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CPA Exam > Knee exam > Flashcards

Knee exam Flashcards

1
Q

What is the position of the patient during an intermediate knee examination?

A

The patient need to be lying on the couch

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2
Q

What is the exposure of the patient during an intermediate knee examination?

A

You need to be able to see the knee joint and the quadriceps and calf muscles to evaluate for wasting

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3
Q

What are the 3 things to look for during an intermediate knee examination?

A

Scars
Wasting of muscle bulk
Knee deformities

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4
Q

What may scars around the knee joint be suggestive of?

A

Can be suggestive of previous surgery or of trauma to the joint

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5
Q

What may wasting of muscle bulk around the knee joint be suggestive of?

A

This can be due to disuse, especially if there is chronic pain on movement, such as in arthritis

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6
Q

Which examination would you conduct if you were concerned about muscle wasting being an LMN finding?

A

A neuro examination

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7
Q

What are the 2 types of knee deformity to look out for?

A
  1. Valgus – knock knees (genu valgum)

2. Varus - bow legged (genu varum)

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8
Q

How do you feel for temperature during an intermediate knee examination? location, hands

A

Using the backs of your hands you will feel the temperature at the patellar and above and below the joint, comparing left to right hand side.

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9
Q

What are causes of warmth in the knee? [2]

A

Warmth can be due to an inflammatory condition such as osteoarthritis or septic arthritis which is an in infection in the joint associated with severe pain.

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10
Q

Why is septic arthritis a serious condition?

A

Septic arthritis is a serious condition as it can cause irreparable damage to the joint.

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11
Q

Which structures in the knee do you palpate [4]?

A

Structures to palpate

Around the patella
Medial and lateral joint lines
The tibial tuberosity and head of the fibula
Popliteal fossa

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12
Q

Why may a patient have pain on their face during palpation fo the medial and lateral joint lines?

A

This can be due to meniscal damage

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13
Q

What may be the cause of a swelling in the popliteal fossa?

A

A Baker’s Cyst

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14
Q

Define effusion

A

An effusion is an excess of synovial fluid

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15
Q

What are some causes of effusion?

A

Effusion can be caused by arthritis or damage to the internal structures of the knee such as the meniscus

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16
Q

Why do we have to empty the supra patellar pouch (SP) during feeling for effusion?

A

The knee joint has a synovial capsule (Image D) that extends upwards under the the quadriceps muscle

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17
Q

What will you feel during a moderate effusion as you firmly press over the patella with your dominant hand following emptying of the supra patellar pouch?

A

You will feel a tap as the patella hits the femur

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18
Q

How do you empty the medial compartment during the sweep method for small effusions?

A

With your non dominant hand sweep upward on the medial side of the knee to empty the medial compartment

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19
Q

What will you see with a small effusion using the sweep method?

A

If there is a small effusion you will see a ripple or bulge of fluid appears on the medial side of the knee from the lateral compartment

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20
Q

Which muscle group handles flexion? [name 4]

A

Flexion is handled by the hamstring muscles: biceps femoris, semitendinosus, semimembranosus and (gracilis).

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21
Q

What comprises the extensor apparatus? [name 5]

A

Extension involves the extensor apparatus comprising of the: quadriceps muscles, quadriceps tendon, patella, patellar tendon and tibial tuberosity.

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22
Q

What is a consequence of damage to the extensor apparatus?

A

An inability to straight leg raise.

23
Q

How do you test the active movements of the knee?

A
  1. Ask the patient to flex and extend each knee as much as possible in turn

Whilst the patient is doing this, look for pain on movement and note the Range of Motion (ROM) of each joint.

24
Q

What may pain during active flexion and extension of the knee be a sign of? [2]

A

Pain can be a sign of damage to the structures such as in a fracture or to the meniscus

25
Q

What may reduced ROM during active flexion and extension of the knee be a sign of? [1]

A

Reduced ROM can be due to arthritis

26
Q

How should ROM compare during passive movement of the knee joint compare to active movement?

