H&P II
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| Spine fxn | protection of spinal canal, structural supports, movement
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| Herniated disc | slipping or weakness of annulus fibrosa and pertrusion of nucleus pulposa
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| Numbness and weakness are associated with what? | Numbness: sensory, weakness: motor
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| How does smoking ↑ back pain? | ↓ blood flow, low regeneration of the interveterbral discs
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| What nerve is associated w/ loss of B/B fxn | L5,S1: loss of muscle tone in pelvic floor
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| contraction of the sternocleidomastoid muscle suggests | torticollis: Lateral deviation and roatation of the head
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| trendelenburg gait suggests | abnl fxn of glut medius in opposite side
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| Types of curves of lumbar and cervical spine | concave
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| Types of curves of thoracic and sacral spine | convex
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| When is winging of the scapulae seen | long thoracic n. palsy: loss of innervation to serratus ant.
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| Asmmetry of iliac crest suggests | leg length discrepancy, or listing to one side: herniated lumbar disc
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| Tenderness at C1-2 in RA pt’s is a red flag for what | subluxation leading to cord compression
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| 1in lateral to the spinious process of c2-c7 | facet joints, deep to trapezious, not palpable if muscles aren’t relaxed
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| Lumbar step off joints suggest | suggests spondylolisthesis or fracture
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| Halfway b/w midline of spine and PSIS of pelvis | SI joints
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| Where is the sciatic notch | midway between the greater trochanter of the hip and ischial tuberosity of the pelvis
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| Tenderness over the sciatic notches suggests | impinging on L4,5, S1,2,3 nerve roots
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| How do we asses the sacrococcygeal joint | nl has no movement
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| What does the straight leg raise test imply | 0-30: n. root compression, 30-60: sciatica n. irritation >60: suggests lumbar arthritis or disc dz
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| Problems w/ hip flexion suggests | N. root compression T12, L1,2,3region
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| Problems/pain with knee extension suggests | n root compression at L3 and L4
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| Weakness w/ ankle dorsiflexion suggests | n. root compression of L4,L5
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| Great toe extension pain/problems suggests | L5 compressions
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| Plantar flexion power aka toe raises difficult means | s1
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| Strength testing | 3: gravity, 4: some resistance 5: nl resistance 2: minus gravity 1: muscle contraction w/ limited motion
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| What does CMS stand for | circultation, motor, sensory
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| Four joints of the shoulder | AC GH SC Scapular thoracic
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| What are the functional ligaments of the shoulder? | Glenohumeral ligaments
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| Function of the rotator cuff | keep humeral head within joint, abducts, externally and internally rotates
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| How can we determine b/w tendonitis vs RCT? | strength test, can still do it w/ tendonitis, just hurts
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| Resisted external rotation tests | infraspinatus and teres minor
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| Internal rotation tests | subscapularis
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| Emplty can tests what | supraspinatus
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| Lift off tests what | subscapularis
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| How can we test for a supraspinatus tear? | abduct arm w/ elbow straight up, bring down to 90degress and let go, if pt’s arm drops and can’t hold it up
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| XR signs of a RCT | high riding humerous
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| What pain is worse at night, outer deltoid pain, especially when reaching over head | impingement syndrome
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| Signs of impingment syndrome | neer’s impingment, abduction, Hawkins
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| Two signs of shoulder instability | apprehension test and the sulcus when pressure is applied
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| Do pt’s get weakness in the arm w/ a biceps tendon tear? | not always because have the brachialis and brachioradialis for other flexors
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| Pelvis is formed by fusion of what | pubis, ileum, and ischium
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| Hip abductors and adductors | gluteus medius and minimus,, adductor brevis longus and magnus
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| Site of pain, radiation, and aggravators for Hip joint pain | Ant, groin, wide, joint movement
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| Site of pain, radiation, and aggravators for n. root L1/L2 herniation | Groin and back, leg, straining
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| What do we palpate for in the femoral grove | nerve, artery, vein, empty space, lymph node (NAVEL)
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| How do we measure true leg length | ASIS to inferior border of medial malleolus
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| Used to detect a fixed flexion deformity of the hip | Thomas’ test
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| Deep boring pain in the gluteal region | Trochanteric bursitis, either truma or pressure or OA
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| Hindfoot, midfoot, forefoot | H: talus and calcaneus M: navicular, cuboid, 3 cuneiforms, F: metatarsals and phalanges
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| Severe inversion of ankle injury often when jumping, pain w/ wt bearing | Jones fracture
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| Mc age for achillie tendon rupture | 40yo, feel like being hit w/ a bat
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| First step feels like stepping on a pin, improves w/ heat and activity | plantar fasciitis
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| In MN where is gout commonly seen | men and hmong
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| MOI is longitudinal injury to foot landing on toes | Lisfranc joint injury
