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Medicine 1 > Rheuma > Flashcards

Rheuma Flashcards

1
Q

Articular Structures

A

 Joint capsule and articular cartilage
 Synovium and synovial fluid
 Intra-articular ligaments
 Juxta-articular bone

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2
Q

Extra Articular Structures

A 
 Periarticular ligaments
 Tendons
 Bursae
 Muscle
 Fascia
 Bone
 Nerve
 Overlying skin
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3
Q

Are ropelike bundles of collagen fibrils that connect bone to bone

A

Ligaments

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4
Q

→ Are collagen fibers connecting muscle to bone

→ Another type of collagen matrix forms the cartilage that overlies bony surfaces

A

Tendons

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5
Q

Are pouches of synovial fluid that cushion the movement of tendons and muscle over bone or other joint structures

A

Bursae

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6
Q

Inflammation of a joint

A

Arthritis

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7
Q

Arthritis

 Symptoms:

A

→ Pain
→ Swelling
→ Warmth
→ Erythema
→ Decrease range of motion of loss of function
 If it doesn’t involve the joints, it is not arthritis!

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8
Q

 Monoarticular

A

1 joint

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9
Q

 Monoarticular examples

A

→ Septic arthritis

→ Gouty arthritis

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10
Q

 Oligoarticular

A

2-4 joints

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11
Q

 Oligoarticular examples

A

→ Reactive arthritis

→ Psoriatic arthritis

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12
Q

 Polyarticular

A

more than 4 joints

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13
Q

 Polyarticular examples

A

→ Rheumatoid arthritis

→ Systemic lupus erythematosus

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14
Q

 Symmetric

A

affecting joints both sides of the body

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15
Q

 Symmetric examples

A

→ Rheumatoid arthritis

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16
Q

 Migratory examples

A

→ Rhuematoid fever (especially in younger individuals)

→ Gonococcal arthritis (sexually active patients)

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17
Q

 Additive examples

A

→ Rheumatoid arthritis

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18
Q

Joint pain in the right wrist, will resolve before it will migrate to another joint

A

Migratory

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19
Q

Joint pain in the wrist, is not yet resolve, yet another pain in other joints

A

Additive

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20
Q

 Acute

A

less than 6 weeks

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21
Q

 Acute examples

A

→ Septic arthritis

→ Acute gout

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22
Q

 Chronic

A

more than 6 weeks

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23
Q

 Chronic examples

A

→ Rheumatoid arthritis

→ Osteoarthritis

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24
Q

Worsen with activity

A

Osteoarthritis

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25
Q

Worsen by rest

A

o Inflammatory arthritis
o Rheumatoid arthritis
o Spondyloarthropathies

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26
Q

Inflammatory symptoms

A 
 Tenderness
 Warmth
 Redness
 Swelling
 Stiffness
 Fever or chills
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27
Q

Systemic features

A 
 Fever
 Chills
 In patient with malignancy
→ Anorexia
→ Weight loss
 Weakness
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28
Q

 Fever

In cases of infections

A

o Rheumatic fever
o Gonococcal infection
o Gonococcal arthritis
o Active arthritis

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29
Q

 Weakness example

A

→ Polymyositis

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30
Q

Butterfly rash on cheeks

A

SLE

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31
Q

Scaly rash and pitted nails

A

psoriasis

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32
Q

Papules, pustules, or vesicles on reddened bases, located on the distal extremities

A

→ Reactive arthritis

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33
Q

Only involving your sole and palm

A

keratoderma blendoragica

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34
Q

Red, burning and itchy eyes conjunctivitis / anterior uveitis

A

Spondyloarthropathy

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35
Q

Preceding sore throat

A

Rheumatic fever

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36
Q

Symptoms of urethritis

A

→ Oligoarthritis
o Acute (less than 6 weeks)
→ Reactive arthritis
→ Reiter’s syndrome

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37
Q

Mental status change, facial or other weakness, stiff neck

A

→ Lupus erythematsus
→ Polymyositis
→ Dermatomyositis

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38
Q

Manifestations of Articular

A

 Deep or diffuse pain
 Pain or limited range of motion on active or passive movement
 Swelling (Caused by synovial proliferation, effusion, bony enlargement)
 Crepitation – abnormal creaking or popping sound when moving a joint
 Instability
 “Locking” – unable to fully flex or extend a joint
 Deformity

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39
Q

Manifestations of Non-articular

A

 Painful on active but not passive ROM*
 Point or focal tenderness in regions adjacent to articular structures
 Seldom demonstrate swelling, crepitus, instability, deformity

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40
Q

Inflammatory Disorders

A

 Infectious (N. gonorrhea or M. tuberculosis)
 Crystal induced (gout, pseudogout)
 Immune related (Rheumatoid arthritis (RA), Systemic lupus erythematosus (SLE), reactive arthritis , rheumatic fever)
 Idiopathic

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41
Q

Non-inflammatory Disorders

A

 Trauma (Rotator cuff tear)
 Repetitive use (bursitis, tendinitis )
 Degeneration or ineffective repair (OA)
 Neoplasm (Pigmented villonodular synovitis)
 Pain amplification

