anteromedial knee is innervated by which nerve?
Which nerve is responsible for hip adduction?
Which nerve is responsible for hip flexion & knee extension?
- Femoral: iliopsoas & quads.
- *Sensory: anteromedial thigh & leg.
Which nerve innervates both the front & back of the leg?
- *Knee flexion.
- *Piriformis Syndrome.
______: pain along the sensory distribution of a nerve root.
- Dermatogenous: pain along the sensory distribution of a nerve root.
_______: pain that originated within a muscle.
Myotogenous: pain that originated within a muscle.
______: pain that arises from structures derived from embryological sclerotomes (joint pain).
- Scleratogenous: pain that arises from structures derived from embryological sclerotomes (joint pain).
- *Facets: deep, dull, achy.
- *Symptoms do not go below the knee.
- *Poorly localized.
______: radiating pain along the course of a dermatome due to irritation of a nerve root.
- Radicular: radiating pain along the course of a dermatome due to irritation of a nerve root.
________: pain along scleroderm of origination involving more than one kind of tissue )shared pathway).
Referred: pain along scleroderm of origination involving more than one kind of tissue )shared pathway).
_______ = dull pain with percussion.
- *Muscle: cramping, spasm, aching, dull (feels like bruise).
Reflex Sympathetic Dystrophy presents as what type of pain?
- Causalgia (Reflex Sympathetic Dystrophy, Complex Pain Syndrome): burning pain.
- *Nerve pain: shooting, radiating, causalgia, burning.
Where does appendicitis pain present initially?
What condition is commonly found with fluid retention & is treated by adjusting, cock up splint, diuretic & B6 (pyrodoxine)?
- Carpal Tunnel Syndrome: under flexor retinaculum.
- *D/T trauma, obesity, fluid retention, pregnancy, hypothyroidism, RA.
- *Nocturnal pain, paresthesia, thenar atrophy, weak opponens pollicus (ape hand apperance), first 3 fingers.
- *Adjust lunate A-P.
- *Tests: Tinel's Sign, Phalen's, Abduction strength Test, Thumb Pinch Test, Grip strength.
Pronator Teres Syndrome affects which nerve?
- Anterior Interosseous Nerve.
- *First 3 fingers.
- *Pain with pronation, wrist flexion.
- *Thenar atrophy.
- *Treatment: trigger point therapy, spray & stretch.
Bike riders commonly present with which nerve entrapment?
- Ulnar Nerve: entrapped at the tunnel of Guyon or cubital tunnel.
- *Affects last 2 digits = weakness/adductor pollicis (claw hand) & hypothenar atrophy.
- *Weak wrist flexion on ulnar side.
- *Treatment: adjust, tape & support.
What 4 Conditions are caused by Radial N issues?
- 1. Saturday Night Palsy: falling asleep with hand above head.
- 2. Crutch Palsy: spiral groove.
- 3. Erb's Palsy: waiter's tip deformity (adduction, int rotation & flexion of the wrist).
- 4. Wrist Drop: cannot extend elbow & wrist.
- Radial N
- *Trauma, lead poisoning, pressure.
- *Loss of triceps reflex.
- *Decreased sensation: post arm, FA & postulate 3.5 fingers.
- *Adjust, increase strength, stretch muscle.
Loss of the triceps reflex is associated with which nerve?
Which nerve roots are affected with Meralgia Paresthetica?
L2 & L3
Weak knee flexion & decreased achille's reflex is due to a problem with which nerve?
- *Sensory pain in the posterior buttocks, thigh & leg down to the foot.
The medial plantar nerve is associated with which syndrome?
- Tarsal Tunnel Syndrome.
- *D/T posterior traumatic ankle deformity, subluxation, arthritis or edema.
- *Burning paresthesia on the soles of feet, aggravated by walking or standing.
- *Decreased sensation on soles of feet & weak muscles of the foot.
- *Adjust, orthotics to keep foot in slight inversion.
Where is the site for Morton's Neuroma?
- Between the 3rd & 4th metatarsals.
- *Treatment: boxed shoes.
Foot drop & a subluxation of the fibular head are associated with which nerve?
- Common Peroneal N.
- *Pain in the lateral aspect of the leg & weak peroneal muscles.
Anterior Compartment Syndrome is associated with which nerve?
- Deep Peroneal N.
- *Weekend warriors.
- *TA, EHL, EDL, PT muscles.
- *S/S similar to Charcot Marie Tooth: neuropathy, progressive all over body.
- *Can become medical emergency or they will lose leg.
________: a deformity with fingertips curled in & cannot be straightened, due to tendon injury.
- Mallet Finger: a deformity in which the fingertip is curled in & cannot be straightened.
- *Results from injury which either damages or tears the tendon from the bone.
- *Avulsion FX.
________ deformity: hyper-extension of the DIP & hyper-flexion of the PIP.
- Boutonniere Deformity: seen with RA.
- *Sticks out like a boob.
- *Swan Neck Deformity: hyper-flexion of the DIP, hyper-extension of the PIP. (RA).
Which condition causes the last two fingers to curl into the palm?
- Dupuytren's Contracture: abnormal thickening underneath the skin of palm & fingers... Nodule in palm between 3rd & 4th metacarpal.
- *May affect middle finger later,.
- *Following MI... Russian males.
- *Treatment: extension exercises.
