Burns

Question	Answer
Superficial Burn	-Outer Epidermis -red, slight edema -no scarring
Superficial Partial-Thickness Burn	-Epidermis + Upper Dermis -extreme pain with blisters -minimal to no scarring
Deep Partial-Thickness Burn	-Epidermis + most of Dermis -discolored, broken blisters, edema -moderate pain (damage to nerve endings) -hypertrophic scars & keloids
Full-Thickness Burn	-Epidermis+Dermis+ Subcutaneous fat(partial) -minimal pain, eschar -require grafts & susceptible to infection
Subdermal Burn	-Epidermis + Dermis + Subcutaneous fat layer -involve muscle & bone -require surgery
Thermal Burn	-Conduction or Convection I.e. steam, fire, hot liquid
Electrical Burn	-Entrance & Exit Wound I.e. Lightening Complications: cardiac, respiratory, renal, neuro., fractures
Chemical Burn	-Chem. reaction continues until diluted I.e. gasoline, sulfuric acid, hydrochloric acid, lye
According to the Rule of 9's, what % of the body are the entire HEAD & NECK? (adult/young child)	Adult: 9% Child: 17%
According to the Rule of 9's, what % of the body is the ANTERIOR TRUNK? (adult/young child)	Adult & Child: 18%
According to the Rule of 9's, what % of the body is the POSTERIOR TRUNK? (adult/young child)	Adult & Child: 18%
According to the Rule of 9's, what % of the body is the ENTIRE TRUNK? (adult/young child)	Adult & Child: 36%
According to the Rule of 9's, what % of the body is (B)ANTERIOR ARM, FOREARM & HAND? (adult/young child)	Adult & Child: 9%
According to the Rule of 9's, what % of the body is (B)ENTIRE ARM, FOREARM & HAND? (adult/young child)	Adult & Child: 18%
According to the Rule of 9's, what % of the body is the LEFT ANTERIOR ARM, FOREARM & HAND? (adult/young child)	Adult & Child: 4.5%
According to the Rule of 9's, what % of the body is the GENITAL REGION? (adult/young child)	Adult & Child: 1%
According to the Rule of 9's, what % of the body is the (B) ANTERIOR LEG & FOOT?(adult/young child)	Adult & Child: 18%
According to the Rule of 9's, what % of the body is the RIGHT POSTERIOR LEG & FOOT? (adult/young child)	Adult & Child: 9%
Zone of Coagulation	-Most severe injury -Irreversible cell damage
Zone of Stasis	-Less severe injury -Reversible damage -Surrounds Zone of Coagulation
Zone of Hyperemia	-Will fully recover -Presents with Inflammation -Surrounds Zone of Stasis
Ideal Positioning of the NECK	extension
Ideal Positioning of the SHOULDER	External rotation Flexion, aBduction <90 degrees
Ideal Positioning of the ELBOW	Extension, Supination
Ideal Positioning of the WRIST	Extension
Ideal Positioning of the HAND	MCP flexion IP extension Thumb opposition
Ideal Positioning of the HIP	extension, neutral rotation 20 degrees aBduction
Ideal Positioning of the KNEE	full extension
Ideal Positioning of the ANKLE	dorsiflexion, neutral eversion/inversion
Allograft (homograft)	temporary skin graft from another human (cadaver)
Autograft	permanent skin graft from pt’s own body
Heterograft (xenograft)	temporary skin graft from another species (pig)
Mesh Graft	altered to cover larger surface area
Sheet Graft	transferred directly from donor site to recipient site
Split-Thickness Skin Graft	only a superficial layer of the dermis + the epidermis
Full-Thickness Skin Graft	dermis + epidermis
Dermis	vascular; below epidermis; contains: hair follicles, sebaceous & sweat glands
Epidermis	superficial avascular; allows for hair follicles, sebaceous & sweat glands
Donor Site	healthy skin taken & used as a graft
Recipient Site	site that has been burned and requires a graft
Eschar	necrotic/nonviable tissue resulting from deep burn; hard, dry, abnormal, black
Escharotomy	surgical removal of eschar…done to enhance CIRCULATION
Z-plasty	surgical procedure to eliminate scar contracture…”z” incision allows scar to lengthen
Hypertrophic scarring	abnormal/disorganized scar formation; raised, firm scar with no pattern
Normotrophic scarring	scar with organized collagen fibers that align in a parallel fashion
Pressure Garments	sustained pressure to improve structure of a scar; worn 22-23 hrs/day up to 2 yrs.

