Exam 1 OSCEs Flashcards
HTN classifications: pre-HTN stage 1 HTN stage 2 HTN HTN crisis
120-139/80-89
>140/90
>160/100
>180/120
BMI: underweight normal overweight obesity I obesity II extreme obesity
< 18.5 18.5 - 24.9 25 - 29.9 30 - 34.9 35 - 39.9 >40
DTRs: biceps brachioradialis triceps patellar Achilles
C5 C6 C7 L4 S1
dermatomes: C4 C6 C8 T4 T10 L5 S1 L1-L3 L4 L5 S1-S4
top of shoulder
radial aspect of forearm
5th digit
nipple line
umbilicus
great toe
posterolateral calf/little toe
anteromedial thigh
patella and big toe
anterior leg and ankle and big toe
posterior thigh
apprehension test
- patient is seated or supine
- shoulder ABducted to 90 degrees and elbow flexed to 90 degrees
- use 1 hand to palpate bicipital groove and monitor there, while the other hand grasps the patient’s wrist
(+): pain and/or tendon subluxation out of groove; unstable bicipital
Speed’s test
- patient arm flexed (50-90 degrees) at the shoulder w/ hands supinated
- slightly flex patient’s elbow
- resist at forearm while patient flexes shoulder
(+): bicipital tendonitis of longhead biceps
empty can test
- flex shoulders to 90 degrees while horizontally abducting to 45 degrees
- internally rotate both arms so thumbs are pointing down
- press down on forearms while patient resists
(+): rotator cuff pathology (supraspinatus)
drop-arm test
-patient abducts arm to 90 degrees, then slowly drops arm
(+): arm will drop; full thickness tear of supraspinatus
painful arc test
(+): pain elicited within 60 to 120 degrees of shoulder abduction; subacromial impingement and/or rotator cuff injury
Neer impingement
- stabilize patient’s shoulder
- w/ forearm pronated, passively flex shoulder to fully flexed position
(+): subacromial bursa or rotator cuff impingement
Hawkins test
- flex shoulder to 90 degrees
- flex elbow to 90 degrees and passively rotate the humerus into external rotation
(+): rotator cuff or subacromial bursa impingement
lift off test
- place patient’s arm into internal rotation and extension
- patient pushes arm into further internal rotation as physician resists
(+): weakness; subscapularis weakness
cross arm test
-physician passively adducts patient’s arm across their chest and rests patient’s hand on their opposite shoulder
(+): AC joint pathology
carrying angle:
males
females
5 degrees in males
10-15 degrees in females
cubitus varus
< 5 degrees; adduction of ulna
cubitus valgus
> 15 degrees; abduction of ulna
anatomic snuffbox:
medial border
lateral border
proximal border
medial: extensor pollicus longus
lateral: extensor policus brevis, abductor pollicis longus
proximal: radial styloid process
valgus stress test (elbow)
- arm slightly abducted and externally rotated
- forearm supinated and flexed to 30 degrees
- slight medial valgus stress
(+): sprained medial (ulnar) collateral ligament; lateral blow
varus stress test (elbow)
- arm slightly abducted and internally rotated
- elbow flexed to 15 degrees
- slight lateral virus stress
(+): sprained lateral (radial) collateral ligament; medial blow
Tinel test
-tap b/w olecranon and medial epicondyle in the ulnar groove
(+): ulnar nerve entrapment/cubital tunnel syndrome (carpal tunnel syndrome)
Golfer’s elbow test
- patient’s elbow is flexed to 90 degrees
- forearm placed in supination with palm facing up
- place hand over patient’s wrist to resist movement; instruct patient to flex wrist
(+): medial epicondylitis
Tennis elbow (Cozen’s) test
- patient’s elbow is flexed to 90 degrees
- forearm placed in pronation w/ palm facing down
- instruct patient to extend wrist against resistance
(+): lateral epicondylitis
Nursemaid’s elbow
radial head instability
annular ligament tear and/or radial head subluxation from annular ligament; often result from trauma w/ traction of child’s extended arm
restricted to posterior glide (pronation)
Ok sign
indicative of fracture of humerus
anterior interosseous nerve
Phalen’s sign
- place dorsal aspects of patient’s hands together and force into flexion
- hold for 60 seconds
DeQuervian’s tenosynovitis
- dorsolateral wrist & thumb pain; grip weakness
- if you have a newborn, texting, gaming, etc.