What condition causes a finger to become locked in a bent position?
- Trigger finger: due to tendon inflammation or swelling.
- *To straighten, must force the swollen area into the sheath which produces a popping or snapping.
What condition involves the EPB & AbPL, Radial N & is treated by bracing the thumb & wrist?
- De Quervain's Disease (Stenosing Tenosynovitis).
- * + Finkelstein's.
Which is responsible for sensory & motor interpretation; the cerebrum or cerebellum?
- Cerebrum: sensory & motor interpretation, langyage... stroke (CVA), Cerebral Palsy, Alcoholism, Alzheimer's & tumors.
- *Cerebellum: balance & coordination.
What 3 things test the posterior columns?
- 1. 2 point discrimination.
- 2. Vibration.
- 3. Join position sense.
What 3 conditions are associated with the posterior columns?
- 1. MS
- 2. Tabes Dorsalis
- 3. Leprosy
What tract is responsible for voluntary motor functions?
- Corticospinal (Pyramidal).
- *Flexors of the hands & feet.
What tract is responsible for crude touch?
- Anterior spinothalamic.
- *Lat ST = pain & temp... syringomyelia.
Which tract crosses at the medullary pyramids & travels to the flexors of the extremities?
- Lateral corticospinal.
- *Ventral corticospinal: crosses at the segmental level & then to the flexors of the trunk.
Midline defects of the central canal results in which condition?
Syringomyelia: pathological longitudinal cyst of the cord, MC @ C5/6.
A 34 YO female woke up blind one day, & has a history of intention tremors & measles. What are 3 tests to diagnose this condition?
- MRI, CSF & + Lhermitte's Test.
- *Multiple Sclerosis: demyelneation of the CNS.
- *Protein plaques seen on MRI.
- *Both motor & sensory tracts are affected.
- *Females 20-40 YO.
- *Periods of exacerbations & remissions.
- *Worse in warm climate.
- *Death D/T infection.
- *Charcot's Triad: Scanning speech, Intention tremor, Nystagmus.
- *Refer to neurologist.
I say CNS demyelenation disease, you say...
Multiple Sclerosis: oligodendrocytes.
Both motor & sensory tracts are affected by which disorder?
What disorder presents with an intention tremor, diploplia, scotomas, transient blindness, retrobulbar optic neuritis, pain, vertigo & UMNL signs in the legs causing distal weakness?
- Multiple Sclerosis.
- My intention...
What is the name of an autoimmune disorder which loves cranial nerves & attacks motor function only?
- Myasthenia Gravis: body makes antibodies against ACH receptors.
- *Myoneural junction dysfunction.
- *Weakness in proximal muscles, progressing distally.
- *Muscle weakness worse @ end of day.
- *Females 20-40 YO.
A 24 YO female presents with ptosis, diploplia, dysarthria & fatigue after working out. Which diagnostic test should you order?
- ACHr (Acetyl Choline Receptor Test) for Myasthenia Gravis.
- *Proximal muscle weakness progresses distally.
- *Cranial nerves first (dysarthria = CN XII).
- *Motor only.
A 54 YO male presents with a 9 month long history of fasciculations in his hands. He now has spastic muscles & increased DTR's in his feet. What is the name of this disease?
- Amytrophic Lateral Sclerosis (ALS) a/k/a Lou Gehrig's Disease.
- *Baseball player = seen in hands first.
- *Affects the corticospinal tract & ant horn.
- *Life expectancy short (3 year survival rate).
- *LMNL in arms, UMNL in legs.
- *DDX w/ lateral canal stenosis.
Stocking & glove paresthesia, B12 deficiency & a + Schilling Test are signs of which disease?
- Posterolateral Sclerosis (PLS) a/k/a Combined Systems Disease.
- *Degeneration of the posterior columns & corticospinal tracts D/T B12 deficiency.
- *Schilling Test: injected with radioactive B12 & see if urinated out.
- *Neurologic SX irreversible.
_______ loss of motor function & proprioception, with ________ loss of pain & temperature...
- Brown Sequard Syndrome: Ipsilateral loss of motor function & proprioception (dorsal columns), with contra-lateral loss of pain & temp.
- *Hemisection of the the cord following an injury.
A patient presents with a scissor gait & a history of a difficult birth. Name that condition.
- Cerebral Palsy: non-progressive motor disorder of cerebral cortex.
- *Scissor gait (walks on toes), spastic paralysis, athenoid & choreiform movements, normal intelligence levels.
- *Dan Alteri.
Paralysis Agitans presents with ______ tremors, & ________ gait & is associated with a loss of ________.
- Parkinson's Disease: Paralysis Agitans presents with unilateral resting tremors, & festinating gait & is associated with a loss of dopamine.
- *Chronic progressive.
- *Loss of dopamine in the substantia nigra = basal ganglionic dysfunction... extrapyramidal.
- *>50 YO.
- *Resting tremors, mask like face, festingating gait (short steps then can't stop), cogwheel/lead pipe rigidity, forward stooped postures & bradykinesia.
- *Dyskinetic properties.
Landry's Paralysis has ________ paralysis & sensory symptoms, beginning in the _______ & going _______.
- Guillian-Barre Syndrome (Landry's Paralysis): ascending paralysis & sensory symptoms, beginning in the lower extremity & going up.
- *Post immunization or illness.
