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Flashcards in Applied Muscularskeletal Deck (182):
0

Perinatal clues for muscle disease (4)

Reduced Intra-uterine movement
Neonatal respiratory distress
Poor Suck
Reduced limb activity

1

Clues for muscle disease in older infants and children (11)

Floppy baby
Delayed milestones
Trouble walking/running
Trouble climbing stairs/Getting up from sitting
Tripping and falling
Fatigue
Double vision at the end of the day
Muscle Pain
Difficulty swallowing
Garbled speech after eating cold food (myotonia?)
Trouble letting go of objects

2

Congenital absence of ____ is associated with _____
- Pectoralis major

Isolated

3

Congenital absence of ____ is associated with _____
- Depressor labii oris

Congenital heart disease

4

Congenital absence of ____ is associated with _____
- Pectoralis muscle

leukemia

5

Congenital absence of ____ is associated with _____
- Temporalis

Myotonia

6

Wasting 1' muscle degeneration

Disuse

7

Wasting 2' (2)

Anterior horn cell dse
Peripheral nerve dse

8

T/F Genital hemihypertrophy involves _____% of the body and is considered ________

50%
SERIOUS

9

Isolated hypertrophy of calf muscles

Duchenne Dystrophy

10

Type of hypertrophy seen in congenital adrenal hyperplasia

Generalized

11

Fasciculation of muscle bundles is seen in conditions associated with irritation of

Anterior horn cell
- Polio
- Werdnig-Hoffmann

12

Palpation of an induration over muscle is seen in (3)

Dermatomyositis
Infectious myositis
Pyomyositis

13

Tenderness on palpation of muscles is seen in

Dermatomyositis
Trichinosis

14

Percussion
Contraction on percussion + delayed relaxation

Best tested on _____ muscle

Myotonia congenita

Biceps

15

Testing Muscle strength
Ant neck flexors

Get up from supine

16

Testing Muscle strength
Trapezius

Shrug shoulders

17

Testing Muscle strength
Deltoids

Elevate arms over head

18

Testing Muscle strength
Biceps

Flex elbow
Palm facing upwards

19

Testing Muscle strength
Quadriceps

Sit on edge of table w/popliteal space flush
Extend knee

20

Testing Muscle strength
Gluteus medius

R lateral side
Flex knee
Abduct hip on L side

21

Testing Muscle strength
Gluteus maximus

Prone
Knees flexed
Lift hip off table

22

Testing Muscle strength
Gastrocnemius and soleus

Using sole of foot, push down on examiner's palm

23

Pattern of weakness
Dermatomyositis

Proximal

24

Pattern of weakness
Peripheral neuritis

Distal extremity weakness

25

Pattern of weakness
One sided weakness

Unilateral cerebral insult

26

Pattern of weakness
Unequal lower limb weakness

Myelomeningocele

27

Pattern of weakness
Equal lower limb weakness

Paraplegia

28

Activities of Daily living
I -
II -
III -
IV -

I Fully independent
II Most independent, minimal help required
III Wheelchair bound
IV Totally dependent

29

Clues in diagnosing muscle weakness
Myotonia

Mental retardation

30

Clues in diagnosing muscle weakness
Exaggerated reflexes

CNS dse

31

Clues in diagnosing muscle weakness
Fasciculations

Anterior horn cell disease

32

Clues in diagnosing muscle weakness
Rashes

Collagen vascular disease

33

Clues in diagnosing muscle weakness
Sensory changes

Peripheral nerve disease

34

Clues in diagnosing muscle weakness
Dark urine

Myoglobinuria

35

Gait
Waddling

Proximal muscle weakness around the hip

36

Gait
Toe walking

Duchenne or
Tight heel cord

37

Gait
Slapping gait

Peripheral neuropathy

38

Gait
High stepping gait

Posterior column lesion

39

History and PE
(+) Joint pain
(-) Swelling

Arthralgia

40

History and PE
(+) Joint Pain
(+) Swelling

Arthritis

41

History and PE: Etiology
Pain: Acute onset in 1 joint

Trauma or
Inflammation

42

History and PE: Etiology
Slow onset of pain

Collagen vascular disease

43

History and PE: Etiology
Generalized pain

Polyarticular

44

History and PE: Etiology
Pain in a joint for 1-2 days

Trauma
Infection

45

History and PE: Etiology
Pain in a joint for days or months

Collagen disease

46

History and PE:
Intense acute pain

Acute rheumatic fever or
Septic arthritis
(Acute onset could also be trauma or inflammation)