Finkelstein test: make a fist encompassing thumb and ulnar deviate wrist
Handlebar palsy
Guyon’s canal (hamate and pisiform) entrapment of ulnar nerve
Gamekeeper/Skier’s thumb
tear of ulnar collateral ligament of MCP
mallet finger
extensor tendon injury at DIP
trigger finger
inflammation and narrowing of flexor tendon sheath
jersey finger
avulsion of flexor digitorum profundus from fingertip
Dupuytren’s contracture
abnormal CT thickening in palmar fascia
Cole’s fracture
distal radius fracture w/ dorsal and radial displacement; “dinner fork”
Smith = ventral displacement
Conteggia fracture
proximal ulna; dislocation of radial head
Galeazzi fracture
distal radius; dislocation of ulna
Nightstick fracture
isolated fracture of the mid shaft/distal ulna from direct blow
hip compartments: central peripheral lateral anterior
central: labrum, ligamentum teres, articular surfaces
peripheral: femoral neck, synovial lining
lateral: gluteus medius/minimus, piriformis, IT band, trochanteric bursae
anterior: iliopsoas
Log roll
-internal/external rotation
(+): central or peripheral compartment pathology
C-sign
-above the trochanter
(+): labral pathology
labral loading
-flex the patient’s knee and hip to 90 degrees; load into the femur
(+): labral or cartilaginous pathology
labral distraction
-distract patient’s femur away from innominate
(+): improvement of pain; labral or cartilaginous pathology
scour
- flex and externally rotate hip
- load into socket and articulate through annular ROM
(+): labral or articular cartilage pathology
apprehension FABER
- flexed, abducted, and externally rotated
- push down on knee to induce further external rotation
(+): labral pathology
rectus femoris test
- patient is supine; 1 hip is flexed up to the chest
- the other leg is bent over the edge of the table
(+): knee flexion < 90 degrees; rectus femoris contraction
jump sign
-pressure at greater trochanter
(+): trochanteric bursitis
straight leg raise
-patient supine; flex patient’s hip w/ knee extended
(+): pain over lateral leg, especially at > 15 degrees; IT band contracture
30-60 degrees: lumbosacral radiculopathy and/or sciatic neuropathy
> 70 degrees: mechanical low back pain d/t muscle strain or joint disease
piriformis test
- patient supine w/ hip and knee flexed, one ankle crossed over contralateral knee
- patient abducts against resistance
(+): pain over greater trochanter; piriformis spasm or pathology
patrick’s FABER
- patient hip is flexed, abducted, and externally rotated
- brace contralateral ASIS; patient externally rotates/abducts against resistance
(+): gluteus medius pathology
patrick’s FABER (anterior/iliopsoas)
- patient’s hip is flexed, abducted, and externally rotated
- brace contralateral ASIS; patient internally rotates/adducts against resistance
(+): iliopsoas insufficiency or pathology
Thomas test
-one leg is lowered to the table to test the flexibility of the hip flexors
(+): inability to fully extend, or extended leg raises off table; hip flexor contraction
Q angles: genus valgum genus varus genus recurvatum normal
valgum: increased Q angle
varus: decreased Q angle
recurvatum: backward curvature r/t hyperextension
normal: 15 degrees; females increased
knee valgus test
- flex knee to 30 degrees
- apply a medial force on proximal tibia while abducting the lower the leg
(+): MCL issues
knee varus test
- flex knee to 30 degrees
- apply a lateral force to the proximal tibia while adducting the lower leg
(+): LCL issues
anterior drawer test
- flex knee to 90 degrees
- sit on patient’s foot and grasp proximal tibia w/ both hands, pulling tibia anteriorly
(+): excessive translation; ACL issues
Lachlan’s test
- cephalad hand on distal thigh, superior to patella
- caudad hand grasps the proximal tibia
- flex the knee 10-30 degrees, using caudad hand to pull the tibia anteriorly while the cephalad hand stabilizes the thigh
(+): ACL insufficiency
McMurray’s test:
lateral
medial
- hip and knee flexed; caudad hand on ankle and cephalad hand on distal femur
- lateral: internal rotation and varus stress, then extension
- medial: external rotation and valgus stress, then extension
(+): pain or click w/ extension; medial or lateral meniscus tear
Apley grind/compression test
- patient prone w/ hip 90 degrees
- downward force on foot w/ compressive force on meniscus, while rotating the foot internally and externally
(+): meniscal injury, collateral ligament injury, or both
Apley grind/distraction test
- patient prone w/ hip 90 degrees
- stabilize thigh, then apply upward traction to the leg while rotating it
(+): pain with distraction is collateral ligament; relief of pain is meniscal
Patellar laxity & apprehension tests
laxity: one hand above and one hand below the joint; thumbs placed on medial side of patella; push patella laterally
(+): previous patellar dislocation or severe instability
patellar compression (grind) test
- supine w/ knee extended
- compressive load to patella w/ one hand while moving the patella medial and lateral
(+): inflammation, chondromalacia, injury to the patellofemoral articular surfaces
patella-femoral grinding test
-compress patella caudally into trochlear groove & instruct pt to tighten quads against resistance
(+): roughness of articulating surfaces (chondromalacia)
patellar glide test
- sitting or supine; slowly extend and flex the knee while physician monitors quality of motion
- place hand lightly over patella to increase sensitivity
(+): damage to articular surface
ankle anterior drawer test
- grasp posterior calculus w/ one hand and distal tibia/fibula with the other, monitoring anteriorly at the anterior talus
- provide anterior force on calcaneus while stabilizing the distal tibia/fibula; normal springing of calcaneus back to neutral should occur
(+): ATF ligament pathology/tear (lateral ankle sprain)
talar tilt test
- grasp distal tibia/fibula w/ one hand and inferior calcaneus w/ the other, blocking motion of the calcaneus on the talus
- invert talus to evaluate ROM
(+): calcaneofibular ligament pathology/tear, also tests some ATF (lateral ankle sprain)
eversion test
- grasp distal tibia/fibula with one hand and plantar surface of the mid-foot w/ the other hand
- evert the foot
(+): deltoid ligament pathology (medial ankle sprain)
squeeze test
- wrap hands around leg proximal to the ankle, contacting distal tibia/fibula w/ both thenar eminences
- squeeze for 2-3 seconds, then rapidly release
(+): syndesmosis pathology (high ankle sprain)
cross log test
- patient crosses affected ankle over opposite knee
- apply pressure to distal fibula of affected leg
(+): syndesmosis pathology (high ankle sprain)
thompson test
- patient prone w/ foot off table
- squeeze patient’s calf and observe for plantar flexion
(+): Achilles tendon rupture
Homan’s sign
- patient laying or seated w/ knee extended
- dorsiflex patient’s foot; can apply lateral compression to calf
(+): thrombophlebitis or acute DVT
Moses sign
- patient seated or supine w/ knee slightly flexed or extended
- induce an anterior compression on the gastrocnemius muscle into the posterior aspect of the tibia
(+): DVT of the posterior tibial veins
