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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
Synovial joints are ?
freely movable
26
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**
27
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
28
Synovial joints examples ?
Spheroidal Hinge Condylar
29
Synovial Joint: Spheroidal example ?
ball and socket hip, shoulder ( like a cup) wide ROM
30
Synovial Joint: Hinge example ?
one plane f fingers
31
Synovial Joint: Condylar example ?
convex/concave surfaces knee, epicondylas , tempomandibular joint
32
Cartilaginous Joints have ?
less movement
33
Cartilaginous Joints examples ?
vertebrae No synovial cavity, but a fibrocartilaginous disc disc instead of synovial cavity
34
Disc: Outer ?
annulus fibrosis
35
Disc: Inner ?
nucleus pulposus **herniated disc - stuff can leak out and then FB reaction to it **
36
Bursae: ____ shaped, _____ filled sac
disc fluid 160 of em!
37
Bursae: where do they lie ?
point of friction
38
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**
39
Bursae facilitate ?
movement
40
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
41
Physical Exam 
General Assessment: General appearance ?
watch gait when they dont know you watching
42
Physical Exam 
General Assessment: Posturing/splinting ?
arm supporting or guarding
43
Physical Exam 
General Assessment: Limited or unrestricted (unstable) movement ?
mean joint is unstable
44
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
45
Physical Exam 
General Assessment: Signs of inflammation ?
Swelling Tenderness Warmth - backs of hands and compare Erythema - leads reliable
46
Physical Exam 
General Assessment: Edema ?
Extra-articular
47
Physical Exam 
General Assessment: Effusion ?
Intra-articular coming from inside the joint, maybe increased prioduction of S fluid
48
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 **
49
Physical Exam 
General Assessment: Bony deformities ?
bad arthritis, note them and there location
50
Physical Exam 
General Assessment: Crepitus ?
Without pain With pain usually a tendon sliding over a bone
51
Physical Exam 
General Assessment: Symmetry of ?
Appearance - compare two sides Strength - graded 0-5/5 ** scrawny teenager verusus build teenager ( condition and age) considerations **
52
Strength assessment numbers: 0/5 ?
0 – no muscle contracture flaccid
53
Strength assessment numbers: 1/5 ?
1 – flicker or trace of contracture
54
Strength assessment numbers: 2/5 ?
2 – active movement without gravity cant even overcome gravity
55
Strength assessment numbers: 3/5 ?
3 – active movement against gravity
56
Strength assessment numbers: 4/5 ?
4 – active movement against gravity and some resistance get fatigued
57
Strength assessment numbers: 5/5 ?
5 – active movement against gravity and full resistance without evident fatigue (NORMAL)
58
Other assessment scales ?
pulses 0-3 reflex 0-4 muscles 0-5
59
Physical Exam 
General Assessment: ROM ?
Active - raise shoulder and arms to ceiling Passive - PA does the raising they dont do anything
60
Physical Exam 
General Assessment: Increased ROM ?
w/ joint instability -ligament laxity
61
Physical Exam 
General Assessment: Decreased ROM ?
w/ inflammation and arthritis
62
Most active joint in the body | ?
Temporomandibular Joint (TMJ)
63
Temporomandibular Joint (TMJ) has what type of disc ?
Fibrocartilaginous disc
64
Physical Exam 
General Assessment: Neck ?
Palpate spinous processes Palpate soft tissues ROM
65
In the neck: __ is most prominent when bending neck
C7
66
Neck flexion ?
chin down
67
Neck Extension ?
chin up
68
Neck lateral bend ?
ear to shoulder
69
Neck Rotation ?
chin to shoulder
70
Hand and Wrist Exam - Inspection: Observe hand in motion ?
Smooth and easy movement make a fist and easier extend fingers
71
Hand and Wrist Exam - Inspection: Relaxed fingers are partially ?
flexed
72
Hand and Wrist Exam - Inspection: Finger edges ________
parallel
73
Hand and Wrist Exam - Inspection: check for ?
deformities atrophy tendon thickening
74
Hand and Wrist ROM ?
Fist then extend Abduct/adduct fingers Oppose thumb Grip strength
75
Hand and Wrist wrist ROM ?
Flexion/extension Radial/ulnar deviation
76
Hand and Wrist: palpate what joints ?
Carpal joints MCP joints PIP and DIP joints **scaphoid has hardest time healing cause less blood supply **
77
Hand and Wrist: palpate ?
Joints of wrist and fingers Anatomical Snuffbox
78
Hand and Wrist: ROM ?
Flexion, extension of wrist, fingers Radial and ulnar deviation of wrist Flex, ext, abd, add and opposition of thumb
79
Hand and Wrist: Strength ?
Grip Thumb
80
Carpal Tunnel: Channel beneath the_____________________ on volar surface of the wrist
transverse carpal ligament
81
Carpal Tunnel: channel beneath contains ?
Tendon sheaths Flexor tendons of forearm muscles Median nerve
82
Vertebrae Anatomy: Joints between vertebrae are cushioned by discs, and there are joints between _______
facets. ** facets it where bone articulates **
83
Spine Exam: Inspect ?
Posture, gait, ease of movement From side From behind **never right straight back **
84
herniated disc occur most commonly in ______ cause greatest degree of curvature
L5 - S1
85
Inspection of Spine: Asymmetry from behind can be due to ?
Leg length discrepancy Scoliosis List (tip), secondary to pain Laterally for kyphosis
86
Palpate spine ?
Spinous processes Paravertebral muscles SI joints
87

 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 **
88
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 **
89
Spine ROM: extension ?
bending backwards
90
Spine ROM: Lateral bend ?
stabilize pelvis dont let them lift leg
91
Spine ROM: Rotation ?
stabilize pelvis
92
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?**
93
Gait: Stance phase - 60% ?
heel strike foot flat mid-stance push-off
94
Gait: Swing phase - 40% ?
acceleration mid-swing deceleration
95
Hip ROM: for flexion the patient is ?
supine
96
Hip ROM: for extension the patient is ?
prone
97
Hip ROM: internal / external rotation ?
extended - toes medially
98
Hip ROM: adduction and abduction ?
hand on opposite hit ( stabilize the far hip when you pull the other)
99
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**
100
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
101
Knee Joint and Bursae examples ?
SPP = suprapatellar pouch **house maids knee pes anserine bursa **
102
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**
103
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
104
With the knee you want to palpate what ?
Tibial margins, condyles, epicondyles, patella Collateral ligaments Tibial tubercle - patellar tendon attaches here
105
Knee ROM ?
standing, sitting or supine Flexion/extension
106
Knee palpate with patient standing, what regions ?
Popliteal fossa standing may recreate baker cysts

Patient Evaluation (29 decks)

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