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42
Q

Inflammatory Symptoms

A

 Cardinal signs of inflammation (erythema, warmth pain & swelling
 Systemic symptoms (fatigue , fever, rash, weight loss)
 Laboratory evidence of inflammation (ESR, CRP, thrombocytosis, anemia of chronic disease or hypoalbuminemia)
 Morning stiffness (hours)

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43
Q

Non-inflammatory Symptoms

A

 Pain without swelling or warmth
 Absence of systemic features
 Daytime gel phenomena
 Normal (for age) or Negative laboratory investigations

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44
Q

→ Young -

A

SLE, reactive arthritis

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45
Q

→ Middle age -

A

RA, fibromyalgia

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46
Q

→ Elderly –

A

Osteoarthritis (OA), polymyalgia rheumatica

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47
Q

→ Men ‐

A

Gout, spondyloarthritis, ankylosing spondylitis

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48
Q

→ Women ‐

A

RA, SLE, fibromyalgia

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49
Q

→ Whites -

A

polymyalgia rheumatica, giant cell arteritis, granulomatosis w/ polyangiitis

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50
Q

→ African American-‐

A

SLE

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51
Q

 Familial aggregation

A

→ Ankylosing spondylitis, gout, Heberden’s node of OA (Bony enlargement of distal phalangeal joint)

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52
Q

→ Abrupt –

A

septic arthritis, gout

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53
Q

→ Indolent presentations -

A

OA, RA, Fibromyalgia

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54
Q

→ Chronic ‐

A

OA

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55
Q

→ Intermittent -

A

crystal or lyme arthritis

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56
Q

→ Migratory –

A

rheumatic fever, gonococcal, viral arthritis

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57
Q

→ Additive –

A

Rheumatoid arthritis, Psoriatic arthritis(PsA)

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58
Q

→ Acute –

A

infectious , crystal induced or reactive

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59
Q

→ Chronic –

A

noninflammatory (OA) or immunologic arthritides (RA), nonarticular disorders (Fibromyalgia)

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60
Q

Monoarticular -

A

Infectious arthritis

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61
Q

Oligoarticular/pauciarticular -

A

Crystal arthritis

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62
Q
  • symmetric and polyarticular
A

→ Rheumatoid arthritis

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63
Q
  • asymmetric and oligoarthritis
A

→ Spondyloarthritis, gout, reactive arthritis

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64
Q
  • either symmetric or asymmetric and oligo- or polyarticular
A

→ OA & PsA

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65
Q

Upper extremities

A

→ frequently involved in RA (MCP, PIP, wrist joints), OA (can also manifest in Heberden and Buchard’s node)

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66
Q

 Lower extremities

A

→ characteristic of reactive arthritis and gout at their onset

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67
Q

 Axial skeleton

A

→ common in OA & AS

→ infrequent in RA, EXCEPT the cervical spine C1 and C2

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68
Q

 Trauma

A

→ Osteonecrosis

→ Meniscal tear

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69
Q

 Drug administration

→ Anti -TB, diuretics, aspirin – can trigger?

A

gouty arthritis

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70
Q

 Drug administration

→ Hydrosteroids – can manifest as?

A

Polymyositis

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71
Q

 Antecedent or Intercurrent infection

→(sore throat prior)

A

Rheumatic fever

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72
Q

 Antecedent or Intercurrent infection

→ (GI & GU)

A

reactive arthritis

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73
Q

 Antecedent or Intercurrent infection

→ hepatitis

A

(certain vasculitis)

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74
Q

Musculoskeletal Consequences:

 Diabetes mellitus –

A

Carpal-tunnel syndrome

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75
Q

Musculoskeletal Consequences:

 Renal Insufficiency –

A

Gout

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76
Q

Musculoskeletal Consequences:

 Depression or insomnia –

A

fibromyalgia

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77
Q

Musculoskeletal Consequences:

 Myeloma –

A

Low back pain (usually in elderlies)

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78
Q

Musculoskeletal Consequences:

 Cancer –

A

myositis

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79
Q

Musculoskeletal Consequences:

 Osteoporosis –

A

Fracture

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80
Q

Musculoskeletal Consequences:

→ Glucocorticoids –

A

osteonecrosis, septic athritis

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81
Q

→ Diuretics or chemotherapy -

A

Gout

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82
Q

 Fever –

A

SLE, infections

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83
Q

 Rash –

A

SLE, Psoriatic arthritis or reactive arthritis

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84
Q

 Myalgia –

A

fibromyalgia, statin or drug induced myopathy

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85
Q

 Weakness –

A

polymyositis, neuropathy

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86
Q

Rheumatologic Conditions Associated with Involvement of other organ systems:
 Eyes-

A

Bechet’s. Disease, carcoidosis (granuloma formation) , spondyloarthritis (anterior uveitis)

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87
Q

Rheumatologic Conditions Associated with Involvement of other organ systems:
 Gastrointestinal tract –

A

scleroderma, inflammatory bowel disease

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88
Q

Rheumatologic Conditions Associated with Involvement of other organ systems:
 Genitourinary tract –

A

reactive arthritis, gonococcemia

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89
Q

Rheumatologic Conditions Associated with Involvement of other organ systems:
 Nervous System –

