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CATA 337 > ASSESSMENT OF THE EXTREMITIES > Flashcards

ASSESSMENT OF THE EXTREMITIES Flashcards

1
Q

what is medical differential diagnosis

A

comp of symptoms of similar diseases and medical diagnosis

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2
Q

what is therapy differential diagnosis

A

comp of neuromusculoskeletal s#s to identify the underlying mvt dysfunction so that tx can be planned as specifically as possible

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3
Q

describe a differential diagnosis

A

-thorough and systematic examination
-knowledge of pathology and MOI
-clinical s/s
-physical exam
-provocation and palpation
-lab and imaging

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4
Q

steps of MSK ass (diff diagnosis)

A

1- patient history
2-observation
3-screening (if necessary)
4-examination of mvt (physical exam)
5-special tests
6-reflexes and cutaneous distribution
7-joint play
8-palpation
9-diagnosis imaging

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5
Q

what do you need to know before doing an assessment

A

application of anatomy (CYRIAX): normal vs abnormal
SOAP (subjective, objective, assessment, plan)

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6
Q

describe the Subjective component in SOAP

A

what you hear:
-patient description of his complaints, loss of function, pain and date of onset
-relevant data obtained from interview, including patient’S self reported level of function
-patient’s home or work environment
-past med history

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7
Q

describe the objective component of SOAP

A

What you observe and do-measures:
-portions of patient’s chart (might include summary of recent surgery, and referral lab reports or x-ray)
-results of your examination

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8
Q

describe the assessment component in SOAP

A

what you think:
-professional evaluation of overall impairements based on intergration of the subjective and objective findings
-identify and interpret problems relate to overall function
-patient’s specific response to intervention

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9
Q

describe the plan component of SOAP

A

what will you do:
-what tx is planned-continue or change tx
-progression of the plan (short and long term goals)
-education planned for patient/family
-frequency/duration of tx
-follow-up: consultation with or referral to other professionals

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10
Q

what does the I and E in SOAPIE stand for

A

I: implementation (this is what you’ve done)
E: evaluation (this is whether the care so far has been effective in helping the patient reach the goals)

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11
Q

pyramid in canada

A

history of clients (prev inj, level of play)
history of inj (recreate MOI)
Observation (look and compare)
Stress tests (MSK=A, P, R; special tests)
Palpation (location, type of pain)
Physician diagnostic (radiology)
physician diagnostic (lab tests)

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12
Q

pyramid in the states

A

history of clients (prev inj, level of play)
history of inj (recreate MOI)
Observation (look and compare)
Palpation (location, type of pain)
Stress tests (MSK=A, P, R; special tests)
Physician diagnostic (radiology)
physician diagnostic (lab tests)

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13
Q

what consists of history

A

client and injury
what has most clinical relevance
practice routine and don’t skip, even if obvious
gain info on disorder, prognosis, appropriate tx

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14
Q

what consists of rapport w patient

A

informed consent
keep patient focused
firmly discourage irrelevant info
communicate within their level (layman’s term) (sh blade vs scapula)

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15
Q

what are some interview techniques

A

open-ended questions
closed-ended questions
funnel sequence technique
paraphrasing technique
«final question»

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16
Q

what to make sure you don’t forget while asking questions

A

get answer before moving on and pay attention to answer
leading questions: does the activity increase your pain
closed ended questions to clarify (yes or no answers)

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17
Q

what choices of words to consider while listening

A

cramping, colicky, throbbing, aching, pressure, thightness, heaviness, weakness, poor balance, numbness, severe, disabling, worst pain I have ever had (WORTHY OF MORE DETAILED INQUIRY AND INVESTIGATION)

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18
Q

what are the two components of history

A

Client’s history and injury history

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19
Q

whqat are some red flags

A

listen (watch) for (table 1-1)
cancer, CV, GI/genitourinary, neurological, miscellaneous
referral to physician

