Wvsom Fom 9-19-14 & 9/22/14

Front 1

Discuss the MSK Imaging modalities, which first & what each is used for.

Back 1

X-Ray always first

CT - bone or cortical bone

MRI - Soft tissue

Bone Scan - scan for increased metabolic activity via tagged glucose.

Front 2

Describe the two types of MRIs

Back 2

Type 1 - fat is bright, fluid is dull/gray

Type 2 - fluid is bright

Front 3

Describe Bone scan process

Back 3

Tracer accumulates in osteoblasts which are increased in fracture, tumor, & infection.

Highly sensitive but not specific.

Front 4

Describe the placement & treatment for Fat Pads.

Back 4

1. Patient is suspected of trauma to the XRAY location (or they wouldn't be having an xray)

2. Darkened area next to the bone where it is normally consistently opaque/diffuse white.

3. indicative of a fracture, treat as a fracture.

Front 5

List the types of fractures

Back 5

transverse, oblique, spiral, comminuted, segmental, avulsed, impacted, torus, greenstick

Front 6

Describe when an ankle fracture is stable vs. unstable.

Back 6

Unstable = proximal to joint space

Stable = distal to joint space

Front 7

Describe the 5 types of Salter-Harris

Back 7

1 . fracture through physis

2. fracture through physis & metaphysis

3. fracture through the physis & epiphysis

4. fracture through epiphysis, metaphysis, physis

5. compression/cruss of physeal plate

Front 8

Describe the contents of the Carpal tunnel

Back 8

8 Carpal bones.

Flexor Retinaculum.

4 flexor digitorum superficialis tendons.

4 flexor digitorum profundus tendons.

Flexor pollicis longus tendon.

Median nerve.

Front 9

List the 8 Carpal bones

Back 9

Scaphoid, Lunate, Triquetrum, pisiform, trapezium, trapezoid, capitate, hamate

Front 10

Discuss the various mechanisms of neck pain

Back 10

Trauma via hyperflexion/extension, strain.

Tension via isometric contraction, emotional factors, or facilitated segments

Degenerative or arthritic.

Referred pain.

Front 11

Describe cervical disc disiease

Back 11

Degenerative disc disease - involving annular tears, loss of disc height & nuclear degradation

Herneated nucleus pulposus implies extension of disc material beyond posterior margin of the vertebral body. Disc degeneration/herniation can impede spinal cord & nerve roots resulting in stenosis or myofascial pain.

Front 12

Describe myofascial pain syndrome

Back 12

1. presence of trigger points (referred pain)

2. muscles usually trapezius, levator scapulae, rhomboids, supraspinatus, infraspinatus.

3. Normal neurologic exam.

4. Neck pain & stiffness worse with stress.

5. limited cervical spine RoM

6. Pain radiation mimics cervical radiculopathy with pain radiating down the arm

Front 13

Describe Thoracic Outlet Syndrome

Back 13

1. More common in females possibly due to differences in thoracic weight bearing aspects.

2. r/t occupations/activities involving prolonged posturing of the neck.

3. Neural compression s/sx more common than vascular compression s/sx.

4.Sensory s/sx 90% vs. Motor s/sx 10%

5. usually involves the lower brachial plexus

Front 14

Describe Double Crush syndrome.

Back 14

Combination of thoracic outlet syndrome & carpal tunnel syndrome.

Compression of axon at one point renders it more susceptible to damage at another site.

Altered function is greater than sum of individual impairments (1+1=3).

Front 15

What tests would be used to detect Thoracic outlet syndrome

Back 15

Adson's manuever.

Costoclavicular compression test.

Pectoralis minor compression test

Front 16

What signs or tests are used to detect Carpal Tunnel Syndrome.

Back 16

Flick Sign

Phalen's maneuver

Tinel's sign

Manual compression

Front 17

Describe the OMT technique used for CTS treatment.

Back 17

1. Wrist & digits simultaneously hyperextended

2. Thumb hyperextended, hyperabducted & laterally rotated.

3. Hold for 5-10 seconds.

4. 10-15 repetitions QID or PRN

Front 18

What are the three levels of motor control in modifying motor output.

