Clara Lopez
Name the mortality most common in younger travelers and the most common morbidity of travelers.
What is Jeff?
What are injuries (mortality) and traveler's diarrhea (morbidity)? For older travelers, smoking history, diabetes, hypertension, etc, cardiovascular disease is the most common mortality in travelers. The second most common mortality in travelers is injury and it is most common in younger, more adventurous travelers.
Name the 8 phases of the gait cycle.
What are Heel strike, loading response (foot flat), midstance, terminal stance (heel off), pressing (toe-off), initial swing, midswing, and terminal swing?
Name the two drugs that do not fit into the drug-receptor model.
What are Antacids and Osmotic Diuretics? Antacids are used to treat GERD and peptic ulcer disease by acting nonspecifically and absorbing or chemically neutralizing stomach acid. Osmotic Diuretics are used to control fluid in the body by altering the relative rates of water and ion absorption and secretion in the kidney by mostly acting on the ion channels, where one class acts on the nephron by altering the osmolarity through the release of Mannitol.
Name the joints of the lower extremity.
What are the femoroacetabular, femorotibial, tibiofibular proximal and interosseous, tibiotalar, subtalar, tarsal-metatarsal, metatarsal-phalangeal, and interphalangeal joints?
Limiting structures of the external rotation of the hip joint.
What are the iliofemoral ligament, pubofemroal ligament, and the anterior joint capsule?
Name the most common cause of diarrhea and the most common specific strain that will cause noninflammatory enteric infection.
What are bacteria and with the specific strain being V. cholera (ETEC)? The most common cause of diarrhea is bacteria with viruses being the most blamed. Diarrhea can also be caused by protozoa. Additionally, there can be non-inflammatory, inflammatory, and penetrating enteric infections.
Name the Phase of the Gait Cycle and active muscle group that has the mechanical goal of clearing the foot.
What is midswing with the active muscle group being the ankle dorsiflexors? These include the muscles in the anterior compartment of the leg which are the Tibialis anterior. Extensor digitorum longus, Extensor hallucis longus, and Fibularis tertius.
Name the G protein, second messenger(s), and function of alpha 1 adrenoceptors on Pilomotor smooth muscle.
What are Gq, IP3 and DAG, and erect hair? When NE binds to an alpha 1 receptor on the pilomotor smooth muscle it activates the Gq protein. The Gq protein will activate PLC to split PIP2 into IP3 and DAG. IP3 will then promote Ca2+ secretion from the sarcoplasmic reticulum. DAG will then activate PKC. This will promote contraction of the smooth muscle and therefore the hair will erect.
Name the major muscles (in relation to OMM) of the lower extremity.
What are the Iliopsoas, Quadriceps, Hamstrings, Triceps surae, and Tibialis Anterior? The Iliopsoas is composed of 2 muscles (Iliacus and Psoas), Quadriceps is composed of four muscles (Rectus femoris, vastus intermedialis, vastus medialis, and vastus lateralis), Hamstrings is composed of 3 muscles (semimembranosus, semitendinosus, and biceps femoris long head), and the triceps surae are composed of 2 muscles (Gastrocnemius and Soleus.
With an injury to the anterior and posterior cruciate ligaments, the ____ movement of the knee will no longer be limited.
What is extension? The limiting structures of the extension of the knee include the anterior and posterior cruciate ligaments, the tibial and fibular collateral ligaments, posterior joint capsule,a nd the oblique popliteal ligament.
What are avoid outbreaks, wear appropriate clothing, check for ticks, bed nets, and use insecticides and spatial repellents?
Name the arch in the foot that is composed of the cuboid, cuneiforms, and bases of metatarsals along with the general passive and active elements of arch support.
What is the transverse arch with the general active elements being ligaments and the general passive elements being tendons of the leg muscles?
Name the rate-limiting steps of the life cycle of Ach at the ______ junction and the life cycle of NE at the _____ junction. Name the metabolism mechanisms of both Ach and NE.
What are choline uptake through the Na+/choline cotransporter step of the Ach life cycle at the cholinergic junction and the tyrosine uptake through the Na+/tyrosine cotransporter and conversion to dopa step in the NE life cycle at the adrenergic junction? Ach is released at the cholinergic junction with the metabolism being through acetylcholinesterase. NE is released at the adrenergic junction with the metabolism being through MAO (nerual tissue) and/or COMT (liver, GI tract, and other target organs)
Name the arch of the foot that is higher than its counterpart, is composed of the calcaneus, navicular, medial cuneiform, and metatarsal 1-3, and its clinical relation in collapse.
What is the medial longitudinal arch which its collapse is indicated in the condition pes planus (flat foot)? This collapse occurs when the individual's tibialis posterior is dysfunctional and is no longer able to support the arch.
Pt presents to the ED with c/o of problems flexing the hip as well as a sensory deficit. Name the most likely spinal nerve impingement and where the sensory deficit is located.
What is the spinal nerve L2 with the sensory deficit being in the medial upper thigh?