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20
Q

what are some yellow flags

A

-abnormal s/s (unusual patterns of complaint)
-bilateral symptoms
-symptoms peripheralizing
-neurological symptoms (n. root or peripheral n.)
-multiple n. root involvement
-abnormal sensation patterns (do not follow dermatome or peripheral n. patterns)
-saddle anesthesia
-upper MNs symptoms (spinal cord signs)
-fainting drop attacks
-vertigo
-ANS symptoms¸
-progressive weakness
-progressive gait disturbances
-multiple inflamed joints
-psychosocial stresses
-circulatory or skin changes

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21
Q

cancer red flags

A

-persistent pain at night
-cte pain anywhere in the body
-unexplained weight loss (4,5 to 6,5 kg in 2 weeks or less)
-loss of appetite
-unusual lumps or growth
-unwarranted fatigue

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22
Q

CV red flags

A

-SOB
-dizziness
-pain or a feeling of heaviness in the chest
-pulsating pain anywhere in the body
-cte and severe pain in lower leg or arm
-discolored or painful feet
-swelling (no history of inj)

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23
Q

GI/ genitourinary red flags

A

-frequent or severe abdominal pain
-frequent heartburn or indigestion
-frequent nausea or vomiting
-change in or problems with bowel and or bladder function(UI tract infection)
-unusual menstrual irregularities

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24
Q

Neurological red flags

A

-changes in hearing
-frequent or severe headaches w no history of inj
-problems w swallowing or changes in speech
-changes in vision (ex: blurriness or loss of sight)
-problems w balance, coordination or falling
-faint spells (drop attaches)
-sudden weakness

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25
Q

miscellaneous red flags

A

-fever or night sweats
-recent severe emotional disturbances
-swellling or redness in any joint w no history of injury
-pregnancy

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26
Q

client history components

A

-age,sex
-occupation
-chief complaint (function ability)
-allergies, medications
-previous injuries/surgeries (other medical history, family medical history

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27
Q

medications components

A

-prescribed, OTC
-other pertinent medication
-taken for this or for other condition

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28
Q

what is important to ask concerning doc.

A

has he seen one
has he had surgery? where, and is the problem associated w the surgery?
hospitalization?

29
Q

factors of injury history

A

MOI: onset (macro or micro trauma), contact w another player, hit w equipment, direction and magnitude
Onset timing (slow, sudden)
Symptoms experienced then and now (where)
OPQRST

30
Q

Factors of duration of injury

A

-length of time since injury
-stage of injury (acute, subacute, chronic)
-leads to tolerance of examination (more acute, less stress)

31
Q

Factors of previous occurence

A

occured before (when, course of tx)
same or different now

32
Q

factors of pain

A

where, when
at time of injury
type (n., m., lig., visceral) table 1-3
course of pain (changes over time) cte, periodic, occasional
rating (repetitive stress, VAS, thermometer, 1-10)

33
Q

pain that isn’t affected by rest or activity usually indicates:

A

b. pain, organic/systemic disorders, or other severe pathology

34
Q

pain w activity that decreases w rest usually indicates:

A

mechanical pain from something being pinches, stretched or contracted (thightened)

35
Q

pain and stiffness in the morning, which improves w activity, usually indicates:

A

chronic inflammation & edema that decreases w activity

36
Q

Pain and aching that increase as the day progresses usually indicates

A

congestion (swelling) in the joint from the joint being overstressed

37
Q

describe functional pain factors

A

what mvt or activities change or cause pain
verbal explanation
related the activities to physical exam ¸
protection of area

38
Q

describe sensation

A

describing pain (table 1-3)
systemic (disturbs sleep, deep, pressure relieves, not mechanical, associations: fever, rash fatigue and infection)
musculoskeletal: lessens at night and w less activity, sharp and superficial, no associations

39
Q

pain type vs structure

A

-cramp, dull, ache: m.
-dull, ache:P lig, joint, capsule
-sharp, shooting: n. root
-sharp, bright, lightening: n.
-burning, pressure, stinging, ache: sympathetic n.
-deep, nagging, dull: bone
-sharp, severe, intolerable : fracture
-throbbing, diffuse: vasculature

