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NMSK 2 > OSCE Station 1 and 2 practice > Flashcards

OSCE Station 1 and 2 practice Flashcards

1
Q

patient is suffering pain the in the buttock
Pins and Needles / numbness
Feels worse when sitting for a long time, sitting to standing.
What tests do you do?

A 
Deep gluteal syndrome
FAIR - Flex/Add/IR
Active pififormis stretch test
Seated piriformis stretch 
Beatty test
Freiberg sign
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2
Q

patient is suffering from buttock pain lateral to ischium
+/- post thigh pain
takes shorter stride as long strides causes pain in back of thigh what tests do you perform?

A

ischiofemoral impingement
IFI test - side lying
extension and adduction

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3
Q

deep localised pain in the region of the ischial tuberosity worse in am, running ( high speed or uphill), Deep hip flexion (lunging, deep squat)

A 
proximal hamstring tendinopathy
Pain with stretch’ (tensile load) tests
Puranen-Ovrava test
Bent- Knee Stretch test
Modified Bent Knee Stretch Test
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4
Q

lateral hip pain
aggravated - sleeping on affected side, weight bearing(walking - single leg stance)
pain on palpation
what tests will be conducted

A

greater trochanter pain syndrome

FABER/Patrick test

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5
Q

Patient with anterior groin pain also describe clicking, catching, locking, stiffness, restricted range of motion or giving way
Pain aggravated by prolonged sitting, driving, climbing stairs, sport activities,
Reduced strength and ROM of flexion and adduction what tests do you do?

A

Femoroacetabular impingement
FADDIR
Scour/Quadrant
Painful flexion and IR

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6
Q

Patient with deep seated pain, dull ache or sharp with movement or loading
Pain aggravated by long walking, pivoting, prolonged sitting, forced adduction, running
+/- Clicking with hip MR/ LR
+/- Locking
+/- Giving way/Instability what tests do you do?

A 
labral tear 
anterior and posterior labral tear tests
Scour/Quadrant test
FADDIR
Thomas
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7
Q

Patient related to anterior groin pain
Sudden pain in groin with abduction/external movement e.g turning in soccer
Pain ± limitation on active/passive abduction of thigh but resisted adduction
Palpation
Localised tenderness

A

adductor groin strain look into history

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8
Q

Quadrant/Scour

A

patient in supine
flex hip as much as possible with hands interlocked over the knee
slowly scoop knee in arch from one shoulder to the opposite shoulder

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9
Q

positive scour test

A

reproduction of pain

femur is not maintained in neutral

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10
Q

FADDIR

A

Patient in supine both legs in extended
hip in 90 degree hip flexion
passive adduction
IR till end of range

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11
Q

positive FADDIR test

tests for what

A

groin pain reproduced

femoroacetabular impingement

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12
Q

anterior labral tear test

A

patient in supine
Flexion + ABd + ER
then
Slowly extend while ADD + IR

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13
Q

posterior labral tear test

A

supine contralateral leg straight
Flex/ADD/IR
then slowly into
EXT/ADD/ER

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14
Q

FABER test

A

Supine
Flex hip
Place heel of foot below patella and tibial tuberosity
stabilise opposite hip
apply pressure on knee of flexed hip to put into abduction

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15
Q

seated piriformis stretch test

A

patient seated
hip flexed at 90 degrees and knees extended
palpate 1cm lateral to ischium
IR w/ foot

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16
Q

active piriformis test

A

side lying

patient pushes heel down w/ ER against resistance

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17
Q

FAIR test tests for

A

deep gluteal syndrome

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18
Q

FAIR test

A

side lying
upper leg has hip flex.
upper most knee is IR using heel and ADD

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19
Q

IFI test

A

sidelying position

upper leg is extended and adducted towards plinth

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20
Q

FADER test

A

supine

hip flexion/ADD/ER

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21
Q

FADER-R test

A

supine

hip flexion/ADD/ER/ resisted IR

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22
Q

FADER test tests for

A

gluteal tendinopathy

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23
Q

single leg stance tests for

A

gluteal tendinopathy

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24
Q

Thomas test

A

flex hip of affected leg
stabilise unaffected leg
examine lumbopelvic position

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25
Q

obers test

A

side lying
upper most in 10-20 deg hip ext.
stabilise pelvis
lower uppermost leg to plinth

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26
Q

A patient suffering from back pain and thigh pain, hears clicking, catching, locking, stiffness, restricted ROM and stiffness and pain worsens when sitting for a long time, driving
what may the patient suffer from
and what tests do you use

A

Femoroacetabular impingement syndrome
Quadrant/Scour
FADDIR

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27
Q

FAIS can predispose to ..

