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What is psychophysiologic?

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Pathology

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7 years ago

Date created

Mar 1, 2020

Cards (42)

Section 1

(42 cards)

What is psychophysiologic?

Front

Define: refer to combo of symptoms like floating, rocking, swimming or inertnal spinning or a feeling of being removed from one's body

Back

How can we screen for diabetes?

Front

Microfilament testing - If has inability to perceive 10g of force (5.07 monofilament) is associated with clinical significant large fiber neuropathy - Sensitivity 66-91% better at ruling out - Specificity 34-86% - testing 4 plantar sites (1st toe pad, 1st MTP, 3rd MTP, and 5th MTP) identifies about 90% of patients with insensate site

Back

What can attribute to neuroapraxia?

Front

something that compresses the endoneurium increasing the internodal distance for example swelling or sitting on toilet for prolong period of time

Back

What are characteristics of somatic pain?

Front

-long duration -described ache, shooting but not electric, diffuse poor localized -cause can be chemical/ mechanical -mostly LE pain due to dura not neuropathic

Back

When should adults be referred to vestibular physical therapy?

Front

seven 1. (POS) Hallpike- Dix 2. (POS) Rhomberg test 3. Dizziness with head movement 4. Slow Gait 5. Dizziness with neck pain 6. H/o fall more than 1 time in 6 months 7. Inability to rise from chair w/o use of arm support

Back

How to rule out and rule in Cancer as low back pain?

Front

Rule out: if have pain relief best with rest (NEG LR: 0.11) Rule in: If POS for H/O of CA, age 50 yrs, unexplained weight loss, or failure to improve with conservative treatment

Back

How much does a nerve regenerate?

Front

1 mm per day or 1 inch per month under optimal conditions of sleep, nutrition, smoking, diabetes, etc

Back

What is vertigo and the most likely cause?

Front

Define: illusion of movement either of the person or of the visual surround Cause: peripheral or central vestibular disorder

Back

What is presyncope?

Front

Define: light-headedness that occurs just before fainting w/o vertigo Cause: vestibular problem

Back

What clinical findings are most reliable indicators of brachial plexus injury?

Front

- check sensory nerves - lateral cord = lateral antebrachial cutaneous- off musculocutaneous nerve (purely lateral cord) - Medial cord=medial antebrachial cutaneous is off purely medial cord - purely posterior cord (radial nerve-) and lateral/ medial cord (median nerve) = median nerve/ radial nerve of 1st and 2nd digits

Back

Draw the brachial plexus

Front

do it!

Back

What are signs and sx of central sensitization with pain in LBP patients +/- leg pain?

Front

3 symptoms: 1. pain disproportionate to injury 2. disproportionate, non mechanical, unpredictable pain provocation to multiple nonspecific agg/ ease factors 3. strong association with maladaptive psychosocial factors 1 sign: diffuse nonanatomic areas of pain or TTP

Back

How do you check C5 ventral rami integrity?

Front

- check rhomboids for dorsal scapular nerve

Back

What are some objective findings that would indicate referral to vestibular physical therapy?

Front

seven 1. (POS) Hallpike- Dix 2. (POS) Rhomberg test 3. Dizziness with head movement 4. Slow Gait 5. Dizziness with neck pain 6. H/o fall more than 1 time in 6 months 7. Inability to rise from chair w/o use of arm support

Back

What clinical findings are most reliable indicators of brachial plexus injury?

Front

- check sensory nerves - lateral cord = lateral antebrachial cutaneous- off musculocutaneous nerve (purely lateral cord) - Medial cord=medial antebrachial cutaneous is off purely medial cord - purely posterior cord (radial nerve-) and lateral/ medial cord (median nerve) = median nerve/ radial nerve of 1st and 2nd digits

Back

What is ESR?

Front

Erythrocyte Sedimentation Rate - used to determine the progress of an inflammatory disease **Rises w/in 24 hours after onset of s/s 0-10 mm/hr - Children 0-20 mm/hr - Women 0-15 mm/hr - Men Combination of radiographs and ESR is 10% specific for identifying cases of occult neoplasm

Back

What is the CPR for pulmonary embolism?

