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PCM-II Exam One (E. McD) > Back and Lower Extremities - Pitcher > Flashcards

Back and Lower Extremities - Pitcher Flashcards

1
Q

What type of synovial joint is the knee joint?

A

Condylar

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2
Q

What type of joint is the foot?

A

Hinge

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3
Q

Two main areas of lumbar spine inspection during exam?

A

Posture and gait

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4
Q

The iliac crest is located at what spinous process level?

A

L4

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5
Q

Three main areas of lumbar spine neurologic exam?

A

Reflexes, sensation and strength

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6
Q

Muscle strength testing scale (again)?

A 
0 = no movement
1 = muscle twitch without joint movement
2 = movement only with gravity eliminated	
*3 = movement against gravity only
4 = movement against gravity + some resistance
5 = movement against gravity + full resistance
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7
Q

***Lumbar neuro exam, sensory deficits:

A

***Sensory area changes:
L4 is lateral strip ankle to large toe
L5 mid top of foot and most of plantar surface
S1 lateral strip of foot

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8
Q

Viscero-somatic reflexes (brief understanding)?

A

If there is disease or pathology in organs, they can reflect a somatic dysfunction in these segments of the spine giving clues to the diagnosis.

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9
Q

Where is the most common area of injury or source of pain from the lumbar spine?

A

L5-S1

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10
Q

Ankylosing spondylitis triad of symptoms?

A

Sacroilitis (SI pain), Uveitis (photophobia and eye pain), and arthritis (generalized) (Reiter’s syndrome?)

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11
Q

Ankylosing spondylitis details?

A 
Hereditary, chronic inflammatory disease  (HLA-B27)
Pronounced  lumbar lordosis
Sacroiliac tenderness (sacroilitis) often the source of their “back pain”
Other body systems affected as well: uveitis (photophobia,pain), general synovial arthritis (hip/shoulder most common) enthesopathathies (inflammation at tendon insertion)
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12
Q

What do you think about in regards to osteoarthritis?

A

Deterioration (common at L5-S1 level of spine)

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13
Q

What do you think about in regards to osteoporosis?

A

Thinning of bone…compression fractures are the source of back pain here

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14
Q

Requirement for sciatica dx?

A

Pain must radiate below the level of the knee

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15
Q

Main test for sciatica?

A

Straight leg raise (sciatica vs. hamstrings)

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16
Q

Description of the hip joint?

A

“stabilizer”

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17
Q

What type of joint is the hip?

A

Spheroidal synovial

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18
Q

With hx of hip dislocation, what do we need to worry about?

A

Femoral head necrosis

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19
Q

What are the most sensitive exam indicators of true hip (hip joint) pathology?

A

Internal and external rotation (***true hip pain is deep inguinal, not lateral)

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20
Q

Location of pain with trochanteric bursitis?

A

Lateral (duh)

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21
Q

How do you inspect/palpate the inguinal ligament?

A

Place the pt supine, then place heel on opposite knee, palpate ASIS to pubic tubercle

NAVEL (lateral to medial = nerve, artery, vein, empty space, lymph nodes)

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22
Q

Trendelenburg test?

A

Evaluates gluteus medius (hip stabilizer during ambulation) muscle

23
Q

Ober test?

A

Evaluates iliotibial tract tightness/ITB syndrome

abnormal test = leg remains in abducted position, ITB tight

24
Q

Thomas test?

A

Flexion contractors of the hip due to tight psoas (iliopsoas)
flex leg to abdomen, positive would be when other leg comes off of table

25
Q

FABER testing

A

flexion, abduction and external rotation

looking to reproduce their pain

26
Q

Leg length discrepancy?

A

measure distance from ASIS to medial malleoli

27
Q

Knee is a ________ joint

A

condylar (synovial hinge joint)

28
Q

Bursas of the knee?

A

Prepatellar, pes anserine, suprapatellar pouch

29
Q

Pain, symptoms, hx, signs with pre patellar bursitis?

A

Anterior pain, dome swelling over patella with tenderness, usually from excessive kneeling, “housemaid’s knee”

30
Q

Anserine bursitis signs?

