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S1 CODO Final > CODO Final > Flashcards

CODO Final Flashcards

1
Q

What are typical potential findings for inspection of an injured limb?

What is an additional inspection for the lower extremity?

A

Skin changes, bruising, swelling, redness, symmetry, atrophy, deformity, contour

additionally:

gait

Iliac crest heights

leg length

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2
Q

What are you checking for during palpation?

A

Feeling anatomical landmarks

tenderness, heat, swelling, masses, crepitus

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3
Q

Describe the standard for grading strength.

A

0-5 scale

0/5 - no muscle contraction detected

1/5 - muscle contract with no movement

2/5 - able to move, not against gravity

3/5 - against gravity

4/5 - against gravity AND resistance

5/5 - normal

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4
Q

Describe the standard for grading DTR’s.

A

4 point scale

0 No response

1+ Diminished

2+ Normal

3+ Brisker than normal

4+ Clonus

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5
Q

What are the DTRs for the lower extremity?

What root are you testing?

A

Patella - L4

Achilles - S1

fuck a L5

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6
Q

What are the major peripheral nerves for sensory testing of the lower extremity?

What nerves are you testing?

A

Sciatic: L4-S3

Peroneal nerve: L5-S2

Lateral femoral: cutaneous L2-L3

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7
Q

Describe the distribution of the peripheral peroneal nerve.

A
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8
Q

Describe the distribution of the lateral femoral cutaneous nerve.

What commonly causes numbness in this area?

A

Obesity, tight clothes, and pregnancy commonly compresses this nerve

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9
Q

How would you test L4 root and/or L3-L4 disk?

Reflex?

Strength? Muscle(s)?

Sensation?

A

Patella reflex

Inversion of the foot, checking anterior tibialis

Sensation of the medial leg and medial foot

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10
Q

How would you test L5 root and/or L4-L5 disc?

Reflex?

Strength testing? What muscle(s)?

Sensation?

A

No reflex

Strength of toe lift, extensor hallucis longus

Sensation of lateral leg and dorsum of the foot

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11
Q

How would you test S1 root and/or L5-S1 disc?

Reflex?

Strength? Muscle(s)?

Sensation?

A

Achilles reflex

Strength of eversion. Peroneus longus and brevis.

Sensation of lateral foot

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12
Q

What anatomic landmarks should be palpated when examining the hip?

A

Pelvic structures

ASIS, PSIS, iliac crest

sacroiliac joint

ischial tuberosities

Hip

greater trochanter

piriformis tenderpoint

iliotibial band

Other

sciatic nerve (1/2 between ischial tuberosity and greater trochanter)

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13
Q

What are the motions of the hip?

What are the normal ranges (in degrees)?

A

Flexion 120

Extension 30

Abduction 45-50

Adduction 20-30

Internal rotation 35

External rotation 45

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14
Q

When performing strength testing of the hip…

What motions?

What nerve roots are you testing?

What muscle(s)?

A

Flexion: L1, L2, L3

Primary - Iliopsoas (femoral nerve)

Secondary - Rectus femoris

Extension: S1

Primary - Gluteus maximus (inferior gluteal nerve)

Secondary - Hamstrings

Abduction: L5

Primary - Gluteus medius (superior gluteal nerve)

Secondary - Gluteus minimus

Adduction: L2, L3, L4

Primary - Adductor longus (obturator nerve)

Secondary - Adductor brevis, Adductor magnus, Pectineus, Gracilis

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15
Q

List the special tests for the hip.

What are they checking for?

A
  1. Straight leg raise: lumbar radiculopathy
  2. Piriformis test: piriformis syndrome
  3. Patrick’s/FABER: differentiate SI pain from hip joint
  4. Ober: IT band syndrome
  5. Trendelenburg: weak hip abductors
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16
Q

Describe how to perform a straight leg raise?

What is a positive test?

What is this checking for?

A

Patient’s knee is extended, lower extremity is passively raised/flexed at the hip

+ pain radiating in the sciatic distribution below the knee

Checking for lumbar radiculopathy (sciatica)

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17
Q

Describe how to perform a piriformis test.

