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Physical Diagnosis > Lecture two (UPPER)-EXAM 3 > Flashcards

Lecture two (UPPER)-EXAM 3 Flashcards

1
Q

Musculoskeletal diseases

  • Musculoskeletal diseases affect how many people?
  • What is the estimated cost?
  • World-wide, WHO reports the most common and debilitating to be what?
  • What is the percentage of all ambulatroy care visits?
  • What identity plays a role in prevalence of specific issues?
A
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2
Q

Health Maintenance & Screening

How many people have Osteoporosis & Osteopenia?

A

over 40% of adults age ≥ 50 in US have osteopenia( why we have fractures – 40 million people/17 million are male

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3
Q

Osteoporosis & Osteopenia:
* What is the risk?
* What are current recommendation for bone density screening?

A
  • Risk factors include; age>50, low BMI, tobacco, ETOH, low physical activity, 1st degree relative with dx, certain pharmaceuticals
  • Current recommendation for bone density screening – all women over 65, and post menopausal women under 65, men over 70 or younger men who have increased risk for low bone mass.
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4
Q

What is the prevalence of osteoporosis age and race/ethnicity?

A
  • 10.3% of adults over age 50 years have osteoporosis at the femoral neck or lumbar spine
  • 15.4% of women and 4.3% of men highest
  • Race/ethnicity: Mexican-American (13.4%) and Non-Hispanic white (10.2%) adults have the highest prevalence
  • Non-Hispanic blacks (4.9%) have the lowest
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5
Q

Morbidity & Mortality:
* How many women sustain an osteoporsis related fracture during their lifetime?
* How many fx’s a year in US from osteoporosis?
* How many hospitalizations and nursing home admissions?
* Half of patients become what? 20-30% do what?
* Mean over 60 have what type of risk?
* Fall are the leading cause of what?
* Accounted for how much of total medical costs in 2015?

A
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6
Q

What is wolff’s law?

A

For every change in the external force on the bone there is a change in the internal architecture

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7
Q
A
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8
Q

What are the Current Exercise Guidelines?
* Moderate-intensity?
* Vigorous-intesity?
* Muscle-strengthening activities of moderate or greater intensity?
* Older adults should do what?

A
  • 150-300 minutes weekly of moderate-intensity
  • 75 -150 minutes of vigorous-intensity
  • Muscle-strengthening activities of moderate or greater intensity, use a weight correct for 8-12 reps, involve all major muscle groups on 2 or more days a week
  • Older adults should do multicomponent physical activity that includes balance training for fall prevention. (Tai chi)
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9
Q

What is the fall risk test?

A

Timed Get Up and Go Test – from armchair, 3 meters and back in 24 seconds or less
* Rise up from chair and walk meter out and back in 24 seconds

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10
Q

Define this:

  • “Gelling” phenomenon:
  • 4 Cardinal features of inflammation:
A
  • “Gelling” phenomenon – decreased active and passive ROM and stiffness upon awakening (this is a sign of articular pain)
  • 4 Cardinal features of inflammation – swelling, warmth, redness in combination with pain
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11
Q

What are the consitiutional symptoms?

A
  • High fever or chills – begin acute work up
  • Chronic systemic disease – constitutional symptoms are common in inflammatory conditions.
  • Joint pain may provide important clues to diagnosis
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12
Q

What does lupus often presents?

A

joint pain, typically symmetric, with erythema, most often seen in knees, fingers, hands and wrists

inflammation disease

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13
Q

What are examples of diagnostic indicators of Systemic Disease that may present as MSK complaints (7)?

A
  • Malar Rash - Lupus
  • Scaly plaques, pitting of nails – Psoriatic arthritis
  • Red based papules, pustules, vesicles on distal extremities – Gonococcal arthritis
  • Target/Bulls eye patch – Lyme disease
  • Mental status change, facial or other weakness, sensory changes, radicular pain - Lyme disease with central nervous system involvement
  • Clubbing of fingernails – Hypertrophic Osteoarthropathy
  • Reactive arthritis (often with urethritis and/or uveitis) - Erosions or scaling on the penis and crusted scaling papules on the soles and palms
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14
Q
  • What is the sign of lupus?
  • What is the sign of psoriatic arthritis?
  • What is the sign of gonococcal arthritis?
A
  • Malar Rash - Lupus
  • Scaly plaques, pitting of nails – Psoriatic arthritis
  • Red based papules, pustules, vesicles on distal extremities – Gonococcal arthritis
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15
Q
  • What is the sign of lyme disease?
  • What is the sign of Lyme disease with central nervous system involvement?
A
  • Target/Bulls eye patch – Lyme disease
  • Mental status change, facial or other weakness, sensory changes, radicular pain - Lyme disease with central nervous system involvement
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16
Q
  • What is the sign of hypertrophic osteoarthropathy?
  • What is the sign of reactive arthritis?
A
  • Clubbing of fingernails – Hypertrophic Osteoarthropathy
  • Reactive arthritis (often with urethritis and/or uveitis) - Erosions or scaling on the penis and crusted scaling papules on the soles and palms
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17
Q

