GALS + REMS

Question 1

GALS general inspection

Answer 1

Body habitus
Scars
Muscle wasting
Psoriasis
Objects - aids, adaptations, prescriptions

Question 2

GAIT

Answer 2

Gait cycling abnormalities
Range movement
Limping
Leg length
Turning
Trendelenburg
Waddling gait
Footwear

Question 3

Anterior inspection GALS

Answer 3

Posture
Scars
Joint swell
Joint erythema
Muscle bulk
Elbow extension
Valgus joint deformity
Varus joint deformity
Pelvic tilt

Question 4

Varus vs valgus

Answer 4

Varus = excessive inward angulation
Valgus = excessive outward angulation

Question 5

Lateral inspection patient position

Answer 5

Ask patient turn 90 degrees

Question 6

Lateral inspection

Answer 6

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Knee joint hyper extension
Foot arch

Question 7

How much should knee be able to extend

Answer 7

Comfortably 10 degrees - beyond = joint laxity

Question 8

Posterior inspection

Answer 8

Muscle bulk
Spinal alignment
Iliac crest alignment
Popliteal swellings
Thickened Achilles’ tendon
Valgus or Varus deformity

Question 9

ARMS inspection

Answer 9

Hands behind head - interlock hands elbows out

Question 10

What look for arms inspection hands behind head

Answer 10

Shoulder abduction
External rotation
Elbow flexion
Range of elbow and shoulder movement

Question 11

What look for arms hands in front palms down

Answer 11

Forward flexion shoulders
Elbow and wrist extension
Extension small joints fingers
For sun hands
Nails
Psoriasis

Question 12

2nd arm inspection position

Answer 12

Hold hands out in front
Palms facing down
Fingers outstretched

Question 13

What look for palms up arms inspection

Answer 13

Supination movement
Thenar and hypothenar eminences

Question 14

What condition is thenar and hypo wasting seen in?

Answer 14

Carpal tunnel

Question 15

3rd step arms inspect

Answer 15

Flip hands over

Question 16

4th step arms inspect

Answer 16

Make a fist

Question 17

What look for when make a fist

Answer 17

Wrist and elbow supination

Question 18

5th step arms

Answer 18

Grip strength - squeeze fingers as hard as you can’t

Question 19

What look for in grips strength

Answer 19

Should be bilaterally equal - compare
Swelling hand, Lower motor neurone

Question 20

Precision grip look for

Answer 20

Coordination small joints
Speed -Brady or tachy
Osteo, gout, RA, traumatic injury

Question 21

What is metacarpopharyngeal squeeze?

Answer 21

Feel over joints of hand

Question 22

What look for in MCP squeeze

Answer 22

Verbal discomfort
Non verbal
Acute inflammatory arthropathy
Boxers fracture - punch wall
Colour and warmth

Question 23

Legs steps exam

Answer 23

Lying down
Passive knee flexion
Passive knee extension - hold leg gently above knee

Question 24

What look for on knee flex

Answer 24

Hyperextension start
Click, grind, pop
Pain
Discomfort
Locked joint
Decreased ROM
OA, meniscus pathology

Question 25

What is normal knee range of flexion movement

Answer 25

0-140 degrees Always compare

Question 26

Scars knee

Answer 26

Either side - arthroscopy Straight line - knee replacement

Question 27

Why is lock joint a red flag

Answer 27

Need imaging asap Meniscus pathology

Question 28

Tibia moving away from fibula

Answer 28

ACL/ligament injury

Question 29

What look for passivelnee extension

Answer 29

Signs discomfort Beyond 10 degrees Ligament laxity, ruptured ligaments

Question 30

What look for passive internal hip rotation

Answer 30

Signs discomfort 10 degrees discomfort OA of hip

Question 31

What hip fracture would you never move

Answer 31

Neck of femur fracture

Question 32

What condition can a metatarsalphalangeal joint squeeze show

Answer 32

Inflammatory arthropathy eg RA Compare symmetry

Question 33

Spine exam steps

Answer 33

Cervical spine flexion - ear to shoulder

Question 34

What look for on cervical spine flexion

Answer 34

Discomfort/pain Decreased ROM

Question 35

Lumbar flexion what look for

Answer 35

Fingers move apart from adjacent spinal processes

Question 36

TMJ JOINT INSPECT

Answer 36

Decreased ROM, pain Cracking, locking High impact trauma Normal to be able to fit three fingers vertically into mouth

Question 37

When to use REMS

Answer 37

After GALS - found problem, inspect region in more detail

Question 38

Basis of joint exam

Answer 38

Look, feel, move Feel at same time to compare

Question 39

Joint specific movements and what test for

Answer 39

Anterior drawer test - ACL empty can test - supraspinatus - motion like emptying can Simmonds test - Achilles’ tendon - feel calf