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Clinical Assessment > Unit IV > Flashcards

Unit IV Flashcards

1
Q

What is the leading primary dx of office visits in the US?

A

Musculoskeletal complaints

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2
Q

Number of MSK d/o (with %)

A

93 million visits

10% of all ambulatory care visits

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3
Q

Arthritis - Stats

A

affects 1 in 5 Americans

22% of the adult population

leading cause of disability

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4
Q

Spinal d/o - Stats

A

4th highest dx group for office visits

LBP is one of the top 20 reasons for office visits

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5
Q

Key factors in evaluation of MSK d/o

A

Articular vs. extra-articular

Acute (< 6wk) vs. chronic (>12 wk)

Inflammatory vs. Non-inflammatory

Localized (monoarticular) vs. diffuse (polyarticular)

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6
Q

Structures of a Joint

A

Articular structures

Extra-articular structures

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7
Q

Articular structures

A 
Joint Capsule
Articular cartilage
synovium
synovial fluid
Intra-articular ligs
Juxta-articular bone
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8
Q

Extra-articular Structures

A 
Ligs
tendons
bursae
muscle
fascia
bone
nerve
overlying skin
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9
Q

What causes is a major potential cause of joint pain?

A

age

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10
Q

Types of joints

A

synovial
cartilaginous
fibrous

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11
Q

synovial

A

Bones covered by articular cartilage

Synovial membrane lines the synovial cavity and secretes a small amount of viscous lubricating fluid

Fibrous joint capsule surrounds the synovial membrane

Freely movable

Example - elbow, shoulder

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12
Q

Types of Synovial Joints

A

Spheroidal (ball & socket)

Hinge

Condylar

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13
Q

Cartilaginous

A

Between pubic symphysis and vertebrae (slightly movable)

Fibrocartilaginous discs separate the bony surfaces

Example - vertebral bodies of the spine

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14
Q

fibrous

A

Almost in direct contact

immovable

Example - sutures of the skull

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15
Q

Spheroidal

A

Ball & socket

Convex surface in concave cavity

Motion - flexion, extension, abduction, adduction, rotation, curcumduction (allows a wide rotary movement)

Example - Shoulder, hip

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16
Q

Hinge

A

Flat, planar, or slightly curved

Motion in one plane; flexion, extension; gliding motion on a single plane

Example - Interphalangeal joints of the hand & foot; elbows

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17
Q

Condylar

A

Convex or concave (condyles)

Movement of two articulating surfaces not dissociable

Knee; TMJ

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18
Q

Bursae

A

Roughly disc-shaped synovial sacs

Allow adjacent muscles or muscles and tendons to glide over each other during movement

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19
Q

Bursae - Examples

A

prepatellar bursa

Hip bursa

subacromial bursa of the shoulder

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20
Q

Common complaints

A

LBP

Neck Pain

Joint pain with associated constitutional symptoms & systemic manifestations from other organ systems

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21
Q

Joint pain - onset

A

Is the pain acute or chronic?

Was there an injury?
Clarify and record the mechanism of injury - esp. if trauma

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22
Q

Joint Pain - Location

A

Localized, diffuse or systemic

“point to the pain”

Does it involve joints or tissues?

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23
Q

monoarticular

A

one joint

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24
Q

polyarticular

A

diffuse or several joints

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25
Q

nonarticular

A

involving muscles, bones & tissues around the joint

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26
Q

joint pain - duration

A 
When does the pain occur?
How long have you had the pain?
Acute or chronic
Did it develop rapidly or insidiously?
Has the pain progressed or fluctuated?
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27
Q

Joint Pain - Direction

A

Does the pain radiate - down arm/legs?
Numbness?
Tingling?

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28
Q

Joint Pain - Determine the severity of the pain

A 
Pain right now?
Pain at its worst
Pain at its bets
Pain with activity?
Pain with Exercise?
Pain with tx?
What is it like over the course of the day?
What is the the pain like in the morning?
How is the pain as the day wears on?
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29
Q

Joint Pain - What makes it worse

A

Rest
Activity
stairs
hills

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30
Q

Joint pain - What makes it better

A 
Ice
Heat
Rest
Activity
Medication
31
Q

Joint pain - Timing

A 
When does the pain occur?
Morning?
Getting in a car?
Lifting weight?
How long does it last?
32
Q

Joint pain - Quality

A 
ADL?
Change in activities?
Do joints "lock-up" or "catch"?
Occupation?
Inflammatory or non-inflammatory
33
Q

Cardinal signs of inflammation

A 
Swelling
Warmth
Redness
Pain
Pattern of stiffness
Hx of arthritis
34
Q

Types of Arthritis

A

Rheumatoid arthritis
Osteoarthritis
Gouty Arthritis

35
Q

RA - definition

A

Chronic inflammation of synovial membranes with erosion of bones

36
Q

OA - Affected areas

A 
knees
hips
DIP
PIP
Wrists - 1st CMC Joint
Joints injured or dzed
37
Q

RA - Affected Joints

A 
PIP
MCP
MTP
Wrists
knees
elbows
ankles
38
Q

Gouty Arthritis - affected joints

A

Acute - 1st MTP (base of big toe), Instep or dorsum of feet, ankles, knees & elbows

