Spine and LE Assessment

Question 1

Where are the superficial inguinal nodes?

Answer 1

Horizontal group along the inguinal ligament and vertical group along the great saphenous vein

Question 2

Arterial ulcers in peripheral vascular disease

Answer 2

Intermittent claudication pain, no edema, no pulse or weak pulse with no drainage, round smooth sores, black eschar
Sores on toes and feet

Question 3

Venous ulcers in peripheral vascular disease

Answer 3

Dull achy pain, lower leg edema, pulse present with drainage, sores with irregular borders, yellow slough or ruddy skin
Sores on ankles

Question 4

Signs of peripheral artery insufficiency

Answer 4

Pallor, dependent rubor, distal hair loss, atrophic skin, nail changes, ulcers, necrosis, gangrene
Cool skin temp
Delayed cap refill

Question 5

Venous insufficiency

Answer 5

Dilated, tortuous superficial veins that result from defective structure and function of the valves

Question 6

Clinical presentation of venous insufficiency

Answer 6

Dull ache or pressure sensation after prolonged standing and relieved with elevation
Dependent ankle edema and ankle ulcerations may develop
Maybe superficial thrombosis/thrombophlebitis

Question 7

What is stasis dermatitis?

Answer 7

Due to chronic venous insufficiency with incompetent valves and higher pressure in capillary bed, tissue is damaged and inflamed
Brawny edema (non-pitting edema)

Question 8

What does lymphedema look like and what is it caused by?

Answer 8

Excessive swelling of the extremities due to lymphatic obstruction or they were destroyed/removed

Question 9

What do you palpate through the LE?

Answer 9

ASIS, greater trochanter, quads, hammies, femur, quadriceps tendon, patella, patellar tendon, medial and lateral joint lines, tibial tuberosity, popliteal fossa (fullness/masses, pulse), tibia, fibula, calf muscles, achilles tendon, medial and lateral malleoli, calcaneus, metatarsals, MTP and IP joints

Question 10

What does a positive Trendelenburg indicate?

Answer 10

Hip drop indicates weak hip abductors on the contralateral side (straight leg) and might be due to pain

Question 11

What is a Baker’s cyst?

Answer 11

Synovial fluid cyst located in the popliteal space

Extend the knee to palpate

Question 12

Popliteal artery aneurysm

Answer 12

Usually due to atherosclerotic vascular disease

Dx with pulsatile swelling behind the knee

Question 13

When is a bulge sign seen?

Answer 13

In minor effusions

Question 14

When do you do balottement of the patella?

Answer 14

In large effusions

Question 15

What is the valgus stress test for?

Answer 15

MCL

Question 16

What is the varus test for?

Answer 16

LCL

Question 17

What is the McMurrays test for?

Answer 17

Externally rotate at heel for medial meniscus- extend knee while giving valgus stress
Internally rotate at heel for lateral meniscus- extend knee while giving varus stress to knee

Question 18

Pes cavus

Answer 18

High arch

Question 19

Pes planus

Answer 19

Flatfoot

Question 20

In what condition do you see a neuropathic ulcer?

Answer 20

Diabetic neuropathy

Question 21

How do you rate pitting edema?

Answer 21

Grade from 0 to 4+

Probably see it dorsum of foot, behind medial malleolus or on shins

Question 22

Grading of pulses

Answer 22

0: absent, unable to palpate
1+: diminished, weaker than expected
2+: brisk, normal
3+: increased
4+: bounding

Question 23

Postural deformities of the spine that we should be looking for

Answer 23

Scoliosis, kyphosis or lordosis

Question 24

What do you always need to evaluate if you notice a discrepancy in the spine?

Answer 24

Limb length discrepancy

Question 25

What is a lean forward test for scoliosis?

Answer 25

Adams Forward Bend Test

Question 26

What is the straight leg raise test for?

Answer 26

Lumbosacral radiculopathy and/or sciatic neuropathy (L5-S1)
Positive test is radiating pain in the affected limb (dorsiflexion of ankle may further increase pain response)
Also called Laseque’s test

Question 27

Seated SLR test

Answer 27

Passively extend knee while patient is sitting and a positive sign is when patient “flips back” due to pain

Question 28

Where do you feel numbness for L4?

Answer 28

Medial knee area

Question 29

Where do you feel numbness for L5?

Answer 29

Lateral shin

Question 30

Where do you feel numbness for S1?

Answer 30

Back of calf and bottom of foot