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Patient Evaluation > MS Exam > Flashcards

MS Exam Flashcards

1
Q

Review of Systems
 Main Questions?

A 
Back pain (is it more middle or on the sides)
Midline or off midline

Neck pain

Hip pain

Muscle pain (myalgia)

Joint pain (arthralgia) or stiffness

Previous problem/trauma

History of:
Arthritis
Gout
Back pain/disc disease
Bursitis/tendonitis
Fractures
Osteoporosis
Surgeries/treatments
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2
Q

Review of Systems
Injury Questions ?

A

“Point to the pain”

Mechanism of injury (MOI)

Tenderness/pain

Inflammation

Hx of repetitive motion

Swelling (edema, effusion)

Discoloration (erythema, ecchymosis

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3
Q

Review of Systems
 More specific questions ?

A

Weakness – guarding or true

Limitation of motion/activities

Hand dominance

Nocturnal pain - wake you up at night, generally more severe like malignancy

Systemic features:
Fever/chills, rash, anorexia, weight loss, weakness
help you with differential
systemic features versus not

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4
Q

Review of Systems
 Main Questions: Back Pain ?

A

Midline or off midline

Radiation

Bowel/bladder dysfunction
compression of the spinal cord

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5
Q

Review of Systems
 Main Questions: Neck Pain ?

A

Radiation to shoulders, arms

more nerve related

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6
Q

Review of Systems
 Main Questions: Hip Pain ?

A

Typically groin or buttocks area

Can be anterior thigh or solely in the knee
knee but it can be hip

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7
Q

Review of Systems
 Main Questions: Joint pain (arthralgia) or stiffness ?

A

Mono or polyarticular
one or many

Pattern of involvement
symmetrical

Associated symptoms
F, fatigue or malaise

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8
Q

Review of Systems
 Main Questions: Previous problem/trauma

?

A

previous trauma or problems with same joint

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9
Q

Review of System s
Injury Questions: “Point to the pain” ?

A

can you point to it - narrow down anatomy

muscle stuff is so close to the surface so they can usually pinpoint the pain

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10
Q

Review of Systems
 Injury Questions: MOI ?

A

how did you do it? which angle did you get hit at?

outside of knee impact - then think medial collateral ligament damage

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11
Q

Review of Systems
 Injury Questions: tenderness / pain ?

A

Timing – duration, sudden/gradual, steady/intermittent

Quality, severity

Aggravating/alleviating

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12
Q

Review of Systems
 Injury Questions: Inflammation ?

A

Tenderness, warmth, redness of areas

inflammation think more infection or trauma

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13
Q

Review of Systems
 Injury Questions: Hx of repetitive motion ?

A

elbow hurts and they a cashier

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14
Q

Review of Systems
 Injury Questions: Swelling (edema, effusion) ?

A

effusion - inside the joint

edema id the soft tissues around the joint swelling

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15
Q

Review of Systems
 Injury Questions: Discoloration ?

A

erythema, ecchymosis

red or blue

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16
Q

Review of Systems
 More specific questions: Weakness ?

A

guarding or true

true cause no strength

or weak and cant cause it hurts

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17
Q

Review of Systems
 More specific questions: Limitation of motion / activities ?

A

can u brush you hair or teeth, can you eat with that arm

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18
Q

Review of Systems
 More specific questions: Hand dominance ?

A

are you R or L handed ( dont care if back pain)

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19
Q

Review of Systems
 More specific questions: Nocturnal pain ?

A

wake you up at night, generally more severe like malignancy

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20
Q

Review of Systems
 More specific questions: Systemic features ?

A

Fever/chills, rash, anorexia,

weight loss, weakness

help you with differential
systemic features versus not

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21
Q

Physical Exam: Need to recall ?

A

Need to recall anatomy

Bony landmarks

Soft tissue structures

Reviewed in Bates -
Chapter 16

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22
Q

Three types of joints ?

A

Fibrous

Synovial

Cartilaginous

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23
Q

Fibrous joints are ?

A

Immovable

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24
Q

Fibrous joints examples ?

A

skull

**no range of motion to it **

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25
Q

Synovial joints are ?

A

freely movable

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26
Q

Synovial joints are comprised of ?

A

Ligaments – bone to bone

Joint capsule

Synovial cavity

Synovial membrane

Articular cartilage

  • *a lot of parts to them
  • more prone to injury**
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27
Q

Synovial joints own notes ?

A

loss of artclar cartilgae is bone on bone

synovial fluid provides a cushion

Synovial membrane- secrete synovial fluid and the membranee is pouched

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28
Q

Synovial joints examples ?

A

Spheroidal

Hinge

Condylar

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29
Q

Synovial Joint: Spheroidal example ?

A

ball and socket

hip, shoulder ( like a cup) wide ROM

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30
Q

Synovial Joint: Hinge example ?