- *Inflammatory polyneuropathy of the PNS.
Wasting away of the posterior columns, slappage gait & Argyll Robertson's Pupil is associated with...
- Tabes Dorsalis: tertiary syphilis.
- *Argyll Robertson's Pupil: accommodates but does not react to direct light.
- *Coordination & balance are disturbed.
A 6 YO boy presents with a waddling gait, pseudo-hypertrophy of the calves, proximal weakness, pot belly stance & Gower's Sign... name that condition!
- Muscular Dystrophy (Erb Duchenne Palsy): proximal muscle weakness causing waddling gait, toe walking, hyperlordosis (pot belly stance), wide gait, pseudo-hypertrophy of the calves (due to swelling) & Gower's Sign.
- *Large increase in CPK (CK-MM), decreased creatinine.
- *Boys < 7 YO.
_________: A hereditary condition that affects both motor & sensory nerves; presenting with weakness of the foot & lower leg muscles.
- Charcot Marie Tooth Disease: a hereditary condition that affects both motor & sensory nerves; presenting with weakness of the foot & lower leg muscles.
- *May result in foot drop & high-stepped gait, with frequent tripping or falls.
- *Lower leg atrophy (peroneal muscles).
"13" had this neurodegenerative genetic disorder...
- Huntington's Chorea: affects muscle coordination, cognitive decline & dementia.
- *35 YO males.
Which phase of the gait cycle is the longest?
Which phase of gait bears the most weight?
Scissor gait = _________.
Waddling gait = _________.
A/k/a for Trendelenburg gait?
Stroke victims present with which type of gait?
- *Swing gait with arm tucked to side.
A wide gait is associated with...
A positive Bakody's indicates....
All of the cervical compression tests indicate...
- *Foraminal Compression:
- *Jackson's Compression: lateral flexion.
- *Max Cerv Compression: no compression applied.
A positive shoulder depression test indicates...
Nerve root ADHESION.
A positive Soto Hall indicates...
What are the 4 tests for SOL?
- 1. Spurlings: hit on the head.
- 2. Valsalva
- 3. Naffziger: jugular V compression, contraindicated w/ vascular compromise.
- 4. Milgram's
- *DeJerene's Triad.
Which way does the patient turn their head for the Scalenus Anticus Test?
- Slightly abduct, extend & externally rotate the arm while taking the radial pulse, then rotate head towards tested side & extend head, then pt takes a deep breath.
- P: alteration in amplitude of radial pulse.
- I: cervical rib.
- *Pt presents w/ hypertonic pec & scalene.
- *TX: neck flexion exercises.
- *DX: angiogram.
Which way does the patient turn their head for the Modified Adson's Test?
- Opposite side.
- *Subclavian A, Scalenus medius syndrome.
A positive Wright's Test indicates...
- Pec Minor Syndrome (Axillary A).
- *Pulse leaving @ same spot bilaterally = WNL.
Which orthopedic test has the patient extend the head back while the examiner exerts downward traction on the arm while taking the pulse?
Haltead's: alteration or radial pulse = cervical rib.
TOS, brachial plexus neuritis, meningeal irritation.
"Sits all morning"
- Suprspinatus ABduction
- Infraspinatus Lateral (ext) rot
- Teres minor Lateral (ext) rot
- Subscapularis Medial (int) rot
- Supraspinatus: suprascapular N... greater tube
- Infraspinatus: suprascapular N... greater tube
- Teres minor: Ax N... greater tube
- Subscapularis: Subscap N... lesser tube
Which of the SITS muscles is responsible for internal rotation?
Which of the SITS muscles inserts on the lesser tubercle?
Which 2 SITS muscles are innervated by the suprascapular N?
Supra & infraspinatus.
A decreased scapular motion indicates...
Frozen shoulder (adhesive capsulitis).
Apley's test indicates...
- Degenerative Tendonitis of Rotator Cuff Muscles (Rotten Apple)
- *DX via MRI.
A tear of the supraspinatus is DX by which test?
- Codman's Drop Arm.
- *Codman's exercise: passive arm rotation, then fingertip wall walking.
Which test diagnoses a chronic shoulder dislocation?
- Apprehension Test.
- *Dugas = acute.
Subacromial bursitis is DX via which test?
- *Reduction of pain = subacromial bursitis.
- *HADD = calcified bursae.
Bicipital tendon instability is DX via which test?
- *Speed's = bicipital tendinitis.
Which muscle is responsible for internal rotation, flexion & abduction of the shoulder?
Radio humeral bursitis presents with pain with extension of the wrist & pronation of the elbow... what muscle is involved?
Lateral epicondylitis (Radiohumeral Bursitis, Tennis Elbow): extensor carpi radialis brevis.
How do you treat Little Leaguer's Elbow?
- Medial epicondylitis (Little Leaguer's Elbow, Golfer's Elbow): transverse massage, US under water & counterforce brace.
- *Affects the flexor carpi ulnaris.
- *Pain with flexion of the wrist @ the medial portion of the elbow.
What are the 2 tests to DX Radiohumeral Bursitis?
- 1. Cozen's
- 2. Mill's Test
- *Reverse Cozen (Golfer's Elbow Test) = medial epicondylitis.
What is a positive finding for Tine's Sign at the wrist?
- Tingling into the lateral 3 fingers of the hand (CTS), or medial 2 fingers (Ulnar N entrapment).