Front

level II clinical findings: 1. clinical sign and sx of DVT with minimum leg swelling and painful palpation 3 pnts 2. no alternative dx 3 pnts 3. heart rate >100 bpm 4. immob of surgery in previous 4 wks 5. pervious DVT or PT 6. hemoptysis 7. malignancy on treatment, treated in last 6 months or palliative greater than 6 points equals high risk

Back

What is a pancoast tumor?

Front

-pancoast tumor: lung tumor -be suspicious with h/o smoking w/o trauma or neuro diagnosis - can present as C8/T1 pain pattern as the lung tumor can enlarge enough to invade brachial plexus - note atrophy of hypothenar and thenar muscles - request chest Xray to rule out

Back

What is disequilibrium and the most likely cause?

Front

Define: imbalance or unsteadiness but w/o vertigo Cause: 1. somatosensory 2. visual illusions 3. cerebellar disorders

Back

What are causes of Gout? What are some characteristics of Gout

Front

usually insidious onset and affects 1st ray lasting 7-10 days MS causes include: surgery, immobilization, trauma nonMS cause include excessive alcohol consumption

Back

How do you differentiate the sensory abnormality between nerve root vs peripheral root problem

Front

-sensory nerve root symptoms travel proximal to distal and travel along dermatomal pattern - sensory peripheral nerve symptoms travel distal to proximal - However, a double crush injury can go both way. i.e. 11% or about 1 out of 10 people with CTS

Back

What are the CPR for peripheral neuropathy?

Front

Level IV- has not been validated 1. Absence of Achilles' tendon reflex 2. Decreased vibration sensation- 3. Decreased positional sensation of toe- less than 8/10 correct movements + if >2 are positive

Back

How to rule out and rule in Cancer as low back pain?

Front

Rule out: if have pain relief best with rest (NEG LR: 0.11) Rule in: If POS for H/O of CA and 1 or more of the following: age >50 yrs, unexplained weight loss, failure to improve with 1 month conservative treatment,no relief with bedrest, recommend lab workup for ESR. POS LR 67. If ESR > 50 mm/hr POS, then recommend advanced diagnostic imaging/ biopsy. If ESR >50 mm/hr NEG, then recommend conservative radiographs If conservative radiographs are NEG, STOP If conservative radiographs are POS, then order advanced diagnostic imaging/ biopsy

Back

According to research, what type of contraction is best for achilles tendinopathy

Front

Sibernagel - combined (of ecc and concentric contraction, balance)

Back

What is CPR for Osteoporosis risk assessment?

Front

predictors: age, weight in kg, and current estrogen use

Back

What does the posterior rami innervate?

Front

- the skin and muscles of the intrinsic back muscles

Back

what are the signs and sx of nociceptive pain in LBP patient +/- leg pain?

Front

7 characteristics: 1. localized 2. clear agg/ easing factors 3. usually intermittent sharp with moement/ mechanical provocation, sometimes dull constant pain at rest 4 absence of pain in association with other dysesthesias 5. night pain 6. antalgic postures/ movements patterns 7. pain variously described as burning, shooting, sharp, electric shocklike

Back

What does the anterior rami of C5-T1 spinal nerve make up?

Front

the brachial plexus

Back

What does the anterior primary rami of spinal nerve become?

Front

the plexus

Back

what are the best interventions for fibromyalgia?

Front

multiple approach is best 1. Education on nutrition, energy conservation, sleep (carb snack before sleep, helps stimulate serotonin production and protein inhibits serotonin, need to reach phase 4 to repair and restore proteins 2. Medicationto inhibits substance P 3. Exercise to include posture, passive stretch, low load low rep strengthening , and low impact aerobics

Back

Does the anterior or the posterior rami make up the brachial plexus?

Front

anterior rami

Back

What is myofascial pain syndrome? How does it differ from fibromyalgia?

