S1_L2: Introduction to MSK & Differential Diagnosis Flashcards
modified T/F
Component of Physical Examinations include: Vital Sign, Observation, ocular inspection, ROM, MMT, Sensory Evaluation, Neurological Examination, Special Tests, Postural & Gait Assessment
The role of musculoskeletal examination will be deeper examinations of a particular muscle / joint that is related to the pathology of a specific patient
TT
modified T/F on OBSERVATION
The Most important phase, AKA Inspection phase of the Objective findings in assessment of normal standing posture
It looks for obvious visible defects or abnormalities, ossible functional deficits & abnormalities in alignment
TT
which of the ff are true about Guidelines in Observation
A. Should be positioned so that the dominant eye is used
B. Both sides of the patients should be compared simultaneously
C. Know the normal body alignment
D. all of the above
D
modified T/F about EXAMINATION
Used to confirm or refute the suspected diagnosis, based on the history and observation
Obtain valid consent to perform special test & inform procedures to be done
TT
the ff are “Red Flags” wherein the PT has to stop the assessment, EXCEPT:
A. Severe and unremitting pain
B. Pain unaffected by medication or position
C. Severe night pain, spasm or pain with no history of injury
D. Psychological overlay
E. None of the above
E
which of the ff are PRINCIPLES OF EXAMINATION
A. During assessment, normal side is tested first
B. Any painful movements are done last
C. Apply overpressure in order to check the integrity of a certain joint or region
D. Each movement may be repeated several times or held for a certain amount of time
E. All of the above
E
match the ff
1. is assessed first to check if the patient
can perform the action on their own. With pain? Without pain? How far can they move?
- is performed in order to check and feel if there are structures that causes the loss or exaggeration of motion
- are done with the joint in resting or neutral position
A. Active
B. Passive
C. Resisted isometric movements
- A
- B
- C
modified T/F
When testing myotomes, each contraction is held for a minimum of 3 seconds
Warn pt of possible exacerbation of symptoms as a result of the assessment
FT
5 secs.
T/F
The ff are the correct PROCEDURES ON HOW TO DO THE ASSESSMENT
1. Vital Signs
2. History Taking
3. Ocular inspection (OI)
4. Active ROM
5. Passive ROM
6. Check for Endfeel
7. Perform MMT
8. Palpation
9. Special Test
T
* Palpation and special tests are done last because if you do them first, you might trigger a particular pain and will result in a false positive result to your
AROM, PROM, EndFeel, MMT
which of the ff are true about SCANNING / SCREENING EXAMINATION
A. To ensure that all possible sources of pathology assessed
B. Performed to rule out the possibility of referral of symptoms especially the spine
C. With any doubt about where the pathology is located
D. Essential to ensure a correct diagnosis by doing a quick look or scan of a part of the body involving the spine and the extremities
E. all of the above
E
modified T/F
Upper limb scan includes the body parts above the diaphragm like Cervical spine, TMJ, Scapular & Thoracic area, Shoulder region, Upper arm, Forearm, Wrist, hand and fingers
Lower limb scan includes the parts of the body below the diaphragm such as Lumbar spine, Pelvis and hip, Knee, Ankle, foot and toes
TT
*Main divider is the diaphragm
match the ff
- more systematic and in-depth to find out if it’s more of a spinal or peripheral joint dysfunction
- any report coming from the pt; subjective findings
- objective findings; how they hold
their postures, walk, etc
A. History
B. Observation
C. Scanning/Screening Examination
- C
- A
- B
the ff statements are true on the FLOW OF ASSESSMENT OF ACTIVE MOVEMENTS, EXCEPT:
A. Aka active physiological movements coming from the patient itself without external help
B. Combined tests of joint, range, control, muscle power, and patient’s willingness to perform the movement
C. Dependent upon contractile, nervous, and inert tissues
D. Base the dysfunction on the abnormal side
E. Maybe abnormal for several reasons and should be differentiated
D. Base the dysfunction on the NORMAL side
End of active movement is referred to as the____
physiological barrier.
