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NR509 - Advanced Assessment > Week 6 - Musculoskeletal and Neuro > Flashcards

Week 6 - Musculoskeletal and Neuro Flashcards

1
Q

Synovial joints

A

Freely movable, no direct contact between bones
- hip
- elbow

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2
Q

Cartilaginous joints

A

slightly moveable
- symbus pubus (pelvic joint)
- intervertebral joints

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3
Q

Fibrous joints

A

immovable
- sutures of the skull

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4
Q

Synovial joint capsules

A

Joints where the bones don’t actually touch
- spheroidal (hip, shoulder)
- hinge (hands, feet, elbow)
- Condylar (wrist, knee, TMJ)

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5
Q

Monoarticular

A

one joint

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6
Q

Oligoarticular

A

2-4 joints

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7
Q

Polyarticular

A

More than 4 joints

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8
Q

Condylar joints

A

Must move on coronal plane (half moon and cup) (anterior/posterior)
- wrist
- TMJ
- knee

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9
Q

Articular structures

A
  • joint capsule
  • articular cartilage
  • synovium
  • synovial fluid
  • intraarticular ligaments
  • juxta articular bone
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10
Q

Abnormal findings in articular structures

A
  • swelling
  • tenderness
  • crepitus
  • instability
  • locking sensation
  • deformity
  • limited active/passive ROM
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11
Q

Nonarticular structures

A
  • periarticular ligaments
  • tendons
  • bursae
  • muscle
  • fascia
  • nonarticular bone
  • nerves
  • overlying skin
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12
Q

Abnormal findings in nonarticular structures

A
  • point or focal tenderness of adjacent regions
  • limited active ROM
  • rarely causes swelling, instability and deformity
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13
Q

What acronym helps you assess joints?

A

IPROMS

I - inspect - look for signs of deformity, swelling, scars, inflammation, atrphy
P - palpation - feel bony joint and soft tissue structures or fluid collection
R - assess active and passive ROM
S - special maneuvers - test specific movements to assess joint stability

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14
Q

Acute pain

A

Less than 6 weeks

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15
Q

Chronic pain

A

Greater than 12 weeks

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16
Q

What should you consider with joint pain in those under 60?

A
  • repetitive strain/overuse
  • crystal induced arthritis
  • RA
  • Psoriatic arthritis
  • reative arthritis
  • infectious arthritis
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17
Q

What should you consider with joint pain in those over 60?

A
  • OA
  • gout and pseudogout
  • polymyalgia rheumatica
  • osteoporitic fracture
  • septic bacterial arthritis
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18
Q

How is muscle strength rated?

A

0 - no contraction (flacid)
1 - barely detectable movement
2 - movement, not against gravity, not against resistance
3 - movement against gravity, not against resistance
4 - movement against gravity, some resistance
5 - full movement with full resistance

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19
Q

Osteoarthritis

A
  • age over 60
  • wear and tear –> degenerative joint disease resulting from the breakdown of joint cartilage and underlying bone affecting the major joints
  • Heberden nodes
  • Bouchard nodes
  • wide base stance
  • pain worse with activity
  • intermittent stiffness/swelling that worsens over the course of the day
  • look for crepitus over inflamed joints
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20
Q

Heberden nodules

A

in DIP (distal interphalangeal joint - close to fingernail) with buldging or inflammation of the joint

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21
Q

Bouchard nodes

A

In the PIP (proximal interphalangeal joint - closer to wrist) - joint enlargement

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22
Q

Rhumatoid Arthritis

A

Chronic inflammatory disorder that affects the lining of the joints causing painful swelling resulting in bone erosion and deformity
- stiffness early in the morning that improves with activity
- polyarticular and symmetrical
- look for SQ nodules
- often persistent bilateral swelling and tenderness
- family history of autoimmune disease
- swan neck deformity of hands

23
Q

Gout

A

Uric acid buildup resulting in crystal deposition at joints.
- causes severe pain
- pain usually unilateral
- erythema
- deformities
- monitor uric acid levels
- commonly found in distal locations
- big toe, knee, elbow

24
Q

Pseudogout

A

Same symptoms as gout but with calcium crystals

25
Q

Myalgia

A

muscle aches which may involve ligaments, tendons and fascia

26
Q

Arthralgia

A

Joint pain without arthritis

27
Q

4 Cardinal Signs of Inflammation

A
  • redness
  • swelling
  • warmth
  • pain
28
Q

Ankylosing Spondylitis

A

Type of autoimmune arthritis that causes inflammation of the joints and ligaments of the spine. Inflammation causes spine stiffness and in severe cases can cause the vertebrae to fuse together.

Tenderness over the scaroiliac joint is common.

