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OSCEs > MSK > Flashcards

MSK Flashcards

1
Q

what questions should be asked in the presenting complaint of a MSK history?

A 
acute vs chronic
joint pain
joint stiffness
joint swelling
associated symptoms
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2
Q

what questions should be asked about joint pain?

A 
site; joint, muscle, body region
distribution; number of joints, axial, a/symmetrical, small or large
character
radiation
aggravating/relieving factors
severity; waking from sleep
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3
Q

what questions should be asked about joint stiffness?

A

which joints?
what time of day?
does it relate to rest and exercise?
what is the duration of stiffness?

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4
Q

what associated symptoms should be asked about in an MSK history?

A 
fever
weakness
fatigue
weight loss
eye symptoms; conjunctivitis
preceding sore throat
symptoms of urethritis; penile discharge, dysuria
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5
Q

what diseases should be asked about in the PHx and FHx of a MSK history?

A

IBD
psoriasis
STDs
iritis

rheumatoid arthritis
osteoarthritis
gout
any other type of arthritis

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6
Q

what questions should be asked in the social Hx of a MSK history?

A

domestic situation
occupation
affects on daily living; dressing, cooking, washing, mobility, leisure, sexual activity

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7
Q

describe the steps of the spine exam

A

exposure; shirt off and ideally wearing shorts

look; gait, observe spine from front, side and posterior, look for abnormal curvatures or scars

feel; palpate bony spine and para-vertebral muscles, tenderness

move;
C-spine; flexion, extension, lateral rotation, lateral flexion
thoracolumbar; flexion, extension, lateral flexion, trunchal rotation (stabilise pelvis)

special tests;
Schober’s test
straight leg raise test

other examinations;
peripheral neurological exam
abdominal exam

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8
Q

what are you looking for in the look section of the spine exam?

A

difficulties removing shirt
straight spine or scoliosis
rib cage asymmetry
normal muscle bulk
scars from previous spinal surgery
loss of normal cervical and lumbar lordosis
alteration of the normal mild thoracic kyphosis

gait;
easy following movement
symmetrical movement
antalgic gait

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9
Q

what are you looking for in the move section of the spine exam?

A

restricted movements
smoothness of movement
pain experienced during movements

explain and demonstrate the movements to the patient

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10
Q

describe Schober’s test

A

identify the dimples of Venus (S2)/feel bilaterally for the PSIS
go to the midline
using a tape measurer, mark a point 10cm above and 5cm below the midline
ask the patient to touch their toes
measure the distance between the 2 marks
the distance should increase to >21cm in a normal patient

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11
Q

describe a straight leg test

A

patient supine
use hand to fix the pelvis
patient attempts to raise one leg at a time with knee fully extended
assess the degree of movement from the horizontal
dorsiflex the ankle; assesses limitation of movement due to sciatic nerve root pressure

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12
Q

describe the steps of the shoulder exam

A

exposure; shirt off
examine both shoulders and compare one side with the other

look; from front, side and posterior aspects
scars, swelling, erythema, muscle wasting, abnormal contours

feel; palpate all aspects of both shoulders from tenderness, swelling or warmth

move;
active; flexion, extension, abduction, adduction, internal and external rotation
passive; flexion, extension, abduction, adduction (stabilise scapula), internal and external rotation

other tests; consider neck exam, upper neurological exam, circulation status
depending on findings; abdominal or cardiovascular exam (referred pain)

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13
Q

what are you looking for in the feel section of the shoulder exam?

A 
1; sternoclavicular joint
2; clavicle
3; acromioclavicular joint
4; humeral head
5; coracoid process
6; deltoid muscle
7; spine of scapula
8; supraspinatus muscle
9; infraspinatus muscle
10; trapezius muscle

repeat on the other side

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14
Q

describe the move section of the shoulder exam

A

active; show the patients the movement
flexion and extension; flex your elbow 90 degrees
internal and external rotation; flex your elbow 90 degrees

passive; get them to relax as much as possible
flexion and extension; flex your elbow 90 degrees
abduction; stabilise the scapula
adduction; extend elbow fully, place their arm across their trunk as far as possible
internal and external rotation; flex your elbow 90 degrees

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15
Q

describe the steps of a hip exam

A

exposure; in shorts
examine both hips and compare one with the other

look; standing and supine, muscle wasting, obvious leg length discrepancy, gait abnormality

feel; true and apparent leg length, palpation for tenderness, swelling, warmth

move; flexion, abduction, adduction, internal and external rotation

special tests; Thomas’s test, trendelenburg test

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16
Q

describe the look section of a hip exam

A

standing; look from all sides with the patient stationary, level of the iliac crests, walk to the other side and walk back, gait, pelvic movements,

laying supine; scars, muscle wasting, obvious leg length discrepancy

17
Q

describe the feel section of a hip exam

A

tenderness, heat or swelling around the inguinal or greater trochanter area
true leg length; ASIS to the medial malleolus
apparent leg length; xiphisternum to medial malleolus

18
Q

describe the move section of a hip exam

A

flexion, internal and external rotation; flex knees and flex hip joint
abduction; stabilise the pelvis and hold the ankle

