Clinical Flashcards
What 3 things must you look for always on elbows?
- Gouty tophi
- Psoriatic plaques
- Rheumatoid nodules
How does carpal tunnel syndrome present?
Paresthesia in thumb and distal 2 1/2 fingers
Loss of sensation - worse at night (improved by hanging hand out of bed)
Weakness in thumb/clumsiness when using hand
Define parasthesia
Abnormal sensation in skin with no apparent physical cause
Pins n needles
Stinging
Burning
Numbness
In what condition may you find wasting of thenar eminence?
Severe carpal tunnel syndrome - due to median nerve compression
What test can be done specifically for carpal tunnel syndrome alongside testing for sensation in affected fingers and Tinel’s test (percussing over median nerve)?
Phalen’s test
Hands in reverse prayer position - if +ve will cause parasthesia
What can confirm carpal tunnel syndrome diagnosis?
Nerve conduction studies
What advice must be given to patients on long dose steroids?
Don’t STOP
Don’t - do not stop steroids as body is now dependant
S - sick day rules - increase meds if feeling unwell
T - treatment card - carry on at all times
O - osteoporosis prophylaxis - bisphosphates + Ca2+ and vit D supplements
P - PPIs
What fingers are felt to test for function of:
median nerve
radial nerve
ulnar nerve
Median nerve
- palmar thumb and radial 2 1/2 fingers
- dorsal 2 1/2 radial fingertips
Radial - back of thenar area and thumb
Ulnar - both palmar and dorsal remaining fingers not affected by median nerve and hypothenar
What tests can be done to test for carpal tunnel syndrome?
Phalen’s test - hands hanging freely for 30s-1min
Tinel’s test - tapping over carpal tunnel causes electric shock sensation
Phalens = falcon = falling = flopped hands Tinels = Tapping
What does Froment’s test test the intergrity of?
How is it conducted?
Paper between thumb and forefinger - thumb flat
Try pull paper away
Tests intergrity of ulnar nerve - tests ADDuctor pollicis
Define valgus
Define varus
Valgus - distal part of limb more lateral from midline
Varus - distal part of limb more medial to midline
L in vaLgus = l in Lateral
How to tell between growing pains and something more suspicious?
Growing pains DO NOT CAUSE LIMP
If a child presents with knee pain what must be done?
Hip examination - can be referred pain
Define sublaxation?
Partial dislocation
In what circumstances would you use a GALS examination?
Rheumatology when trying to establish what more detailed examination to do
What 3 questions must be asked in GALS examination?
- Do you have any pain in joints, muscles or spine?
- Do you have any difficulty dressing yourself?
- Do you have any difficulty getting up and down stairs?
What are the movements used to assess the hand in the GALS examination?
Make a fist
Thumb to each finger
Grip examiner’s hands
Grip across MCP joints
What must be remembered to be looked for in Gait section of GALS?
This may not be visible when lying up
Feet - check for arches
What are the 3 common gaits?
- Trendelenburg
- Antalgic - gait changed to reduce pain
- Stiff
How can you tell the difference between antalgic and stiff gait?
Stiff gait will be slow with little pain
Antalgic gait is painful with minimal time spent on affected side
If when moving shoulder actively patient has pain, you should try to passively assist the movement.
For the following responses what would the underlying pathology be:
- Able to fully complete movement with assistance
- Unable to fully complete movement even with assistance
Fully complete - weakness
Unable to complete - pain and stiffness
What is a painful arc on shoulder examination indicative of?
Rotator cuff problems
With orthopaedic issues is it generally better to keep active and mobile or rest?
Keep active and mobile
What questions should be asked to establish a patient’s pain level?
- Analgesic use?
- Rest pain?
- Sleep disturbance?
After how many weeks does a rheumatological condition go from acute to chronic?
6 weeks
How is carpal tunnel syndrome managed?
- Splintage
- Steroid injection
- Surgery
For the following ligament gradings: what does each mean?
Grade I
Grade II
Grade III
Grade I - sprain
Grade II - partial tear
Grade III - complete tear
What must be investigated at every dislocation?
Neurovascular sufficiency to the distal limb before AND after reduction
How do you correctly test neurovascular status?
Neuro - test sites that are supplied by peripheral nerves
Vascular - pulse, cap refill, temperature
When assessing functional status when taking a history of an injured limb, what information must be attained?
- Dominant hand?
- Previous function of limb?
- Employment (could have a massive impact on career)
When a patient comes in with trauma what is the anagram for the quick history that is vital to be collected?
Explain it
AMPLE
Allergies Medications PMH Last ate Events leading up to presentation
What does “collateral history” mean?
History from those other than patient
How do you assess neurological status of lower limb?
- Deep peroneal/fibular nerve
- Superficial peroneal/fibular nerve
- Tibial nerve
Deep peroneal/fibular nerve - 1st dorsal web space
Superficial peroneal/fibular nerve - dorsum of foot
Tibial nerve - sole of foot
When in resus all patients should be put on high flow oxygen. 15l through non-breather mask. True or false?
True
What is the only liquid that should be used as a fluid for resus?
If needing IV access, where is the cannula fitted and what type is fitted?
Blood (O- if unsure of patients blood type)
Cubital fossa
How high must your systolic pressure be to have a radial pulse?
80 mmHg
Describe the term “permissive hypotension”
This is the understanding that the first clot is the best clot.
Do not want to greatly increase BP as to damage clot formed by body.
Keep BP at around 80mmHg systolic to prevent damaging clot formed but keep perfusion to the brain
Why would tranexamic acid 1g IV be used?
To promote clotting
With intense bruising and trauma to the abdomen what should be suspected?
How is this investigated?
Internal bleed
CT
Why is the patients head rested at 30 degrees if C-spine cleared?
Reduces cranial pressure
What are the 5 factors required to clear a C-spine injury?
Is it better to have a poorly fitted neck brace or no brace at all?
- No post midline cervical tenderness
- No evidence of intoxication
- No distracting injuries
- Alert to situation
- No focal neurological defect
Can be v difficult in major trauma without CT
No brace at all
Damage to what muscle causes a winged scapula?
Serratus anterior
What does a raised ALP mean?
Increased osteoblastic activity