- *TX: Vit B6, cock-up splint & adjust lunate A-P.
Froment's Paper Sign is associated with which palsy?
- Ulnar nerve palsy.
- *Positive fing looks like they are doing "OK" with fingers.
What is the best lumbar ortho test for diagnosing a disc problem?
- Straight Leg Raiser (Lasegue's).
- *Pain down affected side = sciatica, disc, or lumbar lesion.
Which sciatic test do you sharply dorsiflex the foot?
- Bragard's Sign.
- "Brag about how sharply you can dorsiflex that foot."
Which sciatic test do you dorsiflex the big toe?
- Sicard's Sign: perform SLR, drop 5 degrees & dorsiflex big toe.
- *Like Turyn's Test: dorsiflex toe & sciatic pain goes to the butt.
A SLR with dorsiflexion of the foot on the asymptomatic side of the patient is what test, & indicates what?
Well-Leg Raiser (Fajerstazn's): medial disc lesion.
Goldthwait's Sign indications... (3)
- 60-90: lumbar spine or contralateral SI-joint.
- 30-60: lumbosacral joint
- 0-30: SI-joint
What 3 orthopedic tests are preformed the same way but have 3 very different indications?
- 1. Lindner's: head to chest = root sciatica.
- 2. Brudzinskis: buckling = meningitis.
- 3. L'Hermmites: shock = MS or myelopathy.
Bowstring Sign positive finding...
Pain in the lumbar region or rediculopathy = sciatica.
________: with the patient _______, the doctor stands on the side being tested & ________ rotates & _____ the leg, & then preforms a SLR.
- Bonnet's Sign: with the patient supine, the doctor stands on the side being tested & internally rotates & adducts the leg, & then preforms a SLR.
- *Piriformis syndrome.
- "Bonnet's squishes the boner."
When preforming Supported Adam's Test, if the lesion is in the spine, the pain will be present __________.
When preforming Supported Adam's Test, if the lesion is in the spine, the pain will be present in both situations.
A positive Neri's Bowing indicates...
The patient is seated & extends each leg one at a time...
Becterew's Sitting Test = disc.
Is the proper name Minor's Sign, Minor's Test, or Minor's Maneuver?
Ely's test indicates...
Lumbar NR adhesions
Which leg are you testing with Gaenslen's Test?
- The leg that is off the table.
- *Patient is supine.
Which side is the patient lying on with the hip abduction stress test?
- Non-affected side.
- *Indicates: SI-joint probelms, glute med weakness.
Patient position for Lewin-Gaenslen's Test...
Lies on unaffected side & pulls lower knee to chest... Dr hyperextends top thigh.
Pt presents with snow capped apperance on X-ray (AVN)... which ortho test should you do?
Hibb's Test = hip.
What side do you stabilize with Nachlas Test?
- The side you are testing.
- *SI-lesion or femornal nerve (if pain in the ant thigh).
Which test does the doctor stabilize contra laterally while hyperextending the thigh by lifting the knee off the table?
- Yeoman's Test.
- "Yeoman, that hurts deep!"
- *Si lesion.
Positive finding with Thomas Test?
Opposite thigh/knee rises off table = hip flexor contracture.
Describe Ortolani's Test...
- Pediatric patient is supine & you abduct & externally rotate their leg.
- *Palpable or audible click = congenital hip dislocation.
- *Barlow's: hip in adduction, push A-P (posterior pressure)... deep sounding thunk = congenital hip dysplasia.
A positive Ober's indicates...
- Knee stays elevated = TFL contracture.
- *Side-lying, ISU... abduct & extend thigh, then allow the leg to drop into adduction.
Which butt does the heel go to with Ely's Sign?
- Ely's Sign = Same butt = rectus femoris contracture.
- *Ely's Test = opposite butt = hip lesion, iliopsoas irritation/lumbar NR inflammation, hip contracture.
Which butt is being tested with Trendelenburg Test?
- Stance leg.
- *Buttock on side foot is elevated drops = glute med weakness on stance leg.
Coxa varum, genu valga = _______.
- Knock knees.
- *What is the bone distal doing?
The MC injured muscle of the knee is...
3 components of the terrible triad:
- 1. MCL
- 2. ACL
- 3. Medial meniscus
Pain with stairs & running...
- ABduction Stress Test (Valus Stress Test).
- *Lushing L-M = testing medial.
Which side are you testing with Apley's Distraction Test?
- The side the heel is pointing.
- *Knee pain = collateral lig. tear.
Pulling P-A with the Drawer Test (knee) is testing which ligament?
Which knee test tests two structures at once?
- Solcum's Test:
- ACL & MCL w/ external rotation.
- LCL w/ internal rotation.
What is the best ACL instability test?
- Lachman's: knee flexed to 30*.
- *Soft end feel = ACL instability.
A positive Posterior Sag Sign indicates...
What are the 3 tests for the Meniscus?
- 1. Bounce Home Test: torn meniscus.
- 2. Apley's Compression Test: heel points towards side being tested, pain = med or lat menisicus tear.
- 3. McMurray Sign: painful click = lat meniscus (int rot) or med meniscus (ext rot).
- *Meniscus = pt has knee locking.
- *Swelling hours later = meniscus (immediate = cruciates).
- *Open chain exercises for rehab.