A

one plane f

fingers

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31
Q

Synovial Joint: Condylar example ?

A

convex/concave surfaces

knee, epicondylas , tempomandibular joint

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32
Q

Cartilaginous Joints have ?

A

less movement

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33
Q

Cartilaginous Joints examples ?

A

vertebrae

No synovial cavity, but a fibrocartilaginous disc

disc instead of synovial cavity

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34
Q

Disc: Outer ?

A

annulus fibrosis

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35
Q

Disc: Inner ?

A

nucleus pulposus

**herniated disc - stuff can leak out and then FB reaction to it **

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36
Q

Bursae: ____ shaped, _____ filled sac

A

disc

fluid

160 of em!

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37
Q

Bursae: where do they lie ?

A

point of friction

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38
Q

Point of friction examples ?

A

Between skin and convex surface

Where tendon or muscle rub against bone, ligament or other muscle

**help provide a cushion

over olecranon**

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39
Q

Bursae facilitate ?

A

movement

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40
Q

Musculoskeletal Exam: be systematic like ?

A

Inspection - edema, erythema, symmetric

Palpation

ROM

Special maneuvers

Can be thorough in a few minutes

If problems noted – do a more detailed exam

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41
Q

Physical Exam 
General Assessment: General appearance ?

A

watch gait when they dont know you watching

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42
Q

Physical Exam 
General Assessment: Posturing/splinting ?

A

arm supporting or guarding

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43
Q

Physical Exam 
General Assessment: Limited or unrestricted (unstable) movement
?

A

mean joint is unstable

44
Q

Physical Exam 
General Assessment: Gait – swing and stance phase ?

A

Can be affected by back, hip, knee, ankle, foot or cerebellar disorders

walking normally or if they have a hitch in his walk

45
Q

Physical Exam 
General Assessment: Signs of inflammation ?

A

Swelling

Tenderness

Warmth - backs of hands and compare

Erythema - leads reliable

46
Q

Physical Exam 
General Assessment: Edema ?

A

Extra-articular

47
Q

Physical Exam 
General Assessment: Effusion ?

A

Intra-articular

coming from inside the joint, maybe increased prioduction of S fluid

48
Q

Physical Exam 
General Assessment: Surrounding tissue changes ?

A

Atrophy

Skin changes (corns or calsuses), nodules

Discoloration

**atrophy - doesn’t happen in a week it is more chronic **

49
Q

Physical Exam 
General Assessment: Bony deformities ?

A

bad arthritis, note them and there location

50
Q

Physical Exam 
General Assessment: Crepitus ?

A

Without pain

With pain

usually a tendon sliding
over a bone

51
Q

Physical Exam 
General Assessment: Symmetry of ?

A

Appearance - compare two sides

Strength - graded 0-5/5

** scrawny teenager verusus build teenager ( condition and age) considerations **

52
Q

Strength assessment numbers: 0/5 ?

A

0 – no muscle contracture

flaccid

53
Q

Strength assessment numbers: 1/5 ?

A

1 – flicker or trace of contracture

54
Q

Strength assessment numbers: 2/5 ?

A

2 – active movement without gravity

cant even overcome gravity

55
Q

Strength assessment numbers: 3/5 ?

A

3 – active movement against gravity

56
Q

Strength assessment numbers: 4/5 ?

A

4 – active movement

against gravity and
some resistance

get fatigued

57
Q

Strength assessment numbers: 5/5 ?

A

5 – active movement against gravity and full resistance without evident fatigue (NORMAL)

58
Q

Other assessment scales ?

A

pulses 0-3

reflex 0-4

muscles 0-5

59
Q

Physical Exam 
General Assessment: ROM ?

A

Active - raise shoulder and arms to ceiling

Passive - PA does the raising they dont do anything

60
Q

Physical Exam 
General Assessment: Increased ROM ?

A

w/ joint instability -ligament laxity

61
Q

Physical Exam 
General Assessment: Decreased ROM ?

A

w/ inflammation and arthritis

62
Q

Most active joint in the body

?

A

Temporomandibular Joint (TMJ)

63
Q

Temporomandibular Joint (TMJ) has what type of disc ?

A

Fibrocartilaginous disc

64
Q

Physical Exam 
General Assessment: Neck ?

A

Palpate spinous processes

Palpate soft tissues

ROM

65
Q

In the neck: __ is most prominent when bending neck

66
Q

Neck flexion ?

67
Q

Neck Extension ?

68
Q

Neck lateral bend ?

A

ear to shoulder

69
Q

Neck Rotation ?

A

chin to shoulder

70
Q

Hand and Wrist Exam - Inspection: Observe hand in motion ?

A

Smooth and easy movement

make a fist and easier extend fingers

71
Q

Hand and Wrist Exam - Inspection: Relaxed fingers are partially ?