modified T/F on FLOW OF ASSESSMENT
OF ACTIVE MOVEMENTS
Not performed at all or performed with caution during fracture healing or if the movement could put stress on newly repaired tissues
Standard movements follow the cardinal planes
TT
match the ff
- Movements in multiple planes or around combined axes
- Further assessment in order to test if the pt can perform a certain movement for a few times (its frequency) before it gets weak or before pain is felt
- Testing the integrity of the joint, quality of movement, and interaction of different muscles
- Able to test integrity of joint, quality of
movement, any restrictions - Movements that are time bound
A. Combined movements
B. Repeated movements
C. Movements with speed
D. Movements under compression
- A
- B
- A
- B
- C
match the ff
- May also find some pain or restrictions of movements in the planes
- E.g. Ask pt to flex head forward, side bend to the right and rotate to the left
- E.g. Ask pt to reach something continuously
- Can tell you if there is any nerve
involvement or level of spasm - If a movement causes a lot of spasm, it gives you an idea that it might not just be a musculoskeletal problem
A. Combined movements
B. Repeated movements
C. Movements with speed
D. Movements under compression
- A
- A
- B
- C
- C
which of the ff are true about PASSIVE MOVEMENTS
A. Aka passive physiological movement or anatomical movement
B. End of passive movement is referred to as the anatomical barrier
C. Always slightly greater than active movements
D. Patient should be relaxed
E. All of the above
E
match the ff PATTERNS OF INERT TISSUE LESIONS
- No lesion of inert tissues present or being tested by passive movement
- Entire joint is affected which may indicate arthritis or capsulitis & the amount of limitation is not usually the same in each direction
- Noncapsular pattern is presented wherein movements that stretch, pinch, or move the affected structure cause the pain
- There may be internal derangement, Extra articular lesions or Torn ligament (sprain)
A. Pain free, full ROM
B. Pain and limited ROM in every direction
C. Pain and excessive or limited ROM in some directions
D. Pain-free, limited ROM
- A
- B
- C
- C
match the ff PATTERNS OF INERT TISSUE LESIONS
- There may be lesions in other directions or around other joints
- All movements of the joint may be affected, but the motions in the capsular pattern always occur in the particular order listed to help differentiate specific conditions
- End feel is usually bone-to-bone type that may indicate symptomless osteoarthritis
- Osteophytes may be present that are not pinching or compressing any sensitive structures
A. Pain free, full ROM
B. Pain and limited ROM in every direction
C. Pain and excessive or limited ROM in some directions
D. Pain-free, limited ROM
- A
- B
- D
- D
which of the ff are true about RESISTED ISOMETRIC MOVEMENTS
A. Doing some resistance while palpating if there is palpable contraction
B. Can assess the patient wtith no trace of muscle contraction at all by assessing static, voluntary muscle contraction
C. Used primarily to determine if the contractile tissue is the tissue at fault & the nerve supplying the muscle should also be tested
D. Maybe abnormal for several reasons and should be differentiated
E. All of the above
E
- Affecting central nervous system 2.stroke
- anterior horn cell
- polio
A.Upper motor neuron lesion
B. Lower motor neuron lesion
- A
- A
- B
- B
- spinal muscular atrophy
- peripheral nerve injuries (carpal tunnel syndrome, radial nerve palsy)
- TBI
- spinal cord injury
A.Upper motor neuron lesion
B. Lower motor neuron lesion
- B
- B
- A
- A
match the ff PATTERNS OF CONTRACTILE TISSUE & NERVOUS TISSUE LESION
- No lesion of contractile unit being tested or nervous tissue supplying that contractile unit regardless of how tender the muscle may be when palpated
- Amount of strength is usually determined by the amount of pain the patient feels on contraction
- Contractions are not usually as strong as on the good side