Which ortho test diagnoses chronic patellar dislocation?
Apprehension Test (Patella)
Most common site of osteochondritis dessicans in the knee?
Lateral aspect of the medial femoral condyle.
The talar head displaces ________ with pes planus.
The talar head displaces medially & inward with pes plannus (flat foot).
What is the MC birth defect of the foot?
Talipes Equinovarus (clubfoot): heel is elevated & foot is turned inward.
What is the name of a foot condition that improves as the day progresses?
Plantar fasciitis (heel spur): pain when walking around in the morning.
Tarsal Tunnel Syndrome presents with...
Pain & burning on the sole of the foot (medial plantar N).
What is the MC type of strain/sprain in the ankle?
- Inversion sprain: anterior talofibular ligament.
- *Grade 1: no tear, mild swelling & decreased ROM. (TX = RICE).
- *Grade 2: Partial rupture, lots of swelling, no ROM. (TX= cast).
- *Grade 3: Complete tear... surgery required.
- *Eversion sprain = deltoid lig.
A positive anterior drawer test indicates...
Talus slides forward = Ant. Talofib Lig instability.
A positive medial/lateral stability test during inversion indicates...
- Anterior talofibular or calcaneofibular ligament tear.
- *Eversion = deltoid lig tear.
Which bone in the foot is MCly stress FXed?
Which malingering test will a malingerer refuse to perform?
Burn's Bench Test.
Which malingering test does the dr make a dot at the beginning of the appointment & then later have them point again?
Applying pressure with an increase of ________ indicates the patient is not malingering.
heart beat, 10 beats/min (Mannkopf's Sign).
What 2 things do you need to get a final DX of AS?
- 1. + HLA B27
- 2. X-ray.
- *AS: males 15-30.
What is a normal finding with the chest expansion test?
- 1.5 - 3"
- Positive chest expansion test: <1.5" (women), <2" (men).
- *Measured at the 4th ICS.
_______ Sign: side bending to both sides, with a positive finding of tightening on the concave side.
Forrestier's Bowstring Sign: side bending to both sides, with a positive finding of tightening on the concave side.
Having the patient go from a side lying position to a seated position with localized thoracolumbar pain &/or lack of ROM indicates...
Amoss Sign: AS, IVD syndrome, or severe sprain/strain.
A patient with meningitis will present with 4 things...
- 1. Fever
- 2. HA
- 3. Photophobia
- 4. Nuchal rigidity
- *Brudzinski = Buckling.
- *Kernig's = Kicking.
An increase of GLU in the CSF of a suspected meningitis patient indicates what?
- Increased GLU = bacterial meningitis.
- *Increased protein = viral.
Orthopedic test to evaluate thoracic spinal cord NR damage?
Beevor's: T7-12 dermatomes.
A positive Gower's Sign is associated with which condition?
______: pressure over the mastoid process determines the pain threshold of the patient.
Libman's: pressure over the mastoid process determines the pain threshold of the patient.
A positive Rust Sign is associated with which ligament?
Pain on the concave sign with Schepelmann's Sign indicates...
Decreased pain & temperature following a tear drop fracture is associated with which condition?
Anterior Cord Compression Syndrome.
AS & DISH are associated with dysphagia because...
Scheurman's is DX via which view?
Bilateral leg pain with exercise is associated with...
Pain & decreased pulse in the feet indicate...
Pseudotumor Cerebri a/k/a...
Idiopathic Intracranial Hypertension = diploplia.
DJD MC affects which aspect of a joint?
Medial portion, asymmetric.
HEll Being in HAyward
- Distal ->proximal
- HEberden's: DJD & PA.
- Bouchard's: RA & PA.
- HAygarth's: RA & PA.
- *Ray's sign: all 3 joints are affected w/ PA.
What is the MC BBT of the appendicular skeleton?
- *Coat hanger exostosis/cauliflower/sesslie.
- *HME = multiple osteochondroma -> 20% malignant (quasimalignant).
A coat hanger exostosis is associated with _______ bone tumors.
A coat hanger exostosis is associated with benign bone tumors.
This sign is associated with?
- Fallen fragment sign = UBC (SBC).
- *Diaphyseal/metaphyseal location, centrally located, <20 YO.
How do you differentiate an ABC (<20 YO) from an UBC (<20 YO) on x-ray?
- ABC: eccentrically located, unitl grows big enough to expand into a central location = ballooning.
- UBC: centrally located, no ballooning.
Which BBT that requires a referral to an orthopedic surgeon occurs in adults 20-40 YO?
- Giant cell tumor (adults are giants, compared to kids!).
- GCT (osteoclastoma): 20-40 YO, soap bubble appearance.
- UBC: <20 YO, centrally located, fallen fragment sign.
- ABC: <20 YO, eccentrically located & ballooning.
- Chondroblastoma: <20 YO.
________: diaphyseal/metaphyseal location, eccentrically located, <20 YO.
ABC: blood filled benign bone tumor that crosses the growth center.
A/k/a for osteoclastoma?
- GCT: epiphyseal/metaphyseal location, 20-40 YO, soap bubble appearance.
Chondroblastoma presents in patient of which age?
- <20 YO
Which 4 BBT's need to be referred to an orthopedist?
- 1. GCT (Osteoclastoma)
- 2. UBC (SBC)
- 3. ABC
- 4. Chondroblastoma
- *Possible pathological FX.
