Popliteal Fossa
Posterior Compartment
Posterior Compartment
Name the deep fascia of the leg and the three compartments of the leg.
What are the crural fascia and the anterior, lateral, and posterior compartments of the leg? The Posterior compartment is further divided into deep and superficial compartments.
Name the questionnaire for alcohol consumption and the questions commonly asked within it.
What is the CAGE questionnaire? The questions asked are:
Have you ever felt that you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves of get rid of a hangover (Eye-opener)?
Name the muscles that make up the pelvic and urogenital diaphragms.
What are :
Pelvic diaphragm --> levator ani, and coccygeus muscles
Urogenital diaphragm --> deep transverse perineal and sphincter urethra muscles
Name the artery(ies) that contribute to the dorsalis pedis and the artery(ies) that contribute to the deep plantar arch of the foot.
What is that the tibialis anterior contributes to the dorsalis pedis while the lateral plantar (from the posterior tibialis artery) and the deep branch of the dorsalis pedis contribute to the deep plantar arch of the foot?
Name the 4 main processes of pharmacokinetics.
What are absorption, distribution, metabolism, and excretion?
Pt presents to the ED with a complaint of a stab wound in the inferior medial border of the popliteal fossa. Name the affected structure on the pt.
What is the medial head of the gastrocnemius? The borders of the popliteal fossa include:
Superiomedial --> semitendinosus/semimembranosus
Superiolateral --> biceps femoris
Inferiomedial --> medial head of the gastrocnemius
Inferiolateral --> lateral head of the gastrocnemius
Roof --> popliteal fascia and skin
Floor --> posterior capsule of the knee joint, popliteal surface of the femur, popliteus fascia covering the popliteusmuscle
Name the implications of a pt that is unable to perform activities of daily living?
What are malnutrition, poor personal hygiene, isolation, illnesses, and falls?
Pt presents to their OMM visit and it is determined that the pt has a (+)SFT on the right with a steep angle between their ASIS on the right and umbilicus. Name the dysfunction.
What is an innominate inflare? Since they had a (+) SFT on the right with the angle between the right ASIS and umbilicus being steep, it would be an innominate inflare. If the angle between the ASIS and the umbilicus was shallow, it would be an innominate outflare.
Pt presents with the inability to evert the foot. Name the muscles responsible for this action and the nerve that innervates them.
What are the fibularis brevis and fibularis longus with the nerve that innervates them being the superficial fibular nerve?
Pt is in need of a drug that acts on the brain. Name the best drug form for this pt and explain why.
What is a lipophilic drug that is unionized? This is because the lipophilic drugs will be able to cross the blood-brain barrier easier. Additionally, the ionization of a drug affects absorption. If a drug is ionized, it will be more easily excreted, while unionized drugs are easily absorbed. This is important for when an individual overdoses on either an acidic or basic drug, the opposite can be given to ionize the drug to promote excretion.
Pt presents to the ED with c/o a break of the distal phalanx of the Hallucis. Name the muscle that is affected, what innervates it, and the action it performs.
What is the
Pt in an institution needs a re-evaluation for independence. Name the functional status assessment tool that is the best for this pt.
What is the ADL? This functional status assessment is the most appropriate instrument to assess function status as a measurement of the client's ability to perform activities of daily living independently. IADLs are useful in assessing the small changes in function, but are not useful in institutionalized pts.
Pt presents to the office with c/o pelvic pain. The physician decides to perform OMT, but needs to diagnose the pt first. Before looking for the landmarks, the pt needs to have their pelvis reset which can be done by either ____, ____, or ____. Then, upon testing pelvic restriction, they find a negative SFT. Name the next steps.
What are Pelvic bridge, lateral leg swing, and prone resetting? If the pt has a negative SFT that means that either there is no dysfunction or that there is equivocal dysfunction in both innominates. The Physician would perform an ASIS compression test to test SIJ mobility and dysfunction.
Lateral ankle sprain most commonly affects the _____ (Grade I), with the ____ being affected next (Grade II), and the ____ being affected last (Grade III).
What is the anterior talofibular ligament (AFTL), calcaneofibular ligament, and the Posterior talofibular ligament? With a lateral (inversion) ankle sprain, the lateral ligaments are the ones affected. The posterior talofibular ligament is the strongest ligament with the anterior talofibular ligament being the weakest.
Name the two phases of the metabolism by the liver and the population(s) deficient in enzymes for acetylation.
What are phase I (makes the drug more polar and water-soluble) and phase II (makes the drug very polar for kidney excretion) with infants being deficient in enzymes involved in acetylation? Phase I metabolism of the liver involves processes completed by the CYP450 enzyme and involves oxidation, reduction, and hydrolysis. The Phase II metabolism of the liver is called the conjugation process and uses enzymes for acetylation, glucuronidation, and sulfation.
Pt presents to the ED with c/o pain/achiness with active and passive knee flexion and extension with a firm mass between the medial head of the gastrocnemius and the semimembranosus palpable with full extension of the knee. Explain what this condition might be, how to diagnosis, and what to look out for.
