Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6011 Clinical Reasoning Test 3 COMPLETE ☑️ > Module 11: Musculoskeletal System > Flashcards

Module 11: Musculoskeletal System Flashcards

1
Q

MSK

-Terminology

A
  1. Articulation — Where 2 bones come together — I.e Joint
  2. Synovial Joints — Freely movable
    - Spheroidal — Ball and socket
    - Hinge — Elbow and Knee
    - Condyloid — knuckles
  3. Cartilaginous — Slightly moveable — Bones of spine, Sternum
  4. Fibrous — NOT moveable — Sutures in skull
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MSK

-Terminology Cont..

A
  1. Tendons — Connect muscles to bone — Tendon contracts - muscle moves - bone moves
    —Ex: Achilles’ tendon calf attaches to the calcaneus (Heel)
  2. Ligaments — Connect bones to other bones for stability
    —Ex: ACL connect femur to tibia
  3. Bursa — Pouches of synovial fluid that cushion movement of tendon, muscles, and skin over bony prominences.
    —Occurs near joints that perform frequent repetitive motions
    —Ex: Hip & Elbow (Bursa covers the greater trochanter — keeps skin from rubbing the bony prominence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MSK

-Subjective

A
  1. HPI — OLD CARTS
    —Previous Tx — RICE, Meds, therapy?
  2. Past medica, Family, Surgical and social Hx
    -Fam Hx - Arthritis, auto-immune disorders
    -Surgical Hx - Previous surgeries to the affected body part
    -Social Hx - Particularly alcohol, tobacco, drug use/abuse
  3. Meds and allergies
  4. ROS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MSK

-Objective

A
  1. General Exam
  2. IPPA
    - Inspection — Alignment, color, swelling, deformity
    - Palpation/Percussion — Warmth, tenderness, crepitus pulses
    - Passive ROM — Mobility, stability
    - Active ROM — Mobility, stability, strength, reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MSK

-Assessment & Plan

A
  1. Differential Dx
  2. Use pain codes when unsure of dx — Ex. Pain in the wrist

Plan

  • RICE
  • Activity Level
  • NSAIDs and other meds
  • PT
  • Wait and watch (Time is a good medication)
  • Labs — Uric acid, Rheumatoid factors
  • Imaging (X-ray)
  • Referrals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Shoulder Exam

-Joints info

A
  1. Clavicle and Acromion articulate at the acromoioclavicular joint
    - Acromion is an extension of posterior scapula (Ie Shoulder blade)
  2. Glenoid & Humerus articulate at the glenohumeral joint (Shoulder)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Shoulder Exam

-Muscles TEST

A
  1. Infraspinatus
  2. Subscapularis
  3. Teres Minor
  4. Supraspinatus — Most common site of injury in rotator cuff injury — responsible for abduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Shoulder Muscles

-Supraspinatus

A
  1. Responsible for abduction of the shoulder

- Think of a supraspinatus muscle tear IF patient CANNOT lift their arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CC: Shoulder Pain

A
  1. HPI
    —Point to the pain. Anatomy helps guide Dx. Onset?
  2. Joints swell for 3 reasons — Infection, Injury, or Inflammation **TEST
  3. PMH — Joint surgery?
  4. Fam Hx — Any arthritis, auto-immune disorders
    5 .Surgical Hx — Any surgery performed on that body part or around
  5. Social Hx — ETOH, tobacco, illicit drug use (IV Drug user injecting near joints)
  6. ROS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Shoulder Exam (IPPA)

A
  1. Inspection (Anterior and posterior)
    —Alignment (deformity) and symmetry
    —Scapular winging and Sulcus Sign
    -Look for redness, ecchymosis, swelling, wounds, skin
    —Eccymosis can mean a fracture or torn bicep tendon
    -Guarding and non-use
  2. Palpation/Percussion
    - Warmth, tenderness, crepitus, pulses (especially distal)
  3. Passive ROM
    - Movement in all planes. Abduction, abduction, flexiona, and extension, internal & external rotation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Shoulder Assessment

-Scapular Winging

A
  1. Leads to limited functionality of upper extremity — Resulting in a nerve injury or paralysis of the Serratus anterior, Trapezius or the rhomboid muscle
  2. Most commonly the Serratus muscle**
  3. Dx is made on inspection! REFER to Ortho or neurology for the nerve issue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Shoulder Assessment