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| Tests for ankle stability | talar tilt test: lateral ligament stability, anterior drawer test
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| Test for the syndesmosis | widened or displaced mortise joint of the ankle
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| Test for Achilles tendon rupture | Thompson test: if rupture still may have some movement: COMPARE L & R
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| Lisfranc injury | injury to the tarsal metatarsal joint d/t landing on toes
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| What position is it easier to give knee injections | flexed
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| Pain that gets worse in the eve or during/after exercise, improves w/ rest suggests | intra-articular pathology
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| Pain when going up/down stairs or aching in positions when kept flexed for long periods of time suggests | patellar or patelofemoral problems
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| Pain that occurs when the knee is hyperflexed and pain w/ twisting suggests | meniscal pathology
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| Is popping or clicking of the knee nl? Locking? | yes, and no: meniscal injury
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| Pain w/ weight bearing suggests | tibial plateau frx or other intra-articular injury
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| How do meniscal injuries occur | twisting or declaration
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| What is the terrible triad | ACl, MCL and medial meniscus tear
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| Concern w/ dislocation/subluxation of the patella? | injury to the popliteal artery
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| Where do patellar, quad, and IT tract tendonitis present pain | Distal to knee, prox. To patella, and lateral leg along tensor fascia lata
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| Non contact injury w/ a pop most likely | ACL tear d/t hyperextension
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| Contact injury w/ a pop | ACL, PCL, meniscal tears or a fracture
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| Acute swelling of knee could suggest | ACL, PCL tears, frx, patellar dislocation, knee dislocation ant or post
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| Knock-kneed, bow-legged | Genu Valgum, Genu Verum
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| J sign | as knee goes from extension to flexion, the patella tracks sup and lat d/t too strong of quads: vastas lateralis
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| Buldge sign | for mild effusions, “milk” the fluid down place pressure over medial joint line and tap on lat:fluid wave
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| What is the Balloon sign | for lg effusions, 1 hand sup and 1 hand inf to patella, or just tappin on joint sends fluid save
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| Balloting the patella | for lg effusions, compress suprapatellar pouch w/ one hand and patella w/ the other, + if fuild felt being forced into suprapatellar pouch when patella is compressed
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| Two tests for ACL assessment | Anterior Drawer test, Lachman’s test
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| Tests for PCL injury | Post drawer test, Sag sign
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| Two tests for meniscus evaluation | apley’s grind test: prone, McMurry’s test: supine
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| Difference b/w weakness and general fatigue | weakness: muscular, fatigue:to tired to do anything
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| Proximal vs. distal weakness | P: myopathy, D: neuropathy
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| Order of the ortho PE Insepection, Palpation, ROM, Muscle testing, CMS, special tests |
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| Through all PROM no pain | usually extra-articular, w/ pain w/ PROM: intra-articular
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| Fracture through one cortex | greenstick fx
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| MOI is shearing/twisting motion | oblique frx
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| Buckling of the cortex | torus frx
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| Salter-Harris | SALTR: I: physicis, II: metaphysis, III: epi, IV: both epi and meta, V: crush to physis
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| What will plain films show | frxs, joint effusions, joint crystals, arthritis, ST swelling and foreign bodies
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| Good for soft tissues like ligaments and cartilage | MRI scan
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| How do we describe a fracture e | Location, Direction of line (transvers/oblique), Relationship of fragments(displacement, angulation, shortening, rotation) # of fragments (simple/comminuted) Communication w/ atmosphere
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| Are plain films the study of choice for osteoporosis/osteopenia | no d/t variation in XR technique
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| Nerves to the sensory of the hand | Radial: dorsum only, ulnar: 4th and 5th digit, median: palmer
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| Two point discrimination should be how mm apart | 6mm
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| Smoking can cause what in the hand | raynaud’s phenomenon
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| What can psoriasis show up as in the hands | nail deformities eg. Pitting, and psoriatic arthropathies
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| Name the flexors and extensors of the thumb | EPL, EPB, and FPL
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| What joints to OA and RA commonly affect | OA: DIP and PIP RA: MC and wrist
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| Two signs for CTS | Phalen’s and Tinnel’s and Scratch and n. compression test
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| Two tests for ulnar nerve conmpression | Pope’s blessing and fromenents signs
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| Palpation over the MP joint w/movement of finger causes clunking and cracking | Trigger finger of extensor
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| Test for thumb arthritis | CMC grind test, axial force on thumb and grind 180 degrees: pain and clunking
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| What should we asses in a finger lac | digital n. sensation PRIOR to anesthesia
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| 90% of spinal inturies are d/t what? MC area? | blunt force trauma, Cervical MC
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| When do we immobilize the C-spine in a trauma | after ABC’s and life has been assessed
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| Two studies done on clinical c spine clearance | nat’l emergency XR utilization study (NEXUS) and Canadian C-spine study
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| Nexus criteria | 1: no post midline cervical tenderness 2: nl level of alertness 3: no focal neuro deficits 4: no painful distracting injuries 5: no evedince of intoxication