A

Lyme disease, vasculitis

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90
Q

 Gouty Arthritis

A

→ acute, monoarticular, inflammatory

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91
Q

 Septic Arthritis

A

→ acute,monoarticular,inflammatory

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92
Q

 Osteoarthritis

A

→ chronic, monoarticular or oligoarticular, non-inflammatory

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93
Q

 Reactive Arthritis

A

→ acute,chronic, oligoarticular, inflammatory

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94
Q

 Psoriatic Arthritis

A

→ chronic, oligoarticular, inflammatory

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95
Q

 Rheumatoid Arthritis

A

→ chronic, polyarticular, inflammatory, symmetric

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96
Q

 SLE

A

→ chronic, polyarticular, inflammatory, asymmetric

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97
Q

 TB Arthritis

A

→ chronic, monoarticular, inflammatory

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98
Q

 Rheumatoid Arthritis -

A

Female, middle age, symmetric and smaller joints involved

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99
Q

 Rheumatic Fever -

A

Migratory arthritis with history of sore throat

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100
Q

 Pain and tenderness on palpation of TMJ

A

TMJ syndrome

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101
Q

 Pain with chewing

A

in trigeminal neuralgia, temporal arteritis

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102
Q

 Dislocation of the TMJ may be seen in

A

trauma

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103
Q

→ Swelling of the TMJ may appear as?

A

→ Swelling may appear as a rounded bulge approximately 1⁄2 cm anterior to the external auditory meatus.

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104
Q

How to locate and palpate the TMJ?

A

 To locate and palpate the joint, place the tips of your index fingers just in front of the tragus of each ear and ask the patient to open his or her mouth.

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105
Q

→ externally at the angle of the mandible

A

 Masseters

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106
Q

→ externally during clenching and relaxation of the jaw

A

 Temporal muscles

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107
Q

→ internally between the tonsillar pillars at the mandible

A

 Pterygoid muscle

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108
Q

Range of Motion: TMJ

A

glide (upper) and hinge motion (lower)

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109
Q

 Chewing primarily _____ movement?

A

 Chewing primarily gliding movement in the upper compartment

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110
Q

 Normally as the mouth is opened wide, _____ fingers can be inserted between incisors.

A

three

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111
Q

– fine tremors of the muscles

A

→ Fasciculations

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112
Q

May cause elevation of one shoulder. With anterior dislocation of the shoulder, the rounded lateral aspect of the shoulder appears flattened.

A

o Scoliosis

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113
Q

Within 2-3 weeks of rotator cuff tear

A

o Atrophy of supraspinatus and infraspinatus over posterior scapula with increased prominence of the scapular spine within 2-3 weeks of rotator cuff tear.

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114
Q

the summit of the shoulder

A

acromion

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115
Q

→ Its upper surface is rough and slightly convex.

A

acromion

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116
Q

coracoid process is part of the?

A

scapula

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117
Q

where the SITS muscles are inserted.

A

greater tubercle

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118
Q

Palpate the biceps tendon in the?

A

intertubercular bicipital groove

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119
Q

– directly under the acromion

A

→ Supraspinatus

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120
Q

– posterior to supraspinatus

A

→ Infraspinatus

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121
Q

– posterior and inferior to the supraspinatus

A

→ Teres Minor

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122
Q

– inserts anteriorly and is not palpable

A

→ Subscapularis

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123
Q

 The six motions of the shoulder girdle:

A 
→ Flexion
→ Extension
→ Abduction
→ Adduction
→ Internal Rotation
→ External Rotation
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124
Q

―Raise your arms in front of you and overhead

A

Flexion

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125
Q

Raise your arms behind you

A

Extension

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126
Q

Raise your arms out to the side and overhead

A

Abduction

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127
Q

Glenohumeral motion

A

-patient should raise the arms to shoulder level at 90 degrees, with palms facing down

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128
Q

Scapulothoracic motion

A

-patient should turn the palms up and raise the arms an additional 60 degrees.

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129
Q

Cross your arm in front of your body

A

Adduction

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130
Q

Place one hand behind your back and touch your shoulder blade

A

Internal rotation

Identify the highest midline spinous process the patient is able to reach.

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131
Q

Raise your arm to shoulder level; bend your elbow and rotate your forearm toward the ceiling

A

External rotation

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132
Q

Place one hand behind your neck or head as if you are brushing your hair

A

External rotation

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133
Q

Affecting Movement:

Flexion

A 
Anterior deltoid
Pectoralis major (clavicular head), Coracobrachialis
Biceps brachii
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134
Q

Affecting Movement:

Extension

A 
Latissimus dorsi
Teres major
Posterior deltoid
Triceps brachii (long head)
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135
Q

Affecting Movement:

Abduction

A 
Supraspinatus
Middle deltoid
Serratus anterior (via upward rotation of the scapula)
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136
Q

Affecting Movement:

Adduction

A
  • Pectoralis major
  • Coracobrachialis
  • Latissimus dorsi
  • Teres major
  • Subscapularis
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137
Q

Affecting Movement:

Internal rotation

A
  • Subscapularis
  • Anterior deltoid
  • Pectoralis major
  • Teres major
  • Latissimus dorsi
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138
Q

Affecting Movement:

External rotation

A

Infraspinatus, teres minor, posterior deltoid

139
Q

Are the most common cause of shoulder pain in primary care

A

Rotator Cuff Disorders

140
Q

Compression of the rotator cuff muscles and tendons between the ______ and the _______ causes “impingement signs‖ or pain during shoulder movement

A

Compression of the rotator cuff muscles and tendons between the head of the humerus and the acromion causes “impingement signs‖ or pain during shoulder movement

141
Q

Five maneuvers that have the best Likelihood Ratios (LR) and the narrowest confidence intervals are currently recommended:

A

 1 Pain Provocation Test
 3 Strength Tests
 1 Composite Test

142
Q

In ______ tests, the patient experiences either pain or weakness during the maneuver.