-Sulcus Sign

A
  1. Divot in the lateral shoulder — DISLOCATION — Needs ER for reduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Shoulder Assessment

-Neer Sign

A
  1. Test for suspected subacromial impingement
  2. Press on scapula to prevent motion w/ one hand, and raise the patient’s arm w/ the other
    —Pain is a + test for (1) rotator cuff tendinitis (2) Impingement syndrome of the supraspinatus

Sensitivity and specificity aren’t great — couple with other test for dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Shoulder Assessment

-Hawkin’s Kennedy Test

A
  1. Test for Supraspinatus impingement — Usually caused by overuse (overhead sports, Ie. Volleyball, baseball, basketball
  2. Shoulder in 90 degree abduction and elbow flexed to 90 degrees.
    - Internally rotate the shoulder by pushing downward on the hand
  3. Sensitivity and specificity aren’t great — couple with other test for dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Shoulder Assessment

-Drop Arm Test

A
  1. A Positive test would indicate a rotator cuff tear within the supraspinatus
    - A + test is when the shoulder is abducted to 90 degrees then let go of. If it drops, test is +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Shoulder Pain

-ACUTE Differential Dx

A
  1. Shoulder impingement - Rotator cuff tendinitis
    —Differential for people doing things they don’t normally do (ie The weekend warrior or starting a new exercise routine
    —Test w/ NEER, HAWKINS sign — Often overuse
  2. Sprain/strain
  3. Rotator cuff Tear
    —Pt will have weakness/pain w/ abduction. DROP ARM test
  4. Infection — Usually through previous wound near joint — Puncture wound w/ redness visible
  5. Dislocation — Visible deformity w/ recent hx of trauma — SULCUS SIGN
  6. Fracture — Usually humerus or clavicle — Usually direct trauma — Often ecchymosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Shoulder Pain

-CHRONIC Differential Dx

A
  1. Shoulder Osteoarthritis — Gradual Pain and stiffness, Sometimes has crepitus
  2. Adhesive Capsulitis (FROZEN shoulder) — Capsule around shoulder is tight w/ minimal motion
    - Can be idiopathic and last 1-3 years d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Shoulder Treatment (Plan)

A
  1. Rest
  2. NSAIDs
  3. Imaging - Prior to PT
  4. PT
  5. Referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Elbow Anatomy

-Joints

A
  1. Distal humerus articulates w/ the proximal ulna and radius
  2. Distal end of the humerus contains — Medial and lateral epicondyle — Flexors and extensors of the arm are attached here for elbow movement TEST
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CC: Elbow Pain

A
  1. HPI — OLD CARTS
    - Age? Gradual Onset? Previous injury?
  2. Look at other joints around injury site. For a wrist injury, look at the elbow. Vice versa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Elbow Pain Examination (IPPA)

A
  1. Inspection
    -Alignment (Deformity) and symmetry
    —Shortening and bowing of the arm
    -Redness, ecchymosis, swelling, wounds, skin
    -Guarding and non-use
  2. Palpation/Percussion
    - Warmth, tenderness, crepitus
    - ULNAR NERVE aka “funny bone” — Palpate w/ hammer to check for CUBITAL tunnel syndrome = tingling in the 4th and 5th fingers is positive
    - Inspect and palpate the medial and lateral epicondyles
  3. Passive ROM
    - Flexion, extension, pronation, supination — Elbow should be able to do all 4
    - Hyper-mobility “Double Jointed” It’s OK but joint is LESS Stable = MORE INJURIES
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Elbow Pain

-ACUTE Differential Dx

A
  1. Medial/Lateral Epicondylitis — Pain worsens w/ engagement of flexors or extensors
    —Golfers (Medial) / Tennis Elbow (Lateral)
  2. Think Fracture if unable to flex/bend
  3. Dislocation — REFER to ER
  4. Olecranon Bursitis (D/t Trauma or infection of the elbow)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Elbow Pain

-CHRONIC Differential Dx

A
  1. Cubital tunnel syndrome — Persistent paresthesias in the 4th and 5th digits - REFER
  2. Arthritis -Osteoporosis (ONE elbow) & Rheumatoid (Both elbows at the same time)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Elbow Pain