Which 3 BBT's are quasimalignant?
- 1. GCT (Osteoclastoma)
- 2. Osteochondroma
- 3. Enchondroma
Which 3 BBT's are found in pt's <20 YO?
- 1. UBC (SBC)
- 2. ABC
- 3. Chondroblastoma
Which BBT has night pain relieved by Aspirin?
- Osteoid Osteoma: radiolucent central nidus w/ reactive sclerosis.
- *Brodie's Abscess (Chronic Osteomyelitis): also has night pain relieved by Aspirin; looks like an osteoid osteoma.
- Multiple enchondromas: 10-15% malignant degeneration.
- *Enchondroma = MC BBT/hand.
- *With soft tissue calcification: Maffucci's Syndrome.
- *Cotrical thinning & expansile.
- *Pt may have ST swelling leading to a permanent deformity.
What are the 3 BBT's that cross the epiphysis?
- 1. ABC: <20 YO.
- 2. Chondroblastoma: <20 YO.
- 3. GCT: 20-40 YO.
What is the MC BBT of the spine?
_________: bone island.
Multiple bone islands:
MC BBT of the neural arch?
- *Expansile, leading to canal stenosis/cord compression = decreased vibration sense.
- *TX: curettage & radiation.
MC BBT of the skull?
Osteoma: MC found in the frontal sinus.
The Caldwell projection best shows which BBT?
Rind sign, Saber Shin Tibia & Coast of Maine appearance are associated with which BBT?
- Fibrous dysplasia: rind sign, saber shin tibia, sheppard's crook, ground glass, cafe au laid spots, coast of main appearance.
- *70% monostotic.
What is the first sign associated with Von Recklinghausen Disease?
- Neurovibromatosis: first sign = Scoliosis.
- *Family HX.
- *Post. vertebral body scalloping w/ IVF enlargement.
- *Cafe au lait spots & Coast of Cali appearance.
- *Grows & grows & grows until destroys pedicles.
- *Lish nodules: found on the iris.
- *Rib deformity.
- *Tumor/ NR = neuro defect = speech impairment, etc.
FD vs Pagets...
- Look from side to side! Compare medulla to surrounding soft tissue- same color?
- -White = Paget's
- -Darker = FD
- *Dark lesions throughout = MM or lytic mets until proven otherwise.
What is the most common primary malignancy of bone?
- MM (Plasma Cell Sarcoma).
- *>50 YO, cachexia, weight loss, aplastic anemia.
- *Multiple dark densities "punched out lesions."
- *Vertebal plana: ant & post body pathological collapse.
- *Raindrop skull.
- *M-spike, reverse A:G, Bence-Jones proteinuria, elevated ESR & Gamma Globulins.
- *Bone scan cold.
- *Pt has recurrent infections.
How do you differentiate Mets/MM from trauma/osteoporosis on x-ray?
- Mets/MM: A & P body collapse.
- Trauma/osteoporosis: A only.
M-spike on the ImmunoElectroPhoresis is associated with which neoplasm?
Plasma Cell Sarcoma (MM).
What is the most common malignant tumor of bone?
- Mets (lytic & blastic): found in the medulla = travels in via the blood to spread.
- *Does not go to the lower extremity.
Which neoplasm EATS away the pedicle of bone & has a swiss cheese (big holes) appearance in the skull?
- Lytic Mets: moth eaten or permeative pattern of destruction.
- *Lab: Alk Phos, bone scan.
What is the most common metastasis in males <30 YO?
- Hodgkin's Disease: anterior body scalloping.
- *Unilateral hilar lympthadenopathy.
- *Biopsy to confirm Reed-Sternberg cells.
Which neoplasm requires biopsy for final DX?
Hodgkin's DX: Reed-Sternberg Cells.
Which neoplasm results in cortical thickening, anterior body scalloping, enlargement & deformity?
- Blastic Mets.
- * >40 YO.
- *Ivory white vertebrae.
- *MCC = prostatic carcinoma.
- *Increased Alk Phos.
Which neoplasm MCly results from prostatic carcinoma & presents with increased Alk Phos lab tests?
What is the correct order for the 4 stages of Osteitis Deformans (Paget's DX)?
- 1. Lytic: destructive.
- 2. Combined: DDX lytic mets.
- 3. Sclerotic: healing.
- 4. Malignant: osteosarcoma.
- "Laura Combs Spends Money on Paget's"
Which two line drawings aid in the diagnosing of Paget's?
- 1. McGregor's
- 2. Chamberlin's
- *DX basilar invagination.
- *Picture frame vertebrae.
- *Bowing deformities.
- *Labs: Alk Phos & Urinary hydroxyproline.
Which 3 neoplasms make bone radiopaque?
- 1. Hodgkin's DX
- 2. Blastic Mets
- 3. Paget's (Osteitis Deformans)
How do you DDX Osteosarcoma vs Chondrosarcoma/Fibrosarcoma?
- Osteosarcoma: <30 YO.
- Chondrosarcoma/Fibrosarcoma: >40 YO.
What is the MC malignancy of bone found in children?
Which neoplasm has a similar presentation to infection?
- Ewing's Sarcoma.
- * <25 YO.
- *MC in diaphysis of long bones.
- *Permeative lesion w/ multi-paralleled onion skin.