47

History and PE:
Extreme grades of pain

Vasomotor disease

48

History and PE:
Moderate pain

Juvenile Rheumatoid Arthritis

49

History and PE:
Arthritis w/no pain

Neuropathic joint

50

History and PE:
True migrating pain (Flitting-fleeting)

Acute rheumatic fever
Gonococcemia

51

History and PE:
Non-migrating pain

Collagen vascular disease

52

History and PE:
Pain worse on activity

Destructive joint dse
i.e. acute cartilaginous necrosis

53

History and PE:
Pain and stiffness early in the morning

Suggests JRA

54

History and PE:
Pain that interferes w/sleep

Vasomotor dse
Joint Bleeding

55

History and PE:
Growing pain

Septic arthritis
Osteomyelitis
Osteoid osteoma

56

Inspection
Involves 1 side of the joint

Peri-articular

57

Inspection
Swelling extends above and below joint

Cellulitis
(Peri-articular swelling involves 1 side of joint)

58

Inspection
True swelling w/_____ defined edges suggests __________

ill-defined
effusion in the joint

59

Inspection
___________ __________ = swelling of joint w/clear defined edges

Synovial thickening

60

Inspection
Sterno-clavicular swelling
- Acute: ?
- Chronic: ?

Acute - Gonococcemia
Chronic - Juvenile arthritis

61

Inspection: Etiology?
Obliteration of dimples of olecranon

Swelling of elbow

62

Inspection: Manifestation
Swelling of carpal joints

Limitation of wrist extension (seen dorsally)

63

Inspection: Etiology?
Clear, distal, oblique transverse edge

Swelling of extensor tendon sheath

64

Inspection: Etiology?
Diffuse swelling of dorsum of hand

Sickle cell disease
Tenosynovitis w/lymphedema or serum sickness

65

Inspection: Etiology?
Flexed, claw-like fingers

Flexor teno-synovitis

Clawhand - paralysis of ulnar nerve
Bifid Claw-like hand - Thalidomide

66

History and PE:
Swelling of plantar aspect w/tenderness

Ankylosing spondylitis

67

History and PE:
Swelling of sole and dorsum of feet
(-) Tenderness

Serum sickness

68

History and PE: Palpation
Heat and tenderness over the joint

Inflammatory arthritis

69

History and PE: Palpation
Flexor tendon tenderness upon percussion

Flexor tenosynovitis

70

History and PE: Palpation
Percussion of flexor aspect of wrist --> tingling sensation along outer 3 fingers

Carpal tunnel syndrome

71

T/F
Tenderness along femoral tibial edges of knee is a feature of arthritis

FALSE
NOT a feature

72

Most important point in testing for tenderness

Exclude tenderness of peri-articular structures

73

History and PE:
Test to elicit tenderness of sacro-iliac joint

Prezel

Hold and cross one lower limb over the other while crossing the opposite upper limb across the trunk. Hold the shoulder and knee, and do quick spring-like stretching

74

History and PE:
(+) Cashmere velvet feeling =

Hypertrophic synovium

75

History and PE:
(+) Crepitus on auscultation
- Along flexor tendons =
- Over tempero-mandibular joint =

Flexor tendons - Teno-synovitis of scleroderma
TMJ - JRA

76

Range of motion: How to test
Inferior cervical spine

Chin on chest

77

Range of motion: How to test
Atlanto-axial joint

Look up
Side to side

78

Range of motion: How to test
Lower cervical spine

Ear to shoulder

79

Range of motion: How to test
Abduction and internal rotation of shoulder

Arms above shoulders
Touch palms

80

Range of motion: How to test
Indian greeting tests what

Wrist ext
Elbow flexion

81

Range of motion: How to test/What are you testing
Distal and proximal interphalangeal joints

Bend fingers (scratching)

82

Range of motion: How to test/What are you testing
Metacarpo-phalangeal joints

Close the fist

83

Range of motion: How to test/What are you testing
Hip and knee flexion

Squat DOWN

if rising from squatting, test of strength (DUH!)

