Y3S1W8: Exposed

Pulpit Rock, Silverpeaks, Dunedin.

We had another great week of classes followed by an ANZAC remembrance weekend. The Silverpeaks is a tramping area on Dunedin's doorstep - I took a few hours off to walk to Pulpit Rock (en-route to Jubilee Hut). Having pondered the involvement of physiotherapists in historic conflicts (in this sub-alpine, exposed but beautiful landscape - thankfully there were no guns fired), I scouted the internet and found this great article by AUT University's Dave Nicholls: http://criticalphysio.me/2015/04/20/physiotherapy-at-gallipoli-a-small-commemoration/

Path switched tracks this week to look at liver disease, but not before our tutorial examined deep vein thrombosis, "junk in the pulmonary trunk" (saddle embolism), and other thrombi-embolus related case studies. We've got a path exam next week, and so we'll probably spend the weekend revising our notes. I suspect there'll be similar questions (with the addition of histological images) to what we've had in our weekly pre-tutorial quizzes - here are five examples of questions we've had so far (answers are at the bottom of this week's blog).

 1. The inflammatory exudate consists of:
A) Cells accumulating outside the blood vessel
B) Cells and fluid accumulating inside the blood vessel
C) Fluid accumulating outside the blood vessel
D) Cells and Fluid accumulating outside the blood vessel
E) Proteins accumulating outside the blood vessel

2. In acute inflammation, the kinin and coagulation cascades may be activated by:
A) CRP
B) Factor XII (Hageman Factor)
C) Complement
D) Fibrinogen
E) Bradykinin

3. Which of the following is usually the cause of rheumatic fever?

A) A highly virulent organism affecting a normal valve

B) A low virulence organism affecting a damaged valve

C) Sterile vegetations on a damaged valve

D) Exacerbation of the immune response

E) A low virulence organism affecting a normal valve

4. Which of the following is true about polymorphisms in apolipoprotein E?

A) They lead to at least 6 Apo E phenotypes

B) They are genetic variations in the coding genes for Apo E

C) They are associated with changes in LDL levels

D) All of these options

E) They can be used as risk markers for atheroma

5. Platelets become activated, adhere and aggregate on contact with:

A) Aspirin and warfarin

B) Collagen and von Willebrand factor

C) Red blood cells and megakaryocytes

D) All of these options

E) Intact endothelium and endocardium

We've had our first lab for electrophysical agents, and although there wasn't much 'electro' (unless you count the freezer, or heating appliances) we did experience some heating and cooling agents.  We practiced our ice massage, paraffin wax 'dip and wrap' technique, using the hydocollator heat packs, cryo-cuffs etc - all taking in to account the preparation, application, precautions/contraindications/indications for each modality. My favourite was the paraffin wax! The wax is quite hot on the bear hand, but feels cooler with each dip and layer. We then place our plastered hand in to a plastic bag and wrap it in a towel - this feels very relaxing. It's fun taking the wax off too. The wax is stretchy and peels off cleanly. Once it's off, you can play with the warm ball of wax before putting it in the tub to heat up and liquify again.

Paraffin Wax!!

We had a MSK lecture, lab and tutorial this week. In the lecture we took a step back to recap exercise prescription principles, then we applied these to two upper limb case studies in the lab. Exercises ranged from reeling up a weight on a stick and twisting a towel, to using a hockey stick (acted out with a walking stick).

Neuro was all about perception. If you enjoy visual illusions, then you would enjoy this lecture. Our lecturer also presented info on agnosia and apraxia. An interesting video clip of a man with an ideomotor dressing apraxia was shown - he took many minutes to put the shirt on. The length of time taken wasn't due to him not knowing what it was, or not knowing what the action should look or feel like, the problem was executing a motor programme in the right sequence to successfully put the jersey on. The image below is an exaggeration, but accurately depicts how we felt watching the clip (face-palm)...

I was at the sport injury clinic on Saturday from 1-6pm. We had a range of sports injuries flow through... some patient's appeared to be in the wars! The highlights for the day (for me at least) were two dislocations. The first was a dislocation of a patella. Three medics (myself included) arrived with a stretcher to find the basketball player lying on court (in which they were playing on). The patella was stuck on the lateral aspect of the players bent leg. We guided the patella back as we straightened the leg, and it relocated easy as! We then had the player on the stretcher and back to our clinic for an assessment and referral for an x-ray to rule out any bony damage. As we left the bball court the teams gave us a cheer and an applause before the game resumed. The second dislocation was of a rugby player who went into a tackle and came out second best. Two of us medics were needed to relocate the shoulder. Under a medical doctor's supervision, we had the patient in prone lying, one sports medic was applying a sustained distraction to the patients shoulder at about 100deg flexion and I was sustaining an end-range passive scapulae rotation. Soon enough there was a clunk, and the shoulder was back in place. Other injuries I saw today included a suspected concussion, upper thoracic pain following a rugby scrum, thigh contusion, suspected radial fracture, and knee MCL sprain. Other medics helped suture a few eyelids amongst other things (we were all pretty busy!)

Quiz Answers: 1D, 2B, 3D, 4D, 5B