- *Bone expansion, codman's triangle, saucerization.
What is the name of an aberrant notochordal cell tumor that is MC found in the sacrum?
- *2nd MC location = skull.
Which two conditions cause non-marginal syndesmophytes & unilateral SI-joint fusion?
- 1. PA
- 2. Reactive Arthritis (Reiter's)
What is the best line of mensuration for evaluating scoliosis?
- *Risser Ferguson's not as good.
- *Measure to monitor patients <25 YO.
What is the best film for monitoring scoliosis?
- Wrist film: shows how much longer their body will grow.
- *Risser's Sign = #2.
Which 2 conditions present with ulnar deviation?
RA & lupus.
What is an a/k/a for RA in children?
- RA = Still's DX in kids.
- *Bilateral uniform loss of joint space, Rat bite erosions, localized juxtaarticular osteoporosis, atlanto-occipital distribution, Haygarth's nodes (NEVER DIP), swan neck & boutonniere deformity.
- *Lanois' Deformity: ulnar deviation.
- *Baker's cyst.
- *MCC of bilateral protrusio acetabuli.
- *Labs: RA latex, +FANA, +ESR, +CRP, normocytic/normochromic anemia.
- *With dry eyes = Sjogren's Syndrome.
What is the MCC of protrusion acetabuli?
Lanois' Deformity is associated with which condition?
Lanois' Deformity: ulnar deviation = RA.
Marie Strumpell DX is a/k/a ....
- *Males 15-35 YO.
- *Starts in the SI-joints = LBP & morning stiffness... first sign!
- *Ortho's: chest expansion, Forester's Bowstring & Lewin's Supine.
- *Bilateral SI-joint fusion, Ghost Joints, Star Sign, bilateral marginal syndesmophytes, Bamboo spine, Dagger Sign, Trolley Track Sign, Carrot stick FX.
Where is the 2nd MC location for Marie Strumpell DX to start?
What condition presents with Anderson Lesions?
- AS (Marie Strumpell's DX).
- *carrot stick FX failed to heal.
What labs are positive with AS?
+HLA B27 & ESR.
Which condition causes bilateral SI-joint fusion & dagger sign?
AS (Marie Strumpell's DX).
Which condition is identical to AS, plus GI dysfunction?
- Enteropathic Arthropathy.
- *Chron's, UC, Diverticulitis, etc.
Which arthritide affects the DIP joints & affects the skin?
- *Periarticular erosions, silver scales & pitted nails.
- *Cocktail sausage digits.
- * Pencil in cup deformity, mouse ear deformity, Ray Sign, non-marginal syndesmophytes.
- *DJD also affects the DIP's.
"Can't pee, can't see, can't dance with me."
- Reactive Sclerosis (Reiter's DX).
- *Males 20-30 YO.
- *Urethritis, conjunctivitis, arthritis D/t Chlamydia.
- *Calcaneal spur, fluffy periostitis, non-marginal syndesmophytes.
Which arthritide spares the joint space & is associated with Raynaud's Phenomenon?
- SLE: females, sensitive to sunlight, ulnar deviation.
- *Labs: +LE prep, +FANA, +ESR.
- *Affects the kidneys.
Erosions of the distal tufts & CREST syndrome are associated with which arthritide?
- Scleroderma (Progressive Systemic Sclerosis).
- *Females 30-50 YO.
- *Erosions of the distal tufts = auto-amputation, auto-acrolysis.
- *Calcinosis cutis.
- *Sero +
- *Skin hardening, increased ANA.
- *Dysphagia, pulmonary fibrosis, mm weakness.
Which 2 conditions resorb the distal tufts?
- 1. PA
- 2. Scleroderma: does not affect the DIP joint, just the distal tufts.
Osteitis Condensans Ilia affects the _____ half of the SI-joint.
- Osteitis Condensans Ilia affects the lower half of the SI-joint.
- *Multiarous females.
- *Bilateral symmetrical triangular sclerotic areas in the lower half of the SI-joint.
- *Joint space is normal.
- *Trochanteric belt for stability.
- *Ilium side only... no sacrum.
Which condition has a genetic factor, subchondral cysts, Heberden's Nodes & IVF encroachment?
Which condition has a candle wax apperance & positive fasting blood GLU?
DISH (Forestier's DX).
Foresteir's DX may also cause ossification of the ______.
Foresteir's DX may calso cause ossification of the posterior longitudinal ligament (OPLL).
Charcot's Joint is secondary to impaired _______ function in joints.
- Charcot's Joint (Neurogenic Arthropathy) is secondary to impaired sensory function in joints.
- *Seen with diabetes, tabes dorsal is, syphilis, syringomyelia, leprosy & corticosteroids.
- *6 D's:
- Density of subchondral sclerosis
- Destruction of bone
White popcorn apperance is associated with which condition?
Synoviochondrometaplasia: MC affects knee.
How do you DDX AVN vs DJD in the hip? (white femoral head)
- Go to sup. lat. joint space.
- -Preserved = AVN -> Crescent Sign, flat femoral head.
- -Absent = DJD.
- *AVN = HX of corticosteroids, family HX.
- *TX: orthopedist, PROM, bracing.
Podagra is associated with which condition?
- Gout: podagra MCP big toe... 2nd MC = knee.
- *70% monoarticular... >1 joint = jumps around.