A

composite tests

143
Q

Cross-over test

-Palpate and compare both joints for swelling or tenderness. Adduct the patient’s arm across the chest

A

Acromioclavicular Joint

144
Q

Localized tenderness or pain with adduction suggests:

A

-inflammation or arthritis of the acromioclavicular joint

145
Q

Apley scratch test

-Ask the patient to touch the opposite scapula using the two motion

A

Overall Shoulder Rotation

146
Q

Difficulty with Apley scratch test suggests

A
  • rotator cuff disorder

- adhesive capsulitis.

147
Q

Test Neer’s impingement
-Press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other. This compresses the greater tuberosity of the humerus against the acromion.

A

Rotator Cuff

148
Q

Test Neer’s impingement

Pain during this maneuver is a positive test, indicating

A

-inflammation or rotator cuff tear.

149
Q

Hawkin’s impingement

A

-Flex the patient’s shoulder and elbow to 90 degrees with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally. This compresses the greater tuberosity against the coracoacromial ligament.

150
Q

Hawkin’s impingement

Pain during this maneuver is a positive test, indicating

A

-inflammation or rotator cuff tear.

151
Q

-(sometimes called the

“empty can test”). -

A

Test supraspinatus strength

152
Q

Test supraspinatus strength

A

Elevate the arms to 90 degrees and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms.

153
Q

Test supraspinatus strength

Weakness during this maneuver is a positive test, indicating

A

-rotator cuff tear.

154
Q

Test infraspinatus strength

A

-Ask the patient to place arms at the side and flex the elbows to 90 degrees with the thumbs turned up. Provide resistance as the patient presses the forearms outward.

155
Q

Test infraspinatus strength

Weakness during this maneuver is a positive test, indicating

A
  • rotator cuff tear

- bicipital tendinitis.

156
Q

Test forearm supination

A

-Flex the patient’s forearm to 90 degrees at the elbow and pronate the patient’s wrist. Provide resistance when the patient supinates the forearm.

157
Q

Test forearm supination

Pain during this maneuver is a positive test, indicating

A

-inflammation of the long head of the biceps tendon -possible rotator cuff tear.

158
Q

Test the “drop-arm” sign

A

-Ask the patient to fully abduct the arm to shoulder level (or up to 90 degrees) and lower it slowly. Note that abduction above shoulder level, from 90 degrees to 120 degrees, reflects action of the deltoid muscle.

159
Q

If the patient cannot hold the arm fully abducted at shoulder level or cannot control lowering the arm, the test is positive, indicative

A

-rotator cuff tear

160
Q

Swelling over the olecranon process in

A

olecranon bursitis;

161
Q

inflammation or synovial fluid in

A

arthritis.

162
Q

medial epicondylitis

A

(pitcher’s or golfer’s elbow)

163
Q

The olecranon is displaced posteriorly in?

A

posterior dislocation of the elbow and supracondylar fracture.

164
Q

The _____ is most accessible to examination between the olecranon and the epicondyles

165
Q

Can you palpate the synovium & bursae?

A

Normally neither synovium nor bursae is palpable

166
Q

The sensitive ______ nerve can be palpated posteriorly between the olecranon process and the medial epicondyle

A

ulnar nerve

167
Q

The four motions of the elbow joint:

A

→ Flexion
→ Extension
→ Supination
→ Pronation

168
Q

Tenderness distal to the epicondyle

A

lateral epicondylitis

169
Q

(tennis elbow)

A

lateral epicondylitis

170
Q

Usually in Rheumatoid arthritis, the alignment of your DIP’s and PIP’s are not parallel, it is called?

A

subluxation

171
Q

Diffuse swelling of the hand in?

A

arthritis or infection;

172
Q

local swelling of the hand in?

A

cystic ganglion

173
Q

In osteoarthritis, ______ at the DIP joints,

A

Heberden’s nodes

174
Q

In osteoarthritis, _______ at the PIP joints.

A

Bouchard’s nodes

175
Q

In _______, symmetric deformity in the PIP, MCP, and wrist joints, with ulnar deviation

A

rheumatoid arthritis

176
Q

_______ atrophy in median nerve compression from carpal tunnel syndrome;

177
Q

________ atrophy in ulnar nerve compression.

A

hypothenar

178
Q

Flexion contracture in the ring, 5th, and 3rd fingers, aka _____ , arise from thickening of the palmar fascia

A

Dupuytren’s contracture

179
Q

Bogginess is seen in

A

synovial inflammation,

180
Q

usually in Tb arthritis,

181
Q

anatomical snuffbox, a hollowed depression just distal to the radial styloid process formed by the?

A

abductor and extensor muscles of the thumb.

182
Q

“With palms down,
point your fingers
toward the floor.”

A

Wrist Flexion

183
Q

“With palms down,
point your fingers
towards the
ceiling.”

A

Wrist Extension

184
Q

“With palms down,
bring your fingers
toward the
midline.”

