Block 1 Flashcards
(119 cards)
1
Q
Freely movable, bones do not touch each other, bones covered by articular cartilage
Surrounding the membrane is a joint capsule
A
Synovial Joint
Separated by a synovial cavity
Synovial membrane lines the cavity and secretes synovial fluid
2
Q
Slightly movable; at the center of each disc is a nucleus pulposus
Examples are intervertebral discs, ribs-sternum, epiphyseal plates of long bones
A
Cartilaginous
Fibrocartilaginous discs separate the bony surfaces
3
Q
Immovable; examples are sutures, distal talofibular joint, teeth/socket
A
Fribrous
Bones are connected by fibrous connective tissue
Intervening layers of fibrous tissue hold the bones together
4
Q
Tibiofibular (KoJ)
A
Syndesmosis
5
Q
Skull (KoJ)
A
Suture
6
Q
Vertebrae (KoJ)
A
Symphysis
7
Q
Rib (KoJ)
A
Synchondrosis
8
Q
Wrist (KoJ)
A
Condyloid
9
Q
Radioulnar (KoJ)
A
Gliding
10
Q
Elbow (KoJ)
A
Hinge
11
Q
Hip (KoJ)
A
Ball and socket
12
Q
CMC - Thumb (KoJ)
A
Saddle
13
Q
Atlantoaxial (KoJ)
A
Pivot
14
Q
When gathering social history, what is the one big thing to ask that impedes bone healing (orthopedics)?
A
Smoking
15
Q
Approach for the musculoskeletal exam should be systematic after first assessing general appearance body proportions, and ease of movement (walk, sitting, etc.)…
A
1) Inspection
2) Palpation of bony and soft tissue landmarks
3) AROM/PROM
4) Neurovascular examination
5) Special maneuvers
6) Further studies (x-ray, MRI, blood studies, etc.)
16
Q
Acute involvement of only 1 joint suggests…
A
Trauma, septic arthritis, or gout
17
Q
Rheumatoid arthritis typically involves…
A
Several joints, symmetrically distributed
18
Q
What is a fasciculation and how does it differ from a tremor?
A
The muscle starts to tremor without any movement (important during strength testing)
Patient bends arm, starts to twitch and/or tremor but no movement
Tremor alone has slight movement
19
Q
During palpation of bony and soft tissue landmarks, what are you looking for?
A
Tenderness, nodules (popliteal cysts behind knee), crepitus, swelling (effusion or synovitis), warmth (arthritis, tendinitis bursitis, osteomyelitis), redness (erythema)
20
Q
How do you test strength?
A
Asking patient to move actively against your resistance
21
Q
What is the big difference for the grade of strength between 2 and 3?
A
Grade 2: active movement of body part with gravity eliminated (parallel to earth)
Grade 3: active movement against gravity only
22
Q
TMJ is the most active joint in the body. Where does it lie between?
A
External Acoustic Meatus and the Zygomatic Arch
23
Q
What muscle is responsible for opening the jaw? (Depression)
A
External Pterygoid
24
Q
What muscles are responsible for closing the jaw? (Elevation/retraction)
A
Masseter, temporalis, and internal pterygoids
25
TMJ Syndrome
Unilateral chronic pain with chewing or jaw clenching
Often associated with stress
Swelling, tenderness and decreased ROM
Trismus (lockjaw)
26
Rotator Cuff Tear
Atrophy of the supraspinatus and infraspinatus shows increased prominence of the scapular spine and appears within 2-3 weeks
A significant amount of synovial fluid is needed before swelling appears within the shoulder joint
27
There are 4 rotator cuff muscles. What are the three on the posterior and one on the anterior?
Posterior: Supraspinatus, Infraspinatus, Teres Minor
Anterior: Subscapularis
28
Crossover Test
ACJ
29
Apley Scratch Test
Overall rotation
30
Neer’s Hawkin’s
Rotator Cuff Tendonitis/Tear
31
Supraspinatus Strength
Rotator Cuff Tendonitis/trear
32
Infraspinatus Strength
rotator cuff or biceps tendinitis
33
Drop-Arm Test
Rotator cuff tear
34
Forearm Supination
biceps tendonitis
35
Testing External Rotator Muscles
Teres Minor and Infraspinatus Muscle Testing
36
Lift-off Test for....
Subscapularis
37
What nerve runs posteriorly between the olecranon process and medial epicondyle?
Ulnar Nerve
38
What are the 4 motions of the elbow (P/AROM)? And what are the muscles?
Flexion (biceps, brachialis, brachioradialis)
Extension (triceps)
Supination (biceps, supinator)
Pronation (pronator teres, pronator quadratus)
39
Thenar Atrophy
Median nerve compression —> thumb —> carpal tunnel syndrome
40
Hypothenar Atrophy
Ulnar nerve compression
41
Radial styloid and anatomical snuffbox is formed by the....