40
Q

common constitutional symptoms of a systemic disease

A

fever, diaphoresis (unexplained perspiration), night sweats (can also happen during day), neausea, vomiting, diarrhea, pallor, dizziness/syncope (fainting), fatigue, weight loss

41
Q

what are the diff systems

A

integumentary
MSK/neurologic
rheumatologic
cardiovascular
pulmonary
psychological
GI
hepatic/biliary
hematologic
genitourinary
gynecologic
endocrine
immunologic
cancer

42
Q

what is the preliminary diagnosis

A

index of suspicion
made from history alone, but confirmed or refuted by observation and examination (typically 2 or 3 items)

43
Q

What do observations consists of

A

-looking or inspection
-mainly posture assessment (discussed next class)
-gait
-looking for abnormalities
-visible defects (dominant eye)
-abnormalities of alignment
-structural/functional defects/deformities
-dynamic deformities

44
Q

overt pain behaviour (observation)

A

guarding, bracing, rubbing, grimacing, sighing

45
Q

general posture

A

-anterior, side, posterior : alignement , symmetries, deformities, contours
-limb specifics : contour, size (bone, soft tissues)

46
Q

observations on skin

A

-colour, texture
-scars (new and old)
-bruising
-ecchymosis
-cyanosis
-redness
-rash

47
Q

Signs of inflammation acronym

A

Swelling
Heat
Altered Function
Redness
Pain

48
Q

Sounds

A

clicking and crepitus

49
Q

Attitudes

A

facial expressions (also pain)
willingness to move , apprehension

50
Q

basic principles of physical exam

A

-inform patient what you’re doing
-uninvolved side first
-active => passive => resisted
-painful last
-apply tests with care
-warn the patient
-maintain patient dignity
-refer if necessary

51
Q

before starting physical exam…

A

does history and observation lead to scanning and screnning exam

52
Q

what is screening

A

screen for nonmusculoskeletal conditions that mimic MSK disorders and serious pathologies (3 steps)

53
Q

what are the 3 steps od screening

A

-red or yellow flags
-perform quick systems check and review of systems
-rule out the suspected condition or refer

54
Q

what does scanning examination involve

A

peripheral joint scan (for spine)
+motor scan (myotomes vs specific m. & their peripheral n. supply)
+sensory scan (dermatomes vs areas of skin supplied by a specific peripheral n.)

55
Q

when to use scanning exam

A

-no history of trauma
-radicular signs present¸
-trauma w radicular signs
-altered sensation in limb
-spinal cord signs
-abnormal patterns
-suspected psychogenic pain

56
Q

what is peripheral joint scan

A

a quick assessment of the peripheral joints to rule out mvt (mechanical) pathology in those joint

57
Q

what is a sensory scan

A

differentiating btw n. root symptoms (from spine) and peripheral n. symptoms (n. pathology in the periphery)

58
Q

cervical (A, P, R)

A

Flexion, extension, side flexion R and L, rotation R and L

59
Q

Scapular and shoulder mvt

A

elevation thru flexion, abduction
apply scratch
rotation at 90 abduction

60
Q

Elbow wrist and hand mvt

A

elbow (flexion/extension, supination/pronation)
wrist and hand (flex/ext, abd/add, opposition)

61
Q

Lumbar (A, P, R)

A

Flexion/extension
side flexion (R & L)
rotation (R & L)

62
Q

sacroiliac

A

-palpate PSIS, sacral spine w patient hip flexion
-ischial tub, sacral apex, w patient hip flexion

63
Q

Hip and knee

A

hip: F/E, AD/ABD, med/lat rot
Knee: F/E

64
Q

Foot and ankle

A

pf and df
supination, pronation
F/E of toes

65
Q

spinal cord and n. roots: somatic

A

innervating m., sensory input skin, fascia, m.

66
Q

spinal cord and n. root visceral (autonomic)

A

blood vessels, dura mater, periosteum, ligaments

67
Q

what is important in testing

A

dermatomes, myotomes, sclerotomes, reflexes (tables 1-31, 1-32, 1-33)
-referred pains (radicular)

68
Q

peripheral

A

motor and sensory information
neural tension

69
Q
A

CATA 337 (2 decks)

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