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Clin Med 3-2017 > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

What characteristics of the MS history are similar to other patient histories?

A
  1. Age
  2. Chief complaint
  3. History of presenting illness
  4. Past medical history especially prior injuries or operations
  5. Medications
  6. Other treatments for their injury
  7. Allergies: don’t forget latex
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2
Q

What information is part of the patients social history?

A 
1. Occupation
Working / Retired
Manual labor / Desk job
2. Living situation
Alone / Spouse / Other supports
Two storey house / Apartment
3. Ambulatory status
How far can they walk
Do they use a walker / cane 
4. Smoking/ Alcohol/ Drug Use
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3
Q

Specifics of the HPI:
for pain or presenting problem:
COLD TAP RARE

A

Character
Onset
Location
Duration

Therapy attempted
Attenuating Factors
Precipitating Factors

Relieving Factors
Associated Symptoms
Recurrence Problem
Emotional Overtones

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4
Q

If the presenting complaint is pain the main points to elicit can easily be remembered using which mnemonic ?

A 
‘SOCRATES’. 
 S -site
 O -onset
 C -character
 R -radiation
 A - associations
 T -timing
 E -exacerbating & relieving factors
 S -severity
Remember to ask about use of medication for pain relief.
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5
Q

What are some examples of associated sxs?

A
  1. Clicking
  2. Snapping
  3. Catching
  4. Locking
  5. Sensation of giving way (including prior falls or dislocations)
  6. Swelling
  7. Weakness
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6
Q

What are some questions you might ask in reference to: Temporality or Timing?

A
  1. Is it worse when they wake up in the morning?
  2. Does it gradually get worse over the course of the day?
  3. Does the pain ever wake them up at night?
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7
Q

What are RED FLAGS that should not be ignored?

A
  1. Pain at night or rest
  2. Associated weight loss and loss of appetite
  3. Hx. of cancer
  4. Steroids use
  5. Hx. of trauma
  6. Extreme age
  7. Bowel or bladder symptoms
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8
Q

When taking a history for an ACUTE problem you should always inquire about what?

A
  1. the mechanism of injury,
  2. loss of function,
  3. onset of swelling (< 24 hours),
  4. initial treatment
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9
Q

When taking a history for a chronic problem you should always inquire about what?

A
  1. past injuries,
  2. past treatments,
  3. effect on function, (experience their disability)
  4. current symptoms.
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10
Q

What is the musculoskeletal exam is all about?

A

anatomy

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11
Q

What are the cardinal signs of musculoskeletal disease?

A
  1. Pain
  2. Redness (erythema)
  3. Swelling
  4. Increased warmth
  5. Deformity
  6. Loss of function
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12
Q

How should you begin the MS exam?

A

Always begin with inspection, palpation and range of motion, regardless of the region you are examining (LOOK,FEEL, MOVE)

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13
Q

What is an indication for a specialized test?

A

specific abnormality is suspected

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14
Q

What will a complete evaluation always include?

A

a focused neurological exam of the effected area

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15
Q

When you are inspecting the patient, what are you looking for/at?

A
  1. Looking for scars, rashes, or other lesions like abrasions/open wounds
  2. Looking for asymmetry, deformity, or atrophy
  3. Always compare with the other side
  4. Looking for swelling
  5. Looking for erythema (redness)
  6. Posture/position of the joint or limb
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16
Q

T/F: Typically, we don’t percuss things in orthopedics however the one exception is nerves

A

True

17
Q

What is Tinel’s sign?

A

If tapping over a nerve causes pain or electric shock sensations

18
Q

When is Tinel’s sign present?

A

when nerves are compressed or irritated

19
Q

Besides seeing if there is a compressed nerve, what is another use for Tinel’s sign? What is this specific sign called?

A
  • used to monitor nerve recovery after injury

- “advancing Tinel’s sign”

20
Q

T/F: Auscultation is very critical in Ortho.

A

False: nothing is really auscultated–with exceptions of course

21
Q

During palpation, what are we palpating?

A
  1. Examine each major joint and muscle group in turn
  2. Identify any areas of tenderness
  3. Joint line
  4. Tendinous insertions
  5. Palpate for any crepitus
  6. Identify any areas of deformity
  7. Always compare with the other side (examine the unaffected side first)
  8. Warm or cold including pulses
  9. Fluctuation/fluid collection
  10. Compartments – soft or firm and painful
  11. Sensation
22
Q

What are the two types of range of motion?

A
  1. Active

2. Passive

23
Q

What will you do during active ROM?

A

Ask the patient to move each joint through a full range of motion

24
Q

What are you watching for during active ROM?

A
  1. Note the degree and type of any limitations (pain, weakness, etc.)
  2. Note any increased range of motion or instability
  3. Always compare with the other side
25
Q

When should you proceed to a passive ROM?

A

if abnormalities are found

26
Q

What is passive ROM?

A

When you ask the patient to relax and allow you to support the extremity to be examined

27
Q

What should you do during a passive ROM?

A
  • Gently move each joint through its full range of motion

- Note the degree and type (pain or mechanical) of any limitation

28
Q

If there is an increased range of motion detected, what is the next step?

A

perform special tests for instability as appropriate

29
Q

For the patients vascular status, what should be done?

A
  1. Pulses
  2. Upper Extrem.
  3. Lower Extrem.
30
Q

While obtaining the vascular stats of the upper extremity, what should you include?

A
  • radial pulses on both sides

- If the radial pulse is absent or weak, check the brachial pulses

31
Q

While obtaining the vascular stats of the lower extremity, what should you include?

A

-posterior tibial and dorsalis pedis pulses on both sides - -if these pulses are absent or weak, check the popliteal and femoral pulses

Clin Med 3-2017 (6 decks)

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