A

Wrist Adduction
(radial
deviation)

185
Q

“With your palms
down, bring your
fingers away from
the midline.”

A

Wrist Abduction
(ulnar
deviation)

186
Q

PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Flexion

A

Flexor carpi radialis,

flexor carpi ulnaris

187
Q

PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Extension

A

Extensor carpi ulnaris,
extensor carpi radialis
longus, extensor carpi
radialis brevis

188
Q 
PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Adduction
(radial
deviation)
A

Flexor carpi ulnaris

189
Q 
PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Abduction
(ulnar
deviation)
A

Flexor carpi radialis

190
Q

Carpal Tunnel Syndrome
 You can test sensation as follows:
o median nerve

A

→ Pulp of the index finger

191
Q

Carpal Tunnel Syndrome
 You can test sensation as follows:
o ulnar nerve

A

→ Pulp of the 5th finger

192
Q

Carpal Tunnel Syndrome
 You can test sensation as follows:
o radial nerve

A

→ Dorsal web space of the thumb and index finger

193
Q

Test _______ by
asking the patient to grasp
your second and third fingers.

A

hand grip strength

194
Q

This tests function of wrist
joints, the finger flexors, and
the intrinsic muscles and
joints of the hand.

A

hand grip strength

195
Q

Finkelstein’s test

A 
Test the thumb function if there
is wrist pain by asking the
patient to grasp the thumb
against the palm and then
move the wrist toward the
midline in ulnar deviation
196
Q

Pain during Finkelstein’s test identifies?

A

de Quervain’s tenosynovitis

197
Q

Mechanism of de Quervain’s tenosynovitis

A

from inflammation
of the abductor pollicis longus and extensor
pollicis brevis tendons and tendon sheaths.

198
Q

CARPAL TUNNEL THUMB

ABDUCTION

A

Test thumb abduction by asking the patient to raise the thumb straight up
as you apply downward resistance

199
Q

Weakness on the thumb abduction is a?

A

positive test–

the abductor pollicis longus is innervated only by the median nerve.

200
Q

TINEL’S SIGN

A

Test for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel as
shown.

201
Q

Positive TINEL’S SIGN

A

Aching and numbness in the median

nerve distribution is a positive test.

202
Q

PHALEN’S SIGN

A

Test for median nerve compression by
asking the patient to hold the wrists
in flexion for 60 seconds. Alternatively, ask
the patient to press the backs of both hands together to form right angles. These maneuvers compress the median nerve.

203
Q

Reverse prayer sign

A

Phalen’s test

204
Q

Positive Phalen’s test

A

Numbness and tingling in the median nerve distribution within 60 seconds is a
positive test.

205
Q

Range of Motion:

Fingers

A

 Assess flexion, extension, abduction, and

adduction of the fingers.

206
Q

Range of Motion:

Thumb

A

 At the thumb, assess flexion, extension

abduction, adduction, and opposition

207
Q

 Concave Curves

A

→ Cervical (C1-C7)

→ Lumbar(L1-L5)

208
Q

 Convex Curves

A

→ Thoracic (T1-T12)

→ Sacrococcygeal

209
Q

 Cervical –

210
Q

 Thoracic-

211
Q

 Lumbar-

212
Q

 Coccyx-

213
Q

– lateral deviation and rotation of the
head, from contraction of the sternocleidomastoid
muscle (SCM)

A

Torticollis

214
Q

–―hunchback, accentuated flexion of

thoracic spine

215
Q

Fractures in osteoporosis involves?

A

lower thoracic

216
Q

– short-segment structural thoracolumbar

kyphosis resulting in sharp angulation (suggestive of Tb of the Spine)

217
Q

Lost of Lumbar lordisis-

A

in patients with ankylosing spondylitis

218
Q

– abnormal lateral curvature of the spine,

which also includes an abnormal rotation of one vertebra upon the other

219
Q

– most mobile portion of the spine

220
Q

→ Atlas (C1) –

A

flexion and extension

221
Q

→ Axis (C1 & C2) –

222
Q

→ C2 – C7 –

A

lateral bending

223
Q

Touch the chin to the chest

A

Neck Flexion

224
Q

Look up at the ceiling

A

Neck Extension

225
Q

turn the head to each side, looking

directly over the shoulder

A

Neck Rotation

226
Q

Tilt the head, touching each ear to the corresponding shoulder

A

Lateral bending of the Neck

227
Q

Bend forward and try to touch your toes

A

Flexion of lumbar

228
Q

Bend back as far as possible

229
Q

rotate from side to side

230
Q

bend to the side from the waist

A

Lateral bending

231
Q

→ Ankylos:

A

―bent or ―crooked

232
Q

→ Spondylos:

A

―vertebral disk

233
Q

→ -itis:

A

―inflammation

234
Q

(dimples of Venus)

A

 2 midline marks 10 cm apart starting at the posterior superior iliac spine

→ Less than 5 cm difference suggests pathology

235
Q

This is suggestive a back pain which is nervous in origin

A

 To differentiate if the back pain is muscular or nervous in origin
 Raise the leg of the patient up to the level where the pain is felt
 There should be increase pain on dorsiflexion on patient’s foot

236
Q

Mechanical back pain

A

Back pain caused by placing abnormal stress and strain on the muscles of the vertebral column

Results from bad habits, such as poor posture, poorly designed seating
and incorrect bending and lifting

237
Q

Radicular Back pain

A

Radiates into the lower extremities directly along the course of a spinal nerve root

Caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis.