84

Range of motion: How to test/What are you testing
Trouble getting up? Suspect
Trouble sitting down? Suspect

Muscle
Joint

85

Range of motion: Hip
At rest, flexion + external rotation =

Effusion into hip joint

86

Range of motion: How to test/What are you testing
Hip rotation is best tested in what position

Prone

87

Range of motion: Etiology
Limitation of internal rotation of hip

Slipped epiphysis
Legg-Perthes disease

88

Range of motion:
Excessive external rotation of hip is normal up to _____

18 months

89

Range of motion: Etiology/Manifestation
Loss of full extension of knee

Arthritides

90

Range of motion: Etiology/Manifestation
Osgood-Schlatter disease

Pain below knee causing limitation of flexion

91

Torsional deformities of lower limb: Hip
In-toeing:
Out-toeing:

Femoral anteversion
Physiologic (infancy)

92

Torsional deformities of lower limb: Tibia
In-toeing:
Out-toeing:

Internal torsion
External torsion

93

Torsional deformities of lower limb: Foot
In-toeing:
Out-toeing:

Metatarsus adductus
Flat-foot or curved foot

94

Straight lateral border of foot =

Normal

95

Convexity of the lateral border of the foot =

Metatarsus adductus

96

Tibial torsion is best observed when child is in _____ position and thigh _________

Prone
Flexed to 90'

97

Normal Thigh foot angle =

10-30'

98

Thigh foot angle =

Internal tibial torsion (normal first 2 years of life)

99

Excessive external rotation and limitation of internal rotation is normal up to

18m of life

100

Internal rotation normally:

101

Internal rotation >70'

Femoral anteversion

102

Toddler gait:
When child walks in straight line, feet make an angle of
____ in external rotation
____ in-toeing
____ out-toeing

10'
>10'
>30'

103

Testing genu varum, valgum, flat foot and pronated foot
With medial malleoli touching, there must be _________ space between medial condyles

(5cm)

104

Testing genu varum, valgum, flat foot and pronated foot
Genu varum
Space between medial condyles:
Normal until

Bowleg
>2 inches
Physiologic until 2.5 years old

105

Testing genu varum, valgum, flat foot and pronated foot
Genu valgum
Space between medial condyle:
Normal at what age

Knock knee

Normal betwee 2-5 years

106

Testing genu varum, valgum, flat foot and pronated foot
Pronated feet: definition -
Where is weight

Outward curvature of tendo-achilles
Inside edge of sole

107

Functional test for joint problems:
Duration of morning stiffness

Rheumatic dse

108

Functional test for joint problems:
Grip strength of 6-10 y/o

120 mmHg

109

Spine: Inspection
Young child w/
Short neck or Elevated shoulder
+ Scholiosis

Hemi-vertebrae

110

Spine: Inspection
Child walking extremely to avoid pain suggests

Intervertebral disc inflammation

111

Spine: Inspection
Bunch of hair over lower end of spine suggests

Lipo-meningocele

(Spina bifida occulta?)

112

Spine: Inspection
Dimple at lower end of spine (2)

Sacrococcygeal dimple
Pilonidal sinus

113

Spine: Inspection
Curves
- Cervical -
- Thorax -
- Lumbar

C curve
Convex
C Curve

114

Loss of C curve in cervical spine = (2)

JRA
Tuberculosis of the spine

115

Spine: Inspection
Prominent thoracic curve

Kyphosis
i.e. morquio disease

116

Spine: Inspection
Distinct angle at apex of kyphosis =
Indicates:

Gibbus
Fracture/collapse of vertebrae

117

Spine: Inspection
Loss of lumbar lordosis seen in

Ankylosing spondylitis

118

Spine: Inspection
Prominent lordosis is d/t (3)

Familial
Developmental (N up to 7-8 yo)
Hip flexion

119

Spine: Scoliosis
Five (5) physical clues

Elevated shoulder on one side
Unequal bra cup size
Family history of scoliosis
Prominent scapula
Leg length discrepancy

120

Spine: Scoliosis
How to perform Hump Test

Bend fwd

121

Spine: Scoliosis
Modified Schober's tests for

Mobility of lumbar spine

Mark midline over spine 10cm above 1st point
Another mark 5cm below first point.
Patient bends forward and points should be at least 7cm apart

122

Hand:
Handedness established at
What if earlier?