What is a Baker's cyst due to the change in palpation based on position which is not found in other signs such as popliteal artery aneurysms and it can be diagnosed with an Ultrasound to which if cloudy, most likely is infected and must be taken out with extreme care to prevent sepsis and death? Moreover, this is a presentation of a BAker's cyst because the calf does not have pressure as seen with a DVT, the leg is not erythematous or edematous.
Pt presents to their wellness visit for dizziness. Pt states that they're currently on 6 medications chronically. Upon testing their blood pressure sitting down, they have 140/90. Upon standing the pt has a recheck(within 5 minutes of standing) and their blood pressure to which changed to 140/80. Name the most likely cause of the pt's problem.
What is orthostatic hypotension? Pt might also have adverse reactions from polypharmacy. Orthostatic hypotension is defined as a change in 20mmHg in systolic BP or 10mmHg in diastolic BP within the first 2-5 minutes of standing. Dizziness, falls, weight loss, weight gain, and changes in memory or ability to think and process information are all common side effects of medicines in older adults.
Pt presents to the clinic with a left Inferior Pubic Shear. Describe the presentation.
What is the pubic tubercle is down on the left which is coincidentally the same side that has a (+) SFT? With the Inferior Pubic Shear, there is typically a muscle imbalance and can be associated with an anterior innominate rotation or shear. If the pt's ipsilateral innominate(ASIS, PSIS, Iliac crest) was down then it would be considered an inferior innominate shear(downslip).
Pt presents to the ED with a stab wound on the superior 2/3 of the anterior surface of the fibula. Name the muscle affected along with its action and innervation.
What is the extensor digitorum longus with the action of extending the lateral 4 digits, dorsiflexing the ankle, and is innervated by the deep fibular nerve?
Pt has a steady state of 12h and a volume of distribution of 200L. Find the clearance of this pt.
What is 46.2 L/h? First, steady-state concentration is 4x the half-life.
T1/2 = (.693 x Vd)/Clearance
3 = (.693 x 200)/Clearance
Clearance =(.693 x 200)/3
Pt presents to the ED with c/o inability to plantarflex their right foot after running 8 miles today when they felt a loud gunshot-like sound. Their right heel is tender and swollen with feeling like they were "kicked in the calf". Pt states that they are still able to flex the digits 2-5 and invert their foot. Name the pt's affected structure.
What is the calcaneal (Achille's) tendon? These muscles are part of the superficial posterior compartment and include the gastrocnemius, soleus, and plantaris. Most Achille's tendon tears have a loud popping sound and might not show symptoms besides the inability to "push off".
Pt is an elderly adult that presents to an emergency visit with their SO due to recently being diagnosed with Stage I Osteosarcoma. When the physician enters the room, they introduce themselves, wash their hands, and adjust the lights to be dimmer. The Physician sits across from the pt at eye level, but speaks fast and seems like they are trying to race out of the door. When asking about Advanced Directives, the pt states that they do not know what that is. Explain what went wrong in this encounter and how to discuss advanced directives with this pt.
What is that the lights should have been brighter rather than dimmer and that they should not be talking too fast so they can leave room for answers and understanding? The physician should normalize the conversation and instruct the pt that it is just to make sure that their wishes are taken care of in the case they are incapable.
Pt presents to the clinic with a (+) SFT on the left. Additionally, when feeling the ASIS and PSIS on the right, they noticed that it felt like it was "down" in comparison to the left. Pt's Pubic tubercle on the left felt like it was "up". Name the diagnosis.
What is an "Upslip"? The pt had a (+) SFT so the rest of the diagnosis must be in relation to the left side. Since the right ASIS and PSIS felt "down" the left side must be feeling "up" and the Pubic tubercle on the left was already found to be "up" so it must be an "upslip". If just the Pubic Tubercle was "up" then it would be a superior pubic shear, and if just the ASIS that was "up" then it would be a posterior innominate. Conversely, if it was just the PSIS that was up, then it would be an anterior innominate.
Pt presents to the ED 1 day after their 10-hour flight. They are c/o right leg edema, erythema, and calf tightness worsening with walking. Explain this pt's condition. BONUS! name a common drug given for this condition and whether it can be given to this pt. DOUBLE BONUS! name the condition commonly found in pts after they are deceased from a DVT.
What is a DVT in the right leg? These symptoms are common in DVTs (due to the stasis of blood flow) and since the pt was just on a 10-hour flight, it can be expected that they have a DVT and it can be confirmed by utilizing an Ultrasound. BONUS! the drug that is usually given tPA within the first 45 minutes, but since the pt did not show up until a day later, they consider it "out of time range". DOUBLE BONUS! Pulmonary embolism are usually found only once the pt is deceased and even if it is found in alive pts, there is a 10% chance of survival.
Pt is in the hospital post-op and is in need of IV Morphine. In order to maintain the therapeutic range, the physician orders for the level to have a steady state of 3 hr. This drug has a volume of distribution of 243 L. Find the loading dose needed for this pt.
What is 729L*hr?
Loading dose = (Vd x Css)/ F
Loading dose = (243L x 3hr)/1
Loading dose = 729L*hr