238
Q

HIP JOINT

Muscle Groups

A

 Flexor group – anterior, flexes the thigh
 Extensor group – posterior, extends the thigh
 Adductor group – medial, swings the thigh toward the body
 Abductor group – lateral, moves thigh away from the body

239
Q

Stance

A

foot on the ground and bears weight

60% of the walking cycle

240
Q

Swing

A

foot moves forward and does not bear

weight (40%)

241
Q

Measuring the Length of Legs

A

 patient in supine position

 measure the distance between the ASIS and the medial malleolus. (the tape should cross the knee on its medial side)

242
Q

Trendelenburg Test

A

When the gluteus medius is weak, the
pelvis drops on the non-weight-bearing
side when the patient stands on the affected hip

243
Q

Anterior surface landmarks of the hip:

A 
→ iliac crest at the level of L4
→ iliac tubercle
→ anterior superior iliac spine (ASIS)
→ greater trochanter
→ pubic symphysis
244
Q

Posterior surface landmarks of the hip:

A

→ posterior superior iliac spine (PSIS)
→ greater trochanter
→ ischial tuberosity
→ sacroiliac joint

245
Q

Flexion of the hip

A

With the patient supine, place your hand under the patient’s lumbar spine. Ask the patient to bend each knee in turn up
to the chest and pull it firmly against the
abdomen

246
Q

Hip flexion and

flattening found in?

A

lumbar lordosis

247
Q

Hip Extension

A

→ With the patient lying face down, extend the thigh toward you in a posterior direction

248
Q

Hip Abduction

A

→ Stabilize the pelvis by pressing down on the opposite anterior superior iliac spine with one hand. With the other hand, grasp the ankle and abduct the extended leg until you feel the iliac spine move.

249
Q

Hip Adduction

A

→ With the patient supine, stabilize the pelvis, hold one ankle, and move the leg medially across the body and over the opposite extremity.

250
Q

Hip External and internal rotation.

A

→ Flex the leg to 90° at hip and knee, stabilize the thigh with one hand, grasp the ankle with the other, and swing the lower leg— medially for external rotation at the hip and laterally for internal rotation.

251
Q

Stumbling or pushing the knee into extension with the hand during heel strike suggests?

A

quadriceps weakness

252
Q

( genu varum)

A

→ Bowlegs (affected is in the
medial comapartment)
→ Varum- R—Room

253
Q

(genu valgum)

A

knock-knees (affected is in the lateral
compartment)

→ Valgus- L- Locked kness ( in OA)

254
Q

Look for loss of the normal hollows around the patella, a sign of swelling in the knee joint and suprapatellar pouch

A

Atrophy of the quadriceps muscles

255
Q

Swelling over the patella suggests?

A

prepatellar bursitis

256
Q

Swelling over the tibial tubercle

suggests?

A

infrapatellar or, if more medial,

anserine bursitis.

257
Q

Bulge sign (for minor effusions)

A

 With the knee extended, place the left hand above the knee and apply pressure on the suprapatellar pouch, displacing or ―milking‖ fluid downward.
 Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area
 Tap the knee jjust behind the lateral margin of the patella with the right hand.

258
Q

positive bulge sign

A

A fluid wave or bulge on the medial side

between the patella and the femur is a positive bulge sign consistent with an effusion

259
Q

Balloon sign (for major effusions)

A

 Place the thumb and index finger of your right hand on each side of the patella
 with the left hand, compress the suprapatellar pouch against the femut
 feel for fluid entering (or ballooning into) the spaces next to the patella under your right thumb and index finger

260
Q

positive balloon sign

A

When the knee joint has a large effusion,
suprapatellar compression ejects fluid to the spaces adjacent the patella. A palpable fluid wave is a positive balloon sign.

A returning fluid wave into the suprapatellar pouch confirms an effusion

261
Q

Ballotting the patella

A

 To assess large effusions, you can also
compress the suprapatellar pouch and ―ballotte or push the patella sharply against the femur
 Watch for fluid returning to the suprapatellar pouch, it confirms a large effusion
 palpable fluid returning into the pouch further confirms the presence of a large effusion.
 a patellar click with compression may also occur but yields more false positives

262
Q

Maneuver: McMurray Test
Structure: ?

A

Med. Lemniscus and Lat.

Meniscus

263
Q

Maneuver: Abduction/Valgus Stress Test
Structure: ?

A

Med. Collateral Ligament

264
Q

Maneuver: Adduction/Varus Stress Test
Structure: ?

A

Lat. Collateral Ligament

265
Q

Maneuver: Anterior Drawer Sign
Structure: ?

A

Ant. Cruciate Ligament

266
Q

Maneuver: Lachman Test
Structure: ?

A

Ant. Cruciate Ligament

267
Q

Maneuver: Posterior Drawer Sign
Structure: ?

