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osce/ comm & clinical > derm/ MSK > Flashcards

derm/ MSK Flashcards

1
Q

what are the general steps of an MSK examination

A

introduction
look
feel
move
special test
closure

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2
Q

what are you looking for in a hip examination

A

Quadricep/hamstring/gluteal muscle mass
gait: pace, symmetry, trendeleburg test
erythema, swelling, bruising, scar

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3
Q

what are you feeling for in a hip examination

A

Greater trochanter
Groin (mid-point and medially)

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4
Q

what is the patient moving in a hip examination

A

Flexion 100-130degrees
Internal rotation 15 degrees External rotation 40 degrees Adduction 15 degrees
Abduction 45 degrees
(only flexion is active)

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5
Q

what is the trendelenburgh test for in hip examination

A

assesses hip abductor muscle strength (gluteus medius, gluteus minimus and tensor fascia lata

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6
Q

how is trendelenburg test conducted

A

hold patient hands, tell them to balance on one feet, if hips tilt, abductor muscle on standing feet is weak

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7
Q

what is Thomas’s test for in hip examination?

A

identifies a fixed flexion deformity (incomplete extension) at the hip, when flexing, other leg raise on the bed= positive

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8
Q

what are the areas being looked at during shoulder examination

A

anterior, lateral, posterior, axilla
muscle wasting, asymmetry, scars, bruising, swelling

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9
Q

what are you feeling for in a shoulder examination

A

Sterno-clavicular joint, clavicle acromio-clavicular joint, acromion,
Long head of biceps Scapula (spine and body)

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10
Q

what is the move step of a shoulder examination

A

flexion
abduction
Internal rotation (record vertebral level reached)
external rotation
(do active, if abnormal do passive)

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11
Q

what does active/ passive movement reduce mean

A

active only: muscle weakness
active and passive: arthritis, capsulitis

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12
Q

what are the 2 routes of a shoulder examination

A
  1. arthritic, rotator cuff, impingement
  2. instability, subluxation, disclocation
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13
Q

what is the scarf test?

A

acromioclavicular joint
ask to patient to chock them self position, push their arm see if it hurts

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14
Q

what are the 3 tests for suspected rotator cuff problems

A

Supraspinatus Jobe’s test
Infraspinatus (arms on side push out)
Subscapularis (arm behind)
(muscle weakness= positive )

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15
Q

how is Supraspinatus Jobe’s test done?

A

shoulder abducted and slightly flexed forward, point thumb towards the floor.
you push down on their forearms

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16
Q

how is Infraspinatus test done

A

test power of external rotation against the resistance of your hand pushing against the patient’s forearm.

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17
Q

how is Subscapularis test done

A

test power of internal rotation patient to put their hands behind their back push their palm, tell them to resist

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18
Q

what are the tests for Suspected shoulder instability

A

Test for the sulcus sign
Anterior and posterior drawer tests
Anterior apprehension and relocation test

19
Q

how is the sulcus sign test done

A

on hand stabilize shoulder, other pull down on arm
if femur head translate inferiorly= positive sign

20
Q

how is the anteior and posterior drawer tests done

A

patient in bed, one hand stabilize shoulder, other pull arm anterior and posterior (up and down)

21
Q

how is the anterior relocation test done

A

patient lay down, abduct arm and bend elbow, push arm, if it hurts, push humeral head aswell. (imaging guy through a shot put)

22
Q

what are you looking for in spine examination

A

behind: head, neck, shoulder posture
side: cervical lordosis, thoracic kyphosis, lumbar lordosis
ask patient to bend forward
deviation? asymmetry? gibbus?

23
Q

what are you feeling for in spine examination

A

supraclavicular: cervical ribs, lymph
spinous process & para-spinal muscles
iliac crest heights & sacroiliac joints
chest expansion for ankylosing spondylitis

24
Q

what movements are necessary for spine examination (patient should sit down for the first part)

A

cervical: head to chest and back, head left and right, lateral flexion
lumbar: schooner’s test, back bridge, lateral flexion

25
Q

what are you looking for in a Knee examination?

A

quadriceps, valgus or varus deformity
hamstrings, swelling of popliteal fossae
look while they walk: Gait
bed: scars? skin changes? effusion?

26
Q

what are you feeling for in knee examination

A

temperature
medial gutter sweep or patella test
arthritis: patella crepitation, patella grind
instability: patella apprehension
tendonitis: 90 degrees, palpate tibial tuberosity and patella tendon
medial and lateral joint lines
lateral and medial collateral ligaments

27
Q

how is the medial gutter sweep test done

A

small effusion: sweep “ fluid” away from medial side of knee then up then around

28
Q

how is patella tap test done

A

large effusion: hold on top of the knee, bounce patella, see if you feel fluid below

29
Q

how is patella crepitation test done

A

put hands on patella, ask patient to flex and extend the knee

30
Q

how is patella grind test done

A

pushing and translating patella side to side, if painful= positive

31
Q

how is patella apprehension test done

A

translate patella laterally, see if its painful

32
Q

what does joint line tenderness represent

A

arthritis from degenrative meniscal tear
if localized and in young patient: acute meniscal tear (use steinman’s test confirm)

33
Q

how is steinmsan’s test done

A

when tenderness if felt, rotate foot away from affected side, positive in acute meniscal tear, negative in degenerative

34
Q

what are you moving during knee examination

A

straight leg raise
active and passive flexion
passive extension (hold patella, lift feet, should not go up)

35
Q

how to do posterior draw test

A

bend both knees, put feet together, compare, tibia sits anterior to condyle of femur
site of foot while its bent, hold and push down tibia w/ both hands, no movement should be seen if intact

36
Q

how is Lachman’s test done

A

one hand medial and below knee(tibia), one hand lateral and above knee (femur), lift 20 degrees, pull tibia up/ anteriorly in relation to femur

37
Q

what are the general steps of GALS examination

A

introduction
screening questions
Gait
Arms
legs
spine
conclusion

38
Q

what are the screening questions for GALS examination

A

pain or stiffness in your muscles, joints, or back?
can you dress yourself completely without difficulty?
can you walk up and down stairs without difficulty?

39
Q

what to do during Gait portion of GALS examination

A

walk then observe from behind
symmetry: shoulder muscles, spinal alignment, gluteal, popliteal fossae, hind foot
spine: abnormal lordosis or kyphosis

40
Q

what to look for during arm portion of GALS examination

A

symmetry: pectorals, deltoids
hands in anatomical, normal extension
open jaw, move side to side (arthritis)
hands behind head
bend elbow on waist, palms down
hands for any changes palm and back
make fist, tap each finger
grip test, squeeze MCPJ

41
Q

what to look for during leg portion of GALS examination

A

knee flexion, hip flexion and internal rotation, patella tap and sweep test
feet: swelling and deformity
squeeze MTPJ

42
Q

what is the spine portion of GALS examination

A

lateral flexion of cervical spine (tilt head side to side)
ask patient to bend for lumbar

43
Q

what are you looking for in foot and ankle exam

A

foot wear
patient stand: nail changes, swelling, deformity (MTP), bruises
patient tip toes: instability, fracture, tendon rupture
gait: pace, symmetry

44
Q

what are you feeling for in foot and Ankle exam

A

osce/ comm & clinical (3 decks)

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