-Plan: Tx

A
  1. Rest - SLINGS should only be used for 2 days — REFER — Immobilization can lead to elbow locking
  2. NSAIDs / Tylenol
  3. Imaging (radiographs) Prior to therapy
  4. Therapy
  5. Referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Wrist and Hand

-Joints

A
  1. Distal end of the radius and ulna articulate the radiocarpal joint along w/ 8 other small bones
  2. The hand is comprised of — (1) Middle hand bones (2) Metacarpals (3) Phalanges
  3. Phalanges are comprised of — (1) Metacarpophalangeal joints (MCP) (2) Proximal interphalangeal joint (PIP) (3) Distal interphalangeal joint (DIP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CC: Hand or Wrist Pain

A
  1. HPI — OLD CARTS
    - Gradual vs acute are worked up different
    - Repetitive motion? Usually chronic — Think of occupational risks
    - IV drug use? Spider/insect bite?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hand and Wrist Exam?

A
  1. Inspection
    - Alignment (deformity) & Symmetry of fingers
    - Redness, ecchymosis, swelling, wounds, Purulence (Think fracture)
    - Guarding & Non-use
    - Muscle wasting (Suspect nerve injury
  2. Palpation/Percussion
    - Warmth, tenderness, crepitus, pulses, & A1 pulley (for trigger finger)
  3. Passive ROM
    - Flexion and extension — Coordination
28
Q

Arthritis

A
  1. Osteoarthritis —Wear and tear — Takes several years —Gradual loss of joint space
  2. Rheumatoid Arthritis — Effects both hands MCP, DIP joints
  3. Septic Arthritis — Single joint — animal bite, IV drug use
29
Q

Arthritis

-NODES?

A
  1. Heberden node — Bony overgrowth of the distal phalanges (DIP)
  2. Bouchard Node — Bony overgrowth of the Proximal Phalanges (PIP)
30
Q

Hand Pain

-Inspection

A
  1. FELON - Puncture wound of distal finger — Swollen, tender, dusky red —REFER to Hand surgeon
  2. Trigger Finger — finger gets stuck in bent position — Surgery or steroids is the Tx
31
Q

Hand and Wrist Pain

-Tinel’s Test

A
  1. Percuss over the median nerve on the volar (palm) side of the wrist
  2. Test is positive if increased numbness, tingling or radiating pain in fingers 3, 4 and half of 5
32
Q

Hand and Wrist Pain

-Phalen’s Test

A
  1. Reverse prayer hands
  2. Hold back of hands together for 20-30 seconds (May need longer)
  3. Positive result if causes increased numbness, tingling , or radiating pain (fingers 3, 4, or 5)
33
Q

Hand and Wrist Pain

-Ganglion Cyst

A
  1. Harmless unless it causes pain. This can be surgically drained if over a nerve
34
Q

Hand & Wrist Pain

-Finkelstein Test

A
  1. Enclose thumb into a closed fist. Move wrist laterally in a downward motion
    + Test is pain with the maneuver = DeQuervain’s Tenosynovitis
    —Pain is on lateral side of wrist at the Radial styloid — Repetative motions
35
Q

Hand & Wrist Pain

-ACUTE Differential Dx

A
  1. Fractures, dislocation (FOOSH) — Fall on outstretched hand
  2. Tendon Ruptures - REFER
  3. Inflammation — Gout
  4. Infection — Paronychia (Close to nail bed), VS Felon (Finger tip)
  5. DeQuervain’s Syndrome — Pain at the radial styloid
36
Q

Hand & Wrist Pain

-CHRONIC Differential Dx

A
  1. Arthritis — Most common at the carpal metacarpal joint (CMC joint) — Base of the thumb
    —Starts at the distal most part and works the way upward — Aggravated by CELL PHONE USAGE
  2. Carpal Tunnel Syndrome — D/t repetitive motions — Worse at night
  3. Neuropathy — DM - Starts at the distal most part and works its way upward
  4. Trigger finger
  5. Ganglion Cyst
37
Q

Hip

-Anatomy Joints

A
  1. Acetabulum meets femoral head
38
Q

CC: Hip Pain

A
  1. HPI
    - Point to pain — some hip pain comes from the back — Assess both back and hip when one is the CC
    - Lateral hip pain — Bursitis
    - Groin pain
  2. Consider age — Child hip issues — Pain radiates to the knee
39
Q

