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mOSCEs > MSK > Flashcards

MSK Flashcards

1
Q

looking at spine

A

look from side: curvatures of spine

behind: spinal alignment, symmetry,, scoliosis, abnormal hair growth

scars, bruising

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2
Q

feeling spine

A

paplate midline spinous processes from top downwards
feel sacroiliac joints: any ill-alignment, irregularities, tenderness

feel for paraspinal muscle tenderness or increased tone one side at a time

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3
Q

movement of cervical spine

A

active -

flexion: touch chin to chest
extension: tilt head backwards
- lateral flexion: touch ear to shoulder
- rotation: look over each shoulder

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4
Q

movement of lumbar spine

A

flexion: touch their toes, measure by placing fingers on 2 adjacent lumbar spinous processes
extension: lean back

lateral flexion: bend to side, running hand down their leg

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5
Q

neurological examination spine

A

straight leg raise: patient lying down, lift their leg up to their limit then dorsliflex foot: may exacerbate pain if nerve root entrapment or prolapsed disc

reflexes - upper and lower lumvs

-power and sensation upper and lower limbs

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6
Q

ankle and foot: looking

A

shoewear
nail changes, skin rashes, scars, wound, calluses

swelling or muscle wasting of calf muscles

toes for clawing or joint swelling or hallux valgus

sole for callus formation

toe alingment

standing: foot arch position, dropped/hihg arch, alignment if hind foot
varus or valgus deformity
achilles tendon swelling or thickening

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7
Q

ankle and foot: feel

A

temperature
pulses
MTP joint squeeze for tenderness

palpate for tenderness, swelling, irregularity

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8
Q

ankle and foot: move

A

active: dorsiflexion and plantar flexion ankle, flexion + extension big toe

passive; ankle plantar and dorsi flexiom, inversion and eversion subtalatr joint, mid tarsal and subtalar movements

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9
Q

ankle and foot function

A

assess gait

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10
Q

shoulder: look

A 
asymmetry 
deformity 
scapula winging
muscle wasting - deltoid and infra-/supra-spinatous
scars
wounds
bruises
swelling
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11
Q

shoulder: feel

A

temp at joints (4 in shoulder)
bony landmarks for tenderness

sternoclavicular joint
spine scapula
greater tuberosity humerus
ant + pos joint lines humerus
3 muscles 
axillary nerve sensation
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12
Q

shoulder: active movement

A

hands behind head: abduction and external rotation

hands behind back: internal rotation

full extension
full flexion
full abduction
external + internal rotation shoulder: elbows flexed 90d, tucked into sides and rotate

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13
Q

shoulder: passive movement

A

all those for active

extension, flexion, abduction, external rotation

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14
Q

elbow: look

A 
scars
swellings
rashes
deformity 
normal carrying angles
muscle wasting 
bruising
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15
Q

elbow: feel

A

temp

tenderness over medial and lateral epicondyles, olecranon process, radial head

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16
Q

elbow: movement

A

active then passive

flex
extend
supination then pronation

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17
Q

elbow: function

A

check ability to put hand to mouth for feeding

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18
Q

phalen’s test

A

detection carpal tunnel syndrome

wrist in full flexion for 60s

if +ive pts symptoms elicited by this manouvre

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19
Q

tinnel’s test

A

detect carpal tunnel syndrome

tapping over median nerve as it passes through wrist
+ive if tingling in thimb, index and middle fingers

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20
Q

hand + wrist: look

A 
scars 
wounds 
thinning skin 
rash
clubbing 
nail pitting 
splinter haemorrhages
deformity 
muscle wasting 
fasical thickening on palm
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21
Q

hand + wrist: feel

A 
temp 
muscle bulk thenar + hypothenar
distal radius, ulnar, carpals and metacarpals 
fingers
MCP and wrist joint
22
Q

hand + wrist: move

A

straighten fingers fully then make fist

  • finger flexion MCPJ, PIPJ and DIPJ
  • wrist flexion and extension: prayer and reverse prayer sign (active then passive)

phalen’s and tinnel’s tests

23
Q

hand + wrist: function

A

power grip: patient to grip your 2 fingers

pincer grip: patient to pick up small object

24
Q

hand + wrist: neurological examination

A

sensation median, ulnar and radial nerves and then their power

25
Q

trendelenburg sign

A

sign found in people with weak/paralysed hip abductor muscles

patient stand on one foot

test +ive if pelvis dips on side of non-weight bearing leg

26
Q

true leg length

A

measured from anterrior superior iliac spine to just below the ipsilateral medial malleolus