Neurological dysfunctions

Question	Answer
Inflammation of membranes of SC or brain	Meningitis
Which meningitis is usually sicker with more rapid time course	Bacterial
Infection and inflammation of brain	Encephalitis
S/S of brain abscess	HA, fever, brainstem compression, Focal signs in CNII & CNVI
AIDS dementia syndrome (ADC)	confusion, memory loss, disorientation, ataxia, weak, tremor, hypersensitivity, pain, sensory loss
Formation of blood clot or thrombus within cerebral arteries or branches	Cerebral thrombosis
Traveling bits of matter that produce occlusion & infarction in cerebral arteries	Cerebral embolism
Abnormal bleeding as a result of rupture of blood vessel	Cerebral hemorrhage
Risk factors for CVA	atherosclerosis, HTN, CD, DM2, TIA
Lack of oxygen to brain	Cerebral anoxia
Irreversible cellular damage to brain	Cerebral infarction
Accumulation of fluids within brain	Cerebral edema
ICA syndromes include	ACA syndrome and MCA syndrome
ACA supplies	Supplies anterior 2/3 of medial cerebral cortex.
ACA syndrome	CL sensory loss, CL hemiparesis, leg > arm.
Occlusions proximal to anterior communicating artery produce	minimal deficits due to Circle of Willis
MCA supplies	lateral cerebral cortex, basal ganglia, internal capsule
MCA syndrome	CL sensory loss, CL hemiparesis arm>leg, Broca’s aphasia, perceptual dysfunction, homonymous hemianopsia, CL los of conjugate gaze, sensory ataxia
Medial medullary syndrome	VBA occlusion – IL tongue paralysis, CL paralysis of arm and leg, decr sensation
Lateral medullary syndrome (Wallenberg’s)	IL cerebellar, Horner’s syndrome, dysphagia, impaired speech, decr gag reflex, IL arm/trunk/leg sensory loss, CL pain/temp loss
Horner’s syndrome	miosis, ptosis, decr sweating
Basilar artery syndrome	brain stem S/S and PCA s/s. Locked in syndrome
Locked in syndrome	basilar artery occlusion at level of pons. Preserved consciousness but quadriplegia, anarthria.
Medial inferior Pontine syndrome	IL symptoms: cerebellar, conjugate gaze paralysis, diplopia. CL symptoms: hemiparesis, decr sensation.
Lateral inferior pontine syndrome	IL: cerebellar, facial paralysis, conjugate gaze paralysis, deafness, tinnitus. CL: pain/temp sensation
PCA syndrome	CL homonymous hemianopsia, CL sensory loss, thalamic syndrome, involuntary mvmts, CL transient hemiparesis, Weber’s syndrome, visual s/s.
Weber’s syndrome	oculomotor nerve palsy with CL hemiplegia
Lesions of parieto-occipital cortex of dominant hemisphere lead to	aphasia
Lesions of parietal lobe of non-dominant hemisphere lead to	perceptual deficits
Pt with lesion of L hemisphere (R hemi) tend to be	slow, cautious, hesitant, insecure
Pt with lesion of R hemisphere (L hemi) tend to be	impulsive, quick, indifferent, poor judgement, overestimate abilities, underestimate problem
L hemisphere lesion pts learning guidelines	appropriate communication method, frequent feedback & support, do not underestimate learning ability
R hemisphere lesion pts learning guidelines	use verbal cues, demo may confuse, give frequent feedback, focus on slow & control, avoid spatial clutter, do not over estimate ability to learn

Ortho-Differential diagnosis

Question	Answer
Sign of the Buttock	Limited/painful SLR; Limited/painful passive hip flexion with knee bent; Non-capsular pattern
Pancoast Tumor	Men >50 with hx of smoking; Nagging pain in shoulder/vertebral scapular border; Pain progression nagging->burning & extends down arm in ulnar distribution
After how many visits should you refer if no improvement?	3-4 treatments
S/sx of neurommskeletal impairments typically related to what?	Changes in posture or movement
