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Physical Dx Final > Spine/LE > Flashcards

Spine/LE Flashcards

1
Q

Arteries in the leg

A

Femoral artery
popliteal artery
dorsalis pedis
posterior tibial

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2
Q

Venous system in the leg

A

Superficial: Great and small saphenous veins
Deep: femoral vein
Communicating or perforating veins

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3
Q

PVD Arterial ulcers

A

intermittent claudication pain, NO EDEMA, NO PULSE/WEEK PULSE, NO DRAINAGE round/smooth sores, black eschar;

Location: toes and foot

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4
Q

PVD Venous ulcers

A 
dull achy pain
lower leg EDEMA
pulse present, drainage
sores w/ irregular borders
Yellow slough or Ruddy skin

Location: ankles

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5
Q

Signs of PVD

A

dangling foot makes pain better, elevating feet makes it works

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6
Q

Tx for PVD

A

antiplatelets, surgical (Fempop bypass)

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7
Q

Peripheral Artery Insufficiency sigsn

A

pallor, rubor, distal hair loss, atrophic skin/nail changes, Ulcers, Necrosis; check pulses, skin = cool, cap refill delayed; auscultate for bruits (aorta, femora, popliteal)

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8
Q

Venous insufficiency

A

dilated, tortous superficial veins due to defective structure and function of valves

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9
Q

Clinical presentation of venous insufficiency

A

dull achy/pressure after prolong standing; relieved with elevation
dependent ankle edema and ulcerations
superficial thrombosis/thromophlebitis

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10
Q

Stasis Dermatitis

A

Due to chronic venous insufficiency with incompetent valves and higher pressure in capillary bed; tissue is damaged and inflamed;
BRAWNY EDEMA: non-pitting

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11
Q

Brawny-edema

A

non-pitting edema found with Stasis Dermatitis

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12
Q

Lymphadema

A

lymph obstruction causing severe usually one sided swelling

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13
Q

Gangrene

A

necrosis/black

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14
Q

Principles of leg exam

A 
inspection
palpation
ROM
Neuro (motor)
Vascular
Specialized
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15
Q

Type of joint is the hip joint

A

Ball & Socket

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16
Q

Landmarks to palpate on the hip

A

ASIS
Greater Trochanter
Quads, Hamstrings Femur

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17
Q

Trendelenburg Test

A

Stand on one leg; hip drop means weak hip abductors on the contralateral side

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18
Q

FADIR

A

Adduction with internal rotation of the hit; tests for hip joint

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19
Q

FABER

A

abduction, external rotation (figure 4, patricks test); test for ipsilateral hip problem or contralateral SI joint issue

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20
Q

Knee palpation

A 
Quad tendon
Patella
Patellar tendon
Medial & Later joint lines
Tibial Tuberosity
Popliteal fossa/pulse
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21
Q

Palpation of Lower leg

A 
tibia/fibula
musculature
calf tenderness
swelling
achilles tendon
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22
Q

Palpable cord

A

Thrombosed vein

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23
Q

Genus Varum

A

Bow-legged, knees more lateral, may have waddling gait

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24
Q

Genu Valgum

A

Knock-kneed/pigeon toed; knees more medial

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25
Q

Baker’s cyst

A

synovial fluid cyst located in the popliteal space; palpable as fluctuant fullness; may be painful or result in calf swelling if they leak fluid or rupture; extend knee to palpate a baker’s cyst

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26
Q

Popliteal aneurysm

A

due to atheroclerotic vascular disease; M>F, >65 YO; more common aneurysm of peripheral vascular; bilateral 50% of time

27
Q

Dx of popliteal aneurysm

A

Pulsatile swelling behind the knee

28
Q

Bulge Sign

A

With leg straight, place pressure over suprapatellar pouch while “milking” knee joint fluid down one side and up the other to observe a pulge; looks for presence of minor effusion

29
Q

Ballottement

A

Compress suprapatellar pouch and sharply push patella against femur; feel for fluid under the patella and observe for fluid returning to the suprapatellar pouch; Test for LARGE EFFUSION

30
Q

Valgus stress test

A

MCL
stabilize lateral joint line and place one hand on distal tibia; ABduct tibia vs. femur, restricting axial rotation; complete at 0 and 30 degrees of flexion; estimate medial joint space and evaluate sitffness of endpoint to determine amount of laxity