Front

-Myofascial pain syndrome-think trigger points within localized spot on firm muscle, not tender points as in fibromyalgia - represents as a regional pain pattern not global like in fiber - Myofascial pain syndrome elicits pattern of pain, tingling, numbness in response o sustained pressure. - does not follow myotomal, peripheral or dermatomal pattern active and latent trigger points

Back

what else can be expected besides pain with nerve root compression?

Front

compression can also affect larger diameter afferent fibers as in touch, position, temperature, vibration, not only small afferent pain nociceptor fibers

Back

According to CPR on DVT's, what are clinical findings of DVT in lower extremity

Front

Level study 1 1. active cancer (within 6 mos of dx or palliative care 2. paralysis, paresis, or recent plaster immob of LE 3. recently bedridden > 3 days or major surgery within 4 wks of application of CPR 4. Localized tenderness along distribution of deep venous systems 5. Entire LE swelling 6 Calf swelling by> 3 cm compared to asymptomatic LE 7. Pitting edema (greater in symptomatic LE) 8. collateral superficial veins (nonvaricose) tenderness in assessed by firm palpation in center of posterior calf popliteal space, and along are of femoral vein in anterior thigh/ groin scoring: Low</= 0 == 3% chance for DVT moderate 1-2 ==17% chance of DVT high>/= 3 == 75% chance of DVT follow up test: D-dimer lab not as good compression US

Back

Epley manuever is about 80% effective. start maneuver with head turned to side being affected Instructions: 1.Wait 10 min after tx prior to leaving office 2. sleep in semi-recumbent that evening 3.avoid sleeping on involved side, 4. a lot of cervical rotation or extension 5. use at least 2 pillow for sleeping few nights after tx

Front

How do you treat BPPV? what are instructions following treatment?

Back

What are signs and sx of peripheral neuropathic pain in LBP patients =/- leg pain?

Front

2 symptoms: 1. history of nerve injury 2. dermatomal/ cutaneous distribution 1. sign: pain provocation with nerve movement testing

Back

What are characteristics of fibromyalgia?

Front

characteristics: -global widespread in all 4 quadrants (left, right, above, below, and wait level) that consists of axial and appendicular pain - pain> 3 months - no less than 11/18 TTP at 18 tender points and needs 4 kg of force or examiner nailbed blanch Tender points: 9 x2 bilat sides 1. Occiput: 2. Trapezius: mid part of upper border 3. supraspinatus above scapular spine/ medial border 4.lateral epicondyle )2 xm distal to epicondyle 5.low cervical region at C5-7 6. second rib: at costochondral junction 7. gluteal: upper outer quadrant in anterior fold of muscle 8. Greater trochanter: posterior to prominence 9. Knee: medial fat pad to joint line Side note: #1-4 consider diff dx at C spine and #7-8 doesn't represent LB or sciatica

Back

what does Hallpike- Dix diagnose? what is positive sign?

Front

Benign Paroxysmal Positional Vertigo - how to perform: long sit on table arms across chest, rotate head to 45 deg and extend 30 deg, rapidly bring patient into supine with head extended over edge of table hold 60-90 sec - POS: with nystagmus upbeating = posterior canalisthesis on ipsilateral side (side rotated towards) (PUP), or down beating= anterior canalisthesis on contralateral side

Back

According to research, what type of contraction or protocol is best for patellar tendinopathy?

Front

heavy slow repetitive: about 3x/ week, 15 reps x 4-6 sets

Back

How do you treat BPPV? what are instructions following treatment?

Front

Epley manuever is about 80% effective. start maneuver with head turned to side being affected Instructions: 1.Wait 10 min after tx prior to leaving office 2. sleep in semi-recumbent that evening 3.avoid sleeping on involved side, a lot of 4.cervical rotation or extension 5. use at least 2 pillow for sleeping few nights after tx

Back

What does the posterior primary rami of spinal nerve control?

Front

it innervates muscles of spine and structures of spine

Back

What are characteristics of visceral pain?

Front

- slow pain fibers 2/2 limited nociceptors except cavity linings - descrbed as diffuse deep wavelike pain (arterial blood= throb pain) - except for pleura, peritoneum, pericardium results in fast pain fibers mimicking MS pain

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