Pt presents to the ED with c/o diarrhea. The pt states that they were in Mexico about 2 weeks ago and did not show symptoms until the day before they came in. Name the most likely culprit of this pt's infection and name the most common species.
What is protozoa, most likely Giardia lamblia? Protozoa infections can have an incubation time of 1-2 weeks and have durations of weeks-months without treatment. Since this individual did not start showing symptoms till around the 2-week mark, it is most likely due to a parasite rather than a virus or bacteria (incubation of 6-72 hours).
What are the soleus and the gastrocnemius which are both innervated by the tibial nerve?
Name the drug class that affects NE actions by increasing the storage through the inhibition of VMAT and the drug class that promotes the elongation of action of ACh by preventing the metabolism of ACh.
What are Reserpine and AChE inhibitors? Reserpine inhibits the VMAT receptor which is responsible for the transportation of Dopamine into the vesicle and H+ out of the vesicle. In doing so, the dopamine cannot be transformed into NE and there is an increase of Dopamine in the presynaptic neuron. AChE Inhibitors inhibit the actions of Acetylcholinersterases which are responsible for the metabolism of ACh into choline and acetate to allow termination of action of ACh.
Pt presents to the Physical Therapist with c/o a strain in their Semitendinosus. Name the joint(s) and its motion(s) affected by this injury.
What are the flexion of the knee joint (femorotibial), medial rotation of the leg, and extension of the hip joint (femoroacetabular)? The semitendinosus is a hamstring muscle that acts to medially rotate the thigh when the knee is flexed, flex the knee, and extend the hip joint. When this muscle is strained/injured it will alter its normal movements. Moreover, the hamstring muscles are important in both the femoroacetabular joint and the femorotibial joint.
Pt presents to the ED with a reduced Patellar deep tendon reflex. Name the spinal nerves responsible for this reflex and their respective dermatomes.
What are the L3-L4 spinal nerves with the L3 dermatome being the lateral thigh and knee and the L4 dermatome being the medial leg?
Pt presents to their PCP for a wellness check. Pt states that they were out mosquito watching and now has a fever, chills, sweats, N/V, and headaches. Name the most likely cause of this pt's illness including, the agent, MOT, and subclinical presentation.
What is malaria, with the agent being a parasite(P. falciparum, P. malaria, P. vivax, and P.ovale), MOT being mosquito bites, and subclinical presentation being asymptomatic due to the parasite being dormant in the liver? Since the pt was mosquito watching, most likely in Africa or in other areas with specific mosquito species(don't think you need to know the specific species), they most likely got bit by an infected mosquito and now has malaria. This can be distinguished by Zika due to the lack of a maculopapular rash, arthralgia, and non-purulent conjunctivitis.
Pt presents to the ED with c/o having excessive movement in everting their foot. Upon XR it was determined that they had a sprain in the ligament that attaches the tibia (medial malleolus) to the calcaneus and talus. Name the ligament(s) and the joint affected in this pt along with the joint's main motions.
What are the posterior tibiotalar ligament, tibiocalcaneal ligament, subtalar joint with the motions of eversion and inversion? The posterior tibiotalar, tibiocalcaneal, and the tibionavicular ligaments make up the medial ligament(deltoid ligament) of the ankle that helps counter eversion, dorsiflexion, plantarflexion, and reinforce the talocrural joint medially. The subtalar joint has the main motions of eversion and inversion so it might be likely that its ligaments are also affected.
Pt presents to the ED for an actual emergency. When discussing their medications they mention two drugs, both utilize cholinoceptors. The first is used for motion sickness and has the location of expression in the CNS neuron so it is expected to use the ___ receptor. This drug has a therapeutic index of 50. The second drug is used for skeletal muscle contraction and is found at the neuromuscular junction so it is expected to use the ___ receptor. This drug has a therapeutic index of 20. Name the blanks as well as which is considered to "be safer" and why.
What are the M2 receptor and NM receptor with the first drug being considered "being safer" due to the higher therapeutic index? This is because the therapeutic index is a quantitative measurement of the therapeutic window of the drug. If the therapeutic index is higher, that means that the therapeutic dose is smaller with a higher toxic effect. This allows for a wider gap for the drug to be used in for "safer" utilization.
Pt presents to the ED with a torn Achilles tendon. Name the muscles affected and the main motion(s) affected.
What are the triceps surae (gastrocnemius and soleus) and the plantaris will be affected and therefore plantarflexion will be impaired? FUN FACT! If this is not taken care of in a timely fashion, the muscles will actually retract up the leg!
Pt presents to the ED with an open fracture to the distal tibia right above the talocrural joint. The artery that is most likely affected by this fracture is one that crosses in front of the joint. Moreover, the movement(s) affected by the fracture will most likely include ____ and ____.
What is the anterior tibial artery with dorsiflexion and plantarflexion being most likely affected? The anterior tibial artery crosses above this joint and becomes the dorsalis pedis to which has a deep perforating branch (deep pedis) that contributes to the plantar arch along with the lateral plantar artery. The talocrural joint is in charge of dorsiflexing and plantarflexing the ankle through the articulation of the medial malleolus and inferior tibia and the talus.