- *Males >40 YO.
- *Foods high in purintes: red meat, beer, aged cheese, red wine & pork = uric acid.
- *Painful, red hot, swollen joint.
- *Overhanging margin.
- *Juxta-articular erosions.
- *Labs: Urica acid, + ESR... joint aspiration.
- *Acute: Colchicine.
- *Chronic: Allopurinol.
- CPPD: thin linear calcification parallel to the articular cortex w/in a joint space.
- *MC in knee.
- *Called chondrocalcinosis when affecting cartilage.
- *DX: joint aspiration, biopsy & MRI.
HADD affects which joint?
Shoulder: calcifications w/in bursa or tendon.
Which arthritide needs to be DDXed from Scheurmann's DX via x-ray?
- Septic Arthritis "Infective Arthritis, Infective SPondylitis, Discitis, Osteomyelitis"
- *Pt has fever, chills, HX/trauma/surgery & a warm tender, swollen joint.
- *AFFECTS THE JOINT SPACE: into disc space = grossly unequal from disc to disc... eats everything in the joint before moving on.
What is the major cause of AVN?
- *2nd MCC = corticosteroid usage (cuts off blood supply).
- *All AVN's are self-resolving w/in 8mo-2yrs.
What is the best way to DX AVN?
_________: carpal scaphoid AVN.
_________: vertebral endplate epiphysis AVN.
_______: juvenile femoral epiphysis AVN.
- Legg Calve Perthes: child, sagging rope sign.
- *Boys 4-9 YO... >20 YO = AVN of fem head.
- *Crescent sign, flattening of the femoral head, snow capped appearance, increased joint space.
- *Healed = mushroom capped appearance.
- *Refer to orthopedist for "A" brace.
- *Stop all physical activity.
- Legg Calve Perthes.
- Sagging rope sign.
- Mushroom capped appearance.
_____: head of 2nd metatarsal (or 3rd) AVN.
Freiberg's: head appears flat on x-ray... seen w/ Morton's Neuromma.
_______: articular surface of the lateral aspect of the medial femoral condyle AVN.
Osteochondritis Dessicans: 16-25 YO athletes w/ knee locking w/ extension.
- 1. Kohler's: tarsal navicular.
- 2. Keinboch's: carpal lunate.
- 3. Sever's: calcaneus.
- 4. Blount's: medial tibial condyle.
- 5. Panner's: capitullum.
What condition presents with rounded shoulders, loss of anterior body height & multiple endplate irregularities of 3 or more continuous vertebrae?
- Scheuermann's Disease "VB epiphysitis" "Juvenial Osteochondritis of the Spine": 10-60 YO.
- *Rounding of the shoulders or history of back pain... the AHC = fatigue.
- *Untreated = early DJD, permanent postural deformation.
- *Bone scan & MRI.
- *Self-resolving (like all AVN's).
- *STOP all physical activity, T/L brace, recommend swimming, stretch pecs.
- *WBC to r/o infection.
I say slipped capital femoral epiphysis, you say...
- Salter Harris Type I Fracutre.
- *Boys 10-16 YO.
- *Femoral head slides int & med/fem neck slides sup & lat.
- *refer to orthopedist.
- *Open growth center slides along metaphysis.
What is the best line of mensuration for DX of SCFE?
- Kelin's Line.
- *Shenton's & Skinner's not as good.
Putti's Triad is associated with...
- Congenital hip dysplasia: hypoplastic femoral head, shallow acetabular shelf, femoral head outside of acetabulum.
- *Telescoping, Ortolani's, Barlow's & Allis'.
Axial migration of the femoral head w/ uniform loss of joint space...
- Protrusio Acetabuli.
- *MC w/ RA... but also osteoporosis, osteomalacia, paget's & idiopathic.
- *Bilateral = Otto's Pelvis (RA).
- *Obliteration of Kohler's Teardrop = Kohler's Line.
Misc types of fractures...
- 1. Diastasis: displacement or seperation of a slightly movable joint.
- 2. Hickory stick = green stick.
- 3. Impaction: bone fragments driven into one another.
- 4. Torus/Buckling: incomplete FX affecting one side of the cortex.
- 5. Occult: clinically evident but not seen on x-ray... becomes evident 10 days later.
Fracture of the 1st metacarpal...
Fracture of the 2nd or 3rd metacarpal...
Boxer (proper punching)
Fracture of the 4th or 5th metacarpal...
Bar room (improper punching)
BE BO BA
- BEnnet's: 1st metacarpal.
- BOxer: 2nd or 3rd metacarpal
- BAr room: 4th or 5th metacarpal
"Mr. Smith is on the front porch & the colle is in the backyard."
- Smith's: distal radius w/ ant displacement of the distal fragment.
- Colle's: distal radius w/ post displacement of the distal fragment.
Stress FX of the 2nd, 3rd, or 4th metatarsal...
_____: transverse FX/proximal (base) 5th metatarsal.
- Jones (Dance) FX: transverse FX/proximal (base) 5th metatarsal.
- *Peroneous brevis: plantar flexion & eversion... SPN.
Bilateral pedicle FX of C2...
Hangman's: D/T hyperextension injury.
A Type I Odontoid FX (avulsion of the tip/dens) needs to be DDX from...
Os terminale: smooth, circular O @ the top of the dens.