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PD3 Flashcards

1
Q

flexion

A

bending motion that decreases angle between 2 body parts

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2
Q

ABduction

A

motion that pulls a structure or part AWAY from midline

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3
Q

extension

A

bending motion that increases the angle between 2 body parts

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4
Q

ADduction

A

motion that brings a structure or part to/ACCROSS midline

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5
Q

hyperextension

A

added movement (extension) beyond the normal limit

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6
Q

internal rotation

A

rotation TOWARDS the axis of body

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7
Q

rotation

A

rotating, turning action of body part from another, internal or external

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8
Q

external rotation

A

rotation AWAY from axis of body

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9
Q

lateral bending

A

re spine: standing tall and tilting side to side w torsore neck: ear to shoulder (not rotation, just tilting)

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10
Q

inversion

A

rotation inward, medially (most common method of sprained ankle.. sole of foot tilted IN)

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11
Q

supination

A

rotation that is turned outwards - laterally - holding a bowl of soUP

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12
Q

eversion

A

rotation outwards, laterally, sole of foot is tilted OUT

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13
Q

pronation

A

rotation that is turned inwards - toward medial line

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14
Q

plantar flexion

A

toes pointed away from shin

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15
Q

radial deviation

A

hands in neutral (flat) position and turned in towards thumb

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16
Q

ulnar deviation

A

hands in neutral (flat) and turned out towards pinky

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17
Q

dorsiflexion

A

toes brought up towards shin

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18
Q

grading system used to classify muscle strength

A

0-5, 5/5 is normal

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19
Q

supplies needed for exam of musculoskeletal system

A

skin marking pen
goniometer
tape measure
reflex hammer

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20
Q

myopathy

A

any congenital or acquired muscle disease, marked clinically by focal or diffuse musc weakness

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21
Q

neuropathy

A

any nerve disease or injury that affects a single nerve

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22
Q

polyneuropathy

A

any disease that affects multiple peripheral nerves

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23
Q

sprain

A

trauma to ligaments

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24
Q

strain

A

trauma to muscles & tendons from violent contraction or excessive/forcible stretch

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25
Q

dislocation

A

displacement of a bone from its normal position in a joint

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26
Q

subluxation

A

a partial or incomplete dislocation

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27
Q

additional body systems to evaluate during musculoskeletal exam

A

skin/soft tissues
surrounding joints
neurologic

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28
Q

shoulder joint

A

most potentially unstable of all major joints.complex of 4 joints

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29
Q

4 joints that make up the shoulder

A

acromioclavicular
glenohumoral
thoraco-scapular
sternoclavicular

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30
Q

elbow joint

A

serves as link between powerful movements of shoulder and fine motor control of hand

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31
Q

wrist

A

required for most ADLs. injuries here can affect gross and fine motor movements

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32
Q

hands & fingers

A

required for most ADLs. injuries can greatly affect cross and fine motor movements

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33
Q

shoulder ROM

A

flexion: 90
extension: 45
ABduction: 180
ADduction: 45
Internal rotation: 55
external rotation: 40-45

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34
Q

Elbow ROM

A

flexion: 135
extension: 0- -5
pronation: 90
supination: 90

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35
Q

wrist ROM

A

flexion:80
extension: 70
radial deviation: 20
ulnar deviation: 30

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36
Q

fingers ROM

A

flexion: 90
etension: 35-45
opposition (thumb): touch tip of thumb to each fingertip
ABduction: 20
ADduction: 0

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37
Q

Sequence of exam techniques for upper extrem

A
  1. history
  2. inspection
  3. palpation
  4. functional assessment (ROM, musc strength)
  5. neuro
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38
Q

scapular winging

A

w/ abduction of arm, an outward prominence of the scapula indicates injury to the nerve of the anterior serratus muscle

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39
Q

drop arm test

A

w/ pt standing or sitting, a fully abducted shoulder is slowly lowered to the side. if there are rotator cuff tears (esp in supraspinatus muscle), the arm will fall uncontrollably to the side from 90 degrees

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40
Q

Yergason test

A

used to determine the stability of the long head of biceps tendon in the bicipital groove. have pt flex elbow, hold the flexed elbow w/ one hand while holding the pts wrist w/ other hand, internally rotate the arm and pull down on elbow at the same time. if biceps tendon is unstable in the groove, it will pop out and cause pain

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41
Q

apprehension test

A

for chronic shoulder dislocation. abduct and externally rotate pts arm to a position where it would easily dislocate. if the shoulder is ready to dislocate, the pt will have a look of apprehension or pain

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42
Q

tennis elbow test (lateral epicondylitis)

A

to reproduce pain of tennis elbow, stabilize pts forearm while they make a fist and they extend their wrist. apply pressure w/ your other hand to the dorsum of fist to force pts hand into flexion, which will cause pain at the lateral epicondyle

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43
Q

Tinnel sign - elbow

A

to elicit tenderness over a neuroma w/in a nerve. tap the area in the ulnar groove between the olecranon and the medial epicondyle. if neuroma is present, will cause tingling sensation down forearm.

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44
Q

Tinnel sign - wrist

A

tap pts wrist where the median nerve passes under the flexor retinaculum. if a tingling sensation radiates from the wrist into the hand, this is positive and indicative of carpal tunnel syndrome

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45
Q

allen test

A

to determine whether radial & ulnar arteries are supplying adequate amount of blood to hands. Have patient open/close hand into fist several times, then with the hand in a fist, occlude both radial and ulnar arteries. Patient then opens hand (which should appear pale), release ONE of the arteries while still occluding the other. The hand should flush immediately, if it doesn’t, this is an indication of a problem with that artery. Repeat testing the opposite artery and then the opposite hand as well.

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46
Q

Finkelstein test

A

to test for DeQuervain’s disease, where inflammation of the synovial lining of tunnel 1 in wrist narrows the tunnel opening and results in pain when the tendons move. Have patient make a fist with thumb tucked inside the other fingers. Stabilize their forearm with one hand, and use the other to deviate their wrist to the ulnar side. If sharp pain is felt in the area of tunnel 1, indicates stenosing tenosynovitis (DeQuervain’s disease).

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47
Q

Phalen test

A

to test for carpal tunnel syndrome, have patient flex wrists to maximum degree and hold for at least 1 minute. If tingling of fingers occurs, positive test.

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48
Q

DTR of upper extremity

A

Biceps (C5)
Brachioradialis(C6)
Triceps (C7)

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49
Q

Dermatomes of upper extremity

A

C5,6, 7 : lateral parts of upper limb
C8: medial upper limbC6: thumb (ant&post)
C7: middle & index finger&mid hand (ant/post)
C8: ring& pinky fingers, medial hand (anatomical position)

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50
Q

primary sensory functions of upper extremities

A

superficial touch & pain vibration temp & deep pressure proprioception

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51
Q

cortical sensory (cerebral) functions of upper extremity

A 
stereognosis
2-point discrimination
extinction phenomenon
graphesthesia
point location
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52
Q

cubitus valgus

A

deviation in carrying angle >5 in men, >10-15 in women; forearm bending laterally

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53
Q

cubitus varus

A

deviation in carrying angle <10-15 in women; forearm bending medially

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54
Q

olecranon bursitis

A

pain&stiffness surrounding elbow joint, limited motion caused by swelling/pain – inflamed bursa tissue

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55
Q

rheumatoid nodules

A

subcutaneous nodules along pressure points of the ulnar surface

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56
Q

dupuytren contracture

A

involuntary curling of hand digits, generally ring & pinky finger, w/ impaired extension

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57
Q

swan-neck deformity

A

hyperextension of PIP &DIPs are flexed

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58
Q

Boutonniere deformity

A

POP of finger is markedly flexed, DIP is hyperextended

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59
Q

mallet finger

A

DIP hyperflexed

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60
Q

Heberden nodes

A

discrete but palpable bony nodules found on dorsal and lateral surfaces of DIPs, suggests osteoarthritis

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61
Q

ganglion cyst

A

cystic, pea sized swelling filled w jelly-like substance on dorsal and lateral surfaces of DIPs, not fixed to connective tissue, not tender to palpation

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62
Q

carpal tunnel syndrome

A

numbness, burning, tingling in hands, often at night. weakness of thumb, flattening of thenar eminence. from compression of the median nerve

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63
Q

carrying angle of elbow

A

the amount of lateral bending of the forearm from 0 degrees.men: 5women:10-15

64
Q

sequence of exam for lower extrem

A 
inspect
palpate
ROM
strength
neuro
65
Q

DTR of lower extrem

A

patellar (L4, L2, L3)

achilles (S1, S2)

66
Q

Thompson or Simmonds test

A

for achilles tendon rupture: have pt lie prone on table and squeeze calf. should see plantar flexion. if there is rupture, this flexion will be diminished or absent.

67
Q

patellar ballottement

A

for fluid accumulation between the joints (effusion): extend pts knee, push patella into the trochlear groove & quickly release. if there is a large amount of fluid, knee will rebound

68
Q

anterior drawer sign

A

for ACL tear: w/ pt laying supine, flex leg, stabilize the foot and hold the calf and pull towards you. if there is an ACL tear, the leg will go further than expected

69
Q

Posterior drawer sign

A

for PCL tear: w/ pt lying supine, flex the leg, stabilize the foot, hold the calf w/ both hands and push the leg back

70
Q

true/apparent leg length

A

to test for asymmetry: true length (measure from anterior superior iliac crest to malleolus); apparent length (measure from umbilicus to medial malleolus. compare the measurements bilat

71
Q

homan sign

A

for DVT: passively dorsiflex ptsfoot to elicit pain in calf

72
Q

Ortolani/Barlow test

A

for hip dislocation or subluxation in infants.barlow maneuver: use a small amount of force. test 1 hip at a time. w/ infant supine, flex hip and knee to 90. adduct thigh and gently push downwards on femur. a positive sign is indicated when you hear a clunk or sensation is felt as the femoral head dislocates from acetabulum. ortolani maneuver: w/ infant in same position as in barlow test, slowly abduct thigh while maintaining pressure. listen for femur to move back into acetabulum.

73
Q

patellar bulge sign

A

for excess fluid in knee: w/ knee extended, mild the medial and lateral aspects of knee upward. observe for a bulge of fluid to return to the space.

74
Q

apprehension test of knee

A

for patellar dislocation & subluxation: pt supine on table w legs relaxed, press agains the medial side of patella w thumb, watch pts face. if patella begins to move or dislocate, the pts face will show distress

75
Q

mcmurray test

A

medial meniscus tear: have pt lie supine on table, w legs extended in neutral position. w/ one hand, grab the heel and flex the leg. place the other hand at the knee joint and begin to rotate the leg internally and externally. feel for any tenderness, palpable or audible “clicking” may indicate a tear.

76
Q

apley distraction test

A

for ligamentous injury: have pt lie prone w leg flexed to 90. stabilize the back of thigh. apply traction to the leg while rotating the tibia internally and externally. this reduces tension on the menisci and puts pressure on the ligaments. if there is a tear the pt will experience pain.

77
Q

apley grinding test

A

have pt lie prone w leg flexed to 90. stabilize the back of the thigh. lean hard on the heel to compress the medal and lateral menisci between the femur and tibia. rotate the tibia internally and externally. if this elicits pain there is probably a meniscus tear.

78
Q

patellofemoral grinding test

A

for rough articulating surfaces of patella and trochelar groove of femur. pats w/ this often complain of pain when climbing stairs or getting up from a chair. pt lies supine w legs relaxed in neutral position. push the patella distally into the trochelar groove, then have pt flex their quads. palpate and offer resistance to the patella as it moves under your fingers. if there is roughness of the articulating surfaces you will feel crepitus. it should normally be smooth.

79
Q

varus/valgus stress

A

for collateral ligaments damage:valgus stress- to test the MCL, apply stress by pushing on the lateral aspect of the knee w leg extended.varus stress - to test the LCL strength, apply pressure on the medial aspect of the knee w leg extended.

80
Q

genu varum

A

outward bowing of legs

81
Q

hammer toe

A

bending of 2nd-5th toes (contracture)

82
Q

genu valgum

A

knees angle in and touch one another

83
Q

pes planus

A

flat feet

84
Q

genu recurvatum

A

knee bends backwards

85
Q

hallux valgus

A

big toe points toward 2nd toe

86
Q

claw toe

A

toe contracted at PIP &DIP joints

87
Q

pes cavus

A

high arch of foot

88
Q

morton’s neuroma

A

irritation and fibrosis of the nerve running between 3rd &4th toes or 4th and 5th toes, most commonly

89
Q

neck ROM

A

flexion: chin to chestextension: should be able to look at ceilingrotation: chin should be almost in line w/ shoulderlateral bending: 45 degrees

90
Q

back ROM

A

flexion:75
extension: 30
lateral bending: 35
rotation: 30

91
Q

Hip ROM

A

flexion: 120
extension: 30
ABduction: 45
ADduction: 30
external rotation: 45
internal rotation: 40

92
Q

sequence of exam for spinal column

A
  1. inspect C, T, L, S spine
  2. palpate vertebral column
  3. assess ROM
  4. blunt percuss over spinal column
93
Q

distraction test

A

to assess for C spine pain and determine nerve impingement, place one hand under chin and other under occiput. lift upwards gently. if there is C nerve compression, this test should relive the pain.

94
Q

valsalva test

A

have pt hold their breath and bear down. if pain occurs, have pt describe location. this tests for space-occupying lesion (herniated disc or tumor) by increasing intrathecal pressure.e pain may radiate to dermatome corresponding w/ neurologic level of C spine pathology.

95
Q

adson test

A

determines if there i compression of the subclavian artery. find the pts radial pulse and begin to abduct, extend, and externally rotate the arm. have pt take a deep breath and turn their head toward the arm being tested. if there is compression of the cubclav artery, you will feel a marked diminution or absence of the radial pulse.

96
Q

compression test

A

press down on the top of pts head while sitting or supine, if there is an increase in pain, note distribution & dermatome. test will reproduce pain referred to the upper extremity from the C spine to help locate neurologic level of a prob

97
Q

straight leg raising test

A

test to look for discogenic disease that may be compressing/affecting the sciatic nerve. pt is supine and you passively lit the leg (keep straight) upwards. the foot is then dorsiflexed and if there is pain, it is likely sciatic.

98
Q

hoover test

A

place hands under pts heels during active straight leg raise test. as the pt (lying supine) tries to lift one leg up, the opposite heel should be pressing down. used to determine pts effort

99
Q

normal gait phase

A
  1. stance phase - foot is on ground (heel strike, foot flat, mid stance, push off)
  2. swing phase - foot is off ground (acceleration, mid swing, deceleration)
100
Q

spastic hemiparesis gait

A

· The affected leg is stiff and extended with plantar flexion of the foot· Movement of the foot results from pelvic tilting upward on the involved side· The foot is dragged, often scraping the toe, or is circled stiffly outward and forward (circumduction)· The affected arm remain fixed and abducted and does not swing· Examples – cerebral palsy

101
Q

spastic diplegia gait

A

· Patient uses short steps, dragging the ball of the foot across the floor· Legs are extended and the thighs tend to cross forward on each other at each step due to injury to the pyramidal system

102
Q

steppage/drop foot gait

A

· Hip and knee are elevated excessively high to lift the plantar flexed foot off the ground· The foot is brought down to the floor with a slap· Patient is unable to walk on heels· Muscle weakness of tibialis anterior

103
Q

cerebral ataxia

A

Patient’s feet are wide based· Staggering and lurching from side to side is often accompanied by swaying of the trunk

104
Q

sensory ataxia

A

Patient’s gait is wide-based· Feet are thrown forward and outward, bringing them down first on heels, then on toes· Patient watches the ground to guide his/her steps· Positive Romberg sign is present

105
Q

dystonia gait

A

· Jerky, dancing movements appear nondirectional

106
Q

ataxia

A

Uncontrolled falling occurs

107
Q

abductor lurch gait

A

· Weakened gluteus medius muscle forces the patient to lurch toward the involved side to place the center of gravity over the hips

108
Q

extensor lurch gait

A

Gluteus maximus muscle is weakened and patient must thrust his thorax posteriorly to maintain hip extension (an extensor or gluteus maximus lurch)

109
Q

flat foot gait

A

· Patients with muscle weakness of the gastrocnemius-soleus group (S1-S2) may have a flat foot gait with no forceful toe off

110
Q

back knee gait

A

· Patients with quadriceps weakness may walk with a back knee gait to lock their knees into extension

111
Q

antalgic gait

A

Patient limits the time of weight bearing on the affected leg to limit pain

112
Q

5 major areas tested by mini mental status exam

A

orientationregistrationattention/calculationrecalllanguage

113
Q

equipment/supplies needed for neuro exam

A 
eye chart 
cotton swab 
tongue depressor 
tuning fork 
paper clip
monofilament line
key
coin
vials of aromatic scent
pen light
opthalmascope
sterile needles
reflex hammer
114
Q

scoring DTR

A 
0- no response
1+  sluggish or diminished
2+ active or expected
3+brisk, more than expected
4+hyperactive
115
Q

superficial reflexed

A

abdominal
cremasteric
plantar

116
Q

oculocephalic reflex (dolls’ eyes)

A

Evaluation of comatose pt - If Brainstem intact:
Eyes deviate contralaterally
Look away from rotation; lag behind If Brainstem injury:
Eyes follow direction of head rotation
Mimics conscious patient presentation

117
Q

brudzinski sign

A

for meningitis: flex the neck and observe involuntary flexion of legs or knees

118
Q

kernig sign

A

for meningitis: flex the knee/hip & watch for pain in back/resistance to straightening, shrugging of shoulders

119
Q

gower sign

A

seen in pts w/ muscular dystrophy/other muscle diseases - if on floor, pt uses arms to club up own legs to an upright position. extreme muscle weakness

120
Q

clonus

A

repetitive, rhythmic contraction of a muscle when attempting to hold it in a stretched state - a few beats are normal. VERY hyperactive DTR’s

121
Q

romberg sign

A

pt stands with heels together/eyes closed - POS if balance is lost - cerebellar test

122
Q

pronator drift

A

Cerebellar - “Pizza Box Pose” arms out, palms up, closes eyes, see if an arm drifts - provider to tap are to see if it starts to drift or if it easily returns to same position.

123
Q

decorticate posturing

A

rigid posture of flexed arms, clenched fists, andextended legs; characteristic posture of a patient with a lesion at or above theupper brainstem

124
Q

decerebrate posturing

A

rigid posture of stiff, extended arms, pronatedforearms, and exaggerated deep tendon reflexes; posture of a patient who has lost cerebral control of spinal reflexes, usually as a result of an intracranial catastrophe

125
Q

spasticity

A

motor disorder characterized by velocity-dependent increasedmuscle tone, exaggerated tendon jerks, and clonus; the result of an uppermotor neuron lesion

126
Q

flaccidity

A

loss of muscle tone, loss or reduction of tendon reflexes, andatrophy and degeneration of muscles; caused by lesions of the lower motorneurons of the spinal cord

127
Q

paresthesia

A

an abnormal or unpleasant sensation that results from injury toone or more nerves; often described by patients as numbness and tingling, oras a prickly, stinging, or burning feeling

128
Q

receptive aphagia

A

inability to understand written, spoken, or tactile speechsymbols, due to disease of the auditory and visual word centers.

129
Q

expressive aphagia

A

person knows what he or she wants to say yet hasdifficulty communicating it to others

130
Q

3 types of vaginal specula

A
  1. graves (blades curved w a space between closed blades)
  2. pederson (narrower, and flatter blades)
  3. pediatric or virginal (smaller in all dimensions)
131
Q

anteverted/anteflexed uterus

A

normal position of uterus - fundus will be felt between 2 fingers at level of pubis

132
Q

gravida

A

total # of pregnancies, regardless of outcome

133
Q

para/parity

A

of births over the gestational age of 24 weeks. alive or stillborn, does not account for multiples

134
Q

retroverted/retroflexed uterus

A

abnormal position - uterus tilted towards coccyx. palpate through rectovaginal exam

135
Q

multiparous

A

more than 1 birth over gest. age of 24 weeks.
grand-multiparous= 4-6 births.
great-grand-multi= >7 births

136
Q

corpus of uterus

A

body of uterus - includes fundus and isthmus - examined during bimanual exam

137
Q

fundus

A

convex upper portion of uterus - extends into insertions of fallopian tubes. height of fundus is used to estimate stage of pregnancy

138
Q

cervix

A

extends from isthmus of uterus into vagina. assessed during speculum exam. epithelial collection (pap smear) at cervical os

139
Q

nulliparous/nulliparity

A

has not carried a pregnancy to 24 wks

140
Q

cervical motion tenderness

A

during bimanual exam, locate cervix w the palmar surface of fingers. grasp cervix between fingers and move from side to side, watching pts face for discomfort

141
Q

cystocele

A

bladder hernia that protrudes into vagina

142
Q

rectocele

A

protrusion or herniation of the posterior vaginal wall w anterior wall of rectum through vagina.

143
Q

urethrocele

A

pouchlike protrusion of urethral wall

144
Q

uterine prolapse

A

descent or herniation of the uterus into or beyond the vagina

145
Q

ectropion

A

endocervical columnar epithelium protrudes out through external os of cervix

146
Q

rooting reflex in infant

A

o Touch the corner of the infant’s mouth. When hungry the infant will move their head and open mouth on the side of stimulation.o Present at birth and disappears by 3-4 months.

147
Q

tonic neck reflex in infant

A

o With infant lying supine and relaxed, turn his or her head to one side; look for extension of the arm and leg on the side to which the head is turned and for flexion of the opposite arm and leg. Turn their head to the other side and observe the reversal.o The reflex usually diminishes at 3-4 months and disappears by 6 months.o Concern is raised if the infant never exhibits this reflex.o The reflex must disappear before the infant can roll over or bring the hands to the face.

148
Q

startle reflex in infant

A

o Supporting the infant in semi sitting position, allow the head and trunk to drop to a 30-degree angle.o Look for symmetric abduction and extension of the arms; fingers fan out and thumb and index finger form a “C”; the arms then adduct in an embracing motion followed by relaxed flexion. The legs may also follow this pattern.oDiminishes in strength by 3-4 months and disappears by 6 months.

149
Q

cephalohematoma

A

A mass composed of clotted blood, located between theperiosteum and the skull of a newborn. It is confined between suture lines andusually is unilateral. Caused by rupture of periosteal bridging veins due topressure and friction during labor and delivery. The blood reabsorbs graduallywithin a few weeks of birth. Diagnosed by X-ray of infant’s head.

150
Q

caput succedaneum

A

diffuse edema of the fetal scalp that crosses the suturelines. Head compression against the cervix impedes venous return, forcingserum into the interstitial tissues; swelling reabsorbs within 1 to 3 days;Diagnosed by exam of scalp.

151
Q

milia

A

white pinhead-size, keratin-filled cyst; In the newborn, milia occur on theface and, less frequently, on the trunk, and usually disappear without treatmentwithin several weeks. Diagnosed by physical exam of skin.

152
Q

port wine stain

A

(aka: nevus flammeus) A large reddish-purple nevus of theface or neck, usually not elevated above the skin. It is considered a seriousdeformity due to its large size and color. Diagnosed by physical exam of skin.

153
Q

hemangioma

A

a dull red benign lesion, usually present at birth or appearingwithin 2 to 3 months thereafter. This type of birthmark is usually found on theface or neck and is well demarcated from the surrounding skin. It grows rapidlyand then regresses

154
Q

mongolian spots

A

blue or mulberry-colored spots usually located in the sacralregion; may be present at birth in Asian, American Indian, black, and SouthernEuropean infants and usually disappears during childhood. Diagnosed byphysical exam of skin.

155
Q

ADLs

A

(Activities of Daily Living): ➢ Bathing and grooming➢ Ambulation (walking around)➢ Transfers (chair to bed, wheelchair to toilet, etc)➢ Toileting➢ Eating➢ Dressing

156
Q

IADLs

A

(Instrumental Activities of Daily Living): These are often lost first with impairment and often have to betaken over by a family member or caregiver.➢ Writing ➢ Reading➢ Cooking➢ Cleaning➢ Shopping➢ Laundry➢ Using telephone➢ Outdoor activities➢ Managing medications➢ Managing money➢ Transportation

JG (6 decks)

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