Stoddard #1	Back ache, having hx of malignancy during previous 2 yrs, must be assumed to have 2ndary malignant deposits in spine
Stoddard #2	Onset of back pain late in life w/o any previous hx of back s/sx, it is more than likely osteoporosis or 2ndary deposits
Stoddard #3	Serious loss of spinal fxn or shock or vomiting after trivial spinal injury/strain, pt likely to have pathological fx of spine
Stoddard #4	Intense pain requiring morphine >48 hrs may indicate serious disease
Stoddard #5	Severe pain, derofmity & mm spasm in areas of spine other than lower cervical/lower lumbar, should arouse suspicion of disease
Stoddard #6	Constitutional signs like fever, loss of wt, malaise & excessive wkness suggest disease
Stoddard #7	Loss of power too widespread to be accountable by single nerve root lesion suggests neurological disease
Stoddard #8	Loss of sphincter control is never due to simple mechanical causes
Stoddard #9	Continuous pain unrelated to posture is unlikely to be mechanical in origin
Stoddard #10	Normal ESR doesn't exclude disease entirely
Cyriax Normal End Feels	Capsular; Bone-on-bone; Tissue approximation
Cyriax Abnormal End Feels	Empty; Springy Block; Spasm
MMT Strong & Painful	Minor Lesion
MMT Weak & Painless	Neurological/Rupture
MMT Weak & Painful	Gross Lesion
MMT All Painful	Psychogenic/Highly irritable
MMT Painful on repetition	Vascular
MMT Strong & Pain-free	Normal
DTR Biceps; Brachioradialis; Triceps	Biceps/Brachioradialis = C5-6; Triceps = C6-7
S/sx Cervical Radiculopathy	Neck pain, radicular pain with numbness/paresthesia in UE; Mm spasms/fasciculations; Occipital HA; Radiating pain; Wkness, lack of coordination, decreased grip strength
Presentation of Cervical Radiculopathy	Decreased ROM (extension/rotation reproduce radicular s/sx); Myotomes, Dermatomes, DTRs; UMN (rule out cord compression)
Study with ULTT, Spurling, Distraction Tests; Rotation <60 degrees	2 s/sx = 21% have cervical radiculopathy; 3 s/sx = 65%; 4 s/sx = 90%
Diff Dx of Cervical Radiculopathy	Adhesive capsulitis (AROM/PROM); Demyelinating condiiton (s/sx vary); Myocardial ischemia (ECG/stress tests); Peripheral n entrapment (+ Tinel/Phalen's test); RTC (impingement/RTC s/sx); TOS (decreased radial pulse)
Cervical Spondylosis s/sx	Decreased ROM; Chronic neck pain; HA; Radicular s/sx; Irritability, fatigue, sleep disturbances, decreased work tolerance
Presentation of Cervical Spondylosis	Diffuse non-sepcific neck pain exacerbated by neck mvmts
Presence of joint dysfunction with cervical spondylosis	Limited ROM; Palpable tenderness; dermatomes; myotomes; reflexes
Diff Dx of Cervical Spondylosis	Metastatic tumor (night pain); Cervical HNP (younger population); SC tumor (diagnostic studies); Syringomyelia (loss of superficial b reflexes/insensitivity to pain); Vertebral subluxation (advanced spondylosis; RA; trauma)
Cervical Myelopathy s/sx	Palmar paresthesia; Decreased UE dexterity; Subtle gait disturbances; abnormal urinary fxn; Loss of vibration/position sense; UE radiculopathy; May not experience pain
Key Findings with Cervical Myelopathy	Long tract signs (Hoffman's; Babinski; Clonus); Gait disturbances; Decreased UE dexterity
RTC Tear S/sx	Recurrent shoulder pain triggered by specific injury; Night pain; Weakness; Catching; Grating
Presentation of RTC Tear	Supra/infra atrophy; Limited AROM; Drop arm; Tenderness over greater tuberosity
Diff Dx of RTC Tear	AC jt arthritis (localized pain/tenderness, normal ROM); C-spondylosis (neck stiff, myo/dermatomes/DTRs); GH jt arthritis (radiographs); Adh Caps (AROM/PROM); Impingement; Pancoast tumor; TOS (ulnar n distribution; worse with TOS testing)