29
Q

Considerations for assessing neck pain

A
  • ask about any possibly injury
  • radiation may indicate involvement of the spinal cord
  • radiculation (pain radiation from the back or spine into the leg) suggests nerve compression
  • tenderness at C1/C2 indicate possible subluxation and high cervical cord compression (requires prompt additional assessment)
30
Q

Back pain warning signs

A

Infection
- duration for more than 6 weeks
- fever
- weight loss
- injection drug use
- immune comprimised
- unremitting pain

Tumor
- duration over 6 weeks
- under 18 or over 50
- history of cancer
- fever
- weight loss

Spinal cord compression
- incontinence
- saddle anesthesia
- severe or rapidly progressing neurological deficit

31
Q

Red flags for low back pain

A
  • Age <20 yrs or >50 yrs
  • History of cancer
  • Unexplained weight loss, fever, or - decline in general health
  • Pain lasting more than 1 mo or not responding to treatment
  • Pain at night or present at rest
  • History of intravenous drug use, addiction, or immunosuppression
  • Presence of active infection or human immunodeficiency virus (HIV) infection
  • Long-term steroid therapy
  • Saddle anesthesia
  • Bladder or bowel incontinence
  • Neurologic symptoms or progressive neurologic deficit
  • Lower extremity weakness
32
Q

Epicondylitis

A

Painful condition that occurs when tendons in elbow are overloaded usually by repetitive movements of the wrist and arm

Tennis elbow
Pitcher or golfer’s elbow

33
Q

Nervous System Assessment includes what steps…

A
  1. Mental status - level of alertness, language function, memory, calculation, visuospatial processing, abstract reasoning
  2. Speech and language
  3. Cranial nerve assessment
  4. Motor system - body position, involuntary movements, muscle tone, bulk and strength, coordination
  5. Sensory - pain, temperature, vibration, position, light touch and discrimination
  6. Reflexes - deep tendon
34
Q

What comprises the central nervous system?

A

brain and spinal cord

35
Q

Peripheral nervous system

A

Peripheral nerves and cranial nerves

36
Q

Autonomic nervous system

A

Involuntary. Connects to internal organs to control autonomic functions like digestion and BP

37
Q

Sympathetic nervous system

A

Mobilizes organs during times of stress and arousal

38
Q

Parasympathetic nervous system

A

Conserves energy during times of rest and relaxation

39
Q

Somatic

A

voluntary muscle movements in response to pain

40
Q

Tension headaches

A

Most common. Banding sensation around the crown of the head.

  • gradual onset
  • mild to moderate
  • bilateral
  • lasts a few hours
41
Q

Migraine

A
  • with or without aura
  • 3 of 5 POUND symptoms
    • pulsatile
    • One day duration
    • unilateral
    • N/V
    • Disabling

Additional photo/phonophobia

Pain is throbbing, may have aura, moderate to severe, unilateral
Lasts 4-72 hours

42
Q

Cluster Headache

A

Localized to periorbital, orbital, supraorbital, temporal
- unilateral
- more common in men
- severe pain
- occur multiple times per day

43
Q

Characteristics of subarachnoid hemorrhage

A
  • worse headache of my life
  • thunderclap/instantaneous
44
Q

Headache from mass/lesion

A
  • compression type pain
  • worse with cough or sneezing
45
Q

SNOOP

A

Red flag detection tool for high risk features in secondary headaches

S - systemic symptoms/secondary risk factor
- (systemic) fever, weight loss, fatigue
- (secondary) - HIV, cancer, immune suppresion, infection, inflammation

N - neurologic s/s
- altered consciousness/local deficits
- encephalitis, mass lesion, stroke

O - onset
- thunderclap and abrupt
- subarachnoid hemorrhage

O - order
- new s/s over 50
- temporal arteritis

P - positional, prior headache, papilledema
- upright/lying down
-prior headache, progressive
worsening
- intercranial hypotension,
dysautonomia,

46
Q

Nuchal rigidity

A

Nuchal rigidity (neck stiffness with resistance to flexion) is found in patients with acute bacterial meningitis and subarachnoid hemorrhage.

47
Q

Brudzinski Sign

A

As you flex the neck, watch the hips and knees in reaction to your maneuver. Normally they should remain relaxed and motionless.
Flexion of both the hips and knees is a positive Brudzinski sign.

48
Q

Kernig sign

A

Flex the patient’s leg at both the hip and the knee, and then slowly extend the leg and straighten the knee (Fig. 24-63). Discomfort behind the knee during full extension is normal but should not produce pain.
Pain and increased resistance to knee extension are a positive Kernig sign.

49
Q

Joints Accentuation of Headache (JAH)

A

have the patient rotate their head side to side at a speed of 2 to 3 times per second. The test is positive at this maneuver worsens headache. A positive JAH strongly increases the possibility of meningitis, a negative result is not able to rule out the presence of a cute meningitis

50
Q

Intracranial pressure

A
  • cough, sneezing, position change may worsen headache.
  • valsalva maneuvers and leaning forward may increase pain from acute sinusitis’
  • Valsalva and lying down may increase pain from mass lesions due to changing intracranial pressure.
  • Examine the fundi carefully.
  • Examine closely for papilledema, an important sign of elevated intracranial pressure
51
Q

Grading reflexes

A

0: absent
1: somewhat diminished, requires reinforcement
Reinforcement: contraction of muscles for 10 seconds, reassess
2: average response
3: brisker than average
4: very brisk with clonus

52
Q

Red flags for secondary headache syndrome

A
  • recent hx head trauma
  • headache awakens patient from sleep
  • acute onset over a few minutes
  • headaches after age 50
  • new onset in patient with risk factors for HIV, CA
  • signs of systemic illness
  • focal neurological signs other than aura
  • papilledema
53
Q

How is migraine diagnosed?

A
  1. headache lasts 4-72 hours
  2. have at least two of the following:
    - pulsating
    - unilateral
    - moderate or severe
    - aggravation or caused by avoidance of routine activity
  3. Pt has n/v or photo/phonophobia

Diagnosis with 5 attacks that meet the above criteria

NR509 - Advanced Assessment (9 decks)

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