What is this? What is the risk group?

A
  • It is gonococcal arthritis- Unilateral
  • Risk: young, sexual activity
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18
Q

What is this?

A

Lupus

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19
Q

What is this?

A

Psoriatic plaques

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20
Q

What is this?

A

Target/bullseye lesion of Lyme Disease

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21
Q

You need to be careful with neck pain, therefore you need to ask what? (4)

A
  • Radiation of pain to upper extremity (cervical radiculopathy)
  • Bilateral weakness in both upper and lower extremities and urinary frequency is cervical myelopathy until proven otherwise. -> Need to ask about bladder
  • In children – must document that nuchal rigidity nor systemic complaints exist (Meningitis)-> MUST DO chain to neck test
  • Acute onset/episodic with associated achy arm or jaw pain in middle aged female – consider Cardiac etiology
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22
Q
  • What is a sign of cerival radiculopathy?
  • What is sign of cervical myelopathy?
A
  • Radiation of pain to upper extremity (cervical radiculopathy)
  • Bilateral weaknees in both upper and lower extremities and urinary frequency is cervical myelopathy until proven otherwise.
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23
Q

What did you need to document with children that present with neck pain?

A

must document that nuchal rigidity nor systemic complaints exist (Meningitis)

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24
Q

When do you consider cardiac etiology?

A

Acute onset/episodic with associated achy arm or jaw pain in middle aged female

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25
Q

What is myelopathy?
What is radiculopathy?

A
  • Mye: brain and spinal cord, covered by myelin sheath-> usually inflammation
  • Rad: Nerve Roots out -> usually MVA or herniated disc
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26
Q

Spinal nerves:
* Each spinal nerve formed from what?
* What are the posterior and anterior branches?

A
  • Each spinal nerve is formed from anterior and posterior roots on the spinal cord.
  • The posterior branches are afferent (sensEory) nerves; the anterior branches are efferent (motor) nerves
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27
Q

What is neuropraxia?

A

temporary loss of nerve function

28
Q

What are the fibrous joints? And what do they do?

A

Fibrous – Absorbs shock with little or no movement
* Suture – irregularly grooved articulating bone. Sutures of the skull
* Syndesmoses – ligament or fibrous membrane between bones. Allow limited movement. Inferior tibiofibular joint, interosseus membrane between the radius and ulna

29
Q
  • What are cartilaginous joint types? Primary and secondary?
A

Cartilaginous – united by hyaline cartilage or fibrocartilage
* Primary: sternocostal joints and epiphyseal plates while open
* Secondary: intervening pad, plate, or fibrocartilage as in the pubic symphysis and intervertebral joints

30
Q

What are synovial joints?

A

Freely moveable as in the shoulder and knee

31
Q
A
32
Q

What covers with synovial joint? What happens if their is damage?

A

Articular cartilage/hyaline cartilage (vs. fibrocartilage i.e. labrum, menisci, disc)
* Glassy smooth covering on ends of long bones reduces friction, spongy cushion, absorbing compression, no nerve or blood supply, nutrition from synovial fluid
* Damage = arthritis

33
Q

Where is the joint cavity in the synovial joint and what is it filled with?

A
  • Lined with synovial membrane
  • Filled with synovial fluid
34
Q

The joint capsule of the synovial joint is continuous with waht?

A

Continuous with the periosteum

35
Q

Bursa:
* What is it?
* What does it reduce?
* Where is it?
* Can have what? (2)

A
  • Synovial fluid-filled sacs
  • Reduce friction between tendons and bones (subacromial, pes anserine bursae) or
  • Between bone and skin (prepatellar bursa, olecranon bursa)
  • Can have explosive synovial swelling
  • Can have septic bursa

Act as an lubricant
Not dangerous until infected

36
Q

What is a sprain, strain, hemarthrosis?

