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Surgery finals > Ortho examinations > Flashcards

Ortho examinations Flashcards

1
Q

What is the basic premise of ortho examinations?

A

Look
Feel
Move
Special tests

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2
Q

Describe what you are looking for during knee inspection

A

Varus/valgus deformity
Scars
Muscle wasting
Swelling: effusions, popliteal swellings

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3
Q

Describe what you would do in the ‘feel’ part of a knee examination

A
  • Temperature
  • Sweeping fluid test for effusion
  • Patella tap test
  • Bend knee: feel along the joint line for any tenderness, popliteal swellings
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4
Q

Describe what you would do in the ‘move’ part of a knee examination

A

Checking for range of motion

  • Flex foot, extend knee to 0 degrees
  • Lift towards ceiling
  • Bend knee as far as it can go (active movement)
  • Then test passive movement
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5
Q

Describe what you would do in the ‘special tests’ part of a knee examination

A

Position at 80 degrees of flexion

  • Look for posterior sag
  • Anterior + posterior draw tests
  • Extend the leg for Lachman’s test
  • Test for varus + valgus in extension + 30 degrees of flexion
  • OFFER McMurray’s test

To end: pulses + sensation

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6
Q

Describe what you would say to conclude your examination of the knee

A
  • Neurovascular examination
  • Examination of the joints above and below the joint
  • Imaging if indicated eg. Xray, MRI
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7
Q

What does a positive anterior draw test indicate?

A

Anterior cruciate ligament injury

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8
Q

What does a positive posterior draw test indicate?

A

Posterior cruciate ligament injury

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9
Q

What does a positive Lachman’s test indicate?

A

Anterior cruciate ligament injury

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10
Q

What do the varus and valgus stress tests look for?

A

Integrity of the collateral ligaments
Varus: lateral
Valgus: medial

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11
Q

Describe what you would do in the first part of a hip examination

A
  • Assess gait
  • Trendelenberg test
  • Inspect: from all angles standing
  • Inspect again lying down
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12
Q

Describe what you would do in the ‘feel’ part of a hip examination

A
  • Feel temperature
  • Feel greater trochanter
  • Measure apparent + true leg length
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13
Q

Describe what you would do in the ‘move’ part of a hip examination

A
  • Active flexion and extension
  • Passive flexion
  • Thomas’ test: fixed flexion deformity
  • Internal and external rotation
  • Turn over for passive extension

To end: feel pulses + sensation

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14
Q

What is a positive Trendelenberg sign? What does it mean?

A

Positive Trendelenberg is when the contralateral hip falls while standing on one leg. This indicates weakness of the ipsilateral hip abductors eg.
-Stand on the left leg -> right side dips lower
= left sided hip abductor weakness

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15
Q

What is Thomas’ test for? Describe how it is done. What is a positive test?

A

Tests for a fixed flexion deformity(inability to extend leg)- this may be due to OA, contracture from trauma, etc

  • Place one hand under the pt’s lumbar spine
  • Passively flex the hip

Positive test is when pt’s other leg raises off the bed, indicating a fixed flexion deformity on that side

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16
Q

Describe what you are looking for during inspection of the hands + wrists

A
  • Scars
  • Muscle wasting
  • Nail and skin changes
  • Signs of OA: Heberden’s, Bouchard’s node, CMC
  • Signs of RA: ulnar styloid, ulnar deviation, MCP subluxation, swan neck, Boutonnieres, Z thumb
17
Q

Describe what you would do in the ‘feel’ section of a hand examination

A
  • Temperature
  • Feel for Dupuytren’s contracture, muscle bulk
  • Feel individual joints for swelling/tenderness (hands)
  • Feel wrist + elbows
  • Feel pulses
  • Feel for sensation in the nerve distribution: median + ulnar over eminences, radial in 1st web space
18
Q

Describe what you would do in the ‘move’ section of a hand examination

A 
Ask the patient to actively move:
-Make a fist (flexion)
-Spread the fingers out (extension)
-Palms together in front (extension)
-Back of the hands together in front (flexion) 
Check passive movements
19
Q

Describe what you would do in the ‘special tests’ section of a hand examination

A

Check motor function:

  • Hands out flat (push fingers down- radial), spread (push in- ulnar), thumbs up (push down-median)
  • Squeeze my finger
  • Make an ‘OK’ sign and don’t let me break the circle

Carpal tunnel:

  • Tinel’s test: tapping
  • Phalen’s test: prayer hands
20
Q

Describe what you would say to finish a musculoskeletal examination

A
  • Assess neurovascular status
  • Examine the joints above and below, as well as the contralateral joint
  • Present
  • Differential Dx
  • Further investigations eg. imaging

Surgery finals (16 decks)

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