H&P Midterm MSK LE

Question 1

what are the 5 pertinent questions to ask when aquiring spine hx for neck or low back pain

Answer 1

Radiation to arm buttock or legs?
Associated numbness or parasthesias?
Midline? or Lateral to midline?
Associated bowel or bladder dyfunction
Red flag (any key warning signs)?

RAMAR

Question 2

what are spine hx red flags that suggest serious underlying systemic diseases

Answer 2

IV drug use/addiction hx
Nocturnal pain/pain at rest

Weigh loss (unexplained)
Immunosuppression
Steroid Therapy (long term)
History of cancer

Pain unresponsive to therapy
Age <20 or >50
Nuerologic symptoms
Duration of >1 m0onth
Active infection elsewhere

(IN WISH PANDA!)

Question 3

Low back pain + a red flag =

Answer 3

10% probability of finding a serious systemic disease

Question 4

What do I inspect the spine for?

Answer 4

Posture
Gait
Curvature
Paravertebral muscles

Question 5

What is the main condition of the spine that we discussed in class?

Answer 5

Scoliosis (curved spine)

Question 6

what do I palpate the spine for

Answer 6

alignment of spinous processes (note and “step offs” aka forward sipping of vertebre aka spondylolisthesis)
facet joints in neck
percussion of spine (may reveal increased pain if infection, fracture or malignancy is present.)
paravertebral muscles
sacroiliac joints

Question 7

What are the 3 types of gaits?

Answer 7

Antalgic gait (limp)
Wide-stance gait
Waddling/trendelenberg gait (weakness of abductors)

Question 8

What do I inspect the hip for?

Answer 8

Symmetry
Muscle atrophy/bruising
Abnormalities
Leg length (ASIS to medial malleolus)

Question 9

What do I palpate the hip for?

Answer 9

Bony landmarks
Inguinal structures (ligaments, nodes, femoral nerves/vessels)
Bursas (iliopsoas, trochanteric, ischiogluteal, gluteus medius)

Question 10

Where are the four bursa of the hip and where are they located

Answer 10

iliopsoas bursa - deep below inguinal ligament
trochanteric bursa - lies over greater trochanter
ischiogluteal bursa - lies over ischial tuberosity
gluteus medius bursa - found between gluteus medius muscle and greater trochanter

Question 11

What two joints make up the knee?

Answer 11

Patellofemoral
Tibiofemoral

Question 12

rectus femoris
vastus lateralis
vastus medialis
flexors or extensors of the knee

Answer 12

extensors.

Question 13

semimembranosus
gracilius
sartorious
semitendinosus
flexors or extensors of the knee

Answer 13

Flexors

Question 14

what do you inspect when observing possible knee injuries

Answer 14

gait - knee should be extended in heel strike and flexed in all other phases
alignment and contours
joint effusion (loss of hollows around patella or suprapatellar pouch)
valgus and varus deformities

Question 15

what position should a patient be in when you are palpating the knee

what should you be palpating

Answer 15

supine with knee extended

patellofemoral compartment
bursa
gastrocnemius and soleus muscles

Question 16

What is the knee bulge sign?

Answer 16

Drive fluid inferiorly towards knee joint, apply pressure to patellar tendon

+ will show fluid change on opposite side of patellar tendon. Indicative of effusion.

buldge has a U = “under” the bridge (patella tendon) to the other side of the knee.

Question 17

What is balloting the patella?

Answer 17

Drive fluid inferiorly towards knee joint, apply direct pressure to patella and push posteriorly.

+, palpable fluid returning to pouch confirms presence of large effusion.

Question 18

What is the balloon sign?

Answer 18

Compress suprapatellar pouch against femur and feel for fluid entering/ballooning into the spaces next to the patella.

Question 19

What is the mcMurray test?

Answer 19

Medial: Externally rotate leg with valgus stress
Lateral: Internally rotate leg with varus stress

Lift leg, rotate, then pull.

this is for medial and lateral meniscus

Question 20

What are varus and valgus stress tests?

Answer 20

Varus = testing LCL, so force coming from inside knee.
Valgus = testing MCL, so force coming from outside knee.

Lift leg, hold above patella and ankle joint, then twist in opposite directions.

Question 21

What are the anterior and posterior drawer tests?

Answer 21

Flex knees while laying, then push/pull knee.
Tests ACL and PCL.

Question 22

What is lachman’s test?

Answer 22

Tests ACL, watch video to see demo.

> 3mm displacement from uninjured leg = positive for ACL tear.

Question 23

what are you looking for when inspecting the foot

Answer 23

nodules
deformities
swelling
scars
calluses/corn
bunion
plantar warts

Question 24

what do you palpate in ankle and foot inspection

Answer 24

anterior aspect of each ankle joint
achilles tendon
heel and plantar fascia
tenderness over medial and lateral malleoli
metatarsophalangeal joints
heads of metatarsals and grooves in between them

Question 25

What is thompson’s test?

Answer 25

Tests integrity of achilles tendon.

Prone patient. Squeeze calf.

+, foot does NOT plantar flex.