Abductor Pollicis Longus (left when looking down at the right thumb) and Extensor Pollicis Brevis (right when looking down at the right thumb)
42
Carpel Tunnel Tests
Sensation, Thumb abduction and grip strength, Tinel’s Sign, Phalen’s Sign
43
Sensation for carpal tunnel tests
Median nerve (pulp of index finger)
Ulnar nerve (pulp of 5th finger)
radial nerve (dorsal web space of thumb and finger)
44
Tinel’s Sign
Tapping median nerve at carpal tunnel
45
Phalen’s Sign
Hold wrists in flexion x 60 seconds causes numbness and tingling if positive (median nerve)
46
Finkelstein’s Test
| Radial wrist or snuffbox injury
Fist the thumb with wrist ulnar deviation
Pain indicative of de Quervain’s tenosynovitis
47
C5 Neurologic Level
Motor: deltoid, biceps
Reflex: hammer to biceps tendon
Sensation: bicep
48
C6 Neurologic Level
Motor: bicep flexion, wrist extensors: ext carpi rad. Longus and brevis
Reflex: hammer to longus and brevis
Sensation: thumb and index finger up to elbow
49
C7 Neurologic Level
Motor: Triceps extension, wrist flexors, finger extensors
Reflex: ulnar nerve - triceps tendon into olecrannon
Sensation: middle finger
50
C8 Neurologic Level (between C7 and T1)
Motor: finger abduction/adduction, finger flexors (making a fist)
Reflex: none
Sensation: 4th and 5th digits and up arm to just below elbow
51
T1 Neurologic Level
Motor: finger abduction/adduction
Reflex: none
Sensation: elbow + above and below a little bit
52
For hips, what is located at level of L4?
Upper margin of iliac crest
53
What joint in the hip is not always palpable?
Sacroiliac Joint
54
What three things bisect the inguinal ligament? (NAVeL)
Femoral Nerve, Artery, Vein-empty space- Lymph node
55
Atrophy of quadriceps: Genu Varum
bowleg
56
Atrophy of quadriceps: Genu Valgum
Knock-knees
57
Swelling over patella indicates...
Prepatellar bursitis
58
Swelling over tibial tubercle suggests...
Infrapatellar bursitis
59
Swelling medial to tibial tubercle suggests...
Anserine bursitis
60
For effusion of the knee, what are the two signs during palpation for minor and major?
Bulge sign for minor effusions
Ballottment Sign for major effusions
61
McMurray Test
A click or pop along medial joint with valgus stress, external rotation and leg extension suggests tear of the posterior medial meniscus
62
Valgus Stress Test
Pain or a gap in medial joint line suggests injury to MCL
63
Varus Stress Test
Pain or a gap in lateral joint line suggests injury to LCL
64
A/P Drawer
Compare on both knees. If unequal may indicate ACL or PCL injury
65
Lachman Test
Significant forward excursion of the tibia suggests ACL injury (most sensitive test for ACL injury)
66
L4 Neurologic Level
Motor: Tibialis Anterior (Foot inversion)
Reflex: Patellar tendon
Sensation: Instep of foot along big toe
67
L5 Neurologic Level
Motor: Extensor Digitorum Longus (extend toes upward)
Reflex: none
Sensation: dorsal foot between big toe and pinky toe
68
S1 Neurologic Level
Motor: peroneus longus and brevis
Reflex: Achilles Tendon
Sensation: lateral side of food
69
Which nerve lies midway between the greater trochanter and the ischial tuberosity? (Best palpated with pt on side and hip flexed)
Sciatic Nerve
70
The patient has lower back pain with nerve pain that radiates down the leg
Lumbar radiculopathy
71
During the straight-leg raise, when pain radiates into ipsilateral leg, what is it a positive sign for?
Lumbar radiculopathy
Numbness and tingling down into leg increases as the angle increases
72
Patrick’s (FABER) Test
Flexion, abduction, external rotation
- test for sacroiliac joint problems such as sacroilitis
Pain in the groin area indicates a problem with the hip and NOT the spine
Pain in the sacroiliac area indicates a problem with the sacroiliac joints
73
4 regions of the brain
Cerebrum, diencephalon, brainstem, and cerebellum
74
Cortex controls
Higher mental functions, general movement, visceral functions, perception, behavior and integration
75
Function of cerebellum
Voluntary movement; processes sensory information from eyes, ears, touch receptors and the MS system
76
What is the pathway between the cerebral cortex and the spinal cord?
Brainstem
77
Cauda Equina terminates at
L1 or L2 vertebrae
78
Peripheral nerves: each nerve has anterior (ventral) root and posterior (dorsal) root containing which fibers?
Ventral: motor fibers
Dorsal: sensory fibers
79
Corticospinal Tract
Cerebral cortex connects to spinal motor neurons and thereby controls movement of the torso, upper and lower limbs
80
Corticobulbar Tract
Composed of the upper motor neurons of the cranial nerves. The muscles of the face, head and neck are controlled by the corticobulbar system which terminates on motor neurons within the brainstem motor nuclei
81
Corticospinal tract crosses spinal cord in the medulla.