- Pain is in or around the tendon or a Partial avulsion fracture
A. No pain, movement is strong
B. Pain and movement is relatively strong
C. Pain, and movement is weak
D. No pain, and movement is weak
- A
- B
- B
- B
match the ff PATTERNS OF CONTRACTILE TISSUE & NERVOUS TISSUE LESION
- Severe lesion around the joints, such as a fracture or weakness that’s usually caused by reflex inhibition of the muscles around the joint
- Rupture of a muscle (third-degree strain) or its tendon with the involvement of the peripheral nerve or nerve root supplying the muscle
- Differentiate between upper and lower motor neuron lesions E.g. stroke: left side of the brain, weakness
on the right side
A. No pain, movement is strong
B. Pain and movement is relatively strong
C. Pain, and movement is weak
D. No pain, and movement is weak
- C
- D
- D
- Having a list of possible conditions or diseases that could cause the symptoms based on the facts gathered and coming up with what the real thing is happening
- Anatomic, biochemical, physiologic or psychological derangement that labels pathology in any form of written communication related to patient encounter
- Encompasses the preparation and assembly records to authenticate and communicate the care given by a healthcare provider and the reasons for giving that care
- Describing the disease like Fracture on the 3rd proximal part of radius, L3/L4 spondylosis
- Focuses more on the dysfunction, lack of function or the limitation brought about by a certain disease e.g. Right sided weakness secondary to L3/L4
spondylolisthesis
A. DIFFERENTIAL DIAGNOSIS
B. DIAGNOSIS
C. MEDICAL DX
D. PHYSICAL THERAPY DX / PT IMPRESSION
- A
- B
- B
- C
- D
match the 3 STAGES OF DIFFERENTIAL DIAGNOSIS
- Instantaneous realization that the patient conforms to a previously learned pattern of disease (Lowest form of differential diagnosis)
- Usually reflexive, not reflective & able to qualify what they’re feeling but usually cannot be explained to others
- Argued to be learned on patients and not taught in lecture halls
- The pain-staking search for but paying no immediate attention to all the facts about a patient
A. PATTERN RECOGNITION
B. COMPLETE HISTORY & PHYSICAL EXAMINATION
C. HYPOTHETICO-DEDUCTIVE STRATEGY
- A
- A
- A
- B
match the 3 STAGES OF DIFFERENTIAL DIAGNOSIS
- Method of a novice that’s Impractical and inefficient like very impractical in emergency rooms, too many questions asked or nothing wrong but impractical
- The formulation, from the earliest clues of a short list of potential diagnosis using deductive strategies (Highest form of differential diagnosis)
- Subsequent tests are performed which will most likely reduce the length of the list since it can come up with a result right away
- Requires an understanding of probability
A. PATTERN RECOGNITION
B. COMPLETE HISTORY & PHYSICAL EXAMINATION
C. HYPOTHETICO-DEDUCTIVE STRATEGY
- B
- C
- C
- C
which of the ff are IMPORTANT COMPONENTS IN THE APPROACHES IN DIFFERENTIAL DIAGNOSIS
A. Past medical history
B. History of present illness
C. Risk factors
D. Clinical presentation
E. Pain patterns
F. All of the above
F
T/F
CONDITION BASED APPROACH checks the systems involved and reason to come up with a solution
F
SYSTEM BASED APPROACH
which of the ff are part of the CONDITION BASED APPROACH
A. Checks the different conditions that can cause the condition
B. Make a diagnosis based on the condition
C. Acute versus chronic
D. Aggravating / relieving factors
E. All of the above
E
- Sharp, shooting
- Sharp, bright, lightning-like
- Burning, pressure-like
- Deep boring, localized
A. nerve root pain
B. nerve pain
C. sympathetic nerve pain
D. bone
- A
- B
- C
- D
- Throbbing, diffuse
- Cramping, dull hard to localized
- Sharp, severe, intolerable
A. fracture
B. muscle pain
C. vascular pain
- C
- B
- A
modified T/F
Quantitative pain assessment uses Subjective pain scale, Visual analog scale, Body diagrams / pain chart, Pain questionnaire, Pressure-threshold meter (dolorimeter or algometer)
Qualitative pain assessment can give an impression of what is affected