A

hip OA

Labral tear

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28
Q

Patient is suffering from deep seated anterior groin pain and butt pain and is aggravated long walks and prolonged sittings, clicking and locking.
pain aggravated - long waling, prolonged sitting, forced adduction
what does the patient have and how is it tested

A

anterior or posterior labral tear test

FABER/Patrick test

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29
Q

Patient suffering from pain in but and lateral side of hip.
Pain when
walking, running, ascending, descending stairs or crossing legs.
Pain during night and stiffness in morning. What is it?

A

Gluteal Tendinopathy
Single leg stance
FADER/ FADER-R
FABER

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30
Q

Average ROM for hip flexion

A

120

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31
Q

Average ROM for hip extension

A

30°

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32
Q

Average ROM for hip abduction

A

45

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33
Q

Average ROM for hip medial rotation

A

45

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34
Q

Average ROM for hip lateral rotation

A

45

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35
Q

Average ROM for knee flexion

A

135/140

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36
Q

Average ROM for knee extension

A

10

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37
Q

Average ROM for foot dorsiflexion

A

20

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38
Q

average ROM for foot plantarfleion

A

50

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39
Q

accessory glides involved in hip flexion

A

AP

Lateral distraction

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40
Q

accessory glides involved in hip extension

A

PA

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41
Q

accessory glides involved in hip abduction

A

Long Cuad

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42
Q

accessory glides involved in hip lateral rotation

A

PA

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43
Q

accessory glides involved in hip medial rotation

A

AP

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44
Q

accessory glides involved in knee flexion

A

AP

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45
Q

accessory glides involved in knee extension

A

PA

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46
Q

accessory glides involved in ankle dorsiflexion

A

AP

47
Q

accessory glides involved in ankle plantarflexion

A

PA

48
Q

Positioning needed for hip flexion/extension

A

Centre the axis of the goniometer over the lateral aspect of hip joint using middle of the greater trochanter as a bony reference point
Align the stationary arm over the lateral midline of the pelvis
Align the movable arm over the lateral midline of the femur, in line with lateral epicondyle

49
Q

positioning needed for hip abduction

A

Centre axis over ASIS of side to be measured
Align the stationary arm with an imaginary horizontal line extending from one ASIS to other ASIS (this means that even if lumbar side-flexion is allowed happen it will not affect hip measurement).
Align movable arm parallel to anterior midline of femur using midline of patella for reference

50
Q

describe end feel for hip abduction

A

Firm due to capsule and ligamentous tension and possibly tension in adductor muscle group

51
Q

describe end feel for hip flexion

A

soft because of contact between anterior thigh and abdominal muscle bulk or firm because of posterior capsular tension and glut max muscle.

52
Q

describe end feel for hip extension

A

Firm due to anterior joint capsule & ligament tension. May also be firm
due to muscular tightness in anterior hip muscles.

53
Q

describe positioning for hip medial/lateral rotation

A

Centre axis over anterior aspect of patella
Align the stationary arm so that it is vertical i.e. perpendicular to floor or ceiling
Align movable arm with anterior midline of lower leg, using crest of tibia and a point mid-way between 2 malleoli for reference.

54
Q

describe end feel for hip medial rotation

A

Firm due to posterior capsule and ligamentous tension and possibly tension in deep hip and gluteal muscles

55
Q

describe end feel for hip lateral rotation

A

Firm due to anterior capsule and ligamentous tension and possibly
tension in anterior portion of gluteal muscles and adductors

56
Q

describe positioning for knee flexion/extension

A

Centre the axis of the goniometer over the lateral femoral epicondyle
Align the stationary arm over the lateral midline of the femur using the greater
trochanter as a reference point
Align the movable arm over the lateral midline of the fibula using the lateral
malleolus and fibular head as reference points

57
Q

describe end feel for knee flexion

A

soft because of contact between posterior calf and thigh muscle bulk.