What is TOS?	Compression of brachial plexus &/or subclavian vessels as they exit b/t shoulder girdle & 1st rib; may be due to congenital anomalies; Fibromuscular bands in thoracic outlet; Post-traumatic fibrosis of scalenes
TOS s/sx	Vague & variable; Aching pain/paresthesias from neck to shoulder, arm, medial forearm, fingers; Intermittent swelling/discoloration of arm, decreased radial pulse, coldness; Aching, fatigue & wkness exacerbated by overhead activity
Presentation of TOS	Female, late teens to 40s; Must reproduce neuro/vascular s/sx; Fwd head, rounded shoulders; (+) ANTT; Motor/sensory intact
TOS Diff Dx	Brachial neuritis (sudden onset, pain, prox wkness); CTS (radial s/sx; Phalen); HNP (neck involvement; radicular pattern); Impingement (+ tests with localized pain); Pancoast tumor (venous congestion; radiographs); Ulnar n entrapment (Tinel, no prox s/sx)
Medial/Lateral Epicondylitis S/sx	35-50 yo; gradual onset in lateral elbow/forearm during wrist ext; medial presents with medial pain exacerbated with wrist flexion/pronation
Presentation of Med/Lat Epicondylitis	Local tenderness 1 cm distal to lat epicondyle (common extensor origin); Medial epicondylitis tender just distal to med epicondyle
Diff Dx of Med/Lat Epicondylitis	Cubital tunnel sx (ulnar n compression with parasthesias in 4th/5th fingers); Radial tunnel sx (PIN compression; tender 5 cm distal to lat epicondyle)
What nerve compression is the 2nd most common nerve entrapment?	Ulnar nerve compression
Where is ulnar n usually compressed?	Cubital Tunnel
PIN Compression	No sensory, innervates wrist, thumb, fingers extensors
Which nerve is compressed in pronator syndrome?	Median Nerve
S/sx of ulnar n compression	Medial elbow aches w/ N/T in 4th/5th fingers; Rdiate proximal into shoulder/neck; Mm wasting in late stages
S/sx of Radial n compression	Pain 4-5 cm distal to lateral epicondyle; No N/T; Mm weakness in late stages
S/sx of Median n compression	Forearm pain that can radiate proximally into arm; Numbness may affect all/part of median n distribution
Diff Dx of elbow compression syndromes	CTS (numb thumb, index, middle fingers; thenar wasting); HNP; Med/Lat epicondylitis; TOS; Ulnar n entrapment at wrist
Ulnar Nerve supply	FCU; FDP; Superficial sensory; Deep motor; Ulnar lumbricals; IO; Adductor pollicis; FPB
What is the most common compression neuropathy in the UE?	CTS
What occurs most in middle-aged/pregnant females?	CTS
CTS S/Sx	Vague aching radiating into thenar area; Presthesia/numbness in median distribution; Worse at night; Dropping objects/wkness; Need to shake/rub hands
Presentation of CTS	Thenar atrophy; decreased sensory; Phalen test; Tinel sign; Carpal compression; ULTT; Opposition strength
Diff Dx of CTS	CMC arthritis (pain w/ motion); Cervical radiculopathy of C6 (neck pain; C6 dist); Diabetes; Hypothyroid; Median n compression at elbow; Ulnar neuropathy
Median N. supply	FCR; PT; PL; FDS; AI branch = FPL; Radial 1/2 of FDP; PQ; Superficial sensory; Terminal = APB; OP; FPB; Radial lumbricals; Sensory
DeQuervain Tenosynovitis is what?	Swelling/stenosis of sheath surrounding APL & EPB
DeQuervain's is common in what population?	Middle-aged women
S/sx of DeQuervain's	Pain, swelling, triggering resulting in locking/sticking of tendon with thumb motion; Swelling over radial styloid & pain aggravated by moving thumb/making fist
DeQuervain's Presentation	Swelling/tenderness over tendons of 1st dorsal compartment; Crepitus with thumb flex/ext; (+) Finkelstein
Diff Dx of DeQuervain's	CMC arthritis (painful compression); Dorsal wrist ganglion (palpable mass); Scaphoid fx (snuffbox tender); Superficial radial n (cheralgia paresthetic; dog handler's sx)