2.5-3 years old
Earlier suggests hemiplegia

123

Hand:
Tremors at rest (2)

Essential
Wilson's

124

Hand:
Tremor in sustained posture (4)

Anxiety
Fatigue
Thyrotoxicosis
Cerebellar dse

125

Hand:
Intention tremor (2)

Cerebellar dse
Stress

126

Hand:
Inability to sustain grasp =

Chorea

127

Hand:
Writhing movements in distal part of body =

athetosis

128

Hand:
Flopping movement of outstretched hand =
Seen in

Asterixis (liver flap)
Seen in hepatic failure (Reye's syndrome)

129

Hand:
Loss of abduction and extension of thumb d/t

Radial nerve paralysis

130

Hand:
Loss of ADduction of thumb

Ulnar nerve paralysis

131

Hand:
Apposition of thumb d/t

Median nerve paralysis

132

Hand: Size
Achondroplasia

Small

133

Hand: Size
Gigantism

Large

134

Hand: Size
Long hands w/spidery fingers (2)

Arachnodactyl
Homocystinuria

135

Hand: Size
Hypoplasia of radial aspect of hand (2)

Holt-Oram syndrome
Fanconi Syndrome

136

Hand: Shape
Mitten hand + Fused fingers

Apert

137

Hand: Shape
Apert syndrome =

Mitten hand w/fused fingers

138

Hand: Shape
Bifid claw-like hand

Thalidomide syndrome

139

Hand: Position
Policeman receiving tip d/t

Brachial plexus paralysis

140

Hand: Position
Wrist drop

Radial nerve paralysis

141

Hand: Position
Claw hand

Ulnar nerve paralysis

Bifid clawlike = thalidomide
Claw-like fingers = flexor tenosynovitis

142

Hand: Position
Ulnar deviation of hand +
Volar subluxation of the wrist

JRA

143

Rashes and Nodules:
Vesicular lesions are seen in: (6)

Scabies
Herpes simplex
Chicken pox
Epidermolysis bullosa
Congenital Syphilis
Gonococcemia

144

Rashes and Nodules:
Pustules are seen in (2)

Impetigo
Infected scabies

145

Rashes and Nodules:
Lesion in Rheumatoid arthritis

Nodular

146

Rashes and Nodules:
Purpuric (2)

Rocky Mountain spotted fever
Meningococcemia

147

Rashes and Nodules:
Tips of fingers in scleroderma

Vasculitic

148

Fingers:
Short fingers of equal length are seen in (2)

Hypothyroidism
Achondroplasia (banana bunch fingers)

149

Fingers:
Trident sign

Acondroplasia

150

Fingers:
Polydactyl is seen in (2)

Ellis-Van Creveld syndrome
Trisomy 13

151

Fingers:
Syndactyl is seen in (3)

Apert Syndrome
de Lange syndrome
Prader Willi Syndrome

152

Fingers:
Uniformly swollen
Slight flexion
Tender along tendon sheaths

Acute tenosynovitis

153

Fingers:
Triggering (locking) of fingers suggests

Nodules along flexor tendons

154

Fingers:
Flexion deformity of little finger
Seen in (3)
Inherited via

Camptodactyl

Down
Carpenter
Aarskog

Simple dominant gene

155

Fingers:
Shortening of radial aspect of middle phalanx resulting to radial deflection of terminal phalanx

Seen in: M/F?
Normal: ?

Clindodactyl

Females

0.3% of normal population

156

Fingers:
Hypoplasia of metacarpal bones of all fingers is seen in (2)

Coffin-siris syndrome
Cri-du-chat

157

Fingers:
Hypoplasia of 4th metacarpal causes dimple. Seen in

Pseudo-hypo-parathyroidism

158

Fingers:
Patient clenches fist w/thumb inside palm. Tip of thumb protrudes past ulnar border of palm.
(+) in
(-) in

THUMB SIGN
(+) Marfan
(-) Homocystunuria

159

Thumb:
Abnormality: Triphalangeal thumb
Associated Syndrome:

Holt-Oram

160

Thumb:
Abnormality: Thumb Aplasia
Associated Syndrome:

13q syndrome

161

Thumb:
Abnormality: Broad thumb
Associated Syndrome:

Rubinstein-Taybi

162

Thumb:
Abnormality: Proximal placement of thumb
Associated Syndrome:

18q syndrome

163

Thumb:
Abnormality: Flexed thumb
Associated Syndrome:

Arthrogryposis

164

Thumb:
Abnormality: Bifid thumb
Associated Syndrome:

Translocation 3/13

165

Dermatoglyphics:
Three components

Flexion creases
Ridge arrangement of palms
Finger patterns

166

Dermatoglyphics:
2 distal creases fuse and run as single crease along entire palm to ulnar border of palm =

Seen in

Simian crease

Down (NOT pathonomonic)

167

Dermatoglyphics:
2 transverse creases
Proximal runs across entire palm

Seen in:

Sydney line

Congenital rubella syndrome

168

Dermatoglyphics:
2-3 creases over proximal interphalangeal joints
1 over distal interphalangeal joints

Normal

169

Dermatoglyphics:
2 creases over palmar aspect of distal interphalangeal joints are seen in

Sickle cell disease

170

Ankylosing Spondylitis:
Arthritis of the ______
_______ disease
Early symptoms: (2)
Age:

Arthritis of spine
Immune disease (auto?)
Early: Back pain + Stiffness
Late adolescence or early adulthood
Fuse vertebrae together

171

_______ ________ Disease
Idiopathic Osteo-necrosis of capital femoral epiphysis of femoral head

Legg Perthes Disease

172

Legg Perthes
- Cause
- Location (2), referred to (1)
- Pain (2)
- Quality of pain (2)
- History of trauma?

Idiopathic osteo-necrosis of capital femoral epiphysis of femoral head
Hip/Groin --> Thigh
Mild/Intermittent in Ant thigh or knee
NO history of trauma

173

MC cause of knee pain in adolescent
Prognosis:

Osgood-Schlatter (Osteo-chondritis) Dis-ecans
Benign/Self limited

174

Pain + Edema in tibial tubercle
Associated w/traction apophysitis of _____ tubercle
Due to __________ on the ___________ ossification center

Osgood-Schlatter (Osteo-chondritis)
Tibeal
Repetitive strain on 2' ossification center of tibial tubercle

175

____________
Mucopolysaccharidosis type ____
INC clumsiness
Mild coarsening of facial features
Corneal clouding
Hepatomegaly
Odontoid hypoplasia
Exercise intolerance

Morquio Disease

176

_____________ Disease
Inheritance
Liver dse manifestations (jaundice, varices, spider angiomas, palmar erythema)
Neuro-psychiatric
___________ rings
Arthropathy ressembles premature osteo-arthritis
________ anemia

Wilson's
Rare AR
Kayser-Fleischer rings
Hemolytic anemia

177

Fanconi Syndrome
________ of kidneys excrete ____(3)_____ into urine
Evidenced by
___(4)_____ in urine
INC or DEC? Potassium
INC or DEC? in Vit. D

Fanconi Syndrome
Proximal tubules secrete ______ into urine
- Glucose
- AA
- Phosphate

Evidenced by: Glucose, Citrate, AA, Phosphate in urine
Hypokalemia
Vit D deficiency

178

____________ and _________ Syndrome
X-linked
Ocular hyper-telorism
Anteverted nostrils
Broad ________ lip
Scrotal "Shawl" _______ the penis
________ hands

Carpenter and Aarskog Syndrome
Broad upper lip
Shawl Above penis
Small hands

179

______________ Syndrome
- rare congenital
- Sex predilection (?)
- Delay: mental or developmental
- Coarse facial features
- Incompletely formed or absent ______
- Absent 5th finger

Coffin-Siris Syndrome
Females
BOTH Mental and developmental
5th fingernails

180

_____________ syndrome
- Multisystem
- Growth retardation & and delayed ______ age
- Mental retardation
- Craniofacial dysmorphism
- Hyper-telorism
- ___________ nose
- ___________ thumbs and toes
- Breathing and swallowing difficulties

Rubinstein-Taybi
- Delayed bone age
- Broad nasal bridge
- Abnormally large or "beak-shaped" nose
- Broad thumbs and toes

181

__________________
Progressive or non-progressive?
Multiple joint contractions present at birth
Extremities are ________ or _________ in shape
Thin SQ Tissues and absent skin creases
Deformities are (symmetric or asymmetric?)
Severity increases (distally or proximally?)
_________ and ______ are most deformed
Joint rigidity and dislocation (esp ____ and _____)
Atrophy
Sensation (+/-? )
DTR (+/-?)

- Arthrogryposis
- Non-progressive
- Extremities are fusiform or cylindrical
- Deformities are symmetric
- Severity increases distally
- Hands and feet most deformed
- Sensation intact
- DtR diminished or absent