A
  • Sprain – tearing or rupture of ligamentous tissue
  • Strain – tearing or rupture of musculotendinous tissue
  • Hemarthrosis – blood in a joint
37
Q

What is contusion, edema, exostosis?

A
  • Contusion – bruise
  • Edema – swelling
  • Exostosis – extra bone growth (hypertropic bone)
37
Q

ROS guidelines for upper extremity (4)

A
38
Q

What is osteophyte, apophysistis, osteoarthritis, RA?

A
  • Osteophyte – exostosis along joint margin
  • Apophysitis – inflammation where a tendon attaches to bone
  • Osteoarthritis – inflammatory condition at a joint
  • Rheumatoid arthritis – systemic disease-causing arthritis
39
Q

What are the key features of complaint characterization?

A
40
Q

What do you need to know for the history of MSK

A
41
Q

What is the different between pain in small and large joints?

A

pain in small joints (hands/feet) stays local and typically indicates an accurate approximation of location of injury or disease, pain in larger joints, long bones may often be referred pain
* Example: Hip pain is often felt in the groin or at times down leg to knee, pain at the knee may predominate in the young

42
Q

What should you inspect for the MSK upper?

A
  • Visually inspect anterior shoulder and posterior shoulder/scapula, elbow, wrists, hands, fingers
  • You are looking for swelling, deformity, muscle atrophy, fasciculations, unusual contours and abnormal positioning
43
Q

What do you need to verbalize for inspection?

A

You are verbalizing “I am looking for swelling, deformity, atrophy, unusual contours, fasciculations or abnormal positioning””

44
Q

What are the rotator cuff muscles and their actions?

A
45
Q

What do you need to note about inspection? (7)

A
46
Q

What is the right and left picture?

A
47
Q
A
47
Q

Palpation:
* What are you palpating?
* What are you looking for?
* What do you verbalize?
* Assessment of tenderness?
* Fracture assessment?

A
48
Q

How do you do shoulder palpation?

A
49
Q

What are all the ranges of motions for arm?

A
50
Q

What tests do you do for rotator cuff, tendinitis/tendonosus?
What tests do you do for rotator cuff tears?

A
  • Rotator Cuff Tendinitis/Tendonosus (Impingement Syndrome) – Empty Can, Neer, Hawkins, Painful Arc
  • Rotator Cuff Tears – Drop Arm, Lift-Off (Belly Press)
51
Q
  • What do you do for adhesive capsulitis?
  • What is the test for Acromioclavicular Arthritis/Sprain?
A
  • Adhesive Capsulitis (Frozen Shoulder)
  • Acromioclavicular Arthritis/Sprain – Crossover/AC Compression
52
Q

What is the painful arc?

A

Indicative of Impingement

53
Q

What is the neer and hawkins kennedy test for impingement?

A
54
Q

Impingement/Strength Tests: Empty Can for what muscle?

A

Supraspinatus

55
Q

What is another test (not empty can) for supraspinatus? What is the test for subscapularis?

A
56
Q

What test is for a infraspinatus and strength test?

A
57
Q

What is the AC joint crossover test?

A
58
Q

What do you palpate on the elbow?

A
  • Palpate lateral and medial epicondyles
  • Palpate olecranon/bursa
59
Q

What are the 4 different elbow ranges of motion?

A
  • Flexion – bend elbow
  • Extension – straighten elbow
  • Supination – palms up
  • Pronation – palms down
60
Q

What do you need to palpate and compress of the wrists and hands?

A
  • Palpate joint space at distal radius and distal ulna
  • Palpate radial styloid
  • Palpate anatomical “snuffbox”
  • Compress metacarpophalangeal joint
  • Palpate carpometacarpal joint of thumb
  • Palpate PIPS and DIPs medial/lateral
61
Q

What are the range of motions for wrist and fingers?

A
62
Q

What are the thumb motions?

A
63
Q

What is the difference of OA and RA?

A
  • Heberden Nodes-DIPs (OA)
  • Bouchard Nodes- PIPs (RA)
64
Q

What are the tests for carpal tunnel syndrome?

A

Physical Diagnosis (17 decks)

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