A

Post. Cruciate Ligament

268
Q

McMurray Test

A

A click or pop along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the post. portion of the med. Meniscus. The tear may displace meniscal tissue, causing ―locking‖ on full knee extension

269
Q

Abduction/Valgus Stress Test

A

 pain or gap in the medial joint line points to ligamentous laxity and partial tear of the lateral collateral ligament
 most injuries are on the medial side

270
Q

Adduction/Varus Stress Test

A

pain or gap in the lateral joint line points to ligamentous laxity and partial tear of the lateral collateral ligament

271
Q

Anterior Drawer Sign

A

a few degrees of forward movement are normal if equally present on the opposite side. A forward jerk showing the contours of the upper tibia is a positive anterior drawer sign making an ACL tear 11.5 times more likely.

272
Q

Lachman Test

A

Significant forward excursion indicates an ACL tear

273
Q

Posterior drawer sign

A

isolated PCL tears are rare

274
Q

focal heel pain on plantar fascia suggest?

A

focal heel pain on plantar fascia suggest

plantar fasciitis, seen in prolonged standing or heel-strike exercise

275
Q

Tenderness on compression of metatarsals

is an early sign of?

276
Q

Acute inflammation of the 1st MTP joint

A

(PUDAGRA) in gout

277
Q

Maneuver: Dorsiflex and plantarflex the
foot at the ankle

Structure: ?

A

Ankle (tibiotalar) joint

278
Q

Maneuver: Stabilize the ankle with one hand, grasp the heel with the other, and invert and evert the foot

Structure: ?

A

Subtalar (talocalcaneal) joint

279
Q

Maneuver: Stabilize the heel and invert and evert the forefoot

Structure: ?

A

Transverse tarsal joint

280
Q

Maneuver: Flex the toes in relation to the
feet

Structure: ?

A

Metatarsophalangeal joints

281
Q

Indicative of a problem that requires more
extensive examination, precaution and
consideration

A

Yellow Flag Sign and Symptoms

282
Q

Indicative of more serious problem that
should be referred to appropriate medical
specialist

A

Red Flag Signs and Symptoms

283
Q

RED FLAGS:

CANCER

A

Persistent pain at night, constant pain anywhere in the body, unexplained weight loss, loss of appetite, unusual lumps or
growths, unwarranted fatigue

284
Q

RED FLAGS:

CVS

A

Shortness of breath, dizziness, pain or feeling of heaviness in the chest, pulsating pain anywhere in the body, constant and severe pain in the lower leg (calf) or arm,
discolored or painful feet, swelling (no history of injury)

285
Q

RED FLAGS:

GI/GU

A

Frequent or severe abdominal pain, frequent heartburn or indigestion, frequent nausea or vomiting, change in or problems
with bowel and/or bladder function, unusual menstrual irregularities

286
Q

RED FLAGS:

NEUROLOGICAL

A

Changes in hearing, frequent or severe headaches with no history of injury, problems with swallowing or changes in speech, changes in vision (e.g. blurriness or loss of sight), problems with balance,
coordination, or falling, faint spells (drop attacks), sudden weakness

287
Q

RED FLAGS:

MISCELLANEOUS

A

Fever or night sweats, recent severe emotional disturbances, swelling or redness in any joint with no history or injury, Pregnancy

288
Q

YELLOW FLAGS:

A

Abnormal signs and symptoms (unusual patterns of complaint
Fainting
Bilateral symptoms
Drop attacks
Symptoms peripheralizing
Vertigo
Neurological symptoms (nerve root or peripheral nerve)
Autonomic nervous system symptoms Multiple nerve root involvement Progressive weakness
Abnormal sensation patterns (do not follow dermatome or peripheral nerve patterns)
Progressive gait disturbances
Saddle anesthesia
Multiple inflamed joints
Upper Motor neuron symptoms (spinal cord) signs
Psychosocial stresses
Circulatory or skin changes

289
Q

Initial GAIT assessment:

What signs are easily noticed?

A

→ Trendelenburg sign and Drop foot are easily noticed

290
Q

Test the _____ side first

A

Test the normal or uninvolved side first

→ To establish a baseline for normal movement of the joint being tested
→ To show the patient what to expect, thereby increasing patient confidence and less apprehension when testing the injured side.

291
Q

Have patient do _____ movements first,

A

Have patient do active movements first,followed by the passive movements done by the examiner.

292
Q

you let the patient move the limbs first

A

Active movements:

293
Q

If active movement is limited, you can push the joint or limb passively which is usually done by the examiner

A

passive movements

294
Q

Any painful movements are done?

295
Q

How is Resisted isometric movements done?

A

are done with joint in a neutral or resting position

position the limb first, you can have the patient resist your movement or you resist the patient’s movement

296
Q

When testing myotomes (group of muscles supplied by a single nerve root), each contraction is held at least _____ , for Myotomal weakness takes time to develop

297
Q

away from the midline

A

Abduction-

298
Q

toward the midline

A

Adduction-

299
Q

movement of bending from the starting position

300
Q

movement form bending to the starting postion

A

Extension-

301
Q

rotating the forearm to face the palm upward

A

Supination-

302
Q

rotating the forearm to face the arm downward

A

Pronation-

303
Q

turning inward toward the axis of the body

A

Internal Rotation-

medial rotation

304
Q

turning outward away from the axis of the body

A

External Rotation-

lateral rotation

305
Q

turning the hindfoot inward

A

Inversion-

306
Q

turning the hindfoot outward

307
Q

pointing the toes away from the body (toward the floor)

