History and examination

Question 1

general screening tools?

Answer 1

GALS

gait arms legs and spines

Question 2

typical GALS history questions? (3)

Answer 2

any pain or stiffness in your muscles, joints or back

can you dress yourself completely without difficulty

can you walk up and down the stairs without difficulty

Question 3

Orthopaedic symptoms - what may fall under ‘ feeling wrong’

Answer 3

• something feels wrong - PAIN, dysaesthesiae (abnormal sensations), weakness

Question 4

Orthopaedic symptoms - what may fall under ‘ moves wrong ‘

Answer 4

Something moves wrong - STIFFNESS, reduced RoM ( locking - can’t fully straighten the knee), limp, instability/collapsing, crepitus

Question 5

Orthopaedic symptoms - what may fall under ‘ looks wrong ‘

Answer 5

SWELLING, DEFORMITY , wasting, shortening, DISCOLOURATION (redness, pallor, wounds, bruising)

Question 6

history of typical day? (6)

Answer 6

wake with pain, pain during the night?

• how are you first thing in morning- is pain/stiffness present - how long is pain there?
• dressing - socks and shoelaces, shirts
• cut your own toenails?
• can they get in and out of a bath?
• how far can you walk on the flat - how far can you walk (union street = mile long) - if they have to stop why is this? - are you using walking aids?
• driving?

Question 7

Good indicator of progress after hip fracture?

Answer 7

physically able?

are they mobile? mentally able to do their own shopping, co - morbidities not too severe to be housebound

Question 8

general principes - red flags (5)

Answer 8

serious pathology - cancer and infection

• severe and worsening pain
• night pain disturbing sleep
• non-mechanical pain (problems in limbs at rest)
• general malaise, febrile, riggers
• unexplained weight loss, anorexia, night sweets
• past history of malignant disease

Question 9

MISTI - thread - PMH

Answer 9

MI
STROKE
THROMBOSIS - DVT/PE
Icterus

Question 10

Other parts of PMH you may be interested in ?

Answer 10

TB 
hypertension - untreated - don't anaesthetise 
- rheumatic fever- valve disease 
- epilepsy
- asthma - steroids - avascualr necrosis
- diabetes

Question 11

Allergies to ask for? (5)

Answer 11

antibiotics - used as prophylaxis

iodine - cleaning agent

general anaesthetic - family problems?

latex allergies

dressings/elastoplasts

Question 12

Drug history questions you need to get? (7)

Answer 12

• current and recent drugs - started/stopped
• what treatment from their own doctor?
• taking any other drugs - analgesics - IV drug users
• oral contraceptive pill
• aspirin/warfarin/clopidogrel
• NSAIDS - may need to provide clotting agents
• Steroids/ oral steroids - side effects - may induce adesoian crisis

Question 13

MSK examination - principles you need

Answer 13

quiet room, chaperone, space to observe gait

• adequate posture and position - always compare sides
• compare right and left standing, compare right and left sitting

Question 14

limbs - distal - upper and lower ?

what is values and varus

Answer 14

• forearm relative to arm
• shin relative to femur

valgus is when the lower part has moved laterally

varus - towards the mid line

Question 15

the anatomical portion is?

ankle up/down

Answer 15

0 degrees for all joints

dorsiflexion, plantar flexion

Question 16

What do we look for?

Answer 16

posture - how does the limb sit?

skin- scars, wounds, sinuses,ulcers, colour - blue, gangrene
- hairless?, atrophic skin? vascular markings - haemosidrerin on pretibial area

• swellings
• wasting- hip = gluteal muscles - knee = thigh wasting, foot and ankle = calf wasting
• deformity- same length, varus/valgus?

Question 17

LOOK - limb lengths

Answer 17

real/true - a limb is truly short

apparent - looks like one is shorter?

Question 18

FEEL - features of examination (4)

Answer 18

skin - temp, cap refill,

• tendernes (localised, diffuse)
  tenderness is a SIGN
• swelling
• deformity -palpate for anatomical landmarks

Question 19

MOVE - features of examination (3)

Answer 19

Active - ask the patient to move - bend elbow/knee

• passive - would you relax and let me move it/ bend it for them
• special tests - abnormal movements, joint laxity tests

Question 20

When we move joints what are we interested in?

Answer 20

• range, rate and rhythm
• RoM - degrees, side comparisons, knee to buttock, finger to palm
• crepitus? stiffness when we move it - patient may feel pain
• power
• tone
• joint laxity/hypermobility

Question 21

In joint examination, what must you make sure you Examine?

Answer 21

joints above and below - examine spine

• neurovascular examination of whole limb,
• consider other relevant systemic examination - chest, abdomen, neurological