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| Canadian C Spine rules | fall from 3ft or 5stairs, axial load to head/spine, MVA at high speed >100km/hr or rollover/ejection, bicycle collision, colisions w/ motorized recreational vehicle
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| Which criteria is better for cspine clearance | Canadian Cspine rule
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| Name three primary methods of cervical spine imaging | plain films, ct and mri: no really used
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| Three views for c spine | lateral, opontoid, ap lat: 70-80% detection
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| What is the AP view used for | to examine angulation of lateral cortex of articular masses as compared w/ superior or inferior neighbors
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| Lateral xr should include what | C1-T`1, and four lines of the spine: Ant and Post longitudinal ligament line, spino-laminal line, spinous process line
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| What is the pre dental space | distance between posterior aspect of anterior arch of C1 and anterior aspect of odontoid process normally no more than 3 mm in adults and 5 mm in children
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| What measurement of swelling of the preveterbral space indicates a fracture | at C2: >7mm, at C6 >21mm
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| Angulation of more than what indicates abnormalities between the intervertebral spaces | 11 degrees
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| What would indicate ligament disruption on a plain film for a lateral c spine | fanning of the spinous processes
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| How do we evaluate the odontoid location | odontoid view, dens centered bw lat masses of C1, lat masses of C1 should be directly over lat portions of c2,
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| How do we check for rotation of the head in an odontoid view | the dens is inline with the central incisors
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| What are the three types of odointoid frxs | I: avulstion, II: “neck” frx III: through the body of C1
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| Functions and uses of a MRI | all pts w/ neuro deficits d/t spinal cord injury, evaluations of epidural space, herniated discs, hematomas and bone fragments,
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| Four flexion injuries of the c spine | flexion teardrop fx, clay-shoverler’s fx, wedge compression fx, bilateral interfacetal dislocation
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| Flexion-rotation injury | unilateral interfacetal dislocation
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| Hyperextension injuries | extension teardrop fx, hangman’s fx
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| Vertical compression injury | jefferson’s fx
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| Medical specialty devoted to prevention and management of occupational and environmental injury, illness, and disability | Occupational and environmental medicine
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| Temporary flareup of something related to a pre-existing condition (asthma) usually after an injury but recedes to former leven w/I a reasonable period of time | exacerbation
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| Fresh incident producing additional impairment to a previously injured anatomical region | Aggravation: usually not temporary: the arthritic employee
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| Anatomically or physically wrong with an individual and is a means where the medical care provider assigns a numerical rating for whatever type of bodily fxn has been lost | impairment: a % of impairment, can be permanent or temporary
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| Impairment combined w/ person’s age, ed background, other factor affect an injured workers ability to work | Disability
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| Impairment that can be overcome by some type of reasonable accommodation to the impairment | Handicapped
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| Injured workers are only able to do some type of limited work for a short period of time and that further recovery is expected | Temporary partial disability: most work related injuries
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| Person is unable to do any type of work for a temporary period of time | Temporary total disability Work Comp usually paid while injured worker is out of work: BE CAREFUL to hand these out
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| Injured worker cannot return to same type of work he was doing prior to injury and lost his ability to do the prior work | permanent partial disability: loss of a finger
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| Injured worker is unable to do any type of work of any kind and person is completely and permanently incapable of engaging in a type of substantial gainful activities | permanent total disability: loss of vision
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| Law that allows employees at least 12m LOA | FMLA Family and Medical Leave Act
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| Characteristics of FMLA | non-compensatory, JOB PROTECTION, when return, nomore than 12 wks/12m
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| Ensuring the candidate is qualified to perform essential fxns of the job prior to formal consideration for the position | pre-employment exam
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| Conducted after employee has been formally interviewed and is being considered for the position: also w/ a different role | pre-placement exam
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| The exam for occupations w/ significant risk of self or public injury | periodic exams: Aviation, DOT
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| A tool to ensure the employee is able to return after extended absence, usually from a medically leave | Fitness for duty
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| The injured employee has recovered to where no further recovery will happen | maximum medical improvement
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| Gap b/w their improvement and 100% | permanent partial disability
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| Specific modifications that are communicated form clinician to employer | accommodations
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| An employer is either obligated to accommodate per the clinicians modifications or send the employee home | Law of reasonable accommodation: a federal law
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| Work comp payment amount | 85% of employees pay w/o taxes
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| Written statement by the clinician given to the employee/and employer noting clinician dx, limitations, and work assessment | Report of workability
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| How long are work comp cases open? | 130wks or 910 days will get moved to perm partial disability
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