MS Exam Flashcards
Review of Systems Main Questions?
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
Review of Systems Injury Questions ?
“Point to the pain”
Mechanism of injury (MOI)
Tenderness/pain
Inflammation
Hx of repetitive motion
Swelling (edema, effusion)
Discoloration (erythema, ecchymosis
Review of Systems More specific questions ?
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
Review of Systems Main Questions: Back Pain ?
Midline or off midline
Radiation
Bowel/bladder dysfunction
compression of the spinal cord
Review of Systems Main Questions: Neck Pain ?
Radiation to shoulders, arms
more nerve related
Review of Systems Main Questions: Hip Pain ?
Typically groin or buttocks area
Can be anterior thigh or solely in the knee
knee but it can be hip
Review of Systems Main Questions: Joint pain (arthralgia) or stiffness ?
Mono or polyarticular
one or many
Pattern of involvement
symmetrical
Associated symptoms
F, fatigue or malaise
Review of Systems Main Questions: Previous problem/trauma
?
previous trauma or problems with same joint
Review of System s Injury Questions: “Point to the pain” ?
can you point to it - narrow down anatomy
muscle stuff is so close to the surface so they can usually pinpoint the pain
Review of Systems Injury Questions: MOI ?
how did you do it? which angle did you get hit at?
outside of knee impact - then think medial collateral ligament damage
Review of Systems Injury Questions: tenderness / pain ?
Timing – duration, sudden/gradual, steady/intermittent
Quality, severity
Aggravating/alleviating
Review of Systems Injury Questions: Inflammation ?
Tenderness, warmth, redness of areas
inflammation think more infection or trauma
Review of Systems Injury Questions: Hx of repetitive motion ?
elbow hurts and they a cashier
Review of Systems Injury Questions: Swelling (edema, effusion) ?
effusion - inside the joint
edema id the soft tissues around the joint swelling
Review of Systems Injury Questions: Discoloration ?
erythema, ecchymosis
red or blue
Review of Systems More specific questions: Weakness ?
guarding or true
true cause no strength
or weak and cant cause it hurts
Review of Systems More specific questions: Limitation of motion / activities ?
can u brush you hair or teeth, can you eat with that arm
Review of Systems More specific questions: Hand dominance ?
are you R or L handed ( dont care if back pain)
Review of Systems More specific questions: Nocturnal pain ?
wake you up at night, generally more severe like malignancy
Review of Systems More specific questions: Systemic features ?
Fever/chills, rash, anorexia,
weight loss, weakness
help you with differential
systemic features versus not
Physical Exam: Need to recall ?
Need to recall anatomy
Bony landmarks
Soft tissue structures
Reviewed in Bates -
Chapter 16
Three types of joints ?
Fibrous
Synovial
Cartilaginous
Fibrous joints are ?
Immovable
Fibrous joints examples ?
skull
**no range of motion to it **
Synovial joints are ?
freely movable
Synovial joints are comprised of ?
Ligaments – bone to bone
Joint capsule
Synovial cavity
Synovial membrane
Articular cartilage
- *a lot of parts to them
- more prone to injury**
Synovial joints own notes ?
loss of artclar cartilgae is bone on bone
synovial fluid provides a cushion
Synovial membrane- secrete synovial fluid and the membranee is pouched
Synovial joints examples ?
Spheroidal
Hinge
Condylar
Synovial Joint: Spheroidal example ?
ball and socket
hip, shoulder ( like a cup) wide ROM
Synovial Joint: Hinge example ?
one plane f
fingers
Synovial Joint: Condylar example ?
convex/concave surfaces
knee, epicondylas , tempomandibular joint
Cartilaginous Joints have ?
less movement
Cartilaginous Joints examples ?
vertebrae
No synovial cavity, but a fibrocartilaginous disc
disc instead of synovial cavity
Disc: Outer ?
annulus fibrosis
Disc: Inner ?
nucleus pulposus
**herniated disc - stuff can leak out and then FB reaction to it **
Bursae: ____ shaped, _____ filled sac
disc
fluid
160 of em!
Bursae: where do they lie ?
point of friction
Point of friction examples ?
Between skin and convex surface
Where tendon or muscle rub against bone, ligament or other muscle
**help provide a cushion
over olecranon**
Bursae facilitate ?
movement
Musculoskeletal Exam: be systematic like ?
Inspection - edema, erythema, symmetric
Palpation
ROM
Special maneuvers
Can be thorough in a few minutes
If problems noted – do a more detailed exam
Physical Exam General Assessment: General appearance ?
watch gait when they dont know you watching
Physical Exam General Assessment: Posturing/splinting ?
arm supporting or guarding
Physical Exam
General Assessment: Limited or unrestricted (unstable) movement
?
mean joint is unstable
Physical Exam General Assessment: Gait – swing and stance phase ?
Can be affected by back, hip, knee, ankle, foot or cerebellar disorders
walking normally or if they have a hitch in his walk
Physical Exam General Assessment: Signs of inflammation ?
Swelling
Tenderness
Warmth - backs of hands and compare
Erythema - leads reliable
Physical Exam General Assessment: Edema ?
Extra-articular
Physical Exam General Assessment: Effusion ?
Intra-articular
coming from inside the joint, maybe increased prioduction of S fluid
Physical Exam General Assessment: Surrounding tissue changes ?
Atrophy
Skin changes (corns or calsuses), nodules
Discoloration
**atrophy - doesn’t happen in a week it is more chronic **
Physical Exam General Assessment: Bony deformities ?
bad arthritis, note them and there location
Physical Exam General Assessment: Crepitus ?