58
Q

describe end feel for knee extension

A

firm because of posterior joint capsule and ligament tension (including collateral & cruciate ligaments)

59
Q

describe goniometer alignment of ankle dorsiflexion/plantarflexion

A

Centre the axis of the goniometer over the lateral malleolus
Align the stationary arm over the lateral midline of the fibula using the fibular head for reference
Align the movable arm parallel to the 5th metatarsal
start at 90

60
Q

describe end feel of ankle dorsiflexion

A

firm because of posterior joint capsule and ligament tension and Achilles tendon resistance

61
Q

describe end feel of ankle plantarflexion

A

firm because of anterior joint capsule and ligament tension and anterior
muscle resistance. Alternatively, may be hard due to bony contact between talus and
posterior margin of tibi

62
Q

Normative ROM for foot inversion

A

40

63
Q

Normative ROM for foot eversion

A

20

64
Q

describe goniometer alignment for foot inversion/eversion

A

Centre the axis of the goniometer over anterior aspect of ankle; midway
between malleoli
Align the stationary arm over the anterior midline of the lower leg using the tibial tuberosity as a reference point
Align the movable arm over the anterior midline of the 2nd metatarsal

65
Q

Deep gluteal syndrome and FAIR test causes the compression of what nerve

A

sciatic nerve

below piriformis and above obturator internus

66
Q

aetiology of deep gluteal syndrome

A

piriformis syndrome hypertrophy - increased tone
quadratus femoris and ischiofemoral space narrowing
avulsion fracture, muscle, strain or contusion

67
Q

differential diagnosis of deep gluteal syndrome

A

lumbar spine nerve root compression
pelvic tumour
spinal stenosis
SIJ dysfunction

68
Q

how is deep gluteal syndrome differential diagnosis

A

CT, MRI, EMG, Ultrasound

69
Q

what is ischiofemoral impingement or IFI

A

Impingement of Quadratus Femoris muscle between lesser trochanter and ischium.
Narrowing space of femur and ischium

70
Q

aetiology of IFI

A

Coxa valgus
inter-trochanteric fracture
post THR
Hip OA

71
Q

IFI means reduction in what movement

A

Ext, Add, ER

72
Q

Imaging protocol analysis using of IFI

A

MRI

computed tomography - for injection of anesthetics or steroids

73
Q

differential diagnosis of IFI

A

Strain or tear of QFM
tendinopathy of Iliopsoas or hamstring
iliopsoas bursitis

74
Q

management of IFI

A

Correct faulty posture in hip ext/add/ER

gluteal muscle weakness

75
Q

aetiology of proximal hamstring tendinopathy

A

compression of the tendon during hip flexion/adduction

76
Q

greater trochanter pain syndrome involves pain in what muscles

A

Gluteus medius/ minimus

Tensor fascia lata

77
Q

differential diagnosis of greater trochanter pain syndrome

A

trochanteric bursitis

myofascial pain rupture of gluteus medius

78
Q

which action worsens adductor groin pain

A

abduction and external movements

79
Q

types of FAIS

A

Cam impingement - femoral neck growth
Pincer impingement - Acetabulum growth
Combination of cam and pincer impingement

80
Q

describe surgical management of FAIS

A

Surgery Femoral or Pelvic Osteoplasty

81
Q

Described labrum structure

A

a fibrocartilaginous structure; 2-3mm thick.
Enhances hip joint stability.
Contains proprioceptive fibres

82
Q

aetiology of labral tear

A 
Traumatic Injury; twisting or pivoting
FAIS 
Capsular laxity 
developmental dysplasia
osteoarthritis
83
Q

aetiology of FAIS

A

Morphological changes appear as young at age12-13
But symptoms may not appear until early adulthood
Related to growth plate changes

84
Q

investigation for labral tear

A

arthroscopy

MRI/MRA

85
Q

associated impairments with FAIS

A
  • Decreased ROM into flexion/adduction
  • Reduced hip adductor and hip flexor strength
  • Altered biomechanics during squatting and stair climbing
86
Q

Deep squat mechanics for FAIS

A

Reduced squat depth
•Decreased peak hip internal rotation
•More anteriorly tilted pelvis at the time of peak hip flexion. Decreased mean hip extensor moments

87
Q

patient is suffering from a pivoting injury, feels like their knee can buckle from under them, immediately heard and pop or crack and had pain and swelling
What injury do you think they have and what special test do you use?