27
Q

apparent leg lenght

A

point in patient’s midline (either umbilicus or xiphi-sternum) to medial malleolus of ankle of each leg

28
Q

thomas’ test

A

assessment of fixed flexion deformity

if fixed flexion deformity patient usually compensates by increasing lumbar lordosis - stop this by placing one hand under pt lumbar spine

flex normal hip until feel lumbar lordosis flatten on hand. if opposite leg is lifted off bed then there is fixed flexion deformity of that hip

29
Q

hip: look

A 
deformity 
symmetry 
scars
swellings
muscle wasting 
leg length discrepency
30
Q

hip: feel

A

tenderness over greater trochanter

apparent and true leg length

31
Q

hip: move

A

thomas’s test

flexion
rotation: internal and external
abduction
adduction

trendelenburg test

32
Q

hip: function

A

gait - looking for limp

33
Q

antalgic limp

A

pain on weight bearing

34
Q

ataxic gait

A

wide based and marked clumsiness

35
Q

high stepping gait

A

presence of foot drop

36
Q

knee: valgus deformity

A

distal part of tibia is deviated laterally/away from midline

bilateral valgus deformity will give knock-kneed appearance

37
Q

knee: varus deformity

A

distal part of tibia is deviated medially

if deformity bilateral then bow legged appearance

38
Q

two methods to examine for knee effusions

A

patellar tap

bulge sign

39
Q

examine for knee effusions: patellar tap

A

for moderate/large knee effusion

pt lie with leg fully extended. compress suprapatellar pouch by sliding hand down thing until the upper patella border
keep hand in this position and with 2 fingers on other hand press down on patella and you will feel a tap as it impacts on the femur

40
Q

examine for knee effusions: bulge sign

A

smaller effusion

empty medial compartment of knee by sweeping hand upwards. Then stroke down suprapatellar are and on down lateral side of knee
if effusion a bulge will appear in medial side (medial gutter)

41
Q

posterior cruciate sag/draw test

A

bring legs together, bend hips to 45 and flex knees to 90, feet flat on bed

if one tibia lying posterior to other this is sign the posterior cruciate is ruptured

place hands behind knee and thumbs on tibia either side patellar tendon. forward pull and tibia will be drawn forward into same position as opposite leg

+ive posterior draw sign is also sign of posterior cruciate damage

42
Q

anterior cruciate draw test

A

bring legs together, bend hips to 45 and flex knees to 90, feet flat on bed

view both knees from side to check tibial tuberosities are aligned and no sag back

place hands behind knee and pull forward to attempt to draw tibia forwards.

significant movement indicates +ve test indicating anterior cruciate ligament damage

43
Q

knee: look

A

standing then lying

symmetry, alignment 
varus or valgus deformity 
fixed flexion of knee
rashes, wounds, scars, swelling 
wasting of quadriceps muscles
44
Q

knee: feel

A

temp different, mid-thigh vs knee
tenderness along border of patella, extensor mechanism, medial + lateral joint lines
feel behind knee for popliteal cysts
assess for effusions: patellar tap then bulge test

45
Q

knee: move (actions active then passive)

A

flex (bring as far in at possible to bum)
extend

hyperextension by lifting legs by heels and looking for excessive extension

assess extensor mechanism by getting pt to do straight leg raise

46
Q

knee: move - collateral ligaments

A

flex knee to 20-30 and apply lateral and medial stress to knee

repeat extended

excessive movement suggests damage to ligament or wear in medial/lateral compartments in older patients

47
Q

knee move - cruciate ligaments

A

posterior sag/draw test

anterior draw test

48
Q

knee: function

A

get them to walk

look for limp, valgus/varus deformity or fixed flexion gait

49
Q

reasons for inc temp felt over joints

A

septic arthritis

inflammatory arthritis

50
Q

what specific things are felt during general palpation of foot/ankle

A 
metatarsal + tarsal bones
tarsal joint
ankle joint 
subtalar joint 
calcaneum 
medial and lateral malleoli
distal fibula

mOSCEs (13 decks)

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