Chronic - feet, ankles, wrists, fingers & elbows

39
Q

OA - Definition

A

Degeneration & progressive loss of cartilage

40
Q

Gouty - Definition

A

Reaction to accumulation or presence of sodium urate

acute or chronic

41
Q

RA - symptoms

A 
Symmetrically additive
Insidious
Chronic with remissions/exacerbation
Frequent swelling
Sub-Q nodules
Tender
Often warm
Seldom red
Stiffness prominent for an hour or more in AM or after inactivity
Limits motion
Weakness
Fatigue
Weight Loss
Low fever
42
Q

OA - symptoms

A 
One joint or additive
Insidious
Slowly progressive, Temporary exacerbation
Small effusions, possible
Bony hypertrophy
Possibly tender
Seldom warm
Rarely red
stiffness is frequent but brief (in AM)
Limited motion
43
Q

Gouty - Acute Symptoms

A 
Early attacks one joint
Sudden, occasional isolated attacks lasting up to 2 weeks
Swelling
Very tender
Hot &amp; red
No stiffness evidentP
Limited motion
Possible fever
44
Q

Gouty - Chronic Symptoms

A 
Additive
Gradual with repeated attacks
Tophi in joints, bursa &amp; sub-Q
Warmth
Tenderness
Redness
Stiffness
Limited motion
Possible fever
Symptoms of Renal stones &amp; failure
45
Q

Systemic Symptoms with Joint Pain

A 
Fever
Chills
Rash
anorexia
weight loss
weakness
46
Q

SLE

A

Butterfly rash on cheeks

47
Q

Psoriatic arthritis

A

Scaly rash

Pitted nails

48
Q

Gonococcal Arthritis

A

Few papules

Pustules or vesicles on reddened bases on distal extremities

49
Q

Lyme Dz

A

Expanding erythematous patch early in illness

50
Q

Serum sickness

A

Hives

51
Q

Drug reaction

A

Hives

52
Q

Reiter’s syndrome

A

Erosions or scale on the penis and crusted scaling papules on the soles and palms

53
Q

hypertrophic osteoarthropathy

A

Clubbing of the fingernails

54
Q

Rubella

A

Maculopapular rash

55
Q

Conjuctivitis

A

Reiter’s syndrome

Behcet’s syndrome

56
Q

Sore throat

A

Acute rheumatic fever

Gonococcal arthritis

57
Q

Diarrhea
Abdominal Pain
Cramping

A

Arthritis with UC
Regional enteritis
Scleroderma

58
Q

Urethritis

A

Reiter’s syndrome

Gonococcal Arthritis

59
Q

Mental status changes
Facial or other weakness
Stiff neck

A

Lyme dz with CNS involvement

60
Q

Articular symptoms

A 
pain
possible swelling
stiffness
Limited AROM
Limited PROM
Deformity
Locking
61
Q

Non-Articular

A 
pain out of joint
possible swelling
possible stiffness
Limited AROM
No Limited PROM
No Deformity
No Locking
62
Q

Muscles

A 
Pain
Cramping
Fever/Chills/Flu
Weakness
Atrophy
63
Q

LBP / Neck PAin

A 
Is there a hx of trauma?
Establish location (midline or off midline)
Radiate to arms/legs?
Numbness
Tingling
Bladder/bowel dysfunction?
Weakness
64
Q

LBP Red Flags

A 
>50 yo / <20 yo
Hx of ca
unexplained weightloss, fever, or decline in health
Pain >1m &amp; not responding to tx
Pain at rest/night
Hx of IV drug use/ addiction/ immunosuppression
Active infection / HIV
Long-term steroid use
Saddle anesthesaia
bladder/bowel incontinence
Neuro symptoms
Progressive neuro deficit
65
Q

Mechanical LBP - Patterns

A 
Acute
Often Recurrent
Chronic Aching pain
Possibly radiating posterior thigh
aggravated by moving/lifting/twisting
66
Q

Mechanical LBP - Possible Physical Signs

A 
local tenderness
spasm
pain with movement
loss of lumbar lordosis
no sensory or motor loss 
no reflex abnormality
67
Q

Radicular LBP - Patterns

A 
Sciatic pain
Radiates down one or both legs
Below knee
Dermatomal distribution
Worsened by spinal movement
68
Q

Radicular LBP - Possible Physical Signs

A 
Pain with straight leg raise
Tenderness of sciatic N.
Loss of sensation in dermatomal distribution
Local weakness
Atrophy
Decreased/absent ankle jerk
69
Q

Spinal Stenosis - Patterns

A

Pseudocladication in back of legs, worsened with walking

Improving with flexing spine

70
Q

Spinal Steosis - Physical Signs

A

Posture may be flexed forward

Motor weakness & hyporeflexia in LE

71
Q

Chronic Persistent Low Back Stiffness - physical signs

A

Loss of normal lumbar lordosis
Muscle spasm
Limitation or anterior & lateral flexion
Flexion and immobility of spine

72
Q

Aching nocturnal back pain - physical signs

A

Variable

Local bone tenderness

73
Q

Back pain referred from the pelvis or abdomen - patterns

A

Deep, aching pain

Levels varies with source

74
Q

Back pain referred from the pelvis or abdomen - physical signs

A

Spinal movements not painful
ROM not affected
Look for signs of primary d/o

Clinical Assessment (1 decks)

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