Back 18

Cerebrum

Brainstem

Spinal Cord

Front 19

Describe the Cerebrum with regards to modifying motor output.

Back 19

The cerebrum is composed of the basal ganglia and the cerebellum. Function includes planning & initiation of movements & integration of input from the other brain regions.

Front 20

Describe the Basal Ganglia.

Back 20

Movement gait, enforcement of desired movement & suppression of undesired movements (e.g. Parkinson's disease)

Front 21

Describe the Cerebellum

Back 21

Coordination & planning, timing & precision of fine movements, adjusting ongoing movements, motor learning of skilled tasks.

Front 22

Describe the Brainstem with regards to modifying motor output.

Back 22

Control of balance & posture, coordination of head, eyes, & neck movement.

Front 23

Describe the Spinal Cord with regards to modifying motor output.

Back 23

Spontaneous reflexes, rhythmic movements, motor outflow to the body.

Front 24

Describe the function of the lateral descending tract & list the 2 parts.

Back 24

Modifying extremities & distal musculature, responsible for most voluntary movements of the arms & legs.

Parts: Lateral Corticospinal & Rubrospinal

Front 25

Describe the Lateral Corticospinal

Back 25

affects distal limb musculature especially hand precision movements, possibly flexors over extensors.

Origin: motor cortex (primary, premotor, supplementary motor)

Decussation: Caudal medulla (contralateral)

Target: lateral ventral horn, motor neurons & interneurons at all levels of the spinal cord.

Front 26

Describe the Rubrospinal

Back 26

excitation of flexor muscles & inhibition of extensor muscles.

Origin: Red nucleus in the midbrain

Decussation: immediate in midbrain

Target: lateral ventral horn, motor neurons & interneurons at all levels of the spinal cord.

Front 27

List the function of the Medial Descending Tracts & the 4 major parts.

Back 27

Modify the trunk & proximal muscles, posture/balance. Both Ipsolateral & bilateral

Parts: Anterior corticospinal, Tectospinal, Vestibulospinal (medial & lateral), Reticulosponal (pontine & medullary)

Front 28

What is the most important motor tract in medical neuroscience & what does it affect.

Back 28

Lateral Corticospinal: affects distal limb musculature especially hand precision movements, possibly flexors over extensors. 85% of fibers from the motor cortex cross in the medulla & descend to contralateral motorneurons (motor cortex controls opposite side of the body)

Front 29

Define decorticate rigidity

Back 29

abnormal flexion (rubrospinal intact)

Think flex towards core

Front 30

Define decerebrate rigidity

Back 30

extension posturing (rubrospinal NOT intact)

Celebrating = arms away from the body

Front 31

Which tract plays a role in movement velocity

Back 31

Rubrospinal tract

Front 32

What tract plays a role in transmitting learned motor commands?

Back 32

Rubrospinal tract

Front 33

Controls proximal & girdle musculature involved in postural tone, balance & orienting movements of the head & neck & automatic gait-related movements.

Back 33

Medial tract

Front 34

Describe Jacksonian principle

Back 34

Higher Motor centers tonically inhibit lower motor centers resulting in sophistication of motor movements.

Front 35

Describe Lower motor neuron syndrome

Back 35

Peripheral nerves: flaccid weakness, decrease or absent muscle tone & tendon reflexes, fasciculations, atrophy, decreased or absent resistance to passive RoM

Front 36

Describe fasciculations

Back 36

muscle twitches to ACh still present in the cleft immediately after damage.

Front 37

Describe Upper motor neuron syndrome

Back 37

Spastic weakness, increased muscle tone & tendon reflexes, velocity-dependent resistance to passive RoM, Babinski's sign.

Front 38

Describe hypertonia

Back 38

increased muscle tone

Front 39

Describe hyperreflexia

Back 39

increased tendon reflexes

Front 40

Describe spastic weakness

Back 40

Reflexes exist but are uncontrolled

Front 41

Describe Babinski's sign

Back 41

abnormal extensor plantar response