Without pain
With pain
usually a tendon sliding
over a bone
Physical Exam General Assessment: Symmetry of ?
Appearance - compare two sides
Strength - graded 0-5/5
** scrawny teenager verusus build teenager ( condition and age) considerations **
Strength assessment numbers: 0/5 ?
0 – no muscle contracture
flaccid
Strength assessment numbers: 1/5 ?
1 – flicker or trace of contracture
Strength assessment numbers: 2/5 ?
2 – active movement without gravity
cant even overcome gravity
Strength assessment numbers: 3/5 ?
3 – active movement against gravity
Strength assessment numbers: 4/5 ?
4 – active movement
against gravity and
some resistance
get fatigued
Strength assessment numbers: 5/5 ?
5 – active movement against gravity and full resistance without evident fatigue (NORMAL)
Other assessment scales ?
pulses 0-3
reflex 0-4
muscles 0-5
Physical Exam General Assessment: ROM ?
Active - raise shoulder and arms to ceiling
Passive - PA does the raising they dont do anything
Physical Exam General Assessment: Increased ROM ?
w/ joint instability -ligament laxity
Physical Exam General Assessment: Decreased ROM ?
w/ inflammation and arthritis
Most active joint in the body
?
Temporomandibular Joint (TMJ)
Temporomandibular Joint (TMJ) has what type of disc ?
Fibrocartilaginous disc
Physical Exam General Assessment: Neck ?
Palpate spinous processes
Palpate soft tissues
ROM
In the neck: __ is most prominent when bending neck
C7
Neck flexion ?
chin down
Neck Extension ?
chin up
Neck lateral bend ?
ear to shoulder
Neck Rotation ?
chin to shoulder
Hand and Wrist Exam - Inspection: Observe hand in motion ?
Smooth and easy movement
make a fist and easier extend fingers
Hand and Wrist Exam - Inspection: Relaxed fingers are partially ?
flexed
Hand and Wrist Exam - Inspection: Finger edges ________
parallel
Hand and Wrist Exam - Inspection: check for ?
deformities
atrophy
tendon thickening
Hand and Wrist ROM ?
Fist then extend
Abduct/adduct fingers
Oppose thumb
Grip strength
Hand and Wrist wrist ROM ?
Flexion/extension
Radial/ulnar deviation
Hand and Wrist: palpate what joints ?
Carpal joints
MCP joints
PIP and DIP joints
**scaphoid has hardest time healing cause less blood supply **
Hand and Wrist: palpate ?
Joints of wrist and fingers
Anatomical Snuffbox
Hand and Wrist: ROM ?
Flexion, extension of wrist, fingers
Radial and ulnar deviation of wrist
Flex, ext, abd, add and opposition of thumb
Hand and Wrist: Strength ?
Grip
Thumb
Carpal Tunnel: Channel beneath the_____________________ on volar surface of the wrist
transverse carpal ligament
Carpal Tunnel: channel beneath contains ?
Tendon sheaths
Flexor tendons of
forearm muscles
Median nerve
Vertebrae Anatomy: Joints between vertebrae are cushioned by discs, and there are joints between _______
facets.
** facets it where bone articulates **
Spine Exam: Inspect ?
Posture, gait, ease of movement
From side
From behind
**never right straight back **
herniated disc occur most commonly in ______ cause greatest degree of curvature
L5 - S1
Inspection of Spine: Asymmetry from behind can be due to ?
Leg length discrepancy
Scoliosis
List (tip), secondary to pain
Laterally for kyphosis
Palpate spine ?
Spinous processes
Paravertebral muscles
SI joints
Spine: measure leg lengths ?
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 **
Spine ROM: flexion ?
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 **
Spine ROM: extension ?
bending backwards
Spine ROM: Lateral bend ?
stabilize pelvis
dont let them lift leg
Spine ROM: Rotation ?
stabilize pelvis
Hip Inspection: Gait ?
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?**
Gait: Stance phase - 60% ?
heel strike
foot flat
mid-stance
push-off
Gait: Swing phase - 40% ?
acceleration
mid-swing
deceleration
Hip ROM: for flexion the patient is ?
supine
Hip ROM: for extension the patient is ?
prone
Hip ROM: internal / external rotation ?
extended - toes medially
Hip ROM: adduction and abduction ?
hand on opposite hit ( stabilize the far hip when you pull the other)
Hip palpate ?
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
Anatomy of knee joint own notes ?
this is the right knee
ace & pal keep the femur from sliding on the tibia (joint instability)
meniscus - cushion
ACL i more common tears
Knee Joint and Bursae examples ?
SPP = suprapatellar pouch
**house maids knee
pes anserine bursa **
Knee Exam - Inspection with patient standing ?
Genu varus
Genu valgus
Genu recurvatum
**varus - bow legged ( more air between the legs)
valgus - koch need
hyper extended - normal variation - recurvatum
gene - knee**
Knee Palpation: Palpate with pt sitting or supine, knee flexed to ___, foot on table
90°
**best if bent at 90 degrees nd can get to structures a bit better **
little bit of rotation in the knee too
With the knee you want to palpate what ?
Tibial margins, condyles,
epicondyles, patella
Collateral ligaments
Tibial tubercle - patellar tendon attaches here
Knee ROM ?
standing, sitting or supine
Flexion/extension
Knee palpate with patient standing, what regions ?
Popliteal fossa
standing may recreate baker cysts