What is a positive result?

What is this checking for?

A

Patient lies on unaffected side, pelvis stabilized with one hand.

Affected knee and hip flexed, knee if passivlely addicted across midline with other hand

+ pain in sciatic distribution

Tests for piriformis syndrome

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18
Q

Describe how to perform a Patrick’s/FABER test.

What is a positive test?

What is this checking for?

A

FABER: “flexed, abducted, externally rotated”

The affected limb is flexed at the knee and hip, with ankle resting on contralateral knee, forming a “4” shape. Pressure is placed on contralateral ASIS and ipsilateral knee, forcing external rotation.

+ is reproduction of pain

positive result is indicative of hip pathology, as this motion stresses femoral-acetabular joint

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19
Q

Describe how to perform Ober’s test.

What is a positive result?

What is this checking for?

A

Patient lies on unaffected side, with painful limb up. Knee is flexed and abducted. Leg is abruptly dropped.

+ patient doesn’t let thigh fall quickly

Checking for IT band

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20
Q

Describe how to perform the Trendelenburg test.

What is a positive result?

What is this checking for?

A

Patient stands on affected leg and lifts the other

+ trunk leans to the side with foot raised

Checking for weakness in the gluteus medius (abductor)

21
Q

What are some inspection findings specific to the knee?

A

Varus/valgus knee deformity

patellar position

22
Q

What are the anatomical landmarks you should palpate for the knee?

A

Quadriceps

Femoral condyles

Lateral femoral epicondyle

Patella

Medial and Lateral collateral ligaments

Medial and lateral meniscus

Infrapatellar tendon

Tibial plateau and Anterior joint line

Fibular head

Tibial tuberosity

Popliteal fossa

23
Q

Describe the motion of the knee.

What are the ranges in degrees?

A

Flexion 135

Extension 0

Internal rotation 10

External rotation 10

24
Q

When testing strength of the knees..

What motion?

What nerve roots?

What muscle(s)?

A

Extension: L2, L3, L4

Quadriceps (femoral nerve)

Flexion(Hamstrings): L5, S1

Semimembranosus (tibial portion of sciatic)

Semitendinosus (tibial portion of sciatic)

Biceps femoris (tibial portion of sciatic)

25
Q

List the special tests of the knees and what they test for.

A

Collateral ligaments:

-Varus (LCL)

Valgus (MCL)

Meniscus:

  • McMurray
  • Appley grind

Cruciate Ligaments:

  • Lachman (ACL)
  • Anterior drawer (ACL)
  • Posterior drawer (PCL)

Patellar Instability:

-Patella apprehension

26
Q

Describe how you would perform Varus/Valgus testing of the knee.

What are you testing for?

What is a positive result?

A

Valgus testing: MCL

Pushing the knee medially (“Gus gets it in”)

Varus testing: LCL

Pushing the knee laterally

+ is pain

27
Q

Describe how to perform McMurray test.

What is a positive result?

What you checking?

A

Flex the knee, then internally and externally rotate tibia on femur. Externally rotate the leg, and place a valgus stress on the knee. While leg is externally rotated and valgus slowly extend the knee

+ is palpable or audible click

Checking for meniscal injury (Medial)

28
Q

Describe how to perform the Apley Grind test.

What is positive?

What are you testing?

A

The pt lies prone. Flex the affected knee.

Compression test:

press leg into table and rotate dorsiflexed foot back and forth

+ is pain indicative of meniscal tear

Distraction test:

use knee to stabilize thigh, pull up on leg while rotating leg back and forth

+ is pain indicative of ligamentous injury

29
Q

Describe how to perform Lachman test.

What is positive?

What is this checking for?

A

Knee is flexed 15-30 degrees. Patient must be relaxed.. Stabilize thigh. Pull leg away.

+ is excessive translation

Indicative of ACL injury

30
Q

Describe how to perform anterior/posterior drawer test.

What is positive?

What are checking?

A

Patient’s knee is flexed, and examiner sits on foot to stabilize.