A

Medial pain, excessive running is a common cause, can also be from valgus knee deformity and arthritis, difficult to differentiate from a pes anserinus tendonitis

31
Q

Baker’s cyst signs (extra-capsular)?

A

Posterior pain, cyst found in popliteal fossa, can extend medially, check for fullness and tenderness posteriorly when knee is in full extension

32
Q

Sign of tendonitis?

A

tenderness with active ROM (muscle engages and pulls on tendon)

33
Q

Sign of bursitis (vs. tendonitis)?

A

Pain is equal with active or passive ROM

34
Q

What is a balloon sign?

A

Suggests a large effusion

35
Q

Bulge sign?

A

Suggests a minor effusion in suprapatellar pouch

36
Q

What is balloting?

A

Compress suprapatellar pouch, use other hand to sharply press patella to feel for fluid returning to suprapateallar pouch…also for large effusions

37
Q

Patellofemoral grind test?

A

extend leg, place pressure over patella, ask patient to contract quads… reveals chondromalacia or patellofemoral syndrome

38
Q

Apprehension testing?

A

tests for dislocation or subluxation of patella… attempt to manually is locate patella laterally…observe patient’s facial expressions

39
Q

Anterior drawer sign?

A

flex knee to 90 degrees, pull tibia forward to check for movement anteriorly…positive test = ACL tear

40
Q

Lachman test?

A

Only good for ACL (knee flexed at 15 degrees, move femur and tibia in opposite directions)
***always test both knees, asymmetric findings most important

41
Q

Posterior drawer testing?

A

Tests for PCL laxity/tearing (push tibia posteriorly when knee flexed at 90 degrees)

42
Q

McMurray test?

A

Pt supine, fully flex knee, grasp heel and point to the direction of the meniscus getting tested (external rotation for medial meniscus and IR for lateral meniscus)

***not a very specific test

43
Q

Apley’s compression test?

A

Pt prone with knee flexed at 90 degrees, stabilize thigh with one hand while leaning onto heel compressing medial and lateral menisci…rotate heel during compression noting any pain

44
Q

Key features of patient presentation for a meniscal tear?

A

Locking or giving out: sensation of or actual occurrence

Not feeling they can trust the knee when walking or stepping off a curb

A catching sensation or true catching of the knee: sudden pain stops ROM, ie, suddenly cannot extend the leg fully

45
Q

Thessaly test?

A

Standing, rotatory motion on one leg at 5-10 deg, and again at 20 degrees

***More sensitive and specific for mensical injury or tear than McMurray, bent knee position best

46
Q

Homan’s sign?

A

Evaluates for DVT (deep venous thrombosis)

Dorsiflex patient’s ankle with leg extended at knee…pain in calf is a positive sign

47
Q

Thompson test?

A

Patient prone, leg bent 90 deg, squeeze calf and observe for normal passive plantar flexion

Best to determine achilles rupture if done w/in 48 hrs of injury

(Thomas testing is for psoas!)

48
Q

What type of joint is the ankle?

A

Hinge, formed from articulating surface of the tibia, fibula and talus

Principal joints of the hinge are:
Tibiotalar joint
Subtalar (Talocalcaneal) joint

49
Q

Most commonly injured ligaments during a sprain of the ankle?

A

Anterior talofibular and calcaneofibular (lateral ankle)

50
Q

Ottawa Rules (Age > 18yr):

A

Inability to bear weight after 4 steps or tenderness over posterior aspect of either malleolus

***Always be suspicious of fracture

51
Q

Ottawa Rules (details):

A

Developed to avoid unnecessary radiography in ankle injury:

Perform an xray expecting to find a fracture if:
Pain around the malleolus and tenderness in posterior malleolar area or tip of fibula
OR
Pain around the malleolus and unable to weight bear immediately and more than 4 steps in ED
OR
Pain in mid-foot and either
1. Tenderness at base of 5th metatarsal or navicular, OR
2. Unability to weight bear immediately OR more than 4 steps in ED

52
Q

How to you distinguish if pain snot in the hip joint itself?

A

Lack of pain with rotation!

53
Q

When should you order a MRI of the spine?

A

When surgical signs/symptoms are present… atrophy, weakness or intractable pain.

PCM-II Exam One (E. McD) (8 decks)

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