A

ACL injury
anterior drawer test
pivot shift test
lachman’s test

88
Q

function of ACL

A

Primary stabiliser of the knee
Guides knee in locking mechanism
secondary stabiliser in valgus/varus strain

89
Q

patient is suffering from blow to the flexed knee in a road traffic accident, little swelling, and pain in the back of the knee and calf has a positive drawer test and false positive Ant. drawer and Lachman. Patient has

A 
PCL injury
can also be caused by a hyperextension injury
posterior drawer test
sag test
active quadriceps test
90
Q

patient injured in sporting while pivoting, pain and tenderness, minimal swelling positive, valgus stress and minimal loss of ROM and reduced strength. patient has

A

valgus stress test MCL

91
Q

function of medial collateral ligament

A

►Stabilises the medial side of knee

►Rotation and Valgus stresses

92
Q

surgical management of ACL injury

A

autogenous graft using middle third of patellar tendon or gracilis or semitendinosis tendons
early mobilisation post repair

93
Q

25 year old patient patient experiences sudden pain in the knee after a game which gets worse with activity and at night, locking experience and feels like may give way and has clicking noise and tearing sensation. Pain with squatting or kneeling. Patient has - and what tests do you perform

A 
meniscal injury
mcmurrays
apleys distraction
apleys compression
Thessaly
94
Q

reasons for menisectomy

A

Tear not amenable to repair
Failure of conservative
Vascularized region (outer 1/3)
Traumatic vertical /longitudinal or bucket handle tear

95
Q

types of meniscal tear

A

horizontal -> flap tear
radial tear -> parrot beak tear
longitudinal-> bucket handle

96
Q

function of meniscus

A

Absorb compressive forces
Aid symmetrical pressure distribution
Aid joint lubrication
Contribute to stability

97
Q

imaging for collateral ligament

A

MRI

Ultrasound

98
Q

imaging for meniscal injury

A

MRI is gold standard - high specificity and sensitivity

99
Q

Patient is experiencing in the front of the knee, patella
pain w/ contraction of quads, worse in flexion minor/no swelling
pain eased/provoked with accessory PFJ glide test
Weak wasted - Vastus medialis obliques
What do you think it is and what test would you use?

A

patellofemoral pain

mcconnell

100
Q

causes of forefoot/ phalanges fracture

A

falling object
Industrial accidents
Crush injury - STI

101
Q

cause of tarsal fracture

A

Twisting injury

Easily missed X-Ray

102
Q

cause of talus fracture

A

Twisting injury or violent dorsiflexion

103
Q

cause medial ligament injury

A

eversion injury

104
Q

mechanism of injury of ankle fracture

A

abduction
lateral rotation
adduction

105
Q

mechanism of injury of patellar subluxation

A

non-contact injury. The most common mechanism of a patella dislocation in our series was that of an unbalanced individual with a flexed hip, sustaining a valgus force to their flexed knee with the tibia externally rotated.

106
Q

mechanism of knee tibleau fracture

A

blow to knee

107
Q

mechanism of injury of ACL

A

hyperextension

108
Q

mechanism of injury of PCL

A

anterior tibia driven into femor

109
Q

mechanism of injury of Patellar tendinopathy and patellofemoral ain

A

progressive overload

110
Q

patient is facing pain on the front of the following leg, pain with active plantarflexion and after the morning, increased foot pronates during midstance patient has

A

medial tibial stress syndrome

111
Q

mechanism of injury of medial tibial stress syndrome

A

improper training

112
Q

mechanism of injury of meniscal tear

A

twisting force whilst knee is planted on the ground

113
Q

mechanism of injury

A

repeated strain

a sudden change of direction, requiring a push-off, or landing from a jump.

NMSK 2 (8 decks)

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