31
Q

Varus stress test

A

LCL

stabilize medial joint like; ADduct tiba vs. femur; estimate for laxity

32
Q

Anterior Drawer

A 
ACL;
stabilize foot (sit on it), thumbs on medial and lateral joint line with fingers on hamstring insertion; pull tibia foreward checking for excessive movement
(+) anterior translation without firm endpoint
33
Q

Posterior Drawer Sign

A

PCL

push tibia pack; excessive laxity suggests PCL tear

34
Q

Lachman

A

ACL
patient supine, knee flexed 20-30 degrees; stabilized distal femur in one hand while attempting to displace tibia anteriorly with the other; most useful test for ACL; aymmetry compared to other leg and soft endpoint = ACL tear

35
Q

Posterior Sag sign

A

PCL;
back of legs sagging compared to other; anterior tibial surace normally lies 1 cm anterior to the femoral surface; check in both extension and 90 degree flexion with both internal and external rotation

36
Q

ACL tests

A

Anterior drawer, Lachman

37
Q

McMurray test

A

Meniscus
Medial meniscus: flex knee, externally rotate at heel, flex maximally, then slowly extend the knee while providing valgus stress to knee

Lateral: internally rotate at heel, flex maximally, then slowly extend the knee while providing (varus) stress to knee

38
Q

Ankle joint

A 
weight bearing joint
absorbs impact of gait
Hinge joint (tibiotalar, subtalar (talocalcaneal)
39
Q

Foot joints

A

Tarsal/metatarsal joint

PIP/DIP joint

40
Q

Pes planus

A

flat foot; loss of foot arch

41
Q

Pes Cavus

A

High arch

42
Q

Neuropathic Ulcers

A

Diabetic Neuropathy

43
Q

Palpation of foot and ankle

A 
Achilles tendon
medial and lateral malleoli
calcaneus
metatarsal
MTP and IP joints
44
Q

Where to check for pitting/non-pitting edema

A

Dorsum of foot, behind medial malleolus or on shins

45
Q

Grading of pitting edema

A

0-4+

46
Q

Foot pulses

A

Doralis pedis: lateral to tendon on first digit

Posterior tibial pulse: behind the MEDIAL malleolus

47
Q

Pulse grading

A 
0- absent, unable to palpate
1+- diminished, weaker than expected
2+- brisk, normal
3+- increased
4+- bounding
48
Q

Anterior drawer test for ankle

A

Grasp calcaneus and pull forward; looking for sprain

49
Q

Thompson Test

A

have patient knee and squeeze calf; foot should plantar flex if normal; will be (-) in injury to achilles tendon

50
Q

Spine vertebrae #’s

A 
7 Servical
12 Thoracic
5 Lumbar
5 Sacrum (fused)
4 Coccyx (fused)
51
Q

Inspection of spine

A

posture, head erect, shoulders and pelvis level;

spinal curvature

52
Q

Palpation of spine

A

spinous processes

paravertebral mm. (tenderness/spasm)

53
Q

ROM for spine

A

flexion/extension
lateral bending (suitcase)
rotation (look over shoulder)

54
Q

Scoliosis

A

lateral curvature of the spine

55
Q

Kypohsis

A

Increased outer curvature of spine leading to hunchback

56
Q

Lordosis

A

excessive inward curve of spine

57
Q

Testing for LLD

A

Galeazzi

Compare medial malleolus

58
Q

Straight leg raising test (SLR)

A

tests lumbosacral radiculopathy and/or sciatic neuropathy (L5-S1);

Passive ROM while supine with knees extended; dorsiflex ankle may further reproduce pain

(+): radiating pain in affected limb (note degree of elevation) (aka Laseque’s test)

59
Q

Another name for SLR

A

Lasegue’s Test (Sign)

60
Q

Seated SLR Test/Flip sign

A

patient seated, passively extend knee

(+) Patient will “flip back” due to pain

61
Q

L4 radiculopathy

A

Pain: later thigh, anterior leg
Numbness: medial joint line
Weakness: extension of quads
Reflexes: knee diminished

62
Q

L5 Radiculopathy

A

Pain: buttocks, lateral thigh/leg
Numbness: lateral calf
Weakness: dorsiflexion of great too and foot
**heel walking test

63
Q

S1 radiculopathy

A

Pain: posterior butt/leg
Numbness: posterior calf, plantar surface of the foot
Weakness: plantar flexion of great toe/foot
***walk on toes test
Reflex: ankle jerk diminished

Physical Dx Final (4 decks)

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