Hip Exam (IPPA)

A
  1. Inspection
    - Alignment (Deformity), Symmetry and stance
    - Redness, ecchymosis, swelling, wounds, skin
    - Station and gain — walk and watch the gait
  2. Palpation/Percussion
    - Include lower back, posterior hip, and greater trochanter
    - Push on the greater trochanter to assess for bursitis**
  3. Passive ROM
    - Flexion and Extension - Abduction & Adduction. Internal & External Rotation
  4. Active ROM
    - Same as above but w/ resistance
40
Q

Hip Pain

-ACUTE Differential Dx

A
  1. Groin strain (Usually sports injury)
  2. Greater Trochanteric Bursitis
  3. Pelvic or femur fracture
41
Q

Hip Pain

-CHRONIC Differential Dx

A
  1. Hip Osteoarthritis (R/o w/ internal & External rotation with patient lying on their back)
  2. A vascular necrosis of the hip or femur — Multiple steroid injections — sickle cell
  3. Trochanteric Bursitis
42
Q

Knee

-Anatomy & Joints

A
  1. Osteoarthritis is a progressive loss of cartilage in the joint
    —D/t loss of cartilage or meniscus
43
Q

CC: Knee Pain

A
  1. Young Patient — Examine both the KNEE and the HIP w/ Hip pain cc
    2.
44
Q

Knee Pain Examination (IPPV)

A
  1. Infection
    - Alignment (Vargus/valgus deformity) & Symmetry
    - Redness, ecchymosis, swelling/effusion, wounds, skin
    - Guarding & Non-use
  2. Palpation/Percussion
    -Warmth, joint line tenderness, crepitus, bakers cyst
    —If warm, it’s NOT OSTEOARTHRITIS** — Consider gout or septic arthritis w/ WARMTH / Acute injury
  3. Passive ROM
    - Flexion and Extension
  4. Stability/Laxity testing — Strength Testing

EFFUSION — Enlargement of a pocket of fluid** DOCUMENT
Swelling — Enlargement of the tissue

45
Q

Effusion Vs Swelling

A
  1. EFFUSION — Enlargement of a pocket of fluid** DOCUMENT

2. Swelling — Enlargement of the tissue

46
Q

Knee Pain

-ACL Stability Test

A
  1. Anterior Drawer Test
    - Sensitivity & Specificity (92 & 91%)
    - Rule out PCL injury FIRST to avoid false positive results
    - Test is + if Tibia translates anteriorly > 6mm or it is soft and mushy — Test leg at 45 degrees
  2. Lachman Test (MOST ACCURATE)
    - Sensitivity & Specificity (85 & 94%)
    - 30 degrees, slight external rotation of the tibia. Try to translate tibia anterior
    - Test is + if there is a soft/mushy feel or if anterior tibial translation is more than 3mm compared to normal leg

BEST for CHRONIC condition not Acute

47
Q

Knee Pain

-PCL Stability Test

A
  1. Posterior Drawer test
    - Sensitivity & Specificity (90 & 96%)
    - Put leg at 45 degrees. Push tibia forward in explosive movement
    - Test is + if tibia translates positive more than 6 mm or Soft/mushy feel
48
Q

Knee Pain

-Meniscal Damage Test

A
  1. McMurray’s Test
49
Q

Calf Pain

-Homan’s Test?

A
  1. Forced dorsiflexion (Reverse gas pedal)
    - Pain can indicate a DVT
  2. Follow up a positive Homan’s test w/ a Doppler ultrasound.
50
Q

Knee Pain

-ACUTE Differential Dx

A
  1. Contusion
  2. Sprains/strains
  3. Fracture
  4. Meniscus tear (steps and squatting hurts)
  5. Bursitis
  6. Gout — WAKE UP in pain
  7. DVT
  8. Septic Arthritis (Occurs over several days vs gout is OVERNIGHT
51
Q

Knee Pain

-CHRONIC Differential Dx

A
  1. Chondromalacia (aka Runners Knee) / Osteoarthritis

2. Gout

52
Q

Knee Pain

-Plan

A
  1. NSAIDs
  2. PT
  3. X-rays or other imaging
  4. Immobilization (Not used too much)
  5. Labs — Check for RA
  6. Dietary changes
  7. Referral
53
Q

