OSCE 4 - Knee

Question 1

Q angle - normal, how measured, female variation

Answer 1

normal Q angle 15 degrees
measured by creating straight line from ASIS to center of patella and another line through tibial tuberosity and the same point on patella
difference between them forms the Q-angle!
- females typically have increased Q angle

Question 2

ROM for knee flexion, extension, int/ ext rot.

Answer 2

flexion 145-150
extension 0
int/ext rotation 10

Question 3

knee flexion muscles and nerves

Answer 3

hamstrings

tibial N L4-5, S1-3

Question 4

knee extension muscles and nerves

Answer 4

quadriceps

femoral n, L2-4

Question 5

what innervation tested by patellar reflex

Answer 5

primarily L4

L2-4

Question 6

dermatomes in leg

Answer 6

L3-5, S2

Question 7

if the Valgus knee test is also positive with knee fully extended, it indicates

Answer 7

joint capsule injury

Question 8

+ test for valgus/ varus

Answer 8

increased laxity, soft or absent endpoint or pain

Question 9

ACL tests

Answer 9

Lachman’s

Anterior Drawer test

Question 10

Lachman’s test

Answer 10

patient supine, cephaland hand on distal thigh superior to patella
- caudad hand on proximal tibia, flex knee to 15-30, then use caudad hand to pull tibia anteriorly while cephalad hand stabilizes thigh
+ test: increased laxity, soft or absent end point
indicates: ACL insufficiency

Question 11

position of knee and examiner for anterior and posterior drawer test

Answer 11

90 degree flexion

examiner sitting on patient’s foot grasping proximal tibia with both hands

Question 12

PCL tests

Answer 12

Reverse Lachman’s test

Posterior Drawer test

Question 13

Patellar ligament test and positive findings indicate?

Answer 13

Patellar laxity test (graded 1-4 (+1 = 0-25%, +2 25-50%)
patellar apprehension test
- positive previous patellar dislocaiton or severe instability

Question 14

patellar cartilage test

Answer 14

patellar compression (grind) test
patellar glide test

Question 15

patellar compression/ grind test

Answer 15

grind test - compressive load to patella with one hand while moving patella medial and lateral
+ test = pain with compression
indicates: possible infl., chondromalacia, or injury to patellofemoral articular surfaces

Question 16

patellar-femoral gliding variation

Answer 16

patella compressed caudally into trochlear groove and patient instructed to tighten quads against resistance
+ findings: crepitation o rpain indicated roughness of articulating surfaces (chondromalacia)

Question 17

patellar glide test

Answer 17

patient sitting or supine, slowly extending/ flexing the knee, physician notes quality of motion, can place hand lightly over patella to increase sensitivity of test
+ test: palpable or audible crepitus, pain or catching of the patella
indicates: possible damage to articular surface

Question 18

Meniscus cartilage test

Answer 18

McMurray’s Test
Apley compression (grind) test
apley distraction test

Question 19

McMurray’s test

Answer 19

medial meniscus: int. rot tibia as knee extended with varus load
lateral meniscus: ext. rot tibia as knee extended with valgus load
+ test: pian/ painful click during extension
indicates: possible meniscus tear

Question 20

apley compression/ grind test

Answer 20

patient prone, knee flexed to 90
downward force on foot to compress meniscus while rotating foot internally and eternally
+ test: pain w/e rotation, ocmpression
indicates: meniscal injury, collateral ligament injury or both

Question 21

apley distraction test:

Answer 21

patient prone, knee flexed to 90, examiner uses pulling force on foot to provide distraction on meniscus while rotating foot internally and externally
+ test: pain w/ distraction and rotaiton
indicates: collateral ligament damage

Question 22

meniscal segments and red/white and what it means

Answer 22

W/W: medial 1/3
R/W: central 1/3
R/R: lateral 1/3
W/W inadequate blood supply, meniscus is shaved
R/R: adequate blood supply, meniscus repaired and allowed to heal

Question 23

bursa in th eknee

Answer 23

suprapatellar
prepatellar
superficial infrapatellar
infrapatellar 
- bursa below pes anserine

Question 24

valgus/ varus tests are testing what at 30 and 0 knee flexion

Answer 24

30 collateral ligament

0 capsule

Question 25

components of the unhappy triad

Answer 25

ACL
medial meniscus
MCL

Question 26

Overuse injury
 Common in
adolescents
 Avulsion of secondary
ossification center of
tibial tubercle

Answer 26

osgood-schlatter disease