72
Q

Hand and Wrist Exam - Inspection: Finger edges ________

73
Q

Hand and Wrist Exam - Inspection: check for ?

A

deformities

atrophy

tendon thickening

74
Q

Hand and Wrist ROM ?

A

Fist then extend

Abduct/adduct fingers

Oppose thumb

Grip strength

75
Q

Hand and Wrist wrist ROM ?

A

Flexion/extension

Radial/ulnar deviation

76
Q

Hand and Wrist: palpate what joints ?

A

Carpal joints

MCP joints

PIP and DIP joints

**scaphoid has hardest time healing cause less blood supply **

77
Q

Hand and Wrist: palpate ?

A

Joints of wrist and fingers

Anatomical Snuffbox

78
Q

Hand and Wrist: ROM ?

A

Flexion, extension of wrist, fingers

Radial and ulnar deviation of wrist

Flex, ext, abd, add and opposition of thumb

79
Q

Hand and Wrist: Strength ?

A

Grip

Thumb

80
Q

Carpal Tunnel: Channel beneath the_____________________ on volar surface of the wrist

A

transverse carpal ligament

81
Q

Carpal Tunnel: channel beneath contains ?

A

Tendon sheaths

Flexor tendons of
forearm muscles

Median nerve

82
Q

Vertebrae Anatomy: Joints between vertebrae are cushioned by discs, and there are joints between _______

A

facets.

** facets it where bone articulates **

83
Q

Spine Exam: Inspect ?

A

Posture, gait, ease of movement

From side

From behind

**never right straight back **

84
Q

herniated disc occur most commonly in ______ cause greatest degree of curvature

85
Q

Inspection of Spine: Asymmetry from behind can be due to ?

A

Leg length discrepancy

Scoliosis

List (tip), secondary to pain

Laterally for kyphosis

86
Q

Palpate spine ?

A

Spinous processes

Paravertebral muscles

SI joints

87
Q


 Spine: measure leg lengths ?

A

ASIS, cross knee on medial side, down to medial malleolus

**bony point to bony point

find SI joints - draw imaginary line across posterior iliac crest - where Si joint is **

88
Q

Spine ROM: flexion ?

A

bending forward as far a can

**lumbar curve should flatten out when flexed and if it doesn’t then there is loss of flection of those joints **

89
Q

Spine ROM: extension ?

A

bending backwards

90
Q

Spine ROM: Lateral bend ?

A

stabilize pelvis

dont let them lift leg

91
Q

Spine ROM: Rotation ?

A

stabilize pelvis

92
Q

Hip Inspection: Gait ?

A

Swing and stance phase
walk across the room and back

Width of base
should be same a shoulders

Shift of pelvis
asymmetrically

Flexion of knee
should be some knee flexion

Smooth continuous rhythm

**isolate and just watch one leg at a time

limping

can be distributed from problems in the back , hip, knee , cerebellum?**

93
Q

Gait: Stance phase - 60% ?

A

heel strike

foot flat

mid-stance

push-off

94
Q

Gait: Swing phase - 40% ?

A

acceleration

mid-swing

deceleration

95
Q

Hip ROM: for flexion the patient is ?

96
Q

Hip ROM: for extension the patient is ?

97
Q

Hip ROM: internal / external rotation ?

A

extended - toes medially

98
Q

Hip ROM: adduction and abduction ?

A

hand on opposite hit ( stabilize the far hip when you pull the other)

99
Q

Hip palpate ?

A

Greater trochanter and bursa

Ischial tuberosity and bursa
lay on side with leg flexed

cant palpate the joint but you can palpate the bursa’s

100
Q

Anatomy of knee joint own notes ?

A

this is the right knee

ace & pal keep the femur from sliding on the tibia (joint instability)

meniscus - cushion

ACL i more common tears

101
Q

Knee Joint and Bursae examples ?

A

SPP = suprapatellar pouch

**house maids knee

pes anserine bursa **

102
Q

Knee Exam - Inspection with patient standing ?

A

Genu varus

Genu valgus

Genu recurvatum

**varus - bow legged ( more air between the legs)

valgus - koch need

hyper extended - normal variation - recurvatum

gene - knee**

103
Q

Knee Palpation: Palpate with pt sitting or supine, knee flexed to ___, foot on table

A

90°

**best if bent at 90 degrees nd can get to structures a bit better **
little bit of rotation in the knee too

104
Q

With the knee you want to palpate what ?

A

Tibial margins, condyles,
epicondyles, patella

Collateral ligaments

Tibial tubercle - patellar tendon attaches here

105
Q

Knee ROM ?

A

standing, sitting or supine

Flexion/extension

106
Q

Knee palpate with patient standing, what regions ?

A

Popliteal fossa

standing may recreate baker cysts

Patient Evaluation (29 decks)

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