Physical Examination (Screening Exam)

Question 1

Back & Muscles to Know

Answer 1

Bones - Spinous processes C7 & L4, Posterior iliac crests, Sacroilac joints

Muscles - Trapezius, Latissimus dorsi, Erector Spinae

Question 2

Finding C7, L4, Iliact crest, Posterior superior iliac spine, and Sacroiliac joint

Answer 2

C7 - fisrt bump at base of neck

L4 - find top of iliac crest and move medially

Iliac crest - just below where hands rest on hips

Posterior superior iliac spine - locate iliac crest and palpate down or find “back dimples”

Sacroiliac joint - locate PSIS and palpate inferior and lateral

Question 3

Purpose of Musculoskeletal Exam

Answer 3

• Detect abnormalities of function
• Provide diagnostic clues to clinical questions

Question 4

Musculoskeletal Exam Basics (7)

Answer 4

1. Inspection
2. Palpation
3. Range of Motion
4. Special maneuvers (if needed)
5. Assessment of neurological function (sensory and motor)
6. Assessment of circulation
7. Assessment of joints proximal and distal to affected joints

Question 5

Active vs Passive ROM

Answer 5

Active - Patient initiated to test innervation, muscle & tendon, and joint mobility

Passive - Examiner initiated to only test joint mobility

Question 6

Lumbar Puncture (where? how to find it?)

Answer 6

• Find L4 by finding top of iliac crest and move medially
• Give puncture usually above (L3/L4) but can be below (L4/L5)

Question 7

Layers Penetrated for Lumbar Puncture

Answer 7

SLED SAS

1. Skin
2. Ligaments
3. Epidural Space
4. Dura Mater
5. Subdural Space
6. Arachnoid Membrane
7. Subarachnoid Space (injection site)

Question 8

Pain at Medial vs Lateral Epicondyles

Answer 8

Medial - “golfer’s elbow”

Lateral - “tennis elbow”

Question 9

Scaphoid Fracture

Answer 9

• Falling on outstreched hand
• Could disrupt its unique blood supply
• Must intervate quickly to prevent avascular necrosis

Question 10

Tinel’s Sign

Answer 10

• Palpate median nerve and see if pain is the same as carpal tunnel syndrome

Question 11

Pulse Points of Upper Limb

Answer 11

• Brachail
• Radial
• Ulnar

Question 12

Allen’s Test

Answer 12

• Makes sure hand is getting blood from radial & ulnar arteries
• Compress both arteries with patient having a closed fist, patient opens hand (should be splotchy), relase one artery (hand should turn pink)
• Repeat and release other artery

Question 13

Father-In-Law Handshake

Answer 13

• shake right hand
• Use 2/3 fingers from left hand to palpate Epitrochlear Lymph Nodes rotationally just proximal & medial` to elbow

Question 14

Venus systerm implications of fracture at surgical neck of humerus?

Question 15

• Lots of bleeding