Anterior drawer

Pull leg toward you

ACL

Posterior drawer

Push leg away

PCL

+is excessive translation/soft endpoint

31
Q

Describe how to perform patellar apprehension test.

What is positive?

What are you checking?

A

Attempt to laterally translate the patient’s patella while they are resting knee in extension.

+ is fear/apprehension with movement laterally

Indicative of subluxation

32
Q

What landmarks should you palpate when examining an ankle?

A
33
Q

What are the motions of the ankle?

What is the range in degrees?

A

Dorsiflexion 20

Plantarflexion 50

Inversion 5

Eversion 5

34
Q

When performing strength testing of the ankle…

Motion?

Nerve root?

Muscle(s)?

A

Dorsiflexion: L4,L5

  • Tibialis anterior (deep peroneal nerve) L4,L5
  • Extensor hallucis longus (deep peroneal nerve) L5
  • Extensor digitorum longus (deep peroneal nerve) L5

Plantar flexion: L5, S1, S2

  • Peroneus longus and brevis (superficial peroneal nerve) S1
  • Gastrocnemius and soles (tibial nerve) S1, S2
  • Flexor hallucis longus (tibial nerve) L5
  • Flexor digitorum longus and tibialis posterior (tibial nerve) L5
35
Q

List the special tests of the ankle and what they are checking for.

A

Anterior talofibular ligament instability or tear

  • Anterior drawer
  • Talar tilt (inversion stress test): more severe instability

High ankle sprain

-Squeeze test

Achilles tear

Thompson’s test

Lower extremity DVT

Homan’s Sign

36
Q

Describe how to perform the anterior drawer test of the ankle.

What is positive?

What is this testing?

A

Grasping distal leg and calcaneus, push leg posterior while pulling foot forward examiner

+ excessive translation

Testing for intact ness of anterior talofibular ligament

37
Q

Describe how to perform the Talar Tilt (Inversion Stress Test).

What is positive?

What is this checking?

A

Grasping the foot passively invert the foot

+ is excessive inversion

Checks anterior talofibular ligament as well as the calcaneofibular ligament

38
Q

Describe how to perform Thompson test.

What is positive?

What is this checking?

A

Pt rests on knees. Examiner squeezes calf.

+ is lack of plantarflexion

indicative of Achilles rupture

39
Q

Describe Homan’s sign.

What is positive?

What is this checking?

A

Passive dorsiflexion

+ is pain with dorsiflexion

Indicative of DVT

40
Q

Describe the Squeeze Test.

What is positive?

What is this checking for?

A

Squeeze mid tibia and fibula together

+ is pain at ankle

Indicative of a “high ankle” sprain - interosseous ligament

41
Q

What are special inspection exam findings for feet/toes?

A

Claw toes

Hammer toes

Bunions

Corns

Ingrown nails

42
Q

What landmarks should be palpated when examining feet/toes?

A

Base of calcaneus

Metatarsal heads

Phalanges

Plantar fascia

Peripheral pulses

43
Q

Describe range of motion of the feet/toes.

A

Flexion/extension of toes

Dorsi/plantar flexion

Forefoot adduction - 20 degrees

Forefoot abduction - 10 degrees

44
Q

What are the special tests for feet/toes? What do they test for?

A

Squeeze test for Morton’s neuroma

Extensor Hallucis Longus

45
Q

Describe how to perform a Squeeze Test of the foot.

What is positive?

What is this checking?

A

Compress metatarsals between 3rd and 4th metatarsal heads

+ is pain

Morton’s neuroma

46
Q

What are the most common tears/injuries associated with someone “rolling” their ankle into inversion?

A

Anterior talofibular ligament and calcaneofibular ligaments

Always tears first (ATF)

Crutch foot(CF) - idk i made this up

47
Q

How does plantar fasciitis present?

A

Pain along medial aspect of the heel and arch of the foot

worse in the morning

48
Q

Describe the dermatomes, specifically L4, L5, S1.

A

L3 - medial knee

L4 - medial leg and foot

L5 - lateral leg and dorsum of foot

S1 - lateral foot

S1 CODO Final (1 decks)

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