19
Q

describe Thomas’ test

A

place your hand on the small of the patient’s back
flex the hip and feel the lumbar spine flatten
see if the other knee is flat on the couch
measure the angle of fixed hip flexion
repeat; clasp their knee up to their chest and observe for fixed flexion deformity

20
Q

describe trendelenburg test

A

assesses for gluteus medius weakness
ask the patient to stand on each leg in turn
observe the pelvis for any tilt
positive test; pelvis may drop on the side of the leg that has been lifted

21
Q

describe the steps of a knee exam

A

exposure; in shorts
look; standing and walking

feel; temperature, tenderness, patellar tap, bulge test

move;
active; full flexion and extension
passive; flexion and extension, place a hand on the knee

special tests;
medial and lateral collateral ligaments
anterior and posterior cruciate ligaments

22
Q

describe the look section of a knee exam

A 
walking and standing
look at the front, sides and back
limp
appear to be in pain
muscle wasting
scars
rash
red/swollen
bowing or knock kneed
23
Q

describe the feel section of a knee exam

A

temperature; examine the unaffected side first
always compare one knee with the other

tenderness; patella, quadriceps tendon, prepatellar and collateral ligaments
bend and feel the medial and lateral joint lines
feel at the back of the knee for a baker’s cyst

patellar tap; slide your hand down the thigh
use the index and middle fingers to push down on the patella
bouncing indicates an effusion

bulge test; milk any fluid down the leg towards the knee
stroke the medial side and then the lateral side of the knee
observe for any bulging

24
Q

describe the special tests of the knee exam

A

collateral ligament assessment; flex the knee to 30 degrees, apply valgus and varus pressure

cruciate ligament assessment; ask if they have a sore foot, sit on the foot, wrap your fingers around the back of the knee and keep your thumbs in front of the patella, pull anteriorly and then push posteriorly

25
Q

describe the steps of the GALS exam

A 
introduction
screening questions
gait
inspection
arms
legs
spine
temporomandibular joint
complete examination
26
Q

what are the screening questions of the GALS exam?

A

do you have any pain or stiffness in your muscles, joints or back?
do you have any difficulty getting yourself dressed without any help?
do you have any problem going up and down the stairs?

27
Q

describe the inspection section of the GALS exam

A

general; body habits, scars, muscle wasting, psoriasis
anterior; posture, scars, joint swelling, joint erythema, muscle bulk, elbow extension
lateral; lordosis, kyphosis, knee joint hyperextension, foot arch
posterior; muscle bulk, spinal alignment, iliac crest alignment, popliteal swelling, Achille’s tendon

28
Q

describe the arms section of the GALS exam

A 
hands behind head
arms out with palms facing up/down
make a fist
grip strength
precision grip
metacarpal joint squeeze
29
Q

describe the leg section of the GALS exam

A

passive; knee flexion, extension, internal hip rotation
metatarsophalangeal joint squeeze
patellar tap

30
Q

describe the spine section of the GALS exam

A

cervical lateral flexion

lumbar flexion

31
Q

describe the steps of a hand exam

A

introduction
look; general inspection, close inspection of the hand
feel; palms up, palms down, elbow
move; active and passive movement, motor assessment
function
special tests
complete examination

32
Q

describe the introduction of a hand exam

A 
introduction
confirm patient details
explain procedure
expose hands, wrists and elbows
ask if they are in any pain
33
Q

describe the look section of a hand exam

A

general inspection; scars, muscle wasting, aids, adaptations, prescriptions
dorsal and palmar aspects of the hand

34
Q

what are you looking for when examining the dorsal aspect of the hand?

A

hand posture
scars
swelling
skin colour; erythema indicates cellulitis or sepsis
bouchards nodes; PIP swelling
herbedens nodes; DIP swelling
swan neck deformity; DIP flexion, PIP hyperextension
boutonnieres deformity; DIP hyperextension, PIP flexion
z-shaped thumb; RA
skin thinning/bruising; steroids
psoriatic plaques
splinter haemorrhages; trauma, vasculitis, psoriasis, sepsis, infective endocarditis
nail pitting, onycholysis; psoriasis, psoriatic arthritis

35
Q

what are you looking for when examining the ventral aspect of the hand?

A 
hand posture
scars
swelling
dupuytren's contracture
thenar/hypothenar wasting; median nerve damage
elbows; psoriatic plaques, RA
36
Q

describe the feel section of a hand exam

A

ventral;
temperature; septic or inflammatory arthritis
radial and ulnar pulse
thenar and hypothenar eminence
palmar thickening; Dupuytren’s contracture
median and ulnar nerve sensation

dorsal;
radial nerve sensation
temperature
metacarpophalangeal joint squeeze
bimanual joint palpation
anatomical snuffbox
bimanual wrist palpation

elbow; tenderness, rheumatoid nodules, psoriatic plaques

37
Q

describe the move section of a hand exam

A

active;
finger flexion/extension
wrist flexion/extension

passive;
finger flexion/extension
wrist flexion/extension

motor assessment;
wrist and finger extension against resistance
index finger abduction against resistance
thumb abduction against resistance

38
Q

describe the function section of a hand exam

A

power grip
pincer grip
pick up a small object

39
Q

describe the special tests of a hand exam

A

tinels test; tap over the carpal tunnel with your finger

phalens test; hold their wrists in maximum forced flexion for 60 seconds

OSCEs (11 decks)

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