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PCM Midterm > Approach To Pt With Joint Pain > Flashcards

Approach To Pt With Joint Pain Flashcards

1
Q

History of pain

A

OLDCAAARTS
Point to the pain
Anything that might have occurred to cause the pain

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2
Q

Mechanism of injury

A

Direction of force
What did joint do
What did it feel like at the time
Any sounds or sensations

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3
Q

Sprain

A

Ligaments stretch causing tearing
Tearing causes bruising
Greater the tearing of the ligament, the greater the blood loss and subsequent bruising
May fee or hear a “pop”

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4
Q

Strain

A

Muscle is stretched

“Grabbing sensation”

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5
Q

Assessing strain or sprain

A

Any immediate swelling or bruising?
Could you still use the joint (walking/standing)?
How does it feel now?

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6
Q

Symptoms

A

What the patient feels
Pain
Stiffness

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7
Q

Signs

A 
What can be observed, measured, and described
Warmth
Redness
Swelling
Pain
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8
Q

Injury

A

Definitive onset
General mono-articular
Generally unilateral

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9
Q

Non-injury

A 
Insidious or gradual
Associated with constitutional symptoms
Mono-articular or polyarticular
Unilateral or bilateral
Single or multiple joints
Migratory
Change with activity
Extra-articular signs: not on joint, but around joint
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10
Q

Mono articular

A

1 joint

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11
Q

Poly articular

A

Multiple joints

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12
Q

Migratory

A

Moves from one joint to another

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13
Q

Extra-articular

A

Bones, muscles, tendons, bursa, skin

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14
Q

Myalgia

A

Muscle pain

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15
Q

Arthralgia

A

Joint pain

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16
Q

Effusion

A

Fluid escaped from blood vessels or lymphatics into the tissues or a cavity

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17
Q

Tendinitis

A

Inflammation of the tendon

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18
Q

Bursitis

A

Inflammation of the bursa

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19
Q

Tenosynovitis

A

Inflammation of the tendon sheath

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20
Q

Genu varus

A

Bowed legs

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21
Q

Genu valgus

A

Knock kneed

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22
Q

Subluxation

A

Residual contact between two articular surfaces

23
Q

Dislocation

A

Complete lack of contact between two articular surfaces

24
Q

Sensitivity

A

The proportion of patient with the diagnosis that also have the physical sign (true positive)
Rules things out
SnOUT: a sensitive test it’s a negative result rules a disease OUT

25
Q

Specificity

A

The portion of the patient without the diagnosis who lacks the physical sign (true negative)
Rules things in
SpIN: a specific test with a positive result rules IN a disease

26
Q

Likelihood ratio (LR)

A

Values between 0 and infinity
LR>1 increase the probability of a disease
The greater the value of the LR, the more likely the diagnosis or disease
LR<1 decrease the probability of disease
The closer to 0, the probability of the disease or diagnosis decreases
LR=1 do not change the probability of the disease

27
Q

What should you always do when assessing a joint

A 
Do it BILATERALLY
Observe
Palpation
Range of motion
Neuro
Vascular
Diagnostic testing
28
Q

Muscle strength testing

A

0-no visible or palpable contraction
1-visible or palpable contraction with no motion
2-full ROM with no gravity
3-full ROM against gravity
4-full ROM against gravity, with moderate resistance
5-muscle contracts normally against full resistance

29
Q

Reflexes

A

4+-very brisk, hyperactive it’s clonus 9rhythmic oscillations between flexion and extension)
3+-brisker than average, possibly but not necessarily indicative of disease
2+-average; normal
1+-somewhat diminished; low normal
0-no response

30
Q

Triceps reflex

A

C7

31
Q

Biceps reflex

A

C5,6

32
Q

Brachioradialis reflex

A

C5,6

33
Q

Patellar reflex

A

L2-L4

34
Q

Achilles reflex

A

S1

35
Q

Capillary refill

A

Compress digit between index and thumb to cause blanching; release pressure and note time to regain color
Normal time-2 sec or less
Tests digital perfusion (e.g. arterial occlusion, hypovolemic shock, hypothermia)

36
Q

Pulses

A

0/4 absent
1/4-palpable, but thready and weak; easily obliterated
2/4 normal, easily identified; not easily obliterated
3/4 increased pulse; moderate pressure for obliteration
4/4 full, bounding, cannot obliterate

37
Q

Edema

A

Pressing firmly for 5 seconds over the dorsum of foot, anterior tibia, or behind medial malleolus
0-absent
1+: barely detectable, slight pitting (2mm); disappears rapidly
2+ slight indentation (4 mm); 10-15 seconds
3+ deeper indentation (6 mm); over 1 minute
4+ very marked indentation (8 mm); 2-5 minutes

38
Q

C2 Dermatomes

A

Ears

39
Q

C3 dermatome

A

Front of neck

40
Q

C4 dermatome

A

Across clavicles and over shoulders

41
Q

C5 dermatome

A

Superior lateral arm

42
Q

C6 dermatome

A

Lateral arm-forearm and thumb

43
Q

C7 dermatome

A

Middle 1 finger plus lateral half of first finger and medial half of 3rd finger

44
Q

C8 dermatome

A

Pinky finger

45
Q

T4 dermatome

A

Nipples

46
Q

T10 dermatome

A

Umbilicus

47
Q

L1 dermatome

A

Inguinal region

48
Q

L2 dermatome

A

Very top of thigh by femoral triangle

49
Q

L3 dermatome

A

From lateral superior thigh crossing diagonally to medial inside of knee

50
Q

L4 dermatome

A

Lateral middle thigh crossing over knee and down to medial leg

51
Q

L5 dermatome

A

Lateral superior leg crossing over to big toe

Anterior ankle and foot

52
Q

S1 dermatome

A

Lateral thigh and leg and little toe (posterior side)

53
Q

S2 dermatome

A

Posterior side

Medial thigh and leg

54
Q

T1 dermatome

A

Posterior medial side of arm and forearm

PCM Midterm (8 decks)

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