Foot and Ankle

-Joints & Anatomy

A
  1. Distal Tibia and fibula sits on the talus

2. Lateral Malleolus is the distal part of the fibula — COMMON site of fractures

54
Q

Gout

-S/Sx

A
  1. Hot, red, tender and swollen
  2. VERY abrupt onset
  3. High Purine diet — Red meats and alcohol
55
Q

Foot & Ankle Pain

-ACUTE Differential Dx

A
  1. Sprain/Strain (Most common)
  2. Fracture — Lateral Malleolus is MOST COMMON site
  3. Achilles Rupture — Posterior ankle or foot pain — Divot
  4. Gout
  5. Septic Arthritis (knowing how GOUT and SA present (onset) will help differentiate
56
Q

Foot & Ankle Pain

-CHRONIC Differential Dx

A
  1. Achilles Tendinitis — Usually worse after activity
  2. Osteoarthritis (Stiffening of the joint)
  3. Plantar Fasciitis — Bottom of the foot pain

MOST COMMON fracture in the foot is the FIFTH Metatarsal fracture**TEST

57
Q

Cervical Spine

-Anatomy

A
  1. C1 - C7 — 7 vertebral bodies (aka vertebrae)
  2. Atlas and Axis sit on top — Responsible for rotation of the head
  3. Intervertebral discs — cushion the disks
  4. Foramen— Nerves exit the spine
58
Q 
Neck Pain (Cervicalagia)
-Examination of Cervical Spine (IPPA)
A
  1. Inspection
    - Alignment and symmetry (as symmetry indicates musculature)
    - Redness, ecchymosis, swelling, skin
    - Guarding and non-use
  2. Palpation/Percussion (both sides of spine)
    - Trigger points or spasms (Make note of any)
    - Deep tendon reflexes (TEST)
  3. Passive ROM — Flexion and extension - Ear to shoulders, rotation
  4. Active ROM — Strength testing - Same as above w/ resistance
59
Q 
Neck Pain (Cervicalagia)
-Spurling’s Test
A
  1. Used to Diagnose Cervical Radicular Syndrome**

- Sensitivity & Specificity 50 & 83%

60
Q

Cervical Nerve Roots Examination

A

C5 = Elbow Flexion, shoulder abduction

C6 = Elbow Flexion, Wrist extension, Sensory thumb and radial hand

C7 = Wrist Flexion, finger extension, Elbow Extension

C8 = Finger Flexion

T1 = Abduction of the fingers

61
Q

Neck Pain

-ACUTE Differential Dx

A
  1. Sprain/Strains & Whiplash — MOST Common
  2. Fracture — Immobilize when possible
  3. Disc Displacement — If pt has positive Spurlings Sign or Radiculopathy
62
Q

Neck Pain

-CHRONIC Differential Dx

A
  1. Spondylitis — Arthritic changes that occur; involves Degenerative Disc disease DDD
  2. Radiculopathy — Numbness/tingling
  3. Post-laminectomy syndrome — Pt suffers persistent pain following back surgery
    —Tx w/ nerve blocks & Joint injection
63
Q

Thoracic Spine

-Scoliosis

A
  1. S curvature of the spine — Refer to ortho

2. Have patient bend over and observe spine with shirt off

64
Q

Thoracic Spine

-Differential Dx

A
  1. Acute
    - Strains
    - Compression Fractures (elderly patient falling on coccyx)
  2. Chronic
    - Spondylosis
    - Scoliosis

There are 12 vertebrae in the thoracic spine

65
Q

Lumbar spine

-Info

A
  1. 5 lumbar vertebrae — Spinal chord terminates at L1

2. L4 L5 is the most common area for disc ruptures

66
Q

Low Back Pain

-Differential Dx

A
  1. Acute
    - Strains
    - Vertebral Fractures — Commonly from slips and falls
    - Sciatica —Compression of sciatic nerve from lumbar spine
  2. Chronic
    - Spondylosis — Arthritis from wear and tear — Discs and joints degenerate
    - Radiculopathy — aka sciatica
    - Post-laminectomy syndrome
    - Chronic pain syndrome

6011 Clinical Reasoning Test 3 COMPLETE ☑️ (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions