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PHTH 565 - Rheumatology > Physical Ax in RA > Flashcards

Physical Ax in RA Flashcards

1
Q

Active joint count is a measure of _____ ______

A

inflammatory activity

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2
Q

Three criteria for an active joint?

A
  1. effusion
  2. joint tenderness
  3. stress pain
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3
Q

Active joint count criteria are always _______ assessed, as they progressively increase the level of stress imposed on the ____ _____

A

sequentially; joint capsule

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4
Q

Joint count ax for children?

A
  1. presence of joint swelling
    OR
  2. Limitation of motion with heat, plus overpressure pain, OR
  3. joint line tenderness
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5
Q

4 steps in the exam set up?

A
  1. ensure client is relaxed and seated in a comfortable position
  2. provide pillow to support UE
  3. all jewelry must be removed
  4. explain what you are doing and inform the client of the realist
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6
Q

STOP method?

A

S - swelling
T - tenderness
OP - overpressure

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7
Q

When in doubt, record joint at ______

A

inactive

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8
Q

________ = fluid that is confined by the joint capsule but freely mobile within that space

A

effusion

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9
Q

Fluctuation of fluid is detectable along the _____ ______

A

joint margins

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10
Q

3 methods to measure effusion?

A
  1. 2 thumb
  2. 4 finger
  3. bulge sign
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11
Q

_____ tissue deposited about the joint may mimic an effusion

A

fatty

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12
Q

What is the difference between fatty tissue and true joint effusion?

A 
fat = soft but fixed in location and is OUTSIDE joint capsule 
effusion = fluctuation in all planes
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13
Q

Bony enlargement and joint deformities (do/do not) constitute joint swelling.

A

do NOT

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14
Q

In the 2 thumb technique, the pressure thumb should be directed slightly _____ from the sensor thumb to prevent a shift in ______ structure

A

away; periarticular

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15
Q

In the 4 finger technique, the sensor fingers must be just above the ______ _______

A

collateral ligaments

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16
Q

There may be a _____ sign over the _____ head when elbow is moved from 45 degrees of flexion to full extension

A

bulge; radial

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17
Q

When testing joint tenderness, apply firm pressure with enough force to blanch the examiners nail beds (T/F).

A

TRUE

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18
Q

How to test joint tenderness in clients with pain syndromes ?

A

compare pain from pressure on the joint line to an equal amount of pressure on an adjacent bone or soft tissue; for joint to be classified as active, the pain on joint palpation must be greater

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19
Q

Stress pain = stretching the _______ joint capsule

A

inflamed

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20
Q

In stress pain, apply gentle overpressure when the joint is at the limit of its _____ range

A

passive

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21
Q

The # of damaged joints is related to the duration of _____ and its ______

A

disease ; aggressiveness

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22
Q

3 strategies in treating TMJ?

A
  1. posture
  2. soft tissue
  3. regain rotation
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23
Q

TMJ is often involved (later/earlier) in disease

A

later

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24
Q

TMJ involvement in disease = bony erosion of mandibular ______ and joint space narrowing

A

condyle

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25
Q

End stage TMJ disease may result in ____ in open bite

A

fusion

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26
Q

ROM in TMJ: normal opening / closing ?

A

35-50 mm

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27
Q

ROM in TMJ: normal lateral deviation?

A

10-15 mm

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28
Q

ROM in TMJ: normal protrusion ?

A

3-6 mm

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29
Q

What 3 things are you looking for when you palpate the TMJ?

A
  1. crepitus
  2. clicking
  3. locking
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30
Q

______ is common in the shoulder

A

synovitis

31
Q

Thinning of the RC may lead to ______

A

rupture

32
Q

Synovitis in the shoulder can cause the humeral head to migrate _______; leads to impingement of _____ and _____; and ___ joint damage

A

superiorly; bursae; tendons; AC

33
Q

Synovitis will bulge out of the ___-___ fossa in the elbow

A

para-olecranon

34
Q

Loss of ______ is common in elbow, leading to _____ contracture

A

extension; flexion

35
Q

______ _______ joint commonly involved, leading to erosion of radial head

A

superior radioulnar

36
Q

Rheumatoid nodules do not occur in the elbow (T/F).

A

FALSE

37
Q

3 special tests for wrist and hand pathologies in RA?

A
  1. piano key sign at DRUJ
  2. radial collateral ligament test at MCP
  3. Bunnel-Littler (hand intrinsics)
38
Q

What structures does the piano key test test ?

A
  1. TFCC
  2. disc
  3. volar and dorsal RU ligaments
  4. ulnocarpal ligaments
  5. ECU sheath
  6. LT interosseous ligament
39
Q

C__-__ most often involved in RA; why?

A

1-2; has most ligaments, joint capsules, and synovial linings due to mobility at this joint

40
Q

Progression of instability at AA joint is associated with what 3 things?

A
  1. steroid use
  2. seropositive disease
  3. RA nodules
41
Q

Synovitis causes stretching / erosion of the ______ ligament at the AA joint

A

transverse

42
Q

Erosion of ____ and _____ facets of atlas with RA

A

dens; superior

43
Q

Subluxation of AA joint occurs with relative ______ translation of dens with _____ flexion of C spine

A

posterior; forward

44
Q

In AA subluxation, the _____ _____ and _____ _____ are compromised

A

SC; vertebral artery

45
Q

AA subluxation is prevalent is ___-___ % of RA pt’s

A

10-55

46
Q

AA subluxation is more likely in _____

A

males

47
Q

6 s/s of AA subluxation?

A
  1. pain, suboccipital headache
  2. “heavy head” sensation
  3. clunking
  4. bilateral paraesthesia
  5. dizziness, blurred vision
  6. dysphagia
48
Q

Many pt’s with AA subluxation are asymptomatic (T/F)?

A

TRUE

49
Q

From the _______ ax we determine risk and what ______ tests to do or not to do

A

subjective; objective

50
Q

MUST ask pt’s the __ __’s and ___ __’s in regards to C-Spine subjective

A

5 D’s; 3 N’s

51
Q

______ nerve testing in c-spine ax w/ pt’s w/ RA

A

cranial

52
Q

If there is any report of paresthesia, 3N’s or 5D’s, abnormal cranial nerve findings or less than 40 degrees ROM do not test _______

A

stability

53
Q

What 2 tests can be used to rule out anterior instability at AA joint?

A
  1. sharp pursor

2. anterior shear stability test

54
Q

6 possible changes in hip due to RA?

A
  1. synovitis
  2. cartilage erosion
  3. capsular pattern
  4. groin pain
  5. flexion deformity
  6. trochanteric bursitis
55
Q

______ cyst common in knee of pts with RA

A

bakers

56
Q

______ deformity at knee may occur

A

flexion

57
Q

4 changes in ankle due to RA?

A
  1. TC synovitis
  2. visible swelling
  3. capsular pattern
  4. shortened achilles tendon
58
Q

______ may occur at subtalar joint

A

synovitis

59
Q

Ligamentous laxity + bony erosion = ____ drops medially and plantarly; _____ drops; _____ deformity

A

talus; navicular; valgus

60
Q

______ _____ tendinopathy, becomes lengthened, potential rupture

A

tib post

61
Q

Loss of _______ arch = pronation and increased ______ of mid foot and toes; calcaneus _____

A

longitudinal; abduction; everts

62
Q

_______ phalanx at 1st MTP drafts _______ (hallux valgus)

A

proximal; laterally

63
Q

MTP subluxation = displacement of ______

A

flexors

64
Q

Unopposed ______ pull the proximal phalanx into hyper-______

A

extensors; extension

65
Q

Important to check _____ _____ in cases of MTP subluxation

A

skin integrity

66
Q

____ ____ = long and short flexor and extensor altered biomechanics

A

claw toe

67
Q

Claw toe is associated of weakness of _______

A

intrinsics

68
Q

Claw toe = MTP _____, PIP and DIP ______

A

extension; flexion

69
Q

Claw toes affects all the toes (T/F)

A

FALSE (not big toe)

70
Q

Hammer toe = usually at ___ toe

A

2nd

71
Q

Hammer toe = ____ of pip; _______ of DIP

A

flexion; hyperextension

72
Q

Mallet toe = usually ____ toe

A

2nd

73
Q

Mallet toe = ______ of DIP

A

flexion

PHTH 565 - Rheumatology (8 decks)

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