A

Again looking at pain and ROM, the ROM should be more than compared to active movement

27
Q

How much do you flex and extend each of the patients legs during testing of passive testing of movements of the knee joint?

A

To the maximum extent

28
Q

How do you passively test the extensor compartment of the knee?

A

Test the extensor compartment by lifting the patient’s foot with the patient’s leg relaxed

29
Q

What should you look for during passive testing of the extensor compartment of the knee?

A

Look for hyperextension by comparing the angle between the thigh and lower leg.

30
Q

Up to how many degrees of hyperextension is normal provided it is the same on the other side?

A

10 degrees

31
Q

What does the ACL prevent?

A

Anterior subluxation

32
Q

What does the PCL prevent?

A

Posterior subluxation

33
Q

What position is the leg in during the posterior sag and anterior draw tests?

A

Flexed 90 degrees (normally use knee to support this)

34
Q

What is involved in the posterior sag test?

A

Posterior subluxation of the tibia on the femur

35
Q

What may a false positive anterior drawer sign be interpreted as?

A

ACL laxity

36
Q

What may a false positive anterior drawer sign be caused by?

A

Posterior sag

37
Q

How do you test for anterior draw?

A

With your hands behind the upper tibia and both thumbs over the tibial tuberosity, pull the tibia anteriorly.

38
Q

What indicates ACL laxity during the anterior draw test?

A

Significant movement (compared with the opposite knee) indicates that the ACL is lax.

39
Q

What indicates ACL rupture during the anterior draw test?

A

Movement of > 1.5 cm suggests ACL rupture.

40
Q

Which injury is often associated with ACL rupture?

A

There is often an associated medial ligament injury.

41
Q

Which stress do the medial and lateral collateral ligaments resist?

A

Medial and collateral ligaments resist valgus and varus stress.

42
Q

What position is the leg in during the test of the medial collateral ligament?

A

Ask the patient to flex their legs to 30 degrees

43
Q

Which stress does the medial collateral ligament resist?

A

Valgus

44
Q

What may opening of the medial joint line suggest during the application of values stress?

A

Opening of the medial joint line can demonstrate injury to the Medial collateral ligament

45
Q

What position is the leg in during the test of the lateral collateral ligament?

A

Ask the patient to flex their legs to 30 degrees

46
Q

Which stress does the lateral collateral ligament resist?

A

Varus

47
Q

Where do you place your hands hands during the testing of the lateral collateral ligament?

A

Place one hand on medial aspect of the lower thigh

Place your other hand on the lateral aspect upper calf with the fingers over the lateral joint line

48
Q

Where do you place your hands hands during the testing of the medial collateral ligament?

A

Place one hand on lateral aspect of the lower thigh

Place your other hand on the medial aspect upper calf with the fingers over the medial joint line

49
Q

When providing a valgus stress to the knee, which ligament are you testing?

Anterior cruciate ligament
Lateral collateral ligament
Medial collateral ligament
Posterior cruciate ligament

A

Medial collateral ligament

50
Q

Which of the following conditions would you be most worried about in a patient with a hot swollen and painful knee?



Bakers cyst
Osteoarthritis
Rheumatoid arthritis
Septic arthritis

A

Septic arthritis

51
Q

Which of the following conditions is the LEAST likely to cause a knee effusion?

Baker’s Cyst
Damage to the ACL
Fracture
Osteoarthritis

A

Baker’s Cyst

52
Q

Which function does the posterior cruciate ligament serve?

Prevent anterior subluxation
Prevent posterior subluxation
Resist valgus stress
Resist varus stress

A

Prevent posterior subluxation

53
Q

When palpating over the lateral joint line the patient complains of pain, which of the following structures is most likely damaged?

Anterior cruciate ligament
Lateral collateral ligament
Patellar
Tibia

A

Lateral collateral ligament

CPA Exam (6 decks)

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