When UMN is damaged above the crossover or below the crossover....
Damaged above to UMN: motor impairment develops on contralateral side; muscle tone increased and DTRs are exaggerated
Damage below to LMN: motor impairment develops on ipsilateral side; muscle tone and DTRs are absent
(DTRs - Deep Tendon Reflex)
82
Impulses, such as pain, temperature, position and touch, reach the sensory cortex in the brain via two pathways...
Spinothalamic or posterior columns
83
Which senses travel upward in the spinothalamic tract into the thalamus?
Pain, temperature, and crude touch
84
Which senses pass directly into posterior columns of the cord and travel upward to the medulla where they synapse with secondary neurons and cross to the opposite side and continue to the thalamus?
Position, vibration and fine touch
85
A lesion of the sensory cortex may not impair the perception of pain, touch and position, but does impair...
Finer discrimination
A person affected cannot appreciate the size, shape, or texture of an object by feeling it and therefore cannot identify it
86
Lesion/disease of the posterior columns causes a loss in....
Position and vibration
87
Transection of the spinal cord causes a loss of ....
All sensations from the waist down, paralysis and hyperactive DTRs in the legs
88
When checking for alertness, speak in a normal voice.
Abnormal response?
Open eyes, looks at you, and responds fully and appropriately
89
When checking for lethargic, speak in a loud voice.
Abnormal response?
Appears drowsy but opens eyes and looks at you, responds to questions, and then falls asleep
90
Patient is obtunded when shook gently.
Abnormal response?
Opens eyes and looks at you but responds slowly and is confused; alertness and interest are decreased
91
If the patient is stuporous, apply painful stimulus. Abnormal response?
Arouses from sleep only after painful stimuli; verbal responses slow and pt lapses back into sleep
92
If patient is suspected to be in a coma, apply repeated stimuli
Abnormal response?
Remains unarousable with eyes closed
93
For cognitive functions, what should you test?
Short and long-term memory
Intellectual function
94
Describe the mini-mental state examination and how many points is it?
30 points maximum
Orientation, registration (name 3 objects and repeat; record # of trials), attention and calculation (serial 7s or spelling word), recall (ask for the 3 objects again), and language (follow a three stage command, write a sentence, read and obey the following CLOSE YOUR EYES, copy the design)
95
CN III-XII arise from the....
Diencephalon and the brainstem
96
CN I-II are fiber tracts emerging from...
The brain
97
CN I
Smell
98
CN II
VA, visual fields, and ocular fundi
99
CN III
Pupillary constriction, opening eyelid and most EOM
100
CN IV
Downward and internal rotation of the eye
101
CN V
Corneal reflex, facial sensation and jaw movements
102
CN VI
Lateral deviation of the eye
103
CN VII
Facial movements and taste anterior tongue
104
CN VIII
hearing and balance
105
CN IX, X
Swallowing and rise of the palate, gag reflex; taste post tongue
106
CN V, VII, IX, X, XII
Voice and speech
107
CN XI
Shoulder and neck movements
108
Sense of smell is lost with....
Sinus conditions, head trauma, smoking, aging and the use of cocaine
109
Testing for EOM (H): CN III, IV, VI
Loss of conjugate movements in any of the directions is called...
Diplopia
110
3rd nerve palsy (ptosis)
Drooping of the upper eyelid
111
Which nerve raises the eyelids and which nerve pulls it down?
CN III raises
CN VIII pulls it down
112
Anatomically, where are V1, V2, and V3?
V1: forehead
V2: cheek and upper lip
V3: jaw
113
Corneal Reflex; what would be abnormal for this test?
Absent blinking with CN V or VII lesion
114
Flattening of nasolabial fold and drooping of the lower eyelid suggest facial weakness. How would a peripheral injury and central lesion affect CN VII?
Bell’s Palsy (peripheral injury) affects both the upper and lower face
Central lesion (stroke) affects only the lower face
115
Paralysis of CN IX and X causes...
A pulling of the uvula to the unaffected side
116
What does the gag reflex test?
Sensory and motor components of CN IX and X
117
How does a unilateral lesion affect the vagus nerve?
A unilateral lesion (absence off this gag reflex) can produce hoarseness and difficulty swallowing due to a loss of laryngeal function
118
CN XI carries efferent motor fibers to innervate the sternomastoid and trapezius muscles.
Trapezius weakness?
Trapezius weakness with atrophy and fasciculations indicates peripheral nerve disorder
In trapeziums paralysis, the shoulder droops and the scapula is displaced downward and laterally
119
In a unilateral cortical lesion of CN XII, the protruded tongue...
Deviates transiently in a direction AWAY FROM THE SIDE OF THE LESION (toward the side of weakness)