A

Plantar flexion-

308
Q

pointing the toes toward the body (toward the ceiling)

A

Dorsiflexion-

309
Q

Isolate individual muscles with similar functions instead of testing the entire muscle group (to know which muscle is affected)

310
Q

Be aware of basic substitution patterns (e.g. elbow flexion) Ex: when there is weakness of biceps/biceps brachii and when you do elbow flexion, there are some muscles that substitute for the main function of your biceps brachii like your brachioradialis. Know the position of the forearm so that you will know what muscle is functioning

A

Substitution Patterns

311
Q

→ Occur when determining patient’s muscle strength while under the influence of sedatives, significant pain, positioning, language, or cultural barriers, spasticity and hypertonicity

A

Suboptimal testing conditions

312
Q

→ Occurs when the examiner applies increased force when the patient is unable to achieve the full available ROM yet (especially if the examiner is not strong enough, if males ang gina grade nyo, you grade it as 5, basi ang grade ya is only 4)

A

Overgrading

313
Q

→ Occurs when the examiner is not aware of the effects of muscle contracture on ROM; the muscle appears to lack full ROM when it has achieved its full available ROM (if there is lack of ROM in a particular joint and you grade is as 3, pwede na sya ma grade as 5, most probably ang ROM ya is only up to that joint)

A

Undergrading

314
Q

BONES OF THE SHOULDER GIRDLE

A

 Scapula

 Clavicle

315
Q

medial side, widest bone in the elbow

316
Q

lateral side, widest bone in the wrist

317
Q

It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle

A

Acromioclavicular joint

318
Q

Five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones.

A

Carpometacarpal

319
Q

Proximal interphalangeal joints” (PIJ or PIP), those between the first (also called proximal) and second (intermediate) phalanges.

A

Proximal Interphalangeal

320
Q

Distal interphalangeal joints” (DIJ or DIP), those between the second (intermediate) and third (distal) phalanges.

A

Distal Interphalangeal

321
Q

Action:

Supraspinatus

322
Q

Action:

Infaspinatus

A

External Rotation

323
Q

Action:

Teres Minor

A

External Rotation

324
Q

Action:

Subscapularis

A

Internal Rotation

325
Q

MUSCLES OF THE ARM

ANTERIOR COMPARTMENT

A

Biceps brachii
Coracobrachialis
Brachialis

326
Q

MUSCLES OF THE ARM

POSTERIOR COMPARTMENT

327
Q

MUSCLES OF ANTERIOR FOREARM

A 
Pronator Teres
Flexor Carpi Ulnaris
Flexor Carpi Radialis
Palmaris Longus
Flexor Digitorum Superficialis
Flexor Pollicis Longus
Flexor Digitorum Profundus
Pronator Quadratus
328
Q

MUSCLES OF POSTERIOR COMPARTMENT

A 
Extensor Carpi Radialis Brevis
Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris
Anconeus
Supinator
Abductor Pollicis Brevis
Extensor Pollicis Brevis
Extensor Indicis
329
Q

MUSCLES OF LATERAL COMPARTMENT

A

Brachioradialis

Extenso Carpi Radialis Longus

330
Q

SMALL MUSCLES OF THE HAND

A

Palmaris brevis
4 Lumbricals
8 Interossei

331
Q

SHORT MUSCLES OF THE THUMB

A

Opponens Pollicis
Adductor Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis

332
Q

SHORT MUSCLES OF THE LITTLE FINGER

A

Abductor Digiti MInimi
Opponens Digiti Minimi
Flexor Digiti Minimi

333
Q

Caused by an acromioclavicular dislocation with the distal end of the clavicle lying superior to the acromion process

A

STEP DEFORMITY

334
Q

STEP DEFORMITY indicates?

A

When seen at rest, it indicates both the acromioclavicular and coracoclavicular ligaments have been torn.

335
Q

 Appears when traction is applied on the arm

 Caused by multidirectional instability or loss of muscle control due to nerve injury or stroke

A

SULCUS SIGN

336
Q

SULCUS SIGN indicates?

A

Inferior subluxation of the glenohumeral joint.

337
Q

You can see this when you let the patient do resisted isometric elbow flexion and extension.

A

POPEYE SIGN

338
Q

POPEYE SIGN indicates?

A

Indicates third-degree strain/rupture of long head of Biceps tendon

339
Q

 You let the patient push forward

A

SCAPULAR WINGING

340
Q

implies the winging is the result of muscle weakness of one of the scapular muscle stabilizers that, in turn, disrupts the normal muscle force couple balance of the scapulothoracic complex.

A

Primary scapular winging

341
Q

implies that the normal movement of the scapula is altered because of pathology in the glenohumeral joint.

A

Secondary scapular winging

342
Q

SCAPULAR WINGING indicates?

A

Elevation of scapula indicated muscle weakness, pathology of glenohumeral joint and lesion of long thoracic nerve.

343
Q

may be caused by a lesion of the long thoracic nerve affecting serratus anterior, trapezius palsy (spinal accessory nerve), rhomboid weakness, multidirectional instability, voluntary action, or a painful shoulder resulting in splinting of the glenohumeral joint, which in turn causes reverse scapulohumeral rhythm.

A

Dynamic scapular winging (i.e., winging with movement)

Medicine 1 (7 decks)

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