TT
which of the ff are true about special tests
A. Aka clinical accessory, provocative or structural test
B. Performed after completion of the history, observation and evaluation
C. Strongly suggestive of a clinical disease or condition when they yield positive results
D. Do not necessarily rule out the disease or condition when they yield negative results
E. All of the above
E
the ff are true about special test, EXCEPT:
A. Findings of the test depends primarily on the skill & ability of the examiner, and on the patient’s ability to relax while the test is being performed
B. More accurately performed in chronic conditions if done 5-10 mins after the injury under anesthesia or performed during the PT assessment time
C. Most have not been tested for reliability and sometimes the validity may be questioned
D. Should not be used in isolation (do multiple types of diagnosis)
E. It is necessary to learn all special tests, always prefer to use those found to be clinically significant
E It is NOT necessary to learn all special tests
which of the ff are the use of special test
A. To confirm a tentative diagnosis
B. To make a differential diagnosis & differentiate between structures
C. To understand unusual signs
D. To unravel difficult signs and symptoms
E. All of the above
E.
T/F on PRECAUTIONS FOR THE USE OF SPECIAL TESTS
Care should be taken when performing special tests & should be done with caution
T
the ff are CONTRAINDICATIONS FOR THE
USE OF SPECIAL TESTS, EXCEPT:
A. Severe pain
B. Acute and irritable conditions of the joints like Osteoporosis
C. Pathological bone diseases
D. Active disease processes
E. None of the above
E
which of the ff are CONTRAINDICATIONS FOR THE USE OF SPECIAL TESTS
A. Unusual signs and symptoms
B. Major neurological signs
C. Patient apprehension
D. All of the above
D
modified T/F on PATIENT DRAPING DURING PHYSICAL ASSESSMENT
Patient must be adequately undressed in a private assessment area to be observed properly
Explain to the patient that observation and detailed looking at the patient are an integral part of the assessment
TT
which of the ff statements are true AFTER THE EXAMINATION
A. Look back on the history and pertinent findings in the examination
B. Determine what is causing the patient’s problem
C. Design a proper treatment regimen
D. Re-examine the patient
E. All of the above
E
Assisting the pt in raising his/her arm is an example of an active movement.
a. True
b. False
c. Sometimes
b. False
Which of the following is not a contraindication?
a. Pt who has a cancer
b. Pt who is 10 years old
c. Pt who has hemophilia
b. Pt who is 10 years old
During observation in the anterior view which is not one of the surface landmarks that we check with regards to alignment?
a. Nose
b. Xiphisternum
c. ASIS
d. Umbilicus
c. ASIS
During examination, which type of movement is not part of the assessment.
a. Resisted isometric
b. Passive
c. Active
d. Active-assisted
d. Active-assisted
Which is not manifested in a pain-free, limited ROM pattern of inert tissue lesion?
a. End feel is usually bone-to-bone type
b. May indicate symptomless osteoarthritis
c. Noncapsular pattern in presented
d. Osteophytes may be present that are not pinching or compressing any sensitive structures
c. Noncapsular pattern in presented
When performing an upper limb scan, the lumbar spine is one of the regions that we examine.
a. True
b. False
b. False
* lower limb scan
Active movements are limited by the anatomic barrier of a given joint.
a. True
b. False
b. False
- passive movements
For ligamentous testing, the degree of opening is more important than the quality of the opening.
a. True
b. False
b. False
- It is not only the degree of opening but the quality of the opening that is important
During observation in the lateral view which of the ff are the surface landmarks that we check with regards to alignment?
A. Tip of the ear
B. Tip of the acromion
C. High point of the iliac crest
D. Lateral malleolus (anterior aspect)
E. All of the above
E
